Journal of Sheikh Zayed Medical College (JSZMC)

One Health Approach: Way Forward to Prevent Future Pandemics

Masood ul Haq — 2023-04-11

World has seen many new infectious disease outbreaks before COVID-19. Majority of these emerging infections and almost all causing pandemics were zoonotic infections¹ Number of domestic and wild animals were proved to be source of such infections. Common ones include mammals, particularly bats, pigs, poultry, cattle, and camels from domestic animals, rodents & primates among the wild animals, and some birds especially water fowl. Nipah virus disease, avian influenza, Ebola virus disease, severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Zika are few significant examples worth mentioning. Each year, millions of persons in contact with diseased domestic and wild animals suffer from such infections, resulting in considerable morbidity and mortality. Many of such outbreaks actually caused pandemic in recent past, worst hit were the developing countries. Fortunately, there was no significant person to person spread, so their impact was not enormous. Experts always feared, if any infecting agent acquired the ability to spread from one humane being to other, consequences will be devastating. The worst came in shape of COVID 19 which practically shut down the world, physically and economically.

Due to increasing population, cities around the globe are expanding. Such expansion was not possible without encroachment into agricultural land and forests. Similarly, mining and other extracting activities increase the humane footprints into new areas of globe. Increased demand of food due to increasing population and desire to consume more animal proteins lead to addition of new eatables animals in the list of previously known ones and development of large animal farms. All these activities resulted in damage to the environment and disturbed the ecosystem as well as an increased humane interaction with domestic and wild animals. In these circumstances, increasing numbers of zoonotic infections are understandable. Review of the Global disease stats revealed an increase in such outbreaks at the rate of 6.7% since 1980. But from 2000 onward, there was a steep rise and now several hundred such outbreaks are witnessed in different parts of world each year². Furthermore, increasing means and ease of transportation of humane, animals and goods made the world practically a global village. Infections starting in one part of globe can spread quickly across the boundaries depending on the infectious potential of culprit agent. Global authorities are now convinced that

“Pandemic anywhere is potentially the pandemic everywhere in very short span of time”. Worst example in the modern era is that of COVID-19 in recent days.

COVID -19 pandemic has exposed many flaws in our strategy to deal with any pandemic at global as well as national levels. These shortcomings were not limited to developing countries, developed nations were also found inadequately prepared to cope with such situation. Absence of equitable access to health care facilities (medicines, critical care equipment, devices, personal protective equipment, vaccines etc.) was major issue. Inequalities were present both within and between the nations. After a short span of panic, authorities joined their efforts across the globe to formulate new strategies, gain knowledge, translate it into life-saving technologies including equipments, medicines and vaccines, and deliver it equitably across the globe. Things improved overtime, though not ideal, but at the cost of huge loss of humane lives and enormous social and economic burden. Had the world prepared to deal with such catastrophic events, response could have been prompt with lesser consequences.

Considering the evidence quoted above, infectious disease outbreaks are increasing at alarming rates and world is facing several hundreds of such outbreaks in different parts of world each year. Many of these have the potential to give rise to devasting pandemic, so next pandemic may be already on the horizon.³ Can we achieve and maintain the level of preparedness required to deal with an emergency of this scale globally? It might be possible in some developing countries but probably not possible in most of the developing world struggling to meet the minimal standards of health care.

No doubt, prevention is better than cure, and it hold true in case as well. As most of the pathogens involved in the recent pandemics are spill over infections from animals to humane in a conducible environment, risks can be reduced by addressing the factors active at the Humane – Animal - Ecosystem interface. The actions which likely to reduce spill overs and its consequences are strengthening of animal health and veterinary services, improving the on-farm biosecurity, reducing deforestation and/or forest degradation, improve conservation and improving urban planning.⁴

World bank has released a new report,⁵ “Putting Pandemics Behind Us: Investing in One Health to Reduce Risks of Emerging Infectious Diseases”. It must be realized that health of humane, animals, and ecosystem is interdependent and “One Health” means health of all three. World bank advocates all the policy makers, governments and international agencies to implement comprehensive strategies recommended in this report to prevent the possibility of future pandemics by addressing the risks involved at the source.

Among the strategies of pandemic prevention, preparedness and response, the prevention is most cost effective. World bank has estimated that by adopting ‘One Health approach’, prevention cost will be only one third cost of preparedness and less than 1% off cost of responding to COVID -19 pandemic in one single year 2020. There are many co-benefits of ‘One Health approach’ in addition to prevention of pandemic inhumane, like less CO2 emissions leading clean and healthy environment, improved productivity and food safety, reduced economic burden from animal diseases, and increased access to international markets for producers from both developing and developed countries.

To avoid any future devastating pandemic and reap the co-benefits in shape of sustainable humane development, ‘One Health Approach’ way forward to be adopted at national, regional, and global levels.

Hyperglycemia as a Complication of COVID 19: An Observational Study

Hala Bashir Hashmi — 2023-06-13

Background: Hyperglycemia has got a bidirectional importance in COVID 19, on one end it causes aberrant glycation of ACE receptors in the lungs causing more severe disease and on the other end it may occur as a result of complications of the disease itself.

Objectives: To determine whether hyperglycemia is a complication of COVID-19.

Methods: A cross-sectional observational study was conducted on 126 admitted, moderate to severe COVID-19 patients, to observe new-onset hyperglycemia in relation to their previous glycemic control (glycated hemoglobin levels HbA1c). Blood sugar random (BSR) noted at time of admission was taken as the dependent variable and HbA1c, body mass index and severity of disease as independent variables to find out association. Patients who were known diabetic and already taking steroids were excluded from study.

Results: A total of 126 patients (66 male and 60 female) included in the study with a mean age 56.9 yrs. ± 11.8. Based on admission HbA1c, 71(56.4%) patients were non-diabetic, 35(27.7%) pre-diabetic, and 20(15·9%) were diabetic. Initial random blood sugar revealed overall 31(24.6%) patients had normoglycemia, while 95(75.4%) had hyperglycemia, more precisely 67(53.2%) had moderate and 28 (22.2%) had severe hyperglycemia. Hyperglycemia was observed among 9 out of 12 (75%) patients from 20-39 years age group, 51 out of 61 (83%) patients from 40-59 years age group and 35 out of 53 (66%) from 60-75 years age group. Eighty percent male and 76% female had hyperglycemia. Nineteen (15%) were of normal weight, 79 (62.8%) overweight and 28 (22·2%) were obese. The moderate and severe hyperglycemia for 95(75%) patients showed that 49(51·6%) had non-diabetic HbA1c, 27(28·4%) had prediabetes HbA1c and 19 (20%) had diabetic range HbA1c. Further linear association was determined between BSR and HbA1c, p<0•001. Among 31 normoglycemic patients it was found that 13(41.9%) patient were of normal weight, 17(54.8%) patients were overweight and one (3.3%) patients was obese. Moreover, Body Mass Index (BMI) and severity of disease were found to have significant association with new onset hyperglycemia with P <0∙001 and P=0∙01 respectively.

Conclusion: There is an association between new-onset hyperglycemia and moderate to severe COVID-19 disease. Follow-up studies are required to prove the diabetogenic effect of COVID 19.

Concerns of Healthcare Professionals during Covid-19 pandemic in Pakistan

Mehwish Ayyaz — 2023-10-28

Background: The COVID-19 pandemic has adversely affected healthcare professionals.

Objective: To determine the concerns of healthcare professionals during the COVID-19 pandemic.

Methodology: This descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynaecology Unit-5, Lady Aitchison Hospital, Lahore from 1^st March to 31^st March 2020. Sample size of 108 healthcare professionals was taken. Six main categories of concerns were made and various themes were recognized in each category. These included; the provision of PPE, risk of getting disease at work, transmission of infection to family members, access to COVID-19 testing if symptomatic, training to provide high-quality care, and support from institutional governing bodies. Data was analyzed by using SPSS version 20.

Results: Regarding the provision of PPE; 35% got PPE from hospital administration, and 29% faced a shortage of kits during initial days. Regarding the risk of getting disease at work; 21% of Healthcare providers, and patients were not practicing any precautionary measures, and social distancing was not practiced appropriately (15%). Overall 36% feared transmission of infection to family members. Limited number of testing kits available per day was another concern of Healthcare providers (23%). There was not enough training or guidelines and set protocols was a concern shown by 27% and 46% showed nonavailability of funds.

Conclusion: It is concluded that healthcare professionals are concerned about the provision of PPEs, the risk of transmission of infection to family members, the lack of proper training, and the shortage of funds.

Development of Health Literacy Assessment Tool for Type 2 Diabetic Patients of Pakistan having Understanding for Urdu Language

Hala Hashmi — 2023-11-03

Background: Health literacy and its assessment is required to determine health seeking behavior of people in a community. It is the ability of an individual to gain access to health related events and resources in order to maintain and improve his own health. Health literacy level varies according to cultural and lingual diversities of a community.

Introduction: Pakistan is among the developing countries where people are seeking health services and utilizing them depending upon the availability of resources. Urdu language is understood by most of the population as it is their mother language. Almost 6 different languages are being spoken and understood among different areas of Pakistan, but health care providers are using Urdu as a common language. The Health Literacy Assessment Tool has been developed in national language to determine the health related behavior of a population.

Methodology:The health literacy tool for type 2 diabetic patients has been developed to access the ability of individual to understand and interpret the health related information provided to them. Health literacy is not merely the ability to read or write but it is also the ability to understand and seek the health related information. This tool was constructed after discussion with researchers and health care providers. Construct validity was determined through their education, understanding visual and verbal information provided to them and related to health literacy score for diabetic patients. Reliability of tool was determined by Cronbach alpha (>7).

Conclusion: It is specific tool for determination of health literacy of diabetic patients who can understand national language as provided by health professionals

Food Fortification Knowledge of Healthcare Providers and Barriers to its Consumption among their Attended Clients: Cross-Sectional Survey from Punjab

Wardah Nisar — 2023-11-03

Background: Food fortification improves the nutritional value of food products and adds health benefits.

Objective: To assess knowledge of food fortification among health care professionals and barriers to its consumption among their attended Clients of Punjab province.

Methodology: This cross-sectional research design was used to evaluate food fortification knowledge and its related barriers to its consumption amongst healthcare professionals from October 2019 to March 2020. A total of 360 healthcare professionals were selected. Targeted groups include MBBS doctors, nurses, midwives, and lady healthcare workers. A self-administered close-ended questionnaire was formulated. Bar charts were constructed for the source of information regarding food fortification. Chi-Square statistic was used to test the hypothesis. For categorical variables such as knowledge about fortification and barriers to consumption, frequency percentages were calculated.

Results: Overall 121 (33.6 %) healthcare professionals were of the view that food fortification is a type of adulteration, and 214 (59.4%) supported supplements over fortified products. Unaffordability (83%), and change in appearance and taste (84%) were highlighted as top barriers in consumption of fortified foods. Change in color, appearance, or taste of fortified foods 303 (84%) and unaffordability due to high cost 302 (83.8%) were the two most highlighted barriers.

Conclusion: There are major misconceptions about food fortification among healthcare providers and multiple barriers are perceived to be prevalent among patients. Comprehensive efforts are needed to improve knowledge regarding food fortification and its related barriers. The use of educational technology can be beneficial for supporting learning and teaching healthcare professionals and food industrialists regarding food fortification.

Burden of Depression in Patients of Parkinson’s Disease Presenting to a Single Tertiary Care Institution

Shoaib Luqman — 2023-12-05

Background: Depression is a commonly reported co-morbid condition in Parkinson's Disease (PD). It is often ignored while treating somatic motor manifestations of the disease.

Objective: To determine the frequency of depression in patients with Parkinson's disease

Methodology: Study Design: Cross-sectional survey. Place & Duration of Study: Department of Neurology, Bahawal Victoria Hospital, Bahawalpur from December 2020 to May 2021. One hundred and fifty physician-diagnosed cases of PD were recruited. We diagnosed PD through the United Kingdom Parkinson Disease Society Brain Bank criteria (UKPDSBB). Depression was defined according to ICD-10 criteria. Numerical variables like age and duration of disease were presented as Mean±SD, whereas depression and sex were presented as percentages. The chi-square test was used to compare the sex-wise distribution of depression. SPSS version 20 was used for data analysis.

Results: In our study, 54 (36%) patients fulfilled the ICD-10 criteria to be labeled as suffering from Depression whereas 96 (64%) were not found to be depressed. Among the 54 patients meeting the ICD-10 criteria for depression, 24 (44.4%) were females and 30 (66.6%) were males. Of the 96 patients found not to be depressed, 36 (37.5%) were females (37.5%) and 60 were males (62.5%). (p=0.4)

Conclusion: Depression was found to be present in a significant number of patients with Parkinson's disease, with more frequency among females.