Caracterización de la enfermedad cerebrovascular isquémica en pacientes diabéticos del Hospital Universitario Clínico Quirúrgico General Calixto García

Fundamento: las enfermedades cerebrovasculares constituyen una de las principales causas de mortalidad en el mundo. En las Américas constituyen la tercera causa de muerte y su incidencia se ve aumentada en los pacientes diabéticos tipo 2. Objetivo: caracterizar los pacientes diabéticos tipo 2 con enfermedad cerebrovascular isquémica aguda. Método: se realizó un estudio descriptivo en pacientes diabéticos que ingresaron en el Hospital Calixto García con diagnóstico de enfermedad cerebrovascular isquémica aguda en el período comprendido entre enero y diciembre 2022. El universo estuvo constituido por la totalidad de pacientes diabéticos tipo 2 que ingresaron en la Institución y la población por 148 pacientes. Las variables analizadas fueron: sexo, color de piel y edad; tensión arterial e índice de masa corporal; colesterol, triacilgliceridos y glicemia; tipo enfermedad cerebrovascular y su gravedad y comorbilidades. Se utilizaron métodos de la estadística descriptiva como frecuencia absoluta y porciento. Los resultados se presentaron en tablas creadas a los efectos. Resultados: predominó el sexo masculino, el color de piel blanca y el grupo etáreo entre los 60 y 69 años con un 58,1 43,9 y 40,5 % respectivamente. Predominaron los pacientes hipertensos y con sobrepeso relacionados con la mayor gravedad de la enfermedad cerebrovascular, los pacientes hiperglicémicos con valores de colesterol y triacilgliceridos altos, en ellos fue más grave el evento isquémico cerebral. La hipertensión arterial y la cardiopatía isquémica prevalecieron en la población estudiada con un 81,8 y 52,7 respectivamente. Conclusiones: la enfermedad cerebrovascular fue más frecuente en el sexo masculino, color de piel blanca y pacientes de edad avanzada. La hipertensión arterial, el sobrepeso, la hiperglucemia así como los valores altos de colesterol y triglicéridos predominaron en la muestra y se relacionaron con la mayor gravedad del evento cerebrovascular isquémico.

Foundation: cerebrovascular diseases are one of the main causes of mortality in the world. In the Americas they constitute the third cause of death and their incidence is increased in type 2 diabetic patients. Objective: to characterize type 2 diabetic patients with acute ischemic cerebrovascular disease. Method: a descriptive study was carried out in diabetic patients who were admitted to the Calixto García Hospital with a diagnosis of acute ischemic cerebrovascular disease in the period between January and December 2022. The universe consisted of all type 2 diabetic patients who were admitted to the Institution and the population of 148 patients. The variables analyzed were: sex, skin color and age; blood pressure and body mass index; cholesterol, triacylglycerides and glycemia; type of cerebrovascular disease and its severity and comorbidities. Descriptive statistical methods such as absolute frequency and percentage were used. The results were presented in tables created for the purpose. Results: the male sex, the white skin color and the age group between 60 and 69 years predominated with 58.1, 43.9 and 40.5 % respectively. Hypertensive and overweight patients related to the greater severity of cerebrovascular disease, hyperglycemic patients with high cholesterol and triacylglyceride values ​​predominated, and in them the cerebral ischemic event was more severe. Arterial hypertension and ischemic heart disease prevailed in the studied population with 81.8 and 52.7 respectively. Conclusions: cerebrovascular disease was more frequent in males, white skin color and elderly patients. Arterial hypertension, overweight, hyperglycemia as well as high cholesterol and triglyceride values ​​predominated in the sample and were related to the greater severity of the ischemic cerebrovascular event.

Structural Design and Optimization of Cushioning Insole with Variable Stiffness / 医用生物力学

Objective An X-shaped cushioning insole with variable stiffness was designed to explore its effects on plantar pressure and internal stress of diabetic patients with toe amputation. Methods Based on CT images, the feet-calf finite element model of diabetic patients with toe amputation was established, and the insole was divided into different areas according to distribution characteristics of the planter pressure. The three-dimensional (3D) printed cushioning insole with an X-shaped sandwich structure was designed. The modulus of the sandwichstructure was changed by changing thickness of the sandwich structure panel. For simulation analysis, the divided area was filled with the X-shaped sandwich structure with different modulus. Results The peak plantar pressure of diabetic patients with toe amputation was in calcaneal region, and the combined insoles with 1. 2 mpanel thickness in toe area, 1. 4 mm panel thickness in metatarsal area, 2. 0 mm panel thickness in middle area and 1. 6 mm panel thickness in heel area had the best decompression effect. Compared with bare feet, the peak pressure in heel area of the insole, the peak pressure in phalangeal head area and the stress in plantar softissues were reduced by 40. 18% , 31. 7% , and 50. 44% , respectively. Conclusions The 3D printed insoles with variable stiffness can effectively reduce surface pressure and internal stress of the sole and reduce probability of the 2nd toe amputation

Quality of Life of Type 2 Diabetic Patients attending a Tertiary Hospital in South-South Nigeria

Background: Type 2 Diabetes mellitus affects the quality of life of individuals and their ability to function. It affects the physical, social and mental well-being of patients with immediate and delayed complications.This study determined the quality of life of type 2 diabetic patients attending a tertiary hospital in south-south Nigeria.Methods:This was a descriptive cross-sectional study conducted among type 2 diabetic patients attending the medical outpatient clinic of the University of Port Harcourt Teaching Hospital between September and November 2019. Purposive sampling technique was used to select a total of 347 participants for the study following ethical approval. WHOQOL-BREF questionnaire was used to measure the QoL of the participants. Data were analyzed using SPSS version 23.0. Descriptive data were presented in frequency distribution tables while summary statistics were done using mean and standard deviation for continuous variables and in proportions for categorical variables. Results:Results revealed that majority of the type 2 diabetic patients were females (53.3%) and between the ages of 51-60 years. 27.2% of them had poor overall QoL with the score of <45% while 65.7% had fair overall QoL with a score of 45-65 %. 7.1% had good overall QoL with a score of ≥65%. Conclusion:Majority of the type 2 diabetic patients had fair QoL while the least had good QoL. There is urgent need for increased health awareness and education of diabetic patients regarding diabetic care.

Relationship between Urinary Albumin Creatinine Ratio and Severity of Coronary Artery Disease in Non-Diabetic Patients

ackground: Coronary artery disease (CAD) is leading cause of mortality worldwide. CAD accounts for 20% of all deaths in the South Asia region. The burden of CAD is emerging as a public health concern in developing countries like Bangladesh. There are some new biomarkers for detection of CAD. The aim of this study was to find out the relationship between ACR and severity of coronary artery disease in non-diabetic.Material & Methods:This cross-sectional analytical study was conducted in the department of cardiology, National Heart Foundation Hospital and Research Institute from April, 2018 to March, 2019. Purposive sampling was done to select a total 101 study subjects. Data were collected in a predesigned data collection form through clinical history, examination, laboratory findings and coronary angiogram report. Study population was divided into two groups: Group朅: Non-diabetic patients with ACR > 30mg/g Group朆: Non-diabetic patients with ACR ? 30mg/g.Results:Participants had a mean age of 52.5 � 9.9 years with 75.24% men. Group A patients had higher ACR level (49.98�.83 vs 13.36�08; p<0.01) than group B patients. Relation between urinary ACR and severity of CAD remained significant. Conclusions:In this study, there found a significant relationship in ACR and severity of coronary artery disease in non-diabetic patients.

To Evaluate The Incidence Of Diabetic Retinopathy In Newly Diagnosed Diabetic Patients Presented At Tertiary Care Hospital

Background:Diabetes mellitus is defined as metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbances of carbohydrate, protein and fat metabolism resulting from defects in insulin secretion, insulin action, or both. It occurs in two forms: Insulin dependent diabetes mellitus and Non –insulin dependent diabetes mellitus1. This disease results in generalized macrovascular and microvascular complication directly affects kidneys, eyes, peripheral nerves and heart. The incidence of diabetes retinopathy in Indian population was 21.7%. Material And Methods:In this cross sectional study all the patients attending eye OPD and indoor patients at tertiary eye care were screen for eligibility. Total of 150 patients were included in the study for duration of 28 months. Detail history including hypertension and other systemic illness was asked. Best corrected visual acuity was taken after refraction. Anterior segment examination was done with slit lamp, specially looking for rubeosis iridis, pupillary reaction and type of lens opacity. Statistical analysis was done using Z test, unpaired T test and chi-square test with the help of software and methods. Result: Patients with type 2, diabetes have more incidence of developing diabetic retinopathy thanpatients with type 1. Hypertension was more commonly associated disease than other systemic illness. Diabetic retinopathy is more prevalent in patients with higher FBS and HB1Ac.Conclusion:The frequency of retinopathy is more common in patients with high blood sugar profile. Hypertension is more commonly associated with diabetes than other systemic illness.

Protocolo de manejo de hiperglicemia em gestantes em ambiente hospitalar / Hyperglycemia management protocol in pregnant women in a hospital environment / Protocolo de manejo de hiperglucemia en gestantes en ambiente hospitalario

O período gestacional é caracterizado por diversas alterações metabólicas, dentre elas, a hiperglicemia, que confere uma importante condição, muitas vezes associada a desfechos desfavo[1]ráveis tanto para mãe como para o bebê. Diante desse cenário, a manutenção de um bom controle glicêmico se faz necessária, visando diminuir a morbimortalidade perinatal e a morbidade materna em curto e longo prazo. Devido à ausência de um consenso sobre esse manejo, o objetivo deste trabalho foi compilar as melhores práticas publicadas na literatura, no período de 2009 até 2021, para o manejo da hiperglicemia durante a gestação e sugerir um protocolo para o manejo da hiper[1]glicemia intra-hospitalar de gestantes a ser adotado em um hospital público de Salvador, na Bahia.

Pregnancy is characterized by several metabolic alterations, among which hyperglycemia is often associated with unfavorable outcomes for both mother and baby. In this scenario, maintaining a good glycemic control is necessary to reduce perinatal morbidity and maternal morbidity in the short- and long-term. Considering the lack of consensus regarding such a management, this work sought to compile the best management practices for hyperglycemia during pregnancy published in the literature from 2009 to 2021, as well as to suggest a new protocol to be adopted in a public hospital in Salvador, Bahia.

El período gestacional se caracteriza por varias alteraciones metabólicas, entre las cuales la hiperglucemia confiere una condición importante a menudo asociada con resultados desfavorables tanto para la madre como para el bebé. En este escenario, es necesario mantener un buen control glucémico para reducir la morbilidad perinatal y la morbilidad materna a corto y largo plazo. Debido a la falta de consenso sobre este manejo, el objetivo de este trabajo fue recopilar las mejores prácticas publicadas en la literatura, de 2009 a 2021, en cuanto al manejo de la hiperglucemia durante el embarazo, y proponer un protocolo para el manejo de la hiperglucemia interhospitalaria a gestantes, para ser adoptado en un hospital público de Salvador, Bahía.

Factores asociados al autocuidado de la salud en los pacientes diabéticos / Factors associated with self-care in diabetic patients

La diabetes es una enfermedad que afecta a la población mundial, y los adultos mayores son los más propenso a padecerla, como consecuencia a los niveles de estrés y malos hábitos alimenticios que llevaron a lo largo de su vida productiva. Es por ello, que el: Objetivo de esta investigación es, describir los factores asociados al autocuidado de la salud en los pacientes diabéticos. Materiales y métodos: Investigación documental. Se incluyeron estudios de cohortes que analizaron diagnóstico y tratamiento oportuno en el autocuidado de pacientes diabéticos en bases de datos electrónicas, como lo son Porta Scielo, PubMed, Medline PLUS, Embase, Scopus y Web of Science, del 2015 al 2020. Las medidas de autocuidado son habilidades que los individuos practican para el mantenimiento de su salud, sobre todo cuando hay una patología de base que ponga en riesgo el estado de salud y el bienestar en general. Resultado: La diabetes es una enfermedad complicada, requiere vigilancia constante, conocimiento de la enfermedad y del apoyo de varios especialistas en salud, la mayor parte del cuidado y control debe prevenir del paciente mismo. Es importante que los pacientes no solo perciban los daños o la severidad de la ausencia de autocuidado, lo que puede influir en el adecuado control de la diabetes mellitus, sino que se le proporcione mediante la educación para la salud, estrategias que faciliten en ellos el aprendizaje de habilidades que le permitan percibir los beneficios de la adopción de estilos de vida saludables. Conclusiones: el equipo básico de salud desempeña un rol importante en la realización de acciones que faciliten el autocuidado en los pacientes diabéticos, lo que puede constituir una vía para que las personas tomen decisiones serias respecto al mantenimiento de un adecuado estado de su salud. Por ende, es necesario que se realicen programas que desarrollen el ajuste adecuado de expectativas, objetivos definidos, el manejo adecuado del refuerzo, el incremento del sentimiento de autoeficacia, el autocontrol, y que brinden alternativas que favorezcan un autocuidado óptimo(AU)

Diabetes is a disease that affects the world population, and older adults are the most prone to suffer from it, as a consequence of the levels of stress and poor eating habits that they led throughout their productive lives. That is why the: Objective of this research is to describe the factors associated with self-care of health in diabetic patients. Materials and methods: Documentary research. Cohort studies that analyzed diagnosis and timely treatment in the self-care of diabetic patients were included in electronic databases, such as Porta Scielo, PubMed, Medline PLUS, Embase, Scopus and Web of Science, from 2015 to 2020. The measures of Self-care are skills that individuals practice to maintain their health, especially when there is an underlying pathology that puts the state of health and well-being in general at risk. Result: Diabetes is a complicated disease, it requires constant vigilance, knowledge of the disease and the support of various health specialists, most of the care and control must be prevented by the patient himself. It is important that patients not only perceive the damage or the severity of the absence of self-care, which can influence the adequate control of diabetes mellitus, but that it is provided through health education, strategies that facilitate in them the learning skills that allow you to perceive the benefits of adopting healthy lifestyles. Conclusions: the basic health team plays an important role in carrying out actions that facilitate self-care in diabetic patients, which can constitute a way for people to make serious decisions regarding the maintenance of an adequate state of their health. Therefore, it is necessary to carry out programs that develop the adequate adjustment of expectations, defined objectives, the adequate management of reinforcement, the increase of the feeling of self-efficacy, self-control, and that provide alternatives that favor a more optimal self-care(AU)

Proteinuria and Hypertension with and without Type 2 Diabetes Mellitus: 2021 Update

@#INTRODUCTION. This 2021 paper is an update of the 2019 version. In this current update, two new items of information added. Firstly, the 2020 Consensus statement of the Taiwan Hypertension Society and the Taiwan Society of Cardiology on HPDM, provided recommendations on additional medications to be considered in uncontrolled morning or night blood pressure (BP) are noted.9 Secondly, the nephroprotective properties of the SGLT-2 inhibitors are highlighted.19 Similar to the content of the 2019 version, four related areas are reviewed. They are (1) BP definition and classification; (2) Hypertension diagnosis; (3) Hypertension and proteinuria in non-diabetic patients; and (4) Proteinuria and hypertension in the patient with diabetes. METHODOLOGY. PubMed searches were done for papers to the above four topics published in the last five years (2014 to 2019). These were supplemented by papers from hand searches. RESULTS. For diagnosis of hypertension, the current cut off of 140/90 mmHg can be reduced to 130/80 to improve cardiovascular outcomes and all-cause mortality. Diagnosis of hypertension should not be based on office BP readings alone. Hypertension in older patients should be treated to prevent worse outcomes and should be individualised. In non-diabetic patients, both low grade and microalbuminuria needs to be treated; adequate BP control is needed to prevent cardiovascular outcomes and all-cause mortality. In the diabetic patient, a BP target of less than 140/90 mmHg applies to most patients, but individualisation of the BP goal is important. CONCLUSIONS. Much development in the management of proteinuria and hypertension has taken place in the last five years.

Diabetic Foot Ulceration in a Secondary Health Facility

Aims: To determine the prevalence, pattern and presentation of the diabetic foot ulcer.Background: A diabetic foot ulcer is a major complication in diabetes mellitusand probably the major component of diabetic foot. It occurs in 15% of all patients with diabetes and precedes 84% of all lower leg amputations.Poverty, low economic status and ignorance have resulted in this devastating disease. It may worsen in the next decade.There are multiple risk factors that predispose an individual to DM foot ulcer; they include age, gender(male), type of DM, glycaemic (HbA1c) or FBG level, duration of DM (>10yrs) occupational status particular habits of self-foot care and infection.Patients and Methods: This consists of 69 diabetic patients; male and female included done between the monthsof January 2019 to March 2019. A demographic data questionnaire and social history were obtained. Overnight fasting serum glucose was obtained. Serum glucose was determined by enzymatic glucose oxidase method. Data obtained were subjected to Stata Version 11 Software to determine the graphical representation, mean, standard deviation of the analysis. Results: Thirty-Five 35 were male and 34 were female had type 2 diabetes. Forty-Three 43 patients had foot ulcer, 21 patients had gangrene and 5 had infection. The number of patients with peak glucose values 10mmol/L and least glucose at 20-25mmol/L. Those of duration 4-6years were the mostaffected the age group most affected is between 40-59yrs.Discussion and Conclusion: Risk factors for foot ulceration discovered among a host other factors identified in this study, were the infection, low socioeconomic status, improper footwear, poor glycaemic control, structural foot deformity and untreated gangrene. The role of poor glycaemic control in the genesis of diabetic complications cannot be overemphasized as the mean FPG was noted to be considerably higher in patients with foot ulcerationAspart of a comprehensive foot care programme, education on foot care should be directed at patients, family members and healthcare providers.Not less than 85% of all diabetic foot-related problems are preventable. This can be achieved through a combination of good care of foot, provided by an inter-professional diabetes care team, and appropriate education for people with diabetes.

Examination Of Characteristics Of Diabetic Patients Requiring Frequent Exercise Intervention Based On The Transtheoretical Model

Background: Frequent intervention has been strongly recommended for diabetic patients undergoing exercise therapy. However, high-frequency interventions for all patients are inefficient. The purpose of this study is to examine the characteristics of groups divided based on changes in exercise behaviors. Methods: The participants comprised 42 diabetic patients who completed a two-week program to improve their glycemic control and receive diabetes education. Their change in exercise behavior, self-efficacy of exercise, and diabetes and social statuses were collected at the time of discharge and 12 and 24 weeks after discharge. Based on such data, the participants were divided into five groups: (1) the IW12 group whose exercise habits were interrupted within 12 weeks; (2) the IW24 group whose exercise habits were interrupted within 24 weeks; (3) the CO24 group who continued exercising after 24 weeks; (4) the Action group that actively exercised at the time of discharge; and (5) the Maintenance group that maintained same level of exercise at the time of discharge. Results: The total score of self-efficacy of exercise at the time of discharge was 13.7 ± 2.1 (the IW12 group), 11.3 ± 2.5 (the IW24 group), 16.2 ± 3.2 (the CO24 group), 16.7 ± 3.1 (the Action group), and 15.9 ± 2.3 (the Maintenance group). The scores for the IW24 group were significantly lower compared with the Action and Maintenance Patients groups (p < 0.01). Conclusion: Our findings suggest that intervention should be performed frequently, especially in a diabetic patient who is the preparation stage under low self-efficacy of exercise.

Drug Utilisation Evaluation Study on Patients with Diabetes Mellitus Among Rohingya Refugees in IMARET Mobile Clinic

@# Since 1978, Rohingya refugees have fled from their native nation, Myanmar to escape ethnic prosecution. They comprise of the Muslim minority ethnic group originating from the Rakhine state in Myanmar. In many host countries, they may have difficulty to access health care services. The Islamic Association of Malaysia (IMAM) Response and Relief Team (IMARET) have taken many initiatives to provide healthcare services to the refugees through their volunteer-led mobile clinics. Therefore, this study aims to evaluate the utilisation of drugs among type 2 diabetes mellitus (T2DM) patients visiting this clinic. Methods: This was a cross-sectional study among Rohingya refugees with T2DM that visited the IMARET mobile clinics from August until November 2017. Convenient sampling method was used. Data were collected through patient’s interview, review of the patient’s prescriptions and their HbA1c readings. Results: A total of 29 T2DM patients were included in this study. The majority were female (75.9%) and aged below 65 years old (75.9%). The most commonly prescribed anti-diabetic agent was metformin (72.2%), followed by glibenclamide (22.2%) and gliclazide (5.6%). Metformin as a monotherapy (31%) was the most frequent treatment prescribed. More patients had controlled T2DM (62.1%) compared to those with uncontrolled DM. We found 90.9% of patients who were treated according to the recommended DM guidelines achieved a good blood glucose control (p=0.02). Conclusion: In Rohingya refugees having T2DM who were treated in the IMARET mobile clinic, the percentage having good control DM status is higher in those whose treatment regimen adheres to the clinical practice guidelines. Drug utilisation evaluation; Diabetic patients; Diabetes mellitus; Rohingya refugees; Mobile clinic

What is the Prevalence of Use of Herbal Medicine When Compared to Prescribed Medications in Diabetic Patients at Enmore Polyclinic?

Objective:To investigative the prevalence of herbal products used among Diabetic patients of EnmorePolyclinic and correlate with socio -demographic data and to find out the various types of herbal medicines used.Methods:A cross sectional study conducted at Enmore Polyclinic from April to June, 2019. Data were collected using a preset data collectionsheet and analyzed using Microsoft Excel.Results:From a sample size of three hundred and eleven (311) participants, two hundred and thirty (230) -74.2% used herbal medicine to control Diabetes; which was used predominantly by females. East Indians usedmore herbal products. The 51 –60 years age group recorded the highest use of herbal medicine, with corilla being the most widely used herbal product was corilla.Conclusion:The Use of Herbal Medicine in the control of Diabetic patients at Enmore Polyclinic is similar to that of the United States and Dubai, but slightly higher than that of tropical Sub-Saharan Africa and Trinidad.Recommendation:Similar studies should be carried out in other areas of Guyana so as to ascertain the country’s prevalence of the use of Herbal Medicine in the control of Diabetes. Additionally, the adherence to prescribed medication should be enforced: while the effects of these herbal products should be investigated.

Comparative Study of Diabetic Retinopathy by Means of Clinical Evaluation of Fundus and Fundus Fluorescein Angiography among Diabetic Patients Less than 10 Years of Diabetic Age

Introduction: Diabetic retinopathy is one of the leading causesof blindness.Up to 21% of patients with type 2 diabetes haveretinopathy at the first diagnosis of diabetes and most developsome degree of retinopathy over time. Study objectives wereto study diabetic Retinopathy clinically and angiographically,retinal changes in various duration of diabetes, observethe different stages of retinopathy and their analysis and toobserve the advantages of fluorescein angiographyMaterial and methods: This analytical study was performedin Krishna Hospital, Karad for a period of 18 months . Thefundus examination was done with indirect ophthalmoscope,90D/78D lens after pupillary dilatation with a combination ofphenylephrine and tropicamide eyed drops, and FFA was doneResult: The material for the present study consists of 100diabetic patients who attended the outpatient department of,or who were admitted in Krishna Hospital, KaradConclusion: In patients less than 5 years of diabetic ageor those who are at early stage of diabetic retinopathy, weobserved that early pathological changes which could not beseen on ophthalmoscopy were evident on FFA. So by Earlydetection of diabetic retinopathy we can help to stop furtherprogression of retinopathy. FFA is a better diagnostic tool fordiagnosing retinopathy as compared to ophthalmoscopy

Lipid profile in type 2 diabetes mellitus: a case-controlled study

Background: Atherosclerosis is caused by the combination of type 2 diabetes mellitus and dyslipidemia. Combination of DM and dyslipidemia is associated with increased mortality and morbidity. Hence, it is of utmost importance to know the nature of dyslipidemia in DM for its effective management. The major lipid abnormalities seen in DM are elevated triglyceride levels and lowered HDL-C levels.Methods: A case-controlled study was initiated in Vinayaka Missions Medical college and hospital for a period of 2 year. Pre-prandial and post-prandial lipid profile was assessed in 50 cases of type 2 DM and was compared with age and sex matched healthy controls satisfying the inclusion and exclusion criteria.Results: At the end of the study, the mean age±SD was 48.5±5.68 years. The mean HbA1c±SD of the study population was found to be 7.48±1.517. Looking at the lipid profile all cases in fasting state had elevated VLDL-C levels (mean 50.39±60.27), elevated TC (mean 169.70±39.917), elevated TGL (mean 146.04±60.140) and low LDL-C (mean 92.3±27.699) when compared to control group. In the postprandial state, there was a significant raise in TGL level (mean 188±68.59), raised TC (mean 180.74±38.46), decreased HDL-C (mean 38.761±9.028) compared to the fasting state.Conclusions: Lipid profile of type 2 DM in pre-prandial 12 hour fasting state showed elevated TC, VLDL-C levels and low LDL-C and HDL-C levels. Where as in post prandial state TGL levels were markedly elevated with elevated TC and low HDL-C levels.

Molecular detection and antimicrobial resistance of Clostridium perfringens isolated from diabetic patients and bullet wounds

Clostridium perfringens is a major cause of gas gangrene. The morbidity of C. perfringens is connected with producing toxins. This cross-sectional study was designed to isolate, genetically diagnose, and study the antibiotic susceptibility patterns of C. perfringens isolated from clinical samples. Different wound swabs (from diabetic patients, cellulitis, and bullet wounds) were taken from 140 patients. For isolation of anaerobic bacteria, samples (in thioglycolate broth) were immediately incubated anaerobically then identified according to the cultural properties and biochemical tests. DNA was extracted from all specimens. Polymerase chain reaction was applied for detection of 16SrRNA and internal transcribed spacer (ITS) genes of C. perfringens. The susceptibility of bacterial isolates to different antibiotics was determined using Vitek 2 system and disk diffusion test. Out of 140 clinical samples collected during this study, 3 (2.14%) C. perfringens isolates were recovered of which 2 isolates (1.43%) obtained from diabetic patients and one (0.71%) from bullet wounds. Results also showed that only 7 isolates (5%) were detected by a molecular method using specific primers 16S rRNA and ITS genes of C. perfringens. Results of antibiotic susceptibility testing showed that all isolates were highly susceptible to penicillins and β-lactamase inhibitors, metronidazole, and aminoglycosides. On the other hand, all isolates were highly resistant to tetracycline, levofloxacin, and erythromycin. The susceptibility patterns of C. perfringens isolates showed that all isolates were multidrug resistance. Using the amplification of ITS gene increases specificity and sensitivity (by reducing non-specific annealing and primer dimer formation) which increases the probability of detection of suspected C. perfringens isolates.

Nefropatía diabética como factor de riesgo asociado a infección del tracto urinario, servicio de medicina del hospital uldarico rocca fernández, 2011 ­ 2015 / Diabetic nephropathy as risk factor associated with urinary tract infection, medical service of the hospital uldarico rocca fernandez, 2011 - 2015

Introducción: La diabetes mellitus es una de las patologías más prevalentes, afectando hasta el 2014 a un 9% de la población mundial y en el Perú el 4.3% de la población adulta ya es diabética. Estos pacientes son más susceptibles a enfermedades infecciosas, siendo la del tracto urinario la más frecuente, considerándose complicada, lo que significa que deben recibir manejo hospitalario, conllevando a disminución de la calidad de vida de los mismos. Objetivo: Determinar si la nefropatía diabética es un factor de riesgo para la prevalencia de infección del tracto urinario en pacientes hospitalizados en el servicio de medicina del Hospital Uldarico Rocca Fernández. Métodos: Es un estudio observacional, analítico de corte longitudinal, tipo caso y control; la información se recolectó mediante una ficha de datos utilizando las historias clínicas de los pacientes hospitalizados en el servicio de medicina del Hospital Uldarico Rocca Fernández en el periodo 2011-2015. La muestra se obtuvo por muestreo probabilístico, siendo el tamaño de esta de 360, con una proporción de casos y controles 1:1. Resultados: La nefropatía diabética obtuvo un OR=8.62 (IC95% 4.78 ­ 15.57), la macroalbuminuria obtuvo un OR=5.75 (IC95% 2.99 ­ 11.06), el pH alcalino obtuvo un OR=5.42 (IC95% 3.22 - 9.13) y el control glucémico obtuvo un OR=5.44 (IC95% 3.44 - 8.88). Conclusión: La nefropatía diabética se asocia a mayor prevalencia de ITU en pacientes hospitalizados en el servicio de medicina del Hospital Uldarico Rocca Fernández.

Introduction: Diabetes mellitus is one of the most prevalent pathologies, affecting up to 2014 to 9% of the world population and in Peru, 4,3% of the adult population is already diabetic. These patients are more susceptible to infectious diseases, urinary tract infection are the most complicated frequently involve, these patients receive hospital treatment, decreasing their life quality. Objective: To determine if diabetic nephropathy is a risk factor for the prevalence of urinary tract infection in hospitalized patients at the Uldarico Rocca Fernandez Hospital. Methods: It is an observational, analytical study of longitudinal cut, case and control type; the information was collected through a data sheet using the medical records of patients hospitalized in the medical service of the Hospital Uldarico Rocca Fernandez in the period 2011-2015. The sample was obtained by probabilistic sampling, sample size of 360, with a proportion of cases and controls 1:1. Results: Diabetic nephropathy had an OR = 8.62 (95% CI 4.78 - 15.57), macroalbuminuria obtained an OR = 5.75 (95% CI 2.99-11.06), the alkaline pH had an OR = 5.42 (95% CI 3.22-9.13) and the Glycemic control obtained an OR = 5.44 (95% CI 3.44 - 8.88). Conclusion: Diabetic nephropathy is associated with a higher prevalence of UTI in patients hospitalized in the medical service of the Hospital Uldarico Rocca Fernandez.

Care Tips for Self-Care among Older Diabetic Patients / 임상당뇨병

With the increase in the elderly population, the number of elderly diabetics is also increasing rapidly. To educate older people with diabetes, we need to understand their characteristics and those of their main caregiver, establish careful and individualized treatment goals, and provide concrete and practical education. Diabetes educators should provide comprehensive geriatric assessment, personalized diabetes education through psychosocial assessment, practical guidance, family education, self-management skills for elderly diabetic patients and caregivers. Diabetes educators should keep in mind to consider elderly diabetic patients can support family or social resources to continue self-management.

Correlation between HbA1c on admission and blood glucose fluctuations and adverse events after coronary artery bypass grafting in non-diabetic patients / 中国胸心血管外科临床杂志

@#Objective    To explore the relationship between glycated hemoglobin (HbA1c) level and blood glucose fluctuations after coronary artery bypass grafting (CABG) and adverse events in non-diabetic patients, thus providing theoretical support for intensive preoperative blood glucose management in patients undergoing CABG surgery. Methods    A total of 304 patients undergoing CABG with or without valvular surgery from October 2013 to December 2017 were enrolled in this prospective, single-center, observational cohort study. We classified them into two different groups which were a low-level group and a high-level group according to the HbA1c level. There were 102 males and 37 females, aged 36–85 (61.5±9.5) years in the low-level group, and 118 males and 47 females aged 34–85 (63.1±9.4) years in the high-level group. The main results were different in hospital mortality and perioperative complications including in-hospital death, myocardial infarction, sternal incision infection, new stroke, new-onset renal failure and multiple organ failure. To assess the effects of confounding factors, multivariate logistic regression analysis was used. Results     Postoperative blood glucose fluctuation was more pronounced in the high-level group than that in the low-level group before admission [0.8 (0.6, 1.2) mmol/L vs. 1.0 (0.8, 1.8) mmol/L, P<0.01]. This study also suggested that the  incidence of major adverse events was significantly lower in the low-level group compared with the high-level group (P=0.001). Multivariate logistic regression analyses to correct the influence of other confounding factors showed that HbA1c (OR=2.773, P=0.002) and postoperative blood glucose fluctuations (OR=3.091, P<0.001) could still predict the occurrence of postoperative adverse events. Conclusion    HbA1c on admission can effectively predict blood glucose fluctuations in 24 hours after surgery. Secondly, HbA1c on admission and postoperative blood glucose fluctuations can further predict postoperative adverse events. It is suggested that we control the patient's preoperative HbA1c at a low level, which is beneficial to control postoperative blood glucose fluctuation and postoperative adverse events.

Association between physical activity and glycemic control among type 2 diabetic patients with a good compliance level / 中华疾病控制杂志

Objective To examine the relationship between physical activity and glycemic control among type 2 diabetic patients with a good compliance level in China. Methods A total of 1 272 patients diagnosed with type 2 diabetes with a good compliance level were recruited from five community health centers in Nanjing Chemical Industry Administrative Zone from 2014 to 2016. Logistic regression models were used to examine the relationship between physical activity and glycemic control. Results In this cross-sectional study, 1 272 type 2 diabetic patients (596 men and 676 women) were recruited. The participants’ mean (standard deviation, SD) age was (64.63±9.04) years old. Male participants who achieved sufficient physical activity had the odds ratio (OR) of 2.11 (95%CI:1.17-3.18, P=0.013) for a tight glycemic control compared to their counterparts who had sufficient physical activity, after controling for the potential confounders, no significant association between physical activity and glycemic control status existed in women. Conclusions Physical activity is positively associated with glycemic control among male type 2 diabetic patients who had a good compliance level in Nanjing. Specific physical activity interventions should be implemented to type 2 diabetic patients

Proteinuria and Hypertension with and and without type 2 diabetes mellitus: An Update

@#In this update four related areas are reviewed. They are: (1) Blood Pressure (BP) definition and classification; (2) Hypertension diagnosis; (3) Hypertension and proteinuria in non-diabetic patients; and (4) Proteinuria and hypertension in the patient with diabetes. METHODOLOGY. PubMed searches were done for papers to the above four topics published in the last five years (2014 to 2019). These were supplemented by papers from hand searches. RESULTS. For diagnosis of hypertension, the current cut off of 140/90 mmHg can be reduced to 130/80 mmHg to improve cardiovascular outcomes and all-cause mortality. Diagnosis of hypertension should not be based on office BP readings alone. Hypertension in older patients should be treated to prevent worse outcomes and should be individualised. In non-diabetic patients, both low grade and microalbuminuria needs to be treated; adequate BP control is needed to prevent cardiovascular outcomes and all-cause mortality. In the diabetic patient, a BP target of less than 140/90 mmHg applies to most patients but individualisation of the BP goal is important. CONCLUSIONS. Much development in the management of proteinuria and hypertension has taken place in the last five years.