More efforts are needed to create awareness
about the use of Aspirin - Nisar Khuro
Over use of antibiotics and over dosing of drugs must be
checked as it results in serious adverse effects

From our correspondent

LARKANA: Inaugurating the 5th National Conference of Pakistan Aspirin Foundation held here at the Chandka Medical College, Mr. Nisar Khuro Speaker of the Sindh Assembly has emphasized the need to create awareness among public as well as the healthcare professionals about the use of Aspirin which is quite safe and effective besides being economically priced drug. He also advised the healthcare professionals to check the over use of antibiotics and avoid overdosing of drugs as they all lead to serious adverse effects thereby increasing morbidity.

Mr.Ayaz Soomro Sindh Minister for Law presenting a shield to Prof. Mahmood Ali Malik former Principal KEMC and founder President of Pakistan Aspirin Foundation at the public awareness session on Aspirin organized by Pakistan Aspirin Foundation at SMBBMU/CMC Larkana on October 31st. Prof. Saeed Ahmad Sangi and Prof. Akbar Chaudhry are also seen in the picture.

Quality of the drugs being made available was another issue which needs to be looked into. He further stated that we all need to overcome our weaknesses and be loyal to the Nation. By overusing the drugs particularly the antibiotics, we will not be serving the ailing humanity. He suggested promoting rational use of drugs and antimicrobial agents and keeping the healthcare professionals informed on such issues. He also referred to a recent resolution passed by the Sindh Assembly wherein it was suggested that all couples before getting married must be examined and tested for Thalassaemia major, Hepatitis B & C and AIDs. The doctors should also prescribe cost effective medications which are affordable by the people. Over use of antibiotics often leads to kidney failure and other serious diseases which all can be checked and prevented by ensuring ethical practice.
Health and Education Mr. Nisar Khuro said are some of the basic issues and the government was trying to give them due importance and priority. He hoped that with democratic era the country will eventually find peace, overcome terrorism, and ensure economic development. Once the under construction roads are completed, we will have more flights and bigger planes coming to Mohenjo Daro airport and Larkana will get its recognition which it deserves. Nothing is impossible and we all can make everything possible by working together, he remarked.

Mr. Nisar Khuro Speaker Sindh Assembly was the chief guest at the national conference of Pakistan Aspirin Foundation held at SMBBMU/Chandka Medical College Larkana on October 31st 2009. Picture shows Mr. Nisar Khuro, Prof. Sikandar Sheikh VC SMBBMU, Prof.Mahmood Ali Malik, Dr. Maqbool H. Jafary, Prof.Javed Akram, Prof. Zaman Sheikh, Prof. Saeed Ahmad Sangi and Dr. Abdul Majeed speaking in the inaugural session.

Prof. Sikandar Sheikh Vice Chancellor of Shaheed Mohtarma Benazir Bhutto Medical University in his address at the occasion said that SMBBMUJ got its charger on October 18th 2008 and it formally started functioning on July 9th 2009. Its constituent institutions include Chandka Medical College, Sardar Ghulam Mohammad Maher Medical College, Chandka Dental College which was being established, and Chambat Institute of Medical Sciences. We have short term and long term goals for the development of this university. We are shortly sending fifteen to twenty young doctors for higher training leading to PhD in different basic sciences and by the time they return, we will have fully developed basic sciences departments and laboratories. Three to four new buildings are being constructed while a 500-bed state of the art teaching hospital will be part of the University which will provide the most modern teaching, training and diagnostic facilities. Refresher courses for the faculty members are also being organized under faculty development programme. Departments of plastic surgery, thoracic surgery and hepatology will soon be established. He thanked Pakistan Aspirin Foundation for selecting SMBBMU/CMC as a venue for their national conference. Such academic activities also help improve CPD of the participants thereby helping improve the patient care, he added.
Dr. Maqbool H. Jafary President of Pakistan Aspirin Foundation in his presidential address highlighted the safety and efficacy of Aspirin which is the most economically priced drug. This life saving miracle drug continues to surprise us all as its new and emerging indications keep on increasing every day. Lot of research is going on these days. In particular it is its antiplatelet effects which has helped save many patients suffering from acute myocardial infarction, Acute Coronary Syndrome and helped reduce morbidity from cardiovascular and cerebrovascular diseases.

Mr. Ayaz Soomro Sindh Minister for Law was the chief guest at the public awareness session organized by Pakistan Aspirin Foundation during its national conference at SMBBMU/Chandka Medical College Larkana on October 31st 2009. Picture shows him presenting conference shields to (from L to R) Prof. Sikandar Sheikh, Prof. Akbar Chaudhry, Dr.Maqbool H.Jafary, Prof. Talat Naheed and Prof. Khalida Soomro.

Dr. Saeed Sangi Prof.of Cardiology at Chandka Medical College convener of the conference welcomed the guests and participants to the conference. He also thanked the chief guest for gracing the occasion and Vice Chancellor, Principal and faculty members of SMBBMU, CMC for their cooperation. He thanked the delegates and participants particularly from Karachi and Lahore who made it possible to attend and make presentations in the conference.
One of the scientific sessions during the conference was chaired by Prof. Wazeer Sheikh former Principal of CMC and Councilor of CPSP while another session was chaired by Prof. Abrar Ahmad Shaikh Dean Faculty of Medicine at SMBBMU. Prof. M. Akbar Chaudhry chaired the third scientific session. An important highlight of the conference was participation of fifteen former and current Principals of various medical colleges. A number of faculty members from CMC and guests from Lahore and Karachi were members of the Experts Panel in different sessions.
Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation introduced the guest speakers besides highlighting the aims and objectives of the Foundation and its accomplishments so far. Later conference mementoes in the form of shields were presented to the chief guest, VC SMBBMU, Principal CMC, Mr. Munawar Abbasi the local MPA and members of the organizing committee. The traditional Sindhi Ajrak and Cap were presented to all the guest speakers, Patron, Convener and members’ of the organizing committee. The meeting started late and time management could not be improved despite best efforts. Hence no time was left for discussion after the presentations which is so essential. However, the organizers did provide time for discussion on all the presentations at the end of the third scientific session.
Dr. Saeed Sangi hosted a dinner at his residence on Friday October 30th which was largely attended by guests from Karachi and Lahore besides faculty members and Vice chancellor of SMBBMU, CMC and elite of the city. Apart from Atco Laboratories who not only arranged travel of the speakers and their stay besides hosting lunch on October 31st during the conference and making excellent transport arrangements, M/s PharmEvo arranged the conference backdrop and shields. M/s Himont organized the registration desk while a few selected companies participated in the exhibition. Their contributions were recognized by the organizers at the public awareness session held before dinner and they were presented conference mementoes.

Scientific Sessions

Prof. Wazeer Sheikh former Principal Chandka Medical College along with panel of experts chaired the first scientific session. Mr. Shaukat Mutakee consultant pharmacist was the first speaker who talked about mode of action of Aspirin and other antiplatlet agents besides mentioning the side effects profile. He also pointed out that these days 81mg tablet instead of 75mg tablet is being used which is considered much better. Aspirin’s duration of action, he said, is four to six hours and its elimination half life is 4.7 to 9 hours. It does have interaction with other drugs and certain foods and so far the aspirin resistance has been reported in 5.5% of cases.

Mr. Farhan Raza Product Manager Atco Laboratories, Mr.Shaukat Ali Jawaid, Prof. Akbar Chaudhry, Dr. Maqbool H. Jafary, Prof. Saeed Ahmad Sangi, Prof. Mahmood Ali Malik, Prof. Khalida Soomro and others photographed during the national conference of Pakistan Aspirin Foundation at Chandka Medical College Larkana on October 31st 2009.

Prof. Javed Akram Principal Allama Iqbal Medical College highlighted the cost effectiveness of Aspirin therapy. Aspirin, Prof. Javed Akram opined, is a time tested drug. Even otherwise old is always considered Gold. Effectiveness of a drug is measured in various forms i.e. can it cure the disease, can it reduce the majority of the symptoms, safety of the drug also plays a vital role in efficacy and effectiveness. He also referred to various drugs like coxibs and other NSAIDs which had to be withdrawn later on due to their serious side effects. Similarly Hormone Replacement Therapy had to be withdrawn but Aspirin remains in the market and is in clinical use for over hundred years and its indications are increasing with the every passing day. Aspirin is far more effective and better tolerable than clopidogrel which can be effectively used in combination with Aspirin in various conditions. Various studies have shown that Aspirin is the most effective drug in Acute Coronary Syndromes and Acute Myocardial Infarction in particular; stroke and TIAs, secondary prevention of hypertension and stroke but it must be used as per its established protocol. He advised the physicians not to be afraid of simple things. Had Aspirin been a more expensive drug, more healthcare professionals would have been using this, he remarked.
Dr. Maqbool H. Jafary President of Pakistan Aspirin Foundation highlighted the efficacy of combination of Aspirin with Clopidogrel which leads to 20% further risk reduction in AMI. However, this combination should be avoided in primary prevention of cardiovascular events. But this combination can be used in ACS without stents, with bare metal stents, drug eluting stents but not in stroke. Dr. Jawaid Akbar Sial from Chandka Medical College spoke about non-invasive role of GPIIb/IIIa.
Prof. Abrar Sheikh Dean Faculty of Medicine at SMBBMU along with panel of experts chaired the next session. Prof. Zaman Sheikh Prof. of Medicine at DUHS and Executive Director of National Institute of Diabetes and Endocrinology in DUHS spoke about the use of Aspirin in diabetes. He opined that all Type-2 diabetics who are at risk of developing cardiovascular diseases must be put on low dose aspirin therapy. Enteric coated tablet of 75mg is as effective as high dose. Similarly low dose Aspirin therapy should also be prescribed to high risk individuals over the age of forty years, he remarked.
Prof. Mahmood Ali Malik an eminent physician and former Principal of King Edward Medical College in his presentation again emphasized the usefulness of low dose aspirin therapy in all Type-2 diabetics since they are at high risk of developing cardiovascular diseases as well. Studies, he said, have shown that ten years before development of diabetes, people are prone to develop cardiovascular diseases. Abdominal obesity, hypertension, diabetes mellitus, dyslipidemais, chronic cardiovascular diseases are all considered important risk factors. He then talked about the clinical features of Type-2 diabetes. The patients should be advised to control their hypertension, blood glucose, and dyslipidemias. He suggested that all patients with previous myocardial infarction, TIAs, vascular surgery, angioplasty must be put on low dose Aspirin therapy. Majority of the Type-2 diabetics, he said, are high risk patients.
Prof. Ejaz Ahmad Vohra another noted physician and Dean postgraduate studies at Ziauddin Medical University in his presentation pointed out that TIAs should be treated as an established Angina. Most of the diabetics, he further stated, are killed because of cardiovascular diseases. Unless there are some contra indications, all stroke patients and those with TIAs should be prescribed low dose aspirin therapy for secondary prevention.
Prof. Saeed Ahmad Sangi Prof.of Cardiology at Chandka Medical College presented the futuristic vision of medicine. He felt that soon the surgeons are expected to be out of job as robots will take up most of the surgery. Artificial hearts will become available. Cardiovascular medicine by 2034 will undergo drastic changes and after some time anti obesity drugs will be available. Biotechnology is making tremendous progress. It is expected that the incidence of myocardial infarction will go down in the developing countries. Stem cells will become available as standard procedures. There will be drastic reduction in cardiac surgery as robotic surgery will be a reality. Artificial heart replacement will become possible. Prof. Khalida Soomro Professor of Cardiology at Dow University of Health Sciences was the next speaker in this session who also talked about newer antiplatelet agents like GPIIb/IIIa.
Dr. Maqbool H. Jafary in his second presentation talked about the new and emerging indications of Aspirin Therapy which include colorectal cancer, gastric and esophageal cancer, Alzheimer’s disease, pregnancy induced hypertension, renal disorders, pulmonary embolism, DVT etc. During the discussion which followed rational use of antiplatelet therapy in acute coronary syndrome was highlighted.

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