Assessment of knowledge on self-care practices by Diabetes Mellitus Type II attending Diabetes clinic at Kakamega County Referral Hospital

Introduction: In 2012, more than 371 million people presented with Diabetes Mellitus Type II worldwide. Approximately 4.8 million people died in 2012 due to the complications of Diabetes Mellitus Type II (American Diabetes Association 2013). In 2012, in sub-Saharan Africa, Diabetes Mellitus Type II was estimated at 6 percent of total mortality, this reflects an increase from 2.5 percent in 2000. Rapid urbanization leading to sedentary lifestyle and diet changes is a big contributing factor to the rapid increase of Diabetes Mellitus Type II in Sub-Saharan Africa.Kenya presents with heavy disease burden with life expectancy averaging 56 years. Despite the commendable successes to curb CDs (Communicable Diseases), health problem status has stagnated as a result of increase in NCDs causing 28% of all patients deaths in 2010; Diabetes Mellitus Type II accounting for 2% of the total death.Study area: Kakamega County Referral Hospital is approximately 400 kilometers from Nairobi the capital city of Kenya. It is the main referral hospital in western Kenya and receives referrals from neighboring counties e.g. Vihiga County, Bungoma County and various hospitals within the County. Target Population: Diabetes Mellitus Type II patients attending Kakamega County Referral HospitalAim: To assess adequate self-care practice by Diabetes Mellitus Type II patients attending the Diabetes clinic at Kakamega County Referral Hospital.Methods and Materials: This was a descriptive cross-sectional study. Researcher administered questionnaires based on W.H.O Diabetes Mellitus Type II self-care guidelines were used to collect data. Questionnaires that were filled were screened and carefully scrutinized for completeness, relevance and correctness before storage. Qualitative data was analyzed manually and Quantitative data was organized, coded, and standardized then descriptive statistics were used to analyze aided by statistical package for social scientists (SPSS) version 22. Descriptive analysis was carried out to provide simple summaries about the sample and the measures. Tables were used to present the data. Models of statistical analysis were done to validate the findings of the study.Results: The study found out that, only 22.02% of the participants gave correct signs and symptoms of high blood sugars. Only 13% of the participants demonstrated knowledge of signs and symptoms of low blood sugar. On low blood sugar management 84.52% gave correct responses. Frequency of feet checking was poor with only 16.67% of the participants giving correct responses. Majority (93.45%) of the participants were well versed with the complications of Diabetes Mellitus Type II. Frequency of eye examination had 90.48% of the participants giving the correct responses.Conclusion: The spoken knowledge in low literacy patient with Diabetes Mellitus Type II (SKILLD) scale was poorly scored with majority of the participants demonstrating low knowledge regarding common complications of Diabetes Mellitus Type II. Keywords: Diabetes Mellitus Type II, Self-care and Patient

Optimization of insect cell based protein production processes - online monitoring, expression systems, scale-up

Due to the increasing use of insect cell based expression systems in research and industrial recombinant protein production, the development of efficient and reproducible production processes remains a challenging task. In this context, the application of online monitoring techniques is intended to ensure high and reproducible product qualities already during the early phases of process development. In the following chapter, the most common transient and stable insect cell based expression systems are briefly introduced. Novel applications of insect cell based expression systems for the production of insect derived antimicrobial peptides/proteins (AMPs) are discussed using the example of G. mellonella derived gloverin. Suitable in situ sensor techniques for insect cell culture monitoring in disposable and common bioreactor systems are outlined with respect to optical and capacitive sensor concepts. Since scale-up of production processes is one of the most critical steps in process development, a conclusive overview is given about scale up aspects for industrial insect cell culture processes

The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (from the Euro Heart Survey).

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women

Progression From Paroxysmal to Persistent Atrial Fibrillation. Clinical Correlates and Prognosis

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score &gt;5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future. \ua9 2010 American College of Cardiology Foundation

Researching COVID to Enhance Recovery (RECOVER) Adult Study Protocol: Rationale, Objectives, and Design

IMPORTANCE: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. METHODS: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. DISCUSSION: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options

Role of Forest Resources to Local Livelihoods: The Case of East Mau Forest Ecosystem, Kenya

Forests in Kenya are threatened by unsustainable uses and conversion to alternative land uses. In spite of the consequences of forest degradation and biodiversity loss and reliance of communities on forests livelihoods, there is little empirical data on the role of forest resources in livelihoods of the local communities. Socioeconomic, demographic, and forest use data were obtained by interviewing 367 households. Forest product market survey was undertaken to determine prices of various forest products for valuation of forest use. Forest income was significant to households contributing 33% of total household income. Fuel wood contributed 50%, food (27%), construction material (18%), and fodder, and thatching material 5% to household forest income. Absolute forest income and relative forest income (%) were not significantly different across study locations and between ethnic groups. However, absolute forest income and relative forest income (%) were significantly different among wealth classes. Poor households were more dependent on forests resources. However, in absolute terms, the rich households derived higher forest income. These results provide valuable information on the role of forest resources to livelihoods and could be applied in developing forest conservation policies for enhanced ecosystem services and livelihoods

Fortification of alcoholic beverages (12% v/v) with tea (Camellia sinensis) reduces harmful effects of alcohol ingestion and metabolism in mouse model

Background: An animal model was used to study the health benefits inherent in tea fortified alcoholic beverages fed to laboratory mice. Objectives: An investigation of the effects of tea fortified alcoholic beverages 12% alcohol (v/v) on antioxidant capacity and liver dysfunction indicators in white Swiss mice including packed cell volume (PCV), albumin, total protein, alkaline phosphatase (ALP) and glutathione (GSH) was carried out. Methods: Plain, black, green and purple tea fortified alcohols were developed with varying tea concentrations of 1, 2 and 4 g/250 mL in 12% v/v. Control alcoholic beverages without teas were also developed. A permit (number IRC/13/12) was obtained for the animal research from the National Museums of Kenya, Institute of Primate Research prior to the start of the study. Alcoholic beverages were orally administered every 2 days for 4 weeks at 1 mL per mouse, and thereafter animals were euthanised and liver and blood samples harvested for analyses. Assays on body weight (bwt), packed cell volume (PCV) albumin, total protein, ALP and GSH were performed. Results were statistically analysed using GraphPad statistical package and significant differences of means of various treatments determined. Results: Consumption of tea fortified alcohols significantly decreased (p=0.0001) bwt at 0.32-9.58% and PCV at 5.56-22.75% for all teas. Total protein in serum and liver of mice fed on different tea fortified alcohols ranged between 6.26 and 9.24 g/dL and 2.14 and 4.02 g/dL, respectively. Albumin, ALP and GSH range was 0.92-2.88 mu g/L, 314.98-473.80 mu g/L and 17.88-28.62 mu M, respectively. Fortification of alcoholic beverages lowered liver ALP, replenished antioxidants and increased liver albumin, improving the nutritional status of the mice. Conclusions: The findings demonstrate tea's hepatoprotective mechanisms against alcohol-induced injury through promotion of endogenous antioxidants. The beneficial effects of tea in the fortified alcoholic beverages could be used to develop safer alcoholic beverages