Rift Valley fever virus outbreak in Mauritania yet again in 2022: No room for complacency.

Rift Valley fever is an important yet ignored viral hemorrhagic fever claiming many lives of African and Arabian countries over the past decade. Unfortunately, a recent outbreak of Rift Valley fever is currently ravaging in Mauritania. Death toll is rising continuously with 23 deaths reported in the month of October, 2022. Our article aims to shed light on the ongoing Rift Valley fever outbreak and recommendations to eradicate this potential threat to public health. Online databases including PubMed, the Lancet, and Science Direct as well as conferences, news, and press releases were used to for data collection. All the available medical literature related to Rift Valley fever in Mauritania were taken into consideration while writing the manuscript. As of October 17, 2022, 47 cases have been documented out of which 23 are dead. Case fatality rate has been reached to 49% which has given a wakeup call to the authorities. Efforts are being made by the concerned authorities and World Health Organization to halt the progression of this outbreak. Further investigations are required to completely eradicate the recurrent outbreaks in Mauritania especially in the area of vaccine development. Active involvement of public with the government authorities is of extreme significance in combating this disease.

Effects of testosterone therapy in adult males with hypogonadism and T2DM: A meta-analysis and systematic review.

BACKGROUND AND AIMS: Testosterone supplementation therapy (TST) is a longstanding treatment for hypogonadal men with type 2 diabetes mellitus (T2DM), even though the benefits of TST are variable among trials. This meta-analysis was done to determine the specific role of TST in hypogonadal men with T2DM. METHODS: PubMed, Embase, and Google Scholar were queried to discover eligible randomized controlled trials (RCTs) and observational studies. To quantify the specific effects of TST, we estimated pooled mean differences (MDs) and relative risks with 95% confidence intervals (CIs). RESULTS: Our meta-analysis included 1596 hypogonadal T2DM subjects from 12 randomized controlled trials and one observational study. TST can significantly enhance glycemic control compared to placebo by decreasing homeostatic model assessment of insulin resistance (WMD = -1.55 [-2.65, -0.45]; p = 0.26; I2 = 20.2%), fasting glucose (WMD = -0.35 [-0.79, 0.10]; p = 0.07; I2 = 69.7%), fasting insulin (WMD = -2.88 [-6.12, 0.36]; p = In addition, TST can decrease cholesterol (WMD = -0.28 [-0.47, -0.09] p = 0.0008; I2 = 91%) and triglyceride (WMD = -0.23 [-0.43, -0.03] p = 0.03; I2 = 79.2%). Furthermore, Testosterone therapy is related to a significant rise in total testosterone levels (WMD = 5.08 [2.90, 7.26] p = 0.0002; I2 = 92.9%). Pooling of free testosterone levels indicated a larger increase in the patients who got TST than placebo (WMD = 81.21 [23.87, 138.54] p = 0.07; I2 = 70%). CONCLUSION: Our findings suggested that TST can enhance glycemic control and hormone levels and reduce total cholesterol, triglyceride, LDL cholesterol whereas increase HDL cholesterol in hypogonadal T2DM patients. Therefore, in these patients, we propose TST alongside anti-diabetic treatment.

Effect of augmented glycation in mobilization of plasma free fatty acids in type 2 diabetes mellitus.

BACKGROUND AND AIMS: Type 2 Diabetes Mellitus (T2DM) is known to be associated with an increase in total plasma free fatty acid (FFA) concentration. The present study was conducted to determine the changes in plasma fatty acids at different levels of glycation in type 2 diabetes mellitus. METHODS: The study involved 50 subjects having different levels of glycation (HbA1c 4.9-15.0%) and further categorized in 5 groups [group 1 (HbA1c <6%), group 2 (HbA1c 6-7%), group 3 (HbA1c 7.1-9%), group 4 (HbA1c (9.1-12%) and group 5 (HbA1c >12%)] with 10 subjects in each group. RESULTS: A total of 19 free fatty acids were detected by gas chromatography-mass spectrometry (GC-MS) analysis in the plasma samples. The levels of lauric acid (C12:0) and stearic acid (C18:0) were significantly raised at an advanced stage of glycation (HbA1c 9.1-15%). Long-chain fatty acids, pentadecanoic acid (C15:0) and palmitic acid (C16:0) levels were elevated in hyperglycemia as compared to normoglycaemic subjects (HbA1c <6%). Moreover, levels of mono and polyunsaturated fatty acids, oleic acid (C18:1) and linoleic acid (C18:2, w6) were significantly decreased in patients with increased levels of glycation (HbA1c 6-15%). CONCLUSION: GC-MS is a novel way to study the plasma fatty acid profiling and findings of this study suggest that monitoring alterations in plasma FFA profile may be of prognostic value.

OBSERVANCE OF WHO TEN STEPS TOWARDS SUCCESSFUL BREASTFEEDING; A SURVEY FROM POSTPARTUM MOTHERS.

BACKGROUND: Breastfeeding is a physiological phenomenon; nonetheless, this act is a learned behaviour that requires continuous active support to make it successful. This study determines the frequency of mothers practicing successful breastfeeding according to the WHO ten steps at tertiary care hospital. METHODS: A descriptive cross sectional study was conducted in the Obstetrics department of Military Hospital, Rawalpindi over six month duration from July to December 2014. Booked mothers aged 15-49 years, having given birth to healthy, singleton baby were included in the study. Questions were asked after taking written informed consent from the mothers after delivery. Data was entered and analysed on SPSS version 20. RESULTS: Out of 148 mothers, 35 (23.7%) mothers were following successful breastfeeding, i.e., knew 7 or more steps. A total of 100 (67.6%) mothers received support for breastfeeding by healthcare staff during their stay in hospital while 19 (12.8%) mothers started breastfeeding within one hour. About 71% had started formula milk along with breastfeeding. About 127 (85.8%) reported that they fed their children on demand and 144 (97.3%) did not use dummies. Statistically significant difference was observed as housewife mothers gave no top feed (p = 0.005) and multiparous mothers started breastfeeding within one hour of delivery (p = 0.04). CONCLUSION: The steps to achieve successful breastfeeding are followed to a small extent among mothers. Delayed initiation of breastfeeding and increasing trend towards use of formula feed was observed. Employed, primiparous mothers are the most sensitive group to be focused during antenatal period.

Competency profile of locally manufactured clopidogrel Lowplat and foreign manufactured clopidogrel Plavix in patients of suspected ischemic heart disease (CLAP-IHD).

OBJECTIVE: The primary objective of this study was to test the hypothesis that the antiplatelet effects of loading dose of locally manufactured clopidogrel Lowplat referred as drug (B) 600 mg (8 tablets) given once is comparable to the antiplatelet effects of loading dose of foreign manufactured clopidogrel Plavix referred as drug (A) 600 mg (8 tablets) given once in patients with suspected ischemic heart disease. METHODS: This was a double blind, randomized, cross over, study, to compare the safety and efficacy of study drug (B) versus (A) in adult subjects suffering from suspected ischemic heart disease presented at National Institute of Cardiovascular Disease (NICVD), Karachi. RESULTS: Mean platelet aggregation inhibition by drug (B) was 60.7% (p<0.001), while with drug (A) it was 57.8% (p<0.001), using 20 micromol/L ADP, which is statistically significant and comparable. Clopidogrel 600 mg as loading dose was well tolerated. CONCLUSION: Both drugs were equally effective in reducing the platelet aggregation. CLAP-IHD confirmed that drug (B) and (A) are equally effective and comparable antithrombotics in Pakistani population. The cost benefit of drug (B) should be made beneficial to the patients.

Blood pressure and hypertension distribution in a lower middle class urban community in Pakistan.

OBJECTIVE: To determine the awareness level, blood pressure profile and its correlates in Metroville Health Study and to compare the results with those of Pakistan National Health Survey and National Health and Nutrition Examination Survey of USA. METHODS: Sample consisted of 400 households of Metroville, included after informed consent. Demographic data was collected and Blood pressure, Cholesterol, Blood Glucose, Height and weight were measured. Obesity was calculated as BMI. The results were compared with those of the Pakistan National Health Survey and National Health and Nutrition Examination Survey of USA. RESULTS: For both sexes and all age groups, hypertension was more prevalent in MHS than Pakistan National Health Survey (PNHS) and U.S. MHS hypertensives were more likely to be aware of and treated for their condition than hypertensives of PNHS, but less likely than U.S. hypertensives. Systolic and diastolic blood pressure (DBP) rose with increased age in all three populations. Blood pressure also rose with increased body mass index (BMI) in MHS as well as PNHS and NHANES, with little differences in the degree of rise among them. A one-kg/Height (in m approximately) increment in BMI was associated with a 0.40-0.67 mmHg increment in systolic pressure in men and a 0.56-0.74 mmHg increment in women. The main difference between USA and two Pakistani surveys was the level of DBP, which was significantly higher in Pakistani Surveys than NHANES, for both men and women. CONCLUSIONS: The prevalence of Hypertension in Metroville was high. It showed a quantitative relationship to increasing age and BMI. Hypertension and obesity were the major public health problems in the lower middle class community of Metroville. It is recommended that awareness should be increased and preventive measures implemented.

Evaluation and comparison of blood pressure profiles of Pakistani cohort of children.

OBJECTIVE: To determine the blood pressure profile of children in Metroville, a lower middle class urban community of Karachi, Pakistan, and compare it to Pakistan National Health Survey of children. DESIGN: A research survey. PLACE AND DURATION OF STUDY: The study was conducted by National Institute of Cardiovascular Diseases, Karachi from 1996 2002. SUBJECTS AND METHODS: The blood pressure data was generated at the base line examination of MHS and was used to define the BP profile of urban Metroville children, age 2-17 years. Similar data of Pakistan National Health Survey (PNHS) undertaken by Pakistan Medical Research Council (PMRC), was used for comparison. RESULTS: A comparison of the blood pressure profile of the MHS with that of the PMRC showed that blood pressure was lower in the MHS. Additionally, comparison of the PMRC profile with USA data showed higher diastolic pressure in the PMRC. Comparison of Pakistani profiles with European data also showed higher blood pressure in Pakistani children. CONCLUSION: It is concluded that the MHS represents the BP profile of children in newly emerging lower middle class urban communities in Pakistan. PMRC data represents national average and can be used to define the blood pressure characteristics of urban communities similar to Metroville. The comparison with affluent countries highlighted the urgent need for community based preventive programs to combat hypertensive diseases in Pakistan.

Short- and intermediate-term follow-up results of percutaneous transluminal balloon valvuloplasty in adolescents and young adults with congenital pulmonary valve stenosis.

Percutaneous pulmonary balloon valvuloplasty (PBV) is a well-established treatment alternative to surgery in many cardiology centers. We described our experience with PBV in 25 adolescent and young adult patients with isolated pulmonary valve stenosis (PVS). Among 20 successful PBVs, there was a significant immediate decrease in right ventricular systolic pressure from 116.9 32.4 mmHg to 60.5 18.7 mmHg (p < 0.0001) and a decrease in transpulmonary valve pressure gradient from 93.5 32.8 mmHg to 33.5 9.7 mmHg (p < 0.0001) was noted. The follow-up period was 1-5 years (mean = 3.2 1.2 years), during which patients were periodically assessed by Doppler echocardiogram. During follow-up, the transpulmonary valve pressure gradient further decreased from 33.5 9.7 mmHg to 18.6 3.4 mmHg (p < 0.0001) mainly due to regression of infundibular hypertrophy. Thus, the study showed excellent short-term and intermediate-term results of PBV.