LIPID PROFILE PATTERNS AND ASSOCIATION BETWEEN GLYCATED HAEMOGLOBIN (HbA1C) AND ATHEROGENIC INDEX OF PLASMA (AIP) IN DIABETES PATIENTS AT A TERTIARY CARE HOSPITAL IN MALAYSIA

Objective: There is lack of data regarding lipid patterns and the relationship of the atherogenic index of plasma (AIP with glycemic control in Malaysian diabetes patients. This study aimed to assess the lipid patterns and association of AIP with HbA1c in diabetes patients at a tertiary care hospital in Malaysia.Methods: The study was conducted on 72 diabetes patients who were randomly chosen and agreed to participate in the study. AIP values were calculated using log triglycerides/high-density lipoprotein (TG/HDL) ratio. Data were analysed using SPSS 23.Results: Mean age and body mass index (BMI) of the participants were 56.88±8.89 (years) and 28.81±4.78 (kg/m2) respectively. Hypercholesterolemia, hypertriglyceridemia, high low-density lipoprotein (LDL) values were found in 55.5 %, 41.7 %, 45.5 % of total participants respectively and less than desirable HDL values were observed in 25% of total participants. Overall, 37.5% patients were categorised into high-risk AIP category. BMI categories had a significant association with AIP category (p = 0.05). There was a significant positive correlation of AIP with HbA1c (r = 0.34; p = 0.0 04). HDL was negatively correlated with AIP (r = 0.27; p = 0.02). Duration of diabetes and ethnicity showed no significant association with AIP risk values.Conclusion: Diabetes patients in this study exhibited significant lipid abnormalities with increased AIP. AIP was significantly correlated with HbA1c

HEALTH-RELATED QUALITY OF LIFE IN POORLY CONTROLLED TYPE 2 DIABETES PATIENTS - ASSOCIATION OF PATIENTS' CHARACTERISTICS WITH EQ-5D DOMAINS, MEAN EQ-5D SCORES, AND VISAUL ANALOG SCALE SCORE

  Objective: High prevalence of diabetes mellitus in Malaysia demands the appropriate interventions to alleviate or postpone its burden on patients' health-related quality of life (HRQoL). The studies which provide useful knowledge about the components of such interventions are important. The aim of this study was to describe how demographic and clinical characteristics of diabetes patients influence their HRQoL using EQ-5D.Methods: This study used the baseline data of a randomized controlled study carried out to examine the impact of a pharmacist intervention on poorly controlled diabetes patients. A generic HRQoL tool EQ-5D was used to report the data. Logistic regression was used to identify the predictors of problems in individual EQ-5D domains, and ANCOVA was undertaken to examine the effect of patients' characteristic on EQ-5D mean scores and visual analog scale (VAS) mean scores.Results: Pain discomfort was reported to be significantly predicted by high HbA1c levels. Increasing age (OR =1.04; CI 1.01, 1.16) and increasing body mass index (OR = 1.15; CI 1.01, 1.30) were significant predictors of reduced mobility. The presence of complications (OR = 8.03; CI 1.34–48.02) and (5–10 years) diabetes duration predicted the reduced score in anxiety domain (OR = 7.05; CI 1.03, 48.04). Problems in usual activities were significantly predicted by age (OR = 1.4; CI 1.01, 1.18). Self-care was not affected by any of the model covariates. Mean EQ-5D score was (0.89; CI 0.85, 0.92) significantly predicted by HbA1c values (p=0.04). Mean VAS score (70.54) was significantly lower in the group receiving insulin (69.46; CI 73.74, 84.02) than the oral diabetes medication (78.88; CI 64.94, 73.98) (p=0.009).Conclusion: Patients' characteristics were significantly associated with the HRQoL in type 2 diabetes. There was a significant and inverse association of HRQoL with medication group (insulin use), high HbA1c, obesity, and presence of complications

Role of Short Duration Double Phototherapy in The Treatment of Unconjugated Hyperbilirubinemia

Objective: To determine the role of short duration double phototherapy in the treatment of unconjugated hyperbilirubinemia. Materials and Methods: This prospective cases series study was conducted at pediatric department of CMH hospital at Malir Karachi. All the neonates diagnosed with unconjugated hyperbilirubinemia admitted to the neonatal ward were included. All the cases underwent short duration double phototherapy. Babies were observed for side-effects of phototherapy, like skin reaction and dehydration. Serum bilirubin was checked by bilirubinometre after 6 hourly of the treatment. Al the data was collected via study proforma. Data was analyzed by using SPSS version 20 Results: Total 74 neonates were studied, most of the neonates presented within 48-72 hours after birth. Majority of the term babies as 59.5% had history of 37-40 weeks of gestation and 28.4% had gestational age history >40 weeks. Out of all, males’ babies were 58.1% and female babies were 41.9%. Neonatal bilirubin level was significantly decreased from bassline 18.35+0.97 after 6 hours of double phototherapy as 14.66+1.18 with mean difference of 3.68+1.37 (p-value 0.001). Conclusion: Short duration double phototherapy found to be the effective, reliable and safe for skin reaction in the treatment of unconjugated hyperbilirubinemia. Key words: Hyperbilirubinemia, double phototherapy, six hours

Effects of maternal depression on fetal health

Case Description Patient is a 27 years old pregnant (18 weeks) female with a past medical history of depression, post-traumatic stress disorder (PTSD), and military sexual trauma admitted for suicidal ideation with intent and plan. During admission, the patient refused all antidepressants after emesis on sertraline and prenatal vitamins. Patient was discharged after clinical stabilization and scheduled for follow-up outpatient. Conclusions Depression during pregnancy can have numerous adverse effects on mother as well as fetal and child development and thus treatment is of the utmost importance. Depression leads to alterations in the serotonin system and the HPA axis, as well as causes epigenetic changes to the infant glucocorticoid receptor gene. Changes in these pathways are most apparent during the second trimester and have downstream consequences leading to altered fetal heart rate variability, preterm birth, and low birth weight. Maternal depression can also lead to altered cortisol reactivity, and delayed motor and cognitive development in childhood. Furthermore, prevalence of depression varies throughout the pregnancy with depression more prevalent in the second and third trimesters. Clinical Significance Pregnant women are less likely to receive any mental health treatment for depression than their non-pregnant counterparts; 49% and 57% respectively, and screening for depression focuses on postpartum screening with few guidelines to screening during pregnancy. Due to the adverse effects on the fetus, maternal surveillance and treatment of depression during pregnancy is essential

Electrokinetic Desalination of Compound Building Materials by Applying Electric Field

Damaging of building materials is directly connected to the salt crystallization. The present research is based on removal of NaCl from compound building materials, where a direct current (DC) electric field was applied to the mortar plus bricks system. The main objective of this work is to investigate the electrokinetic desalination methodology that can provide sufficient removal of salts. pH neutralization in the surrounding of mortar plus bricks system is crucial to obtain sufficient desalination. For this purpose, the electrodes across the brick were inserted in kaolin clay mixed with buffer agents to suppress the pH changes. Most of the experiments were performed with kaolin clay and sponge. The concentration of chloride ions and sodium ions in all the segments and clay poultice was measured using argentometric titration method and flame photometer, whereas the pH variations in the entire system was measured by using pH indicator papers. The electrokinetic desalination was found to be an efficient method as 86 % removal of chloride and 80 % removal of sodium was achieved

Psychological complications of polycystic ovarian syndrome and women’s health

Background: Polycystic Ovarian Syndrome (PCOS) affects approximately 5-10% females of reproductive age worldwide. Recent research shows that this syndrome is associated with psychological upset and devastating effects on women′s mental health and wellbeing.  Lack of clinicians′ awareness of adverse psychological effects is a major concern in developing countries to provide standard care and to improve overall health outcomes.Purpose of study was to determine the frequency of anxiety and depression among women with PCOS in order to promote awareness among clinicians about psychological complications of disease.Methods: Present study was conducted in the department of Obstetrics and Gynaecology/ University Medical and Dental College, from October 2018 to March 2019. Sixty patients with diagnosis of PCOD and sixty participants without this disease were included in the study. Participants having other endocrine or metabolic disorders were excluded from study. Hospital anxiety and depression scale was used to detect anxiety and depression among both groups. SPSS version 16 was used for data analysis. Chi- square test was applied to compare prevalence of anxiety and depression in both groups, p-value ˂0.05 was taken as statistically significant.Results: Women having PCOD exhibited statistically significant prevalence of anxiety (78.3% vs 35%) and depression (60% vs 30%) with p value of 0.0001 and 0.001 respectively.Conclusions: It is highly recommended that initial evaluation of these patients should include assessment of psychological domain of disease to provide more comprehensive treatment to improve overall health related quality of life

Oral versus intravenous maternal hydration in isolated third trimester oligohydramnios

Background: To study the effect of oral and intravenous maternal hydration in patients with isolated oligohydramnios in terms of mean change in amniotic fluid.Methods: A total number of 38 patients included in the study which fulfill the selection criteria.  Patients were randomly divided in two groups. Amniotic fluid index (AFI) of all patients was measured before the hydration therapy according to the method of Phelan et al.  In maternal oral hydration (Group A), every patient was instructed to drink two liters of water over two hours daily for 1 week. In intravenous hydration (Group B), every woman infused two liters of 0.9% normal saline in two hour daily for 1 week. After 48 hours and 1 week of oral and intravenous hydration, the AFI was reassessed by the same observer. Patients were monitored closely for sign and symptoms of fluid overload. Data was stratified for mean difference in improvement in amniotic fluid index.Results: After oral hydration therapy AFI was 5.926±0.4593 after 48 hours and 8.286±0.6000 after 7 days in Group A. In Group B AFI was 5.784±0.4622 after 48 hours and 7.868±0.2810 after 7 days of intravenous hydration. P value after 48 hours is 0.348 and p=0.014 after 7 days means oral hydration therapy significantly increase amniotic fluid index.Conclusions: Oral maternal hydration significantly increase the amniotic fluid index in patients with isolated oligohydramnios. It is simple, safe and non-invasive method

Academic Stress Levels in Annual & Semester System: A Cross-Sectional Comparative Study on Students of Physiotherapy in Lahore, Pakistan

Physical Therapy in Pakistan has not yet been considered amongst the reputed professions due to the lack of awareness among the public. This being the very reason of the higher stress among the students studying physiotherapy is kept under consideration in this study. The main purpose of this study was to determine if the students of Annual system endure stress levels higher than those of Semester system. Also the aim was to determine which assessment system was more conducive for an effective learning & to acknowledge the major stressors among the DPT students along with their coping strategies. This study was a Comparative Cross-Sectional Study conducted in duration of 8 months. Data was collected from both male and female students of DPT who had completed 50% of their credit hours of the curriculum. The sample size calculated was found to be 343 (n=343). Exposure assessment included the International Stress Questionnaire which is most commonly used instrument for the evaluation of stress levels among students. The International Stress Questionnaire was administered into a group of 70 students from Public and Private Institutes for validation purpose. Thus 560 questionnaires were distributed among students amongst which only 384 were fully completed and thus included for the statistical analysis. Mean age of the students was found to be 21±1.34 years. Amongst 384 students, 292 were females and 92 were males.190 students were from Annual system i.e. Pass/Fail system and 194 had GPA system as their assessment system. Interpretations were done according to the standard way i.e. a score of 4 or less was supposed to be mild, 5-13 was moderate and 14 or more was severe. Amongst those from Annual system, 17 had mild, 139 had moderate and 34 had severe stress. Amongst 194 students from GPA system, 122 had mild and 72 had moderate stress whereas none of those reported to fall in the category of severe stress. Independent t test was applied to identify if there were significant differences between the two groups and the p value was found to be 0.00 i.e. highly significant. A forum should be developed to register all the students enrolled in Doctor of Physiotherapy every year encompassing all Institutes to prevent the biasness due to non-probability sampling method used to recruit sample

The Impact of Counter-terrorism Effectiveness on Economic Growth of Pakistan: An Econometric Analysis

Abstract The purpose of present study is to explore theoretically and empirically the impact of counterterrorism effectiveness on economic growth of Pakistan. The data for counter-terrorism components construct from GTD and data for growth variables gathered from WDI for the time 1980 to 2015. This study developed “negative binomial regression model” for investigating the magnitude and significance of counter-terrorism effectiveness. It also uses the ARDL bound test and causality analysis for examining the causal relationship between economic growth and counter-terrorism effectiveness. This study further identifies that there are three types of proactive strategies used by Government and military authorities to reduce violence: civilian policies, peace accords and military operations. The result shows that there are long term impacts of counter-terrorism policies on economic growth. The findings also imply that counter-terrorism strategies may not be able to restrict violence and incapacitate militant’s organization and their sleeper cell if it lacks strong political support. The present work is raw evidence for the effort level of authorities and their preemptive strategies that leads to the significant breakdown effect to curb terrorism across the country