Burden of Diabetes Mellitus and Role of Telemedicine in its Management: Narrative Review

Objective: The purpose of this review is to summarize the findings regarding the prevalence and risk factors of Diabetes Mellitusin developed and developing world and to review the management options for Diabetes Mellitus especially the role of telemedicine. Methodology: Extensive literature review was carried by retrieving articles from various databases like Pub med, Google scholar, Science direct, Scopus and Archives of Medicine. Relevant articles were retrieved from different databases by using text words and phrases like ‘Diabetes Mellitus’, ‘Management’, ‘risk factors’, ‘prevalence of Diabetes’, ‘telemedicine’, ‘e- health’. Types of studies were descriptive studies, systematic reviews and various reports. Findings: Various supporting systems have been made to upgrade the management of type 2 Diabetes Mellitus including mobile phones and internet. Mobile phones and internet are mechanical support tools for the patients with type 2 DM to improve their health by facilitating good communication between the patients and their respective health care providers. Conclusion: There are multiple ways of managing Diabetes Mellitus ranging from oral medicines to insulin. These can be done either through the visits to the patients or the patients can be reminded to take the medicines through telemedicine. Telemedicine can play an important role in managing the patients with chronic diseases including Diabetes Mellitus

Iron Deficiency Anemia among Women of Reproductive Age, an Important Public Health Problem: Situation Analysis

Background: Iron deficiency is a major cause of anemia and is more prevalent in developing countries, posing additional burden on health care systems, in the presence of scarcity of resources. The high-risk group consists of females and children but comparatively it is higher in females due to physiological reasons. Multiple factors can predict anemia, which in turn leads to various adverse outcomes. Objective: The purpose of this literature review was to review and synthesize the findings from literature about the burden, causes, outcomes and important interventions of iron deficiency anemia for developing countries. Methods: An extensive literature review was carried out by retrieving articles from various databases like Pub med, Google scholar, Science direct, World Bank and WHO databases. Relevant articles were retrieved from different databases by using following text words and phrases: ‘anemia’, ‘Iron deficiency’, ‘risk factors of anemia’, ‘outcomes of anemia’, ‘interventions’ and developing countries. Results: Multiple determinants of iron deficiency anemia have been identified in the literature including genetic and environmental factors. Some of these factors are lack of proper diet, poor socioeconomic status, high parity of women, access to poor health and genetic etc. Moreover, anemia can result in various poor outcomes like fatigue, poor mental health, lack of concentration, poor feto-neonatal outcomes like stillbirth, preterm birth and postpartum Hemorrhage. Conclusion: Iron deficiency anemia is one of the important public health problems in developing countries among the women of reproductive age group. Multiple factors like age, parity, socioeconomic status and diet can determine the stores of iron in the women of reproductive age group. Anemia can lead to multiple adverse outcomes, which can be prevented by doing appropriate cost-effective interventions on time

Important steps to maintain the privacy of patients in the hospital

Women are considered as vulnerable groups in our society in spite of their defined women rights by various laws. This shows that unfortunately these laws are not implemented practically in the real life. Society is shaped by the individuals and everyone should be responsible for advocating their own rights as well as the right of others especially of the vulnerable groups within the population

Childhood obesity, a public health crisis: Narrative review of public health interventions for childhood obesity

Introduction: Child obesity is the major pediatric public health crisis of the current century and its trend is increasing in the developing countries due to nutrition and epidemiologic transition. Considering the burden of childhood obesity and its associated outcomes need for obesity prevention in children has become priority both for government and researchers.Objective: The objective of this review is to provide the updated knowledge and evidence from various research studies, designed to provide interventions either in school or at home.Methodology: Electronic databases like Google scholar, PubMed and Sciencedirect were used as search engines. Key terms used during the review were obesity, overweight, childhood obesity, interventions for childhood obesity and Body Mass Index. Those intervention studies were selected which have been delivered to the 6-12 years old children either at home or at school or both.Findings: Schools are essentialsocial environmentfor children andmany endeavors have been made to utilize this environment to uphold healthy behaviors among youth, including healthful eating habit. Furthermore, greater involvement of family members has been suggested as a way of increasing the effectiveness of interventions aimed at weight control, weight maintenance, and weight loss.Conclusion: School curriculum including healthy eating, physical activity, development of movement skills, improvements in nutritional quality of the food supply in schools, environments, and cultural practices can play a vital role in preventing the obesity. Moreover, weight-loss interventions targeting food intake and/or physical activity might be most operative if they involve family members appropriately. Involving parents in the home setting to encourage children to be more active, eat more nutritious foods and spend less time in screen-based activities can prevent the childhood obesity

Predictive Model for Blood Product Use in Coronary Artery Bypass Grafting

Objective: To build a clinical predictive model to determine the need for transfusing blood and its products in coronary artery bypass grafting (CABG) procedures in South East Asian population.STUDY Design: Analytical study.PLACE AND DURATION OF STUDY: Section of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, from January 2006 to October 2014.METHODOLOGY: Information on pre-, intra- and postoperative variables were collected for all adult patients who underwent on-pump CABG. The patients grouped into those who received blood and its components, and those who did not. Aunivariate as well as multivariate logistic model was built to determine the predictors of transfusion.Results: A total of 3,550 patients underwent CABG and males were dominant in both groups (75 vs. 93%). The transfusion rate was 56.4% (n=2001). Age (adjusted OR 1.03, p \u3c 0.001), obesity (1.50, p=0.001), tobacco use (1.29, p=0.001), and male gender (4.51, p \u3c 0.001) found to be a stronger predictor. Among preoperative comorbidities, diabetes (1.20, p=0.016), myocardial infarction (1.22, p=0.009), preoperative creatinine (1.12, p=0.033), and left main vessel disease of \u3e 50% (1.49, p \u3c 0.001) were independently associated with the outcome. Compared to elective cases, transfusion rates were high in urgent and emergent cases (OR: 1.93 and 3.36 respectively, p \u3c 0.001 for both).CONCLUSION: Age, male gender, obesity, tobacco use, diabetes, myocardial infarction, high creatinine, urgent and emergent cases were independent predictors of transfusion in CABG procedure. This model can be utilized for preoperative risk stratification of patients and their management to improve the outcomes

Validation of a food frequency questionnaire for assessing Macronutrient and calcium intake in adult Pakistani population

Objective: To develop and validate a food frequency table (FFQ) for use in urban Pakistani population. Study Design: A validation study. Place and Duration of Study: The Aga Khan University, Karachi, from June to November 2008. Methodology: Healthy adult females, aged ≥ 18 years who consented to be included in the study were inducted, while males, unhealthy females, aged below 18 years or who did not consent were excluded. The FFQ was administered once while 4, 24 hours recalls spread over a period of one year were administered as the reference method. Daily intakes for energy, protein, fat, and calcium intake were estimated for both the tools. Crude and energy adjusted correlations for nutrient intakes were computed for the FFQ and mean of 4, 24 hours recalls and serum N-telopeptide of type-I collagen (NTx). Results: The correlation coefficients for the FFQ with mean of 4, 24 hours recall ranged from 0.21 for protein to 0.36 for calcium, while the correlation for nutrient estimates from the FFQ with NTx ranged from -0.07 for calcium to 0.01 for energy. Conclusion: Highly significant correlations were found for nutrient intakes estimated from the FFQ vs. those estimated from the mean of 4, 24 hours recalls but no correlations was found between nutrient estimates from the FFQ and serum NTx levels. FFQ was concluded to be a valid tool for assessing dietary intake of adult females in Pakistan

Interaction pattern for the complex of B-DNAFullerene compounds with a set of known replication proteins using docking study

Fullerenes have attracted considerable attention due to their unique chemical structure and potential applications which has opened wide venues for possible human exposure to various fullerene types. Therefore, in depth knowledge of how fullerene may interfere with various cellular processes becomes quite imperative. The present study was designed to investigate how the presence of fullerene affect the binding of DNA with different enzymes involved in replication process. Different fullerenes were first docked with DNA and then binding scores of different enzymes was analyzed with fullerene docked DNA. C30, C40 & C50 once docked with DNA, reduced the binding score of primase, whereas no significant change in the binding score was observed with the helicase, ssb protein, dna pol δ, dna pol ɛ, ligase, DNA clamp, and topoisomerases. On the contrast, the binding score of RPA14 decreases in fluctuating manner while interacting with increasing molecular weight of fullerene bound single-stranded DNA complex. The study revealed the affect of fullerene family interacting with DNA on the binding pattern of enzymes involved in replication process. Study suggests that the presence of most of fullerenes may not affect the activity of these enzymes necessary for replication process whereas C30, C40 & C50 may disrupt the activity of primase, (strating point for DNA polymerase) its docking score decreases from 13820 to 10702

Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan : Evidence from two longitudinal cohort studies 15 years apart

Funding Information: Study 1 was funded through the Applied Diarrheal Disease Research Program at Harvard Institute for International Development with a grant from USAID (Project 936–5952, Cooperative Agreement # DPE-5952-A-00-5073-00), and the Aga Khan Health Service, Northern Areas and Chitral, Pakistan. Study 2 was funded by the Pakistan US S&T Cooperative Agreement between the Pakistan Higher Education Commission (HEC) (No.4–421/PAK-US/HEC/2010/955, grant to the Karakoram International University) and US National Academies of Science (Grant Number PGA-P211012 from NAS to the Fogarty International Center). The funding bodies had no role in the design of the study, data collection, analysis, interpretation, or writing of the manuscript. Publisher Copyright: © 2020 The Author(s).Peer reviewedPublisher PD

Assessment of dietary compliances among patients with type diabetes mellitus receiving text message (SMS) reminder : a randomized control trial

Background It has been estimated that 285 million people are suffering from Diabetes Mellitus (DM) worldwide. Furthermore, 80% of deaths attributable to DM take place in developing countries. Compliance to a healthy diet is very important for effective management of type 2 DM. Use of electronic devices in the field of health care has been successful in motivating patients to improve their health behaviors. We can send text messages to improve compliance to healthy diet for management of type 2 DM. Studies have proved that by motivating patients with reminders through SMS, compliance to healthy diet can be improved which can lead to better diabetes control. However such studies have not been conducted in Pakistan. Objective To assess the difference in dietary compliance in patients with type-II diabetes, who were reminded through text message (SMS) vs. those provided standard Care. Methods A block randomized control trial is being conducted at Aga Khan University and Hospital in Karachi, Pakistan. Diabetic patients age 30 to 70 years, who have been diagnosed and conformed as a known cases of type 2 DM in the last 2 to 15 years, have a cell phone are being invited to participate in the study. In the intervention arm three text message reminders are being sent per week using Frontline SMS software for 3 months. Compliance to diet is being assessed in 2 ways. Firstly, overall compliance to dietary guideline is being measured by assigning score to the dietary intake assessed by Food Frequency Questionnaire (FFQ). Secondly, compliance is being measured by assessing responses to fortnightly two-item (fruits and vegetables) questionnaire that was sent to all participants via cell phone. Interim analysis was conducted after follow-up of 1.5 months instead of per protocol follow up of 3 months on 30 participants from each arm, because of time line issues for thesis submission. Results of interim analysis are presented in this thesis. Results There were no significant differences in distribution of variables in both the study arms at the baseline. The mean dietary compliance score (assessed by FFQ) in the intervention arm at the baseline was 7.90 and after follow-up was 7.80 while in control arm, the mean compliance score at the baseline was 7.77 while after follow-up it was 7.87. There was no significant difference between the two arms (F (group) = 0.065; p-value= 0.79) as well as within the arms (F (time) = 0; p-value\u3e0.99). Marginal interaction was observed between group variable (intervention and control arm) and factor variable (mean dietary compliance score by time) (F (interaction) = 3.702; p-value= 0.059). No significant difference was found in dietary compliance between the two arms assessed by response to fortnightly two-item questionnaire (p-value=0.22). There was no significant effect of the intervention status as well as response to fortnightly two-item questionnaire on the mean dietary compliance score assessed with FFQ ( p-value (Intervention status)= 0.65; p-value (Response status)= 0.29). Interaction between the intervention status and response status was also insignificant (p-value =0.85). Conclusion We are unable to make conclusion about the relationship of dietary text message reminders and dietary compliance in type 2 diabetic patients. The reasons might be reduced follow up time as compared to per protocol and low post-hoc power of interim analysis