CLIMATE SECURITY OF PAKISTAN: DISSECTING THE CARBON DILEMMA

Carbon accretion in the atmosphere is having widespread climatic impacts on Pakistan like reduced agricultural productivity, water shortage, and coastal erosion, etc. Tormented with a poor economy, any abrupt scarcity of livelihood resources can breed violence, crime, communal tensions, and a threat to national security. Encumbered by the financial and technical deficit, Pakistan is facing considerable challenges for crafting a pragmatic climate security regime. Significant divergence in the public and academic opinion on the nature of this threat have attributed to a sluggish policy response so far. This paper, therefore, focuses on Pakistan’s Carbon dilemma and critically examines its treatment in national climate policies. It calls for an integrated approach across multiple sectors and mainstreaming of a national security policy with climate-smart infrastructure that assimilates core national security resources. It further calls for political discourses that encompass food, energy, agriculture, health, and even diplomacy to overcome this national threat. Towards the end, this paper proffers some recommendations to mitigate threats to our climate security.   Bibliography Entry Kahlon, Tahir-ul-Mulk, and Syed Ahmad Talal. 2020. "Climate Security of Pakistan: Dissecting the Carbon Dilemma." Margalla Papers 24 (1): 97-111

Patterns of coronary artery vessel disease on diagnostic angiography in a south asian population

Objective: The objective was to establish patterns of diseased vessels amongst the study population.Methodology: This retrospective descriptive study analyzed the data of 396 patients who underwent diagnostic angiographies at a large tertiary care public hospital in Islamabad, from January-2018 till October 2018. All data was coded and recorded in SPSS and was quantitatively run to find percentages and tests of significance were done.Results: We found that single vessel disease was the most common at 31.6%, and that the left anterior descending was the most commonly involved vessel with the most significant coronary artery disease, 86.6% and 71.4% respectively. Conclusion: Hypertension and diabetes has a great burden on our South Asian population and contribution to the development of coronary artery disease. Severe disease present in one vessel should alert physicians to the possibility of multi-vessel involvement and multi vessel progression in the disease progress.  Delineation of the vessel involvement pattern in South Asians forms the basis for formulating local guidelines and strategies for tackling coronary artery disease.Keywords: Angiography, CAD, patterns

Morphological characterization, phytochemical profile, and cytotoxic and insecticidal activities of diverse parts of Bryophyllum pinnatum (Lam.)

Purpose: To standardize Zakham-e-Hayat (Bryophyllum pinnatum Lam.) as well as determine its cytotoxic and insecticidal activity. Methods: Different parts of the plant (flowers, young leaves, old leaves and stem) and different solvents, viz, methanol, ethyl acetate and n-hexane were used for the extraction. Morphological characterization (macroscopic and microscopic), phytochemical screening for primary and secondary metabolites, and thin layer chromatography (TLC) using various solvent systems, namely, methanol/chloroform (MeOH/CHCl3), n-hexane/methanol/chloroform (n-hexane/MeOH/CHCl3), methanol/chloroform/water (MeOH/CHCl3/H2O), n-hexane/chloroform (n-hexane/CHCl3), n-hexane/ethyl acetate (n-hexane/EtOAc) were carried out. Fourier transform infrared spectroscopy (FTIR) was also performed. In addition, the extracts were evaluated for their cytotoxic and insecticidal activities. Results: The methanol fraction of the young leaves had 50% lethal dose (LD50) of 28.46 µg/mL while the ethyl acetate fraction of young and old leaves showed significant cytotoxicity at LD50 of 0.13 µg/mL and 142.68 µg/mL respectively. On the other hand, n-hexane fraction was inactive. The methanol fraction of the flower revealed the presence of carbohydrates, the ethyl acetate fraction showed the presence of carbohydrates and amino acids, while the n-hexane fraction showed the presence of carbohydrates as primary metabolites. Furthermore, alkaloids, flavonoid, saponins and resins were present in the methanol fraction, flavonoid and alkaloids in the ethyl acetate fraction, and alkaloids and resins in the n-hexane fraction as secondary metabolites. Conclusion: Methanol and n-hexane fractions of Bryophyllum pinnatum have some safe bioactive compounds which may exhibit potential health benefits

Breast cancer awareness and breast self-examination among future female university graduates: comparison between medical and non-medical students

Background: Breast cancer is a common health problem among females in Saudi Arabia. The disease account for 27% of all female malignancies representing 25.1% of all newly diagnosed female cancers. The objectives of the current study were to assess the level of carcinoma breast awareness of female university students, Majmaah University in Saudi Arabia and to compare the level of awareness, breast self-examination and breast cancer screening between medical and non-medical students.Methods: The current study was a cross-sectional, conducted among female students in Majmaah University in Saudi Arabia. The stratified and the systematic sampling were employed to select the colleges and the students respectively. The sample size was calculated as 325. Data was collected by a pre tested questionnaire and analyzed by SPSS.Results: The university students who acquired good knowledge were 111 (34.2%). Students who acquired average and poor knowledge were 42.2% and 23.6% respectively. Medical students who had good knowledge were 37.6% compared to 26.9% of non-medical students.  The results showed that 94 (28.9%) of the participants practice breast self-examination and 25 (7.6%) performed a screening test.Conclusions: The study concluded that Majmaah University students’ awareness of carcinoma breast is low. There is no significant difference in the level of awareness between students of medical colleges and those of non-medical colleges. The level of practicing breast self-examination and performing screening test for carcinoma breast among female university students is low. There is a significant difference in performing carcinoma breast screening test between medical and non-medical students.

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised