Effectiveness of telemedicine among patients with diabetes in family practice: A meta-analysis

Background@#Diabetes mellitus is one of the most commonly encountered diseases in primary care. The complications of diabetes, especially uncontrolled diabetes, are extensive. Given the broad and devastating complications of diabetes, achieving optimal glycemic control is paramount. The onslaught of the COVID-19 pandemic has caused a recent and rapid increase in the utilization of telemedicine, especially in primary care. Due to the significant complications of uncontrolled diabetes, it is crucial to determine if this change in the manner of delivering healthcare is effective for our patients with chronic diseases such as diabetes.@*Objective@#This study aimed to systematically review and analyze existing data using meta- analysis on the effectiveness of using telemedicine as a platform for managing patients with diabetes in family practice.@*Methods@#The researchers performed a systematic review and meta-analysis of randomized controlled trials that compared telemedicine versus standard care for the management of Type 2 Diabetes Mellitus with HbA1c as the primary outcome.@*Results@#All 11 studies that were included in this study reported a mean difference in favor of telemedicine over standard care, with HbA1c significantly lower in the telemedicine group as compared to standard care in 91% of the studies. The overall effect of the 11 studies is a decrease in HbA1c by a pooled mean of -0.63% with a 95% CI between -0.78% to -0.48% (p<0.00001).@*Conclusion@#The results of this meta-analysis demonstrate that various forms of telemedicine and telemedicine-assisted programs are effective in the management of adult patients with Type 2 Diabetes Mellitus as compared to standard face-to-face outpatient visits.

Molecular genetic profiling of Filipino patients with retinoblastoma: A preliminary study

Objective@#To detect and characterize retinoblastoma susceptibility gene (RB1) mutations in tumor samples collected from Filipino patients with retinoblastoma.@*Methods@#Six tumor samples were obtained from Filipino patients diagnosed with retinoblastoma. DNA was extracted from the tumor samples and exons 13-21 of the RB1 gene were amplified by polymerase chain reaction (PCR). PCR amplification products were subsequently purified and sequenced. Mutation detection and characterization were done by alignment of obtained sequences to the RB1 reference sequence from NCBI GenBank using Bioedit® software. The identified mutations were correlated with clinical presentation and family history. These mutations were also compared to known mutations reported in the RB1 Gene Mutation Leiden Open Variation Database (LOVD).@*Results@#Mutations were detected in two out of the six samples. In a patient with unilateral disease and no family history, two mutations were identified: a novel CGT>AGT (Arginine → Serine) missense mutation in position c.1861 of exon 19 and a previously reported CGA>TGA (Arginine → STOP) nonsense mutation in position c. 1735 of exon 18. A possible large exonic deletion was identified in a case of unilateral disease with no family history.@*Conclusion@#We were able to identify both novel and known mutations in the RB1 gene of Filipino retinoblastoma cases using DNA sequencing techniques. These techniques may be applied to further characterize the genetic mutations of Filipino retinoblastoma cases and their families in developing a rational method of genetic testing for early diagnosis and counseling.

Cystic Adenocarcinoma of prostate: a case report

Prostate cancer is not uncommon amongst the elderly men. Diagnosis is made using histopathology specimens of Transrectal Ultrasound guided biopsy of the prostate gland. However, prostate cancer presenting as a intra-prostatic cysts are rare. We report a case of elderly gentleman who presented with malignant intra-prostatic cysts.

Pelvic lipomatosis in an asymptomatic Asian man: a case report

Pelvic lipomatosis is a rare disease of unknown cause, characterised by overgrowth of benign mature fat cells commonly located in the perivesical and perirectal spaces. The disease is rare amongst Asian population and has a wide range of presenting symptoms varying from lower urinary tract symptoms to bowel symptoms. However, this disease can be easily diagnosed based on certain characteristic radiological imaging techniques. We report a case of pelvic lipomatosis in an asymptomatic Chinese gentleman, who presented with classical radiological features of pelvic lipomatosis but provided us with challenging therapeutic scenario. (JUMMEC 2010; 13(2): 111-114)

Congenital bilateral aplasia of vas deferens (CBAVD): a reminder to clinicians

Male factor infertility which accounts for 30-50% of infertility is a major problem faced by married couples. Congenital absence of the vas deferens, though uncommon, remains the most common abnormality seen in extratesticular ductal and ejaculatory system, accounting for 1-2% of male infertility. It may be unilateral or bilateral. Association with renal abnormality has also been reported with congenital absence of vas deferens (1). The patients are asymptomatic and the congenital abnormality is usually detected when investigation for infertility is carried out. We present a case of an unusual presentation of congenital bilateral absence of vas deferens (CBAVD).

Recomendaciones para mejorar la atención en enfermería / Recommendations to improve attention in nursing

El personal de enfermería desempeña una actividad fundamental en los servicios de salud, con fuerte apego a principios científicos y éticos; sus intervenciones permiten fortalecer la calidad en los servicios de salud, através de acciones interdisciplinarias. Se analizaron las inconformidades relacionadas con atención de enfermería que recibió la Comisión Nacional de Arbitraje Médico (CONAMED) de junio de 1996 a diciembre de 2001. Con base en el análisis se elaboraron recomendaciones dirigidas a prevenir el conflicto, mejorar la práctica de enfermería y propiciar la adecuada comunicación con el paciente, familiares y equipo interprofesional de salud. Se integró un grupo representativo de las instituciones educativas y gremiales de enfermería más prestigiadas y reconocidas, para su validación externa. De esta manera, la CONAMED y el grupo de validación externa, proponen al personal de enfermería atender las siguientes recomendaciones: 1) Mantener una comunicación efectiva con las personas a las que proporciona atención; 2) Reconocer en la persona su concepción holística; 3) Proporcionar cuidados que garanticen la atención libre de riesgos y daños innecesarios; 4) Establecer una coordinación efectiva con el equipo interprofesional de salud; 5) Actuar con base en los principios éticos que rigen la práctica profesional de enfermería.

Nurse personnel performs a fundamental activity in t health services, with strong attach at scientific and ethical principles, whose interventions can fortify the services of health quality, through interdisciplinary actions. We analyzed the compliants related to nursing attention that were received in CONAMED since June 1996 to December 2001. Wedevised recommendations directed to prevent patient-health care professionals conflicts, improve the practice of nursing and favor adequate communication with the patient, family and interprofessional health care team. Those recommendations were presented to the more prestigious and recognized educational and professional groups of nursing, for their external validation. In this manner, CONAMED and the external group of validation, propose to nurses to attend the following recommendations: 1) Maintain an effective communication with the patients that provides attention; 2) Recognize the holistic concept in the person; 3) Provide cares that guarantee tree-risk attention and prevent unnecessary damages; 4) Establish an effective coordination with the health care interprofessional team and 5) Act based on ethical principles that govern the professional practice of nursing.

A phacoemulsification chopping technique that attacks the posterior plate

Surgical Technique: The technique involves creating a central crater, flipping the nucleus out into the supracapsular space, and creating another crater through the posterior surface that will eventually connect with the anterior crater to produce a central hole. The donut-shaped nucleus is then chopped and the fragments are aspirated with greater ease. Results: The technique was performed successfully in seven eyes of six patients with only minor problems. Phacoemulsification times were longer than usual because of the additional sculpting, but clinical results were not adversely affected. Conclusion: For dense or hard cataracts for which the surgeon anticipates a tough posterior plate, this technique is a safe alternative to the usual chopping techniques.

Hydroxychloroquine sulphate inhibits in vitro apoptosis of circulating lymphocytes in patients with systemic lupus erythematosus.

The serological hallmark of systemic lupus erythematosus (SLE) is the presence of antibodies against double-stranded DNA. However, several studies have suggested that it is not DNA itself, but nucleosomes that are the immunogenic particles involved both in the induction of anti-DNA antibodies, and in the pathophysiology of SLE. Meanwhile, It has been demonstrated that there is an accelerated in vitro apoptosis of lymphocytes from patients with SLE. Therefore, one can postulate that the process of apoptosis may provide a source of nuclear antigens to drive the autoantibody response seen in SLE. Our study has demonstrated that hydroxychloroquine exhibits an anti-apoptotic action and this anti-apoptotic effect is dependent on monocyte coexistence. We used both morphology assessment and fluorescent antibody cell sorter (FACS) analysis to measure the apoptotic percentage of lymphocytes from 25 SLE patients in medium alone (control) or with the addition of different concentrations of hydroxychloroquine. Our results have shown that there is a significant decrease in the percentage of apoptosis at the therapeutic concentration (10(-6) M) as compared with the control (p < 0.05). It has been reported that the anti-rheumatic properties of hydroxychloroquine result from its interference with antigen processing in macrophages and other antigen-presenting cells. We propose that this results in decreased stimulation of autoreactive lymphocytes reactive with self-peptides, and consequently diminution of activation-induced cell death (apoptosis) of mature peripheral lymphocytes.

The effect of allergen immunotherapy on in vitro IL-4 and IFN-gamma production by peripheral mononuclear cells in house dust-sensitive Chinese patients with bronchial asthma.

The IFN-gamma produced by Th1 cells and IL-4 produced by Th2 cells are two most important cytokines in the regulation of IgE production. House dust immunotherapy has been tried in the treatment of house dust-sensitive Chinese asthmatic patients with good results. We examined the influence of such treatment on in vitro IL-4 and IFN-gamma production by peripheral blood mononuclear cells in house dust-sensitive asthmatic patients. Allergen immunotherapy in house-dust sensitive asthmatic patients can significantly decrease IL-4 production from peripheral mononuclear cells (p<0.05). The production levels of IL-4 in patients without treatment had higher levels than those in patients with hyposensitization (p<0.01). Such therapy also have some effect on promotion of IFN-gamma production in asthmatic patients. In conclusion, immunotherapy with house dust may have the potential ability to shift the Th1/Th2 balance of immune response to allergens and to create a favorable cytokine microenvironment to suppress the allergic reaction in the asthmatic airway.

Prevalence of antibodies to hepatitis C virus in relation to surrogate markers in a blood donor population of Singapore.

Prevalence of antibodies to HCV is studied among a blood donor population in Singapore and its relationship to surrogate markers was examined. Sequential serum samples from 4,091 blood donors were tested for the presence of anti-HCV using the second generation immunoassay (Abbott). 275 random serum samples were tested for anti-HBc and ALT. All the samples positive for anti-HCV were also tested for anti-HBc and ALT. Only 22 of the 4,091 donor samples (0.54%) were repeatedly reactive for anti-HCV. Of the 275 random samples tested, 43 samples (15.6%) were positive for anti-HBc and 24 (8.7%) had ALT levels more than 45 IU/l. None of these 67 samples were positive for anti-HCV. Only 3 of the 22 anti-HCV positive samples (13.6%) were positive for anti-HBc and only 6 samples (27.2%) had ALT level more than 45 IU/l. The prevalence of anti-HCV among the donors is only 0.54% which is much lower than the prevalence of HBV. An important finding is that about 60% of the donors positive for anti-HCV had no detectable surrogate markers. Exclusion of blood donors positive for anti-HBc, if implemented in an area where the prevalence of HBV infection is relatively high will result in the loss of blood donors estimated to be 15.6% and the use of raised ALT will result in a further loss of 6.1% of the blood donors.

Monoclonal gammopathies and the related autoimmune manifestations in Taiwan.

A total of 50,000 patients were surveyed for the presence of monoclonal immunoglobulins during the past two decades. There were 411 cases of monoclonal gammopathies including 243 cases of plasma cell neoplasms and 168 cases of secondary plasma-cell dyscrasia. Among the 227 cases of multiple myeloma and Waldenström's macroglobulinemia, there were 49.3% IgG class, 22.9% IgA class, 9.7% IgM class and 13.2% light chain type. In addition, there were 1.3% of nonexcretory myeloma including an IgM type. A relatively high frequency (4.8%) of IgD M-proteins was detected but heavy chain disease was not encountered in the present series. Purified M-components from patients with possible autoimmune manifestations were subjected to immunofluorescence studies. Autoimmune activity of M-proteins was found in a patient of Waldenström's macroglobulinemia with peripheral neuropathy, and another patient of cryofibrinogenemia with recurrent purpura and gangrene. In conclusion, a high frequency of IgD myeloma is found in Chinese patients of this area. M-components may have autoimmune activity resulting in unusual clinical manifestations.