Exploring threatened traditional knowledge; ethnomedicinal studies of rare endemic flora from Lesser Himalayan region of Pakistan

ABSTRACT Himalayas are one among the world biodiversity hotspots harboring many endemic medicinal plants. Despite augmentation in the documentation of ethnopharmacological knowledge of medicinal plant species, information regarding endemic species is still underway. Current paper highlights the traditional medicinal uses of rare endemic and unexplored group of plants having potential for novel chemical constituents with effective pharmacological activities. In total, 142 informants (91 male and 51 female) including seventeen traditional healers were interviewed using semi-structured questionnaire, personal observations and group discussions. Interviews were taken in field or otherwise photographs were shown for identification. Females were interviewed indirectly through male family members. For data analysis, quantitative analytical approach was adopted using ethnopharmacological indices as Relative frequency of citations and Fidelity Level. In total, 38 endemic plant species belonging to nineteen families were utilized by the local inhabitants. Highest number of endemics was belonging to Ranunculaceae (7), followed by Gentianaceae and Rosaceae (4 each) with respect to number of species. Highest number of endemics was used in fever, wound healing, throat infection and tonic (4 species each). Root was the most widely used part (36.17%) in cure of diseases and the leading mode administered was decoction (25.49%). Highest use reports and RFC values were recorded for Pimpinella stewartii (58 citations, 0.41 RFC), Caltha alba var. alba (52 citations, 0.37 RFC). Endemic plant species considerably contribute toward ethnomedicinal knowledge and despite rarity, the communities prefer their utilization. Conservation of endemics is necessary for future availability to the local communities.

Knowledge and perceptions of parents of children below 2 years of age towards immunization in twin cities of Pakistan a challenge for achieving millennium development goals

Immunization is one of the most cost-effective public health interventions which have a large impact on public health. The main objective of the study is to assess knowledge and perceptions of parents regarding immunization of children less than two years of age in twin cities of Pakistan. A descriptive cross-sectional study design was used to evaluate the knowledge and perception of parents regarding immunization practices. The sample size was calculated to be 382. Convenient sampling technique was used to select the respondents and semi-structured questionnaire was used in the region. After data collection, data was cleaned, coded and entered in SPSS version. Descriptive statistics of frequency and percentage was calculated. Kruskal-Wallis and Mann-Whitney tests [p<0.05] were performed to find out the differences among variables. Parents with Master's Degree and having monthly income between Rs20,000-30,000 had significantly better knowledge. While no significant differences [p<0.05] were found between the genders, age, occupation, city and number of children. The results of the present study concluded that knowledge of parents regarding immunization of children less than two years of age was not adequate but they had positive perceptions toward immunization. Besides the availability of EPI immunization guidelines for parents in the form of immunization card they miss schedules of immunization because they are unaware of the schedule, immunization timing of children, and knowledge about vaccine preventive diseases. There is a dire need to educate the people about its importance and to enhance their knowledge regarding diseases against which they must immunize their children less than two years of age?

Pattern of dyslipidemia and other risk factors for coronary artery disease and macrovascular complications in diabetic patients

Objective: to determine the pattern of dyslipidemia and other risk factors and their association with macrovascular complications in our diabetic patients presenting to OPD [outpatients department] on routine follow up

Methods: this study was done in medical outpatients department, Akhter Saeed teaching hospital, from December 2014 to August 2015. one hundred diabetic patients, male and female, coming for routine follow up were screened for macrovascular complications, and risk factors like obesity, hypertension, deranged glucose levels and lipid abnormalities were measured and analyzed

Results: of the one hundred patients recruited for this study, fifty three were females and forty seven were males. Male patients were more likely to be obese and overweight [5 [10%] and 11 [23%] respectively] than the females [2 [3%] and 10 [19%] respectively]. Males were also more likely to be hypertensive [24 [51 %]] than females [23 [43%]]. The average BP [blood pressure] for males was [141+/-44 SD]/ [91+/-14 SD] mmHg, and [129+/-41 SD]/ [85+/-15 SD] mmHg for females. All the patients had fasting hyperglycemia; however females were having more deranged values [FBS [141+/-79 SD] mg/ di for males and [151+/-91 SD] mg/ di for females]. Male patients were found to have dyslipidemia predominantly in the form of high total and LDL cholesterol or low HDL cholesterol, while more of the females had hypertriglyceridemia. In this study, high LDL cholesterol or total cholesterol and low HDL cholesterol were found to be associated with hypertension and macrovascular complications. Of the 72 among all the 100 patients with evidence of macrovascular complications, high total cholesterol was seen in 58 [80%] patients while it was seen in 17 [61 %] of the remaining patients. High BMI [Body Mass Index] was also independent risk factor for hypertension and coronary artery disease in age matched patients. Increased triglyceride levels did not show any clear correlation with macrovascular complications

Conclusion: this study shows increased incidence of lipid abnormalities and other risk factors in diabetics especially in patients with evidence of macrovascular disease

Polymorphisms of the ABCB1 gene in the pakistani population

To investigate the frequency of the single nucleotide polymorphism C1236T in exon 12 of the ABCB1 gene in Pakistani population and to compare it with published data on Asian and Caucasian populations. A cross-sectional observational study. Combined Military Hospital, Rawalpindi and Institute of Biomedical and Genetic Engineering [IBGE], Islamabad, from August 2012 to May 2013. C1236T polymorphism was investigated in 426 Pakistani subjects. The frequency was compared with the published data on other Asian and Caucasian populations. The frequencies of ABCB1 C1236T were 16.4% for CC, 44.1% for CT and 39.4% for TT. Pakistanis differed significantly from all the European populations compared in the distribution of the TT genotype of C1236T ABCB1 [p < 0.05]. The Pakistani population also differed significantly from some of the European populations in the distribution of CC and CT genotype [p < 0.05]. There was significant difference in the genotype frequency of the ABCB1 gene compared to other populations. This study has provided a framework for future pharmacogenetic and pharmacokinetic studies on this polymorphic variant of ABCB1 gene in the Pakistani population

Hypoglycaemic effects of methanolic extract of Canscora decussata [Schult] whole-plant in normal and alloxan-induced diabetic rabbits

In present study hypoglycaemic effects of the crude powdered C. decussata and its methanolic extract [ME] in alloxan diabetic rabbits were evaluated. The hypoglycaemic effect was measured by blood glucose, insulin level, HbA1c and his to pathology of pancreas. Glucose lowering effect of the ME was studied in diabetic rabbits. The effects of extract on blood glucose, body weight, food in take, fluid intake, OGTT were also evaluated. The results showed that 0.5,1 and 2g/kg of the powder significantly decreased blood glucose levels in normal rabbits and diabetic rabbits at the intervals checked. Oral intake of pioglitazone also reduced the levels in these rabbits. Synergistic hypoglycaemic effect of 600mg/kg of ME with different doses of insulin [2 and 3unit/kg, s/c] further reduced blood glucose levels of treated alloxan-diabetic rabbits. The oral glucose tolerance test revealed lowered area under curve values in ME treated rabbits. Treatment with ME [400 and 600 mg/kg] for 30 days showed highly significant decrease in blood glucose level by augmenting insulin secretion, HbA1cand significant increase in body weight, serum insulin levels in treated diabetic rabbits. Histopathology study showed regeneration of beta -cells. These studies have, therefore, supported the traditional use of this herb in diabetic patients

Frequency of behavioural features among insomniac patients

Background: Insomnia may affect daytime quality of life and have different behavioral symptoms among patients

Objective: To determine the frequency of behavioral and demographic features among insomniac patients

Patients and Methods: A cross sectional study was conducted on patients from southern Punjab, who were insomniac and taking medications from Psychiatric Ward, Nishtar Hospital Multan, from 1[st] January 2010 to 31[st] January, 2011. Data was collected from 417 insomniac patients. A questionnaire was administered targeting insomnia criteria. Confidentiality of information taken was ensured. The data was entered and analyzed by SPSS version 15

Results: A total of 417 patients participated in the study. The age range was 10-80 years, with 52% females, 272 insomniac patients out of 417 [65.2%] were anorexic. 225 [54%] cases were the eldest, among insomnia patients, following were the youngest who were 116 [28%] and the least were in between the eldest and the youngest who were 75 [18%]. 284 [68%] patients complained about the uncontrolled level of anger with destructive behavior

Conclusion: Anorexia, uncontrolled anger, restlessness was found in insomnia. Females, illiterate and elder members of family were more insomniac

Prevalence of congestive gastro and doudenopathy in patients with portal hypertension

The aim of this study was to determine the prevalence of congestive gastropathy/ duodenopathy in portal hypertension. A cross sectional study of 100 patients with portal hypertension undergoing upper gastro-intestinal endoscopy in Medical Unit IV was carried out in which their history, clinical and endoscopic examination was done. Congestive gastropathy was seen in 88% of the patients, while congestive duodenopathy was seen in 19% of the patients. The study data analysis leads to the conclusion that the congestive gastropathy can by included as one of the common complications of advanced liver cirrhosis

Comparison of efficacy of topical glycerin trinitrates with capsaicin in painful diabetic neuropathy

Objective: to compare the efficacy of topical glycerin triturates with capsaicin in painful diabetic peripheral neuropathy

Material and Methods: this quasi experimental study was conducted in Diabetes Management Centre Medical Unit-IV Services Hospital, Lahore over a period of six months from 01-06-2008 to 30-11-2008. Sixty-two patients of diabetes mellitus having symptoms of neuropathy were included in this study and were divided into two groups of thirty one patients each: .In group A topical capsaicin cream was applied twice a day for thirty minutes for the period of seven days aft he strength of 0.075% w/w. In group B glycerin triturate cream was applied twice a day for thirty minutes for the period of seven days at the strength of 2% w/w. After seven .days of treatment, intensity of numbness and par aesthesia and tissue perfusion were again assessed using visual analogue scale and Perl scan respectively. Perl scan and visual analogue chart assessment were repeated after the seven days wash out period and patients were .crossed over to the other treatment group. Numbness and para aesthesia were reassessed at the end of last treatment on visual analogue chart and Perl scan were repeated as well for tissue perfusion

Results: the age of the patients in group .A. was49:90+/-8.06 years and in group B were 49.58+/-6.62 years. In group A, the efficacy of GTN in peripheral neuropathy was 38.7% as compared to capsaicin which was only 19.3%. Similar results were seen in group B, in which efficacy of GTN in peripheral neuropathy was 51.6% as compared to capsaicin that was 29%.The overall results when combined in both the groups showed a response to capsaicin in 15 [24.2%] patients only versus 28 [45.2%] to GTN. This difference was statistically significant [p=0.02356]

Conclusion: there is a significant difference in efficacy of topical glycerin triturates and capsaicin in the management of diabetic peripheral neuropathy. GTN cream, a well-tolerated drug, provides significant improvement in painful diabetic neuropathy

Adherence of private practitioners with the National Tuberculosis Treatment guidelines in Pakistan: a survey report

In Pakistan, over 80% of the patients suffering from TB consult a private practitioner for the initial evaluation. A cross-sectional survey was conducted in seven thickly populated urban communities of Rawalpindi district to evaluate the adherence of private practitioners with TB treatment guidelines as laid down by National Tuberculosis Control Programme [NTP] in Pakistan. The data was collected over 30 days. A young lean man was simulated to act as a TB patient and was provided with a chest X-ray suggestive of TB and two Acid-Fast Bacilli [AFB] positive sputum reports. Only those prescriptions were included for analysis which either had recognized the patient having TB or had any TB drug written in the prescription. A total of 77 practitioners were visited. Prescriptions of 53 general practitioners fulfilled the inclusion criteria and were analyzed. Only 2 [3.7%] prescriptions out of 53 met the required standard for TB patients as laid down by NTP. Eighty three% [n = 44] favored a combination drug for the treatment while the rest preferred individual preparations. The study reflects the lack of knowledge about standardized TB treatment protocols amongst the private practitioners in Pakistan. Public Private Partnerships between government public health departments and non-governmental organizations working in public health can be a valuable tool in generating mass awareness campaigns

Ileal typhoid perforation: a study of 40 cases

This is a retrospective study of 40 patients, who presented as acute abdomen and underwent emergency surgery for ileal perforations. High grade fever, abdominal pain, vomiting and constipation were common symptoms, while generalized tenderness, rigidity and obliteration of liver dullness were the main clinical findings. Sex incidence revealed male predominance, 33 male versus 7 females. The ages of the patients ranged from 12 to 75 years with a mean of 34 years. Ileal perforation due to typhoid enteritis was the diagnosis in all cases. Surgical procedures carried out included primary closure of the perforation in 27 cases and primary closure with loop ileostomy in 12 cases. In one case right hemicolectomy was performed. A mortality rate of 15% was seen in this series

Goitre management: a study off 106 cases

One hundred and six cases of thyroid swellings were seen in this 5 years retrospective study. Amongst them the highest incidence was of simple multinodular goiter [46%] followed by cold nodules [22%]. Female to male ratio was found to be 6:1. The mean age was 31 years while our youngest patients was 16 years old and the eldest 69 years. Maximum number of patients [54.70%] belonged to the age group 21 to 40 years. Subtotal thyroidectomy was the commonest procedure, performed in 42% cases. The average postoperative stay of patients in the ward was 4.25 days