Ethnomedicinal plants used against common digestive problems

Background: Ethnomedicinal knowledge is highly significant for persistence of human health care. Different studies have shown that medicinal plants are considered as curing agent for digestive disorders in Pakistan. The aim of present review is to explore this ethnomedicinal information all over the Pakistan and to investigate the ecological status of these species in the country.Methodology: Online literatures on ethnomedicinal plants used to treat digestive complaints in Pakistan were searched and gathered using online bibliographic databases including PubMed, Scopus, Google Scholar, Web of Science and Flora of Pakistan.Results: The review documented 178 medicinal plant species, belonging to 59 families, used for different digestive ailments. The majority of species were herbs (60%), used in drug preparation. The most frequent part used in preparation of these remedies is leaves (23%), followed by roots (19%).Conclusion: In conclusion, the study provides enormous ethno-medicinal knowledge and due to the unsustainable activities of the people of Pakistan, some medicinal plants need to be conserved for the future.Key words: Ethno-medicine, medicinal plants, gastrointestinal diseases, ecological status

Genome Analysis Linking Recent European and African Influenza (H5N1) Viruses

Although linked, these viruses are distinct from earlier outbreak strains

Benchmarking the scientific output of industrial wastewater research in Arab world by utilizing bibliometric techniques

Rapid population growth, worsening of the climate, and severity of freshwater scarcity are global challenges. In Arab world countries, where water resources are becoming increasingly scarce, the recycling of industrial wastewater could improve the efficiency of freshwater use. The benchmarking of scientific output of industrial wastewater research in the Arab world is an initiative that could support in shaping up and improving future research activities. This study assesses the scientific output of industrial wastewater research in the Arab world. A total of 2032 documents related to industrial wastewater were retrieved from 152 journals indexed in the Scopus databases; this represents 3.6 % of the global research output. The h-index of the retrieved documents was 70. The total number of citations, at the time of data analysis, was 34,296 with an average citation of 16.88 per document. Egypt, with a total publications of 655 (32.2 %), was ranked the first among the Arab countries followed by Saudi Arabia 300 (14.7 %) and Tunisia 297 (14.6 %). Egypt also had the highest h-index, assumed with Saudi Arabia, the first place in collaboration with other countries. Seven hundred fifteen (35.2 %) documents with 66 countries in Arab/non-Arab country collaborations were identified. Arab researchers collaborated mostly with researchers from France 239 (11.7 %), followed by the USA 127 (6.2 %). The top active journal was Desalination 126 (6.2 %), and the most productive institution was the National Research Center, Egypt 169 (8.3 %), followed by the King Abdul-Aziz University, Saudi Arabia 75 (3.7 %). Environmental Science was the most prevalent field of interest 930 (45.8 %). Despite the promising indicators, there is a need to close the gap in research between the Arab world and the other nations. Optimizing the investments and developing regional experiences are key factors to promote the scientific research

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Safe and cost-effective treatment response monitoring of MDR pulmonary tuberculosis by using micro colony broth culture method

Aims and objectives: Multidrug resistant tuberculosis (MDR-TB) management is expensive, prolonged and complicated. After starting anti-tuberculous treatment in MDR-TB patients, microbiological response to therapy is monitored by monthly sputum cultures. Conventional culture methods are costly, leading to poor compliance with this recommendation in resource-limited settings and reliance on less sensitive sputum microscopy. Published data suggests a less favorable outcome with sputum microscopy and stresses upon use of follow-up cultures. Micro-colony liquid culture method is an established method for diagnosis of new TB cases. As anti- tuberculous treatment may produce considerable changes in bacterial morphology, leading to pleomorphic shapes and sizes, the utility of micro colony broth culture for treatment follow-up cases is uncertain. Therefore, this study aims to evaluate the micro-colony liquid culture method in terms of its sensitivity, specificity, rapidity and cost to monitor response to second-line ATT in diagnosed MDR-TB patients. Methods: Prospective cross-sectional study performed at Clinical Microbiology Laboratory of Aga Khan University. During the period of February 2013–September 2014, a total of 139 adult, MDR-pulmonary TB patients were enrolled in this study. For each patient an appropriate sputum specimen was collected for MTB culture initially and then monthly (maximum) up to the next 6 months. Samples were processed using the standard protocol for microscopy, routine MIGIT & LJ culture and micro colony broth culture method. Micro colony broth culture finally evaluated for sensitivity, specificity, rapidity, cost and contamination rate. Results: To date, a total of 502 sputum samples were submitted from 139 enrolled patients. Out of these, 170 were smear-positive, while 310 were smear-negative. Sensitivity, specificity, positive predictive value and negative predictive value of micro colony broth culture for AFB smear positive samples were 100% (95% CI: 97.83–100), 95.45% (95% CI: 77.08–99.24), 99.42% (95% CI: 96.77–99.90), and 100.00% (95% CI: 83.75–100.00), respectively. Sensitivity, specificity, positive predictive value and negative predictive value of micro colony broth culture for AFB smear negative samples was 100.00% (95% CI: 93.78–100.00), 99.60% (95% CI: 97.80–99.93), 98.31% (95% CI: 90.88–99.72) and 100.00% (95% CI: 98.53–100.00), respectively. Average time of positivity of standard cultures for smear positive samples (n = 192) was 26.0 days, while micro colony broth culture average positivity time was 8.8 days. Average time of positivity of standard cultures for smear negative samples (n = 310) was 30.0 days, while micro colony broth culture average positivity time was 11.4 days. Average contamination rate of micro colony broth culture was 4.5% in comparison with 6.1% of routine cultures. Finally, the cost of the micro colony methods was about 35% of the combined BACTEC and LJ media cultures. Conclusions: The preliminary data from this study indicates micro colony broth culture method for MTB detection to be highly sensitive, specific, rapid and cost-effective for treatment monitoring of MDR-TB cases. In resource-limited settings this method can be used safely either alone or along with LJ medium for monitoring of second-line anti-tuberculous treatment. Acknowledgement: This work was supported by a grant from Aga Khan University Research Council