Diabetes was estimated to be responsible for 109 thousand deaths, 1157 thousand years of life lost and for 2263 thousand disability adjusted life years (DALYs) in India during 2004. However, health systems have not matured to manage diabetes effectively. The limited studies available on diabetes care in India indicate that 50 to 60% of diabetic patients do not achieve the glycemic target of HbA1c below 7%. Awareness about and understanding of the disease is less than satisfactory among patients, leading to delayed recognition of complications. The cost of treatment, need for lifelong medication, coupled with limited availability of anti-diabetic medications in the public sector and cost in the private sector are important issues for treatment compliance. This article attempts to highlight the current constraints in the health system to effectively manage diabetes and the need for developing workable strategies for ensuring timely and appropriate management with extensive linkage and support for enhancing the availability of trained manpower, investigational facilities and drugs.

Challenges in diabetes management with particular reference to India

Introduction and Aims: Diabetes is one of the chronic and prevalent diseases in the world. Diabetic patients' number has increased 7 times during last 20 years. If this current situation continues, diabetic patients' population will be 350 millions ones in 2030. It means that 7 millions people will be added annually. Up to now, different uncontrollable factors have been monitored in self-caring of this disease for managing and preventing from its early and late side effects. This research is conducted to study the role of self-efficacy as a determinant agent in self-caring of diabetic patients. Study Method: This is a narrative review study in which various information banks and search motors such as PubMed, ProQuest, SCOPUS, Elsevier were reviewed. Diabetes, self-care and self efficacy keywords from cross sectional, cohort, clinical experimental studies and systematic review were also used in the study construction. Iranian Banks such as IRANMEDEX, MEDLINE and also different articles from domestic research and scientific magazines were selected. Time spectrum of reviewed studies was supposed to be published from 1990 up to 2011. Results: Self-care situation among diabetic patients not only is unsatisfactory but also the studies` results show that self-efficacy rate is low among them. The findings of the studies prove that there is a direct relation between self-efficacy and self-care in the patients in a way that this construct owns the predictability power of self-care behavior. Conclusion: Self-caring has a significant role in controlling of diabetes disease. Self-efficacy can induce motivation directly take health promoting behavior through efficacy expectations. It also affects motivation, indirectly, through perceived barriers and determining commitment or stability for following function map. So, self-efficacy is very important in changing self-care behavior process.

Review the key role of self-efficacy in diabetes care

Background and Objectives: Diabetes is one of the major concerns in the third millennium, affecting more people every day. The prevalence of this disease in Iran is reported to be high (about 7.7%). The most important method to control this disease and prevent its complications is self-care. According to various studies, this method has not found its proper place among patients with diabetes due to several reasons. The present study was aimed at determining the relationship between social support, especially family support, and self-care behavior of diabetes patients. Materials and Methods: This study was a narrative review in which the relevant papers of cross-sectional, cohort, clinical trial, and systematic review designs were selected using databases and scientific search engines such as PubMed, ProQuest, SCOPUS, and Elsevier, with the keywords diabetes, social support, and self-care. Moreover, Persian papers were selected from MEDLAB and IRANMEDEX databases and through searching the websites of original research papers published in Iran. All the papers published from 1990 to 2011 were reviewed. Results: The results of the study indicated that the status of self-care and social support in patients with diabetes was not favorable. All the studied papers showed that there was a positive relationship between social support and self-care behavior. Also, some studies pointed to the positive effect of social support, especially family support and more specifically support from the spouse, on controlling blood sugar level and HbA1c. Conclusion: As social support can predict the health promoting behavior, this concept is also capable of predicting self-care behavior of patients with diabetes. Therefore, getting the family members, especially the spouse, involved in self-care behavior can be of significant importance in providing health care to patients with diabetes.

Importance of social support in diabetes care

Evidence that the Echinococcus granulosus G6 genotype has an affinity for the brain in humans

Purpose. The study was aimed to investigate the frequency of diabetes mellitus type 2 in patients infected with chronic hepatitis C virus and its association with cirrhosis. Patients and Methods. This prospective case series was conducted at Section of Gastroenterology and Hepatology, Isra University Hospital, Hyderabad, over a period of 4 months from June 2009 to October 2009. Hepatitis C virus seropositive patients who were older than 18 years, diabetic or nondiabetic, were included. Basic demographic data collected by questionnaire and laboratory investigations including fasting blood glucose levels, serum cholesterol, and liver function tests were done. A logistic regression model was used to explore the association between diabetic and nondiabetic HCV seropositives and type 2 diabetes mellitus with cirrhosis. Results. A total of 361 patients with hepatitis C were analyzed; the prevalence of type 2 diabetes mellitus in HCV patients was 31.5%. Out of the total number of the participants, 58.4% (n = 211) were cirrhotics, while 41.6% (n = 150) were noncirrhotic HCV seropositives. In multivariate analysis, cirrhotic patients appeared significantly more likely (P = 0.01) to be diabetic as compared with noncirrhotic patients (OR = 2.005, 95% CI: 1.15, 3.43). Conclusion. Advancing age, increased weight, and HCV genotype 3 are independent predictors of type 2 diabetes in HCV seropositive patients, and there is a statistically significant association of cirrhosis observed with type 2 diabetes mellitus.

/pdf/prevalence-of-type-2-diabetes-mellitus-in-hepatitis-c-virus-5j0c4il0cd.pdf

Prevalence of type 2 diabetes mellitus in hepatitis C virus infected population: a Southeast Asian study.

Background: Brain involvement with hydatid disease occurs in 1–2% of all Echinococcus granulosus infections. Cerebral hydatid cysts are usually supratentorial, whereas infratentorial lesions are quite rare. Objective of the study was to determine the clinical presentation and surgical outcome of cranial hydatidosis. Methods: This retrospective study was performed in the department of neurosurgery LRH Peshawar from December 2000 to Oct 2007. Twenty one cases with intracranial hydatidosis were operated. The patients were either admitted through OPD or referred from other units. CT and/or MRI were the imaging modalities to reach the diagnosis in addition to serological and haematological tests. Surgery was the only treatment option used. Pericystic hydraulic method was the technique used for the excision of the hydatid cyst of brain. Results: There were 9 males and 12 females with male to female ratio of 1:1.3. All patients belonged to paediatric age group with age range of 3–14 years and mean age of 7.42±3.2 years. Headache, vomiting, papilloedema were present in all the patients while seizures were the present in 16 patients. The lesion was removed surgically by adopting pericystic hydraulic method during craniotomy in all cases. There was no intra-operative morbidity except that the cyst ruptured in one case. No postoperative complications were noted and there was no mortality. Conclusion: Hydatid cyst of the brain presents clinically as intracranial space occupying lesion and is more common in children. Surgery is the treatment option with affordable morbidity and low mortality. Keywords: Cerebral hydatid cyst, Echinococcosis, Intracranial hydatidosis

/pdf/hydatid-cysts-of-the-brain-tonea10kwb.pdf

Hydatid cysts of the brain.

Objective To assess the status of glycaemic control in patients with type-2 diabetes mellitus (DM) in NWFP, Pakistan. Design Observational study. Place and duration of study Medical Out-patient Department (OPD), Lady Reading Hospital, Peshawar and a private clinic of physician from January 2003 to December 2003. Patients and methods Two hundred and ten patients with type-2 diabetes were included in the study. The glycemic control of these patients was determined by estimation of blood glucose (fasting and random) and glycosylated hemoglobin (HbA1c). The patients were grouped in three categories, the 1st one having good glycaemic control, the 2nd having fair (acceptable) glycaemic control and the 3rd group having poor diabetic control with their HbA1c values being 6%-7%, 7.1%-8.2% and >8.2% respectively. Statistical analysis of the results was made by application of Pearson's chi-square test and student's t-test. Results Around half, 51.43%, of the patients had poor control of diabetes, with mean HbA1c of 10.183 +/- 1.73 SD (standard deviation) and were placed in category 3. Good control of diabetes accounted for 31.43% of our patients having mean HbA1c of 6.64 +/- 0.27 SD and were placed in category-1. The rest, 17.14%, were placed in fair control category having mean HbA1c value of 7.68 +/- 0.44 SD. Conclusion Majority of our patients with type-2 diabetes are having poor control of their glycaemic status.

Glycemic control status in patients with type-2 diabetes.

Objective: To determine the frequency of various genotypes of Hepatitis C virus in District Buner, Swat. Methods: This Descriptive case series study was conducted at District Headquarter Hospital Daggar, and Bilal Medical Trust, Pir Baba, Swat, Pakistan from January 2007 to June 2008. A total of 400 patients, 154 Male and 246 Female aged 16–65 years (Mean age 31±13 years) without clinical and ultrasonographic evidence of cirrhosis, and with positive Hepatitis C Virus (HCV) antibodies by ELIZA, and HCV RNA detected by PCR were included. Hepatitis C virus genotypes were checked in serum by real time PCR (RT-PCR). Results: Genotype 3 was the most common type accounting for 61.5% of the study population. Amongst the subtypes, 182 (45.5%) had genotype 3a and 64 (16%) had genotype 3b. Thirty-five (8.7%) patients had genotype 1a, 12 (3%) had genotype 1b. Twenty-six (6.5%) patients had genotype 2a. Four (1%) patients had genotype 2b. Three (0.75%) patients had genotype 4a, and 1 (0.25%) had genotype 6a. Sixty-four (16%) patients had mixed infections. Forty (10%) patients had genotype 3a and 3b, 12 (3%) patients had genotype 1a, 1b, and 9 (2.25%) patients had genotype 2a and 1c, 2 (0.5%) had genotype1a, 3a and 1 patient (0.25%) had genotype1a, 3b. Nine (2.25%) patients had untypable genotype. Conclusion: Genotype 3 with its subtypes 3a and 3b is the commonest Hepatitis C virus present in District Buner, Swat. The others in order of decreasing frequency are genotype 1a, 2a and mixed types. Keywords: Hepatitis C virus, HCV, Genotypes, District Buner

/pdf/genotype-variation-of-hepatitis-c-virus-in-district-buner-2tx3987nhp.pdf

Genotype variation of hepatitis c virus in district buner swat

This study includes seventy-five adult patients of Nephrotic syndrome who underwent successful Renal Biopsy in order to determine the Glomerular pathology on light microscopy. More than 90% patients had primary> glomerular lesions and the rest had secondary glomerular involvement. Focal and segmental proliferative glomerulonephritis ( 3 8 % ) and membranous glomerulonephritis (30%) were found to be the commonest lesions. Diabetes was the commonest (5%) cause of secondary glomerular lesions.

Glomerular lesions causing nephrotic syndrome (light microscopic findings) in 75 adult patients

Objective: To describe the clinical manifestations and laboratory features of Crimean Congo Hemorrhagic Fever (CCHF).Material and Methods: The study was conducted at Lady reading Hospital, MTI, Peshawar from July 2017 to July2018. 112 suspected cases of CCHF were included. There demographics, clinical features and laboratory findingswere recorded on pre-designed proforma. Blood samples were sent to NIH, Islamabad for testing RT-PCR and CCHFVantigens and anti-CCHFV antibodies. Data was analysed by SPSS version 21.Results: 15 cases were found to be positive for CCHFV by RT-PCR and CCHFV antigens. Almost fifty percent of thestudied patients were butchers by profession. Fever, headache and petechial hemorrhages/bruises were the mostcommon presenting complaints. Thrombocytopenia (platelet count less than 150,000) was the most common laboratoryfinding followed by deranged liver function tests and abnormal coagulation profile. Overall mortality was 33.3%.Conclusion: CCHF carries high mortality with limited treatment options. Health authorities should focus on the primordialand primary prevention of the disease.

/pdf/clinical-characteristics-of-crimean-congo-hemaorrhagic-fever-1q4wkjqwz2.pdf

Clinical characteristics of crimean congo hemaorrhagic fever: experience at a tertiary care hospital in khyber pakhtunkhwa

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