Habitual Physical Activity, Peripheral Neuropathy, Foot Deformities and Lower Limb Function: Characterizing Prevalence and Interlinks in Patients with Type 2 Diabetes Mellitus

Background: Patients with type 2 diabetes mellitus (T2DM) may have diverse foot problems, but how these problems are linked with physical activity is not clear. This study investigated the prevalence of foot problems among patients with T2DM and investigated how the problems were related to physical activity.Methods: Habitual physical activity, peripheral neuropathy, lower limb functions and foot deformities of 246 T2DM patients were respectively assessed with the Baecke Physical Activity Questionnaire, Michigan Neuropathy Screening Instrument, Lower Limb Function Scale, and a self-designed foot deformity audit form.Results: Habitual physical activity index (3.2 ± 0.83) was highest in work-related activities; 69 (26.1 %) patients presented with peripheral neuropathy and 52 (19. 7%) had the lowest limb function. Pes planus was the most prevalent foot deformity (20.1%). Significant differences existed in physical activity indices across deformity groups (p < 0.05) and total activity index was related to neuropathic and lower limb function scores (p < 0.05).Conclusion: A higher work-related but reduced participation in sports and leisure time physical activity among the patients was observed. Habitual physical activity was lowest in patients with a forefoot deformity, higher neuropathic scores and lesser lower limb function scores. Patients with T2DM in these categories may be a target for special physical activity intervention programmes.Keywords: Diabetes Mellitus, Foot Complications, Physical Activit

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Effect of Two Pot Types on Iron Content of Fufu, a Fermented Cassava Meal

In order to alleviate iron deficiency anaemia there is need for cheap sources of iron. Cassava was peeled, washed, soaked in water for three days after which it was wet-milled and processed into fufu using locally – made iron pots and Tower pots. Native iron content of raw cassava slurry and fufu was analyzed. The Total iron content of fufu was found to contain 80.20% and 65.49% contaminant iron which leached from locally made iron pots and Tower pots respectively. This is equivalent to 35.50%, 26. 40% and 20.54% of dietary iron of an adult male, adult female and a toddler respectively. These findings show that contaminant iron that leached into fufu in the course of preparation may be a cheap source of dietary iron, and encouraging the consumption of fufu thus prepared may be an effective way of alleviating iron deficiency anaemia especially in the southeastern and southwestern Nigerian population.Keywords: Pot types, iron content, cassava meal