Common issues in diabetes

Diabetes mellitus (DM) is a chronic medical condition that can attack many people regardless age and gender, and which is defined as that condition where there is too much glucose in the bloodstream. DM occurs when body cannot use insulin very well or the pancreas is unable to produce enough insulin to process ingested sugars. This study revealed that the vast majority of patients registered with the outpatient clinic at Hospital Tengku Ampuan Afzan (HTAA) have uncontrolled diabetes; the risk factors for uncontrolled diabetes include being female and over 40 years old, which indicates that this was most prevalent among those with type 2 diabetes. Based on the findings of the current study, the majority of caregivers have a high awareness of diabetic foot care. More than half of the caregivers claim that they have received information about diabetic foot care. In terms of sociodemographic data factors, the study indicated that age, race, religion, education level, and monthly family income are independent variables that are not related to the level of awareness among caregivers about diabetic foot care.This study showed that public in Kuantan, Pahang Darul Makmur, has a low level of knowledge about maggot therapy treatment in diabetic foot ulcers (DFU) healing and that a high number of people thus tend to reject maggot therapy treatment. Based on the outcomes, the majority of DM type 2 respondents were identified as having high self-efficacy beliefs, suggesting they had confidence in caring for their own feet. In terms of actual foot-care behaviours, both in the past week and in general, the majority of respondents displayed good practice. However, there was no significant association shown between foot-care self-efficacy beliefs and actual foot-care behaviour in the past week or in general.Finally, the findings of this study suggest that the prevalence of gestational diabetes mellitus (GDM) at the Maternal and Child Health Clinic Indera Mahkota was higher than in other similar studies. It also demonstrated that higher maternal age, higher body mass index (BMI) and a history of GDM were factors associated with increased risk of developing gestational DM

The nephrotoxicity of concurrent use of enalapril and gentamicin in rats

Objective: The present study was aimed to assess the concurrent administration of Enalapril (ENAL) and Gentamicin (GM) in the kidney of rats. Methods: Sixty male Sprague Dawley rats were divided into 4 main groups (n=15) according to the administered dose. Each main group was further subdivided into three subgroups according to the day of sacrificing (n=5). Group (C) was administered daily with normal saline as control, Group (E) was treated with oral ENAL, Group (G) was treated with 75 mg/kg GM, and Group (EG) was treated with GM and ENAL. The handling of the experiment persisted daily for 15 days, and the investigational examination carried out on days 5, 10, and 15. Results: The result showed that GM nephrotoxicity augmented with the period of the experimental study, there was rising in the levels of serum creatinine and blood urea nitrogen on the 10th day and persisted in rising significantly during the period on the 15th day of the experiment. Administration of ENAL showed no significant alteration from those of controls. While the concurrent administration of ENAL and GM showed that ENAL gradually increased GM nephrotoxicity, these physiological retrogressions were accompanied with intensive renal histopathological deteriorations. Conclusion: The present study has revealed that the concurrent administration of ENAL enormously aggravated the functional and histological nephrotoxicity of GM in rats

DEVELOPMENT AND VALIDATION OF UV-VIS SPECTROSCOPIC METHOD OF ASSAY OF CARBAMAZEPINE IN MICROPARTICLES

Objective: This study aimed to develop a new, rapid, robust, effective, inexpensive, and accurate UV-Vis method for the quantification analysis of carbamazepine (CBZ) in the carbamazepine-loaded microparticles.Methods: CBZ was encapsulated in ethyl cellulose microparticles by a solvent evaporation method using polyvinyl alcohol (PVA) as a stabilizer. Methanol was used to dissolve CBZ followed by dilution with distilled water as diluent. CBZ drug, excipients, and microparticles were subjected to specificity, solution stability, linearity, precision and accuracy to confirm and ensure the validity of this method.Results: The results showed no interference from the excipients in the selected wavelength 286 nm. It was exhibited linearity in the range 2-12 μg/ml with R2 = 0.9992. CBZ solution was stable during 24 h. Accuracy and precision were within the accepted limits (100±2%). All results were in accordance to the ICH-Q2 guideline.Conclusion: As a conclusion, CBZ could be quantified from loaded EC microparticles using UV-Vis spectrophotometer at 286 nm. Therefore, this method can be used for the quantification analysis of CBZ in CBZ-loaded microparticles can be utilized also as an alternative method to calculate CBZ in different dosage forms.Â

Carbamazepine gel formulation as a sustained release epilepsy medication for pediatric use

This study aimed to develop a carbamazepine (CBZ) sustained release formulation suitable for pediatric use with a lower risk of precipitation. The CBZ was first prepared as sustained release microparticles, and then the microparticles were embedded in alginate beads, and finally, the beads were suspended in a gel vehicle. The microparticles were prepared by a solvent evaporation method utilizing ethyl cellulose as a sustained release polymer and were evaluated for particle size, encapsulation efficiency, and release profile. The beads were fabricated by the dropwise addition of sodium alginate in calcium chloride solution and characterized for size, shape, and release properties. The gel was prepared using iota carrageenan as the gelling agent and evaluated for appearance, syneresis, drug content uniformity, rheology, release profile, and stability. The microparticles exhibited a particle size of 135.01 ± 0.61 µm with a monodisperse distribution and an encapsulation efficiency of 83.89 ± 3.98%. The beads were monodispersed with an average size of 1.4 ± 0.05 mm and a sphericity factor of less than 0.05. The gel was prepared using a 1:1 ratio (gel vehicle to beads) and exhibited no syneresis, good homogeneity, and good shearthinning properties. The release profile from the beads and from the gel was not significantly affected, maintaining similarity to the tablet form. The gel properties were maintained for one month real time stability, but the accelerated stability showed reduced viscosity and pH with time. In conclusion, CBZ in a gel sustained release dosage form combines the advantages of the suspension form in terms of dosing flexibility, and the advantages of the tablet form in regards to the sustained release profile. This dosage form should be further investigated in vivo in animal models before being considered in clinical trials

A comprehensive study of chronic diabetes complications in streptozotocin-induced diabetic rat

Objective: The purpose of this study was to provide a reference of chronic diabetes complications by investigating the prolonged hyperglycemia effects on hematological, biochemical and histopathological changes (liver, kidney, spleen, cardiac muscle, adrenal gland, and endocrine pancreas) in diabetic rats induced by streptozotocin. Methods: Ten adult female Sprague-Dawley of uniform age were divided into two Groups. Group 1 was made diabetic by single intraperitoneal injection of streptozotocin (60 mg/kg/bw) whereas Group 2 served as control. After six months, the rats were anesthetized using pentobarbital. Cardiac puncture was performed to get 3 ml of the blood sample; following 12 hours of an overnight fast. Serum chemistry test and complete blood analysis for lipid profile and blood glucose test; liver and renal functions were performed. Tissue specimens of liver, kidney, spleen, cardiac muscle, adrenal gland, and endocrine pancreas were fixed in 10% formal saline and processed for histological study. Results: There were severe histopathological changes in the affected organs; and the presence of a significant abnormality of lipid profile, liver, and renal functions. Conclusions: The presence of histopathological changes with abnormal biochemical changes is related to the chronic absence of insulin production in the destroyed β –cells which reflect the diabetic complications in a human being

Analgesic synergism of gabapentin and carbamazepine in rat model of diabetic neuropathic pain

Purpose: To evaluate synergy in the analgesic effects of a combination therapy of carbamazepine (CBZ) and gabapentin (GBP) in diabetic neuropathic pain. Methods: Neuropathic pain was produced in rats by a single intraperitoneal injection of streptozotocin (STZ) at 60 mg/kg. CBZ, GBP, and their combination were orally administered at varying doses (GBP 30 - 180 mg/kg; CBZ 20 - 40 mg/kg) comparable to their therapeutic doses in humans. Nociceptive responses in the diabetic rats were assessed using hot plate test. Results: Hot plate latency significantly increased with oral administration of GBP at a dose of 180 mg/kg when compared with control group (p < 0.05), while at a dose of 90 mg/kg, the increase was not significant. Oral administration of CBZ at doses of 20 and 40 mg/kg did not produce any significant impact on hot plate latency. However, a combination of GBP at 90 mg/kg and CBZ at 20 mg/kg produced significant increase in latency, compared with control group and other groups (p < 0.05), except the group that received 180 mg/kg GBP. The combination of low dose GBP 30 mg/kg and carbamazepine 30 mg/kg had no significant effect on latency (p > 0.05). Conclusion: The results obtained in this study provide useful information on the combination therapy of GBP and CBZ, which may be applied in the treatment of pain in diabetic neuropathy

A cross-sectional study on the quality of life of patients with peripheral diabetic neuropathy pain in Hospital Tegku Ampaun Afzan, Kuantan, Malaysia

Purpose: To evaluate the quality of life of patients with peripheral diabetic neuropathy pain (PDNP) in Hospital Tegku Ampaun Afzan (HTAA), Kuantan, Malaysia.Methods: Ninety (90) participants were selected from the Medical Outpatient Department (MOPD) clinic of HTAA. The study adopted a cross-sectional design, and the self-administered Douleur Neuropathy 4 (DN4) and Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaires were used for data collection.Results: The negative impact of diabetes on QoL was clearly reflected in the fact that every domain had a negative mean value. Overall, 27.8 % of the participants reported that DM negatively affected their QoL and 37.8 % expressed the opinion that their QoL would have been higher if they were not diabetic. QoL correlated with marital status and age, with married participants and participants in the age range 50 - 59 years old showing QoL negatively affected (p &lt; 0.05) by DM with PDNP. Apart from diabetes type, all other characteristics significantly affected participants QoL as reflected by the various related domains (p &lt; 0.05).Conclusion: Based on the findings of this study, it seems that individuals with diabetes and PDNP have a low QoL, with regard to “freedom to eat”, “freedom to drink”, “physical health”, “family life”, and “living condition”.Keywords: Quality of life, Diabetes, Peripheral neuropathy pai

Microencapsulation of peppermint oil using an ionic gelation electrospray technique

INTRODUCTION: Alginate has become the material of choice for encapsulation by ionic gelation and widely used in engineering and biotechnological industries, due to its biocompatibility, low cost and being a non-toxic polymer. Peppermint oil have been used for many pharmaceutical formulations and currently used as pharmaceutical active ingredient for few specific diseases. OBJECTIVES: This study aims to encapsulate and characterize peppermint oil in alginate microbeads by electrospray technique. METHODS: In this study, sodium alginates, Lecithin, calcium chloride and peppermint oil were used consecutively as an encapsulating material, emulsifying or, stabilizing agent, gelling solution and, as an active pharmaceutical ingredient. The electrospray technique was employed to encapsulate the peppermint oil by preparing the microbeads. To characterize emulsion, emulsion stability, size distribution of emulsion oil droplets and zeta potential, microstructure and shape and size of beads was determined followed by centrifugation or accelerated technique, a light scattering instrument, and light microscope. Finally, the analytical method was validated followed by ICH_Q2 guideline and encapsulation efficiency was determined by using UV-vis spectrophotometric (600 nm) method. The method was validated for specificity, linearity, accuracy, precision, limit of detection, and limit of quantitation. RESULTS: For the analysis method, it was found that peppermint oil obeys linearity within the concentration range of 3 mg/ml - 25 mg/ml and coefficient correlation was found to be 0.9890. The proposed method was found to be specific while estimating commercial formulations without interference of excipients. The emulsion was found to be highly stable while the percentage of beads yield was about 88%. In addition, the distribution of particle size of the emulsion was almost in nano size. In the characterization of beads, the size and shape of the beads were in good spherical shape. CONCLUSION: The analytical method was found to be simple, sensitive, accurate, precise & the most important cost effective and can be used for quantifying peppermint oil in the beads. Furthermore, peppermint oil was successfully encapsulated in alginate microbeads

Electro-hydrodynamic assisted synthesis of lecithin-stabilized peppermint oil-loaded alginate microbeads for intestinal drug delivery

Peppermint oil (PO) is the most prominent oil using in pharmaceutical formulations with its significant therapeutic value. In this sense, this oil is attracting considerable attention from the scientific community due to its traditional therapeutic claim, biological and pharmacological potential in recent research. An organic solventfree and environment-friendly electrohydrodynamic assisted (EHDA) technique was employed to prepared POloaded alginate microbeads. The current study deals with the development, optimization, in vitro characterization, in vivo gastrointestinal tract drug distribution and ex-vivo mucoadhesive properties, antioxidant, and antiinflammatory effects of PO-loaded alginate microbeads. The optimization results indicated the voltage and flow rate have a significant influence on microbeads size and sphericity factor and encapsulation efficiency. All these optimized microbeads showed a better drug release profile in simulated intestinal fluid (pH 6.8) at 2 h. However, a minor release was found in acidic media (pH 1.2) at 2 h. The optimized formulation showed excellent mucoadhesive properties in ex-vivo and good swelling characterization in intestine media. The microbeads were found to be well distributed in various parts of the intestine in in vivo study. PO-loaded alginate microbeads similarly showed potential antioxidant effects with drug release. The formulation exhibited possible improvement of irritable bowel syndrome (IBS) in MO-induced rats. It significantly suppressed proinflammatory cytokines, i.e., interleukin- IL-1β, and upregulated anti-inflammatory cytokine expression, i.e., IL-10. It would be a promising approach for targeted drug release after oral administration and could be considered an antiinflammatory therapeutic strategy for treating IBS

LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS: LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION: LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures