Incidence of cutaneous Leishmaniasis in humans during the COVID-19 pandemic in Baluchistan Province, Pakistan.

INTRODUCTION: Cutaneous leishmaniasis (CL) is one of the neglected tropical diseases that affects impoverished communities throughout the world. In Pakistan CL is an endemic disease. AIMS AND OBJECTIVES: This study aimed to determine the incidence of CL infection in the Baluchistan province of Pakistan from January 2020 to March 2022 during the COVID-19 pandemic. METHODOLOGY: A total of 1047 clinically suspected cases of CL from Bolan Medical College Hospital, Quetta, were followed up in the study. The data regarding the epidemiological characterstics, pathological information, and treatment of patients was collected. RESULTS: Out of 1047 probable cases of CL, 594 (56.73%) cases were found to be positive for CL. Females had the highest infection rate, with the majority of reported cases being in the 0-9-year age group. Most CL cases were reported in April in the year 2020, with a few cases reported in June. But in the year 2021, the highest number of cases were reported in December. The number of overall cases has gradually increased in the year 2022, most likely because of the reduction in COVID-19 pandemic restrictions. The p value for the positive as compared to suspected cases in the years 2020, 2021, and 2022 was calculated as 0.8925, 0.8763, and 0.8535 respectively. CONCLUSIONS: Further epidemiological studies and health education campaigns are recommended to increase public awareness. It is strongly advised that local, provincial, and national health authorities establish and maintain effective leishmaniasis surveillance systems to promptly identify disease outbreaks and implement timely control measures.

Recapitulation of Peste des Petits Ruminants (PPR) Prevalence in Small Ruminant Populations of Pakistan from 2004 to 2023: A Systematic Review and Meta-Analysis.

Peste des petits ruminants (PPR) is an extremely transmissible viral disease caused by the PPR virus that impacts domestic small ruminants, namely sheep and goats. This study aimed to employ a methodical approach to evaluate the regional occurrence of PPR in small ruminants in Pakistan and the contributing factors that influence its prevalence. A thorough search was performed in various databases to identify published research articles between January 2004 and August 2023 on PPR in small ruminants in Pakistan. Articles were chosen based on specific inclusion and exclusion criteria. A total of 25 articles were selected from 1275 studies gathered from different databases. The overall pooled prevalence in Pakistan was calculated to be 51% (95% CI: 42-60), with heterogeneity I2 = 100%, τ2 = 0.0495, and p = 0. The data were summarized based on the division into five regions: Punjab, Baluchistan, KPK, Sindh, and GB and AJK. Among these, the pooled prevalence of PPR in Sindh was 61% (95% CI: 46-75), I2 = 100%, τ2 = 0.0485, and p = 0, while in KPK, it was 44% (95% CI: 26-63), I2 = 99%, τ2 = 0.0506, and p < 0.01. However, the prevalence of PPR in Baluchistan and Punjab was almost the same. Raising awareness, proper surveillance, and application of appropriate quarantine measures interprovincially and across borders must be maintained to contain the disease.

Assessment of Suitable Habitat of the Demoiselle Crane (Anthropoides virgo) in the Wake of Climate Change: A Study of Its Wintering Refugees in Pakistan.

The inevitable impacts of climate change have reverberated across ecosystems and caused substantial global biodiversity loss. Climate-induced habitat loss has contributed to range shifts at both species and community levels. Given the importance of identifying suitable habitats for at-risk species, it is imperative to assess potential current and future distributions, and to understand influential environmental factors. Like many species, the Demoiselle crane is not immune to climatic pressures. Khyber Pakhtunkhwa and Balochistan provinces in Pakistan are known wintering grounds for this species. Given that Pakistan is among the top five countries facing devastating effects of climate change, this study sought to conduct species distribution modeling under climate change using data collected during 4 years of field surveys. We developed a Maximum Entropy distribution model to predict the current and projected future distribution of the species across the study area. Future habitat projections for 2050 and 2070 were carried out using two representative concentration pathways (RCP 4.5 and RCP 8.5) under three global circulation models, including HADGEM2-AO, BCC-CSM1-1, and CCSM4. The most influential factors shaping Demoiselle Crane habitat suitability included the temperature seasonality, annual mean temperature, terrain ruggedness index, and human population density, all of which contributed significantly to the suitability (81.3%). The model identified 35% of the study area as moderately suitable (134,068 km2) and highly suitable (27,911 km2) habitat for the species under current climatic conditions. Under changing climate scenarios, our model predicted a major loss of the species' current suitable habitat, with shrinkage and shift towards western-central areas along the Pakistan-Afghanistan boarder. The RCP 8.5, which is the extreme climate change scenario, portrays particularly severe consequences, with habitat losses reaching 65% in 2050 and 85% in 2070. This comprehensive study provides useful insights into the Demoiselle Crane habitat's current and future dynamics in Pakistan.

Spatial distribution of drinking and irrigation water quality in different climatic zones of Baluchistan, Pakistan.

Baluchistan's water profile was developed by dividing it into seven zones (Northern Highlands-NH, Southern Highlands-SH, Quetta Valley-QV, Desert-D, Sibbi Plains-SP, Coastal Lasbella-CL, Coastal Gwadar-CG) based on geography, water availability, and climate of the area. A total of 106 water samples were collected from karaiz, spring water, and tube wells. Spatial distribution of EC, TDS, TH, SO42-, Cl-, Na+, and K+ showed an increasing trend in concentration from the highlands towards the desert and coastal zones. For anion, HCO3- is predominant in NH, SH, and QV, Cl- in D, CL, and CG and only SO42- in SP, whereas the cationic trend in overall zones is Na+>Ca2+>Mg2+>K+. In the NH, SH, QV, and SP zones, the physicochemical parameters met the drinking water quality guidelines; however, D, CL, and CG exceeded in almost all quality parameters. Furthermore, the drinking water quality index (WQI) shows excellent to good water quality in NH, SH, QV, and D zones, while CL and CG fall in poor to unsuitable water classes. In terms of hydrogeochemical facies, maximum water samples from NH fall in Ca-Mg-HCO3, and SH, QV, and SP in Ca-Mg-Cl type, where major ion chemistry is controlled by rock-weathering, while D, CL, and CG fall in the NaCl type, where evaporation is dominant. Similarly, irrigation water quality parameters (EC, SAR, RSC, Na%, MH%, PI, SSP, and KR) reveal that NH, SH, QV, and SP have suitable water for irrigation, and D, CL, and CG require proper treatment. Additionally, USSL and Wilcox's diagrams indicated that NH, SH, QV, and SP have "excellent to permissible"; however, D, CL, and CG have "permissible to unsuitable" class water, requiring special management practices. Consequently, appropriate control measures and targeted water purification programmes should be implemented to protect the public health and sustainability of water resources in Baluchistan.

Revisiting Brucellosis in Small Ruminants of Western Border Areas in Pakistan.

Brucellosis, globally known bacterial zoonosis, is endemic to Pakistan. B. abortus in bovines, B. melitensis in small ruminants and B. canis in dogs mainly cause this disease. A total of 1821 sera (1196 from sheep and 625 from goats) from animal herds near the Pakistan-Afghanistan border were collected. In parallel testing of sera for anti-Brucella antibodies (B. abortus and B. melitensis) was carried out by RBPT and indirect ELISA. The presence of Brucella DNA in sera was tested by real-time PCR. The overall percentage of seropositive samples was 0.99 (18/1821) by both tests. All positive samples originated from Baluchistan territory which translated into 1.76% (18/1021). None of the positive sera had signals for Brucella DNA and none of sera from goats carried detectable antibodies. Both tests showed an almost perfect agreement with Kappa statistics. The flock size was found to be associated with the presence of anti-Brucella antibodies. The samples of Khyber Pakhtunkhwa (KPK) tested negative in both serological tests and hence were not processed for real-time PCR. The present study shows the presence of anti-Brucella antibodies in sheep in the Baluchistan region of Pakistan. Diagnostic services need to be improved and test and slaughter policies might be implemented for eradication of Brucella infection in these areas. Awareness about the infection is needed at the farmer's level. Isolation and molecular biology of the isolates could help with understanding the prevailing etiology in a better way.

Surgically confirmed cases of cystic echinococcosis from Baluchistan Province, Pakistan for the years 2011-2018.

INTRODUCTION: Cystic echinococcosis (CE) is a parasitic zoonotic disease caused by the larval stage of Echinococcus granulosus tapeworms. It has a worldwide geographic distribution and can threaten the livestock industry and human health in endemic areas, including Pakistan. CE prevalence is high in Pakistan due to lack of local knowledge about disease transmission and a lack of control measures. The Pakistan province of Baluchistan shares a border with Iran and Afghanistan and is largely agricultural. However, little is known about E. granulosus transmission in this region. METHODS: Information on surgically confirmed cases of CE in Baluchistan Province was obtained through evaluation of paraffin fixed cyst samples and patient records obtained from three local hospitals for the years 2011-2018. RESULTS: A total of 22 paraffin fixed samples were collected during the study period. The majority of cysts were obtained from the liver (9/22; 40.9%), with anatomical location not available for two of the cysts. Demographic information was available for 18 cases. Females made up 61.1% (11/18) of the cases. The largest numbers of cases were found in the 31-40 years age group (5/18; 22.7%). DISCUSSION: This study shows that Echinococcus spp. parasites are circulating in the study area. In order to control the disease, a comprehensive regional surveillance and control program is needed.

Employing Different Traps for Collection of Mosquitoes and Detection of Dengue, Chikungunya and Zika Vector, Aedes albopictus, in Borderline of Iran and Pakistan.

BACKGROUND: Southeastern Iran has been established as an area with the potential to harbor Asian tiger mosquito populations. In 2013, a few numbers of Aedes albopictus were detected in three sampling sites of this region. This field study was aimed to evaluate the efficacy of various traps on monitoring mosquitoes and status of this dengue vector, in five urban and 15 suburban/rural areas. METHODS: For this purpose, four adult mosquito traps (BG-sentinel 2, bednet, Malaise, and resting box trap) were used and their efficacy compared. In addition, large numbers of CDC ovitraps were employed, within 12 months. RESULTS: A total of 4878 adult samples including 22 species covering five genera were collected and identified from traps. It was not revealed any collection of Ae. albopictus. Statistical analysis showed no significant difference in meteorological variables between the two periods, the previous report and the current study. There were significant differences in the total number of mosquitoes collected by various traps in the region across different months. CONCLUSION: The resulting data collected here on the efficiency of the various trap types can be useful for monitoring the densities of mosquito populations, which is an important component of a vector surveillance system. While the presence of Ae. albopictus was determined in this potential risk area, there is no evidence for its establishment and further monitoring needs to be carried out.

Health risk assessment of nitrate in groundwater resources of Iranshahr using Monte Carlo simulation and geographic information system (GIS).

Because of exposure to a wide range of chemical contaminants such as nitrate via potable water resources, the use of the approaches to set standards for drinking water quality and also to do a risk assessment is necessary for maintaining the public health. High levels of nitrate in drinking water can have adverse health effects; primarily for infants and pregnant women. So, the present study aimed to the assessment of nitrate health risk in drinking water resources of the Iranshahr city, Sistan and Baluchistan province and also, evaluation of the uncertainty of nitrate and the probability of contamination occurrence by Monte-Carlo Simulation (MCS) technique. Besides, the geographic information system (Arc GIS, Ver 10.3) was applied to mapping the nitrate concentration in groundwater resources of the studied area. For these aims, the numbers of 66 samples were collected from rural groundwater resources, and nitrate concentration was measured using a Spectrophotometer in wavelength of 220 nm. According to the results, the nitrate concentration was in the range of 6.49 mg/L, and its average level was 6.15 mg/L. Also, the simulation results with 90% confidence showed that the hazard equitant (HQ) in the infant groups, children-teenagers and adults was less than 0.331, 0.311, 0.312, and 0.3, respectively.

Evaluation of treatment outcomes and factors associated with unsuccessful outcomes in multidrug resistant tuberculosis patients in Baluchistan province of Pakistan.

BACKGROUND: Evaluating treatment outcomes of a cohort of patients is an effective way for analyzing the effectiveness of a program. Information regarding drug resistance pattern, detailed management, treatment outcomes and factors associated with unsuccessful outcomes in multidrug resistant (MDR-TB) patients is missing from Baluchistan province of Pakistan. METHODS: This study was carried out at Programmatic Management of Drug Resistant TB unit at Fatimah Jinnah General and Chest Hospital Quetta. All eligible 186 MDR-TB patients enrolled at the study site from January 1, 2012 to April 30, 2016 were retrospectively followed until the treatment outcomes were reported. Data was abstracted through a standardized data collection form and analysed by SPSS 20. Multivariate binary logistic regression (MVBLR) analysis was used to evaluate factors associated with i) death and treatment failure and ii) lost to follow up. A p-value of <0.05 was considered statistically significant. RESULTS: The study participants were resistant to a median of four drugs (range 2-8) with majority being resistant to any second-line anti-TB drug (SLD) (55.5%). Among SLD, resistance was highest for ofloxacin (52.2%). The study site had an overall treatment success rate of 71.6%. A total of 129 (69.4%) patients were cured, four (2.2%) completed treatment, 37 died (19.9%), 14 (7.5%) were lost to follow up and two (1.1%) were declared treatment failures. In MVBLR analysis, patients' age of >40 years (OR = 4.249, p-value = 0.001) had statistically significant positive and baseline body weight of >40 kg (OR = 0.256, p-value = 0.002) had statistically significant negative association with death and treatment failure. No factor had statistical significant association with lost to follow up. CONCLUSION: Overall treatment success rate was promising but did not achieve the target success rate (>75%) set by World Health Organization. It can be further improved by paying special attention and providing enhanced management to the patients with risk factors for unsuccessful outcomes.

Genetic characterization of Y-chromosomal STRs in Hazara ethnic group of Pakistan and confirmation of DYS448 null allele.

Pakistan harbors 18 major ethnic groups and Hazara is one of the distinct but smaller groups comprising 0.090% of the total population. Hazara individuals have typical Mongolian facial features and they claim to be descendants of Genghis Khan's army in the first quarter of the thirteenth century AD. In this study, we genotyped 153 unrelated males living in Quetta, Baluchistan, Pakistan, for a total of 26 (n = 153) to 30 (n = 47) Y-chromosomal STR loci. One hundred forty unique haplotypes were developed for Hazara population using the PowerPlex Y23 loci. The Y-STR locus showed a genetic diversity ranging from 0.2384 to 0.7918, and an overall discrimination capacity (DC) of 91.5%. The Hazara population samples were profiled for three additional Y-STRs (DYS388, DYS449 and DYS460), which increased the number of unique haplotypes to 144 while the DC increased to 94.11% in Hazara Population of Pakistan. Interestingly, null alleles were observed at DYS448 in 25 individuals of Hazara population. The Hazaras showed significant differences from other local populations of Pakistan as well as neighboring populations, but had considerable genetic affinities to Kazakhs and Mongols.

Data on aluminum concentration in drinking water distribution network of rural water supply in Sistan and Baluchistan province, Iran.

The aim of this study is to determine the Aluminum concentration in groundwater resources of Sistan and Baluchestan province, Iran. See the data in this article. For the purpose of this study, a total of 871 water samples were collected and values of quality parameters including pH, turbidity, total dissolved solids (TDS) and Aluminum concentration were measured (with two-time repetitions) according to Standard Methods for the Examination of Water and Wastewater, during the year 2016. The mean, maximum, minimum of Aluminum concentrations in all groundwater resources of Sistan and Baluchistan province, were: 0.015, 0.059, 0.0004 mg/l, respectively and also, the standard deviation was 0.012. Moreover, employing GIS software, the geo-statistical distribution of Aluminum concentration in groundwater aquifer in Sistan and Baluchestan was mapped.

Ethnobotanical and ethnomedicinal studies in Baluchi tribes: A case study in Mt. Taftan, southeastern Iran.

ETHNOBOTANICAL RELEVANCE: From ancient times, the applied use of herbs has been common among indigenous people throughout the world. The present survey is a regional ethnobotanical study of Baluchi tribes living in the Mt. Taftan area, Sistan and Baluchistan Province, southeastern Iran. The aim of this study was to document all traditional knowledge and analyze the medicinal plants used in area and also to identify significant plant species for future pharmacological study. MATERIALS AND METHODS: Local knowledge was obtained through semi structured and open interviews, in which 51 informants were interviewed. Data were analyzed with Informant Agreement Relative (IAR) and Frequency of Citation (FC) indices. RESULTS: A total number of 106 taxa of medicinal plants were collected from ten villages from the surrounding plains and highlands of Mt. Taftan, out of 446 plant taxa collected or reported as native in the area. Most plants belong to the Irano-Turanian phytogeographical region in which Asteraceae (15%), Lamiaceae (11%), Fabaceae (8%), Rosaceae (7%), Apiaceae (7%) and Brassicaceae (5%) are those predominantly used. The regression analysis shows that families Apiaceae, Lamiaceae, Solanaceae and Rosaceae are more highly used as medicinal than species rich families such as Asteraceae and Fabaceae, which are the richest families in the Iranian flora. The highest FC was recorded for Artemisia spp. (41) and Berberis integerrima (40). The highest IAR Index was obtained for stings (0.86), followed by disorders in the circulatory system (0.7), dental problems (0.70) and injuries (0.69). Comparing our data with major ethnobotanical references in Iran revealed that medicinal applications of 34 taxa have not been cited, including Hyoscyamus malekianus, a local endemic plant using for ailments of toothache and worms. The toxicity of the endemic Semenovia suffruticosa is also reported. CONCLUSION: As a result of this study we conclude that Taftan area harbours many plant species for which indigenous knowledge provides a background of medicinal importance. The high percentage of medicinal plants proportional to the native flora is 23.8%, compared to the world percentage of 17.1%, is an indication of the rich knowledge and relationship of isolated Baluchi tribes living in Mt. Taftan to the local flora growing in their surroundings. This rich knowledge should be highly regarded as a cultural and ethnobotanical heritage. Furthermore, ethnobotanical results show some weak interrelation between Baluchi tribes living in Iran and Pakistan, probably because of a different flora and/or unfavourable environmental conditions and perhaps local conflicts which might have reduced active cultural exchange.

Problems in Mitochondrial DNA forensics: while interpreting length heteroplasmy conundrum of various Sindhi and Baluchi ethnic groups of Pakistan.

The insight heterodox genetics of mtDNA infer new perspectives at the level of human mitochondrial control region heteroplasmy, which is substantial in evolutionary as well as forensic interpretation. The main goal of this study is to interrogate the recurrence and resolve the ambiguity of blurry spectrum of heteroplasmy in the human mtDNA control region of 50 Baluchi and 116 Sindhi unrelated individuals. Sanger sequencing was employed classically, that was further investigated by minisequencing. Only 20% Baluchi and 25.8% Sindhi were homoplasmic, whereas rest of 80% Baluchi and 74.1% Sindhi exhibited at least one heteroplasmy within the specimen. In total, 166 individuals have length heteroplasmy (LH) found at positions 16189, 303-315, 568-573, and 514-524, whilst point mutation heteroplasmy (PMH) was detected at positions 73, 16093, 16189, and 16234, respectively. Overall LH was observed albeit high frequency in Sindhi ethnic group (82%) rather than Baluchi's (37%), whereas PMH accumulation was relatively extensive (24%) in Baluchi's than Sindhi's (11.2%). The obtained results ascertained that growing knowledge of heteroplasmy assisted to develop consciences in the forensic community that heteroplasmy plays a pivotal role in the legal interpretation on a regular basis and knowledge of its biological underpinnings has a vital niche in the forensic science. Limited studies have focused on heteroplasmy, yet scientific attention should be given, in order to determine its magnitude in different ethnic boundaries.

Malaria Four-year Epidemiological Trends in Sistan and Baluchistan Province, Iran.

INTRODUCTION: Malaria is one of the foremost public health concerns in Iran, where more than 90% of malaria cases are reported in the southern and south-eastern areas of the country. The aim of this study was to assess the epidemiological trends of malaria over a four-year period in in the Sistan and Baluchistan province in south east of Iran. METHODS: This descriptive epidemiological study examined malaria trends in Sistan and Baluchistan province from 2011 to 2014. The study used data collected in accordance with the Iranian Ministry of Health's malaria control and elimination protocol. This protocol has digitized the data reporting system for malaria, and all information were sent online to the Center of Disease Control in the Ministry of Health. In this manner, information on malaria cases in Sistan and Baluchistan were made available for the researchers to analyze. Descriptive and comparative analyses were conducted using the SPSS version 13. RESULTS: Annual incidence rates reported in 2011, 2012, 2013, and 2014 showed the prevalence of 89.9, 43.9, 38.3 and 36.6 (per 100,000 persons), respectively. Across all 4 years, the highest numbers of cases were found in persons 16-25 years old and among males. Most of the infected individuals were villagers and workers. In total, 64.8% of patients were Iranian and 29.5% were Pakistani. The highest number of cases was diagnosed in the cities of Sarbaz and Chabahar, with 1,742 and 1,707 cases, respectively. The results showed that over the last 4 years, 50.8% of cases have entered into Iran from foreign countries. The majority of cases involved parasites in the trophozoite stage of the life cycle. In terms of surveillance, passive care was reported in the majority of cases, and vivax malaria had the highest prevalence in comparison with other types. CONCLUSION: The findings are showing that the care, control and treatment system applied to Sistan and Baluchistan province has had a positive effect on decreasing the prevalence rate of Malaria disease. Meanwhile, it is recommended to policy makers to provide more health controls for border entries, stop irregular immigration and apply more precise case searches in order to have a complete and on time treatment in a way that the chain of transmission of the disease would be cut. Health education and knowledge-ability promotion programs are better to be set in order to develop self-protection and environment improvement among people.

Ethnobotany of medicinal plants in district Mastung of Balochistan province-Pakistan.

ETHNOPHARMACOLOGICAL RELEVANCE: The aim of this study was to document the medicinal uses of plants in district Mastung of Balochistan province, Pakistan. The ethnobotanical results contain quantitative information on medicinal plants diversity documented for the first time in the area. MATERIALS AND METHODS: The information was collected through semi-structured interviews, rapid appraisal approach, open ended questionnaire and personal observations. Results were analyzed using quantitative indices of information consent factor (ICF), fidelity level (FL), use value (UV), frequency citation (FC) and relative frequency citation (RFC). RESULTS: In total of 102 plant species belonging to 47 families were reported for the medicinal purposes. Asteraceae was found to be dominant family in terms of species in the area with 11 species. The whole plant and leaves were noted as most frequently used parts (24%). Decoction (31% with 40 species) was the most commonly used preparation method. Highest ICF value (1) was recorded for antidote category. 100% fidelity level was found for four plant species i.e. Achillea welhemsii, Caralluma tuberculata, Citrullus colocynthis, and Seripidium quettense. The highest use value was reported for the Acroptilon repens (0.5) while highest RFC value was calculated for Berberis balochistanica and Citrullus colocynthis (0.18). Highest use report was calculated for Caralluma tuberculata, Citrullus colocynthis, Malva neglecta and Mentha longifolia with five use reports for each. CONCLUSIONS: The area is rich in medicinal plants and these plants are still commonly used for medicinal purposes among the people in their daily lives. However, there is a gradual loss of traditional knowledge about these plants in new generation. This study provides basis for the conservation of the local flora, its use as food and medicine. It also provides various socio-economic dimensions associated with the common people.