Coronavirus disease (COVID-19) is a highly transmittable infection and Pakistan faces sudden hike in number of positive cases including number of healthcare professionals (HCPs) also acquired infection. Knowledge, attitude, and practice survey provides a suitable format to evaluate existing programs and to identify effective strategies for behavior change in society. Therefore, the aim of study is to assess knowledge, attitude and practice among HCPs in Pakistan regarding COVID-19. An online survey-based study was conducted among healthcare professionals including physicians, pharmacists and nurses. A self-administered validated (Cronbach alpha= 0.077) questionnaire comprised of five sections (Demographics, Knowledge, attitude, practice and perceived barriers) were used for data collection. Of 414 participants, 29.98% (n=120) physicians, 46.65% (n= 189) pharmacists and 25.36% (n= 105%) nurses. Most commonly utilized information source was social media. Findings showed HCPs have good knowledge (93.2%, n=386), positive attitude (8.43±1.78) and good practice (88.7%, n=367) regarding COVID-19. HCPs perceived that overcrowding in emergency room (52.9%, n=219), limited infection control material (50.7%, n=210) and poor knowledge regarding transmission (40.6%, n=168) of COVID-19 are the major barriers in infection control practice. Binary logistic regression analysis demonstrated that HCPs of age group 40-49 years (OR: 1.419, 95%CI: (0.14-4.78, P=0.041) have higher odds of good knowledge. Similarly, age group of 31-39 years (OR: 1.377, 95% CI: 0.14-2.04, P=0.05), experience of more than 5 years (OR: 10.71, 95% CI: 2.83-40.75, P<0.001), and pharmacist job (OR: 2.247, 95% CI: 1.11-4.55, P=0.025) were the substantial determinants of good practice regarding COVID-19. HCPs in Pakistan have good knowledge, yet, there are areas where gaps in knowledge and practice was observed. To effectively control infection spread, well-structured . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) : medRxiv preprint training programs must be launched by government targeting all kinds of HCPs to raise their existed knowledge.

SummaryBackgroundSurgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.MethodsThis international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.FindingsBetween Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).InterpretationCountries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

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The ubiquitin proteasome pathway plays a key role in cell cycle, function and survival. Bortezomib (BTZ) and Carfilzomib (CFZ) are the first two inhibitors of the proteasome pathway, indicated in treatment of patients with multiple myeloma. In the past few years, there have been few case reports that have highlighted the association between proteasome inhibitors (BTZ and CFZ) with acute kidney injury (AKI). In most of these case reports and initial trials, the underlying mechanism of AKI has been unclear. In this article, we discuss the association and pathogenesis of proteasome inhibitors-associated AKI. We also report the first case of CFZ-associated AKI with kidney biopsy evidence of thrombotic microangiopathy and the presence of microangiopathic hemolytic anemia.

The coronavirus disease 2019 (COVID-19) is a global pandemic having no therapy and pharmacists being a part of the healthcare system had a vital role in the management of COVID-19. The purpose of this study is to assess the knowledge, attitude, and practices (KAPs) of community pharmacists (CPs) regarding COVID-19. An online survey was conducted among 393 CPs in two provinces of Pakistan during the lockdown period. A validated questionnaire (Cronbach alpha, 0.745) was used for data collection. All statistical analysis was analyzed by using SPSS version 21. Among 393 participants, 71.5% (n=281) had good knowledge, 44% (n=175) positive attitude and 57.3% (n=225) had good practice regarding COVID-19. Social media (45.29%, n=178) was reported as the main source to seek information of COVID-19. Good knowledge, age ≥ 26 years and Ph.D. degree level were the substantial determinants (p= <0.05) of a good attitude. Similarly, community pharmacist who had an experience of >5 years, hold a Ph.D. degree, good knowledge and good attitude had higher odds of good practice as compared to reference categories (p= <0.05). In short, majority of CPs had good knowledge, but had a poor attitude and practice towards the COVID-19. Standard-structured educational and counselling programs for CPs regarding COVID-19 are needed for effective management.