BACKGROUND & AIMS: :District Dir is a part of North-West frontier Province (NWFP) in Pakistan with poor health, education and socioeconomic and other facilities. Data regarding occupational cancer were here collected from cancer registry of Institute of Radiotherapy and Nuclear Medicine (IRNUM) Peshawar for January-2000 to December-2004 and medical records of 1105 patients were traced and analyzed. It was observed that 61 % (683/1105) were males and 39% females. Farmers accounted for 43.8% of cancers, the second most effected people being housewives with 33.8% then children/students at third place with 12.8%. Cancers in laborers and other people like government employees, businessman and shopkeepers were less often found. The data from a cancer registry for a low socioeconomic region should be helpful for future mass screening and determination of risk factors within the country and in Asia in general region. Increased awareness by education is highly important and may play a beneficial role in diagnosis, treatment and prevention.

背景与目标： : District Dir是巴基斯坦西北边境省 (NWFP) 的一部分，健康，教育，社会经济和其他设施都很差。有关职业性癌症的数据是从白沙瓦放射治疗和核医学研究所 (IRNUM) 癌症登记处收集的，用于1月-2000至12月-2004，并追踪和分析了1105例患者的病历。据观察，61% (683/1105) 为男性，39% 为女性。农民占癌症的43.8%，第二受影响的人是33.8% 的家庭主妇，然后是12.8% 的第三名的儿童/学生。很少发现劳工和政府雇员，商人和店主等其他人的癌症。来自低社会经济区域的癌症登记处的数据应该有助于未来的大规模筛查和确定该国和亚洲一般区域的危险因素。通过教育提高认识非常重要，并且可能在诊断，治疗和预防中发挥有益作用。

BACKGROUND & AIMS: BACKGROUND:Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. METHODS:A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. RESULTS:HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. CONCLUSION:Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real, rather than perceived needs. With a large part of HIV program funding dedicated to public-private partnerships, it becomes imperative to develop public sector capacity to administer contracts, coordinate and monitor activities of the non-governmental sector.

背景与目标：

BACKGROUND & AIMS: :The fate of trace elements (like Ca, Fe, Al, Pb, K, and Cu) in various pulses (mash, mung, lentils and red kidney beans) of Pakistan has been studied. Samples were collected from two districts (Mansehra and Rawalpindi) and analyzed by wet acid digestion method using atomic absorption spectrophotometry. Experimental results show that the intensity of heavy metal accumulation in plants depends upon the type of the soil, the species of plants, the physicochemical properties of heavy metals, and their content in the soil. The obtained values were compared with the World Health Organization (WHO) standards for food quality. The grains from District Mansehra contained greater amount of trace metals as compared to those collected from District Rawalpindi. However, those values did not exceed the upper limits described by the WHO in nearly all the cases. Based on these findings, the consumption of pulses in larger amounts may easily be recommended.

背景与目标： : 研究了巴基斯坦各种脉冲 (mash，mung，小扁豆和红芸豆) 中微量元素 (如Ca，Fe，Al，Pb，K和Cu) 的命运。从两个地区 (Mansehra和Rawalpindi) 收集样品，并使用原子吸收分光光度法通过湿酸消解法进行分析。实验结果表明，植物中重金属积累的强度取决于土壤的类型，植物的种类，重金属的理化性质及其在土壤中的含量。将获得的值与食品质量的世卫组织标准进行比较。与从拉瓦尔品第地区收集的谷物相比，曼塞拉地区的谷物含有更多的痕量金属。然而，在几乎所有情况下，这些值都没有超过世卫组织描述的上限。基于这些发现，可以很容易地建议大量消耗脉冲。

BACKGROUND & AIMS: OBJECTIVE:To evaluate the biological activity of Elaeagnus umbellata extracts on standard microorganism strains as well as multi-drug resistant bacteria isolated from hospitals. METHODS:We carried out this study at the Plant Pathology Laboratory of the University College of Agriculture, Rawalakot Pakistan during the period between September-November 2004. Flowers, leaves, and berries of the plant were extracted in different solvents and tested for their antibacterial activity by disc diffusion method on selected organisms like methicillin resistant Staphylococcus aureus (S. aureus), multi-drug resistant Pseudomonas aeruginosa (P. aeruginosa), and enterohemorrhagic Escherichia coli (E. coli). RESULTS:The ether extract of flower was found to be highly effective against E. coli, P. aeruginosa, S. aureus, and Bacillus subtilis (B. subtilis). The alcohol extract of these leaves also demonstrated strong activity against gram positive and negative bacteria. The aqueous extract from the berry strongly inhibited the growth of E. coli and S. aureus whereas, it exhibited a very small zone of inhibition against B. subtilis. Multi-drug resistant P. aeruginosa was found completely resistant to aqueous extract. The acetone extract of the berry showed good activity against P. aeruginosa. CONCLUSION:The present study reports the antibacterial activity of Elaeagnus umbellata. Most of the extracts displayed broad-spectrum activity, since gram positive bacteria including S. aureus, B. subtilis and gram-negative bacteria including E. coli and P. aeruginosa were inhibited. These preliminary findings may provide the basis for traditional use of this plant in the treatment of infectious diseases.

背景与目标：

BACKGROUND & AIMS: :The present study was intended to report the incidence of the most frequently occurring β-thalassemia (β-thal) mutations in the Kohat region [Khyber Pakhtunkhwa (KP) Province, Pakistan], their inheritance pattern in patients, and consanguinity in the parents. Moreover, this study could provide valuable information regarding thalassemia diagnoses such as prenatal diagnosis (PND), genetic counseling and carrier screening for controlling the affected births in the population. During this study, 160 peripheral blood samples of affected patients, their parents and siblings were collected from 25 discrete families having at least one child needing regular blood transfusions from different areas of the Kohat region. β-Thalassemia mutations found in the population were screened via the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). A total of 320 alleles was evaluated for the presence of six β-thal mutations. Of these six β-thal mutations, the frameshift codons (FSC) 8/9 (+G) (HBB: c.27_28insG) was found to be the most frequent in the studied population, and more interestingly, followed by IVS-I-5 (G>C) (HBB: c.92+5G>C) and FSC 5 (-CT) (HBB: c.17_18delCT). The findings of the present study show differences with previous results from other regions of the Pashtun population, which demarcates the heterogeneity in mutations found in the Pashtun ethnicity. These observations may help in implementing parental meetings about disease recurrence in future, large scale mutation screening and PND for the population of the Kohat region and also the whole Pashtun ethnicity.

背景与目标： : 本研究旨在报告巴基斯坦开伯尔-普赫图赫瓦 (KP) 省Kohat地区最常见的 β-地中海贫血 (β-thal) 突变的发生率，患者的遗传模式以及父母的血缘关系。此外，这项研究可以提供有关地中海贫血诊断的有价值的信息，例如产前诊断 (PND)，遗传咨询和携带者筛查，以控制人群中受影响的分娩。在这项研究中，从25个离散的家庭中收集了受影响患者，其父母和兄弟姐妹的160个外周血样本，这些家庭至少有一个孩子需要从Kohat地区的不同地区定期输血。通过扩增难治性突变系统-聚合酶链反应 (ARMS-PCR) 筛选人群中发现的 β-地中海贫血突变。评估了总共320个等位基因的六个 β-thal突变的存在。在这六个 β-thal突变中，发现移码密码子 (FSC) 8/9 (+ G) (HBB: c.27 _ 28insG) 是研究人群中最常见的，更有趣的是，其次是IVS-I-5 (G>C) (HBB: c.92 + 5G>C) 和FSC 5 (-CT) (HBB: c.17_18 delCT)。本研究的结果表明，与普什图族其他地区的先前结果存在差异，从而界定了普什图族中发现的突变的异质性。这些观察结果可能有助于在将来进行有关疾病复发的父母会议，对Kohat地区以及整个Pashtun种族进行大规模突变筛查和PND。

BACKGROUND & AIMS: BACKGROUND:Ethnoveterinary medicine is crucial in many rural areas of the world since people living in remote and marginal areas rely significantly on traditional herbal therapies to treat their domestic animals. In Pakistan, communities residing in remote areas, and especially those still attached to pastoralist traditions, have considerable ethnoveterinary herbal knowledge and they sometimes use this knowledge for treating their animals. The main aim of the study was to review the literature about ethnoveterinary herbals being used in Pakistan in order to articulate potential applications in modern veterinary medicine. Moreover, the review aimed to analyze possible cross-cultural and cross regional differences. METHODS:We considered the ethnobotanical data of Pakistan published in different scientific journals from 2004 to 2018. A total of 35 studies were found on ethnoveterinary herbal medicines in the country. Due to the low number of field studies, we considered all peer-reviewed articles on ethnoveterinary herbal practices in the current review. All the ethnobotanical information included in these studies derived from interviews which were conducted with shepherds/animals breeders as well as healers. RESULTS:Data from the reviewed studies showed that 474 plant species corresponding to 2386 remedies have been used for treating domestic animals in Pakistan. The majority of these plants belong to Poaceae (41 species) followed by the Asteraceae (32 species) and Fabaceae (29 species) botanical families, thus indicating a possible prevalence of horticultural-driven gathering patterns. Digestive problems were the most commonly treated diseases (25%; 606 remedies used), revealing the preference that locals have for treating mainly minor animal ailments with herbs. The least known veterinary plants recorded in Pakistan were Abutilon theophrasti, Agrostis gigantea, Allardia tomentosa, Aristida adscensionis, Bothriochloa bladhii, Buddleja asiatica, Cocculus hirsutus, Cochlospermum religiosum, Cynanchum viminale, Dactylis glomerata, Debregeasia saeneb, Dichanthium annulatum, Dracocephalum nuristanicum, Flueggea leucopyrus, Launaea nudicaulis, Litsea monopetala, Sibbaldianthe bifurca, Spiraea altaica, and Thalictrum foetidum. More importantly, cross-cultural comparative analysis of Pathan and non-Pathan ethnic communities showed that 28% of the veterinary plants were mentioned by both communities. Cross-regional comparison demonstrated that only 10% of the plant species were used in both mountain and plain areas. Reviewed data confirm therefore that both ecological and cultural factors play a crucial role in shaping traditional plant uses. CONCLUSION:The herbal ethnoveterinary heritage of Pakistan is remarkable, possibly because of the pastoral origins of most of its peoples. The integration of the analyzed complex bio-cultural heritage into daily veterinary practices should be urgently fostered by governmental and non-governmental institutions dealing with rural development policies in order to promote the use of local biodiversity for improving animal well-being and possibly the quality of animal food products as well.

背景与目标：

BACKGROUND & AIMS: :The present study was conducted to explore morphometric variations of Pteropus medius (the Indian flying fox) and the roosting trees in Lower Dir, Pakistan. The bats were captured from Morus alba, Morus nigra, Brousonetia papyrifera, Pinus raxburghii, Hevea brasiliensis, Platanus orientalis, Populous nigra, Melia azedarach, Eucalyptus camaldulensis and Grevillea robusta through sling shot and mess net methods. A total of 12 bats were studied for the differential morphological features based on age and sex. Male bats were recorded higher in weight than females. The variations were found in body mass (821.1±34.65gm), circumference of body with wings (25.43±0.39cm), wingspan (112.58±1.90cm), Body length (20.73±0.68cm), Snout length (3.42±0.04cm), Eye length (1.45±0.033cm), Length of ear (3.56±0.05cm), Width of ear (2.46±0.04cm), Length b/w ear (5.51±0.11cm), Circumference of neck (12.23±0.24cm), Circumference of body without wings (18.68±0.31cm), Arm wing length (23.2±1.03cm), Length of thumb (5.43±0.1cm), Length of nail (1.89±0.05cm), Hand wing length (29.1±0.51cm), Maximum width of wing (21.03±0.68cm), Length b/w tip of wing to 5th digit (29.39±0.30cm), Length b/w 5th digit to foot (22.97±1.09cm), Length b/w feet (18.31±0.74cm) and Length of foot claw (4.23±0.05cm). This study was designed for analysis of external morphological variations for P. medius (the Indian flying fox) that may help in identification of these bats and their roosting sites.

背景与目标： : 本研究旨在探索Pteropus medius (印度飞狐) 和巴基斯坦Lower Dir的栖息树木的形态变化。蝙蝠是通过吊带射击和杂乱网方法从桑树，黑桑树，木瓜，松松，巴西橡胶树，东方悬铃木，人口众多的黑树，油菜，桉树和Grevillea robusta捕获的。总共研究了12只蝙蝠的年龄和性别差异形态特征。记录到雄性蝙蝠的体重高于雌性。体重 (821.1 ± 34.65gm)，有翅膀的身体周长 (25.43 ± 0.39厘米)，翼展 (112.58 ± 1.90厘米)，体长 (20.73 ± 0.68厘米)，鼻子长 (3.42 ± 0.04厘米)，眼长 (1.45 ± 0.033厘米)，耳长 (3.56 ± 0.05厘米)，耳宽 (2.46 ± 0.04厘米)，耳长b/w (5.51 ± 0.11厘米)，颈围 (12.23 ± 0.24厘米)，无翼体围 (18.68 ± 0.31厘米)，臂翼长 (23.2 ± 1.03厘米)，拇指长度 (5.43 ± 0.1厘米)，指甲长度 (1.89 ± 0.05厘米)，手翼长度 (29.1 ± 0.51厘米)，翼最大宽度 (21.03 ± 0.68厘米)，翼尖到第5位长度b/w (29.39 ± 0.30厘米)，到脚的长度b/w第5位 (22.97 ± 1.09厘米)，脚的长度b/w (18.31 ± 0.74厘米) 和脚爪的长度 (4.23 ± 0.05厘米)。这项研究旨在分析P. medius (印度飞狐) 的外部形态变化，这可能有助于识别这些蝙蝠及其栖息地点。

BACKGROUND & AIMS: :Urbanization can increase the vulnerability of soils to various types of contamination. Increased contamination of urban soils with polycyclic aromatic hydrocarbon (PAH) could relate to increased number of petrol pump stations and mechanical workshops-a phenomenon that needs to be constantly monitored. This study was undertaken to explore the soil PAH levels in Rawalpindi and Islamabad urban areas in relation to land use activities. Composite soil samples from petrol pump stations and mechanical workshops (n = 32) areas were evaluated for five PAHs--naphthalene, phenanthrene, pyrene, benzo[a]pyrene, and indeno(1,2,3-cd)pyrene-and compared with control area locations with minimum petroleum-related activity (n = 16). Surface samples up to 3 cm depth were collected and extraction of analytes was carried out using n-hexane and dichloromethane. Prior to running the samples, standards (100 μg ml(-1)) were run on HPLC to optimize signal to noise ratio using acetonitrile as mobile phase at a flow rate of 1.25 ml/min at 40 °C. Significant differences between petrol pump stations and mechanical workshop areas were observed for individual PAH as well as with control area soil samples. Naphthalene was found to be the most abundant PAH in soil, ranging from 2.47 to 24.36 mg kg(-1). Correlation between the benzo[a]pyrene (BaP) level in soil and the total PAH concentration (r = 0.82, P < 0.0001) revealed that BaP can be used as a potential marker for PAH pollution. A clear segregation between petrogenic and pyrogenic sources of contamination was observed when low molecular weight PAHs detected in soil was plotted against high molecular weight PAHs. The former source comprised lubricants and used engine oil found at mechanical workshops, whereas the latter could be mostly attributed to vehicular emission at petrol pumps. The results indicate that PAH contamination in urban areas of Rawalpindi and Islamabad has direct relevance with land use for petroleum activity. We conclude that in order to reduce the soil PAH exposure in urban environment, petrol pumps and mechanical workshops must be shifted to less densely populated areas because of their role as important point sources for PAH emission.

背景与目标： : 城市化会增加土壤对各种污染的脆弱性。多环芳烃 (PAH) 对城市土壤的污染增加可能与加油站和机械车间的数量增加有关-这种现象需要不断监测。进行这项研究是为了探索拉瓦尔品第和伊斯兰堡城市地区与土地利用活动有关的土壤PAH水平。评估了来自加油站和机械车间 (n   =   32) 地区的复合土壤样品中的五种PAHs-萘，菲，芘，苯并 [a] 芘和茚并 (1,2，3-cd) 芘-并与具有最小石油相关活性的控制区位置 (n   =   16) 进行比较。收集高达3厘米深度的表面样品，并使用正己烷和二氯甲烷进行分析物的提取。在运行样品之前，标准 (100 μ g ml(-1)) 在HPLC上运行，以使用乙腈作为流动相在40 °C下以1.25毫升/min的流速优化信噪比。在加油站和机械车间区域之间观察到单个PAH以及对照区域土壤样品的显着差异萘是土壤中最丰富的多环芳烃，2.47 ~ 24.36 mg kg(-1)。土壤中苯并 [a] 芘 (BaP) 含量与总PAH浓度的相关性 (r   =   0.82，P  <  0.0001) 揭示了BaP可用作PAH污染的潜在标记。当在土壤中检测到的低分子量PAHs与高分子量PAHs作图时，观察到岩石成因和热成因污染源之间的明显分离。前来源包括润滑剂和机械车间发现的用过的机油,而后者可能主要归因于汽油泵的车辆排放。结果表明，拉瓦尔品第和伊斯兰堡的城市地区的PAH污染与石油活动的土地使用直接相关。我们得出结论，为了减少城市环境中的土壤PAH暴露，汽油泵和机械车间必须转移到人口较少的地区，因为它们是PAH排放的重要点源。

BACKGROUND & AIMS: Background:The prevalence of mental and physical comorbidities is unknown in South Asia, as estimates of mental ill health in patients with non-communicable diseases (NCDs) have predominantly come from studies based in the United States, Europe and Australasia. This systematic review and meta-analysis summarises evidence and provides pooled estimates of the prevalence of common mental disorders in adults with non-communicable diseases in South Asia. Methods:We included prevalence studies of depression and anxiety in adults with diabetes, cancer, cardiovascular disease, and chronic respiratory conditions in Bangladesh, India, and Pakistan, published from 1990 onwards in international and country-specific databases. Results:Out of 96 included studies, 83 provided data for random effects meta-analyses. The pooled prevalence of depression was 44% (95% confidence interval (CI) = 26 to 62) for patients with COPD, 40% (95% CI = 34 to 45) for diabetes, 39% (95% CI = 23 to 56) for stroke, 38% (95% CI = 32 to 45) for hypertension, and 37% (95% CI = 30 to 45) for cancer. The pooled prevalence of anxiety based on 28 studies was 29% (95% CI = 22 to 36). Many quality issues were identified in a critical appraisal of included studies, mostly relating to the sampling frame and selection process, the description of the methods and basic data, and the description of non-responders. Conclusions:Depression and anxiety are prevalent and underdiagnosed in people with physical comorbidities in Bangladesh, India, and Pakistan.

背景与目标：

BACKGROUND & AIMS: :Peel, pulp and kernel extracts of seven mango fruit (varieties) were analyzedsubjected for antibacterial and antioxidative potential. Langra peel showed good activity against B. subtilis, S. aureus and E. aerogenes. Good zone of inhibition by chaunsa kernel (28mm) and pulp (22mm) against Streptomyces stipulate its potential as anticarcinogencancerous. Dosehri and almashil pulp and sindhri peel asserted free radical scavenger (upto 79%) determined through DPPH assay. The peel and kernel of almashil contained maximum (total) flavonoids contents (58 & 43μgQE/100mg, respectively) while; total phenolics were higher in kernel of sindhri, chaunsa, langra and hujra and almashil pulp. Reducing power potential demonstrated variation from 300 to 554μgAAE/100mg. Total antioxidant potential was maximum in hujra pulp (512μg AAE/100mg). Concluded This study concludes that mango has vast beneficial potential for prone to human health and may also be used for isolation of antioxidative and antimicrobial as well as a protein kinase inhibition agent.

背景与目标： : 分析了七个芒果果实 (品种) 的果皮，果肉和果仁提取物的抗菌和抗氧化潜力。Langra peel对枯草芽孢杆菌，金黄色葡萄球菌和产气大肠杆菌显示出良好的活性。chaunsa仁 (28毫米) 和果肉 (22毫米) 对链霉菌的良好抑制区规定了其潜在的抗癌作用。Dosehri和almashil纸浆和sindhri peel断言通过DPPH测定法测定的自由基清除剂 (79%)。almashil的果皮和果仁含有最大 (总) 黄酮含量 (分别为58和43 μ gqe/100mg)，而sindhri，chaunsa，langra和hujra的果仁和almashil果肉中的总酚含量较高。降低功率电位显示出从300到554 μ gaae/100mg的变化。在hujra果肉中，总抗氧化潜力最大 (512 μ gaae/100mg)。结论这项研究得出的结论是，芒果具有促进人类健康的巨大潜力，也可用于隔离抗氧化和抗菌药物以及蛋白激酶抑制剂。

BACKGROUND & AIMS: BACKGROUND:In Asia, over 50% of patients with symptoms of tuberculosis (TB) access health care from private providers. These patients are usually not notified to the National TB Control Programs, which contributes to low notification rates in many countries. METHODS:From January 1, 2011 to December 31, 2012, Karachi's Indus Hospital - a private sector partner to the National TB Programme - engaged 80 private family clinics in its catchment area in active case finding using health worker incentives to increase notification of TB disease. The costs incurred were estimated from the perspective of patients, health facility and the program providing TB services. A Markov decision tree model was developed to calculate the cost-effectiveness of the active case finding as compared to case detection through the routine passive TB centers. Pakistan has a large private health sector, which can be mobilized for TB screening using an incentivized active case finding strategy. Currently, TB screening is largely performed in specialist public TB centers through passive case finding. Active and passive case finding strategies are assumed to operate independently from each other. RESULTS:The incentive-based active case finding program costed USD 223 per patient treated. In contrast, the center based non-incentive arm was 23.4% cheaper, costing USD 171 per patient treated. Cost-effectiveness analysis showed that the incentive-based active case finding program was more effective and less expensive per DALY averted when compared to the baseline passive case finding as it averts an additional 0.01966 DALYs and saved 15.74 US$ per patient treated. CONCLUSION:Both screening strategies appear to be cost-effective in an urban Pakistan context. Incentive driven active case findings of TB in the private sector costs less and averts more DALYs per health seeker than passive case finding, when both alternatives are compared to a common baseline situation of no screening.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Stunted growth in early infancy is a public health problem in low-and-middle income countries. Evidence suggests heavy agricultural work during pregnancy is inversely associated with maternal body mass index (BMI) and infant birth weight in low- and middle-income countries; but pathways linking agricultural work to length-for-age Z-scores (LAZ) in early infancy have not been examined. This study aimed to investigate the relationship between agricultural work during pregnancy, post-natal maternal BMI and LAZ among young infants in rural Pakistan; and explored whether maternal BMI mediated the relationship between agricultural work and infant LAZ. METHODS:A cross-sectional survey was conducted from December 2015 to January 2016 in rural Sindh, Pakistan. Mother-infant dyads were recruited via systematic random cluster sampling at 2-12 weeks' post-partum (n = 1161). Anthropometric measurements (maternal and infant height/length and weight) and questionnaire data were collected. Multivariable linear regression and structural-equation based mediation analyses were used to examine associations of agricultural work during pregnancy with maternal BMI and infant LAZ. RESULTS:During pregnancy, women reported engaging in livestock-related work (57.0%), crop-related work (42.7%), and cotton harvesting (28.4%). All three forms of agricultural work were negatively associated with maternal BMI (β = - 0.67 [- 1.06; - 0.28], β = - 0.97 [- 1.51; - 0.48]; and β = - 0.87 [- 1.33; - 0.45], respectively). Maternal engagement in cotton harvesting alone was negatively associated with infant LAZ after controlling for confounding factors. The total negative effect of cotton harvesting on infant LAZ was - 0.35 [- 0.53; - 0.16]. The indirect effect of maternal BMI on infant LAZ was - 0.06 [- 0.08; - 0.03], revealing that 16% (- 0.06/- 0.35) of the relationship between cotton harvesting and infant LAZ, after adjustment, was mediated via maternal BMI. CONCLUSION:These results underscore a need to reduce labour-intensive agricultural workload demands during pregnancy, especially in cotton harvesting, to reduce risks of negative maternal energy balance and poor growth outcomes in early infancy.

背景与目标：

BACKGROUND & AIMS: :Rotavirus A (RVA) is a diarrheal pathogen affecting children under age five, particularly in developing and underdeveloped regions of the world due to malnutrition, poor healthcare and hygienic conditions. Water and food contamination are found to be major sources of diarrheal outbreaks. Pakistan is one of the countries with high RVA related diarrhea burden but with insufficient surveillance system. The aim of this study was to gauge the RVA contamination of major open sewerage collecting streams and household water supplies in two major metropolitan cities of Pakistan. Three concentration methods were compared using RNA purity and concentration as parameters, and detection efficiency of the selected method was estimated. Water samples were collected from 21 sites in Islamabad and Rawalpindi in two phases during the year 2014-2015. Meteorological conditions were recorded for each sampling day and site from Pakistan Meteorological Department (PMD). Nested PCR was used to detect the presence of RVA in samples targeting the VP7 gene. Logistic regression was applied to assess the association of weather conditions with RVA persistence in water bodies. Statistical analysis hinted at a temporal and seasonal pattern of RVA detection in water. Phylogenetic analysis of selected isolates showed a close association of environmental strains with clinical RVA isolates from hospitalized children with acute diarrhea during the same period. This is the first scientific report cataloging the circulating RVA strains in environmental samples from the region. The study highlights the hazards of releasing untreated sewerage containing potentially infectious viral particles into collecting streams, which could become a reservoir of multiple pathogens and a risk to exposed communities. Moreover, routine testing of these water bodies can present an effective surveillance system of circulating viral strains in the population.

背景与目标： : 轮状病毒A (RVA) 是一种腹泻病原体，由于营养不良，医疗保健和卫生条件差，影响五岁以下儿童，特别是在世界发展中国家和欠发达地区。发现水和食物污染是腹泻暴发的主要来源。巴基斯坦是与RVA相关的腹泻负担较高但监测系统不足的国家之一。这项研究的目的是衡量巴基斯坦两个主要大都市的主要露天排污系统收集溪流和家庭供水的RVA污染。以RNA纯度和浓度为参数，比较了三种浓度方法，并估算了所选方法的检测效率。在2014-2015年期间，分两个阶段从伊斯兰堡和拉瓦尔品第的21个地点收集了水样。记录了巴基斯坦气象局 (PMD) 每个采样日和地点的气象条件。巢式PCR用于检测靶向VP7基因的样品中RVA的存在。应用逻辑回归来评估天气条件与水体中RVA持久性的关联。统计分析暗示了水中RVA检测的时间和季节模式。对选定分离株的系统发育分析表明，环境菌株与同期住院急性腹泻儿童的临床RVA分离株密切相关。这是第一份对该地区环境样品中循环的RVA菌株进行分类的科学报告。该研究强调了将含有潜在传染性病毒颗粒的未经处理的污水排放到收集流中的危害，这可能成为多种病原体的储存库，并对暴露的社区构成风险。此外，对这些水体的常规测试可以为人群中循环病毒株提供有效的监视系统。

BACKGROUND & AIMS: :Envenomings by some populations of the Russell's viper (Daboia russelii) are characterized by a systemic capillary leak syndrome (CLS) which causes hemoconcentration, and is associated with the severity of envenoming. We adapted a model of CLS in mice by assessing hemoconcentration. The venom of D. russelii from Pakistan, but not that of another viperid, Bothrops asper, induced hemoconcentration and an increment in vascular permeability, being devoid of hemorrhagic activity at the doses tested. These findings reveal a dichotomous pattern of vasculotoxicity in viperid snake venoms. This difference might depend on variations in venom composition, especially regarding metalloproteinases (SVMPs), which are low in Pakistani D. russelii and high in B. asper. Inhibition of SVMPs and phospholipases A2 in D. russelii venom did not abrogate hemoconcentration. An hemoconcentration-inducing fraction was obtained by chromatography, which contains vascular endothelial growth factor (VEGF), a known potent inducer of increment in vascular permeability. Exudates collected from tissue injected with venom also induced hemoconcentration, and the effect was inhibited by antivenom. However, the amount of venom in exudate required to induce the effect is low, as compared with venom dissolved in saline solution, hence suggesting that endogenous proteins present in the exudate, probably inflammatory mediators, potentiate the effect.

背景与目标： : 罗素毒蛇 (Daboia russelii) 的某些人群的毒害特征是引起血液浓缩的全身性毛细血管渗漏综合征 (CLS)，并与毒害的严重程度有关。我们通过评估血液浓度来适应小鼠CLS模型。来自巴基斯坦的D. russelii的毒液，而不是另一种viperid Bothrops asper的毒液，会引起血液浓缩和血管通透性增加，在测试剂量下没有出血活性。这些发现揭示了蛇毒液中血管毒性的二分模式。这种差异可能取决于毒液组成的变化，尤其是关于金属蛋白酶 (svmp)，巴基斯坦D. russelii低，B. asper高。抑制D. russelii毒液中的SVMPs和磷脂酶A2不会消除血液浓缩。通过色谱法获得血液浓缩诱导级分，其中包含血管内皮生长因子 (VEGF)，这是一种已知的有效的血管通透性增加诱导剂。从注射毒液的组织中收集的渗出物也会引起血液浓缩，并且该作用被抗蛇毒血清抑制。然而，与溶解在盐溶液中的毒液相比，诱导作用所需的渗出液中的毒液量较低，因此表明渗出液中存在的内源性蛋白质 (可能是炎症介质) 增强了作用。

BACKGROUND & AIMS: :Venous thromboembolism (VTE) is an important cause of in-hospital mortality. A local understanding of disease burden, occurrence, etiology and successful preventive and therapeutic interventions is of vital import. We aimed to review the current literature of VTE originating from Pakistan to determine gaps in knowledge in order to prioritize future research. An electronic search was performed using Pakmedinet, Pubmed and Google Scholar to retrieve research articles on thrombosis, deep vein thrombosis and pulmonary thromboembolism in Pakistan. The search included all years and no limits were applied. All original research articles presenting primary data from Pakistan were selected. Full texts were reviewed and information synthesized and summarized in our review. Eighty-one studies were found, out of which we were able to retrieve and review 77 (95%) full texts. A total of 6,501 patients are included in this review. Among the studies, we found 25 case reports/series, 1 case-control, 3 cohort, 20 cross-sectional, 1 quasi-experimental, 2 randomized controlled trials, 4 retrospective file reviews and 21 review articles. Most of these were small studies with only eight having a patient population above 100. Six studies presented incidence of DVT which ranged from 2.6 to 12.82% depending on the population under study. Two articles studied risk factors for DVT. Six looked at different treatment modalities, often comparing one modality to the other, while another 15 articles assessed diagnostic strategies. Preventive aspects of VTE were addressed by only three studies and all found the rates of thrombo-prophylaxis grossly inadequate. There is a dearth of quality research on venous thromboembolism in Pakistan. We describe key areas of neglect and recommend prioritizing research on epidemiological and preventive aspects.

背景与目标： : 静脉血栓栓塞 (VTE) 是院内死亡的重要原因。对疾病负担，发生，病因以及成功的预防和治疗干预措施的局部了解至关重要。我们旨在回顾来自巴基斯坦的VTE的最新文献，以确定知识差距，以便优先考虑未来的研究。使用Pakmedinet，Pubmed和Google Scholar进行了电子搜索，以检索有关巴基斯坦血栓形成，深静脉血栓形成和肺血栓栓塞的研究文章。搜索包括所有年份，没有应用限制。选择了所有介绍巴基斯坦主要数据的原始研究文章。我们对全文进行了回顾，并对信息进行了综合和总结。发现了81项研究，我们能够检索和审查77 (95%) 全文。本综述共纳入6,501例患者。在这些研究中，我们发现了25个病例报告/系列，1个病例对照，3个队列，20个横断面，1个准实验，2个随机对照试验，4个回顾性文件综述和21篇综述文章。其中大多数是小型研究，只有八个患者人数超过100。根据所研究人群的不同，六项研究提出了DVT的发生率，范围从2.6到12.82%。两篇文章研究了DVT的危险因素。六篇研究了不同的治疗方式，经常将一种方式与另一种方式进行比较，而另外15篇文章评估了诊断策略。仅通过三项研究解决了VTE的预防方面，所有研究都发现血栓预防的发生率严重不足。巴基斯坦缺乏关于静脉血栓栓塞的质量研究。我们描述了忽视的关键领域，并建议优先考虑流行病学和预防方面的研究。