Diabetes mellitus (DM) is one of the most challenging health problems of the 21st century. About 422 million people have DM and by year 2035, this number is expected to reach 592 million. Pakistan with an escalating DM prevalence is expected to be among the top ten high burden diabetic countries of the world by year 2035. Today, with the global increase in the diabetic population there is a resurgence of interest in the dual epidemic of DM and tuberculosis (TB). Pakistan ranks 4th in terms of global burden of TB with an estimated incidence of 231 cases per 100,000 population. DM increases the risk of developing TB, delays sputum conversion, increases risk of failure of treatment, death, recurrence and relapse. There is scarcity of data regarding the impact of diabetes on TB treatment outcomes in Pakistan. This prospective cohort study was conducted in October 2013 at Gulab Devi Chest Hospital, Lahore, Pakistan to estimate the risk of adverse outcomes in diabetic patients who were being treated for TB. A total of 614 pulmonary tuberculosis (PTB) patients were recruited and screened for DM through random and fasting blood glucose tests; and based on the results were divided into exposed (diabetic) and unexposed (non-diabetic) groups. Both groups were followed up at 2, 5 and 6 months during anti-tuberculosis treatment (ATT) and 6 months after ATT completion to determine treatment outcomes. Of the total, (n= 113 (18%) were diabetic and (n= 501 (81%) non-diabetic. About half of them i.e. (n= 323 (52%) were illiterate with mean age of 32±15 years. The final multivariate analysis showed that diabetics were more likely to experience an unfavorable outcome as compared to non-diabetics (OR= 2.70, 95% CI= 1.30 to 5.59, p = 0.008), after adjusting for age, residential background, smoking status and body mass index (BMI). Other independent predictors of unfavorable outcome were identified as rural area of residence (OR= 1.98, 95% CI =1.14 to 3.47, p = 0.008), BMI less than 18.50 (OR=1.89, 95% CI=1.03 to 3.47, p=0.041) and being a smoker (OR=2.03, 95%CI=1.04 to 3.94, p=0.037). Kaplan Meier survival analysis showed that survival among the diabetic PTB patients was significantly lower as compared to the non-diabetic PTB patients. The final multivariate Cox regression analysis showed that diabetics had decreased survival compared to non-diabetics (aHR=2.52, 95%CI=1.02 to 6.23, p=0.045) after adjusting for age, BMI and smoking status. Other independent predictors of death as treatment outcome were found to be age (aHR=1.03, 95%CI= 1.01 to 1.06, p=0.004) and a BMI of less than 18.50 (aHR=3.26, 95%CI=1.33 to 8.01, p=0.010). Our study has documented adverse treatment outcomes among diabetic PTB patients as opposed to non-diabetic PTB patients. DM was found to be associated with unfavorable treatment outcome and a decreased survival among PTB patients. As the way forward we propose an emerging framework for the transfer of research results into policy and practice based on the systematic review undertaken by us. A comprehensive integrated program for the co-management of TB and DM needs to be initiated.
The concept of time management is practice from decades. Time management has grabbed the attention of many scholars and there were many writings and analysis made. Time management is an important issue of human life as you cannot add more hours in a day, you have to plan yourself with the limitation of time. Islam focuses on the time management so that a believer should balance his life (spiritually, socially and economically). Islamic teachings are dynamic in their approach, they teach Muslim from every aspect of life and allow them to spend their time productively. Islam’s main focus is on the planning and organizing the time and our main focus is to depict what Islam teaches about time management and how it is practiced in the world. Then conventional methods of management are similar to the Islamic teachings.
Biosurfactants are extracellular microbial products that show a high degree of structural, functional and chemical heterogeneity. In comparison with synthetic surfactants, biosurfactants exhibit environmental compatibility, biodegradability, high reaction rate, astonishing chemical diversity, and better physiochemical characters. In the first phase of study, physicochemical characterization of crude oil affected and unaffected soil of Chak Naurang, Punjab, Pakistan was done. Results demonstrated that the contaminated soil was slightly alkaline clay-loam with TPH of 22.2 g/kg and TOC of 23.11 g/kg. The concentration of nitrogen, phosphorus and potassium was found to be quite low i.e. 0.644 g/kg, 12.46 mg/kg and, 20 mg/kg, respectively. Enrichment and isolation experiments were typically designed to obtain indigenous biosurfactants producing microorganisms of crude oil contaminated soil. Amongst forty isolates, qualitative and quantitative screening for biosurfactants production confirmed fourteen potential microorganisms, which were identified through morphological, microscopic, biochemical and molecular studies. The two most efficient biosurfactants producing microorganisms i.e. Pseudomonas aeruginosa MF069166 with 84 % of E.I24, 26.6 mN/m of S.T, 8 cm of oil displacement zone and, Meyerozyma spp. MF138126 with 82 % of E.I24, 26 mN/m of S.T and 7.4 cm of oil displacement zone were selected for further studies of bioprocess optimization, characterization and environmental applications of biosurfactants.In the second phase of study out of five different fermentation media, M 2 was found to be the most suitable for P. aeruginosa MF069166 whereas, M 5 for Meyerozyma spp. MF138126. Plackett-Burman optimization showed that glycerol, K2HPO4, peptone, KNO3, NaCl, yeast extract and MgSO4 were significant components of M 2 for maximum rhamnolipids production (3.46 g/L) from P. aeruginosa MF069166 whereas, peptone, glycerol, NaH2PO4, yeast extract and MgSO4 were significant components of M 5 for maximum sophorolipids production (4.02 g/L) from Meyerozyma spp. MF138126. Optimization of culture conditions using Response Surface Methodology revealed that the predicted values of pH; 6.5, T; 35 °C, SOI; 3.4 % and agitation speed of 120 RPM resulted in maximum growth of 3.06 and rhamnolipids production of 4.31 g/L from P. xiii aeruginosa MF069166. In case of Meyerozyma spp. MF138126, the predicted values of pH; 5.5, T; 33.2 °C, SOI; 3.3 % and agitation speed of 161 RPM resulted in maximum growth of 3.17 and sophorolipids production of 6.9 g/L.Chemical characterization techniques of TLC, FTIR, RP-HPLC, 1H and 13CNMR and LC-ESI-MS confirmed that biosurfactants produced by P. aeruginosa MF069166 and Meyerozyma spp. MF138126 were rhamnolipids and sophorolipids, respectively. The stability of rhamnolipids was witnessed from 15-121 oC T, 4-11 pH and 2-10 % NaCl whereas, the stability of sophorolipids was observed from 5-115 oC T, 3-10 pH and 2-10 % NaCl. Cell surface hydrophobicity (CSH) studies showed more than 50 % affinity of the two isolates for crude oil, hexadecane and dodecane whereas, more than 70 % emulsification activity was observed by their respective rhamnolipids and sophorolipids in the presence of different hydrocarbons. cmc of rhamnolipids was found to be 40 mg/L whereas, the cmc of sophorolipids was 50 mg/L. z-average diameter of purified rhamnolipids and sophorolipids was noted under the effect of varying cmc, pH and electrolytes through Dynamic Light Scattering technique. In the final phase of study, role of P. aeruginosa MF069166 and Meyerozyma spp. MF138126 and, their respective rhamnolipids and sophorolipids was evaluated in biodegradation of crude oil and bioremediation of heavy metals. In crude oil degradation experiments, gravimetric and GC-MS analysis demonstrated that the bacterial strain degraded 90 % of the petroleum hydrocarbons while the yeast species showed 85 % biodegradation efficiency after 14 days of incubation period. Results of heavy metals bioremediation studies indicated more than 75 % removal of zinc from aqueous phase and contaminated soil through metal chelating activity of rhamnolipids. Similarly, sophorolipids were able to precipitate out more than 80 % of lead from the two phases. Kinetic study of biosurfactants mediated soil washing demonstrated a gradual increase in percentage removal of lead and zinc with the passage of time. These findings suggested that biosurfactants producing P. aeruginosa MF069166 and Meyerozyma spp. MF138126 have high potential to be used in different environmental applications and can be considered as suitable candidates for field scale bioremediation studies.