Investigation of japanese encephalitis virus as a cause of acute encephalitis in southern Pakistan, april 2015-january 2018

Background: Japanese encephalitis (JE) occurs in fewer than 1% of JE virus (JEV) infections, often with catastrophic sequelae including death and neuropsychiatric disability. JEV transmission in Pakistan was documented in 1980s and 1990s, but recent evidence is lacking. Our objective was to investigate JEV as a cause of acute encephalitis in Pakistan.Methods: Persons aged ≥1 month with possible JE admitted to two acute care hospitals in Karachi, Pakistan from April 2015 to January 2018 were enrolled. Cerebrospinal fluid (CSF) or serum samples were tested for JEV immunoglobulin M (IgM) using the InBios JE DetectTM assay. Positive or equivocal samples had confirmatory testing using plaque reduction neutralization tests.Results: Among 227 patients, testing was performed on CSF in 174 (77%) and on serum in 53 (23%) patients. Six of eight patient samples positive or equivocal for JEV IgM had sufficient volume for confirmatory testing. One patient had evidence of recent West Nile virus (WNV) neurologic infection based on CSF testing. One patient each had recent dengue virus (DENV) infection and WNV infection based on serum results. Recent flavivirus infections were identified in two persons, one each based on CSF and serum results. Specific flaviviruses could not be identified due to serologic cross-reactivity. For the sixth person, JEV neutralizing antibodies were confirmed in CSF but there was insufficient volume for further testing.Conclusions: Hospital-based JE surveillance in Karachi, Pakistan could not confirm or exclude local JEV transmission. Nonetheless, Pakistan remains at risk for JE due to presence of the mosquito vector, amplifying hosts, and rice irrigation. Laboratory surveillance for JE should continue among persons with acute encephalitis. However, in view of serological cross-reactivity, confirmatory testing of JE IgM positive samples at a reference laboratory is essential

Quit Smoking for Life-Social Marketing Strategy for Youth: A Case for Pakistan

Smoking is the single most avoidable risk factor for cancers. Majority of smokers know about this fact but it is difficult for them to give it up mainly in the face of widespread smoking advertisements by the tobacco industries. To reduce the prevalence of smoking and its associated cancers, immediate actions are required by public health authorities. Social marketing is an effective strategy to promote healthy attitudes and influence people to make real, sustained health behavior change by transiting through different stages which include precontemplation, contemplation, preparation, action, and maintenance. Social marketing can influence smokers to voluntarily accept, reject, modify, or abandon their smoking behavior. In Pakistan, the smoking prevalence has been increasing, necessitating effective measures. The trend of its usage has been going upwards and, according to the World Health Organization, in Pakistan, the usage of cigarette smoking is increased by 30% compared to 1998 figures. The Pakistan Pediatrics Association has estimated 1,000 to 1,200 school-going children between the ages of 6 and 16 years take up smoking every day. In Pakistan, ex-smokers in the low socioeconomic group reported spending 25% of the total household income on this habit. This paper focuses on the antismoking social marketing strategy in Pakistan with an aim to reduce smoking prevalence, especially among the youth

Whether maternal factors are associated with childhood obesity: a matched case-control study

Background: Obesity in childhood has a major impact on health in terms of premature deaths and disabilities worldwide. Evidences from several robust studies has linked maternal obesity has with childhood obesity. Early identification of modifiable risk factors is the key to prevention in this vulnerable group that accounts for 45 percent of the total population in Pakistan. Objective: The association between childhood obesity, life style factors, and childhood history of breast feeding are mentioned elsewhere. This paper will only address whether maternal factors are related with the obesity in childhood. Methodology: An age- and sex-matched case–control study conducted from April 2012 to July 2012. Total sample size for the study was 528 school going children, aged 5–14 years of age (132 cases and 396 controls). Findings: Most of the mothers (64.4%), among the cases, and the controls were between 31–40 years of age. Maternal education was comparatively high for the cases (41%) as compared to the controls (32.1%). The rate of employment among cases and controls was (16.7%), and (13.6%) respectively. 12.9% of mothers among the cases, had positive history for chronic illnesses such as (Hypertension, Diabetes Mellitus, Asthma), and obesity as compared to (7.3%) of mothers among the controls had these diseases. Likewise, a higher percentage more mothers among the cases (5.3%) reported selfperception of obesity, as compared to controls (2.3%). Conclusion: We found no conclusive evidence of association between maternal risk factors and childhood obesity. In Pakistan, prospective studies are needed to develop understanding of modifiable risk factors to address the fast flowing epidemic by employing population based studies

Association between breastfeeding and childhood obesity among school-going children, 5-16 years of age in Karachi, Pakistan

Background: Overweight and obesity in children are major risk factors for adult obesity, associated chronic diseases, and premature deaths worldwide. In Pakistan, the rate of overweight and obesity among children is on rapid rise. A substantial body of evidences has suggested breast feeding, as being protective against childhood obesity. However, such an association is neither conclusive in literature nor has it been explored in the Pakistani context. Objective: This study aimed to investigate the association between breast feeding and childhood obesity in school going children, 5–16 years of age in Karachi. Pakistan. Methodology: In this study, 528 school going children, aged 5–14 years of age (132 cases and 396 controls) matched on age and gender, were recruited from public and private schools of Karachi. Findings: Conditional logistic regression results showed that being breast fed for less than 12 months [mORadj= 1.96; 95% CI (1.0–3.7)],having a history of not being exclusively breast fed [mORadj= 5.5; 95% CI (2.3–12.9)], exclusively breast fed for less than 3 months [mORadj= 4, 95% CI (2.0–7.8)], and exclusively breast fed for 4–5 months in school going children was [mORadj= 2.6; 95% CI (1.5–4.7)] associated with a higher obesity risk. Conclusion: Longer duration of breast feeding, and exclusive breast feeds have a protective effect against childhood obesity in a dose-response manner. In Pakistan, future longitudinal studies are urged to confirm this association because of its implications for public health

Urinary epidermal growth factor/monocyte chemotactic peptide 1 ratio as non-invasive predictor of Mayo clinic imaging classes in autosomal dominant polycystic kidney disease

Age- and height-adjusted total kidney volume is currently considered the best prognosticator in patients with autosomal dominant polycystic kidney disease. We tested the ratio of urinary epidermal growth factor and monocyte chemotactic peptide 1 for the prediction of the Mayo Clinic Imaging Classes