Health and road transport in Pakistan.

OBJECTIVE: The 1998 Global Burden of Disease Study estimated that road traffic injuries (RTIs) will become the third leading cause of lost disability-adjusted life years, with two-thirds of the deaths occurring in the least developed nations. Moreover, automobile-based transport systems are associated with air pollution (lead toxicity, asthma and greenhouse gas accumulation), noise disturbances, physical inactivity and obesity. STUDY DESIGN: This study (1) reviewed road transport literature in Pakistan and the impacts on health outcomes; (2) examined health policies to assess their focus on transport-related health problems; and (3) identified policy gaps for future research. METHODS: A methodological review of the literature on direct and indirect effects of road transportation in Pakistan. This review includes government documents, memos, statements and draft policies as well as relevant articles indexed in MEDLINE. RESULTS: A systematic review revealed no approved transport policy in Pakistan, despite three national health policy documents. The Health Chapter of the 9th Five Year Plan appreciates the grave threat of unchecked RTI, but fails to offer specific policy interventions. Despite ambitious plans by the Pakistan Environmental Protection Agency, actual projects and their implementation remain scarce, resulting in ever-increasing air pollution. The health impact of lead toxicity, noise pollution and RTIs remain high, while obesity is on the rise. CONCLUSION: The increasing health impact of road transport on 140 million people calls for immediate policy action. Government agencies must intervene effectively to establish monitoring and decentralised enforcement nationwide, while simultaneously supporting alternative modes of transportation.

Experience of direct coronary stenting at National Institute of Cardiovascular Diseases.

OBJECTIVE: To assess the efficacy, safety and advantage of direct coronary stenting versus traditional angioplasty and stenting. METHODS: From May 2000 to June 2001, 486 patients underwent PTCA procedure. One hundred fifteen (24%) were considered candidates for direct stenting. Out of 150 coronary lesions, 119 (79%) had direct coronary stenting. In 5% patients stent could not be passed across the lesion. These stents were withdrawn without stent damage and after predilatation the same were successfully deployed. RESULTS: Primary success rate was 95%. Angiographically assessed success was achieved in all patients with immediate TIMI 111 flow in 97%. The vessels directly stented were LAD 53%, RCA 27% and LCX 18%. Two saphenous vein grafts were also directly stented. The coronary lesions stented were type A 36%, B1 54% and B2 10%. In borderline lesions IVUS was used for quantification of stenosis. There was no in-hospital death, MI or emergency CABG. Compared to traditional stenting there was 46% reduction in procedure time, 62% reduction in radiation exposure time and 35% decrease in use of contrast media. There was also significant (18%) cost benefit in direct stenting. CONCLUSION: This study supports the view that direct coronary stenting is feasible and a safe procedure in our population with additional benefits of cost reduction by 18%. We recommend direct stenting in appropriately selected patients.

The efficacy and safety of cefaclor in respiratory infections amongst Pakistani children.

PURPOSE: To evaluate the efficacy and safety of Cefaclor in respiratory tract infections amongst Pakistani children. PATIENTS AND METHODS: Multicenter, open label and non-comparative study was done to evaluate the response in terms of symptoms (In vivo) and bacterial cultures (In Vitro) to Cefaclor amongst children with respiratory tract infection between the ages 2 months to 12 years. Each patient was asked to visit the doctor on three occasions i.e., Day 0 (Initial evaluation prior to commencement of study), Day 4 (During therapy assessment and confirmation of compliance) and Day 10 (End of therapy assessment and compliance evaluation). Representative swab specimens (Throat swabs, Ear swabs or Sputum) were collected from the infected site on day 0 and day 10 for culture and sensitivity. Patients were also assessed by the evaluators on each visit in terms of clinical symptomatic response and information collected was documented on a prescribed data base form. RESULTS: A total of 160 patients were enrolled in the study, of whom 15 were lost to follow-up between the first and second visit and a further 38 were lost by the 3rd visit. Thus 107 patients completed the study as per protocol. Otitis media and Upper respiratory tract infection were the predominant ailments amongst the cases enrolled. One or more bacteria were isolated in 75 (46%) instances, the maximum number of isolates being from ear swabs of Otitis media patients. Beta haemolytic Streptococcus (group A,C,F,G) seen in 18 cases was the most common pathogen reported followed by Staphylococcus aureus, H. influenzae and Streptococcus pneumoniae in 13,12 and 11 cases respectively. Sensitivity of Cefaclor for bacteria commonly seen in the respiratory tract was greater than 90% in most of the cases. Evaluation of the 42 culture proven cases for patients who completed the study showed that Cefaclor had a 93% efficacy for indicated bacteria and 54% for non-indicated bacteria. In Vivo analysis of Cefaclor (i.e. on the basis of symptomatic response) showed that 96% cases had a symptomatic response by the second visit, which improved to 97% by the third visit. Only 15 non-serious adverse events were observed in 160 patients, none of the cases necessitated discontinuation of drug. Mild gastrointestinal symptom was the most common adverse event reported. CONCLUSION: Cefaclor was found to be a safe and efficacious drug in the treatment of bacterial respiratory tract infections amongst Pakistani children.

Motor vehicle crashes in Pakistan: the emerging epidemic.

SETTING: Motor vehicle injuries are increasingly being recognized as a growing public health issue in the developing world. Pakistan is a developing country in South Asia where motor vehicle use has increased since independence in 1947. OBJECTIVE: This paper explores the magnitude and impact of injuries from motor vehicle crashes in Pakistan. METHODS: An exhaustive review of published and gray literature, together with a detailed analysis of government data from 1956. RESULTS: The data indicate a persistent increase in the numbers of motor vehicle crashes, injuries, and fatalities. Changes in the reporting of rates are important to note in evaluating the data. Commercial vehicles contribute disproportionately to these motor vehicle injuries. CONCLUSIONS: There is a need to further the recognition of injuries as a public health issue in this country. Specific exploration of the epidemiological data; intersectoral collaboration between health, law, police and transport; and the development of appropriate information systems, will contribute to an appropriate response by Pakistan.

Waldenstrom's macroglobulinaemia with intracerebral haemorrhage.

A 65-year-old male was admitted for evaluation of severe anaemia, recurrent epistaxis, axillary lymphadenopathy, and hepatomegaly. The diagnosis of Waldenstrom's macroglobulinaemia was made on the basis of clinical and laboratory findings. The patient developed intracerebral haemorrhage without associated hypertension and with normal coagulation profile.

Cockayne syndrome.

We report four cases of Cockayne Syndrome in a family of seven children. Apart from the usual clinical and laboratory features, sparse eye lashes and high arched palate in two patients, conjunctival and corneal edema in one, and proximal muscle weakness in one patient were noticed as additional findings.

Further observations on acute renal failure following physical torture.

Thirty-four males aged 16-40 (mean 25) years in the period from August 1991 to February 1993 presented in acute renal failure (ARF), 3-14 (mean 5) days after they had been apprehended and allegedly tortured in Police interrogation centres in Kashmir. All were beaten involving muscles of the body, in addition 13 were beaten on soles, 11 were trampled over and 10 had received repeated electric shocks. Patients were studied in three groups: group I, those with evidence of only myoglobinuria (n = 21); group II, those with both myoglobinuria and haemoglobinuria (n = 10); and group III, those with evidence of only haemoglobinuria (n = 3). All had varying degrees of ecchymotic patches on the body and patients in groups II and III were beaten on soles had ecchymosis of soles. Hypertension was present in 11 and pulmonary oedema in five. Mean haemoglobin, BUN and serum creatinine were not significantly different in the three groups. Creatine phosphokinase in groups I, II and III were 985-7516 (1358 +/- 368), 917-5277 (1431 +/- 188), and 517-816 (772 +/- 69) and lactic dehydrogenase levels were 757-3727 (2191 +/- 56), 592-3454 (1923 +/- 164), and 446-958 (632 +/- 115) respectively. All the cases had metabolic acidosis, 20 had hyperkalaemia. Plasma haemoglobin was 11-48 (mean 26) mg/dl in group II and 26-56 (mean 35) mg/dl in group III. Urine test for haemoglobin was positive in seven cases in group II and two cases in group III. Pigment casts were present in 10, eight and two cases in groups I, II, and III respectively. Only those who were beaten on soles had evidence of haemoglobinuria.(ABSTRACT TRUNCATED AT 250 WORDS)