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Zarzeczny A, Kahar P. Vaccine Trends in Pakistan: A Review of Immunization Challenges and Setbacks Prompted by Inadequate Disaster Management. Cureus 2024; 16:e55357. [PMID: 38562365 PMCID: PMC10982083 DOI: 10.7759/cureus.55357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Pakistan bears an incredible burden of vaccine-preventable diseases, and efforts to improve widespread immunization have been hindered by inadequate public health management following disasters and other health emergencies. Through a brief review of Pakistan's health system, an understanding of routine immunization challenges is sought based on the organizational changes made to the planning and delivery of immunization activities. Further, recent immunization trends of measles, polio, and tuberculosis are examined in correspondence to health emergencies prompted by climate change and the COVID-19 pandemic. The national public health response to each disease is discussed, and insight is given to how the devolution of Pakistan's health system may have influenced the severity of each emergency. Focus is given to the potential immunization challenges and how they may impact future initiatives for the control of vaccine-preventable diseases. Although incidence rates suggest increased cases of certain vaccine-preventable diseases and disruptions of immunization activities following recent disasters, further studies may need to be conducted to establish a stronger understanding of the immunization trends noted within this review.
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Affiliation(s)
| | - Payal Kahar
- Health Sciences, Florida Gulf Coast University, Fort Myers, USA
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Ullah K, Saleem J, Zakar R, Ishaq M, Khattak FA, Majeed F, Sadiqa HA, Fischer F. Exploring the reasons for defaulting from childhood immunization: a qualitative study in Pakistan. BMC Public Health 2024; 24:408. [PMID: 38331754 PMCID: PMC10851579 DOI: 10.1186/s12889-024-17926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Childhood vaccination is widely recognized as the most effective means to prevent various diseases. However, a considerable amount of children still miss out on their vaccination schedules. Therefore, this study explores the reasons for defaulting from the expanded program on immunization in district Swat, Pakistan. METHODS A qualitative phenomenological approach was used. Data collection took place from March to September 2022. Thirty-six in-depth interviews were conducted with participants who had defaulter children. The collected qualitative data were analysed thematically to identify key patterns and themes related to the reasons for defaulting from childhood vaccination schedules. RESULTS Six themes emerged, i.e., illness of the defaulter child at the scheduled time, perceived side effects of the vaccination, factors related to caregivers, myths and misconceptions, vaccinators attitudes and crowed vaccination centres, as well as poor immunization service arrangements. Four subthemes arose related to caregivers, such as lack of clear understanding about completion of vaccination, least priority for child's vaccination, cultural restriction on mothers, and the loss of vaccination card. CONCLUSION According to the study's findings, caregivers have their own perceptions regarding the non-completion of their children's vaccination schedule. The childhood immunization defaulting arises from various factors including child illness, Adverse Events Following Immunization (AEFIs) concerns, misconceptions, improper injection techniques, and negative vaccinator attitudes. The vaccination completion rate may be increased if the concerns of the caregivers are appropriately addressed.
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Affiliation(s)
- Kifayat Ullah
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Javeria Saleem
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Muhammad Ishaq
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | | | - Fatima Majeed
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Hafiza Aisha Sadiqa
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
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Shakoor S, Fatima T, Mir F, Shahid A, Shaheen N, Khan E, Jamil B. Etiology of Acute Infectious Meningitis and Meningoencephalitis in Karachi, Pakistan: Retrospective Observational Study from a Tertiary Care Center. Am J Trop Med Hyg 2023; 109:450-459. [PMID: 37460090 PMCID: PMC10397433 DOI: 10.4269/ajtmh.23-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/31/2023] [Indexed: 08/04/2023] Open
Abstract
Meningoencephalitis (ME) is potentially fatal and is caused by a wide array of pathogens. Diagnostic and health-care access gaps prevent accurate estimation of the pathogen-specific burden in low-resource settings. We present pathogen-specific etiologies among patients hospitalized with ME in Karachi, Pakistan. We performed a retrospective hospital database evaluation of pathogen etiology and outcomes of community-acquired infectious ME at a single tertiary care center in Karachi, Pakistan. Annual rates of hospitalization (ARH) were calculated by adjusting for missed cases and are reported per 100,000 population. From May 2017 to April 2020, 522 episodes of infectious ME were identified in 514 patients. The overall ARH from ME was 5.7/100,000 population (95% CI, 5.1-6.1). Among children younger than 5 years, the ARH was 9.8/100,000 population (95% CI, 8.1-11.8). Unknown causes of ME resulted in the greatest burden, with an ARH of 1.9/100,000 population (95% CI, 1.7-2.2). Among known causes, the greatest burden of hospitalizations resulted from tuberculous ME (0.8/100,000; 95% CI, 0.6-0.97), followed by pneumococcal and enteroviral ME (both 0.6/100,000 population; 95% CI, 0.5-0.8). The burden of ME caused by pathogens preventable through vaccination or public health measures outweighed that of ME from other causes (P = 0.0092, Fisher's exact test). We report a broad range of pathogens causing ME in southern Pakistan and show a high burden of preventable illness. Synergistic actions to improve diagnostic strategies, increase vaccinations, and introduce measures to reduce water-borne and vector-borne diseases are required to reduce the ME burden in Pakistan and prevent future outbreaks.
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Affiliation(s)
- Sadia Shakoor
- Departments of Pathology and Laboratory Medicine, Pediatrics, and Medicine, Aga Khan University, Karachi, Pakistan
| | - Tazeen Fatima
- Departments of Pathology and Laboratory Medicine, Pediatrics, and Medicine, Aga Khan University, Karachi, Pakistan
| | - Fatima Mir
- Departments of Pathology and Laboratory Medicine, Pediatrics, and Medicine, Aga Khan University, Karachi, Pakistan
| | - Asima Shahid
- Departments of Pathology and Laboratory Medicine, Pediatrics, and Medicine, Aga Khan University, Karachi, Pakistan
| | - Najma Shaheen
- Departments of Pathology and Laboratory Medicine, Pediatrics, and Medicine, Aga Khan University, Karachi, Pakistan
| | - Erum Khan
- Departments of Pathology and Laboratory Medicine, Pediatrics, and Medicine, Aga Khan University, Karachi, Pakistan
| | - Bushra Jamil
- Departments of Pathology and Laboratory Medicine, Pediatrics, and Medicine, Aga Khan University, Karachi, Pakistan
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Awan UA, Hussain M, Qureshi M, Siddique Z, Khattak AA, Akhtar S, Guo X. From COVID-19 to measles: Prioritizing immunization in Pakistan's far-flung regions. J Infect 2023; 87:76-79. [PMID: 37116619 PMCID: PMC10131744 DOI: 10.1016/j.jinf.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/26/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Usman Ayub Awan
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan.
| | - Mushahid Hussain
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Masood Qureshi
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Zeeshan Siddique
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Aamer Ali Khattak
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Sohail Akhtar
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Xingyi Guo
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Siddique M, Iftikhar S, Dharma VK, Shah MT, Siddiqi DA, Malik AA, Chandir S. Using geographic information system to track children and optimize immunization coverage and equity in Karachi, Pakistan. Vaccine 2023; 41:2922-2931. [PMID: 37012115 DOI: 10.1016/j.vaccine.2023.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Despite the potential of geospatial technologies to track and monitor coverage, they are underutilized for guiding immunization program strategy and implementation, especially in low-and-middle-income countries. We conducted geospatial analysis to explore the geographic and temporal trends of immunization coverage, and examined the pattern of immunization service access (outreach and facility based) by children. METHODOLOGY We extracted data to analyze coverage rates across different dimensions (by enrolment year, birth year and vaccination year) from 2018 till 2020 in Karachi, Pakistan using the Sindh Electronic Immunization Registry (SEIR). We conducted geospatial analysis to assess variation in coverage rates of BCG, Pentavalent (Penta)-1, Penta-3, and Measles-1 vaccines using Government targets. We also analyzed the proportion of children receiving their routine vaccinations at fixed centers and outreach and examined whether children received vaccinations at the same or multiple immunization centers. RESULTS A total of 1,298,555 children were born, enrolled or vaccinated from 2018 till 2020. At the district level, analysis by enrollment and birth year showed coverage increased between 2018 and 2019 and declined in 2020, while analysis by vaccination year showed consistent increase in coverage. However, micro-geographic analysis revealed pockets where coverage persistently declined. Notably 27/168, 39/168 and 3/156 Union councils showed consistently declining coverage when analyzing by enrollment, birth and vaccination year respectively. More than half (52.2%, 678,280/1,298,555) of the children received all their vaccinations exclusively through fixed centers and, 71.7% (499,391/696,701) received all vaccinations from the same centers. CONCLUSION Despite overall improving vaccination coverage between 2018 and 2020, certain geographic areas have consistently declining coverage rates, which is detrimental for equity. Making immunization inequities visible through geospatial analysis is the first step to ensure resources are allocated optimally. Our study provides impetus for immunization programs to develop and invest in geospatial technologies, harnessing its potential for improved coverage and equity.
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Affiliation(s)
- Muhammad Siddique
- Maternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Sundus Iftikhar
- Maternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Vijay Kumar Dharma
- Maternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Mubarak Taighoon Shah
- IRD Global, 16 Raffles Quay, #16-02, Hong Leong Building, Singapore 048581, Singapore
| | - Danya Arif Siddiqi
- IRD Global, 16 Raffles Quay, #16-02, Hong Leong Building, Singapore 048581, Singapore.
| | - Amyn A Malik
- IRD Global, 16 Raffles Quay, #16-02, Hong Leong Building, Singapore 048581, Singapore
| | - Subhash Chandir
- Maternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan; IRD Global, 16 Raffles Quay, #16-02, Hong Leong Building, Singapore 048581, Singapore
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Ali I, Hamid S. Implications of COVID-19 and "super floods" for routine vaccination in Pakistan: The reemergence of vaccine preventable-diseases such as polio and measles. Hum Vaccin Immunother 2022; 18:2154099. [PMID: 36573023 PMCID: PMC9891673 DOI: 10.1080/21645515.2022.2154099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
With multiple waves and variants, the coronavirus disease 2019 (COVID-19) pandemic has affected routine vaccination programs globally. Its impact is also visible in Pakistan as routine health services continue to be disrupted. Consequently, thousands of children have emerged as vulnerable in the face of vaccine-preventable diseases (VPDs), which have already started causing outbreaks in the country. Infections with polio and measles have been significantly reported, especially during the last few years. This reemergence of both diseases is posing great challenges for the country at local, national, and global levels. These impacts are being multiplied by the 2022 flooding - called "super floods" - in the country. Hence, relevant stakeholders, such as the Pakistani government and the World Health Organization (WHO), need to revisit the entire vaccination program to address and resolve issues occurring at the management or local levels. It is highly important to pay attention to the context that provides a fertile ground to negatively affect vaccine uptake.
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Affiliation(s)
- Inayat Ali
- Department of Public Health and Allied Sciences, Fatima Jinnah Women University, Rawalpindi, Pakistan,Department of Anthropology, Fatima Jinnah Women University, Rawalpindi, Pakistan,CONTACT Inayat Ali Department of Public Health and Allied Sciences, Fatima Jinnah Women University, Rawalpindi, Pakistan
| | - Saima Hamid
- Fatima Jinnah Women University, Rawalpindi, Pakistan
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Lack of COVID-19 vaccination in rural areas of Pakistan. VACUNAS (ENGLISH EDITION) 2022. [PMCID: PMC9683831 DOI: 10.1016/j.vacune.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Daood U, Ilyas MS, Ashraf M, Akbar M, Bapat RA, Khan AS, Pichika MR, Parolia A, Seow LL, Khoo SP, Yiu C. Biochemical changes and macrophage polarization of a silane-based endodontic irrigant in an animal model. Sci Rep 2022; 12:6354. [PMID: 35428859 PMCID: PMC9012771 DOI: 10.1038/s41598-022-10290-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/21/2022] [Indexed: 02/08/2023] Open
Abstract
Silane-based/fully hydrolyzed, endodontic irrigant exhibiting antimicrobial properties, is prepared, and is hypothesized to control macrophage polarization for tissue repair. Albino wistar rats were injected with 0.1 ml root canal irrigant, and bone marrow cells procured. Cellular mitochondria were stained with MitoTracker green along with Transmission Electron Microscopy (TEM) performed for macrophage extracellular vesicle. Bone marrow stromal cells (BMSCs) were induced for M1 and M2 polarization and Raman spectroscopy with scratch assay performed. Cell counting was used to measure cytotoxicity, and fluorescence microscopy performed for CD163. Scanning Electron Microscopy (SEM) was used to investigate interaction of irrigants with Enterococcus faecalis. K21 specimens exhibited reduction in epithelium thickness and more mitochondrial mass. EVs showed differences between all groups with decrease and increase in IL-6 and IL-10 respectively. 0.5%k21 enhanced wound healing with more fibroblastic growth inside scratch analysis along with increased inflammation-related genes (ICAM-1, CXCL10, CXCL11, VCAM-1, CCL2, and CXCL8; tissue remodelling-related genes, collagen 1, EGFR and TIMP-2 in q-PCR analysis. Sharp bands at 1643 cm-1 existed in all with variable intensities. 0.5%k21 had a survival rate of BMSCs comparable to control group. Bacteria treated with 0.5%k21/1%k21, displayed damage. Antimicrobial and reparative efficacy of k21 disinfectant is a proof of concept for enhanced killing of bacteria across root dentin acquiring functional type M2 polarization for ethnopharmacological effects.
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Affiliation(s)
- Umer Daood
- Restorative Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Muhammad Sharjeel Ilyas
- Department of Oral Biology, Post Graduate Medical Institute, 6 Birdwood Road, Lahore, Pakistan
| | - Mariam Ashraf
- Department of Oral Biology, Post Graduate Medical Institute, 6 Birdwood Road, Lahore, Pakistan
| | - Munazza Akbar
- Department of Oral Biology, Post Graduate Medical Institute, 6 Birdwood Road, Lahore, Pakistan
| | - Ranjeet Ajit Bapat
- Restorative Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Abdul Samad Khan
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Mallikarjuna Rao Pichika
- Pharmaceutical Chemistry, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Abhishek Parolia
- Restorative Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Liang Lin Seow
- Restorative Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Suan Phaik Khoo
- Division of Oral Diagnostic and Surgical Sciences, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Cynthia Yiu
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Pokfulam, Hong Kong SAR, China
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Saleem A, Rashid M, Shaikh A, Ali S. Lack of COVID-19 vaccination in rural areas of Pakistan. VACUNAS 2022; 23:S125-S126. [PMID: 35502214 PMCID: PMC9046080 DOI: 10.1016/j.vacun.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Alisha Saleem
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Maha Rashid
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Ameerah Shaikh
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Sajjad Ali
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
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Shah D, Khan MS, Aziz S, Ali H, Pecoraro L. Molecular and Biochemical Characterization, Antimicrobial Activity, Stress Tolerance, and Plant Growth-Promoting Effect of Endophytic Bacteria Isolated from Wheat Varieties. Microorganisms 2021; 10:microorganisms10010021. [PMID: 35056470 PMCID: PMC8777632 DOI: 10.3390/microorganisms10010021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 02/05/2023] Open
Abstract
Endophytic bacteria have been utilized as an alternative source to chemical fertilizers and pesticides to enhance plant productivity and defense mechanisms against biotic and abiotic stress. Five endophytic bacterial strains were isolated from the seeds of three different Pakistani wheat varieties (Ghaneemat-e-IBGE, Atta-Habib, and Siren). The isolated strains AH-1, S-5, S-7, GI-1, and GI-6 showed phylogenetic similarity with Bacillus altitudinis, B. aryabhattai, B. wiedmannii, Pseudomonas aeruginosa, and Burkholderia gladioli, respectively. All strains showed catalase activity (except AH-1) and Indole-3-acetic acid production, with the highest concentration (16.77 μg·mL-1) found for GI-6, followed by S-5 (11.5 μg·mL-1), nitrogen assimilation (except S-7), phosphorus solubilization (except S-7 and AH-1), and ability to produce siderophores, with maximum productions for GI-6 (31 ± 3.5 psu) and GI-1 (30 ± 2.9 psu). All five analyzed strains possessed antimicrobial activity, which was particularly strong in GI-6 and S-5 against Klebsiella pneumonia, Escherichia coli, and Bacillus subtilis. Increasing salinity stress with NaCl negatively affected the bacterial growth of all isolates. However, strains GI-6 and S-5 showed salt tolerance after three days of incubation. A drought tolerance test resulted in a negative impact of poly ethylene glycol on bacterial growth, which was, however, less pronounced in GI-6 strain. The GI-6 strain revealed growth-promoting effects on inoculated wheat plants.
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Affiliation(s)
- Dawood Shah
- Institute of Biotechnology and Genetic Engineering, The University of Agriculture Peshawar, Peshawar 25000, Pakistan; (D.S.); (M.S.K.); (S.A.); (H.A.)
- School of Pharmaceutical Science and Technology, Tianjin University, 92 Weijin Road, Tianjin 300072, China
| | - Mohammad Sayyar Khan
- Institute of Biotechnology and Genetic Engineering, The University of Agriculture Peshawar, Peshawar 25000, Pakistan; (D.S.); (M.S.K.); (S.A.); (H.A.)
| | - Shahkaar Aziz
- Institute of Biotechnology and Genetic Engineering, The University of Agriculture Peshawar, Peshawar 25000, Pakistan; (D.S.); (M.S.K.); (S.A.); (H.A.)
| | - Haidar Ali
- Institute of Biotechnology and Genetic Engineering, The University of Agriculture Peshawar, Peshawar 25000, Pakistan; (D.S.); (M.S.K.); (S.A.); (H.A.)
| | - Lorenzo Pecoraro
- School of Pharmaceutical Science and Technology, Tianjin University, 92 Weijin Road, Tianjin 300072, China
- Correspondence: ; Tel.: +86-185-2082-4550
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Ali SA, Taj MK, Ali SH. Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan. Infect Drug Resist 2021; 14:5107-5120. [PMID: 34880636 PMCID: PMC8646111 DOI: 10.2147/idr.s339231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/23/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Bacterial meningitis (BM) is a lethal infectious disease that persists as a substantial cause of morbidity and mortality. The antimicrobial drug resistance in BM pathogens poses a major threat to the community while raising challenges for clinicians. For the first time, we elucidate the incidence rate of BM and its drug resistance among the population of Quetta, Balochistan. Methods A cross-sectional study was conducted (from January 2018 to March 2021) among meningitis patients admitted to government hospitals in Quetta. The cerebrospinal fluid (CSF) specimen was collected and processed for microbiological and cytological analysis. Bacterial isolates were identified and confirmed using phylogenetic analysis of the 16S rRNA gene. Results We found 35.9% (321/894) confirmed cases of BM among the population of Quetta, Balochistan. The identified bacterial isolates comprised Streptococcus pneumoniae 14.7% (130/894), Staphylococcus aureus 6.9% (61/894), Neisseria meningitidis 5.7% (51/894), Haemophilus influenzae 2.5% (22/894), Escherichia coli 4.5% (40/894), and Klebsiella pneumoniae 1.9% (17/894). A high percentage in male patients of 20.8% (186/894) was identified as compared to female patients of 15.1% (135/894). Extreme age groups such as infants (age range: 1 month to 1 year) and adults (age range: 61 years to 99 years) with low immunity were critically affected by BM. Clinical parameters such as abnormal CSF appearance, pH, and high WBCs in BM patients with endocarditis as the underlying disease were significantly at elevated risk of fatal outcome. 16S rRNA gene phylogenetic analysis confirmed the evolutionary similarity of isolated strains with prevailing pathogenic strains in Asia. Furthermore, age was identified as a significant risk factor for clinical outcomes. Conclusion The majority of the identified BM patients belonged to rural areas with limited health-care facilities and paramedic staff. The high case fatality rate 11% demonstrates increased antibiotic resistance among BM isolates, thereby stimulating its devastation in underdeveloped regions. Timely detection and intensive treatment of BM may improve critical outcomes in patients.
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Affiliation(s)
- Syeda Ayesha Ali
- Center for Advanced Studies in Vaccinology and Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan.,Department of Biochemistry, Sardar Bahadur Khan Women's University (SBKWU), Quetta, Pakistan
| | - Muhammad Kamran Taj
- Center for Advanced Studies in Vaccinology and Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan
| | - Syeda Hafsa Ali
- Department of Microbiology, Balochistan University of Information Technology, Engineering, and Management Sciences (BUITEMS), Quetta, Pakistan
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