SERUM FERRITIN AND HbA1c LEVELS IN TYPE 2 DIABETES MELLITUS

Introduction: Complications due to diabetes are a major cause of disability, reduced quality of life and death. Recent studies have emphasized the role of serum ferritin in insulin resistance and the incidence of diabetes mellitus. However, the role of ferritin as a marker of iron overload in pancreatic damage and peripheral insulin resistance or its role as an inflammatory marker is not clear. The aim of this study is to establish a correlation between serum ferritin, FBS and HbA1c in type 2 diabetes mellitus and to evaluate the role of serum ferritin on the glycemic status in type 2 diabetes mellitus. Methods: This was a cross- sectional study of 100 cases, visiting medical outpatient department of a tertiary care teaching hospital. Diabetic patients were compared with age and sex matched normal healthy controls. Effect of serum ferritin on glycemic status, gender and age was noted. Results: Statistically significant increase of FPG, HbA1C and serum ferritin levels were observed in type 2 diabetes mellitus group than controls in both females and males while there was no statistically significant difference of hemoglobin between diabetic group and controls in females and males. There was a high (r= 0.62, r= 0.66) positive correlation between SF and HbA1c of females and males respectively in diabetic group P-value=< 0.01. Conclusion: Higher positive correlation of serum ferritin with HbA1c shows that hyperglycemia affects ferritin levels possibly due to inflammation or oxidative stress or a combination of the two. KEYWORDS: Type 2 diabetes mellitus; Glycosylated haemoglobin; Ferritin

SERUM FERRITIN AND HbA1c LEVELS IN TYPE 2 DIABETES MELLITUS

Introduction: Complications due to diabetes are a major cause of disability, reduced quality of life and death. Recent studies have emphasized the role of serum ferritin in insulin resistance and the incidence of diabetes mellitus. However, the role of ferritin as a marker of iron overload in pancreatic damage and peripheral insulin resistance or its role as an inflammatory marker is not clear. The aim of this study is to establish a correlation between serum ferritin, FBS and HbA1c in type 2 diabetes mellitus and to evaluate the role of serum ferritin on the glycemic status in type 2 diabetes mellitus. Methods: This was a cross- sectional study of 100 cases, visiting medical outpatient department of a tertiary care teaching hospital. Diabetic patients were compared with age and sex matched normal healthy controls. Effect of serum ferritin on glycemic status, gender and age was noted. Results: Statistically significant increase of FPG, HbA1C and serum ferritin levels were observed in type 2 diabetes mellitus group than controls in both females and males while there was no statistically significant difference of hemoglobin between diabetic group and controls in females and males. There was a high (r= 0.62, r= 0.66) positive correlation between SF and HbA1c of females and males respectively in diabetic group P-value=< 0.01. Conclusion: Higher positive correlation of serum ferritin with HbA1c shows that hyperglycemia affects ferritin levels possibly due to inflammation or oxidative stress or a combination of the two. KEYWORDS: Type 2 diabetes mellitus; Glycosylated haemoglobin; Ferritin

Barriers and facilitators to the recruitment of disabled people to clinical trials: a scoping review

Introduction Underrepresentation of disabled groups in clinical trials results in an inadequate evidence base for their clinical care, which drives health inequalities. This study aims to review and map the potential barriers and facilitators to the recruitment of disabled people in clinical trials to identify knowledge gaps and areas for further extensive research. The review addresses the question: ‘What are the barriers and facilitators to recruitment of disabled people to clinical trials?’. Methods The Joanna Briggs Institute (JBI) Scoping review guidelines were followed to complete the current scoping review. MEDLINE and EMBASE databases were searched via Ovid. The literature search was guided by a combination of four key concepts from the research question: (1) disabled populations, (2) patient recruitment, (3) barriers and facilitators, and (4) clinical trials. Papers discussing barriers and facilitators of all types were included. Papers that did not have at least one disabled group as their population were excluded. Data on study characteristics and identified barriers and facilitators were extracted. Identified barriers and facilitators were then synthesised according to common themes. Results The review included 56 eligible papers. The evidence on barriers and facilitators was largely sourced from Short Communications from Researcher Perspectives (N = 22) and Primary Quantitative Research (N = 17). Carer perspectives were rarely represented in articles. The most common disability types for the population of interest in the literature were neurological and psychiatric disabilities. A total of five emergent themes were determined across the barriers and facilitators. These were as follows: risk vs benefit assessment, design and management of recruitment protocol, balancing internal and external validity considerations, consent and ethics, and systemic factors. Conclusions Both barriers and facilitators were often highly specific to disability type and context. Assumptions should be minimised, and study design should prioritise principles of co-design and be informed by a data-driven assessment of needs for the study population. Person-centred approaches to consent that empower disabled people to exercise their right to choose should be adopted in inclusive practice. Implementing these recommendations stands to improve inclusive practices in clinical trial research, serving to produce a well-rounded and comprehensive evidence base

Mechanisms of cognitive trust development in artificial intelligence among front line employees: An empirical examination from a developing economy

Drawing upon insights from the trust literature, we conducted two empirical surveys with the front-line employees of firms in Pakistan investigating the factors influencing cognitive trust in artificial intelligence (AI). Study1 consisted of 46 in-depth interviews aimed at exploring factors influencing cognitive trust. Based on the findings of Study 1, we developed a framework to enhance employees’ cognitive trust in AI. We then conducted a quantitative survey (study 2) with 314 employees to validate the proposed model. The findings suggest that AI features positively influence the cognitive trust of employees, while work routine disruptions have negative impact on cognitive trust in AI. The effectiveness of data governance was also found to facilitate employees' trust in data governance and subsequently, employees' cognitive trust in AI. We contribute to the technology trust literature, especial in developing economics. We discuss the implications of our findings for both research and practice

ILAJ BIL HIJAMAH (TERAPIJA PUŠTANJEM KRVI) U MEDICINSKOM SUSTAVU UNANI: OD ANEGDOTALNE PRAKSE DO TERAPIJE TEMELJENE NA DOKAZIMA

Background: Cupping (Hijamah) therapy is very well documented as a result of several thousand years of clinical experiences in Unani medicine. In this procedure, suction is created by various means either with or without bloodletting. Though this therapy is being widely practiced across the globe for treating many chronic and intractable ailments but many reports reveal its unscientific and improper practices which results in many complications. Therefore to develop standard operative procedures and to propose protocols of cupping therapy in various diseases is the need of hour. Materials and methods: A thorough literature review of relevant journals and textbooks was performed to gather the maximum available data on cupping therapy. Conclusion: This paper seeks to introduce the general concepts of cupping therapy in Unani medicine and other traditional systems of medicine, shortcomings and limitations of the currently published studies and suggest ways to improve these technical/methodological flaws. In addition, the authors have also attempted to provide the cupping related materials, hypotheses, observations which will provide the researchers the base for evaluating their usefulness in future clinical trials.Uvod: Terapija puštanjem krvi (hijamah) vrlo je dobro dokumentirana kao posljedica nekoliko stotina godina kliničkih iskustava medicine Unani. U tom je postupku sukcija ostvarena različitim sredstvima s ispuštanjem krvi ili bez njega. Iako se ova terapija primjenjuje širom svijeta za liječenje mnogih kroničnih i teško lječivih bolesti, mnoga izvješća otkrivaju neznanstvene i nepravilne prakse koje rezultiraju mnogim komplikacijama. Stoga je nužno čim prije razviti standardnu proceduru te predložiti protokole za terapiju puštanjem krvi kod različitih bolesti. Materijali i metode: Kako bi se prikupila maksimalna količina podataka o terapiji puštanjem krvi, učinjen je pregled relevantnih časopisa i udžbenika. Zaključak: Ovaj rad nastoji predstaviti osnovni koncept terapije puštanjem krvi u medicini Unani kao i u drugim tradicijskim medicinama, nedostatke i ograničenja objavljenih aktualnih studija te predložiti na koje načine poboljšati ove tehničke/metodološke nedostatke. Osim toga autori su također pokušali odrediti materijale koji se koriste pri puštanju krvi, hipoteze i opažanja koja će istraživačima omogućiti temelj za evaluaciju njihove korisnosti u budućim kliničkim ispitivanjima

A novel, cost effective escharotomy simulator and trainee assessment

Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. In the 21st century, however, it is important to continue to develop simple teaching aids which are available to large audiences in low and middle-income countries. We present a simple 'escharotomy simulator' which has been well received, resulting in an increase in knowledge, and an increase in confidence to carry out the procedure

The use of imagery in global health: an analysis of infectious disease documents and a framework to guide practice

We report an empirical analysis of the use of imagery by the key actors in global health who set policy and strategy, and we provide a comprehensive overview, particularly related to images used in reports on vaccination and antimicrobial resistance. The narrative currently depicted in imagery is one of power imbalances, depicting women and children from low-income and middle-income countries (LMICs) with less dignity, respect, and power than those from high-income countries. The absence of any evidence of consent for using intrusive and out-of-context images, particularly of children in LMICs, is concerning. The framework we have developed provides a platform for global health actors to redefine their intentions and recommission appropriate images that are relevant to the topic, respect the integrity of all individuals depicted, are accompanied by evidence of consent, and are equitable in representation. Adhering to these standards will help to avoid inherent biases that lead to insensitive content and misrepresentation, stigmatisation, and racial stereotyping

Genetic Alterations of RET: Possible Implications and Clinical Correlations in Thyroid Carcinogenesis

Thyroid cancers are malignant tumors in the thyroid gland. DNA polymorphisms are playing a decisive role in unscrambling the genomic basis of tumor formation and development in cancer. Thyroid cancer is influenced in a polygenic and low-penetrance manner by RET gene polymorphisms and this part of the world (North India) has not recorded any study regarding RET alterations in this very cancer. We assessed RET G691S (rs1799939), L769L (rs1800861) and S904S (rs1800863) polymorphisms by restriction fragment length polymorphism (RFLP) in order to explain their potential role in the diagnosis and prognosis of Papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC). In RET G691S polymorphism, the total dissemination of variant alleles (GA + AA) was 62.9% in cases as related to 44.5% in controls (P < 0.05). RET L769L variant alleles (TG + GG) was 70% in cases versus 88% in controls (P < 0.05). In RET S904S, occurrence of variant alleles (CG + GG) was 56% in cases versus 44% in controls (P < 0.05). G691S and L769L polymorphism advocate a “Dominant mode of inheritance”. The S904S polymorphism approves an “Additive mode of inheritance”. In conclusion, there was an over-representation of RET G691S/S904S polymorphisms and under-representation of L769L polymorphism in PTC and FTC patients. Additionally, our data suggest that some haplotypes (A T G, G T G and A T C) of RET may act as low penetrance alleles for predisposition of thyroid cancer

Optineurin downregulation induces endoplasmic reticulum stress, chaperone-mediated autophagy, and apoptosis in pancreatic cancer cells

Pancreatic ductal adenocarcinoma (PDAC) shows a high level of basal autophagy. Here we investigated the role of optineurin (OPTN) in PDAC cell lines, which is a prominent member of the autophagy system. To that purpose, mining of publically available databases showed that OPTN is highly expressed in PDAC and that high levels of expression are related to reduced survival. Therefore, the role of OPTN on proliferation, migration, and colony formation was investigated by transient knockdown in Miapaca, BXPC3, and Suit2-007 human PDAC cells. Furthermore, gene expression modulation in response to OPTN knockdown was assessed by microarray. The influence on cell cycle distribution and cell death signaling cascades was followed by FACS, assays for apoptosis, RT-PCR, and western blot. Finally, autophagy and ROS induction were screened by acridine orange and DCFH-DA fluorescent staining respectively. OPTN knockdown caused significant inhibition of colony formation, increased migration and no significant effect on proliferation in Miapaca, BXPC3 and Suit2-007 cells. The microarray showed modulation of 293 genes in Miapaca versus 302 in Suit2-007 cells, of which 52 genes overlapped. Activated common pathways included the ER stress response and chaperone-mediated autophagy, which was confirmed at mRNA and protein levels. Apoptosis was activated as shown by increased levels of cleaved PARP, Annexin V binding and nuclear fragmentation. OPTN knockdown caused no increased vacuole formation as assessed by acridine orange. Also, there was only marginally increased ROS production. Combination of OPTN knockdown with the autophagy inducer erufosine or LY294002, an inhibitor of autophagy, showed additive effects, which led us to hypothesize that they address different pathways. In conclusion, OPTN knockdown was related to activation of ER stress response and chaperone-mediated autophagy, which tend to confine the damage caused by OPTN knockdown and thus question its value for PDAC therapy