A study on diabetes-related self-care plan and its determinants among diabetes patients in a Warangal region, Telangana, India

Abstract The prevalence of epidemiological diseases, including diabetes, has continued to increase because of the adaption of Western culture and the lack of self-care activities among patients with diabetes. Therefore, in this cross-sectional study, we aimed to assess self-care plans and determinants among diabetes outpatients in Warangal. We conducted a prospective observational study among diabetes outpatient clinic in Warangal, India over 6 months from October 2019 to March 2020. We used the expanded Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. A P value of less than < 0.05 was considered statistically significant. Respondents (mean age, 52.3 (standard deviation (SD), 11.01) years) had an overall SDSCA score of 49.18 ± 3.57 (SD). Mean scores for the diet, physical activity, foot care, medication adherence, and blood sugar testing scales were 12.79 (SD, 1.61), 10.24 (SD, 1.77), 15.67 (SD, 1.5), 5.66 (SD, 1.17), and 4.80 (SD, 0.68), respectively. Patients' age, education, disease duration and hemoglobin A1C (HbA1C) levels of <7.5% (P < 0.001)) had significantly higher mean scores for blood sugar testing, diet, physical activity, and adherence (P < 0.001). The employment status is associated with all the domains of Summary of Diabetes Self-Care Activities (P < 0.001). Taken together, our results revealed that patients with diabetes in Warangal had poor self-care planning, highlighting the need for strengthening initiatives that generate awareness regarding diabetes and improving related self-care practices

Cerebrospinal fluid procalcitonin: a promising diagnostic tool in differentiating bacterial from aseptic meningitis

Background: Procalcitonin in cerebrospinal fluid has been evaluated with regard to its usefulness in distinguishing between the possible causative organisms for infections. CSF PCT as a diagnostic marker has also been evaluated for differentiating bacterial from viral meningitis with conflicting results obtained so far. The current study was designed to see the role of procalcitonin as diagnostic marker and in differentiating bacterial from aseptic meningitis in pediatric age group.Methods: Children from 5 months to 15 years of age who were suspected cases of meningitis and were admitted to Pediatric Department in SKIMS Srinagar, Jammu and Kashmir were included in this case control prospective study conducted from 2014 to 2016. The total number of 200 children participated in the study among which 100 were cases and 100 controls. Serum and CSF PCT was measured by a fluorescence immunoassay using QDX Instacheck with a detection limit of 0.25-100 ng/ml. Data was analyzed by using standard statistical tests using SPSS 20.Results: The mean CSF PCT in ng/ml in our study for viral meningitis was 0.59'0.43 (range=0.00-1.90), for bacterial meningitis 4.92'1.50 (range=2.89-10.82) and for controls 0.22'0.11 (range=0.00-0.32), respectively. CSF PCT was significantly higher in viral and bacterial meningitis as compared to controls (p<0.01) and significantly higher in bacterial meningitis as compared to viral meningitis (p<0.01). An AUC of 1.000 was established using serum and CSF PCT for bacterial meningitis. The diagnostic accuracy of serum and CSF PCT was almost 100% at cut-off of 2.2 ng/ml and 2.89 ng/ml, respectively.Conclusions: Author have concluded that CSF PCT can be used as a diagnostic marker with better results in differentiation of bacterial from aseptic meningitis.

Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children / Lactato no líquido cefalorraquidiano: um marcador diferencial para meningite bacteriana e meningite viral em crianças

Abstract Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut-off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2 mmol/L.

Resumo Objetivo: Estudar o desempenho do lactato no líquido cefalorraquidiano como biomarcador para diferenciar a meningite bacteriana da meningite viral em crianças, e definir uma concentração de lactato ótima no líquido cefalorraquidiano que possa ser significativa para a diferenciação. Métodos: Foram estudadas crianças com achados clínicos compatíveis com meningite. O nível de lactato no líquido cefalorraquidiano e outros parâmetros convencionais do líquido cefalorraquidiano foram registrados. Resultados: Em um valor de corte de 3 mmol/L, o lactato no líquido cefalorraquidiano apresentou uma sensibilidade de 0,90, especificidade de 1,0, valor preditivo positivo de 1,0, valor preditivo negativo de 0,963, com uma precisão de 0,972. Os índices de probabilidade positivo e negativo foram 23,6 e 0,1, respectivamente. Para comparação entre a meningite bacteriana e viral, a área abaixo da curva do lactato no líquido cefalorraquidiano foi 0,979. Conclusões: Concluímos que o lactato no líquido cefalorraquidiano possui alta sensibilidade e especificidade na diferenciação da meningite bacteriana da meningite viral. Embora em um valor de corte de 3 mmol/L o lactato no líquido cefalorraquidiano possua alta precisão de diagnóstico da meningite bacteriana, os níveis médios na meningite viral permanecem basicamente abaixo de 2 mmol/L.

Formulation design and in vitro ex vivo evaluation of transdermal patches of Cinnarizine

The aim of this study was to develop a Transdermal patch containing Cinnarizine using different ratios of hydrophilic and hydrophobic polymeric systems by solvent evaporation technique employing Polyethylene glycol [PEG 400] as plasticizer. The physicochemical compatibility of the drug and the polymers were studied by performing FT-IR spectroscopic analysis. Formulated patches were evaluated for physicochemical properties, skin irritation, in vitro drug release, ex-vivo permeation studies across rat abdominal skin and stability studies. The results of FT-IR studies revealed that there were no interactions between drug and polymers used. All the formulations exhibited uniformity in physicochemical properties. In vitro permeation studies of the formulations were performed by using Franz diffusion cells. Formulation F3 showed better permeation through rat skin [i.e., 8527.5+/-1.25microg/cm[2] /hr] compared to rest of formulations and followed Pick's diffusion mechanism. On the basis of in-vitro drug release and ex-vivo skin permeation performance, Formulation F3 containing the polymeric blend 19:1 Hydroxypropylmethyl Cellulose [HPMC E 50cps: Eudragit RL 100] has shown optimum release in comparison to other formulations and indicated good physical stability. So it has been demonstrated that Cinnarizine can be designed as matrix type transdermal drug delivery system [TDDS] and further in-vivo evaluations were required

Blood Pressure-to-Height Ratio as a Screening Tool for Hypertension in Children.

Objective: To test whether blood pressure-to-height ratio (BPHR) can be used to screen for hypertension in children. Methods: Data regarding blood pressure and other variables was recorded for 2702 school children between the ages of 10-16 years as a part of a nutritional survey. Results: The optimal thresholds for defining hypertension in boys were 0.76 for systolic BPHR and 0.50 for diastolic BPHR; the respective threshold in girls were 0.80 and 0.52. Conclusion: BPHR can be used as an effective screening test for diagnosing both hypertension and prehypertension in children aged 10-16 years.

Evaluation of knowledge of Health Care Professionals on warfarin interactions with drug and herbal medicines

Objectives: To evaluate health care professionals' knowledge on warfarin interactions with drugs and herbs

Methods: A self-administered questionnaire was developed to assess health care professionals' knowledge on warfarin interactions with drug and herb. Respondents were asked to classify 15 drugs that may effect on warfarin action as "enhance", "inhibit ", "no effect". The study sample involved health care professionals [physicians, pharmacists and nurses] from king Salman hospital, Saudi Arabia

Results: About 92.2% of health care professionals identified warfarin interactions with aspirin, 4.4% for warfarin and fluoxetine .Warfarin and cardiac agents [atenolol] was correctly identified by 11.1% of respondents. In warfarin -herb interactions section, the majority of respondents [66.7%] identified the interaction between green tea and warfarin. Approximately one-third of respondents [n=33] correctly classified warfarin interactions with cardamom. No significant difference was found between the health care professionals [p=0.49] for warfarin-drug interactions knowledge score and p= 0.52 for warfarin- herb interactions knowledge score

Conclusion: This study suggests that health care professionals' knowledge of warfarin- drug-herb interactions was inadequate. Therefore, health care professionals should receive more education programs about drugdrug/ herb interactions to provide appropriate patient counseling and optimal therapeutic outcomes

Hereditary Folate Malabsorption with Extensive Intracranial Calcification.

Background: Anemia is a common accompaniment of cerebral palsy, mental retardation and neurodegenerative disorders. Clinical Characteristics: A 4-year-old boy with chronic megaloblastic anemia, global developmental delay, seizures, intracranial calcification and new onset neuro-regression. Observation: A diagnosis of hereditary folate malabsorption was made, and he was put on oral and injectable folinic acid. Outcome: Marked improvement at 6 month follow up. Message: Hereditary folate malabsorption should be suspected in any child having megaloblastic anemia and neuro degeneration disorder.

Clinical and Mutation Profile of Children with Cystic Fibrosis in Jammu and Kashmir.

Objective: To study the clinical and mutation profiles of children with cystic fibrosis in Jammu and Kashmir Methods: One hundred consecutive patients presenting with one or more phenotypic features suggestive of cystic fibrosis (CF) were screened by quantitative sweat chloride testing. For patients with positive/equivocal test result on two occasions, CFTR gene mutation analysis was done by polymerase chain reaction. Results: Of the 100 patients, 18 (10 females) were diagnosed to have CF at a median age of 10.5 y (IQR 4.75-15.25 y) while the median age at the onset of symptoms was 12 mo (IQR 4-63 mo) with a delay in diagnosis by 102.4±80.5 months. Clinical features at presentation included failure to thrive (94.4%), chronic cough (78%), recurrent pneumonia (61%), persistent pneumonia (11%), and chronic diarrhea (50%). Positive sweat chloride (>60 meq/L) was seen in 14 (14%) patients and 4 (4%) patients had equivocal (40-60 meq/L) value on two different occasions. Mutational analysis done in 15 patients showed DeltaF508 mutation in 20% (3/15) patients in homozygous form and in 13% (2/15) patients in heterozygous form. Intron 19 mutation 3849+10kb C>T was found in 40% (6/15) in heterozygous form. One (6.6%) patient had DeltaF508 and 3849+10kbC>T mutations in compound heterozygous form. Patients with equivocal sweat chloride and 3849+10kbC>T mutation had delayed onset of pulmonary involvement. Conclusion: 3849 +10kbC>T mutation appears to be common in children with cystic fibrosis in Jammu and Kashmir followed by DeltaF508, although the data are quite limited. Although presentation is delayed and sweat chloride is in the equivocal range, severe lung involvement may occur in these patients.

Study on alternative therapeutic agents on methicillin-resistant staphylococcus aureus from clinical and environmental isolates

The in vitro antimicrobial activity of Sea buckthorn [SBT] [Hippophaerhamnoides], Green tea [Camellia sinensis] and Dandasa [Juglansregia] on selected methicillin resistant Staphylococcus aureus [MRSA] isolates from clinical samples was tested. The in vitro antimicrobial activity of six antiseptics/disinfectants against MRSA isolated from environmental samples was also evaluated. Experimental Observational. This study was conducted in Immunology and Infectious Diseases Research Laboratory [IIDRL] Lab, University of Karachi from January 2011 to July 2011. Minimum Inhibitory Concentration [MICs] of plant extracts was determined by micro- broth dilution method and, susceptibility of MRSA isolates from environmental samples against antiseptics/ disinfectants was estimated by the agar disk diffusion and agar well diffusion methods. None of the plant extracts inhibited the isolates originating from blood samples. SBT offered comparatively more inhibitory zones and among the antiseptics/disinfectants, savion was the most effective. In view of the rising antibiotic resistance, exploring possible natural plant extracts for their antimicrobial action seems like an attractive substitute. The results showed some degree of susceptibility and can be suggested for use in vivo after standard clinical trials

Detection of genes for superantigen toxins in methicillin-resistant Staphylococcus aureus clinical isolates in Karachi

To detect genes for enterotoxins, exfoliative and toxic shock syndrome toxins in Staphylococcus aureus [S. aureus] strains isolated from clinical specimens. Cross-sectional observational study. Department of Molecular Genetics, Dr. Ziauddin Hospital, Karachi, from January to December 2010. Two hundred and ninety eight S. aureus clinical isolates were obtained from various clinical samples received at Dr. Ziauddin Hospital, Karachi. Out of these, 115 were detected as methicillin resistant [MRSA] by cefoxitin disk diffusion test showing a prevalence rate of 38.6%. Detection of individual toxin genes was performed by Polymerase Chain Reaction [PCR] by using only one primer pair for each tube. Uniplex primers were preferred as multiplex primers are longer in base pairs and have the potential for cross reaction due to non-specific binding and increase in optimization time. The possession of a single gene or more than a single gene in MRSA isolates was found in 61.73% of clinical samples; the highest number was found in pus swab, followed by sputum, blood, urethral swab, and urine. The prevalence of toxin genes was higher in MRSA as compared to methicillin sensitive [MSSA] isolates [19.12%]. PCR detects strains possessing toxin genes independent of their expression. The possession of genes for super-antigens seems to be a frequent and habitual trait of S. aureus more so in MRSA

Sensitivity and specificity of phenotypic and genotypic tests for detection of methicillin-resistant staphylococcus aureus in clinical isolates

Methicillin-resistant Staphylococcus aureus [S. aureus] [MRSA] is an important pathogen in hospitals and communities. There is advance in technologies but infections by MRSA are difficult to diagnose. The current study was conducted to compare three phenotypic methods for with a genotypic method. Cross-sectional study. Methicillin resistance was tested in 450 isolates of S. aureus retrieved from various clinical samples received in Dr. Ziauddin Laboratory Department of Molecular Genetics [DMG], Karachi from January to October 2011. Methods used were, oxacillin disc diffusion, oxacillin screen agar, cefoxitin disc diffusion and Polymerase Chain Reaction [PCR] for mecA gene, which was taken as the gold standard. The Kirby Bauer disc diffusion, using cefoxitin discs 30microg, identified a total of 174 [38.6%] S. aureus isolates as methicillin resistant. With oxacillin disk diffusion test, 152 [33.77%] strains were MRSA with sensitivity of 87.35% and specificity of 100%. Oxacillin-agar screen detected 168 [37.33%] strains with sensitivity of 96.5% and specificity of 100%. PCR method detected mec A gene in 169 [37.55%] isolates with sensitivity of 97.12%, specificity of 100%. The cefoxitin disc diffusion, as suggested by the Clinical and Laboratory Standards Institute [CLSI], is a consistent method for MRSA diagnosis but must be augmented with other methods like oxacillin screen agar, so that no MRSA is overlooked. PCR although taken as the gold standard cannot be recommended as routine because of the high cost and time consumption

Formulation development and in vitro evaluation of theophylline microcapsules

The study was aimed to investigate microencapsulation of theophylline using different ratios of eudragit S 100 as wall material by the emulsion solvent evaporation technique. The release profiles, effect of stirring speed and different pH of dissolution medium on release profiles and stability were also studied. Various formulations of microcapsules were compressed in to tablets. In vitro dissolution studies indicated that the rate of drug release was reduced with an increase in the amount of Eudragit S 100. Moreover, the release data of various formulations were fitted to Zero order, First order, Higuchi, Hixson Crowell and Korsmeyer Peppas kinetic models. It was observed that the release of drug from all the formulations followed Higuchi's kinetic model as its value of coefficient of determination is greater than that of others. The release profiles of the test formulation in distilled water and various pH media were compared and decreased release rate was seen at lower pH i.e. pH 1.0. Slight or no change was apparent in the release rate at higher stirring speed compared to lower stirring speed. No significant changes were also observed in the drug release profiles of test tablets stored at different temperatures. Test tablet [F2] was found to produce similar and sustainable release rate compared to commercial product, Quibron-T/SR tablet on the basis of their T[70%]. Similarly, f[2] values of reference versus F2 is 66.98 which show less difference between these two as compared to the comparison of reference with F1 and F3