This cross-sectional study was carried out to explore the epidemiological and clinical features of dengue fever in Faisalabad, Pakistan during 2011 and 2012. During the study period, anti-dengue IgM positive cases were reported in the post-monsoon period during the months of August–December. Certain hotspots for the dengue infection were identified in the city that coincide with the clusters of densely populated urban regions of the city. Out of total 299 IgM positive patients (male 218 and female 81); there were 239 dengue fever (DF) and 60 dengue hemorrhagic fever (DHF) patients. There was decrease in the median age of dengue patients from 31 years in 2011 to 21.5 years in 2012 (p<0.001). Abdominal pain was seen in 35% DHF patients followed by nausea in 28.3%, epistaxis in 25% and rash in 20% patients (p<0.05). Patients reported to be suffering from high-grade fever for an average of 8.83 days in DHF as compared to 5.82 days in DF before being hospitalized. Co-morbidities were found to be risk factor for the development of DHF in dengue patients. Clinical and laboratory features of dengue cases studied could be used for the early identification of patients at risk of severe dengue fever.

Dengue has become endemic in Pakistan with annual recurrence. A sudden increase in the dengue cases was reported from Rawalpindi in 2016, while an outbreak occurred for the first time in Peshawar in 2017. Therefore, a multi-center study was carried out to determine the circulating dengue virus (DENV) serotypes and Chikungunya virus (CHIKV) co-infection in Lahore, Rawalpindi, and Peshawar cities in 2016–18. A hospital-based cross-sectional study was carried out in Lahore and Rawalpindi in 2016–18, while a community-based study was carried out in Peshawar in 2017. The study participants were tested for dengue NS1 antigen using an immunochromatographic device while anti-dengue IgM/IgG antibodies were detected by indirect ELISA. All NS1 positive samples were used for DENV serotyping using multiplex real-time PCR assay. Additionally, dengue samples were tested for CHIKV co-infection using IgM/IgG ELISA. A total of 6291 samples were collected among which 8.11% were NS1 positive while 2.5% were PCR positive. DENV-2 was the most common serotype (75.5%) detected, followed by DENV-1 in 16.1%, DENV-3 in 3.9% and DENV-4 in 0.7% while DENV-1 and DENV-4 concurrent infections were detected in 3.9% samples. DENV-1 was the predominant serotype (62.5%) detected from Lahore and Rawalpindi, while DENV-2 was the only serotype detected from Peshawar. Comorbidities resulted in a significant increase (p-value<0.001) in the duration of hospital stay of the patients. Type 2 diabetes mellitus substantially (p-value = 0.004) contributed to the severity of the disease. Among a total of 590 dengue positive samples, 11.8% were also positive for CHIKV co-infection. Co-circulation of multiple DENV serotypes and CHIKV infection in Pakistan is a worrisome situation demanding the urgent attention of the public health experts to strengthen vector surveillance.

Keywords: Dengue; Epidemiology; Geographic clusters; Seroprevalence; Socioeconomic status

Background: The estimates of economic burden due to smoking attributed illnesses provide an opportunity to assess its overall impact on the economy and generate evidence for public health policy interventions for tobacco control. In this study, we estimated out of pocket expenditures on tobacco attributed illnesses and smoking attributable burden in Pakistan. Methods: We used a prevalence-based disease-specific cost approach by including three major tobacco attributed illnesses i.e. lung cancer, chronic obstructive pulmonary disease, and cardiovascular diseases. Our analysis included out of pocket healthcare expenditures including direct and indirect costs which were estimated by interviewing the patients of selected illnesses. The smoking-attributable expenditure was calculated by the WHO tool kit. Results: In 2018, the economic burden attributed to smoking related illnesses was Rs 192 billion (USD 1.3 billion). Smoking-attributable expenditure on cardiovascular disease was Rs 123 billion (USD 0.9 billion) which was 69% of the total economic cost of tobacco attributed illnesses in Pakistan. The economic cost in males was nearly three times higher than females. Conclusions: Our study showed a significant economic burden due to tobacco attributed illnesses in Pakistan which can be prevented by implementing tobacco control policies effectively.

Five desiccation-tolerant rhizobacteria (Brevibacterium frigoritolerans-LPS1B, Bacillus subtilis- CHFT15, B. subtilis-CHFT12, B. subtilis-CH13, and Pseudomonas stutzeri-CHP413A) isolated from Pakistan’s Cholistan desert were characterized on the basis of morphological, biochemical, and 16S rDNA ribotyping. The desiccation tolerance was checked at various relative humidity levels (5, 23, and 100%) for a period of 1-40 days. Heavy metal and antibiotic resistance, auxin, cytokine, siderophore, hydrogen cyanide production, and phosphate solubilization of select bacterial isolates was also investigated. Pot experiments with corn in sandy and pure soil were also carried out to check the plant growth-promoting potential of select strains after 90 days of growth. After harvest, various growth parameters like seed germination, root and shoot length, number of leaves, dry weight per gram fresh weight, and chlorophyll contents were determined. The inoculation of P. stutzeri-CHP413A resulted in 3, 33,12, and 37% increases in seed germination, number of leaves, shoot and root length, and dry weight·g^-1 fresh weight, respectively, in sandy soil (p<0.05).