Usman Waheed

Blood safety system reforms in Pakistan

The Islamic Republic of Pakistan is the sixth most populous country in the world with a population of 180 million1. Literacy rate is 49.5% and the population growth rate is 2.03%. Urdu is the national language but English is also widely spoken and understood. Islamabad is the federal capital and the total country area is 796,095 km2. The health care system in Pakistan faces numerous challenges and operates through a three-tier delivery structure and a variety of public health interventions. The role of private sector is growing and according to an estimate its share has reached 75%2. The overall health regulatory framework is weak and inadequate3. The total expenditure on health is 2.5 % of the GDP4. Following the implementation of the 18th amendment of the constitution in June 2011, all the functions related to health were devolved to the provincial/state health departments5. The public health system is deficient in terms of human and physical infrastructure to match the needs of the growing population and the challenges faced by natural and man-made disasters including terrorism occurring with increasing frequency in the recent past.

Evaluation of HIV/AIDS diagnostics kits and formulation of a testing strategy for Pakistan

BACKGROUND Rapid diagnosis of HIV/AIDS enables the development of prevention and treatment programmes but accurate, reliable and cost effective testing strategies should be used for testing of HIV/AIDS from a large population. OBJECTIVE To evaluate the performance and effectiveness of three assays for the diagnosis of HIV in comparison with Western blot and to formulate an alternative cost-effective confirmatory approach for HIV diagnosis. STUDY DESIGN 472 specimens (serum) from a Pakistani population were evaluated. Two rapid HIV testing kits (Capillus, SD Bioline) and one ELISA (Vironostika Ag/Ab) kit were used to detect HIV. Results were compared with Western blot against which sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of all HIV assays were assessed. RESULTS 280/472 (59.3%) of the samples were positive for antibodies against purified HIV-1 viral proteins. The sensitivity of SD Bioline and Vironostika ELISA was 100% (95% CI; 98-100) while that of anti-HIV Capillus™ kit was 94.6% (95% CI; 91-96.8). The specificity of the Vironostika ELISA and anti-HIV Capillus™ kit was 100% (95% CI; 97-100) while specificity of SD Bioline was 98.4% (95% CI; 95-99). PPV was 100% (95% CI; 98-100%) for the anti-HIV Capillus™ and Vironostika ELISA and 98.9% (95% CI; 96-99%) for SD Bioline. NPV for SD Bioline and Vironostika ELISA was 100% (95% CI; 98-100%) and 92.7% for anti-HIV Capillus™ (95% CI; 88-96%). CONCLUSION The sensitivity and specificity of all three kits were satisfactory compared to Western blot and could be used for effective diagnosis of HIV/AIDS in Pakistani population.

National Baseline Survey on Monitoring and Evaluation of Blood Screening Systems in Pakistan

The objective of the national survey was to analyze all aspects of the blood screening system in blood banks in Pakistan. The survey tools were based on WHO evaluation framework for assessment, monitoring and evaluation of blood screening systems adapted for application in Pakistan. The survey documented quantitative (sample size 170 blood centers, both in public and private sector in all the four provinces and Azad Jammu & Kashmir, Gilgit Baltistan, and Federally Administrated Tribal Areas) as well as qualitative aspects to the extent possible. A structured pretested questionnaire was used to collect the data. Statistical analyses were carried out by simple descriptive statistics using MS Excel 2010. The survey documented quantitative (sample size 170 blood centers, both in public and private sector in all the four provinces and AJK, GB, and FATA) and qualitative aspects to the extent possible. The findings of the survey provided a comprehensive situation analysis of the state of the blood screening system in the country.

Estimation of Hepatitis B Virus, Hepatitis C Virus, and Different Clinical Parameters in the Thalassemic Population of Capital Twin Cities of Pakistan

Hepatitis B and C are serious public health problems worldwide. Thalassemia patients are dependent on blood transfusions throughout their life and are at high risk of viral infections. The aim of this study was to estimate the prevalence of hepatitis B/C infections and different clinical parameters in multitransfused thalassemia population. In this study, 262 multitransfused β-thalassemia patients were enrolled from the capital twin cities of Pakistan. The presence of hepatitis B virus (HBV)/hepatitis C virus (HCV), alanine aminotransferase (ALT) level, serum creatinine, serum ferritin, hepatomegaly, splenomegaly, and splenectomy were analyzed. The overall prevalence of HBV and HCV was 3.08% and 55.73%, respectively, with 100% of patients older than 20 years had HCV infection. The ALT levels among HBV- and HCV-positive thalassemia patients were 92.62 ± 41.57 U/L and 98 ± 63.65 U/L, respectively; creatinine values observed were 0.4 ± 0.35 mg/dL (for HBV) and 0.39 ± 0.24 mg/dL (for HCV), while serum ferritin levels were 6865.87 ± 1649.13 ng/dL (for HBV) and 5445.95 ± 3059.28 ng/dL (for HCV). A total of 74.8% and 82.20% of HBV- and HCV-positive patients had hepatomegaly with an average increase in liver size of 4.17 and 4.33 cm, respectively. Splenomegaly was observed in 64.9% and 67.12% of HBV- and HCV-positive patients with an average increase in spleen size of 4 and 4.46 cm, respectively. Splenectomy was observed among 14.50% and 15.75% of HBV- and HCV-infected thalassemia patients. There is a strong need to properly screen blood before transfusions to reduce the future load of viral hepatitis from Pakistan.

Blood transfusion service in disasters

1. Types of disasters and its impact on BTS ....................................................................................................................................................................... 2 1.1. Earthquake ................................................................................................................................................................................................................... 2 1.2. Floods ............................................................................................................................................................................................................................. 2 1.3. Terrorism ...................................................................................................................................................................................................................... 2 1.4. Biological event .......................................................................................................................................................................................................... 2 2. Response plan ........................................................................................................................................................................................................................... 2 3. Staff capacity building ........................................................................................................................................................................................................... 3 4. Managing voluntary donors during disasters ............................................................................................................................................................... 4 5. Consolidation of blood transfusion services in Pakistan after the 2005 Earthquake ...................................................................................... 4 6. Role of media in blood management during disasters .............................................................................................................................................. 4 References .................................................................................................................................................................................................................................. 5

The impact factor: A bad impact on individual research:

During the pre-internet era, libraries used to be very selective in subscribing to research magazines and journals from their limited institutional funds and hence only a few prestigious journals could make it onto their racks. This scenario prompted the need for a system to evaluate the quality of circulating journals in order to help both libraries and readers choose wisely. Historically, the quality and standing of a journal used to depend on the reputation of the society which published it, the members of its editorial board, the circulation size, the frequency of publication, the manuscript processing time and the quality of the peer reviewing process. With the advent of internet, another dimension of the potential for online search and retrieval of an article has also been introduced. The first citation-based design for rating academic manuscripts was proposed by Eugene Garfield in 1955.1 This was called the ‘Citation Index’. The term citation index refers to the number of acknowledgements or citations that an already published work (indexed by the Institute of Scientific Information or ISI) receives by other scientists in their research work, which again gets published in an ISI indexed journal. The Citation Index can be used for bibliometric purposes and for assessment of research evaluation in the form of the journal impact factor. The impact factor is a citation-based metric that has become an instrument for the assessment of the quality of journals and it is monitored every year by Thomson Reuters (formerly called ISI). It collects references from indexed journals in its database and calculates the impact factor for a journal by taking the ratio of the number of citations to articles published by that journal during the last two years to the total number of articles it published during that period. For example, this year’s impact factor for a journal can be calculated as:

Phlebotomy as the Backbone of the Laboratory

In Pakistan, phlebotomy is the most underestimated procedure in laboratory medicine, although it is a complex process requiring knowledge and skill to perform. Most errors arise during this laborintensive, preanalytical phase. Lack of appropriate training can result in improper specimen collection, which can lead to serious complications, including misdiagnosis of the patient. In Pakistan, no certification body or council exists for this discipline. Phlebotomists must be properly trained and certified from an accredited organization. Paramedical institutes need to introduce these processes as a separate diploma or certificate course.

Impact of regulation of blood transfusion services in Islamabad, Pakistan

The strengthening of the regulatory authorities is the backbone of the blood safety systems reforms being implemented in Pakistan. One of the key elements of this reform process is the re-activation of blood transfusion authorities (BTAs) to guide and steer the overall development of the blood sector in Pakistan. The success of these efforts will also help fulfill the governments international commitment in achieving the millennium development goals. The revived Islamabad BTA has in a very short time developed a very successful model of regulation based on constructive nonpunitive approach. A database of facilities providing blood services in Islamabad has been created, their registration and licensing completed and a system of regular inspections and re-inspections developed and capacity building of the technical and management staff conducted. In addition, as a result of strict adherence to the minimum licensing criteria, the standard of practices, equipment, manpower, and financial resource allocations of the blood centers in Islamabad have improved significantly in the public as well as the private sector. The successful demonstration of a practical model of regulation best suited to the prevailing scenario in Pakistan has provided a framework which will be followed in all confederating units through the provincial authorities.