Foreign Debt, Dependency, and Economic Growth in South Asia

Many developing countries are following a policy to attract foreign capital through loans and other means to enhance investment. The inflow of these resources is seen as an addition to investment for accelerating economic growth. However, there are only a few success stories where such resources have made any significant contribution to improve the economic conditions of recipient country. Pakistan and other South Asian countries have received significant amount of foreign loans2 but its role is critical [Chaudhary and Ali (1993, 1996)]. In spite of increasing foreign aid, South Asia has emerged one of the poorest and illiterate regions of the world, having more than 500 million poor living below poverty line and about 46 percent of the world’s illiterate live in the South Asia [UNDP/MHHDC*(1997)]. This is the region, which has 22 percent of the world’s population, while having only 3 percent of the world’s income. It also appears one of the most indebted regions of the world [Anwar (1995)]. In spite of a significant inflow of foreign aid, the economic conditions remained poor in this region. Such a situation calls for an in depth analysis of the contribution of foreign aid. Therefore, this paper is focused to analyse the role and implications of international debt in South Asia. Besides, South Asia’s dependency upon foreign debt is also analysed. In addition, tendency of resources outflow from South Asia to other countries, in terms of debt services, is also identified.

Vitamin D Deficiency in Rawalpindi –Islamabad Region

To assess vitamin – D deficiency in Northern Pakistan in order to provide inputs towards developing effective preventive and remedial strategies.Methods:A total of five thousand six hundred and ninety three (n=5693) adult patients of both genders were screened for serum Vitamin D-3 levels over the period of six years.Results:Mean serum Vitamin D3 levels among males and females were in insufficient range and showed no significant difference (P>0.05). In study population 56.5% (n=3216) of patients were Vitamin D-3 deficient (<20 ng/ml), 18.2% (n=1037) showed insufficient levels (20-30 ng/ml) and 25.3% showed sufficient levels (>30 ng/ml). Significant difference was observed on gender stratification with female population showed higher percentage of deficient levels (79.7%) versus males (20.3%) (p<0.05). Age based stratification also showed significant difference with age groups younger than 50 years showed higher percentage of deficient levels than in patients older than 50 years (P<0.05). Conclusion: There is a high prevalence of vitamin D deficiency in population of Rawalpindi and Islamabad region

Prevalence of Hepatitis C Virus (HCV) Genotypes in Rawalpindi and Islamabad Region

To determine the frequency of different genotypes in HCV positive cases in the population of Rawalpindi/ Islamabad over the period of five years. Methods: Data of total of three thousand eight hundred and eighteen (n=3818) HCV positive adult of both genders screened for genotype testing over the period of six years were analyzed.Results: Most frequent genotype identified in our study was genotype 3, accounting for 95.8%. The second most common genotype was Type 1 (2.9%). Other genotypes were Type 2 (0.3%)and Type 4 (0.1%). Mixed genotype (Type 1 and 3) were detected in 1 %. Genotype 5 and 6 was not detected in any case. No significant difference was observed among males and females in genotype distribution (p>0.05). Conclusion: Most common genotype among HCV patients was genotype 3, followed by genotype 1

Incidence of Epilepsy and Drug Dependence after Post Traumatic Contusions Managed Conservatively

contusions managed conservatively. Material and Methods:  A prospective observational study was carried out in, Punjab Institute of Neurosciences, Lahore. A total of 97 patients, from 15-65 years, who were diagnosed with cerebral contusions and being managed conservatively were enrolled from July 2019 to December 2019. They were followed-up for 12 – 18 months. Results:  A total of 23% patients developed early post-traumatic seizures (PTS) and 11% of patients developed late post-traumatic seizures with mild to moderate brain injury.6% of patients with early PTS used antiepileptic drugs (AED) for at least three months during follow up and 7% with late PTS used AED. 8% of patients developed late PTS without any early PTS. The results of our study show that among 23% early PTS and 11% late PTS only 3 % actually required to use AED for at least 6months. To prevent this, 3% of the population 44% were using AED supplementary. Conclusion:  In our study, the incidence of early and late PTS is comparable to the other studies. The non-judicious use of the anti-epileptic drug is common in our country which leads to an increase in the risk of drug resistance and cost-intensive for poor patients in developing countries as prophylactic and excessive use of anti-epileptics does not affect the PTE

Antifungal and antispasmodic activities of the extracts of Euphorbia granulata

The dichloromethane and methanolic extracts of the plant Euphorbia granulata were investigated for their antifungal, antibacterial, phytotoxic, brine-shrimp cytotoxic, antioxidant, spasmolytic (antispasmodic) and acetylcholinestrase inhibitory activities. The dichloromethane extract showed strong inhibition against Microsporum canis (90%) and against Aspergillus flavus (50%). Both the extracts inhibited the spontaneous contractions in rabbit jejunum preparations with EC50 value of 0.17 and 1.3 mg/mL, respectively and also relaxed the K+-induced contractions with EC50 0.2 and 2.8 mg/mL, respectively, suggesting a calcium channel blocking activity. However, the extracts did not show antibacterial, phytotoxic, brine-shrimp cytotoxic, antioxidant and acetylcholinestrase inhibitory activities

Impact of natural killer cells on outcomes after allogeneic hematopoietic stem cell transplantation: A systematic review and meta-analysis.

Background: Natural killer (NK) cells play a vital role in early immune reconstitution following allogeneic hematopoietic stem cell transplantation (HSCT). Methods: A literature search was performed on PubMed, Cochrane, and Clinical trials.gov through April 20, 2022. We included 21 studies reporting data on the impact of NK cells on outcomes after HSCT. Data was extracted following the PRISMA guidelines. Pooled analysis was done using the meta-package (Schwarzer et al.). Proportions with 95% confidence intervals (CI) were computed. Results: We included 1785 patients from 21 studies investigating the impact of NK cell reconstitution post-HSCT (8 studies/1455 patients), stem cell graft NK cell content (4 studies/185 patients), therapeutic NK cell infusions post-HSCT (5 studies/74 patients), and pre-emptive/prophylactic NK cell infusions post-HSCT (4 studies/77 patients). Higher NK cell reconstitution was associated with a better 2-year overall survival (OS) (high: 77%, 95%CI 0.73-0.82 vs low: 55%, 95%CI 0.37-0.72; n=899), however, pooled analysis for relapse rate (RR) or graft versus host disease (GVHD) could not be performed due to insufficient data. Higher graft NK cell content demonstrated a trend towards a better pooled OS (high: 65.2%, 95%CI 0.47-0.81 vs low: 46.5%, 95%CI 0.24-0.70; n=157), lower RR (high: 16.9%, 95%CI 0.10-0.25 vs low: 33%, 95%CI 0.04-0.72; n=157), and lower acute GVHD incidence (high: 27.6%, 95%CI 0.20-0.36 vs low: 49.7%, 95%CI 0.26-0.74; n=157). Therapeutic NK or cytokine-induced killer (CIK) cell infusions for hematologic relapse post-HSCT reported an overall response rate (ORR) and complete response (CR) of 48.9% and 11% with CIK cell infusions and 82.8% and 44.8% with NK cell infusions, respectively. RR, acute GVHD, and chronic GVHD were observed in 55.6% and 51.7%, 34.5% and 20%, and 20.7% and 11.1% of patients with CIK and NK cell infusions, respectively. Pre-emptive donor-derived NK cell infusions to prevent relapse post-HSCT had promising outcomes with 1-year OS of 69%, CR rate of 42%, ORR of 77%, RR of 28%, and acute and chronic GVHD rates of 24.9% and 3.7%, respectively. Conclusion: NK cells have a favorable impact on outcomes after HSCT. The optimal use of NK cell infusions post-HSCT may be in a pre-emptive fashion to prevent disease relapse

Outcomes with chimeric antigen receptor t-cell therapy in relapsed or refractory acute myeloid leukemia: a systematic review and meta-analysis

BackgroundWe conducted a systematic review and meta-analysis to evaluate outcomes following chimeric antigen receptor T cell (CAR-T) therapy in relapsed/refractory acute myeloid leukemia (RR-AML).MethodsWe performed a literature search on PubMed, Cochrane Library, and Clinicaltrials.gov. After screening 677 manuscripts, 13 studies were included. Data was extracted following PRISMA guidelines. Pooled analysis was done using the meta-package by Schwarzer et al. Proportions with 95% confidence intervals (CI) were computed.ResultsWe analyzed 57 patients from 10 clinical trials and 3 case reports. The pooled complete and overall response rates were 49.5% (95% CI 0.18-0.81, I2 =65%) and 65.2% (95% CI 0.36-0.91, I2 =57%). The pooled incidence of cytokine release syndrome, immune-effector cell associated neurotoxicity syndrome, and graft-versus-host disease was estimated as 54.4% (95% CI 0.17-0.90, I2 =77%), 3.9% (95% CI 0.00-0.19, I2 =22%), and 1.6% (95%CI 0.00-0.21, I2 =33%), respectively.ConclusionCAR-T therapy has demonstrated modest efficacy in RR-AML. Major challenges include heterogeneous disease biology, lack of a unique targetable antigen, and immune exhaustion

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries