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Background Non-alcoholic fatty liver disease (NAFLD) is a common liver disorder caused by the deposition of lipids and fats in the hepatocytes, in individuals who consume little or no alcohol, which eventually progresses to cirrhosis and carcinoma. Apart from the known risk factors like obesity, metabolic syndrome (MS), and lack of physical activity (PA), diet also plays a major role in the development of NAFLD. A high body mass index (BMI) and waist circumference (WC) have positive associations with NAFLD. The aim of this study was to find the prevalence of risk factors of hepatic steatosis in NAFLD population and to raise public awareness about the condition. Method We conducted a cross-sectional study from October to December 2019 with a sample size of 98 subjects determined by using a confidence interval (CI) of 99.9%. Patients presenting to Essa Laboratory, Karachi for abdominal ultrasound (US) were scanned for fatty changes in the liver, after obtaining consent, and were then assessed for risk factors by administering a 20-item questionnaire along with registering their BMI and WC measurement. The collected data was analyzed using the Statistical Package for Social Sciences (SPSS), version 22 (IBM, Armonk, NY). The independent sample t-test was applied for the exploration of variables and a p-value <0.05 was considered significant. Result Our study included 96 participants, of which 49 (51%) were male and 47 (49%) female. Mean BMI in females was slightly greater (30.58) than in males (27.98), whereas WC (in inches) was almost equal in males (40.796) and females (40.383). Among the people that had any comorbidities (n = 60, 62.5%), hypertension (HTN) was the most common one (n = 37, 38.5%) followed by diabetes mellitus (DM) type 2 (n = 26, 27.1%). A significant majority (n = 63, 65.5%) never consumed any fruits or vegetables in their meal nor did they perform any sort of physical exercise (n = 46, 47.9%). Conclusion Obesity (high BMI), lack of PA, lower consumption of fruits and vegetables along with a carbohydrate-and fat-rich diet play a vital role in the development of hepatic steatosis. Moreover, HTN and DM, as components of MS, exhibit a significant association with NAFLD. Screening and counseling sessions should be considered for individuals with these Open Access Original Article

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Candida auris a multidrug- resistant nosocomial fungal pathogen is an emerging global public health threat. Since its discovery in Japan in 2009, the fungus has now affected more than 40 countries worldwide. It is a haploid microscopic fungus belonging to the Metschnikowiaceae family in the Candida/Clavispora clade. (1). More commonly colonizing the skin, Candida auris is isolated from multiple infection sites and is generally acquired from hospital environments. The risk factors for contracting the fungus are immunodeficiency, diabetes mellitus, elderly age, previous surgery, indwelling medical device and the use of broad- spectrum anti-microbial therapy (1,2). Unlike other Candida species, Candida auris is usually thermotolerant and osmotolerant which helps the pathogen to withstand environmental stresses (2). The strains of Candida auris are resistant to common anti-fungal drugs like Fluconazole, Amphotericin B and rarely Echinocandin too, making it a significant and notorious member among other Candida species (1,2). According to the Center for Disease Control and Prevention, Candida auris causes infections of bloodstream, ear and wounds. The most common symptoms of invasive infection by Candida auris are fever and chills that do not remit on antibiotic therapy. Diagnosis is mainly based on blood and urine cultures. (3). Recently, a case was presented in a Public sector tertiary care hospital of Karachi in the paediatric age group. The patient was a six year old boy suffering with meningitis and septicemia and was admitted first in the ICU and subsequently in the ward. The patient got discharged after getting routine empirical therapies. The blood and urine culture taken during the stay was positive for Candida auris. Previously, an outbreak reported in ICU patients in Rawalpindi in 2018 was controlled by adopting staunch measures (4). There is a paucity of recording and reporting outbreaks to the concerned health authorities in P.akistan Moreover, lack of hygiene practices followed by patients and the attendants, and poor infection control measures have caused such outbreaks. Pakistan, a developing country with minimal resources reserved for health, coped with three invasive waves of the deadly Coronavirus/COVID-19 pandemic. Candida auris manifests itself as a serious public health threat for the country. The policymakers should take swift actions related to this. Some steps that we recommend are that Candida auris infection should be declared as a prioritized notifiable disease and measures instituted for prompt reporting. ---Continue

Respected Editor, The corona virus hit the world in 2019 creating a pandemic through the SARS nCov2 variant. Afflicting more than a hundred million and proving to be fatal for over three million people globally, Pakistan was also affected by the disease, the stats from National Command and Coordination cell as of 15 June, 2020 were that 944,065 people are tested positive and about 22,000 have died from pneumonia induced by this notorious virus. A silver lining came in the late 2020 by the revolutionary breakthrough in the development of COVID-19 vaccines. Pakistan also started the vaccination drive in February 2021 on a priority bases from Registered Health Care Workers to Senior Citizens to General Public in a descending order of age. Recently the vaccination drive came to jabbing people of age 19+ with the vaccine. Since most of the COVID-19 vaccines dispensed comprise of two doses and there is at least a gap of 21 days between them, there is seen a paucity of people returning to the vaccination centers for their second shot and to our astonishment this list also includes the health care workers (1). The policy makers cited the following causes for this issue (1, 2): Some of them might have died before the second dose. Many of them could have been in the spell of myths and rumours related to the vaccine like magnet sticking, etc. The people might have contracted the virus which led to hesitancy while getting the second jab done. Madam Editor we want to bring to your attention that the lack of people returning for the second dose including health care workers might prove fatal for our health sector. We have suffered four waves of the pandemic and now the only source to prevent another one is the vaccine. If the second dose is not administered (which is usually a booster one), then antibodies against the virus will wane after about 6 months (2) and the people will again become susceptible to fatal outcomes of the disease (2, 3). ---Continue