Syed Wasif Gillani

Diet and Colorectal Cancer Risk in Asia - a Systematic Review

Diet is one of the major factors that can exert a majorly influence on colorectal cancer risk. This systematic review aimed to find correlations between various diet types, food or nutrients and colorectal cancer risk among Asian populations. Search limitations included Asian populations residing in Asia, being published from the year 2008 till present, and written in the English language. A total of 16 articles were included in this systematic review. We found that red meats, processed meats, preserved foods, saturated/animal fats, cholesterol, high sugar foods, spicy foods, tubers or refined carbohydrates have been found by most studies to have a positive association with colorectal cancer risk. Inversely, calcium/dairy foods, vitamin D, general vegetable/fruit/fiber consumption, cruciferous vegetables, soy bean/soy products, selenium, vitamins C,E and B12, lycophene, alpha-carotene, beta-carotene, folic acid and many other vitamins and minerals play a protective role against colorectal cancer risk. Associations of fish and seafood consumption with colorectal cancer risk are still inconclusive due to many varying findings, and require further more detailed studies to pinpoint the actual correlation. There is either a positive or no association for total meat consumption or white meats, however their influence is not as strong as with red and processed meats.

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.

Applicability of Pharmaceutical Care in endocrine clinic of Hospital Penang, Malaysia

Abstract Objective: This study aimed to evaluate the impact of pharmaceutical care on pharmacotherapy optimization and health related quality of life among Diabetes patients of endocrine clinic in Hospital Pulau Pinang,

Technological study of preparing gel from semi-solid extract of Cacalia hastata L.

Most of the drugs which are used for wound healing are imported in Mongolia. It is required to develop drug formulation and increase local productions used for the treatment of wound healing. For the purpose of solving the above problems, we aimed to prepare new drug formulation from Cacalia hastata L. for the treatment of wound healing. Cacalia hastata L. is a medicinal plant, member of the family Asteraceae. Cacalia hastata L. is widely used for the Mongolian traditional medicine to treat wound healing, gastric ulcer, poisoning fever, liver fever, bile fever, oral cavity, and gynecological diseases. We prepared Cacalia gel from semi-solid extract of Cacalia hastata L. using various excipients such as gel former, solvent, neutralizer, antimicrobial preservative, and humectant. Gel formulation was standardized by such criteria, as the amount of biologically active compound, appearance (color, smell), pH, viscosity, and bacterial contamination. Stability testing of gel formulation was studied by long-term method. The quality of the Cacalia gel which was stored in room temperature, its appearance, viscosity, and amount of biological active compound were stable. The stability testing of the gel formulation from Cacalia hastata L. is continued.

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.

Case Report: Post-surgical Patient Management and Compliance.

The pharmacist plays a crucial role in ensuring optimal patient outcomes, by working with the healthcare team as well as educating the patient. This study focuses on two major aspects that affect patient outcome: pharmacist intervention during the provision of healthcare and patient compliance. Case presentation: YT is a 42 year old Malay male who was referred for the presentation of back and axilla carbuncles 3 days before admission. The patient has a history of diabetes mellitus, hypertension and hyperlipidemia since 2008. He has undergone saucerization surgery for the removal of the carbuncles and has responded well to therapy. His diabetes and hypertension are uncontrolled while his hyperlipidemia status is unknown due to lack of lipid profile data. Clinical evaluation: Patient’s main issue is non-compliance of drug regimen leading to poorly controlled disease states. Insufficient dose of medication also contributed to poor control. There were also a number of lab data, such as prothrombin time, INR value and lipid profile data that were not addressed during admission. Pharmacist’s Intervention is crucial in ensuring optimal patient outcomes.

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.