Pakistan BioMedical Journal

Role of Public-Private Partnerships in Strengthening Pakistan's Healthcare System

Riffat Mehboob — 2023-08-31

Pakistan's healthcare system stands at a critical juncture, facing challenges that demand innovative solutions. Among these, the role of public-private partnerships (PPPs) emerges as a promising avenue to bridge gaps, enhance service delivery, and transform the healthcare landscape. The collaboration between public and private sectors has the potential to bring together diverse expertise, resources, and perspectives, ultimately leading to a more resilient and effective healthcare system.

In a country where public healthcare resources often struggle to meet the demands of a growing population, PPPs offer a strategic approach. Private sector entities, with their operational efficiency and investment capabilities, can inject vitality into the system. The provision of healthcare services, infrastructure development, and technology implementation are areas where PPPs can make a substantial impact. This synergy allows the public sector to leverage the strengths of the private sector while ensuring equitable access to quality healthcare services for all citizens.

However, successful PPPs in healthcare necessitate careful planning, transparent frameworks, and clear delineation of roles and responsibilities. Balancing financial viability with social responsibility remains a challenge. It is essential to strike a harmonious equilibrium where the interests of both sectors converge for the greater good. Moreover, effective governance and regulatory oversight are crucial to prevent any compromise on healthcare quality or ethics.

As Pakistan strives to achieve its healthcare development goals, lessons from successful PPP models globally can offer valuable insights. These models emphasize collaboration built on trust, open communication, and a shared vision. By fostering an environment that encourages innovation and collaboration, Pakistan can harness the full potential of PPPs to create a healthcare system that is robust, inclusive, and responsive to the needs of its citizens.

In conclusion, the role of public-private partnerships in strengthening Pakistan's healthcare system is undeniable. By pooling resources, knowledge, and expertise, both sectors can collectively address the challenges that have long impeded the nation's healthcare progress. A well-structured and ethically sound approach to PPPs can pave the way for a future where quality healthcare services are accessible to all, setting Pakistan on a transformative path toward healthier communities and improved well-being.

Rivaroxaban: Management of Coronary Artery Thrombosis in a Patient Presenting with Anterior Wall Myocardial Infarction

Ayesha Tariq — 2023-08-31

Coronary artery thrombosis is one of the most common clinically manifested disease that if not treated timely leads to morbidity and mortality particularly stroke or myocardial infarction. Anti-platelets are already the first line of treatment that are adopted for the prevention of coronary artery thrombosis however, there is need of a novel and potent anticoagulant that could help to reduce the frequency of coronary or atherothrombotic events in patients presenting with coronary diseases. Case Summary: We present a case of anterior wall myocardial infarction (AWMI) driven by coronary artery thrombosis. The patient upon diagnosis was found to have a clot in proximal left anterior descending artery (LAD). The patient was treated and discharged on anticoagulation therapy. We examined and report the effectiveness of anticoagulation therapy via a novel oral anticoagulant. i.e. Rivaroxaban for managing the risk of coronary artery thrombosis associated with AWMI within our patient. Onset of coronary artery thrombosis is associated with the mortality in myocardial infarct patients, regardless of its timing. This calls out for the need to manage the disease by adopting strategies that would prevent the frequent onset of these events in myocardial infarction survivors. Treatment with Rivaroxaban has emerged as a promising oral anticoagulant that could potentially serve as a long-term anticoagulant for managing coronary artery thrombosis in patients with heart complications.

Seroprevalence of Human Toxoplasmosis in Gujranwala Punjab, Pakistan

Adeel Masih — 2023-08-31

Toxoplasmosis, transmitted by Toxoplasma gondii, is a disease caused by water pollution. Consuming undercooked food or drinking polluted water can lead to severe infections, including seizures, cerebral necrosis, and hearing loss. Objective: To find out the prevalence of human toxoplasmosis in Gujranwala Punjab Pakistan. Methods: Human blood samples were obtained at random from various locations in Gujranwala. About 5ml blood was draw by puncturing the vein using the sterilized syringe and collected in EDTA vials. Serum was separated from collected blood by centrifugation at 3000rpm for 15 minutes and was collected in serum cup. The Latex Agglutination Test Kit was used to find the presence or absence of T. gondii in the collected serum. Results: The overall seroprevalence of human toxoplasmosis was 34.25%, with the highest prevalence found in the age group of 15-25 years (41.26%) and the lowest in 65-70 years (28.57%). The prevalence was found to be 36.5% in males and 32% in females, with the highest prevalence found in the age group of 15-25 years (41.26%). The prevalence was also higher in the age group of 65-70 years (28.57%). Factors contributing to the prevalence of toxoplasmosis include employment, direct contact with pets, drinking from tape water/supply water (51.38%), mud houses (60.46%), and eating raw vegetable and undercooked meat (81.81%) as compared to cooked fully cooked meat and vegetables (13.25%). Conclusions: The study highlights the complicated prevalence of toxicity in the Gujranwala community, affecting factors like age, education, employment, water supply, housing, and nutrition, requiring targeted interventions.

Varicocele Surgery: Three Years Experience

Suleyman Sagır — 2023-08-31

Despite available treatments like varicocelectomy, a standard therapy remains controversial. Varicocele repair has shown promise in improving sperm parameters, but further research is needed, especially in nonobstructive azoospermia cases. Techniques such as microscopic testicular sperm extraction and intracytoplasmic sperm injection have shown some success in achieving pregnancies. Objective: To articulate our hands-on experience and understanding pertaining to varicocele. Methods: This study included patients who presented to our clinic due to varicocele and underwent surgical procedures between November 2020 and January 2023. Results: This research involved 26 varicocele patients, primarily age rage was 27.5 years old. The majority (85%) had varicocele on the left side, and 15% had bilateral varicocele. The mean vein diameter was 3.58mm and 2.6mm for the left side and bilateral cases respectively, with a general average of 3.45mm. Analysis of sperm count, motility, and morphology reflected an average of 32.6 million/ml, 23.2%, and 5.23%, respectively. An average of 4.45 veins was ligated during surgery, with a slight variance based on the side. One patient lost approximately 85% of the testicular blood supply due to a complication during surgery, leading to testicle hardening without atrophy. Two patients experienced recurrence (7.6% recurrence rate). Negative and positive correlations were found between the number of ligated veins and preoperative sperm count (p=0.043, r=-0.408), and vein diameter and preoperative sperm morphology (p=0.004, r=0.544), respectively. Conclusions: Despite the limitations, our study provides valuable insights into the relationship between varicocele severity and sperm parameters.

Isolation of Facultative Anaerobic Bacterial Pathogens from Canned Food and Use of Lactobacillus Plantarum as A Bio-Control Agent

Khudija Malik — 2023-08-31

Preserved foods can play a significant role in causing food poisoning when they are not handled, processed, or stored properly. Objective: To investigate facultative anaerobic foodborne bacterial pathogens from canned foods and to control their growth Lactobacillus plantarum was used as a bio-control agent. Methods: Different canned food samples were collected to isolate and identify facultative anaerobic bacterial pathogens. Results: Out of n=65 samples, n=13 samples cultured positive as facultative anaerobes. They were further confirmed with biochemical and molecular identifications as foodborne bacterial pathogens with a ratio of 62% Escherichia coli, 30% Salmonella typhimurium, and 8% Vibrio cholerae. During bio-control studies, the results revealed possible inhibition of facultative anaerobic bacterial pathogens by using purified compounds of Lactobacillus plantarum. Conclusions: The use of probiotics in canned foods requires careful consideration, as factors such as the specific strain, food matrix, processing conditions, and storage practices can influence its effectiveness.

Exploring Maternal Health and Pregnancy Practices: A Comprehensive Study Among Pregnant Women

Muhammad Hasnain Shaikh — 2023-08-31

Maternal health and pregnancy practices are critical to ensuring the well-being of both expectant mothers and their unborn children. Women undergo significant physiological and emotional changes during pregnancy, making adopting appropriate nutrition and healthcare practices essential. Objective: To explore maternal health and pregnancy practices. Methods: This cross-sectional study was conducted in the Rural Community of Karachi, Pakistan, from August 2022 to January 2023. A total of 100 pregnant women were part of the study. Results: The study shows that around 36% of participants follow a balanced diet during pregnancy, and 47% take prenatal vitamins or iron supplements as recommended. Moreover, 29% prefer home delivery, 81% prefer healthcare facility delivery, and 75% believe home delivery has more complications than healthcare facility delivery. Conclusions: The study reveals that numerous expectant mothers follow advice on a balanced diet and prenatal care. However, a significant number still face challenges in accessing healthcare. Despite a preference for home remedies, most opt for healthcare facility deliveries, showcasing trust in professional assistance. Enhancing healthcare access, prenatal services, and nutritional education could enhance the well-being of both mothers and babies.

Assessment of Water Quality and Targeted Accumulation of Some Heavy Metals in Different Organs of Fresh Water Fish Ompok bimaculatus in Riverine System of Punjab, Pakistan

Hasnain Akmal — 2023-08-31

Heavy metals are metals that have high-density and are non-biodegradable. Among all pollutants, heavy metal pollution is the most serious. Ompok bimaculatus is a freshwater fish that belongs to cat family. Objective: To estimate concentration of six heavy metals (Copper, Ferric, Cadmium, Chromium, Nickel and Lead) in water, sediments and some organs (gills, fins and muscles) of fish collected from river Ravi. Methods: The accumulation level was recorded through atomic absorption spectrophotometer whereas, physiochemical parameters were also studied through testing water quality. Results: The heavy metal analysis indicated that the level of Fe was maximum in water and sediments followed by Ni and Pb. Other metals, Cu and Cr were also above permissible standards for drinking water. Further metal concentration was lower in bank water of river than in the main stream. The gills have higher metal accumulation level which is most likely due to direct contact with water followed by fins and muscles. The pattern of accumulation was Cadmium < Chromium < Nickel < Cupper < Lead < Ferric in fish organs. Higher concentrations of ALP and ASP than reference value which showed that the metal pollutants had started damaging the fish organs. Conclusions: In conclusion, the accumulation of all studied metals was higher in water and sediments than WHO permission standards. Same was true in the case of studied fish organs. Further, metals also fluctuate the hematological parameters of O. bimaculatus.

Sesquiterpene Lactones as Potential G1/S Phase Cell Cycle Inhibitors: A Molecular Docking Study

Zoufishan Yousaf — 2023-08-31

Cell cycle checkpoints play a crucial role in cell division by monitoring the orderly progression of each phase, ensuring accurate completion before advancing to the next stage. They act as quality control mechanisms, pausing the cell cycle when optimal conditions are not met, thereby preventing errors during cell division. Objective: To discover Sesquiterpene Lactones (SLs) as inhibitory compounds targeting Cyclin D1/Cyclin Dependent Kinase 4 (CDK4)- Cyclin Dependent kinase 6 (CDK6) complex and Eukaryotic Transcription Factor 2 protein (E2F-2). Methods: The inhibitory potential of SLs, namely ilicol, eucalyptone, and ascleposide E, was investigated using molecular docking analysis. The docking and visualization of ligand-protein complexes were performed using MGL Tools version 1.5.7, BIOVIA Discovery Studio version 21.1.0, and PyMol version 2.5.2. Additionally, drug likeness and pharmacokinetic properties of SLs were assessed via pkCSM and ADMET analysis. Results: Findings demonstrate that ilicol exhibit most favourable complex with CDK6 having binding energy of –7.8 kCal/mol and inhibition constant 1.81 μM. The visualization of ligand-receptor complexes reveals substantial hydrogen bonding interactions. Conclusions: Current study revealed that novel SLs show favourable drug likeness and promising ADMET profile along with strong inhibitory effect on G1/S regulatory proteins. The potency of SLs is in order of ilicol> ascleposide E>eucalyptone. To further validate the inhibitory effect of ilicol, implementation of comprehensive in vitro and in vivo investigations must be employed for progression of its development as a novel anti-cancer therapeutic.

Comparative Analysis of Tyrosine tRNA (MT-TY) Gene Mutation Related to Lung Cancer Patients from District Peshawar, Khyber-Pakhtunkhwa, Pakistan During 2020-2022

Zeeshan Abbas — 2023-08-31

The uncontrolled growth of cells in the lungs is called lung cancer (LC). Majority of recorded LC cases is as a result of cigarette smoking. It is one of the most occurring types of cancer around the globe. Objective: To emphasizes on amplification of specific mitochondrial DNA (mtDNA) genes coding for tyrosine tRNA and to find out its association with LC patients of Peshawar. Methods: In 18 LC patients, the mitochondrially encoded tRNA tyrosine gene was studied. Samples were collected from the Institute of Radiotherapy & Nuclear Medicine (IRNUM), Peshawar, Khyber Pakhtunkhwa. The participants varied in age from 12 to 86 years. Patients had diabetes, hypertension, hepatitis C, bronchial asthma, dyspnea, hemoptysis, cardio myopathy, and stomach ulcers. DNA extraction and PCR of the tyr tRNA gene were performed. Along with gel electrophoresis. 8 samples were cleaned and sequenced. Results: The results were used for comparison with the reference DNA sequence of mitochondria i.e., revised Cambridge Reference Sequence (rCRS) Accession No 0129201. According to NCBI BLAST data, there were no variations in the nucleotide position 5826-5891 of the mitochondrially encoded tyrosine tRNA gene in LC subject. Chromatogram of tyrosine gene which was taken from UGENE software showed that there is no variation in Tyrosine gene subject sequence. Conclusions: We found no mutation in the mtDNA encoded tyr tRNA gene related to LC patient from District Peshawar Khyber-Pakhtunkhwa, Pakistan during 2020-2022.

Antimicrobial Drug Resistance Trends of Bacteria Causing Bloodstream Infections in a Diagnostic Centre in Lahore

Sara Minahil — 2023-08-31

Bacteraemia due to multidrug-resistant (MDR) bacteria, particularly those producing carbapenemase or extended-spectrum beta-lactamase (ESBL), causes a significant threat to patients and associated morbidity and mortality. The global rise in the incidence of bacteremia necessitates the rapid and accurate identification of pathogens to ensure effective patient health management. Objective: To investigate antimicrobial drug resistance trends among bacteria causing bloodstream infections from a diagnostic centre in Lahore. Methods: This research was conducted at the Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore and Citilab and Research Centre, Lahore, from January 2020 to December 2022. A total of 2919 blood samples were cultured to screen the bacteremia patients. Following standard protocols, four hundred twenty isolates proceeded for gram-staining, biochemical characterization, and antimicrobial susceptibility testing (AST). The AST results of each strain calculated multiple antibiotic resistance (MAR). Results: Of 420 bacterial isolates, Gram-negative and Gram-positive isolates accounted for 48.57% and 51.43%, respectively. The predominant pathogens were Staphylococcus epidermidis (48.10%) and Salmonella typhi (27.14%), with other significant pathogens including Klebsiella spp., Pseudomonas spp., Enterobacter, Acinetobacter spp., Escherichia coli, Staphylococcus aureus, Enterococcus spp., Citrobacter, Morganella morganii, and Proteus mirabilis. AST revealed high resistance to Cephalosporins, Nitrofurantoin, Fosfomycin, and Quinolones. In contrast, Carbapenems demonstrated notable sensitivity. Salmonella typhi and Staphylococcus epidermidis exhibit the highest MAR values. Conclusions: The study highlights the prevalence of multidrug resistance bacteremia-causing pathogens, with a concerning trend towards decreasing antibiotic efficacy.