Comparing risk factors of HIV among hijra sex workers in Larkana and other cities of Pakistan: an analytical cross sectional study

Background In 2005, Pakistan was first labeled as a country with concentrated epidemic of Human Immunodeficiency Virus (HIV). This was revealed through second generation surveillance conducted by HIV/AIDS Surveillance Project (HASP). While injection drug users (IDUs) were driving the epidemic, subsequent surveys showed that Hijra (transgender) sex workers (HSWs) were emerging as the second most vulnerable group with an average national prevalence of 6.4%. An exceptionally high prevalence (27.6%) was found in Larkana, which is a small town on the right bank of river Indus near the ruins of Mohenjo-Daro in the province of Sindh. This paper presents the risk factors associated with high prevalence of HIV among HSWs in Larkana as compared to other cities of the country. Methods Data were extracted for secondary analysis from 2008 Integrated behavioral and biological survey (IBBS) to compare HSWs living in Larkana with those living in other cities including Karachi and Hyderabad in Sindh; Lahore and Faisalabad in Punjab; and Peshawar in Khyber Pakhtunkhwa provinces. After descriptive analysis, univariate and multivariate analyses were performed to identify risk factors. P value of 0.25 or less was used to include factors in multivariate analysis. Results We compared 199 HSWs from Larkana with 420 HSWs from other cities. The average age of HSWs in Larkana was 26.42 (±5.4) years. Majority were Sindhi speaking (80%), uneducated (68%) and unmarried (97%). In univariate analysis, factors associated with higher prevalence of HIV in Larkana included younger age i.e. 20–24 years (OR: 5.8, CI: 2.809–12.15), being unmarried (OR: 2.4, CI: 1.0–5.7), sex work as the only mode of income (OR: 5.5, CI: 3.70–8.2) and longer duration of being involved in sex work 5–10 years (OR: 3.3, CI: 1.7–6.12). In multivariate logistic regression the HSWs from Larkana were more likely to lack knowledge regarding preventive measures against HIV (OR 11.9, CI: 3.4–41.08) and were more prone to use of alcohol during anal intercourse (OR: 6.3, CI: 2.77–17.797). Conclusion Outreach programs focusing on safer sexual practices and VCT are urgently needed to address the upsurge of HIV among HSWs in Larkana

Research fatigue among injecting drug users in Karachi, Pakistan

Background Karachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities. It is also the epicenter of HIV epidemic in the country. Since 2004, one pilot study and four behavioral and biological surveillance rounds have been conducted in Karachi. In addition many student research projects have also focused on key risk groups including injection drug users (IDUs). As a result of this extra ordinary exposure of same kind of questions, IDUs know how to respond to high value questions related to sharing of needles or unsafe sexual practices. The purpose of the study was to explore the element of research fatigue among IDUs in Karachi, Pakistan. Methods The study was conducted on 32 spots in Karachi, selected on the basis of estimate of IDUs at each spot. A trained field worker (recovered IDU) visited each spot; observed sharing behavior of IDUs and asked questions related to practices in January 2009. Verbal consent was obtained from each respondent before asking questions. Results On average 14 IDUs were present at each spot and out of 32 selected spots, 81% were active while more than two groups were present at 69% spots. In each group three to four IDUs were present and everyone in the group was sharing. One dose of injecting narcotics was observed. Sharing of syringes, needles and distilled water was observed at 63% spots while professional injector/street doctor was present at 60% spots. Conclusion There is a need to check internal consistency in surveillance research. It is highly likely that IDUs and other risk groups know how to respond to key questions but their responses do not match with the practices

Urdu News Clustering Using K-Mean Algorithm On The Basis Of Jaccard Coefficient And Dice Coefficient Similarity

Clustering is the unsupervised machine learning process that group data objects into clusters such that objects within the same cluster are highly similar to one another. Every day the quantity of Urdu text is increasing at a high speed on the internet. Grouping Urdu news manually is almost impossible, and there is an utmost need to device a mechanism which cluster Urdu news documents based on their similarity. Clustering Urdu news documents with accuracy is a research issue and it can be solved by using similarity techniques i.e., Jaccard and Dice coefficient, and clustering k-mean algorithm. In this research, the Jaccard and Dice coefficient has been used to find the similarity score of Urdu News documents in python programming language. For the purpose of clustering, the similarity results have been loaded to Waikato Environment for Knowledge Analysis (WEKA), by using k-mean algorithm the Urdu news documents have been clustered into five clusters. The obtained cluster's results were evaluated in terms of Accuracy and Mean Square Error (MSE). The Accuracy and MSE of Jaccard was 85% and 44.4%, while the Accuracy and MSE of Dice coefficient was 87% and 35.76%. The experimental result shows that Dice coefficient is better as compared to Jaccard similarity on the basis of Accuracy and MSE

Investigation of Cloud Scheduling Algorithms for Resource Utilization Using CloudSim

Compute Cloud comprises a distributed set of High-Performance Computing (HPC) machines to stipulate on-demand computing services to remote users over the internet. Clouds are capable enough to provide an optimal solution to address the ever-increasing computation and storage demands of large scientific HPC applications. To attain good computing performances, mapping of Cloud jobs to the compute resources is a very crucial process. Currently we can say that several efficient Cloud scheduling heuristics are available, however, selecting an appropriate scheduler for the given environment (i.e., jobs and machines heterogeneity) and scheduling objectives (such as minimized makespan, higher throughput, increased resource utilization, load balanced mapping, etc.) is still a difficult task. In this paper, we consider ten important scheduling heuristics (i.e., opportunistic load balancing algorithm, proactive simulation-based scheduling and load balancing, proactive simulation-based scheduling and enhanced load balancing, minimum completion time, Min-Min, load balance improved Min-Min, Max-Min, resource-aware scheduling algorithm, task-aware scheduling algorithm, and Sufferage) to perform an extensive empirical study to insight the scheduling mechanisms and the attainment of the major scheduling objectives. This study assumes that the Cloud job pool consists of a collection of independent and compute-intensive tasks that are statically scheduled to minimize the total execution time of a workload. The experiments are performed using two synthetic and one benchmark GoCJ workloads on a renowned Cloud simulator CloudSim. This empirical study presents a detailed analysis and insights into the circumstances requiring a load balanced scheduling mechanism to improve overall execution performance in terms of makespan, throughput, and resource utilization. The outcomes have revealed that the Sufferage and task-aware scheduling algorithm produce minimum makespan for the Cloud jobs. However, these two scheduling heuristics are not efficient enough to exploit the full computing capabilities of Cloud virtual machines

Stigmatisation in chronic hepatitis B and C infections-time to debunk the myth!

Background: Hepatitis B and C are chronic diseases with mental and social impacts which can result in poor quality of life. The routes of transmission and lack of education among the masses may cause stigmatisation of the affected patients.  The aim of the study was to document the stigmatisation among chronic hepatitis B and C positive patients. Methods: The 242 patients suffering from hepatitis B and C were included in the study. Stigma experienced from relatives, friends, spouse and health care providers was assessed using a semi structured questionnaire. Results: Majority of the patients were males 174 (72%). The 162 (67%) were hepatitis B infected and 76 (32%) were Hepatitis C infected and 4 were dual infected. Male patients were significantly more affected than females in term of changes in lifestyle (86% versus 61%) and changes in relationship with the spouse (89% versus 16%). Significantly more females than males reported feelings of loneliness and isolation (64% versus 30%). Stigma was marked in terms of disease transmission, with 170 (70%) of patients fearing that they could transmit the infection to others. Marital relationships were affected for 52% of married patients. Around 80% unmarried patients were experiencing delay in getting married. Conclusions: Patients comments showed a sense of family and societal discrimination resulting in feelings of disappointment which could be changed by educational interventions, effective patient and family centric awareness and scientific models of approach

Recycling of Injection Equipment in Pakistan

The prevalence of hepatitis C virus (HCV) infection is high in the general population in Pakistan, ranging from 2% to 6%. Reuse of injection equipment in the absence of sterilization is common, particularly in healthcare facilities that serve low-income populations. Studies have identified unsafe injection practices as a major route of transmission of HCV in Pakistan. Changing the behavior of injection providers so that they would use new freshly opened disposable syringes would improve injection safety in Pakistan. However, frequent reports of recycling of injection equipment in the local media question the safety of apparently new syringes. Clinical laboratories are one of the major sources of production of used syringes. To evaluate the resale of used syringes, we followed the course of used syringes from their initial use to their final destinatio

High risk behaviors of injection drug users registered with harm reduction programme in Karachi, Pakistan

BACKGROUND: Surveillance data of Sindh AIDS Control Programme, Pakistan suggest that HIV infection is rapidly increasing among IDUs in Karachi and has reached 9% in 2004–5 indicating that the country has progressed from nascent to concentrated level of HIV epidemic. Findings of 2(nd )generation surveillance in 2004–5 also indicate 104/395 (26.3%) IDUs HIV positive in the city. METHODS: We conducted a cross sectional study among registered IDUs of a needle exchange and harm reduction programme in Karachi, Pakistan. A total of 161 IDUs were included in the study between October–November 2003. A detailed questionnaire was implemented and blood samples were collected for HIV, hepatitis B & C and syphilis. HIV, hepatitis B and C antibody tests were performed using Enzyme Linked Immunosorbent Assay (ELISA) method. Syphilis tests (RPR & TPHA) were performed on Randox kit. Besides calculating frequencies univariate analysis was performed using t tests for continuous variables as age, age at first intercourse and average age of initiation of addiction and chi square for categorical variables like paid for sex or not to identify risk factors for hepatitis B and C and syphilis. RESULTS: Average age of IDU was 35.9 years and average age of initiation of drugs was 15.9 years. Number of drug injections per day was 2.3. Shooting drugs in group sharing syringes was reported by 128 (79.5%) IDUs. Over half 94 (58.3%) reported paying for sex and 64% reported never using a condom. Commercial selling of blood was reported by 44 (28%). 1 of 161 was HIV positive (0.6%). The prevalence of hepatitis B was 12 (7.5%), hepatitis C 151 (94.3%) and syphilis 21 (13.1%). IDUs who were hepatitis C positive were more likely to start sexual activity at an earlier age and had never used condoms. Similarly IDUs who were hepatitis B positive were more likely to belong to a younger age group. Syphilis positive IDUs were more likely to have paid for sex and had never used a condom. CONCLUSION: Prudent measures such as access to sterile syringes, rehabilitation and opiate substitution therapies are required to reduce high risk behaviors of IDUs in Pakistan

Association between Injections and HIV Incidence

Editors of medical journals accept that published research should be open to comment and correction in published correspondence ([1]; Box 1).“Post-publication peer review” enables comments on, clarifications of, and corrections to published research. All journals should have a correspondence page for this purpose. I previously criticised the effective “statute of limitations” in several leading general medical journals “whereby authors of papers are immune to disclosure of methodological weaknesses once some arbitrar

Role of fibreoptic bronchoscopy in haemoptysis: an analysis of 157 patients

Background: Objectives of this study were to define the role of fibreoptic bronchoscopy (FOB) in determining the etiology of haemoptysis, to determine whether bronchoscopy is useful in haemoptysis with normal chest x-ray, to determine whether early bronchoscopy is better than delayed bronchoscopy.Methods: This prospective study was conducted on 157 patients who presented with hemoptysis to the Department of Tuberculosis and Chest diseases. All these patients underwent FOB after taking proper history and examination and ruling out any contraindication to the procedure.Results: In patients with haemoptysis with normal CXR, a diagnosis was established in 54.5% by FOB while 38.6% had a normal bronchoscopy. An endoscopic diagnosis of bronchitis was made in 22.7% patients. In only 9.1% patients an endobronchial mass was seen on bronchoscopy, and all of them were more than 40 years of age. Active bleeding/bleeding site was localized in 18.1% patients. In patients with abnormal chest roentgenogram who underwent FOB, a definitive diagnosis was established in 75.4% cases with active bleeding/ bleeding site localized in 59.6%. Thirty five percent were having an endobronchial mass. Of all the patients who underwent FOB for recurrent haemoptysis, active bleeding/bleeding site was localized in 48.4% patients. Bleeding site was localized in 62.9% patients who underwent early FOB, while the yield was lower (29.4%) in patients who underwent delayed FOB.Conclusions: Fibreoptic bronchoscopy (FOB) is an important and useful investigation in patients of haemoptysis in determining the bleeding site and etiology of haemoptysis. Early FOB has higher yield in localizing the bleeding site than delayed FOB.