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Seroprevalence of Dengue Virus IgG among Children 1 - 15 Years, Selected from an Urban Population in Karachi, Pakistan: Population Based Study  [PDF]
Shakeel Ahmed, Syed Rehan Ali, Farhana Tabassum
Open Journal of Pediatrics (OJPed) , 2015, DOI: 10.4236/ojped.2015.52019
Abstract:

Objectives: This was to estimate the proportion of Dengue virus specific IgG ELISA among asymptomatic children between the ages of 1 year to 15 years, residing in an urban population of Karachi. Design: Cross-sectional study. Settings: Subjects were selected from Garden, Karachi; an urban area located adjacent to the Central district of Karachi. Participants: Children of ages 1 year to 15 years, of either sex, residing in the urban area of Garden, Karachi for more than 1 year were selected for the study. Those with a history of yellow fever or using corticosteroids within 1 month of recruitment were excluded. Outcome measures: Data were collected on socioeconomic status of households, medical history, including previous dengue infection, general examination findings and anthropometric indices. Blood samples were collected and sent to Research Laboratories, AKU for determining complete blood counts and serum IgG antibodies for Dengue. All collected information was then analyzed for ascertaining the predicting factors for positive IgG among children less than 15 years. Results: From a total of 900 subjects, 46% were found to have positive IgG in their bloods. Our results revealed that a male child of age more than 10 years was more likely to be IgG positive. Other risk factors identified with the seropositivity included lower household income and absence of anemia, thrombocytopenia and lack of hand washing. Conclusions: The study indicated a significant proportion of children under 15-year-old infected with Dengue virus, with a potential risk of severe complications, if re-infected with dengue. Stringent measures are still needed by both public and private authorities to contain dengue outbreaks, and reducing the proportion of associated mortality, as seen in the previous years. Trial registration: Seed Money Grant (ID# SM090101) was awarded to the corresponding author by Research Committee, Faculty of Health Sciences, Aga Khan University, Pakistan.

Evaluation of Risk Factors of HCV infection in Lahore, (Pakistan)  [cached]
Rao Muhammad Ijaz,Ahmad Saeed Akhter
Pakistan Journal of Statistics and Operation Research , 2007, DOI: 10.1234/pjsor.v3i1.77
Abstract: Hepatitis C Virus (HCV) infection is rapidly growing disease in world in general and in Pakistan in particular. In Pakistan more than 10 million persons have HCV +ve signs. Risk factors for this fatal disease included main, historic and demographic factors. Some researchers segregated few independent factors but other, include them in the category of depends. We have collected the data for Lahore (Pakistan) and analyzed this data by considering the aforesaid factors. Some results of this research do not match with the existing theories. We recommended that interaction effects of associated factors should also be considered in evaluation.
Dengue Fever (DF) in Pakistan
Fridous Jahan
Asia Pacific Family Medicine , 2011, DOI: 10.1186/1447-056x-10-1
Abstract: The World health Organization (WHO) declares dengue and dengue hemorrhagic fever to be endemic in South Asia. WHO currently estimates there may be 50 million dengue infections worldwide every year. In 2007 alone, there were more than 890 000 reported cases of dengue in the Americas, of which 26 000 cases were Dengue Hemorrhagic Fever (DHF)[1]. The disease is now endemic in more than 100 countries in Africa, Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific. South-east Asia and the Western Pacific are the most seriously affected.Pakistan is at high risk of being hit by large epidemics because of many over crowded cities, unsafe drinking water, inadequate sanitation, large number of refugees and low vaccination coverage. These conditions promote the spread of infectious diseases and consequently every year a large number of epidemics/outbreaks occur in different parts of the country, which result in increased morbidity and mortality.Dengue virus infection is increasingly recognized as one of the world's emerging infectious diseases. About 50-100 million cases of dengue fever and 500,000 cases of Dengue Hemorrhagic Fever (DHF), resulting in around 24,000 deaths, are reported annually[1].A pandemic of dengue began in Southeast Asia after World War II and has spread around the globe since then. In the 1980 s, DHF began a second expansion into Asia when Sri Lanka, India, and the Maldive Islands had their first major DHF epidemics.Pakistan first reported an epidemic of dengue fever in 1994.The epidemics in Sri Lanka and India were associated with multiple dengue virus serotypes, but DEN-3 was predominant and was genetically distinct from DEN-3 viruses previously isolated from infected persons in those countries. In Asian countries where DHF is endemic, the epidemics have become progressively larger in the last 15 years. In 2005, dengue is the most important mosquito-borne viral disease affecting humans[2].Dengue virus is now endemic in Pakistan,
Motivational determinants among physicians in Lahore, Pakistan
Ahmad Malik, Shelby Yamamoto, Aurélia Souares, Zeeshan Malik, Rainer Sauerborn
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-201
Abstract: A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural.Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians.Motivational determinants differed across different levels of care, sectors and genders. Nonetheless, the important motivators across setups in this study were mostly intrinsic and socio-cultural, which are difficult to affect while the demotivators were largely organizational. Many can be addressed even at the facility level such as less personal safety and poor working conditions. Thus, in resource limited settings a good strategic starting point could be small scale changes that may markedly improve physicians' motivation and subsequently the quality of health care.The wor
Seroprevalence of dengue virus antibodies in asymptomatic Costa Rican children, 2002-2003: a pilot study
Iturrino-Monge,Roberto; Avila-Agüero,Maria L.; Avila-Agüero,Claudio R.; Moya-Moya,Tatiana; Ca?as-Coto,Alejandro; Camacho-Badilla,Kattia; Zambrano-Mora,Betzana;
Revista Panamericana de Salud Pública , 2006, DOI: 10.1590/S1020-49892006000700005
Abstract: objectives: since 1993 dengue has become more frequent in costa rica. adults have been the most affected population, while children have remained virtually unharmed. so far no studies have investigated how many asymptomatic children have been affected by this virus. this pilot study documents the seroprevalence, measured as the presence of igg antibodies, of dengue virus in asymptomatic children from two different geographical areas. methods: this descriptive, prospective epidemiologic study compared the presence of antibodies in children who live in a coastal region of a tropical country where dengue is endemic, and an inland area where dengue is not endemic. an enzyme-linked immunosorbent assay was used to test the serum for dengue virus igg antibodies. none of the children had a prior history of dengue, fever, immunosuppressive therapy or underlying disease. results: during the period from july 2002 to july 2003, 103 children were recruited from each area. in the costal region we found a seroprevalence of 36.9%. in the inland area seroprevalence was 2.9% conclusions: we found a substantial number of asymptomatic infections in costa rican children. this greatly increases the risk of dengue hemorrhagic fever or dengue shock syndrome in these children, in whom previous dengue infection had gone undetected. preventive efforts should be targeted at the costal region due to the higher prevalence in this area.
Spatial Evaluation and Modeling of Dengue Seroprevalence and Vector Density in Rio de Janeiro, Brazil  [PDF]
Nildimar Alves Honório ,Rita Maria Ribeiro Nogueira,Cláudia Torres Code?o,Marilia Sá Carvalho,Oswaldo Gon?alves Cruz,M?nica de Avelar Figueiredo Mafra Magalh?es,Josélio Maria Galv?o de Araújo,Eliane Saraiva Machado de Araújo,Marcelo Quintela Gomes,Luciane Silva Pinheiro,Célio da Silva Pinel,Ricardo Louren?o-de-Oliveira
PLOS Neglected Tropical Diseases , 2009, DOI: 10.1371/journal.pntd.0000545
Abstract: Background Rio de Janeiro, Brazil, experienced a severe dengue fever epidemic in 2008. This was the worst epidemic ever, characterized by a sharp increase in case-fatality rate, mainly among younger individuals. A combination of factors, such as climate, mosquito abundance, buildup of the susceptible population, or viral evolution, could explain the severity of this epidemic. The main objective of this study is to model the spatial patterns of dengue seroprevalence in three neighborhoods with different socioeconomic profiles in Rio de Janeiro. As blood sampling coincided with the peak of dengue transmission, we were also able to identify recent dengue infections and visually relate them to Aedes aegypti spatial distribution abundance. We analyzed individual and spatial factors associated with seroprevalence using Generalized Additive Model (GAM). Methodology/Principal Findings Three neighborhoods were investigated: a central urban neighborhood, and two isolated areas characterized as a slum and a suburban area. Weekly mosquito collections started in September 2006 and continued until March 2008. In each study area, 40 adult traps and 40 egg traps were installed in a random sample of premises, and two infestation indexes calculated: mean adult density and mean egg density. Sera from individuals living in the three neighborhoods were collected before the 2008 epidemic (July through November 2007) and during the epidemic (February through April 2008). Sera were tested for DENV-reactive IgM, IgG, Nested RT-PCR, and Real Time RT-PCR. From the before–after epidemics paired data, we described seroprevalence, recent dengue infections (asymptomatic or not), and seroconversion. Recent dengue infection varied from 1.3% to 14.1% among study areas. The highest IgM seropositivity occurred in the slum, where mosquito abundance was the lowest, but household conditions were the best for promoting contact between hosts and vectors. By fitting spatial GAM we found dengue seroprevalence hotspots located at the entrances of the two isolated communities, which are commercial activity areas with high human movement. No association between recent dengue infection and household's high mosquito abundance was observed in this sample. Conclusions/Significance This study contributes to better understanding the dynamics of dengue in Rio de Janeiro by assessing the relationship between dengue seroprevalence, recent dengue infection, and vector density. In conclusion, the variation in spatial seroprevalence patterns inside the neighborhoods, with significantly higher risk patches
Emergence and Diversification of Dengue 2 Cosmopolitan Genotype in Pakistan, 2011  [PDF]
Mohammad A. Khan, Esther M. Ellis, Hasitha A. Tissera, Mohammad Y. Alvi, Fatima F. Rahman, Faisal Masud, Angelia Chow, Shiqin Howe, Vijaykrishna Dhanasekaran, Brett R. Ellis, Duane J. Gubler
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0056391
Abstract: Major dengue epidemics have been observed in the Indian subcontinent since the 1980s and have occurred with increased hospitalizations and mortality. In 2011, the first major epidemic of dengue occurred in Lahore, the second largest city in Pakistan, and resulted in 21,685 confirmed cases and 350 deaths. To investigate the possible viral causes for the increased epidemic activity, we determined the predominant serotype and characterized the viruses genetically. Of 50 patients carefully selected as probable dengue fever or dengue hemorrhagic fever, 34 were positive by virologic testing (i.e. PCR and/or virus isolation). DENV-2 was detected in 32 patients and DENV-1 in two. A total of 24 partial and three full DENV genomes were sequenced. Phylogenetic analyses of the capsid (C), pre-membrane (prM), and envelope genes comprising 2500 nucleotides in length indicated that all DENV-2 isolates in Pakistan since 2007 form a monophyletic lineage that is endemic in the country. These viruses were all of the cosmopolitan genotype (IV) and most closely related to viruses isolated in India and Sri Lanka in the past two decades. Phylogenetic analyses of data currently available in GenBank suggest that the Cosmopolitan genotype has diverged into two geographically distinct sub-lineages: sub-lineage IV-a has only been observed in Southeast Asia, China and Oceania, while IV-b is prevalent in the Indian subcontinent. These results highlight the increased diversity of dengue viruses as they spread geographically within the region.
Community Knowledge, Health Beliefs, Practices and Experiences Related to Dengue Fever and Its Association with IgG Seropositivity  [PDF]
Li Ping Wong ,Sazaly AbuBakar,Karuthan Chinna
PLOS Neglected Tropical Diseases , 2014, DOI: 10.1371/journal.pntd.0002789
Abstract: Background Demographic, economic and behavioural factors are central features underpinning the successful management and biological control of dengue. This study aimed to examine these factors and their association with the seroprevalence of this disease. Methodology We conducted a cross-sectional telephone survey of households in a 3 km radius of the schools where we had conducted serological tests on the student population in a previous study. Households were surveyed about their socio-demographics, knowledge, practices, and Health Belief Model (HBM) constructs. The results were then associated with the prevalence rate of dengue in the community, as marked by IgG seropositivity of the students who attended school there. Results A total of 1,400 complete responses were obtained. The community's IgG seropositivity was significantly positively associated with high household monthly income, high-rise residential building type, high surrounding vegetation density, rural locality, high perceived severity and susceptibility, perceived barriers to prevention, knowing that a neighbour has dengue, frequent fogging and a higher level of knowledge about dengue. In the multivariate analyses, three major correlates of the presence of IgG seropositivity in the community: (1) high-rise residential apartment house type or condominium buildings; (2) the main construct of the HBM, perceived severity and susceptibility; and (3) the additional constructs of the HBM, lack of preventive measures from the community level and having a neighbour with dengue as a cue to action. Weak correlations were found between self-practices to prevent dengue and the level of dengue seropositivity in the community, and between HBM constructs and knowledge (r = 0.09). Conclusions The residential environment factor and the constructs of the HBM are useful and important elements in developing interventions to prevent and control dengue. The study also sheds light on the importance of the need for approaches that ensure the translation of knowledge into practice.
A Study of Suspended Participate Matter in Lahore (Pakistan)

K Hussain,Ruby Riffat,A Shaukat,M Ashraf Siddiqui,

大气科学进展 , 1990,
Abstract: The results obtained from an investigation of suspended particulate matter in the metropolitan city of Lahore (Pakistan) are reported and analysed in this paper. X-ray diffraction studies of the airborne matter collected from va-rious urban and suburban sites show that non-clay minerals such as quartz, calcite and albite are contained in most of the samples in almost comparable amounts. Chemical analysis of some samples was carried out for complementing the x-ray diffraction data. The amount of quartz in the samples of dusty areas was found to be an order of magnitude more than in the samples of relatively cleaner areas. As the dust particles of these compounds are poor substrate for promoting nucleation of ice in the atmospheric clouds, they are liable to stay steadily in the atmosphere as pollutants.A comparison of the results of the airborne particulates and the soil samples collected from various sites show that the sources of quartz, calcite and albite in the airborne matter are both local and remote.
High HCV seroprevalence and HIV drug use risk behaviors among injection drug users in Pakistan
Irene Kuo, Salman ul-Hasan, Noya Galai, David L Thomas, Tariq Zafar, Mohammad A Ahmed, Steffanie A Strathdee
Harm Reduction Journal , 2006, DOI: 10.1186/1477-7517-3-26
Abstract: From May to June 2003, 351 IDUs recruited in harm-reduction drop-in centers operated by a national non-governmental organization in Lahore (Punjab province) and Quetta (Balochistan province) completed an interviewer-administered survey and were tested for HIV and HCV. Multivariable logistic regression identified correlates of seropositivity, stratifying by site. All study participants provided written, informed consent.All but two were male; median age was 35 and <50% had any formal education. None were HIV-positive; HCV seroprevalence was 88%. HIV awareness was relatively high, but HCV awareness was low (19%). Injection behaviors and percutaneous exposures such as drawing blood into a syringe while injecting ('jerking'), longer duration of injection, and receiving a street barber shave were significantly associated with HCV seropositivity.Despite no HIV cases, overall HCV prevalence was very high, signaling the potential for a future HIV epidemic among IDUs across Pakistan. Programs to increase needle exchange, drug treatment and HIV and HCV awareness should be implemented immediately.Until recently, Pakistan had been classified as a country with a low seroprevalence but high potential for a HIV epidemic [1,2]. Several reasons given for this included the lack of resources to screen donations at blood banks, the use of unsterilized medical equipment, and the high prevalence of unnecessary medical injections where needles and syringes are often reused without proper sterilization [1,3].A growing risk for the transmission of bloodborne diseases in Pakistan is related to injection drug use [2]. Recent global HIV outbreaks in Indonesia, China, Vietnam, Eastern Europe and Central Asia have been driven by injection drug use [2,4-7]. Pakistan is especially vulnerable because it is a main trafficking route for opiates smuggled from Afghanistan, the world's largest producer of opium [8]. A recent report by the United Nations estimated a country-wide annual prevalence of 0.8%
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