Agriculture and Nutrition in Pakistan: Pathways and Disconnects

Results of the latest nationwide nutrition survey show that Pakistan has persistently high rates of undernutrition despite respectable rates of economic growth. Amongst economic sectors, agriculture could have positive impacts on nutrition outcomes, but only through nuanced approaches. Exploring possible links between agricultural growth and nutrition improvement in the country reveals that land, gender relations, individual behaviour and preferences, as well as political priorities and organisational effectiveness, act as disconnects between agriculture and nutrition. These areas represent both opportunities and challenges for improving nutrition outcomes. This has important implications for existing policy and programmes that address issues such as labour arrangements, women’s agency, social protection and citizenship. This summary is based on the evidence review ‘Agriculture and Nutrition in Pakistan – Pathways and Disconnects’ written by Mysbah Balagamwalah and Haris Gazdar (CSSR) for LANSA.UK AidDepartment for International Development (DFID

Integration of geriatrics into a spiral undergraduate medical curriculum in Pakistan: evaluation and feedback of third-year medical students.

Background: In the last decades there has been a sharp rise in the elderly population throughout the world. The unique needs of the elderly require a multidisciplinary and comprehensive medical approach. None of the 50 medical schools in Pakistan teach geriatrics in their undergraduate or postgraduate training. This paper discusses the development and implementation of the first geriatric curriculum in a medical school of Pakistan and its effect on knowledge and attitudes of third-year medical students. Methods: The curriculum was designed through collaboration and approval of various academic departments at the Aga Khan University in Karachi Pakistan. After a review of existing geriatric curricula at other institutions, a problem-based, inter-disciplinary spiral curriculum was designed. Strategy of student and course evaluation was planned and incorporated in the curricular program. No extra resources or funds were used. A component of the new curriculum was assessed by evaluating pre- and post- course knowledge, and seeking feedback from participating third-year students. Results: A significant improvement in mean scores for summed overall knowledge in geriatrics (pre-test mean 4.7 vs. post-test mean 6.4, p value of of \u3c0.001; out of a maximum possible of 9 was noted. Breakdown of knowledge mean scores into component areas of knowledge showed a significant increase in understanding in aging demographics (pretest 0.7 vs. post-test 1.7, p value of \u3c0.001), geriatric history taking (pretest 0.64 vs. post-test 0.88, p 0.001) and geriatric assessments (pre- test 1.4 vs. post- test 1.7,p value 0.01). A strong majority (87%) of the students felt that the overall course objectives were achieved. All students were satisfied with the quality of teaching, 90% rating it good or higher. Conclusion: An important advance in medical education was achieved via integration of a low cost, spiral geriatrics curriculum in a medical university of Pakistan. We found that introduction of the geriatric curriculum improved the knowledge of third-year medical students. This was our school\u27s initial step towards building professional capacity in response to a rising elderly population

Increased risk of cervical canal infections with intracervical foley catheter

OBJECTIVE: To evaluate the effect of intracervical Foley catheter insertion, for the induction of labor, on cervical canal infection. DESIGN: A prospective interventional study with paired analysis. PLACE AND DURATION OF STUDY: The study was conducted in the department of Obstetrics and Gynecology at the Aga Khan University, Karachi, between June 1 and August 31, 2002. SUBJECTS AND METHODS: In 45 women undergoing cervical ripening with intracervical Foley catheter for the induction of labour at term, cervical swabs were taken for culture and sensitivity before its insertion and again after its spontaneous expulsion or removal. RESULTS: Intracervical Foley catheter was retained for mean duration of 8.1 +/- 1.7 hours. There was a significant change in the pathogenic organisms (0 % v 16.3 %; p 0.016) from pre-Foley to post-Foley catheter cervical swab cultures. Growth of beta-hemolytic Streptococcus group-B, Candida albicans, Candida glabrata and Gardnerella vaginalis on cervical swab were considered pathogenic. One woman (2.2 %) developed fever following insertion of intracervical Foley catheter. No statistically significant effect of potential confounding factors was observed on change in growth of pathogenic organisms. CONCLUSION: Induction of labour at term with Foley catheter is associated with a significant increase in intracervical pathogenic organisms despite undertaking routine aseptic measures. We recommend evaluation of this technique for its potential infectious harm in larger studies. Meanwhile, extreme aseptic measures should be undertaken during its insertion to avoid maternal and possible neonatal infections

Uterine atony at a tertiary care hospital in Pakistan: A risk factor analysis

Objectives: To identify risk factors for uterine atony following assisted or unassisted vaginal delivery.Design: This hospital based case control study was done at The Aga Khan University Karachi, Pakistan. Cases were defined as all women with uterine atony within 24 hours of an assisted or unassisted vaginal delivery. Controls were based on women with normal assisted or unassisted vaginal delivery without uterine atony. Data abstracted form the medical records; adjusted odds ratios were estimated by multiple logistic regression.Results: Factors having a significant association with uterine atony were gestational diabetes mellitus (odds ratio 7.6, 95% CI 6.9-9.0, p = 0.003) and a prolonged second stage of labour in multiparas (odds ratio 4.0, 95% CI 3.1-5.0, p = 0.002). No associations were found with high parity, age, preeclampsia, augmentation of labour, antenatal anemia and a history of poor maternal or perinatal outcomes.Conclusions: Among previously documented risk factors for uterine atony, only a prolonged second stage of labour in multiparas was found to be significant in this study. Gestational diabetes mellitus, a previously undocumented factor, has also been identified as an independent risk factor. Multiparity and age were not found to be significant risk factors. The study underlines the importance of confirming these findings for better prevention and management of uterine atony

Nitric oxide mediated effect of cyclo-oxygenase inhibitors

Objectives: Non-Steroidal anti-inflammatory drugs (NSAIDS) have long been used as anti-inflammatory agents, yet their mode of action is not entirely clear. The inhibitory effects of NSAIDS on prostaglandin production can only partly explain their anti-inflammatory actions. This study was aimed at defining the role of cycl-oxygenase (COX) inhibitors on nitric oxide (NO) production in murine macrophages in vitro.Methods: Murine macrophages were obtained from the peritoneum and after exposure, in vitro to lipopolysaccharide (LPS) produced nitrite, measured after 24 hours by Griess reaction. The macrophages were pre-incubated with aspirin or indomethacin before activation with LPS.Results: Treatment with aspirin resulted in an increase in nitric oxide production. A similar response was obtained with indomethacin treatment.Conclusion: This study shows that COX inhibitors significantly increase NO production in murine macrophages in vitro and this may be one of the mechanisms by which they exert their anti-inflammatory effects

Effect of prepregnancy body mass index and gestational weight gain on birth weight

Objective: Nutritional status of women has been considered an important prognostic indicator of birth outcome. The study aims to show the effect of various prepregnancy Body Mass Index (BMI) categories and corresponding gestational weight gain on newborn birth weight.Methods: Two hundred women were included in the study. These women had regular antenatal visits and later delivered at The Aga Khan University Hospital (AKUH) between the period January 1, 1996 to December 31, 1997.Results: For women with prepregnancy BMI \u3c 19., mean birth weight of newborns was lower for those gaining \u3c 12.5 kg than those gaining \u3e 12.5 kg (P \u3c 0.001). Women who started their pregnancy with BMI 19.8-26 and gained weight above expected range gave birth to high birth weight babies (P = 0.009). Gestational weight gain did not have a significant association with birth weight for women having prepregnancy BMI \u3e 26.Conclusion: Efforts should be made to attain adequate prepregnancy weight to reduce the likelihood of low birth weight babies. Hence, special attention should be paid to women with low prepregnancy BMI

Processing of soot in an urban environment: case study from the Mexico City Metropolitan Area

Chemical composition, size, and mixing state of atmospheric particles are critical in determining their effects on the environment. There is growing evidence that soot aerosols play a particularly important role in both climate and human health, but still relatively little is known of their physical and chemical nature. In addition, the atmospheric residence times and removal mechanisms for soot are neither well understood nor adequately represented in regional and global climate models. To investigate the effect of locality and residence time on properties of soot and mixing state in a polluted urban environment, particles of diameter 0.2–2.0 μm were collected in the Mexico City Metropolitan Area (MCMA) during the MCMA-2003 Field Campaign from various sites within the city. Individual particle analysis by different electron microscopy methods coupled with energy dispersed x-ray spectroscopy, and secondary ionization mass spectrometry show that freshly-emitted soot particles become rapidly processed in the MCMA. Whereas fresh particulate emissions from mixed-traffic are almost entirely carbonaceous, consisting of soot aggregates with liquid coatings suggestive of unburned lubricating oil and water, ambient soot particles which have been processed for less than a few hours are heavily internally mixed, primarily with ammonium sulfate. Single particle analysis suggests that this mixing occurs through several mechanisms that require further investigation. In light of previously published results, the internally-mixed nature of processed soot particles is expected to affect heterogeneous chemistry on the soot surface, including interaction with water during wet-removal

The analgesic efficacy of ultrasound-guided transversus abdominis plane block vs. local anesthetic infiltration technique in major gynecologic surgery: A randomized controlled trial

Background and aim: Transversus abdominis plane (TAP) block and local anesthetic infiltration (LAI) technique are used as part of the multimodal analgesic regimen after abdominal surgery. Postoperative opioid consumption and analgesic efficacy was compared using TAP and LAI techniques in patients undergoing gynecologic surgery in a randomized, controlled clinical trial.Material and methods: Total of 135 patients scheduled for major gynecological surgeries were allocated into three groups: group T received bilateral TAP block with bupivacaine 0.25%; group I received LAI with 0.25% bupivacaine with epinephrine 5 μ/mL in the peritoneum and abdominal wall, and group C was control group. Anesthesia and postoperative analgesia were standardized. Outcome measures were cumulative and rescue tramadol consumption, numerical rating score (NRS) for pain and side effects in post-anesthesia care unit (PACU) at 4, 8, 12 hours postoperatively.Results: Tramadol consumption, need for rescue analgesia, and NRS for pain between three groups at 4, 8, and 12 hours postoperatively had no statistically significant difference (P \u3c 0.05). In PACU, median tramadol consumption used for rescue analgesia between group T (15 (15-30)) and group C (30 (15-45)) (P = 0.035), and between group T (15 (15-30)) and group I (30 (15-52)) was statistically significant (P = 0.034). In PACU, the percentage of patients having NRS \u3e4 on movement in group C (72%) compared to group T (46.5%) and group I (46.5%) was significant (P = 0.034). No statistically significant difference was observed in the incidence of side effects among study groups (P \u3e 0.05).Conclusion: Except for the immediate postoperative period, neither TAP block nor LAI had added benefit to the multimodal analgesia regimen in patients undergoing gynecological surgeries

De novo SCN1A mutations in Dravet syndrome and related epileptic encephalopathies are largely of paternal origin

Background: Dravet syndrome is a severe infantile epileptic encephalopathy caused in approximately 80% of cases by mutations in the voltage gated sodium channel subunit gene SCN1A. The majority of these mutations are de novo. The parental origin of de novo mutations varies widely among genetic disorders and the aim of this study was to determine this for Dravet syndrome. Methods: 91 patients with de novo SCN1A mutations and their parents were genotyped for single nucleotide polymorphisms (SNPs) in the region surrounding their mutation. Allele specific polymerase chain reaction (PCR) based on informative SNPs was used to separately amplify and sequence the paternal and maternal alleles to determine in which parental chromosome the mutation arose. Results: The parental origin of SCN1A mutations was established in 44 patients for whom both parents were available and SNPs were informative. The mutations were of paternal origin in 33 cases and of maternal origin in the remaining 11 cases. De novo mutation of SCN1A most commonly, but not exclusively, originates from the paternal chromosome. The average age of parents originating mutations did not differ from that of the general population. Conclusions: The greater frequency of paternally derived mutations in SCN1A is likely to be due to the greater chance of mutational events during the increased number of mitoses which occur during spermatogenesis compared to oogenesis, and the greater susceptibility to mutagenesis of the methylated DNA characteristic of sperm cells.Sarah E. Heron, Ingrid E. Scheffer, Xenia Iona, Sameer M. Zuberi, Rachael Birch, Jacinta M. McMahon, Carla M. Bruce, Samuel F. Berkovic, John C. Mulle