Developing health service delivery in a poor and marginalised community in North West Pakistan

Objectives: To improve maternal health and reduce child mortality through developing health service delivery in a poor and marginalised community in North West Pakistan

Methods: This was a multifaceted intervention to extend and strengthen the range and quality of services provided at an existing health centre, in a rural community in Peshawar District, Khyber Pakhtunkhwa Province. The intervention was developed with community involvement and had four main components: service development, staff capacity development, community engagement and the introduction of a micro-credit scheme. The evaluation assessed the efficiency and effectiveness of project implementation, including a survey of maternal and child health indicators

Results: Between 2014 and 2017, a range of new health services were developed at the health centre. Local volunteers were trained to promote health awareness in the community and refer pregnant women to the health centre. The survey indicated health improvements, such as increased vaccination rates for women and children, and a dramatic reduction in unskilled deliveries

Conclusions: Community engagement was essential to achieve much needed maternal and child health improvements in this poor and marginalised community. Sustainability was achieved by training local volunteers as community health workers

Pharmacological basis for the medicinal use of Michelia champaca in gut, airways and cardiovascular disorders

Objective: To discover the mechanism behind ameliorative effects of Michelia champaca (M. champaca) in gastrointestinal, respiratory and cardiovascular disorders. Methods: Anti- spasmodic potential was evaluated by trying the M. champaca extract (aqueous:ethanolic) on rabbit aorta, trachea and jejunum in vitro. Isotonic and isometric transducers coupled with Power Lab data acquisition system was used to record the responses of isolated tissues. Results: M. champaca extract relaxed the spontaneous and high K

Pharmacological basis for the medicinal use of Michelia champaca in gut, airways and cardiovascular disorders

Objective:To discover the mechanism behind ameliorative effects of Michelia champaca (M. champaca) in gastrointestinal, respiratory and cardiovascular disorders.Methods:Anti- spasmodic potential was evaluated by trying the M. champaca extract (aqueous:ethanolic) on rabbit aorta, trachea and jejunum in vitro. Isotonic and isometric transducers coupled with Power Lab data acquisition system was used to record the responses of isolated tissues.Results:M. champaca extract relaxed the spontaneous and high KConclusion:M. champaca possesses spasmolytic, airways relaxant and vasodilator actions mediated perhaps due to blocking of Ca

Teaching microscopy effectively through a combined Peyton's fourstep approach and Gagne's instructional model

Objective: To design a lesson plan for teaching microscopy using a combined Peyton's and Gagne's model

Study Design: Qualitative study with scoping review

Place and Duration of Study: Khyber Medical University, Peshawar from April-September 2017

Material and Methods: We searched Pub Med through a variety of search strategies. The purpose of the search was to identify relevant articles [using an inclusion and exclusion criteria] on making a lesson plan for a psychomotor skill. After selection of articles, the evidence was synthesized including author's name, year of publication, country, key findings, model used to make a lesson plan and limitations of the study. From the synthesised evidence, a lesson plan was designed on microscopy. This is a qualitative study with scoping review, therefore, no quantitative analysis or software was used

Results: In total, 130 articles were identified but after screening and assessment for eligibility five articles were selected. The synthesized evidence suggested that four articles had used Gagne's model, while one article had used a combined Gagne's and Peyton's model to design a lesson plan to teach psychomotor skills. We used the combined model to design a lesson plan for pathology students on microscopy. The microscopy skill was broken down into different parts and each learning step was integrated into the nine events of Gagne's model. The Peyton's model was combined to teach the actual microscopy skill for better learning and executing the skill

Conclusion: The model combined Gagne's and Peyton's model, which was used to design an effective lesson plan to teach microscopy. This model could also help in delivering better teaching sessions for other psychomotor skills

Efficacy of 2.5% and 1.25% povidone-iodine solution for prophylaxis of ophthalmia neonatorum

Objective: To determine the efficacy of 2.5% and 1.25% Povidone-Iodine solution for Ophthalmia neonatorum prophylaxis

Study Design: Interventional study

Place and Duration of Study: Eye Department, Combined Military Hospital, Sargodha, from May to November 2014

Methodology: A total of 200 eyes of 100 newborn babies were enrolled and divided into two groups of 100 right eyes and 100 left eyes. A conjunctival swab for bacterial culture was taken within 30 minutes after delivery. A single drop of 2.5% Povidone-Iodine was then placed in the right eye while in the left eye a single drop of 1.25% Povidone-Iodine was placed. Thirty minutes after placing Povidone-Iodine, a conjunctival swab was again taken. A bacterial suspension was prepared from each swab in determining bacterial counts. The bacterial suspension was inoculated on yeast extract agar and the number of colony forming units were counted. At each culture, the number of colony forming units before and after instillation of 2.5% Povidone-Iodine and 1.25% Povidone-Iodine were compared. Wilcoxon's signed rank test was used for statistical analysis

Results: The 2.5% Povidone-Iodine solution caused a statistically significant decrease in the number of colony forming units [p=0.001]. Similarly, the 1.25% Povidone-Iodine solution also reduced the number of colony forming units to a statistically significant level [p=0.001]

Conclusion: The 1.25% concentration of Povidone-Iodine is as effective as the 2.5% concentration of Povidone-Iodine in reducing the number of colony forming units in healthy conjunctivae of newborns

Cadmium toxicity affects chlorophyll a and b content, antioxidant enzyme activities and mineral nutrient accumulation in strawberry

BACKGROUND: Cadmium (Cd) is well known as one of the most toxic metals affecting the environment and can severely restrict plant growth and development. In this study, Cd toxicities were studied in strawberry cv. Camarosa using pot experiment. Chlorophyll and malondialdehyde (MDA) contents, catalase (CAT), superoxide dismutase (SOD), ascorbate peroxidase (APX) activities and mineral nutrient concentrations were investigated in both roots and leaves of strawberry plant after exposure Cd. RESULTS: Cd content in both roots and leaves was increased with the application of increasing concentrations of Cd. We found higher Cd concentration in roots rather than in leaves. Chlorophyll a and b was decreased in leaves but MDA significantly increased under increased Cd concentration treatments in both roots and leaves. SOD and CAT activities was also increased with the increase Cd concentrations. K, Mn and Mg concentrations were found higher in leaves than roots under Cd stress. In general, increased Cd treatments increased K, Mg, Fe, Ca, Cu and Zn concentration in both roots and leaves. Excessive Cd treatments reduced chlorophyll contents, increased antioxidant enzyme activities and changes in plant nutrition concentrations in both roots and leaves. CONCLUSION: The results presented in this work suggested that Cd treatments have negative effect on chlorophyll content and nearly decreased 30% of plant growth in strawberry. Strawberry roots accumulated higher Cd than leaves. We found that MDA and antioxidant enzyme (CAT, SOD and APX) contents may have considered a good indicator in determining Cd tolerance in strawberry plant.

Early onset neonatal sepsis in preterm premature rupture of membranes

To determine the frequency of early onset neonatal sepsis in newborn with various duration of preterm premature rupture of membranes [PPROM]. Cross sectional study. Neonatal Intensive Care Unit Combined Military Hospital, Lahore from November 2009 to November 2010. Neonates of singleton pregnancies complicanted by pretern premature rupture of the membranes [PPROM] with delivery between 30 and 36 weeks gestation were included in the study. The overall frequency of neonatal sepsis was calculated on clinical and serological basis. Comparison of the frequency of sepsis among groups with varying duration of rupture of membranes was done. Out of 164 babies, 84 [51.2%] were female and 80 [48.8%] were male. Mean maternal age was 23 year [range: 18-36 years] .Mean gestational age was 33 weeks [range: 30-36 weeks]. Sepsis was suspected in 41 [25%] babies on clinical grounds. C-reactive protein was raised in 36 [22%] neonates. There was statistically insignificant difference between clinical versus serological diagnosis [p=0.515]. Frequency of neonatal sepsis was significantly higher in mothers with longer duration of rupture of membrane [p< 0.001]. Frequency of neonatal sepsis was observed to be 22%. PPROM is an important risk factor for early onset neonatal sepsis

Pharmacological basis of the use of Acortus calamus L. in inflammatory diseases and underlying signal transduction pathways / Bases farmacológicas del uso de Acorus calamus L. en enfermedades inflamatorias y las vías de transducción de señales subyacentes

Acorus calamus L. is used as anti-inflammatory remedy in traditional system of medicine in Pakistan and India. This study was designed to explore the anti-inflammatory mechanism of Acorus calamus L. and its underlying signaling pathways. Aqueous, butanolic and n-hexane fractions of Acorus calamus were tested against cyclooxygenase (COX) and lipoxygenase (LOX) mediated eicosanoids production by arachidonic acid (AA). Butanolic fraction of Acorus calamus, but not the aqueous and n-hexane fractions, inhibited the COX mediated production of thromboxane B2 (TXB2) and liopxygenase product 1 (LP1) -a metabolite of LOX pathway. 12-(hydroxyeicosatetraenoic acid) HETE- another product of the LOX pathway was unaffected by all three fractions. Butanolic fraction of Acorus calamus showed strong inhibition against AA-induced platelet aggregation. Investigation of the underlying signaling pathways revealed that butanolic fraction inhibited phospholipase C (PLC) pathway in platelets, most probably acting on protein kinase C (PKC). Aqueous and n-hexane fractions of Acorus calamus were not effective against any platelet agonist. This study shows that butanolic fraction of Acorus calamus possesses components that inhibit AA metabolism and platelet aggregation through multiple pathways.

Acorus calamus L. se utiliza como remedio anti-inflamatorio en el sistema tradicional de la medicina en Pakistán y la India. Este estudio fue diseñado para explorar el mecanismo anti-inflamatorio de Acorus calamus L. y sus vías de señalización subyacentes. Fracciones acuosa, butanólica y de n-hexano de Acorus calamus se ensayaron frente a la ciclooxigenasa (COX) y de la lipoxigenasa (LOX) mediada por la producción de eicosanoides por el ácido araquidónico (AA). La fracción butanólica de Acorus calamus, pero no las fracciones acuosas y de n-hexano, inhibieron la producción de COX mediada por tromboxano B2 (TXB2) y el producto lipoxigenasa 1 (LP1) - un metabolito de la vía de LOX, 12 - (ácido hidroxieicosatetraenoico) HETE - otro producto de la ruta de LOX no fue afectado por las tres fracciones. La fracción butanólica de Acorus calamus mostró una fuerte inhibición contra la agregación plaquetaria inducida por AA. La investigación de las vías de señalización subyacentes reveló que la fracción butanólica inhibió la fosfolipasa C (PLC) y la vía en las plaquetas, probablemente actuando sobre la proteína quinasa C (PKC). Fracciones acuosas y de n - hexano de Acorus calamus no fueron eficaces contra ningún agonista de plaquetas. Este estudio muestra que la fracción butanólica de Acorus calamus posee componentes que inhiben el metabolismo del AA y la agregación plaquetaria a través de múltiples vías.

Compositional studies and Biological activities of Perovskia abrotanoides Kar. oils

BACKGROUND: Current study has been designed to evaluate the chemical composition of essential and fixed oils from stem and leaves of Perovskia abrotanoides and antioxidant and antimicrobial activities of these oils. RESULTS: GC-MS analysis of essential oil identified 19 compounds with (E)-9-dodecenal being the major component in stem and hexadecanoic acid in leaves. In contrast, GC-MS analysis of fixed oil showed 40 constituents with α-amyrin the major component in stem and α-copaene in leaves. The antioxidant activity showed the highest value of 76.7% in essential oil from leaves in comparison with fixed oil from stem (45.9%) through inhibition of peroxidation in linoleic acid system. The antimicrobial assay tested on different microorganisms (e.g. E. coli, S. aureus, B. cereus, Nitrospira, S. epidermis, A. niger, A. flavus and C. albicans) showed the higher inhibition zone at essential oil from leaves (15.2 mm on B. cereus) as compared to fixed oil from stem (8.34 mm onS. aureus) and leaves (11.2 mm on S. aureus). CONCLUSIONS: The present study revealed the fact that essential oil analyzed from Perovskia abrotanoides stem and leaves could be a promising source of natural products with potential antioxidant and antimicrobial activities, as compared to fixed oil.

Compositional studies and biological activities of some mash bean (Vigna mungo (L) Hepper) cultivars commonly consumed in Pakistan

BACKGROUND: In recent years, the desire to adopt a healthy diet has drawn attention to legume seeds and food products derived from them. Mash bean is an important legume crop used in Pakistan however a systematic mapping of the chemical composition of mash bean seeds is lacking. Therefore seeds of four mash bean (Vigna mungo (L.) Hepper, family Leguminoseae) cultivars (NARC-Mash-1, NARC-Mash-2, NARC-Mash-3, NARC-Mash-97) commonly consumed in Pakistan have been analyzed for their chemical composition, antioxidant potential and biological activities like inhibition of formation of advanced glycation end products (AGE) activity and tyrosinase inhibition activity. RESULTS: The investigated cultivars varied in terms of biochemical composition to various extents. Mineral composition indicated potassium and zinc in highest and lowest amounts respectively, in all cultivars. The amino acid profile in protein of these cultivars suggested cysteine is present in lowest quantity in all cultivars while fatty acid distribution pattern indicated unsaturated fatty acids as major fatty acids in all cultivars. All cultivars were found to be rich source of tocopherols and sterols. Fourier transform infrared spectroscopy (FTIR) fingerprints of seed flour and extracts indicated major functional groups such as polysaccharides, lipids, amides, amines and amino acids. Results indicated that all investigated cultivars possessed appreciable antioxidant potential. CONCLUSIONS: All cultivars are rich source of protein and possess sufficient content of dietary fiber, a balanced amino acid profile, low saturated fatty acids and antioxidant capacity that rationalizes many traditional uses of seeds of this crop besides its nutritional importance. The collected data will be useful for academic and corporate researchers, nutritionists and clinical dieticians as well as consumers. If proper attention is paid, it may become an important export commodity and may fetch considerable foreign exchange for Pakistan.

Phenolic compounds and vitamins in wild and cultivated apricot (Prunus armeniaca L) fruits grown in irrigated and dry farming conditions

BACKGROUND: Turkey is the main apricot producer in the world and apricots have been produced under both dry and irrigated conditions in the country. In this study, phenolic compounds and vitamins in fruits of one wild (Zerdali) and three main apricot cultivars ('Cataloglu', 'Hacihaliloglu' and 'Kabaasi') grown in both dry and irrigated conditions in Malatya provinces in Turkey were investigated. RESULTS: The findings indicated that higher content of phenolic compounds and vitamins was found in apricot fruits grown in irrigated conditions. Among the cultivars, 'Cataloglu' had the highest rutin contents both in irrigated and dry farming conditions as 2855 µg in irrigated and 6952 µg per 100 g dried weight base in dry conditions and the highest chlorogenic acid content in irrigated and dry farming conditions were measured in fruits of 'Hacihaliloglu' cultivar as 7542 µg and 15251 µg per 100 g dried weight base. Vitamin C contents in homogenates of fruit flesh and skin was found to be higher than ß-caroten, retinol, vitamin E and lycopen contents in apricot fruits both in irrigated and dry farming conditions. CONCLUSION: The results suggested that apricot fruits grown in both dry and irrigated conditions had high health benefits phytochemicals and phytochemical content varied among cultivars and irrigation conditions as well. However, more detailed biological and pharmacological studies are needed for the demonstration and clarification of health benefits of apricot fruits.

An audit of cesarean sections in Military Hospital Rawalpindi

To analyze the rate, the frequency of different indications and the most common indication of cesarean sections in Military Hospital Rawalpindi. Cross sectional study. Obstetrics and Gynecology Department of Military Hospital Rawalpindi from September 2011 to February 2012. A total of 3555 pregnant females delivered during study period were enrolled in the study. Health volunteers and the cases of uterine rupture, pregnancy with fetal anomaly, or termination of pregnancy were excluded from the study. All patients were admitted in labor room. Detailed obstetric and gynecological history was taken. Detailed general physical examination and obstetric examination was done. Baseline investigations were checked. Fetal anomalies were ruled out by anomaly scan. Strict fetomaternal monitoring was done during labor. Cervical foley catheter and prostaglandin E2 [Prostin] tablets were used for induction according to Bishop score. Clinical record of all patients, including mode of delivery and indication, was analyzed in terms of percentage and frequency and documented in a special performa after written informed consent. Filled performas were attached with patient's case notes. Patients enrolled in the study over six months were 3555, out of which 1620 [45.5%] were delivered by cesarean section, 1901 [53.4%] were spontaneous vaginal deliveries and 34 [0.9%] were delivered by vaginal birth after cesarean [VBAC]. The rate of cesarean section in our study was 45.5% and the most common factor was repeat cesarean section [44.4%], followed by failed trial of labor [27.1%] and fetal distress seen in 165 [10.1%] cases. The rate of cesarean section in our study was 45.5% and the most common factor was repeat cesarean section 44.4%

Common mullein, pharmacological and chemical aspects

Verbascum thapsus L. [Khardhag or Common mullein], a member of the family Scrophulariaceae, is a famous herb that is found all over Europe, in temperate Asia, in North America and is well-reputed due to its medicinal properties. This medicinal herb contains various chemical constituents like saponins, iridoid and phenylethanoid glycosides, flavonoids, vitamin C and minerals. It is famous in various communities worldwide for the treatment of various disorders of both humans and animals aliments. A number of pharmacological activities such as anti-inflammatory, antioxidant, anticancer, antimicrobial, antiviral, antihepatotoxic and anti-hyperlipidemic activity have been ascribed to this plant. The plant is used to treat tuberculosis also, earache and bronchitis. In the present paper botanical and ethnomedicinal description, pharmacological profile and phytochemistry of this herb is being discussed.

Assessment of total phenolic content and antioxidant potential of methanol extract of Peltophorum pterocarpum [DC.] Backer ex K Heyne

Plants are rich in a variety of chemical compounds. Many are secondary metabolites including aromatic substances most of them are phenols or their oxygen substituted derivatives. Medicinal plants are also rich in antioxidant constituents such as phenols, tocopherols, ascorbic acid, carotenoids, and flavonoids etc. They are found to acquire free radical scavenging activity and used worldwide for the treatment of various immune system dependent diseases. Peltophorum pterocarpum [DC] Backer ex K. Heyne [Caesalpiniaceae] is a beautiful ornamental tree, widely grown in tropical regions and its parts are used in traditional medicine as an effective therapeutic agent. Fresh pods of Peltophorum pterocarpum was evaluated for its antioxidant potential by using various methods including DPPH, superoxide anion, nitric oxide scavenging, and metal chelating activity. TPC via Folin-Ciocalteau's reagent and anti haemolytic activity red blood cells respectively have also been measured. The methanol extract of pods of Peltophorum pterocarpum was found to possess the significant amount 439.21 +/- 0.17 mg GAE [gallic acid equivalents] / g of TPC. The antioxidant potential of pods extract at mature stage showed potent activity and measured as, free radical scavenging activity 73.29 +/- 0.81%, superoxide anion scavenging activity 89.03 +/- 1.07%, nitric oxide scavenging activity 84.25 +/- 1.18%, and metal chelating activity 64.12 +/- 0.11%. The extract also showed potent anti haemolytic activity 79.09 +/- 75%. Peltophorum pterocarpum exhibited strong but varying level of antioxidant and anti haemolytic activity in various methods along with total phenolic contents

Evaluation of anti-inflammatory activity of selected legumes from Pakistan: In vitro inhibition of Cyclooxygenase-2

Crude methanolic extracts of selected legumes namely, black gram [Vigna mungo L.], green gram [Vigna radiata [L.] R. Wilczek], soybean [Glycine max [L.] Merr.] and lentil [Lens culinaris Medik.] were investigated for anti-inflammatory effects, using COX-2 producing PGE[2] inhibitory assay. Percentage inhibition observed was 73.93, 79.84, 92.17 and 74.47 for black gram, green gram, soybean and lentil respectively at 20microg/ml extract concentration. The l00 micro g/ml concentration showed increase in the percent inhibition except for soybean. This is the first report on COX-2 inhibitory potential of food legumes

Biological screening of selected flora of Pakistan

Methanolic extracts of different parts of five medicinal plants, Ferula assafoetidaL. resin, Grewia asiaticaL. leaves, Ipomoea hederaceaJacq. seeds, Lepidium sativumL. seeds and Terminalia chebulaRetz. fruits were tested in vitrofor their cytotoxic, phytotoxic, insecticidal, nematicidal and anthelmintic activities. Ipomoea hederaceashowed very significant phytotoxic and cytotoxic activity, with 100% inhibition of Lemna minorgrowth and 100% death of Artemia salinaat concentrations of 1000 and 100 µg mL-1. Grewia asiaticaexhibited very weak activities while Lepidium sativumand Ferula assafoetidashowed moderate to good potential in all three bioassays. The results suggest screening of Ipomoea hederaceaseeds further for isolation of bioactive compounds that may be responsible for its toxic potential.

Evaluation of antioxidant and urease inhibition activities of roots of Glycyrrhiza glabra

The object of this study is to determine the antioxidant activity of extracts from Glycyrrhiza glabra roots. The parent extract is methanolic extract while its sub fractions were prepared in ethyl acetate, chloroform, and n-butanol. The method based on scavenging activity and reduction capability of 1, 1-diphenyl-2-picrylhydrazyl radical [DPPH]. Urease inhibition activities of these extracts were also evaluated. Chloroform fraction was the most effective antioxidant with 87.7% activity but the activity is less than the crude methanolic extract i.e. 90%. Chloroform fraction showed the same trend in reducing power as that in radical scavenging activity. However n-butanol extract was devoid of any activity when compared to standard BHA. Crude methanolic fraction and its sub-fractions were also screened for enzyme inhibition activities using jackbean urease as substrate. Significant anti urease activity i.e. 72% was observed in the ethyl acetate fraction with respect to standard inhibitor thiourea

Platelet aggregation inhibition activity of selected legumes of Pakistan

The current study was designed to explore the platelet aggregation activity of methanolic extracts of green gram, lentil, mash bean and soya bean. The extracts dose-dependently inhibited platelet aggregation initiated by arachidonic acid [AA] and platelet activating factor [PAF]. Extract of green gram was effective only against AA mediated activity while mash bean and soya bean extracts were effective against both AA and PAF mediated activity. But lentil extract has no activity. The order of activity based on IC[50] value is, Mash bean> Soya bean> Green gram. This preliminary result suggests that legume seed extract may be taken as a candidate lead natural compound to be considered in the search for natural products with beneficial effects on aberrant platelet activation mediated cardiovascular disorders

Preparation, characterization and release of verapamil hydrochloride from polycaprolactone/ acrylic acid [PCL/AA] hydrogels

In this study pH sensitive, biocompatible and controlled released hydrgels were prepared and their localized drug delivery effect was analyzed. Polycaprolactone and acrylic acid [PCL/AA] were reacted by free radical polymerization and developed inter penetrating polymeric network [IPN] hydrogels. Benzylperoxide was used as initiator and N, N methylenebisacrylamide [NNMBisAm] was employed as a cross-linking agent. Different concentrations of monomer, polymer and cross-linking agent were used and the reaction parameters were optimized. The obtained PCL/AA hydrogels were fully characterized by Fourier transform infrared spectroscopy [FT-IR], scanning electron microscopy [SEM], and thermogravimetric analysis [TGA] that determined the polymer structure, its morphology and strength respectively. Verapamil, a calcium channel blocker was loaded by incubation of polymerization method. Controlled release Verapamil hydrogel was developed due to its low solubility; low permeability and having very short half life of 1.2-2 h. The dynamic swelling, equilibrium swelling and drug release were carried out in a buffer solution of pH 1.2, 4.5 and 6.8. Concentration of Acrylic acid showed direct, while Polycaprolactone inverse relation to swelling and drug release due to their hydrophilic and hydrophobic nature respectively. Cross-linking agent also had the contrary effect on swelling. Diffusion coefficient [D] of hydrogels was determined by using Flory-Rehner theory. Drug release and swelling data were analyzed by different kinetic models, like Zero order, First order, Higuchi, Korsmeyer's and Peppas. The release and diffusion was best described by the first order kinetics where n value was <0.5 for all the formulations indicating Fickian drug release mechanism