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Background. Millions of people in Bangladesh, India, Taiwan, and Chile are consuming high concentration of arsenic through drinking water, and thousands of them have already developed chronic arsenic poisoning. There is no specific treatment. Some authors suggest the use of vitamins and minerals for more than 6 months. The present placebo-controlled double-blind study was conducted to evaluate effectiveness of spirulina extract plus zinc in the treatment of chronic arsenic poisoning. Methods. Forty-one patients of chronic arsenic poisoning were randomly treated orally by either placebo (17 patients) or spirulina extract (250 mg) plus zinc (2 mg) (24 patients) twice daily for 16 weeks. Each patient was supplied with arsenic-safe drinking water by installing a locally made water filter at household level. Effectiveness of spirulina extract plus zinc was evaluated by comparing changes in skin manifestations (clinical scores), arsenic contents in urine and hair, between the placebo- and spirulina extract plus zinc-treated groups. Results. The concentrations of total arsenic in water (without filtration) of placebo- and spirulina extract plus zinc-treated groups were 150.1 [+ or -] 18.3 and 161.7 [+ or -] 23.9 [micro]g/l, respectively. Intake of these high concentrations of arsenic lead to increased excretion of arsenic in urine (72.1 [+ or -] 14.5 [micro]g/l in placebo-treated group and 78.4 [+ or -] 19.1 [micro]g/l in spirulina plus zinc-treated group). After 2 weeks of using filtered water, there were significant reduction of both arsenic intake through water and urinary arsenic excretion (8.3 [+ or -] 3.6 [micro]g/l and 18.4 [+ or -] 7.3 [micro]g/l in placebo group; 9.7 [+ or -] 5.4 [micro]g/l and 21.6 [+ or -] 5.8 [micro]g/l) in spirulina extract plus zinc-treated group. There was a sharp increase in urinary excretion of arsenic (138 [+ or -] 43.6 [micro]g/l) at 4 weeks following spirulina plus zinc administration and the effect was continued for another 2 weeks. Spirulina extract plus zinc removed 47.1% arsenic from scalp hair. Spirulina extract had no major adverse effect that required physician's attention. The clinical scores (median) for melanosis before and after treatment with placebo was not statistically significant (p > 0.05), whereas in spirulina extract plus zinc-treated group it was statistically significant (p < 0.01). In cases of keratosis, the median clinical scores before and after treatment was not statistically significant (p > 0.05) in placebo-treated group. In spirulina extract plus zinc-treated group, the clinical scores for keratosis before and after treatment was statistically significant (p < 0.05). Conclusions: Results show that spirulina extract (250 mg) plus zinc (2 mg) twice daily for 16 weeks may be useful for the treatment of chronic arsenic poisoning with melanosis and keratosis. Keywords Chronic arsenic poisoning; Spirulina; Zinc, BACKGROUND In 1993, Bangladeshi people realized that they were exposed to high concentrations of inorganic arsenic (more than 50 ppb) through drinking water (1). Shallow tubewells are the main source [...]

The ragtag band of rebels led by Pashtun leader Gulbuddin Hekmatyar and Tajik commander Masud who overthrew Najibullah's regime agreed to work for a peaceful transition of power. Pakistan's Prime Minister Nawar Sharif tried hard to arrive at a peaceful solution for Afghanistan's provisional government, being directly benefited by stability in his neighbor country. There are no guarantees, however, that peace within the once-warring factions would last. Everybody, incidentally, is dependent on Pakistan's donations for food.

The dissolution of the Soviet Union and the outcome of the 1991 Persian Gulf War have changed the relationship between the US and the Islamic nations from Central Asia to North Africa. With the former Soviet Union no longer communist, pan-Islamists have begun to target the US as their principal enemy. US officials are however divided over the fundamentalist threat. Some see it as inevitable and containable while others say fundamentalism will never be compatible with western political values and should be opposed.

Pakistan's interim Prime Minister Moeen Qureshi is attempting to launch significant fiscal and governmental reforms with the help of a coalition government. The main coalition consists of the Pakistan People's Party, led by former Prime Minister Benazir Bhutto, and the Pakistan Muslim League, led by another former Prime Minister, Nawaz Sharif. The coalition is greatly weakened by the respective parties' accusations that the other is guilty of influence peddling and corruption. However, until elections are called the appointed coalition can carry out reforms that an elected government would not dare.

Pakistan's mostly state-owned banking system suffers from several problems. The government's control of 80% of all credit results in endlessly tight credit. Public sector and related banks have acquired 23.47 billion rupees of bad debt, equal to 1% of Pakistan's gross domestic product. Financial inefficiency and inaccurate estimates of credit requisites contributed to this staggering load of bad debt. These problems have caused interest rates to rise, which in turn has destabilized the economy. Privatization has been proposed as a solution.

The Pakistan army acted to resolve the country's political crisis by persuading both Pres Ghulam Ishaq Khan and Prime Minister Nawaz Sharif to resign. New elections to be supervised by the army are scheduled for Oct 1993. A key factor in the end to the six-month conflict was opposition leader Benazir Bhutto's agreement to postpone a protest march on the capital. Despite the end to the current crisis, Pakistan could again face the dilemma of conflicts between a strong president, a strong prime minister and a strong army.

A constitutional crisis is paralyzing the government of Pakistan. Supreme Court decisions transferred most of the powers formerly held by president Ghulam Ishaq Khan to the prime minister, Nawaz Sharif. However, Sharif has not been able to impose federal rule in the troubled Punjab province and has announced plans to consult the Supreme Court on the issue. The army has remained neutral during the crisis, but military intervention is a possibility if the situation deteriorates.

Conflict in Pakistan between Prime Minister Nawaz Sharif and Pres Ghulam Ishaq Khan continues. The dispute between the two leaders' supporters worsened in Apr 1993 when Ishaq Khan tried to dismiss Sharif. A court returned Sharif to power in May. What the country's hitherto neutral military will do remains uncertain. Pakistan's political crisis developed from the constitutional system established by former Pres Zia-ul Haq in the mid-1980s. This system combines a powerful presidency with a parliamentary form of government.

The Pakistani Supreme Court on May 26, 1993 returned Prime Minister Nawaz Sharif to power. Pres Ghulam Ishaq Khan's Apr 18 decision to remove Sharif was thus voided, making this the first occasion in which the Pakistani judiciary has taken the side of the prime minister and parliament against the president. However, the court did not address the broader issue of whether the president should have the authority to dismiss an elected parliament and prime minister. Benazir Bhutto, leader of the opposition Pakistan People's Party, called for new elections.

Pakistan's new government will carry on the market reforms begun by former Prime Minister Nawaz Sharif, whom Pres Ghulam Ishaq Khan removed from office on Apr 18, 1993. The conflict between Sharif and Ishaq Khan showed that the country strongly supported the economic policy that Sharif has advocated since achieving office in Nov 1990. Accordingly, Interim Prime Minister Balakh Sher Mazari and Finance Minister Farooq Leghari will move ahead with the deregulation and privatization of the Pakistani economy.

Pakistani Pres Ghulam Ishaq Khan initiated a political crisis by removing Prime Minister Nawaz Sharif from power on Apr 18, 1993 and naming Balakh Sher Mazari caretaker prime minister until elections are held on Jul 14. This action reprises earlier removals of prime ministers by Pres Zia-ul Haq in 1988 and by Ishaq Khan in 1990. Pakistani presidents have had broad powers since Zia changed the constitution in 1985 to replace parliamentary with presidential rule. However, Sharif has vowed to contest his dismissal and to organize opposition to Ishaq Khan.

Politics in Pakistan has changed its focus from the opposition to the leadership conflict between Pres Ghulam Ishaq Khan and Prime Minister Nawaz Sharif. The dispute was started by a hard criticism on the Sharif government by loyal official of the president Sen Tariq Chaudhry on Feb 28, 1993. Sharif responded by saying that Pakistan's Democratic foundations are shaky and recommended amendments to the constitutional provisions on the authority of the parliament.Pres Khan retaliated saying it is his duty to defend the present constitution.

The Pakistani opposition is demanding the holding of new elections and the release of all political prisoners. These demands have sparked a confrontation with the ruling government of Prime Minister Nawaz Sharif, with opposition leader Benazir Bhutto leading a political agitation campaign against the government. Observers say the country's powerful military is closely watching the recent developments, possibly intervening if the government is unsuccessful in quelling the unrest.

International economists are skeptical about Pakistan's two year old policy of privatizing public utilities. Analysts at the World Bank are ambivalent about the success of Pakistani Prime Minister, Nawaz Sharif's economic policies. The difficulties in the impending privatization of telecommunications, water, power, railways and gas, is also raising serious doubts about the viability of privatization.

Both Pakistan and the US have made small but important policy adjustments to alleviate the tension caused by disagreement about Pakistan's alleged nuclear weapons program and the resulting ban of US civil and military aid to the country under the Pressler Amendment. The US Congress grouped Pakistan, China and India together on the nuclear and ballistic missiles issue, with the Pressler restrictions no longer exclusive to Pakistan, after enacting an amendment to its 1961 Foreign Aid Act. Both nations' governments have agreed to view nuclear affairs in a regional context.

Several factors may drastically change the face of the banking industry in Pakistan. One of them isthe mandate of the federal Sharia court, the highest religious court in the land, that the banks' practice of charging interest is against the tenets of the Islamic religion, and is therefore illegal. Sharia ordered all banks stop to charging interest starting Jul 1, 1993. However, the Pakistani government filed a petition to the Supreme Court of Pakistan to nullify the religious court's order.

Escalating armed conflicts among ethnic groups in Afghanistan may result in the country's fragmentation. Heads of mujahideen groups are considering the partitioning of Afghanistan into areasruled by different ethnic factions. The threat of partitioning has precipitatedbloody confrontations between warring groups which are all determined to gain control over specific territories. The factions that are fighting for supremacyover three primary regions of Afghanistan are the Hazaras, the Pashtuns and thecombined forces of Tajiks and Uzbeks.

The involvement of some Pakistani military intelligence officers in a plot aimed at bribing members of parliament to topple the popularly-elected government of Benazir Bhutto in 1989 has further eroded the people's comnfidence in the military. The Pakistan People's Party, which is headed by Bhutto, procured 13 audiotapes as evidence of the involvement of Inter Services Intelligence officers in the plot. The tapes show the officers attempting to bribe MPs to vote in favor of a non-confidence motion against Bhutto.

Leaders of the different Afghan guerilla factions have recently agreed to end the bloody sectarian fighting in Kabul. Afghan Pres Burhanuddin Rabbani led the move to end the fighting by convening a meeting of the Council of Afghanistan, the coalition grouping the various mujahideen parties. The agreement between the rival factions stipulates the withdrawal of all guerilla groups from Kabul. The fighting in Kabul lasted from the end of Jun, 1992 until Jul 21, 1992.

Pakistan has been hounded by a trade deficit which threatens to increase. The government has adopted a double-pronged approach to solve the problem. It has removed certain constraints to the importation of capital goods and raw materials necessary to the manufacture of exportable products. Non-traditional exports are being given a push to increase the country's total exports by 15% in FY 1992-93 over the previous period.

Pakistan and Bangladesh are on the way to solving severely inadequate and outmoded telecommunications systems. Both countries have found out that cable and radio systems can be harnessed to suit each of their peculiar needs based on geography, capacity and economic resources. Pakistan plans to meet telephone backlogs by 1993 and telecommunications infrastructure is one of the top priorities of the government as a route to economic growth. Bangladesh, meanwhile, with its perennial flood problems has opted for more radio-based systems but still pland to install 150,000 telephone lines in a joint venture with Siemens of Germany.

A record deficit of Rs 89 billion was proposed by Pakistan's Finance Minister Sartaj Aziz in his budget statement while also instituting several tax reforms. The country's thin direct-tax base makes cutting the deficit, which constitutes 5% of the GDP, difficult. The tax reforms include a sales tax at the retail level to counteract smuggling, taxing formerly tax-exempt military and police welfare foundations and raising excise duties and other levies on certain goods and services. Furthermore, companies have been guaranteed gradual income-tax reductions over the next five years.

The continuing tension among the different ethnic groups in Afghanistan is making a lasting peace improbable. Gulbuddin Hekmatyar's Hizbe Islami mujahideen group is a major threat to the provisional government, a threat reinforced by the group's proximity to the seat of government. Additionally, the Hizbe Wahdat coalition of mujahideen groups has also expressed dissatisfaction over their exclusion from the provisional regime. Observers believe the mujahideen groups must first be disarmed before peace initiatives could work.

Preparations are being rushed for a proposed 15-member interim governing council in Afghanistan, which has received the support of the incumbent Pres Najibullah's government and neighbor countries Pakistan and Iran. The composition of the council depends on the outcome of talks slated for Apr 1992 in Islamabad, Pakistan. However, mujaheddin groups based in Pakistan and Iran vowed to reject any government that does not meet their demands, among which are the assurance of Shia Muslim's rights and the exclusion from the council of members of Najibullah's ruling Watan Party.

The Middle East has provided a steady source of income to migrant workers since the 1970s' oil boom. The boom's subsequent demand for skilled laborers benefited Pakistan most of all. The country liberalized its immigration policy in 1971, when Zulfikar Ali Bhutto, aiming to deliver on his promise of economic advancement, began his policy of exporting laborers. Pakistan's overseas labor remittances increased from $136 million in 1973 to $2.9 billion in 1983.

Former International Services Intelligence director Lieutenant General Hameed Gul's retirement from the military establishment concurs with the evolving Pakistani policies concerning Afghanistan. In accordance with this new initiative, Pakistan has decided to halt its supply of arms to Afghan guerillas. A central point to this change in Pakistani foreign relations is the government's announcement of support for a United Nations (UN) peace plan that will call all Afghans to a consultative meeting. The government further stated that it will respect any decision reached at the UN-convened assembly.

A Dec 1991 ruling by the Lahore High Court established the dominance of Islamic laws over Pakistani constitutional laws. The decision gives Shariat or religious courts the power to countermand any constitutional law that violates Shariat rules. The decision affects domestic politics, businesses, industries and international relations. As a result, foreign finance institutions are becoming hesitant towards Pakistani business ventures. The Shariat was created by Zia-ul Haq who also empowered it to decide on cases that involve violations of Islamic laws.

Pakistan's relations with the US have been deeply strained because of the US's opposition to Pakistan's nuclear weapons program. The US suspended military and economic assistance to Pakistan in 1990. Pakistan's army chief General Asif Nawaz Janjua recently went to the US and received assurance of continued supply of US military spare parts. Pakistan has asserted it will oppose a non-proliferation treaty unless it also applied to India. India's closer ties with the US could induce Pakistan to join a fundamentalist Muslim block.