To determine population-based estimates of coronavirus disease 2019 in a densely populated urban community of Karachi, Pakistan. Methods: Three cross-sectional surveys were conducted in April, June and August 2020 in low-and hightransmission neighbourhoods. Participants were selected at random to provide blood for Elecsys immunoassay for detection of anti-severe acute respiratory syndrome coronavirus-2 antibodies. A Bayesian regression model was used to estimate seroprevalence after adjusting for the demographic characteristics of each district. Results: In total, 3005 participants from 623 households were enrolled in this study. In Phase 2, adjusted seroprevalence was estimated as 8.7% [95% confidence interval (CI) 5.1-13.1] and 15.1% (95% CI 9.4-21.7) in low-and high-transmission areas, respectively, compared with 0.2% (95% CI 0-0.7) and 0.4% (95% CI 0-1.3) in Phase 1. In Phase 3, it was 12.8% (95% CI 8.3-17.7) and 21.5% (95% CI 15.6-28) in low-and high-transmission areas, respectively. The conditional risk of infection was 0.31 (95% CI 0.16-0.47) and 0.41 (95% CI 0.28-0.52) in low-and high-transmission neighbourhoods, respectively, in Phase 2. Similar trends were observed in Phase 3. Only 5.4% of participants who tested positive for COVID-19 were symptomatic. The infection fatality rate was 1.66%, 0.37% and 0.26% in Phases 1, 2 and 3, respectively. Conclusion: Continuing rounds of seroprevalence studies will help to improve understanding of secular trends and the extent of infection during the course of the pandemic.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to almost every country on the globe, and each country is reporting the symptomatic presentation of their patients to give better insight into the various clinical presentations of SARS-CoV-2. However, the epidemiological literature from Pakistan is scanty. Methods We retrospectively analyzed data from 412 patients who were residents of East Karachi and tested positive for SARS-CoV-2 between February 26 to April 24, 2020. Patients' demographics, symptoms, travel and contact history, and outcomes were recorded. All statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 22 (IBM SPSS Statistics for Windows, IBM Corp, Armonk, NY). Results Most of the patients were male (64.6%), the majority (43.3%) belonging to the 21-to 40year age group. Most of the patients (65.5%) were residents of Gulshan Iqbal. A total of 15.8% of the patients were admitted to the hospital, and 3.9% of patients expired. The three most common presenting symptoms were fever (74.8%), cough (60.4%), and flu (35.5%). The majority of patients (89.3%) gave a history of contact with SARS-CoV-2 patients. Conclusion The number of SARS-CoV-2 cases is rapidly increasing in Karachi, Pakistan. There is a need to educate the population about the most common sign and symptoms of the virus so that individuals can identify these symptoms and get themselves tested. The concerned authorities should devise an adequate and effective plan to flatten the infectivity curve.

Background Pakistan is among the first low- and middle-income countries affected by COVID-19 pandemic. Monitoring progress through serial sero-surveys, particularly at household level, in densely populated urban communities can provide insights in areas where testing is non-uniform. Methods Two serial cross-sectional household surveys were performed in April (phase 1) and June (phase 2) 2020 each in a low- (District Malir) and high-transmission (District East) area of Karachi, Pakistan. Household were selected using simple random sampling (Malir) and systematic random sampling (East). Individual participation rate from consented households was 82.3% (1000/1215 eligible) in phase 1 and 76.5% (1004/1312 eligible) in phase 2. All household members or their legal guardians answered questions related to symptoms of Covid-19 and provided blood for testing with commercial Elecsys Anti-SARS-CoV-2 immunoassay targeting combined IgG and IgM. Seroprevalence estimates were computed for each area and time point independently. Given correlation among household seropositivity values, a Bayesian regression model accounting for household membership, age and gender was used to estimate seroprevalence. These estimates by age and gender were then post-stratified to adjust for the demographic makeup of the respective district. The household conditional risk of infection was estimated for each district and its confidence interval were obtained using a non-parametric bootstrap of households. Findings Post-stratified seroprevalence was estimated to be 0.2% (95% CI 0-0.7) in low-and 0.4% (95% CI 0 - 1.3) in high-transmission areas in phase 1 and 8.7% (95% CI 5.1-13.1) in low- and 15.1% (95% CI 9.4 -21.7) in high-transmission areas in phase 2, with no consistent patterns between prevalence rates for males and females. Conditional risk of infection estimates (possible only for phase 2) were 0.31 (95% CI 0.16-0.47) in low- and 0.41(95% CI 0.28-0.52) in high-transmission areas. Of the 166 participants who tested positive, only 9(5.4%) gave a history of any symptoms. Interpretation A large increase in seroprevalence to SARS-CoV-2 infection is seen, even in areas where transmission is reported to be low. Mostly the population is still seronegative. A large majority of seropositives do not report any symptoms. The probability that an individual in a household is infected, given that another household member is infected is high in both the areas. These results emphasise the need to enhance surveillance activities of COVID-19 especially in low-transmission sites and provide insights to risks of household transmission in tightly knit neighbourhoods in urban LMIC settings.

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Background: Cardiovascular diseases are “lifestyle diseases” cause death worldwide. Most are acquired starting from adolescence. So this study was designed following objective to determine the prevalence of risk factors of cardiovascular diseases among medical undergraduates of a district of West Bengal. Methods: Cross-sectional observational study conducted 96 medical students Analysis of results was done by percentage and proportion. Results: A total of 96 students were interviewed and examined. Mean age 19.3 years. 37.7% male, 8.3% were alcohol users. 53.1% did no exercise. 12.5% were current smokers Abnormal waist hip ratio in 46.5% female.35.8% males were pre hypertensive while 4% boys were hypertensive. 4.5% were early diabetic 4.5% high had high blood cholesterol. Conclusions: A high prevalence of risk factors for cardiovascular diseases was found that emphasizes the need of interventions to reduce these risk factors among these future doctors.