A scoping review of sources of mercury and its health effects among Pakistan's most vulnerable population.

Mercury and methyl mercury are poisonous to human body. In the recent times, exposure to mercury has been anthropogenic in nature. Within the past several decades, many incidences of mercury poisoning have been documented in several countries including Pakistan. Mercury has been ingested where it has been used to preserve crops, through the point and non-point source discharge into the surface water, and consequently entering the food chain. We conducted this scoping review of mercury and its health effects in Pakistan in order to raise the flag to a silent ongoing Minamata disease in the country. We conducted a systematic search of the available literature in Google Scholar, PubMed, and grey literature of unpublished theses and reports of various universities across the country. We found that in the northern Pakistan, suspended sediments were the major pathway of the riverine mercury transport. Sediments of Hunza and Gilgit River were found high in mercury concentrations. Gold mining leads to an increase in mercury concentration in soil and river waters flowing in this region. High concentrations up to 108 ng/L were found in Shimsal River. It is suspected that that high level of mercury transport may be leading to accumulation of mercury in major water bodies and lakes downstream. Occupational exposure to mercury and other heavy metals is common in an unregulated private sector of the country. Goldsmiths burn the amalgamated gold without personal protective measures. Direct exposure to the fumes of mercury leads to respiratory, dermatological, systemic and neurological ailments specific to mercury poisoning. We found good evidence of bioaccumulation of mercury in fish and fish products in Pakistan. The untreated waste water discharge is responsible to not only afflicted the fish but also the birds which feed on this fish. Further, the same untreated waste water from factories and agriculture runoffs affect vegetables grown in it. Studies looking at the biomarkers for mercury in humans have shown increased and even toxic levels of mercury among the most vulnerable populations of the country. Other sources of mercury exposure included mercury in traditional medicines and cigarette products. Though no evidence was found for its presence in drinking water, its existence in the food chain and occupational exposure pose great threat to the humans as well as animals.

Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study.

BACKGROUND: As global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period. METHODS: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations. RESULTS: The global incidence of hand trauma has only modestly decreased since 1990. In 2017, the age-standardised incidence of hand and wrist fractures was 179 per 100 000 (95% uncertainty interval (UI) 146 to 217), whereas the less common injuries of thumb and non-thumb digit amputation were 24 (95% UI 17 to 34) and 56 (95% UI 43 to 74) per 100 000, respectively. Rates of injury vary greatly by region, and improvements have not been equally distributed. The highest burden of hand trauma is currently reported in high SDI countries. However, low-middle and middle SDI countries have increasing rates of hand trauma by as much at 25%. CONCLUSIONS: Certain regions are noted to have high rates of hand trauma over the study period. Low-middle and middle SDI countries, however, have demonstrated increasing rates of fracture and amputation over the last 27 years. This trend is concerning as access to quality and subspecialised surgical hand care is often limiting in these resource-limited regions.

24-Epibrassinolide application in plants: An implication for improving drought stress tolerance in plants.

Drought stress is one of most dramatic abiotic stresses, reduces crop yield significantly. Application of hormones proved as an effective drought stress ameliorating approach. 24-Epibrassinolide (EBL), an active by-product from brassinolide biosynthesis increases drought stress tolerance in plants significantly. EBL application enhances plant growth and development under drought stress by acting as signalling compound in different physiological processes. This article discussed potential role of 24-epibrassinolide application and drought tolerance in plants. Briefly, EBL sustains or improves plant growth and yield by enhancing carbon assimilation rate, maintaining a balance between ROS and antioxidants and also plays important role in solute accumulation and water relations. Furthermore, we also compared different EBL application methods and concluded that seed priming and foliar application are more productive as compared with root application method. In conclusion, EBL is very impressive phyto-hormone, which can ameliorate drought stress induced detrimental effects in plants.

Review - Ricinus cmmunis - Ethnomedicinal uses and pharmacological activities.

Ricinus cmmunis L. (Castor oil plant) is an important medicinal plant belonging to family Euphorbiaceae. Its phytochemistry, biological and pharmacological activities, and ethnomedicinal uses have been reviewed in the present study. The reported chemical constituents showed the presence of flavonoids, phenolic compounds, fatty acids, amino acids, terpenoids, phytosterol etc. The compounds have been reported to exhibit anticonceptive, antidiabetic, antifertility, anti-inflammatory, antimicrobial, antioxidant, hepatoprotective, insecticidal and wound-healing activities. They also showed free radical scavenging and Hg scavenging activities, and repellent properties. Various parts of R. communis have been widely used in traditional medicine such as abdominal disorders, arthritis, backache, muscle aches, bilharziasis, chronic backache and sciatica, chronic headache, constipation, expulsion of placenta, gallbladder pain, period pain, menstrual cramps, rheumatism, sleeplessness, and insomnia. Castor oil plant has also revealed toxic effects due to the presence of ricin (protein) and ricinine (alkaloid). Comparatively, ricin is more toxic. But still there is need of more research to be conducted with reference to its medicinal importance (particularly exploring of medicinal recipes) and active compounds responsible for various activities.

Ethics In Health Care Settings: Practices Of Healthcare Professionals And Perceptions Of Patients Regarding Informed Consent, Confidentiality And Privacy At Two Tertiary Care Hospitals Of Islamabad, Pakistan.

BACKGROUND: Medical profession works within thin lines of professionalism and trust. Faith of the patients often breached but less reported among the Low and Middle-Income Countries (LMICs). In Pakistan, though the Pakistan Medical and Dental Council (PMDC) have its own code of medical ethics but there isn't much evidence on regulating ethical misconducts. Apart from the gross violations of the code of conduct, the "insensible" misuse of informed consent, confidentiality and privacy is very common. This study is an effort to explore practices of informed consent, confidentiality and privacy among health care providers along with assessment of perceptions of patients about ethical practices in two tertiary care hospitals of Islamabad, Pakistan. METHODS: We conducted eight homogenous Focus Group Discussions (FGDs), four each in both the public and private sector hospitals till the saturation was achieved. RESULTS: Informed consent, in clinical practice, was found not being practiced. Confidentiality was not being uniformly applied in practices. Patients perceived the practices being contrary to the ethics. According to patients, ethical measures were found satisfactory in private hospitals. However, patients were not gratified fully with both the systems of healthcare delivery. CONCLUSIONS: There is insufficient adherence to the ethical principles in clinical practice, in both public and private sector hospitals in Islamabad, Pakistan. Informed consent, privacy and confidentiality are time and time again unheeded due to lack of robust system of monitoring and penalties by the responsible authorities.

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

OBJECTIVES: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). METHODS: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). RESULTS: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. CONCLUSIONS: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013.

BACKGROUND: The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. METHODS: Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. RESULTS: In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. CONCLUSIONS: Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

Useful ethnophytomedicinal recipes of angiosperms used against diabetes in South East Asian Countries (India, Pakistan & Sri Lanka).

This paper is based on data recorded from various literatures pertaining to ethnophytomedicinal recipes used against diabetes in South East Asia (India, Pakistan and Srilanka). Traditional plant treatments have been used throughout the world for the therapy of diabetes mellitus. In total 419 useful phytorecipes of 270 plant species belonging to 74 Angiospermic families were collected. From the review it was revealed that plants showing hypoglycemic potential mainly belong to the families, Cucurbitaceae (16 spp.), Euphorbiaceae (15 spp.), Caesalpiniaceae and Papilionaceae (13 spp. each), Moraceae (11 spp.), Acanthaceae (10 spp.), Mimosaceae (09 spp.), Asteraceae, Malvaceae and Poaceae (08 spp. each), Hippocrateaceae, Rutaceae and Zingiberaceae (07 spp. each), Apocynaceae, Asclepiadaceae and Verbenaceae (06 spp. each), Apiaceae, Convolvulaceae, Lamiaceae, Myrtaceae, Solanaceae (05 spp.each). The most active plants are Syzigium cumini (14 recipes), Phyllanthus emblica (09 recipes), Centella asiatica and Momordica charantia (08 recipes each), Azadirachta indica (07 recipes), Aegle marmelos, Catharanthus roseus, Ficus benghalensis, Ficus racemosa, Gymnema sylvestre (06 recipes each), Allium cepa, A. sativum, Andrographis paniculata, Curcuma longa (05 recipes each), Citrullus colocynthis, Justicia adhatoda, Nelumbo nucifera, Tinospora cordifolia, Trigonella foenum-graecum, Ziziphus mauritiana and Wattakaka volubilis (4 recipes each). These traditional recipes include extracts, leaves, powders, flour, seeds, vegetables, fruits and herbal mixtures. Data inventory consists of botanical name, recipe, vernacular name, English name. Some of the plants of the above data with experimentally confirmed antidiabetic properties have also been recorded. More investigations must be carried out to evaluate the mechanism of action of diabetic medicinal plants. Toxicity of these plants should also be explained. Scientific validation of these recipes may help in discovering new drugs from these medicinal plants for diabetes.

Healthcare waste management (HCWM) in Pakistan: current situation and training options.

BACKGROUND: Hospitals in Pakistan produce about 250,000 tons of waste per year. Hospital waste has been reported to be poorly handled and managed by the hospital staff and administration respectively. This leads to environmental and health consequences within hospitals as well as to outside population. Our study aimed to describe the qualitative results of observations of ten large private and public hospitals in the cities of Rawalpindi and Islamabad Pakistan. METHODS: The qualitative data was obtained through direct and indirect observations on hospital staff including doctors, nurses, sweepers and persons in administration and the way they handled the waste. Also direct observations of the hospitals premises inside and outside were made and noted. We also describe the process of involving the hospital staff for trainings. RESULTS: Our results showed that almost all of the hospitals did not have practice of HCWM on their priority. Segregation, handling, storage, transportation and disposal of waste were below WHO and Pakistan bio-safety rules 2005 standards. The ten hospitals did not have HCWM rules and regulations in place hence the staff do not follow the best practices in this regard which causes numerous health and environmental consequences not only within the catchment area but also to patients and staff. CONCLUSIONS: Our study highlights the lack of HCWM practices within the ten public and private hospitals in two major cities in Pakistan. There is need of trainings of hospital staff in Pakistan. We also found that such trainings are highly feasible if accompanied with incentives to participants.

Bread wheat varieties as influenced by different nitrogen levels.

Experiment was conducted to determine the effect of different nitrogen levels on four bread wheat varieties (Triticum aestivum L.) viz. Inqilab-91, Daman-98, Dera-98 and Punjab-96 at Gomal University, Dera Ismail Khan (NWFP), Pakistan during 2000 approximatey 2001. The experiment was laid out in split plot design having four replications using a net plot size of 2 m x 5 m. Nitrogen doses used were 0, 50, 100, 150 and 200 kg/ha. The results showed that different nitrogen levels had significant effects on plant height, total number of plants/m(2), number of grains/spike, number of spike/m(2), spike weight, biological yield, grain yield and grain protein content. Maximum plant height, total number of plants/m(2), number of spikes/m(2), spike weight, biological yield and grain protein content were observed at 200 kg N/ha. Among wheat varieties Daman-98 had maximum plant height, spike weight, grains/spike, 1000-grain weight, biological yield and grain yield. Inqilab-91 had heavier grains and the most grain protein content, while Dera-98 had the maximum plant population and spikes/m(2). Grain yield and biological yield were statistically similar at doses of 150 kg N/ha and 200 kg N/ha. However, dose of 200 kg N/ha, compared to dose of 150 Kg N/ha, significantly increased the protein content.