Planning and reform of human resources for health in Afghanistan

Afghanistan is ranked 155 out of 169 countries on the human development index [HDI], a composite measure of three basic dimensions of human development, one of which is health. While some progress has been made, many of the key indicators of health status have not improved in the last decade. Many factors contribute to the lack of progress, but central to improving the situation is strengthening the national health system, particularly in the arena of human resources. The Ministry of Public Health [MoPH] has prioritized the issue of human resources, viewing this as a fundamental necessity to the provision of healthcare. To bring together a number of distinct planning efforts, the General Directorate of Human Resources [GDHR], MoPH organized a process to develop a comprehensive plan. In this paper, we summarize the process that was established by the GDHR to lay a foundation for developing the strategic plan to address human resources for health [HRH] in Afghanistan. This plan includes the synthesis and harmonization of data and the involvement of all key stakeholders. We document both success and shortcomings, discuss the remedial action initiated to continue to advance the HRH agenda, and conclude with several recommendations

Hepatoprotective effect of garlic [allium sativum] and milk thistle [silymarin] in isoniazid induced hepatotoxicity in rats

Assessment and comparison of hepatoprotective role of garlic and silymarin in antituberculosis drug [Isoniazid] induced hepatotoxicity. Healthy rats weighing 150-200g were selected for the study. Rats were divided into four groups, i.e. group A [Control], group B [INH treated group], group C and D serve as experimental groups. The group A received only the normal diet, Group B along with normal diet received the isoniazid [50 mg/kg/day], Group C along with normal diet received the isoniazid [50 mg/kg/day] and Silymarin [200 mg/kg/day], and Group D along with normal diet received the isoniazid [50 mg/kg/day] and garlic [0.25 g/kg/day]. On completion of 28 days of treatment blood samples were collected for the assessment of liver function. In group B there was abnormal rise in the levels of biochemical markers [ALT, AST, ALP and Total Bilirubin]. In group C the biochemical markers were near normal levels and in group D the levels of biochemical markers were within normal limits. Both the garlic and silymarin have shown the hepatoprotective effect against the Antituberculosis drug [isoniazid] induced hepatotoxicity in experimental animal model

Anti-hyperlipidemic effect of Acacia honey [desi kikar] in cholesterol - diet induced hyperlipidemia in rats

In this study, the hypolipaemic effect of acacia honey [desi kikar] on cholesterol diet induced hyperlipidaemia in rats has been observed. The study was carried out on 60 male wistar rats weighing 200 - 250g. Rats were divided into five groups, each having 12 animals. Initially all four groups [B to E] were given cholesterol diet [2%] 2 gms cholesterol in 98 gms diet for 2 months to induce hyperlipidaemia except Group A, which served as [control]. Group B received no therapy after establishing hyperlipidaemia. Groups C received 20 mg/kg of body weight acacia honey and group D received 10 mg/kg body weight of simvastatin orally for 8 weeks after establishing hyperlipidaemia, while group E received combination of 20 mg/kg and 10 mg/kg body weight of acacia honey and simvastatin respectively orally for 8 weeks. Rats having normal lipid profile were included in this study. Blood samples were taken on 60[th] day after giving antihyperlipidaemic therapy. Group B showed increase in serum LDL, TGs, cholesterol but decrease HDL levels. The level of these parameters decreased in group C which was given acacia honey reached near towards normal level. On the other hand with simvastatin, in group D, these levels reached near normal level. In group E given combination of acacia honey simvastatin the levels reached towards normalcy. In conclusion, acacia honey has an antihyperlidaemic effect against cholesterol diet induced hyperlipidaemia in rats

Causes of infertility among females attending infertility clinics: a cross sectional study

To determine the major types of infertility in females attending in vitro fertilization [IVF] and infertility clinics in the United Arab Emirates, to identify the major causes of primary and secondary infertility to assess the factors and menstrual disorders contributing to infertility and to determine the common investigations done in infertility. A Cross-sectional study was done in the infertility clinics of three hospitals in United Arab Emirates. 200 females diagnosed with infertility aged 18-43 participated in this study. A questionnaire incorporating all the variables in the study was used for data collection. Data was entered in Excel and analyzed using PASW 17.0 version. Chi-square test was done for associations, Z-test for proportions and t-test was done to compare between means. All subjects diagnosed with infertility were between the ages 18-43. 91 subjects had primary infertility and 109 had secondary infertility. The mean age of patients in this study is around 30.9 and the mean age of menarche is 12 years. Poly Cystic Ovarian Syndrome [PCOS] was the most common cause of infertility which was seen in 27% of those diagnosed with infertility, followed closely by male factors which were 26.5%. There was previous history of abortions in 42.2% of females diagnosed with secondary infertility. PCOS is the leading cause of infertility. Positive associations between types of infertility and abortions, types of infertility and Body Mass Index were correlated and uterine transverse length vs secondary infertility. We found that most of our results matched with those of international studies

Intermediate and long term outcome of patients after device closure of ASD with special reference to complications

Device closure of Secundum atrial septal defect [ASD] is an accepted mode of treatment in selected patients with a suitable defect. The major initial concern over the long term outcome has been erosions and more recently development of aortic regurgitation. Objective was to assess the intermediate and long term outcome of patients with device closure of ASD with special reference to complications. Two hundred and four patients with significant Secundum ASD, 16 months to 55 years [median 8 years] were considered for transcatheter closure with the Amplatzer septal occluder from October 1999 to April 2009 with follow up examinations at 1, 3, 6, and 12 months and thereafter at yearly interval. Device closure of ASD was done successfully in 202/204 patients. The immediate [first 24-hour] major complications included device embolization [n=4], pericardial effusion [n=1] and 2:1 heart block [n=1]. At a mean follow up of 4.9 years [90 days to 9.6 years, median 5.3 years] complete closure was documented in all patients. Two patients [1%] had developed mild aortic regurgitation. A trial fibrillation occurred in 3 adult patients [1.5%] at a mean of 2 weeks post procedure with complete recovery within 6 months. There were no late embolizations, erosions or thromboembolic events on long term follow up. Device closure of secundum ASD using Amplatzer septal occluder is safe and effective in intermediate and long term follow up with extremely low mortality rate. The risk of development of aortic regurgitation or atrial fibrillation is also very low

Thrombo-embolism in patients with myocarditis

Myocarditis and dilated Cardiomyopathy continues to be an important cause of hospital admission in our part of the world. Systemic embolism due to thrombi in left ventricle is a rare but important complication of these patients. Study objectives: To determine the incidence, course and outcome of thrombo-embolism in children with dilated dysfunctioning heart due to acute myocarditis or dilated Cardiomyopathy. Design: A 5 year analysis [December 1999- Nov 04] of all children under 16 years of age admitted and diagnosed as having myocarditis or dilated Cardiomyopathy in a single tertiary care center. Patients and The charts and echocardiography records of all patients with dilated dysfunctioning heart and systemic thrombo-embolism were reviewed. Data was reviewed for mode of presentation, age, hospital course and outcome. Echocardiography data was reviewed with special reference to the size, function and presence of thrombus in LV. Of all admissions to the paediatric cardiology unit over the study period, myocarditis and dilated Cardiomyopathy was the underlying lesion in 405 patients. The mean age of patients was 2.1 +/- 4 years. Systemic embolism was the presenting feature in 28 [6.9%] patients [Group A]; while another 17 [4.2%] developed it during the hospital stay [Group B]. Another 5 patients had thrombus in the LV but did not develop embolism. All 50 patients showed seriously impaired LV function with mean ejection fraction [EF] for those with vs. those without thrombo-embolism was 17.5 +/- 5.5 vs. 20.0 +/- 6.9 [p = 0.08]. The groups were similar with respect to other baseline characteristics, co morbid illnesses, and drug therapies other than anticoagulants. In group A 26/28 patients presented with a stroke. Only 6 had a thrombus in LV at the time of admission. All 28 patients with or without LV thrombus were treated with heparin and then oral anticoagulant warfarin. There were two deaths. In group B, 3/17 patients had thrombus in the LV on echocardiography at presentation. They were started anticoagulation but still went on to develop a stroke. There were 2 deaths in this group as well. Conclusions: Myocarditis and dilated Cardiomyopathy is an important cause of hospital admission in our set up accounting for 15% of all admissions to a paediatric cardiology unit. These patients are at risk of developing thromboembolism, which may well be the presenting feature. The risk is higher in patients with lower ejection fraction of the LV. All patients with EF below 17% should be treated with prophylactic anticoagulation. A peripheral embolic event adds to morbidity and is related to poor long-term survival in this patient group

[Primary adenocarcinoma of the bladder. Observations on 7 cases]

Objective: The analysis of the etiopathologic, diagnostic and therapeutic aspects of the primary adenocarcinoma of the bladder

Patients and Methods: We report on a series of 7 cases of primary adenocarcinoma of the bladder out of a total of 564 cases of bladder tumors seen at our institution during a period of 14 years [1989-2003]. All 7 patients with primary adenocarcinoma of the bladder presented with gross hematuria. Treatment consisted of chemotherapy using 5-fluorouracil [5-FU] in 3 cases where the tumor was locally advanced or metastatic; radical cystectomy with bilateral pelvic lymph node dissection and urinary diversion in 2 cases where the tumor was located in the bladder neck and trigone; partial cystectomy with pelvic lymph node dissection and bladder augmentation ileoplasty followed by an adjuvant chemotherapy in one case where the tumor was located at the dome of the bladder, and transurethral bladder resection followed by a chemotherapy with intravesical instillation of mitomycin-C in the remaining patient with superficial lesions. Follow-up ranged from 6 months to 15 years with a mean follow-up of 93 months

Results: The two patients treated by radical cystectomy had no recurrence after 12 months, while the patient treated by transurethral resection followed by intravesical instillation of mitomycin-C was free of disease 15 years after the intervention. The patient treated by partial cystectomy did not show any local recurrence after 10 months. Among the patients treated by chemotherapy [5-FU], a partial response was achieved in two with a mean survival of 12 months, while the remaining patient died within 6 months from treatment

Conclusion: Adenocarcinoma of the bladder is often diagnosed late. No consensus on therapy has been achieved so far. Radical cystectomy remains the gold standard for organ-confined tumors. Superficial lesions are very rare and may be treated conservatively

Postoperative peritonitis after digestive surgery. About 92 cases

92 cases of post-operative peritonitis in digestive surgery are recorded: - Diagnosis is difficult inspite of the multiplicity of symptoms which are variable and non specific. - Clinical presentation is dominated by the frequency of infectious symptoms essentially fever, neuro -psychic, hemodynamic and respiratory disorders. Abdominal signs though advocatory are late. - Early reoperation represents the only possibility of survival for the patients. It must contain a way large, a complete peritoneal washing, an eradication of the source of peritonitis and an effective drainage. - A correct ressucitation effective before, during, and after operation is fundamental. - The prognosis of this fearful complication improves clearly in case of operation and the mortality rate declines from 100% [in absence of operation] to 47.4% [in case of operation]. Because of the high mortality rate, [44.4%], this post-operative complication has to be prevented