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Pre-diabetes is the state of hyperglycemia at an intermediate stage in which parameters of blood glucose are above standard value but less than the threshold of diabetes. Diabetes mellitus is measured as a risk factor with a high probability of its development. Although the analytic measures for pre-diabetes are not the same in different international professional organizations, the danger of diabetes development is still in height, with conversion rates ranging from 5% to 10% per year. Databased studies propose a relationship between diabetic complications and pre-diabetes like early kidney disease, early retinopathy, small fiber neuropathy and the danger of macrovascular disease. Numerous analyses have revealed the effectiveness of daily routine interpositions in preventing diabetes, with a comparative danger decrease of 40% to 70% in prediabetic adults. Though there is cumulative indication that drug therapy is effective in preventing diabetes in prediabetic adults, drug options for treatment rather than metformin are related with side effects that bound their usage in prediabetics. There are no studies of systematic assessment of the healthiness consequences associated with prediabetes among Children. The effect of pharmacology treatment of pre-diabetes on development and growth in children during adolescence is unidentified. Secondary involvement with metformin pharmacology treatment is recommended for speculative persons, but the standards for assessing the advantage of such primary interference, the longstanding cost-effectiveness of such treatment is still uncertain. Pharmacological treatment should be cast-off with care in prediabetic children. Although pre-diabetes is usually asymptomatic, pre-diabetes always occurs before diabetes develops. The high blood sugar level persists and therefore pre-diabetes cannot be considered completely mild. Conclusions: The purpose of this review is to define the difficulties related with the analysis of pre-diabetes, the potential adverse outcomes of pre-diabetes, and the treatment opportunities and validation of its practice in the context of pre-diabetes.

Hypothyroidism is a communal thyroid hormone deficit disorder. It affects ten percent of the general population and it is estimated that 5% go undiagnosed. If not treated properly, it can cause serious health problems and even death1-2. There is no great variability in the clinical picture or specificity of symptoms, therefore it is most often diagnosed mainly biochemically3. Levothyroxine (L-thyroxine, LT4) is the gold standard in the treatment of hypothyroidism. It was introduced in 1949 and has since improved the lives of millions of hypothyroid patients. As it is usually given for the patient's life, the dose can be affected by physiological changes. In addition, the dosage should be adjusted in the event of concomitant medical conditions, pregnancy and the elderly. Clinically significant interactions between levothyroxine and other drugs, food and dietary supplements may occur. This can change the safety and effectiveness of the treatment4-5. The physician should be aware of the use of thyroxine and its interactions with other medications and diet6. Hypothyroidism, levothyroxine uses and dose adjustments and their interactions will be discussed in this review. Keywords: hypothyroidism, levothyroxine, dose adjustment, interaction

Aim: To probe the existence of dyslipidemia in Type II diabetic patients at Mirpurkhas and to assess different pattern of dyslipidemia in Type II diabetic patients. Study design: Cross sectional prospective study. Place and duration of study: Two GP Clinics @ Mirpurkhas, 06 Months from 1st September 2020 to 28th February 2021. Methodology: Four hundred type II diabetic patients were registered. Complete history and physical examination done for all registered patients. The age, sex, occupation, address, family history of diabetes, addiction was recorded. Results: There were 241 (60.25%) females and 159 (39.75%) males. The prevalence of dyslipidemia in diabetic males was 58.49% and for females were 58.09%. High triglycerides and low high-density lipoprotein (HDL) were most prevalent pattern of dyslipidemia found in females and high low-density lipoprotein (LDL) followed by low high-density lipoprotein (HDL) was found in males. Overall, low HDL and high TG was most prevalent pattern found. Conclusion: Dyslipidemia is very prevalent in diabetic patients, and common patterns are hypertriglyceridemia and reduced levels of high-density lipoprotein cholesterol whereas, dyslipidemia may lead to cardiovascular abnormalities in diabetic patients. Optimal control of sugars and cholesterol can play major role in prevention of such sinister complications. Keywords: Dyslipidemia, Diabetes, Cardiovascular disorders. Prevalence

Objective: To determine association of T2DM with depression, Covid-19, hypertension, junk food, weight, age, physical activity, smoking, family history, education and income. Study Design: Cross-sectional, multicenter study Duration and Place of Study: Family Health Clinic, Mehmoodabad, Ahmad Medical Centre, FB Area Karachi, Al-khidmat Hospital North Karachi, Rafah-E-Aam Hospital FB Area Karachi, from 1st November 2020 to 30th April 2021. Methodology: Pre-tested, researcher administered questionnaire was used through medics and paramedics. Information was collected from general patients and care givers. Non–diabetics and non-hypertensives were tested/checked on the spot. Results: Mean age of the participants was 35 years with minimum 18 and maximum 70 years. Males were 279 (95%). In males 30 (11%) were diabetic and in females 7 (47%) were diabetic. 168 (57%) of the participants got above matric education. Low-income group consisted of 271 (92%) participants. Diabetes was present in 37 (13%). Forty six percent diabetics were diagnosed incidentally. Most (24; 65%) were diagnosed by general practitioner, six (16%) by Family Physician, four (11%) by specialist and one (3%) by self. Conclusions: General practitioners play a pivotal role in diagnosing and managing diabetes mellitus. To reduce the burden of diabetes in Pakistan, modifiable risk factors like low education and high inflation have to be addressed. More over marriages between first cousins need to be discouraged. Keywords: Diabetes mellitus, Junk food, Lifestyle, Obesity

Background: Diabetic Peripheral Neuropathy (DPN) is a common and difficult complication of diabetes and poses significant burden to many diabetics and the public health-care system. Diabetic patients in rural areas have higher risk of developing diabetes related complications and have inadequate access to proper treatment especially low-income countries. Objectives: To determine prevalence of diabetic peripheral neuropathy in patients with Type II diabetes in rural areas of Nawab Shah and to determine various risk factors the development of diabetic peripheral neuropathy in Type II diabetic patients. Study Design: Cross-sectional study Place and Duration of Study: Study was done in rural areas of Nawab Shah District (SBA), 06 months from September 2020 to February 2021 Methodology: One thousand and fifty-seven diabetic patient’s demographic parameters and diagnostic criteria depend on primary care setup first three were enrolled. Results: The overall prevalence rate in rural areas the Nawab Shah was almost 57.42%. Conclusion: The prevalence of diabetic peripheral neuropathy increased with increasing age and it is observed to be associated with duration of diabetes, physical activity, smoking habit and systemic hypertension. Keywords: Diabetes mellitus, Peripheral neuropathy, Risk factors, Rural population, Prevalence

Sore throat is a common complaint to both laryngeal mask airway (LMA) insertion and endotracheal tube intubation. Its incidence in LMA has been found to vary between 5.8% and 34%. Administration of medicated lozenges in the preoperative period is also a route available for the prevention of postoperative sore throat (POST).The aim of this double-blinded randomized controlled study was to evaluate the efficacy of turmeric-based lozenges given preoperatively in patients undergoing general anesthesia (GA) under LMA insertion for the prevention of POST.This study was conducted at the Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Rama Nagar, Dehradun, over a period of 12 months.Two hundred and fifty patients of the American Society of Anesthesiologists classes I and II posted for elective surgeries under GA with insertion of LMA were included in our study. Randomization was done by the sealed envelope technique. Turmeric extract with menthol and eucalyptus oil lozenges was given in Group A (The data were analyzed using Chi-square test, Fisher's exact test, and Student'sThe turmeric lozenges containing 6.4 mg eucalyptus oil and 6.3 mg menthol oil along with turmeric extract 100 mg significantly reduced the incidence of POST across all time intervals (POST was reduced with preoperatively administered eucalyptus oil and menthol oil containing turmeric lozenges.

Background: Type 1 diabetes mellitus (T1DM) and familial hypercholesterolemia (FH) are two different genetic disorders with serious health consequences. T1DM is an immune mediated disease that impacts the pancreas and causes a lack of insulin levels, whereas FH is an inherited condition that causes high cholesterol levels in the blood. FH and type 1 diabetes mellitus are both linked to substantial morbidity and premature mortality due to atherosclerotic cardiovascular disease. Material and Methods: To better understand the ongoing debate regarding the relationship of type 1 Diabetes mellitus with familial hypercholesterolemia. Medline search of the literature was held between 2016 and 2022. From this search, 35 articles with relevant material were selected. Results: The data from the previous conbined studies show that there is a link between types 1 dm with familial hypercholesterolemia in children. Less physical activity, higher BMI value and obesity are some of the areas that link hypercholesterolemia with diabetes mellitus 1. Therefore, it is advised to have metabolic control to treat hyperlipidemia. Conclusion: Familial hypercholesterolemia is significantly linked with type 1 diabetes mellitus and is more common among children and adolescents. Dyslipidemia is more frequently reported among female patients. The most of the patients of dyslipidemia shows elevated LDL-C and low HDL-C. Keywords: Type 1 diabetes mellitus, familial hypercholesterolemia, low-density lipoprotein, blood glucose level and cardiovascular disease.

The World Organization of Family Doctors (WONCA) is a not-for-profit organization and was founded in 1972 by member organizations in 18 countries. WONCA now has 118 Member Organizations in 131 countries and territories with a membership of about 500,000 family doctors and more than 90 percent of the world's population. WONCA has seven regions, each of which has its own regional Council and run their own regional activities including conferences. WONCA South Asia Region is constituted by the national academies and colleges and academic member organizations of this region namely India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives. In the background of the ongoing COVID 19 pandemic, the office bearers, academic leaders, practitioners, and researchers of primary care from the South Asia Region have issued a solidarity statement articulating the role of primary care physicians.

Aim: To investigate evaluation of diabetic nephropathy and associated risk factors in type I and type II diabetic patients. Study design: Cross sectional prospective study Place and duration of study: Diabetic Clinic, Badin, 06 Months from August 2020 to January 2021 Methodology: Five hundred patients were conducted at Diabetic Clinic, Badin of Type I diabetes mellitus and Type II diabetes mellitus. Results: Twenty-five patients of Type I and 475 patients of Type II. The mean comparison of age, weight, height, body mass index, blood sugar, systolic BP, diastolic BP, HbA1c, serum creatinine, urine albumin and serum urea showed their significant value. Conclusion: Type II diabetes mellitus represent the large majority of macroalbuminuric, diabetics at risk of ESRD and diabetic nephropathy as compared to type I diabetic patient. Keywords: Diabetes mellitus, Diabetic nephropathy, Risk factors

Gene therapy orphan medicinal products constitute a unique group of new drugs which in case of hereditary diseases are usually administered only once at an early age, in the hope to provide sufficient gene product to last for the entire life of the patients. The combination of an exceptionally large single payment and the life-long clinical follow-up needed for understanding the long-term benefits and safety of gene therapy, represent new types of scientific, financial, social and ethical challenges for the pharmaceutical industry, regulators and society. With special consideration of the uniqueness and importance of gene therapy, the authors propose a three points plan for a close cooperation between the pharmaceutical industry and society to develop orphan gene therapy. (1) In fully transparent health technology negotiations a close and long-lasting, contractually fixed cooperation should be established between the manufacturers and local health-care stakeholders for sharing the medical and scientific benefits, the financial risks as well as the burdens of the post-authorization clinical and regulatory development. (2) The parties should agree on a fair, locally affordable drug price without the usually very high premium price calculated to compensate for the low number of patients. In case of high manufacturing costs, the companies should offer prolonged, 15–20 years long payment by installment with risk-sharing, especially considering that the late outcome of the treatment is unknown. Society should assist scientifically and financially organizing a specific patient registry, treatment in specialized hospitals and adequate long-term follow-up of patients, the coordinated management of financial transactions related to the risk sharing program. (3) The post-authorization treatment and prolonged observation of additional new cases coordinated by society should provide real world data needed for the modern complex regulatory evaluation of gene therapy products by the competent authorities. We assume that fair sharing of the benefits and risks as well as a well-organized cooperation of society with the industry in collecting real world evidence might result in better drug evaluation and improved accessibility due to lower prices. The outlined concept might support gene therapy more efficiently than the presently requested outstandingly high prices.

Expansion of data-driven research in the 21st century has posed challenges in the evolution of the international agreed framework of research ethics. The World Medical Association (WMA)’s Declaration of Helsinki (DoH) has provided ethical principles for medical research involving humans since 1964, with the last update in 2013. To complement the DoH, WMA issued the Declaration of Taipei (DoT) in 2016 to provide additional principles for health databases and biobanks. However, the ethical principles for secondary use of data or material obtained in research remain unclear. With such a perspective, the Working Group on Ethics (WGE) of the International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP) suggests a closer scientific linkage in the DoH to the (Declaration of Taipei) DoT focusing specifically on areas that will facilitate data-driven research, and to further strengthen the protection of research participants.