The Role of Health Belief Model in HIV Screening Decision Among International Students in the U.S

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Vol 4 No 1 (2020)

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STRIKING DIFFERENCES IN PHYSICAL AND MENTAL/BEHAVIORAL H EALTH STATUS BETWEEN HOMELESS BISEXUAL AND GAY YOUNG M EN IN NEW YORK CITY, UNITED STATES

Harlem Gunness, PhD, MPH

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Gay • Mental health • Physical health Although • Add your third bullet point here many studies have been conducted on Human Immunodeficiency Virus (HIV) infection and treatment among homeless bisexual and gay young men, few have focussed on their overall health status. This study was conducted as a comparative assessment of self-reported physical and mental health status between homeless bisexual and gay young adult men in New York City, United States. Face-to-face interviews were conducted with a purposive sample of 30 subjects in a homeless drop-in program. Bisexual men reported more physical and mental/behavioural health concerns than gay men. More large-scale research is needed to understand reasons how bisexual men accessed healthcare as compared to gay men.

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Key words: • Health • Homeless • Bisexual • Vol 4 No 1 (2020), Published: 2020-02-25; DOI: https://doi.org/10.21106/ijtm

GESTATIONAL DIABETES MELLITUS AND ASSOCIATED HEALTH RIS K OUTCOMES IN MOTHERS AND NEONATES Maureen Atieno Adoyo, PhD | Yeri M. Kombe, PhD

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Global Gestational Diabetes Mellitus (GDM) • Add your third bullet point here pregnancy complication is estimated at 200,000 cases annually with serious health consequences for maternal and neonates. A cohort study to establish GDM risks and associated health outcomes was conducted among 238 women attending antenatal clinic in selected health facilities in Nairobi, Kenya.

Results indicated that mothers with GDM are four times more likely to have varied physical discomforts and complicated deliveries as result of high neonatal birth weight. To improve population health, there is need to advocate for inclusion of diabetes testing and management as part of Essential Health Services Package for Kenya to realize positive health outcomes among women.

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Key words: • Gestational diabetes mellitus • Maternal • Neonates

Vol 4 No 1 (2020), Published: 2020-06-03; DOI: https://doi.org/10.21106/ijtm

THE ROLE OF HEALTH BELIEF MODEL IN HIV SCREENING D ECISION AMONG INTERNATIONAL STUDENTS IN THE UNITE D STATES: A PILOT STUDY Oluwasola Stephen Ayosanmi, MSc, MD | Lorette Oden, PhD | Titilope Ayosanmi, ABSTRACT MSc and | Babatunde Alli, BDS | Mei Wen,List PhD | Jamie Johnson, PhD Title Content Layout with •

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Objectives: We sought to determine how the Health Belief Model (HBM) • Add your constructs relate to Human Immunodeficiency Virus (HIV) screening decisions second bullet point here among international students and which of the HBM constructs was most relevant • Add your third bullet point here in those screening decisions.

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Methods: We conducted a cross-sectional pilot study using an online survey of international students at Western Illinois University in the United States.

Participants signed electronic informed consent. The online survey comprised of questions that assessed their sociodemographic characteristics, acceptance of HIV screening, and perceived knowledge of HIV. The survey also determined the role of perceived benefits, perceived threat, and cues to action in making HIV screening decisions among the study population.

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Results: Four hundred and ninety students were invited to participate in the survey out of which 185 responses were obtained. In all, 107(57.8%) were males, and 78(42.8%) were females. Most of the respondents were from Asia (64.9%) and Africa (24.9%). The prevalence of acceptance of HIV screening among international students was found to be 73.5%. About 90% of the participants perceived HIV screening to be beneficial to their health, and 76% of them would accept the screening because they were offered. The majority (83%) of participants who said that they would not accept HIV screening, were also not sexually active, and they did not think they could be susceptible to HIV.

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Conclusion and Implications for Translation: Perceived benefits and cues to action were found to be the significant factors that informed the decision of people who accepted to be screened for HIV. Perceived susceptibility informed the decision of those that rejected the screening. Caution is warranted in generalizing the findings from this study because of the limited sample size; however, we are confident that our findings are reproducible in a larger population context.

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Key words: • HIV • HIV screening • Decision • Acceptance • Perceived benefit • Perceived threat • Perceived susceptibility • Health belief model • International students Vol 4 No 1 (2020), Published: 2020-03-12; DOI: https://doi.org/10.21106/ijtm

REFERRAL OUTCOMES OF IDENTIFIED HEALTH PROBLEMS AND DIF FICULTIES RELATED TO SCHOOL MEDICAL INSPECTIONS IN GOVER NMENT SCHOOLS IN AN EDUCATION ZONE IN SRI LANKA Mahendra Arnold, MBBS, MSc, MBA, AAL, MD | Sepali Wickramatilake, MBBS, MSc, MD | Palitha Karunapema, MBBS, MSc, MD | Dinusha Fernando, MBBS, MSc, MD | Roshan MSc,with MD | Buddhika Title andSampath, ContentMBBS, Layout List Mahesh, MBBS, MSc, MD | Sujeewa ABSTRACT Panditharathna, MBBS, MSc, MD •

Background Introduction: • Add yourand first bullet point here School Medical Inspections (SMI) assess the health status of children, and provide opportunities for early detection, referral and • Add your prevention of disease conditions among school-aged children in Sri Lanka. There is second bullet point here paucity of data on the outcomes of referrals and difficulties encountered in relation • Add your third bullet point here to SMI. This study describes the outcomes of identified health problems in SMI and the difficulties encountered by public health staff in the conduct of SMI in an educational zone in the Kandy District, Sri Lanka.

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Methods: This study is comprised of a quantitative and a qualitative component.

The quantitative component - a descriptive cross sectional study was conducted with secondary data of 87 government schools in the Katugasthota Educational Zone in Kandy district, Sri Lanka. The study sample consisted of 2,876 children in whom health problems were identified and referrals were made. The qualitative component - key informant interviews (KIIs) were conducted among 5 Medical Officers of Health (MOH) and 10 Public Health Inspectors (PHIs) to identify the difficult ies they encountered related to SMI.

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Results: The overall SMI coverage was 88.6%. Dental caries was the main health defect identified (22.9%, N=2247). Other leading conditions included: skin diseases (2.9%, N=202); anaemia (2.9%, N=202); visual defects (1.8%, N=182); and suspected heart disease (1.2%, N=120). Of the referrals 92.1% (N=2071) were for dental caries; 84.6% (N=154) were for visual defects; 90% (N=108) were for suspected heart diseases; 100% (N=100) were for skin diseases; 100% (N=202) were for anaemia; and 66.6% (N=8) were for behavioural problems. Support from the schools to conduct the SMI was not satisfactory; parents faced many obstacles in obtaining services at the referral centers.

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Conclusions and Implications for Translation: There is a high coverage of SMI. Referral outcomes for dental caries, skin diseases and anaemia were relatively higher. Follow-up of area PHI in referral-outcome tracking and management should be strengthened. Offering of priority services at the hospital settings for referred school children must be improved.

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Key words: • School Medical Inspection • Health defects • Referrals • Sri Lanka • School health Vol 4 No 1 (2020), Published: 2020-04-08; DOI: https://doi.org/10.21106/ijtm

HYPERTENSION IN SAUDI ARABIA: ASSESSING LIFE STY LE AND ATTITUDES Bushra Elbashir, MBBS, DCB, PhD | Msab Al-dkheel, MBBS | Hamad Aldakheel | Naif Aruwished, MBBS | Nasser Title and Content Layout with List Alodayani ABSTRACT •

Background: Dietary Approaches to Stop Hypertension (DASH) diet lowers • Add your first bullet point here blood pressure (BP) effectively. There is evidence that strongly supports the • Addthat yourlifestyle second bullet point here has powerful effect on BP. DASH diet concept modification includes increased physical activity, reduced salt intake, weight loss, increased • Add your third bullet point here potassium intake, and an overall healthy dietary pattern. This study assesses the knowledge and attitudes of Saudis in Riyadh City towards lifestyle and hypertension.

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Methods: A cross-sectional study was designed using a questionnaire-based assessment tool, which included sociodemographic data, knowledge and lifestyle attitude with hypertension, such as dietary factors, stress, smoking, physical activities, diet-related diseases such as obesity and diabetes mellitus.

Statistical analyses included frequency, percentile, and chi-square test.

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Results: Out of total 934 participants, 13.6% were hypertensive; 84.4% and 60.2% of participants believed eating salty food and fatty food, respectively, was risk factors for hypertension. Almost 65.8% of participants considered stress as a risk factor for the development of hypertension, whereas 77.0% considered smoking as a risk factor. The data showed that 87.5% considered obesity as a risk factor, and 73.8% considered reducing weight as a preventive measure for hypertension. Also, 68.8% believed that physical inactivity was a risk factor for hypertension. Data showed that 16.6 % ate vegetables and 23.1% ate fruits as recommended, whereas 18.8% and 18.4%, respectively, rarely ate vegetables and fruits. About 12.1% smoked and 19.7% exercised regularly, whereas 15.6% did not exercise at all. Traffic and examination were reported as stress factors by younger participants whereas older participants reported chronic diseases as stressors.

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Conclusion and Implications for Translation: The knowledge of the relationship between hypertension risk factors with eating salty food and fatty food was high, whereas knowledge of not eating vegetables and fruits as a risk factor for the development of hypertension was very low among the Saudis.

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Key words: • DASH • Hypertension • Life style • Knowledge • Saudi Arabia Vol 4 No 1 (2020), Published: 2020-05-06; DOI: https://doi.org/10.21106/ijtm

EPIDEMIOLOGICAL, CLINICAL AND VIROLOGICAL CHA RACTERISTICS OF PATIENTS WITH HEPATITIS C IN MO ROCCO Mohamed Rida Tagajdid, Pharm D | Safae Elkochri, Pharm D | Hicham Title and Layout with List Lahlou Amine, Pharm D Elannaz, MD, Content PhD | Rachid Abi, MD | Idriss

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Objectives: Morocco, the exact • Add yourIn second bullet point here and recent prevalence of Hepatitis C Virus (HCV) infection is not well-known, due to the lack of recent epidemiological • Add bulletMoroccan point here population. The objective of this study was to studies ofyour the third general determine the prevalence of HCV and to describe the epidemiological, clinical and virological characteristics of patients infected with HCV diagnosed at the Mohammed V Military Teaching Hospital in Rabat, Morocco.

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Methods: This was a prospective study, spread over a period of 3 years (April 2015 - April 2018). All patients with a positive anti-HCV serology were included in the study except those on hemodialysis. In addition to HCV serology, all patients included benefited from HIV serology as well as the Hbs antigen by a Chemiluminescent type Microparticle Immuno-Assay technique (Architect®, Abbott). RNA viral load and HCV genotyping was carried out using a real-time polymerase chain reaction.

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Results: We collected 14,944 samples, of which 269 had positive anti-HCV antibodies (1.8%). The average age of patients with positive HCV serology was 61 years, the sex ratio (Male/Female) was 1.4. Dental care was identified in 53% of the cases. Viral hepatitis C was identified in 82% of cases during a systematic check up. The main clinical signs reported in our series were asthenia (25% of cases) and subicterus (7% of cases).

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Conclusion and Implications for Translation: In Morocco, the exact prevalence of HCV infection is not well known, due to the lack of recent epidemiological studies of the general Moroccan population. Our study showed a prevalence of about 1.8% which is in accordance with the World Health Organization (WHO) estimation of between 1% and 2.49%.Our Epidemiological study provides important on the extent of the problem in Morocco, it raises the interest of mass screening and describes the populations at risk that will need to be identified as a priority.

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Key words: • Epidemiology • Diagnosis • Hepatitis C • Morocco • Risk factor • Military Hospital • Virology Vol 4 No 1 (2020), Published: 2020-05-06; DOI: https://doi.org/10.21106/ijtm

LUMBAR PUNCTURE IN SAUDI ARABIA: KNOWLEDGE, AWAR ENESS, ACCEPTANCE AND ITS REFUSAL AMONG HEALTH P ROFESSIONALS Amani A. Alrehaili, PhD Title and ContentABSTRACT Layout with List •

BACKGROUND OBJECTIVES: Lumbar puncture (LP) is a standard • Add your first AND bullet point here technique to acquire cerebrospinal fluid (CSF) for either diagnostic or • Add your second bullet point here therapeutic management of neurological disorders. This study assesses the awareness and level ofpoint acceptance of LP among medical laboratory students.

• Add your third bullet here The study also investigates the level of understanding of the purpose of performing LP and determines the acceptance rate among the study population.

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METHODS: A cross-sectional study was conducted in Taif, Saudi Arabia, using an online questionnaire distributed among medical laboratory students attending the College of Applied Medical Sciences at Taif University. Of over 200 questionnaires distributed, 176 students responded. The questionnaire queried students’ socio-demographic information, their knowledge, acceptance rate, and possible complications and precautions concerning LP. A univariate analysis was performed.

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RESULTS: The study showed that 81.8% of participants were aware of LP. About 53.6% of participants received their information from their education. The participants’ understanding of the side effects and precautions surrounding LP operations was significantly high at 87.5% and 72.7%, respectively. In all, 65.9% of participants reported their acceptance compared to 34.1% of participants who did not accept LP. In contrast, about 72.7% of participants preferred not to do LP, even if the LP was prescribed by their doctor.

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CONCLUSION AND IMPLICATIONS FOR TRANSLATION: The study showed high knowledge of the purpose, process, and duration of the LP procedure among clinical laboratory students. The key reasons for the LP’s rejection in the majority of participants were fear of injection and side effects, including paralysis. This research demonstrated the need to raise awareness of LP using methods such as social media, academic seminars and training courses.

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Key words: Lumbar puncture; Cerebrospinal fluid; Taif; Saudi Arabia; Medical laboratory students.

Vol 4 No 1 (2020), Published: 2020-05-16; DOI: https://doi.org/10.21106/ijtm

DIGITAL DIVIDE: MARKED DISPARITIES IN COMPUTER AND BROADBAND I NTERNET USE AND ASSOCIATED HEALTH INEQUALITIES IN THE UNITED S TATES Gopal K. Singh, MS, MSc, PhD | Mehrete Girmay, PhD, MPH, CGH | Michelle ABSTRACT Allender, MS, BSN, RN | Ramey T Christine, MBA, BSN, RN • Background: Despite the considerable in computer and internet use over the Title and Content Layoutincrease with List past two decades, few studies have examined socioeconomic, demographic, and health characteristics associated with computer and internet use in the United States.

Community-level differences computer and internet use and associated disparities in • Add your first bullet pointin here health and mor tality indicators have not been analyzed. This study examines these associations • Add your at the individual andhere community level using national census, health, and second bullet point mortality data.

• Add your third bullet point here • Methods: We analyzed data from the 2017 American Community Survey (ACS) Microdata Sample, the 2013-2017 ACS Summary File, 2013-2017 National Vital Statistics System, and 2019 County Health Rankings and Roadmaps. Health and socioeconomic characteristics associated with broadband internet and computer use among adults aged ≥18 were modelled by logistic regression (N=2,385,595).

• Results: In 2017, 89.7% of Asian/Pacific Islanders (APIs) had broadband internet service, compared with 66.0% of American Indians/Alaska Natives (AIANs), 77.2% of Blacks/African-Americans, 78.8% of Hispanics, and 83.5% of non-Hispanic Whites.

APIs (97.4%) were more likely than other racial/ethnic groups to own or use a computer (including smartphones), while AIANs (80.3%) were less likely. Socioeconomic gradients in internet and computer use were marked. Those below the poverty level and with less than a high school education reported 18 and 15 percentage points lower rates of internet and computer use respectively. Compared to metropolitan areas, nonmetropolitan areas had lower internet access (80.3% vs. 69.7%) and computer use (88.4% vs. 80.5%). Rural areas and small urban towns had the lowest level of internet and computer use. Risks of disabilities and lack of health insurance were greater among persons with lower broadband internet and computer access. Communities with low internet and computer use had seven years shorter life expectancy than communities with high use and were at increased risks of mortality from various chronic conditions, poor health, mental distress, hospitalization, smoking, obesity, and physical inactivity.

• Conclusions and Implications for Translation: Significant socioeconomic and racial/ethnic disparities in internet and computer use and associated health inequalities exist in the US. Closing the social divide in internet and computer use can positively impact individual empowerment, educational attainment, economic growth, community development, access to health care and health-related information, and health promotions efforts.

• Key words: • Digital divide • broadband internet • computer use • disability • health insurance • causespecific mortality • morbidity • health behaviors • Vol 4 No 1 (2020), Published: 2020-06-10; DOI: https://doi.org/10.21106/ijtm

DEFRAGMENTING THE HEALTH CARE SYSTEM IN MEXICO: UNIVE RSAL ACCESS FOR OBSTETRIC EMERGENCIES María G. Ramírez-Rojas, MD, DScPH | María G. Freyermuth-Enciso, DAnth | María B. Duarte-Gómez, DScPH

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Background and Objectives: This article aims to analyze how the needs • Add your first bullet point here of Mexican women requiring emergency obstetric care (EmOC) can be fully met •through as the General Agreement on Inter-Institutional Add your initiatives second bulletsuch point here Collaboration for Emergency Obstetric Care (the Agreement). We • Add your third bullet point here compared EmOC accredited facilities operating under the Agreement with facilities outside the Agreement which, although not accredited, provide their affiliates with EmOC services.

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Methods: Based on an observational, descriptive, cross-sectional design, we analyzed the Agreement interinstitutional strategy within four different scenarios in order to verify whether Mexico was in compliance with United Nations (UN) recommendations on EmOC availability: five facilities, with at least one offering comprehensive services, per 500,000 inhabitants.

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Results: Taking into account all facilities in the Mexican health care system, we found that Mexico offered 75% of the required facilities and was therefore 25% short of compliance. According to data on hospital discharges, 734 438 cases of obstetric emergencies (OEs) were registered in Mexico in 2013, the vast majority of which were assisted by facilities unaccredited for that function. Meanwhile, the 466 accredited facilities, all operating under the Agreement, served a negligible proportion (0.07%) of these patients.

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Conclusion and Implications For Translation: The Agreement would undoubtedly reach its potential as a vehicle for universal EmOC coverage were its field of action not restricted to such a small number of services for women. The Mexican health care system is faced with the double challenge of increasing institutional coverage and upgrading installed EmOC infrastructure.

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Key words: • Medical emergency services • Mexico, Medical assistance • Hospitalization • Health regulation • Agreements.

Vol 4 No 1 (2020), Published: 2020-06-10; DOI: https://doi.org/10.21106/ijtm

HIV-1-SYPHILIS CO-INFECTION ASSOCIATED WITH HIG H VIRAL LOAD IN FEMALE SEX WORKERS IN THE DEM OCRATIC REPUBLIC OF THE CONGO Godefroid M.A. Musema, MPH | Ali M. Mapatano, MD, MPH, PhD | Desire K. Tshala, ABSTRACT Title and with List MD, MPH, PhD MD,Content MPH, PhDLayout | Patrick K. Kayembe, • Background:

Sexually transmitted infection (STI) and HIV co-infection are common in countries where resources are limited constituting a leading • Add your first bullet point here public health issue. The negative impact of HIV transmission and • Add your bulletThe pointaim here of this study was to determine whether HIVacquisition aresecond known.

1-syphilis co-infection is associated with high HIV-1 viral load (VL) in female • Add your third bullet point here sex workers (FSWs) in the Democratic Republic of the Congo (DRC).

• Methods: Sera from 411 FSWs tested HIV+ in a national, DRC HIV/STI Integrated Biological and Behavioural Surveillance Survey (IBBSS) conducted between December 2012 and January 2013. HIV and syphilis testing were performed according to validated DRC national testing algorithms used by the national HIV-AIDS and STI program (PNLS). VL was measured according to Abbot m2000sp and m2000rt protocols. HIV-1syphilis co-infection proportion was determined and multivariate analyses were used to identify factors associated with higher VL in HIV-1-syphilis coinfected FSWs. • Results: Of 411 HIV-infected FSWs, 19.2% (95% CI: 15.4 – 23.0) were coinfected with syphilis. The mean HIV-1 VL in HIV-1-positive FSWs coinfected with syphilis [2.9 log10 HIV RNA/mL (95% CI: 2.49 – 3.29)] was higher compared with those not co-infected with syphilis [2.2 log10 HIV RNA/mL (95% CI: 1.97 – 2.46)]. Multivariate analysis showed that syphilis co-infection was associated with high HIV-1 VL (aOR [95% CI] = 1.90 [1.03, 3.52]) but HIV-1 VL was not influenced by age, education level, duration in sex profession, abnormal fluid, and sore to sex.

• Conclusion and Implications for Translation: HIV-1 – Syphilis coinfection was associated with higher HIV-1 VL. Preventing FSWs from getting STIs and screening HIV infected individuals for STIs and providing them with appropriate treatment could impact the transmission of HIV from FSWs to their clients.

• Keywords: • HIV-1 • Syphilis • Co-infection • Viral load • Female sex workers • DRC Vol 4 No 1 (2020), Published: 2020-06-11; DOI: https://doi.org/10.21106/ijtm

THE U.S. OPIOID CRISIS: DECRIMINALIZATION AS A PO TENTIAL APPROACH Valerie Luzi, BS

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There have been numerous approaches to treating the opioid crisis, but some downfalls include not addressing stigmas against the affected population. While it may seem to be a radical proposal, but decriminalizing all drugs may provide safer access to drugs, decrease the number of drug overdoses, decrease the stigma surrounding addicts, and decrease the barriers around access to care for addicts.

Vol 4 No 1 (2020), Published: 2020-07-11; DOI: https://doi.org/10.21106/ijtm

COVID-19 PANDEMIC IN PAKISTAN Nasir Ilyas, MPhil, MSc | Romuladus E. Azuine, DrPH, MPH, RN | Alina Tamiz, MA

Title and Content Layout with List ABSTRACT • Since February 26, point 2020, • Add your first bullet herewhen

coronavirus disease 2019 (COVID19) pandemic emerged in Karachi City and rapidly spread throughout • Add your second bullet point here Pakistan, the disease has affected more than 6200 people and more Add your third bullet point here reported till April 15. If we compare the than• 111 deaths have been disasters of COVID-19 in Pakistan with other countries like China, Iran and European Union nations, so many questions arise. We have so many challenges in controlling this pandemic like the geopolitics of country, poverty, low literacy rate, environmental conditions, hygienic conditions, and food intake habits. In all these aspects, there are poor conditions but the outbreak of COVID-19 in Pakistan was slower than other developing countries. Pakistan’s humid condition, hot weather, early response to COVID-19, population immune system, BCG vaccination and the number of young people favors to attenuate the impact of COVID-19. In this paper, we discuss the outbreak of COVID-19 pandemic in China, Iran and Pakistan and share day-by-day developments in this pandemic. We present the structure of COVID-19 and its similarity with SARSCOV and SARSCOV2. We also discuss the treatment procedure like use of Remdesivir (an adenosine similarity) used against RNA viruses, Chloroquine (extensively used anti-malarial drug), convalescent plasma, neutralizing antibody targeting the ACE-2 receptor and ACE2-like molecule that might bind to the S protein of the coronavirus and disadvantages of the discussed medications. The impact of COVID-19 in the economics of Pakistan and government reliefs are also discussed.

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words: • Coronavirus • COVID-19 • Pakistan • Pandemic • Outbreak Vol 4 No 1 (2020), Published: 2020-05-19; DOI: https://doi.org/10.21106/ijtm

International Journal of Translational Medical Research and Public Health Journal Information

TitleEditor-in-Chief: and ContentRomuladus Layout with List E. Azuine, DrPH, MPH, RN. •

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Gopal K. Singh, PhD

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Editorial Assistant: Carl Dowling, SAP.

Contact Information: submissions@ijtmrph.org

Website: www.ijtmrph.org