The role of microvascular endothelial dysfunction and genetics on severity and progression of primary open angle glaucoma in Malays

There is lack of knowledge of clinical presentation and risk factor for primary open angle glaucoma (POAG) in Malays. Identification of the risk factors for severity and progression of POAG in Malays is important to strategies prevention of blindness and effective management. This study was conducted to determine the severity and progression of POAG in Malay patients and to determine the role of microvascular endothelial function and genetics in progression and severity of POAG. A cross-sectional study was conducted involving 215 Malay (114 POAG patients and 101 controls) subjects. Progression was determined based on Humphrey visual field analysis (HVF) of 114 POAG patients using combination criteria of Advanced Glaucoma Intervention Study (AGIS) scoring and Hodapp, Parish and Anderson classification. Severity of POAG was based on modified AGIS scoring of HVF. Microvascular endothelial function was assessed using Laser Doppler Fluximetry (LDF) with the process of acetylcholine (ACh) and sodium nitroprusside iontophoresis. Venesection was also conducted. High purity genomic DNA was extracted. Microarray Human Omni Express-12 platform was used to identify genetic markers. rs1392912 and rs1660029 from KALRN gene, and rs1210977of COL9A1 gene were identified as potential markers for progression and microvascularendothelial function. These single nucleotide polymorphisms (SNPs) were then subjected to DNA sequencing. After the mean 4.1(3.0) years of follow up, 35 patients showed evidence of visual field progression. Based on HVF at recruitment, 55 patients were mild, 29 moderate and 30 severe POAG. There was significant reduction of microvascular endothelial function in POAG patients compared to control (p<0.001)). ACh and sodium nitroprusside response was significantly reduced in severe POAG (p<0.001). There was significant reduction of microvascular endothelial function in patients who showed visual field progression (p<0.001). The risk of progression is 4.8 folds (95% CI 1.52, 14.86) in patients with rs1392912GA and 5.8folds (95% CI 1.85, 18.61) in patients with rs1660029AG. However, there was no association betweenrs1210977 of COL9A1 and microvascular endothelial function of Malay patients with POAG The progression rate of POAG in Malay patients was 8.5 patients/year. Microvascular endothelial function play a role in progression and severity of POAG in Malays. rs1392912GA and rs1660029AG of KALRN gene are potential genetic markers for progression of glaucoma. Perhaps, improvement in microvascular endothelial function and early detection of patients with genetic variations of KALRN gene may retard the progression of POAG in Malays

Does Poverty Stem Human Trafficking in Pakistan?

The present study has conducted to see the application and causes of Human Trafficking on effected families. The study based on primary data collected through case studies and survey. The study examined that poor economic conditions push people towards the glamorous world. Unemployment and political instability created the feelings of disparity and deprivation among people. Most of the times developed countries life style attracted the poor people and facilitate the immigration agents to hire the labour force by fraud. It has explored that poverty brings the people on roads and relative poverty was also the supportive factor in human trafficking. On one hand the poverty is fuel to human trafficking; it is inevitable to overcome the nemeses of human trafficking without poverty alleviation while on other hand the Law enforcement agencies were capable enough to detect the inhuman act, but there was trust deficit among the people towards the law enforcement agencies. Study suggested that the betterment in economic condition could be controlled human trafficking on large scale. Key words: Families; Human; Pakistan; Poverty; Traffickin

ASSESSMENT OF RADIOLOGICAL HEALING IN ELDERLY HIP FRACTURES FIXED WITH INTRAMEDULLARY VERSUS EXTRAMEDULLARY IMPLANTS AT THREE MONTHS

OBJECTIVE: To compare the radiological healing in elderly patients with hip fractures fixed with intramedullary versus extramedullary implants at 3 months by using Radiological Union Score for Hip (RUSH score). METHODS: This quasi-experimental study was conducted at Lady Reading Hospital, Peshawar from September 2020 to March 2021, in elderly patients (50-80 years) with hip fractures. Out of 238 patients, 119 were non-randomly assigned to Group-A undergoing intra- medullary implants and 119 to Group-B undergoing fixation with an extra-medullary implant. After the surgery, the patients were followed up periodically at 2nd week, 6th week and 12th week after surgery and assessed for radiological healing through RUSH score. The data was analyzed using SPSS version 23. RESULTS: Out of 238 patients, 96 were males and 142 were females. In Group-A, 51 (42.9%) were males and 68 (57.1%) were females. In Group-B, 45 (37.8%) were males and 74 (62.2%) were females. Majority (n=135/238: 56.72%) were aging from 50-60 years. Mean±SD of age was 63.1±8.8 years and 61.7±8.1 years in Group-A & Group-B respectively. Mean±SD of RUSH score in Group-A & Group-B was 19.50±6.92 and 22.51±5.60 respectively. Mean RUSH score for males in Group-A and Group-B was 21.52±6.39 and 22.33±6.99 (p=0.354) and for females in Group-A and Group-B was 19.36±7.33 and 22.18±5.75 (p=0.025) respectively. Median and IQR of RUSH score in Group-A & Group-B was 21±10 and 23±8 respectively (p=0.069). CONCLUSION: There was statistically insignificant difference in median RUSH score with use of either intramedullary or extramedullary implants in the management of hip fractures

Evaluation of bioformulation of Enterobacter sp. UPMSSB7 and mycorrhizae with silicon for white root rot disease suppression and growth promotion of rubber seedlings inoculated with Rigidoporus microporus

White root rot (WRR) disease, caused by Rigidoporus microporus, is one of the major constraints causing the economic loss to rubber plantation worldwide including in Malaysia. This glasshouse study was conducted to evaluate the efficacy of a peat-based bioformulation of Enterobacter sp. UPMSSB7 and an arbuscular mycorrhizal fungus (AMF, Glomus mosseae) with silicon (Si) for WRR suppression and plant growth promotion of rubber seedlings. Results revealed that the tested bioformulation significantly (P < 0.0001) reduced the disease compared to positive control while, was not significantly different than the propiconazole, a triazole fungicide. The lower values of disease incidence, disease severity of foliar and root rot symptoms, area under disease progress curve, pathogen colonization and higher value of disease reduction were recorded in both bioformulation and the triazole fungicide treated seedlings than positive control treatment 24 weeks after inoculation with R. microporus. Results indicated that pathogen-inoculated seedlings treated with bioformulation had significantly (P < 0.0001) increased stem height, girth size, chlorophyll content, leaf area, shoot and root dry weight, total root length, root volume and root surface area (103.8 cm, 8.08 mm, 56.62 SPAD value, 3534.8 cm2, 37.04 g and 36.76 g, 1617.7 cm, 24.15 cm3 and 402.97 cm2, respectively) as compared to fungicide and control treatments. The tested bioformulation also significantly (P < 0.0001) increased silicon content in root and shoot (18.56 g kg−1 and 27.61 g kg−1, respectively) as well as leaf nutrient (N, P, K and Ca) contents (3.89%, 0.19%, 1.06% and 0.57%, respectively) as compared to the triazole fungicide and control treatments. The population of Enterobacter sp. (1.1 × 108 cfu g−1 soil) recorded in pathogen-inoculated seedlings treated with bioformulation was not significantly different than non-inoculated seedlings treated with bioformulation. AMF spore density and root colonization were recorded higher in bioformulation treated seedlings with or without pathogen inoculation than the triazole fungicide and control treatments. From this study, it was concluded that the peat-based bioformulation of Enterobacter sp. and an AMF (Glomus mosseae) with Si could be a potential approach to suppress WRR and improve growth of rubber seedlings

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Complementary and Alternative Medicine Use Among Patients with Diabetes Mellitus

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Students’ perception of the safety and value of a herbal vs. a conventional medicine for treating insomnia

University students suffer from variable sleep patterns including insomnia;[1] furthermore, the highest incidence of herbal use appears to be among college graduates.[2] Our objective was to test the perception of safety and value of herbal against conventional medicine for the treatment of insomnia in a non-pharmacy student population. We used an experimental design and bespoke vignettes that relayed the same effectiveness information to test our hypothesis that students would give higher ratings of safety and value to herbal product compared to conventional medicine. We tested another hypothesis that the addition of side-effect information would lower people’s perception of the safety and value of the herbal product to a greater extent than it would with the conventional medicine

Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics

Objective The primary objective of this study was to evaluate the use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics. Another aim was to identify demographic and socio-economic factors that are associated with CAM use. Research design and methods Face-to-face interviews of conveniently selected patients with chronic diseases were conducted in outpatient clinics of a general hospital. A validated data collection form was used to gather the information regarding pattern, perception, reasons, and perceived effect of CAM on the disease state. The other relevant information including demographics, diagnosis, indication, and treatment were collected from the patients' medical records. Results Out of 321 patients interviewed in this study, 205 patients were using some form of CAM, and thus the utilisation rate was 63.9%. A significant number of patients (35.5%) were using CAM for diabetes mellitus. Thirteen types of CAM were identified in the study with the most common being vitamins supplements (48.2%), herbal medicines (26.4%), ginseng (4.7%) and traditional Chinese medicine (4.0%). The patients with higher education level, higher income, and aged more than 50 years were independently associated with CAM use. Majority of the patients (77.6%) reported that their condition had improved by using CAM. Conclusion The present study confirms the high frequency of CAM use among patients with chronic diseases in a Malaysian public hospital. The popularity of CAM indicated the patients' preference towards holistic approach to health care

Epidemiology of hip & knee replacement across Pakistan according to Pakistan national joint registry: A cross-sectional study

Objective: To know about the predictive prevalence of hip and knee arthroplasty across Pakistan.Methods: It is retrospective cross-sectional study with data collection from Pakistan National Joint Registry (PNJR) of number of hip and knee arthroplasty cases in seven years (2014-2021). Fourteen high volume centers across Pakistan who consented for data publication were included. Stata version 16 was used for data analysis. Mean & standard deviation was reported for quantitative variable & frequency and proportion were reported for qualitative variables. Results: Our results showed a total of 9572 people had total knee replacement in last seven years from 2014-2021 with the rate of 9.57/100,000 population. Mean age of the patient was 61.7±8.95 with 69.5% patients being female and 30.5% being male. Our results showed a total of 2265 people had total hip replacement in last seven years from 2014-2021with the rate of 2.26/100,000 population. Mean age of the patient was 50.7±15.4 with 62% patients being male and 38% being female.Conclusion: This is the first epidemiological study in Pakistan on the rates of hip and knee arthroplasty cases in Pakistan based on registry data, showing that more knee arthroplasty cases are being performed as compared to hip arthroplasty

Reasons, perceived efficacy and factors associated with complementary and alternative medicine use among Malaysian patients with diabetes mellitus

This study aimed to evaluate complementary and alternative medicine (CAM) use among Malaysian diabetic patients. Subjects for this case—control study were randomly selected from the pool of patients who were attending diabetes clinics, at the Hospital Tuanku Jaa’far, Seremban, Malaysia. Perceived effect of CAM use, reasons for starting CAM, and sociodemographic factors were collected from patients (n=230). Blood glucose levels were also recorded. Almost half of the study population (49.6%, 114/230) were using CAM together with conventional treatment for diabetes. Thirteen different types of CAM were utilised by the 114 CAM users and herbal medicine (64.9%) was found to be the most commonly used CAM modality. The majority of patients reported quality and safety of CAM (63.2%) and an additional treatment for diabetes (53.5%) as two main reasons for using CAM. About 44% of patients reported that their condition had improved by using CAM (R2=0.512, p=0.004), which was evident by their lowered fasting blood glucose (p=0.045, 7.171 versus 8.767). About 18% perceived their health condition as poor compared to 56% who perceived it as good after commencing CAM use