The comparative study of the effect of telmisartan and ramipril on diabetic profile in hypertensive pre-diabetic patients

Background: Hypertension, a common cardiovascular disease, is being increasingly associated with other co-morbid conditions like Diabetes mellitus, worsening its outcome. Both telmisartan and ramipril are effective anti hypertensive agents. The present study compares the efficacy of telmisartan and ramipril in controlling or preventing the progression of pre-diabetes to diabetes in stage 1 hypertensive patients.Methods: A prospective, randomised, single centre, comparative observational study is conducted over a period of 12 months on stage 1 hypertensive patients with pre-diabetes. 60 patients are recruited and randomised into two treatment groups. They received the assigned drug for a period of 12 months and are followed up. At each visit, blood pressure was measured and diabetic profile was tested.Results: This study showed that both telmisartan and ramipril controlled the blood pressure effectively. Telmisartan controlled the progression of fasting blood sugar and glycosylated haemoglobin better than ramipril in stage 1 hypertensive patients with pre diabetes.Conclusions: Both telmisartan and ramipril were affecting in controlling the blood pressures. Telmisartan has a statistically significant effect in preventing the progression of prediabetes to diabetes mellitus in stage 1 hypertensive patients with pre diabetes when compared with ramipril

Plasmid optimization and the localization of the binding site of GPS2-UBC13

The GPS2 protein (G-protein pathway suppressor 2) is a product of the mammalian gps2 gene. It was originally identified and characterized in the context of G protein mitogen-activated protein kinase (MAPK) signaling pathways. Several studies have linked GPS2 with the inhibition of the ubiquitin conjugating enzyme UBC13. GPS2-mediated inhibition of UBC13 regulates several metabolic and inflammatory pathways. It has been shown that a lack of GPS2 is correlated with an increase in adiposity and inflammation due to the aberrant activity of UBC13 affected pathways. Therefore, understanding the relationship between UBC13 and GPS2 will provide further understanding of the molecular processes involved in adipose tissue levels, inflammation and downstream molecular responses. In this study, we attempt to determine the molecular determinants of GPS2 interaction with UBC13 by optimizing the protein expression protocol required to produce GPS2 protein expression in Escherichia coli in quantities viable for biochemical and structural assays. Our results indicate that optimization of the gps2 sequence is required for efficient GPS2 protein expression in E. coli cells. Thanks to this optimization we have been able to successfully express GPS2 full length and several fragments, however, further optimization will be required for assessing GPS2-UBC13 molecular binding via in vitro binding assays

Perceived Servant Leadership Style of Principals Correlates with Job Satisfaction of Secondary School Teachers in Pakistan

Servant leadership is a type of leadership that encourages people to work together. A leader intends to help the institution’s personnel favorably. The school leader interacts with teachers and administrative staff as a collegial friend rather than a boss and tries to make things as easy as possible for them. The major goal of this study was to see if there was a correlation between servant leadership and job satisfaction among secondary school teachers in Pakistani settings. The study’s participants were male and female public sector secondary school teachers from the districts of Lahore and Kasur, of Punjab province, Pakistan. The sample was chosen using a stratified random sampling technique. A total of 510 teachers participated in the study as a sample. In this study, adapted  questionnaires with responses measured on a five-point Likert type scale was used. Both variables, perceived servant leadership style of principals and work satisfaction of teachers showed a strong association. Further sub-factors correlations showed significant results. It is proposed that school principals adopt servant leadership style as it would be more beneficial for them to ease and comfort the school employees that might improve the institutional performance

Effects of Smartphone Usage on Social Wellbeing of School Going Children (5-16 years) in Lahore, Pakistan

The aim of this study was to analyze the effects of smartphone usage on social wellbeing of school going children (5-16 years). Descriptive cross sectional household survey was carried out in all ten towns of Lahore, Pakistan in five months duration from January 2017 to May 2017. The sampling technique was multistage cluster sampling. The school going smartphone users included in the study were 2889. The study tool was structured questionnaire. The gathered data was analyzed through IBM SPSS Statistics Version 21 in terms of Descriptive statistics and Bivariate logistic regression. Long term smartphone usage was found significantly associated with social networking among school going children. The p-value of hours spent by school going smartphone users with family per day was <0.01, smartphone use during breakfast, lunch & dinner was 0.011, smartphone use when family sitting closer to them was <0.001 and smartphone use to interact with friends and cousins was 0.0001. The study concluded that long term smartphone usage can result in decreased face-to-face communication and decreased interaction between family members living in one home and increased interaction with friends and people outside the home

The Effects Of Simvastatin On Islets Of Langerhans In The Pancreas Of Rats: A Histological And Biochemical Study

Objective: This study explored the effect of simvastatin on the histomorphology of islets of Langerhans, glucose and insulin levels in rats. Study Design: The study was a one-year laboratory-based experimental control trial. Place and duration of study: It was conducted at Army Medical College Rawalpindi, in collaboration with the National Institute of Health Islamabad and Armed Force Institute of Pathology Rawalpindi. Methods: A one-year, laboratory-based, two-group experimental control trial was conducted. Thirty rats were assigned to each group: a control group receiving saline injections, and a simvastatin group receiving a simvastatin 60 mg/kg/day. Histological analysis of pancreatic islets, and measurements of blood glucose and insulin levels were performed. Statistical analysis was conducted using independent sample t-tests, with significance set at p < 0.005. Results: While simvastatin treatment did not affect the number of islets of Langerhans, The area of pancreatic islets of Langerhans was significantly higher in the simvastatin treatment group compared to control (52,664±38,871 μm2 vs 24,643±16,256 μm2, p=0.001). Serum insulin levels were also significantly elevated with simvastatin treatment (21.49±7.03 μIU/ml) compared to control (16.72±5.38 μIU/ml) (p=0.005). There were no significant differences in weekly fasting blood glucose levels at 4 or 12 weeks between groups (p>0.05). These findings suggest potential modulation of pancreatic islet function by simvastatin without affecting glycemic control in this model. Conclusions:  These findings demonstrate that simvastatin treatment significantly impacts the morphology and function of pancreatic islets in rats, increasing insulin secretion without affecting blood glucose levels. Further research is necessary to elucidate the underlying mechanisms and clinical implications of these observations.

Safety Assessment of Glucose-Lowering Drugs and Importance of Structured Education during Ramadan : A Systematic Review and Meta-Analysis

Background. Ramadan is the sacred month of the Islamic Hijri (lunar) calendar, and during this entire month, healthy adult Muslims abstain from eating and drinking from dawn to sunset. Muslims with Type 2 Diabetes Mellitus (T2DM) who choose to fast during Ramadan encounter major risks such as hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Although patients with poor glycemic control and on multiple insulin injections are at high risk and exempt from fasting, many still insist on it. Thus, healthcare professionals play a pivotal role in managing diabetes-related complications in patients who fast during Ramadan. However, there is a lack of standard guidelines to be followed in association with structured education and administration of drugs and dosage. Therefore, we performed a systematic review and meta-analysis of the literature to determine the safety and efficacy of different classes of drugs and the importance of structured education during Ramadan. Methods. In this review, an extensive PubMed search was performed to obtain literature on T2DM patients who fast during the month of Ramadan until the year 2020. Preference was given to fully downloadable articles. The articles were extracted based on the eligibility criteria. The extracted data were analyzed using Review Manager software version 5.3. Results. A total of 32 articles were included for the review and 7 studies for meta-analysis. Majority of the studies demonstrated the importance of structured education either as a group session or as a one-on-one session with the healthcare professionals in preventing diabetes-related risks during Ramadan. As far as glucose-lowering drugs are concerned, DPP-4 inhibitor combined with metformin remains the drug of choice for T2DM patients who fast during Ramadan. The newer class of glucose-lowering agents appear to lower the risk of hypoglycemia in comparison with sulphonylureas, while among sulphonylureas gliclazide is relatively safe. The meta-analysis indicates that DPP-4 inhibitors would significantly reduce the risk of hypoglycemia as compared to sulphonylurea (odds ratio=0.38, 95% CI: 0.26 to 0.55, p < 0.00001). Conclusion. The results of our systematic review show that structured education and counselling by healthcare professionals can be an effective tool in preventing complications associated with fasting during Ramadan in people with T2DM. Additionally, the safest class of oral glucose-lowering drugs preferred during Ramadan fasting in T2DM patients is DPP-4 inhibitors.Peer reviewe

Legal Protection Policy for Obstetricians-Gynecologists in Cases of Maternal, Perinatal, and Neonatal Mortality

Introduction to The Problem: Obstetrician-gynecologists (OB-GYNs) must be observant in diagnosing diseases suffered by patients. OB-GYNs who act based on their knowledge can certainly not be blamed if their actions are already according to the procedures. Legal policies protect OB-GYNs in the case of a patient’s death.Purpose/Objective Study: This article aims to analyze the legal protection for OB-GYNs in cases of maternal, perinatal, and neonatal mortalities. Design/Methodology/Approach: This research was a field research with juridical-sociological method conducted in 2021. The researchers conducted interviews with four informants who experienced maternal, perinatal, or neonatal emergencies.Findings: Conditions with a high risk of maternal, perinatal, and neonatal deaths are handled by OB-GYNs. OB-GYNs must be proficient in the standards for obstetric and neonatal emergencies. OB-GYNs who have correctly followed the processes but experienced an accident also have the right to legal protection. In providing health services, OB-GYNs do not only examine the patients, but they also make efforts to recover the patient through treatments. In health law, such efforts of recovery are known as the Therapeutic Agreement. The relationship between obstetricians and patients is bound to a therapeutic transaction. OB-GYNs have the legal obligation to make improvements in their efforts and expertise in healing patients. Legal regulations stipulated in the Indonesian Civil Law are still too general. There  was one case involving dr DASP SpOG and dr HS SpOG, who were sentenced with 10 months in prison because they violated article 39 of the Indonesian Criminal Code because their patient died during the treatment. This case caused unrest among the OB-GYNs. Therefore, there needs to be a law that regulates the relationship between OB-GYNs and their patients. In terms of human rights in Indonesia, this particular healthcare issue is regulated in Law Number 36 of 2009 regarding Health (Indonesian Health Act). Chapter III Article 1 clause (1) and (4) specifially regulate the patients' rights. The legal and ethical responsibilities in health services observe how far the obstetricians' actions have legal implications in cases of errors or negligence in providing health treatments.Paper Type: Research Articl

Impact of caffeine and vitamin D3 on the body-weight of pregnant BALB/c mice

Objective:  To investigate the effect of caffeine and Vitamin D3 on the body weight of pregnant BALB/c mice.  Design of Study:  An RCT (Randomized control trial) in the Lab.  Place and Duration of Study:  The study was carried out at Anatomy Department, Army Medical College (AMC), Rawalpindi, in collaboration with National Institute of Health (NIH), Islamabad, from Oct 2018 to Oct 2019.  Material and Methods:  Six-week old pregnant BALB/c mice, thirty (30) in number, weighing  26-28g, were taken and divided into three groups with 10 pregnant mice in each group.  The control group G1 was given standard diet with water ad libitum for 21 days.  The animals in experimental group G2, in addition to the standard diet, were given 10mg of caffeine per 100g body-weight once a day on alternate days by oral gavage for 21 days.  Similarly, mice in group G3, in addition to the diet of group G2, were given 0.1µg of vitamin D3 per day by oral gavage for 21 days.  The body-weights on 1st day, 7th day, 14th day and 21st day of gestation in all the groups were measured to determine the influence of caffeine and vitamin D3.  Results:  Mean body-weights of mice in control group G1 were noted as 26.8 ± 0.789g,  30.7 ± 0.949g, 36 ± 0.667g and 42 ± 1.054g on 1st, 7th, 14th and 21st day of gestation, respectively.  The mean body-weights of experimental group G2 were recorded to be 26.7 ± 0.675g, 29.9 ± 0.738g, 34.3 ± 0.823g and 39.5 ± 0.972g on 1st, 7th, 14th and 21th day of gestation, respectively.  The mean body-weights of experimental group G3 were determined as 26.8 ± 0.632g, 30.4 ± 0.699g, 34.6 ± 0.516g and 40.5 ± 0.850g on 1st, 7th, 14th and 21st day of gestation, respectively.  In comparison to the control group G1, the body-weights of animals in experimental group G2 showed more decrease in accrual of body-weight than noted in experimental group G3.  Conclusion:  Caffeine intake has decreasing influence on the growth of body-weight in pregnant mice while intake of vitamin D3 somewhat nullifies the harmful effect of caffeine on body-weight.

Knowledge of Safe Swaddling Practices among Mothers of Neonates Visiting a Tertiary-Care Hospital in a Developing Country

OBJECTIVES Swaddling of new-borne and infants remains common in the developing world, but little is known about maternal knowledge of swaddling. Therefore, this study aimed to determine the level of knowledge of safe swaddling practices among mothers of neonates visiting a Tertiary-Care Hospital.METHODOLOGY This cross-sectional study was conducted in the paediatric unit of tertiary care hospital in Peshawar city, Pakistan, between July and December 2018. A total number of 370 mothers of neonates who volunteered their participation were selected using a non-probability consecutive sampling technique. The study was based on a questionnaire comprised of socio-demographic and other questions related to the knowledge of safe swaddling practices.RESULTSA total number of 370 mothers of neonates knowledge were assessed. The study participants ranged between 17 - 49 years, with a mean age of 27.14 (SD ± 5.46). Of the total, 365 (98.6%) mothers were swaddling their babies, while only 5 (1.3%) reported not practising swaddling. Most mothers (51.1%) had good knowledge, while 44.3% had adequate knowledge, and only 4.6% had insufficient knowledge regarding safe swaddling. Knowledge of safe swaddling increased with age and parity. Most mothers (90%) correctly identified that "cotton cloth or light blanket should be used to swaddle baby".CONCLUSIONIt is concluded from this study that most mothers have adequate knowledge about safe swaddling, and the level of knowledge increases with age and parity. Safe swaddling techniques and information should be given to mothers at the beginning of antenatal care to benefit from its positive outcomes and, at the same time to avoid its drawbacks

Performances, challenges and opportunities in strengthening reinforced concrete structures by using FRPs – A state-of-the-art review

Structures are often subjected to extreme loading conditions that lead to their premature deterioration, and replacement of those structures before the end of their design lives is very expensive. The rehabilitation of deteriorated structures by using externally bonded fibre-reinforced polymer (FRP) composites is gaining popularity in the construction sector owing to its high strength, optimum durability and compatibility with concrete structures during application. This paper aims to review the current state-of-the-art on the performances, challenges and future opportunities of FRP-strengthened reinforced concrete (RC) structures under different loading scenarios. FRP strengthening leads to satisfactory performances under static, dynamic and extreme environmental conditions. Debonding and FRP rupture are the common types of failure observed, however, the failure mechanisms operating under the combined action of service loads and environmental exposures are still unclear. The acceptance and application of FRPs in strengthening RC structures will further increase upon developing techniques for utilising the full FRP strength, reducing the brittleness, risk of fires and accidental damage, minimising the energy consumption as well as carbon emission during production, and reducing the high initial cost. This paper also identifies the gaps in the present state of knowledge and the potential research directions for FRP-strengthened structures that lead to better understanding and establishment of design guidelines