People awareness about diabetes disease and its complications among aged 18 years and older in Bushehr port inhabitants (Iran)

Introduction: One of the most prevalent metabolic disease is diabetes and it can lead to enormous medical as well as socio-economic consequences. The Iranian diabetes population is estimated to be around 1.5 million. Studies show that approximately half of the people with type 2 diabetes (T2DM) are undiagnosed and thus unaware that they have the disease. This lack of awareness can lead to presentation with complications and its consequences. The aim of this survey was to determine the level of population awareness in Bushehr port, based on the available education programs. Material and methods: The cross-sectional study was assessed upon 719 subjects aged over 18 years old, without diabetes and inhabitant in Bushehr port in 2005. Multistage random simple sampling was used in this study. A questionnaire was prepared with validity checked by researchers in Yazd Diabetes Research Center and reliability alpha-cronbach = 75%. The questionnaire was included 39 questions: demographics indices, fundamentals about diabetes, its presenting signs and symptoms, the early and late complications, means of management as well as looked into the source of the information. The data was analyzed with independent t-test, Pearson’s correlation coefficient, ANOVA and multiple-regression models by SPSS package ver. 10.05. Results: In this study, 719 subjects (417 male and 302 female) that mean age was 40.13 � 11.48 years (40.8 � 12.93 for male and 39.19 � 9.03 for female) were assessed. The male awareness rate was more than of female (P = 0.001). There was indirect relation between subjects’ awareness and their age (r = �0.203, P = 0.001). There was direct relation between awareness and the level of education of subjects (P = 0.01, r = 0.07). The mean of awareness scores of subjects was not same between singles and married (P = 0.042). Studies population awareness about fundamental diabetes disease, primary symptoms, early complications, delay complications, diet awareness was low and about controlling methods of diabetes was high. Conclusion: The results indicate that most subjects’ awareness about fundamental and complications of diabetes disease were low, so the people need more education about diabetes

Automated deep learning-based segmentation of COVID-19 lesions from chest computed tomography images

Purpose: The novel coronavirus COVID-19, which spread globally in late December 2019, is a global health crisis. Chest computed tomography (CT) has played a pivotal role in providing useful information for clinicians to detect COVID-19. However, segmenting COVID-19-infected regions from chest CT results is challenging. Therefore, it is desirable to develop an efficient tool for automated segmentation of COVID-19 lesions using chest CT. Hence, we aimed to propose 2D deep-learning algorithms to automatically segment COVID-19-infected regions from chest CT slices and evaluate their performance. Material and methods: Herein, 3 known deep learning networks: U-Net, U-Net++, and Res-Unet, were trained from scratch for automated segmenting of COVID-19 lesions using chest CT images. The dataset consists of 20 labelled COVID-19 chest CT volumes. A total of 2112 images were used. The dataset was split into 80% for training and validation and 20% for testing the proposed models. Segmentation performance was assessed using Dice similarity coefficient, average symmetric surface distance (ASSD), mean absolute error (MAE), sensitivity, specificity, and precision. Results: All proposed models achieved good performance for COVID-19 lesion segmentation. Compared with Res-Unet, the U-Net and U-Net++ models provided better results, with a mean Dice value of 85.0%. Compared with all models, U-Net gained the highest segmentation performance, with 86.0% sensitivity and 2.22 mm ASSD. The U-Net model obtained 1%, 2%, and 0.66 mm improvement over the Res-Unet model in the Dice, sensitivity, and ASSD, respectively. Compared with Res-Unet, U-Net++ achieved 1%, 2%, 0.1 mm, and 0.23 mm improvement in the Dice, sensitivity, ASSD, and MAE, respectively. Conclusions: Our data indicated that the proposed models achieve an average Dice value greater than 84.0%. Two-dimensional deep learning models were able to accurately segment COVID-19 lesions from chest CT images, assisting the radiologists in faster screening and quantification of the lesion regions for further treatment. Nevertheless, further studies will be required to evaluate the clinical performance and robustness of the proposed models for COVID-19 semantic segmentation

A historical literature review on the role of posterior axillary boost field in the axillary lymph node coverage and development of lymphedema following regional nodal irradiation in breast cancer

To elucidate whether (1) a posterior axillary boost (PAB) field is an optimal method to target axillary lymph nodes (LNs); and (2) the addition of a PAB increases the incidence of lymphedema, a systematic review was undertaken. A literature search was performed in the PubMed database. A total of 16 studies were evaluated. There were no randomized studies. Seven articles have investigated dosimetric aspects of a PAB. The remaining 9 articles have determined the effect of a PAB field on the risk of lymphedema. Only 2 of 9 articles have prospectively reported the impact of a PAB on the risk of lymphedema development. There are conflicting reports on the necessity of a PAB. The PAB field provides a good coverage of level I/II axillary LNs because these nodes are usually at a greater depth. The main concern regarding a PAB is that it produces a hot spot in the anterior region of the axilla. Planning studies optimized a traditional PAB field. Prospective studies and the vast majority of retrospective studies have reported the use of a PAB field does not result in increasing the risk of lymphedema development over supraclavicular-only field. The controversies in the incidence of lymphedema suggest that field design may be more important than field arrangement. A key factor regarding the use of a PAB is the depth of axillary LNs. The PAB field should not be used unless there is an absolute indication for its application. Clinicians should weigh lymphedema risk in individual patients against the limited benefit of a PAB, in particular after axillary dissection. The testing of the inclusion of upper arm lymphatics in the regional LN irradiation target volume, and universal methodology measuring lymphedema are all areas for possible future studies

Bezpieczeństwo i skuteczność dwufazowej insuliny aspart 30 (BIAsp30) u Irańczyków chorych na cukrzycę typu 2: otwarte, nierandomizowane, wieloośrodkowe badanie - irańska podgrupa badania IMPROVE™

Introduction: To evaluate the clinical profile of BIAsp 30 (30% soluble insulin aspart, 70% protamine-crystallized insulin aspart) (NovoMix®30) in type 2 diabetes patients in routine clinical practice in Iran. Material and methods: IMPROVE&#8482; was a 26-week, multinational, open-label, non-randomized study in patients with type 2 diabetes. The safety and efficacy of BIAsp 30 were assessed at baseline and at 13 and 26 weeks. The titration of BIAsp30 was at the physician&#8217;s discretion. Results: In Iran, 478 patients (47% male) previously treated with oral antidiabetic drugs (OADs) (N = 159, 33.3%) and/or insulin other than BIAsp30 (N = 317, 66.3%) or a few who were treatment-na&#239;ve (N = 2, 0.4%) participated in the study. After 26 weeks of treatment with BIAsp 30, the rate of reported major hypoglycaemic episodes was reduced by 88.1% from baseline (baseline v. Week 26: 0.303 v. 0.037 episodes/pt-year; p < 0.001). No significant differences in minor hypoglycaemic episodes between baseline and Week 26 were found. Glycaemic control was significantly improved from baseline to Week 26 with a mean HbA1c reduction of 1.2 &#177; 1.9%. Patients&#8217; quality of life as measured by the DiabMedSat questionnaire significantly improved from baseline (58.1) to the end of the study (75.4, p < 0.001). Conclusions: BIAsp 30 therapy appeared safe and effective and improved quality of life in Iranian patients with type 2 diabetes after 26 weeks of treatment. (Pol J Endocrinol 2010; 61 (4): 364-370)Wstęp: Celem badania była ocena profilu działania insuliny BIAsp 30 (30% rozpuszczalnej insuliny aspart, 70% insuliny krystalizowanej z protaminą) (NovoMix®30) u chorych na cukrzycę typu 2 w warunkach standardowej opieki zdrowotnej w Iranie. Materiał i metody: IMPROVE&#8482; było 26-tygodniowym, wieloośrodkowym, międzynarodowym, otwartym i nierandomizowanym badaniem z udziałem chorych na cukrzycę typu 2. Bezpieczeństwo i skuteczność insulin BIAsp 30 oceniano na początku badania oraz po 13 i 26 tygodniach. Dawkowanie insuliny BIAsp30 było zależne od zaleceń lekarskich. Wyniki: W irańskiej części badania uczestniczyło 478 chorych (47% stanowili mężczyźni) leczonych dotychczas doustnymi lekami hipoglikemizującymi (N = 159, 33,3%) i/lub insuliną inną niż BIAsp30 (N = 317, 66,3%) oraz nieliczna grupa pacjentów niestosujących wcześniej farmakoterapii (N = 2, 0,4%). Po 26 tygodniach leczenia insuliną BIAsp 30, częstość epizodów ciężkiej hipoglikemii zmniejszyła się o 88,1% (wartości wyjściowe v. tydzień 26: 0,303 v. 0,037 epizodów/pacjenta-rok; p < 0,001). Dane dotyczące częstości epizodów lekkiej hipoglikemii na początku badania i po 26 tygodniach leczenia nie różniły się istotnie. Odnotowano natomiast poprawę kontroli glikemii; po 26 tygodniach odsetek HbA1c obniżył się średnio o 1,2 &#177; 1,9% w stosunku do wartości wyjściowej. W okresie od rozpoczęcia do zakończenia badania nastąpiła istotna poprawa jakości życia chorych, oceniana przy użyciu kwestionariusza DiabMedSat; punktacja wynosiła odpowiednio 58,1 i 75,4 (p < 0,001). Wnioski: Terapia insuliną BIAsp 30 stosowana przez 26 tygodni u Irańczyków chorych na cukrzycę typu 2 okazała się bezpieczna i skuteczna, a ponadto spowodowała poprawę jakości życia pacjentów. (Endokrynol Pol 2010; 61 (4): 364-370

Effect of metformin and folic acid on plasma homocysteine level in type 2 diabetic patients

Hyperhomocysteinemia is associated with an increased risk of cardiovascular disease in diabetic patients. The aim of this study was to evaluate effects of metformin and folic acid on plasma homocysteine level in diabetic patients. In this clinical trial 47 new cases of type 2 diabetes were randomized to two groups. We treated patients in trial group with metformin and 1 mg folic acid, whereas patients in control group treated with metformin and placebo for 16 weeks. There was no significant difference in plasma homocysteine level and glycosylated hemoglobin (HbA1c) between two groups at the start of study. After 16 weeks plasma homocysteine level in the trial group did not change. In contrast plasma homocysteine level increased in the placebo group. There was significant difference in mean plasma homocysteine level between two groups (P-value &lt; 0.01). This difference was highly significant in males (P-value &lt; 0.0001). Correlation between glycosylated hemoglobin and plasma homocysteine level at start and end of study was not significant. This finding indicated that metformin increases plasma homocysteine level in diabetic patients especially males, whereas administration of folic acid with metformin can prevent this process

Variation in the SLC23A1 gene does not influence cardiometabolic outcomes to the extent expected given its association with L-ascorbic acid

Background: Observational studies showed that circulating l-ascorbic acid (vitamin C) is inversely associated with cardiometabolic traits. However, these studies were susceptible to confounding and reverse causation. Objectives:We assessed the relation between l-ascorbic acid and 10 cardiometabolic traits by using a single nucleotide polymorphism in the solute carrier family 23 member 1 (SLC23A1) gene (rs33972313) associated with circulating l-ascorbic acid concentrations. The observed association between rs33972313 and cardiometabolic outcomes was compared with that expected given the rs33972313-l-ascorbic acid and l-ascorbic acid–outcome associations. Design: A meta-analysis was performed in the following 5 independent studies: the British Women's Heart and Health Study (n = 1833), the MIDSPAN study (n = 1138), the Ten Towns study (n = 1324), the British Regional Heart Study (n = 2521), and the European Prospective Investigation into Cancer (n = 3737). Results: With the use of a meta-analysis of observational estimates, inverse associations were shown between l-ascorbic acid and systolic blood pressure, triglycerides, and the waist-hip ratio [the strongest of which was the waist-hip ratio (−0.13-SD change; 95% CI: −0.20-, −0.07-SD change; P = 0.0001) per SD increase in l-ascorbic acid], and a positive association was shown with high-density lipoprotein (HDL) cholesterol. The variation at rs33972313 was associated with a 0.18-SD (95% CI: 0.10-, 0.25-SD; P = 3.34 × 10−6) increase in l-ascorbic acid per effect allele. There was no evidence of a relation between the variation at rs33972313 and any cardiometabolic outcome. Although observed estimates were not statistically different from expected associations between rs33972313 and cardiometabolic outcomes, estimates for low-density lipoprotein cholesterol, HDL cholesterol, triglycerides, glucose, and body mass index were in the opposite direction to those expected. Conclusions: The nature of the genetic association exploited in this study led to limited statistical application, but despite this, when all cardiometabolic traits were assessed, there was no evidence of any trend supporting a protective role of l-ascorbic acid. In the context of existing work, these results add to the suggestion that observational relations between l-ascorbic acid and cardiometabolic health may be attributable to confounding and reverse causation