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

The Impact of Social Media on Teacher's Performance: A Case of Higher Educational Institutions of Pakistan

The purpose of this study is to see the impact of social media on teacher’s performance in higher educational institutions of Pakistan, particularly in Vehari (Punjab) and D.I Khan (KPK). This research study explored that social media has a significant impact on teachers performance. Because the faculty members of higher educational institutions play a vital role in the development of students, society and as a whole the nation. The main purpose of this study is to understand the nature of social media and up to how much extend social media is playing its role regarding the development of faculty performance. This study is quantitative and descriptive in nature .The researcher, distributed 357 survey questionnaires to the higher education sector of District Vehari and D.I. Khan and got a response from 318 respondents. Linear and multi regression were used to analyze the results and for drawing a conclusion. Knowledge sharing, creativity, collaboration and interaction through social networking sites have a significant impact on teacher’s performance which suggests that use of social networking sites in education increases the teacher performance

Supply and Demand Model for the Malaysian Cocoa Market

This paper investigates a system of supply, demand, and price equations for Malaysian cocoa using annual data over the period 1975-2008. Theoretically, in supply and demand models, the price variable is treated as endogenous. However, Hausman specification test result indicates that there is no simultaneity problem in the model. Thus, we estimate the system of equations utilizing the Seemingly Unrelated Regression (SUR) estimation technique which might be considered a more efficient estimator for supply and demand model of the Malaysian cocoa. The results suggest that the Malaysian cocoa production is mainly affected by the previous year production, price of cocoa beans at lag two as well as the harvested area. In the export demand equation, the real effective exchange rates is statistically significant determinant while the index of industrial production of advanced economies and the world price of cocoa are found to be insignificant. The results also suggest that both Malaysian industrial production index and domestic price of cocoa beans are key determinants of domestic demand for cocoa beans in Malaysia. Finally, the domestic price of cocoa beans is highly sensitive to its domestic consumption, lagged domestic price, and its world price.Supply and Demand; Malaysian Cocoa; SUR technique

Seasonal influence on postoperative hip fracture complications: Retrospective cohort of more than 1000 patients from a tertiary-care university hospital

Background: Hip fractures account for one of the most debilitating conditions affecting the general population amongst the developed and developing nations. Investigators aimed to study the influence of the ongoing season i.e. whether patients operated upon in summer or winter, on post-operative complications occurring within 30 days of surgical procedure for hip fractures at a tertiary care hospital and level 1 trauma center.Materials and methods: Investigators conducted a non-funded, non-commercialized retrospective cohort of 1045 patients with hip fractures managed surgically. Primary exposure was surgical procedures undertaken during the summer months (April-September). Our primary outcome was determining post-operative complication rates from January 2010 to December 2018 and evaluating impact of the season through univariate and multivariable regression analyses using Cox Proportional Hazard Algorithm with STATA V15. The work has been reported in line with the STROCSS criteria.Results: Age, ASA status, type of procedure, mechanism of injury and Charlson Comorbidity Index (CCI) were identified as significant associated factors with postoperative complications after hip fracture surgery. Although overall results revealed a rising rate of complications during the summer season with a relative risk (RR; 95% CI) of 1.1(0.89-1.32), univariate and multivariable analysis did not show any significant correlations.Conclusions: The results of this study did not demonstrate a significant seasonal variability in the rate of postoperative complications for hip fracture patients operated upon during the hot months of summer. More research is required to analyze postoperative complications in order to optimize patients\u27 outcomes

Neonatal hyperbilirubinemia in infants with G6PD c563C \u3e T variant

Background: There is a strong correlation between glucose-6-phosphate dehydrogenase (G6PD) deficiency and neonatal hyperbilirubinemia with a rare but potential threat of devastating acute bilirubin encephalopathy. G6PD deficiency was observed in 4–14% of hospitalized icteric neonates in Pakistan. G6PD c.563C \u3e T is the most frequently reported variant in this population. The present study was aimed at evaluating the time to onset of hyperbilirubinemia and the postnatal bilirubin trajectory in infants having G6PD c.563C \u3e T. Methods: This was a case–control study conducted at The Aga Khan University, Pakistan during the year 2008. We studied 216 icteric male neonates who were re-admitted for phototherapy during the study period. No selection was exercised. Medical records showed that 32 were G6PD deficient while 184 were G6PD normal. Each infant was studied for birth weight, gestational age, age at the time of presentation, presence of cephalhematoma, sepsis and neurological signs, peak bilirubin level, age at peak bilirubin level, days of hospitalization, whether phototherapy or exchange blood transfusion was initiated, and the outcome. During hospital stay, each baby was tested for complete blood count, reticulocyte count, ABO and Rh blood type, direct antiglobulin test and quantitative G6PD estimation [by kinetic determination of G6PDH]. G6PDgenotype was analyzed in 32 deficient infants through PCR-RFLP analysis and gene sequencing. Results: G6PD variants c.563C \u3e T and c.131 C \u3e G were observed in 21 (65%) and three (9%) of the 32 G6PD deficient infants, respectively. DNA of eight (25%) newborns remained uncharacterized. In contrast to G6PD normal neonates, infants with c.563C \u3e T variant had significantly lower enzyme activity (mean ± 1SD; 0.3±0.2 U/gHb vs. 14.0±4.5 U/gHb, p\u3c0.001) experienced higher peak levels of total serum bilirubin (mean ± 1SD; 16.8±5.4 mg/dl vs. 13.8±4.6 mg/dl, p=0.008) which peaked earlier after birth (mean ± 1SD 2.9±1.6 vs. 4.3±2.3 days, p=0.007). No statistically significant difference was observed in mean weight, age at presentation, hemoglobin, reticulocyte count, TSH level, hospital stay or in the frequency of initiation of phototherapy or blood exchange between the two groups. Conclusions: We concluded that infants with G6PD c.563C \u3e T variant developed jaundice earlier than infants with normal G6PD enzyme levels. Compared to G6PD normal infants, G6PD c.563C \u3e T carrying infants had significantly low G6PD activity

Do new trainees pose a threat to postoperative complications after hip fracture surgeries? Retrospective cohort of 1045 patients over a decade at a university hospital

Introduction: Induction of new residents and surgical trainees in most institutes occurs once a year. Fresh residents with no experience, may pose a threat to the surgical procedure outcome and there can be a potential increase in patients\u27 morbidity and mortality as a result of this turnover. Literature is inconclusive about this effect. Our aim was to study the new residents\u27 induction effect on postoperative complications after hip fracture surgeries.Methodology: This is non funded non commercialized study from a university hospital. Investigators studied a retrospective cohort of 1045 adult hip fracture patients who were operated at our tertiary care and level 1 trauma centre of a metropolitan city between 2008 and 2018. We defined primary exposure as the time period of new resident\u27s induction (January-March) with the primary outcome in-hospital and 30days postoperative complications. Cox proportional hazard algorithm analysis was done at univariate and multivariable levels reporting Crude Relative Risk (RR) and Adjusted Relative Risk (aRR), respectively. Results were reported in line with STROBE criteria.Results: There were 274 (26%) patients in exposed group out of whom 109 (40%) developed postoperative complications. Interestingly, patients who had their surgeries during the induction period of new residents had 8% less risk of developing postoperative complications. However, result was statistically insignificant at both univariate and multivariable levels with RR; 95% C.I of 0.9 (0.78-1.22) and aRR; 95% C.I of 0.9 (0.78-1.22) after adjusting for the all other independent variables.Conclusion: The association of new residents\u27 induction on postoperative hip fracture surgery complications, although protective, was insignificant after controlling for the potential confounding effect of patients\u27 background and demographic characteristics. We recommend further multi-centre high powered studies to analyze this

Malaysian Cocoa Market Modeling: A Combination of Econometric and System Dynamics Approach

The Malaysian cocoa sector has undergone dramatic changes during the last few decades. In the early years of 1970s, this sector has maintained an upward trend in the area and consequently the production. However, the trend reversed in the late 1980s due to factors such as declining world prices, higher labour costs, widespread of cocoa pod diseases and the pull of more lucrative crops (in particular palm oil). By 2008 only about 19,976 hectares were planted with cocoa compared to a peak of 414,236 ha in 1989. Production of cocoa beans has trended down accordingly. The study combines the econometric and system dynamics approach in modeling the Malaysian cocoa market. A first order system was developed to capture the interdependencies of the major structural elements of the markets such as production, local and export demands, inventory and imports. Nevertheless, the model provides an understanding of the interrelationships between the system components and allows the simulation of policy variables changes. Future work will involve a detail examination of the interaction cocoa supply chain system (from farm to export) to provide a much more comprehensive representations of the dynamics of the market.Econometric methods; system dynamics; Malaysian cocoa market

Effects of Telehealth on Dropout and Retention in Care among Treatment-Seeking Individuals with Substance Use Disorder: A Retrospective Cohort Study

Background: During the COVID-19 pandemic, telehealth became a widely used method of delivering treatment for substance use disorders (SUD), but its impact upon treatment engagement and dropout remains unknown. Methods: We conducted a retrospective analysis of adult SUD patients (n = 544) between October 2020 and June 2022 among a cohort of treatment-seeking patients at a nonprofit community behavioral health center in Southwestern Ohio. We estimated the likelihood of treatment dropout using survival curves and Cox proportional hazard models, comparing patients who used telehealth with video, telephone, or solely in-person services within the first 14 days of diagnosis. We also compared the likelihood of early treatment engagement. Results: Patients who received services through telehealth with video in the initial 14 days of diagnosis had a lower hazard of dropout, compared to patients receiving solely in-person services (0.64, 95% CI [0.46, 0.90]), while there was no difference in hazards of dropout between patients who received telephone and in-person services. Early use of telehealth, both via video (5.40, 95% CI [1.92, 15.20]) and telephone (2.12, 95% CI [1.05, 4.28]), was associated with greater odds of treatment engagement compared to in-person care. Conclusion: This study adds to the existing literature related to telehealth utilization and engagement in care and supports the inclusion of telehealth in SUD treatment programs for treatment-seeking individuals

Frequency of Post-Operative Wound Contamination in Bakhtawar General Hospital, Jamshoro

Background: Surgical site wound infection (SSI) imposes a great challenge worldwide. It is the third most commonly reported nosocomial infection. The objective of the study was to assess the frequency of postoperative wound infections in a newly developed health organization.Material and Methods: This cross-sectional study was conducted from June 2017 to May 2018 in Bakhtawar General Hospital, Jamshoro. A total of 364 cases of surgery, from Obstetrics and Gynecology and General Surgery department were included. Surgical interventions involving an incision were assessed. Infection (SSI) rate was noticed and data was analyzed by SPSS version 18.Results: Healthy discharge rate was 97%. The overall surgical site wound infection rate was 3.1%. These infections were high in genitourinary surgeries (9.09%). Among Obstetrics & Gynecology surgeries, maximum number of SSIs were reported in cases of emergency Lower Segment Cesarean Section (LSCS).Conclusions: The overall rate of SSI for different types of surgeries performed at Bakhtawar General Hospital, Jamshoro was only 3.1%. Frequency of SSI was highest in genitourinary surgeries followed by gastrointestinal and obstetrics and gynecology surgeries, respectively.Key words: General Surgery, Genitourinary surgery, Obstetrics & Gynecology surgery, Post-operative wound contaminatio