Process, rationale, and interventions of Pakistan's National Action Plan on Chronic Diseases

Most developing countries do not comprehensively address chronic diseases as part of their health agendas because of lack of resources, limited capacity within the health system, and the threat that the institution of national-level programs will weaken local health systems and compete with other health issues. An integrated partnership-based approach, however, could obviate some of these obstacles. In Pakistan, a tripartite public-private partnership was developed among the Ministry of Health, the nongovernmental organization (NGO) Heartfile, and World Health Organization. This was the first time an NGO participated in a national health program; NGOs typically assume a contractual role. The partnership developed a national integrated plan for health promotion and the prevention and control of noncommunicable diseases (NCDs), which as of January 2006 is in the first stage of implementation. This plan, called the National Action Plan on NCD Prevention, Control, and Health Promotion (NAP-NCD), was released on May 12, 2004, and attempts to obviate the challenges associated with addressing chronic diseases in countries with limited resources. By developing an integrated approach to chronic diseases at several levels, capitalizing on the strengths of partnerships, building on existing efforts, and focusing primary health care on chronic disease prevention, the NAP-NCD aims to mitigate the effects of national-level programs on local resources. The impact of the NAP-NCD on population outcomes can only be assessed over time. However, this article details the plan's process, its perceived merits, and its limitations in addition to discussing challenges with its implementation, highlighting the value of such partnerships in facilitating the missions and mandates of participating agencies, and suggesting options for generalizability.     

Incomplete immunisation uptake in infancy: maternal reasons

We examined uptake of primary immunisations in infancy and the reasons given by mothers for either incompletely or not immunising their infants. We used data from the Millennium Cohort Study, a cohort of 18,819 infants born between September 2000 and January 2002 in the UK. 95.6% infants were reported to be fully immunised, 3.3% partially immunised and 1.1% unimmunised. Mothers most frequently cited medical reasons (45%) for partial immunisation (n=697), but beliefs or attitudes (47%) for no immunisation (n=228). An understanding of maternal reasons for incomplete immunisation status may assist in identifying appropriate interventions to maximise uptake.     

Inhibition of restraint-induced neuroendocrine and serotonergic responses by buspirone in rats

The effects of buspirone (0.5 mg/kg) on the neuroendocrine and serotonergic responses to stress were monitored in rats. Exposure to 2-h of restraint stress increased circulating levels of corticosterone, noradrenaline and glucose. The metabolism of 5-hydroxytryptamine (5-HT; serotonin) increased in the brain. Prior administration of buspirone did not alter levels of corticosterone, noradrenaline and glucose in unrestrained rats, but inhibited stress-induced increase in the activity of hypothalamic-pituitary-adrenal (HPA) axis and circulating levels of glucose. Restraint-induced rise in brain 5-HT and 5-hydroxyindole-acetic acid (5-HIAA) was also attenuated by buspirone. Unrestrained animals injected with buspirone also exhibited a decrease in brain 5-HIAA concentration. The findings are discussed in the context of the role of somatodendritic 5-HT(1A) receptors in responses to stress.     

Ingestion of metallic rods and needles

Foreign bodies in gastrointestinal tract (GIT) are not very rare. This case describes a patient purposefully swallowing metallic objects. These were five iron rods ranging 4-5 inches in length, and two needles. One of the rod perforated duodenum and was found in pelvic cavity upon exploration. The rest of the rods were in small gut and stomach.     

A fatal case of Degos' disease which presented with recurrent intestinal perforation

Degos’ disease,otherwise known as "malignant atrophic papulosis" is a rare vasculopathy with an unknown etiology characterized by typical cutaneous lesions.Involvement of the gastrointestinal(GI) tract is observed in approximately half of patients and small infarctions in the mucosa can cause perforation and resulting peritonitis,the leading cause of death.We present a fatal case of Degos’ disease with skin and GI involvement,manifesting as recurrent intestinal perforations and peritonitis,in a 15-year-old Iranian boy.     

Prostaglandin E2 receptor EP4 contributes to inflammatory pain hypersensitivity

Prostaglandin E(2) (PGE(2)) is both an inflammatory mediator released at the site of tissue inflammation and a neuromodulator that alters neuronal excitability and synaptic processing. The effects of PGE(2) are mediated by four G-protein-coupled EP receptors (EP1-EP4). Here we show that the EP4 receptor subtype is expressed by a subset of primary sensory dorsal root ganglion (DRG) neurons, and that its levels, but not that of the other EP1-3 subtypes, increase in the DRG after complete Freund' adjuvant-induced peripheral inflammation. Administration of both an EP4 antagonist [AH23848, (4Z)-7-[(rel-1S,2S,5R)-5-((1,1'-biphenyl-4-yl)methoxy)-2-(4-morpholinyl)-3-oxocyclopentyl]-4-heptenoic acid] and EP4 knockdown with intrathecally delivered short hairpin RNA attenuates inflammation-induced thermal and mechanical behavioral hypersensitivity, without changing basal pain sensitivity. AH23848 also reduces the PGE(2)-mediated sensitization of capsaicin-evoked currents in DRG neurons in vitro. These data suggest that EP4 is a potential target for the pharmacological treatment of inflammatory pain.