WHAT DIABETICS KNOW ABOUT DIABETES?

Patient’s lack of understanding of disease hinders in proper control of disease thus increasing the morbidity and mortality. Review of the studies done in this region, dose not provide a detail account of patients understanding about the disease. Majority of patients when interviewed in clinics do not know the right answer to cause, level of desired sugar, possible complication. Material and methods: Hospital-based cross-sectional KAP study was conducted on diabetic patients visiting the diabetic clinic in two tertiary care Hospitals and a diabetic poly clinic in different areas of Karachi during the month of September 2012. Results: The mean age was 56 years, with 122 male and 118 female, 40.4 % patients were uneducated, 22.9% metric, 12.9% intermediate and 22.9% were graduate. Considering the knowledge, as to what is diabetes? only 46% answered correctly. What could cause the disease? 35% thought there was no reason for sugar. Regarding most frequent symptom, 27% thought there were no specific symptoms, 24.2% weight loss and 23.8% excessive urine and 21.7% thought not healing of wound was first indicator and 2.1 % thought that increase appetite is the cause. The desired levels of random sugar only 24.2% thought it be around 180 mg /dl while 32.5% had no idea about the value. Desired fasting sugar was correctly known by 34.6% as less than 100 mg/dl and 22.9% as less than 120 mg/dl. , Duration of treatment was believed to be life long treatment by 85%.Oral hypoglycemic were consumed by 68%, 24% were on insulin. And 6% were using both. 75% patients did not do exercise regularly. Regarding the harms created by diabetes, 51.3 % knew that heart or kidneys may get damaged. Regular doctor visits were done by 80% , and 85 % were satisfied with the level of care. The average sugar check cost was less than 100 rupees for 62.1 % . Conclusion: Lack of proper concepts regarding the disease, desired level of sugars, possible complications could be a big hinder in achieving good diabetic control. Thus by addressing the specific deficiencies in the knowledge and practices of patients, a better outcome may be achievable

Clinical performance and Willingness To Pay for soft toric contact lenses in low and moderate astigmats

Purpose: To determine clinical performance and the ‘Willingness To Pay’ for toric vs. spherical soft contact lenses in an astigmatic population. Methods: In the clinical study, subjects with binocular low to moderate astigmatism (-0.75DC to − 1.50DC) wore pairs of soft toric (Biofinity toric) and spherical (Biofinity) contact lenses in random sequence. Visual acuity (high and low contrast, monocular and binocular), subjective comfort and subjective vision were recorded. In the economics study, first subjects who had participated in the clinical study were presented with a series of randomised economic scenarios in order to determine their Willingness To Pay a premium (i.e. an increase) for toric lenses. Then, a similar set of scenarios were presented to a much larger group of online respondents and again, Willingness To Pay was established. Results: For the four measures of visual acuity, the Biofinity toric lens out-performed the Biofinity spherical lens by 0.6 to 1.1 lines.. Subjective vision performance was statistically significantly better with the toric lens for the distance task only. Comfort scores were not significantly different. Similar findings for Willingness To Pay were established for the clinical subjects and for the online respondents. The Willingness To Pay premium (additional fee) for a monthly supply of toric lenses (over spherical lenses) was between £13 and £16, if a toric lens provides better vision and similar comfort, as shown in the clinical study. Conclusion: Consumers are willing to pay a monthly premium of around 50% to benefit from the typical experience of better vision and similar comfort for toric vs. spherical lenses. The level of additional cost for toric lenses compared to their spherical equivalents is less than this in the market, so eye care professionals should consider that toric lenses are delivering a greater clinical return than anticipated by wearers for the relatively small increase in price

Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan : Evidence from two longitudinal cohort studies 15 years apart

Funding Information: Study 1 was funded through the Applied Diarrheal Disease Research Program at Harvard Institute for International Development with a grant from USAID (Project 936–5952, Cooperative Agreement # DPE-5952-A-00-5073-00), and the Aga Khan Health Service, Northern Areas and Chitral, Pakistan. Study 2 was funded by the Pakistan US S&T Cooperative Agreement between the Pakistan Higher Education Commission (HEC) (No.4–421/PAK-US/HEC/2010/955, grant to the Karakoram International University) and US National Academies of Science (Grant Number PGA-P211012 from NAS to the Fogarty International Center). The funding bodies had no role in the design of the study, data collection, analysis, interpretation, or writing of the manuscript. Publisher Copyright: © 2020 The Author(s).Peer reviewedPublisher PD

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Testing a global standard for quantifying species recovery and assessing conservation impact.

Recognizing the imperative to evaluate species recovery and conservation impact, in 2012 the International Union for Conservation of Nature (IUCN) called for development of a "Green List of Species" (now the IUCN Green Status of Species). A draft Green Status framework for assessing species' progress toward recovery, published in 2018, proposed 2 separate but interlinked components: a standardized method (i.e., measurement against benchmarks of species' viability, functionality, and preimpact distribution) to determine current species recovery status (herein species recovery score) and application of that method to estimate past and potential future impacts of conservation based on 4 metrics (conservation legacy, conservation dependence, conservation gain, and recovery potential). We tested the framework with 181 species representing diverse taxa, life histories, biomes, and IUCN Red List categories (extinction risk). Based on the observed distribution of species' recovery scores, we propose the following species recovery categories: fully recovered, slightly depleted, moderately depleted, largely depleted, critically depleted, extinct in the wild, and indeterminate. Fifty-nine percent of tested species were considered largely or critically depleted. Although there was a negative relationship between extinction risk and species recovery score, variation was considerable. Some species in lower risk categories were assessed as farther from recovery than those at higher risk. This emphasizes that species recovery is conceptually different from extinction risk and reinforces the utility of the IUCN Green Status of Species to more fully understand species conservation status. Although extinction risk did not predict conservation legacy, conservation dependence, or conservation gain, it was positively correlated with recovery potential. Only 1.7% of tested species were categorized as zero across all 4 of these conservation impact metrics, indicating that conservation has, or will, play a role in improving or maintaining species status for the vast majority of these species. Based on our results, we devised an updated assessment framework that introduces the option of using a dynamic baseline to assess future impacts of conservation over the short term to avoid misleading results which were generated in a small number of cases, and redefines short term as 10 years to better align with conservation planning. These changes are reflected in the IUCN Green Status of Species Standard

Unraveling the importance of nitric oxide in plant-microbe interaction

Nitric oxide, because of having exceptional biochemical properties, is considered as a pluripotent signaling and effector molecule. It plays an important role in growth, development, abiotic stress, and plant immunity in plant. Microorganisms are present everywhere, and they live in close proximity to plants. Understanding the type of interaction between plants and microorganisms is a critical process since chemical communication is required to form the association between them, which is still a matter of debate. Nitric oxide (NO), produced by numerous living activities in bacteria, soil, and plants, works as a signal molecule to trigger several essential mechanisms occurring in plant-microbe association, contributing to managing the response and battle of plant defense. Notably, the important knowledge about NO development and its effective relationships with plants and microbes is poorly described. In particular, NO's role in plant-microbe interactions is discussed as a signaling molecule. The mechanisms underlying plant-microbe interactions were reported in this review in order to provide comprehensive perspectives into the biochemical and molecular processes of plant-microbe interaction