Resumo Este estudo teve como objetivo investigar as alterações patológicas induzidas por carbofurano (CF) em garças-vaqueiras. Duzentas dessas garças foram criadas e divididas igualmente em quatro grupos e receberam diferentes concentrações de CF: 0,03 mg/L; 0,02 mg/L; 0,01 mg/L; e 0 mg/L (grupo controle). Foram realizadas análises de hematologia, bioquímica sérica, histopatologia e marcadores imunológicos. Nossos resultados confirmaram que CF induz condições anêmicas, leucocitose, atividade enzimática hepática elevada e alterações nos biomarcadores renais. Além disso, lesões microscópicas específicas, como necrose multifocal, núcleos picnóticos, hemorragias, congestão e proliferação de células inflamatórias, foram observadas no fígado, rim, baço e timo. Esses achados sugerem que o CF pode causar efeitos nocivos, portanto a aplicação desse agrotóxico no campo deve ser rigorosamente monitorada para mitigar a possibilidade de exposição a espécies não alvo.

Abstract This study was aimed to investigate Carbofuran (CF)-induced pathological changes in cattle egret. Two hundred cattle egrets were reared and equally divided into four groups and given different CF concentrations (0.03 mg/L, 0.02 mg/L, 0.01 mg/L and 0 mg/L (control group)). Hematology, serum biochemistry, histopathology, and immunological markers were studied. Our results confirm that CF induces anemic conditions, leukocytosis, elevated liver enzymatic activity, and alterations in renal biomarkers. Moreover, specific microscopic lesions such as multifocal necrosis, pyknotic nuclei, hemorrhages, congestion, and inflammatory cell proliferation were observed in the liver, kidney, spleen, and thymus. These findings suggest that CF can induce harmful effects, so the application of this pesticide in the field must be strictly monitored to mitigate the possibility of exposure to non-target species.

Resumo As bactérias foram isoladas de amostras de suco de maçã fresco de lojas de três diferentes localidades de Lahore. A análise de amostras dos mercados Liberty, Anarkali e Yateem khana mostram diferentes níveis de contaminação. Havia bactérias patogênicas e não patogênicas em todas as amostras e foram identificadas pelos testes morfológicos e bioquímicos. A maioria dos plasmídeos de bactérias patogênicas tinha 4 kb em seu tamanho molecular. A ribotipagem do sequenciamento do gene do RNA ribossômico 16S foi realizada para confirmar a cepa de Helicobacter pylori e Gluconobacter oxydans. A maior sensibilidade de 210 mm foi mostrada por Enterobacter sp. contra disco de azteromisina (15µg) enquanto Micrococcus sp. foi altamente resistente a todos os antibióticos aplicados. A resistência a antibióticos de bactérias patogênicas também foi verificada contra extratos de plantas de Ricinus communis, todos os patógenos bacterianos isolados foram resistentes, mas apenas E. coli foi inibida em 300µl dos extratos. A presença de bactérias patogênicas nas amostras de suco de maçã deveu-se à contaminação da água de esgoto na água potável, enquanto algumas dessas bactérias patogênicas vieram da árvore da maçã e outras de armazéns de frutas.

Abstract Bacteria were isolated from samples of Fresh Apple juices from shops of three different localities of Lahore. Analysis of samples from Liberty, Anarkali and Yateem khana Markets show different levels of contamination. There were pathogenic and non-pathogenic bacteria in all samples and were identified by the morphological and biochemical tests. Most of the plasmids of pathogenic bacteria were 4kb in their molecular size. Ribotyping of 16S ribosomal RNA gene sequencing was done to confirm Helicobacter pylori strain and Gluconobacter oxydans. The highest sensitivity of 210mm was shown by Enterobacter sp. against Aztheromysine disk (15µg) while Micrococcus sp. was highly resistant against all of the Antibiotics applied. The antibiotic resistance of pathogenic bacteria was also checked against Ricinus communis plant's extracts, all isolated bacterial pathogens were resistant but only, E.coli was inhibited at 300µl of the extracts. Presence of pathogenic bacteria in Apple juice samples was due to contamination of sewage water in drinking water while some of these pathogenic bacteria came from Apple's tree and other from store houses of fruits.

Resumo O novo coronavírus (nCoV), nomeadamente “SARS-CoV-2”, foi considerado responsável pela pandemia atual iniciada em Wuhan (China) desde dezembro de 2019 e foi descrito com ligação epidemiológica à China em cerca de 221 países e territórios até agora. Neste estudo, caracterizamos a linhagem genética do SARS-CoV-2 e relatamos a recombinação dentro do gênero e subgênero dos coronavírus. A relação filogenética de 39 coronavírus pertencentes a seus quatro gêneros e cinco subgêneros foi analisada usando o método de Neighbour-joining usando MEGA 6.0. Árvores filogenéticas do genoma de comprimento total, várias proteínas (espícula, envelope, membrana e nucleocapsídeo), sequências de nucleotídeos foram construídas separadamente. A recombinação putativa foi testada via RDP4. Nossa análise descreve que o “SARS-CoV-2”, embora mostre grande semelhança com as sequências de Bat-SARS-CoVs em todo o genoma (dando semelhança de sequência de 89%), exibe agrupamento conflitante com as sequências de coronavírus do tipo Bat-SARS (MG772933 e MG772934) Além disso, sete eventos de recombinação foram observados em SARS-CoV-2 (NC045512) por RDP4. Mas nem um único evento de recombinação preenche o alto nível de certeza. A recombinação está alojada mais em genes de proteína de pico, principalmente, do que no resto do genoma, indicando que o cluster de ponto de interrupção surge além dos intervalos de densidade de ponto de interrupção de 95% e 99%. Os níveis de similaridade genética observados entre “SARS-CoV-2” e Bat-SARS-CoVs defendem que o último não exibe a variante específica que causa surto em humanos, sugerindo que “SARS-CoV-2” tenha se originado possivelmente de morcegos. Essas características genômicas e sua provável associação com as características do vírus, juntamente com a virulência em humanos, requerem uma consideração mais aprofundada.

Abstract Novel coronavirus (nCoV) namely “SARS-CoV-2” is being found responsible for current PANDEMIC commenced from Wuhan (China) since December 2019 and has been described with epidemiological linkage to China in about 221 countries and territories until now. In this study we have characterized the genetic lineage of SARS-CoV-2 and report the recombination within the genus and subgenus of coronaviruses. Phylogenetic relationship of thirty nine coronaviruses belonging to its four genera and five subgenera was analyzed by using the Neighbor-joining method using MEGA 6.0. Phylogenetic trees of full length genome, various proteins (spike, envelope, membrane and nucleocapsid) nucleotide sequences were constructed separately. Putative recombination was probed via RDP4. Our analysis describes that the “SARS-CoV-2” although shows great similarity to Bat-SARS-CoVs sequences through whole genome (giving sequence similarity 89%), exhibits conflicting grouping with the Bat-SARS-like coronavirus sequences (MG772933 and MG772934). Furthermore, seven recombination events were observed in SARS-CoV-2 (NC_045512) by RDP4. But not a single recombination event fulfills the high level of certainty. Recombination mostly housed in spike protein genes than rest of the genome indicating breakpoint cluster arises beyond the 95% and 99% breakpoint density intervals. Genetic similarity levels observed among “SARS-CoV-2” and Bat-SARS-CoVs advocated that the latter did not exhibit the specific variant that cause outbreak in humans, proposing a suggestion that “SARS-CoV-2” has originated possibly from bats. These genomic features and their probable association with virus characteristics along with virulence in humans require further consideration.

RESUMO Para investigar o papel do esterco de vaca na recuperação do solo e bioassimilação, juntamente com a bioacumulação de metais pesados em minhocas (P. posthuma) (N = 900), minhocas foram usadas e grupos de tratamento de mistura CD-solo de diferentes proporções de esterco de vaca foram projetados. Doses não letais de acetato de chumbo e cloreto de cádmio foram adicionadas aos grupos de tratamento. P. posthuma maduros foram liberados em cada vaso experimental, mantendo as condições favoráveis. Foram avaliados o pH, carbono, nitrogênio, fósforo, cátions trocáveis e nível de metais pesados de cada mistura. Os resultados indicaram que a bioassimilação de Pb e Cd por P. posthuma foi significativamente (P ˂ 0,01) maior em diferentes tratamentos de solo-CD em relação ao controle. A maior bioassimilação de ambos os metais foi observada em T1 de ambos os grupos (Pb = 563,8 mg / kg e Cd = 42,95 mg / kg). O conteúdo de ambos os metais foi significativamente (P ˂ 0,05) reduzido na fundição. A concentração de nutrientes nas fundições finais de todos os tratamentos de solo-CD também foi igualmente transformada de menos ou insolúvel para mais solúvel e disponível para as plantas, exceto o nível de carbono que aumenta com a proporção de CD. Conclui-se que o esterco de vaca como matéria orgânica tem um efeito positivo na recuperação do solo e na bioassimilação de metais por P. posthuma.

Abstract To investigate the role of cow dung in soil reclamation and bio assimilation along with bio accumulation of heavy metals in earthworm (P. posthuma) (N=900) earthworms were used and treatment groups of CD-soil mixture of different proportion of cow dung were designed. Nonlethal doses of lead acetate and cadmium chloride were added in treatment groups. Mature P. posthuma were released in each experimental pot maintaining the favorable conditions. The pH, carbon, nitrogen, phosphorus, exchangeable cations, and heavy metal level of each mixture was evaluated. The results indicated that bio-assimilation of Pb and Cd by P. posthuma were significantly (P ˂ 0.01) higher in different soil-CD treatments compared to control. Highest bio-assimilation of both metals was observed in T1 of both groups (Pb = 563.8 mg/kg and Cd = 42.95 mg/kg). The contents of both metals were significantly (P ˂ 0.05) lowered in casting. The nutrient concentration in the final castings of all soil-CD treatments were also equally transformed from less or insoluble to more soluble and available for plants, except for carbon level which increased with CD proportion. It is concluded that cow dung as organic matter has a positive effect on soil reclamation and bio-assimilation of metals by P. posthuma.

Resumen Las plantas han desarrollado la base de los sistemas tradicionales de medicina que existen desde hace miles de años debido a la presencia de constituyentes bioactivos vitales. Además de las numerosas actividades antioxidantes, antimicrobianas, hipoglucemiantes, anticancerígenas y de los productos naturales, existe un reconocimiento limitado con respecto a los diversos atributos terapéuticos de las plantas medicinales como Momordica charantia, Syzygium cumini, Zingiber officinale y Parthenium hysterophorus. El estudio actual fue diseñado para explorar las capacidades inhibidoras de enzimas (alfa glucosidasa y acetilcolinesterasa) y citotóxicas de las fracciones solventes de estas plantas autóctonas. Todas las muestras tuvieron efectos inhibidores sobre la alfa glucosidasa, pero los fraccionamientos metanólicos de cada planta exhibieron una mayor eficacia inhibidora contra la acción enzimática en comparación con otros fraccionamientos. A excepción del extracto metanólico de Parthenium hysterophorus (33,25 ± 0,43), todas las demás plantas estudiadas, a saber. Zingiber officinale (50,33 ± 0,99), S. cumini (73,91 ± 1,05) y Momordica charantia (72,30 ± 1,17) indicaron más del 50 % de potenciales inhibidores de la alfa glucosidasa. Las inhibiciones de acetilcolinesterasa (porcentaje de inhibición) por diferentes fracciones de P. hysterophorus, Z. officinale, S. cumini y M. charantia estuvieron en el rango de 0,23 ± 0,14 a 11,40 ± 0,26, 13,04 ± 0,11 a 44,05 ± 0,76, 4,21 ± 0,15 a 71,55 ± 0,80 y 1,03 ± 0,09 a 50,12 ± 0,82 respectivamente. Entre todas las plantas estudiadas, Momordica charantia, Syzygium cumini y Zingiber officinale no fueron mutagénicas. Aunque se observó una ligera variación en las bioactividades, todos los extractos botánicos son excelentes fuentes de constituyentes bioactivos con el potencial de inhibir la alfa glucosidasa y la acetilcolinesterasa. Se justifica una mayor investigación a este respecto que involucre una evaluación guiada por bioensayo.

Abstract Plants have developed the foundation of traditional systems of medicine that have been in existence for thousands of years due to the presence of vital bioactive constitutes. Aside from antioxidant, antimicrobial, hypoglycemic, anticarcinogenic and numerous activities of natural products, limited recognition regarding diverse therapeutic attributes of medicinal plants such as Momordica charantia, Syzygium cumini, Zingiber officinale and Parthenium hysterophorus exist. The current study was designed to explore the enzyme inhibitory (alpha glucosidase and acetylcholinesterase) and cytotoxicity capacities of solvent fractions of these indigenous plants. All the samples had inhibitory effects on alpha glucosidase, but methanolic fractionations of each plant exhibited greater inhibitory efficacy against enzyme action compared to other fractionations. Except for the methanolic extract of Parthenium hysterophorus (33.25 ± 0.43), all other studied plants, viz. Zingiber officinale (50.33 ± 0.99), S. cumini (73.91 ± 1.05) and Momordica charantia (72.30 ± 1.17) indicated more than 50% alpha glucosidase inhibitory potentials. Acetylcholinesterase inhibitions (percentage inhibition) by different fractions of P. hysterophorus, Z. officinale, S. cumini and M. charantia were in the range of 0.23 ± 0.14 to 11.40 ± 0.26, 13.04 ± 0.11 to 44.05 ± 0.76, 4.21 ± 0.15 to 71.55 ± 0.80 and 1.03 ± 0.09 to 50.12 ± 0.82 respectively. Among all studied plants, Momordica charantia, Syzygium cumini, and Zingiber officinale were non-mutagenic. Although slight variation in bioactivities was observed, all the botanical extracts are excellent sources of bioactive constituents with the potential to inhibit alpha glucosidase and acetylcholinesterase. Further research in this regard is warranted involving bioassay-guided assessment.

Abstract Ultrasonic radiation (U. S.) is the sustainable and green technology which has transformed the domain of textiles. In the current study, ultrasonic treatment was employed to improve the reactive dyeing of cellulosic fabricby Violet H3R dye. For this purpose, U.S. treatment has been given to both solution & fabric upto 50 min. at 30 to 60 oC. Promising results were obtained when cellulosic fabric was exposed to U.S. treatment at at 50 oC for a period of 30 min. using dye bath of 55 mL having 7.5 pH. Glauber salt (8 g/L) was employed as an exhausting agent at 60 oC for 55 min. Various shades of cotton fabric dyed at optimal conditions were obtained which showed that U.S. treatment has enhanced not only the colour strength but also the fastness rating from medium to outstanding. So, it can be concluded from the current study that U. S. treatment is not only good enough for improving the dyeing aptitude of Reactive Violet H3R dye, but it also uplifts the color features of dyed cotton fabric.

Resumen La radiación ultrasónica (U:S. por sus siglas en inglés) es la tecnología sostenible y verde que ha transformado el campo de los textiles. En este estudio, se llevó a cabo un tratamiento ultrasónico para mejorar el teñido reactivo de tela celulósica por el tinte Violet H3R. Para este propósito, se llevó a cabo un tratamiento con ultrasonido tanto a la solución como a la tela por hasta 60 minutos a 30 y 60 oC. Se obtuvieron resultados prometedores cuando la tela celulósica se expuso a un tratamiento con ultrasonido a 50 oC durante un período de 30 min, utilizando un baño de tinte (de 55 mL) a pH 7,5 de sal de Glauber (8 g/L). Estas condiciones representan un sistema de agotamiento, aplicado a 60 oC durante 55 min. Se obtuvieron varios tonos de tela de algodón teñidos en condiciones óptimas, lo que mostró que el tratamiento por ultrasonido mejora no solo la intensidad del color sino también el índice de solidez de media a sobresaliente. Por lo tanto, del estudio actual se puede concluir que el tratamiento con ultrasonido no solo es lo suficientemente bueno para mejorar la capacidad de teñido del tinte Reactive Violet H3R, sino que también realza las características del color de la tela de algodón teñida.

Resumo O esgoto não tratado e os resíduos industriais da cidade de Faisalabad, no Paquistão, são descartados no Rio Chenab através do dreno principal de Chakbandi (CMD). O presente projeto busca investigar os efeitos dessa poluição de água doce no corpo de peixes Ictalurus punctatus. Os espécimes deste peixe foram coletados a montante e a jusante da entrada do CMD no Rio Chenab. Brânquias, fígado, rim e músculos das regiões dorsolaterais dos peixes foram submetidos à histopatologia. Peixes de criação e peixes de áreas a montante foram utilizados como controle. Peixes coletados em locais experimentais poluídos mostraram danos significativos em órgãos selecionados. Os tecidos branquiais mostraram uma anormalidade na forma de elevação do epitélio primário, fusão, vacuolação, hipertrofia e necrose. Observou-se que os tecidos hepáticos estão sujeitos a degeneração de hepatócitos, necrose, hepatócitos mitocondriais granulares e dilatação de sinusoides. Os tecidos renais indicaram aumento do espaço dos arqueiros, glomérulos contraídos e néfrons degenerados. Edema, necrose e atrofia foram observados nos tecidos musculares de peixes de áreas poluídas. Peixes da área a montante apresentaram lamelas branquiais fundidas, infiltração de células inflamatórias, hipertrofia e vacuolização em hepatócitos. Os tecidos renais indicaram a presença de células tubulares nucleares, túbulos renais destrutivos, hemorragia e necrose no epitélio tubular. Os espaços intramiofibrilas também foram observados nos músculos. Amostras de peixes controle não indicaram variação em brânquias, fígado, rim e músculos. O presente estudo revelou uma forte correlação entre o grau de dano tecidual e a contaminação ambiental. As descobertas atuais também constituem avisos globais para proteger nossos corpos d'água e peixes para resguardar a população humana.

Abstract Untreated sewage and industrial wastes from Faisalabad city are disposed to River Chenab through Chakbandi Main Drain (CMD). The present project is planned to investigate the effects of this freshwater pollution on the body of fish Ictalurus punctatus. The specimens of this fish species were collected upstream and downstream of the entrance of CMD into River Chenab. Fish gills, liver, kidney and muscles from dorsolateral regions of fish were subjected to histopathology. Farmed fish and fish from upstream areas were used as control. Fish collected from polluted experimental sites showed significant damage in selected organs. Gill tissues showed an abnormality in the form of an uplifting of the primary epithelium, fusion, vacuolation, hypertrophy, and necrosis. While liver tissues subjected to hepatocytes degeneration, necrosis, mitochondrial granular hepatocyte, and sinusoids dilation. Kidney tissues indicated increased bowmen space and constricted glomerulus and degenerated nephrons. Edema, necrosis, and atrophy were observed in muscle tissues of fish from polluted areas. Fish from the upstream area showed fused gill lamellae, inflammatory cell infiltration, hypertrophy and vacuolation in hepatocytes. Kidney tissues indicated the presence of nuclear tubular cells, destructive renal tubules, hemorrhage, and necrosis at tubular epithelium. Intra myofibril spaces were also observed in muscles. Specimens of control fish indicated no variation in gills, liver, kidney, and muscles. The present study revealed a strong correlation between the degree of tissue damage and environmental contamination. Present findings also compel global warnings to protect our water bodies and fish to rescue the human population.

ABSTRACT Natural polymers have been widely used in different fields specifically in pharmaceutical industry due to their biocompatibility, biodegradability, and less toxicity properties. Among these polymers, chitosan is a potentially pursued biomaterial. However, limited solubility of chitosan in water creates significant barrier in realizing its applications as a biomaterial. Modification of chitosan helps to overcome this barrier with improved solubility in water. In this study, N-succinyl chitosan was synthesized from the chemical reaction of chitosan and succinic anhydride via Schiff base mechanism by using glutaraldehyde as a crosslinking agent. N-succinyl chitosan is water soluble, biocompatible, biodegradable, and less toxic. The physico-chemical properties of NSC and prepared hydrogel were characterized by using Fourier transform infrared (FTIR) spectroscopy, Nuclear Magnetic Resonance Spectroscopy (NMR), X-ray diffraction (XRD) analysis, and differential scanning calorimetry (DSC). The surface morphology was investigated through Field emission scanning electron microscopy (FESEM). All these results confirmed the successful synthesis of N-succinyl chitosan and its hydrogel. Moreover, the mechanical properties of the hydrogel were evaluated using rheometer and found that hydrogel has significant potential to be used in the biomedical field. In addition, the swelling properties of the hydrogel were also studied in buffer solutions of pH 1.2 and 7.4. These results endorsed its applications as a drug delivery carrier.

Objective: Alzheimer’s disease occurs at a higher prevalence and an earlier age in individuals with Down syndrome (DS) than typically developing individuals. However, diagnosing dementia in individuals with intellectual disability remains a challenge due to pre-existing cognitive deficits. The aim of this study was to investigate the validity and reliability of the Brazilian version of the Cambridge Examination for Mental Disorders of Older People with Down’s syndrome and Others with Intellectual Disabilities (CAMDEX-DS) for individuals with DS. Methods: Two psychiatrists, working independently, evaluated 92 adults with DS ≥ 30 years of age. The concurrent validity of the CAMDEX-DS was analyzed in relation to the gold standard of established international criteria. In a subgroup of 20 subjects, the concurrent validity of the CAMDEX-DS was analyzed in relation to an independent objective assessment of cognitive decline over three years. We analyzed the inter-rater reliability of cognitive assessment. Results: The diagnostic accuracy of the CAMDEX-DS compared to the gold standard was 96.7%. CAMDEX-DS-based diagnosis was considered consistent with cognitive decline. The probability of a participant with dementia having cognitive decline was 83%. Inter-rater reliability for the participant assessment was good, with a kappa of > 0.8 for 93% of the CAMDEX-DS items. Conclusion: The CAMDEX-DS can be considered the first valid and reliable instrument for evaluating dementia in adults with DS in Brazil. Its use in such individuals could improve clinical practice and research.

ABSTRACT: The present study was aimed to evaluate the effect of heavy metals on an important tissue of two fish species Cyprinus carpio and Wallago attu, sampled from the Indus river, Mianwali District, Pakistan. The concentration of selected heavy metals Fe, Cr, Cu, and in gills, muscles, kidney and liver was compared with an International standard of food fish. The overall metal concentrations among different weight categories in C. carpio were in the order of Fe > Cu > Cr >. In W. attu the overall accumulation of these metals were, in order of Fe > Cu > Cr > Pb The order of accumulation of metals in gills and muscle of C. carpio was Fe > Cr > Pb > Cu; kidney and muscles of W. attu was Fe > Cr > Cu > Pb; liver Fe > Cu > Cr > Pb. An increasing trend of concentration of iron, copper, chromium and lead occurred with an increase in weight of C. carpio and W. attu. There was a significant difference in the accumulation of heavy metals in different organs of both species (p<0.01). All studied heavy metals except Cr were within permissible limits described by various international agencies like WHO, FAO and FEPA in edible tissues of C. carpio and W. attu.

INTRODUCTION: In research projects such as vaccine trials, accurate and complete surveillance of all outcomes of interest is critical. In less developed countries where the private sector is the major health-care provider, the private sector must be included in surveillance systems in order to capture all disease of interest. This, however, poses enormous challenges in practice. The process and outcome of recruiting private practice clinics for surveillance in a vaccine trial are described. METHODS: The project started in January 2002 in two urban squatter settlements of Karachi, Pakistan. At the suggestion of private practitioners, a phlebotomy team was formed to provide support for disease surveillance. Children who had a reported history of fever for more than three days were enrolled for a diagnosis. RESULTS: Between May 2003 and April 2004, 5540 children younger than 16 years with fever for three days or more were enrolled in the study. Of the children, 1312 (24%) were seen first by private practitioners; the remainder presented directly to study centres. In total, 5329 blood samples were obtained for microbiology. The annual incidence of Salmonella typhi diagnosed by blood culture was 407 (95% confidence interval (95% CI), 368-448) per 100 000/year and for Salmonella paratyphi A was 198 (95% CI, 171-227) per 100 000/year. Without the contribution of private practitioners, the rates would have been 240 per 100 000/year (95% CI, 211-271) for S. typhi and 114 (95% CI, 94-136) per 100 000/year for S. paratyphi A. CONCLUSION: The private sector plays a major health-care role in Pakistan. Our experience from a surveillance and burden estimation study in Pakistan indicates that this objective is possible to achieve but requires considerable effort and confidence building. Nonetheless, it is essential to include private health care providers when attempting to accurately estimate the burden of disease in such settings.

INTRODUCCIÓN: En proyectos de investigación como los ensayos de vacunas, es fundamental aplicar una vigilancia exhaustiva de todos los resultados de interés. En los países poco desarrollados donde el sector privado constituye el principal proveedor de atención sanitaria, dicho sector debe formar parte de los sistemas de vigilancia si se desea detectar todas las enfermedades pertinentes. Sin embargo, en la práctica esto plantea grandes retos. Se describen aquí los procedimientos y los resultados de la contratación de consultorios privados con fines de vigilancia en el ensayo de una vacuna. MÉTODOS: El proyecto comenzó en enero de 2002 en dos asentamientos ilegales urbanos de Karachi, Pakistán. Por sugerencia de algunos médicos privados, se formó a un equipo de flebotomía para que apoyara las actividades de vigilancia de la morbilidad. Se reclutó para diagnóstico a los niños que presentaban una historia de fiebre de más de tres días. RESULTADOS: Entre mayo de 2003 y abril de 2004 se reclutó para el estudio a 5540 niños menores de 16 años con una historia de fiebre de al menos tres días de duración. De ellos, 1312 (24%) fueron examinados por primera vez por médicos privados; los otros acudieron directamente a los centros de estudio. En total se obtuvieron 5329 muestras de sangre para análisis microbiológico. La incidencia anual de Salmonella typhi diagnosticada mediante hemocultivo fue de 407 (intervalo de confianza del 95% (IC95%): 368 - 448) por 100 000/año, y la de Salmonella paratyphi A, de 198 (IC95%: 171 - 227) por 100 000/año. Sin la ayuda de los médicos privados, las tasas habrían sido de 240 (IC95%: 211 - 271) por 100 000/año para S. typhi y de 114 (IC95%: 94 - 136) por 100 000 /año para S. paratyphi A. CONCLUSIÓN: El sector privado cumple una importante función de atención sanitaria en el Pakistán. La experiencia de nuestro estudio de vigilancia y estimación de la morbilidad en el pais indica que el objetivo planteado se puede lograr pero requiere un considerable esfuerzo y medidas que estimulen la confianza. No obstante, si se desea estimar con precisión la carga de morbilidad en esas circunstancias, la participación de proveedores de salud privados es fundamental.

INTRODUCTION: Pour les projets de recherche tels que les essais vaccinaux, une surveillance précise et exhaustive de l'ensemble des résultats intéressants revêt une importance critique. Dans les pays moins développés, où le secteur privé est le principal prestataire de soins de santé, il faut faire collaborer ce secteur à l'activité des systèmes de surveillance afin de bien prendre en compte toutes les maladies à suivre. Dans la pratique cependant, la mise en place de cette collaboration pose d'énormes difficultés. L'article décrit le processus de recrutement des établissements privés en vue de leur participation à la surveillance dans le cadre d'un essai vaccinal et les résultats de ce processus. MÉTHODES: Le projet a débuté en janvier 2002 dans deux lotissements urbains spontanés de Karachi (Pakistan). A l'initiative de praticiens privés, une équipe spécialisée dans les prélèvements veineux a été constituée pour apporter un appui à la surveillance des maladies. Les enfants ayant des antécédents signalés de fièvre pendant plus de trois jours ont été recrutés dans l'étude pour faire l'objet d'un diagnostic. RÉSULTATS: Entre mai 2003 et avril 2004, 5540 enfants de moins de 16 ans ayant présenté de la fièvre pendant trois jours ou plus ont été recrutés dans l'étude. Parmi ces enfants, 1312 (24 %) ont été vus d'abord par des praticiens privés, les autres ayant été présentés directement aux centres d'étude. Au total, 5329 échantillons de sang ont été prélevés pour examen microbiologique. L'hémoculture a permis d'évaluer l'incidence annuelle de Salmonella typhi à 407 cas [intervalle de confiance (IC) à 95 % : 368-448 ] pour 100 000 enfants appartenant à la tranche d'âges considérée et celle de Salmonella paratyphi A à 198 (CI à 95 % : 171-227) pour 100 000 enfants appartenant à la tranche d'âges considérée par an. Sans la contribution des praticiens privés, ces taux auraient été évalués à 240 pour 100 000 enfants de l'âge considéré et par an (CI à 95 % : 211 - 271) pour S. typhi et à 114 (CI à 95 % : 94-136) pour 100 000 enfants appartenant à la tranche d'âges considérée et par an pour S. paratyphi A. CONCLUSION: Le secteur privé joue un rôle majeur dans la dispensation de soins de santé au Pakistan. L'expérience tirée de cette étude de surveillance et d'estimation de la charge de morbidité au Pakistan indique qu'il serait possible d'atteindre l'objectif d'amélioration de la surveillance grâce à la collaboration du secteur privé, mais que cela nécessiterait des efforts considérables et un renforcement de la confiance. Quoi qu'il en soit, il est essentiel de prendre en compte les dispensateurs de soins privés lorsqu'on tente d'estimer avec précision la charge de morbidité dans de tels pays.