THE ASSOCIATION BETWEEN SOFT DRINK CONSUMPTION AND BONE MINERAL DENSITY AMONG QATARI WOMEN: ANALYSIS OF QATAR BIOBANK DATA

With the rapid increase in longevity, osteoporosis is viewed as a global problem and recognized to be one of the most common diseases in both developed and developing world. It is common in older women, as the bone mineral density (BMD) tends to decrease with age, particularly after menopause. Decrease in BMD increases the risk of osteopenia and osteoporosis. Often the first clinical manifestation of osteoporosis might be a fracture, as the women do not recognize the decreases in BMD levels. Whilst age and hormonal changes are well established risk factors, there are other factors that have been investigated for possible links to increase the risk of osteoporosis. These factors include dietary patterns and lifestyle. Few studies have examined the soft drinks consumption as a potential riskfactor for lowering BMD levels. Reports from these studies presented conflicting findings. Some suggesting significant decreases in BMD levels due to soft drink consumption, while others find null associations. In the context of the unclear association, we made use of a relatively larger Qatar Bio-Bank (QBB) data to explore the cross-sectional association between soft drink consumption and BMD. The strength of the QBB data include objective and validated measurement of outcome and risk factors. This study included 1000 Qatari women age ≥ 40 years volunteered to take part in the QBB survey. BMD levels were measured using the Dual-Energy X-ray Absorptiometry (DXA) scan one of the most reliable and valid measures and the soft drink consumption was assessed using validated food frequency questionnaires. Data were checked for errors and explored using descriptive statistical methods. Multiple regression models were then used to assess the association between bone mineral density and soft drink consumption. The use of multiple regression was essential to adjust for a number of person-centered confounders. Given those with lower BMD levels were considered to have high risk of osteoporosis, quantile regression models were used. This is one of the most sophisticated models that is meant to identify the risk factors associated with high risk population while adjusting for potential confounders. Nutritional epidemiology studies have shown use of quantile regressions can pick up the risk factors much more efficiently. Our findings suggest that there was a clinically and statistically significant association between BMD and soft drink consumption after adjusting for age, BMI, menopausal status, smoking status, physical activities, milk intake, and fruit and vegetable consumption. Further high-quality studies with long term follow up with specific purpose of testing the hypothesis are warranted before we can comment on potential causal association. If future cohort studies were to confirm such association, it is possible to develop appropriate public health intervention to improve bone health via reduced soft drink consumption

Participant Experience of the First Massive Open Online Course (MOOC) from Pakistan

Background: In recent years, massive open online courses (MOOCs) have steadily gained popularity. It appears, however, that MOOC learners are concentrated mostly in the affluent English-speaking countries. MOOCs’ free-of-cost, easy accessibility should make them obviously attractive to participants from low-and-middle-income countries (LMIC). The reason why LMIC enrollments in MOOCs are so low is therefore unclear. In the year 2014, the first MOOC was launched from Pakistan. We administered a survey to the enrollees of this MOOC to explore concerns, fears, and limitations that might be deterring the LMIC audience from participating in MOOCs. Methods: The MOOC was a three-week course on bioinformatics that covered current concepts and techniques employed in the area of computer-based drug design. More than 230 participants enrolled for this course. At the end of the course, to examine the MOOC experience from their perspective, we invited the participants to take an online survey. Results: Fifty-four participants, mostly from Pakistan, completed the survey. The participants reported satisfaction with the course, and felt that the course participation was an enriching experience. Although they appeared eager to explore MOOC learning, we found that the learners from LMICs may not be completely comfortable with various aspects of online learning. Conclusion: Our results indicate that there is a definite market for MOOCs in LMICs. Computer accessibility and literacy must be enhanced in the LMICs to allow the citizens of these regions to feel comfortable with e-learning. Moreover, LMIC nations acknowledge their own unique learning cultures and experiences when they produce and share their MOOC offerings with the world

A roadmap for offering MOOC from an LMIC institution

MOOCs are massive open online courses that are globally accessible, free of charge. Given their cost-free and open accessibility, it is surprising that only a few institutions have offered MOOCs from low- and middle-income countries (LMICs). Pakistan recently made this short list of LMICs as the first two MOOCs were launched from the country, in 2014 and 2016. Drawing from that experience, the organizers of that course present a roadmap for LMIC institutions for developing a MOOC, focusing especially on the technological and pedagogical limitations that an LMIC institution might find deterring

Ameliorative Effects of Two Forms of Pomegranate on Glomerular Transvertical Diameter in Steroid- Induced Kidney Damage in Mice

To observe the effects ofPomegranate juice (PJ) and Pomegranate peel extract(PPE) on glomerular transvertical diameter in steroidinduced mice kidney damage.Methods: In this experimental study forty healthyadult mice (BALB/c strain), average weighing 25-30gms were divided into four groups, having ten miceeach. Control group A received only standardlaboratory diet without alteration.Experimentalgroups B, C and D were injected ND (Nandrolonedecanoate) (1 mg/100 gm body weight),intramuscularly (I/M), in the hind limb once a weekfor 8 weeks. Experimental group C was also given PJ(3ml/kg body weight) by oral gavage tube daily for 8weeks and experimental group D was given PPE(200mg/kg body weight) through oral gavagetube,daily for 8 weeks.After the experimental period,the animals were sacrificed and both kidneys of allmice were obtained. Kidneys were processed,embedded and stained for histological study byusing Hematoxylin and Eosin (H&E) and PeriodicAcid Schiff (PAS) stains. The results were compiledand compared.Results: After ND administration, glomerulardiameter was significantly reduced in experimentalgroup B when compared to control groupA.Protective effects were seen when comparison ofexperimental group B was done with PJ and PPEadministered experimental groups C and D,respectively. When results of experimental groups Cand D were compared with each other no statisticalsignificance was present.Conclusion: Both forms of Pomegranate hasameliorative effects on glomerular transverticaldiameter in steroid induced mice kidney disease

Glyphosate: cancerous or not? Perspectives from both ends of the debate

Glyphosate is non-selective herbicide. Studies published in the last decade, point towards glyphosate toxicity. Shikimic acid pathway for the biosynthesis of folates and aromatic amino acids is inhibited by glyphosate. Glyphosate carcinogenicity is still considered to be a controversial issue. The World Health Organizations’ International Agency recently concluded that glyphosate is “probably carcinogenic to humans.” Some researchers believed that glyphosate is not linked with carcinogenicity

Caesarean delivery of a Western Lowland gorilla with fetal distress and suspected pre-eclampsia

Pre-eclampsia is a well-recognised complication of human pregnancy however case reports suggest that it also affects non-human primates. The authors present the case of a primigravid western lowland gorilla (Gorilla gorilla gorilla) who developed behavioural changes, significant proteinuria, and ultrasound features of suspected fetal distress at term, three days prior to her estimated due date. A working diagnosis of pre-eclampsia was made, and the baby was delivered by emergency caesarean section. In spite of a prolonged recovery complicated by sepsis, anaemia and persistent proteinuria in the mother, both mother and baby made a good recovery. This case highlights how the application of basic principles of obstetric medicine and collaboration between obstetricians and veterinarians in the care of captive gorillas resulted in the successful management of pregnancy complications

Factors leading to meconium aspiration syndrome in term- and post-term neonates

Background: Meconium aspiration syndrome (MAS) is considered a major cause of respiratory morbidity. It is a common issue encountered in the delivery room and newborn nursery. There is a need to identify the factors that lead to MAS to develop strategies to screen such patients at an early stage to decrease the mortality and morbidity. The objective of this study was to determine the factors leading to MAS in neonates delivered at ≥37 weeks of gestational age. Methods: A cross-sectional study was conducted through non-probability consecutive sampling technique at Liaquat University Hospital, Hyderabad from August 2016 to February 2017. All neonates at ≥37 weeks of gestation with meconium-stained amniotic fluid (MSAF) detected during delivery were included in this study after obtaining informed consent from their parents. The demographic and factors related to MAS were recorded through predesigned proforma and analyzed using SPSS version 22. Mean and standard deviation were determined for quantitative variables whereas frequency and percentages were calculated for qualitative variables. Results: Overall 136 neonates were included in the study. The mean gestational age was 38 ± 1.43 weeks. The major factors for MAS were detected as fetal distress (67.0%, n = 91), non-reassuring fetal heart rate (54.0%, n = 73), cesarean birth (48.0%, n = 65), intrauterine growth restriction (IUGR; 17.0%, n = 23), and post maturity (12.0%, n = 16). Conclusion: We conclude that the major factors for MAS are fetal distress, non-reassuring FHR tracing, cesarean birth, IUGR, and post maturity. Screening of such patients at an early stage may minimize morbidity and mortality related to MAS

Loss-to-follow-up and delay to treatment initiation in Pakistan's national tuberculosis control programme

BACKGROUND: Researchers and policy-makers have identified loss to follow-up as a major programmatic problem. Therefore, the objective of this study is to quantify TB related pre-treatment loss to follow up and treatment delay in private sector health care facilities in Pakistan. METHODS: This was a retrospective, descriptive cohort study using routinely collected programmatic data from TB referral, diagnosis and treatment registers. Data from 48 private healthcare facilities were collected using an online questionnaire prepared in ODK Collect, for the period October 2015 to March 2016. Data were analysed using SPSS. We calculated the: (1) number and proportion of patients who were lost to follow-up during the diagnostic period, (2) number and proportion of patients with pre-treatment loss to follow-up, and (3) the number of days between diagnosis and initiation of treatment. RESULTS: One thousand five hundred ninety-six persons with presumptive TB were referred to the laboratory. Of these, 96% (n = 1538) submitted an on-the-spot sputum sample. Of the 1538 people, 1462 (95%) people subsequently visited the laboratory to submit the early morning (i.e. the second) sample. Hence, loss to follow-up during the diagnostic process was 8% overall (n = 134). Of the 1462 people who submitted both sputum samples, 243 (17%) were diagnosed with sputum smear-positive pulmonary TB and 231 were registered for anti-TB treatment, hence, loss in the pre-treatment phase was 4.9% (n = 12). 152 persons with TB (66%) initiated TB treatment either on the day of TB diagnosis or the next day. A further 79 persons with TB (34%) commenced TB treatment within a mean time of 7 days (range 2 to 64 days). CONCLUSION: Concentrated efforts should be made by the National TB Control Programme to retain TB patients and innovative methods such as text reminders and behavior change communication may need to be used and tested

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training