Ethno-Dentistry of Medicinal Plants Used in North Waziristan, Pakistan.

OBJECTIVE: This study aimed at recording therapeutic plant species used by inhabitants to treat dental disorders in the district of North Waziristan, Pakistan. The indigenous people of the studied area are dependent on medicinal plants for their basic health care needs including dental care. METHODS: Ethnomedicinal data were collected using a semi-structured questionnaires, and in addition 130 local informants were interviewed. The collected data were evaluated using various quantitative indices, including use value (UV), relative frequency of citation (RFC), fidelity level (FL%), and Jaccard Index (JI). RESULTS: A total of 69 plants belonging to 48 plant families used in dental disorders were identified. The Lamiaceae was the leading family that shared 7 species, followed by Solanaceae (4 spp).The dominant life form used was herbs (47.83%), folowed by leaves (43.90%) in preparing remedies for different dental disorders. Decoction was the most common mode of preparation (34.21%), followed by pastes (21.05%). The highest RFC (0.36) was reported for Bergenia ciliata, followed by Salvadora oleoides (0.35). The majority of the plants (36 spp) were utilised as herbal medicine to treat toothache, followed by 13 species for periodontal (gum) infections, 11 species used for teeth cleaning, and 9 species for halitosis (bad breath). CONCLUSIONS: This study is the first-ever record of ethnomedicinal applications for the treatment of dental diseases from Pakistan. Some of the forgeoing hebal medications should be further evalauted for the development of pahrmaceutical bio-products for the treatment of dental disorders.

Characterizing cutaneous leishmaniasis in a conflict-affected region: a study from North Waziristan, Pakistan.

Background/aim: Cutaneous leishmaniasis is an emerging tropical disease that remains a serious public health issue in Pakistan, particularly in North Waziristan. The current research was carried out to investigate the presence of cutaneous leishmaniasis in this region. Materials and methods: This prospective observational study was conducted from October 2018 to December 2020 at District Head Quarter Hospital Miranshah in North Waziristan with the collaboration of the Pathology Department of Gomal Medical College Dera Ismail Khan, Khyber Pakhtunkhwa. Needle aspirates were used for the microscopic Giemsa-stained slides. SPSS was used for data analysis. Results: Of the 5406 clinically-suspected cases, 2603(48.2%) were positive by microscopic examination. Of these 2603 patients, 1474 (57%) were male and 1129 (43%) were female. Most of the lesions were on the face, followed by upper and lower limbs. The 5-10-year age group had the highest percentage of 1167 (45%). A single lesion affected 96.6% of the patients, while 2.7% had double lesions and 0.7% had triple lesions. A high number of cutaneous leishmaniasis were seen from April to August, while the lowest number was seen November to December. Conclusion: This study provides extensive information in relation to the existence of cutaneous leishmaniasis in the North Waziristan district of Pakistan, as well as the detailed demographic features of those affected by the disease.

Ethnoveterinary Practices of Medicinal Plants Among Tribes of Tribal District of North Waziristan, Khyber Pakhtunkhwa, Pakistan.

Domestic animals play a vital role in the development of human civilization. Plants are utilized as remedies for a variety of domestic animals, in addition to humans. The tribes of North Waziristan are extremely familiar with the therapeutic potential of medicinal plants as ethnoveterinary medicines. The present study was carried out during 2018-2019 to record ethnoveterinary knowledge of the local plants that are being used by the tribal communities of North Waziristan, Khyber Pakhtunkhwa, Pakistan. In all, 56 medicinal plant species belonging to 42 families were identified, which were reported to treat 45 different animal diseases. These included 32 herbs, 12 shrubs, and 12 trees. Among the plant families, Asteraceae contributed the most species (5 spp.), followed by Amaranthaceae (4 spp.), Solanaceae (4 species), and Alliaceae, Araceae, and Lamiaceae (2 spp. each). The most common ethnoveterinary applications were documented for the treatment of blood in urine, bone injury, colic, indigestion, postpartum retention, skin diseases, constipation, increased milk production, mastitis, foot, and mouth diseases.

Molecular Characterization of ß-Thalassemia Mutations Via the Amplification Refractory Mutation System-Polymerase Chain Reaction Method at the North Waziristan Agency, Pakistan.

ß-Thalassemia (ß-thal) is a monogenic disease characterized by mutations on the HBB gene, affecting the production of globin that results in hypochromic and microcytic anemia. The aim of this study was to determine the prevalence of six common ß-thal mutations, and their frequency and inheritance pattern in affected populations of North Waziristan Agency, Pakistan. In this study, 130 blood samples from 37 unrelated ß-thalassemic families having a minimum of one transfusion-dependent child with ß-thal major (ß-TM), were retrieved either from the Thalassaemia Centre for Women and Children Hospital Bannu or their home towns situated in Noth Waziristan Agency. All samples were analyzed by the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) using six allele-specific primers for the presence of the six ß-thal mutations common in the Pakistani population. Of the six common mutations, our study demonstrated five HBB mutations comprising HBB: c.27_28insG, HBB: c.92+5G>C, HBB: c.126_129delCTTT, HBB: c.92+1G>T and HBB: c.17_18delCT from the families studied, while mutation HBB: c.47G>A [codon 15 (G>A)] was not detected in any of the studied families. Furthermore, the HBB: c.27_28insG and HBB: c.92+5G>C were noted to be the most common with frequencies of 42.85 and 31.42%, respectively. The findings of the present study may be useful in launching carrier screening and prenatal diagnosis (PND) programs by screening analyzed and other unanalyzed affected families for the possible presence of common mutations through the ARMS-PCR technique that will help to control the disease.

High incidence of malaria along the Pak-Afghan bordering area.

OBJECTIVE: To check the epidemiology of malaria along Pak-Afghan bordering area.. METHODS: The prospective study was conducted at Hatmi Medical Centre, Barmal district, Afghanistan, from March 2014 to February 2016, and comprised patients living in bordering areas between Pakistan's North Waziristan Agency and Afghanistan's Paktika province. Blood samples were collected from subjects with symptoms of malaria for plasmodium microscopy in Giemsa-stained thick and thin film. Slides were stored in a secure slide box and were reconfirmed by microscopy expert at the Department of Pathology, Gomal Medical College, Dera Ismail Khan, Pakistan. SPSS 19 was used for data analysis. RESULTS: Of the total 3,840 patients, 2,655(69.1%) tested negative for malaria while the remaining 1,185(30.9%) tested positive - of whom 788(66.5%) were males and 397(33.5%) were females. Of the positive cases, positive, 1,074(90.6%) were Plasmodium vivax, 76(6.4%) Plasmodium falciparum and 35(3%) were mixed species infections with no case of Plasmodium ovale and Plasmodium malariae. CONCLUSIONS: Strict malaria-control measures are needed in both countries.

Genomic Surveillance Elucidates Persistent Wild Poliovirus Transmission During 2013-2015 in Major Reservoir Areas of Pakistan.

BACKGROUND: Despite tremendous efforts in the fight against polio, Pakistan bears the highest proportion of poliomyelitis cases among the 3 endemic countries including Afghanistan and Nigeria. Apart from insecurity and inaccessibility challenges, the substantial shift of unimmunized children from North Waziristan due to recent military operations was presumed to favor the widespread poliovirus infection in Pakistan. METHODS: To better understand the current epidemiological situation, we analyzed the virologic data of wild poliovirus type 1 (WPV1) strains detected in Pakistan during 2013-2015. RESULTS: Five genetic clusters (A-E) were identified with at least 5% nucleotide divergence in the viral protein 1 (VP1) coding region. Peshawar, Quetta, and Karachi were found to be the major endemic foci where multiple discrete genetic lineages of WPV1 were detected. Phylogenetic analysis suggests that wild poliovirus strains from endemic regions were genetically distant (with 5%-15% VP1 nucleotide divergence) from those detected in North Waziristan cases, excluding the possibility of a recent progenitor of WPV1 instigating single-source transmission across the country. Orphan lineages detected in Rawalpindi, Lahore, Hyderabad, Sukkur, and Jacobabad revealed silent transmission and the need for vigilant surveillance. Sustenance of analogous genetic lineages over a period of 3 years highlights multiple unimmunized foci present to maintain viral genetic diversity. CONCLUSIONS: Our findings are inconsistent with the hypothesis that impoverished populations from North Waziristan serve as a possible determinant of widespread poliomyelitis infection in Pakistan and further emphasize the need to scale-up clinical and environmental surveillance as well as immunization activities.