Antimicrobial Resistance: Stewardship and One Health in the Eastern Mediterranean Region.

Antimicrobial resistance (AMR) is a major threat in the Eastern Mediterranean region (EMR) due to factors such as the high prevalence of infectious diseases, weak health systems, and the misuse of antimicrobials. This paper aims to discuss how interdisciplinary action and collaboration, specifically through antimicrobial stewardship (AMS) and the One Health approach, can effectively address AMR in the EMR. The review focuses on successful AMS initiatives and the adoption of the One Health approach in countries within the EMR, including the Gulf Cooperation Countries (GCC), Egypt, Iran, Jordan, and Pakistan. The goal is to highlight the potential for progress in combating AMR and identify challenges and opportunities for strengthening interdisciplinary collaboration. The results showcase successful AMS programs and One Health initiatives in various EMR countries, demonstrating their potential to address AMR challenges. The paper also discusses the challenges faced by these nations, such as limited resources, fragmented health systems, and knowledge gaps. Additionally, opportunities for enhancing interdisciplinary action through regional cooperation, international partnerships, and research and innovation are outlined. In conclusion, this paper emphasizes the importance of a comprehensive and collaborative response to combat AMR in the EMR. It advocates for the One Health approach as a crucial framework to guide these efforts, promoting coordinated action, improved surveillance, responsible antimicrobial use, and enhanced interdisciplinary collaboration to effectively mitigate the threat of AMR.

Crimean-Congo Hemorrhagic Fever (CCHF) in Pakistan: The Daunting Threat of an Outbreak as Eid-ul-Azha Approaches.

The Crimean-Congo hemorrhagic fever (CCHF) virus is a tick-borne virus that can spread from infected people and other animals, including cattle and ticks of the Hyalomma genus. People who are infected describe symptoms that range from flu-like manifestations to severe multi-organ failure. With a death rate between 10% and 30%, the virus is undoubtedly a disease of high concern. With 10,000-15,000 cases/y, it is endemic in parts of Asia, Africa, and South-Eastern Europe. There has been a recent CCHF outbreak in Iraq, with 212 cases documented, 80% of which were reported between April and May and led to 27 fatalities.

Managing and treating Sydenham chorea: A systematic review.

INTRODUCTION: Sydenham's chorea (SC), prevalent in developing countries and occasionally affecting developed ones, poses a clinical challenge due to the lack of systematic guidelines for diagnosis and treatment. Resulting from Group A Beta-Hemolytic Streptococcus infection, SC presents various symptoms. This review aims to collect and evaluate available data on SC management to propose a cohesive treatment plan. METHODS: We searched PubMed, the Cochrane Library, Google Scholar, and ClinicalTrials.gov for literature on SC management from inception until 24th July 2022. Studies were screened by titles and abstracts. Cochrane Collaboration's Risk of Bias tool (RoB-1) assessed Randomized Controlled Trials, while the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool evaluated nonrandomized studies. RESULTS: The review includes 11 articles assessing 579 patients. Excluding one study with 229 patients, of the remaining 550 patients, 338 (61.5%) were females. Treatments used were dopamine antagonists in 118 patients, antiepileptics in 198, corticosteroids in 134, IVIG in 7, and PE in 8 patients. Dopamine antagonists, particularly haloperidol, were the primary treatment choice, while valproic acid (VPA) was favored among antiepileptics. Prednisolone, a corticosteroid, showed promising results with weight gain as the only side-effect. Our review emphasizes the importance of immunomodulators in SC, contrasting previous literature. CONCLUSION: Despite limitations, dopamine antagonists can serve as first-line agents in SC management, followed by antiepileptics. The role of immunomodulators warrants further investigation for conclusive recommendations.

Battling chronic myeloid leukemia in a resource-constrained country: A case of public-private partnerships.

Pakistan, where chronic myeloid leukemia constitutes around 80% of all myeloproliferative disorders, has been exploring multiple avenues in order to ensure the accessibility and affordability of imatinib and nilotinib. While most provinces of the country have joined hands with a pharmaceutical company to dispense free anti-CML medicines as part of a public-private partnership, the patients are still facing numerous challenges in the form of geographical disparity in the availability of these medicines, other out-of-pocket expenditures and most importantly, the uncertainty associated with the long-term continuation of this public-private endeavor due to procedural delays. In light of these predicaments, channeling resources towards research and development, fostering partnerships between government and NGOs and tapping into the domain of compulsory licensing appear to be the most sustainable solutions.

Pakistan at the precipice: The looming threat of measles amidst the COVID-19 pandemic.

The global focus on curbing the COVID-19 pandemic has reduced the overall immunization rates worldwide. This, coupled with increasing malnutrition and strained healthcare, has increased measles cases and mortality globally. Many countries are thus facing outbreaks, with Afghanistan having reported 372 deaths between January and September 2022. Therefore, Pakistan, a country in a similar economic state and the world's fourth highest reported measles cases in 2022, must take action. Moreover, the current flooded state of Pakistan and the subsequent mass movement of population, deterioration of health services, and worsened living conditions all contribute to put the country at a high risk of potentially devastating Measles outbreaks. With vaccination rates down by 42% since the start of the pandemic and the threat of an outbreak increasing daily, there is only so much time before the situation spirals out of control.