Are type 2 diabetic patients meeting targets? A Helen Joseph Hospital Diabetic Clinic Audit

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Effects of diabetes mellitus on health-related quality of life at a tertiary hospital in South Africa: A cross-sectional study

Background. Diabetes mellitus (DM) is a chronic metabolic disease that potentially causes debilitating and life-threatening complications, demands a lifestyle change, and has important implications with regard to wellbeing and health-related quality of life (HRQOL).Objectives. To: (i) determine the HRQOL of a sample of patients with type 2 diabetes; (ii) describe the demographics (age, gender, and smoking and alcohol use) of the population studied; (iii) document the following parameters, which are important in determining the control and severity of type 2 diabetes: (a) glycosylated haemoglobin (HbA1c), (b) total amount of insulin required per day (if on insulin therapy), (c) body mass index (BMI), and (d) exercise compliance; (iv) determine whether there was an association between any or all of the above parameters and the HRQOL of these patients; and (v) determine whether coexisting diseases (hypertension (HT) and dyslipidaemia) were present, and compare HRQOL between diabetic patients with and without these diseases.Methods. This was a cross-sectional and descriptive study of 200 patients attending the diabetes clinic at Helen Joseph Hospital, Johannesburg, South Africa. HRQOL assessments were made using the Diabetes 39 (D-39) questionnaire, which patients filled in once consent had been obtained and if they fulfilled the inclusion criteria. Patients’ questionnaire forms were then analysed with regard to their demographics (age and gender), exercise regimen, smoking and alcohol history, employment status, living arrangements, age of diagnosis of DM, and concurrent use of antihypertensive and cholesterol-lowering drugs. The patients’ files were analysed and various clinical parameters were noted (HbA1c, lipogram, BMI, number of insulin units used per day, and whether any antihypertensive and/or lipidlowering drugs were used).Results. There was an association between HRQOL and HbA1c, and between HRQOL and HT and dyslipidaemia.Conclusions. No association was found between HRQOL and other clinical parameters, namely number of insulin units used per day, exercise, BMI, lipogram and the use of oral hypoglycaemic agents. Demographic parameters (age, gender, age at diagnosis, employment status and living arrangements) were also shown to have no impact on HRQOL. We found no association between HRQOL in patients who consumed alcohol and smoked cigarettes and in those who did not

Prevalence and pattern of dyslipidaemia in type 2 diabetes mellitus patients at a tertiary care hospital

Background: Diabetes mellitus (DM) is a common secondary cause of dyslipidaemia, particularly if glycaemic control is poor, which in turn is an important risk factor for atherosclerosis and coronary artery disease.Objectives: (1) To study the prevalence and pattern of dyslipidaemia in patients with type 2 DM. (2) To determine the relationship (if any) between HbA1C and the lipid profile in type 2 diabetic patients.Methods: This was a cross-sectional study done in 200 type 2 diabetic patients  attending the Diabetic Clinic at the Helen Joseph Hospital. Patients suffering from other known causes of secondary dyslipidaemia were excluded. Each patient’s  HbA1C and lipid profile results were recorded from their clinic files. The lipid profile included total cholesterol (TC), triglyceride (TG), high-density lipoprotein  cholesterol (HDL-C) and calculated low-density lipoprotein cholesterol (LDL-C). Patients with one or more of the above parameters outside the targets recommended by the 2012 South African Dyslipidaemia Guidelines were considered to have uncontrolled dyslipidaemia.Results: Of the 200 type 2 DM patients studied, 86 (43%) were male and 114 (57%) female. Despite all patients being treated with lipid-lowering therapy  (simvastatin at a mean daily dose of 20 mg), 187 patients (93.5%) did not achieve all their lipid targets. The most prevalent lipid parameter not at target was an LDL-C of ≥ 1.8 mmol/l in nearly 80% of patients. The most common pattern of  dyslipidaemia was a combined dyslipidaemia (any two abnormal lipid parameters) affecting a total of 82 out of the 187 patients (43.8%) not reaching recommended  targets. No significant relationship was found between HbA1C and any of the lipid parameters.Conclusion: The vast majority of the type 2 diabetic patients studied had  dyslipidaemia not meeting recommended targets, despite the use of lipid-lowering therapy in all patients. There is a need for more intensive lipid-lowering therapy, particularly statin therapy in patients with dyslipidaemia. Measures aimed at  combating obesity and other lifestyle-related risk factors are also vital and need to be implemented for effectively controlling dyslipidaemia and reducing the burden of CVD.Keywords: combined dyslipidaemia, LDL, lipid target

A study of the efficacy of furosemide as a prophylaxis of acute renal failure in coronary artery bypass grafting patients: A clinical trial

BACKGROUND: Renal failure is a frequent event after coronary artery bypass grafting (CABG). Hemodynamic alterations during surgery as well as the underlying disease are the predisposing factors. We aimed to study intermittent furosemide therapy in the prevention of renal failure in patients undergoing CABG. METHODS: In a single-blind randomized controlled trial, 123 elective CABG patients, 18-75 years, entered the study. Clearance of creatinine, urea and water were measured. Patients were randomly assigned into three groups: furosemide in prime (0.3-0.4 mg/kg); intermittent furosemide during CABG (0.2 mg/kg, if there was a decrease in urinary excretion) and control (no furosemide). RESULTS: There was a significant change in serum urea, sodium and fluid balance in �intermittent furosemide� group; other variables did not change significantly before or after the operation. Post-operative fluid balance was significantly higher in �intermittent furosemide� group (2573 ± 205 ml) compared to control (1574 ± 155 ml) (P < 0.010); also, fluid balance was higher in �intermittent furosemide� group (2573 ± 205 ml) compared to �furosemide in prime� group (1935 ± 169 ml) (P < 0.010). CONCLUSION: The study demonstrated no benefit from intermittent furosemide in elective CABG compared to furosemide in prime volume or even placebo. © 2015, Isfahan University of Medical Sciences(IUMS). All rights reserved

SEMDSA/ACE-SA Guideline for the Management of Hypothyroidism in Adults

Background: Hypothyroidism is a common clinical condition confronting all healthcare practitioners yet there remains uncertainty about the optimal medication and optimum treatment targets. In addition, many patients remain symptomatic despite using recommended medications and attaining recommended treatment targets.Methods: All endocrinologists in South Africa who consented to be part of the guideline process were assigned various aspects of the management of patients with thyroid disease. In each section the current literature was reviewed and the level of evidence was graded. This information was then presented at a guideline meeting. Where evidence was lacking a consensus among participants was adopted.Results: This guideline provides 11 recommendations for the management of primary hypothyroidism, secondary hypothyroidism and subclinical hypothyroidism in adults.Conclusions: This is the first South African guideline for the management of hypothyroidism in adults and represents a comprehensive review of the current literature in an attempt to provide evidence-based guidance for all healthcare practitioners regarding the many clinical aspects encountered when managing patients with hypothyroidism

Effects of diabetes mellitus on health-related quality of life at a tertiary hospital in South Africa: A cross-sectional study

Background. Diabetes mellitus (DM) is a chronic metabolic disease that potentially causes debilitating and life-threatening complications, demands a lifestyle change, and has important implications with regard to wellbeing and health-related quality of life (HRQOL).Objectives. To: (i) determine the HRQOL of a sample of patients with type 2 diabetes; (ii) describe the demographics (age, gender, and smoking and alcohol use) of the population studied; (iii) document the following parameters, which are important in determining the control and severity of type 2 diabetes: (a) glycosylated haemoglobin (HbA1C), (b) total amount of insulin required per day (if on insulin therapy), (c) body mass index (BMI), and (d) exercise compliance; (iv) determine whether there was an association between any or all of the above parameters and the HRQOL of these patients; and (v) determine whether coexisting diseases (hypertension (HT) and dyslipidaemia) were present, and compare HRQOL between diabetic patients with and without these diseases.Methods. This was a cross-sectional and descriptive study of 200 patients attending the diabetes clinic at Helen Joseph Hospital, Johannesburg, South Africa. HRQOL assessments were made using the Diabetes 39 (D-39) questionnaire, which patients filled in once consent had been obtained and if they fulfilled the inclusion criteria. Patients’ questionnaire forms were then analysed with regard to their demographics (age and gender), exercise regimen, smoking and alcohol history, employment status, living arrangements, age of diagnosis of DM, and concurrent use of antihypertensive and cholesterol-lowering drugs. The patients’ files were analysed and various clinical parameters were noted (HbA1C, lipogram, BMI, number of insulin units used per day, and whether any antihypertensive and/or lipid-lowering drugs were used).Results. There was an association between HRQOL and HbA1C, and between HRQOL and HT and dyslipidaemia.Conclusions. No association was found between HRQOL and other clinical parameters, namely number of insulin units used per day, exercise, BMI, lipogram and the use of oral hypoglycaemic agents. Demographic parameters (age, gender, age at diagnosis, employment status and living arrangements) were also shown to have no impact on HRQOL. We found no association between HRQOL in patients who consumed alcohol and smoked cigarettes and in those who did not

Experimental wound healing using microamperage electrical stimulation in rabbits

We investigated the effects of microamperage electrical stimulation (MES) on the healing of skin incision in rabbits. Thirty male adult rabbits were randomly divided into sham-treated and experimental groups. Each group was divided into three subgroups, based on the duration of experiment (4, 7, and 15 days). A full-thickness incision was made on the skin of each rabbit. The experimental group received an MES of 200 microamperes current intensity for 2 h/day. Morphometrical and biomechanical evaluations were carried out. The mean number of fibroblasts at day 7 and the mean of tensile strength at day 15 were found to be significantly higher for the experimental group than for those in the sham-treated group (p < 0.01 and p < 0.05, respectively). Daily application of MES significantly accelerated the wound-healing process of full-thickness incision in the rabbits' skin

Cognitive Effects of Almond Consumption: A Review of Animal Studies

Kawsar Alami, Zahra Nazari, Raheel Bayat, Aqdas Bayat, Somaya Qasemi, Fereshta Karimi, Maliha Sultani, Sayed Yousof Mousavi Department of Cognitive Neuroscience, Neuroscience Research Center, Kavosh Nonprofit Educational Research Institute, Kabul, AfghanistanCorrespondence: Sayed Yousof Mousavi, Department of Cognitive Neuroscience, Neuroscience Research Center, Kavosh Nonprofit Educational Research Institute, First Street of Karte 4, Kabul, 1004, Afghanistan, Tel +93705343480 ; Fax +93796850084, Email [email protected] and Background: Learning and memory are fundamental processes essential to human cognition. Memory disorders can greatly impact cognitive abilities and overall quality of life. Synthetic drugs are not always completely effective in the treatment of memory disorders and can have diverse side effects. As a result, the use of plants for treating various diseases, including those related to memory disorders, is common. Almond is a highly nutritious nut and has been used as a traditional remedy for a long time. They contain active compounds that have numerous biological effects on the entire body, particularly the nervous system. Therefore, the purpose of this study is to review animal studies that have investigated the effects of almond intake on memory and its related disorders.Methods: In this study, a comprehensive search in several databases including PubMed, Web of Science, Scopus, Science Direct, and Cochrane Library was performed. The study included published articles featuring preclinical studies conducted on healthy animals or models with memory impairments. These studies employed specific controlled groups and evaluated memory-related parameters through behavioral tests or molecular investigations. Eleven original papers that met the criteria were selected from a total of 1190 identified articles and included in the study.Results: Almond consumption has been shown to have beneficial effects on learning and memory in healthy animals. Additionally, evidence suggests that consuming almonds can positively impact scopolamine-, cadmium-, chronic stress-, and high-fat diet-induced memory impairment in animal models.Conclusion: Based on available evidence, consuming dietary supplementation of almonds may have a significant role in brain processes, specifically the neuromodulatory systems. Consequently, incorporating almonds into one’s diet could potentially enhance memory function, making them a readily available and useful natural resource with both nutritional and therapeutic benefits. Keywords: Almond, Prunus amygdalus, Prunus dulcis, learning, memory, neuromodulatory system

The Claustrum in Relation to Seizures and Electrical Stimulation

The neural mechanisms of altered consciousness that accompanies most epileptic seizures are not known. We have reported alteration of consciousness resulting from electrical stimulation of the claustrum via a depth electrode in a woman with refractory focal epilepsy. Additionally, there are reports that suggest possible claustral involvement in focal epilepsy, including MRI findings of bilaterally increased T2 signal intensity in patients with status epilepticus (SE). Although its cytoarchitecture and connectivity have been studied extensively, the precise role of the claustrum in consciousness processing, and, thus, its contribution to the semiology of dyscognitive seizures are still elusive. To investigate the role of the claustrum in rats, we studied the effect of high-frequency stimulation (HFS) of the claustrum on performance in the operant chamber. We also studied the inter-claustral and the claustro-hippocampal connectivity through cerebro-cerebral evoked potentials (CCEPs), and investigated the involvement of the claustrum in kainate (KA)-induced seizures. We found that HFS of the claustrum decreased the performance in the operant task in a manner that was proportional to the current intensity used. In this article, we present previously unpublished data about the effect of stimulating extra-claustral regions in the operant chamber task as a control experiment. In these animals, stimulation of the corpus callosum, the largest interhemispheric commissure, as well as the orbitofrontal cortex in the vicinity of the claustrum did not produce that same effect as with claustral stimulation. Additionally, CCEPs established the presence of effective connectivity between both claustra, as well as between the claustrum and bilateral hippocampi indicating that these connections may be part of the circuitry involved in alteration of consciousness in limbic seizures. Lastly, some seizures induced by KA injections showed an early involvement of the claustrum with later propagation to the hippocampi. Further work is needed to clarify the exact role of the claustrum in mediating alteration of consciousness during epileptic seizures

Effect of family-based cognitive behavioral therapy in modification of self-image associated with obesity among children

Background and purpose: The purpose of this study was to investigate the effect of family-based cognitive behavioral therapy in modification of self-image associated with obesity in children. Materials and methods: A randomized controlled trial was performed in children with obesity (BMI � 95th percentile(aged 8-15 years old. Using convenience sampling, the participants were recruited from Children Hospital and Morsali clinic in Arak, Iran. They were randomly assigned to either the experimental group (n= 15) or control group (n= 15). The children in experimental group received family-based cognitive behavioral therapy (6 group sessions) and their parents attended 5 group sessions. All participants completed Body Parts Satisfaction Scale-Revised (BPSS-R) and Standard Figural Stimuli Scale (SFSS) in pretest, posttest and follow-up. BMI was calculated in all three stages. Results: Family-based cognitive-behavioral therapy was found effective in improving the body parts satisfaction (P=0.023) and body image satisfaction (P=0.0001). The improvement maintained only in body image at follow-up (P=0.0001). Conclusion: According to these results, family-based cognitive behavioral therapy is effective in modification of self-image in children. © 2016, Mazandaran University of Medical Sciences. All rights reserved