Assessment of the Deficiency of Vitamin D among the Tuberculosis Patients at People Medical College Hospital Nawabshah, Pakistan

Objective: The objective of this study is to assess deficiency of Vitamin D among the Tuberculosis Patients at People’s Medical College Hospital (PMCH) Nawabshah, Pakistan. Methodology: This was a case-control study in which 184 new diagnosed tuberculosis patients aged between 30 to 50 years were selected and 200 were taken as control. The study was conducted from June 2020 to May 2021. Well-structured questionnaire was administered to both case and control groups. Body mass index (BMI) was recorded as (kg/m2). Blood samples were collected for the presence of Vitamin D3 levels. Statistical Software for Social Sciences (SPSS) version 23 was used to analyze the data. Results: The mean age and standard deviation (SD) of the patients was 45.11 ± 7.99 years and gender distribution was females 94/184 (51%) and males 90/184 (49%) in patients. There was Vitamin D deficiency in 79/184 (39%) patients. Conclusion: Vitamin D deficiency was common among tuberculosis patients in contrast to control group. The female patients with low Body Mass Index (BMI) (kg/m2) were having the more deficiency of Vitamin D. Vitamin D supplementation has vital role in tuberculosis treatment and prevention. 

Role of Green Tea on Obesity and Type-II Diabetes Mellitus Male Individuals

Objective: To evaluate the effects of Green tea on obesity and hyperglycemia. Methodology: This observational study was carried out at the department of physiology, in affiliation to Medical Research Centre Liaquat University of Medical and Health Sciences Jamshoro. The sample was collected by convenient random sampling. Total 100 participants, 50 controls and 50 obese diabetics were enrolled. Informed written consent was taken from participants. The body mass index (BMI) of the participants was taken at the time of recruitment, and later at 16 weeks of consuming green tea. The serum glucose levels were assessed by fasting (FBS) and random blood sugar (RBS) levels, and HbA1C. The levels of serum Blood glucose were obtained with the glucose oxidase method. Data analysis was done on SPSS 21.0, analysis of variables was done by applying student t-test, the p-value of <0.05 was taken as statistically significant. Results:100 participants recruited out of which 50 controls and 50 obese diabetics men, it was found that the prolong consumption of green tea for 16 weeks with 20-30 minutes’ walk had statistically significant declined in FBS, RBS, HbA1c, and BMI in the obese diabetic subjects, as compared to the controls. Conclusion: This study concludes that the green tea has positive effect in reducing the total body weight and BMI and helps in maintaining the normoglycemic levels in Type 2 DM.

A Multicenter, Open-Label, Single-Arm Study to Evaluate the Efficacy and Safety of Saroglitazar in Patients With Primary Biliary Cholangitis

INTRODUCTION

Patients with primary biliary cholangitis (PBC) without biochemical response to ursodeoxycholic acid (UDCA) are at increased risk of liver-related mortality. Saroglitazar is a novel peroxisome proliferator-activated receptor (PPAR) agonist with dual PPAR agonistic properties (α/γ). There is a strong mechanistic rationale for studying saroglitazar in PBC because PPARα is a molecular target of fibrates that showed improvements in liver tests in patients with PBC.

METHODS

In this 16-week, open-label, phase 3 study, 37 patients were screened across 3 clinical centers to enroll 7 patients. All patients received daily dose of saroglitazar 4 mg for 16 weeks in addition to their ongoing treatment with UDCA. The primary efficacy endpoint was the reduction in alkaline phosphatase (ALP) level at week 16 as compared to baseline.

RESULTS

Mean age of the study population was 51.1 ± 10.0 years, all patients were female of Mexican descent, and mean body mass index was 25.5± = 4.8 kg/m2. Six (85.7%) patients reported taking ursodiol at baseline and continued throughout the study with a mean daily dosage of 417 mg. Among these, the daily dosage of UDCA 500 mg in 4 and 250 mg in 2 subjects, respectively. The mean baseline ALP level was 230 ± 103 U/L. The primary efficacy endpoint, mean change (reduction) from baseline in ALP concentration at week 16 based on the modified intent-to-treat population was -94 ± 53 U/L (P = 0.003), corresponding to a reduction of 48 ± 23%. Treatment with saroglitazar 4 mg resulted in a rapid and sustained decrease of ALP levels at week 4 (-84 ± 47 U/L, P = 0.003). Six patients who completed the study achieved mean ALP reduction of at least 40% at week 4 and all subsequent visits.

DISCUSSION

Although the study was terminated because of lack of enrollment, saroglitazar daily for 16 weeks resulted in rapid and sustained improvements in ALP with an acceptable safety profile in patients with PBC.

Assessment of the Infections and Use of Antibiotics in Pregnancy among the Pregnant Women Reported at Gynae Opd Civil Hospital Khairpur Mirs Pakistan

Introduction: Pregnancy presents uncommon issues regarding anti-infection treatment. A significant concern is the conceivable teratogenic or harmful impact on the fetus. Objectives: The objectives of this study are to assess the infections and use of antibiotics in pregnancy among the pregnant women reported at Gynae OPD Civil Hospital Khairpur Mirs Pakistan. Methodology: This was an observational cross-section study conducted at Gynae OPD Civil Hospital Khairpur Mirs Pakistan from July 2020 to January 2021. A total of 400 sample size was calculated by using Slovin’s Formula. Data were collected by purposive sampling technique. Finally, collected data were analyzed by using a statistical package for social science (SPSS) software version 24.  Results: Results reported commonly prescribed antibiotics during the pregnancy in which Phenoxymethylpenicillin was most commonly prescribed i.e. 31% and it was indicated for Maxillary sinusitis 40% and Acute tonsillitis 74%. The infections which were diagnosed during pregnancy among which vaginal candidiasis was high 117 (29.2%). Common antibiotics duration of treatment was observed in which penicillin frequency for 8-10 days was high 39 (9.7%). Common prescribed antibiotic dosages during pregnancy were observed in which the frequency of penicillin's recommended dose was high at 80 (20%). Antibiotics timing during pregnancy was observed in which Metronidazole+Tinidazole were mostly used during II trimester. Conclusion: The antibiotics use in Khairpur Mirs is very high. The dosage regiment should be properly monitored, according to the pharmacokinetic data of particular antibiotics during the pregnancy.

Assessment of the Patterns of Exercise and Diet Intake among the Pregnant and Pre-pregnant Women Reported at Gynae OPD Civil Hospital Khairpur, Sindh, Pakistan

Objectives: The objective of this study is to assess the patterns of exercise and diet intake among the pregnant and pre pregnant women visiting the Gynae OPD Civil Hospital Khairpur, Sindh, Pakistan. Methodology: This is a descriptive cross sectional study conducted at the Gynae OPD Civil Hospital Khairpur, Sindh, Pakistan, from November 2020 to January 2021. A well-structured questionnaire was introduced to collect the study data and consent was taken. Sample size was calculated by Slovin’s Formula which was 400 with 95% confidence level and 5% margin of error. Results were analyzed by using statistical package for social sciences (SPSS) software version 23. Results: Results reported that, out of 400 women, during pregnancy 304 were not having gestational diabetes, before pregnancy 348 women did not exercise. It was also found that out of 322 having normal range of Body Mass Index (BMI) during pregnancy 36 of participants performed exercise, before pregnancy 40 performed the exercise, during pregnancy 256 did the household work, during pregnancy 42 followed the special diet. Conclusion: It was concluded that women who visited the OPD do not exercise properly and do not take proper diet before and during pregnancy because of inadequate awareness of role of exercise and diet for pregnancy.

Difficult Central Venous Cannulation under Laryngeal Mask Airway Anesthesia in Adolescent

We report a case of difficult central venous cannulation under general anesthesia with laryngeal mask airway in a young female child. Our case demonstrated a difficulty in surgically finding the right internal jugular vein due to neck veins displacements by laryngeal mask airway, which caused morbidity such as prolonged surgical duration and excessive blood loss. Once the laryngeal mask airway was replaced with endotracheal tube, the internal jugular vein appeared on surface and procedure was successfully completed in a few minutes. Such difficulties warrant an alternate approach in airway management in order to prevent major adverse effects.

Thiamine Level in Type I and Type II Diabetes Mellitus Patients: A Comparative Study Focusing on Hematological and Biochemical Evaluations

Objective

Diabetes has been found to be associated with low levels of thiamine stores in the body, as thiamine directly affects carbohydrate metabolism. Amplified renal clearance of thiamine has been found in both type I and type II diabetic patients. It has been shown that high-dose thiamine therapy may have a therapeutic effect on early-stage diabetic nephropathy. The aim of this study was to evaluate various biochemical parameters and serum thiamine levels in type I and type II diabetic patients and compare them with a healthy control group.

Methods

A case-control study was carried out in the diabetic out-patient multi-centers in Karachi. A total of 90 participants were selected by using a non-probability convenient sampling technique and divided into three groups, each with 30 subjects. Group A included healthy non-diabetic subjects, while group B included subjects with type I diabetes mellitus (DM), and group C included subjects with type II DM. After receiving informed consent, blood samples were collected from all the participants for hematological and biochemical evaluation. The duration of the study was eight months.

Results

The study results revealed that the patients with type II DM had significantly higher mean fasting blood sugar (FBS), random blood sugar (RBS), and hemoglobin A1c (HbA1c) levels than those with type I DM or the control group (p<0.001 for all). Furthermore, the patients with type I or II DM had significantly higher mean levels of triglyceride (p<0.001) and total cholesterol (0.013) while significantly lower mean levels of high-density lipoprotein (HDL) (p=0.014) than controls. The study results further revealed that the patients with type I or II DM had significantly lower serum thiamine levels than controls (14.89±4.82 and 7.35±1.90 vs. 69.56±12.75, p<0.001).

Conclusion

The study results revealed that FBS, RBS, HbA1c, triglyceride, and total cholesterol levels were significantly higher in both type I and type II diabetes patients compared to controls. Furthermore, HDL and serum thiamine levels were found to be significantly lower in both type I and type II diabetic patients than in controls.

Failure Mode and Effect Analysis (FMEA) may enhance implementation of clinical practice guidelines: An experience from the Middle East

RATIONALE, AIMS, AND OBJECTIVES

Implementation of clinical practice guidelines (CPGs) has been shown to reduce variation in practice and improve health care quality and patients' safety. There is a limited experience of CPG implementation (CPGI) in the Middle East. The CPG program in our institution was launched in 2009. The Quality Management department conducted a Failure Mode and Effect Analysis (FMEA) for further improvement of CPGI.

METHODS

This is a prospective study of a qualitative/quantitative design. Our FMEA included (1) process review and recording of the steps and activities of CPGI; (2) hazard analysis by recording activity-related failure modes and their effects, identification of actions required, assigned severity, occurrence, and detection scores for each failure mode and calculated the risk priority number (RPN) by using an online interactive FMEA tool; (3) planning: RPNs were prioritized, recommendations, and further planning for new interventions were identified; and (4) monitoring: after reduction or elimination of the failure mode. The calculated RPN will be compared with subsequent analysis in post-implementation phase.

RESULTS

The data were scrutinized from a feedback of quality team members using a FMEA framework to enhance the implementation of 29 adapted CPGs. The identified potential common failure modes with the highest RPN (≥ 80) included awareness/training activities, accessibility of CPGs, fewer advocates from clinical champions, and CPGs auditing. Actions included (1) organizing regular awareness activities, (2) making CPGs printed and electronic copies accessible, (3) encouraging senior practitioners to get involved in CPGI, and (4) enhancing CPGs auditing as part of the quality sustainability plan.

CONCLUSION

In our experience, FMEA could be a useful tool to enhance CPGI. It helped us to identify potential barriers and prepare relevant solutions.

Quality of life, continence and frequency of pouchitis following laparoscopic versus open colectomy and ileal pouch-anal anastomosis: an Irish perspective

BACKGROUND

This study aims to assess quality of life outcomes, continence, rates of pouchitis and predictors of pouchitis for patients undergoing laparoscopic versus open three-stage ileal pouch-anal anastomosis (IPAA) surgery in our institution.

METHODS

Forty-two patients having had three-stage (IPAA) surgery were identified. One was excluded as they had undergone pouchectomy. A postal questionnaire followed by telephone contact was undertaken. The questionnaire was based on The Gastrointestinal Quality of Life Index (GIQLI) and Wexner/Cleveland Clinic Faecal Incontinence Symptom Severity Scoring Systems.

AIMS

Our aim was to assess morbidity, quality of life, incidence of pouchitis and continence following restorative panproctocolectomy and IPAA.

RESULTS

Thirty-five patients completed the response. The median age at colectomy of our patient population was 32 years. 57 % were male and 43 % were female. 54.3 % of cases were carried out laparoscopically. 8/19 patients who had laparoscopic surgery had pouchitis (42.1 %) versus 9/16 patients who had open surgery (56.3 %). The median Wexner score was 0. Nine patients (25.7 %) had a GIQLI score that was within or above the range reported for healthy controls. The rate of complications was 31.7 % for emergency cases and 25.7 % for elective cases. The rate of pouchitis in this group was 48.5 %. Overall pelvic sepsis rate was 12.8 %.

CONCLUSIONS

Ileal pouch-anal anastomosis is a successful and well-tolerated procedure with 94 % of patients opting to have the surgery again. Preliminary results do not show any significant difference in the incidence of pouchitis following laparoscopic surgery.