An Assessment of Knowledge, Attitude and Practices (KAP) towards Diabetes Mellitus and Diabetic Retinopathy among Patients of Nishter Medical University Hospital Multan, South-Punjab Pakistan

Objective: This study aimed to determine the Knowledge, Attitude and Practices (KAP) towards diabetes mellitus and diabetic retinopathy among the patients of a tertiary care hospital. Study design This study was an observational, cross-sectional study. Place and duration of study The current study was conducted at department of General Medicine, Nishtar Medical University Hospital Multan, Pakistan. The time span of the study was from March 2016 to February 2017. Method After taking approval from Ethical Review Committee, a questionnaire based descriptive study was conducted on 692 patients.  The technique of convenient sampling was used. All the gathered data were retrieved into MS Excel. The data were analyzed by using computer program SPSS 21 version. Results: Six hundred ninety two adults were interviewed. Of these, 271 (39.2%) were suffering from diabetes mellitus. Lowest mean knowledge score (5.28 ± 6.09) was seen in illiterate study population. Male’s Mean Knowledge score (5.61 ± 5.56) was better than female’s (4.46 ± 5.21). Over all mean score of Attitudes towards diabetes was 4.43 ± 2.37. It was higher (6.62 ± 2.03) in diabetic respondents as compared with non-diabetic respondents (4.70 ± 2.59) with p < 0.000. In Practice module majority of the respondents (69.9%) did not exercise, 49% took high caloric snacks between meals and 87% ate outside home once a month, 56.8% diabetics visited ophthalmologist for routine eye examination; but only 9.2% asked for retinal examination. Conclusion Poor knowledge of diabetes was found in the community. The problem was more marked in females, illiterate and the individuals not having diabetes mellitus. Key Words: Diabetes mellitus, Diabetic retinopathy, Diabetic Education Program, Knowledge, Attitude and Practices (KAP

Prevalence of Bovine Brucellosis in Organized Dairy Farms, Using Milk ELISA, in Quetta City, Balochistan, Pakistan

A total of 200 milk samples from cattle (n = 86) and buffalo (n = 114) were evaluated using milk ring test (MRT) and indirect enzyme-linked immunosorbent assay (i-ELISA). The overall prevalence was found to be 3% and 8.5% in cattle and buffaloes using MRT and i-ELISA, respectively. The prevalence was 4.6% and 1.7% in cattle and buffalo using MRT, respectively, while i-ELISA exhibited 20% and 0% in cattle and buffalo, respectively. The prevalence was higher in government dairy farm, compared to privately owned dairy farm. This paper points out an alarming situation in the target area with respect to the public health significance

Antagonistic Potentiality of Trichoderma harzianum Against Cladosporium spherospermum, Aspergillus niger and Fusarium oxysporum

Many species of genus Trichoderma are used as an important source of biological agents. The potential efficacy of Trichoderma harzianum against the pathogenic fungi like Cladosporium spherospermum, Aspergillus niger and Fusarium oxysporum was evaluated on the fungal growth by culture pattern in which radial growth extension rates of two categories of fungal colonies were analyzed. All the fungal species were isolated from the rhizosphere of Juglans regia L. and cultured on the separate sterilized potato dextrose agar (Hi Media). Antagonism of T. harzianum was observed when all the fungal isolates were grown on the same PDA petri-plate in vitro by using the dual culture techniques. Trichoderma harzianum had a discernible inhibitory effect on the growth of pathogens in dual culture. The mycelial growth of pathogenic isolates was noticeably constrained after a period of 10 days at the temperature of 250C and pH of 5.6. T. harzianum caused the maximum growth inhibition in A. niger (75%) followed by C. spherospermum (72.2%) and F. oxysporum (25%) at the specific temperature and pH, which justifies that T. harzianum is a promising biological agent for restricting the wilt and other fungal diseases. Keywords; Trichoderma harzianum, pathogenic fungi, antagonism, radial growt

Potential Applications of Rhizobacteria as Eco-Friendly Biological Control, Plant Growth Promotion and Soil Metal Bioremediation

Modern agriculture has an immense problem in the depletion of agricultural productivity owing to a variety of biotic and abiotic stresses. Agriculture’s sustainability and safety are dependent on ecologically friendly practices. Plant rhizobia have been proven to have an important role in disease control, as well as promoting plant growth, productivity, and biomass. Rhizobacteria are soil bacteria that live on the root surface and either directly or indirectly contribute to plant development. Rhizobia are used to induce mediated immune resistance through the manufacture of lytic enzymes, antibiotics, phytoalexins, phytohormone, metabolites. It supports the growth of plants through nitrogen fixation, nutrient enrichment, phosphate solubilization and phytohormone synthesis. In addition, it supports plants during different stresses such as temperature, osmotic, heavy metal and oxidative stress. Plant growth-promoting rhizobacteria have the ability to control heavy metal pollution of soils as well as enhancing plant growth in these soils. Efficient bioremediation is possible by using rhizobacterial inoculants, still, the distribution and functioning of microbes in the rhizosphere need to be fully explored. This review focuses on the effectiveness, biomonitoring processes and function in promoting plant development. Rhizobia application can be considered an alternative method for the improvement of biodiversity, agriculture, and the environment

Implications of risk conferred by 5p15.33 loci genetic variants; human telomerase reverse transcriptase rs2736098 and rs2736100 in predisposition of bladder cancer

Background: The polymorphic variations of human telomerase reverse transcriptase (hTERT) gene play an important role in predisposition to carcinogenesis. The current study aimed to elucidate the genetic predisposition to bladder cancer in two important variants, rs2736098 and rs2736100 of hTERT gene. Materials and methods: Confirmed 130 patients of bladder cancer and 200 healthy controls were genotyped by PCR-RFLP to determine different variants of hTERT rs2736098 and rs2736100. Results: hTERT rs2736098 homozygous variant AA genotype frequency was observed to significantly differ 2-fold between cases and controls (26.15% vs. 13.5%) (p = 0.02). In addition, rare ‘A’ allele significantly differed among two groups (cases: 47% versus controls: 39%: p = 0.03). hTERT rs2736098 was observed to be presented significantly more in high stage tumors (p = 0.02). hTERT rs2736100 genotype AA or variant allele A showed no significant difference between cases and controls. Haplotype CA displayed significantly different pattern of frequency as 0.5 in cases as compared to 0.16 in controls (p < 0.0001). Combination of variant A/G haplotype frequency implicated more in cases than in controls (0.34 vs. 0.16, p = 0.001). Conclusions: It is concluded that hTERT rs2736098 polymorphic variant has a vital role to confer a strong risk to bladder cancer in our population. Further, hTERT haplotypes CA and AG inhTERT could prove to be a promising tool to screen the risk for bladder cancer

Low-carbohydrate diets for overweight and obesity: a systematic review of the systematic reviews

Low‐carbohydrate diets are being widely recommended, but with apparently conflicting evidence. We have conducted a formal systematic review of the published systematic reviews of RCTs between low‐carbohydrate vs. control (low‐fat/energy‐restricted) diets in adults with overweight and obesity. In MEDLINE, Embase, Web of Knowledge and Cochrane Database of Systematic Reviews, searched from inception to September 2017, we identified 12 systematic reviews, 10 with meta‐analyses. Differences in methods, study quality, weight change and citations of published systematic reviews were assessed by AMSTAR‐2. Review methods varied in definitions of low‐carbohydrate diet, databases searched and bias assessment. Overall review quality was high in two, moderate in three, critically low in seven. Among meta‐analyses, 4/5 with critically low quality showed low‐carbohydrate diet superiority for weight loss (0.7–4.0 kg), while high quality meta‐analyses reported little or no difference between diets. Greater numbers of participants correlated with smaller differences in weight loss (r = 0.73, p = 0.03). More citations correlated with lower review quality (rho = −0.9, p = 0.037), with larger differences in weight loss (rho = −0.9, p = 0.037), and with journal impact factor (rho = 1.0, p = 0.01). In conclusion, publication acceptance and citations appear to favour apparently larger effect sizes above methodological quality. Better quality reviews and RCTs are needed, before recommending low‐carbohydrate diets as preferred to other approaches for energy restriction

Routine immunization coverage in Pakistan: a survey of children under 1 year of age in community-based vaccination areas.

Pakistan is one of two countries in which poliovirus remains endemic. Considering the high number of children born every year, reaching and vaccinating new birth cohorts by improving routine immunization coverage in children <1 year of age is crucial to halting virus transmission. In 2015, a community-based vaccination (CBV) strategy, using local community members to enhance vaccine acceptance and improve routine immunization service delivery, was introduced in areas of Pakistan that have never interrupted poliovirus transmission. In order to assess progress towards improving routine immunization, we performed house-to-house immunization surveys across ten CBV areas in 2017 and 2018. In each household, we determined age-appropriate routine antigen coverage for children <1 year of age based on vaccination card and caregiver recall. We surveyed 5,499 and 5,264 children in 2017 and 2018, respectively. Overall, coverage of inactivated poliovirus vaccine (IPV) at 14 weeks of age was 32% in 2017 and 39% in 2018 based on vaccination card and recall. Across the surveyed areas, coverage ranged from 7% in Killa Abdullah to 61% in Peshawar in 2018. Oral poliovirus vaccination coverage decreased with successive vaccination visits, ranging from 66% for the birth dose to 42% for the 14-week dose in 2018. No area reached the target of 80% coverage for any routine antigen. Our findings highlight the need for concerted efforts to improve routine immunization coverage in these critical areas of wild poliovirus transmission

Cytisine for smoking cessation in patients with tuberculosis: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial

Dogar O, Keding A, Gabe R, et al. Cytisine for smoking cessation in patients with tuberculosis: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. Global health. 2020;8(11):e1408-e1417.BACKGROUND: Smoking cessation is important in patients with tuberculosis because it can reduce the high rates of treatment failure and mortality. We aimed to assess the effectiveness and safety of cystine as a smoking cessation aid in patients with tuberculosis in Bangladesh and Pakistan.; METHODS: We did a randomised, double-blind, placebo-controlled, trial at 32 health centres in Bangladesh and Pakistan. Eligible patients were adults (aged >18 years in Bangladesh; aged >15 years in Pakistan) with pulmonary tuberculosis diagnosed in the previous 4 weeks, who smoked tobacco on a daily basis and were willing to stop smoking. Patients were randomly assigned (1:1) to receive behavioural support plus either oral cytisine (9 mg on day 0, which was gradually reduced to 1·5 mg by day 25) or placebo for 25 days. Randomisation was done using pregenerated block randomisation lists, stratified by trial sites. Investigators, clinicians, and patients were masked to treatment allocation. The primary outcome was continuous abstinence at 6 months, defined as self-report (of not having used more than five cigarettes, bidis, a water pipe, or smokeless tobacco products since the quit date), confirmed biochemically by a breath carbon monoxide reading of less than 10 parts per million. Primary and safety analysis were done in the intention-to-treat population. This trial is registered with the International Standard Randomised Clinical Trial Registry, ISRCTN43811467, and enrolment is complete.; FINDINGS: Between June 6, 2017, and April 30, 2018, 2472 patients (1527 patients from Bangladesh; 945 patients from Pakistan) were enrolled and randomly assigned to receive cytisine (n=1239) or placebo (n=1233). At 6 months, 401 (32·4%) participants in the cytisine group and 366 (29·7%) participants in the placebo group had achieved continuous abstinence (risk difference 2·68%, 95% CI -0·96 to 6·33; relative risk 1·09, 95% CI 0·97 to 1·23, p=0·114). 53 (4·3%) of 1239 participants in the cytisine group and 46 (3·7%) of 1233 participants in the placebo group reported serious adverse events (94 events in the cytisine group and 90 events in the placebo group), which included 91 deaths (49 in the cytisine group and 42 in the placebo group). None of the adverse events were attributed to the study medication.; INTERPRETATION: Our findings do not support the addition of cytisine to brief behavioural support for the treatment of tobacco dependence in patients with tuberculosis.; FUNDING: European Union Horizon 2020 and Health Data Research UK.; TRANSLATIONS: For the Bengali and Urdu translations of the abstract see Supplementary Materials section. Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved