Home > Prevalence of Diabetic Complications Among Low Income Group of Patients Attending Diabetes Opd in New Karachi Township from March 2013 to June 2014 and In-Vivo Study of Transdermal Delivery of Insulin.
Prevalence of Diabetic Complications Among Low Income Group of Patients Attending Diabetes Opd in New Karachi Township from March 2013 to June 2014 and In-Vivo Study of Transdermal Delivery of Insulin.
Diabetes mellitus is a metabolic syndrome, prevalence of which is increasing day by day worldwide. The disease is related to a number of micro vascular and macro vascular changes mainly due to hyperglycemia which accelerates the mechanism of deposition of advanced glycation end product in the capillary network leading to hypoxic changes in the tissues resulting in end organ diseases. Diabetic micro vascular complications leads to blindness, end stage renal disease and limb amputations. Top priority treatment of diabetes remains insulin replacement therapy which is till date administered only by parenteral route, which is associated with decreased compliance due to fear of injection and hindrance in daily routine of life. To solve this problem, a number of routes of administrations to name a few nasal, oral and transdermal routes are investigated for long term insulin therapy. Till date no drug has come to the market in its final form. Present study was conducted in three phases that is a survey, study of emulgel in large animal model and in human subjects. Prevalence of diabetic complications in low income group presented in diabetes OPD of Sind Government Hospital, New Karachi Township: Aim of the present survey was to study the prevalence of diabetic micro vascular complications in the low income population group of New Karachi Township. Additionally, what is the impact of metabolic syndrome in the prevalence of complications? To serve the purpose a sample size of one hundred and fifty four participants with type II diabetes for more than 5 years was collected at 80% power and 10% prevalence of diabetes in Pakistan. After acquiring consent from the participants, they were interviewed in detail about their disease, general condition, systemic review, history of co-morbidities, duration of diabetes and medication history. Detailed checkup of feet and eyes by trained personals was carried out followed by blood and urine sample collection for laboratory investigations which included glucose, lipid and kidney profiles. Many parameters were also calculated using different formulas from the data collected by these laboratory investigations. Statistical analysis was carried out by using SPSS -20 (IBM) with Pearson‟s chi squared test for correlation between categorical variables, student‟s t-test for numerical data with level of significance at p < 0.05. Response rate was 50%, and average age of the participants was 50 years. 27% were men and 73% of the participants were women. 84% of the sample belonged to Urdu speaking ethnic group. 68% participants were uneducated or had primary education. Average BMI was 26.28 and average duration of diabetes was 11 years. Majority of patients were found on oral hypoglycemic agents i.e. only 28% participants were prescribed insulin out of which 20% were having insulin along with oral hypoglycemic agents. Most important findings were that 42.89% participants presented with either type of diabetic retinopathy. Proliferative diabetic retinopathy which leads to advanced eye disease however was found 3% (n = 5). 61.69% participants presented with impaired urinary albumin creatinine ratio. 3% (n = 5) of whom presented with overt nephropathy. On the basis of Ipswich touch test, neuropathy was classified in 62% (n = 96) participants, who showed positive loss of sensations on distal phalanges. Metabolic syndrome was found in 60% (n = 93) participants. Analysis of different risk classifications revealed that 8% (n = 13) participants were at high risk to develop diabetic foot (χ2 = 92, p < 0.001),additionally 3 participant presented with active foot. 8% (n = 12) showed high risk to develop coronary artery disease in next 10 years (χ2 = 235, p < 0.001). Risk of stroke was luckily found only 1% (n = 2) in next 10 years. Risk to develop diabetic kidney disease was seen in 8% (n = 13) participants. Gender based stratification showed that average age of female participants was younger (48.5 years) than the male participants (56 years, t = 4.5, p < 0.001). Average BMI of the females (26.99) was greater than the male (24.4) participants (t = 2.88, p < 0.001). There was no gender difference found in the prevalence of microvascular complications i.e. retinopathy, nephropathy and neuropathy. However significant gender difference was found in prevalence of metabolic syndrome as 68% female and 42% male participants presented with the syndrome (χ2 = 9.57, p < 0.025). Significant coronary artery disease risk between gender strata was observed as 64% of male participants had moderate to very high risk to develop coronary artery disease in next ten years compared to females (χ2 = 46.92, p < 0.001). However, risk to develop diabetic foot and diabetic kidney disease was not found statistically different between gender groups. On the basis of metabolic syndrome strata, participants with metabolic syndrome presented with nausea vomiting (χ2 = 6.87, p < 0.001), heavy headedness (χ2 = 13.11, p < 0.001), vertigo (χ2 = 13.4, p < 0.001) and burning sensations of extremities (χ2 = 5.82, p < 0.001). All the microvascular complications were found more prevalent in metabolic syndrome strata i.e. 45% retinopathy, 76% nephropathy and 52% neuropathy. Logistic regression analysis for the complications revealed that body mass index, systolic blood pressure, cholesterol, triglycerides and nephropathy were positive correlates for presence of metabolic syndrome. Retinopathy was found affected by BMI and presence of nephropathy. Glycated hemoglobin, metabolic syndrome and urinary albumin creatinine ratio was found to positively correlate with diabetic nephropathy. Diabetic neuropathy on the other hand was found to be positively correlated with BMI, systolic BP, cholesterol, triglycerides, LDL, HDL, CHR, Serum creatinine, diabetic nephropathy and metabolic syndrome. To conclude, diabetic nephropathy and metabolic syndrome exert their influence in the development and progression of diabetic retinopathy and neuropathy. Study population is at high risk to develop diabetes and its compliations. Hypoglycemic activity of Transdermal dosage form of Insulin in large animal model Aim of this study was to evaluate the effects of optimized insulin emulgel preparation in large animals. Six sheep (Ovis aries) of either sex weighing 20 – 25 kg were used in the study. Baseline sugar level was tested and then anesthesia and hyperglycemia was induced by Ketamine (10 mg/kg) and Xylazine (0.2 mg/kg) for acute and sustained hyperglycemia. Animals were divided into two groups of three animals each. One group received subcutaneous insulin and other received emulgel with the help of a derma roller on shaved skin. The results were found comparable with the insulin injection. Emulgel followed the same pattern of hypoglycemia but a significant difference was observed between the two treatment groups at the end of the study. Hypoglycemic effect of insulin with the help of derma roller was confirmed. Effect of Transdermal insulin on human subjects Objective of this segment of study was to observe the effect of insulin emulgel on human volunteers. 32 human subjects were recruited for the study after sample size calculation at 80% power and 10% prevalence of diabetes in Pakistan. The subjects were divided into healthy and hyperglycemic volunteers. Each group consisted of 16 individuals. After written and informed consent a two day study was conducted. On day 1, baseline data was obtained. Breakfast was provided to the participants to avoid food related bias. On 2nd day participants were applied with emulgel with the help of derma roller then data of blood glucose for next 2.30 hours was collected. In healthy (normoglycemic) subjects good glycemic control was observed, as nonsignificant difference between baseline and post administration data was found. However in hyperglycemic individuals this condition was not found and emulgel was not able to control glucose level after 30 minutes resulting in exaggerated glucose curve.
Introduction: A total of 144 medical colleges are contributing to the country’s progress. Excessive usage of social media is a cause of not only the deterioration of physical and psychological health of medical students, but has also become a defining reason of procrastination and attaining less than ideal grades. Where most western institutes implement strict social media policies in medical schools, those in Pakistan are gravely lacking. Objective: The objective of this research implementation of social media in medical schools of Pakistan and then identify the need to develop such policies. Methods: We conducted qualitative research in which method of data collection was primarily focus group discussions (FGD) of a total of 40 participants from five different medical colleges of Pakistan. The participants included medical practitioners and medical students(n=20) who were further divided into four groups of five participants each. FGD was conducted online. Results: Content analysis revealed seven core themes as point of discussions to be highlighted. Almost all participants were grossly unaware of the importance of social media usage regulation and its implementation in medical schools. Conclusion: At the end of the FGD it was unanimously agreed upon that there must be a uniform and standard social media policy defined by the regulating bodies of medical schools. This research may further be conducted by including policymakers in the sample. KEYWORDS: Social media, policy, medical colleges.
Brand equity loss is the most neglected area of research in brand management science at Asian level that has inhibited the developing nations to utilise the intangible value of brand equity of their firms. Brand equity is in nascent stage with no clear theoretical boundaries and notable research at Asian level whereas it‘s touching maturity at western world that not only nullifies the logic of using western theories in Asian perspective but also questions the credibility of past research in present scenario for Asian countries. In terms of research dominance, all the scholars of brand management have been working on the description, measurement and sustainable growth of brand equity from various business management research paradigms. In practice and theoretical explanation, intellectual property governance cannot explain the problem of brand equity loss; in contrast, brand governance is more holistic and provides the flexibility for the convergence of marketer and consumer perspective for identifying the most impactful reasons for brand equity loss. Qualitative descriptive research method was used by the researcher for the study of brand equity loss. Stratified purposeful sampling technique was deployed for collecting research problem concentric information from key informants for knowledge thickness after the analysis. Stratified samples were owners/brand managers/VPs/marketers from Businesses purposive sample for studying marketer perspective. Organisations and legal fraternity purposive samples had top managers and advocates as stratified samples for studying the consumer perspective. Primary data was collected from the stratified samples. The reports and documents of industries and organisations, related to brands, were used for support in extracting the targeted information from the interview transcripts for increasing data analysis richness. Thematic content analysis, by using Nvivo (version 10), was implemented through encoding the interview transcripts into nodes and reflecting the relation between the grouped data of the nodes through the Word Tag clouds, Frequency Tree Maps, Cluster Maps and Matrix Coding Maps. Brand governance model, as the result of the analysis, was crafted that provided the basis for deviation from previous main stream research on brand equity by having the meaning of brand equity loss from the dissection and integration of all the layers of the model, from top to bottom that cover both perspectives of brand science. The first layer is intellectual property governance and the consecutive ones are intellectual property enforcement, and brand equity loss. Therefore, brand equity loss cannot be explained by considering one approach or perspective holistically in Asian context. This invites cross sectional research in terms of approaches and perspectives. The study faced limitation in terms of lack of market documented evidence, theoretical work at Asian context, having a handful of people at national level who are information rich respondents under stratified sample and faced territorial restrictions. Conclusively, Cognitive Construct, personal concept of the brand in the minds of the consumer, is surrounded by loyalty, social sense, counterfeit, price, experience, and promises. All these are indicators of ''experience‘ that create suitable environment for infringement and counterfeiting that follows brand equity loss or vice versa. Furthermore, at the field, the best points of ''experience‘ are distributors, local sellers and people appointed from the same community as promoters.