Mirza R. Baig

Oxidative Stress Correlates (OSC) in Diabetes Mellitus Patients

BACKGROUND/AIM Diabetes mellitus (DM) is a considerable systemic metabolic disorder to exhibit various metabolic and cardiovascular disorders, mainly hyperglycemia. Our study aims to evaluate oxidative stress markers in DM patients and to determine the clinical correlates affecting the investigational parameters. METHODOLOGY To evaluate oxidative stress, the following parameters were included: tri-glycerides(TG), total cholesterol, low density lipoprotein cholesterol(LDL), oxidized LDL cholesterol(Ox LDL), superoxide dismutase(SOD), glutathione peroxidase(GSH-Px) and plasminogen activator inhibitor(PAI) which were measured at single observation point. Patient clinical and demographic data were taken from registered medication profiles from the Outpatient Department. RESULTS The diabetic subjects have significantly high measured values of endocrine(p<0.01), metabolic(p<0.01) and antioxidant parameters(p<0.05), and have significant higher values of TG(3.69±1.27 vs 1.79±0.84 mmol/L, p< 0.01), Ox LDL(85.37±19.1 vs 77.11±26.64 mmol/L, p<0.05) and SOD enzyme activity(918.78 ± 145.39 vs 880.08±149.52 U/g Hb, p<0.05) compared to the controls. A significant negative correlation was found between Ox LDL and HbA1c(r = -0.6782, p < 0.001) among diabetic subjects. CONCLUSION Elevated Ox-LDL, SOD and GSH-Px are associated with the diabetic patients. However, oxidative stress threshold values also showed high oxidative activity markers among controls. Clinical variables showed predictive information on oxidative activity among diabetes patients.

Effect of Pharmacist Intervention to Self-Care Practices among Diabetes Patients

Our study objective was to evaluate the pharmacist interventions in providing patient home care. A 24-week longitudinal quasi-experimental-pre-test/post-test study design was used to assess the effectiveness of a diabetes education program to enhance self-care practices. Since this was a longitudinal study a 25% attrition rate was included in the calculation of sample size. Hence the sample size for the proposed study was 106 subjects with 53 subjects in each group. All analyses were done using SPSS version 18 ® . The level of significance was set at 0.05. The Research Ethics Committee of hospital and the Malaysian Medical Research and Ethics Committee approved the study. Of the 109 subjects who met the study-entry criteria, 3 subjects declined to participate due to lack of time and interest. There was no significant relationship between the demographic and clinical characteristic of participants who completed the study. During follow-up there was a statistically significant difference in Self Monitoring Blood Glucose (SMBG) practices between the intervention group (M=2.94, SD=2.25) and control group (M=0.47, SD=1.36; t(127.64)=-8.23, p ≤ 0.001) with moderate effect size (eta squared=0.06). Total physical activity was defined as the combination of non-leisure and leisure activities. There was a statistically significant difference in total physical levels between the intervention (M=14.01, SD=6.41) and control groups (13.21, SD=5.22; t(148.04)=-3.15, p=0.002) with no difference in the non-leisure activity (p=0.43). As for the control group, there was no significant difference in SMBG practices from baseline (M=0.70, SD=1.35) to follow-up (M= 0.47, SD=1.36, t(72)=0.97, P=0.34) and no relationship was found between the number of blood glucose tests done with demographic or clinical variables. Improvement of self-care practices that require lifestyle changes such as diet and increased in physical activities are problematic. This could be due to the complexity of these self-care practices that are socially and culturally constructed and often lifetime habits when compared to SMBG.

Perceived Stress Scale Psychometric Validation for Malaysian Diabetic Patients

Aims: The purpose of this study was to provide factorial analytic findings, construct validation and normative data for the Malaysian diabetic patients. Gender difference was also examined with racial response to PSS-10. Study design: Population base cross sectional survey. Place and Duration of Study: Penang between Nov 2009 and March 2010. Methodology: Cluster random sampling technique was employed for the selection participants in the community. A total of 1924 diabetic patients with age ≥ 18 (mean age = 39.51) were approached; 992 of them were female and 932 of them were male. People rated how often they had experienced these feelings in the last week on a five-point Likert scale from 0 = never to 4 = very often. The scale was translated into Malay language independently by two psychological counselors who had at least a master’s degree and bilingual efficiency. The LISREL 8.30 program was used to assenting factor analysis. Chisquare ( χ 2 )/df (degree of freedom) ratio, GFI (goodness of fit index), AGFI (adjusted goodness of fit index) and root mean square error of approximation (RMSEA) were used to evaluate the fit of the model (two-factor). Results: Barlett’s test of sphericity was 1603.417 ( p< 0.001) and Kaiser-Meyer-Olkin measure of the sampling adequacy was 0.83. Varimax rotation was conducted with these two identified factors. Factor A integrated items 1, 2, 3, 6, 9 and 10, labeled as ‘Perceived Avoidance’ while Factor B containing items 4, 5, 7, 8 and labeled as ‘Perceived

Refining knowledge, attitude and practice of evidence-based medicine (EBM) among pharmacy students for professional challenges.

Practicing evidence based medicine (EBM) is a professional need for the future clinical pharmacist in UAE and around the world. An attempt was made to evaluate pharmacy student’s knowledge, attitude and proficiency in the practice of EBM. A within-subject study design with pre and post survey and skill test were conducted using case based practice of EBM through a validated questionnaire. The results were tabulated and there was a statistically significant increase in pharmacy students’ perceived ability to go through steps of EBM, namely: formulating PICO questions (95.3%), searching for evidence (97%), appraising the evidence (81%), understanding statistics (78.1%), and applying evidence at point of care (81.2%). In this study, workshops and (Problem Based Learning) PBLs were used as a module of EBM teaching and practices, which has been shown to be an effective educational method in terms of improving students’ skills, knowledge and attitude toward EBM. Incorporating hands on experience, PBLs will become an impetus for developing EBM skills and critical appraisal of research evidence alongside routine clinical practice. This integration would constitute the cornerstone in lifting EBM in UAE up to the needed standards and would enable pharmacy students to become efficient pharmacists that rely on evidence in their health practice.

Factors associated with infections in diabetic population

Increase in the prevalence of diabetes worldwide and it becoming an epidemic has resulted in a clinical research shift to the management of diabetes mellitus globally. The study aimed to investigate the socio-demographic differences among diabetes patients with infection incidence. The study was conducted in an urban, governmental hospital in Penang Malaysia. The records of patients, more than and equal to age 18 years, who were admitted with diabetes mellitus between January 1, 2008 and December 31, 2010 were reviewed. Statistical analyses were performed using SPSS version 17®. This study was approved by the hospitals “Clinical Research Committee (CRC)” as well as “Ministry of Health Malaysia (MOH)”. During the time period of January 2008 through December 2010, there were total 2174 diabetes patients admitted; 2174 (100%) patients’ charts were reviewed. Of the total, 1063 (48.9%) were males and the rest, 1111 (51.1%), females. Mean and standard distribution (SD) showed females have less mean age distribution (35.2 ±4.187 years) as compared to males (37.9±5.724 years). A total of 798 (36.7%) had infection exposure before and/or during hospital admission; statistical significance (p<0.001) was found in association of diabetes ketoacidosis (DKA) and infection exposure. Though the rate of hospitalization increased among females, OR showed that males were more likely to get the infection severely as compared to females (1.81 (95%CI 1.1-2.40) p <0.021). Profound ethnic difference is three times more prone to severity rate of infection among Malay diabetic patients as compared to other non-Malays (OR 3.44 (95%CI 1.60-5.68) p<0.001). Further analysis showed that with the age of � 65 years and history of diabetes (mean ± SD: 27.13 ± 2.782) average patient utilizes 135.7 days (average) of antibiotic course. Increased and recurrent use of antibiotic was found among Malays; also Malays predominantly experience clinical manifestations (poor glycaemic control) as compared to other ethnics. Every third patient with diabetes mellitus had infectious exposure.

Predicting relationship of eating behavior, physical activity and smoking with type II diabetes and related comorbidities among Saudi citizens: cross-sectional observational study

The aim of the study was to investigate the correlation pattern of social habits and cardiovascular risk assessment with disease history (e.g., obesity, T2DM and HPT) among free-living citizens of Saudi Arabia. Cross-sectional observational study design was used to collect the data among the citizens of Saudi Arabia. Convenient sampling technique was used to contact over 1163 free-living individuals. A self-administered questionnaire containing 49 items divided into following three sections was used to measure the correlation. Logistic regression analysis was used to predict the response. Sixty-seven percent (n = 725) of the respondents (male n = 419 (57.79%) vs. female n = 306 (42.21%), respectively; p > 0.01) perceived unhealthy nutritional habits. Also, a total of 785 (72.55%) participants (436 (55.54%) vs 349 (44.56%); males vs. females; p > 0.05) responded insufficient daily physical activity. Leisure time and uncontrolled eating were independently associated with BMI (S.E − 0.13, 95% CI − 1.81 to − 0.11, p = 0.035; and S.E 0.31, 95% CI 0.23 to 0.45, p < 0.001, respectively). T2DM showed significant independent association with leisure time, uncontrolled eating, and the Framingham risk (S.E − 0.25, 95% CI − 1.27 to − 0.14, p = 0.022; S.E 0.49, 95% CI 0.21 to 0.97, p < 0.001, and S.E − 0.17, 95% CI − 0.87 to − 0.13, p < 0.001, respectively). Study concluded a strong inverse correlation pattern between the level of physical activity (leisure time) with BMI, T2DM, obesity, and HPT. Uncontrolled eating behavior showed significant effect on BMI, obesity, and T2DM. However, HPT was significantly associated with work time (PA) and the Framingham risk assessment score.

Women with Type 1 Diabetes Mellitus: Effect of Disease and Psychosocial-Related Correlates on Health-Related Quality of Life

Background This study is aimed at investigating the various disease-specific and health-related psychosocial concepts of HRQOL among insulin-dependent diabetes mellitus (IDDM) and understanding the gender differences in HRQOL among IDDM patients. Methods A cross-sectional observational study was conducted to assess the effect of health-related and psychosocial correlates on HRQOL of IDDM patients in Penang, Malaysia. The participants were recruited from five governmental diabetic clinics. Patients with insulin use only, IDDM diagnosed at least 1 year earlier, were identified from clinical registers. The sample was then age stratified for 20–64 years, and severe complications (e.g., end-stage renal failure, hemodialysis, and liver cirrhosis) were excluded; a total of 1003 participants were enrolled in the study. Multivariate regression analysis was used to predict the response. Results A total of 853 (100%) participants were enrolled and completed the study. Women exhibited significantly higher/better mental health (p < 0.013) and health perception scores (p < 0.001) despite high prevalence of impaired role (49.2%), social (24.2%), and physical (40.5%) functionings as compared to men. Women with longer diabetes exposure and uncontrolled glycemic levels (HbA1c) have poorer HRQOL. Availability of social support showed no significant association with either HRQOL or diabetes distress levels. Diabetes distress levels remained not associated with social support. Women also showed significantly higher association with health perception (15% versus 13% men, p < 0.001) and mental health (13% versus 11% men, p < 0.001) in diabetes-specific psychosocial factors. Thus, among women alone, diabetes-related specific and psychosocial factors explained 15% and 13% of variations in HRQOL extents, respectively. Conclusion Women exhibit extensive and significant patterns with health-related factors and diabetes-specific psychosocial factors (self-efficacy, social support, and DLC) to improve HRQOL. Also, women have significantly high reported distress levels and low social functioning compared to men.

Bronchopneumoniae with Melioidosis Infection in a Paediatric Patient

This patient was diagnosed with bronchopneumonia with left plural empyema on admission. A list of various tests was done to identify the causal organism which causes the lung infection. However, the results for all the tests were negative. The doctor prescribed several antibiotics which have actions to cover the most common organisms that can cause bronchopneumoniae in children. However, they were uncertain regarding the specific type or organism which causes the infection. On the 7 th May 2013, Melioidosis test was done on this patient and it had shown positive result. Melioidosis is a type of infection caused by Burkholderia pseudomallei. The treatment was then immediately changed to the antibiotics that have actions on Burkholderia pseudomallei. The combination of IV Imipenem 280 mg TDS and IV Augmentin 280 mg TDS were prescribed to this patient. Many drug related problems were detected in this case study. The doctor prescribed several antibiotics to this patient before coming to a conclusion that the combination of IV Imipenem 280 mg TDS and IV Augmentin 280 mg TDS were the most suitable treatment as the culprit of the lung infection in this child was Burkholderia pseudomallei. The patient was prescribed with quite a number of antibiotics. Based on observations and evaluations, it was found that there were many drug related problems found in this case that can lead to many setbacks. Careful evaluations were done in this patient and all the drug related problems in this case were listed. Authors also took into consideration the doctor’s opinion regarding the antibiotic regimens prescribed. Recommendations or solutions to the drug therapy problems were also listed.

Monitoring of Hypocalcaemia & Hyperglycemia predictive consequences of Thyroidectomy.

Background Hyperglycemia and hypocalcaemia have separately been attributed to adverse outcomes in critically ill patients. The study was aim determine whether hyperglycemia and hypocalcaemia together post-operative effect of thyroidectomy and evaluate the gender & age impact on the extend of clinical condition. Methods All the patients underwent thyroidectomy in the duration of 1st Jan 2012 till 30th June, 2013 in HPP and HUSM Kelantan, Malaysia. Serum evaluation has been made on 4 consecutive reading with duration of 6 hours. The predictive trend has been established to identify the hypokalemic and hyperglycemic condition. Ethical approvals & Patients’ consent forms have been made prior to conduct this study. Results The incidence of hyperglycemia [≥ 150 mg/dl(8.3 mmol/L)] and hypocalcaemia (serum calcium < 8.5 mg/dl (2.2 mmol/L)] were 39.4% and 43.9% respectively. Hyperglycemia and hypocalcaemia associated with age and length of stay, significant association has been found among pre-operative diagnosis as well. The interaction of hyperglycemia and hypocalcaemia did not separate effects on mortality. Conclusion As demonstrated, the prevalence of hyperglycemia and hypocalcaemia in post-thyroidectomy patients is considerable high. Also, the linear association pattern has been shown. However, considering the disease severity, the association of hyperglycemia and hypocalcaemia with surgical ward indicators of morbidity could not be verified.