BackgroundBoth Plasmodium vivax and Plasmodium falciparum are prevalent in Pakistan, yet up-to-date data on the epidemiology of malaria in Pakistan are not available. This study was undertaken to determine the current prevalence and distribution of Plasmodium species across the country.MethodsA malariometric population survey was conducted in 2011 using blood samples collected from 801 febrile patients of all ages in four provinces and the capital city of Islamabad. Microscopically confirmed Plasmodium-positive blood samples were reconfirmed by polymerase chain reaction (PCR). Confirmed parasite-positive samples were subjected to species-specific PCR capable of detecting four species of human malaria.ResultsOf the 707 PCR-positive samples, 128 (18%) were P. falciparum, 536 (76%) were P. vivax, and 43 (6%) were mixed P. falciparum and P. vivax. Ninety-four microscopy-positive samples were PCR-negative, and Plasmodium malariae and Plasmodium ovale were not detected. Prevalence of P. vivax ranged from 2.4% in Punjab Province to 10.8% in Sindh Province and prevalence of P. falciparum ranged from 0.1% in Islamabad to 3.8% in Balochistan.ConclusionsPlasmodium infections in Pakistan are largely attributed to P. vivax but P. falciparum and mixed species infections are also prevalent. In addition, regional variation in the prevalence and species composition of malaria is high.

No abstract

The big picture An overview of the HIV epidemic and response in Asia and the Pacific Asia and the Pacific's AIDS response is showing mixed results. ■ Despite important progress, such as a 26% reduction in new HIV infections since 2001 and significantly increased domestic financing for AIDS, the epidemic still outpaces the response and half of people eligible for antiretroviral treatment are not accessing it. ■ There are growing epidemics in some geographical areas and within key populations at higher risk, notably among men who have sex with men, in many countries. ■ Not enough people from key populations at higher risk know their HIV status. This is hampering increased access to treatment. ■ Domestic financing for HIV has increased considerably in the region but HIV expenditure remains insufficient and international funding is shrinking. An estimated 3-4 million people living in Asia inject drugs. In three countries with expanding epidemics-Indonesia, Pakistan and the Philippines-injecting drug use has been a significant factor in the spread of HIV. In 2012, HIV prevalence among people who inject drugs was 36.4% in Indonesia, 27.2% in Pakistan and 13.6% in the Philippines. 5 National trends sometimes mask significant geographical variations in HIV prevalence among injecting drug users. In the Philippine province of Cebu, prevalence among people who inject drugs was estimated at 53.8% in 2011 compared with 13.6% nationally. 6 In the province of Thai Nguyen in Viet Nam, the prevalence among this group was reported to be 38.8% in 2012, compared with national prevalence of 11.6%. 7 There has been progress in reducing new HIV infections among female sex workers across the region. National prevalence has declined in the early Fewer new HIV infections overall, but instances of rising trends Total people living with HIV in 12 countries 4 734 000

No abstract

Objective: Prevalence of aplastic anemia (AA) is high in the Asian population. This study was done to explore the etiology and association of AA with various socioeconomic and environmental factors. Study design and setting: Study included 1324 consecutive AA cases registered at Armed Forces Bone Marrow Transplant Centre Rawalpindi, Pakistan, from March 2001 to August 2016. The study questionnaire was completed through an interview. It included patients' socio-demographic details, personal and family medical history, environmental attributes and clinico-hematological features. Results: The median age of patients was 20 years, 997 were male and 327 female. Distribution of non-severe, severe and very severe AA was 230 (17.4%); 598 (45.2%) and 496 (37.4%), respectively. The majority of patients were from low (n = 761, 57.5%) or middle socioeconomic class (n = 543, 41%). Consanguinity among patients (n = 806, 61%) was slightly higher than the national statistics. History of chemical exposures included fertilizers (n = 116, 8.7%), pesticides (n = 56, 4.2%) and industrial chemicals (n = 37, 2.8%). PNH clone was found in 63 of AA patients. After excluding 298 patients undergoing HSCT and 660 deaths/lost to follow-up, disease evolution was observed in 38(10.4%) patients out of 366 evaluable patients. These included PNH = 18, MDS = 11 and AML = 9. Discussion: Due to lack of funding and adequate human resource at the center, age and sexmatched controls could not be included. Other limitations were a lack of molecular testing to exclude the possibility of inherited bone marrow failure syndromes on a genetic basis. Conclusion: Younger age, male predominance and higher consanguinity point toward genetic factors in AA etiology among the South Asian population.