Relationship of nutrition to the outcome of WHO compliance clinical practice in a deprived population of Pakistan

A healthy diet is an important part of a healthy lifestyle at any time, but is especially vital if a woman is pregnant or planning a pregnancy. Eating healthily during pregnancy will help the baby to develop and grow. The present study determined the association of nutrition and body mass index with pregnancy losses using WHO obstetric practice guidelines in deprived societies of Pakistani population. The study comprises of a random sample of 1200 houses in the Peri-urban area of Gadap Town, Karachi and was conducted by 33 lady health workers from January 2008 to June 2009. The maternal and fetal outcomes for 1109 term pregnancies were studied. The nutritional assessment was carried out using a 7 day food diary and an in depth food frequency questionnaires. The entire cohort delivered 775 [69.9%] live healthy neonates from 1109 mothers with 4 maternal deaths, a perinatal mortality of 176/1000 and pregnancy failure in 30.1% was observed if abortions were included. A body mass index of 23.5 or more in pre- or early pregnancy was considered as the cutoff point for adequate nutrition in pregnancy. There was a highly significant association between pregnancy failure and maternal sub nutrition in the rural areas of Gadap Town, Karachi. Thus, the study concluded that the nutritional status and body mass index at the time of conception was associated with maternal mortality, pregnancy failure and perinatal mortality of deprived mothers in Pakistani villages. All outcomes demonstrated the lack of effect of WHO guidelines. The detection of at risk fetuses in deprived populations. Inclusion of translational scientific advances into the epidemiological guidelines of Millennium Development Goals [MDG's] or Sustainable Development Goals [SDG's] suggests the way forward

changing face of medicine in the 21st century: the example of infertile clomid failed insulin

The outcome of metformin administration in insulin resistant infertile polycystic ovary syndrome [PCOS] patients who had failed clomid. The research was conducted at the University Assisted Reproductive Techniques [ART] Institute in Pakistan - a developing country with a high prevalence of diabetes. 166 PCOS patients submitted to ART out of 277 referrals [59.9%]. Of these 78 [47%] achieved pregnancies with 75.6% take home babies and 24.4% reproductive failure prior to ART, Intra Cytoplasmic Sperm Injection [ICSI] and In Vitro Fertilization [IVF]]. The total healthy take home baby rate was 47% of the 166 patients. These seventy eight [78] patients became pregnant prior to ART after starting metformin for insulin resistance. 88 required ART and 19 of these delivered a healthy baby. Metformin [500 to 2500 mg daily] was started prior to pregnancy and continued throughout pregnancy. Metformin 1500 mg daily for 3 months resulted in 59 live and well neonates averaging 3.1kg. Metformin <1500 mg daily and / or administration for less than 3 months prior to Pregnancy resulted in 18 abortions and 1 intrauterine death at 30 weeks gestation with no live neonate. Almost 50% became pregnant without ART. When ART was needed 19 out of 88 patients delivered a live baby. Almost 50% of patients with failed ART elsewhere became pregnant on this regime with take home healthy babies and 6 did not require ART. Metformin 1500mg daily administrated for at least 3 months prior to pregnancy and continued throughout pregnancy had an uncomplicated neonatal outcome in 59 patients compared to lower doses or shorter duration of administration in 19 patients who had a uniformly poor pregnancy outcome. The European Society of Human Reproduction and Embryology [ESHRE] and American Society for Reproductive Society [ASRM] guidelines are biologically and statistically flawed. In South Asia infertile PCOS patients require a long term life cycle approach. Early insulin resistance should be evaluated and metformin is the drug of choice in our hands. This has major implications for the life cycle of the patient, particularly as type II diabetes is now considered to be reversible

What are the requirements of medical education in the 21st century?

Doctors in the 21st century will have to move beyond the century old Flexnerian system of medical education and practice. This entails dealing with an increased quantum of knowledge and incorporating genomic medicine and systems biology into clinical practice. This is particularly important in Pakistan and university education rather than disguised technical colleges is required to produce a doctor capable of dealing with the increased pressures of the new century rather than simple technical competence. This ahility to unlearn and relearn is essential for both teachers and students

Developments in diabetes

Diabesity and its common precusor, the metabolic syndrome is becoming an epidemic worldwide and at an ever younger age. It is already the major precursor of death and will become dominant in deprived countries very soon. All diseases are due to genomic predisposition and expressed due to interaction with lifestyle, particularly the thrifty genotype and diet. This affords a huge opportunity for prevention. Advances in molecular medicine and the information explosion has resulted in better understanding of diabetes at the molecular level and the development of more effective agents. Very recently bariatric surgery has been shown to cure established diabetes in more than 90% of patients

Germ cell tumors in childhood

Germ cell tumours of children are curable by chemotherapy in almost all patients with virtually no effect on subsequent reproductive function