Prevalence and Risk Factors of Non-proliferative Diabetic Retinopathy in Individuals with Type 2 Diabetes Mellitus Taking Oral Antidiabetic Medications

Background: Non-proliferative diabetic retinopathy (NPDR) is a significant complication of long-term diabetes in Sudan. This study aimed to determine the prevalence and risk factors of diabetic retinopathy among Sudanese individuals with type 2 diabetes mellitus who are taking oral antidiabetic medication. Methods: This cross-sectional, facility-based study recruited 196 individuals with type 2 diabetes at the Jabir Abu Eliz Diabetes Health Center in Khartoum State. Data were collected through a structured questionnaire, which patients filled out after providing informed consent. The data were analyzed using the Statistical Package for the Social Sciences (SPSS). Logistic regression was performed to predict factors associated with diabetic retinopathy. Results: The mean age of the patients was 50.1 ± 10.7 years. The prevalence of NPDR was 78 (39.8%). Bivariate analysis revealed that age, education level, and residence (Pvalue < 0.05) were significantly associated with diabetic retinopathy. Additional factors that were significantly associated with diabetic retinopathy included the duration of diabetes, the presence of other comorbidities, HbA1c, and fasting blood glucose in 68 (87.2%) individuals (P-value < 0.05). Conclusion: The study revealed a prevalence of 39.8% for NPDR in this cohort. A longer duration of diabetes and poor control are the primary risk factors for diabetic retinopathy in Sudan. Further research is necessary to determine whether intensifying therapy or administering insulin may reduce the prevalence of retinopathy

From Rupture to Refuge The Coordinates of Contemporary Refugee Narratives

From Rupture to Refuge is a wide-ranging study of both contemporary refugee fiction and memoir. From international best-selling novels such as Khaled Hosseini’s The Kite Runner and Christi Lefteri’s The Beekeeper of Aleppo, to memoirs by Zoya Phan and Clemantine Wamariya, it follows refugees as they narrate their experiences and memories of homeland, war, escape, camp, and finally finding refuge. Tracing literary connections between this wide body of 21st Century writing, the book provides an overview of a genre of writing and a detailed textual analyses of thematic and poetic intersections. It also introduces the concept of ‘narrative displacement’, uncovering the ways in which refugees are discursively displaced from their own tales as well as being displaced spatially. Sloane argues that in writing and recording, refugees replace themselves at the centre of their own life stories

An opportunity lost? The declining role of authorised covert human intelligence sources in combating organised crime

Combatting organised crime, requires Agencies to deploy a range of collection capabilities to identify community threats, to accurately select and prioritise organised crime targets and to inform operational decision-making. Central to this effort is the ability to identify, recruit and deploy Covert Human Intelligence Sources (CHIS). It is therefore paradoxical that the United Kingdom’s CHIS authorisations have been in steep decline since the enactment of the bespoke Regulation of Investigatory Powers Act 2000 (Regulation of Investigatory Powers Scotland Act, 2000). This research seeks to critically discuss as to what are the key factors contributing to this decline. Consequently, this review suggests that the decline in CHIS authorisations are to be found in a complex configuration of factors. Two stand out as significant; i) the impact of resource reduction on CHIS operational capacity and capability, and ii) an emergence of a culture of fear and risk aversion as a constraining factor on CHIS recruitment and use

Bare Trusts and Private Purpose Powers

Private purpose powers are crucial to the functioning of non-charitable unincorporated associations and Quistclose trusts—both of which concern bare trusts. However, a sufficient understanding of what a bare trust is, as well as overreaching, reveals a fundamental problem: explaining how these powers overreach the equitable interests. They can do so, it is argued, when characterised as the s32 Trustee Act 1925 power of advancement

Is Fatty Liver the Last Nail in The Coffin for Central Pontine Myelinolysis? A Case Report and Literature Review

We report a case of a 45-year-old male admitted with recurrent falls, melaena, abdominal pain, vomiting, deranged electrolytes, and a low heamoglobin. He has a complex past medical history, including a lung abscess, alcohol abuse, a history of falls, cholecystitis, duodenal ulcer, duodenitis, epilepsy, folate deficiency, an ankle fracture, gallstones, a history of anoxic brain injury, and pancreatitis. His medications include lamotrigine, losartan, quetiapine, omeprazole, and venlafaxine MR. The patient's history reveals excessive alcohol intake, malnutrition, and smoking. Ultrasound showed the presence of diffuse fatty liver and gallstones. He developed left-sided weakness, which was not present before. MRI of the head revealed a classic trident appearance in the pons, consistent with post-motor demyelination/pontine myelinolysis. It was noted that a few days prior to the MRI, the patient had been treated for mild hyponatraemia, and 10 days before, he had been noted to have mild hypernatremia. In this case report, we demonstrate how fatty liver can be associated with an increased risk of central pontine myelinolysis (CPM)

Hemichorea-Hemiballismus as A First Presentation of Diabetes: Basal Ganglia Involvement and Hba1c Threshold

We report a case of a 72-year-old woman who presented with a one-week history of abnormal, involuntary movements in her left upper limb. These movements were persistent throughout the day, occurring during both activity and sleep, and had progressively increased in intensity since onset. She also experienced weakness in the affected arm. Her past medical history included hypertension, managed with Amlodipine 5 mg once daily. On examination, she exhibited continuous, involuntary, flinging movements of the left arm, consistent with hemiballism. The rest of her neurological examination was unremarkable, and cerebellar signs could not be assessed due to the involuntary movements. Her blood pressure on admission was 202/81 mmHg. Random blood glucose was 27 mmol/L, with ketones at 0.8 mmol/L and serum osmolality at 285 mOsm/kg. She was managed as a case of hyperosmolar hyperglycemic state. Investigations showed an HbA1c of 18.6%. A head computed tomography (CT) revealed no intracranial abnormalities, while magnetic resonance imaging (MRI) showed tiny hypodensities in the left ganglio-capsular region and small hypointensities in the right ganglio-capsular area and this not stroke. Treatment with Risperidone successfully resolved the chorea. Her blood pressure and blood glucose were optimized, and she was discharged in stable condition. Hemichorea-hemiballismus as the first presentation of diabetes is extremely rare. Most case reports indicate an HbA1c of 12% or higher can be associated with hyperglycemia-induced hemichorea-hemiballismus (HIHH). Further research is needed to clarify the mechanisms underlying HIHH and to determine a definitive HbA1c threshold

A Contemporary Multifaceted Insight into the Association Between Diabetes Mellitus and Diverticular Disease: An Update About Geriatric Syndrome

Introduction: Diverticular disease, once considered a rare geriatric gastrointestinal condition, has now become a prevalent disorder associated with increased morbidity and healthcare costs. The spectrum of complications from diverticular disease ranges from incidental findings to more serious issues such as bleeding and diverticulitis. Symptomatic diverticular disease represents a significant economic burden in the western world. Diabetes mellitus is a major global health issue. As global aging accelerates, geriatric syndromes such as diabetes mellitus (DM) and diverticular disease (DD) are becoming increasingly prevalent. Understanding their interplay is critical, particularly within the geriatric population. Both conditions are linked to lifestyle, dietary habits, and changes in gut physiology. Additionally, age-related alterations in the gut microbiome and immune system make this association more complex, contributing to morbidity and healthcare burdens in older adults. The primary aim of this review is to provide an update on the association between diabetes mellitus and diverticular disease. Methods: This narrative review explores the association between diabetes mellitus and diverticular disease. Relevant articles were identified by searching major databases. Results: Risk factors for diverticular disease include insulin resistance, diabetes mellitus, smoking, non-alcoholic fatty liver disease, lack of physical activity, a low-fibre diet, and a high-carbohydrate diet. These risk factors are also associated with the development of diabetes mellitus. Major population studies indicate that diabetes can either increase the risk of diverticular disease or have a neutral impact. A complication of diabetes mellitus includes impaired intestinal peristalsis and enteric nervous system dysfunction, which can ultimately lead to the formation of intestinal diverticula. High-calorie foods low in fibre are a staple in the diets of many type 2 diabetes mellitus patients, contributing to gut dysbiosis. A detrimental consequence of dysbiosis is a breach in the protective intestinal barrier, which promotes the development of diverticulosis. Conclusions: Diabetes mellitus may be associated with diverticular disease, and the risk factors that contribute to diabetes mellitus can also be linked to diverticular disease. Further studies are needed to explore the complex relationship between diabetes mellitus and diverticular disease

How medical diagnosticians earn their stripes: Horses, zebras, and divergent thinking

The acquisition of medical expertise is a rigorous endeavor that involves developing a range of cognitive, technical, and interpersonal skills. While clinical knowledge is routinely tested through written and practical examinations in medical school, benchmarking expertise performance for experienced physicians has proven more challenging. The present article considers the acquisition of medical expertise from candidacy through residency and clinical years. Particular attention is given to the skills that distinguish routine Journeymen medical experts who settle for a lower level of automatic skill from adaptive Experts and Masters, as well as the difficulties in defining the metrics required to distinguish these levels. A model of the physician as both a knowledgeable and creative expert is proposed, drawing from multifactorial models of expertise together with the Four Cs model of creativity at each stage of acquisition. Particular emphasis is placed on divergent thinking, a form of creative problem-solving. The benefits of divergent thinking in medicine are discussed in relation to core cognitive functions supporting the acquisition and maintenance of medical skills, differential diagnosis, cognitive heuristics and biases, and the drive for both personal and social innovation. In particular, a novel argument is put forth for the role of divergent thinking and cognitive flexibility as facilitators of expertise acquisition in the medical field. Recommendations are discussed for the integration of divergent thinking training into the medical selection and training practices to support the development of medical expertise

Orchestration of Corporate Social Responsibility in Company Law – Reframing Human Security through Education

The objective of this paper is to argue the fundamental significance of education in addressing notable gaps in the constitutive, performance and evaluation criteria for corporate social responsibility (CSR) and endeavours to showcase the complementarity between education, human security, sustainable human development, and the pursuit of CSR as an ideal normative paradigm. An abstractive approach to studying CSR, which is common with some authors engages with corporate philanthropy, which has not been helpful outside traditional CSR paradigms without looking at key dynamics that can robustly underpin successful CSR. The paper explores the systemic nexus between sustainable development as an educational externality when embedded in CSR, climate change and action competence and how it dovetails into ‘education for sustainable development’. Methodologically, this paper doctrinally relies on the systematic analysis of written data sources to theoretically explore the central significance, and complementarity between human security, education, and human dignity and how they can orchestrate a holistic CSR paradigm. In 1994, the United Nations Development Programme (UNDP) in formulating the human security doctrine recognised the syncretic correlation between human security, education, and sustainable human development as fundamental elements that should underpin CSR. This paper contends that these are necessary intrinsic components of human dignity as the central factor that justifies a multi-dimensional and proactive approach to CSR. Despite the criticisms against human security, this paper identifies it as an important concept that could instrumentally orchestrate a model of CSR that uniformly mainstreams sustainable human development and human dignity that leverages education which has routinely and traditionally been seen as a constitutive component of CSR. It reveals how a holistic path to CSR can reinvigorate the central pillars of human security and human dignity using education as a springboard and makes a compelling case for supporting explicit references to education in company law with appropriate human security informed constitutive, performance and evaluation criteria which are absent in existing legally orchestrated CSR

Précis of The Psychology of Creative Performance and Expertise

The study of expertise has recently moved into an exciting phase. While previous research had a narrow focus on deliberate practice versus innate aptitude, recent multifactorial models of expertise development have breathed new life into contemporary research. Reflecting these opportunities, the Psychology of Creative Performance and Expertise explores our understanding of the wide range of factors contributing to greatness in creative domains. With the intention of expanding the conversation around expertise, the book transcends traditional fields such as chess, sports, and music, exploring the intersection of expertise with creativity and the performing arts. The applied chapters therefore cover more unfamiliar fields, including extreme-memory athletes, dance, creative writing, acting, art, and STEM, as well as the more conventional domains of mind games and music. Each applied chapter explores the psychological and opportunity factors that shape success within these domains, offering a close look at how creative experts develop, thrive, or falter. In other dedicated chapters, the book also examines the facilitators of creative performance, including aesthetic sensitivity, creativity, and mental imagery, as well as the obstacles to performance such as burnout, procrastination, and gender-related challenges. The exploration concludes by engaging with pressing issues facing expertise, including the effect of artificial intelligence (AI). Addressing a gap in the market for an approachable guide to the multidimensional complexities of expertise development, this book is suitable as a resource for final-year undergraduate and postgraduate students across a range of disciplines. However, given that the book uniquely synthesizes material from the creativity, gifted and talented, and expertise literatures in a number of unfamiliar domains, it should provide fresh insights for newcomers and seasoned scholars alike