Ethno-Dentistry of Medicinal Plants Used in North Waziristan, Pakistan.

OBJECTIVE: This study aimed at recording therapeutic plant species used by inhabitants to treat dental disorders in the district of North Waziristan, Pakistan. The indigenous people of the studied area are dependent on medicinal plants for their basic health care needs including dental care. METHODS: Ethnomedicinal data were collected using a semi-structured questionnaires, and in addition 130 local informants were interviewed. The collected data were evaluated using various quantitative indices, including use value (UV), relative frequency of citation (RFC), fidelity level (FL%), and Jaccard Index (JI). RESULTS: A total of 69 plants belonging to 48 plant families used in dental disorders were identified. The Lamiaceae was the leading family that shared 7 species, followed by Solanaceae (4 spp).The dominant life form used was herbs (47.83%), folowed by leaves (43.90%) in preparing remedies for different dental disorders. Decoction was the most common mode of preparation (34.21%), followed by pastes (21.05%). The highest RFC (0.36) was reported for Bergenia ciliata, followed by Salvadora oleoides (0.35). The majority of the plants (36 spp) were utilised as herbal medicine to treat toothache, followed by 13 species for periodontal (gum) infections, 11 species used for teeth cleaning, and 9 species for halitosis (bad breath). CONCLUSIONS: This study is the first-ever record of ethnomedicinal applications for the treatment of dental diseases from Pakistan. Some of the forgeoing hebal medications should be further evalauted for the development of pahrmaceutical bio-products for the treatment of dental disorders.

Keeping their own and integrating the other: medicinal plant use among Ormurs and Pathans in South Waziristan, Pakistan.

BACKGROUND: In multicultural societies, traditional knowledge among minorities faces several challenges. Minority groups often face difficult situations living in specific peripheral geographies and striving to retain their biocultural heritage, including medicinal plant knowledge and practices. Folk medicinal plant knowledge is a dynamic eco-cultural complex influenced by various environmental, socio-cultural, and political factors. Examining medicinal plant knowledge among minorities has been an increasingly popular topic in cross-cultural ethnobiology. It also helps understand the dynamics of local/traditional ecological knowledge (LEK/TEK) change within a given community. The current study was designed to investigate the status of medicinal plant knowledge among two linguistic groups, i.e. Ormurs and Pathans, living in a remote valley of West Pakistan. METHODS: We recruited 70 male study participants from the studied groups for semi-structured interviews to record the medicinal plant use of their communities. Data were compared among the two studied communities using the stacked charts employing the presence or absence of data with Past 4.03 and Venn diagrams. Use reports (URs) were counted for each recorded taxon. RESULTS AND DISCUSSION: A total of seventy-four medicinal plants were quoted as used as ethnomedicines by the researched communities. Most of the reported plants were used to treat digestive and liver problems. The cross-cultural comparison revealed a considerable homogeneity of medicinal plant knowledge (the two groups commonly used more than seventy plants); however, comparing uses recorded for the widely utilised medicinal plants showed numerous idiosyncratic uses among Ormurs but very few among Pathans. Ormurs reported a higher number of cultivated, wild, and imported plant uses than did Pathans. These results indicate that, compared to Pathans, the Ormur linguistic minority retain more folk medicinal plant knowledge, which may be explained by the fact that they have incorporated different folk remedies: their "own knowledge" plus that of Pathans, with whom they have lived together for centuries. Moreover, the local plant nomenclature among Ormurs was highly affected by the plant nomenclature of Pathans. CONCLUSION: The current study revealed that living together for a few centuries has not implied sharing plant knowledge (as the Pathans do not seem to have learnt from the Ormurs) or, in other words, that plant knowledge exchanges have been unidirectional. The findings show that the Pashto dominant culture may have possibly put pressure on the minority groups and affected local plant-centred cultural practices, as we see in the case of local plant nomenclature hybridisation among Omuri speakers. Hence, it is imperative to employ diverse educational strategies to revitalise the decline of medicinal plant knowledge in the studied communities, especially among Ormurs, who need more attention as they face more challenges than the other group. Locally based strategies should be devised to restore the fading connection with nature, which will be advantageous for revitalising plant knowledge.

Characterizing cutaneous leishmaniasis in a conflict-affected region: a study from North Waziristan, Pakistan.

Background/aim: Cutaneous leishmaniasis is an emerging tropical disease that remains a serious public health issue in Pakistan, particularly in North Waziristan. The current research was carried out to investigate the presence of cutaneous leishmaniasis in this region. Materials and methods: This prospective observational study was conducted from October 2018 to December 2020 at District Head Quarter Hospital Miranshah in North Waziristan with the collaboration of the Pathology Department of Gomal Medical College Dera Ismail Khan, Khyber Pakhtunkhwa. Needle aspirates were used for the microscopic Giemsa-stained slides. SPSS was used for data analysis. Results: Of the 5406 clinically-suspected cases, 2603(48.2%) were positive by microscopic examination. Of these 2603 patients, 1474 (57%) were male and 1129 (43%) were female. Most of the lesions were on the face, followed by upper and lower limbs. The 5-10-year age group had the highest percentage of 1167 (45%). A single lesion affected 96.6% of the patients, while 2.7% had double lesions and 0.7% had triple lesions. A high number of cutaneous leishmaniasis were seen from April to August, while the lowest number was seen November to December. Conclusion: This study provides extensive information in relation to the existence of cutaneous leishmaniasis in the North Waziristan district of Pakistan, as well as the detailed demographic features of those affected by the disease.

Ethnoveterinary Practices of Medicinal Plants Among Tribes of Tribal District of North Waziristan, Khyber Pakhtunkhwa, Pakistan.

Domestic animals play a vital role in the development of human civilization. Plants are utilized as remedies for a variety of domestic animals, in addition to humans. The tribes of North Waziristan are extremely familiar with the therapeutic potential of medicinal plants as ethnoveterinary medicines. The present study was carried out during 2018-2019 to record ethnoveterinary knowledge of the local plants that are being used by the tribal communities of North Waziristan, Khyber Pakhtunkhwa, Pakistan. In all, 56 medicinal plant species belonging to 42 families were identified, which were reported to treat 45 different animal diseases. These included 32 herbs, 12 shrubs, and 12 trees. Among the plant families, Asteraceae contributed the most species (5 spp.), followed by Amaranthaceae (4 spp.), Solanaceae (4 species), and Alliaceae, Araceae, and Lamiaceae (2 spp. each). The most common ethnoveterinary applications were documented for the treatment of blood in urine, bone injury, colic, indigestion, postpartum retention, skin diseases, constipation, increased milk production, mastitis, foot, and mouth diseases.

Molecular Characterization of ß-Thalassemia Mutations Via the Amplification Refractory Mutation System-Polymerase Chain Reaction Method at the North Waziristan Agency, Pakistan.

ß-Thalassemia (ß-thal) is a monogenic disease characterized by mutations on the HBB gene, affecting the production of globin that results in hypochromic and microcytic anemia. The aim of this study was to determine the prevalence of six common ß-thal mutations, and their frequency and inheritance pattern in affected populations of North Waziristan Agency, Pakistan. In this study, 130 blood samples from 37 unrelated ß-thalassemic families having a minimum of one transfusion-dependent child with ß-thal major (ß-TM), were retrieved either from the Thalassaemia Centre for Women and Children Hospital Bannu or their home towns situated in Noth Waziristan Agency. All samples were analyzed by the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) using six allele-specific primers for the presence of the six ß-thal mutations common in the Pakistani population. Of the six common mutations, our study demonstrated five HBB mutations comprising HBB: c.27_28insG, HBB: c.92+5G>C, HBB: c.126_129delCTTT, HBB: c.92+1G>T and HBB: c.17_18delCT from the families studied, while mutation HBB: c.47G>A [codon 15 (G>A)] was not detected in any of the studied families. Furthermore, the HBB: c.27_28insG and HBB: c.92+5G>C were noted to be the most common with frequencies of 42.85 and 31.42%, respectively. The findings of the present study may be useful in launching carrier screening and prenatal diagnosis (PND) programs by screening analyzed and other unanalyzed affected families for the possible presence of common mutations through the ARMS-PCR technique that will help to control the disease.

High incidence of malaria along the Pak-Afghan bordering area.

OBJECTIVE: To check the epidemiology of malaria along Pak-Afghan bordering area.. METHODS: The prospective study was conducted at Hatmi Medical Centre, Barmal district, Afghanistan, from March 2014 to February 2016, and comprised patients living in bordering areas between Pakistan's North Waziristan Agency and Afghanistan's Paktika province. Blood samples were collected from subjects with symptoms of malaria for plasmodium microscopy in Giemsa-stained thick and thin film. Slides were stored in a secure slide box and were reconfirmed by microscopy expert at the Department of Pathology, Gomal Medical College, Dera Ismail Khan, Pakistan. SPSS 19 was used for data analysis. RESULTS: Of the total 3,840 patients, 2,655(69.1%) tested negative for malaria while the remaining 1,185(30.9%) tested positive - of whom 788(66.5%) were males and 397(33.5%) were females. Of the positive cases, positive, 1,074(90.6%) were Plasmodium vivax, 76(6.4%) Plasmodium falciparum and 35(3%) were mixed species infections with no case of Plasmodium ovale and Plasmodium malariae. CONCLUSIONS: Strict malaria-control measures are needed in both countries.

Epidemiology of Cutaneous Leishmaniasis Outbreak, Waziristan, Pakistan.

During 2013-2015, prevalence of cutaneous leishmaniasis in war-affected Waziristan areas was 3.61% by PCR. Youths (1-15 years of age) were more susceptible. Internal transcribed spacer 1 PCR followed by restriction fragment length polymorphism analysis identified Leishmania tropica in 215 samples and Leishmania major in 6 samples.

Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives:To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan.Methods:Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species.Results:An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis.Conclusions:In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan.

Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives: To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan. Methods: Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species. Results: An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis. Conclusions: In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan.

Genomic Surveillance Elucidates Persistent Wild Poliovirus Transmission During 2013-2015 in Major Reservoir Areas of Pakistan.

BACKGROUND: Despite tremendous efforts in the fight against polio, Pakistan bears the highest proportion of poliomyelitis cases among the 3 endemic countries including Afghanistan and Nigeria. Apart from insecurity and inaccessibility challenges, the substantial shift of unimmunized children from North Waziristan due to recent military operations was presumed to favor the widespread poliovirus infection in Pakistan. METHODS: To better understand the current epidemiological situation, we analyzed the virologic data of wild poliovirus type 1 (WPV1) strains detected in Pakistan during 2013-2015. RESULTS: Five genetic clusters (A-E) were identified with at least 5% nucleotide divergence in the viral protein 1 (VP1) coding region. Peshawar, Quetta, and Karachi were found to be the major endemic foci where multiple discrete genetic lineages of WPV1 were detected. Phylogenetic analysis suggests that wild poliovirus strains from endemic regions were genetically distant (with 5%-15% VP1 nucleotide divergence) from those detected in North Waziristan cases, excluding the possibility of a recent progenitor of WPV1 instigating single-source transmission across the country. Orphan lineages detected in Rawalpindi, Lahore, Hyderabad, Sukkur, and Jacobabad revealed silent transmission and the need for vigilant surveillance. Sustenance of analogous genetic lineages over a period of 3 years highlights multiple unimmunized foci present to maintain viral genetic diversity. CONCLUSIONS: Our findings are inconsistent with the hypothesis that impoverished populations from North Waziristan serve as a possible determinant of widespread poliomyelitis infection in Pakistan and further emphasize the need to scale-up clinical and environmental surveillance as well as immunization activities.

An ethnobotanical survey of indigenous medicinal plants in Wana district south Waziristan agency, Pakistan.

ETHNOMEDICINAL RELEVANCE: Medicinal plants are treasure of any region for ailment treatment. The present research work was focused to document the indigenous knowledge of unexplored area of Wana, South Waziristan Agency, Pakistan. This was the very first study, to explore the potential ethno-medicinal plants of study area. MATERIALS AND METHODS: Data was collected by opting people participation involving interviews, group meetings, semi structured discussions and filling of questionnaires. RESULTS AND DISCUSSION: A total 50 wild medicinal plants belonging to 30 families were collected. Medicinal plants used against the stomach disorders were 10% followed by the cold/cough (8%), hepatitis (7%), diuretic (7%), sedative/narcotic (7%), tonic (6%), asthma (5%), cardiac problems (4%), jaundice (4%) and so on. Among plant parts used for indigenous medicines, leaves were (24%) followed by the fruit (15%), root (12%), seed (11%), whole plant (9%), arial parts (8%), flower (6%), rhizome, bark and stem (4%), bulbs (2%) and pods (1%). Xanthium strumarium reported the highest use value i.e. 0.95. CONCLUSION: People of Wana still rely on indigenous plants for their basic healthcare needs. Harvesting of roots and whole plants is a big threat to conservation of medicinal plants diversity.