Predictors of serious findings on bi-directional endoscopy in young patients with anemia and GI symptoms

Background: Iron deficiency anemia (IDA) has been cited as the most common cause of anemia globally. Gastrointestinal (GI) lesions are amongst the common cause of IDA. Endoscopic evaluation is the most effective way to investigate the IDA. The aim of this study was to show the association of alarming GI symptoms with abnormal endoscopic findings and to cut off the burden and cost of unnecessary endoscopies. Methods: This is cross sectional study of anemic patient who underwent upper and lower GI endoscopies in Aga Khan University Hospital, Karachi between July-December 2016. Results: Total 243 patients were identified after excluding ineligible patients. The mean age of subjects was 31.9 ± 6.1 years with a slight over-representation of females (57.4%). 149 (61.31%) patients underwent only upper GI endoscopic evaluation, and 83 (34.15%) patients on whom bi-directional endoscopy was performed (upper and lower). The remaining 11 (4.52%) patients underwent colonoscopy only. 16 (6.6%) subjects had negative findings on evaluation, while gastritis and serious findings were observed in 175 (72.0%) and 52 (21.4%) patients respectively. We found that patients with alarm features such as dysphagia (aOR: 2.07, 95%CI: 0.12-34.1), altered bowel habits (aOR: 1.64, 95%CI: 0.44-6.09) and weight loss (aOR: 1.25 95%CI: 0.54-2.85) demonstrated higher odds of serious findings on endoscopic evaluation as compared to the reference category, however they were not independently associated. Conclusion: Most of our patients had non-malignant pathologies, while alarm features were not found to be useful predictors of serious findings

Needs assessment survey regarding effectiveness of chronic care in Diabetes in a hospital setting

Objectives: To assess the current knowledge level about diabetes and acceptance of nurse-led educational programmes among diabetic patients. Method: The cross-sectional study was conducted at a community health centre in Karachi from August, 2018 to December, 2019 and comprised adult patients of ether gender with diabetes. Data was collected using a predesigned questionnaire to record demographic information, participants’ DM knowledge, self-management aspects and their opinions along with preferences for a DM educational support group. Data was analysed using STATA/SE 15.1. Results: Of the 215 participants, 80(37%) were males and 135(63%) were females. The overall mean age was 55.814.5 yrs. Most participants had diabetes for 5 years 127(59%) and 141(66%) did not know their type of diabetes. Most participants were prescribed anti-diabetic medications 201(94%), and 45(2%) had forgotten to take their medication recently. Insulin was being used by 65(30%) participants, and, among them, 27(42%) reused syringes. Most patients struggled to make lifestyle modifications 133(62%), and 144 (67%) were willing to attend nurse-led diabetic education sessions. Conclusion: There was found to be a need of diabetes education support programme to address knowledge deficiencies, and a nurse-led programme was found to be acceptable to the majority of study subjects. Key Words: Diabetes mellitus, Diabetes complications, Tertiary prevention, Health educators

Successes and failures in tracheal bioengineering: Lessons learned

Background: Controversy in tracheal reconstruction using grafts and bioengineered constructs highlights the importance of animal studies before human application. Small animal models help to refine designs, but do not adequately model sizes relevant to human anatomy. We have conducted extensive large animal studies and summarize our findings in 26 consecutive transplants.Methods: We pooled 26 large animal studies together to investigate common elements related to successes and failures. In general, the engineered tracheal graft consisted of a decellularized extracellular matrix (ECM) surgical patch supported by a 3D printed plastic polymer scaffold. Circumferential graft coverage ranged from 50% to 100%, spanning the length of 4-6 tracheal rings. Some grafts included embedded stem cells. Control grafts were fabricated without the support scaffold. At death, grafts were harvested and examined grossly and through histology.Results: The support scaffold prevented graft malacia and collapse. Luminal epithelialization was most extensive in grafts with smaller circumferential coverage. Smaller circumferential coverage was also associated with longest animal survival. Chondrogenesis was only observed in grafts with embedded stem cells. Survival time was shortest in 100% circumferential grafts. Granulation tissue was an issue for all graft designs.Conclusions: Large animal models capture challenges and complexities relevant to human anatomy. Development of granulation tissue remains a challenge, especially in circumferential grafts. Significant additional research is needed to investigate granulation tissue formation and to provide actionable insight into its management

Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review

Pregnancy in adolescence and malnutrition are common challenges in low- and middle-income countries (LMICs), and are associated with many complications and comorbidities. The preconception period is an ideal period for intervention as a preventative tactic for teenage pregnancy, and to increase micronutrient supplementation prior to conception. Over twenty databases and websites were searched and 45 randomized controlled trials (RCTs) or quasi-experimental interventions with intent to delay the age at first pregnancy (n = 26), to optimize inter-pregnancy intervals (n = 4), and supplementation of folic acid (n = 5) or a combination of iron and folic acid (n = 10) during the periconception period were included. The review found that educational interventions to delay the age at first pregnancy and optimizing inter-pregnancy intervals significantly improved the uptake of contraception use (RR = 1.71, 95% CI = 1.42–2.05; two studies, n = 911; I2 = 0%) and (RR = 2.25, 95% CI = 1.29–3.93; one study, n = 338), respectively. For periconceptional folic acid supplementation, the incidence of neural tube defects were reduced (RR = 0.53; 95% CI = 0.41–0.77; two studies, n = 248,056; I2 = 0%), and iron-folic acid supplementation improved the rates of anemia (RR = 0.66, 95% CI = 0.53–0.81; six studies; n = 3430, I2 = 88%), particularly when supplemented weekly and in a school setting. Notwithstanding the findings, more robust RCTs are required from LMICs to further support the evidence