Association of Obesity With Type 2 Diabetes Mellitus: A Hospital-Based Unmatched Case-Control Study.

Background The prevalence of type 2 diabetes mellitus (T2DM) and obesity is alarmingly increasing with the accessibility of the modern lifestyle. This study aimed to assess the association of obesity with T2DM among the patients visiting the Medicine Department of Ayub Teaching Hospital, Abbottabad, Pakistan. Method This hospital-based, unmatched case-control study was conducted from March 2022 to September 2022. A total of 200 patients (age ≥ 18) (100 cases and 100 controls) were recruited. Those patients with a history of T2DM were selected as cases, and those without diabetes were selected as controls after taking informed written consent. Patients with BMI ≥ 25 were considered obese. Data were collected through a non-probability convenience sampling technique using a self-structured non-validated questionnaire. Data were organized and analyzed through IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY). Results We found a significant positive association of obesity with T2DM with a crude odds ratio of 3.6 (95% CI: 2.0-6.6), a p-value of 0.000, and an adjusted odd ratio of 3.7 (95% CI: 1.9 - 7.1), with a p-value of 0.004 (adjusted for potential confounders, including gender, age group, stress, and status of physical activeness) using a logistic regression model. Conclusion It is concluded that obesity is strongly associated with developing T2DM and lack of physical activity, people over 45 years, and males with obesity have a higher chance of developing T2DM.

Isaric 4c Mortality Score As A Predictor Of In-Hospital Mortality In Covid-19 Patients Admitted In Ayub Teaching Hospital During First Wave Of The Pandemic.

BACKGROUND: Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)- ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care. METHODS: This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included. RESULTS: A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality. CONCLUSIONS: The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start.

Availability And Storage Conditions Of Essential Medicines At Primary Healthcare Facilities In Punjab, Pakistan.

BACKGROUND: Availability of essential medicines is one of the most important universal human right. For one third of the world, unavailability of essential medicines remains a major problem. The objective of this study is to authenticate the availability of essential medicines along with the storage conditions at primary healthcare level, district central warehouses and private pharmacies in the rural areas. METHODS: A community based cross-sectional survey was conducted in five districts of Punjab, Pakistan. Data was collected retrospectively and prospectively, by World Health Organization (WHO) tool, Operational Package for Assessing, Monitoring and Evaluating Country Pharmaceutical Situations. RESULTS: On an average availability of essential medicines in primary healthcare, private pharmacies, and warehouses were 90.32±1.78 (SD), 82.83±2.75 (SD) and 96±0.83 (SD), respectively. Stock out duration of essential medicines in primary healthcare and district central warehouses were 11.56±4.08 (SD) and 10.24±5.95 (SD) respectively. Expired medicines were not found. Storage conditions of medicines in store room in PHC, private pharmacies and district central warehouses were 75.76±1.53(SD), 73.33±2.16 (SD), and 82.0±2.48 (SD) respectively. Storage conditions of dispensing room in PHC and private pharmacies were 66.06±2.52 (SD) and 39.65±4.25 (SD) respectively. CONCLUSION: Availability of essential medicines was below WHO standards. Medicines were found to be stocked out. No expired medicine was found on shelves. Storage conditions of medicines were poor.

Factors Influencing Healthcare Seeking Behaviour At Primary Healthcare Level, In Pakistan.

BACKGROUND: The objective of this study is to explore the factors which influence the health seeking behaviour and utilization of healthcare services of the community in context of geographical, socio-demographic, cultural, economic and educational background. METHODS: A community based cross-sectional survey was performed on 900 households in five districts of Punjab from 1st February to 2nd March, 2016. In each of the selected district random sampling method was used for selection of six primary health facilities. Nine hundred household purposively selected around each selected PHCF in opposite direction at distance of 5, 10, 15 km. A pretested questionnaire, WHO operational package (for assessing, monitoring and evaluating country pharmaceutical situations Level IIb) was acquired, and analysed by SPSS 23. RESULTS: In 900 households visited, total population was 5024, out of which females and males were 47.7% and 52.3% respectively. About 95% of community had source of income. The male respondents and females were 95% and 5% respectively. 43.3% of patients visited PHCF, were with the serious complaints. 37% patients in households didn't take medicines when got sick. Females who completed their primary education were same in number as male but after primary education, males were more who perused further education. For 14% of the respondents, PHC was too far and for 61.9% of the respondents, PHC was close to reach.74.5% of the respondents were not satisfied with timings. 42.7% got medicines they need from PHC. Community with access <15 min to PHCF were 57.2%, and >1 hour was 5%. 49.1% of respondents could get free medicines from PHC. 64.4% respondent found medicines expensive at private pharmacies. In 53.3% of the cases, prescriber was doctor and for 47.6% were trained health assistant. CONCLUSIONS: There is a potential to improve the health seeking behaviour and PHC utilization by addressing the demandside (community) factors created by geographical access, socio-economic factors, level of education, cultural beliefs and by healthcare system itself. Male dominance was found. Level of education was more among males. Physical access was a significant barrier. Availability of medicines was low. There was absence of doctor at PHCF..

A Survey On Household Storage Of Medicines In Punjab, Pakistan.

BACKGROUND: Household storage of medicines is a world-wide practice that triggers the irrational use of medicines and consequent threats. The purpose of this research is to explore sources of medicines availability, utilization and reasons of medicines storage in household.. METHODS: A community-based survey was performed on 900 households in five districts of Punjab, Pakistan from 1st February to 2nd March, 2016. Data was collected through employing a pretested questionnaire, the World Health Organization (WHO) operational package (for assessing, monitoring and evaluating country pharmaceutical situations Level IIb), and analysed by SPSS-23. RESULTS: A mean of 2.94 medicines per household were observed in 900 households visited with 2,648 of total medicines found. Significant number of medicines was analgesics (58.6%) and antibiotics (12.97%). Out of total, 20.4% of household medicines were for current treatments. Left over medicines from past treatments were 8.7%, and 70.9% were anticipated for future use. Household medicines existed in the form of oral tablets, were 89%. Household medicines of 91.2%, were satisfactorily labelled in acute cases and majority were obtained from private pharmacies. Household medicines of 80% were acquired by respondents with post-graduation qualification and 61.2% of the medicines were obtained by respondents with no formal education and in both cases source of medicines was private pharmacies. While overall, 61.5% of respondents took medicines from the private pharmacy. In general, patients got 3.4% of medicines from the primary healthcare facilities. Adherence to medical treatment was very poor. In chronic cases 35.7% of patients left treatment when symptoms improved, while in acute cases 41.1% of the patients showed non-adherence to the treatment. Patients who knew about use of medicines were 92.32%. CONCLUSIONS: Maximum medicines stored were for the future use. The main source of medicines found in households was private pharmacies. Antibiotics and analgesic were in common in use. Patient's nonadherence to the treatment was one of the reasons of presence of medicines at home.

Association of TP53 codon 72 polymorphism in women suffering from endometriosis from Lahore, Pakistan.

OBJECTIVE: To investigate TP53 gene codon 72 polymorphism in women with endometriosis and compare it with healthy samples. METHODS: This case-control study was carried out at Jinnah Hospital, Services Hospital and Sheikh Zayed Hospital, Lahore, Pakistan, from 2014 to 2016, and comprised patients with endometriosis and healthy controls. SPSS 21 was used for statistical analysis. RESULTS: Of the 176 participants, 88(50%) were healthy controls and 88(50%) were endometriosis patients. The observed genotype frequencies for controls and patients were 14(15.9%) and 31(35.3%) for proline/proline, 46(52.3%) and 35(39.8%) for proline/arginine, and 28(31.8%) and 22(25%) for arginine/arginine, respectively. The association of different genotypes was not significant in patients with moderate-to-severe endometriosis (p=0.574). The presence of pro/pro genotype enhanced the chances/odds of getting the disease (p<0.05). However, the risk further increased with the advancement of age, particularly in the 27-46 age group (p<0.05). CONCLUSIONS: In Pakistani women the association of TP53 gene codon 72 arginine/proline polymorphism was present..