Enhancing diabetes care in LMICs: Insights from a multinational consensus

The International Cardio-Metabolic Forum held a plenary session to establish a multinational consensus on the challenges faced in diabetes management within lower-middle-income countries (LMICs) and their potential solutions. Stakeholders, including patients, family/caretakers, healthcare professionals, and healthcare policymakers & organizations, participated in discussions. The audience of 280 doctors from 15 different countries (Pakistan, Qatar, Sri Lanka, Kenya, Myanmar, Georgia, Nigeria, Philippines, Uzbekistan, Iraq, Tanzania, Cambodia, Kazakhstan, South Sudan and Libya) was divided into 4 groups led by Group Leaders to represent each stakeholder group. Questionnaires addressing key challenges and solutions specific to each group were used to facilitate consensus development. Participants voted on relevant options based on their clinical experience. SLIDO software was used for polling, generating separate results for each group. The insights shared by healthcare professionals highlighted the importance of improving medication accessibility and cost-effectiveness for patients, emphasizing the need for adherence to treatment plans and lifestyle modifications. The significance of balanced nutrition with low glycemic index food for enhancing quality of life was recognized. Caregivers of diabetic patients with comorbidities face increasing demands for care, particularly in relation to age-related milestones. Healthcare professionals emphasized the challenges posed by cultural beliefs and health awareness, underscoring the importance of teamwork and early referral for managing comorbidities. Healthcare policymakers need to focus on disease education, awareness programs, screening guidelines, and advocacy for community and clinical screening. By addressing these challenges, a more comprehensive and effective approach to diabetes management can be achieved in LMICs, ultimately improving outcomes for individuals with diabetes

Free Space Optics Transmission Performance Enhancement for Sustaining 5G High Capacity Data Services

Enhanced bandwidth issues for 5G system are fruitfully resolved by organizing free space optics (FSO) communication frameworks. The high bandwidth, the maximum number of channel transmission requirements, and high data rate have been boosted during the last years because of the COVID-19 pandemic. The online services and digital applications have increased pressure on installed optical network models. In addition, the optical networks with high capacity transmission produce nonlinear distortions, which degrade system efficiency. This paper presents a mixed FSO and fiber network to tackle the factors of nonlinearities and enrich the system capacity and range. Furthermore, the issues related to radio frequency, FSO pointing, and co-channel interference are considered in this work. The theoretical and simulation structures are validated using advanced measuring parameters, such as bit error rate (BER), peak to average power ratio (PAPR), cumulative distribution function (CDF), and outage probability. The nonlinear factors are addressed successfully, and the capacity is developed from current models. Finally, the proposed model’s limitations and future direction are discussed in this paper

Challenges in Idiopathic Pulmonary Fibrosis Management

Objective: The authors aim to evaluate the challenges faced by each stakeholder for Idiopathic pulmonary fibrosis (IPF) management, including the patients, their families/caretakers, Healthcare professionals, and Healthcare policymakers and organizations in Lowmiddle income countries (LMICs) as perceived by 140 pulmonologists from 11 countries who participated in International Respiratory Forum conference 2022 in Ho Chi Minh City, Vietnam. Methodology: A predesigned structured questionnaire was developed about challenges faced by each stakeholder for IPF management. Study participants were randomly divided into four groups, and only one section of the questionnaire was distributed among the participants of each group. Results: It was observed that the physicians greatly supported the psychological well-being of the patients/caregivers and awareness among Healthcare professionals (HCPs) for timely referrals and diagnosis. The caregivers must support the patients to keep their willpower intact. The availability of only those therapies with modest treatment outcomes with no benefits in halting the disease or reducing mortality and the absence of disease-modifying drugs was considered the major challenge faced by Pulmonologists. Patient affordability was considered the key hindering factor affecting High- Resolution Computed Tomography (HRCT) utilization. The development of Interstitial lung disease (ILD) national registries to keep track of disease prevalence and challenges at hand was defined as the urgent healthcare initiatives that need to be taken by the concerned healthcare policymaking authorities. Moreover, the healthcare systems considered comprehensive patient education about disease management and outcomes the most effective self-management strategy to be incorporated and disseminated. Although a small number of patients with ILDs, specifically IPF, receive a prompt and accurate diagnosis, the survey found that protracted delays, frequent misdiagnoses, exposure to expensive and invasive diagnostic procedures, and significant use of healthcare resources mark the more typical diagnostic experience for those with ILD. Conclusion: These findings indicate the requirement for novel diagnostic tools, best clinical practices, and HCPs training to improve the accuracy of diagnoses in ILD patients. Keywords: Idiopathic Pulmonary Fibrosis, Management, Challenges

Significant challenges of COPD Management in developing countries

To explore the challenges faced by each stakeholder for COPD management, including the patients, their family/caretakers, healthcare professionals, and healthcare policymakers & organizations, the authors conducted a survey during the International Respiratory Forum conference 2022 in Ho Chi Minh City, Vietnam. A total of 140 pulmonologists from 11 countries participated in the study. A predesigned structured questionnaire was developed pertaining to questions related to challenges faced by each stakeholder for COPD management in Low-middle income countries (LMIC). Each group received one of the four sections of the questionnaire. It was found that 47% of doctors thought that patients couldn't understand the early symptoms as indicators of a serious illness and were afraid of forming a dependency on long-term drugs. According to 64% of doctors, the most frequent implications experienced by caregivers when caring for COPD patients were the financial burden of lifelong therapies and disappointments from treatment failure brought on by a lack of access to high-quality or specialized healthcare. Of the difficulties experienced by healthcare professionals, 50% said that misusing investigations for diagnosis resulted in delayed or underdiagnoses of COPD. The biggest issue with COPD referrals in developing nations was general practitioners' ignorance of recognizing highrisk patients and the need for their referrals. Approximately 80% of respondents said that a sizeable percentage of annual healthcare spending was consumed by expenses related to exacerbations and repeated ER visits. It is concluded that the questionnaire responses reflect physicians' perceptions and experiences in routine clinical practice. Increased knowledge of COPD diagnosis and treatment recommendations, as well as proactive identification of patients at higher risk of developing COPD due to environmental or lifestyle exposures, will help with prompt, accurate diagnoses and efficient treatments, ultimately improving patient outcomes. Keywords: COPD Management, Challenges, Developing Countries

Challenges in the Management of Community-Acquired Pneumonia in Low- Middle Income Countries.

Abstract Despite progress in developing new and powerful medications, Community-acquired Pneumonia (CAP) is still closely linked to significant morbidity and mortality, especially in Low-middle income countries (LMICs). Hence, a group of experts gathered to discuss the main challenges associated with CAP management by the stakeholders (patients, their families/caretakers, Healthcare professionals, and Healthcare policymakers & organizations). During the commencement of the International Respiratory Forum Conference 2022 held in Ho Chi Minh City, Vietnam, a survey was conducted, including 140 pulmonologists from 11 countries. A predesigned structured questionnaire was developed pertaining to challenges faced by each stakeholder for CAP management in LMICs. Physicians were randomly divided into four groups, and only one section of the questionnaire was distributed among the participants to determine their opinion regarding that respective stakeholder's challenges. Among the patient-related challenges, most physicians believed that self-medication was the most significant reason behind the high mortality rate from CAP as the patients continue to have various troubles in seeking timely diagnosis and treatment. It was found that healthcare expenditure is the most intriguing challenge experienced by families and caretakers of patients with CAP. Moreover, 52% agreed that the diagnosis made by healthcare providers are primarily based on clinical judgment, and Pneumonia Severity Index (PSI) is not commonly used for clinical prediction and patient outcomes. The physicians mostly believed that healthcare policymakers must focus on establishing early diagnostic and treatment strategies to reduce hospitalization rates and costs. Keywords: Community-Acquired Pneumonia, Management, Challenges

Challenges to Asthma Management

Despite significant advancements in our understanding of the disease process, the increased morbidity and mortality from asthma may be due in part to inadequate attention being paid to the management of the condition and approaches to improve bronchial asthma control. Data about the difficulties encountered in managing asthma in Low-middle income countries (LMIC) is scarce. The authors aimed to evaluate the challenges faced by each stakeholder in Asthma management. The International Respiratory Forum Conference 2022 commenced in Ho Chi Minh City, Vietnam, including 140 pulmonologists from 11 countries. A survey was conducted using a predesigned structured questionnaire about the challenges faced by each stakeholder (patients, family/caretakers, healthcare professionals, and healthcare policymakers) for Asthma management. Four groups were formed, physicians were randomly divided, and only one section of the questionnaire was distributed among the physicians of each group. Per the physician's perception regarding challenges faced by patients for asthma management, awareness about how to administer the dose or have poor inhaler techniques is usually still being determined. More than 50% believed that there is a need for additional patient education about the day-to-day management of their disease. The cost of therapy was considered the significant barrier faced by the family/caretakers affecting drug adherence. The frequently reported challenge from the physician's end was poor technique use because of poor asthma disease education followed by hurried communication by health care providers to the patients. Around 53% of pulmonologists from the policy maker group reported that the lack of access to affordable quality-assured inhaled medications was the major avoidable barrier that needs to be tackled on the highest priority by the policymakers. This survey has gauged the influence of personal, social, and clinical factors on asthma management and pointed out the gaps regarding adherence from patients' and health professionals' perspectives. The resolutions and inputs suggested providing a practical framework for patient-centered care that treats asthma as an inflammatory disorder and education promoting treatment compliance. Keywords: Asthma Management, Challenges, Developing Countrie