Mortality Associated with Priority Diseases in Flood-Affected Areas Using District Health Information System (DHIS2) During September-December 2022: Pakistan Experience.

OBJECTIVES: To quantify the burden of communicable diseases and characterize the most reported infections during public health emergency of floods in Pakistan. METHODS: The study's design is a descriptive trend analysis. The study utilized the disease data reported to District Health Information System (DHIS2) for the 12 most frequently reported priority diseases under the Integrated Disease Surveillance and Response (IDSR) system in Pakistan. RESULTS: In total, there were 1,532,963 suspected cases during August to December 2022 in flood-affected districts (n = 75) across Pakistan; Sindh Province reported the highest number of cases (n = 692,673) from 23 districts, followed by Khyber Pakhtunkhwa (KP) (n = 568,682) from 17 districts, Balochistan (n = 167,215) from 32 districts, and Punjab (n = 104,393) from 3 districts. High positivity was reported for malaria (79,622/201,901; 39.4%), followed by acute diarrhea (non-cholera) (23/62; 37.1%), hepatitis A and E (47/252; 18.7%), and dengue (603/3245; 18.6%). The crude mortality rate was 11.9 per 10 000 population (1824/1,532,963 [deaths/cases]). CONCLUSION: The study identified acute respiratory infection, acute diarrhea, malaria, and skin diseases as the most prevalent diseases. This suggests that preparedness efforts and interventions targeting these diseases should be prioritized in future flood response plans. The study highlights the importance of strengthening the IDSR as a Disease Early Warning System through the implementation of the DHIS2.

From crisis to responsibility: The role of industry type, leadership style, and regulatory environment in shaping post-COVID-19 CSR initiative.

Corporate social responsibility (CSR) is a major concern in modern industries. Chinese industries are growing rapidly and delivering products and services to the market. The Covid-19 pandemic has changed the working style of every type of industry. The objective of this research was to determine the influence of leadership style and industry type on the regulatory environment. This research also aims to determine the impact of the regulatory environment on CSR from the perspective of Chinese industries. Data based on a sample size of 599 was used for data analysis, and Smart PLS 3.0 was used for the results of measurement model assessment and structural model assessment. This study highlighted that industry type and leadership style have a significant positive impact on the regulatory environment and CSR. The framework of this research is based on the identified research gap, and the findings of this study are significant for Chinese policymakers. Furthermore, the research also asserted practical implications that are reliable to advance practices in the regulatory environment and achieve CSR by Chinese firms. This study has several limitations that are required to be significantly addressed for the sustainability of organizations.

Thirty-year trends of triple burden of disease in the adult population of Pakistan.

BACKGROUND: The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades. Therefore, this study aims to determine and analyse the 30-year disease burden trends through prevalence, death rates and percentages. METHODS: The data for the last three decades, i.e. 1990 to 2019, was extracted from the Global Burden of Disease for Pakistan. Percentage change in prevalence and deaths over 30 years was calculated. Poisson regression analysis was performed to evaluate the triple disease burden trends and the incidence rate ratio. RESULTS: A relative decrease of 23.4% was noted in the prevalence rate of communicable diseases except for human immunodeficiency virus and dengue fever. A relative increase of 1.4% was noted in the prevalence rate of non-communicable diseases. A relative increase of 56.1% was recorded in the prevalence rate of injuries. The prevalence rate ratios of communicable diseases significantly decreased to 0.9796 [95% CI: 0.9887-0.9905], but the prevalence rate of injury increased to 1.0094 [95% CI: 1.0073-1.01145], respectively. CONCLUSION: Pakistan must take the next steps and develop strategies to decrease this burden and mortality rates in the population to create better outcomes and therefore help the healthcare system overall.

Genomic characterization of human respiratory syncytial virus circulating in Islamabad, Pakistan, during an outbreak in 2022-2023.

In this study, conducted at the National Institute of Health, Islamabad, during an outbreak of human respiratory syncytial virus (hRSV) from December 2022 to January 2023, the first whole-genome sequences of hRSV isolates from Islamabad, Pakistan, were determined. Out of 10 positive samples, five were sequenced, revealing the presence of two genotypes: RSV-A (GA2.3.5, ON1 strain) and RSV-B (GB5.0.5.a, BA-10 strain). A rare non-synonymous substitution (E232G) in G the protein and N276S in the F protein were found in RSV-A. In RSV-B, the unique mutations K191R, Q209R, and I206M were found in the F protein. These mutations could potentially influence vaccine efficacy and viral pathogenicity. This research underscores the importance of genomic surveillance for understanding RSV diversity and guiding public health responses in Pakistan.

Insights into measles virus: Serological surveillance and molecular characterization.

BACKGROUND: Measles has been a significant public health concern in Pakistan, especially in the Khyber Pakhtunkhwa (KPK) province, where sporadic and silent epidemics continue to challenge existing control measures. This study aimed to estimate the prevalence and investigate the molecular epidemiology of the measles virus (MeV) in KPK and explore the vaccination status among the suspected individuals. METHODS: A cross-sectional study was conducted between February and October 2021. A total of 336 suspected measles cases from the study population were analyzed for IgM antibodies using Enzyme-Linked Immunosorbent Assay (ELISA). Throat swabs were randomly collected from a subset of positive cases for molecular analysis. Phylogenetic analysis of MeV isolates was performed using the neighbor-joining method. The vaccination status of individuals was also recorded. RESULTS: Among the suspected participants, 61.0% (205/336) were ELISA positive for IgM antibodies, with a higher prevalence in males (64.17%) compared to females (57.04%). The majority of cases (36.0%) were observed in infants and toddlers, consistent with previous reports. The majority of IgM-positive cases (71.7%) had not received any dose of measles vaccine, highlighting gaps in vaccine coverage and the need for improved immunization programs. Genetic analysis revealed that all MeV isolates belonged to the B3 genotype, with minor genetic variations from previously reported variants in the region. CONCLUSION: This study provides valuable insights into the genetic epidemiology of the MeV in KPK, Pakistan. The high incidence of measles infection among unvaccinated individuals highlights the urgency of raising awareness about vaccine importance and strengthening routine immunization programs.

Development of a robust method for Cd(II) ions analysis using CeO2- and CeO2-Cu-BTC-based electrochemical sensors.

Simple and sensitive electrochemical sensors were fabricated from cerium oxide (CeO2) and copper-benzene tricarboxylic acid-modified cerium oxide (CeO2-Cu-BTC) materials for differential pulse voltammetric analysis of toxic cadmium (Cd) ions in aqueous solutions. The materials were prepared by hydrothermal method and structurally characterized by Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy with energy-dispersive X-ray (SEM-EDX), thermogravimetric analysis (TGA), and X-ray diffraction analysis (XRD). The CeO2-modified carbon paste electrode (CeCPE) and the CeO2-Cu-BTC-modified carbon paste electrode (CeBCPE) were electrochemically characterized by their cyclic voltammetry and electrochemical impedance study in standard K3[Fe(CN)6] single-electron redox process. Their electrochemical surface areas, electrode surface coverages, and charge transfer resistances were calculated to be 1.46 cm2, 2.338 × 10-5 mol∙cm-2, and 2790 Ω and 5.48 cm2, 2.476 × 10-5 mol∙cm-2, and 1254.65 Ω for CeCPE and CeBCPE, respectively. These fabricated electrodes were used as electrochemical sensors for cadmium ion estimation by optimizing the experimental parameters through differential pulse voltammetry. The optimized conditions included 10% modifier for CeCPE and 5% modifier for CeBCPE in 0.12 M HCl solution of pH 5 as supporting electrolyte at - 1.2 V deposition for 30 s in 0.01 to 10 mg L-1 linear cadmium solution range. Under these conditions, the limit of quantification (LOQ) of 0.368 mg L-1 and 0.005 mg L-1 was calculated for CeCPE and CeBCPE electrodes, respectively. The limit of detection (LOD) was calculated to be 0.121 mg L-1 and 0.002 mg L-1 for CeCPE and CeBCPE, respectively. All the experimental results indicated that electrodes fabricated from CeO2-Cu-BTC show better performance as compared to CeO2-based electrodes. Both these types of electrochemical sensors presented good repeatability and performance in the presence of interfering ions as well. From these findings, it can also be inferred that these electrochemical sensors can provide a simple and very sensitive method for approximation of toxic cadmium ions in aqueous solutions.

Demographic and clinical features of dengue fever infection in Pakistan: a cross-sectional epidemiological study.

BACKGROUND: Dengue fever caused by dengue virus is a tropical disease and is among the deadliest vector-borne diseases. The humid and hot summers of Pakistan support the probation of the vectors responsible for the transmission of viral and other parasitic diseases. METHODOLOGY: A retrospective study, from 2012- 2019, of dengue infected individuals from the Punjab province of Pakistan was carried out to analyze epidemiology, clinical and laboratory findings of subjects with dengue virus infection. Data was derived from National Institute of Health (NIH) followed by Dengue control program of Pakistan, covering the incidence rate in 36 districts of Punjab and Islamabad Capital Territory (ICT) respectively. Patients data including the presence of dengue specific antigen or/and antibodies such as NS1 and IgG/IgM were observed. The study also included the analysis of demographic data, geographic data, and the month-wise distribution of dengue cases to examine seasonal trends. RESULTS: We analyzed 25,682 dengue infected individuals. The statistical analysis revealed a significant association between genders in which male population was more affected by dengue than females. It was also noted that the middle age group was the most affected age group while the highest number of cases were reported in October. Rawalpindi and Lahore were the most affected cities in Punjab province while Islamabad represented the highest number of cases during the recent outbreak in 2019. The IgM and IgG antibodies were highly prevalent among the infected patients. CONCLUSION: Dengue is endemic in Pakistan, circulating throughout the year. Highest number of cases were observed in the month of October, September and November respectively. Association between climate change and vector-borne diseases need to be investigated in Pakistan as they significantly influence the timing and intensity of dengue and other disease outbreaks. Further exploration of hematological parameters is required to better diagnose and treat the disease. For the effective control of dengue outbreaks, awareness campaigns on sewage management and vector control along with social factors are strongly recommended for better control and eradication of the disease.

A hidden dilemma; post COVID-19 first detection of Varicella zoster M4 genotype from Pakistan.

OBJECTIVES: During the COVID-19 pandemic, the risk of childhood infectious diseases was increased. Post-COVID-19 escalation of chickenpox cases, becoming an emerging public health concern. Thus, the study was designed to compare chickenpox prevalence and Varicella zoster virus (VZV) genotypes circulating before, during, and post-COVID-19 in Pakistan. METHODS: A total of 267 lesion specimens collected from tertiary care hospitals, and chickenpox outbreaks from Pakistan were analysed by a two-amplicon approach with phylogenetic analysis. RESULTS: Among suspected cases, overall 178/267 were VZV positive. Majority (84.2 %; 150/178) cases were of post-COVID-19 pandemic time. Small outbreaks occurred soon after COVID-19 in Rawalpindi and Islamabad (Pakistan), 40 positive cases out of 178 cases were outbreak cases. There was first time detection of the M4 genotype, which was significantly associated with disease severity (p = 0.0006) and post-COVID-19 chickenpox outbreaks in 2021 (77.9 %; 46/59; p < 0.00001). However, in pre-COVID-19 only M2 genotype was detected. The M2 prevalence varied from 2019 (100 %; 19/19) to 2022 (3.2 %; 3/91). However, the most prevalent strain of 2022 belonged to the M1 genotype (64.8 %; 59/91). CONCLUSION: A significant rise in chickenpox cases detected soon after COVID-19 in Pakistan, and oscillation of different VZV genotypes with first time detection of M4 genotype is an alarming situation. This demands further detailed genotypic studies on transmission dynamics of a rare M4 with other genotypes to protect the local population and restrict spread in other regions.

Crimean-Congo Hemorrhagic Fever Virus Diversity and Reassortment, Pakistan, 2017-2020.

Sporadic cases and outbreaks of Crimean-Congo hemorrhagic fever (CCHF) have been documented across Pakistan since 1976; however, data regarding the diversity of CCHF virus (CCHFV) in Pakistan is sparse. We whole-genome sequenced 36 CCHFV samples collected from persons infected in Pakistan during 2017-2020. Most CCHF cases were from Rawalpindi (n = 10), followed by Peshawar (n = 7) and Islamabad (n = 4). Phylogenetic analysis revealed the Asia-1 genotype was dominant, but 4 reassorted strains were identified. Strains with reassorted medium gene segments clustered with Asia-2 (n = 2) and Africa-2 (n = 1) genotypes; small segment reassortments clustered with the Asia-2 genotype (n = 2). Reassorted viruses showed close identity with isolates from India, Iran, and Tajikistan, suggesting potential crossborder movement of CCHFV. Improved and continuous human, tick, and animal surveillance is needed to define the diversity of circulating CCHFV strains in Pakistan and prevent transmission.

Research on Blockchain-Enabled Smart Grid for Anti-Theft Electricity Securing Peer-to-Peer Transactions in Modern Grids.

Electricity theft presents a significant financial burden to utility companies globally, amounting to trillions of dollars annually. This pressing issue underscores the need for transformative measures within the electrical grid. Accordingly, our study explores the integration of block chain technology into smart grids to combat electricity theft, improve grid efficiency, and facilitate renewable energy integration. Block chain's core principles of decentralization, transparency, and immutability align seamlessly with the objectives of modernizing power systems and securing transactions within the electricity grid. However, as smart grids advance, they also become more vulnerable to attacks, particularly from smart meters, compared to traditional mechanical meters. Our research aims to introduce an advanced approach to identifying energy theft while prioritizing user privacy, a critical aspect often neglected in existing methodologies that mandate the disclosure of sensitive user data. To achieve this goal, we introduce three distributed algorithms: lower-upper decomposition (LUD), lower-upper decomposition with partial pivoting (LUDP), and optimized LUD composition (OLUD), tailored specifically for peer-to-peer (P2P) computing in smart grids. These algorithms are meticulously crafted to solve linear systems of equations and calculate users' "honesty coefficients," providing a robust mechanism for detecting fraudulent activities. Through extensive simulations, we showcase the efficiency and accuracy of our algorithms in identifying deceitful users while safeguarding data confidentiality. This innovative approach not only bolsters the security of smart grids against energy theft, but also addresses privacy and security concerns inherent in conventional energy-theft detection methods.

The CSR perspective: Interplay of technological innovation, ethical leadership and government regulations for sustainable financial performance.

The financial performance of Chinese public and private sector banks is changing over time. There is no stability in the financial performance of Chinese banks which hurts businesses and the market. The purpose of current research was to determine the influence of corporate social responsibility (CSR) on driving the sustainable financial performance of Chinese banks. From methodological perspective, data was collected from 329 banking sector employees from China to partial least square-structural equation model (PLS-SEM) is employed for data analysis. The research used SPSS 24 and Smart PLS 4 as statistical analysis tools. This research confirmed that achieving sustainability in financial performance for Chinese banks can be achieved with CSR influenced by technological innovation, ethical leadership, and government regulations. This research has statistically confirmed that transformational leadership leading to CSR with technological innovation, ethical leadership, and government regulations can make significant improvements in financial performance. The framework developed by current research is a novel contribution to the literature. The findings of this research improve the literature on the banking sector and advanced performance. Furthermore, this research has highlighted significant ways that can help the banking sector employees to improve their financial performance with sustainability.

Evolutionary analysis of seasonal influenza A viruses in Pakistan 2020-2023.

INTRODUCTION: Influenza A viruses cause global health concerns due to their high amino acid substitution rates. They are linked to yearly seasonal epidemics and occasional pandemics. This study focused on sequencing influenza A virus strains in Pakistan. MATERIALS AND METHODS: We analyzed the genetic characteristics of influenza A(H1N1)pdm09 and A(H3N2) viruses circulating in Pakistan from January 2020 to January 2023. Whole genome sequences from influenza A (n = 126) virus isolates were amplified and sequenced by the Oxford Nanopore (MinION) platform. RESULTS: The HA genes of influenza A(H1N1)pdm09 underwent amino acid substitutions at positions K54Q, A186T, Q189E, E224A, R259K, and K308R in sequenced samples. The HA genes of influenza A(H3N2) had amino acid substitutions at G53D, E83K, D104G, I140M, S205F, A212T, and K276R in the sequenced samples. Furthermore, the HA gene sequences of influenza A(H1N1)pdm09 in this study belonged to subclade 6B.1A.5a.2a. Similarly, the HA gene sequences of influenza A(H3N2) were classified under six subclades (3C.3a.1 and 3C.2a1b.2a [2, 2a.1, 2b, 2c, and 2a.3b]). Notably, amino acid substitutions in other gene segments of influenza A(H1N1)pdm09 and A(H3N2) were also found. CONCLUSION: These findings indicate influenza A(H1N1)pdm09 and A(H3N2) viruses co-circulated during the 2020-2023 influenza season in Pakistan. Continued surveillance is crucial for real-time monitoring of possible high-virulence variation and their relevance to existing vaccine strains.

Identification and molecular mapping of a major gene conferring resistance to Phytophthora sansomeana in soybean 'Colfax'.

KEY MESSAGE: The first single dominant resistance gene contributing major resistance to the oomycete pathogen Phytophthora sansomeana was identified and mapped from soybean 'Colfax'. Phytophthora root rot (PRR) is one of the most important diseases in soybean (Glycine max). PRR is well known to be caused by Phytophthora sojae, but recent studies showed that P. sansomeana also causes extensive root rot of soybean. Depending upon the isolate, it might produce aggressive symptoms, especially in seeds and seedlings. Unlike P. sojae which can be effectively managed by Rps genes, no known major resistance genes have yet been reported for P. sansomeana. Our previous study screened 470 soybean germplasm lines for resistance to P. sansomeana and found that soybean 'Colfax' (PI 573008) carries major resistance to the pathogen. In this study, we crossed 'Colfax' with a susceptible parent, 'Senaki', and developed three mapping populations with a total of 234 F2:3 families. Inheritance pattern analysis indicated a 1:2:1 ratio for resistant: segregating: susceptible lines among all the three populations, indicating a single dominant gene conferring the resistance in 'Colfax' (designated as Rpsan1). Linkage analysis using extreme phenotypes anchored Rpsan1 to a 30 Mb region on chromosome 3. By selecting nine polymorphic SNP markers within the region, Rpsan1 was genetically delimited into a 21.3 cM region between Gm03_4487138_A_C and Gm03_5451606_A_C, which corresponds to a 1.06 Mb genomic region containing nine NBS-LRR genes based on Gmax2.0 assembly. The mapping results were then validated using two breeding populations derived from 'E12076T-03' × 'Colfax' and 'E16099' × 'Colfax'. Marker-assisted resistance spectrum analyses with 9 additional isolates of P. sansomeana indicated that Rpsan1 may be effective towards a broader range of P. sansomeana isolates and has strong merit in protecting soybean to this pathogen in the future.

A comparative study of ammonia solubility in imidazolium-based ionic liquids with different structural compositions.

Four imidazolium-based ionic liquids (ILs) with two cations 1-pentyl-3-butylimidazolium [PBIM]+ and 1-benzyl-3-butylimidazolium tetrafluoroborate [BzBIM]+, and two anions tetrafluoroborate (BF4-) and trifluoromethanesulfonate (OTf-) were synthesized for NH3 solubility enhancement. The structural, thermal, and electrochemical stabilities, ionic conductivity, and viscosity of the four ILs, namely, [PBIM]BF4, [BzBIM]BF4, [PBIM]OTf, and [BzBIM]OTf, were investigated. Due to the intermolecular interaction of the benzyl group attached to the imidazolium ring, [BzBIM]+-based ILs exhibited higher thermal stability but lower ionic conductivity compared to [PBIM]+-based ILs. Further, the NH3 solubility in all ILs was measured using a custom-made setup at temperatures ranging from 293.15 to 323.15 K and pressures ranging from 1 to 5 bar. The effects of the cation and anion structures of ILs, as well as pressure and temperature, on the NH3 solubility in the ILs were also investigated. [PBIM]BF4 showed the best solubility because of its high free volume and low viscosity. Density functional calculations validated the superior NH3 solubility in [PBIM]BF4, attributable to the minimal reorganization of the [cation]anion complex geometry during the solvation process, yielding a low solvation free energy. The findings of this study suggest that ILs exhibit a high NH3 solubility capacity and cation and anion structures considerably affect the NH3 solubility in ILs.

Atypical Complications during the Course of COVID-19: A Comprehensive Review.

COVID-19 is primarily a respiratory disease, but numerous studies have indicated the involvement of various organ systems during the course of illness. We conducted a comprehensive review of atypical complications of COVID-19 with their incidence range (IR) and their impact on hospitalization and mortality rates. We identified 97 studies, including 55 research articles and 42 case studies. We reviewed four major body organ systems for various types of atypical complications: (i) Gastro-intestinal (GI) and hepatobiliary system, e.g., bowel ischemia/infarction (IR: 1.49-83.87%), GI bleeding/hemorrhage (IR: 0.47-10.6%), hepatic ischemia (IR: 1.0-7.4%); (ii) Neurological system, e.g., acute ischemic stroke/cerebral venous sinus thrombosis/cerebral hemorrhage (IR: 0.5-90.9%), anosmia (IR: 4.9-79.6%), dysgeusia (IR: 2.8-83.38%), encephalopathy/encephalitis with or without fever and hypoxia (IR: 0.19-35.2%); (iii) Renal system, e.g., acute kidney injury (AKI)/acute renal failure (IR: 0.5-68.8%); (iv) Cardiovascular system, e.g., acute cardiac injury/non-coronary myocardial injury (IR: 7.2-55.56%), arrhythmia/ventricular tachycardia/ventricular fibrillation (IR: 5.9-16.7%), and coagulopathy/venous thromboembolism (IR: 19-34.4%). This review encourages and informs healthcare practitioners to keenly monitor COVID-19 survivors for these atypical complications in all major organ systems and not only treat the respiratory symptoms of patients. Post-COVID effects should be monitored, and follow-up of patients should be performed on a regular basis to check for long-term complications.

Bacterial co-infections, secondary infections and antimicrobial use among hospitalized COVID-19 patients in the sixth wave in Pakistan: findings and implications.

INTRODUCTION: Previous studies in Pakistan have shown considerable over prescribing of antibiotics in patients hospitalized with COVID-19 despite very low prevalence of bacterial infections. Irrational use of antibiotics will worsen antimicrobial resistance (AMR). METHODS: Retrospective analysis of medical records of patients in the COVID-19 wards of three tertiary care hospitals to assess antibiotic use during the sixth COVID-19 wave. RESULTS: A total of 284 patients were included, most were male (66.9%), aged 30-50 years (50.7%) with diabetes mellitus the most common comorbidity. The most common symptoms at presentation were cough (47.9%) and arthralgia-myalgia (41.5%). Around 3% were asymptomatic, 34.9% had mild, 30.3% moderate, and 23.6% had severe disease, with 8.1% critical. Chest X-ray abnormalities were seen in 43.3% of patients and 37% had elevated white cell counts, with 35.2% having elevated C-reactive protein levels. Around 91% COVID-19 patients were prescribed antibiotics during their hospital stay, with only a few with proven bacterial co-infections or secondary bacterial infections. Most antibiotics were from the 'Watch' category (90.8%) followed by the 'Reserve' category (4.8%), similar to previous COVID-19 waves. CONCLUSION: There continued to be excessive antibiotics use among hospitalized COVID-19 patients in Pakistan. Urgent measures are needed to address inappropriate prescribing including greater prescribing of Access antibiotics where pertinent.