Journal of the Dow University of Health Sciences (JDUHS)

Achieving Large-Scale Remission in Type 2 Diabetes Mellitus: The Role of Diet and Lifestyle Interventions

Fareeha Rizvi — 2024-12-16

Type 2 diabetes mellitus (T2DM) is a major global public health challenge, with over 382 million adults affected in 2013, a figure projected to rise to 592 million by 2035. Pakistan ranks third globally in diabetes prevalence, with 33 million adults currently living with T2DM, a number expected to nearly double by 2045. This rapid increase places immense financial pressure on the healthcare system, with complications like dialysis and cardiovascular diseases consuming substantial 3 resources. Urban areas in Pakistan show a higher prevalence of diabetes compared to rural areas. For instance, the prevalence of diabetes in urban areas is reported to be 28.3% compared to 25.3% in rural areas, highlighting the role of lifestyle, socioeconomic factors, and healthcare access.This editorial explores the drivers of T2DM in Pakistan, its challenges, and the potential for large-scale remission through culturally tailored diet and lifestyle interventions.

Prevalence and Associated Risk Factors of Retinopathy of Prematurity in Preterm Infants: A Cross-Sectional Study

Manisha Kumari — 2024-12-16

Objective: To determine the prevalence of Retinopathy of Prematurity (ROP) and its associated risk factors in preterm infants at the National Institute of Child Health (NICH), Karachi, Pakistan.
Methods: This cross-sectional study was conducted in the neonatal intensive care unit (NICU) department of NICH, Karachi, Pakistan from October 2020 to March 2021. The study included preterm infants with a gestational age under 32 weeks, admitted to the NICU at the NICH, Karachi. ROP was diagnosed by indirect ophthalmoscopy following pupil dilation, performed by a trained ophthalmologist. Risk factors were assessed based on preterm infants' age, gestational age, residence, gender, maternal education, sepsis, respiratory distress syndrome (RDS), anemia, oxygen dependency duration, and mechanical ventilation.
Results: Of total 310 preterm infants, the mean age was 5.73 ±1.49 days. There were 184 (59.3%) males and 126 (40.6%) females. ROP was observed in 139 (44.8%) preterm infants. Binary logistic regression indicated significantly increased ROP risk in infants of illiterate mothers (aOR 3.31, 95% CI 1.08 to 10.17, p-value 0.036), those with family income ≤ 45,000 rupees (aOR 3.70, 95% CI 1.40 to 9.76, p-value 0.008), and reduced risk in female infants (aOR 0.12, 95% CI 0.04 to 0.31, p-value <0.001), infants on oxygen ≤ 4 days (aOR 0.04, 95% CI 0.01 to 0.12, p-value <0.001), and NICU stay ≤ 12 days (aOR 0.02, 95% CI 0.01 to 0.08, p-value <0.001).
Conclusion: Nearly half of the preterm neonates were affected by ROP, with contributing factors including maternal illiteracy, low family income, prolonged oxygen dependency, and extended NICU stays.

Comparison of Aspiration Versus Incision and Drainage in the Treatment of Breast Abscess, in terms of Recurrence: An Analytical Cross-Sectional Study

Maha Tariq — 2024-12-16

Objective: To assess and compare the treatment outcomes of breast abscess using two different methods aspiration versus incision and drainage.
Methods: This analytical cross-sectional study was conducted at Combined Military Hospital, Karachi, Pakistan, from October 2023 to March 2024. Females age`d 18 to 50 years with ultrasound-diagnosed acute breast abscesses up to 5 cm, presenting with signs and symptoms such as breast pain, localized swelling, erythema, tenderness, and fever, were included. Patients were randomly assigned to receive needle aspiration or incision and drainage. Outcomes were assessed based on recurrence and scarring. Recurrence was defined as the reappearance of similar signs and symptoms after complete resolution. Patients were monitored for one-month post-treatment.
Results: Of total 124 patients, the mean age was 38.10 ±5.21 years. The mean duration of procedure was 26.33 ±10.58 minutes. A significantly longer mean duration of the procedure was observed in the aspiration group as compared to the incision and drainage group i.e., 36.61 ± 2.82 minutes vs. 16.04 ± 1.67 minutes (p-value <0.001). A significant association found between the two groups in terms of parity (p-value <0.001) and site of abscess (p-value 0.001). Treatment outcome showed higher rate of recurrence and scarring in the aspiration group compared to the incision and drainage group i.e., 8 (66.7%) vs. 4 (33.3%) and 5 (100.0%) vs. 0 (0.0%). However, a significant association of scar (p-value 0.022) was observed between groups.
Conclusion: Incision and drainage proved more effective than aspiration for treating breast abscesses, with lower rates of recurrence and scarring.

Comparison of Anti-Inflammatory Effects of Prednisolone versus Nepafenac 0.3% after Phacoemulsification and Intraocular Lens Implantation

Adnan Abdul Majeed — 2024-12-16

Objective: To compare the anti-inflammatory effects and safety profiles of prednisolone acetate 1% and nepafenac 0.3% in patients undergoing phacoemulsification with intraocular lens implantation (IOL).
Methods: This retrospective cross-sectional study was conducted at Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad, Pakistan from December 2023 to July 2024. The study included patients underwent uneventful phacoemulsification with IOL implantation. Post-operative outcomes were assessed at a single follow-up conducted at 4 weeks. Primary efficacy endpoint was improvement in best-corrected visual acuity, measured as the reduction in Logarithmic Minimum angle of resolution (logMAR) values from baseline to follow-up. Clinically significant improvement was defined as a reduction of ≥0.2 logMAR units. Secondary outcomes included anterior chamber inflammation, graded using Standardization of Uveitis Nomenclature criteria, and incidence of adverse events.
Results: Of total 324 patients, mean age was 64.77 ±9.27 years. Mean logMAR change from baseline to follow-up was 0.28 ±0.11 units in the Prednisolone group and 0.30 ±0.11 units in the Nepafenac group, with statistically significant difference (p-value 0.050). The findings of clinical improvement, showed that 121 (48.8%) patients achieved clinical improvement in the Prednisolone group and 127 (51.2%) in the Nepafenac group. The distribution of inflammation grades (0, 1+, 2+, 3+), was similar between the Prednisolone and Nepafenac groups. A total of 76 (23.4%) adverse events were reported, with 40 (52.6%) occurring in the Prednisolone group and 36 (47.4%) in the Nepafenac group.
Conclusion: Both prednisolone acetate and nepafenac are effective and safe in managing post-operative inflammation and improving visual outcomes following phacoemulsification.

Health-Related Quality of Life among Medical Students and Its Associated Factors: A Cross-Sectional Study

Mohi Uddin — 2024-12-16

Objective: To assess the health-related quality of life (HRQOL) and its associated factors among medical students residing in Faisalabad, Pakistan.Methods: This cross-sectional study was conducted at Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan from July 2023 to December 2023. All medical students aged 18 years and above were included. HRQOL was assessed using the 36-Item Short Form Survey (SF-36), covering eight domains: Physical Functioning, Role Limitations due to Physical Health, Role Limitations due to Emotional Problems, Vitality, Mental Health, Social Functioning, Bodily Pain, and General Health Perception. Each domain was scored from 0 (low) to 100 (high). Physical and Mental Component Summary scores were also calculated. Results: Of total 300 students, SF-36 domains showed higher mean scores in Bodily Pain and Physical Functioning i.e., 66.6 ±24.9 and 61.6 ±29.1. Males reported significantly higher mean scores in General Health Perception (p-value < 0.001) and Vitality (p-value 0.013), while females had significantly higher Physical Functioning scores (p-value <0.005). Students >21 years had significantly higher mean scores in Physical Functioning (p-value 0.017). Furthermore, day scholars showed significantly better mean scores in Physical Functioning (p-value <0.001), Bodily Pain (p-value 0.020), Social Functioning (p-value 0.030), and Physical Component Summary (p-value <0.001) than hostelites. Students who exercised (p-value 0.020), had strong family relationships (p-value 0.003), and faced no distressing family events (p-value <0.001) reported significantly higher SF-36 scores.

Conclusion:Overall, SF-36 domains showed higher mean scores in Bodily Pain and Physical Functioning, with significant differences in HRQOL based on age, gender, residence, and lifestyle.