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Agency: European Commission | Branch: H2020 | Program: RIA | Phase: HCO-05-2014 | Award Amount: 3.61M | Year: 2015

South Asians, who represent one-quarter of the worlds population, are at high risk of type-2 diabetes (T2D). Intensive lifestyle modification (healthy diet and physical activity) is effective at preventing T2D amongst South Asians with impaired glucose tolerance, but this approach is limited by high-cost, poor scalability and low impact on T2D burden. We will complete a cluster-randomised clinical trial at 120 locations across India, Pakistan, Sri Lanka and the UK. We will compare family-based intensive lifestyle modification (22 health promotion sessions from a community health worker, active group, N=60 sites) vs usual care (1 session, control group, N=60 sites) for prevention of T2D, amongst 3,600 non-diabetic South Asian men and women with central obesity (waist100cm) and/or prediabetes (HbA1c6.0%). Participants will be followed annually for 3 years. The primary endpoint will be new-onset T2D (physician diagnosis on treatment or HbA1c6.0%, predicted N~734 over 3 years). Secondary endpoints will include waist and weight in the index case and family members. Our study has 80% power to identify a reduction in T2D risk with family-based intervention vs usual care of: 30% in South Asians with central obesity; 24% in South Asians with prediabetes; and 24% overall. Health economic evaluation will determine cost-effectiveness of family based lifestyle modification for prevention of T2D amongst South Asians with central obesity and / or prediabetes. The impact of gender and socio-economic factors on clinical utility and cost-effectiveness will be investigated. Our results will determine whether screening by waist circumference and/or HbA1c, coupled with intervention by family-based lifestyle modification, is an efficient, effective and equitable strategy for prevention of T2D in South Asians. Our findings will thereby provide a robust evidence base for scalable community-wide approaches to reverse the epidemic of T2D amongst the >1.5 billion South Asians worldwide.


Afdhal N.H.,Beth Israel Deaconess Medical Center | Dusheiko G.M.,University College London | Giannini E.G.,University of Genoa | Chen P.-J.,National Taiwan University Hospital | And 16 more authors.
Gastroenterology | Year: 2014

Background & Aims Thrombocytopenia is common among patients with hepatitis C virus (HCV) infection and advanced fibrosis or cirrhosis, limiting initiation and dose of peginterferon-alfa (PEG) and ribavirin (RBV) therapy. The phase 3 randomized, controlled studies, Eltrombopag to Initiate and Maintain Interferon Antiviral Treatment to Benefit Subjects with Hepatitis C-Related Liver Disease (ENABLE)-1 and ENABLE-2, investigated the ability of eltrombopag to increase the number of platelets in patients, thereby allowing them to receive initiation or maintenance therapy with PEG and RBV. Methods Patients with HCV infection and thrombocytopenia (platelet count <75,000/μL) who participated in ENABLE-1 (n = 715) or ENABLE-2 (n = 805), from approximately 150 centers in 23 countries, received open-label eltrombopag (25-100 mg/day) for 9 weeks or fewer. Patients whose platelet counts reached the predefined minimal threshold for the initiation of PEG and RBV therapy (95% from ENABLE-1 and 94% from ENABLE-2) entered the antiviral treatment phase, and were assigned randomly (2:1) to groups that received eltrombopag or placebo along with antiviral therapy (24 or 48 weeks, depending on HCV genotype). The primary end point was sustained virologic response (SVR) 24 weeks after completion of antiviral therapy. Results More patients who received eltrombopag than placebo achieved SVRs (ENABLE-1: eltrombopag, 23%; placebo, 14%; P =.0064; ENABLE-2: eltrombopag, 19%; placebo, 13%; P =.0202). PEG was administered at higher doses, with fewer dose reductions, in the eltrombopag groups of each study compared with the placebo groups. More patients who received eltrombopag than placebo maintained platelet counts of 50,000/μL or higher throughout antiviral treatment (ENABLE-1, 69% vs 15%; ENABLE-2, 81% vs 23%). Adverse events were similar between groups, with the exception of hepatic decompensation (both studies: eltrombopag, 10%; placebo, 5%) and thromboembolic events, which were more common in the eltrombopag group of ENABLE-2. Conclusions Eltrombopag increases platelet numbers in thrombocytopenic patients with HCV and advanced fibrosis and cirrhosis, allowing otherwise ineligible or marginal patients to begin and maintain antiviral therapy, leading to significantly increased rates of SVR. Clinical trial no: NCT00516321, NCT00529568. © 2014 by the AGA Institute.


Mannan A.,Services Institute of Medical science | Anwar S.,Sheikh Zayed Medical College | Qayyum A.,Social Security Hospital | Tasneem R.A.,Services Institute of Medical science
Singapore Medical Journal | Year: 2011

Introduction: This was a retrospective study conducted to assess the nature, presentation, mode of insertion, diagnosis and management of foreign bodies in the urinary bladder. Methods: Between January 1998 and December 2007, 20 patients with foreign bodies in their urinary bladder were treated at our centre. The records of these patients were reviewed and analysed for their symptoms, mode of insertion, diagnosis, management and complications. Results: A total of 20 foreign bodies were recovered from the urinary bladders during the study period. These included JJ stents with calculi, intrauterine contraceptive devices with stones, a rubber stick, ribbon gauze, encrusted pieces of Foley catheter, proline thread with calculus, a suture needle, broken cold knives, the ceramic beak of a paediatric resectoscope, a knotted suprapubic tube, a hair clip, a nail, an electrical wire and a hairpin. The common presenting features were dysuria and haematuria. The diagnosis was established radiologically in most of the cases. The circumstances of insertion were variable; iatrogenic in 16 (80.0 percent) cases, sexual stimulation in two (10.0 percent), accidental insertion by a child in one (5.0 percent) and physical torture in one (5.0 percent). 17 (85.0 percent) foreign bodies were recovered endoscopically, and cystolithotomy was required in three (15.0 percent) patients. Conclusion: The instances of foreign bodies in the urinary bladder are uncommon. A diagnosis is usually made radiologically. Iatrogenic foreign bodies were found to be the most frequent type of insertion encountered. Endoscopic retrieval is usually successful, with minimal morbidity.


Anees M.,King Edward Medical University | Hameed F.,Shalamar Hospital | Mumtaz A.,University of Health Sciences, Lahore | Ibrahim M.,Government of Pakistan | Khan M.N.S.,Services Institute of Medical science
Iranian Journal of Kidney Diseases | Year: 2011

Introduction. Treatment modalities for end-stage renal disease affect quality of life (QOL) of the patients. This study was conducted to assess the QOL of patients on hemodialysis and compare it with caregivers of these patients. Cause of ESRD and dialysis-related factors affecting QOL were also examined. Materials and Methods. This cross-sectional study was conducted on patient on maintenance hemodialysis for more than 3 months at 3 dialysis centers of Lahore. Fifty healthy individuals were included as controls from among the patients' caregivers. The QOL index was measured using the World Health Organization QOL questionnaire, with higher scores corresponding to better QOL of patients. Results. Eighty-nine patients (71.2%) were men, 99 (79.2%) were married, 75 (60.0%) were older than 45 years, and 77 (61.6%) were on dialysis for more than 8 months. Patients on hemodialysis had a poorer QOL as compared to their caregivers in all domains except for domain 4 (environment). There was no difference in the QOL between the three dialysis centers of the study, except for domain 3 (social relationship) of the patients at Mayo Hospital (a public hospital), which was significantly better. Nondiabetic patients had a better QOL in domain 1 (physical health) as compared to diabetic patients. Duration of dialysis had a reverse correlation with the overall QOL. Conclusions. We found that QOL of hemodialysis patients was poor as compared to caregivers of the patients, especially that of diabetics. Also, duration of dialysis had a reverse correlation with QOL.


Nabi M.S.,Services Institute of Medical science | Waseem T.,Services Institute of Medical science
International Journal of Surgery | Year: 2010

The treatment of the pulmonary hydatid disease has largely remained surgical. There is a range of surgical procedures which is currently being practiced; however, there is no scientific consensus over selection of these operative interventions. The extent and severity of the disease clearly dictates the choice of surgical intervention and patients need to be individualized for adequate and safer management. This mini-review attempts to critically analyze these approaches and end up with a practical surgical treatment algorithm based on previous literature. The mini-review also briefly discusses various controversies in the management of pulmonary hydatid disease. © 2010 Surgical Associates Ltd.


Ali A.A.,Services Institute of Medical science
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Objective: To assess the adequacy or deficiency of relevant communication skills needed in clinical practice among students of King Edward Medical University and identify the need of developing curriculum for communication skills. Study Design: Sequential mixed method design using survey questionnair and in-depth interviews. Place and Duration of Study: King Edward Medical University, Lahore, from March - September 2010. Methodology: Final year students consented to participate in the survey questionnaire regarding communication skills needed in clinical practice selected on the basis of random stratified sampling technique. The questioned aspects include communication skills, supervised training, breaking bad news, counselling and written communication skills. In the second qualitative phase, volunteers who had passed final year were selected on the basis of non-probability purposive sampling technique for recording in-depth interviews. Qualitative data was analyzed with content analysis after identifying themes and trends from the data. Results: Only 20% students had clarity of communication skills training, 28% believed that their learning was supervised, 20% believed training was structured, 28% were confident about handling difficult situations, 15% could effectively break bad news, and 22% were confident in written communication skills. In the interviews 70% felt that their peers had average skills in handling difficult situations like breaking bad news and counselling, 60% believed that communication skills program was non-existent and 100% agreed that patient turnover is a strength for the institute and structured training would improve their communication skills performance. Conclusion: The communication skills of the studied group were inadequate to address special situations. This presses need for developing a communication skills training program.


Mahmud W.,Rawalpindi Medical College | Haroon M.,Services Institute of Medical science | Munir A.,Rawalpindi Medical College | Hyder O.,Rawalpindi Medical College
Journal of the College of Physicians and Surgeons Pakistan | Year: 2014

Objective: To describe the correlation between Self-directed Learning (SDL) and medical students' attitude towards research, based on the premise that self-directed learners are independent, motivated, and curious learners. Study Design: Observational cross-sectional study. Place and Duration of Study: Rawalpindi Medical College, Rawalpindi, from August 2011 to January 2012. Methodology: One hundred and ninety-four students of final (5th) year class at Rawalpindi Medical College, Rawalpindi participated in this cross-sectional study. SDL ability of students was measured using Oddi's Continuing Learning Inventory (OCLI) whereas Attitude Towards Research (ATR) scale was used to measure their research attitudes. Spearman's rank-order analysis was performed to measure correlation between SDL scores on OCLI and all the 18 items on ATR scale. Results: Statistically significant relationships with correlation coefficients ranging from +0.12 to +0.32 were found for the correlation between scores on the OCLI and eleven statements highlighting research use and positive attributes of research (14 items). Those students who participated in extra-curricular research projects (n=58, 29.9%) had relatively higher scores on OCLI as compared to those who did not participate (n=136, 70.1%, p=0.041). Conclusion: Self-directed learners show a positive attitude towards research, though the relationship is not strong.


Bashir M.U.,Services Institute of Medical science | Qureshi H.J.,Services Institute of Medical science
Journal of the College of Physicians and Surgeons Pakistan | Year: 2010

Objective: To determine the analgesic effect of ethanolic extract of Nigella sativa seeds on experimentally-induced pain in albino mice. Study Design: Randomized controlled trial (RCT). Place and Duration of Study: Physiology Department, Services Institute of Medical Sciences (SIMS), Lahore, from May to September, 2009. Methodology: The study was carried out in 90 male albino mice using acetic acid induced writhing test as a chemical model of nociception. The mice were divided in three groups of 30 each. Group A was given normal saline (control); group B was given Nigella sativa seed extract in a dose of 50 mg/kg; and group C received diclofenac sodium, as a reference drug. Number of writhings in treated and control groups were compared. Results: The ethanolic extract of Nigella sativa seeds given intraperitoneally caused significant (p < 0.05) analgesic effect on nociceptive response initiated by 0.6% acetic acid; although this analgesic effect was less than that produced by diclofenac sodium. Conclusion: Ethanolic extract of Nigella sativa possessed significant analgesic effect in mice.


Cheema S.A.,Services Institute of Medical science
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2012

The minimum distance between two stimulus points on the skin, which are perceived as distinct points, is defined as two point discrimination (TPD). Among the two types of TPD, i.e., static and dynamic, static two-point discrimination (STPD) is commonly used to determine digital nerve integrity. Local flaps usually do well in maintaining sensibility of the covered area in terms of two-point discrimination in contrast to split thickness skin grafts (STSG). Aim was to determine the frequency of sensory deficit in terms of Two Point Discrimination (TPD) in Split Thickness Skin Grafts (STSG) and local flaps for soft tissue defects of fingers three months postoperatively. Thirty-five patients underwent local flap coverage and other thirty-five had split thickness skin grafting for soft tissue defects of fingers depending upon nature of defect. Patients were followed up at 2, 4, 8 and 12 weeks. TPD, measured at 3 months of follow-up, of 7 mm was considered normal (no sensory deficit) and TPD of 8 mm or more was considered as sensory deficit. The sensory deficit observed at the end of 12th week post operatively was 8.6% in the patients with local flap coverage (3 patients) and 45.7% with STSG (16 patients). Patients with no sensory deficit were 91.4% (32 patients) in the local flap coverage and 54.3% (19 patients) in the STSG at 12th week of follow up. The relative ratio (RR) of sensory deficit in local flaps and STSG was 5 (> 2). Local flaps are better options in terms of TPD preservation as opposed to STSG for soft tissue defects of fingers.


Qureshi H.J.,Services Institute of Medical science
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

In postmenopausal women, the two major causes of bone loss are oestrogen deficiency after menopause and age related processes. Bone turnover increases to high levels and oestrogen deficiency may induce calcium loss by indirect effects on extra skeletal calcium homeostasis. Objective of this study was to evaluate calcium status in pre-menopausal and postmenopausal women. This cross sectional study was carried out in 34 premenopausal women and 33 postmenopausal women, in Department of Physiology, Services Institute of Medical Sciences, Lahore. Height and weight of each woman were taken to find out the body mass index (BMI). Serum calcium, parathyroid hormone and calcitonin levels of each subject were determined. Premenopausal women were obese (BMI>30 Kg/m2) while postmenopausal women were overweight (BMI>25 Kg/m2). Serum calcium levels were significantly lower in postmenopausal women than in pre-menopausal women, while serum parathyroid hormone levels were significantly higher in postmenopausal woman. Serum calcitonin level was not significantly different in the two groups. Postmenopausal women are calcium deficient and have increased bone turnover as indicated by increased serum parathyroid hormone levels.

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