Organized by The Infectious Diseases Society of Pakistan (IDSP) A record 792 delegates registered in workshops and scientific sessions – 560 for the Conference and 232 for the workshops. Participants were from Karachi (mainly), Lahore, Islamabad, Rawalpindi, Hyderabad, Nawabshah, Nawabpur, Larkana, Quetta, Peshawar, Multan. Overseas speakers were from India and UK. Several others regretted in the last week because of the uncertain geopolitical situation and insecurity in the city. Islamabad based National Institute of Health (NIH), Health Management Information and Surveillance) HMIS, National AIDS Control Program (NACP), Armed Forces Institute of Pathology (AFIP) and Ministry of Health (Director General Health of Pakistan) were well represented in the scientific sessions. 63 keynote lectures, thematic lectures and free papers were presented, plus 42 posters. A novel scientific lecture “From quarks to bacteria and beyond” by Pakistan’s renowned physicist Dr. Pervez Hoodbhoy was appreciated by participants of scientific bent of mind. The consensus was that the scope of our knowledge should be enhanced in all spheres of science. Four parallel sessions in two separate blocks dealt with specific themes. Unique among them were zoonosis, and disaster -related infections, and entire sessions on maternal-child infections and varied topics for family practitioners. Other well discussed topics were on emerging viral diseases, tuberculosis, hepatitis, CNS infections, viral hemorrhagic fevers, HIV/AIDS and vaccines. Most delegates complained that parallel sessions deprived them of sessions they wished to attend. During off- conference meetings definite plans were made to enhance IDSP’s objectives of Rabies prevention, antimicrobial resistance and infection control. There was discussion on forming a pediatric chapter of IDSP. WORKSHOPS Workshops were interactive sessions designed for problem solving. The group consisted of a co-ordinator, 3-4 panel members and 50-80 participants in each workshop. Common diseases were selected. The lead person presented a case scenario that doctors are frequently faced with in their clinical practices, and the audience was given a chance to give suggestions regarding the approach to the problem. Each workshop was of 2 ½ hours duration The four workshops at this conference were: 1. Tuberculosis 2. HIV/AIDS 3. Infection Control 4. Perinatal infections Tuberculosis Co-ordinator: Dr. Javed Khan Panelists: Dr. Naseem Salahuddin, Dr. M. Hussain, Dr. Kauser Jabeen According to WHO 1/3 of the world’s population is infected with the TB bacillus, and 20% of these actually manifest the disease. In Pakistan as in other developing countries TB is one of the most common infectious diseases. Issues that were addressed related to Lab. diagnosis, Extra pulmonary TB and MultiDrug Resistant TB. Lab. diagnosis: Culture is the gold standard, but this test is expensive, labour intensive and available only in a few labs. in the country. In the absence of culture, chemical stain (Ziel Nielsen) should be done on properly collected sputum or material to be tested. Multiple samples may be required to prove or disprove TB, and the patient must co-operate to collect and submit samples. Occasionally tissue samples need to be taken for microscopic examination. TB can involve every organ of the body besides the lungs (Extra pulmonary TB) and the onus is on the doctor to make the diagnosis by using available tests in the correct order. Extra pulmonary TB is not contagious to others, and is treated with the same medicines as for lung TB. Treatment of TB is with at least four standard first line drugs, according to the patient’s weight. Successful outcome of treatment depends on the patient’s drug compliance and rapport with the doctor. Any of the drugs may have side effects and using the medicines erratically can cause drug resistance. If multi drug resistant (MDR) bacteria spread to other persons, it compounds difficulties in treatment in the community. The incidence of MDR TB is rising fast in Pakistan, leading to treatment failures. Second line drugs are not as potent, erratically available, and toxic and require prolonged therapy. Cases of suspected or proven cases must be referred to an experienced specialist. . Neonatal infections Moderators: Dr. Ejaz Khan, Dr. Ayesha Mehnaz, Dr. Anita Zaidi, Dr. Sajid Maqbool Neonatal infections, i.e. infections occurring within the first 28 days of life are one of the leading causes of morbidity and mortality in Pakistan. Neonatal mortality is one of the highest in the world. Infant mortality is >80/1,000 life births. Almost 2/3 succumb during the first month of life. The incidence is almost 20 times higher than in western countries. Almost 1/3 of all neonatal deaths are attributable to infections. Lack of antenatal care, unhygienic deliveries, lack of breast feeding and poor access to health care facilities are some of the reasons for this high incidence. This is especially true in rural areas of Pakistan where health facilities are lacking or not properly utilized. Most births take place at home or in private clinics that are poorly equipped and unprofessionally staffed. A large proportion of births are unattended especially in rural and far flung areas. Traditionally, birth attendants are local dais who usually do not have enough expertise or the ability to create proper hygienic conditions for safe and sterile delivery. Additionally they may not recognize risk factors that are posed in the first few days of life. Even in poor urban areas conditions are not very different and probably even worse. In large cities like Karachi a number of deliveries in the periphery and slum areas are conducted by un-trained dais. In government hospitals most cases are un-booked, presenting late or just at the time of labour, resulting in high incidence of infections and asphyxia in the newborn. Prematurity and low birth weights are common and the situation has not changed over the last two decades. These babies are particularly vulnerable to infections. Most neonatal infections are acquired at the time of delivery or shortly after. In major hospitals and clinics extremely poor hygienic conditions are prevalent. Some preventable infections may be transmitted from the mother to the baby. Most infections are bacterial in nature, especially Gram-negative bacterial infections. More alarming is the rising rates of antibiotic resistant bacteria. Indiscriminate use of antibiotics and lack of knowledge among the treating physician are responsible This workshop was organized to address these issues. The workshop provided the trainee doctors, post graduates and pediatricians the opportunity to have hands on experience in management of common infections in newborns. The experts talked about diagnosis, management and preventive aspects. Emphasis was laid on proper and judicious use of antibiotics, good infection control practices and safe and hygienic delivery. HIV/AIDS Moderator: Co-ordinators: Dr. Faisal Mahmood, Dr. Farheen Ali, Dr. Maqsood Bhatti With 45 million cases worldwide, HIV/AIDS is one of the most important infectious diseases of the late 21st centaury. There are now 3100 confirmed cases in Pakistan since 1987, and an estimated 105,000 persons living with HIV. The WHO has ‘upgraded’ the official status of Pakistan in regards to HIV from a “Low prevalence, High risk country” to a “Concentrated Epidemic” due to the increased prevalence rates in the high risk groups (for example 37% of IVDUs in Karachi). The diagnosis of HIV/AIDS poses unique medical, social and moral problems. HIV cannot be confirmed on a single test and current recommendations are to perform the test at least 3 times with different assays or repeat the test with the more accurate Western Blot. Unconfirmed cases can be associated with significant social stigmas making it imperative for physicians to engage in thorough pre-test counseling and to broach the issue of a possible positive test with care. Advances in therapy have now made HIV/AIDS a long-term chronic disease such as diabetes and hypertension. The management involves using a combination of three or more anti-retrovirals from at least 2 classes (Highly Active Antiretroviral Therapy or HAART). However this is extremely complex and involves considering multiple factors and should therefore only be administered by physicians trained in HIV management. Without HAART, patients with HIV rapidly progress to AIDS, the end-stage of the disease. This marked by severe immunodeficiency and is heralded by the development of multiple infections caused by usually innocuous organisms. Prevention at a national level is being attempted at the level of the government and NGOs by setting up services for the high risk groups as well as for the spouses and contacts of HIV infected individuals. Infection Control Moderator: Dr. Altaf Ahmed Co-ordinators: Dr. Afia Zafar, Dr. Fatima Nauman, Dr. Sobia Qazi, Dr. Sharaf Ali Shah The Infection Control workshop was best attended. There were over a hundred participants, mostly nurses and doctors. Stress was put on hand washing and hand disinfectants, explaining the need and how to do it properly. A demonstration was given by an infection control nurse on proper technique of hand washing. Prevention and surveillance of needle stick injury and hepatitis B vaccination were highlighted. Control of VRE outbreak and antibiotic resistance problems were also described with demonstration of contact precautions. Role of clean operation theaters and CSSD, and the impact on the control of surgical site infections was also described. An infection control manual published by an NGO BRIDGE was distributed.