Normothermic Perfusion: a game-changer for kidney transplantation?

Respected Madam, Organ transplantation has revolutionized the field of medicine. Kidney transplant, in particular, is of significant importance in Pakistan as there is an estimated prevalence rate of patients with end-stage renal disease (ESRD) of 100 per million population. The annual transplant rate is only about 8 to 10 cases per million.1,2 Due to this shortage in organ transplants, over 15,0000 people lose their lives each year due to end-stage organ failure, among which 15000 are patients with end-stage kidney failure. These numbers can be reduced greatly if the number of kidneys available is increased.3 As the number of organs available for a kidney transplant is limited in Pakistan owing to strict regulations to end transplant tourism, it is crucial to increase the viability of the organs  available to ensure the success and survival of patients suffering from ESRD.4 An exciting finding was revealed by Kidney Research UK, where 100 kidneys could potentially be saved for transplant each year after being retrieved from donors in the UK via normothermic perfusion, This technique  has shown promising results in numerous research.5  As evident from the name, in this technique, oxygen is provided to organs during preservation to allow aerobic metabolism.  In a review conducted by Franka Messner et al, it was concluded that this technology may be used as an ex-vivo organ assessment and treatment platform. During renal NMP, mesenchymal stromal/stem cells, multipotent adult progenitor cells, and microRNA have been used in studies, and preliminary data shows that these therapies do indeed reduce kidney injury and inflammatory response. Furthermore, in comparison to any cold preservation approach, normothermic ex vivo kidney perfusion (NEVKP) revealed a considerable reduction in preservation harm in a study conducted by Laura I Mazilescu et al.6 As the demand for kidney transplants increases in Pakistan, normothermic perfusion can be studied further to provide an efficient technique for the preservation of organs. By ensuring the better viability of the available organs, we can perhaps help to increase the chances of survival of patients suffering from ESRD since we already face a shortage in the number of organs available for transplantation

Rise of tuberculosis globally after a decline

Dear Madam, Tuberculosis is an infectious disease caused by Mycobacterium Tuberculosis that primarily affects the lungs and spreads via respiratory droplets from person-to-person contact. Tuberculosis has remained endemic in Pakistan for many decades despite the preventative measures taken. With an overwhelming population of 179.6 million, Pakistan ranks fifth amongst the countries with the highest TB burden. 63% of TB cases come from Pakistan in the eastern Mediterranean region. Furthermore, according to the National Tuberculosis Control Program (NTP), 413,450 TB cases (of all types) occur in Pakistan each year, with an incidence of 231 per 100,000 people. According to the NTP, the prevalence of tuberculosis is 630,000 cases (364/100,000 people), with mortality rates in the 60,000 (34/100,000 people) range. [1] The enormity of the population, coupled with a lack of trained medical personnel and the shortage of medical facilities provided, especially in rural areas, makes it extremely difficult to detect and treat the patients. Pakistan already has a fragile healthcare system, and with the addition of the covid 19 pandemic, tuberculosis seems to be on the rise more than ever. Because of the acute and rising burden of the pandemic, the priorities were shifted. Interruptions in regular outpatient services caused by government-mandated lockdowns, general fear of visiting hospitals, and redirection of TB-specific facilities all attributed to the deterioration of case management of TB detection, allowing countless cases to go undiagnosed. [2] The World health organization’s 2022 Global TB report showed that 10.6 million people were diagnosed with tuberculosis in 2021, a staggering increase of %t from the previous year. Approximately 1.6 million people lost their lives to this disease. From 2021 to 2022, the burden of drug-resistant TB increased of 3%, coupled with 450 000 additional cases of rifampicin-resistant tuberculosis (RR-TB) in 2021. [3] As the burden of the pandemic and other infectious diseases, such as poliomyelitis, are still under scrutiny, we need to put more efficient measures to come up with new systems to prevent and lessen the burden of TB, especially when there is a marked global rise in cases