BackgroundCardio-metabolic diseases (CMDs) are a growing public health problem, but data on incidence, trends, and costs in developing countries is scarce. Comprehensive and standardised surveillance for non-communicable diseases was recommended at the United Nations High-level meeting in 2011.Aims: To develop a model surveillance system for CMDs and risk factors that could be adopted for continued assessment of burdens from multiple perspectives in South-Asian countries.MethodsDesign: Hybrid model with two cross-sectional serial surveys three years apart to monitor trend, with a three-year prospective follow-up of the first cohort.Sites: Three urban settings (Chennai and New Delhi in India; Karachi in Pakistan), 4000 participants in each site stratified by gender and age.Sampling methodology: Multi-stage cluster random sampling; followed by within-household participant selection through a combination of Health Information National Trends Study (HINTS) and Kish methods.Culturally-appropriate and methodologically-relevant data collection instruments were developed to gather information on CMDs and their risk factors; quality of life, health-care utilisation and costs, along with objective measures of anthropometric, clinical and biochemical parameters. The cohort follow-up is designed as a pilot study to understand the feasibility of estimating incidence of risk factors, disease events, morbidity, and mortality.ResultsThe overall participant response rate in the first cross-sectional survey was 94.1% (Chennai 92.4%, n = 4943; Delhi 95.7%, n = 4425; Karachi 94.3%, n = 4016). 51.8% of the participants were females, 61.6% < 45years, 27.5% 45–60years and 10.9% >60 years.DiscussionThis surveillance model will generate data on prevalence and trends; help study the complex life-course patterns of CMDs, and provide a platform for developing and testing interventions and tools for prevention and control of CMDs in South-Asia. It will also help understanding the challenges and opportunities in establishing a surveillance system across countries.

BackgroundThe World health Organization (WHO) declares dengue and dengue hemorrhagic fever to be endemic in South Asia. Despite the magnitude of problem, no documented evidence exists in Pakistan which reveals the awareness and practices of the country's adult population regarding dengue fever, its spread, symptoms, treatment and prevention. This study was conducted to assess the level of knowledge, attitudes and practices regarding dengue fever in people visiting tertiary care hospitals in Karachi, Pakistan.MethodsA cross-sectional pilot study was conducted among people visiting tertiary care hospitals in Karachi. Through convenience sampling, a pre-tested and structured questionnaire was administered through a face-to-face unprompted interview with 447 visitors. Knowledge was recorded on a scale of 1–3.ResultsAbout 89.9% of individuals interviewed had heard of dengue fever. Sufficient knowledge about dengue was found to be in 38.5% of the sample, with 66% of these in Aga Khan University Hospital and 33% in Civil Hospital Karachi. Literate individuals were relatively more well-informed about dengue fever as compared to the illiterate people (p<0.001). Knowledge based upon preventive measures was found to be predominantly focused towards prevention of mosquito bites (78.3%) rather than eradication of mosquito population (17.3%). Use of anti- mosquito spray was the most prevalent (48.1%) preventive measure. Television was considered as the most important and useful source of information on the disease.ConclusionAdult population of Karachi has adequate knowledge related to the disease ‘dengue’ on isolated aspects, but the overall prevalence of ‘sufficient knowledge’ based on our criteria is poor. We demonstrated adequate prevalence of preventive practices against the disease. Further studies correlating the association between knowledge and its effectiveness against dengue will be helpful in demonstrating the implications of awareness campaigns.

Background: Health research training is an essential component of medical education and a vital exercise to help develop physician research skills. This study was carried out to assess the level of knowledge, attitudes and practices towards research amongst a group of Post Graduate Medical Trainees (PGMTs') at Aga Khan University (AKU), Pakistan.

Aim To estimate the prevalence of, and assess factors associated with, diabetes and prediabetes in three South Asian cities. Methods Using a multi-stage cluster random sample representative of each city, 16,288 subjects aged ≥20 years (Chennai: 6906, Delhi: 5365 and Karachi: 4017) were recruited to the Centre for cArdiometabolic Risk Reduction in South-Asia (CARRS) Study. Fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) were measured in 13720 subjects. Prediabetes was defined as FPG 100-125mg/dl (5.6-6.9 mmol/l) and/or HbA1c 5.7-6.4% (39-46mmol/mol) and diabetes as self-report and/or drug treatment for diabetes and/or FPG ≥126 mg/dl (≥7.0mmol/l) and/or HbA1c ≥6.5% (48mmol/mol). We assessed factors associated with diabetes and prediabetes using polytomous logistic regression models. Results Overall 47.3-73.1% of the population had either diabetes or prediabetes: Chennai 60.7% [95%CI: 59.0-62.4%] (diabetes-22.8% [21.5-24.1%], prediabetes-37.9% [36.1-39.7%]); Delhi 72.7% [70.6-74.9%] (diabetes-25.2% [23.6-26.8%], prediabetes-47.6% [45.6-49.5%]); and Karachi 47.4% [45.7-49.1%]; (diabetes-16.3% [15.2-17.3%], prediabetes-31.1% [29.5-32.8%], respectively). Proportions of self-reported diabetes were 55.1%, 39.0%, and 48.0% in Chennai, Delhi, and Karachi, respectively. City, age, family history of diabetes, generalized obesity, abdominal obesity, body fat, high cholesterol, high triglyceride, and low HDL cholesterol levels were each independently associated with prediabetes, while the same factors plus waist-to-height ratio and hypertension were associated with diabetes. Conclusion Six in ten adults in large South Asian cities have either diabetes or prediabetes. These data call for urgent action to prevent diabetes in South Asia.

Excision of the pseudoaneurysm with ligation of vessels and wide debridement without immediate revascularization in infected pseudoaneurysms is a safe and effective treatment.