Listening to students: Perspectives, experiences, and next steps

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Gastroprotective effects of aquous solution: Acacia catechu on gastric mucosal injury in experimental albino rats model

Background: Around the globe, acid peptic disease and its potential complications are among the major cause of morbidity and is a significant burden on health system. Till now, the main stay of treatment are the pharmaceutical agents which decrease the secretion of acid. But these have potential complications and tolerability issues. Among such plants one is Acacia catechu commonly available in India and Pakistan.Methods: This experimental study involved 48 albino rats that were divided into four groups. Group A, B, C, and D were given water, 100mg aspirin, 100 mg aspirin+ 250 mg Acacia catechu and 100 mg aspirin+500 mg Aacacia catechu respectively, and were sacrificed on day 3, 7 and 14th day of study and observed for changes.Results: Difference between blood vessels in subgroup B1 and subgroup C1 with subgroup D1 was statistically significant (p=0.05) and (p=0.001). Group C1 and D1 had normal vessels in mucosa and submucosa. However, dilatation of blood vessels was noted in both groups receiving Acacia catechu along with ASA.Conclusions: Aqueous extracts of Acacia catechu stem and bark showed significant anti-ulcer and anti-inflammatory activities by increasing blood flow to the stomach

Effects of Growing Media and Irrigation Interval on Growth of Amaryllis (Amaryllis Belladonna)

Four combinations of various growing media i.e. garden soil, canal silt, farm yard manure,  mushroom compost,  leaf mold and  poultry manure and four irrigation intervals (i.e. 5, 10, 15 and 20 days) were  trailed to investigate their effects on growth and flowers production of Amaryllis belladonna, at Horticulture Nursery of University of Agriculture, Peshawar during 2012.Growing medium composed of garden soil, canal silt, and mushroom compost resulted in early emergence (18.66 days), maximum leaf length (47.87cm), leaf width (2.44 cm), number of leaves (13.55). Maximum leaf length (48.16cm), leaf width (2.36 cm), number of leaves per plant (13.55), was noted at irrigation interval of 10 days. Since Mushroom compost growing media and 10 days irrigation interval interaction showed significant result among most of the parameters observed hence for better growth growing media garden soil + canal silt + mushroom compost with 10 days irrigation interval is recommended. Keywords: Emergence, leaf length & width

Phytoremediation of potentially toxic elements from contaminated saline soils using Salvadora persica L.: seasonal evaluation

Plants in coastal ecosystems are primarily known as natural sinks of trace metals and their importance for phytoremediation is well established. Salvadora persica L., a medicinally important woody crop of marginal coasts, was evaluated for the accumulation of metal pollutants (viz. Fe, Mn, Cu, Pb, Zn, and Cr) from three coastal areas of Karachi on a seasonal basis. Korangi creek, being the most polluted site, had higher heavy metals (HM’s) in soil (Fe up to 17,389, Mn: 268, Zn: 105, Cu: 23, Pb: 64.7 and Cr up to 35.9 mg kg−1) and S. persica accumulated most of the metals with >1 TF (translocation factor), yet none of them exceeded standard permissible ranges except for Pb (up to 3.1 in roots and 3.37 mg kg−1 in leaves with TF = 11.7). Seasonal data suggested that higher salinity in Clifton and Korangi creeks during pre- and post-monsoon summers resulted in lower leaf water (ΨWo) and osmotic potential at full turgor (ΨSo) and bulk elasticity (ε), higher leaf Na+ and Pb but lower extractable concentrations of other toxic metals (Cr, Cu, and Zn) in S. persica. Variation in metal accumulation may be linked to metal speciation via specific transporters and leaf water relation dynamics. Our results suggested that S. persica could be grown on Zn, Cr and Cu polluted soils but not on Pb affected soils as its leaves accumulated higher concentrations than the proposed limits.Higher Education Commission, Islamabad | Ref. 6592/Sindh/NRPU/R&D/HEC/201

ETHNOBOTANICAL AND BIOLOGICAL ACTIVITIES OF Leptadenia pyrotechnica (Forssk.) Decne.: A REVIEW

Background: Leptadenia pyrotechnica is traditionally used for treating various diseases. This species holds variety of bioactive constituents that trigger healing properties. The present review was aimed to analyze nutritional, phytochemical and pharmacological activities of L. pyrotechnica. Materials and Methods: The present review regarding Leptadenia pyrotechnica (Forssk.) Decne. Is the compilation of data from the previous research works conducted by various scientists across the world. Various published papers, medicinal plant databases,etc were utilized to compile the information. Results: L. pyrotechnica is a wonderful desert plant belongs to the family Asclepiadaceae This plant possesses antifungal, antibacterial, anticancer, antioxidant, wound healing, anthelmintic, antiatheroscloretic, hypolipidemic, antdiabetic and hepatoprotective activities coupled with other multifarious uses. Almost all plant parts are used in the traditional medicinal system to treat various disorders. Conclusion: This review includes the substance of different ethnobotanical uses, phytochemistry and exclusive capability of this plant in the field of anti-microbial and human disease activities

Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys

Background: Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. In this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. The Robson system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates, and gestational age. Methods: We studied deliveries in 287 facilities in 21 countries that were included in both the WHO Global Survey of Maternal and Perinatal Health (WHOGS; 2004–08) and the WHO Multi-Country Survey of Maternal and Newborn Health (WHOMCS; 2010–11). We used the data from these surveys to establish the average annual percentage change (AAPC) in caesarean section rates per country. Countries were stratified according to Human Development Index (HDI) group (very high/high, medium, or low) and the Robson criteria were applied to both datasets. We report the relative size of each Robson group, the caesarean section rate in each Robson group, and the absolute and relative contributions made by each to the overall caesarean section rate. Findings: The caesarean section rate increased overall between the two surveys (from 26·4% in the WHOGS to 31·2% in the WHOMCS, p=0·003) and in all countries except Japan. Use of obstetric interventions (induction, prelabour caesarean section, and overall caesarean section) increased over time. Caesarean section rates increased across most Robson groups in all HDI categories. Use of induction and prelabour caesarean section increased in very high/high and low HDI countries, and the caesarean section rate after induction in multiparous women increased significantly across all HDI groups. The proportion of women who had previously had a caesarean section increased in moderate and low HDI countries, as did the caesarean section rate in these women. Interpretation: Use of the Robson criteria allows standardised comparisons of data across countries and timepoints and identifies the subpopulations driving changes in caesarean section rates. Women who have previously had a caesarean section are an increasingly important determinant of overall caesarean section rates in countries with a moderate or low HDI. Strategies to reduce the frequency of the procedure should include avoidance of medically unnecessary primary caesarean section. Improved case selection for induction and prelabour caesarean section could also reduce caesarean section rates

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

International Consortium on Mammographic Density:methodology and population diversity captured across 22 countries

Mammographic density (MD) is a quantitative trait, measurable in all women, and is among the strongest markers of breast cancer risk. The population-based epidemiology of MD has revealed genetic, lifestyle and societal/environmental determinants, but studies have largely been conducted in women with similar westernized lifestyles living in countries with high breast cancer incidence rates. To benefit from the heterogeneity in risk factors and their combinations worldwide, we created an International Consortium on Mammographic Density (ICMD) to pool individual-level epidemiological and MD data from general population studies worldwide. ICMD aims to characterize determinants of MD more precisely, and to evaluate whether they are consistent across populations worldwide. We included 11755 women, from 27 studies in 22 countries, on whom individual-level risk factor data were pooled and original mammographic images were re-read for ICMD to obtain standardized comparable MD data. In the present article, we present (i) the rationale for this consortium; (ii) characteristics of the studies and women included; and (iii) study methodology to obtain comparable MD data from original re-read films. We also highlight the risk factor heterogeneity captured by such an effort and, thus, the unique insight the pooled study promises to offer through wider exposure ranges, different confounding structures and enhanced power for sub-group analyses

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation