Exploring determinants of sex and family history-based disparity in type 2 diabetes mellitus prevalence among clinical patients.

BACKGROUND: Type 2 diabetes mellitus represents a multifaceted disorder characterized by intricate pathophysiological mechanisms, encompassing diminished insulin secretion, augmented hepatic glucose production, and heightened insulin resistance. This study aims to assess the sex (Male and Female only) and family history-based differences in the prevalence of T2DM and explore the determinants contributing to this disparity among clinical patients. SUBJECTS AND METHODS: The study encompassed a diverse pool of clinical patients, encompassing both individuals with diabetes and those without the condition, who had previously sought medical attention for clinical checkups at healthcare centers. The collected data included essential parameters such as blood pressure, weight, height, smoking habits, educational background, and physical activity levels. To ensure methodological rigor and data accuracy, blood pressure measurements adhered to the stringent guidelines set forth by the World Health Organization. RESULTS: Participants of the present study reported diabetes, among which notable findings emerged regarding health indicators. It was observed that the prevalence of high blood pressure, obesity, and high blood cholesterol exhibited a statistically significant increase among the female participants, underscoring the sex-based disparities in these health parameters. The male population aged 60 or older, the presence of a family history of DM accentuated this risk, resulting in a striking 3.1 times higher prevalence compared to females, who exhibited a 2.4 times higher risk (OR = 2.4, p = 0.0008). This intriguing relationship between diabetes and cholesterol levels was not limited to sex. Both male (OR = 2.47) and female (OR = 2.1) diabetes patients displayed highly significant associations with cholesterol levels. The risk of T2DM was significantly associated with triglycerides in both sexes (1.58 times higher in males, and 1.71 times higher in females). CONCLUSIONS: The significance of hypertension as a comorbidity in T2DM, highlighting sex-specific associations and the potential impact of a family history of diabetes on blood pressure. Our findings emphasize the importance of considering lipid profiles, obesity, and their sex-specific associations when assessing and managing diabetes risk. Comprehensive diabetes care should include strategies for lipid control, weight management, and cardiovascular risk reduction, tailored to the individual's sex and specific risk profile.

Mapping of global research on familial Mediterranean fever: a SCI-Expanded-based bibliometric analysis.

BACKGROUND: Familial Mediterranean fever (FMF) is a disease of the innate immune system. The disease is prevalent in the Mediterranean region. A comprehensive bibliometric analysis of the published literature on FMF indexed in the SCI-Expanded is lacking. OBJECTIVE: To review the global research trend, developments, leading authors, journals, institutions, and countries, and visualization mapping of the published scientific literature on FMF. METHODS: The data were obtained from SCI-Expanded of the WoSCC database. The obtained data were analyzed using Bibliometrix: An R-tool and an online Bibliometric tool. P-value less than 0.05 was considered statistically significant. RESULTS: In this study, a total of 1665 publications (research article, 92% and review, 8%) on FMF were analyzed and characterized. These publications were authored by 5630 authors, and published in 465 journals. The scientific production in FMF research has been increasing over time (p < 0.0001), with scientific annual growth of 3.96%. The most frequent year of publications was 2021 (n = 98), while the most attractive and published journal in FMF research was Rheumatology International (n = 116). The leading institution was Hacettepe University. The top ranked and most cited country in FMF research was Turkey. In total, the authors' collaboration index was 3.47. CONCLUSION: Generally, FMF scientific research production has increased over the last two decades. The most studied research areas in FMF were rheumatology, general internal medicine and genetics heredity. The most studied recent trend topics in FMF research were validity, reliability, endothelial dysfunction, management, and recommendations. Moreover, regional collaboration between less active countries should be extended in order to expand FMF-related research and thus prevent and control the disease in the near future.

The impact of COVID-19 pandemic on anxiety and depression among physical therapists in Saudi Arabia: a cross-sectional study.

BACKGROUNDS: A physical therapist may become infected while treating a patient since they are in direct contact with them or within a two-meter radius. In addition, physical therapists may feel that they are more susceptible to COVID-19 infection when applying rehabilitation practices, which often involve direct contact with patients. The physical therapist were surveyed on their level of anxiety and depression due to the Coronavirus disease pandemic (COVID-19). METHODS: The physical therapists were asked to complete two reliable and validated scales, the Generalized Anxiety Disorder scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), to identify the presence of anxiety and depression in the participants. In addition, logistic regression models were used to determine the general characteristics of anxiety or depression. RESULTS: Among the 117 physical therapists who completed and participated in the study, 74 (63%) and 65 (55.5%) physical therapists reported having symptoms of anxiety and depression, respectively. The prevalence of overall anxiety levels was higher; mild (OR = 2.09; P = 0.08), moderate (OR = 2.26; P = 0.15), and severe levels six times as high (OR = 6.28; P = 0.1) in females compared to male physical therapists. Females, younger age, unmarried individuals, not having children, and not living with family showed a higher prevalence of anxiety and depression. Binary logistic regression analysis also revealed that the female gender, a single individual, and having no children were associated with anxiety and depression. CONCLUSIONS: A significant percentage of physical therapists reported symptoms of anxiety and depression, especially among females, younger age, single individuals, not having children, and not living with family. Thus, the mental health of physical therapists is suggested to be constantly and cautiously monitored, especially for those at high risk of developing psychological symptoms.

Comparison of Ondansetron versus Domperidone for treating vomiting in acute gastroenteritis in children at a resource limited setting of South Punjab, Pakistan.

Objectives: To compare the efficacy of Ondansetron versus Domperidone for treating vomiting in acute gastroenteritis (AGE) in children at a resource limited emergency setting of South Punjab, Pakistan. Methods: This open label randomized controlled trial was conducted at The Pediatric Emergency Department of Tehshil Headquarter Hospital, Liaqatpur, Pakistan, from July 2020 to June 2021. A total of 300 children of both genders aged below 12 years of age having 3 or more non-bilious, non-bloody vomiting episodes within 24 hours and with suggestive signs and symptoms of AGE were enrolled and randomized (150 in each group). Efficacy of both drugs was compared in terms of need of 2nd dose within 15 minutes, cessation of vomiting at 6-hour and 24-hour follow up. Results: Out of a total of 300 children, 162 (54.0%) were male. Mean age was 4.7±2.3 years. Twenty seven (18.0%) children in Ondansetron group required 2nd dose within 15 minutes while 38 (25.3%) children in Domperidone group required the 2nd dose (p=0.1232). Cessation of vomiting at 6-hour interval was noted among 126 (84.0%) children in Ondansetron group in comparison to 118 (78.7%) in Domperidone group (p=0.2359). It was revealed that 127/142 (89.4%) children in Ondansetron group had cessation of vomiting at 24-hours follow up while this was noted to be among 108/134 (80.6%) children in Domperidone group (p=0.0390). Conclusion: In comparison to Domperidone, Ondansetron was found to have better efficacy aiming cessation of AGE associated vomiting among children with mild to moderate dehydration.

An insightful estimation of undergraduate medical students' experience about the Flipped Classroom.

BACKGROUND AND OBJECTIVE: The Flipped Classroom (FC) approach has become increasingly predominant and popular in medical education. This study aimed to explore the usefulness and the scope of FC based on medical students' experience, with their adaptation challenges. METHODS: The present study was a mixed-method accomplished during the academic years 2019-20, involving fourth-year students at the College of Medicine in Riyadh, Saudi Arabia. A self-administered questionnaire was used to seek their first experience and opinion of the FC. RESULTS: A total of 234 questionnaires were distributed to the students, and 214 students completed the survey (response rate of 91.45%). Out of this total, 68.2 % were males and 31.8% were females. Most of the students agreed 156 (72.9%) that the flipped classroom was more engaging than the traditional lecture, among them 100 (68.5%) males and 56 (82.3) females agreed. Almost ~79% of students liked FC as it enabled them knowing the material in advance, and the class time was spent clarifying the facts and principles with active interaction, as commented during focus group discussion "More chance for discussing with the doctors, and I got the chance to answer" (St. 6). CONCLUSION: The results showed that the students like the FC more than the conventional classroom. Suggestions were given by students to improve the active learning sessions within the FC modality.

Anti-Inflammatory Activity of Fucoidan Extracts In Vitro.

Fucoidans are sulfated, complex, fucose-rich polymers found in brown seaweeds. Fucoidans have been shown to have multiple bioactivities, including anti-inflammatory effects, and are known to inhibit inflammatory processes via a number of pathways such as selectin blockade and enzyme inhibition, and have demonstrated inhibition of inflammatory pathologies in vivo. In this current investigation, fucoidan extracts from Undaria pinnatifida, Fucus vesiculosus, Macrocystis pyrifera, Ascophyllum nodosum, and Laminaria japonica were assessed for modulation of pro-inflammatory cytokine production (TNF-α, IL-1ß, and IL-6) by human peripheral blood mononuclear cells (PBMCs) and in a human macrophage line (THP-1). Fucoidan extracts exhibited no signs of cytotoxicity in THP-1 cells after incubation of 48 h. Additionally, all fucoidan extracts reduced cytokine production in LPS stimulated PBMCs and human THP-1 cells in a dose-dependent fashion. Notably, the 5-30 kDa subfraction from Macrocystis pyrifera was a highly effective inhibitor at lower concentrations. Fucoidan extracts from all species had significant anti-inflammatory effects, but the lowest molecular weight subfractions had maximal effects at low concentrations. These observations on various fucoidan extracts offer insight into strategies that improve their efficacy against inflammation-related pathology. Further studies should be conducted to elucidate the mechanism of action of these extracts.

Treatment outcomes of patients with tuberculosis in war affected region of Khyber Pakhtunkhwa, Pakistan.

BACKGROUND: Globally, tuberculosis (TB) remains the leading cause of death from a single infectious disease. TB treatment outcome is an important indicator for the effectiveness of a national TB control program. This study aimed to assess treatment outcomes of TB patients and its determinants in Batkhela, Khyber Pakhtunkhwa, Pakistan. METHODS: A retrospective cohort study was designed using all TB patients who were enrolled at District Head Quarter (DHQ) Hospital Batkhela, Pakistan, from January 2011 to December 2014. A binary logistic regression models were used to identify factors associated with successful TB treatment outcomes defined as the sum of cure and completed treatment. RESULTS: A total of 515 TB patients were registered, of which 237 (46%) were males and 278 (53.98%) females. Of all patients, 234 (45.44%) were cured and 210 (40.77%) completed treatment. The overall treatment success rate was 444 (86.21%). Age 0-20 years (adjusted odds ratio, AOR = 3.47; 95% confidence interval, CI) = 1.54-7.81; P = 0.003), smear-positive pulmonary TB (AOR) = 3.58; 95% CI = 1.89-6.78; P = < 0.001), treatment category (AOR = 4.71; 95% CI = 1.17-18.97; P = 0.029), and year of enrollment 2012 (AOR = 6.26; 95% CI = 2.52-15.59; P = < 0.001) were significantly associated with successful treatment outcome. CONCLUSIONS: The overall treatment success rate is satisfactory but still need to be improved to achieve the international targeted treatment outcome. Type of TB, age, treatment category, and year of enrollment were significantly associated with successful treatment outcomes.

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

BACKGROUND: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. METHODS: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. RESULTS: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. CONCLUSIONS: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

BACKGROUND: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. METHODS: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). FINDINGS: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). INTERPRETATION: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

Coronavirus Disease 2019 (COVID-19) Pandemic and Economic Impact.

In less than two decades, the world has experienced three outbreaks of deadly Coronaviruses, including the recent pandemic of Coronavirus Disease 2019 (COVID-19) in China. COVID-19 posed an emergency of international concerns, and cases have been reported in more than 200 countries/regions that resulted in health, lives, and economic losses. China's economic growth is projected to fall to 5.6% this year, the International Monetary Fund (IMF) projected that policy investment and tax policies to implement $3.3 trillion and contributes further $4.5 trillion. IMF forecasts grow from 3.7% of global gross domestic product (GDP) in 2019 to 9.9% in 2020. GDP ratio projected from 3.0% in 2019 to grow 10.7% in 2020, the US ratio expected to increase from 5.8% to 15.7%. France, Germany, Italy, Japan, and the United Kingdom (UK) each reported public sector funding programs totalling > 10% of their yearly GDP. There is a dire need for regional and international co-operation to extend hands to prevent further spreading of COVID-19.

Morning cortisol as an alternative to Short Synecthan test for the diagnosis of primary adrenal insufficiency.

OBJECTIVE: To determine 7-9 am serum cortisol less than 5mcg/dl is an independent reliable confirmatory test for the diagnosis of primary adrenal insufficiency (PAI). METHODS: A total of 164 patients who visited the outpatient or inpatient department of Aga Khan University Hospital from June 2011 to June 2017 were included for the study. All those patients whose levels came out less than 5mcg/dl were recruited for the study and they all underwent SST. Other demographic and laboratory data were also recorded. RESULTS: The sensitivity of morning cortisol for diagnosis of PAI is 100% if levels are <1mcg/dl and decreases to 71.88% if levels are up to 5mcg/dl. CONCLUSION: Morning cortisol is sensitive enough as an alternative to SST if levels are <1mcg/dl (100%). However, if the levels are increased from > 1mcg/dl to < 5 mcg/dl, the sensitivity decreases gradually from 98% to 71%.

Meteorological factors and its association with hand, foot and mouth disease in Southeast and East Asia areas: a meta-analysis.

Since the late 1990s, hand, foot and mouth disease (HFMD) has become a common health problem that mostly affects children and infants in Southeast and East Asia. Global climate change is considered to be one of the major risk factors for HFMD. This study aimed to assess the correlation between meteorological factors and HFMD in the Asia-Pacific region. PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data and Weipu Database were searched to identify relevant articles published before May 2018. Data were collected and analysed using R software. We searched 2397 articles and identified 51 eligible papers in this study. The present study included eight meteorological factors; mean temperature, mean highest temperature, mean lowest temperature, rainfall, relative humidity and hours of sunshine were positively correlated with HFMD, with correlation coefficients (CORs) of 0.52 (95% confidence interval (CI) 0.42-0.60), 0.43 (95% CI 0.23-0.59), 0.43 (95% CI 0.23-0.60), 0.27 (95% CI 0.19-0.35), 0.19 (95% CI 0.02-0.35) and 0.19 (95% CI 0.11-0.27), respectively. There were sufficient data to support a negative correlation between mean pressure and HFMD (COR = -0.51, 95% CI -0.63 to -0.36). There was no notable correlation with wind speed (COR = 0.10, 95% CI -0.03 to 0.23). Our findings suggest that meteorological factors affect the incidence of HFMD to a certain extent.

Outbreak investigation report of dengue fever during June-November 2014: A case study of district Swat, Pakistan.

OBJECTIVE: To determine the frequency distribution of dengue fever during the 2014 outbreak in a district in northern Pakistan. METHODS: This cross-sectional study was conducted between June and November, 2014, at Saidu Sharif Teaching Hospital, Swat, Pakistan, where patients were screened for dengue virus non-structural protein using Dengue Duo strips from Standard Diagnostics (SD). Data was obtained from patient's record, filled forms and through questionnaire. RESULTS: Of the total 812 patients, 290(35.71%) tested positive for dengue virus non-structural protein, of whom 175(60.34%) were males and 115(39.66%) were females. Overall, 146(50.34%), cases were recorded in the 16-30 age group, while 7(2.41%) were reported in those aged >60 years. The highest numbers of cases were recorded from Faizabad 84(28.96%), whereas the lowest numbers of cases 42(14.48%) were reported from Sethi Amankot. CONCLUSIONS: Dengue virus affected male individuals more compared to female. The affected areas had poor drainage and water storage system.

Outcome of radioactive iodine therapy in Toxic Nodular Goiter in Pakistan.

OBJECTIVE: To determine the outcome of patients receiving radioactive iodine therapy for toxic nodular goiter coming to Aga Khan University Hospital Karachi. METHODS: A total of 89 patients who visited the outpatient department of Aga Khan University Hospital from January 2010 to August 2017 were recruited for the study. Toxic nodular goiter was diagnosed on the basis of having hot nodule on thyroid scan with low TSH and high FT4/T4. Other demographic and laboratory data were also recorded. RESULTS: Eighty nine patients with toxic nodular goiter received a dose range from 10 to 30mCi RAI. Six months after RAI, 36.2% became hypothyroid, 38.5% became euthyroid while 25.3% remained hyperthyroid. Thyroid outcome at 3 months were correlating with 6 months results. CONCLUSION: Radioactive iodine therapy is a safe and effective way of treating toxic nodular goiter which usually results in cure of hyperthyroidism in majority of patients.

Medical students' perception of the progress test as a quality-controlled assessment tool for improving learning and teaching, at a public sector medical college in Saudi Arabia.

Progress test's distinguishing characteristics make it pertinent worldwide. We explored medical students' perceptions and opinions about Progress Test (PT) with a view to identifying areas concomitant with it's execution. This cross-sectional study took place at College of Medicine, Saudi Arabia, during the academic year 2015-16. A questionnaire (14 items) was administered. Reason for majority n=96 (89.7%) of the total participants to take the PT was their keenness to compare their academic standing with their peers from other participating medical colleges. The majority of students were highly satisfied with PT implementation; i.e. its orientation (58.9%) and allocated time (90.7%). Students (76.6%) considered PT to offer academic support as future physicians. Students (75.7%) also agreed to participate in the future PT. Students being highly satisfied with the organization of PT. They found it to be a tool helping them to focus on improving the knowledge domain.

Principled physicians are not born-they are mentored: Medical students perception of the values and need of mentors at the College of Medicine, Saudi Arabia.

OBJECTIVE: To discuss the perception of medical students about mentoring at the medical school. METHODS: This cross-sectional descriptive study was conducted at the King Saud University, Riyadh, Saudi Arabia, from April 2015 to April 2016, and comprised medical students. A well-structured, bilingual (English and Arabic) quantitative questionnaire with 21 items was administered online via Google Docs to the students. SPSS 21 was used for data analysis. RESULTS: Of the 311 students who received the questionnaire, 296(95.17%) completed it. Of them, 257(86.8%) expressed an interest in having a mentor during their medical school career and 276(93.2%) selected the role of their mentor as a "guide". Moreover, 107(36.1%) students agreed that it was "not important at all" that their mentor should be of the same gender. CONCLUSIONS: Participants were interested in having a mentor during their medical school career.

Microalbuminuria in Type-2 Diabetes Mellitus; the tip of iceberg of diabetic complications.

OBJECTIVE: To determine the prevalence of microalbuminuria and its association with hypertension and other diabetic complications among Type-2 diabetic patients attending at Aga Khan University Hospital Karachi. METHODS: 1280 Type-2 diabetes patients who visited the outpatient department of Aga Khan University Hospital from September 2014 to August 2016 were included in the study. Microalbuminuria was diagnosed if spot urinary microalbumin excretion was confirmed to be more than 20mg/l. Hypertension was diagnosed if BP >140/90 or already on antihypertensive medications. Other demographic, clinical and laboratory data were also recorded. RESULTS: Microalbuminuria was diagnosed in 404(31.56%) patients and among these albuminuric patients 335(82.9%) had hypertension. They were also dyslipidemic, having raised triglyceride levels, lower HDL levels, with more prevalence of background diabetic retinopathy and peripheral neuropathy. They also showed higher HbA1C levels and longer duration of diabetes. CONCLUSION: The prevalence of the microalbuminuria in our patients with Type-2 diabetes is 31.56% and is not only an early sign of diabetic nephropathy but also a host of other diabetic complications and should be dealt early with strict control of their hyperglycemia and hypertension to help prevent the future complications.