The recent rapid rise of multi-drug resistant Enterobacteriaceae (MDR-E) is threatening the treatment of common infectious diseases. Infections with such strains lead to increased mortality and morbidity. Using a cross-sectional study, we aimed to estimate the prevalence of gut colonization with extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae among healthy infants born in Pakistan, a setting with high incidence of MDR-E infections. Stool samples were collected from 104 healthy infants between the ages of 5 and 7 months. Enterobacteriaceae isolates were screened for resistance against several antimicrobial classes. Presence of ESBL and carbapenemase genes was determined using multiplex PCR. Sequence types were assigned to individual strains by multi-locus sequence typing. Phylogenetic analysis of Escherichia coli was done using the triplex PCR method. Forty-three percent of the infants were positive for ESBL-producing Enterobacteriaceae, the majority of which were E. coli. We identified several different ESBL E. coli sequence types most of which belonged to the phylogenetic group B2 (23%) or D (73%). The widespread colonization of infants in a developing country with ESBL-producing Enterobacteriaceae is concerning. The multiple sequence types and reported non-human sources support that multiple non-epidemic MDR lineages are circulating in Pakistan with healthy infants as a common reservoir.

Background Iron deficiency anemia is a common public health issue among women of reproductive age (WRA) because it can result in adverse maternal and birth outcomes. Although studies are undertaken to assess iron efficacy, some gaps and limitations in the existing literature need to be addressed. To fill the gaps, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the role of iron in reducing anemia among WRA in low-middle-income countries (LMICs). Methods A comprehensive search strategy was used to search Medline through PubMed, Embase, and Science Direct for RCTs published between 2000 and 2020. The primary outcome was the mean change in hemoglobin level. We used standardized mean differences and their respective 95% CI to estimate the pooled effect. We used I2 statistics and Egger’s test to assess heterogeneity and publication bias, respectively. This review was carried out in accordance with revised guidelines based on the Preferred Reporting Items for Systematic Review and Meta-analysis. Results The findings showed that iron therapy improved hemoglobin and ferritin levels, though the results varied across studies. An overall pooled effect estimate for the role of iron therapy in improving the hemoglobin levels among WRA was -0.71 (95% CI: -1.27 to -0.14) (p = 0.008). Likewise, the overall pooled effect estimate for the role of iron therapy in improving the ferritin levels among WRA was -0.76 (95% CI: -1.56 to 0.04) (p = 0.04). The heterogeneity (I2) across included studies was found to be statistically significant for studies assessing hemoglobin (Q = 746.93, I2 = 97.59%, p = 0.000) and ferritin level (Q = 659.95, I2 = 97.88%, p = 0.000). Conclusion Iron therapy in any form may reduce anemia’s burden and improve hemoglobin and ferritin levels, indicating improvement in iron-deficiency anemia. More evidence is required, however, to assess the morbidity associated with iron consumption, such as side effects, work performance, economic outcomes, mental health, and adherence to the intervention, with a particular focus on married but non-pregnant women planning a pregnancy in the near future. Trial registration Registered with PROSPERO and ID is CRD42020185033.

INTRODUCTION Undernutrition is a significant public health concern in the developing world and factors such as high parity and short birth intervals are significant contributors to maternal undernutrition. This study aimed to assess determinants of undernutrition among women of reproductive age in Sindh, Pakistan, using the national demographic health survey. METHODS Data of 4050 ever married women of reproductive age from the Pakistan Demographic and Health Survey (PDHS) 2012-2013 were analyzed. These included sociodemographic and fertility-related variables. Logistic regression was applied to assess the determinants of undernutrition. RESULTS Women having ≥5 children were 47% less likely to be undernourished compared to women having <5 children (OR=0.53; 95% CI: 0.43-0.63). Undernourished women included those who belonged to rural areas (adjusted odds ratio, AOR=3.47; 95% CI: 2.76-4.36), those who breastfed their infants (AOR=1.40; 95% CI: 1.16-1.68), were smokers (AOR=4.35; 95% CI: 2.58-7.34) or worked (AOR=1.22; 95% CI: 1.09-1.47). CONCLUSIONS The highest rates of undernourishment were found among working women as well as those who breastfed, smoked or belonged to the rural setting. We recommend that breastfeeding and working women should be provided awareness through teaching sessions and other means to improve their nutritional status as this subset of patients typically require additional calories.

Background In Pakistan, there is a dearth of literature on the perceptions of anemia among women of reproductive age (WRA). This study was undertaken to explore the perceptions of women, their husbands, and healthcare providers about anemia, its possible causes, and how anemia impacts maternal and child health in Thatta, Pakistan. Methods A qualitative study was conducted in Thatta, Pakistan from September to December 2018. Using a pre-tested semi-structured interview (SSI), we collected data to understand their definitions of anemia through ten focus group discussions (FGDs) with women and their partners and ten primary informant interviews (KIIs) with healthcare providers. We identified six major themes: (I) Knowledge and awareness of anemia, (II) Causes and consequences of Anemia, (III) Dietary practices, (IV) Knowledge and practices regarding the use of iron-folic acid supplements, (V) Factors influencing prevention and control of anemia and (VI) Women’s health behavior. We analyzed the data through thematic analysis using NVivo 10 software. Results Most community members were not aware of the term anemia but described anemia as a condition characterized by ‘blood deficiency’ in the body. All study participants perceived anemia as an important health problem tending to cause adverse outcomes among WRA and their children. Study participants perceived gutka (chewable tobacco) consumption as an important cause of anemia. Healthcare providers identified short inter-pregnancy intervals, lack of family planning, poor health-seeking behavior, and consumption of unhealthy food as causes of anemia in the district. Consumption of unhealthy food might not be related to related to a poorer knowledge of iron-deficient foods, but economic constraints. This was further endorsed by the healthcare providers who mentioned that most women were too poor to afford iron-rich foods. All men and women were generally well versed with the sources of good nutrition to be consumed by WRA to prevent anemia. Conclusion The findings suggest that the government should plan to develop strategies for poverty-stricken and vulnerable rural women and plan health awareness programs to improve dietary practices, compliance with supplements, and health-seeking behavior among women of reproductive age. There is a need to develop effective counseling strategies and context-specific health education sessions to improve the health-seeking behavior of women and men in the Thatta district of Pakistan. Besides, there is need to address social determinants of health such as poverty that pushes women of poorer socioeconomic strata to eat less nutritious foods and have more anaemia. Therefore, a comprehensive and robust strategic plan need to be adopted by government that focuses not only on the awareness programs, but also aim to reduce inequities that lead to pregnant women eat iron-poor foods, which, in turn, forces them to become anemic.

BackgroundIron deficiency anemia is a common public health problem problem among women of reproductive age (WRA) as it is can lead to unfavorable maternal and birth outcomes. Although studies are undertaken to assess the efficacy of iron, there are some gaps and limitations in the existing studies that need to be addressed. To address the gaps, we undertook a systematic review and meta-analysis to assess the existing evidence regarding the role of iron in decreasing anemia among WRA in low-middle-income countries.MethodsPubMed, Embase, and Science Direct were systematically searched using a comprehensive search strategy for randomized controlled trials published between 2000 to 2020. Mean change in hemoglobin level was assessed as a primary outcome. We performed a meta-analysis to estimate the pooled effect of all studies using standardized mean differences and their respective 95% CI. We assessed heterogeneity and publication bias using I2 statistics and Egger’s test respectively. This review was conducted with the help of updated guidelines based on the Preferred Reporting Items for Systematic Review and Meta-analysisResultsGenerally, the results demonstrated a favorable effect of iron therapy in improving hemoglobin levels with variation across studies. An overall pooled effect estimate for the role of iron therapy in decreasing the burden of anemia among WRA was -0.51 (95% CI: -1.03 to 0.01) (p = 0.04). Likewise, iron therapy improved ferritin levels and decreased the prevalence of anemia. The heterogeneity across included studies was found to be statistically significant as indicated by the parameters of heterogeneity (Q = 1191.60, I2 = 98.24%, p = 0.000). ConclusionIron therapy in any form may reduce the burden of anemia and improve the hemoglobin and ferritin levels, indicating improvement in iron-deficiency anemia. However, more evidence is needed to assess the morbidity associated with iron consumption such as side effects, work performance, economic outcomes, mental health, and compliance to the intervention with a special focus on married but non-pregnant women planning a pregnancy in near future. A systematic review and Meta-analysis registration: Registered with PROSPERO and ID is CRD42020185033

The American Academy of Pediatrics recommends the use of donor human milk in infants when mother’s own milk is not available. Our objective was to analyze whether the use of donor human milk in preterm, very-low-birth-weight (VLBW, <1500 g) infants affected the rates of necrotizing enterocolitis, duration of parenteral nutrition (PN), growth, culture-positive sepsis, length of hospital stay, and mortality in an urban NICU population with low exclusive breast-feeding rates. A retrospective cohort study was conducted comparing two 2-year epochs of VLBW neonates before and after the introduction of donor breast milk in our neonatal intensive care unit (NICU). With the introduction of donor human milk, there was a significant reduction in the rate of necrotizing enterocolitis (NEC) (5% vs. 13%; p = 0.04) and less severe NEC as defined by Stage III based on the Modified Bell Staging Criteria (10% to 3%; p = 0.04). In the donor milk era, there was earlier initiation of enteral feeding (2.69 days vs. 3.84; p = 0.006) and a more rapid return to birthweight (9.5 days. 10.9 days; p = 0.006). In this study, a change in practice to the use of donor breast milk in a population with low rates of human milk provision was associated with earlier initiation of enteral feeding, faster return to birth weight, and a reduced incidence of NEC.

Background Preliminary data on COVID-19 in the pediatric population has revealed that children account for a milder clinical course and better prognosis compared with adults. However, infants are at the greatest risk within this subset, with studies demonstrating the highest proportion of critical cases in this age group. The clinical spectrum of the disease in these children remains largely unexplored. Similarly, there is a dearth of research on the potential vertical/perinatal transmission of SARS-nCoV and the clinical outcomes of infants born to mothers who have been tested positive for the virus. In this review, we aim to summarize available literature on the clinical spectrum of COVID-19 in neonates and infants. Methodology This review will explore the clinical characteristics of COVID-19 in infants tested positive for SARS-nCoV using RT-PCR assays as well as neonates born to mothers who were detected with the virus during pregnancy. We will conduct a comprehensive search of two large databases, i.e. PubMed and Google Scholar and shortlist published and unpublished (pre-proof and pre-proof accepted) articles in English between 1 st November 2019 and 15 th May 2020 that meet the eligibility criteria. Keeping in view the paucity of data on the study topic, we plan to include all relevant articles irrespective of study design. The findings will be synthesized narratively following an analytical interpretation to capture emerging themes. Discussion Through this systematic review, we hope to provide an evidence-based framework for pediatricians to incorporate into their practice while managing neonates and infants tested positive for COVID-19 or those born to mothers who tested positive for the disease. This will set the stage for prospective clinical research to address the questions that remain unanswered. More importantly, exploring disease pathogenesis and transmission in pediatric patients could provide practical insights to guide future therapeutic and preventative measures and, perhaps, vaccine development. Systematic review registration: This review has been submitted for registration with PROSPERO (acknowledgement of receipt -185333).

Objectives To determine association between physical activity and hours of physical activity and stress levels in medical students  Methods A cross sectional study was conducted at a private medical college in Karachi, during April and May 2015. Convenience sampling was used to identify the study participants. The subjects were medical students from year one through five. We interviewed 235 students. A pre-tested, self-administered three-part questionnaire was used to collect the data. The first part of the questionnaire inquired about the subjects’ demographics and exercise habits, the second part of the questionnaire was adapted from the Perceived Stress Scale (PSS) to determine stress scores within participants, and the third part of the questionnaire asked about other stress relieving factors. Results According to the PSS, 30.3% of the participants were moderately stressed. The mean PSS was found to be 16.95 ± 5.72. 2A significant correlation was found between physical activity and stress levels; those involved in physical activity were 52 percent less likely to be moderately stressed (OR 0.48, p-value = 0.015) as compared to those who had not partaken in physical activity. Furthermore, studentswho performed physical activity for >4 hours per week had a lower mean PSS score (16.2) when compared to those who exercised for <2 hours per week. (18.2). Post-hoc statistical testing revealed the difference to be significant (p=0.028). Conclusion Based on the findings of our study, we conclude that physical activity of any form is associated with significantly decreased stress levels in medical students.