Aga Khan University is a non-profit institution and an agency of the Aga Khan Development Network. It was Founded in 1983 as Pakistan's first private university. Starting in 2000, the university expanded to Kenya, Tanzania, Uganda, the United Kingdom and Afghanistan.AKU began life as a health-sciences university. It is among the largest private health-care providers in Pakistan and East Africa. AKU hospitals were the first in those regions accredited by U.S.-based Joint Commission International.More recently, the university has initiated programmes in teacher education, the study of Muslim civilisations, journalism, early childhood development and public policy. In the near future, the university plans to launch an undergraduate liberal-arts programme to educate future leaders in a wide range of fields and establish additional graduate professional schools.
Background/Aims Achieving functional cure (hepatitis B surface antigen [HBsAg] loss) and discontinuing lifelong nucleos(t)ide analog (NUCs) therapy are critical clinical goals in chronic hepatitis B (CHB) management. This study evaluated the long-term clinical outcomes and cost-effectiveness of different treatment strategies aimed at functional cure in hepatitis B e antigen (HBeAg)-negative patients with CHB across Asia-Pacific income strata. Methods A Markov state-transition model was developed to project 30-yr hepatitis B virus (HBV) disease outcomes in HBeAg-negative patients. Three finite strategies, PegIFN add-on to NUCs (PegIFN+NUC), switching from NUCs to PegIFN (Switch), and bepirovirsen add-on to NUCs (Bepi+NUC), were compared with lifelong NUC therapy. Analyses were stratified by country income level (high-income country [HIC], upper-middle-income country [UMIC], and lower-middle-income country [LMIC]). Costs were estimated from the health care payer perspective in 2023 USD. Incremental cost-effectiveness ratios (ICERs), probabilistic sensitivity analyses, and cost-effectiveness acceptability curves were generated across a range of willingness-to-pay thresholds. Results Switch led to the largest reduction in hepatocellular carcinoma (31%) and HBV-related deaths (32%). In HIC, Switch was the dominant strategy (lower cost and higher quality-adjusted life years [QALYs] than standard care). In UMIC and LMIC settings, Switch remained highly cost-effective with ICERs of 1774 and 2200 per QALY gained, respectively. Probabilistic sensitivity analysis demonstrated a >89% probability of finite PegIFN strategies being cost-effective at 1× GDP per capita thresholds across all income strata. In contrast, the bepirovirsen add-on strategy was dominated in all settings due to high acquisition costs and the impact of modeled seroreversion on long-term gains. Conclusions Finite PegIFN-based combination therapies are cost-effective toward functional cure in AP region. While bepirovirsen represents a major milestone in HBV drug development, its current economic viability is limited by high costs and durability concerns. Policy efforts should prioritize optimizing established immunomodulatory combinations to accelerate global hepatitis B elimination.
The persistent learning crisis in science and mathematics across countries of the Global South raises critical questions about the quality of classroom instruction. While participatory pedagogy is widely advocated for promoting cognitive engagement, inclusion, and student agency, large-scale empirical evidence on how practices are enacted, and the conditions that enable them, remains limited in contexts such as Pakistan. This study develops a national profile of participatory practices in elementary (Grades 5, 6, and 8) science and mathematics classrooms in Pakistan and examines the predictors of these practices. Grounded in the dynamic model of school effectiveness and constructivist theory, participatory pedagogy is conceptualised as teaching that promotes collaboration, student voice, shared decision‑making, and meaningful cognitive engagement. Using a large‑scale cross‑sectional design, the study reports findings from structured observations of 436 classrooms in 96 public and private schools across 16 districts. Classrooms were assessed using an adapted Classroom Observation Scale‑Revised (COS‑R), measuring the physical environment, classroom interactions, and teaching practices. Results indicate that instruction remains largely teacher‑centred, with limited student participation and weak cognitive engagement, although teacher–student interactions were generally positive. Peer interaction and formative feedback were minimal. Multivariate analyses show that class size and the effective use of allocated instructional time are key determinants of participatory practices. The study contributes large‑scale empirical evidence from the Global South, introduces a contextually grounded observation tool, and offers scalable insights for strengthening participatory pedagogy in pursuit of equitable learning outcomes aligned with SDG4.
Temporal Lobe Epilepsy with Hippocampal Sclerosis (TLE-HS) presents a significant therapeutic challenge, primarily due to pharmacoresistance and progressive hippocampal neurodegeneration. Since current anti-seizure therapies often provide limited seizure control in TLE-HS, there is increasing interest in exploring alternative and complementary treatment approaches. Chinese herbal medicine (CHM) or Traditional Chinese medicine (TCM) has gained attention for its multifaceted therapeutic potential, particularly its neuroprotective and anticonvulsant effects. This review explores preclinical and emerging clinical evidence supporting the efficacy of TCM in modulating key molecular targets involved in epileptogenesis. Several TCM-derived bioactive compounds exhibit anti-inflammatory properties by downregulating proinflammatory cytokines and damage-associated molecular patterns. Additionally, TCMs promote neurotrophic factor expression and enhance synaptic plasticity, thereby supporting neuronal survival. By balancing excitatory (glutamatergic) and inhibitory (GABAergic) neurotransmission, TCM may reduce seizure susceptibility and progression. Notably, herbs such as Gastrodia elata and Uncaria rhynchophylla demonstrate promising mechanistic effects. Although encouraging, these findings necessitate further pharmacological validation and clinical trials to substantiate TCM as a complementary, evidence-based intervention for patients with pharmacoresistant TLE-HS.
This chapter reviews the most recent data on malnutrition and catch-up growth published between July 1, 2015 and June 30, 2016. Catch-up growth is defined as height velocity above the expected for age that occurs after a period of growth retardation during childhood and puberty. The first paper in this chapter deals with research priorities in the field of malnutrition and highlights the most rated questions for future studies by experts (Angood et al., 2016). This is followed by research studies providing new insights into various aspects of the field: meaningful parameters for the measurement of population-level catch-up in linear growth in children (Leroy et al., 2015); new postnatal growth standards for preterm infants (Villar et al., 2015); the consequences of marginally low birth weight on weight and height in childhood (Berglund et al., 2016); important components of the malnutrition rehabilitation diet, especially proteins (Ghosh 2016; Manary et al., 2016; Stobaugh et al., 2016; Batra et al, 2016; Masarwi et al., 2016; Bortolotti et al., 2016; Semba et al., 2016), micronutrients (Shafique et al., 2016), and prebiotics (Bryk et al., 2015); and the link between the gut macrobiota and malnutrition (Blanton et al, 2016).
The hypothalamus serves as a central regulator of metabolism, integrating signals pertinent to food intake and energy balance. Brain-Derived Neurotrophic Factor (BDNF) is widely distributed in brain, including expression in hypothalamic nuclei, which regulates feeding behavior. Chronic ethanol (EtOH) consumption has adverse effects on metabolic function, affecting the hypothalamus and striatum, a reward-associated region. Virgin coconut oil (VCO), a dietary lipid rich in medium-chain triglycerides, which have been shown to modulate BDNF expression. Based on these findings, we hypothesized that chronic EtOH consumption would impair metabolic regulation and causes oxidative stress, while VCO would counteract these effects. To test this, water drinking control and EtOH drinking Wistar male rats received water as vehicle or VCO by gavage (12 days). Growth, diet and fluid consumption were recorded throughout the experiment. Hypothalamic BDNF, striatal oxidative stress, and serum metabolic markers following EtOH and VCO exposure were examined. Statistical analysis utilized t-test, two-way ANOVA and Kruskal-Wallis test. Findings revealed that VCO reduced hypothalamic BDNF, decreased food and food caloric intake, and led to weight loss in EtOH exposed rats. Metabolic effects were further modulated by alterations in serum glucose, cholesterol, and triglycerides, where EtOH lowered glucose and cholesterol due to reduced caloric intake, while VCO increased all three markers. Additionally, VCO restored oxidative stress markers in the striatum, potentially mitigating EtOH- induced neurotoxicity by normalizing catalase and peroxide levels. This study highlights the complex interaction between EtOH and VCO in metabolic regulation, oxidative stress, and neuroendocrine function, warranting further research to explore its potential therapeutic implications.
