<div style="text-align:justify;"> <b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></span><b>...<div style="text-align:justify;"> <b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></span><b> </b><span style="font-family:Verdana;">The interplay between financial deprivation and tuberculosis (TB) is considered one of the vital socio-economic determinants of disease. This is the first study of its kind to be carried in Pakistan, which aims to identify leading factors contributing towards catastrophic costs of TB diagnosis and management in order to help policy makers. <b></b></span><b><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">From </span><span style="font-family:Verdana;">f</span><span style="font-family:Verdana;">our tertiary care hospitals (TCH) in Islamabad and Rawalpindi</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> 400 TB patients were interviewed through a cross-sectional survey. The patient’s pre and post</span><span style="font-family:Verdana;">-</span><span "=""><span style="font-family:Verdana;">TB income and direct and indirect costs for treatment were analysed following WHO recommendations. Multivariable logistic regression model was used to identify the determinants of catastrophic total cost. <b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"><b></b></span><b><b> </b></b></b><span style="font-family:Verdana;"></span><span style="font-family:Verdana;"></span><span style="font-family:Verdana;">For TB management expenditures, the median (interquartile range) of total costs by households was Rs.</span></span><span "=""> </span><span style="font-family:Verdana;">58,175 Rs</span><span "=""> </span><span style="font-family:Verdana;">(32,050</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">97,500). At 20% threshold, 67% of TB patient’s households were affected by catastrophic costs. The determinants of the catastrophic total cost were as follows: patient/guardian employed (adjusted odds ratio [aOR] = 3.428, 95% confidence interval [CI]: 1.900</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">6.186), patient/guardian the only breadwinner (aOR = 1.751, 95% CI: 1.011</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">3.032), follow-up visits at current health facility (aOR = 1.352, 95% CI: 1.223</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">1.494), job loss (aOR = 3.381, 95% CI: 1.512</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">7.561), and unpaid sick leaves (aOR = 2.862, 95% CI: 1.249</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">6.558).</span><b><b><span "=""> </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> </span></b></b><span style="font-family:Verdana;">The fi</span><span style="font-family:Verdana;">nancial deprivation experienced by patients of low socio-economic status increases as TB treatment proceeds</span><span style="font-family:Verdana;">. This negatively impacts the treatment adherence, resulting in poor treatment outcomes due to income and job loss. Outcomes are exacerbated if the family has single breadwinner and treatment requires follow-up visits.</span> </div>展开更多
COVID-19 pandemic has become a serious public health crisis for developed and developing countries around the world.As of February 17,2022,over 420 million cases including 5.8 million deaths have been reported across ...COVID-19 pandemic has become a serious public health crisis for developed and developing countries around the world.As of February 17,2022,over 420 million cases including 5.8 million deaths have been reported across the globe[1].The first case of COVID-19 in Pakistan was detected on February 26,2020;since then,the toll of confirmed COVID-19 cases reached 1491423 including 29877 deaths as of February 17,2022[1].展开更多
Background: Previous case-control studies and a small number of cohort studies in high-risk populations have found an association between smoking and tuberculosis, but limited studies are available in the general popu...Background: Previous case-control studies and a small number of cohort studies in high-risk populations have found an association between smoking and tuberculosis, but limited studies are available in the general population that predicts association of smoking and TB. Objectives: To investigate the association between smoking and tuberculosis in a cohort of a general population. Methods: Four districts of Punjab province (Lahore, Rawalpindi, Faisalabad and Islamabad) were randomly selected. In routine, household contact investigation is practiced by the National TB Control Programme. For two years from July 2013-June 2015, all people who were living within 50 metres from the household of smear positive TB patients were screened for tuberculosis. Those found presumptive TB were investigated through smear microscopy and those found smear negative;the Xpert MTB/RIF test was done. All the diagnosed TB patients were referred to nearest basic health unit for further treatment and care. Results: A total of 783,043 contacts were screened for tuberculosis, of whom 19,815 (2.53%) were smokers. Smoking was common among men, in diabetic & teenage, elderly age population and in household contact of smear positive TB patients. Smoking was associated with an increased risk of tuberculosis (odds ratio [OR], 2.43;95% confidence interval, 2.27 - 2.60) in household contact of smear positive TB patients. The association was stronger among those greater than 45 years of age (OR, 11.09) than those between 25 - 44 years of age (OR, 5.83) and diabetic persons (OR, 2.0). Conclusions: Smoking was associated with a twofold increased risk of active tuberculosis in a cohort of general population.展开更多
Background:Fever of unknown origin(FUO)in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO.Methods:A multi-center study for infectious causes of FUO...Background:Fever of unknown origin(FUO)in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO.Methods:A multi-center study for infectious causes of FUO in lower middle-income countries(LMIC)and lowincome countries(LIC)was conducted between January 1,2018 and January 1,2023.In total,15 participating centers from seven different countries provided the data,which were collected through the Infectious DiseasesInternational Research Initiative platform.Only adult patients with confirmed infection as the cause of FUO were included in the study.The severity parameters were quick Sequential Organ Failure Assessment(qSOFA)≥2,intensive care unit(ICU)admission,vasopressor use,and invasive mechanical ventilation(IMV).Results:A total of 160 patients with infectious FUO were included in the study.Overall,148(92.5%)patients had community-acquired infections and 12(7.5%)had hospital-acquired infections.The most common infectious syndromes were tuberculosis(TB)(n=27,16.9%),infective endocarditis(n=25,15.6%),malaria(n=21,13.1%),brucellosis(n=15,9.4%),and typhoid fever(n=9,5.6%).Plasmodium falciparum,Mycobacterium tuberculosis,Brucellae,Staphylococcus aureus,Salmonella typhi,and Rickettsiae were the leading infectious agents in this study.A total of 56(35.0%)cases had invasive procedures for diagnosis.The mean qSOFA score was 0.76±0.94{median(interquartile range[IQR]):0(0–1)}.ICU admission(n=26,16.2%),vasopressor use(n=14,8.8%),and IMV(n=10,6.3%)were not rare.Overall,38(23.8%)patients had at least one of the severity parameters.The mortality rate was 15(9.4%),and the mortality was attributable to the infection causing FUO in 12(7.5%)patients.Conclusions:In LMIC and LIC,tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.展开更多
COVID-19 has swept globally and Pakistan is no exception.To investigate the initial introductions and transmissions of the SARS-CoV-2 in Pakistan,we performed the largest genomic epidemiology study of COVID-19 in Paki...COVID-19 has swept globally and Pakistan is no exception.To investigate the initial introductions and transmissions of the SARS-CoV-2 in Pakistan,we performed the largest genomic epidemiology study of COVID-19 in Pakistan and generated 150 complete SARS-CoV-2 genome sequences from samples collected from March 16 to June 1,2020.We identified a total of 347 mutated positions,31 of which were over-represented in Pakistan.Meanwhile,we found over 1000 intra-host single-nucleotide variants(iSNVs).Several of them occurred concurrently,indicating possible interactions among them or coevolution.Some of the high-frequency iSNVs in Pakistan were not observed in the global population,suggesting strong purifying selections.The genomic epidemiology revealed five distinctive spreading clusters.The largest cluster consisted of 74 viruses which were derived from different geographic locations of Pakistan and formed a deep hierarchical structure,indicating an extensive and persistent nation-wide transmission of the virus that was probably attributed to a signature mutation(G8371T in ORF1ab)of this cluster.Furthermore,28 putative international introductions were identified,several of which are consistent with the epidemiological investigations.In all,this study has inferred the possible pathways of introductions and transmissions of SARS-CoV-2 in Pakistan,which could aid ongoing and future viral surveillance and COVID-19 control.展开更多
The rapid spread of SARS-Co V-2 has significantly impacted the worldwide health system.The SARS-Co V-2 currently bears a remarkably low genetic diversity even though it carries one of the largest RNA genomes among vir...The rapid spread of SARS-Co V-2 has significantly impacted the worldwide health system.The SARS-Co V-2 currently bears a remarkably low genetic diversity even though it carries one of the largest RNA genomes among viruses(Rausch et al.,2020).However,the coronaviruses harbor the capability of undergoing recombination at a high rate which can lead to the emergence of novel viral derivatives(Rausch et al.,2020;Gribble et al.,2021).展开更多
Availability of mobile laboratories can facilitate rapid on-spot detection of pathogens,monitor its presence in certain populations and inform health authorities to take immediate remedial measures.Currently available...Availability of mobile laboratories can facilitate rapid on-spot detection of pathogens,monitor its presence in certain populations and inform health authorities to take immediate remedial measures.Currently available biosafety and biosecurity guidelines and policies may not completely articulate the increased demand to manage mobile units in infectious disease outbreaks in remote parts of the country for rapid diagnosis,and also allows research and epidemiological study take place appropriately.The main objective of this study is to evaluate the current limitations and develop and implement biosafety and biosecurity guidelines as well as the protocols for operations,security,and response plan of mobile biosafety level 2 laboratories and their deployment.Keeping in view the sensitivity of it,a comprehensive plan was developed to address it in view of Global Health Security framework.Biosafety and biosecurity protocols were developed including Risk Assessment Tool(RAT)fitting the needs and strengthen the diagnostic and epidemiological capacity in the field covering remote parts of country to fill the gaps observed during the COVID-19 pandemic.Currently the biosafety and biosecurity best practices guidelines and biosecurity policy and regulations are directed mostly towards static laboratories.A biosafety and biosecurity manual developed to adopt and meet the requirements for MBSL 2.For acute health infectious threats including the COVID-19 outbreak and other epidemics,rapid diagnosis can curb and mitigate the problem before it gets out of its boundaries creating significant health risks for the public and economy.The deployment of mobile laboratories will certainly help in curbing these catastrophes.展开更多
文摘<div style="text-align:justify;"> <b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></span><b> </b><span style="font-family:Verdana;">The interplay between financial deprivation and tuberculosis (TB) is considered one of the vital socio-economic determinants of disease. This is the first study of its kind to be carried in Pakistan, which aims to identify leading factors contributing towards catastrophic costs of TB diagnosis and management in order to help policy makers. <b></b></span><b><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">From </span><span style="font-family:Verdana;">f</span><span style="font-family:Verdana;">our tertiary care hospitals (TCH) in Islamabad and Rawalpindi</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> 400 TB patients were interviewed through a cross-sectional survey. The patient’s pre and post</span><span style="font-family:Verdana;">-</span><span "=""><span style="font-family:Verdana;">TB income and direct and indirect costs for treatment were analysed following WHO recommendations. Multivariable logistic regression model was used to identify the determinants of catastrophic total cost. <b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"><b></b></span><b><b> </b></b></b><span style="font-family:Verdana;"></span><span style="font-family:Verdana;"></span><span style="font-family:Verdana;">For TB management expenditures, the median (interquartile range) of total costs by households was Rs.</span></span><span "=""> </span><span style="font-family:Verdana;">58,175 Rs</span><span "=""> </span><span style="font-family:Verdana;">(32,050</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">97,500). At 20% threshold, 67% of TB patient’s households were affected by catastrophic costs. The determinants of the catastrophic total cost were as follows: patient/guardian employed (adjusted odds ratio [aOR] = 3.428, 95% confidence interval [CI]: 1.900</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">6.186), patient/guardian the only breadwinner (aOR = 1.751, 95% CI: 1.011</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">3.032), follow-up visits at current health facility (aOR = 1.352, 95% CI: 1.223</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">1.494), job loss (aOR = 3.381, 95% CI: 1.512</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">7.561), and unpaid sick leaves (aOR = 2.862, 95% CI: 1.249</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">6.558).</span><b><b><span "=""> </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> </span></b></b><span style="font-family:Verdana;">The fi</span><span style="font-family:Verdana;">nancial deprivation experienced by patients of low socio-economic status increases as TB treatment proceeds</span><span style="font-family:Verdana;">. This negatively impacts the treatment adherence, resulting in poor treatment outcomes due to income and job loss. Outcomes are exacerbated if the family has single breadwinner and treatment requires follow-up visits.</span> </div>
文摘COVID-19 pandemic has become a serious public health crisis for developed and developing countries around the world.As of February 17,2022,over 420 million cases including 5.8 million deaths have been reported across the globe[1].The first case of COVID-19 in Pakistan was detected on February 26,2020;since then,the toll of confirmed COVID-19 cases reached 1491423 including 29877 deaths as of February 17,2022[1].
文摘Background: Previous case-control studies and a small number of cohort studies in high-risk populations have found an association between smoking and tuberculosis, but limited studies are available in the general population that predicts association of smoking and TB. Objectives: To investigate the association between smoking and tuberculosis in a cohort of a general population. Methods: Four districts of Punjab province (Lahore, Rawalpindi, Faisalabad and Islamabad) were randomly selected. In routine, household contact investigation is practiced by the National TB Control Programme. For two years from July 2013-June 2015, all people who were living within 50 metres from the household of smear positive TB patients were screened for tuberculosis. Those found presumptive TB were investigated through smear microscopy and those found smear negative;the Xpert MTB/RIF test was done. All the diagnosed TB patients were referred to nearest basic health unit for further treatment and care. Results: A total of 783,043 contacts were screened for tuberculosis, of whom 19,815 (2.53%) were smokers. Smoking was common among men, in diabetic & teenage, elderly age population and in household contact of smear positive TB patients. Smoking was associated with an increased risk of tuberculosis (odds ratio [OR], 2.43;95% confidence interval, 2.27 - 2.60) in household contact of smear positive TB patients. The association was stronger among those greater than 45 years of age (OR, 11.09) than those between 25 - 44 years of age (OR, 5.83) and diabetic persons (OR, 2.0). Conclusions: Smoking was associated with a twofold increased risk of active tuberculosis in a cohort of general population.
文摘Background:Fever of unknown origin(FUO)in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO.Methods:A multi-center study for infectious causes of FUO in lower middle-income countries(LMIC)and lowincome countries(LIC)was conducted between January 1,2018 and January 1,2023.In total,15 participating centers from seven different countries provided the data,which were collected through the Infectious DiseasesInternational Research Initiative platform.Only adult patients with confirmed infection as the cause of FUO were included in the study.The severity parameters were quick Sequential Organ Failure Assessment(qSOFA)≥2,intensive care unit(ICU)admission,vasopressor use,and invasive mechanical ventilation(IMV).Results:A total of 160 patients with infectious FUO were included in the study.Overall,148(92.5%)patients had community-acquired infections and 12(7.5%)had hospital-acquired infections.The most common infectious syndromes were tuberculosis(TB)(n=27,16.9%),infective endocarditis(n=25,15.6%),malaria(n=21,13.1%),brucellosis(n=15,9.4%),and typhoid fever(n=9,5.6%).Plasmodium falciparum,Mycobacterium tuberculosis,Brucellae,Staphylococcus aureus,Salmonella typhi,and Rickettsiae were the leading infectious agents in this study.A total of 56(35.0%)cases had invasive procedures for diagnosis.The mean qSOFA score was 0.76±0.94{median(interquartile range[IQR]):0(0–1)}.ICU admission(n=26,16.2%),vasopressor use(n=14,8.8%),and IMV(n=10,6.3%)were not rare.Overall,38(23.8%)patients had at least one of the severity parameters.The mortality rate was 15(9.4%),and the mortality was attributable to the infection causing FUO in 12(7.5%)patients.Conclusions:In LMIC and LIC,tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.
基金supported by grants from the National Key R&D Program of China(Grant Nos.2021YFC0863300,2020YFC0848900,and 2016YFE0206600)the National Natural Science Foundation of China(Grant No.82161148009)+3 种基金the Strategic Priority Research Program of Chinese Academy of Sciences,China(Grant Nos.XDA19090116 and XDB38060100)the Open Biodiversity and Health Big Data Programme of International Union of Biological Sciences,International Partnership Program of Chinese Academy of Sciences(Grant No.153F11KYSB20160008)the Professional Association of the Alliance of International Science Organizations(Grant No.ANSO-PA-2020-07)the Youth Innovation Promotion Association of Chinese Academy of Sciences(Grant No.2017141)。
文摘COVID-19 has swept globally and Pakistan is no exception.To investigate the initial introductions and transmissions of the SARS-CoV-2 in Pakistan,we performed the largest genomic epidemiology study of COVID-19 in Pakistan and generated 150 complete SARS-CoV-2 genome sequences from samples collected from March 16 to June 1,2020.We identified a total of 347 mutated positions,31 of which were over-represented in Pakistan.Meanwhile,we found over 1000 intra-host single-nucleotide variants(iSNVs).Several of them occurred concurrently,indicating possible interactions among them or coevolution.Some of the high-frequency iSNVs in Pakistan were not observed in the global population,suggesting strong purifying selections.The genomic epidemiology revealed five distinctive spreading clusters.The largest cluster consisted of 74 viruses which were derived from different geographic locations of Pakistan and formed a deep hierarchical structure,indicating an extensive and persistent nation-wide transmission of the virus that was probably attributed to a signature mutation(G8371T in ORF1ab)of this cluster.Furthermore,28 putative international introductions were identified,several of which are consistent with the epidemiological investigations.In all,this study has inferred the possible pathways of introductions and transmissions of SARS-CoV-2 in Pakistan,which could aid ongoing and future viral surveillance and COVID-19 control.
文摘The rapid spread of SARS-Co V-2 has significantly impacted the worldwide health system.The SARS-Co V-2 currently bears a remarkably low genetic diversity even though it carries one of the largest RNA genomes among viruses(Rausch et al.,2020).However,the coronaviruses harbor the capability of undergoing recombination at a high rate which can lead to the emergence of novel viral derivatives(Rausch et al.,2020;Gribble et al.,2021).
文摘Availability of mobile laboratories can facilitate rapid on-spot detection of pathogens,monitor its presence in certain populations and inform health authorities to take immediate remedial measures.Currently available biosafety and biosecurity guidelines and policies may not completely articulate the increased demand to manage mobile units in infectious disease outbreaks in remote parts of the country for rapid diagnosis,and also allows research and epidemiological study take place appropriately.The main objective of this study is to evaluate the current limitations and develop and implement biosafety and biosecurity guidelines as well as the protocols for operations,security,and response plan of mobile biosafety level 2 laboratories and their deployment.Keeping in view the sensitivity of it,a comprehensive plan was developed to address it in view of Global Health Security framework.Biosafety and biosecurity protocols were developed including Risk Assessment Tool(RAT)fitting the needs and strengthen the diagnostic and epidemiological capacity in the field covering remote parts of country to fill the gaps observed during the COVID-19 pandemic.Currently the biosafety and biosecurity best practices guidelines and biosecurity policy and regulations are directed mostly towards static laboratories.A biosafety and biosecurity manual developed to adopt and meet the requirements for MBSL 2.For acute health infectious threats including the COVID-19 outbreak and other epidemics,rapid diagnosis can curb and mitigate the problem before it gets out of its boundaries creating significant health risks for the public and economy.The deployment of mobile laboratories will certainly help in curbing these catastrophes.
