Clinical evaluation of patients suffering from osteoarthritis along with prevalence, pharmacological and non-pharmacological treatment

Background: Osteoarthritis is a disorder of joints that most often influences the knee, spine, hip, and small hands joints. It is one of the common types of arthritis. It can lead to reduced mobility in elder patients. Primary objective: The aim of the project is to evaluate the current etiology, pathogenesis, investigations, and management of osteoarthritis. Methods/Design: The history of patients suffering from osteoarthritis was collected on a designed questionnaire which includes age, gender, job status, duration of disease, weight, pain, and current medical history. Setting: Data was taken from different people in the community Participants: Data from 50 patients were taken. Intervention: This work will discuss the challenges of developing good quality outcome measures for use in large-scale multicenter clinical trials for new osteoarthritis treatments, especially disease-modifying osteoarthritis drugs. Primary Outcome Measures: The data evaluation showed that this disease is most common in women than men having a weight greater than 50kg. Results: Most persons suffering from this disease were unemployed and had limited physical activities, and the maximum had complaints of knee pain and shoulder pain. A few patients complained of neck, elbow, feet, and backbone pain. Most were suffering from other concomitant diseases along with osteoarthritis, and a few were diagnosed with osteoarthritis only. Conclusion: This study clearly showed the prime factors involved in osteoarthritis which may help the community to avoid those factors to increase the quality of life

Clinical evaluation of patients suffering from breast cancer and determination of evolving treatment therapies and better strategies related to breast cancer

Abstract: Breast cancer is basically the lesion of female breast that may create from the connective tissue or epithelial cells of breast.Primary objective: The objective of study was to conduct a survey about the prevailing of rate of breast cancer in community of Rawalakot, Islamabad and local community and to find out strategies used for the diagnosis, treatment and prevention of breast cancer. Methods/Design: A well structure questionnaire including 35 questions about the history, sociodemograhic characteristics, diagnostic tools, treatment plans and prevention methods has been prepared and circulated among the patients of breast cancer through survey. Setting: Study was conducted in Rawalakot and Islamabad Pakistan Participants: 50 participants were involved Intervention: The study was also conducted to communicate with larger community of breast cancer patients and to give them awareness related to initial diagnosis of this harmful disease. Primary Outcome Measures: This study was very very helpful in educated and non-educated community of the specific cities . Results: While conducting the research based on studies, it was found that about 68.84% patients has been report with the reoccurrence of breast cancer after surgery, 70% patients have been diagnosed with invasive type and 30% non-invasive type and 50% have been treated with hormonal therapy as continued treatment after surgery. Conclusion : Breast cancer variation among population or regional differences in the types have been attribute to the prevalence of major risk factors, availability and use of medical practices such as cancer screening, availability and quality of treatment, completeness of reporting and age structure.

Rational Use of Antibiotics and Requisition of Pharmacist

ABSTRACT Background: Direct consequence of microbes developing resistance against antibiotics is prolonged hospitalization, increased treatment cost and duration. Increased duration of hospitalization causes prolonged use antibiotics which results towards side effects. Primary Study Objective: The purpose of antibiotics use is either to kill the microbes (bactericidal) or slows down their growth (bacteriostatic). Irrational use of antibiotics makes them do their exact opposite. Instead of killing microbes or slowing down their growth, it allows microbes to develop resistance against antibiotics. Methods/Design: An observational concurrent study was performed in which data was collected. Individuals were interviewed using structured questionnaire. Percentage of rationality and irrationality of antibiotics use was observed. Additionally percentage of prescribed class of antibiotics was also observed in patients. Setting: Health care system includes: Quaid e Azam International Hospital Islamabad, Benazir Hospital Rawalpindi, CMH Rawalakot AJK, Amna Hospital Rawalakot AJK, DHQ Kotli AJK Pakistan. Participants: This study was conducted on 100 patients of different health care systems, to whom antibiotics were prescribed. Most patients interviewed were female with UTI aged above 30 and adults male with RTI or chest infection. Intervention: Different patients were interviewed in different hospital settings to evaluate the rational use of antibiotics Primary Outcome Measures: Rational use of antibiotics is using antibiotics according to the guidelines provided by WHO. Major guidelines include:  patient receives medication according to their clinical needs, dosage appropriate to the individual requirements and for specific duration of time with low cost. Results: 47 percent of these patients were using antibiotics rationally and 53 percent were taking antibiotics medication irrationally. The most prevalent form of irrational use was patients without counseling about the antibiotics use. Patients with poor knowledge about the use of antibiotics were 84 among the 100. Irrational use of antibiotics in the form of pre-mature discontinuation was reported 56 patients among the 100. Patient who irrationally use antibiotics as OTC or Self medications were 38 among the 100. Conclusion: Major form of irrationality found in the study was no proper counseling provided to the patients by specialist physician or Pharmacists. The reason we critically observed for this is the burden of patients on physicians due to which they are not able to properly guide patients. The community on which this study was conducted has a major absence of pharmacist. Dispensers and pharmacy technicians are performing pharmacist’s tasks. Absence of pharmacist leads to dosage dispensing errors, lack of professional medical counseling, and no drug utilization revie

Diversity in conception of COVID-19 in pastoral and metropolis areas of Pakistan

Background: SARS (severe acute respiratory syndrome) COV-2 has become a global problem since its emergence in 2019 from Wuhan, China as it is most deadly pandemic since Spanish flu in 1918. Primary Study Objective: This study analyzed the people ‘s perception regarding COVID-19 and precautionary measures taken by them during COVID- 19 peak time. Methods/Design: An observational concurrent study was performed in which data was collected from population in rural and urban areas of Punjab and Azad Kashmir using questionnaires. Setting: This survey was carried out in rural and urban areas of Punjab and Azad Jammu and Kashmir Participants: 305 participants were included in the study Intervention: Data was collected from the educated participants of different age groups belongs to different profession. Primary Outcome Measures: Purpose of the study is to know about that conception of COVID -19 in both rural and urban areas of Pakistan so that effective therapy can be given to the nation. Results: It was found that people from both populations had adequate knowledge about COVID-19 and followed restriction imposed by the government during lockdown period. Moreover, population in rural areas was more likely to believe in the myths and rumors about COVID-19 existence. Conclusion: It was concluded that there is need of generating awareness among general population through adequate means which provide authentic information to people and lockdown is not a solution. Everyone should take of his own life by wearing masks and following protocols

Awareness of Nephrolithiasis in Educated Community of Azad Kashmir Pakistan: -

Background: Renal stone is an important health problem in the world and is the most common disease in the urinary tract system. It is particularly a common problem in many countries Knowledge and lifestyle attitude of individuals toward renal stone plays a role in delivering optimum management. Primary Study Objective: To determine the public awareness of renal stones causes, symptoms, and management among the population of AJK Pakistan Setting: General population of all the ages was under consideration and data were taken from the general population Participants: This study was conducted on 100 patients from different areas  Methods: The data of this quantitative cross-sectional study was collected from participants of AJK. Participants were given a self-administered questionnaire written in English. August 2020 to September 2020. individuals of all ages are included in this study. Results: Out of hundred participants we determine the awareness among the educational community of AJK. All category of individuals is involved in our research married and unmarried people and students with arts and science subjects. About 13% of males and 87% of females are involved in our research with different ages. Conclusion: This data indicates that the participants are to some degree aware of some aspects of renal stone prevention, symptoms, and modes of diagnosis and treatment. Individuals who experienced renal stones were more knowledgeable in some respects. Further emphasis on public awareness of renal stones is recommended

Antihyperglycemic Activity of Hydroalcoholic Extracts of Selective Medicinal Plants , , , and and Their Polyherbal Preparation in Alloxan-Induced Diabetic Mice

Background: Diabetes mellitus is a metabolic disorder associated with relative or absolute insulin deficiency or resistance, characterized by hyperglycemia. Modern prescriptions such as pioglitazone have better therapeutic potential, but its side effects and financial burden for developing countries have motivated the researchers to find alternative natural drugs to compete hyperglycemia in patients with diabetes. The present study was conducted to explore the therapeutic potential of selected medicinal plants for the treatment of diabetes as an alternative to allopathic medicines. Method: In present study, hydroalcoholic extracts of Curcuma longa , Lavandula stoechas , Aegle marmelos, and Glycyrrhiza glabra and their polyherbal preparation (PHP) as compound drug were investigated for their antihyperglycemic potential in alloxan-induced diabetic mice. The study subjects (mice) were divided into different groups as normal control, diabetic control, pioglitazone treated (standard drug), test groups (plant extract treated 50, 100, and 150 mg/kg body weight), and PHP-treated group. Blood glucose concentration of all the study animals was determined by Glucose strip test. Qualitative phytochemical analysis of all the plant extracts was also performed following standard methods. Result: It was investigated that treatment of alloxan-induced diabetic mice with hydroalcoholic extracts of studied medicinal plants showed significant ( P < .05) effects on fasting blood glucose levels (from baseline to normal range) in a manner comparable to that of the reference drug, pioglitazone (1 mg/kg body weight intraperitoneal). The tested plant extracts significantly ( P < .05) reduced the glucose concentration in blood of diabetes-induced mice in a dose-dependent manner. Conclusion: It could be concluded that studied medicinal plants have antihyperglycemic activity. The study findings favor the use of traditional herbal medicinal practices for the management of diabetes that might due to the presence of bioactive phytoconstituents in plants. However, larger studies are required to identify, isolate, and characterize the bioactive phytoconstituents responsible for antihyperglycemic activity of studied medicinal plants

Assessment of risk factors associated with diabetes: Assessment of risk factors associated with diabetes

Abstract: Objective: Purpose of the study was to assess to risk factors of diabetes type II and complications in diabetic patient of tertiary care hospital. Methods/Design: Cross sectional study conducted to evaluate the risk factors associated with diabetes Mellitus. Setting: Tertiary hospitals of Islamabad and Azad Kashmir was selected for the current study. Participants: 50 patients assessed without any gender discrimination age between 35 to 85 years for risk factors and complications. Intervention: Data was collected from patients that were bed ridden admitted in hospitals. A total of 50 patients were included in this study with age limit more than 35 years and without any discrimination of gender. Primary Outcome Measures:  In tertiary care hospitalized patient’s obesity, inactivity and family history were the major risk factor for diabetes mellitus type 2 and we calculated the obesity, inactivity and family history percentage in diabetic patients 63%, 49% and 67% respectively. Results: Percentage of risk factors calculated the obesity, inactivity and family history in diabetic patients 63%, 49% and 67% respectively. Macro vascular complications in patients with diabetes mellitus type 2 were stroke 3%, angina 8%, hypertension and cognitive impairment have highest percentages i.e., 78%. 46% patients were suffering from ulceration; gangrene and amputation have percentages 19% and 3% respectively. Patients with microvascular complications of diabetic nephropathy were assessed for their albuminuria 25%, edema 32% and incontinence 28%. Conclusion: These complications can be avoided if patients of DM type 2 adopt a healthy lifestyle, do exercise and monitor their blood glucose levels regularly. Patients should also control their blood pressure to avoid damage to their microvasculature

Simulation of the meltwater under different climate change scenarios in a poorly gauged snow and glacier-fed Chitral River catchment (Hindukush region)

Seasonal and annual water supplies of the rivers originating in the Hindukush-Karakoram-Himalaya (HKH) region of Pakistan are important to manage the Indus basin irrigation system for better agricultural production and its dependent agrarian economy. In this study, we simulated the current and future snowmelt runoff in a poorly gauged river basin of the Hindukush region under Representative Concentration Pathways (RCP) climate change scenarios. Snowmelt Runoff Model (SRM) furnished with satellite snow cover maps and hydro-meteorological data were used to simulate the daily river discharge for the period 2000‒2005. The results indicated that SRM has effectually simulated the runoff in Chitral River with Nash-Sutcliffe model efficiency coefficient of 0.85 (0.84) and 0.88 (0.83) in the basin-wide (zone-wise) application during the calibration and validation periods, respectively. The results obtained under future climate change scenario showed ∼14‒19% increase in mean summer discharge under three mid-21st century RCP (2.6, 4.5 and 8.5) scenarios. While an increase of ∼13‒37% is expected under late-21st century RCP scenarios. This study can help water resource managers to plan and manage peak discharges from the Chitral River Basin in the future and can thus prevent major losses due to floods in the area

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society