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Maternal mortality is a serious health concern, with casualties amounting to 295,000 in  2017.[1] As of present, about 25% of all maternal deaths fall under a condition known as postpartum haemorrhage (PPH), which is defined as abnormal bleeding of more than 500 – ml post child birth; 80% of all PPH cases are attributed to an atonic uterus. Consequently, a stepwise progression is observed to achieve haemostasis, starting from compression therapy to uterotonics like oxytocin followed by uterine balloon tamponade and even surgical intervention as the last line of treatment.[2] In their study, Dalton et al. introduce The Jada System, a novel intrauterine vacuum induced haemorrhage control device and evaluate its safety and effectiveness. [3] This novel innovation uses low- level intrauterine vacuum to assist physiological forces, collapse the uterine cavity and occlude blood vessels to control excessive bleeding. Moreover, the study showcased successful definitive treatment in 94% of the patients within an average of 3 minutes, minimal low-grade adversities, 98% investigators deeming it easy to use and majority recommending it for future treatment.[3] The Jada System’s rapid and early use renders it an exceptional treatment to PPH in comparison with alternatives like balloon tamponade that can only be used after a significant blood loss. Furthermore, with a success rate of 87%, the balloon tamponade can take up to 24 hours to control bleeding and carries numerous risks like rupture of the overfilled balloon, infections, cervical tears and vaginal lacerations. [4] While tackling maternal mortality with the help of The Jada System, it is imperative to recognize that 94% of all maternal deaths occur in low and lower middle-income countries, therefore  coherent and competent approaches to maternal health care must be introduced to developing countries around the world.[1] Pakistan is one such low-middle income country that reported a Maternal Mortality Rate (MMR) of 140 per 100000 deaths in 2017.[1] Additionally, in a 2002 study, Jafarey outlined lack of management, scarcity of medications, services, skills and blood banks to accommodate excessive blood loss as the major causes of continued maternal deaths due to PPH (52.9%) in the country.[5] Considering The Jada System's high success rate in managing PPH, low - middle income countries like Pakistan can invest in the local production of this device in a cost- efficient manner. Such an incentive can prove to be a feasible and swift solution to obstetric emergencies in the region.

Madam, allogeneic hematopoietic stem cell transplant (HSCT) remains a life altering cure to exceptionally challenging diseases ranging from hematologic malignancies to primary immunodeficiencies and blood cancers. One of its adversities includes graft versus host disease (GVHD), a lethal immunologically mediated condition wherein the donor's T-cells attack the host's tissues. The presentation can be classified as acute or chronic. Acute GVHD is divided into four grades. Despite current prophylaxis, including a combination of calcineurin inhibitor with either methotrexate or sirolimus, the incidence of grade-II or higher GVHD is between 30% to 80%, with grade-IV GVHD approaching mortality rates up to 90%.1 A recent phase II trial by Farag et al. addresses the issue by introducing a novel combination of sitagliptin – a specific DPP-4 inhibitor used to manage type 2 diabetes in adults – along with tacrolimus and sirolimus for prevention of GVHD.2 Using the new blend, an overall marked reduction in the risks of grade-II to IV (5%) and grade-III to IV (3%) acute GVHD was shown, compared to previous studies using only sirolimus and tacrolimus.3 Moreover, no adverse effects were associated with the drug during the period of study. Advancements in the field of HSCTs are particularly crucial in developing countries such as Pakistan. The high prevalence of consanguineous marriages and insufficient genetic counselling make the country especially vulnerable to diseases like thalassemia, bone marrow failure syndromes and immunodeficiency states. Up to 9000 children require transplantation each year due to the high prevalence of beta- thalassemia major.4 The situation is further complicated by limited resources and few stem cell transplant centres, which are limited to major cities. Although HSCT efficiently treats numerous life-threatening conditions, only 719 patients underwent HSCT till mid-2017 cumulatively in Pakistan.4 In accordance with the aforementioned factors, the number of transplants performed heavily outnumbers their demand, making it essential to tackle a complication as deadly as acute GVHD. In a 2005 study conducted in Rawalpindi by Hashmi et al., the overall incidence of acute GVHD grade-II to IV after standard immunosuppressive therapy was 44.2%.5 While the results were comparable to other studies, the high f morbidity and mortality rates necessitates alternate treatment courses. Sitagliptin, a locally manufactured, cost-effective drug, will be an appropriate choice of medication in Pakistan where average income amounts to a meagre US$1000 per year.4 However, randomized trials are needed to further investigate its role in the prevention of acute GVHD. Continue....