Response of People with Type 1 Diabetes for Follow Up

Diabetes is becoming a global epidemic. Type1 diabetes (T1DM) accounts for 3-5% of all the diabetics. As T1DM is diagnosed in childhood and adolescence, it is associated with more complications because of longer life span of individuals with this condition. The main objective of the study was to find out attitudes of people with type 1 diabetes especially with regards to their follow up. A cross-sectional study was planned and a total of 97 people with type 1 diabetes were included for a period of one year. To analyze the data SPSS 20.0 version was used. Results showed that out of 97 people, 48 (49.5%) were male and 49 (50.5%) were female. The mean age of total type 1 diabetics were 17.03±6.54 years. Mean glycated hemoglobin (HbA1c) was 10.59±3.09. The results revealed that 45% of people showed positive attitude and 55% showed negative behavior towards follow-up. It was concluded that overall follow up of people with type 1 diabetes was poor. It was observed that they wanted a complete cure and this contribute to missed follow up

Control of Type II Diabetes, Its Relationship with Obesity and Basal Metabolic Rate

Background: The prevalence of T2DM is around 7-10%. Control of diabetes and factors influencing it in third world countries need to be clearly defined as most of the people have poor glycemic control. Methods: A cross sectional study was conducted and purposive sampling was done to collect data for 5 months. A total of 766 type 2 diabetic patients were enrolled who visited SiDER (Sakina Institute of Diabetes and Endocrine Research Center) at Shalamar Hospital, Lahore, Pakistan. Only pre-diagnosed diabetic subjects with a random blood glucose of more than 200mg/dl at two occasions and fasting blood glucose levels more than 126mg/dl were included in the study. Variables like Body Mass Index (BMI), Glycated Hemoglobin (HbA1c) and Basal Metabolic Rate (BMR) were recorded. The data was analyzed by SPSS 22 version. Results: A total of 766 diabetics were recruited in the study out of which 40.3% were male and 59.7% were females. The mean age was 48.72±10.43 years. Out of these 53.39% were obese, 32.64% were overweight and only 13.97% had a normal body mass index BMI). HbA1c levels in the sample population showed that only 13.05% had very healthy control i.e. 7% or less. There was a positive co-relation between Body Mass Indexand glycemic control. However there was no statistically significant relation between Basal Metabolic Rateand glycemic control. Conclusion: People with high Body Mass Index were found to have suboptimal glycemic control. It was also observed that higher percentage of diabetic patients fall in age group of 41-55 years. More powerful studies are needed to establish a relation between glycated hemoglobin and Basal Metabolic Rate

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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

Amelioration of Rheumatoid Arthritis by Anacardium occidentale via Inhibition of Collagenase and Lysosomal Enzymes

Anacardium occidentale (cashew) has been used in the traditional system of medicine for curing many inflammatory disorders. The present study investigates the antiarthritic effects of cashew leaves extract using the rat model of FCA-induced rheumatoid arthritis. Arthritic rats were treated with 100 and 200 mg/kg b.w. ethanolic extract of cashew leaves. Animals were sacrificed at day 23, and before sacrificing the animals, gross pathological changes were observed. Histopathology of ankle joint was evaluated with hematoxylin and eosin staining, whereas the serum levels of C-reactive protein (CRP) were evaluated by the agglutination method. Inflammatory cells and other hematological parameters were assessed by employing an automated hemocytometer and chemistry analyzer. Rheumatoid factor (Rf) and lysosomal enzymes levels were determined in blood. Results indicated that A. occidentale significantly decreased the CPR levels, macroscopic arthritic score, and rheumatoid factor as compared to the diseased group. Histopathological evaluation showed significant attenuation in bone erosion, joint inflammation, and pannus formation by plant extract. Treatment with A. occidentale significantly suppressed the levels of acid phosphatase, β-galactosidase, β-glucuronidase, N-acetylglucosaminidase, and collagenase. Moreover, A. occidentale significantly raised the HB levels and RBCs counts which were found depleted in the diseased group. The raised counts of total leukocytes, platelets, neutrophils, lymphocytes, and monocytes were also significantly decreased by treatment with plant extract. Comparative analysis showed that higher dose of A. occidentale demonstrated superior amelioration of rheumatoid arthritis as compared to low dose. In conclusion, A. occidentale possesses significant antiarthritic potential, which may be attributed to the suppression of lysosomal enzymes and collagenase levels

Knowledge and Awareness Regarding T1DM in Primary Health care Providers

Background: Diabetes is one of the commonest non-communicable diseases in the world. Type 1 Diabetes Mellitus (T1DM) is relatively less common but it is associated with greater morbidity and mortality. It is important to have the knowledge and awareness of T1DM especially in primary care providers (PCPs) to save the lives of children and young adults with T1DM. Methods: A cross sectional study was performed by distributing questionnaires amongst the doctors belonging to the field of General Medicine working at the primary care level with practices comprising approximately 10% of diabetic patients. Responses were recorded on a questionnaire and the data was analyzed by SPSS versions 20. Results: Only 62% doctors were aware about the correct pathogenesis of T1DM. Regarding the most important and fatal complications of T1DM i.e. diabetic ketoacidosis (DKA), 88.9% came up with correct answer. However when asked about the mortality related to T1DM only 22% PCPs gave the right answer. Only 40% of the PCPs could give correct answer regarding the mechanism of action of insulin. 55.6% PCPs were aware of the variation in blood glucose levels and had knowledge how to adjust them. Only 55.6% doctors were aware of cause of hypoglycemia. Conclusion: Most of the PCPs had suboptimal knowledge regarding T1DM, its pathogenesis, complications and mechanism of action of insulin. This study had identified the need for further improvement in PCPs practices for treating and educating diabetes and recommended that awareness and educational programs are necessary to update the PCPs on screening, effective treatment of T1DM, and prevention of its complications

Are we Using the Right Evidence to Inform Suicide Prevention in Low- and Middle-Income Countries?:An Umbrella Review

ObjectiveSuicide disproportionately affects low- and middle-income countries and evidence regarding prevention approaches developed in high income countries may not be applicable in these settings. We conducted an umbrella review to assess whether the conclusions of suicide prevention systematic reviews accurately reflect the studies contained within those reviews in terms of setting generalizability.MethodsWe conducted database searches in PubMed/Medline, Embase, PsycInfo, PsychExtra, OVID global health, and LILACS/BECS. We included systematic reviews with the outcome of suicide, including bereavement studies where suicide death was also the exposure.ResultsOut of the 147 reviews assessed, we found that over 80% of systematic reviews on suicide deaths do not provide an accurate summary of review findings with relation to geographic relevance and ultimately generalizability.ConclusionSystematic reviews are often the resource used by practitioners and policymakers to guide services. Misleading reviews can detrimentally impact suicide prevention efforts in LMICs. We call for systematic reviewers to be responsible when generalizing the findings of their reviews particularly in the abstracts

Outcomes and Complications of Radiological Gastrostomy vs. Percutaneous Endoscopic Gastrostomy for Enteral Feeding: An Updated Systematic Review and Meta-Analysis

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are commonly utilized to establish access to enteral nutrition. However, data comparing the outcomes of PEG vs. PRG are conflicting. Therefore, we aimed to conduct an updated systemic review and meta-analysis comparing PRG and PEG outcomes. METHODS: Medline, Embase, and Cochrane library databases were searched until February 24, 2023. Primary outcomes included 30-day mortality, tube leakage, tube dislodgement, perforation, and peritonitis. Secondary outcomes included bleeding, infectious complications, and aspiration pneumonia. All analyses were conducted using Comprehensive Meta-Analysis Software. RESULTS: The initial search revealed 872 studies. Of these, 43 of these studies met our inclusion criteria and were included in the final meta-analysis. Of 471,208 total patients, 194,399 received PRG and 276,809 received PEG. PRG was associated with higher odds of 30-day mortality when compared to PEG (odds ratio (OR): 1.205, 95% confidence interval (CI): 1.015 - 1.430, I = 55%). In addition, tube leakage and tube dislodgement were higher in the PRG group than in PEG (OR: 2.231, 95% CI: 1.184 - 4.2 and OR: 2.602, 95% CI: 1.911 - 3.541, respectively). Perforation, peritonitis, bleeding, and infectious complications were higher with PRG than PEG. CONCLUSION: PEG is associated with lower 30-day mortality, tube leakage, and tube dislodgement rates than PRG