Food Security in Pakistan: Can It Be Achieved?

Wide fluctuations in world prices of food-grains, especially rice and wheat, in the seventies and the early eighties forced many developing countries to strive for self-sufficiency in food-grain production. Pakistan is among the countries where near self-sufficiency was achieved in wheat in the early eighties. It also maintained its status as a leading rice-exporting country. However, a continuously high rate of population growth, a changing pattern of income distribution, and a greater level of urbanisation have greatly influenced the demand for food-grains. At the same time, additional factors like a sharp rise in the cost of irrigation, a dramatic decline in the world price of rice, a heavy debt burden, the lack of technology and human capital development, and mismanagement in the distribution system have contributed towards a slower growth of grain production as compared with the levels achieved in the sixties and the eighties. This change in the demand and supply situation with respect to food has necessitated the need to re-evaluate the existing agricultural policies. Within demand and supply constraints, the question is whether or not Pakistan can attain selfsufficiency in wheat while at the same time maintaining its status as a significant exporter of rice. In the immediate future, the situation appears desperate, but in the long-run, when available resources are adequately utilised and consistent policies are adopted, there is hope and optimism. This study not only reviews the current food situation in Pakistan but also develops alternative policy scenarios which are consistent with the target of food security in Pakistan. This paper is developed as follows. The second section reviews the current food situation in Pakistan briefly. Based on supply and demand elasticities, the baseline forecasts or the control solution is generated in the third section. Alternative policy scenarios are developed in the fourth section, and the last section concludes this study.

Role of Ajwa date (Phoenix Dactyl L) derived polyphenols in male infertility

Madam, prevalence of male infertility with its associated social and health problems calls for an insight for its elucidation.1 Over the past few decades, there have been many experimental and clinical studies on the pathophysiology of oxidative stress and its impact on fertility disorders, both in men and women. Oxidative stress impairs sperm function and count, damage to DNA and accelerates the cellular apoptotic functions leading to the inability to achieve conception or lack of development of the embryo. 23456

Evaluation of neonatal admission to neonatal intensive care unit in a tertiary care hospital in Kashmir

Background: Neonatal period is the most unguarded period which influences the survival and overall wellbeing of a child. Many illnesses affecting the neonates lead to morbidities and mortality among them. According to 2015 Global health observatory (GHO) data, neonatal deaths constitute roughly 45% of all under five deaths. Worldwide, neonatal mortality rate has seen a steady decline by 47% between 1990 and 2015 from 36 to 19 per 1000 live birth. India contributes to nearly 25% of the mortality around the world.Methods: This descriptive retrospective study was carried out at LallaDed hospital, only tertiary care obstetrics and gynaecology hospital of Kashmir valley from August 2020 to January 2021. The study was conducted with records of the neonates who were admitted to NICU of this hospital during the above mentioned time period. The data regarding gestational age, sex, mode of delivery, birth weight, Apgar score at birth, indication for admission and outcome was recorded.Results: The total number of NICU admission during this time period was 252. The mode of delivery was FTVD in 144 (57.1%) and LSCS in 108 (42.9%). The number of preterm babies was 175 (69.4%) and number of term babies was 77 (30.6%). Among the admitted neonates, 141 (56%) were male and 111 (44%) were female babies. The birth Apgar score 0 minutes was 8 in 24, 7 in 75, 6 in 130 and 4 in 23 babies.Conclusions: This study identified RDS and MAS among the most common reasons for NICU admission. Early neonatal period is the major contributor to neonatal mortality which is influenced by birth weight and Apgar score. Understanding causes of neonatal mortality, education and training of medical and para medical staff and implementation of interventions regarding neonatal resuscitation will play major role in decreasing the neonatal NICU admission and mortality thereof.

Evaluation of maternal admission to intensive care unit in a tertiary care hospital of Kashmir valley

Background: Management of critically ill obstetric women at an ICU is a challenge to both physicians and obstetricians due to physiological adaptations and progress of diseases during pregnancy and puerperium. There has been a striking association between the number of maternal deaths and the accessibility to ICU care. Obstetric patients get admitted to the ICU approximately at 0.1-0.9% times of all deliveries. Objective was to evaluate the occurrence, indication and outcome of patients admitted in the ICU of an obstetric tertiary care hospital.Methods: This retrospective study was carried out from August 2020 to January 2021 at Lalla Ded Hospital, a tertiary care Obstetrics and Gynaecology Hospital of Kashmir valley. Data for this study was collected retrospectively from hospital records. The demographic details, indication for ICU admission, co-morbidities, ante natal care records were noted on admission to the ICU.Results: The total ICU admission during this time period was 212 (1.44%) with obstetric patients being 194 (91.5%) and gynaecologic patients 18 (8.5%). Obstetric haemorrhage (38.2) followed by hypertensive disorders of pregnancy (24.1%) were the most common indications for ICU admission. 26.9% patients needed mechanical ventilation during ICU admission.Conclusions: Analysing intensive care unit utilization during pregnancy can be an accepted approach to identify severe and near miss maternal morbidity. Development and upliftment of primary health care facilities with involvement of multi-disciplinary teams and referral of high risk pregnancies to higher health centres is the key to decrease maternal mortality and morbidity

Frequency, Indications And Complications Of Pulmonary Artery Catheter Insertion In Adult Open-Heart Surgery Patients Of A Tertiary Care Hospital

Background: Patients presenting for cardiac surgery have unstable cardiovascular disease and haemodynamics with multiple coexisting diseases. Optimal monitoring in the perioperative period is very important for best perioperative outcome. The introduction of the flow-directed pulmonary artery catheter (PAC) into clinical practice is one of the most important and popular advances in the field of cardiac anaesthesia. The objective of the study was to determine the frequency, indications and complications of pulmonary artery catheter insertion in adult open-heart surgery patients.Methods: A Prospective observational study was conducted at cardiac operating rooms and Cardiac Intensive care unit (CICU) of Aga Khan University Hospital for a period of six months from Nov 2015 to April 2016.Two hundred and seven patients were included in this study. PAC was inserted through right/left internal jugular vein or subclavian vein. Complications noted were arrhythmias (atrial and ventricular), right bundle branch block, coiling and knotting, pulmonary artery rupture, and infection up to 72 hours of PAC insertion. Frequency and percentage were computed for gender, comorbids (Hypertension, Diabetes, Chronic kidney disease, Chronic Obstructive Pulmonary Disease) and PAC frequency of insertion, indications and complications were noted.Results: The frequency of PAC insertion was 47.83%. Major indications for PAC insertion were poor left ventricular function, acute coronary syndrome, cardiogenic shock, significant left main disease and valvular heart disease patients. Minor complications were found in 23.22% cases, which included arrhythmia in 19.2% cases and coiling in 4.02%.CONCLUSIONS: TPulmonary artery catheter insertion is a safe technique with useful clinical application in the management of high-risk cardiac surgical patients. The PAC insertion rationale must be standardized to confirm the judicious use

Association of oxidative stress with female infertility - a case control study

Objective: To compare stress markers and reproductive hormones in fertile and infertile females, and to relate the markers with age, duration and cause of infertility, and body mass index..Methods: The case-control study was conducted at Aga Khan University Hospital, Karachi, from March 2017 to February 2018. Females aged 16-50 years regardless of ethnic background were recruited from the Australian Concept Infertility Medical Centre, Karachi, and were equally divided into infertile cases group A, and fertile controls group B. Serum follicular stimulating hormone, luteinizing hormone, estradiol, glutathione reductase and cortisol were measured using enzyme-linked innmunosorbent assay. SPSS 19 was used for statistical analysis..Results: There were 328 female subjects divided into two equal groups of 164(50%). Serum luteinizing hormone and cortisol was higher in the group A than in group B (p\u3c0.001). Serum glutathione reductase was low in group A compared to group B (p\u3c0.001). Duration of infertility, serum levels of glutathione reductase and cortisol were also significantly different among infertile females when distributed on the basis of cause of infertility (p\u3c0.05). Serum cortisol had negative correlation with glutathione reductase (p\u3c0.001). Age and body mass index had a positive correlation with serum cortisol (p=0.035; p=0.63), while there was a negative correlation with glutathione reductase (p = -0.732)..Conclusions: Prolonged duration of infertility, age of females and body mass index enhanced the production of stress hormones and decreased antioxidant activity which augmented the risk of infertility

Effect of administration of antihelminthics for soil transmitted helminths during pregnancy

Background: Helminthiasis is infestation of the human body with parasitic worms and it is estimated to affect 44 million pregnancies, globally, each year. Intestinal helminthiasis is associated with blood loss and decreased supply of nutrients for erythropoiesis, resulting in iron deficiency anaemia. Over 50% of the pregnant women in low- and middle-income countries suffer from iron deficiency anaemia. Though iron deficiency anaemia is multifactorial, hook worm infestation is a major contributory cause in women of reproductive age in endemic areas. Antihelminthics are highly efficacious in treating hook worm but evidence of their beneficial effect and safety, when given during pregnancy, has not been established.Objectives: To determine the effects of administration of antihelminthics for soil transmitted helminths during the second or third trimester of pregnancy on maternal anaemia and pregnancy outcomes.Search strategy: We searched the Cochrane Pregnancy and Childbirth Group\u27s Trials Register (September 2008). Selection criteria: All prospective randomised controlled trials evaluating the effect of administration of antihelminthics during the second or third trimester of pregnancy. Data collection analysis: Two review authors independently assessed trial quality and extracted the data.Main results: Three studies (1329 women) were included in this review. Analysis showed that administration of a single dose of antihelminth in the second trimester of pregnancy is not associated with any impact on maternal anaemia in the third trimester (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.68 to 1.19, random effects (2 studies, n = 1075)). Subgroup analysis on the basis of co-interventions other than antihelminthics which included iron supplementation given to both groups in the study by Larocque et al, and a subset of the study by Torlesse et al, showed that a single dose of antihelminth along with iron supplementation throughout the second and third trimester of pregnancy was not associated with any impact on maternal anaemia in the third trimester as compared to iron supplementation alone (RR 0.76, 95% CI 0.39 to 1.45, random-effects (2 studies, n = 1017)). No impact was found for the outcomes of low birthweight (RR 0.94, 95% CI 0.61 to 1.42 (1study, n = 950)), perinatal mortality (RR 1.10, 95% CI 0.55 to 2.22 (2 studies, n = 1089)) and preterm birth (RR 0.85, 95% CI 0.38 to 1.87 (1 study, n = 984)). Impact on infant survival at six months of age could not be evaluated because no data were available.Authors\u27Conclusion:The evidence to date is insufficient to recommend use of antihelminthics for pregnant women after the first trimester of pregnancy. More well-designed, large scale randomised controlled trials are needed to establish the benefit of antihelminthic treatment during pregnancy

Learning approaches and performance of medical students

Objective: To identify the best assessment method for medical students with different learning approaches.Methods: The cross-sectional questionnaire-based study was conducted at Bahria University Medical and Dental College, Karachi, from March 2010 to April 2011, and comprised first year medical students. The questionnaire was tailored from the Approaches and Study Skills Inventory for Students on a five-point scale Deep approach, Surface apathetic approach and Strategic approach were assessed through relevant sub-scales. Response to questions was summed for the subscales and main scales for a learning approach. Mean scores for aggregate marks obtained by multiple choice questions, short answer questions, problem-based learning and objective structured physical examination were derived. Coefficient of variation was estimated to find the most reliable assessment method.Results: Of the 100 students enrolled, 98(98%) completed the study. Of them, 51(52%) were girls and 47(48%) were boys. Overall, 70(71.4%) students displayed Strategic approach, and 13(13.3%) showed Surface apathetic approach. Objective structured physical examination had the least variation (12.27) for all approaches whereas maximum variation (14.92) was observed by problem-based learning scores.Conclusions: Assessment by problem-based learning scores was able to demarcate deep learners whereas consistent scores were obtained by objective structured physical examination which failed to discriminate variance in performance by different learners