Impact of Ramadan focused education program on hypoglycemic risk and metabolic control for patients with type 2 diabetess

Background: Fasting during the month of Ramadan could lead to acute complications and increased hypoglycemic risk of patients with type 2 diabetes. Therefore, diabetes is one of the diseases that need careful observation and special considerations during Ramadan including patients’ education and counseling. Objectives: To evaluate the impact of Ramadan focused education program on acute complications and biomedical parameters. Methods: A prospective nonrandomized interventional controlled design was run on three phases: before, during, and after Ramadan on 262 type 2 diabetes patients. The intervention group (n=140) received focused individualized diabetic education sessions and antidiabetic medications adjustment before and after Ramadan, while the control group (n=122) received standard diabetic care. A validated hypoglycemia questionnaire was used in both groups to assess the change of the risk. Patients were advised to adjust the dosage and timing of antidiabetic agents according to the recommendations for management of diabetes during Ramadan. Primary outcomes were postintervention change of hypoglycemia score and HbA1c over 6-month follow-up. Data were presented as mean ± standard deviation. HbA1c was expressed in percentage. Results: The hypoglycemic scores before, during, and after Ramadan were 14.21±8.50, 6.36±6.17, and 5.44±5.55 in the intervention group, respectively (P,0.001) and 14.01±5.10, 13.46±5.30, and 9.27±4.65 in the control group, respectively (P,0.001). HbA1c levels were 9.79±1.89, 8.26±1.54, and 8.52±1.61 before, during, and after Ramadan in the intervention group, respectively (P,0.001), and 10.04±1.47, 9.54±1.38, and 9.59±1.79 in the control group, respectively (P,0.001). Post-Ramadan reductions of HbA1c and hypoglycemic scores were significantly higher in the intervention group (-13.0% vs -4.5%, P=0.004 for HbA1c and -61.7% vs -33.8%, P,0.001 for hypoglycemic score). Low-density lipoprotein cholesterol improved in the intervention group from 2.41±0.91 mmol/L before Ramadan to 2.28±0.68 mmol/L after Ramadan (P,0.001). No statistically significant effects were observed on blood pressure or body weight in the intervention group. Also, no change was observed in the control group. Conclusion: Ramadan educational program had a positive impact with reduction of hypoglycemic risk, HbA1c, and low-density lipoprotein cholesterol. Therefore, it could be recommended for patients with increased risk of hypoglycemia during Ramadan fasting

Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations - Part II.

This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text via the publisher's site.Published (Open Access

Teaching communication skills in family medicine: A qualitative study

Background:The ability of a doctor to communicate with patients effectively is one of the core competencies of a family physician. Teaching communication skills is a peculiar and challenging subject. Objectives:This study was conducted to explore the perceptions of family medicine trainers, their teaching approaches, and their opinions about improvements in teaching communication skills. Materials and Methods:The was a qualitative study. Both semi-structured interviews and a focus group discussion were used. The group of trainers was purposively selected and analysis was performed manually. Results:Twenty-four trainers were interviewed. It was found that interviewees perceived teaching communication skills as something very important and interesting but challenging and difficult. Effective teaching of the subject was limited by curriculum design where time distribution between the hospital and family medicine training did not satisfy the requirement of teaching communication skills. Time constraints and the organization of patient services in family medicine teaching centers contribute to the challenges of teaching the subject effectively. The practice of and the attitudes toward effective communication skills teaching methods were variably perceived among this group of trainers. The assessment modalities as a final point in the whole process of teaching were not perceived as a discriminating indicator to the true level of residents’ communication skills. Their main ideas for improvements were to give more emphasis to the teaching curriculum, to give it more weight in the final assessment of the board examination, and to establish standard teaching skills and attitudes toward the practice of communication skills in family medicine. Conclusions:Communication skills teaching in family medicine is a complex area of training. Focused efforts are required in developing the curriculum and training standards

2-(4-Methylpiperazin-1-yl)-4-phenyl-6-(thiophen-2-yl)-pyridine-3-carbonitrile

2-(4-Methylpiperazin-1-yl)-4-phenyl-6-(thiophen-2-yl)-pyridine-3-carbonitrile (4) was synthesized via nucleophilic substitution reaction of 1-methylpiperazine with 2-bromo analogue 3. The latter was obtained through bromination (Br2/AcOH) of 2-[3-oxo-1-phenyl-3-(thiophen-2-yl)propyl]malononitrile (2)

2-(4-Methylpiperazin-1-yl)-4-phenyl-6-(thiophen-2-yl)-pyridine-3-carbonitrile

2-(4-Methylpiperazin-1-yl)-4-phenyl-6-(thiophen-2-yl)-pyridine-3-carbonitrile (4) was synthesized via nucleophilic substitution reaction of 1-methylpiperazine with 2-bromo analogue 3. The latter was obtained through bromination (Br2/AcOH) of 2-[3-oxo-1-phenyl-3-(thiophen-2-yl)propyl]malononitrile (2)