Archive for 2006
Pakistan, a real destination for tourism: President Musharraf
Sunday, December 17th, 2006
Saturday, 16 December 2006
ISLAMABAD, Dec 15 (APP):President General Pervez Musharraf Friday said Pakistan is a real destination for tourism and the government is making all out efforts to improve infrastructure and facilities for the tourists. Launching the year-long celebrations in connection with “Destination Pakistan 2007â€,here at Convention Centre, the President said there is great “untouched and uncovered†potential for promoting tourism, which should be explored to attract maximum tourists from across the world.Â
President Musharraf said ensuring law and order is the responsibility of the government adding that the government had been taking adequate measures in this regard, therefore, the countries having “travel advisory†for their citizens to Pakistan should be removed.
The President highlighted the scope for tourism relating to religion said there are many important holy places of Bhudism, Hinduism and Sikhism which should be projected in an appropriate way to attract the tourists relating to these religion.
President Musharraf said soft image of the country would also be projected through the promotion of tourism.
He said, “Pakistan is much different what it has been projected and perceived outside†therefore, with the promotion of tourism, this perception would also be improved.
The President said Pakistan has all types of weathers and land while the temperature range here is from 50 degree centigrade to minus 50 degree centigrade, and it could have attraction for all kind of tourists from various countries.
President Musharraf said tourism is multi-billion industry and its improvement in the country could enhance economic activities and alleviate poverty.
Referring to the share of Pakistan in the tourism, he said out of 8 per cent of the world’s tourism business of South Asia, Pakistan has just 4 per cent of this business.
He said the development of tourism would also improve job opportunities and the economic benefits of tourism would reach the poor.
The President said Pakistan has all types of terrains, and it is a great honour that the country has the second highest mountain of the world, K-2.
He said Pakistan has five highest peaks out of 14 in the world and there are tremendous chances for hiking, mountaineering and many other sports.
Referring to Cholistan desert, the President said it could be a natural attraction for many tourists while coastline of Pakistan from Karachi to Gwadar was another beautiful area to be explored for tourism.
He said the plains of the Punjab have many beautiful sites as it has one of the biggest ever canal network in the world, which is worth-seeing.
Musharraf said Pakistan has also many oldest civilizations like Ham Gargh, Gandhara, Moenjo Daro and Harappa, which have attraction for many world tourists.
Referring to natural beauty in Northern Areas of Pakistan, the President said Karakoram Highway, which is considered 8th wonder of the world, has great attraction for the tourists.
He said Pakistan has the highest polo ground in the world at Shandur where Polo matches are played every year. He said the country has snow covered mountains and lakes, besides many valleys.
The President said infrastructure in the Northern Areas is being improved and many valleys like Chitral, Hunza, Skardu and Kaghan have been linked through roads to facilitate the tourists.
President Musharraf, however said still the country needs good and better airports, quality roads, hotel accommodations and other facilities to further promote the tourism.
Appreciating the efforts of Ministry of Tourism for promoting tourism, the President emphasised the need to encourage “domestic tourists†to explore the beautiful places in the country.
The President urged the people to see the country and know it, as it has great potential for tourism.
He also asked the Ministry of Tourism to start Car Rally, particularly in the Northern Areas as these areas are among the highest places in the world and the rally would be “on top of the worldâ€.
The President said there should be more comprehensive publicity to promote the tourism, both at domestic and international level.
He said the government has also relaxed the visa restriction and it is now the most liberal visa regime and the number of countries have been increased to 24 for granting visa on arrival.
The President said due to various religious attractions and natural spots, there could be millions of tourists from India to Pakistan.
Appreciating the efforts of Minister for Tourism Nilofar Bakhtiar, the President said, though it is a humble start to promote tourism, it is very good beginning.
He assured his full support and cooperation to the Ministry of Tourism for further promoting tourism.
He said the calendar of the events for “Destination Pakistan 2007†is also very attractive.
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Earlier, the Minister for Tourism Nilofar Bakhtiar in her welcome address, highlighted various features of the “Destination Pakistan 2007â€.
She said it is a humble start by the Ministry of Tourism adding it would promote soft image and project the country in a better perspective.
She also thanked the delegates from 40 countries, and representatives of tour operators for their participation in the inaugural ceremony of the year-long celebrations.
Nilofar Bakhtiar said Pakistan has attraction for tourists from across the world including the religious tourists.
Begum Sehba Musharraf, the first lady, also attended the function.   Â
Ministry of Tourism arranged a cultural show on this occasion to highlight the traditional culture of various areas, tourist attractions and music to promote tourism.
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Govt promoting safe, affordable rail travel Prime Minister
Sunday, December 17th, 2006
RAWALPINDI: The government is trying to promote rail travel, as it is an affordable, safe and comfortable mode of transportation, said Prime Minister Shaukat Aziz on Saturday.
Inaugurating a non-stop train, ‘Pakistan Express’, between Rawalpindi and Karachi at the Rawalpindi Railway Station, he said the rail links of the country were a source of promoting solidarity among people living in different areas of the country, as it connected them all.
He said that these measures were part of the Pakistan Railways’ (PR) efforts to make the department more efficient and rail travel more comfortable. He said that the department was also making arrangements for starting a bullet train.
He said that railways were the backbone of the national economy, adding that it had played an important role in the progress and prosperity of the country.
He said that all the projects prepared by the Ministry of Railways would be approved to further improve the railway services, adding that the salaries of PR employees would also be increased.
He said that the Pakistan Muslim League and its allied parties were carrying out record development work in the country, adding that the number of development schemes completed in the past few years by the government were unprecedented in the country’s history. He said that the economic condition of the country had improved greatly in the past half decade, adding that tremendous development had taken place in all sectors of the economy. He said that continuation of the policies was necessary for maintaining economic momentum.
Federal Minister for Railways Sheikh Rashid Ahmed said that the new train service would benefit people with low incomes, as a one-way fare was only Rs 600. He said that a new “luxury†train service would be inaugurated on December 25. He said that two million people travelled on the PR trains in the last six months, adding that the figure would reach five million in a year.
He said that PR had also started a shuttle train service between Peshawar and Rawalpindi and its fare was Rs 70. He said that past governments had neglected the development of the PR and instead of building a new rail track, it had allowed 1,000 kilometres of track to fall into disrepair.
He said that PR engines and coaches were being repaired and built at the local carriage factories without any foreign assistance. He said that the salaries and other allowances of the employees of department would be increased.
He said that the railroad from Sohawa to Dena was the cause of the unnecessary delay in the Lahore-Rawalpindi trains, adding that if the route could be modified, trains would travel between the two cities in just two and a half hours.
He said that tenders for running a bullet train had been received from two Spanish and Austrian companies. He said that there were 4,000 unmanned railway crossing from Lahore to Karachi. He said 300 of them would be immediately closed to avoid accidents, while the department would hire more staff for working on the rest.
He said that computer ticketing systems had been introduced at all stations and PR had a service to deliver tickets at home on nominal charges.
He said that land belonging to the PR was being auctioned off to generate revenue for the department and to construct hotels to promote tourism in the country. app
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Year 2007 to be celebrated as Visit Pakistan Year
Wednesday, December 13th, 2006
Ms Bakhtiar said the tourism ministry had finalised and printed a “Calendar of Events 2007†that carried dates of the events being held to promote tourism.
She said the celebrations and the events would begin with Lahore Marathon on Jan 14, followed by one-week Pakistan Tourism Fair in Lahore beginning from Jan 15, besides a twoday competition of brass band by Pakistan armed forces on Jan 17 and 18.
She said the events would help create a soft image of Pakistan commensurate with its tourism attractions and compatible with the socio-cultural heritage of the country.
During the next year, Ms Bakhtiar said, the tourism ministry would market its tourism products, including history and heritage sites, mountains, northern areas, religious tourism as well as Pakistani people and their hospitality. “We need to end suppression and create an environment of openness in the society,†she added.
She said the tourism ministry, in collaboration with all four provincial governments, would ensure that all foreign tourists’ stay in Pakistan would be very pleasant. “Law and order should not be an issue in `Visit Pakistan Year,†she stressed.
Answering a question, she admitted that many countries had issued negative travel advisories for their citizens warning them against traveling to Pakistan, and urged the media to promote a soft image of the country instead of highlighting crime incidents. Crime was a global issue, and not specific to Pakistan, she added.
Ms Bakhtiar said the tourism ministry was cultivating brand ambassadors, besides contacting different countries’ ambassadors, tour operators and other officials concerned for the promotion of a better image of Pakistan. The tourism ministry was also sending a lot of promotional material to all Pakistani embassies as well as tour operators in different countries.
Punjab Tourism Minister Mian Aslam Iqbal, Punjab Social Services Board chairperson Saba Sadiq and TDCP managing director Arshad Bhatti were also present on the occasion.
The major tourism events being arranged during 2007 also include Sibi Mela (Feb 45), National skiing Championship, Malam Jaba (Feb 10-15), Thar Desert Festival, Marathon, cultural programme at Umarkot Fort, Sindh (Feb 16-18), Jashan-eBaharan Spring Festival (Feb 18-23), Third Cholistan Jeep Rally with a cultural Programme (March 8-10), Channan Pir Festival (Indus Guides) (March 8-9), Mehrgarh Conference, Quetta (March 15th), Spring Blossom Festival Northern Area (March 15-20).
Similarly, from March 23 to 25 Tour of Islamabad, March 26 to 31 Gandhara Week, Historical Review of the Buddhist Civilization, Sound and Light Show, Taxila; April 11 to 14 Baisakhi (Hasan Abadal); April 12 to 24 Adventure/Extreme Sports, Deosai Plain, Northern Areas; April 12 to 13 Baisakhi Mela (Festival at Sakhi Sarwar); April 24 to 26 Train Safari, Khewra Salt Mines with a Cultural Programme, 49th meeting of UN WTO CSA; May 11 to 15 Chitral and Kalash Festival; May 16 to 21 White Water Rafting, Azad Kashmir; May 25 to 27 SAARC Tourism Mart Karachi.
On June 9, Golden Jubilee Celebrations of the First Ascent of Broad Peak (8047m) will be held; from June 15 to July 15 Pakistan Women Kushek Training/Expedition will be held in Hunza; June 22 to 29 Shogran Festival, June 15 to Aug 30 Pakistan Broad Peak Golden Jubilee Expedition; June 25 to 27 Hunza Festival and The Tourism Convention; July 7 to 9 Shandur Polo Festival (ChitralGilgit), with a festival at Kalash.
Other events include : July 10 to 15 Karakorum Car Rally; July 15 to 17 Broghil Festival; July 23 to 28 Mountain Marathon (AJK Kaghan); August 12 to 14 Freedom jeep Rally, Gaddani Beach; August 14, 60th Independence Day; September 13 International Mountain Marathon, Hunza; Sept 1-6 Silk Route Festival (Northern Areas); Sept 3-6 Sufi Festival at Sehwan Sharif; Sept 7-9 International Mountain Bike Race, Kaghan; Sept 10-11 International Mountain Tourism Conference Islamabad; Sept 10-12 Karakorum International Film Festival KIFF, Islamabad; Sept 2024 Painted Truck Caravan Karachi to Khyber; Sept 27 World Tourism Day Celebrations, Peshawar (Ramazan Celebrations in NWFP); Oct 9-14 Hot Air Ballooning Competition, Islambad; Oct 15-20 Jashn-e-Sahil, Gawadar; OCt 21-28 Journey Through Time-Sound and Light Show and a cultural event at Moenjodaro; Nov 1 Jashn-eAzaadi, Gilgit Celebrations; Nov 113 A walk through historic times; Nov 2-11 Birthday Celebrations of Guru Nanak Dev Jee at Lahore, Hasan Abdal and Nankana Shaib; Nov 10-19 International paragliding Competition, Islamabad, Swat and Azad Kashmir; Nov 21-27, International Festival of Performing Arts, Lahore;.Nov 24 World Buddhist Congress and a Festival of Asian Arts and Crafts, Islamabad; Dec 1-20 Pakistan Cultural Train Safari, Peshawar to Karachi; Dec 24 Christmas Celebrations, Lahore; Dec 30 Tourism Convention and the Closing Ceremony, Islamabad and a Cultural Show.
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Silk Route Cultural Pluralism Festival in Gulmit
Tuesday, November 7th, 2006
Wakhi Tajik Cultural Association (WTCA) celebrated the Silk Route Cultural Pluralism Festival in Gulmit, Gojal Hunza for Tourism and Youth Development on October 28th 2006. It was organized by Wakhi Tajik Cultural Association (WTCA) in collaboration with Aga Khan Rural Support Programme (AKRSP), Aga Khan Cultural Service Pakistan (AKCSP) and IUCN.
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The festival successfully celebrated its opening day and then had to be closed due to the death of Mr. Adina Baig, a local social and political leader. Raja Shebaz Khan, Member District Council Gojal was Chief Guest on the festival. The artists from Gilgit, Baldistan, Hunza and Gojal present songs in Shina, Balti, Buroshaski, Khowar and Wakhi, Ghulam Nabi Hamraaz was much appreciated in Shina song by the audience. Al Amyn Model School Gulmit and Nasir-e-Kisrove School Ghulkin students present King Foe actions and tableaus. Artist from Shimshal present the Silk Rout Karvan song in Persian. A Drama (MOM SHUME) was presented by Gulkin drama Association and the audience enjoyed it very much. Sword Dance was present by Gulmit Young Star.
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Launch of first liner puts Karachi on world Sea Cruise Map: Musharraf
Monday, November 6th, 2006
KARACHI: President General Pervez Musharraf Saturday said Karachi has been placed on the map of world sea cruise with the launch of first ever sea cruise liner.
Pakistan is blessed with a unique landscape - loftiest mountains, vast plains, deserts, coastlines, rich cultural heritage, ancient civilizations and cradle of different religions.
Karachiites must see up North and northern area people must see coastal linesâ€, he noted while addressing the select gathering of diplomats, senior officials, leading businessmen, bankers and notables on-board Gulf Dream Cruise Liner at Karachi Port.
First Lady Begum Sehba Musharraf, Sindh Governor Dr. Ishrat-ul-Ebad, Chief Minister Dr. Arbab Ghulam Rahim, Ports and Shipping Minister Babar Ghauri were also present on the launching of first-ever sea cruise vessel.
The President noted that more than 500 destinations are covered by sea cruise operators and Karachi has now been added to that list.
He asked KPT to provide more facilities to attract more cruise operators. He noted that more has to be done in the form of port infrastructure, passenger services, amenities to facilitate cruise operations.
He asked Pakistanis to promote tourism within the country by self to attract foreign tourists into Pakistan. He asked people to first see the unique places of the country. It would help in development of hotels, motels and other tourism facilities at the tourist resorts, he noted.
“Pakistanis themselves must travel to see their own tourist attractions. Then foreign tourists will comeâ€, President Musharraf said.
The President said Pakistan is a land of exotic and picturesque pleasure and its people should explore these tourist attractions. Pakistan offers varied temperatures starting from 50 degrees plus Celsius to minus 50 degrees.
The country is blessed with difficult terrain and virgin coastal line with coastal towns like Ormara, Gwadar. He said the government was developing Gwadar as an industrial and tourist town and its town planning was already done. It will emerge as one of the most beautiful towns of Balochistan and Pakistan in next 15 to 20 years, he said amid thunderous applause.
He said the plains of Punjab and Sindh and the inhospitable deserts in Punjab and Sindh offer great tourist attractions. “In the North, you will find some of the highest mountains of the world.â€
Cultural Heritage
Talking of cultural heritage, President Musharraf said Pakistan is blessed with 8000- year- old Meher Garh civilization in Balochistan, Indus civilization, Gandhara civilization, Mughal period landmarks and relics of Alexander’s stay, etc.
He noted that Pakistan happens to be the cradle of three olden religions - Buddhism, Hinduism and Sikhism.
He said the government was trying to open up these attractions through road links connecting remote northern mountainous areas to main roads.
“We are linking Chitral, Hunza, Gilgit, Skurdu, Astore, Kaghan, Chilas. I strongly recommend Karachiites to explore their own country and its beauty. Travel, these are very safe areas. The most exquisite and most beautiful places of the world,†he observed.
Referring to sea cruise, President Musharraf said it is most comfortable when the sea is calm. Launching of Karachi-Dubai cruise is for the first time in the history of Pakistan, he added.
He urged the cruise operator Rizwan Mohiuddin to also include Gwadar as one of the destinations.
Talking of his association with the water, the President said that he has promoted water sports in the country.
Earlier, Port and Shipping Minister Babar Khan Ghauri said more cruise liners have shown interest to operate from Pakistan due to the business friendly shipping policy of the country.
He said he was going to India by the end of this month to sign a shipping protocol to start shipping and ferry services between the two countries.
KPT Chairman Vice Admiral (Rtd) Ahmed Hayat said the port was encouraging more sea cruise liners. He said it was the fastest growing business in the world.
He said Manora (Island) was being developed as a tourist resort and its construction will begin in August next at a cost of Rs 2 billion
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Prevention and treatment of dengue virus infection
Monday, October 30th, 2006
Prevention and treatment of dengue virus infection
By Jamal Panhwar Information source from Alan L Rothman, MD
There have been around 600 confirmed Dengue Virus cases and over 2000 people admitted in hospitals in Pakistan. It is an alarming situation in a country where self medication is very popular and not all the cases are reported specially in the villages and suburbs of Pakistan. It is very Important to educate people about this disease. Special announcements may be made on TV Radio and Mosques for prevention of the disease. The only and most effective precaution is to stay away from the mosquitoes It is very important to put mosquito proof nets on windows stagnant water should be sprayed with carosine oil on weekly basis by the Naib Nazims and Mohala cometees. At home people should also make sure there is no stored wather in un covered containers, mosquito repalent MUST be used while going out and inside the home every effort be taken to get rid of mosquitoes.
Here are some detailed facts about dengue Virus. This important has been extracted for several medical journals.
INTRODUCTION — Dengue is a febrile illness that is caused by any one of four serotypes of this flavivirus (DEN-1, DEN-2, DEN-3, and DEN-4). It is endemic in more than 100 countries in tropical and subtropical regions of the world and causes an estimated 50 million infections annually worldwide [1-3].
The public health burden of dengue predominantly relates to its most serious manifestations, dengue hemorrhagic fever and dengue shock syndrome (DHF/DSS) [4]. Epidemiologic studies have demonstrated that the greatest risk factor for the development of DHF or DSS is secondary infection with a different dengue serotype from the original infecting virus [5]. Thus, severe disease occurs primarily in patients who reside in hyperendemic areas where multiple serotypes circulate simultaneously.
Dengue virus infection is a risk for anyone living in or traveling in a dengue endemic region, especially in tropical Asia, Central and South America, and the Caribbean. In most of these regions, dengue virus transmission occurs year-round. However, the risk of infection tends to be seasonal and can be expected to be highest during a recognized outbreak of dengue infections. The objectives of programs to prevent dengue infections differ depending upon whether local residents or visitors are targeted. There is no direct therapy available against the dengue virus, which increases the importance of prevention.
Measures to prevent dengue fever and supportive treatment for the complications of dengue virus infection will be reviewed here. The pathogenesis, clinical manifestations, and diagnosis of infection are discussed separately. (See “Pathogenesis of dengue virus infection” and see “Clinical presentation and diagnosis of dengue virus infections”).
PREVENTION — The greatest risk for dengue virus infection is in individuals residing in endemic areas and not in travelers.
Public health efforts in endemic areas — Control of the Aedes aegypti mosquito which transmits dengue virus and the development of vaccines are two potential approaches in preventing dengue virus infections.
Mosquito control — Mosquito control is the most effective approach to the prevention of dengue transmission. Programs targeting the Aedes aegypti mosquito as a means to eliminate urban yellow fever in the Americas from the 1940s through 1970s were quite successful [6]. These programs were also effective at reducing dengue transmission in the region. These programs were based on a “top down” approach involving aggressive mosquito surveillance and insecticide use. However, lack of attention and funding of these programs in the 1970s led to re-emergence of A. aegypti throughout its former region and the corresponding re-emergence of dengue.
Insecticide spraying, in response to dengue outbreaks, is not highly effective against A. aegypti mosquitoes, which frequently breed inside houses [6,7]. Community-based approaches involving education of the population in efforts to reduce breeding sites, such as discarded tires and other containers that accumulate standing water, have shown some promise [6].
A comprehensive community and governmental control strategy, including the seeding of water vessels with copepods that feed on mosquito larvae, has been successful in eliminating A. aegypti and dengue transmission in 32 communities in rural areas of Vietnam [8]. However, this strategy will be more difficult to apply in cities where breeding sites are different and community participation may be harder to sustain [9].
Vaccination — Infection with dengue provides long-term protection against the particular serotype that caused the disease, supporting the feasibility of a dengue vaccine. However, it provides only short-lived immunity to the other three dengue serotypes. In view of the association of DHF with previous exposure to dengue viruses and the recognition that all four serotypes are capable of inducing DHF it is the general consensus in the scientific and public health communities that any candidate vaccine should produce protective immunity against DEN 1-4. Since waning immunity might also increase the risk for DHF in vaccinees, vaccine-induced protective immunity should also be long-lived.
Animal studies indicate that protective immunity against dengue can be mediated by neutralizing antibodies, especially those directed against the envelope (E) glycoprotein. However, natural dengue infection induces low levels of cross-reactive antibodies that are detected in neutralization assays, but do not prevent infection with the other dengue serotypes [10]. This cross-reactivity will further complicate the laboratory assessment of vaccine-induced immunity.
A tetravalent vaccine that induces immunity against all four serotypes is in development. In a rhesus monkey model, a tetravalent live attenuated dengue virus vaccine demonstrated seroconversion rates of 100, 100, 90 and 70 percent against dengue serotypes 1,2,3, and 4 [11]. In addition, vaccination resulted in complete protection against viremia from inoculation with serotype 2; protection against challenge with the other dengue serotypes resulted in protection in 50 to 80 percent of animals compared to controls.
To date, there is no licensed vaccine available for preventing dengue. Several live attenuated tetravalent vaccines have entered clinical testing, and preliminary data are encouraging with regard to reactogenicity and immunogenicity in adults and children [12-14]. Interference in replication between the four component viruses has been problematic, leading to skewing of the antibody and cellular immune responses. The need for adjustment of the vaccine formulations and multi-dose vaccination regimens has slowed clinical testing of these vaccines as well. As a result, data on vaccine efficacy and persistence of immune responses are lacking [10].
Recommendations for travelers — Most travelers from non-endemic countries are at exceedingly low risk for DHF because they lack previous exposure to dengue viruses (see “Pathogenesis of dengue virus infection”). Possible exceptions include immigrants from endemic areas subsequently returning to their countries of origin and frequent international travelers. Regardless of the risk for DHF, most travelers will wish to avoid the morbidity of dengue fever.
Avoidance of exposure to infected A. aegypti mosquitoes is the primary approach to prevention of dengue virus infections in travelers. These mosquitoes predominantly live in urban areas in and around houses [7]. Thus, travelers to major cities are at risk for exposure to A. aegypti. Bed netting is of little use since the mosquitoes are most active during the daytime [15]. Remaining in well-screened or air-conditioned buildings during the day can reduce the risk of exposure but many travelers are unwilling or unable to comply. When outside during the day, travelers wishing to avoid dengue should wear clothing that reduces the amount of exposed skin and should use an effective mosquito repellent, such as N,N-diethyl-metatoluamide (DEET).
THERAPY — Since, as noted above, there is no specific therapy available for dengue virus infections, it is important to exclude other treatable diagnoses. Patients at risk for dengue can acquire other diseases with similar clinical features, such as malaria, typhoid fever, and leptospirosis. Symptoms in patients with dengue virus infections resolve in five to seven days.
Supportive treatments are available for the specific disease manifestations of dengue virus infection.
Dengue fever — Patients with dengue fever should be cautioned to maintain their intake of oral fluid to avoid dehydration. Fever and myalgias can be managed as needed with acetaminophen. Aspirin or nonsteroidal antiinflammatory agents should generally be avoided because of the risk of bleeding complications and in children because of the potential risk of Reye’s syndrome. The most important measure to assist the patient with dengue fever is to carefully evaluate the patient for impending complications, such as early evidence of DHF, as described below.
Dengue virus infection with significant bleeding — Gastrointestinal bleeding or menorrhagia in patients with DHF, and occasionally in patients with dengue fever as well, can be severe enough to require blood transfusion. Factors that contribute to bleeding include thrombocytopenia due to decreased platelet survival [16] and, in severe cases, frank disseminated intravascular coagulation. (See “Pathogenesis of dengue virus infection”). Platelet transfusions are rarely given, but may be warranted in patients with severe thrombocytopenia (<10,000/mm3) and active bleeding.
Dengue hemorrhagic fever — Plasma leakage in DHF is important to manage with aggressive intravascular volume repletion to prevent or reverse hypovolemic shock [17]. In mild cases, particularly when medical attention is received early, oral rehydration may be sufficient. However, in patients with established intravascular fluid loss, intravenous fluid administration is recommended. Blood transfusion is appropriate in patients with significant bleeding; subsequent hematocrit measurements must be interpreted with caution since it is also critical to assess the adequacy of fluid repletion.
Treatment of shock — A protocol for intravenous fluid therapy has been developed by the World Health Organization (WHO) based upon clinical experience mainly in children from Southeast Asia [18]. For patients with shock, an initial bolus of five percent dextrose in normal saline or Ringer’s lactate (10 to 20 mL per kg of body weight) infused rapidly is recommended, followed by continuous infusion (10 to 20 mL/kg per hour) until vital signs and urine output normalize. The infusion rate can then be gradually reduced until it matches plasma fluid losses.
There has been debate as to whether crystalloids or colloids should be used for volume replacement in critically ill patients. Three randomized, blinded trials have investigated the effect of different fluid regimens on outcome [19-21]. The largest of these studies was a double-blind randomized comparison of three fluids for initial resuscitation of 512 Vietnamese children with dengue shock syndrome [21]. Three hundred eighty-three patients with moderate shock were assigned to Ringer’s lactate or one of two different colloid solutions: six percent dextran 70 or six percent hydroxyethyl starch. One hundred twenty-nine patients with severe shock were randomized to receive one of the two colloids. The treatment regimen closely followed the WHO protocol above, with 15 mL/kg administered over the first hour and 10 mL/kg over the second hour. Only one patient died. This trial established that Ringer’s lactate was a safe, effective, and inexpensive alternative in initial resuscitation of patients with moderate shock. In patients with severe shock, dextran and starch performed similarly, although dextran was associated with more hypersensitivity reactions.
The adequacy of fluid repletion should be assessed by serial determination of hematocrit, blood pressure, pulse, and urine output. Patients with shock on presentation should initially have vital signs measured at least every 30 minutes and hematocrit measured every two to four hours. Narrowing of the pulse pressure is an indication of hypovolemia in children even with a normal systolic blood pressure. Normalization of the hematocrit is an important goal of early fluid repletion; however, a normal or low hematocrit may be misleading in patients with overt bleeding and severe hypovolemia. (See “Treatment of severe hypovolemia or hypovolemic shock in adults”).
Close clinical observation is essential, even after normal blood volume is restored, because patients can develop shock for one to two days after initial fluid resuscitation which represents the period of increased vascular permeability in DHF. Most patients who present for medical attention before profound shock develops and who receive appropriate fluid therapy will recover quickly.
The fluids that are lost into tissue spaces during the period of plasma leakage are rapidly reabsorbed. Thus, intravenous fluid supplementation should be discontinued once patients are taking oral fluids and have normal hematocrit, vital signs, and urine output. Usually no more than 48 hours of intravenous fluid therapy are required. Excessive fluid administration after this point can precipitate hypervolemia and pulmonary edema.
In the absence of complications from prolonged hypotension or from medical interventions, most patients with DHF will have stabilized within a few days of admission. Discharge from the hospital is appropriate when patients have been afebrile for at least 24 hours and have normal oral intake, urine output, and hematocrit.
The basis of DHF pathogenesis is hypothesized to be immunologic, which has led to interest in immunomodulatory drugs for therapy. (See “Pathogenesis of dengue virus infection”). However, a meta-analysis of four trials involving 284 participants found that corticosteroids were no more effective than placebo in reducing the number of deaths, the need for blood transfusion, or the number of serious complications [22].
Unusual complications — Encephalopathy and liver failure are uncommon manifestations of DHF which are associated with a high mortality rate [23]. While seizures or jaundice should always be regarded as indicative of severe disease, no specific treatment is available.
Outpatient management and early recognition of DHF — Because dramatic plasma leakage can develop suddenly, substantial attention has been placed upon the early identification of patients at higher risk for shock and other complications. The following clinical features are helpful in this determination:
·                                Duration of illness — The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after defervescence.
·                                “Alarm signs” — Severe abdominal pain, persistent vomiting, abrupt change from fever to hypothermia, or abnormal mental status, such as disorientation, are noted in a minority of patients [24]. In one study, these signs developed less than one day prior to hospitalization.
·                                Hematocrit — An elevation of the hematocrit is an indication that plasma leakage has already occurred and that fluid repletion is urgently required.
·                                Platelet count — Severe thrombocytopenia (<100,000/mm3) is one of the clinical criteria for DHF and usually precedes overt plasma leakage.
·                                Serum aspartate transaminase (AST) — Mild elevations in serum transaminases are common in both dengue fever and DHF. However, levels are significantly higher in patients with DHF, and elevated AST levels are noted earlier in illness than the other signs listed above. In one study conducted in Thailand, a normal AST level was a strong negative predictor of DHF (negative predictive value 0.96) even in the first three days of illness [1].
·                                Soluble dengue NS1 protein — Blood levels of soluble dengue NS1 protein (> 600 mg/mL) were predictive of DHF in one study of Thai children with secondary dengue 2 virus infections [25]. Another assay that measures blood soluble dengue NS1 levels has become commercially available outside the United States; if the clinical utility of this commercial assay is similar to the published data, measurement of soluble dengue NS1 protein may become a clinically useful parameter for patient management.
Patients with suspected dengue who do not have any of the above indicators can be safely managed as outpatients as long as close clinical observation is assured. Daily outpatient visits may be needed to permit serial assessment of blood pressure, hematocrit, and platelet count. One study in Malaysia over a two month period tested a standard treatment protocol for patients with suspected dengue [26]. Daily outpatient visits were conducted and referral for hospitalization was made only for one of the following signs:
·                                Blood pressure <90/60 mmHg
·                                Hematocrit >50 percent
·                                Platelet count <50,000/mm3
·                                Evidence of bleeding other than petechiae
There were no deaths among 162 adults studied (average age 27 years), of whom 28 (17 percent) had DHF; the overall hospitalization rate was 44 percent. All of the subjects with DHF either were hospitalized or qualified for hospitalization according to the protocol, whereas 89 (66 percent) of the subjects without DHF were managed without hospitalization.
For many resource-poor dengue endemic countries, routine laboratory testing is not readily available. One study of 1250 children aged 2 months to 10 years presenting to a pediatric hospital in southern Vietnam evaluated whether an assessment tool designed for first level health care workers, using only clinical signs, could appropriately classify and guide management of acute illnesses in an endemic area [27]. The assessment tool was derived from the WHO/UNICEF “Integrated Management of Childhood Illness” algorithm designed for use in Africa and was modified to include common signs and symptoms of DHF. Although the 20 children with established dengue shock syndrome were correctly identified as requiring urgent hospitalization, classification of less severe DHF was imperfect and reevaluation within one to two days was needed to detect children who developed shock.
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President Musharraf for ‘drastic change’ in Pakistan’s image
Friday, September 29th, 2006
New Delhi, Sep 28 (IANS) Pakistan President Pervez Musharraf, fully aware of his country’s “grim reputation for terrorism,” has called for a “drastic change” in the image of Pakistan and asked the media to join him in promoting the “soft image of a culturally rich, inviting and economically vibrant country.”
“It is unfortunate that Pakistan’s image abroad has been tarnished so badly that the world associates it only with terrorism and extremism,” says Musharraf in his recently published “In The Line of Fire: A Memoir.”
“Our grim reputation for terrorism and the many travel advisories against us hinder tourism,” he says.
Asking the world to look at the country he rules afresh, Musharraf waxes lyrical about “virgin coastline, picturesque mountains, dense forests and mighty rivers” of Pakistan and invites the world to soak in “rich and distinct cultures” of Pakistan’s four provinces.
“Ironically, all this has remained the best-kept secret of Pakistan,” says Musharraf.
“Worse, the forces of religious extremism and obscurantism reject this cultural activity as being un-Islamic. No previous government had the courage to tell them that they were wrong,” says the Pakistani leader in his memoirs that sounds more like his campaign pitch for the elections next year.
In his bestselling book, that hit Indian bookstores Wednesday, Musharraf, who ousted democratically elected Nawaz Sharief in a military coup in 1999, also asserts that contrary to popular perception Pakistan is predominantly a moderate country, albeit one with a small fringe group of extremists.
But he rues that despite his diligent efforts to promote what he calls “a truer image of Pakistan” and its myriad achievements in the field of culture, sports and tourism the world has chosen to tar it with the brush of extremism.
“However much we plead that the vast majority of Pakistan is moderate and that only a fringe element is extremist - and that our national fabric has been damaged by the turbulence to our west in Afghanistan and to our east in Kashmir, not by anything inherent within our borders and society - the message does not get across,” says Musharraf, who has used his memoirs to promote him as a moderate leader of a moderate country seven months before elections in Pakistan.
Distancing the Pakistani state from acts of terrorism - a charge New Delhi has often hurled against Islamabad - Musharraf asserts that the fringe group of extremists in Pakistan are indoctrinated into terrorism by a combination of vested interests and socio-economic deprivation.
“I have therefore tried to project a truer image of Pakistan, which I call a soft image, through the promotion of tourism, sports and culture,” he says in self-congratulatory tone.
He exhorted the Pakistani media to help him sell the image of a new resurgent Pakistan - a “dynamic, progressive and moderate nation.” “We have to defeat terrorism and extremism, but at the same time must also present a culturally rich, inviting and economically vibrant alternative in its place. The media need to gear up to sell Pakistan abroad.”
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Pakistan conducive to all kinds of tourism: President, PM
Wednesday, September 27th, 2006
ISLAMABAD: President General Pervez Musharraf and Prime Minister Shaukat Aziz Tuesday said that Pakistan is proud to join the comity of nations in celebrating World Tourism Day with a renewed determination to earn its rightful place among the more attractive tourist destinations world-wide.
President General Pervez Musharraf and Prime Minister Shaukat Aziz on the ocassion of World Tourism Day falling on September 27 (today) in their separate messages have said that Pakistan is a destination for special interest tours and is conducive to all kinds of tourism.
President in his message has said that Pakistan is a land of much splendour. We care in the process of revitalising our tourism industry which until now has remained largely undiscovered.
President added that we can only move forward with public-private partnership. The private sector must come forward and play a leading role in the development of tourism industry and Government will provide all possible assistance as facilitator to these prospective investors from private sector.
On the other hand, PM said that Pakistan recognises tourism as an export industry in the services sector and its promotion is now a State policy with due commitment.
“We have recently taken decisions to promote Pakistan as a destination for international tourists. A tourist friendly visa policy is already in place and the next year has been designated as “Visit Pakistan” year”, PM maintained.
The Prime Minister added that the continuing positive state of our economy and improved investment climate have generated substantial inbound business travel, giving positive exposures to our tourist products and services.
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Pakistan to host world Budhist assembly next year, says Nilofer
Tuesday, September 26th, 2006
TOKYO: Federal Tourism Minister Nilofer Bakhtiar has said that Pakistan would host a World Buddhist Assembly next year and hoped that large number of Japanese tourists would also visit Pakistan on this occasion.
She stated this while talking to Chief Priest of the eight hundred years old temple Kenchoji, Rev. Roshi Shodo Yoshida on the occasion of Iftar Dinner hosted in the honour of the Minister for Tourism, Nilofer Bakhtiar and her delegation here the other day.
The Minister thanked the chief priest for observing the sanctity of ‘Ramadhan’ and hoped that such gestures would help in promoting inter-faith harmony in the world. She reiterated the invitation to Reverend Yoshida to visit Pakistan.
The ancient temple is located in a picturesque suburbs of Tokyo. A replica of the famous Fasting Buddha statue was presented to the temple in October last year.
The decision for the donation of this unique sacred gift was made by the Prime Minister of Pakistan Shaukat Aziz during his visit to Japan.
The Minister apprised the chief priest that Buddhist religious sites were well preserved in Pakistan. She said that Pakistan had been a cradle of many ancient civilizations. She described ‘Gandhara Civilization’, which flourished in the north of Pakistan two millennia ago and made its fascinating journey to Japan, was one of the most significant motifs in Pakistan’s historical mosaic.
Nilofer Bakhtiar stated that Pakistan would host a World Buddhist Assembly next year. Leader of the Assembly had recently visited Pakistan to tie up arrangements in this regard.
The chief priest thanked the government and people of Pakistan for gifting the rare sculpture to the temple.
Meanwhile, Federal Minister for Tourism Nilofer Bakhtiar held a meeting with the Chairman of Japan Association of Travel Agents (JATA), Koji Shinmachi at Tokyo.
The chairman agreed to send a team of JATA experts in the near future to Pakistan to make on ground evaluation of tourism facilities and potential.
Tourism Minister reiterated that ‘Pakistan is a peaceful country and its people are very hospitable’.
She added that ‘not a single tourist has ever been attacked in Pakistan.’ She informed the chairman that Pakistan would host a World Buddhist Assembly next year. She said that the Government of Pakistan had declared 2007 as ‘Year of Tourism’.
Baluchistan Tourism Minister, Syed Sher Jan Baloch, Ambassador Kamran Niaz, Secretary Culture, Mr. Jalil Abbas, president of JATA, Harumi Umeda, Secretary General of JATA, Jun Ishiyama, MD PTDC, and senior Pakistani officials attended the meetings.
Nilofer Bakhtiar said that the present government in Pakistan had worked out a comprehensive Tourism Policy to tap the tourism potential of the country.
“Growth in tourism would contribute towards socio-economic development particularly in the far-flung and under-developed areas”, she maintained.
The Minister added that duties on imports of hotel equipment and special concessions for the hotel industry would attract foreign investment in this sector.
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Snow Leopard Cub Settles into U.S. Home
Tuesday, September 26th, 2006
Global effort to conserve endangered wildlife hailed
By Judy Aita
Washington File Staff Writer
New York — Leo, the orphaned snow leopard cub from Pakistan, made his New York debut September 25, greeted by delighted officials from two continents who worked to save one of the world’s most endangered and beautiful mammals.
Leo’s new home is a quiet .4 hectare area — known as the Himalayan Highlands Habitat — at the end of a path through a bamboo grove in the 107-hectares Bronx Zoo. But Leo’s tranquil retreat and the hushed voices of his greeters belie the size and complexity of his rescue, care, travel from Pakistan and temporary stay in the United States at one of the world’s greatest zoos.
Steven Sanderson, president of the Wildlife Conservation Society (WCS) and its Bronx Zoo, said that the cub will be an inspiration to 2 million zoo visitors each year.
The beautiful snow leopard “is a symbol of shared values between our two countries, a sense of devotion to natural resources, and preservation of our heritage both cultural and biological,” Sanderson said at a small ceremony.
After WCS heard that Leo had been orphaned and could not be released into the wild because he would not have the opportunity to learn hunting and survival skills from his parent, the zoo was invited by the government of Pakistan to help, Sanderson said.
“We are uniquely situated to care for this wonderful animal because we were the first zoo in the world to show snow leopards over 100 years ago,” Sanderson said. “Since 1903, we’ve had 90 snow leopard babies at the Bronx Zoo. So rest assured Leo will have the best of care and a wonderful situation.”
Sehba Musharraf, the first lady of Pakistan, said Leo marks “the beginning of a new dimension” in the multifaceted U.S.-Pakistani relationship.
“Leo will return to Pakistan,” the first lady said. But before he returns, Pakistan will develop a snow leopard conservation center for rehabilitation and breeding facilities for snow leopards with the support of the United Nations and in cooperation with the Bronx Zoo.
“I know Leo will meet new friends at the Bronx Zoo. His presence is symbolic of the excellent cooperation between Pakistan and the United States and the enduring friendship and goodwill” between Pakistan and the United States, she said.
U.S. Assistant Secretary of State for Oceans, Environment and Science Claudia McMurray called Leo’s arrival “an important success story in the global effort to conserve endangered wildlife.”
“Some might ask, is it important to bring an animal from the wild to live temporarily in a U.S. zoo? Does this action actually help save the endangered snow leopard for future generations? The answer to both of these questions is an overwhelming yes,” McMurray said.
Leo can educate thousands of visitors, both American and from other countries, about the plight of the snow leopard. And, eventually, he will spread the same word among the Pakistani people, McMurray said.
The assistant secretary of state read a letter from U.S. first lady Laura Bush, who hailed the cub as an ambassador of friendship and education that can “teach all of us so much about how to save other endangered snow leopards and about our responsibilities as stewards of the earth.”
LEO NAPPED
Leo appeared unmoved by the event. True to his species, he was shy and barely could be seen through the trees as he lounged on a boulder with his back to the visitors. His pale gray fur with dark rosettes made him blend into his new home so well that only when he moved could he be seen near the top of a hill.
Leo’s new neighbors, two red pandas, seemed equally unimpressed by the distinguished visitors. One slept in a tree; the other paced by a stream. White-naped cranes, the endangered Asian birds bred successfully at the Bronx Zoo, reside in a marsh area across the path from Leo.
The snow leopard cub, now about 14 months old, was found by a goatherd in the Naltar Valley in the Karakorum Mountains of northern Pakistan. After caring for the growing cub in their house, the herder and his family approached representatives of the World Wildlife Fund, which was working in the region, for help. The cub then was moved to Gilgit where the Pakistani government took over its care. (See related article.)
A cooperative effort by Pakistan, the U.S. government and the WCS enabled a team of wildlife experts to travel to the remote valley and transport the animal by jeep to Islamabad. Leo arrived in New York on August 9 aboard a British Airways plane after an officially arranged quick transfer through Heathrow Airport in London to minimize the effect of the summer heat.
Leo then underwent routine quarantine at the zoo’s Wildlife Health Center and an acclimation period in his new home among tall oaks, tulip trees, boulders and 12 other snow leopards before his official presentation September 25.
Snow leopards are among the world’s most endangered big cats. An estimated 3,500 to 7,000 remain in the wild, restricted to remote mountains of Central Asia, according to zoo officials. Pakistan has 200 to 400 snow leopards in the wild.
Snow leopards still are hunted for their pelts, in spite of the fact they are a protected species under the Convention on International Trade in Wild Fauna and Flora and are listed on the World Conservation Union Red List of Threatened Species as endangered.
Additional information is available on the WSC Web site.
(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)
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