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Background: Diabetes is co-morbid with various metabolic and psychological disorders. Diabetes and depression are both chronic conditions with allied adverse and complicated outcomes. Objectives: The current study was designed and planned accordingly to elucidate the associated frequency of depression with DM (Diabetes Mellitus) type 2 and prescribing practice of doctors depending on the distressing reality and threatening figures. Methodology: A prototype prospective study was monitored in different public and private sector hospitals and clinics of outpatient settings in Karachi after taking approval from the Ethical Review Board of Hamdard University. In this context, seven hundred patients having diabetes were covered in the study and their data were analyzed through the Statistical software version 20. Beck Depression Inventory (BDI) was the preferred approach to evaluate the depression level. Results: The outcome of the study established the fact of high prevalence for the co-morbidity of stress, anxiety and depression among patients with diabetes in Karachi, specifically among age bracket from forty to sixty years. Unfortunately, 80% (544) of diabetic patients in the study were suffering from depression and anxiety, while only 22.05% (120) patients were taking antidepressants and they were not counseled for the root cause of the disease. Severe depression (BDI score=38) was present in 100 subjects, moderate depression (BDI score=27) in 200 subjects, and mild depression was present in 175 of subjects. Being a patient of DM is itself a strong reason for contracting a depressive disorder. The result highlight improper treatment of depression in diabetic patients. Conclusion: However, the current situation demands to follow proper treatment through effective and appropriate drugs to treat the disease from progressing. Moreover, efforts should be undertaken to strengthen the healthcare system where practitioners, either doctors, pharmacists or nurses are liable for patient care in both the physical and psychological domains.

Diabetes mellitus is co-morbid with various metabolic and psychological disorders characterized by high blood glucose levels due to defects in insulin availability in body. Glucose work as a fuel to provide energy for all physical activities whereas in type 1 diabetes, the beta cells in the pancreas becomes unable to make insulin because of autoimmune disease, consequently there is no insulin to convert glucose leading to low energy level and other metabolic disorders. The disease is also called juvenile diabetes as usually starts to appear in childhood, that cannot be controlled but can be managed by timely diagnosis and care. The present study covers the case of a young child having type 1 diabetes in childhood and its consequences. The child inherited from paternal grandmother however other siblings were deficit. The case was become complicated because of poor timely investigations and management. Furthermore weak awareness and inappropriate healthcare practices made the disease more knotty. The work also covers the measures that should be taken by the health care providers through proper counseling and educating the parents and family, furthermore an accurate guidelines regarding nutrition, medications should be utmost. Self identification of having diabetes is necessary for school going children in order to manage abrupt hypoglycemic corollaries. Bangladesh Journal of Medical Science Vol.19(2) 2020 p.326-332

Objective:After the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic, intense efforts to combat the novel coronavirus were undertaken, with many fatalities in most regions of the world. The high fatality rate and socioeconomic collapse affected the health of uninfected individuals because healthcare measures and scheduled clinical and hospital visits were avoided by people in an attempt to reduce their exposure to the contagion. The general population began self-medication practices as means to safeguard against exposure to the virus.Methods:The present study investigated the effectiveness of self-medication compliance among the general population. For this purpose, a questionnaire on the Zenodo scale was developed and adults and teen respondents were asked to complete it, after providing consent. The data gathered were analyzed using IBM SPSS Statistics Version 26.Results:The study amazingly found high compliance with self-medication among the focused population during the period of COVID-19. Estimated results showed a highly significant correlation of 0.000, P < 0.05, between the adaptation of self-medication and pandemic situation, which was estimated from chi-squared and Fisher test results.Conclusions:However, the fear of coronavirus made the practice, or malpractice, a survival of the fittest, innate ability of human nature.

The purpose f the study is to explore the prospective use of Carica papaya leaves extracts for Dengue fever that is a painful, debilitating mosquito-borne disease caused by dengue viruses. An estimated 390 million dengue infections occur worldwide each year, with about 96 million resulting in illness. It has been found at height in developing nations like India, Pakistan, Sri Lanka and Bangladesh. Mostly tropical areas have been reported infected. The disease is transmitted by an Aedes mosquito infected with a dengue virus; interestingly it is not transferred from person to person. Symptoms are mild to serious including hemorrhagic fever; a rare complication characterized by high fever, damage to lymph and blood vessels, bleeding from the nose and gums, enlargement of the liver, and failure of the circulatory system and it can cause the death. All the symptoms of disease are due to low platelets count that may become very low if not managed. Consequently the research reveals that juice of the leaves of the Carica papaya plant from the family Caricaceae help to increase the platelet levels. The present review is done to enlighten the theory of the management of dengue through this alternative therapy that can be implement along with conventional treatment. The covered researches in present study would raise and support the possibility of being, the remedy and significant alternative in the prospect.

The idea of this study is based on the marvelous fact of nojirimycin and deoxy nojirimycin, naturally occurring from piperidine class and having their role as alpha glucosidase inhibitors. In the present work some hydroxyl piperidine analogues have been synthesized and analysed for their hypoglycemic effect through glucosidase inhibition owing to the structural resemblance with nojirimycin. The activity was done by spectral absorbance analysis using acarbose as standard. Two analogues (IIV) were found to pose excellent activity having 87.4 and 54.7% inhibition respectively, hence strengthening the idea of studying piperidine analogiues as glucosidase inhibitors due to structural similarity with nojirimycin.

Prescriptions comprising multi-drug therapy mostly illustrate the prescribing error. The phenomenon of error is bonded with human inaccuracy. The erroneous practice is observed in under developed countries like Pakistan, Bangladesh and also in developed ones. Consequently drug-drug interaction is one of the most common error associated with potentially serious adverse response even death. Accordingly the present study was conducted to assess the prevalence of prescribing errors and drug-drug interactions in out-patients receiving angiotensin receptor blockers. The study was done with population size one hundred fifty prescriptions obtained from different out-patient settings in Karachi. The prescriptions were screened for prescribing errors and risk factors for drug-drug interactions. Drug-drug interactions were recognized by Micromedex.2.0.Drug-Reax®database. The most common type of error was omission error. These errors were patient's age, weight and diagnosis found in 51.3%, 97.3% and 74% of prescriptions, respectively. The prevalence of drug-drug interaction was 38%. A total of 746 drugs were prescribed with an average of 5 drugs per prescription and 450 medication errors were detected. Majority of the interaction were moderate (19.33%), others were minor (14%) and major (6%) in severity. Patients who prescribed many drugs (more than 5 drugs in a while) had a higher risk of developing drug-drug interactions (OR=4.76; 95% CI=2.30-9.64; p=0.0001*).The study data reports the occurrence of prescribing errors in Karachi and also necessitate the need of clinical pharmacist's services in health care system. The step will help to minimize the risk factors by having the drug prescriptions reviewed by the pharmacists.

The objective is to assess the awareness level and practice for the consumption of expired pharmaceuticals in general public of Karachi, Pakistan. In this regard, a cross-sectional study was conducted and completed from December 2013 to September 2014. Self-administered study instrument was used which consisted of total 11 variables regarding the assessment of participants’ perspective on product expiry and its usage was distributed to 120 participants. Data were analyzed in SPSS version16.0. Primarily descriptive nature was used while frequency percentages of respondents were computed for categorical variables. Mean ± SD were computed for assessment of knowledge scores. Overall response rate was 83.33% in which 74 male and 26 females filled the study instrument. Average scores of respondents’ awareness regarding expiry of pharmaceutical products was 4.62 ± 0.75. The qualification of respondents includes the graduates’ count (64.9% male and 65.4% females) while 16.2% male and 23.1% female were postgraduate. Response distribution of respondents showed that 93.2% male and 92.3% female were aware about the product expiry concept. Similarly, 87.8% male and 96.2% female were in favor for their non-utilization, as 89.2% male and 96.2% female reported its severe harmful effects. Overall, 87.8% male and 76.9% female were interested to discard such products. Interestingly, 82.4% male 73.1% female were in full opinion to check the product expiry date before its purchase whereas, 78.4% male and 92.3% female have their opinion to purchase long expiry products. Box plot regarding products preference and total aggregated knowledge scores showed consistency. Results concluded that the knowledge, responses and practices of participants were in favor for the non-utilization of expired pharmaceuticals.

Objective Glucagon-like peptide-1 (GLP-1) plays a major role in pancreatic β-cell function and survival by increasing cytoplasmic cAMP levels, which are thought to affect transcription through activation of the basic leucine zipper (bZIP) transcription factor CREB. Here, we test CREB function in the adult β-cell through inducible gene deletion. Methods We employed cell type-specific and inducible gene ablation to determine CREB function in pancreatic β-cells in mice. Results By ablating CREB acutely in mature β-cells in tamoxifen-treated Creb loxP/loxP ;Pdx1-CreERT2 mice, we show that CREB has little impact on β-cell turnover, in contrast to what had been postulated previously. Rather, CREB is required for GLP-1 to elicit its full effects on stimulating glucose-induced insulin secretion and protection from cytokine-induced apoptosis. Mechanistically, we find that CREB regulates expression of the pro-apoptotic gene p21 ( Cdkn1a ) in β-cells, thus demonstrating that CREB is essential to mediating this critical aspect of GLP-1 receptor signaling. Conclusions In sum, our studies using conditional gene deletion put into question current notions about the importance of CREB in regulating β-cell function and mass. However, we reveal an important role for CREB in the β-cell response to GLP-1 receptor signaling, further validating CREB as a therapeutic target for diabetes.

Purpose: To investigate the knowledge and attitude of outpatients regarding pharmaceutical package inserts (PPIs) in Karachi, Pakistan.Methods: The study design was cross-sectional and conducted from August to December 2013. A previously validated questionnaire was adopted, modified and revalidated. Outpatients were asked to respond to the questionnaire.Results: A total of 456 patients responded to the questionnaire. The patients (n = 226, 49 %) were found to be keen on reading inserts in their mother language. Among the study population, 24.1 % (n = 110) of respondents faced problem in reading and 29.8 % (n = 136) in understanding inserts. There was general awareness of the essential components of package inserts and 78.3 % (n = 357) of patients opted for further improvement in PPIs of drugs available in Pakistan. Chi square test revealed that educational status of patients was significantly associated with all of the items of the questionnaire (p

A central challenge of developmental and evolutionary biology is to understand the transformation of genetic information into morphology. Elucidating the connections between genes and anatomy will require model morphogenetic processes that are amenable to detailed analysis of cell/tissue behaviors and to systems-level approaches to gene regulation. The formation of the calcified endoskeleton of the sea urchin embryo is a valuable experimental system for developing such an integrated view of the genomic regulatory control of morphogenesis. A transcriptional gene regulatory network (GRN) that underlies the specification of skeletogenic cells (primary mesenchyme cells, or PMCs) has recently been elucidated. In this study, we carried out a genome-wide analysis of mRNAs encoded by effector genes in the network and uncovered transcriptional inputs into many of these genes. We used RNA-seq to identify >400 transcripts differentially expressed by PMCs during gastrulation, when these cells undergo a striking sequence of behaviors that drives skeletal morphogenesis. Our analysis expanded by almost an order of magnitude the number of known (and candidate) downstream effectors that directly mediate skeletal morphogenesis. We carried out genome-wide analysis of (1) functional targets of Ets1 and Alx1, two pivotal, early transcription factors in the PMC GRN, and (2) functional targets of MAPK signaling, a pathway that plays an essential role in PMC specification. These studies identified transcriptional inputs into >200 PMC effector genes. Our work establishes a framework for understanding the genomic regulatory control of a major morphogenetic process and has important implications for reconstructing the evolution of biomineralization in metazoans.

A central challenge of developmental and evolutionary biology is to understand how anatomy is encoded in the genome. Elucidating the genetic mechanisms that control the development of specific anatomical features will require the analysis of model morphogenetic processes and an integration of biological information at genomic, cellular and tissue levels. The formation of the endoskeleton of the sea urchin embryo is a powerful experimental system for developing such an integrated view of the genomic regulatory control of morphogenesis. The dynamic cellular behaviors that underlie skeletogenesis are well understood and a complex transcriptional gene regulatory network (GRN) that underlies the specification of embryonic skeletogenic cells (primary mesenchyme cells, PMCs) has recently been elucidated. Here, we link the PMC specification GRN to genes that directly control skeletal morphogenesis. We identify new gene products that play a proximate role in skeletal morphogenesis and uncover transcriptional regulatory inputs into many of these genes. Our work extends the importance of the PMC GRN as a model developmental GRN and establishes a unique picture of the genomic regulatory control of a major morphogenetic process. Furthermore, because echinoderms exhibit diverse programs of skeletal development, the newly expanded sea urchin skeletogenic GRN will provide a foundation for comparative studies that explore the relationship between GRN evolution and morphological evolution.

The failure to expand functional pancreatic β-cell mass in response to increased metabolic demand is a hallmark of type 2 diabetes. Lineage tracing studies indicate that replication of existing β-cells is the principle mechanism for β-cell expansion in adult mice. Here we demonstrate that the proliferative response of β-cells is dependent on the orphan nuclear receptor hepatocyte nuclear factor-4α (HNF-4α), the gene that is mutated in Maturity-Onset Diabetes of the Young 1 (MODY1). Computational analysis of microarray expression profiles from isolated islets of mice lacking HNF-4α in pancreatic β-cells reveals that HNF-4α regulates selected genes in the β-cell, many of which are involved in proliferation. Using a physiological model of β-cell expansion, we show that HNF-4α is required for β-cell replication and the activation of the Ras/ERK signaling cascade in islets. This phenotype correlates with the down-regulation of suppression of tumorigenicity 5 (ST5) in HNF-4α mutants, which we identify as a novel regulator of ERK phosphorylation in β-cells and a direct transcriptional target of HNF-4α in vivo. Together, these results indicate that HNF-4α is essential for the physiological expansion of adult β-cell mass in response to increased metabolic demand.