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Objective: The objective of this study is to evaluate the awareness of cross-infection control measures followed by DHCPs during the 5th wave of Covid-19 pandemic, Omicron variant in a government sector university of Karachi, Pakistan. Method(s): A Cross-sectional study was conducted from June till September 2022 at Sindh Institute of Oral Health Science during the 5th wave of Covid 19 pandemic, Omicron variant. Data was collected from 153 DHCPs from government sector university using a self-administered questionnaire, comprising of 20 closed ended question to assess the awareness and practice of cross infection protocols by DHCPs. Result(s): 98.7% of the participants were vaccinated against Covid 19. 96% of the participants used surgical gowns, face shields, and face masks as part of PPE during examining patients and while performing procedure. After treatment 99.3% of participants washed hands with hand wash, soap or used antiseptic solution. 77.1% of participants asked for Covid 19 test report and 68.6% of participants asked for proof of vaccination against covid 19 before treating patients. 96.1% of participants recommended disinfection of dental unit after every patient. 98% of participants changed glove after every patient. 88.2% of the participants said they would carry all elective and emergency procedures. Conclusion(s): The results of this study show that DHCPs practicing at government sector university have adequate knowledge regarding prevention of cross infection protocols and their importance to limit spread of infections. But their practice of prevention of cross infection during Covid 19 pandemic is not ideal as percentage of DHCPs requiring proof of vaccination or negative reports for Covid 19 were rather low and the percentage of DHCPs willing to carry elective procedures along with emergency ones was rather high.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Objective: To find the correlation between the degree of androgenetic alopecia and the severity of COVID-19 disease. Study Design: Cross-sectional study. Place and Duration of the Study: Dermatology department, PEMH, Rawalpindi Pakistan from Feb to Aug 2021. Methodology: A total of 227 patients (male and female) of COVID-19 admitted in a Corona ward of Pak Emirates Military Hospital, Rawalpindi, Pakistan were selected randomly. The degree of androgenetic alopecia was assessed with the help of using the Hamilton-Norwood Scale (HNS) for men and the Ludwig Scale (LS) for women, and the severity of COVID-19 was graded based on CT severity score (CTSS). Results: Out of the total, 161 (71%) were male, and 66 (29%) were female. Out of 161 males, 31 (19.2%) had no alopecia, and 130 (80.7%) had some degree of alopecia. Out of patients with alopecia, 33 had moderate alopecia, and 97 had severe alopecia. Out of 66 females, 32 (48.5%) had no alopecia, while 34 (51.5%) had some degree of alopecia. Conclusion: High frequency of androgenetic alopecia in severely ill-hospitalized patients of COVID-19 suggests that androgen has a vital role in the disease severity of COVID-19. © 2022, Army Medical College. All rights reserved.
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Aim: To examine the impact of the Dose Adjustment for Normal Eating (DAFNE) structured education program on reducing hypoglycemia episodes and diabetic ketoacidoses (DKA) in people with type 1 diabetes (T1D) who fasted Ramadan during the COVID-19 pandemic. Method: A total of 85 DAFNE graduates, aged 18 years and above, who chose to fast during Ramadan were provided virtual care. Of them, 70 patients were on multiple daily injections and 15 were on insulin pump therapy. All users had flash glucose monitoring or sensor-augmented pump. HbA1c, weight, blood pressure, time in range, time below range, and total daily dose were collected at baseline and during the fasting period. Results: Patients fasted for a median of 26 days (range 10-30). Most of the participants (84%) fasted between 20 and 30 days out of 30 fasting days. Mean (SD) HbA1c were 7.4 (0.89)% and 7.6 (0.98)% before and after the fasting respectively. Percentage time in range, 3.9- 10 mmol/L (pre 63.7 ± 12.8% vs. during 58.9 ± 12.8%, p = 0.001) and percentage time spent <3.9 mmol/L (pre 5.2 ± 5.0 % vs. during 3.0 ± 3.2%, p<0.001) were significantly reduced. The total daily dose (TDD) of insulin was also reduced (4.9 units) during the fasting period. No episodes of severe hypoglycemia, DKA, or hospitalization occurred during the fasting period. Discussion: With proper follow-up and education, DAFNE graduates can fast safely without the fear of hypoglycemia and DKA.
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Aims: Vaccination against the coronavirus disease (covid- 19) is prioritized in people with diabetes. This study aimed to investigate the impact of the vaccination on glycemia which is currently unknown. Methods: The glucose metrics and vaccination records of 297 adults with type 1 diabetes were collected using the Ambulatory Glucose Profile (AGP) reports and the Dose Adjustment for Normal Eating (DAFNE) Kuwait research database respectively. All subjects were using continuous glucose monitoring (CGM) devices for ≥ 70% of the time. The primary outcomes were HbA1c, Time in Range (TIR), Time above Range (TAR), Time below Range (TBR) and Glucose Measurement Indicator (GMI) before and after the first and second doses of covid-19 vaccine. The secondary outcome measures were the average glucose, the Glucose Variability (CV), and the number of daily CGM scans collected at the same timepoints. Results: The Mean (SD) HbA1c were 63.9 (14.6)mmol/mol before and 62.3 (13.3)mmol/mol after the second doses of vaccine (p = 0.009). The differences of TAR >10mmol/L [mean differences (md = 1.02%)], TAR >13.9mmol/L (md = -0.86), TIR 3.9-10mmol/ L (md = -1.06%), TBR < 3.9mmol/L (md = 0.08%), and TBR <3.0mmol/L (md = 0.06%) were not significant after the second dose of vaccine. There was also no significant change in percentage of GMI, CV, and no episodes of severe hypoglycemia, diabetic ketoacidosis (DKA), or hospitalization after the vaccination was recorded. Conclusions: The covid-19 vaccination did not significantly affect the glycemic control among people with type 1 diabetes.
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Several pieces of research have spotlighted the importance of count data modelling and its applications in real-world phenomena. In light of this, a novel two-parameter compound-Poisson distribution is developed in this paper. Its mathematical functionalities are investigated. The two unknown parameters are estimated using both maximum likelihood and Bayesian approaches. We also offer a parametric regression model for the count datasets based on the proposed distribution. Furthermore, the first-order integer-valued autoregressive process, or INAR(1) process, is also used to demonstrate the utility of the suggested distribution in time series analysis. The unknown parameters of the proposed INAR(1) model are estimated using the conditional maximum likelihood, conditional least squares, and Yule–Walker techniques. Simulation studies for the suggested distribution and the INAR(1) model based on this innovative distribution are also undertaken as an assessment of the long-term performance of the estimators. Finally, we utilized three real datasets to depict the new model’s real-world applicability. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
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Background: The coronavirus disease (COVID-19) pandemic created a new challenge for people with diabetes seeking face-toface consultations. We developed virtual care for people with type 1 diabetes (T1DM) by providing structured education on glycemic control and weight management. The objective of this study was to evaluate the effectiveness of this virtual support. Material(s) and Method(s): A total of 170 T1DM people treated with multiple daily injections (MDI) were offered virtual care through multi-disciplinary team. The outcome measures were changes in HbA1c, weight, hypoglycemic, and diabetic ketoacidosis (DKA) episodes, monitored at baseline and throughout the virtual support period. Result(s): During the virtual support HbA1C reduction was significant in people who showed continuity (n= 130;-8.05 mmol/mol, p< 0.0001) and 79 people were overweight/obesity had reduced their weight significantly (-2.96 kg, p= 0.003). CGM user for glucose monitoring had further reduction (n=79;-8.12 mmol/mol, p<0.001). The daily hypoglycemia episode also decreased (n= 5, pre 2.82 vs post 1.64, p= 0.003). No episodes of severe hypoglycemia, DKA, or hospitalization occurred during this period. Conclusion(s): Virtual care has a significant role in diabetes care in a pandemic situation and can be integrated into future consultation.
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In the past ten years, sustainable supply chain management (SSCM) attach great importance due to consumers, for-profit and profitless organizations, laws and regulations to the social and corporate responsibilities of consumers, so it has been recognized by practitioners and scholars. Supplier selection, environmental effect like a lockdown, and social cooperation and other SSCM programs can play an important part in realizing the triple bottom line (TBL) of economic, environmental, social assistances. In supply chain management (SCM), the sustainable supplier selection (SSS) and firm performance plays an important role. Traditionally, when evaluating SSS performance, organizations will consider a new framework to obtain the overall criteria/sub-criteria of the sustainability index by encapsulating sustainability. In this paper 12 sub-criteria for 3 pillars of sustainability as economic, environment and social performance is collected. Although there are many articles on SSS and evaluation, so far, research on sustainability issues is very limited. This study endeavours to propose a fuzzy multi-criteria approach to discuss SSCM planning, and studies the issue of determining a current model for SSS in the supply chain during COVID-19 based on the TBL method. For express the linguistic value of the subjective preference of experts we use triangular fuzzy numbers. By using fuzzy numbers to find standard weights for qualitative performance evaluation, then fuzzy TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) is proposed to find the ranking of SSS. However, COVID-19 has a negative role in SSS and in firm performance. The situation of lockdown due to COVID-19 has a negative effect on the performance of the organizations. An example is given of the proposed method. © 2022, Politechnika Lubelska. All rights reserved.
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Aims: Severe acute respiratory syndrome coronavirus (covid-19), changed diabetes care delivery globally. The impact of virtual care is unknown. Our study aims to evaluate the effectiveness of virtual clinics on glycaemia in DAFNE Kuwait graduates. Methods: A total number of 221 DAFNE graduates were invited to join virtual care. 184 DAFNE graduates accepted to follow-up virtually and were recruited to the cohort group. A matched number of 184 DAFNE graduates did not follow-up virtually and served as controls. Three structured virtual care were developed by the multidisciplinary team at DAFNE Kuwait. The primary outcome measures were HbA1c and weight which were monitored at baseline and after three months for both groups. A cross-sectional analysis was conducted in this study. Results: At three months' follow-up, there was a significant reduction in HbA1c for subjects who attended all virtual appointments (n = 122, pre 72.75 vs. post 63.81 mmol/mol, p < 0.001) in the cohort group. Whereas, HbA1c increased significantly for subjects in the control group (n = 134, pre 56.82 vs. post 63.05, p < 0.001). On average, the mean of virtual visits per subject was 18 visits for completers. The frequency of daily hypoglycaemic episodes decreased significantly among the hypoglycaemia unawareness group (n = 6, pre 2.8 vs. post 1.7 events per day, p = 0.002). Interestingly, the difference between HbA1c and weight in covid-19 infected (n = 6) and non-infected cases (n = 178) were almost equal. Lastly, a significant weight reduction was observed among overweight DAFNE graduates followed up virtually (n = 85, pre 80.9 vs. post 77.8 kg, p < 0.001). Conclusions: DAFNE Kuwait virtual care had significantly reduced HbA1c and weight.
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COVID-19 continues to pose a global public health emergency several months after the first cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (then referred to as novel coronavirus [2019-nCoV]) infection were reported in Wuhan, China. Starting off as local infection, it has now affected most countries devastatingly while taking its toll on millions of people. So far, clinicians and researchers have derived biological understanding and treatment designs to tackle COVID-19 from the recently learned lessons during similar epidemics caused by coronaviruses, namely, SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). However, COVID-19 has transformed into a pandemic surpassing the previously reported epidemics and requires a targeted therapy approach in addition to synchronized preventive measures. With the advent of new knowledge and developments on the subject of SARSCoV-2 almost every day, an update to the biological understanding of coronaviruses is necessary as well. This article presents a comprehensive review of SARS-CoV-2 biology, COVID-19 epidemiology, and therapeutic approaches for patients along with the major issues of concern. We cover the structure and infection mechanism of SARS-CoV-2 known till date, along with the common pathological findings and immune responses in patients. We also review the patterns of disease epidemiology in India and worldwide, the current therapeutic modalities as well as the possible strategies of prophylaxis and treatment that may be used for COVID-19 patients in the near future. Finally, we discuss a few challenges put forth by this pandemic in a developing country like India which need to be addressed immediately. © 2021 Irshad, et al.