The study showed that children with beta thalassemia major had delayed physical growth possibly secondary to iron overload. Effective and early iron chelation is needed for preventing growth failure in transfusion-dependent beta thalassemia.
IntroductionIn April 2019, 14 children were diagnosed with HIV infection by a private healthcare provider in Larkana district, Sindh province, Pakistan. Over the next 3 months, 930 individuals were diagnosed with HIV, >80% below 16 years, the largest ever outbreak of HIV in children in Pakistan. In this protocol paper, we describe research methods for assessing likely modes of HIV transmission in this outbreak and investigate spatial and molecular epidemiology.Methods and analysisA matched case–control study will be conducted with 406 cases recruited. Cases will be children aged below 16 years registered for care at the HIV treatment centre at Shaikh Zayed Children Hospital in Larkana City. Controls will be children who are HIV-uninfected (confirmed by a rapid HIV test) matched 1:1 by age (within 1 year), sex and neighbourhood. Following written informed consent from the guardian, a structured questionnaire will be administered to collect data on sociodemographic indices and exposure to risk factors for parenteral, vertical and sexual (only among those aged above 10 years) HIV transmission. A blood sample will be collected for hepatitis B and C serology (cases and controls) and HIV lineage studies (cases only). Mothers of participants will be tested for HIV to investigate the possibility of mother-to-child transmission. Conditional logistic regression will be used to investigate the association of a priori defined risk factors with HIV infection. Phylogenetic analyses will be conducted. Global positioning system coordinates of participants’ addresses will be collected to investigate concordance between the genetic and spatial epidemiology.Ethics and disseminationEthical approval was granted by the Ethics Review Committee of the Aga Khan University, Karachi. Study results will be shared with Sindh and National AIDS Control Programs, relevant governmental and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals.
Background: Vaccination against COVID-19 is one of the control measures for an ongoing COVID-19 pandemic. Vaccine acceptance is known to be low in Pakistani population, we identified the factors associated with vaccine hesitancy (VH) for COVID-19 at the time of first introduction of this vaccine for elderly and health care workers. Methods: An online survey was launched using a google form during March to April 2021 to assess VH in adult (> 18 years) Pakistani population. The survey form determined VH individuals who declined to questions on getting vaccinated and maintained a perspective of reluctance to vaccinate. In addition to sociodemographic characteristics, observation of standard precautions, and sources of information on COVID-19 vaccine were inquired. Results: Of the 278 responses 80% of the study population was less than 45 years of age, 68% were males, 91% had 16 or more years of education, 39% were in health care profession, 81% reported consistent use of face masks in public places, 68% sanitized hands each time, 35% always avoided social gatherings, 24% had received vaccination, 20% had suffered from COVID-19, and 45.7% were vaccine hesitant. At multivariable level, being health care worker, increasing mean precautionary score, not being vaccinated against COVID-19 and those with concerns for vaccine safety were the contributing factors for VH. Participants who presumed COVID-19 vaccine was safe were 90% less hesitant to get COVID-19 vaccine (Adjusted Prevalence Ratio: 0.1; 95% CI 0.09, 0.29) than who were uncertain on vaccine safety.Conclusion: Reliable safety information on COVID-19 vaccine and trust building influenced VH, to mass vaccinate Pakistani population to control the pandemic.
Background Bendamustine is an attractive option for the management of both de novo and relapsed lymphomas. It is being increasingly used in the conditioning regimen for autologous stem cell transplantation (SCT) and can be an alternative to the traditionally-used carmustine. In this study, we aimed to determine the safety and efficacy of bendamustine in the conditioning regimen for autologous SCT in refractory/relapsed lymphomas. Methods We designed a descriptive study to evaluate bendamustine in combination with etoposide, cytarabine, and melphalan (BeEAM) in the conditioning regimen for autologous SCT. Results Fourteen patients (median age, 28 yr) with Hodgkin's lymphoma (HL) (N=8), non-Hodgkin's lymphomas (NHL) (N=5), or peripheral T-cell lymphoma, not otherwise specified (PTCL NOS) (N=1) were included in the study. A median number of 5.95×10 6 CD34+ cells/kg were transfused. Median times to absolute neutrophil count and platelet engraftment were 17 days and 24 days, respectively. The 100-day transplantation mortality rate was 28% (4 patients). Eight patients (57.14%) had GII-III acute kidney injury, four patients (28.5%) had GIII-IV hyperbilirubinemia, and twelve patients (85%) had GII-III diarrhea. After 3 months, 37% (5 patients) and 21.4% (3 patients) demonstrated complete response and partial response, respectively. The median follow-up was 5.5 months (15 days–19 mo). At the final follow-up, 7 patients (50%) were alive and in CR. Conclusion Our study showed that bendamustine is a potentially toxic agent in the conditioning regimen for autologous SCT, resulting in significant liver, kidney, and gastrointestinal toxicity. Further studies are required to assess its safety and efficacy at reduced doses.
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