ÿþ<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns="http://www.w3.org/TR/REC-html40"> <head> <meta http-equiv="Content-Language" content="en-gb"> <meta name="GENERATOR" content="Microsoft FrontPage 5.0"> <meta name="ProgId" content="FrontPage.Editor.Document"> <META NAME="DESCRIPTION" CONTENT="PULSE International: Fortnightly Medical Newspaper from Pakistan"> <META NAME="KEYWORDS" CONTENT="Pulse, Medical, Pakistan, News, Professional Medical Publications"> <META NAME="OWNER" CONTENT="masood@masoodjawaid.com"> <META NAME="AUTHOR" CONTENT="Masood Jawaid"> <meta http-equiv="Content-Type" content="text/html; charset=unicode"> <title>Pulse International - Main News</title> </head> <body topmargin="0" leftmargin="0" link="#000000"> <SCRIPT LANGUAGE="JavaScript"><!-- imgsrc=new Array(); imgsrc[1]="a_current_button1.gif"; imgsrc[2]="p_current_button1.gif"; img =new Array(); for (i=0; i< imgsrc.length; i++) { img[i]=new Image(); img[i].src=imgsrc[i]; } function change(number, picture) { { document[picture].src=img[number].src; } } // --> </SCRIPT> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber1" background="../images/index_topstrip.gif" height="36" dir="ltr"> <tr> <td width="33%" height="130" align="center"> <p><b> <font color="#008000" face="Arial" size="2">Fortnightly Medical Newspaper <br> published from Pakistan</font></b></td> <td width="33%" height="130" valign="bottom" dir="ltr"> <p align="center" dir="ltr"> <img border="0" src="../../images/pulselogo.gif" width="282" height="120"></td> <td width="34%" height="130" align="center" dir="ltr"> <p align="center" dir="ltr"><font face="Arial" color="#008000" size="2"><b> Published by <br> Professional Medical Publications</b></font></p> </td> </tr> <tr> <td width="33%" height="26" align="center"> <p align="center"><span lang="en-us"><b> <font face="Arial" size="2">January</font></b></span><font face="Arial" size="2"><b><span lang="en-us"> </span>1<span lang="en-us">5</span>-<span lang="en-us">31</span>, 20</b></font><span lang="en-us"><b><font face="Arial" size="2">12</font></b></span></td> <td width="33%" height="26" align="center" dir="ltr"> <p align="center" dir="ltr">&nbsp;</td> <td width="34%" height="26" align="center" dir="ltr"> <p align="center" dir="ltr"><b><font size="2" face="Arial">ISSN: 1026-6828</font></b></td> </tr> </table> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber2" height="36" dir="ltr"> <tr> <td width="100%" valign="top" align="center" height="36" dir="ltr"> <p dir="ltr"><font size="2">&nbsp;</font></p> <div align="center" dir="ltr"> <!--webbot CLIENTSIDE bot="XmmFpEx" MODULEID="'mj (project)\top_menu1_off.xws'" PREVIEW="&lt;img src='../../top_menu1.gif?02A9627E' editor='menumaker' border='0'&gt;" startspan --><script src="xaramenu.js"></script><script menumaker src="../../top_menu1.js"></script><noscript><img src="../../top_menu1.gif?02A9627E" editor="menumaker"></noscript><!--webbot bot="XmmFpEx" endspan i-checksum="64999" --></div> </td> </tr> </table> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber3" dir="ltr"> <tr> <td width="100%" colspan="3" dir="ltr"><hr dir="ltr"></td> </tr> <tr> <td width="18%" align="left" valign="top" dir="ltr"> <p align="center" dir="ltr">&nbsp;<!--webbot CLIENTSIDE bot="XmmFpEx" MODULEID="'mj (project)\menu_r_off.xws'" PREVIEW="&lt;img src='menu_r.gif?02BBEDF2' editor='menumaker' border='0'&gt;" startspan --><script menumaker src="menu_r.js"></script><noscript><img src="menu_r.gif?02BBEDF2" editor="menumaker"></noscript><!--webbot bot="XmmFpEx" endspan i-checksum="5033" --> &nbsp;</p> <p dir="ltr">&nbsp;</td> <td width="76%" align="left" valign="top" dir="ltr"> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber5" dir="ltr" height="274"> <tr> <td width="100%" dir="ltr" height="19"> <p dir="ltr">&nbsp;</td> </tr> <tr> <td width="100%" dir="ltr" height="43"> <p class="MsoNormal" align="center"><b><span style="font-family: Arial"> <u>Diabetes conference at DUHS</u><br> <font size="5" color="#0000FF">Diabetic neuropathy and infections are the most common cause <br> of amputation in developing countries<span lang="en-us"> </span>- Prof. Vijay</font></span></b></td> </tr> <tr> <td width="100%" dir="ltr" height="16"> <p dir="ltr"></td> </tr> <tr> <td width="100%" dir="ltr" height="177"> <p align="justify" dir="ltr"><span lang="en-us"><font face="Arial" size="2"> KARACHI: Prof. Helmut Schatz from Germany was the first speaker in the first session on December 11th 2011 during the International Diabetes Conference organized jointly by Diabetic Association of Pakistan and NIDE at Dow University of Health Sciences. The topic of his presentation was an Update on the management of Type 2 Diabetes with special reference to broad spectrum of new anti diabetic drugs. He also discussed in detail the new developments in this field. This session was chaired by Prof. Khalid Mahmood along with Dr. Rana Qamar Masood and Prof. Rauf Memon.</font></span><p align="center" dir="ltr"> <img border="0" src="images/Pict-01=ZamanShekh.jpg" width="394" height="238"><blockquote> <blockquote> <blockquote> <blockquote> <blockquote> <blockquote> <blockquote> <blockquote> <p align="justify"><i><font size="2" face="Arial">National Institute of Diabetes and Endocrinology DUHS in collaboration with Diabetic Association of Pakistan organized an international conference on Diabetes at DUHS during December 2011. Group photograph shows some of the invited guest speakers along with Prof. Masood Hameed VC DUHS, Dr. A. Samad Shera and Prof. Zaman Sheikh. </font></i> </blockquote> </blockquote> </blockquote> </blockquote> </blockquote> </blockquote> </blockquote> </blockquote> <p align="justify" dir="ltr"><span lang="en-us"><font face="Arial" size="2"> Prof. Helmut also talked about insulin sensitizers, Glucokinese activators and its dual action. These are the new agents which are known as ultrafast insulin s. Novo and Lilly, he said, are also working for the development of slow release insulin s preparations which will require just once weekly dose. Then there are some very slow acting insulin s, smart insulin s while oral insulin s are also being tried. Bio similar insulin s are also being developed by India and China.  They have the same effect, are safe and have no adverse reactions. He also mentioned about the inhaled insulin s which are being developed.<br> Prof. Vijay Vishwanathan from India was the next speaker who talked about prevention of amputation in the developing world. He pointed out that patients of diabetic neuropathy ignore this disease while the healthcare professionals lack the appropriate knowledge to treat it with the result that it leads to poverty as patients have to borrow money to get treatment. Diabetic neuropathy and infections are the most common cause of amputations in the developing countries. Appropriate foot care can prevent not only amputations but also complications. If the patients are educated, these diabetics can take care of their foot problems themselves. Those patients who lose one leg then lose their second leg in three years time. He laid emphasis on regular foot examination once or twice a year. Economical foot care is important and for this we have to ensure that at risks foot are recognized early at primary care level. All non healing ulcers should be managed effectively so that these patients can go to work soon and appropriate dressing will ensure proper healing, he added.<br> Speaking about the foot wear problems Prof. Vijay said that footwear for diabetics require special material. We have developed our own foot wear. Training of healthcare professionals, he stated, was extremely important and we have to move step by step as suggested by the International Working Group on Diabetic Foot. He also referred to training of nurses in foot care and regular screening programmes. Prevention of amputation is a priority in diabetics. Make special arrangements for high risk foot and patient education will reduce amputations. It is essential that we ensure good glycaemic control and develop our own footwear. Often poor follow up is the major reason for amputation. Acute infection cases should be put on insulin and once ulcer heals, infection is controlled continue with the oral hypoglycemic agents, he added.<br> Participating in the discussion Prof. A. Basit from BIDE remarked that they have developed about fifty Foot Clinics but it is a problem how to get data from primary clinics. Off loading devices were the other major problems, he remarked.<br> Prof. Masood Hameed Khan along with Prof. M.Akbar Chaudhry and Dr. Samad Shera chaired the next session wherein Sir Michael Hirst President-elect of IDF was the guest speaker. He narrated the story how he got interested in diabetes and said that it was in 1985 that he had an accidental experience of taking a child with diabetes to the doctor. When I came to know that the child was suffering from diabetes, I felt it was a life time sentence of insulin injections. Diabetes will not ruin our lives and we need to prevent it. Since then I decided to become a Champion of Diabetes. Child with diabetes is a stigma. I talked to three other members of the parliament and we were able to get through a bill providing blood glucose monitoring strips free to the patients. Diabetes UK joined and we started having free education programmes. We raised the profile of diabetes. Research on diabetes has now improved quality of life of people suffering from diabetes mellitus. Amputation rate is very low in UK as compared to the developing countries. We ensured that children have free access to Insulin and for this we had to work hard and convince the concerned authorities but eventually we succeeded.<br> Continuing Sir Michael Hirst said that currently in the world there are one hundred eighty three million people with diabetes who are undiagnosed. The prevalence of diabetes is 6.72% in Pakistan and 8.31% in India, 9.58% in Bangladesh and 7.77% in Sri Lanka. IGT is also increasing in the region. People use unhealthy diet and fast food has increased obesity. Healthy diet is expensive. There is a need to educate the public to use healthy diet, health education should be another priority and we should also encourage people to live healthy life, regular activity like cycling to work and change in their behaviour. He concluded his presentation by stating that we can prevent and postpone onset of diabetes by healthy advice. Let us ensure that Pakistan does not join the top ten countries with massive burden of diabetes in the Year 2030.<br> Prof. Salahuddin Afsar along with Prof. Shams Shaikh chaired the next session. Dr.Rayaz Malik from UK was the guest speaker who talked about diagnoses and treatment of diabetic neuropathy. He discussed at length retinopathy, nephropathy and neuropathy. Most often patients consult the physician when it is too late. Patients, he said, have a right to the best treatment and we must try to prevent the complications. Most often the diagnosis is too late. It is easy to diagnose but extremely difficult to cure. For diagnosis after neurological examination, 10g monofilament can be used to diagnose it. He also talked about vibration perception threshold and the usefulness of electrophysiology in diagnosis. It all starts with small fibers and ulceration which then leads to sweating, blood flow and then it leads to pain. We should try to diagnose it at the time of early small fiber damage. Skin biopsy is also helpful in early diagnosis and should be done if this facility is available and we can detect normal, mild, and moderate to severe neuropathy. Look into the eyes of the patient to predict amputation risk. Speaking about the risk factors he mentioned hypertension, smoking, increased HbAIC, duration of diabetes, increased BMI, increased TGs and high total cholesterol. He also referred to the role of fiber and the role of cardiovascular disease risk factors for diabetic neuropathy.<br> Dr. Samad Shera talking about global challenge of diabetes said that diabetes has become an epidemic in developing countries. It has high prevalence; population in these countries is also increasing. These countries also have limited resources with low literacy rate but fast food outlets are increasing. To do nothing, he opined, was not an option. We must act now as tomorrow will be too late. As per MENA study there will be 23% increase in diabetes in these countries from 2011-2030. He laid emphasis on primary prevention and treatment of diabetics. Education, he reiterated, was the cheapest and most effective treatment of diabetes. We need to educate public, policy makers, healthcare professionals and above all politicians. Management of diabetes should be a priority with healthy diet, education, exercise and then empowerment of the people. Water, he emphasized, is the only drink for the wise man as stated by Henry David. Metformin is safe in pregnancy. Use of oral hypoglycemic agents in type 2 diabetes are quite effective. He then quoted Joslin who in 1922 had remarked that Insulin is for the Wise and not foolish, may it be patient or doctor.<br> Prof. Zaman Sheikh talked about retinopathy in diabetes mellitus and said that its prevalence is about 21-24%. They conducted a study in three villages in Karachi in newly diagnosed diabetics. Out of 6404 people screened, seven hundred thirty eight were diabetics and 19.7% had diabetic retinopathy. All type 2 diabetics, he said, should have yearly screening. By controlling diabetes, we can prevent complications and if it is not controlled, it may lead to total blindness.<br> Prof. Mohan from India talked about community empowerment to control diabetes. His presentation was based on Indian Diabetes Studies conducted in four states. The sample size was sixteen thousand. At present there are 62.4 million diabetics in India in addition to 77.2 million pre diabetics and this epidemic is not yet over. In the days to come we will have more obesity and more population in India than China hence we will be the No. 1 country with a diabetes burden, he remarked. Continuing he said that there is 6% diabetes in Chennai and now it is under control. Nephropathy prevalence in India is about 26.9%. He then gave details of PACE study which consists of creating diabetes awareness and screening for diabetes and pre diabetics. It also includes GPs affiliation programme in diabetes mellitus.<br> He then talked about the ASIAD success story whereby a Park was built and maintained by public who used it with the result that the number of people doing exercise in the village increased from 13.8% to 52.1%. It has modest increase in diabetes and more increase was witnessed in poor areas. Since use of white rice is related to diabetes, they started using brown rice as a part of this project. The tragedy is that more people live in rural areas and more scientists live in urban areas. We initiated a rural diabetes care project. Mobile hospital goes from door to door. Various tests are also performed free. Within nine months HbA1C decreased from 9.3% to 8.5%. His conclusions were that with team work and passion, we can prevent diabetes and it is feasible. Almost 95% of the patients were managed there and only 5% of patients with eye or foot complications had to be brought to Chennai. It is the poor who have less activity, drink coca and eat more which worry us all, he stated.<br> Prof Akbar Chaudhry chaired the afternoon session with Prof. Abrar Sheikh. Dr.Abdullah Hamaq from Qatar was the first speaker who talked about rights of students with diabetes and he narrated the Qatar experience. He stated that they had to educate the school principal as well as bus driver. Now school associations work together to achieve good environment for students with diabetes. They are the responsibility of school management and staff. Schools employ nurses trained in diabetes management. The students are allowed to go to the bathroom when needed. All the child students get free therapeutic support. In all there are six hundred diabetic students children out of which seventy are now using insulin pump.<br> Prof. Williams talked abut economic aspects of diabetes care and prevention. Economic impact, he said, is massive and complexity creates highest impact. Many of the complications are preventable. The diabetics have low quality of life and their cost of care can be reduced. One of the diabetics, he said, once remarked, I wish I had AIDs rather than diabetes.</font></span></td> </tr> <tr> <td width="100%" dir="ltr" height="19"> <p dir="ltr">&nbsp;</td> </tr> </table> </td> <td width="6%" valign="top" dir="ltr"> <p align="left" dir="ltr"> <br> <br> &nbsp;</td> </tr> <tr> <td width="18%">&nbsp;</td> <td width="76%">&nbsp;</td> <td width="6%">&nbsp;</td> </tr> <tr> <td width="16%" bgcolor="#3366FF" height="1"><font size="1" color="#3366FF"> 1</font></td> <td width="62%" bgcolor="#3366FF" height="1"><font size="1" color="#3366FF"> -</font></td> <td width="22%" bgcolor="#3366FF" height="1"><font size="1" color="#3366FF"> -</font></td> </tr> <tr> <td width="16%" bgcolor="#008000" height="19">&nbsp;</td> <td width="62%" bgcolor="#008000" height="19"> <p align="center"><FONT color=#ffffff size="2" face="Arial">© Professional Medical Publications. 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