The SARS-CoV-2 Pandemic a Global Emergency: The Journey from Bats to Humans

Bats are considered as the reservoirs of coronaviruses (CoVs) which resulted in severe disease outbreaks in humans. Zoonotic coronaviruses responsible for Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), were originated from bats and remain highly pathogenic to humans during the last two decades. Recently, an acute respiratory disease outbreak which spread in Wuhan, China was caused by a novel coronavirus (SARS-CoV-2) also known as 2019-nCoV, received worldwide attention. The World Health Organization (WHO) officially declared the COVID-19 epidemic caused by SARS-CoV-2 as a public health emergency. The emergence of SARS-CoV-2 has been considered as the third highly pathogenic epidemic of the 21st century. The SARS-CoV-2 belongs to β-coronavirus group with highly identical genome to bat coronavirus RaTG13, assuming bat as the natural host. According to WHO as of December 21, 2020, approximately 75,479,471 persons were infected with 16,86,267 deaths in 222 countries. Whereas the in Pakistan according to WHO as of December 21, 2020, around 4 57,288 persons were infected with 9, 330 death reported in the country. Keywords: SARS-CoV-2; 2019-nCoV; Bats; Human; Epidemic; Pandemic DOI: 10.7176/FSQM/105-07 Publication date: February 28th 202

Glycated hemoglobin (HbA1c) as diagnostic criteria for diabetes: the optimal cut-off points values for the Pakistani population; a study from second National Diabetes Survey of Pakistan (NDSP) 2016–2017

Aim Glycated hemoglobin (HbA1c) cut-off values as diagnostic tool in diabetes and prediabetes with its concordance to oral glucose tolerance test (OGTT) in Pakistani population.Methodology Data for this substudy was obtained from second National Diabetes Survey of Pakistan (NDSP) 2016–2017. With this survey, 10 834 individuals were recruited and after excluding known subjects with diabetes, 6836 participants fulfilled inclusion criteria for this study. Demographic, anthropometric and biochemical parameters were obtained. OGTT was used as standard diagnostic tool to screen population and HbA1c for optimal cut-off values. Participants were categorized into normal glucose tolerance (NGT), newly diagnosed diabetes (NDD) and prediabetes.Results Out of 6836 participants, 4690 (68.6%) had NGT, 1333 (19.5%) had prediabetes and 813 (11.9%) had NDD by OGTT criteria with median (IQR) age of 40 (31–50) years. Optimal HbA1c cut-off point for identification of diabetes and prediabetes was observed as 5.7% ((AUC (95% CI)=0.776 (0.757 to 0.795), p<0.0001)) and 5.1% ((AUC (95% CI)=0.607 (0.590 to 0.624), p<0.0001)), respectively. However, out of 68.6% NGT subjects identified through OGTT, 24.1% and 9.3% participants were found to have prediabetes and NDD, respectively by using HbA1c criteria. By using both OGTT and HbA1c criteria, only 7.9% and 7.3% were observed as prediabetes and diabetes, respectively.Conclusion Findings from second NDSP demonstrated disagreement between findings of OGTT and HbA1c as diagnostic tool for Pakistani population. As compared with international guidelines, HbA1c threshold for prediabetes and NDD were lower in this part of world. HbA1c as diagnostic tool might require ethnic or regional-based modification in cut-off points, validated by relevant community-based epidemiological surveys