Stem cells therapy as a treatment for spinal cord injury

Stem cells therapy holds a great promise to treat several degenerative diseases and repair damaged tissues that are otherwise very difficult to treat by conventional therapies. In future, stem cells therapy will treat spinal cord injury [SCI] which is a major problem associated with demyelination of neurons caused by trauma resulting in cell death that is irreplaceable. Patients usually survive with spinal cord injury but this trauma remains uncure. After SCI, endogenous neuroprogenitor cells migrate towards the affected tissue but many messenger cascades suppress their proliferative activity. Different exogenous stem cells sources are another option to treat SCI patients. Although there is no permanent cure of SCI patients but due to excitable development in the field of stem cells transplantation, promises a hope for its cure in future. Due to intricacy of factors involved after SCI, there is a need for combinatorial therapies

Protecting Pakistan's health during the global economic crisis

The world is facing an unprecedented global economic crisis, with many countries needing to reconsider their level of health care spending. This paper explores the many consequences of the global economic turndown on Pakistan's health, including reduced government and donor spending and increased poverty with the consequent diversion of funds away from health. Nevertheless, these challenges may provide opportunities not only to mitigate the adverse effects of the economic crisis but also to institute some much-needed reforms that may not receive political support during more affluent times. Our suggestions focus on setting priorities based on the national disease burden, prioritizing prevention interventions, demanding results, curbing corruption, experimenting with innovative funding mechanisms, advocating for increased funding by presenting health spending as an investment rather than an expense and by selected recourse to civil society interventions and philanthropy to bridge the gap between available and needed resources

Female spouses of injection drug users in Pakistan: a bridge population of the HIV epidemic?

An estimated 21% of injection drug users [IDUs] in Pakistan are HIV-positive and data suggest that the spouses of IDUs may be a critical component of the HIV transmission chain. This study interviewed 101 spouses of male IDUs about their sexual practices and drug use. We found that 43% had been sexually active with their partners in the past month but only 4% reported selling sex. Almost a quarter [23%] used drugs and 19% injected drugs, usually a combination of diazepam and pheniramine. Although sex work was infrequent among spouses of IDUs, their risk of contracting HIV and transmitting it to others was high because they received injection drugs, sometimes along with their IDU husbands, from the same health centres that provided therapeutic injections to the rest of the community. IDU spouses may thus serve as a bridge group via therapeutic injections, rather than via sex work

Assessment of phytochemical and pharmacological activities of Leucas zeylanica [L.] R.Br. [Family: Lamiaceae]

The aim of the present study is to investigate the antioxidant, neuropharmacological, analgesic and antimicrobial activities of the EtOH extract of the whole plant of Leucas zeylanica. Phytochemical screening indicated the presence of gums, carbohydrate, reducing sugar, phenols, tannins [gallic acid], cardiac glycosides and saponins. TLC-based antioxidant assay by DPPH free radical revealed positive activity of the extract and in quantitative assay IC[50] value was 62.9 microg/ml. The extract potentiated the phenobarbitone-induced sleeping time in mice in a dose dependent manner. From the study of analgesic activity using the model of acetic acid-induced writhing in mice it was found that the extract exhibited [***p<0.001] writhing inhibition was dose dependent. The extract showed moderate antimicrobial activity

Creating synergies for health systems strengthening through partnerships in Pakistan - a case study of the national eye health programme

Blindness and visual impairment are major causes of noncommunicable diseases in Pakistan. Two national population-based blindness surveys conducted in 1988 and 2002-04 demonstrated a reduction in prevalence of blindness from 1.78% to 0.9% with a significant drop in cataract blindness as a result of accelerated nationwide interventions and eye care integration in primary health care. In addition, between 2006 and 2008r 88 facilities were upgraded as a result of the national eye health programme. These measures resulted in a 279% increase in eye outpatient attendances and a 375% increase in eye surgeries performed. Investment in human resources development and policy change contributed significantly to the sustainability of the programme. Key challenges facing the programme include aligning national eye health strategies with health system strengthening informed through health systems research. This gaper attempts to document this extraordinary success

comparative evaluation of oral health knowledge, attitudes and practices of dental and pharmacy students of Riphah international university

Oral health promotion by healthcare professionals is a vital aspect of preventive dentistry. However, their personal oral hygiene behaviors play an integral role in such promotions. The aim of this study was to compare the oral health knowledge, attitudes and practices of dental and pharmacy students of Riphah International University [RIU]. Using a self-administered structured questionnaire for a cross-sectional survey, a study population of 157 dental students [DS] and 303 pharmacy students [PS] were recruited by convenience sampling from the Islamabad campus of the university. DMFT index for each subject also was recorded. Comparisons between the two study groups were made using independent sample t-test. Results were grouped into four categories of caries prevalence, oral hygiene behaviors, oral health attitudes and knowledge. The mean DMFT index of dental students was 1.67 +/- 2.39 and PS 1.47 +/- 1.71 [p=0.36]. Most DS [72.6%] and half of PS [55.4%] brushed their teeth twice or more times a day [p=0.43], while only 19.3% of the study population flossed their teeth daily. Attitudes towards oral health were shown by 45.2% DS and 45.9% PS visiting the dentist only when driven by pain while 26.1% DS and 30% PS had never been to a dentist. Oral health knowledge was judged by only 33% DS and 34% PS [p=0.40] ever having noticed a sticky white layer on their tooth surfaces while only 17.5% DS and 2.9% PS [p=0.03] used a soft-bristled toothbrush. The DS did not exhibit any particularly exemplary oral hygiene preventive behaviors which generally fell below the recommended standards. Greater emphasis during their dental training could improve their oral self-care behaviors

Growing burden of noncommunicable diseases: the contributory role of oral diseases, Eastern Mediterranean Region perspective

Associations of oral diseases with noncommunicable diseases such as diabetes, cardiovascular diseases, chronic respiratory diseases, osteoporosis and chronic renal failure are widely reported in the literature from developed countries. Commonality of risk factors, changes in systemic inflammatory mediators and body metabolism play a role in this association. This paper reviews current knowledge on the burden and association of oral and systemic diseases, and highlights the paucity of information and research from the Eastern Mediterranean Region and other developing countries. A call is made for further research to understand the status and significance of oral-systemic disease associations and develop guidelines for their control in this Region

Teaching biostatistics and epidemiology in a postgraduate medical institution: are we going in the right direction?

We examined the attitude and knowledge of 40 supervisors and trainees as well as the impact of workshops on statistical thinking and analytical processes in a medical facility in Pakistan: 45% thought that statistics and epidemiology should be left to professional statisticians; 86% of the trainees and 58% of the supervisors, however, thought that statistics should be taught as a full-time subject. The majority of trainees [86%] were dissatisfied with the workshops compared to 33% of supervisors. Our findings indicate an urgent need to revise our approach to teaching statistics and epidemiology

Diagnosis and management of urinary incontinence in older patient

To review the various causes of urinary incontinence [UI] in elderly patients and to outline a therapeutic approach to the clinical management of UI. Online search of MEDLINE and additional references selected from the articles found during the search. All peer-reviewed articles and review articles listed on MEDLINE published between 1966 and 2006. Key search terms included urinary incontinence, geriatric, aging, pelvic floor rehabilitation and indwelling catheter. Articles with clinical relevance to the geriatric population were selected based on the robustness of the study and reviews. If applicable, data from studies of healthier or younger populations was extrapolated to the elderly population examined in the reviews. UI is a common occurrence among older adults treated in rehabilitation settings. The causes of UI in the elderly vary, including transient causes, established pathologic states of the urinary tract, and systemat ic multifactorial influences. Both behavioral and pharmacologic management strategies can successfully be implemented for UI, even in the frail elderly. UI can be effectively investigated and treated by rehabilitation practitioners by following a simple, stepwise approach

Clinical characteristics of pulmonary tuberculosis in adult Pakistani patients with co- existing diabetes mellitus

A review was made of the records of all patients with pulmonary tuberculosis and diabetes mellitus admitted over a 5- year period to a teaching hospital in Karachi, Pakistan. Among 42358 the total number with both tuberculosis and diabetes was 173. The prevalence of tuberculosis patients, in diabetic patients was 10- times higher than in non- diabetic patients and prevalence increased with duration of diabetes. The lower lung field was most frequently involved, followed by the upper and middle. Bilateral involvement was seen in half and an associated pleural effusion in one- third of the patients. Cavitating lesions were seen in 32% of men and 15% of women

Primary carcinoid tumour of the testis

A left radical orchidectomy was performed on a 32-year-old man presenting with a testicular mass. Histology revealed a tumour comprising of cells with monotonous nuclei and granular cytoplasm arranged in an insular pattern. Immunohistochemical expression for NSE, synaptophysin and chromogranin A were positive. No teratomatous elements were seen. Postoperatively, a staging CT and an octreotide scan were normal. Urinary 5-HIAA levels were not elevated. Based on these investigations the tumour was diagnosed as a pure primary carcinoid tumour of the testis. The patient has been followed up for 3 years with no evidence of recurrence

Clinicopathological analysis of ovarian tumours

To study the relative frequency and histological pattern of ovarian tumours in various age groups. The study was carried out in the Histopathology department, AFIP Rawalpindi from Jan 2002 to Jun 2003 One hundred and ninety four specimens of ovarian tumours were received in Histopathology department, AFIP Rawalpindi. All the surgical specimens were fixed in 10% formalin and routinely processed. The sections were then cut and stained with Haematoxylin and Eosin. The histological typing of ovarian tumours was done according to WHO classification of 2003. The main bulk comprised surface epithelial tumours [73%]. Among them, 107 [75.33%] were benign neoplasms and 35 [24.09%] were malignant. There were 40 [21%] germ cell tumours, 10 [5%] sex cord stromal tumours and 2 [1%] metastatic tumours. The benign category comprised 88 cases of serous cystadenoma, 34 cases of mature cystic teratomas and 19 mucinous cystadenomas. In the malignant group, there were 15 serous cystadenocarcinomas, 10 endometrioid carcinomas, 7 mucinous cystadenocarcinomas, 2 yolk sac tumours and 2 cases of granulosa cell tumour. Benign tumours were mostly diagnosed in 3rd and 4th decades of life, whereas malignant tumours were seen after 40 years, with exception of malignant germ cell tumours, which were mostly found in younger age groups. There were minor differences from local studies. The overall frequency of various tumour groups was very similar to that in the west with some difference in tumour types

Complications and visual outcome of sclerally fixed posterior chamber intraocular lenses

Hundred eyes of 97 patients were operated for determining complications and visual outcome of Sclerally Fixed Posterior Chamber Intraocular Lenses at Institute of Ophthalmology, Mayo Hospital, Lahore from January 2002 till December 2002. Those operated either had ICCE done previously, per-operated large rent in posterior capsules, dislocated lens and t raumatic subluxated cataractous Iens. Immediate complications were transient rise in IOP, corneal edema, striate keratopathy. Late complications noted had decentration of IOL [4%], Cystoid Macular edema 4%, suture erosion [2%] and lens tilt [1%]. 80% patients had Post-operative V/A of 6/6-6/12 and 20% had V/A 6/18- 6/60 as compared to Pre-Operative V/A of 56% in 6/6-6/12, 10% in 6/18-6/60 and 34% in 3/60-PL+ ve. Encouraging results favour this procedure

Comparison between primary repair and exteriorization in cases typhoid perforation

This comparative study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of typhoid perforation 80 patients were selected out of which 48 were males and 32 were females. Consisted of a history of fever abdominal pain, constipation, sharp shooting pain superimposed over the colicky abdominal pain clinical finding included tense tender abdomen and absent bowel sounds, investigations including gas under diaphragm in abdominal x-ray and positive widal test. Consisted of negative Widal test even if there was gas under diaphragm, per op findings suggestive of tuberculosis or histopathology reports suggestive of tuberculosis or any pathology other than typhoid. Primary repair was done in patients who presented within 36 hrs of experiencing sharp shooting pain and per op findings of minimal contamination. Exteriorization in the form of loop or double barrel ileostomy was done in other cases

Magnitude of vitamin A deficiency in poor communities of the four selected districts of Punjab using - [rapid assessment technique]

To determine the prevalence and associated factors responsible for vitamin A deficiency [VAD], a survey was carried out in the 21 selected villages of the 4 selected districts of Punjab, using a rapid assessment technique in July-August 1998. A total of 1526 pre-school going children from 6 months to 6 years were examined for Night Blindness [XN], Bitot's Spots [X1B] and Corneal Scars [XS]. Prevalence of VAD came as 6.4% [97 cases], out of which 0.8% [12 cases] were of XN, 5.4% [82 cases] were of X1B and 0.2% [3 cases] were of XS. Male to female ratio was 3:1. Sixty four percent of VAD occurred between ages 4 to 6 years having weights between 15 to 17 kg, which was below the recommended weights. The reason for malnourishment was that majority of VAD cases had diarrhea. Other factors responsible for high prevalence were poor socioeconomic conditions, increased number of children per household, lack of mother's education, low monthly family income, lack of proper breast-feeding, and inadequate usage of vitamin A rich items, like milk and milk products, liver, fish, eggs and mangoes. The reason for not consuming vitamin A rich food was cost of items. The biggest barrier responsible for VAD was poverty. Thus, vitamin A deficiency is a significant major public health problem in the poor communities of Punjab

Pulmonary infiltrates during chemotherapy-induced febrile neutropenia: incidence, patterns and outcome

To analyze the incidence, etiologies, radiographic patterns, and clinical outcomes of adult leukemics with prolonged febrile neutropenia and pneumonia. A retrospective study was conducted at a tertiary care hospital. The medical records of adult patients with acute myeloid leukemia diagnosed between January 1989 and June 2000 and undergoing induction chemotherapy were included. Only the patients who presented with a pulmonary infiltrate, secondary leukemia [e.g., transformed chronic myeloid leukemia underlying myelodysplastic syndrome, or disease following alkylating agent therapy] were included and those developing infiltrates following consolidation chemotherapy were excluded. A total of 124 patients were admitted to the hospital with a diagnosis of AML during the study period. Thirty-one patients were excluded; 93 patients received induction chemotherapy and were included in the study analysis. The median age was 36 years [15 - 70 years]; 58 males and 35 females. Sixty two% patients received Cytosine Arabinoside [Ara-C], 17% received Etoposide, 11% received Ara-C and Mitoxantrone, and 6% received All-trans-retinoic Acid. The mean onset and duration of neutropenia were 5 and 15 days, respectively. Pulmonary infiltrates were identified during 45% of neutropenic episodes. A presumptive causative organism was isolated from 50% of patients with an infiltrate: Gram- positive bacteria were most common [47%] followed by Gram-negative bacilli [33%] and fungi [20%]. Survival data were available for 88 patients; median disease free survival for the entire cohort was 7 months. Male sex [p=0.015], onset of neutropenia [p=0.02] and bilateral distribution of an infiltrate [p=0.03] were statistically significant predictors of early mortality. For patients with and without pneumonia, the median disease-free interval and overall survival were 2.5 and 4.6 months and 9 and 13 months [p=0.038 and p=0.095] respectively. Neutropenia occurred at a mean of 5.0 after initiation of induction chemotherapy. The majority of patients had bilateral pulmonary infiltrates. Male sex, onset of neutropenia and bilateral distribution of an infiltrate were found to be statistically significant predictors of early mortality

Spetrum of complications and mortality of bacterial meningitis: an experience from a developing country

The aim of this study was to obtain data on predisposing factors, causative organisms and their associated mortality and complications related to acute bacterial meningitis. The chart review of all patients in whom acute bacterial meningitis was diagnosed at The Aga Khan University Hospital from January 1995 through December 2001. One hundred ninety-four patients were included in study. There were 146 males and 48 females. The mean age of our study population was 41 +/- 12.3 years. One hundred and ninety [97.9%] patients had communityacquired meningitis-, only 4 [2.0%] patients developed meningitis nosocomially. The two most common predisposing factors were diabetes mellitus [13.9%] and otitis media [7.7%] among all 194 patients. A significant proportion of patients with complications had diabetes mellitus [24.6%, p<0.001]. CSF and blood cultures were positive in 53 [27.3%] and 42 [21.6%] patients respectively-, there was no statistical difference found. The most common organisms isolated were Streptococcus pneumoniae in 35 [36.8%] patients followed by Neisseria meningitides in -30 [31.5%] -patients. Approximately 68% of -positive cultures -yielded S. pneumoniae and N. meningitides [p<0.0001]. The overall mortality rate was 22.1%. The mortality rate for Streptococcus pneumoniae was 17.1%. The highest mortality was observed in patients with Pseudomonal meningitis where all four patients expired followed by mortality rate of 85.7% in Escherichia coli afflicted patients [p<0.001]. Complications occurred in 73 [37.6%] patients with persistent complications in 31 [42.4%] patients. Complications resolved in 34 [46.5%] patients. The most common complications were seizures [12.8%] and cranial nerve palsies [11.3%]. Seizures were more likely to occur in older patients [p<0.05] whereas hydrocephalus was more common in younger patients [p<0.05]. Bacterial Meningitis remains a serious disease associated with substantial morbidity and mortality. Most cases are community acquired with S. Pneumoniae being the most common pathogen. Old age, diabetes mellitus, a positive culture, seizures as a complication and late stage in the disease are the important predictors of a poor outcome