Hemoglobin adducts in paint industry workers: An electrophoretic analysis

Background: Hemoglobin (Hb) has a significant role among other blood proteins vital for carrying nutrients to blood cells. Being a conjugated protein, Hb is prone to be captured by compounds of low molecular weight like organic acid anhydrides (OAAs) which are prominent industrial/occupational hazards. Hindered or lowered availability of Hb to blood cells can cause anemia, thalassemia and porphyria. Along with these disorders, workers exposed to OAAs can also acquire like type-I allergy, type-IV allergy, skin problems, rhinitis and asthma. Revelation of Hb-OAAs compounds prior to appearance of actual symptoms could be important for subsequent therapy.Methods: The Hb separation was achieved successfully by SDS-PAGE electrophoresis on 10-15% gels of different concentration, stained with CBB-R250 Blue. Total of 66 blood protein samples were used for the comparative study of exposed workers of paint industry workers with control (normal) group to detect proteins, which might serve as marker for the early disease diagnosis.Results: The better Hb separation resolution was achieved on 12% gel as shown in electrograms. The electrograms of paint workers exposed to OAAs showed bands at 12, 48, 66, 78, 128 and 132 KDa in most of cases. In normal cases the bands were found at 13, 30, 48, 67, 76, 125 and 155 KDa in majority of control samples for Hb electrophoresis.Conclusion: This study supports the association between Hb and OAAs adducts among the exposed paint workers from hypersensitive effects like fever (rhinitis) leading to asthma, skin allergies and major clinical effects.

HIV infection predominantly affecting children in Sindh, Pakistan, 2019: a cross-sectional study of an outbreak.

BACKGROUND: In April 2019, an HIV screening camp for all ages was established in response to a report of an unusually large number of paediatric HIV diagnoses in Larkana, Pakistan. We aimed to understand the clinical profile of the children who registered for HIV care. METHODS: In this cross-sectional study, we review the outbreak response from the government, academia, and UN agencies in Larkana, Sindh, Pakistan. We report age-stratified and sex-stratified HIV prevalence estimated among individuals screened. For children who registered for HIV care, clinical history of previous injections and blood transfusions, HIV disease stage, hepatitis B and hepatitis C status, and CD4 count was abstracted from clinical records from Sindh AIDS Control Program HIV Clinic (Shaikh Zayed Childrens Hospital, Larkana, Pakistan) and analysed using percentages, χ2 tests, and weight-for-age Z scores. We also analysed data for parents who were tested for HIV. FINDINGS: Between April 24, and July 15, 2019, 31 239 individuals underwent HIV testing, of whom 930 (3%) tested positive for HIV. Of these, 763 (82%) were younger than 16 years and 604 (79%) of these were aged 5 years and below. Estimated HIV prevalence was 3% overall; 7% (283 of 3803) in children aged 0-2 years, 6% (321 of 5412) in children aged 3-5 years, and 1% (148 of 11 251) in adults aged 16-49 years. Of the 591 children who registered for HIV care, 478 (81%) were 5 years or younger, 379 (64%) were boys, and 315 (53%) of 590 had a weight-for-age Z score of -3·2. Prevalence of hepatitis B surface antigen was 8% (48 of 574) and hepatitis C antibody positivity was 3% (15 of 574). Of children whose mothers tested for HIV, only 39 (11%) of 371 had HIV-positive mothers. Most children (404 [89%] of 453) reported multiple previous injections and 40 (9%) of 453 reported blood transfusions. INTERPRETATION: This HIV outbreak is unprecedented among children in Pakistan: a 54% increase in paediatric HIV diagnoses over the past 13 years. The outbreak was heavily skewed towards young children younger than 5 years, with a predominance of boys. Epidemiological and molecular studies are needed to understand the full extent of the outbreak and its drivers to guide HIV control strategies. FUNDING: None

Investigation of an extensive outbreak of HIV infection among children in Sindh, Pakistan: protocol for a matched case-control study.

INTRODUCTION: In April 2019, 14 children were diagnosed with HIV infection by a private healthcare provider in Larkana district, Sindh province, Pakistan. Over the next 3 months, 930 individuals were diagnosed with HIV, >80% below 16 years, the largest ever outbreak of HIV in children in Pakistan. In this protocol paper, we describe research methods for assessing likely modes of HIV transmission in this outbreak and investigate spatial and molecular epidemiology. METHODS AND ANALYSIS: A matched case-control study will be conducted with 406 cases recruited. Cases will be children aged below 16 years registered for care at the HIV treatment centre at Shaikh Zayed Children Hospital in Larkana City. Controls will be children who are HIV-uninfected (confirmed by a rapid HIV test) matched 1:1 by age (within 1 year), sex and neighbourhood. Following written informed consent from the guardian, a structured questionnaire will be administered to collect data on sociodemographic indices and exposure to risk factors for parenteral, vertical and sexual (only among those aged above 10 years) HIV transmission. A blood sample will be collected for hepatitis B and C serology (cases and controls) and HIV lineage studies (cases only). Mothers of participants will be tested for HIV to investigate the possibility of mother-to-child transmission. Conditional logistic regression will be used to investigate the association of a priori defined risk factors with HIV infection. Phylogenetic analyses will be conducted. Global positioning system coordinates of participants' addresses will be collected to investigate concordance between the genetic and spatial epidemiology. ETHICS AND DISSEMINATION: Ethical approval was granted by the Ethics Review Committee of the Aga Khan University, Karachi. Study results will be shared with Sindh and National AIDS Control Programs, relevant governmental and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals

Phylogenetic and Drug-Resistance Analysis of HIV-1 Sequences From an Extensive Paediatric HIV-1 Outbreak in Larkana, Pakistan.

INTRODUCTION: In April 2019, an HIV-1 outbreak among children occurred in Larkana, Pakistan, affecting more than a thousand children. It was assumed that the outbreak originated from a single source, namely a doctor at a private health facility. In this study, we performed subtype distribution, phylogenetic and drug-resistance analysis of HIV-1 sequences from 2019 outbreak in Larkana, Pakistan. METHODS: A total of 401 blood samples were collected between April-June 2019, from children infected with HIV-1 aged 0-15 years recruited into a case-control study to investigate the risk factors for HIV-1 transmission. Partial HIV-1 pol sequences were generated from 344 blood plasma samples to determine HIV-1 subtype and drug resistance mutations (DRM). Maximum-likelihood phylogenetics based on outbreak and reference sequences was used to identify transmission clusters and assess the relationship between outbreak and key population sequences between and within the determined clusters. Bayesian analysis was employed to identify the time to the most recent common recent ancestor (tMRCA) of the main Pakistani clusters. RESULTS: The HIV-1 circulating recombinant form (CRF) 02_AG and subtype A1 were most common among the outbreak sequences. Of the treatment-naïve participants, the two most common mutations were RT: E138A (8%) and RT: K219Q (8%). Four supported clusters within the outbreak were identified, and the median tMRCAs of the Larkana outbreak sequences were estimated to 2016 for both the CRF02_AG and the subtype A1 clusters. Furthermore, outbreak sequences exhibited no phylogenetic mixing with sequences from other high-risk groups of Pakistan. CONCLUSION: The presence of multiple clusters indicated a multi-source outbreak, rather than a single source outbreak from a single health practitioner as previously suggested. The multiple introductions were likely a consequence of ongoing transmission within the high-risk groups of Larkana, and it is possible that the so-called Larkana strain was introduced into the general population through poor infection prevention control practices in healthcare settings. The study highlights the need to scale up HIV-1 prevention programmes among key population groups and improving infection prevention control in Pakistan

Serum enzymes activities in Plasmodium falciparum infection in Southern Pakistan

Objective: Serum levels of lactate dehydrogenase (LDH),aspartate aminotranferase (AST), alanine aminotransferase(ALT), and alkaline phosphatase (ALP) were assessed todetermine the liver functions of patients infected withPlasmodium falciparum. The enzyme activities were assessedin 60 malarial patients and a control group of 44 people.Materials and Methods: The data for the study was collectedfrom the survey conducted from Liaquat University of medicaland health sciences Hospital, Hyderabad, Pakaistan. Sample of60 patients aged between 20 and 50 years were collected. Acontrol group of 44 healthy individual adults was also assessedfor comparative purposes. All the malaria patients who visitedthe OPD during the study period enrolled in the study.Results: The LDH activity in male patients was found to be674.89 ± 33.354 IU/L. This is above the control LDH activity of296.59 ± 14.476 IU/L. Similarly, in female patients, the serumLDH activity of 580.25 ± 24.507 IU/L is over twice the controlfemale serum LDH activity of 302.18 ± 18.082 IU/L. Furtherone-way anova test was performed to find any significance ininfected and control male and female.Conclusion: Hepatic dysfunction was found to be associated toP. falciparum malaria infection

ASSESSMENT OF AIR POLLUTION CAUSED BY THERMAL POWER PLANT OF PAKISTAN STEEL

The aim of this study is to assess and analyse the. exhaust flue gases coming out from the chimney of Thermal Power Plant, and its effects on workers, vegetation and on the local environment. As there is no monitoring facility at source for the determination of toxic gases like S02 and NO2 therefore, ambient and work place diurnal monitoring was done for nine months regularly. The handy toximeters provided by Environment Protection Department of Pakistan Steel were used. At source only CO2, CO, H2, 02 and N2 were possible to be analysed and CO2 was considered as an indicator of burning efficiency.This paper presents the systematic and detailed analysis of toxic flue gases, their comparison with national and international standards, their effects on workers, vegetation and on the local environment

Stylistic Analysis of Ahmed Ali’s Short Story Our Lane

The undertaken study is based on stylistic analysis of Ahmed Ali’s short story Our Lane. The study analyzes how the author has used linguistic features like noun, adjective, conjunction, sentence complexity to portray the social, political, economic, religious, psychological and cultural conditions of the colonized natives of the Indian subcontinent in the wake of the British colonial rule. The story portrays how the colonial rule has deteriorated the people socially, economically, politically and psychologically. Ahmed Ali’s use of adjective is in consonant with the established norm of using 7 to 8% of the total text (Hofland & Johansson, 1987:6). Whereas, the median of 343 sentences is 13, which is shorter than the length of an average modern sentence, which according to Ellegard is 17.8 words. While rebutting colonial narrative, he deviates from the standards of English language: excessive use of coordinating conjunction ‘and’ is evidence to it. Most adjectives of positive characteristics qualify to the past, whereas the adjectives referring to present are either of negative or of neutral characteristics, and thus the writer recognizes the glory of the past and condemns the disintegrating present and uncertain future in the colonized land

Stylistic Analysis of Ahmed Ali’s Short Story Our Lane

The undertaken study is based on stylistic analysis of Ahmed Ali’s short story Our Lane. The study analyzes how the author has used linguistic features like noun, adjective, conjunction, sentence complexity to portray the social, political, economic, religious, psychological and cultural conditions of the colonized natives of the Indian subcontinent in the wake of the British colonial rule. The story portrays how the colonial rule has deteriorated the people socially, economically, politically and psychologically. Ahmed Ali’s use of adjective is in consonant with the established norm of using 7 to 8% of the total text (Hofland & Johansson, 1987:6). Whereas, the median of 343 sentences is 13, which is shorter than the length of an average modern sentence, which according to Ellegard is 17.8 words. While rebutting colonial narrative, he deviates from the standards of English language: excessive use of coordinating conjunction ‘and’ is evidence to it. Most adjectives of positive characteristics qualify to the past, whereas the adjectives referring to present are either of negative or of neutral characteristics, and thus the writer recognizes the glory of the past and condemns the disintegrating present and uncertain future in the colonized land

Longevity of serologic responses following a single dose of typhoid conjugate vaccine among children living with HIV in Pakistan: A prospective cohort study

Background: This study aimed to assess the longevity of serologic response and seroconversion rates at several time points following TCV vaccination among children living with HIV aged 6 months to 15 years in Pakistan.Methods: From November 20, 2020, to January 2, 2021; 336 children were enrolled and followed up prospectively for 12 months. Blood samples were collected before the administration of TCV and at 4-6 weeks, 6 months, and 1 year after administration of a single dose (0.5 ml) of intramuscular Typbar TCV®. Samples were analyzed for anti-Vi-IgG antibodies using ELISA. Geometric mean titers (GMTs), seroconversion rates (fourfold rise in anti-Vi-IgG from baseline), and factors associated with sustained seroconversion at 1 year were evaluated using generalized linear mixed models.Findings: The seroconversion rates were significantly lower in children aged 6 months to 5 years compared to children \u3e 5 years; (127/216 (58·8%)) versus (81/111 (73·0%)) at 6 months and (110/217 (50·7%)) versus (78/109 (71·6%)) at 1 year, only two-third; 188/326 (57·7%) remained seroconverted at 1 year. The GMTs (95 % CI) were significantly lower in children aged 6 months to 5 years compared to children \u3e 5 years, 9·6 (7·6, 12·0) versus 28·9 (20·2, 41·4) at 6 months, and 6·6 (5·4, 8·0) versus 23·1 (16·4, 32·5) at 1 year time point. The odds of sustained seroconversion significantly decreased with time (adjusted odds ratio (aOR): 0·232; 95 % CI: 0·136,0·396). The odds of sustained seroconversion following 1 year of TCV vaccination were significantly higher among children with non-severe HIV clinical disease (aOR: 10·6; 95 % CI: 1·5, 73·9) and children in elder age group (aOR: 7·45; 95 % CI: 11·2, 47·0).Conclusions: There was a decline in seroconversion after one year of TCV in children living with HIV. The decline was significant in children with severe or advanced HIV disease. A significant decrease in seroconversion rates was observed among children living with HIV following one year of TCV administration

Factors associated with HIV infection among children in Larkana district, Pakistan: A matched case-control study

Background: In April, 2019, an HIV outbreak predominantly affecting children occurred in Larkana District, Sindh, Pakistan. By December, 2019, 881 (4·0%) of 21 962 children screened for HIV had tested positive. We aimed to assess factors associated with HIV infection in this outbreak.Methods: In this individually matched case-control study, we sampled 406 cases (individuals aged Children\u27s Hospital in Larkana City, Pakistan) and 406 controls (individuals without HIV matched by age, sex, and neighbourhood residence, recruited through doorknocking at houses adjacent to case participants). An interviewer-administered questionnaire was used to collect data on possible risk factors for HIV acquisition and a blood sample was collected from all participants for hepatitis B and hepatitis C serology. Mothers of all participants underwent HIV testing. Odds ratios were estimated using conditional logistic regression to assess factors associated with HIV infection.Findings: 406 case-control pairs were recruited between July 3 and Dec 26, 2019. Five pairs were excluded (three pairs had an age mismatch and two pairs were duplicate cases) and 401 were analysed. The prevalence of hepatitis B surface antigen was 18·2% (95% CI 14·5-22·3) among cases and 5·2% (3·3-7·9) among controls, and the prevalence of hepatitis C antibodies was 6·5% (95% CI 4·3-9·4) among cases and 1·0% (0·3-2·5) among controls. 28 (7%) of 397 mothers of cases for whom we had data, and no mothers of 394 controls, were HIV positive. In the 6 months before recruitment, 226 (56%) of 401 cases and 32 (8%) of 401 controls reported having more than ten injections, and 291 (73%) cases and 78 (19%) controls had received an intravenous infusion. At least one blood transfusion was reported in 56 (14%) cases and three (1%) controls in the past 2 years. HIV infection was associated with a history of more injections and infusions (adjusted odds ratio 1·63; 95% CI 1·30-2·04, pInterpretation: The predominant mode of HIV transmission in this outbreak was parenteral, probably due to unsafe injection practices and poor blood safety practices. General practitioners across Pakistan need training and systems support in reducing injection use, and in providing safe injections and transfusions only when necessary.Funding: Department of Pediatrics and Child Health, the Aga Khan University, Karachi, Pakistan