Recent data for the global burden of disease reflect major demographic and lifestyle changes, leading to a rise in non-communicable diseases. Most countries with high levels of tuberculosis face a large comorbidity burden from both non-communicable and communicable diseases. Traditional disease-specific approaches typically fail to recognise common features and potential synergies in integration of care, management, and control of non-communicable and communicable diseases. In resource-limited countries, the need to tackle a broader range of overlapping comorbid diseases is growing. Tuberculosis and HIV/AIDS persist as global emergencies. The lethal interaction between tuberculosis and HIV coinfection in adults, children, and pregnant women in sub-Saharan Africa exemplifies the need for well integrated approaches to disease management and control. Furthermore, links between diabetes mellitus, smoking, alcoholism, chronic lung diseases, cancer, immunosuppressive treatment, malnutrition, and tuberculosis are well recognised. Here, we focus on interactions, synergies, and challenges of integration of tuberculosis care with management strategies for non-communicable and communicable diseases without eroding the functionality of existing national programmes for tuberculosis. The need for sustained and increased funding for these initiatives is greater than ever and requires increased political and funder commitment.

We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.

Background: Seroconversion rates reported after Hepatitis B virus (HBV) vaccination globally ranges from 85-90%. Health care workers (HCWs) are at high risk of acquiring HBV and non responders' rates after HBV vaccination were not reported previously in Pakistani HCWs. Therefore we evaluated immune response to HBV vaccine in HCWs at a tertiary care hospital in Karachi, Pakistan.

BACKGROUND: No data exist on the population prevalence of, or risk factors for, human papillomavirus (HPV) infection in predominantly Muslim countries in Asia. METHODS: Cervical specimens were obtained from 899 married women aged 15 -59 years from the general population of Karachi, Pakistan and from 91 locally diagnosed invasive cervical cancers (ICCs). HPV was detected using a GP5 þ /6 þ PCR-based assay. RESULTS: The prevalence of HPV in the general population was 2.8%, with no evidence of higher HPV prevalence in young women. The positivity of HPV was associated with women's lifetime number of sexual partners, but particularly with the age difference between spouses and other husbands' characteristics, such as extramarital sexual relationships and regular absence from home. The HPV16/18 accounted for 24 and 88% of HPV-positive women in the general population and ICC, respectively. CONCLUSION: Cervical cancer prevention policies should take into account the low HPV prevalence and low acceptability of gynaecological examination in this population. To date, there are no data on the population prevalence of, or risk factors for, human papillomavirus (HPV) infection in predominantly Muslim countries in Asia, where sexual mores differ from many other world populations (Wellings et al, 2006). These data are essential to assess the potential relevance of HPV vaccination and HPV test-based screening to invasive cervical cancer (ICC) prevention in the region, as well as to identify any changes in risk occurring in young generations. Thus, a study of women with and without cervical cancer was carried out in Karachi, Pakistan, according to the standardised protocol of the International Agency for Research on Cancer (IARC) HPV Prevalence Surveys (Clifford et al, 2005), which was approved by both the IARC and local ethical review committees. METHODSA total of 3882 married women aged 15 -59 years living in Orangi, a densely populated suburb of Karachi, were visited at their homes and invited to join the study, with the aim to enrol B100 women in each 5-year age group. Participation rates were 24.1, 25.7, 25.1 and 23.6% among women aged 15 -24, 25 -34, 35 -44 and 45 -59 years, respectively. All participants signed an informed consent form and were administered a questionnaire. In all, 915 participants came to the study clinic located in the Sindh Government Qatar Hospital, where a sample of exfoliated cervical cells was collected and placed into PreservCyt media (Hologic, Marlborough, MA, USA) for HPV testing and liquid-based cytology.In parallel, formalin-fixed tumour biopsies were retrieved from women presenting with histologically confirmed ICC between 2004 and 2008 to the Ziauddin and Aga Khan University Hospitals, Karachi. After exclusion of 40 biopsies that were b-globin negative and/or without histological evidence of tumour, 91 ICCs remained (79 squamous cell, 3 adeno, 4 small cell and 5 other or unspecified carcinomas).Liquid-based cytology and HPV testing were carried out at the Vrije University, Amsterdam, the Neth...

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