Assessment of Leishmaniasis, an infectious skin disease, in Khyber Pakhtunkhwa

Partner Institutes
London School of Hygiene & Tropical Medicine	University of Peshawar

Project brief:
The Baghdad boil or the Lahore sore, as the name implies, is a skin disease prevalent in refugee camps in Afghanistan and in the northern parts of Pakistan. The scientific name for the disease is cutaneous leishmaniasis and it is common in the developing world, usually afflicting the poorest sections of the population. 

The disease is caused by the bite of the female sandfly and manifests itself in the form of lesions, or sores, on exposed body parts such as the face, neck and arms. The social stigma associated with this infection is great, especially for women living in these conservative societies, where the slightest disfiguration can mean a lifetime of isolation and ridicule.

The INSPIRE partnership between the University of Peshawar and the London School of Hygiene & Tropical Medicine is carrying out research to study the properties of drugs used to treat cutaneous leishmaniasis. The aim of the project is to establish a cell culture laboratory in the department of zoology at the University of Peshawar. 

This will be a first-of-its-kind facility in the Khyber Pakhtunkhwa region and students from all over the province can benefit from it. Experiments on skin cells will be carried out to investigate the properties of the drugs and to determine their reaction on the affected cells. 

The project will also promote the exchange of information and strengthen the existing links between British and Pakistani scientists. 

The research will have far-reaching implications for the rural population in Khyber Pakhtunkhwa, the majority of which lives in remote areas beyond the scope of national health programmes. 

Lessons learnt:
The interaction between the UK and the Pakistani teams has reaped many benefits, such as the exchange of knowledge and transfer of new ideas. The visit of the Pakistani team to the London School of Hygiene & Tropical Medicine allowed them to work in state-of-the-art labs and learn from published results to create an efficient pathway to bring scientific innovation from the lab to the people who need it the most. 

Challenges faced:
The security situation in the Khyber Pakhtunkhwa region was a concern for the UK researchers.

The impact/benefits of the project: 
The staff and students at the University of Peshawar have learnt of new developments in experimental design, cell culture, molecular techniques and molecular diagnosis. A major achievement is the establishment of a modern cell culture lab at the University of Peshawar.  

Key contacts: 
Dr. Colin Sutherland, London School of Hygiene & Tropical Medicine
colin.sutherland@lshtm.ac.uk, www.lshtm.ac.uk/

Dr. Akram Shah, University of Peshawar
Akram_shah@upesh.edu.pk, www.upesh.edu.pk/

Analysing the cause of hydrocephalus in newborns

Partner Institutes
University of Manchester	COMSATS Institute of Information Technology

Project brief:
Hydrocephalus, also known as ‘water in the brain’, is a neurological condition caused by the abnormal accumulation of cerebrospinal fluid in the brain. It affects one in 500 live births worldwide, up to one in 100 in developing countries, and is associated with life-long neurological problems. Very little research has been carried out to improve treatment for hydrocephalus, even though it has existed for centuries, with references to it in ancient Egyptian and Greek medical literature. To this day, there is no known cure for it and terminating the foetus is the only control method being practised.

The collaboration between the University of Manchester, UK and the COMSATS Institute of Information Technology, Pakistan aims to understand the cause of hydrocephalus in human babies which would help in developing a preventative and/or cure for the condition. The project builds on pre-clinical research on animals demonstrating a specific folate imbalance in the cerebrospinal fluid. In hydrocephalic rats, the condition has been shown to be preventable and treatable with a combination folate supplement given to the pregnant mother.

The project will determine whether an imbalance of the cerebrospinal fluid is associated with hydrocephalus in humans as well, indicating the potential to prevent and treat the condition. This is the first time there has been hope for a treatment for hydrocephalus, a major problem in Asia where termination is restrictive and/or not practised. The impact would be enormous given the numbers born with this condition in all social classes.

The project has been able to bring together neonatologists, neurosurgeons and scientists based at hospitals in Lahore and in Manchester, Liverpool and Leeds to collect and work on samples of cerebrospinal fluid collected from babies. 

The project also aims to raise awareness in the local communities about the defect. Numerous government and non-government institutions have participated in a health campaign designed to educate parents and caregivers about how best to handle children afflicted with this life-threatening condition.

Lessons learnt:

While looking for the best way to transport samples of cerebrospinal fluid to COMSATS and UK, the team made connections with the Biosciences Department at the University of Punjab in Lahore to process the samples for transport. This led to the idea of establishing a joint PhD programme between Manchester and Lahore, which is in final planning stages.

Challenges faced:

• It took a long time to get the project on ground for various political and security reasons and proved impossible to find any English clinical staff to visit Pakistan due to the security situation. Visa difficulties also prevented a Pakistani postgraduate student visiting UK during the first year of the project.
• Analysing cerebrospinal fluid samples at COMSATS proved a problem as the arrival of key biochemicals from Pakistani suppliers was unnecessarily delayed. It also proved difficult to transport the chemicals from the UK. The consequence has been that much of the analysis has been carried out in the UK by the UK team, with visits from the PhD students at COMSATS.

The impact/benefits of the project:

• A major outcome of the project has been the setting up of the first research laboratory in Lahore Children's Hospital. The lab will initially be used for processing samples to send to the UK and Islamabad but will shortly have a permanent technician with the possibility of running two PhD projects. This is a very exciting outcome of the project and will be fostered and nurtured as a major long-term and sustainable outcome.
• Another benefit has been the introduction of international research relevant to an important clinical condition which has led to the possibility of future collaborations between Pakistan and the UK.

Key contacts:

Dr Jaleel Miyan, University of Manchester

j.miyan@manchester.ac.uk, www.manchester.ac.uk/

Prof. Shahid Nadeem Chohan, COMSATS Institute of Information Technology

shahid_chohan@comsats.edu.pk, www.ciit.edu.pk/