The Effect of Phyllanthus Amarus Aqueous Extract on Blood Glucose in Non-Insulin Dependent Diabetic Patients

The glycaemic response to 124.5 ± 9.3 (mean ± SD) g of pancakes was monitored in 21 non-insulin dependent diabetic (NIDDM) patients while on oral hypoglycaemics, after a one week washout period and after a one week twice daily treatment with 100 ml of an aqueous extract from 12.5 g of powdered aerial parts of Phyllanthus amarus. After the one week washout period, fasting blood glucose (FBG) and postprandial blood glucose increased significantly compared to when on oral hypoglycaemics (P ≤ 0.05). After one week herbal treatment no hypoglycaemic activity was observed. Both FBG and postprandial blood glucose remained very similar to that recorded after the washout period (P > 0.05). Both liver and renal functions based on alanine transaminase (ALAT) and serum creatinine, respectively, were not significantly affected by the use of the extract. Although lymphocyte and monocyte levels were significantly decreased (P ≤ 0.05) and granulocyte level was significantly increased after treatment (P ≤ 0.05) overall total white blood cell (WBC) count and haemoglobin (Hb) were not significantly affected by the one week herbal treatment. We conclude that one week treatment with the aqueous extract of Phyllanthus amarus was incapable of lowering both FBG and postprandial blood glucose in untreated NIDDM patients

Can a combination of lifestyle and clinical characteristics explain the presence of foot ulcer in patients with diabetes?

Aims: The aim of this study was to identify the biomechanical, neurological and clinical parameters along with other demographics and life style risk factors that could explain the presence of foot ulcer in patients with diabetes in Africa. Methods: A total of 1270 (M/F:696/574) patients; 77(M/F:53/24) with ulcerated vs 1193 (M/F: 643/550) with non-ulcerated feet; participated in this study. A set of 28 parameters were collected and compared between the participants with and without active foot ulcers. Multivariate logistic regression was utilised to develop an explanatory model for foot ulceration. Results: Foot swelling (χ2(1,n=1270)=265.9,P=0.000,Phi=0.464) and impaired sensation to monofilament (χ2(2,n=1270)=114.2,P=0.000,Cramer’sV=0.300) showed strong association with presence of ulceration. A lower Temperature sensitivity to cold stimuli and limited ankle joint mobility were observed to be significant (P<0.05) contributors to ulceration. The logistic regression model can justify the presence of foot ulceration with 95.3% diagnostic accuracy, 99.1 % specificity and 37.3% sensitivity. Conclusion: Participants with ulcerated foot show distinct characteristics in few foot related parameters. Swollen foot, limited ankle mobility, and peripheral sensory neuropathy were significant characteristics of patients with diabetic foot ulcer. One out of three patients with ulcerated foot showed common characteristics that could be justified by the model

Home-based Factors Associated with Competencies in Literacy Among Learners in Primary Three and Four in Uganda

This study investigates the home-based factors associated with children’s competencies in literacy among primary three and four children in Uganda. It identifies and analyses the various factors within the home environment that may enhance the development of literacy skills in children. This study utilized the Uwezo secondary data of August 2021 on basic literacy assessment conducted on children aged 4-16 across 29 districts. The literacy assessment centered on pre-literacy and literacy skills in English language focusing on their ability to identify letters/sounds, read short words, read sentences, read a story and comprehension. This study also identifies key home-based factors such as parental involvement, socio-economic status, parent level of education and access to educational resources that may impact children's performance in literacy. Findings reveal that the education level of the household head, source of lighting, possession of radio and television are highly significant with p-value &lt; 0.05 in fostering literacy competencies among children. The findings of this study could inform the development of targeted literacy interventions within the home-based environment as well as policies to enhance children's learning outcomes in Uganda. Keywords: Home-based factors, children’s competencies, literacy, learning assessment DOI: 10.7176/JEP/15-5-08 Publication date: April 30th 202

Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania

Objectives The aim of this study was to identify the parameters that predict the risk of future foot ulcer occurrence in patients with diabetes.Research design and methods 1810 (male (M)/female (F): 1012/798) patients, with no foot ulcer at baseline, participated in this study. Data from a set of 28 parameters were collected at baseline. During follow- up, 123 (M/F: 68/55) patients ulcerated. Survival analyses together with logistic regression were used to identify the parameters that could predict the risk of future diabetic foot ulcer occurrence.Results A number of parameters (HR (95% CI)) including neuropathy (2.525 (1.680 to 3.795)); history of ulceration (2.796 (1.029 to 7.598)); smoking history (1.686 (1.097 to 2.592)); presence of callus (1.474 (0.999 to 2.174)); nail ingrowth (5.653 (2.078 to 15.379)); foot swelling (3.345 (1.799 to 6.218)); dry skin (1.926 (1.273 to 2.914)); limited ankle (1.662 (1.365 to 2.022)) and metatarsophalangeal (MTP) joint (2.745 (1.853 to 4.067)) ranges of motion; and decreased (3.141 (2.102 to 4.693)), highly decreased (5.263 (1.266 to 21.878)), and absent (9.671 (5.179 to 18.059)) sensation to touch; age (1.026 (1.010 to 1.042)); vibration perception threshold (1.079 (1.060 to 1.099)); duration of diabetes (1.000 (1.000 to 1.000)); and plantar pressure at the first metatarsal head (1.003 (1.001 to 1.005)), temperature sensation (1.019 (1.004 to 1.035)) and temperature tolerance (1.523 (1.337 to 1.734)) thresholds to hot stimuli and blood sugar level (1.027 (1.006 to 1.048)) were all significantly associated with increased risk of ulceration. However, plantar pressure underneath the fifth toe (0.990 (0.983 to 0.998)) and temperature sensation (0.755 (0.688 to 0.829)) and temperature tolerance (0.668 (0.592 to 0.0754)) thresholds to cold stimuli showed to significantly decrease the risk of future ulcer occurrence. Multivariate survival model indicated that nail ingrowth (4.42 (1.38 to 14.07)); vibration perception threshold (1.07 (1.04 to 1.09)); dry skin status (4.48 (1.80 to 11.14)); and temperature tolerance threshold to warm stimuli (1.001 (1.000 to 1.002)) were significant predictors of foot ulceration risk in the final model. The mean time to ulceration was significantly (p<0.05) shorter for patients with: dry skin (χ2=11.015), nail ingrowth (χ2=14.688), neuropathy (χ2=21.284), or foot swelling (χ2=16.428).Conclusion Nail ingrowth and dry skin were found to be strong indicators of vulnerability of patients to diabetic foot ulceration. Results highlight that assessments of neuropathy in relation to both small and larger fiber impairment need to be considered for predicting the risk of diabetic foot ulceration

Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania

Objectives: The aim of this study was to identify theparameters that predict the risk of future foot ulceroccurrence in patients with diabetes.Research design and methods: 1810 (male (M)/female (F): 1012/798) patients, with no foot ulcer atbaseline, participated in this study. Data from a set of 28parameters were collected at baseline. During follow-up,123 (M/F: 68/55) patients ulcerated. Survival analysestogether with logistic regression were used to identifythe parameters that could predict the risk of futurediabetic foot ulcer occurrence.Results: A number of parameters (HR (95% CI)) includingneuropathy (2.525 (1.680 to 3.795)); history of ulceration(2.796 (1.029 to 7.598)); smoking history (1.686 (1.097to 2.592)); presence of callus (1.474 (0.999 to 2.174));nail ingrowth (5.653 (2.078 to 15.379)); foot swelling(3.345 (1.799 to 6.218)); dry skin (1.926 (1.273 to2.914)); limited ankle (1.662 (1.365 to 2.022)) andmetatarsophalangeal (MTP) joint (2.745 (1.853 to4.067)) ranges of motion; and decreased (3.141 (2.102to 4.693)), highly decreased (5.263 (1.266 to 21.878)),and absent (9.671 (5.179 to 18.059)) sensation totouch; age (1.026 (1.010 to 1.042)); vibration perceptionthreshold (1.079 (1.060 to 1.099)); duration of diabetes(1.000 (1.000 to 1.000)); and plantar pressure at the firstmetatarsal head (1.003 (1.001 to 1.005)), temperaturesensation (1.019 (1.004 to 1.035)) and temperaturetolerance (1.523 (1.337 to 1.734)) thresholds to hotstimuli and blood sugar level (1.027 (1.006 to 1.048))were all significantly associated with increased risk ofulceration. However, plantar pressure underneath the fifthtoe (0.990 (0.983 to 0.998)) and temperature sensation(0.755 (0.688 to 0.829)) and temperature tolerance(0.668 (0.592 to 0.0754)) thresholds to cold stimulishowed to significantly decrease the risk of future ulceroccurrence. Multivariate survival model indicated thatnail ingrowth (4.42 (1.38 to 14.07)); vibration perceptionthreshold (1.07 (1.04 to 1.09)); dry skin status (4.48(1.80 to 11.14)); and temperature tolerance threshold towarm stimuli (1.001 (1.000 to 1.002)) were significantpredictors of foot ulceration risk in the final model.The mean time to ulceration was significantly (p<0.05)shorter for patients with: dry skin (χ2 =11.015), nailingrowth (χ2 =14.688), neuropathy (χ2 =21.284), or footswelling (χ2 =16.428)

What characteristics are most important in stratifying patients into groups with different risk of diabetic foot ulceration?

Aims/Introduction: This study aimed to assess if patients can be divided into different strata, and to explore if these correspond to the risk of diabetic foot complications. Materials and Methods: A set of 28 demographic, vascular, neurological and biomechanical measures from 2,284 (1,310 men, 974 women) patients were included in this study. A two‐step cluster analysis technique was utilised to divide the patients into groups, each with similar characteristics. Results: Only two distinct groups: group 1 (n = 1,199; 669 men, 530 women) and group 2 (n = 1,072; 636 men, 436 women) were identified. From continuous variables, the most important predictors of grouping were: ankle vibration perception threshold (16.9 ± 4.1 V vs 31.9 ± 7.4 V); hallux vibration perception threshold (16.1 ± 4.7 V vs 33.1 ± 7.9 V); knee vibration perception threshold (18.2 ± 5.1 V vs 30.1 ± 6.5 V); average temperature sensation threshold to cold (29.2 ± 1.1°C vs 26.7 ± 0.7°C) and hot (35.4 ± 1.8°C vs 39.5 ± 1.0°C) stimuli, and average temperature tolerance threshold to hot stimuli at the foot (43.4 ± 0.9°C vs 46.6 ± 1.3°C). From categorical variables, only impaired sensation to touch was found to have importance at the highest levels: 87.4% of those with normal sensation were in group 1; whereas group 2 comprised 95.1%, 99.3% and 90.5% of those with decreased, highly‐decreased and absent sensation to touch, respectively. In addition, neuropathy (monofilament) was a moderately important predictor (importance level 0.52) of grouping with 26.2% of participants with neuropathy in group 1 versus 73.5% of participants with neuropathy in group 2. Ulceration during follow up was almost fivefold higher in group 2 versus group 1. Conclusions: Impaired sensations to temperature, vibration and touch were shown to be the strongest factors in stratifying patients into two groups with one group having almost 5‐fold risk of future foot ulceration compared to the other

Predicting the risk of amputation and death in patients with diabetic foot ulcer. A long‐term prospective cohort study of patients in Tanzania

IntroductionThis prospective cohort study aimed to identify the characteristics of patients with diabetic foot ulcer who are at higher risk of amputation and at increased risk of death.MethodsAbout 103(M/F:60/43) participants, with active foot ulcer at baseline, participated in this study and followed for 22 years till death or lost to follow-up. Ten clinical measures were collected at baseline. During the follow-up of 4.2 ± 5.4 years, 22(M/F:14/8) participants had an amputation and 50(M/F:32/18) participants passed away during 5.5 ± 5.8 years follow-up period.ResultsCox Proportional Hazard regression (HR[95%CI]) indicated neuropathy (6.415[1.119–36.778]); peripheral arterial disease (PAD) (9.741[1.932– 49.109]); current smoking (16.148[1.658–157.308]); diabetes type- 1 (3.228[1.151–9.048]) and longer delay attending appointment after ulcer (1.013[1.003–1.023]) were significantly (p < .05) associated with increased risk of amputation. In addition, death was significantly associated with the risk of amputation (3.458[1.243–9.621]). Three parameters (HR[95%CI]) including neuropathy (3.058[1.297–7.210]); PAD (5.069[2.113–12.160]); amputation history (3.689[1.306–10.423]) and retinopathy (2.389[1.227–4.653]) were all significantly associated with increased risk of death. Kaplan–Meier survival analyses indicates that the time to amputation in years for participants who eventually died was significantly shorter (11.122 ± 1.507) vs those who stayed alive (15.427 ± 1.370).ConclusionNeuropathy and PAD were the only two characteristics that increased both the risk of amputation and death. Amputation showed to contribute to an increased risk of death and those participants who eventually died had a higher risk of amputation. Delay in attending appointments after ulceration is shown to increase the risk of amputation. In addition, the participants with PAD showed a significantly shorter time to both amputation and death while neuropathy was only associated with decreased time to death. Amputation history and death during follow-up decrease the time to death and amputation respectively

Predicting the risk of amputation and death in patients with diabetic foot ulcer. A long‐term prospective cohort study of patients in Tanzania

Introduction This prospective cohort study aimed to identify the characteristics of patients with diabetic foot ulcer who are at higher risk of amputation and at increased risk of death. Methods About 103(M/F:60/43) participants, with active foot ulcer at baseline, participated in this study and followed for 22 years till death or lost to follow-up. Ten clinical measures were collected at baseline. During the follow-up of 4.2 ± 5.4 years, 22(M/F:14/8) participants had an amputation and 50(M/F:32/18) participants passed away during 5.5 ± 5.8 years follow-up period. Results Cox Proportional Hazard regression (HR[95%CI]) indicated neuropathy (6.415[1.119–36.778]); peripheral arterial disease (PAD) (9.741[1.932– 49.109]); current smoking (16.148[1.658–157.308]); diabetes type- 1 (3.228[1.151–9.048]) and longer delay attending appointment after ulcer (1.013[1.003–1.023]) were significantly (p < .05) associated with increased risk of amputation. In addition, death was significantly associated with the risk of amputation (3.458[1.243–9.621]). Three parameters (HR[95%CI]) including neuropathy (3.058[1.297–7.210]); PAD (5.069[2.113–12.160]); amputation history (3.689[1.306–10.423]) and retinopathy (2.389[1.227–4.653]) were all significantly associated with increased risk of death. Kaplan–Meier survival analyses indicates that the time to amputation in years for participants who eventually died was significantly shorter (11.122 ± 1.507) vs those who stayed alive (15.427 ± 1.370). Conclusion Neuropathy and PAD were the only two characteristics that increased both the risk of amputation and death. Amputation showed to contribute to an increased risk of death and those participants who eventually died had a higher risk of amputation. Delay in attending appointments after ulceration is shown to increase the risk of amputation. In addition, the participants with PAD showed a significantly shorter time to both amputation and death while neuropathy was only associated with decreased time to death. Amputation history and death during follow-up decrease the time to death and amputation respectively

The Charcot Foot: An Emerging Public Health Problem for African Diabetes Patients

Background: Although the awareness, diagnosis, management of the complications associated with diabetes have improved in African countries over the past decade, surveillance activities in Tanzania and anecdotal reports from other African countries have suggested an increased prevalence of Charcot Neuroarthropathy (CN) over the past few years. Aim: To characterize the epidemiology and the clinical burden of CN in a large diabetes population in Tanzania, and to evaluate outcomes of persons with the condition. Methods: This was a prospective analytic cohort study conducted between January 2013 through December 2015. Following informed consent, patients were followed at the outpatient clinic. Detailed clinical assessments and documented presence of diabetic peripheral neuropathy (DPN), macrovascular disease and microvascular disease were recorded. Education and counselling were part of the follow-up program. Results: 3,271 ulcerations were presented at the clinic during the 3-year study period. 571 (18%) met the case definition for CN; all patients had Type 2 diabetes. The prevalence for each of the years 2013, 2014, and 2015 was 19/1192 (1.6%), 209/1044 (20%), and 343/1035 (34%), respectively; the increases in the slope of the trendline was statistically significant (p<0.001). Conclusion: The prevalence of CN is increasing in the Tanzanian diabetes patient population, and is strongly associated with neuropathy. CN can lead to severe deformity, disability, and amputation. Due to the risk of limb amputation, patients with diabetes must seek immediate care if signs or symptoms appear and avoid delay in seeking medical attention. Early diagnosis of CN by caregivers is extremely important for successful outcomes