Breakfast Session on Aspirin Update during PHL Symposium
Prof. Akbar Chaudhry urges doctors not to deprive their 
patients of benefits of Low Dose Aspirin Therapy
We put our all ACS patients on Aspirin, Beta Blockers,
Statins and ACE Inhibitors - Prof. Ijaz

MULTAN: Pakistan Aspirin Foundation organized a Breakfast session on Aspirin Update during the recently concluded Pakistan Hypertension League annual symposium at Multan on February 25th 2012. It was chaired by Prof. M. Ishaq President of PHL while the main speaker was Prof. M. Akbar Chaudhry President of Pakistan Aspirin Foundation and Principal of Azra Naheed Medical College, Lahore. His presentation was followed by an interactive session in which a large number of cardiologists were invited to share their knowledge and experience on use of Aspirin therapy.
In his brief introductory remarks, Prof. M. Akbar Chaudhry pointed out that Aspirin is a wonder drug which reduces morbidity and mortality in many diseases particularly CAD, ACS and is life saving in Acute Myocardial Infarction. He urged the health care professionals not to deprive their patients of the benefit of Low Dose Aspirin Therapy keeping in view its well established indications.

Pakistan Aspirin Foundation organized a Breakfast Session on Aspirin Update during the PHL Symposium at Multan on February 25th 2012. Group photograph taken on the occasion shows Prof. Ijaz, Prof. M. Ishaq President PHL, Maj. Gen. Ashur Khan and Prof. M. Akbar Chaudhary President of the Foundation along with Prof. Mansoor Ahmad, Prof. Feroz Memon, Dr. Rashid, Mr. Akhtar, Mr. Waqar, Mr. Farhan Raze from Atco and Mr. Shaukat Ali Jawaid.

Referring to the AAUS Study which enrolled over fourteen hundred ACS patients from seventeen CCUs from all over the country and was conducted by Pakistan Aspirin Foundation many years ago, he said that it showed only 16% patients got Aspirin when they had chest pain at home, only 20.8% of family physicians prescribed Aspirin while 60% patients in Emergency room got Aspirin and in ward it further increased to 71%. However, on discharge unfortunately only 50% were prescribed Aspirin which was because when the discharge slips were made by the junior doctors, they did not give importance to Aspirin. Keeping all this in view, Pakistan Aspirin Foundation started its CME programme for the healthcare professionals and during the last few yeas we have organized seminars, Update meetings , discussions all over the country which has greatly helped to increase awareness among public as well as the doctors community with the result that now Aspirin use has increased a lot.

Dr. Rashid, Mr. Akhtar Business Unit Head at Atco, Prof. M. Akbar Chaudhary President of Pakistan Aspirin Foundation photographed along with some members of marketing team from Atco Laboratories which are sponsoring CME programmes of Pakistan Aspirin Foundation. The photograph was taken during the breakfast session on Aspirin ‘Update held at Multan on February 25th 2012.

Prof. Ijaz Ahmad from CPE Institute of Cardiology Multan said that they put all their ACS patients on Aspirin, Beta Blockers, Statins and ACE Inhibitors. Prof. Feroz Memon from Hyderabad said that patients should be advised to immediately take a tablet of soluble Aspirin or chew the enteric coated tablets of Aspirin when they have chest pain at home. It is life saving and can be termed as poor man’s Statin. Prof. Ishaq opined that all patients coming in emergency should immediately get soluble Aspirin and first time they should be given full dose of 325 mg and then they can be put on low dose aspirin therapy. In literature many doses are listed i.e. 75mg, 81mg and 100mg and they are all effective. He was of the view that we need to redo the study on Aspirin Awareness and Usage as now the figures which we earlier had must have changed as the situation has improved a lot. Prof. Mansoor Ahmad from Karachi said that make sure to control the blood pressure before putting hypertensive’s on Low Dose Aspirin therapy. Dr. Rashid Ahmad from Abbasi Shaheed Hospital Karachi also highlighted the importance of Aspirin therapy in IHD and in chest pain in emergency, just one tablet of 325mg of Aspirin can prove to be life saving, he added.
Dr. Naeem opined that in primary prevention of CAD, the use of Aspirin is still being debated at which Mr. Shaukat Ali Jawaid Secretary General of Pakistan Aspirin Foundation pointed out that ARRIVE study which has enrolled twelve thousand patients in five countries including UK, USA, Germany and China started in 2009 and final results will be available in 2013. This is by far the biggest study on use of Aspirin in primary prevention and though lot of evidence in favour of its use in primary prevention is accumulating, but final answers will be available from ARRIVE study in 2013. Dr. Abu Bakar Sheikh from Karachi remarked that we need to develop posters, cards for display in Emergency Rooms for creating awareness among the public about the safety and efficacy of Aspirin. Another participant said that small booklets on Aspirin in Urdu should be prepared which can be distributed among the patients when they are waiting in the hospitals, clinics and in Emergency. Dr. Abu Bakar Sheikh further remarked that enteric coated tablets of Aspirin should be used to avoid chances of G.I. Bleeding. Major Gen. Ashur Khan former President of Pakistan Aspirin Foundation felt that at times patients complain of epigastric pain which has nothing to do with chest pain and it should be kept in mind. Dr. Fazalur Rehman from Red Crescent Hospital Hyderabad said that they were the first one in Pakistan to start giving Aspirin to all patients coming in emergency with chest pain.
Prof. M. Ishaq in his concluding remarks urged the healthcare professionals to use the low dose aspirin therapy judiciously in its well established indications. In case of Aspirin resistance, one can use other antiplatelet agents. Earlier Mr. Shaukat Ali Jawaid Secretary General of Pakistan Aspirin Foundation pointed out that they were extremely grateful to M/s Atco Laboratories who have been sponsoring our CME activities for the last many years. It is because of their financial help and support that we have been able to continue this awareness programme. However, keeping up the professional ethics, we in Pakistan Aspirin Foundation do not promote or patronize any particular brand of Aspirin. As usual this CME meeting was also sponsored by Atco Laboratories and Mr. Farhan Raza their Product Manager along with his team had worked hard for its success. Mr. Akhtar Business Unit Head in Atco Laboratories, Mr. Waqar from the marketing department and others were also present on this occasion.

Aspirin Update seminar at Dera Ghazi Khan
People with high risk of CAD, those with family history of
heart disease and Type-2 diabetics should be put on
Low Dose Aspirin therapy-Prof. Akbar Chaudhry
Blood Pressure should be controlled before prescribing
hypertensive’s LDA - Dr. Yousuf
Low Dose Aspirin 75mg daily is quite useful in
recurrent miscarriages - Dr. Humaira Shakeel

DERA GHAZI KHAN: All people with high risk of coronary artery disease, those with family history of heart disease and all type 2 diabetics should be put on Low Dose Aspirin therapy if there are no contra indications. Enteric coated aspirin should be preferred because of its safety in long term use and any dose 75mg, 81mg and 100mg is equally effective. This was stated by Prof. M. Akbar Chaudhry a noted physician, President of Pakistan Aspirin Foundation who is Principal and Prof. of Medicine at Azra Naheed Medical College, Lahore. He was making a presentation at a seminar organized by Pakistan Aspirin Foundation in collaboration with Pakistan Medical Association Dera Ghazi Khan here on February 23rd 2012. Other speakers who shared their views on medical uses of Aspirin on this occasion included an eminent local physician Dr. Mohammad Yousuf and Dr. Humaira Shakeel consultant obstetrician and gynaecologist. Dr. Tahir Farid Turk General Secretary of PMA Dera Ghazi Khan and his team and worked hard and made excellent arrangements to organize this meeting which was very well attended and the participants showed keen interest in this academic activity by actively participating in the discussion.

Dr. Gul Mohammad Shamsi senior most physician of Dera Ghazi Khan presenting flower bouquet to Dr. Mohammad Yousuf and Prof.M. Akbar Chaudhry at a seminar on Medical Uses of Aspirin organized by Pakistan Aspirin Foundation in collaboration with PMA Dera Ghazi Khan here on February 23, 2012.

Prof. Akbar Chaudhry in his presentation first talked about the burden of high prevalence of cardiovascular disease in the world and in Asia in particular and then traced the history of discovery of Aspirin in early 19th century. Speaking about the known risk factors for CAD he mentioned dyslipidemia, obesity, metabolic syndrome, smoking, high blood pressure, etc. He laid emphasis on preventive measures starting with prevention of smoking, regular exercise, use of healthy diet, weight control, blood pressure control, lipid control and control of blood glucose and finally highlighted the safety and efficacy of low dose Aspirin therapy.
Aspirin is being used for a variety of diseases but its major use these days is in cardiovascular disease which accounts for 37.6%. Aspirin is also referred to as Poor Man’s Statin. A single tablet of 325mg soluble aspirin can prove life saving in heart attacks as it reduces the mortality by almost 23%. Enteric coated tablets can also be chewed if need be. If Aspirin is combined with clopidogrel, the reduction in mortality is reported to be up to 44%. However, if Aspirin is contra indicated, other anti platelet agents can be used. Aspirin, Prof. Akbar Chaudhry remarked remains the mother antiplatelet which is the most cost effective therapy and reduces morbidity and mortality in CAD. There have been numerous studies to prove this but even then Aspirin remains underused all over the world Pakistan being no exception. That is why Aspirin Foundations around the world including Pakistan Aspirin Foundation has started this awareness campaign to educate the healthcare professionals and promote its use in well established indications. Today’s meeting, he said, was a part of the CME programme which the Pakistan Aspirin Foundation has been running for the last many years. Apart from secondary prevention of CAD, Aspirin use in prevention of stroke is also well established. To prevent recurrent attacks of Stroke, the patient should be put on 150mg enteric coated Aspirin therapy indefinitely. However, after the age of eighty years its use is not advocated. Since in Pakistan life expectancy is about ten years less, hence here it should be used with caution after the age of seventy years.

Dr. Tahir Farid Turk General Secretary PMA D. G. Khan, Dr. Yousuf, Prof. M.Akbar Chaudhry, Mr. Akhtar Business Unit Head in Atco, Mr. Waqar from Atco Labs and others photographed at the Seminar on Medical Uses of Aspirin held here recently which was sponsored by Atco Laboratories.

Regular use of Aspirin has more protective effect in women as regards stroke. So far well established uses of Aspirin has been confirmed in Acute Myocardial Infarction, Acute Coronary Syndrome, secondary prevention of MI,TIAs and Stroke, prophylaxis for thrombo embolism following different interventional procedures, surgery, hypertension and diabetes. A large primary prevention trial in CAD known as ARRIVE which has enrolled twelve thousand patients in five countries started in 2009 and the final results will be available in 2013. He then referred to various studies which have shown reduction in non-fatal MI, Non-fatal stroke, and reduction in total cardiovascular mortality besides other important vascular events. He also referred to the results of AAUS study conducted by Pakistan Aspirin Foundation many years ago which showed that Aspirin was very much underused, even 50% of ACS patients on discharge were not prescribed Aspirin therapy. He also referred to some recent reports which say that Aspirin fails in primary prevention of asymptomatic peripheral disease and diabetes. A Meta analysis has showed that Aspirin reduced the risk of MI in men by 43% with no significant effect in women. Some studies say that the expected benefits of aspirin in diabetes might not exceed the risk of major bleeding; hence its role in such patients is controversial. All this shows that the physicians have to make choice of use of low dose aspirin therapy by looking at the individual patients keeping in view his medical history. Replying to a question, he said that aspirin therapy should be stopped a week before expected surgery.
Finally he referred to the new and emerging indications of Aspirin in Dementia, Alzheimer’s disease, colorectal cancer, insulin resistance, pulmonary embolism, gastric cancer and so on. Hence, this drug which is over hundred years old keeps us surprising with the new and more indications being reported by research scientists all over the world.
Earlier Dr. Mohammad Yousuf, Consultant Physician in his brief presentation on Aspirin therapy talked about the use of Aspirin as antipyretic, for relief of body aches, pain, fever, arthritis tough it does not alter the disease process in arthritis. He also referred to its use in CAD, prevention of MI, colorectal cancer, and pregnancy induced hypertension etc. While using Aspirin one must be careful of its side effects like urticaria, edema, about 10% of asthamatics might become worse hence avoid it in these patients, allergic rhinitis. Major side effects are gastric, nausea vomiting, bleeding. Hence it should be avoided in patients with known peptic ulcer, bleeding ulcers. It should also be avoided in children because of Rye’s syndrome. Aspirin remains a good therapy in tension type headaches, body aches, it is an effective anti-inflammatory in rheumatoid arthritis, and it remains a gold standard in CAD and ischaemic strokes. Before using Aspirin in hypertensives, one must control the blood pressure first, he remarked.
Dr.Humaira Shakeel consultant obstetrician and gynaecologist in her brief presentation highlighted the safety and efficacy of low dose aspirin therapy in recurrent miscarriages. She also talked about its pathophysiology. It can be used in combination with LMWH. Pregnant women treated with low dose aspirin therapy had no eclampsia and they had no PPH, she added.
Mr.Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation talked about the history and accomplishments of the Foundation since its inception and also highlighted its CME activities. Dr. Tahir Farid Turk General Secretary of PMA welcomed the guest speakers and the participants to the meeting. He asked them to be punctual and promised that as today, in future too they will start their programme in time and won’t take more than two hours, hence they should try to be in time. He also thanked M/S Atco Laboratories and their management for providing this opportunity to update their knowledge on Aspirin and from today I will be using enteric coated low dose Aspirin therapy regularly and he advised all his colleagues as well to do the same to avail its benefits.

Aspirin Update seminar at Gojra
Prof. Akbar Chaudhry urges healthcare
professionals to promote the use of Aspirin
This economically priced mother anti-platelet agent reduces morbidity
and mortality in many disorders including cardiovascular diseases
Dr. Obaidur Rahman reminds the doctors to uphold professional ethics

From our correspondent

GOJRA (FAISALABAD): Pakistan Aspirin Foundation continues its Continuing Medical Education programme for the healthcare professionals updating them in the use of Aspirin in its well established indications. In this on-going academic programme, a seminar on Aspirin Update was also organized here on October 21st which was very well attended. Dr. Obaidur Rahman Consultant Physician and Cardiologist was the local organizer and the meeting was held in collaboration with the local Pakistan Medical Association. Prof. M. Akbar Chaudhry Principal Continental Medical College who is also President of Pakistan Aspirin Foundation was the guest speaker who in his presentation called upon the healthcare professionals in general and Family Physicians in particular to promote the use of Aspirin the economically priced mother anti-platelet agent in its well established indications. Despite proven safety and efficacy in a wide range or disorders, Aspirin still remains under-used all over the world and situation was no better Pakistan, he added.

Pakistan Aspirin Foundation in collaboration with PMA Gojra organized a seminar on “An Update on Aspirin” at Gojra on October 21^st 2010. Picture taken on the occasion shows from (L to R) Prof. M.Akbar Chaudhry President PAF presenting bouquet to Dr. Mian Mahmood ul Hassan  while on right Mr.Shaukat Ali Jawaid GS of PHL is presenting bouquet to Dr. Riaz A. Khan GS PMA Gojra and Dr. Obaidur Rehamn.

He also referred to the Aspirin Awareness and Usage Study (AAUS) conducted by Pakistan Aspirin Foundation which enrolled over fourteen hundred Acute Coronary Syndrome patients from seventeen Coronary Care Units across the country. This showed that only 20% of the Family Physicians prescribed Aspirin to the patients at the time of acute myocardial infarction while only 16% got Aspirin at home. This is a very dismal picture which shows that we need to create more awareness not only among the medical profession but public as well regarding the usefulness of this wonderful drug. One full tablet taken immediately after AMI, can prove life saving and numerous studies have documented 23% reduction in mortality in such a situation. In case Aspirin is combined with streptokinase, the risk reduction is over 40%. Aspirin is readily available every where and it is very economically priced, hence the physicians must educate their patients and general public that in case of chest pain, they must take one tablet of Aspirin and chew it or use soluble Aspirin.
All CCU patients on discharge must be put on Low Dose Aspirin therapy 75mg per day. Similarly all Type-2 diabetics, those patients who have had interventional cardiac procedures and stroke should be put on Low Dose Aspirin therapy unless there is some contraindication. Enteric coated Aspirin is safe and also effective even in long term use that is why it is and should be preferred. He also referred to the new and emerging indications for use of Aspirin like Pre-eclampsia, Dementia, Alzheimer’s disease, Colo-rectal Cancer, Gastric and Esophageal cancer, insulin resistance and so on. Almost every day there is some new discovery of its uses and this wonderful drug which has been in clinical use for now over one hundred ten years continues to surprise us all. Once hypertension is controlled, all hypertensive’s also needs to be put on low dose aspirin therapy. However, in those patients where Aspirin is contra indicated, other antiplatelet agents should be used. Combination of Aspirin and Clopidogrel further enhances the risk reduction in cardiac patients. Now there is lot of data available supporting the use of Aspirin even in primary prevention of Coronary Artery Disease but the results of largest ever Primary Prevention Trial (ARRIVE) which will enroll over twelve thousand patients from five countries will be available in 2013 which it is hoped will conclusively prove the safety and efficacy of Aspirin even in primary prevention of CAD.

Group photograph taken during the seminar on Aspirin at Gojra shows from (L to R) Dr. Riaz A. Khan General Secretary PMA Gojra, Mr. Akhtar  General Manager Marketing from Atco Labs, Dr. Mian Mahmoodul Hassan and Prof. M. Akbar Chaudhry President of Pakistan Aspirin Foundation.

Responding to various questions from the audience, Prof Akbar Chaudhry said that use of Aspirin must be stopped at least five to seven days before elective surgery. Aspirin is not recommended in all pregnant patients but only in pregnancy induced hypertension. One of the participants advised the family physicians to use few drugs but they must know their price and side effects, interactions. Re-bleeding has also been noted in some patients after stenting and angioplasty, and these patients need to be carefully managed.
Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation highlighted the aims, objectives and achievements, accomplishments of the Foundation since its inception. It is a very democratic body and its membership is open to physicians and general public. He also quoted Scottish Physician Prof. Peter Elwood the pioneer research scientists who for the first time clinically proved and reported in 1974 that Aspirin can be a life saving drug in AMI. Peter Elwood says that we all must keep Aspirin with us all the time, at clinic and at homes as we ourselves, our friends of family members may need it any time and in case of an emergency i.e. Acute Myocardial Infarction it can save live. He thanked M/s Atco Laboratories for their generous sponsorship of these academic programmes and hastened to add that keeping up the professional ethics; they do not patronize or promote any particular brand of Aspirin. It is up to the medical profession to make their choice.
Earlier Dr. Obaidur Rahman in his welcome address advised the healthcare professionals to uphold professional ethics. Unethical practiced indulged in by some members of the medical profession was bringing bad name to the entire doctors community. Medicine is a noble profession and we all must practice ethical medicine. He thanked Pakistan Aspirin Foundation for selecting Gojra for one of their CME meetings.

Mr. Farhan Raza

This CME programme was conducted by Mr. Farhan Product Manager in Atco Laboratories which had sponsored this meeting. Atco Laboratories, it may be mentioned here is sponsoring all CME programmes of Pakistan Aspirin Foundation for the last many years. Atco has also produced a highly informative Booklet on Aspirin in Urdu which is being distributed among the healthcare professionals and public all over the country.

Aspirin Update Seminar at Sargodha
Patients with more than 10% absolute ten years risk of CAD
should be put on low dose Aspirin therapy - Prof. Akbar Chaudhry
Despite lot of data showing safety and efficacy of Aspirin in prevention of CAD and Stroke, this mother anti-platelet agent still remains under used

From our correspondent

SARGODHA: Pakistan Aspirin Foundation in collaboration with Pakistan Medical Association Sargodha organized a seminar on Aspirin Update here on October 20th 2010. It was chaired by Prof. M. Siddique a noted physician and it was very well attended by members of the medical profession. Prof. M.Akbar Chaudhry FRCP Principal Continental Medical College Lahore who is also President of Pakistan Aspirin Foundation in his presentation discussed in detail the well established indications of Aspirin therapy. He was of the view that despite lot of data showing its safety and efficacy in prevention of CAD and Stroke, this mother anti-platelet agent was still under used all over the world including Pakistan. This is one of the reasons that Pakistan Aspirin Foundation has started this CME programme for healthcare professionals to update them and promote the use of Aspirin to help the patients.

Pakistan Aspirin Foundation organized a seminar on Aspirin at Sargodha in collaboration with the local PMA.  Picture taken on the occasion shows on left Mr. Akhtar General Manager Marketing of Atco which had sponsored this CME programme presenting a flower bouquet to one of the distinguished paraticipants while President of Sargodha PMA Dr.Sikandar Hayat Warriach is also seen in the center. Also seen in the picture are Mr. Shaukat Ali Jawaid, Mr. Akhtar, Prof. Akbar Chaudhry, and Dr. Niazi.

Aspirin, he said was now one hundred ten years old drug. Speaking about its well established indications he mentioned Acute Myocardial Infarction, Acute coronary Syndrome, Secondary prevention of AMI, Primary prevention of CAD, Acute Ischemic Strokes, Transient Ischemic Attacks (TIAs), primary and secondary prevention of stroke, hypertension, diabetes mellitus besides prophylaxis against Deep Vein Thrombosis and Pulmonary Embolism. In addition it has numerous emerging indications which include colorectal cancer, esophageal and gastric cancer, prostate cancer, pre eclampsia, Alzheimer’s disease, insulin resistance etc. This most economically priced and easily available anti-platelet agent which has life saving properties has proved to be a miracle drug which is also called as Poor Man’s Statin.

Field force representatives of Atco laboratories photographed along with Prof. Siddique, Prof. Akbar Chaudhry and Dr. Mushtaq Cheema during the Aspirin seminar held at Sargodha on October 20^th 2010

He advised the healthcare professionals that any patient who complains of chest pain should be asked to immediately chew 325mg tablet of Aspirin or use soluble Aspirin before taking him to any doctor or healthcare facility as it could prove life saving. We should keep Aspirin with us all the time, in emergency bag, at clinic and at home as we may need it any time. In case of Acute Myocardial Infarction if used within six hours, it reduces mortality by about 23% and if it is used along with streptokinase, the risk reduction could be 45%. It can be used in combination with clopidogrel which will further reduce the risk but one has to be careful of increased side effects. All CCU patients on discharge must be prescribed Low Dose Aspirin therapy 75mg daily unless there is some contra indication. Those who are allergic to Aspirin can be put on other ant platelet agents.
In case of stroke, Aspirin 150-300mg daily should be initiated as early as possible and then continued indefinitely. In high risk patients it can be combined with Dipyridamol or Ticlodipine or Clopidogrel. Studies have shown relative risk reduction of stroke and death with Aspirin by 31% as compared with placebo and there is minimal risk of bleeding. Relative risk reduction of secondary ischemic stroke, TIAs and death is 27% with Aspirin. There is evidence that continuous low dose Aspirin therapy reduces risk of colorectal cancer by 40-50%, esophageal cancer risk reduction is reported as 90% while gastric cancer reduction is reported 48% in male and 52% in female. There are reports that Aspirin can reduce prostate cancer risk by 50%.
He thanked Dr. Maqbool H. Jafary the former President of Pakistan Aspirin Foundation who had collected most of this data and called upon the healthcare professionals to ensure that all those who need to be on Low Dose Aspirin therapy are not deprived of the benefits of this miracle drug. Enteric coated Aspirin tablets are safe for long term use that is why it is preferred. Replying to questions from the audience Prof. Akbar Chaudhry said that Aspirin should be stopped at least seven to ten days before elective surgery and in case of emergency surgery, patients on Aspirin therapy may require plasma transfusion. In pregnancy it is only indicated in pre-eclampsia in women with poor obstetric history.
Prof. M. Siddique commended the presentation and remarked that at home Aspirin should be kept away from children.
Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation talked about the aims and objectives of the Foundation and also highlighted some of its achievements so far. He thanked Atco Laboratories for sponsoring CME activities of the Foundation for the last many years but hastened to add that keeping up the professional ethics, we do not promote and patronize any particular brand of Aspirin, he added. Earlier Dr.Sikandar Hayat Warraich President of Sargodha PMA welcomed Prof. Akbar Chaudhry, participants and also thanked Pakistan Aspirin Foundation for organizing this academic activity. He suggested that a public awareness session on Aspirin should also be organized which will be quite informative and useful.
The meeting was conducted by Mr. Farhan Raza Product Manager in Atco Laboratories which had sponsored this meeting.

Antiplatelet therapy has a role in prevention of
cardiovascular diseases - Dr. Maqbool H. Jafary
Regular use of Low Dose Aspirin reduces the risk of unstable angina by 46%, stable angina by 33%, peripheral arterial disease by 23% and in patients undergoing angioplasty by 53% - Prof. Akbar Chaudhry
Aspirin is considered as poor man’s Statin - Prof. Feroze Memon

KARACHI: Prof. Feroze Memon Prof.of Cardiology at Isra University Hyderabad along with Prof. Naeem Aslam Prof. of Cardiology at Sheikh Zayed Medical College Rahim Yar Khan chaired the Breakfast session on Antiplatelet Therapy during the KIHD 3rd annual symposium. The session held at the KIHD campus on May 1st 2010 was very well attended. The panel of experts included Prof. Akbar Chaudhry President of Pakistan Aspirin Foundation and Dr. Maqbool H. Jafary. Also present were Prof. Wahid Sahibzada from Peshawar, Dr. Masood Ahmad from Ittefaq Hospital Lahore, Prof. S.H. Shafqat and Dr. A. Rashid Khan besides many family physicians.
In his introductory remarks Prof. Feroze Memon said Aspirin is considered as poor man’s Statin. It is economically priced and is easily available. Hence its use need to be promoted in its well established indications.

KIHD’s third annual symposium started with a breakfast session on Anti Platelet therapy with special reference to safety and efficacy of low dose Aspirin sponsored by Atco Labs. Group photograph taken on the occasion shows some eminent cardiologist of Pakistan from (L t o R) Prof. SH Shafaqt, Dr. Masood, Prof. Naeem Aslam, Mr. Farhan Raza (Product Manager Atco), Prof. Feroze Memon, Prof. Ishaq, Prof. Akbar Chaudry, Mr. Shaukat Ali Jawaid (Chief Editor PULSE), Prof. Hafiz Chaudry, Prof. Wahid Sahibzada who participated in the discussion. Mr. Zia and Dr. Faisal from Atco Labs are also seen on extreme left and extreme right.

Prof. Akbar Chaudhry Principal Continental Medical College in his brief presentation highlighted the safety and efficacy of antiplatelet therapy in reducing morbidity and mortality in cardiovascular diseases. He was of the view that CAD has now become an epidemic in Pakistan. Use of Aspirin therapy he said is recommended for all apparently healthy individuals at high risk of CVD. AHA recommends it for primary prevention of first mi which is reduced by one third and one sixth reduction in vascular events. Similarly in secondary prevention myocardial infarction risk is reduced by one third, stroke by a quarter and CVD death by one sixth. Enteric coated aspirin he said is preferred as it is safe and there is no risk of gastric irritation. Low dose aspirin therapy is extremely safe and effective but those who are resistant or allergic to Aspirin, should be put on other antiplatelet agents.
Dr. Maqbool H. Jafary in his remarks said that emphasis should always be on preventive aspects. Anti platelets have a role in prevention of cardiovascular diseases? Participating in the discussion Prof. M. Ishaq said that Aspirin remains under utilized. It is economical priced and Pakistan Aspirin Foundaiton also needs to revise its guidelines which were earlier revised couple of years ago. AAUS study conducted by Pakistan Aspirin Foundation had revealed very low use of Aspirin by Family Physicians as well as in CCU when the patients were being discharged but due to CME activities by the PAF, now use of Aspirin has considerably improved among the family physicians as well. Prof.Feroze Memon felt that since it is the junior doctors who prepare the discharge slips in the CCU, they should be educated not to forget aspirin in the prescription. There are very few contra indications for the use of Aspirin and the important one are active peptic ulcer disease but it must be ensured that diagnosis of PU are correct and one should not confuse it with Gas, and heartburn etc which is quite common.
Persantin it was said is not superior to aspirin therapy. Persantin is used quite frequently in stroke patients as well as in TIAs. In fact it is the combination of Aspirin and Persantin which is considered more effective in these Stroke and TIA patients. Prof. S.H. Shafqat opined that as the awareness about the use of Aspirin goes up, hopefully more and more patients will benefit. It remains under use and family physicians in particular must promote its use, he remarked. Dr. Maqbool H.Jafary opined that we need to conduct another study to find out the benefits of our CME programmes which have been going on now for many years wherein a large number of Family Physicians have been participating. Prof. Naeem Aslam remarked that all Type-2 diabetics must be put on low dose Aspirin therapy on regular basis and the recommended dose is 150mg of enteric coated tablets. Dr. Masood consultant cardiologist from Ittefaq Hospital Lahore felt that except patients with gastric symptoms, Aspirin can be safely prescribed to CAD, ACS patients. Dr. A Rashid Khan from Abbasi Shaheed Hospital said that regular use of low dose Aspirin reduces morbidity and mortality in cardiovascular diseases significantly. It added advantage is that it is economically priced and its availability is not problem even in small towns and cities.
Responding to another question Prof. Akbar Chaudhry said that in case of major surgery, Aspirin therapy should be stopped at least ten days before surgery but in case of minor surgery, even five days stoppage of aspirin therapy is good enough. This meeting was sponsored by M/s Atco laboratories as a part of their CME programme to keep the healthcare professionals update on the use of Aspirin therapy. Atco Laboratories has also played a vital role in promoting the use of Aspirin in Pakistan sponsoring all the academic activities of Pakistan Aspirin Foundation for the last many years.

Aspirin Update Seminar at Okara
In primary prevention Aspirin reduces the risk of first MI
by 33%, risk of first stroke by 25% and the risk of
CVD death by about 17% - Prof. Akbar Chaudhry
Usage of Low Dose Aspirin has increased but
still we need to do a lot more
Family Physicians and GPs can play a vital role in promoting
the use of LDA which can also save many precious lives in AMI

From our correspondent

OKARA: Pakistan Aspirin Foundation in its Continuing Medical Education programme to promote the use of Aspirin in its well established indications organized a seminar on Aspirin Update in collaboration with Pakistan Medical Association Okara on April 8th 2010. The meeting held at the local PMA house was very well attended by members of the PMA. Prof. M. Akbar Chaudhry a noted physician and President of Pakistan Aspirin Foundation who is currently Principal of Continental Medical College Lahore was the main guest speaker.

Prof. M. Akbar Chaudhry and Mr. Shaukat Ali Jawaid President and General Secretary respectively of Pakistan Aspirin Foundation photographed along with office bearers of PMA Okara and some other guests during the seminar on Aspirin Update held at Okara on April 8th 2010

In his presentation Prof. Akbar Chaudhry highlighted the safety and efficacy of Aspirin therapy in coronary artery disease particularly Acute Coronary Syndromes and said that one tablet of soluble Aspirin or four tablet of enteric coated Aspirin chewed immediately after chest pain can prove to be life saving. Most often the heart attacks occur late at night or early in the morning hours when it is not possible to find a doctor or reaching the healthcare facility may also take some time. Hence, if Aspirin is readily available, the patient should be advised to immediately take Aspirin tablet and then efforts should be made to shift the patient to a hospital. It was also pointed out that recent meta analysis in Cochran Review has revealed that regular use of low dose Aspirin should be preferred at night which can take care of early morning episode in case of blood pressure peaks.

Pakistan Aspirin Foundation in collaboration with PMA Okara organized a seminar on Aspirin Update at the local PMA House on April 8^th. Photograph taken on the occasion shows Prof. M.Akbar Chaudhry President of PAF along with some members of PMA and executives and field force representatives of Atco Laboratories which had sponsored this meeting.

American Heart Association has recommended regular use of low dose aspirin for all apparently healthy individuals who are at risk of cardiovascular diseases. In random trials and Meta analysis, it has been shown that Aspirin significantly reduces the risk of cardiovascular diseases. As regards primary prevention, it reduces first MI by about one third and all important vascular events by one sixth. In secondary prevention, MI is reduced by one third and stroke by about a quarter and cardiovascular death by one sixth. Speaking about the guidelines for primary prevention of CVD Prof. Akbar Chaudhry said that one should begin risk factor assessment in adults at the age of twenty years. All adults over the age of forty years should know their absolute risk of developing CVD. Risk intervention strategies include smoking cessation, physical activity, diet therapy, weight control, blood pressure control, lipid control, diabetes control and Aspirin therapy.

Prof. Akbar Chaudhry President Pakistan Aspirin Foundation and Principal Continental Medical College presenting flower bouquet to Dr. Abdul Aleem Asif and Dr. Zaeemuddin Abid consultant physicians in Okara at the Aspirin Update seminar held in Okara on April 8th 2010.

Speaking about the benefits of Aspirin, Prof. Akbar Chaudhry said that in primary prevention it reduces the risk of first MI by 33%, reduces the risk of first stroke by 25% and the risk of CVD death by about 17%. In secondary prevention, the chances of serious vascular events are reduced by 46% in unstable angina, 33% in stable angina, 23% in peripheral arterial disease and 53% in patients undergoing angioplasty. Despite all these findings, it is a pity that Aspirin remains under used. Referring to the Aspirin Awareness and Usage Study (AAUS) conducted by Pakistan Aspirin Foundation couple of years ago at seventeen CCUs all over Pakistan which enrolled over fourteen hundred ACS patients, Prof. Akbar Chaudhry said that only 16% of patients got aspirin at home when they suffered from chest pain. Again only 20.8% of these patients were prescribed Aspirin by their family physicians and what is more tragic is the fact that only 50% of these patients were prescribed Aspirin on discharge. It is because most often the discharge slips are prepared by junior house offices who need to be educated as most of them do not realize the importance of Aspirin therapy. However, Prof. Akbar Chaudhry further stated that this study was conducted many years ago. Since then Pakistan Aspirin Foundation has been conducting its CME activities all over the country and this has increased the usage of Aspirin therapy to a great extent though we still need to do a lot to promote the regular use of low dose Aspirin in its established indications.
Prof. Akbar Chaudhry’s views were further confirmed when taking part in the discussion Dr. Zaeemuddin Abid consultant physician pointed out that he has started using Aspirin in his patients. Whenever the patient with ACS comes, he immediately asks him to take two tablets of Aspirin. First their blood pressure is controlled and then they are put on regular use of Low Dose Aspirin therapy. Once he saw a patient who died the next morning due to acute myocardial infarction. Since then, as a practice he makes sure that all these patients are given aspirin immediately when they consult him and it also convinces the patients of the importance of Aspirin therapy.

Members of Sales team of Atco Laboratories photographed along with Mr. Akhtar Tahir Business Unit Head and Mr. Farhan Raza Product Manager Atco Laboratories during a seminar on Aspirin Update held at Okara recently.

Dr. Abdul Aleem another consultant physician of Okara pointed out that Aspirin is extremely safe and effective in ACS. In his clinical practice he has found Aspirin highly beneficial in acute coronary syndrome. He advised his patients to immediately take Aspirin tablet in case of chest pain irrespective of the fact whether it is cardiac in nature or not but those who do not tolerate Aspirin they are advised not to take it. Similarly in acute gastric bleeding, patients are advised not to take Aspirin. He advised the family physicians to use enteric coated Aspirin which is much safer. Dr. Aleem further stated that in secondary prevention of CAD, Aspirin should be used without any hesitation unless it is contra indicated. However, he re-emphasized that one must first control blood pressure before putting patient on low dose aspirin therapy. In elderly patients with gout, urine analysis and keratinine should be checked regularly. Aspirin, Dr. Aleem said is very economically priced wonder drug and affordability is not a problem. It should be used more and more. Family Physicians should encourage its usage. All doctors over the age of fifty years, he said, must use low dose aspirin regularly.

Mr. Shaukat Ali Jawaid General Secretary Pakistan Aspirin Foundation highlighted the objectives and accomplishments of the Foundation so far. Referring to the use of Aspirin therapy in primary prevention of CAD, he stated that though lot of evidence is available but the largest trial which will enroll over twelve thousand patients in five countries including USA, UK, Germany and China has commenced in 2009 and it will last for four years. The results of this ARRIVE study will be available in 2013 which will further confirm the efficacy of regular use of low dose Aspirin therapy in primary prevention of CAD. He also referred to the publication of Book on Aspirin- the wonder life saving drug, an Urdu Booklet on Aspirin, revision of consensus report on use of Aspirin in various diseases which gives details about the dosage, indications and contra indications etc. This report is also accessible on the website of Pakistan Aspirin Foundation (www.pakaspirin.org) and it is being freely distributed throughout the country. Both Prof. Akbar Chaudhry and Mr. Shaukat Ali Jawaid made it clear that though they are thankful to M/s Atco Laboratories and its team headed by Mr. Akhtar and Mr. Farhan Raza for helping Pakistan Aspirin Foundation in its academic activities but upholding professional ethics, they do not support any particular brand of Aspirin. It is up to the physicians to prescribe the drug of their choice based on their clinical experience and trust.
Later Dr. Liaquat Ali took up the issue of violence against doctors and asked the doctors community to have unity among their ranks. He also talked to the SHO and other officials of the district administration urging them to arrest the culprits who misbehaved with doctors on duty at the local DHQ Hospitals a few days ago otherwise they will march to their offices to stage a sit in and record their protest.
The programme was conducted by Dr. Nasir Mahmood General Secretary of the local PMA while Dr. Ishtiaq Ali President of PMA also briefly spoke on the occasion. Later flower bouquet was presented to the guest speakers and others. The meeting as usual was sponsored by Atco Laboratories for which Mr. Farhan Raza and his team from Atco laboratories had been quite busy. Mr. Akhtar Business Unit Head in Atco laboratories was also present on this occasion.
The PMA Okara needs to be commended to have established its own purpose built PMA House which is being used for holding all such academic activities. The PMA Okara it is learnt is quite active and its successive leadership has been quite busy in not only holding CME programmes from time to time but also safeguarding the interests of the doctor’s community. During the recent violence against the doctors, the PMA has played a vital role to ensure that their viewpoint is heard by the administration and necessary steps are taken so that doctors can work with devotion without any fears about their security.

Aspirin Update seminar at Kasur
Regular use of low dose Aspirin reduces morbidity
and mortality in CAD - Prof. Akbar Chaudhry
All Type-2 diabetics should be put on Aspirin therapy
if there is no contra indication - Prof. Mahmood Ali Malik

KASUR: Pakistan Aspirin Foundation in collaboration with the PMA Kasur organized a seminar on An Update on Aspirin here on April 7th 2010. Prof. Mahmood Ali Malik a noted physician and former Principal of King Edward Medical College and Prof. M. Akbar Chaudhry President of Pakistan Aspirin Foundation currently Principal of Continental Medical College Lahore were the two guest speakers. The meeting was very well attended by members of the PMA which included GPs and Family Physicians as well.

Pakistan Aspirin Foundation in collaboration with PMA Kasur organized a seminar Update on Aspirin at Kasur on April 7th. Picture sows Dr. Safdar one of the senior most physicians presenting flower bouquet to Prof.M. Akbar Chaudhry President of the Foundation.

In his presentation Prof. Akbar Chaudhry said that Aspirin which has now completed over one hundred ten years of its use in clinical medicine was a wonder drug of the century. Despite numerous studies which have proved that continued use of low dose Aspirin reduces the morbidity and mortality to a great extent, it remains underused. Its established indications include Acute Myocardial Infarction, Acute Coronary Syndrome, secondary prevention of MI, primary prevention of CAD, TIAs and Stroke, prophylaxis for thromboembolism, DVT, Hypertension and Diabetes. In addition there are many emerging new indications like cancer, prostate cancer, Alzheimer’s disease, Pre-eclampsia, renal diseases, insulin resistance, etc., which continues to amaze the research scientists.

Prof. Mahmood Ali Malik, Prof. Akbar Chaudhry, Dr. Ghulam Shabbir Yazdani, Dr. Inayat, Mr. Akhtar Business Unit Head of Atco and others photographed after the seminar on Aspirin held at Kasur recently.

He also gave a brief historical background to the discovery of Aspirin and the story starts from 1948 but it was the pioneering study of Scottish Physician Dr.Peter Elwood who first showed in 1974 that Aspirin prevents heart attacks. Since then its anti-platelet activities have been highlighted in various disorders. In case of acute myocardial infarction, one full tablet of Aspirin or use soluble Aspirin immediately which will reduce the chances of any fatal event by almost 25%. According to reports over forty thousand tones and one hundred billion tablets of Aspirin are used every year all over the world. Its popular uses include cardiovascular diseases, arthritis, headaches, etc. As regards its use in primary prevention of cardiovascular diseases, studies have shown that it reduces non-fatal MI by 32%, non-fatal stroke by 18% and total cardiovascular mortality is reduced by 13% besides it also reduces important vascular events by 13%. It reduces strokes in women much more than men.
Continuing Prof. Akbar Chaudhry said that if the absolute ten years risk is less then six percent, there is no need for aspirin but if it is between 7-14%, it should be left to the patient’s preference. However, if the absolute ten years risk is more than 15%, these patients must be put on Aspirin therapy. In secondary prevention of cardiovascular diseases, Aspirin reduces non-fatal MI by 32%, non-fatal stroke by 27% and total CV mortality by 15% and important vascular events by 25%.

Pakistan Aspirin Foundation in collaboration with PMA Kasur organized a seminar on Aspirin Update at Kasur on April 7th which was very well attended. Picture shows Prof. Akbar Chaudhry, Prof. Mahmood Ali Malik, Mr. Shaukat Ali Jawaid, Dr. Ghulam Shabbir Yazdani, Dr. Aslam Randhawa and Dr. Inayatullah speaking at the occasion.

As regards use of Aspirin in stroke, Meta analysis of six studies which enrolled 51, 342 women and 44,112 men the reduction in stroke in women was 17% as compared to men which was 14%. Evidence is also accumulating regarding the use of low dose aspirin in primary prevention of stroke. In case of acute ischaemic stroke, the patient should be given 150-300mg of Aspirin within forty eight hours as it is the drug of choice. Aspirin reduces the risk of early death as well as recurrence of stroke. SALT study regarding secondary ischaemic stroke has demonstrated that relative risk reduction of stroke and death with Aspirin vs. placebo is 31% with minimal risk of bleeding. Again relative risk reduction of TIA and death is 27% with Aspirin therapy. Regular use of low dose Aspirin also helps in prevention of secondary stroke. Various studies have confirmed that Aspirin remains underused in stroke, TIAs, CAD. Hence these patients should be encouraged to use Aspirin for secondary prevention especially in the high risk patients.
Prof. Akbar Chaudhry also refereed to AAUS study conducted by Pakistan Aspirin Foundation which involved over fourteen hundred ACS patients in 17 CCUs all over Pakistan. It showed that only 16% patients got Aspirin at home, only 20% patients were advised use of Aspirin by GPs while in ER 60% patients got Aspirin and in Ward about 71% patients got Aspirin. What was more surprising was the fact that at discharge only 50% of these patients were prescribed Aspirin. Prof. Akbar Chaudhry remarked that since most often the discharge slip is prepared by junior doctors, they do not give too much importance to Aspirin. However, ever since we started this awareness campaign, the situation has improved and now the use of Aspirin in its well established indications is increasing. However, there is still lot to be done as regards education of the GPs, Family Physicians, other healthcare professionals as well as the patients. He concluded his presentation by stating that every doctor must keep Aspirin with him, at the clinic as they may need it any time and it might prove life saving. They should also educate the patients that in case of chest pain irrespective of the fact whether it is cardiac or non cardiac, they must immediately chew a full tablet of Aspirin of 325mg or use soluble Aspirin. Combination therapy of Aspirin plus clopidogril further reduces the relative risk by 20%. In patients who are sensitive to Aspirin therapy, other anti platelet agents should be used. Enteric coated Aspirin is preferred as it eliminates the chances of any gastric irritation. Prof. Akbar Chaudhry acknowledged Dr. Maqbool H. Jafary the former President of PAF who he said has made a major contribution to this presentation.

Dr. Aslam Randhawa EDO Health Kasur and Dr. Iqbal Mayo President PMA Kasur presenting bouquet to Prof. Mahmood Ali Malik and Mr.Shaukt Ali Jawaid at the Aspirin seminar held here on April 7th 2010

Prof. Mahmood Ali Malik in his brief presentation advised the participants to control blood sugar and blood pressure of their patients. In diabetics a BP level of 120/80 is desirable but 130/85 is also acceptable. Make sure that the HbA1c is less than six which is preferred. Fasting blood sugar should be less than one hundred which must be aimed at. All Type-2 diabetics in high risk group must be put on regular low dose Aspirin therapy. However, young patients, with no history of cardiovascular disease, no TIA, no family history, non-smokers will not require Aspirin therapy. In known ulcer patients, Aspirin is avoided because of risk of bleeding. However, in case of emergency if need be, one tablet of Aspirin could be use in AMI just once as it might prove life saving.
Dr. Aslam Randhawa EDO Health speaking at the occasion said that Aspirin is very economically priced drug which is easily available and affordable. He thanked the speakers for their valuable advice and felt that many a time’s doctors in rural areas with not many facilities can save many precious lives by just administering Aspirin therapy to AMI patients.
Dr. Iqbal Mayo President of local PMA and Dr. Inayatullah Sheikh GS of PMA also briefly addressed the meeting and thanked the speakers and Atco Laboratories for sponsoring this academic activity. Dr. Ghulam Shabbir Yazdani consultant cardiologist at DHQ Hospital Kasur welcomed the guest speakers.
Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation highlighted the history and accomplishments of the Foundation. He as well as Prof.Akbar Chaudhry both emphasized that the Foundation does not promote any particular brand of Aspirin and it is up to the physicians to decide. Keeping up the professional ethics we just promote the use of Aspirin. However, we are grateful to M/s Atco Laboratories who have been sponsoring our CME programmes all over the country for the last many years. They specially thanked Mr. Akhtar Business Unit Head and Mr. Farhan Raza Product Manager from Atco Laboratories for organizing these meetings in far flung areas all over Pakistan on regular basis to update the healthcare professionals on safety, efficacy and use of Aspirin therapy. Copies of Consensus Statement on Guidelines for the use of Aspirin as well as an Urdu Booklet on Aspirin was also distributed among the participants.
Prof. Mahmood Ali Malik, Prof. Akbar Chaudhry and Mr. Shaukat Ali Jawaid also visited the DHQ Hospital Kasur where they were welcomed by Dr. Ghulam Shabbir Yazdani. They also met the MS of the hospital and visited various sections of the hospital. During the visit to the CCU and cardiology ward, Dr. Yazdani informed that during the last three months they had received about fifty patients of AMI and most of them were quite young. Thrombolysis therapy is available free. The 120-Bed DHQ Hospital has 32-bed cardiology ward. Senior staff at the hospital includes physician, surgeon, cardiologist, obstetrician and gynaecologist besides pediatrician. Lot of development activity is going on to improve and upgrade the facilities available at the hospital. A few more residences for senior doctors are also being constructed.

Prof. Akbar Chaudhry takes over as the
new President of Pakistan Aspirin Foundation
Prof. Javed Akram to organize the next National Conference at Lahore in 2011

LARKANA: After consensus among the founder members, Prof. M. Akbar Chaudhry former Principal of Fatima Jinnah Medical College and currently Principal of Continental Medical College Lahore was selected as the new President of Pakistan Aspirin Foundation. He replaced Dr. Maqbool H. Jafary whose term expired this month. A decision to this effect was taken at the General Body Meeting/consensus consultations held before and during the recently held national conference of Pakistan Aspirin Foundation at Larkana on October 31st 2009.

Prof. M. Akbar Chaudhry Principal Continental Medical College and newly elected President of Pakistan Aspirin Foundation presenting shields to Prof. Ejaz Ahmad Vohra, Prof. Khalida Soomro and Prof. Javed Akram during the national conference of Pakistan Aspirin Foundation held at SMBBMU/CMC Larkana on October 31^st 2009.

Prof. Akbar Chaudhry, it may be mentioned here is the life member of Pakistan Aspirin Foundation and has successfully organized one of the National Conferences at FJMC. He has also been working as Central Coordinator for Pakistan Aspirin Foundation for Punjab for the last two years. Selection of the President is made keeping in view the fact that the person selected must show his commitment, must have time to coordinate and organize its Continuing Medical Education programmes which involves lot of travelling to small cities and towns all over the country. As per schedule and past traditions of rotating Presidentship of the Foundation in different provinces, this time it was the turn for some one from Punjab. Prof. Mumtaz Hassan an eminent physician and former Principal of King Edward Medical College was the first choice. However, he expressed his inability due to some personal engagements but assured his support for the CME activities. He further stated that he will fully support Prof. Akbar Chaudhry and will be too glad to be one of the speakers at the CME programmes.
Prof. Javed Akram Principal of Allama Iqbal Medical College was selected as organizer for the next national conference which will be held at Lahore during 2011. He is also a founder member of Pakistan Aspirin Foundation. Keeping in view his organizational capabilities the members were unanimous that we will have a very successful meeting with good informative and interesting scientific programme in 2011.

Mr. Ayaz Soomro Sindh Minister for Law presenting shields to Mr. Munawar Abbasi MPA, Prof. Saeed Ahmad Sangi, Prof. Asadullah Maher Principal CMC and Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation at the public awareness session on Aspirin at CMC Larkana on October 31^st 2009.

Organizing this national conference at Larkana had been a very difficult task due to the prevailing law and order situation in the country besides inaccessibility. There are a few flights to Mohenjodaro Airport from different cities in Pakistan and that too not daily. Hence, some of the delegates from Lahore had to travel to Sukkur to reach Larkana and managed to get their return flights from Sukkur to Karachi and then Lahore which was quite inconvenient. However, it was their dedication, devotion and commitment that they made it possible despite difficult travel schedule.
Among the invited guest speakers and participants who travelled from Karachi and Lahore to participate in the conference were Prof. Mahmood Ali Malik former Principal of KEMC and founder President of Pakistan Aspirin Foundation, Prof. M. Akbar Chaudhry Principal Continental Medical College, Prof. Javed Akram Principal Allama Iqbal Medical College, Prof. Talat Naheed Prof.of Medicine at FJMC. From Karachi the speakers included Dr. Maqbool H. Jafary, President of Pakistan Aspirin Foundation, Prof. Ejaz Ahmad Vohra Dean Postgraduate Studies and Head of Dept. of Medicine at Ziauddin Medical University, Prof. Zaman Sheikh Prof.of Medicine at DUHS and Executive director of National Institute of Diabetes and Endocrinology at Ojha Campus, Prof. Khalida Soomro from DUHS Karachi, Mr. Shaukat Muttaki consultant pharmacist. The meeting was also attended by some cardiologists from interior of Sindh besides the faculty members of Sardar Ghulam Mohammad Maher Medical College at Sukkur and Chandka Medical College, SMBBMU Larkana and students of Chandka Medical College.
During the General Body meeting Prof. Mahmood Ali Malik, Prof. Akbar Chaudhry and Dr. Maqbool H. Jafary recorded their appreciation for Prof. Saeed Sangi for organizing this meeting at such a short notice. They also put on record the efforts made by General Secretary of Pakistan Aspirin Foundation Mr. Shaukat Ali Jawaid to make it possible that the meetings are held as schedule. They also expressed their gratitude to Atco Laboratories in general and its focal person looking after Aspirin related activities Mr. Farhan Raza Product Manager in Atco in particular and the entire ATCO team for their hard work which helped to make the conference a success.
Dr. Maqbool H. Jafary thanked the members for their support during his tenure as President and said that he tried his best to contribute as much as possible. Apart from addressing various CME meetings at Isra University in Hyderabad, KIHD in Karachi, small towns and cities like Khanewal, Vehari, Sialkot, Sahiwal etc., a booklet on Aspirin in Urdu was also published to create awareness and promote the use of Aspirin. It is quite useful not only for the public but also for the Family Physicians. Now efforts are being made to translate this booklet in other regional languages. Prof. Akbar Chaudhry speaking at the occasion sought help and assistance from all the members so that we can carry forward the message and thus promote the aims and objectives of Pakistan Aspirin Foundation.