The National Medical Newspaper

Pakistan’s First Independent Medical Periodical from Karachi Vol. 51 No. 21 April 15-30, 2019 Published Fortnightly Reg. No. ID. MC-153 ISSN 1728-1520 Controlled Circulation

8000 to 10000 kids fall Rs 22.5 Million fine Polio virus detected Reproductive rights Inside victim to cancer in ... 03 imposed on 3 ... 06 in sewage systems ... 13 become a reality ... 14

Dr Zafar Mirza welcomed Pharma industry as Health Minister; Kiani forced to slash prices shown the door MN Report MN Report ISLAMABAD - The recent KARACHI - Pakistan appointment of eminent Pharmaceutical public health specialist, Dr Zafar Mirza, as the Manufacturers' Association Minister of State for (PPMA) announced to National Health Services, decrease the prices of 395 Regulations, and Coordination was essential medicines along with welcomed by the global and national public 464 medicines voluntarily by health fraternity. Assigning health at the 10 to 15 per cent in order to federal level to a top expert in the field provide due economic relief with years of relevant experience in to masses. Pakistan and at the regional and global Zahid Saeed, Chairman levels is expected to augur well for the PPMA announcing the manufacturers, PPMA prices of around 45,000 reform agenda promised by Prime Minister, decision of the industry said Chairman said they were medicines by 15 per cent Imran Khan. The new incumbent has the that prices of 395 essential forced to lower down the following a suo moto taken by vision, capacity, and capability to introduce medicines are being reduced prices of medicines on the the Supreme Court of and implement sweeping reforms in from one per cent to 471 per pressure from the Health Pakistan but in some hardship healthcare. cent as per government's Minister Aamir Kiani as well cases, prices of 464 Until yesterday, Dr Zafar Mirza was serving SRO no. 1610 and within 15 as Commerce Advisor Abdul medicines were increased at the post of Director, Health System days, these medicines would Razzaq Dawood even though over 15 per cent because their Development, at the WHO's Office for be available on reduced prices continuous increase in cost cost of production had Eastern Mediterranean Region (EMRO) throughout Pakistan. of production of medicines become unbearable for the based in Cairo, Egypt. The post portfolio Accompanied by Ayesha had made doing business industry and production of covers Universal Health Coverage, primary Tammy Haq, the very difficult in Pakistan. many of these drugs had been healthcare, health governance and representative from Pharma At the same time, the stopped by the financing, health workforce development, Bureau in Pakistan and in the pharmaceutical industry has pharmaceutical Continued on Page 09 presence of several drug voluntarily decided to lower manufacturers. the prices of another 464 "It is very painful and medicines by 10-15 per cent challenging decision for the 50% dip expected in and providing it to the pharmaceutical industry since people on their original hardship cases were decided HEC budget cut Founder: Ayaz Mahmood cost of production, in Nov 2018 when rupee MN Report PPMA chairman valued at 138 against the US Publisher: M Hassan Mahmood ISLAMABAD - Chairman HEC Dr Tariq announced, saying dollar. Today it is 143", Zahid Chief Executive: Syed Hashim Hasan Banuri recently chaired a special meeting /MedicalNewsPk medicines whose Saeed said, adding that of the Higher Education Commission Online Editor: Haseeb Uddin prices were being continuation of these prices /MedicalNewsPk (HEC), wherein the implications of Assistant Editor: reduced were is possible if the dollar does ongoing fiscal crisis for the higher Dr Hira Mustasfa Khan very well known not appreciate, utility prices education sector were reviewed, Honorary Advisor: and commonly are maintained and the Dr Sulman Akhtur particularly the budgetary projections for used medicines government is able to control Manager Production the fiscal year 2019-20. & Coordination: M Irfan Ali for the treatment inflation as prices of drugs medicalnewspk.com The commission was informed that the Advertising Manager of communicable cannot be isolated from these projected recurring budget demand of the Tel: 021-35833172 SM Shakil (0300-2559344) as well as non- factors. 021-35872289 higher education institutions for 2019-20 Business Executives communicable PPMA chairman announced was Rs103.55 billion, while development Khawaja Akhlaq Ahmed diseases. that the decisions are (0342-2393917) demand was Rs 55 billion; however the Haroon Rashid Recently, the implemented with immediate sector could face unprecedented budget (Islamabad: 0300-9710774) government of Pakistan effect and work on the Designing & Layout Continued on Page 09 Sh M Sadiq Ali allowed an increase in Continued on Page 09 Sindh needs dedicated treatment Healthcare initiative centre for hemophilia patients by ICWS team

MN Report Maher, Director, SBTA, Dr bleeding disorder with the MN Report KARACHI - Eminent Dur e Naaz Jamal, CEO, absence of clotting factor in KARACHI - ICWS recently organized a hematologists recently Hussaini Blood Bank, human blood and common community welfare medical camp for free blood stated there is no treatment Karachi, Asad Hussain, symptoms of this blood screening and health awareness at Elaj Medical centre dedicated to catering Consultant Hematologist, Dr disorder include excessive Center, DHA Phase II. The program was to patients suffering from Shabneez Hussain, and bleeding, bleeding gums, organized in collaboration with iSTOC Finland. hemophilia blood disorders others were also present on frequent nosebleeds, and in the Sindh province. occasion. pain in the joints. "Hemophilia Director, is a rare SBTA, Dr disorder in Dur e Naaz which the Jamal, said blood does that the not clot SBTA is properly. This striving hard means to provide people with safe and this condition screened bleed for blood to the The event was inaugurated by Governor of Sindh, longer than usual. This is On this occasion, Consultant children suffering from H.E. Imran Ismail, who appreciated the efforts of because these individuals Pediatric Hematologist, Dr hemophilia and other blood organizers. lack a clotting factor, which Saqib Ansari, said that World disorders. She explained The program was led by Dr Samiya who along works with platelets to cease Hemophilia Day is that generally male children with her team organized the event. bleeding at the site of injury. celebrated on April 17th with are affected by this inherited iSTOC's mission is to improve healthcare by This condition is usually the aims to increase bleeding disorder and enabling faster, easier, more accurate and less inherited and mostly affects awareness about inherited females are carriers of costly diagnostics all over the world. men." bleeding disorders. He said hemophilia. iSTOC is a global player in mobile point of care They shared these views that although there was no Speakers stressed on the (POC) diagnostics. It transforms stagnant and during an awareness national-level registry of this need for a dedicated facility disconnected data into relevant and actionable seminar organized by the inherited bleeding disorder, and rehabilitation centre for information. Sindh Blood Transfusion an estimate states that there children living with By integrating mobile technologies with smart Authority (SBTA) with are 3000 registered hemophilia in the Sindh services iSTOC has deployed and is deploying regards to World Hemophilia hemophilia patients in province as currently, these POC services to both consumers and professional Day in the Conference Pakistan out of which 1000 inherited bleeding disorder users. Room of the SBTA. The live in the Sindh province. management facilities are Director of Health Services, He explained that available only in private Karachi, Dr Abdul Fattah hemophilia is an inherited sector day-care centres. PPMA to organize 4th Pakistan Pharma Summit SHCC successfully completes MN Report KARACHI - The Pakistan Pharmaceutical Manufacturers' Association (PPMA) is hosting the first milestone year 4th Pakistan Pharma Summit on 23-24 April 2019 in Karachi. The event has become the annual biggest MN Report gathering of people associated with the KARACHI - Chairman, Sindh Healthcare in Sindh province pharmaceutical industry in the country. The theme Commission (SHCC), Prof Dr Tipu Sultan, and 193 HCEs of the conference this year is "Pharma in the age of revealed that the SHCC has successfully have been sealed Data and Disruption." completed its first milestone year of while a warning has been issued to 500 operations and achieved their specific others. goals set by the management despite He further quoted that training to 200 many hurdles and issues that impeded HCEs has been imparted for Service progress. Delivery Standards. The Directorate of He shared these views during the Complaints is also fully functional, and launching ceremony of the first progress 27 complaints have been resolved so far report which gives an overview of the out of 40 in total. "For ensuring quality SHCC progress from its inception till date. service, delivery standards have been Chief Executive Officer, SHCC, Dr Minhaj developed by the commission and pieces Qidwai, Dr Ayaz Mustafa, and others were of training have been imparted to two Eminent names such as Prof Dr Sarfaraz K Niazi also present on occasion. members from each registered hospital (Sitara-e-Imtiaz) - Founder Therapeutic Proteins, a Prof Tipu Sultan said that the SHCC has to prepare for training & inspection" he biosimilar Company, USA; Dr Adil H. Haider - Dean, successfully worked on the process of added. The Aga Khan University & Co-Founder, registration and licensing and so far, 4238 Chairman, SHCC, said that the standards doctella.com, USA; Khurram Hamid - Chief Marketing registration certificates have been given for primary care clinics, homeopathy, and & Strategy Officer, Investech Partners Investment to various Healthcare Establishments Tibb have also been developed, while LLC; Daniel Ghinn - Top Global Pharma Influencer (HCEs) in the province. He informed that initiatives have been taken on bringing UK; Dr Nadia Bukhari (Fellow of the Royal the licensing process of the hospital has the stakeholders together for hospital Pharmaceutical Society) will address the conference. also been initiated. He said that the drive waste management. He stated that the Jill Donahue - President and Founder, Engage Rx and Dr Kivilcim Kayabali - Founder of PTMS against quackery has started in full force Continued on Page 09 Continued on Page 09

02 MEDICAL NEWS / April 15-30, 2019 8000 to 10000 kids fall victim International Delegation to cancer in Pakistan annually visits RBTC

MN Report MN Report KARACHI - The Aga Khan KARACHI - A two-member University Hospital (AKUH) hosted delegation of the GIZ and KFW their annual Oncology Hematology (German Development Bank) party for the year 2019. recently paid a visit to the This event is organized every year Regional Blood Transfusion to celebrate the successful journey Centre (RBTC) in Karachi and of young cancer survivors and also reviewed the newly constructed to encourage the parents and building. families of children going through The delegation comprised of cancer treatment, give them hope 8000 to 10000 kids probably Head of the Pediatric Oncology internationally acclaimed and make them believe that cancer develop cancer every year, and Department, Dr Zehra Fadoo, said, architect, Mr. Rainer Riha, and is curable. The event was attended amongst them, only 3000 to 4000 "Leukemia is the most common Zahid Mehmood, who paid a visit by the faculty, staff, pediatric reach the cancer centre for form of cancer among children. to the RBTC, Karachi, along with patients, their families, and appropriate care. The majority of AKUH is providing treatment the Director of the Sindh Blood caregivers. patients come in for treatment at for all types of cancers at all stages. Transfusion Authority (SBTA), Dr This year's theme for the event was the very late stage of cancer." We have a multidisciplinary team Durenaz. During their stay, they 'Happiness is here.' In line with the The party had numerous on stage dedicated to children's cancer, reviewed the building structure theme of the event, the party arena and off stage activities for the providing all kinds of support. The and equipment in detail. was decorated with bright balloons children which included Zumba and AKUH has teams having expertise Briefing the delegation, Director, and had the children dressed in singing. It was heartwarming to including but not limited to, SBTA, Dr Durenaz, said that the vivid colours. watch the participants tap their feet, neurology, brain tumors, bone, and RBTC, Karachi, had been handed The multi-disciplinary team at the sway their shoulders, bob their soft tissues, and transplantations." over to the Fatimid Foundation in Aga Khan University Hospital head, as they immersed themselves A poster competition was also recent past and would be made provides quality treatment and in collaborative drumming with the organized, and the theme of the operational under the public- statistics show that if the treatment drum circle. The children had a competition was "Happiness is private partnership mode. She is given well in time, there is an good time playing games at the here." Numerous kids participated further said the RBTC, Karachi 80% chance of the child being gaming zone, getting their faces in the competition and made was linked with other major health cured. painted, and participating in the Arts amazing posters. Certificates were facilities of Karachi to ensure safe As per the Chief Medical Officer, & Crafts booth. distributed to the survivors on provision of blood when needed. Dr Asim Belgaumi, "Approximately Associate Professor and Section fighting their disease bravely.

MEDICAL NEWS / April 15-30, 2019 03 Compositional Quality and Potential gastrointestinal Behavior of Probiotic Products commercialized in Italy

By Alessandra Vecchione1, each product. Total CFU were formulations in two standard Enterelle. On the other hand, in the ASTM juice, 1 Francesco Celandroni , Diletta concordant with the labeled simulated gastric fluids, both the bacteria contained in Enterolactis Plus, 1 2 Mazzantini , Sonia Senesi , number of cells for characterized by a low pH Enterogermina, Yovis, and Lactoflorene Plus, Reuflor, Antonella Lupetti1 and Emilia Enterogermina, Codex, (1.4-1.5), containing (USP) or VSL3 were found to be able Codex, Prolife, Dicoflor, and Ghelardi1,3* Prolife, and Dicoflor. not (ASTM) pepsin, in order to tolerate the acidic condition Enterelle showed a significant ecent guidelines indicate Lactoflorene Plus produced to mimic an extremely harsh of the juice as long as 120 reduction (P < 0.01) in the R that oral probiotics, living a lower CFU number per unit gastric environment. Figure 1 min. At this time, the% survival number of viable cells after microorganisms able to confer dose than that declared by shows the results of the total of the organisms contained in 30 or 60 min of incubation in a health benefit on the host, the manufacturer. Total CFU counts obtained at 0 min and these formulations was 96, the artificial gastric juice. At should be safe for human originating from Enterolactis after 30-, 60-, and 120-min 97, and 99%, respectively. At the end of the incu- bation in consumption, when Plus, Reuflor, Enterelle, Yovis, incubation for a unit dose of the end of the incubation in the artificial gastric juice, no administered in a sufficient and VSL3 were 1-3 log higher each formulation in the ASTM the artificial gastric juice, a residual colonies were found amount, and resist acid and than those labeled. The artificial gastric juice. The 36, 65, and 75% survival was for Enterolactis Plus, bile to exert their beneficial amount of spores contained majority of products registered for Reuflor, Codex, Lactoflorene Plus, and effects (e.g., metabolic, in Enterogermina, (Enterolactis Plus, and Prolife, respectively. No Dicoflor, a 24% survival was immunomodulatory, anti- Lactoflorene Plus, and Prolife Lactoflorene Plus, Reuflor, residual alive organisms were obtained for Enterelle, while inflammatory, competitive). was concordant with the Codex, Prolife, Dicoflor, found in Enterolactis Plus and Reuflor, Codex, and Prolife This study evaluated quanti- labeled amount of B. clausii Enterelle) showed a Lactoflorene Plus after 120 showed a 69, 78, and 62% tative and qualitative aspects spores and B. coagulans significant reduction (P < 0.05) min of incubation. survival, respectively. Vitality and the viability in simulated (2 × 109, 2 × 107, >109, in the number of viable cells Figure 2 shows the results of of the microorganisms gastric and intestinal juices of respectively). already after 30 min of the total counts obtained at 0 present in Enterogermina, commercial probiotic All morphologically different incubation in the artificial min and after 30-, 60-, and Yovis, and VSL3 was not formulations available in Italy. colonies isolated from each gastric juice. At this incubation 120-min incubation in the affected by the incubation in Plate counting and MALDI- product were subjected to time, no residual CFU were USP artificial gastric juice. the juice as long as 120 min. TOF mass spectrometry were identification by MALDI-TOF found for Dicoflor and Similar to the results obtained Continued on Page 12 used to enumerate and MS. Biochemical identify the contained identification was also organisms. In vitro studies applied to Bacillus, with two artificial gastric juices Streptococcus, and and pancreatin-bile salt Enterococcus spp. solution were performed to Table 3 reports the gain information on the gastric results of all the tolerance and bile resistance identification of the probiotic formulations. procedures. Most preparations satisfied Concordant results the requirements for were obtained by probiotics and no MALDI-TOF MS and contaminants were found. biochemical testing. All Acid resistance and viability the identified species in bile were extremely variable corresponded to those depending on the composition labeled by the of the formulations in terms manufacturers. No of contained species and contaminant strains. In conclusion, this microorganism was study indicates good found in any product. microbiological quality but Lactobacillus striking differences in the delbrueckii subsp. behavior in the presence of bulgaricus, which is acids and bile for probiotic declared to be present formulations marketed in Italy. in Yovis and VSL3, was Keywords: probiotics, identified only at the microbial identification, MalDi- genus level. Possibly TOF, gastric juice, intestinal due to the difficulty to fluid, acid resistance, bile recognize the colonies tolerance produced by different Results Bifidobacterium species Enumeration and and to the genus identification of the complexity, we were not Organisms contained in able to identify the three Probiotic Formulations Bifidobacterium species Considering the importance labeled on Yovis and of compositional quality for VSL3. commercial probiotic Microbial survival in products, particularly for simulated gastric medicinal products, we Juice analyzed the formulations stomach pH is reported in Table 1 in terms important in predicting of enumeration and the potential survival of identification of the contained probiotics in the organisms. Table 2 reports gastrointestinal the labeled number of cells, conditions. Gastric pH the total counts (total CFU), varies from 1.5 to 3.5 and the counts of spores in the human stomach (CFU from spores only) lumen. In this study, obtained for a unit dose (one we decided to evaluate vial, one capsule, one bottle, the behavior of the one sachet or five drops) of selected probiotic

04 MEDICAL NEWS / April 15-30, 2019 2019 NATIONAL April 8-9 International Conference and Exhibition on Traditional & Alternative Medicine (ICETAM-19) at Pakistan.

Drug prices low in Pakistan April 26-28 Annual Islamabad Congress Of Ophthalmology at Pearl Continental compared to India & Bangladesh Hotel Bhurban, Bhurban, Pakistan.

MN Report to ensure the very survival of increased manifold since 2018 KARACHI - Central Chairman, the pharmaceutical industry of due to an unprecedented October 19-21 Pakistan Pharmaceutical the country. The pharmaceutical decrease in value of rupee as International Conference on Medical Manufacturers' Association industry is facing serious compared to the dollar while (PPMA), Zahid Saeed, recently economic challenges in its keeping in view the fact that up Education 2019. Theme: 21st Century informed that the government strive to produce quality drugs to 90% of the raw material of challenges in the Health Professionals had ordered a 15% increase in at affordable prices for the the industry was imported. Education Has Workshops and the prices of locally produced patients in Pakistan. "Meanwhile, the electricity tariff medicines in January this year He stated this while addressing increased by 45%, the natural Lectures. at Riphah Academy of a press conference at a gas bill increased by 65% while Research and Education (RARE) local hotel of Karachi, diesel price also increased by Riphah International University, Al- Provision of safe blood accompanied by other 95% as all these factors also Mizan Campus, 274-Peshawer Road, representatives of the directly affect the cost of our to patients, Sindh Pakistani Pharma production," said the PPMA Rawalpindi, Pakistan. industry. He claimed that chairman. Govt's top priority locally produced drugs in "The media have done Pakistan had lower prices reporting in such a manner as MN Report as compared to India, if there has been ordered an October 28-29 KARACHI - The Sindh Minister Bangladesh and the rest unprecedented hike in the International Conference on Medical for Health and Population Welfare, of the world. prices of medicines. It is our & Health Science at Pearl Continental Dr Azra Fazal Pechuho, said that said on the occasion that duty to inform you that such it is our fundamental duty to the increase in prices of negative propaganda could Hotel, Rawalpindi, Pakistan. provide safe blood to the patients medicines had been compel the Pakistani Pharma in order to save their lives and to ordered after following all industry to move outside the maintain vigilance the due procedures, country as has been the case on blood banks as formalities, regulatory of multi-national drug 2019 well. framework, and is in manufacturers," said Zahid This she said accordance with the latest Saeed. while witnessing Drug Pricing Policy of the Saeed further quoted that in the signing government. He said that such a situation it had become APRIL SEPTEMBER ceremony the increase in prices of utterly difficult for local and 2 World Autism Awareness Day 9 International Fetal Alcohol 7 World Health Day Syndrome Day of the concession medicines had been in foreign drug companies to 17 World Haemophilia Day 21 World Alzheimer’s Day agreement between conformity with the several introduce new medicines in the 24 World Immunization Week 20 World Retina Week 25 World Malaria Day 25 World Pharmacist Day the Sindh Health directions of the apex Pakistani market. MAY 26 World Retina Day Department and the Fatimid 29 World Heart Day judiciary on the issue. He said that apart from the 15% 5 World Asthma Day Foundation for the Regional Blood He said that in case the increase in the prices of 8 World Thalassemia Week OCTOBER 10 World Move For Health Day Bank, Karachi, under the public, government had not medicines, the Drug Regulatory 12 World Chronic Fatigue And 8 World Sight Day private partnership mode in her Immune Dysfunction Syndrome 10 World Mental Health Day allowed the much-needed Authority of Pakistan had 12 International Nurses Day 12 World Arthritis Day office. relief to the Pakistani ordered an increase in prices 17 World Hypertension Day 12 World Bone And Joint Week 28 International Day of Action 15 World Handwashing Day Secretary Health, Sindh, Saeed medicine manufacturers of 450 medicines as all their for Women’s Health 16 World Food Day Ahmed Awan, and Chief Operating 31 World No Tobacco Day 17 World Spine Day in the form of the 15% cases fall in the category of 17 World Trauma Day Officer, Fatimid Foundation, Dr increase in locally extreme hardship. Special JUNE 20 World Osteoporosis Day Waleed Bin Izhar, signed on the 1 World Milk Day 24 World Polio Day produced drugs, the public consideration was required to 1 International Children Day 29 World Stroke Day concession agreement. Chairman, healthcare system of the ensure continuous local 5 World Environment Day Fatimid Foundation, General (R) 14 World Blood Donor Day NOVEMBER country would have been manufacturing of these 19 World Sickle Cell Day 1 Lung Cancer Awareness Month Moin Haider, and Director, PPP 26 International Day Against Drug 9 World Quality Day in sheer shambles due to essential drugs as their cost of Abuse And Illicit Drug Trafficking 14 International Diabetes Day Mode, Dadlo Zuhrani were also the unavailability of production went up 17 World Chronic Obstructive present on occasion. JULY Pulmonary Disease Day medicines. phenomenally during the last 11 World Population Day 26 World Anti-Obesity Day While speaking on occasion, Dr 28 World Hepatitis Day He stated that cost of 10 years due to various DECEMBER Azra Pechuho asked all the blood production of the local economic and business factors. AUGUST 1 World Aids Day Continued on Page 09 3 International Day of Disabled Persons pharma industry had Continued on Page 09 1-7 World Breastfeeding Week 5 World Patient Safety Day

MEDICAL NEWS / April 15-30, 2019 05 Rs 22.5 Million fine MAP confers lifetime imposed on 3 medical achievement award on Dr Abdul Bari Khan and dental institutes MN Report KARACHI - The Management MN Report institutions. Dental College; Association of Pakistan has ISLAMABAD - Three The inquiry found that Mirpurkhas Sindh (BDS); conferred its Lifetime Achievement medical and dental eight of the 22 institutions and AJ&K Medical Award on Dr Abdul Bari Khan, Hilal- colleges have been named by the PMDC had College, Muzaffarabad. e-Imtiaz, CEO, Indus Health penalized by Competition misrepresented facts The CCP order imposed Network, for his lifelong services Commission of Pakistan about their recognition by a penalty of Rs7.5m each to humanity. Dr Abdul Bari Khan (CCP) for violating Section the council through their on the Bhittai Medical & has been providing quality health 10 of the Competition Act, websites, and had not Dental College, care services to less-privileged 2010 by fraudulently communicated to the Mirpurkhas; Women people and has done exemplary philanthropic and social claiming recognition by the students and their parents Medical College, work for the nation. Pakistan Medical and that they had been barred Abbottabad; and Pak Red The Award was presented at the 34th Corporate Dental Council (PMDC) from offering admissions Crescent Medical & Dental Excellence Awards ceremony of the Management and offering Association of Pakistan which was recently held in admissions to Karachi. MAP has been organizing the Corporate students for Excellence Awards, which are considered a benchmark 2013-14 for corporate excellence in the country, consistently sessions. The since 1982. imposed fine is Speaking on occasion, Dr Abdul Bari Khan said that Rs22.5 million. MAP's contribution in imparting management education The CCP and developing management professionals in the conducted an country was unparalleled. He stressed that holding inquiry into events like the Corporate Excellence Awards promote allegations of networking amongst companies and is a means for resorting to sharing their best practices. deceptive Earlier, Mr Asif Ikram, President, MAP, talked about the marketing practices, after for the year 2013-14, and College, Lahore for role that the MAP has played in creating awareness the PMDC in a press in doing so violated violating Section 10 of the about the best management practices amongst release named 22 private Section 10 of the Competition Act in view of companies. The MAP Corporate Excellence Award, he medical and dental Competition Act. the timing of their said, is considered the ultimate accolade in the realm colleges that had failed to These eight institutions advertisements about of corporate management. He said that the goal of meet its registration include the Pak Red offering admissions for corporate excellence must be to use corporate assets criteria for 2013-14 and Crescent Medical & Dental 2013-14 despite being - especially human capital-to build and enhance were either not recognised College, Lahore; restricted by the PMDC. sustainable social and environmental systems. or had restrictions placed Mohiuddin Islamic Medical No penalty was imposed Mr Asif Ikram also talked about the MAP's interactions on offering admissions for College, Mirpur, Azad on the remaining medical with international bodies such as the Asian Association the 2013-14 sessions. Kashmir; Abbottabad and dental colleges due of Management Organizations (AAMO) and about the The CCP inquiry was not International Medical to lack of evidence but various value-added benefits it offers to MAP members. only aimed to implement College, Abbottabad; they were strongly He said that on the recommendation of MAP, the Asian its mandate but also to Independent Medical cautioned against Association of Management Organizations would confer safeguard the interests of College, Faisalabad; publicising their an AAMO Leadership Award on Dr Abdul Bari, at an thousands of students Women Medical College, recognition by the PMDC event to be held in Kuala Lumpur in the last week of from being adversely Abbottabad; Hashmat when that recognition is April 2019. affected by the Medical & Dental College, either suspended or The top trophy winner for the 34th Corporate Excellence unrecognised medical Gujrat; Bhittai Medical & cancelled. Awards in the Amir S. Chinoy Industrial category was the Indus Motor Company Ltd. while Jubilee Life Insurance Co. Ltd. was awarded the top trophy in the PMDC to revisit NUMS merit lists Finance category. Sector-wise awards in the Industrial sector were given MN Report to Pakistan Tobacco Co. Ltd., International Steels Ltd., Mari Petroleum Co. Ltd., Al-Ghazi Tractors Ltd., Thal RAWALPINDI - After learning of the discrepancies in the merit lists provided Ltd., Pakistan International Container Terminal Ltd., by the National University of Medical Sciences (NUMS), the Pakistan Medical Lucky Cement Ltd., Fauji Fertilizer Co. Ltd., Abbott and Dental Association (PMDC) will be revisiting the merit lists for MBBS and Laboratories Pak Ltd., Archroma Pakistan Ltd., Cherat BDS admissions. Packaging Ltd., Colgate-Palmolive Pakistan Ltd., Feroze The admission board of the council has directed to maintain the status quo until the NUMS Mills Ltd., Hub Power Company Ltd. and Shifa discrepancies are addressed and a final admissions list for NUMS is approved and notified International Hospitals Ltd. by the PMDC admissions board. Sector-wise awards in the Financial Sector were received Moreover, the council's admission board has approved medical admissions on the vacant seats of the Punjab University of Health Sciences, Khyber Medical University and the Jinnah- by Standard Chartered Bank Ltd., Jubilee General Sindh Medical University. Insurance Company Ltd., Orix Leasing Pakistan Ltd., To protect the rights of students, some 136 applicants have been adjusted while they have Orix Modaraba, Golden Arrow Selected Fund, and been directed to contact their respective colleges to finalise their admissions. MCB-Arif Habib Savings & Investments Ltd. However, the PMDC has clarified that it will not upgrade or add to the admissions list it has Certificates of Excellence in the Not-for-Profit Sector already issued. were presented to Shaukat Khanum Memorial Hospital, Any applicant who does not avail the allocated seat, they will not be accommodated further The Citizens Foundation, and the LRBT. nor will the vacant seat be filled at the college since admissions for the current academic The runners up companies were awarded Certificates year are closed. of Corporate Excellence.

06 MEDICAL NEWS / April 15-30, 2019 MEDICAL NEWS / April 15-30, 2019 07 Acute hunger still 257 Thari children die in 4 months as affects over 100m drought persists MN Report MITHI - According to sources, at least people worldwide 257 children have died of malnutrition and disease during four months of this year in the Thar region as drought conditions persist. BRUSSELS - According to a and the number of countries number of hungry people. And The latest reported death was that of report presented recently jointly affected has risen. Moreover, an one thing we need world leaders a baby Narain Bheel, resident of by the European Union, the Food additional 143 million people in to do as well: step up to the plate village Londhar, who died of and Agriculture Organization of another 42 countries are just one and help solve these conflicts, malnutrition and disease at Civil the United Nations (FAO), and step away from facing acute right now," said WFP Executive Hospital, Mithi, exposing the major the UN World Food Programme hunger. Director David Beasley. hospital's efficiency and performance. (WFP), around 113 million Nearly two-thirds of those facing The report's findings are a Although a matter of grave concern, people in 53 countries acute hunger are in just 8 powerful call for strengthened this news is not surprising as it has experienced acute food countries: Afghanistan, the cooperation that links together become routine for infants to die in insecurity in 2018, compared to Democratic Republic of the prevention, preparedness and this hospital. 124 million in 2017. Congo, Ethiopia, Nigeria, South response to address urgent Commissioner for International Sudan, Sudan, Syria, and humanitarian needs and root Cooperation and Development, Yemen. In 17 countries, acute causes, which include climate Neven Mimica said, "Food hunger either remained the same change, economic shocks, insecurity remains a global or increased. conflict, and displacement. It challenge. That's why, from 2014 Climate and natural disasters further highlights the need for a to 2020, the EU will have pushed another 29 million people unified approach and action provided nearly €9 billion across the humanitarian According to a report, over 505 for initiatives on food and and development children died in Thar in 2018, 450 in nutrition security and dimensions of food 2017, 479 in 2016, and 398 in 2015. sustainable agriculture in crises, and for more These deaths can be attributed to over 60 countries. investment in conflict various reasons, including pre- Today's Global Report mitigation and term/low birth weight, birth asphyxia, highlights the need for sustainable peace. severe pneumonia, neonatal sepsis, strengthened Global Report is respiratory distress syndrome (RDS), cooperation between produced each year by acute malnutrition with complication, humanitarian, the Global Network sepsis (under five), and diarrhea. development and peace Against Food Crises, "Thar is the most severely affected actors to reverse and which is made up of area of Sindh by the drought. As a prevent food crises. A international result, food insecurity is rising with stronger Global Network can into acute food insecurity in 2018. humanitarian and development each passing day. The women have help deliver change on the And 13 countries - including partners. This year's report is become weak due to malnutrition, ground for the people who really North Korea and Venezuela - are being presented at a two-day and they give birth to weak babies need it." not in the analysis because of high-level event, 'Food and who are unable to get their required Christos Stylianides, EU data gaps. agriculture in times of crisis' that milk and other needy medicines. As Commissioner for Humanitarian "It is clear from the Global Report begins in Brussels today and will a result, the yearly death toll of Aid and Crisis Management, said that despite a slight drop in 2018 look at innovative approaches children is rising because authorities "Food crises continue to be a in the number of people and solutions for preventing and have failed to save them," said Abdul global challenge, which requires experiencing acute food addressing food crises, plus a Rasool, a resident of Mithi. our joint efforts. The EU insecurity - the most extreme roadmap for future joint action. Sindh authorities almost seemed continues to step up its form of hunger - the figure is still For more key findings from the surrounded by political issues; hence, humanitarian efforts. Over the far too high. We must act at scale report, see the Global Report they pay next to no heed to the Thar last three years, the EU allocated across the humanitarian- fact sheet. region. It is a matter of great concern the biggest humanitarian food development-peace nexus to Acute food insecurity is when a that the children of Thar have been and nutrition assistance budget build the resilience of affected person's inability to consume dying in larger proportions daily as ever, with nearly EUR 2 billion and vulnerable populations. To adequate food puts their lives or compared to the other areas of Sindh, overall. Food crises are save lives, we also have to save livelihoods in immediate danger. he added. The Sindh government has becoming more acute and livelihoods," said FAO Director- It draws on internationally placed the health sector on top priority, complex, and we need innovative General José Graziano da Silva. accepted measures of extreme but by the looks of it, this sector still ways to tackle and prevent them "To truly end hunger, we must hunger, such as the Integrated seems to be at low priority, Rasool from happening. The Global attack the root causes: conflict, Food Security Phase observed. Report provides a basis to instability, the impact of climate Classification (IPC) and the A multi-sector needs assessment was formulate the next steps of the shocks. Boys and girls need to Cadre Harmonisé. carried out by the National Disaster Global Network by improving our be well-nourished and educated, Chronic hunger is when a person Consortium (NDC) led by the IOM in coordination mechanisms." women need to be truly is unable to consume enough collaboration with the FAO, UNICEF, The figure of 113 million people empowered, and rural food to maintain a healthy, active WFP, WHO, HANDS, and ACTED facing food crises is down slightly infrastructure must be lifestyle over an extended period. that confirms that overall 71% of from the 124 million figure for strengthened in order to meet The FAO's most recent State of households are moderately or 2017. However, the number of that Zero Hunger goal. Food Security and Nutrition severely food insecure whereas 32% people in the world facing food Programmes that make a report, in September 2018, found are severely food insecure. Food crises has remained well over community resilient and more that 821 million people on the Continued on Page 09 100 million in the last three years, stable will also reduce the planet are going hungry.

08 MEDICAL NEWS / April 15-30, 2019 Pharma industry forced ... the Constitution of the Islamic Republic of be discussing the current innovations and were coming to get treatment. Continued from front page Pakistan, The President, on the advice of technology trends in the pharma industry, Bilawal informed that the new Cardiac replacement of stocks has commenced the Prime Minister, has been pleased to the emerging issues such as Precision Complex had been established consisting ensuring availability of reduced price, remove Aamer Mehmood Kiani from the Medicine, Wearables/IoT, Digital of 60 beds. Dr Nadim Qamar, Executive adding that process to recover and replace office of Federal for National Health Thereupatics, Data Analytics, Health Tech Director, NICVD, said that a satellite center stocks at distributor / retail shelf level will Services, Regulations and Coordination Startups, Serialization, Social Media, AI was established at the NICVD on May be 100% complete in next 15 days since with the effect from 18th April, 2019." and Blockchain in Pharma, etc. will also 13th, 2017 during which 76670 patients logistics will take time and shortages must be discussed. had been provided with premium health be avoided. 50% dip expected in ... The founders of five health startups will facilities. Zahid Saeed maintained that the Continued from front page also give innovative talks on different He further informed that in Tando government had allowed 15 per cent cuts of up to 50 per cent, a press release aspects of digital health. Muhammad Khan Center, 191845 increase in prices of locally produced said. A pre-conference workshop will precede patients, in the Hyderabad Center, 43782, medicines in January this year to ensure "If this turns out to be true, it will bring the conference on Digital Health Pharma in Sehwan Center, 28918, in Sukkur, the very survival of the pharmaceutical about a massive disruption in the provision 101 - Physician & Patient Engagement 194362, in Nawabshah, 57732, in Mithi, industry of the country facing serious of facilitated higher education and conduct beyond the Pill on Tuesday, 23rd April 2019 26935 and Khairpur Center, 47999 economic challenges in its strive to produce of research," the commission underscored. which will be co-facilitated by Daniel Ghinn patients, have been provided health quality drugs at affordable prices for the The commission expressed grave and Dr Zakiuddin Ahmed - Digital Health facilities so far. patients in Pakistan. concerns about these indications and Expert & Health Entrepreneur. TerraBiz is Increase in prices of medicines had been called upon the quarter concerned to the lead partner of the conference while 257 Thari children die ... in conformity with the several directions of ensure that adequate resources were Martin Dow is the founding partner. Continued from page 08 the apex judiciary on the issue, he said provided to higher education institutions. consumption for the majority of households and added that in case the government The commission directed the chairman to Provision of safe blood ... is either 'poor' or 'borderline' with 18% had not allowed the much-needed relief to undertake a sensitivity analysis of Continued from page 05 having acceptable, 41% having poor and the Pakistani medicines' manufacturers in alternative budgetary scenarios, with a banks across the province to provide safe 41% having borderline food consumption. the form of 15 per cent increase in locally view to ensure that essential programmes blood to the patients, and if anyone violated The findings suggest that the drought has produced drugs, public healthcare system are not slashed, especially those that the standard operating procedure in this caused an overall 34% reduction in crop of the country would have been in sheer sustain the quality of undergraduate regard, strict measures would be taken to cultivation. shambles due to unavailability of medicines. education in the country. task. The crop wise reduction in area cultivation "Cost of production of the local Pharma The commission also urged vice- She asked the concerned authorities to was highest in Tharparkar, where cluster industry had increased manifold since 2018 chancellors to invest in greater efficiency keep a vigilant eye on the working of blood bean cultivation was reduced by 92%, due to an unprecedented decrease in value and transparency, and identify possible banks and ensure the supply of safe blood millet by 84%, and pulses by 95%. In of rupee as compared to the dollar while austerity measures which ensure that to the patients. Tharparkar and Umerkot, sesame keeping in view the fact that up to 90 per resources were used most effectively. cultivation was reduced by 100% thus cent raw material of the industry was The HEC decided to accelerate the Drugs prices low in Pakistan ... severely impacting food security and imported", he informed. deployment of the Higher Education Continued from page 05 livelihoods. Initial findings from the National Urging the government to slash duties and Management Information System in order He said that the increase in prices of these Nutrition Survey show that the malnutrition taxes on import of raw material including to enhance transparency and enable hardship medicines had been well in rate among children under five, as well as packaging material, he said they contribute increased efficiency. accordance with the Drug Pricing Policy among pregnant and lactating women in Rs. 50 billion annually to the national It directed the chairman to establish a of 2018 and earlier directions of the Baluchistan, is alarmingly high. exchequer in the form of taxes and added fundraising programme for higher Supreme Court on the issue. Global acute malnutrition among children that if the government makes them tax free education including mobilization of Saeed stated that earlier several locally under five was 18.6% above the global industry, they could slash prices by another resources from alumni, philanthropists, manufactured medicines had virtually nutrition emergency threshold of 15% in 15-20 per cent while they could also earn industry and by attracting a broader array vanished from the market as the every district. Similarly, malnutrition among valuable foreign exchange by becoming of students including students from foreign government did not allow a review on their pregnant women is 37%. Around 20% of the second largest exporting industry of countries. prices for over a period of ten years while acute malnutrition is prevalent among Pakistan within two years. their cost of production kept on increasing. children and pregnant and lactating SHCC successfully ... Their local production became infeasible Women (PLW). Dr Zafar Mirza welcomed ... Continued from page 02 for the Pharma industry. Such cases did Pakistan is among the few countries with Continued from front page task forces responsible for the anti- include medicines required to treat patients a high infant mortality rate, with 22 infants integrated health service delivery, quackery campaign had been notified, and battling life-threatening diseases in the dying before turning one-month-old. A pharmaceuticals, and health technologies. training material is being developed for country. baby born in Pakistan is almost 50 times Dr Zafar Mirza also served as the acting doctors & lady health workers for infection He said that the survival of the Pakistani more likely to die during his or her first WHO Representative in Iran and remained control. pharmaceutical industry had been equally month than a baby born in Japan, Iceland, the team lead for Public Health, Innovation, CEO, SHCC, Dr Minhaj Qidwai, informed beneficial for all the concerned stakeholders and Singapore. and Intellectual Property at the WHO, that for the first time in the history of Sindh including the government, the public The government needs to take hectic Geneva. He remained functional as the province, the SHCC had launched a geo- healthcare system, regulatory authorities, measures to provide full treatment to the Regional Adviser for Essential Medicines mapping of public and private HCEs which and most importantly, the ailing citizens of sick children of the Thar region in view of and Pharmaceuticals in Cairo. Earlier on, will help in providing the data on HCEs the country who required quality medicines its claim of keeping the health sector at he served as the founding National and eradicating quacks. at affordable prices. top most priority basis besides providing Coordinator of The Network for Consumer He said that the quality of healthcare is of sufficient food and other relief items Protection in Pakistan. the utmost importance in ensuring patient Bilawal inaugurates ... because of the ongoing drought in the Eisenhower Fellow (2004), Britannia safety. Maintenance of quality of health Continued from page 06 Thar region. Scholar (1994), and holder of a Master's service delivery and guaranteeing ethical Bilawal said that after the passing of the The drought in Tharparkar has gravely degree in Public Health (London), Dr Zafar practices with the eradication of quackery 18th amendment, they had done a affected the lives of many. The worst-hit had been on the faculty of Boston School are the two mandates for the enactment tremendous job in the health sector but demographic is children. Malnutrition and of Public Health, Joint Faculty of WHO of the Sindh Healthcare Commission those who wanted one unit say that 'we disease are on the rise due to poverty and Harvard Medical School, and the Federal (SHCC) Act 2013. have no such capacity,' he added. food insecurity. However, the government Health Services Academy of Pakistan. The NICVD has proved itself to be a world- has initiated relief measures to provide Prime Minister Imran Khan had removed PPMA to organize 4th ... class institution by providing free treatment some food items to the poor, but the fact now-former Federal Minister for National Continued from page 02 services to the ailing masses which is an is that it is insufficient. Health Services, Regulations and Organizer of Digital Health Summits will achievement for Pakistan as it is the The Sindh government should come Coordination Aamir Mehmood Kiani. On be addressing the conference via Skype. largest hospital of heart diseases in South forward with sincere efforts and do what the recommendation of the Prime Minister, Chairman of Pakistan Pharma Summit, Dr Asia." is necessary for the Thar region instead President of Pakistan Arif Alvi approved Shaikh Kaiser Waheed, expressed the He said it was the habit of other parties of merely delivering lip service. The fact de-notification of Kiani as Health Minister. hope that the summit will build on the to focus on a single city, but the PPP had is that Rs100 billion are required to spend A notification to this effect was issued, momentum of the first three such summits established the NICVD in all the major on the people of Thar per annum to which stated: "In exercise of powers held previously in Karachi and Lahore. He cities of Sindh where patients from Punjab, alleviate poverty as Imran Khan has conferred by the clause (3) of Article 92 of further added that the conference would KPK, Baluchistan, and even Afghanistan announced for the FATA region.

MEDICAL NEWS / April 15-30, 2019 09 Skit competition to highlight Bilawal inaugurates NICVD Cardiac Alzheimer’s disease Complex in Larkana

MN Report patients. Rawalpindi Chapter (APRC) MN Report RAWALPINDI - A seminar Prof Dr Mubashar Malik and Maj Rtd M. Abdul Basit, LARKANA - PPP Chairman, Bilawal Bhutto and inter-university skit retired Brig Dr Muwadat Master trainer (Champion of Zardari, offered the Sindh government's competition was recently Hussain Rana, professors of Dementia Friends) Ms. Sadaf cooperation to the federal government for organized by Fatima Jinnah psychiatry, talked about the Ehtisam, and Clinical establishing better hospitals in areas Women University (FJWU) in disease and the need to Psychologist Ms. Faria extending from Cholistan to Gujar Khan collaboration with Alzheimer's address the stigma associated Rehman. and FATA to Peshawar. Bilawal stated that Pakistan Rawalpindi Chapter with the disease. They Brig Rana spoke of the role they had made state of the art hospitals (APRC). The event was based encouraged the students to played by APRC in raising like the NICVD from Karachi to Sukkur to Mithi where free medical treatment is provided.

Bilawal stated that he would request the Sindh Chief Minister to write a letter in this connection to his counterparts in other provinces offering them the necessary services for the establishment of cardiac hospitals. He was talking to media persons after inaugurating the new Cardiac Complex of the NICVD building in Chandka Medical College Hospital recently. Bhutto quoted that annually, 25000 cardiac patients expired in Pakistan. Bilawal claimed that the developments made in on the theme: 'Alzheimer's volunteer their services in awareness about Alzheimer's the health sector in Sindh were unmatched disease and related disorders' raising awareness of among the community. Ms. compared to other provinces for which he and the motive was to raise Alzheimer's disease. Faria Rehman explained the also congratulated Sindh government. awareness regarding this Registrar, Fatima Jinnah phenomenon of Dementia Continued on Page 09 disease. Multiple universities Women University, Prof and its prevalence rates in across Rawalpindi Samina Bukhari, in her closing Pakistan. She also discussed participated in the several symptoms Seminar for a Rabies-free event. that are an indication Dr Iram Gul, the of Alzheimer's but are Karachi, HU focal person of ignored due to lack MN Report the event is of awareness in the confident that general public. KARACHI - The Hamdard College of even in its wake, Sadaf Ehtisam Medicine & Dentistry, Hamdard University, the event would shared her personal organized a seminar on "Rabies-free go a long way in experiences and Karachi " in collaboration with the Indus raising challenges of Hospital. awareness of caregiving for Prof Dr Naseem Salahuddin, Head of Alzheimer's persons with Infectious Diseases, and Member, WHO disease and its Dementia. Executive Committee for Rabies, presented effect on the Maj Rtd Basit her lecture for the staff and students of quality of life of explained in detail Hamdard University. Dr Naseem discussed the caregivers of patients. address, thanked the the contribution of APRC in the prevention and treatment plans for rabies FJWU Vice Chancellor Prof participants of the inter- raising awareness, and with the future doctors and trained them to Dr Samina Amin Qadir university skits competition training of mental health deal with this deadly disease. highlighted the role of the and reiterated that such professionals and caregivers. Prof Dr Abdul Bari Khan, CEO, Indus university toward many events should be held in In addition, he also shared the Hospital, was the Guest of Honor. important causes such as, future to persistently raise activities that APRC is Prof Dr Shabib ul Hassan introduced Dr and motivated the students to awareness about Alzheimer's. planning in near future. Maj Bari Khan to the audience and presented engage and remain active in Department of Behavioral Rtd Basit thanked the a shield on behalf of the University. such community initiatives. Sciences, FJWU, conducted Department of Behavioral Dr Bari Khan in his speech recalled the Speaking on the occasion, the seminar on Sciences for organizing this services and humble manners of Shaheed- Punjab Minister for Literacy "Alzheimer's/Dementia: seminar and showed keen e-Pakistan, Hakim Mohammed Said, and and Non-formal Education Management and interest in future collaboration told the students that Hakim Sahab had Raja Rashid Hafeez said Caregiving". between FJWU and APRC in been a source of inspiration for him as well. there was a need to raise Guest speakers included areas of mutual interest. Dr Bari shared his intentions for collaborative awareness among people current president of APRC In the end, Dr. Shoaib Akhtar, proposals between Hamdard University and about Alzheimer's disease so Brig Rtd Munawwar A. Rana, Director ORIC, FJWU the Indus Health Network for the provision better healthcare facilities Founding member of distributed University Souvenir of free medical service to destitute people could be provided to the Alzheimer's Pakistan to the esteemed guests. around the university.

10 MEDICAL NEWS / April 15-30, 2019 MEDICAL NEWS / April 15-30, 2019 11 Compositional Quality and ... subsp. bulgaricus. This species was Upon reaching the intestine, probiotics Continued from page 04 previously shown to be identifiable by encounter alkaline conditions and are the MALDI Biotyper 3.0 software. In exposed to the effect of bile salts. In Microbial Behavior in simulated our case, we can only hypothesize that general, Gram-positive bacteria are intestinal Juice the low score values obtained for this more sensitive to the deleterious effects The pancreatin-bile salt solution (pH bacterium are due to the limited number of bile than Gram-negative bacteria, 8.0) aims at simulating the conditions of strains of this species included in although in a strain- specific manner. of the intestine. The probiotic the MALDI-TOF database (n = 1). In The use of artificial intestinal fluids is formulations were dissolved in the fact, commercial databases are mostly a good model for analyzing the survival solution and the number of viable designed for the identification of species of microorganism during transit in the organisms present in the suspension that are encountered at higher gut. In this study, seven of the was quantified by plating at 0 min and frequency in clinical practice. considered formulations (Enterolactis after incubation for 30, By using both MALDI-TOF MS and Plus, Reuflor, Prolife, Dicoflor, Yovis, 60, 120, 240, and 360 min. A very dif- Vitek2, all the formula- tions were VSL3, Lactoflorene Plus) underwent a ferent behavior was observed among shown to contain the labeled species. significant reduction in the number of the probiotic formulations (Figure 3). In Lactoflorene Plus, Bifidobacterium viable organisms following incubation A significant reduction in cell viability BB-12 resulted as B. animalis subsp. in the intestinal juice. Nevertheless, was recorded for Enterolactis Plus, lactis, as reported in the literature for the time required for microbial Reuflor, Prolife, and Dicoflor starting such a strain. In Prolife, the labeled B. inactivation was very different from one from 30 min of incubation, for Yovis lactis HN019 resulted to be B. animalis formulation to another, with and VSL3 starting from 240 min, and subsp. lactis, as indicated by the current Lactoflorene Plus, Yovis, and VSL3 for Lactoflorene Plus at 360 min. No nomenclature. S. faecium labeled on formulations being the most resistant variation in cell viability was observed Yovis was correctly identified as E. to the intestinal juice. Interesting for Enterelle. Interestingly, the bacteria faecium, and S. thermophilus St-21 behavior was observed for Codex, a present in Enterogermina were found and S. thermophilus BT01 (Prolife and monomicrobial preparation of S. able to replicate in the juice, with a VSL3), as S. salivarius subsp. cerevisiae. In fact, after an initial 2-log significant increase in their number thermophilus, as recommended by decrease in the number of viable cells, being recorded starting from 240 min updated nomenclature. Oral probiotics the strain was able to multiply almost of incubation. Following an initial must be capable of surviving passage regaining the initial t0 number of cells. decrease at 30 min, the S. cerevisiae through the gastric environment. This can result from a precocious killing strain contained in Codex was able to Resistance to gastric harsh condition of a certain amount of yeast cell replicate in the juice reaching at 360 has been evaluated in a variety of followed by a tardive multiplication of min a number of cells comparable with different conditions, in terms of the residual population, which is in line 0 min (Figure 3). composition of the juice, pH and times, with S. cerevisiae doubling time (90- Discussion using both simulated gastric juice or 140 min). Peculiar behavior was also The effectiveness of a probiotic product animal and human fluids. Although the observed for Enterogermina. B. clausii is the result of its microbial quality, use of artificial fluids does not consider was found to be able to replicate in the resistance to harsh gastric the influence of dietary and nonacid intestinal juice, with a significant environment, and exertion of functional constituents of gastric secretions, it increase in the number of cells starting properties, such as antioxidant, has the benefit of not being restricted from 240 min of incubation. This finding antimicrobial, and immunomodulatory by the availability of animal-derived indicates that the B. clausii spores abilities. material. Moreover, it provides more contained in Enterogermina can The number of viable cells contained controllable and homogenous experi- germinate and actively multiply in the in a probiotic formula- tion is one of mental conditions to compare the effect intestinal fluid. B. clausii adaptability the qualifications that the Food and of acidity on different probiotic products. to the alkaline environment of the juice Agriculture Organization (FAO) and the The B. clausii spore suspension might be the consequence of the World Health Organization (WHO) contained in Enterogermina [strains alkaliphilic nature of this Bacillus document have recommended. O/C, SIN, N/R, T; Ref. (39)] tolerated species. At present, we are unable to decline in the artificial intestinal juice. According to the Italian Ministry of the acidic condi- tions of both ASTM explain the resistance of B. clausii to The integration of these artificial in vitro Health guidelines on food and USP gastric juices well for 120 bile salts. Nevertheless, this finding studies with func- tional and supplements based on probiotics the min. This result could be expected, correlates with previous data from an immunological investigations appears daily uptake of a probiotic should be since bacterial spores are well known in vivo study on human volunteers essential for selecting strains or at least 1 × 109 CFU. Lower numbers for their ability to survive inextreme indicating that Enterogermina B. clausii mixtures that hold the potential for of viable microorganisms could pre- environments (pH, temperature, salinity, (strains O/C, SIN, N/R, T) multiplies in probiotic application. clude an effective health benefit. This etc.). The finding that the B. coagulans the human intestine. Author contributions investigation hence intends to clarify spores contained in Lactoflorene Plus In conclusion, the results of this study AV, FC, and DM wrote and critiqued whether probiotics on the Italian market (1.35 ± 1.50 × 107) underwent indicate high quality of the examined the experimental protocol and comply with these general quality progressive inactivation in both juices probiotic preparations and highlight performed the experimental work. EG requirements. Since routine industrial (Figure 2) can be explained with the their different behavior in the presence conceived the research idea, analyzed con- trols for probiotic products are diverse susceptibility of spores derived of acid and bile. Apart from a minor the data, and wrote the manuscript. AL mainly carried out by traditional plate from different bacteria toward acids. drawback in the identification of L. and SS critiqued the experimental count techniques, herein plate counting B. coagulans spores have, indeed, delbrueckii subsp. bulgaricus, MALDI- protocol and edited the manuscript. onnon-selective and selective media already been reported to be gradually TOF MS demonstrated an excellent Acknowledgments was chosen as the method for inactivated at pH 1.5. applicability for the identification of the The authors pay tribute to the late enumerating the microorganisms Lactobacillus species are considered microorganisms constituting the Professor Mario Campa for his long- contained in the formulations. The intrinsically resistant to acids, but preparations. The analysis of microbial standing inspiration. This work was results obtained indicate that, with the tolerance to gastric environments is a survival in extreme acid conditions supported by Sanofi S.p.A. exception of the examined batch of species- and strain-specific property. aimed at mimicking the worst Conflict of Interest Statement: Lactoflorene Plus, all the other Our results on formulations only environment these microorganisms EG has been a lecturer for Sanofi formulations contain more than containing one Lactobacillus strain are may encounter during transit in the S.p.A. AV, FC, DM, SS, and AL have 1×109 CFU per unit dose. The Bacillus in line with this charac- teristic of the stomach lumen. Our results indicate no conflict of interest to declare. species declared to be contained in genus. Polymicrobial formulations, such that amount of microorganisms 1 Department of Translational Research Enterogermina, Lactoflorene Plus and as Yovis and VSL3, displayed good contained in Enterogermina, Yovis, and and New Technologies in Medicine and Prolife were all represented by heat- resistance to the acidic conditions of VSL3 is not reduced in these conditions Surgery, University of Pisa, Pisa, Italy, resistant bacterial forms (spores). both juices. Although we did not for up to 2 h. The behavior the 2 Department of Biology, University MALDI-TOF MS has successfully been investigate the outcome of each of the formulations exhibited in the presence of Pisa, Pisa, Italy, 3 Research Center applied for the identification of bacteria species contained in such formulations, of pancreatin and bile salts at pH 8 Nutraceuticals and Food for Health- present in probiotics. In this study, it can be speculated that their was very different. Enterogermina B. Nutrafood, University of Pisa, Pisa, Italy. MALDI-TOF MS was able to correctly complexity potentially favor resistance clausii was the only one able to multiply - Courtesy identify all the organisms contained in and adaptability of these microbial significantly above the initial amount the analyzed probiotic formulations, consortia to different environmental and Codex S. boulardii to replicate up with the exception of L. delbrueckii stresses. to the starting amount after an initial

12 MEDICAL NEWS / April 15-30, 2019 DUHS organizes Polio virus farewell ceremony for detected in sewage Pro VC Prof. Masroor MN Report KARACHI - The Vice- systems of 11 districts Chancellor of the Dow University of Health Sciences (DUHS), Prof MN Report Mohammad Saeed RAWALPINDI - In light of new surveys Quraishy, said that Prof that detected polio virus in sewage Mohammad Masroor, who systems of 11 districts of the country recently completed his the Health Ministry has decided to run tenure and was discharged monthly polio campaigns in these from his duties at DUHS as districts that still have a high prevalence the Pro-Vice-Chancellor, of the polio virus. The monthly campaign has contributed significantly nothing without them and all will administer polio drops and injections in the progress of the the honor he is receiving to all children under the age of 10. university. Prof Masroor today is dedicated to his Health officers have been on high alert special contribution towards seniors and the teachers at after confirmation of the virus was the establishment of the the Dow University of Health received in said districts including Ojha Campus is exemplary Sciences. Rawalpindi and Lahore in Punjab, and tremendous. He added that during his 4- Karachi, Hyderabad, Sukkur and He has gained a highly year term, the last 2 years Qambar in Sindh, Quetta and Qilla respectable and prominent were very crucial when the Abdullah in Balochistan and Peshawar, The families refusing to administer polio status in the eyes of the Vice-Chancellor, Prof students as well as his Bannu and Waziristan in Khyber drops to the children will be given Mohammad Saeed juniors. It is due to his Quraishy, handed over Pakhtunkhwa (K-P). In other districts special focus and will be persuaded. In tireless efforts and some very confidential of the country, diagnostic tests for polio the future, B-forms, birth certificates hardworking ability that the responsibilities to him which virus proved negative. and school admissions for children will DUHS is where it is today. he fulfilled successfully. The mentioned 11 districts have also be issued upon submission of He expressed his views Prof Khawar Saeed Jamali reported prevalence of the virus for the certificates confirming the polio vaccine. while talking at the farewell said that Prof Masroor third consecutive year, which warrants Rawalpindi Additional Deputy ceremony of Prof always treats his patients a monthly polio campaign, the first being Commissioner Saima Yunus has given Mohammad Masroor sincerely and with scheduled between April 22nd and 26th. strict directions to the mobile teams to celebrating the completion generosity. Prof Zarnaz Polio camps will be set up in private remain highly focused and serious in of his 4-year tenure as the Wahid told that Prof and government schools, airports, bus their duties. Each child should be given Pro-Vice-Chancellor and Mohammad Masroor not stands, district kacheris, hospitals and polio drops, she advised the teams, getting retired from his only fulfilled his own primary healthcare centres while mobile directing them to especially focus on duties. responsibilities but he also teams will hold door-to-door campaign reluctant families and approach their Along with Prof Mohammad used to help others in their like they have in the past. children at schools instead. Masroor himself, the work. Simplicity and farewell ceremony was humbleness are some of his addressed by the Pro-Vice- greatest personality traits. Paralyzed after wrong injection, the Chancellor, Prof Khawar Prof Kartar Dawani said that Saeed Jamali, Prof Zarnaz Prof Mohammad Masroor minor has now passed away Wahid, Prof Kartar Dawani, does not believe in Prof Sumbul Shamim, Dr discrimination and always MN Report mentally paralysed. Nisar Ahmed Rao, Prof used to help his juniors and KARACHI - Nine-month-old Nishwa, who Nishwa's father, Qaiser Ali, informed that the Akhtar Baloch, Prof Shuja his fellow colleagues. had suffered irreparable brain damage and incident occurred due to an overdose of Farrukh, Prof Shaheen Prof Aurangzeb told that became paralysed after she was administered potassium chloride (KCL) injected by Sharafat, Prof Mohammad during the process of a drug wrongly by nursing staff of Darul Sehat untrained hospital staff. He complained that Aurangzeb, and Dr Saba posting at Civil Hospital, Prof Hospital. the hospital has recruited many amateur Hasan Shamim. Masroor distributed free of The FIR stated that a high dosage of medicine medical technicians and staff on low salaries Prof Quraishy added that cost medicines to the people was administered to the minor girl, Nishwa, putting the lives of patients in danger. the always welcoming in need. He even conducted which soon worsened her condition. The Another account claims that the mistake approach and leadership the MRI of several patients hospital administration has also accepted its occurred after the staff got confused between qualities of his personality on his own expense. Prof mistake, the FIR read. two syringes containing proved to be very useful as Akhtar Baloch said that Prof According to the report, two different injections, which he always placed his work Masroor has a unique ability nine-month-olds, Nishwa Ali resulted in incorrect and responsibilities at his to do even the most difficult and Amisha Ali, daughters of administration of the given priority. Such aspects of his tasks with teamwork without Qaiser Ali, were brought to injection. character are no doubt a creating any panic. Darul Sehat, a private hospital According to the hospital in Gulshan-e-Iqbal area of administration, when Nishwa shining example for his Prof Shuja Farrukh said that Karachi. The girls needed was admitted, she was colleagues. Prof Masroor possesses a treatment for diarrhea. After suffering from gastroenteritis, Prof Mohammad Masroor great personality with undergoing treatment for a day at the hospital for which a KCL injection of was instantly said that if you tie your knots extraordinary management their condition improved. However, before administered. Due to the abnormal heartbeat strongly with your mentor skills. According to Prof discharging the infant patients, the hospital and shortness of breath, the patient was and your teacher, then no Shaheen Sharafat, Prof staff administered an injection to Nishwa after shifted to a ventilator after which she came hurdle can come in the way Masroor is a man who which her heartbeat abnormally increased. out of danger. of you and success. Where strictly follows the rules and She also faced difficulty in breathing. The The hospital administration has suspended I am standing today is all regulations. infant was shifted to the hospital's ICU where the responsible staff. In addition, the because of my teachers. He Prof Sumbul Shamim said she was placed on a ventilator. administration has taken responsibility of all expressed gratitude to his that he was always willing According to a CT scan, Nishwa has become medical expenditures incurred on Nishwa. mentors stating that he is to guide us in any situation.

MEDICAL NEWS / April 15-30, 2019 13 Reproductive rights become a reality for more women: UNFPA report

NEW YORK - Reproductive reproductive autonomy was new report, which is titled rights and choices have the most significant in two "Unfinished business: The become a reality for more countries: the Philippines pursuit of rights and choices women than ever, says the and Ukraine, where 81% of for all." It was only in 1968 UNFPA's flagship report, women are empowered to that leaders affirmed, for State of World Population make these decisions for the first time in a global 2019. Despite these gains, themselves. declaration, that individuals vast numbers of women It was lowest in three had the right to "determine around the world are not countries: Mali, Niger, and freely and responsibly the empowered to make Senegal. In these countries, number and the spacing of fundamental decisions only 7% of women can their children." Increasing about their own bodies. make their own choices numbers of people were UNFPA's report published over all three areas. "We able to exercise this right data on women's ability to still have a long way to go as family planning methods make decisions over three before all women and girls became more accessible adopted a revolutionary exercise their reproductive key areas: sexual have the power and the and reliable. agreement calling for rights. intercourse with their means to govern their own And as women grew women's reproductive "We must push back partner, contraception use, bodies and make informed empowered to make their health and rights to take against forces that would and health care. Across the decisions about their sexual own reproductive choices, centre stage in see us return to a time 51 countries where this and reproductive health," a wide range of benefits development efforts. when women had little say information is available, said UNFPA Executive accrued to their health and Since then, access to in reproductive decisions only 57% of women who Director, Dr Natalia Kanem. economic well-being. Then voluntary family planning or, for that matter, in any are married or in a As dire as the statistics may 25 years ago, at the has expanded around the area of their lives," said Dr relationship are able to seem, they represent International Conference on world. In 1994, at the ICPD, Kanem. "The fight for rights make their own choices massive progress in the Population and 52% of women used and choices must continue over all three areas. long history of reproductive Development (ICPD), modern contraceptives, until they are a reality for Women's sexual and health and rights, says the governments of the world compared to 58% today. all." This year, a quarter Access to reproductive century after the landmark health services has ICPD agreement, the world improved, too. The number must redouble its efforts to of women who die from secure the reproductive pregnancy-related causes health and rights of all has dropped from 369 per people. 100000 live births in 1994 In November, the to 216 in 2015. Government of Kenya, the Marginalized groups, in Government of Denmark, particular, face some of the and the UNFPA will highest unmet need for convene a high-level sexual and reproductive conference in Nairobi urging health services, the report leaders, governments and says. These include ethnic a wide range of partners to minorities, youth, unmarried re-commit to realizing rights people, lesbian, gay, and choices for all. "The bisexual and intersex Nairobi Summit will help us people, people with rally a broad coalition of disabilities, and those living stakeholders to protect the in poverty. And in some gains made and advance circumstances, people are the ICPD agenda," said Dr even losing access to the Kanem, "to ensure that no services they need to one is left behind." Sindh Nurses Alliance warns of province-wide protest MN Report KARACHI - The Sindh Nurses Alliance demanded the Sindh government to approve the summary of their health professional allowance, up-gradation, and promotion of nurses under a four-tier formula in a week, otherwise a complete strike would be observed in the public sector hospitals of the province. Central Leader of Sindh Nurses Alliance, Ejaz Ali Kaleri, informed that the Sindh Health Department had not approved their summary for the up-gradation, allowance, and promotions of nurses and health professionals for several months. He said that the representatives of nurse organizations are regularly visiting the Sindh Health Department and the Finance Department since several months for the approval of the summary, but it seems that the authorities concerned have no interest in resolving the genuine issues that nurses face. He gave a one-week ultimatum to the authorities concerned with the Sindh government to approve the summary and issue a notification soon otherwise the nurses of Sindh will boycott their duties and shut down the public sector hospitals all over the province from next week if the summary is not approved.

14 MEDICAL NEWS / April 15-30, 2019 SHCC organizes awareness Breast cancer patients in KPK sessions in Sindh to benefit from free treatment MN Report MN Report get effective medicines for SINDH - The Sindh Healthcare KPK- The number of breast one year. The medicines Commission (SHCC) hosted a series of awareness sessions at Sukkur, Ghotki, and Larkana in efforts cancer cases reported in have shown good results in to improve healthcare services in the Sindh province. Khyber Pakhtunkhwa is developed countries. We In the Sukkur session, Minister, Works & Services, almost fifteen thousand, and plan to treat 3,000 patients, Syed Nasir Hussain Shah, was the Chief Guest. He more than 40,000 women using the latest way of appreciated the initiatives taken by the SHCC to pass away in Pakistan after medication." improve healthcare services in Sindh. suffering from this deadly "The programme will include In another session held in Ghotki, Deputy disease every year. The new programme will be patients' management Commissioner, Ghotki, Saleem Ullah Otho, was the The provincial government issued in June 2019 and will relation system to enable the Chief Guest, who in his talk, emphasized to doctors has now announced free carry on till 2022, the people to contact medics in and DHOs to get them registered with the SHCC. treatment programme meant medicines of worth Rs24 an emergency situation." In the Larkana session, Commissioner, Larkana, to provide services to 6,000 billion will be supplied and Prof Abid said that the Muhammad Saleem Raza, was the Chief Guest. patients suffering from the government's programme initiated by KPK He also emphasized the importance of the SHCC as general and blood cancers expenditure will be Rs2.4 was also appreciated at the the regulatory body for the implementation of in the next three years. billion. conference in Oxford. Prof. necessary measures needed for the improvement The breast cancer patient The director of the project Abid stated that their model of health care services in the province. will get the latest treatment and head of oncology was replicated in Sindh and Director, Clinical Governance & Training (SHCC), Dr at Hayatabad Medical department at Hayatabad Punjab provinces, as well as Syed Ahmed Raza Kazmi, informed the audience Complex under a cost- Medical complex, Prof Abid Gilgit-Baltistan, where that the SHCC would make provisions to improve sharing formula with Novartis Jamil said, "For the first time, people had a lot of difficulties the access, equity, and quality of healthcare services, Pharma. breast cancer patients will in the treatment. and regulate healthcare services delivery in Sindh. Director, Licensing and Accreditation, Dr Farhana Memon, also addressed the session and elaborated the process of registration. The Team of Clinical Governance (SHCC) met with Head of Medical Microbiology and Infectious Diseases Society of Pakistan (MMIDSP), Dr Bushra Jamil, to device a framework for the training of infection control and prevention in Sindh. The team also met with the management of the Sindh Solid Waste Department to discuss the formulation of SOPs for hospital waste management. In this meeting, the need for auditing for hospital waste from the site of origin to the site of dumping was discussed. Chairman, SHCC, Dr Tipu Sultan, and CEO, SHCC, Dr Minhaj Qidwai, attended a forum arranged by the Urban Resource Center regarding the drive against quackery in which Dr Tipu Sultan, Chairman, SHCC, informed that there are 600,000 quacks active in Pakistan. He further reported that the ratio of doctor to population is 1200 people to 1 doctor and in these stats, for every 350 people, one quack is present. The Directorate of Anti -Quackery sealed 8 HCEs in a week operated by quacks in the District of South Karachi and around 190 health facilities had been shut downed across the Sindh province so far. MS and MD doctors rejoice after recognition in KSA

MN Report ISLAMABAD - Saudi Arabia has finally recognized the degrees of thousands of postgraduate doctors in Pakistan with MS (Doctor of Surgery) and MD (Doctor of Medicine) qualifications. These doctors will now be able to work in KSA and other Gulf States without any obstacle. Pakistan Institute of Medical Sciences (PIMS) Executive Director Dr Ejaz Qadeer informed that there were around 200 students at the hospital completing their MS and MD degrees. "Although MS and MD degrees are recognised as clinical degrees in Pakistan, in Saudi Arabia both degrees were considered research degrees, due to which degree holders were not allowed to practice there. The fact is that in Pakistan, both MS and MDs work in hospitals and get clinical work experience," he added.

MEDICAL NEWS / April 15-30, 2019 15 16 MEDICAL NEWS / April 15-30, 2019

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