ABSTRACT
Access to quality healthcare service is a challenge for many patients, especially in situations which impose movement restrictions, such as the COVID-19 pandemic. Although it has the disadvantage of lacking a physical consultation, high accessibility makes telemedicine alongside teleconsultation preferred in numerous situations, contributing to high treatment adherence in patients. An important pathology addressed through telemedicine is diabetes mellitus, due to its possible commorbidities and negative impact. This study consisted of the analysis of the electronic files of 260 patients, between April and December 2020. A high adherence in prescription days covered was observed (89.91%). The increase of teleconsultations which was maintained even after the ease of lockdown measured suggested a good adherence to this method. Teleconsultation is an efficient method, with future prospects for providing healthcare. (English) [ FROM AUTHOR] Accesul la servicii de sănătate de calitate reprezintă o provocare pentru numeroși pacienți, în special în situații care impun limitarea deplasării, precum pandemia de COVID-19. Deși prezintă dezavantajul lipsei unui consult fizic, gradul ridicat de accesibilitate face ca telemedicina împreună cu teleconsultul să fie de preferat în numeroase situații, contribuind la aderența crescută la tratament a pacienților. Un loc important în rândul patologiilor abordate prin telemedicină îl deține diabetul zaharat, având în vedere posibilele comorbidități, precum și impactul negativ. Acest studiu a presupus analizarea fișelor electronice ale unui eșantion de 260 de pacienți, din perioada aprilie-decembrie 2020. S-a constatat o aderență bună la ridicarea rețetei (89,91%). Creșterea numărului de vizite prin teleconsult, care s-a menținut și după relaxarea măsurilor restrictive, a sugerat o aderență bună la această metodă. Teleconsultul este o metodă eficientă și cu perspective pentru furnizarea serviciilor de sănătate. (Romanian) [ FROM AUTHOR] Copyright of Farmacist.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Introduction: Diabetic peripheral neuropathy (DPN) is the most common neuropathic syndrome seen in patients with diabetes. Roughly 30% of the diabetes patient population1 experience painful DPN symptoms including bilateral stabbing or burning pain in addition to numbness in the feet and lower legs. Traditionally painful DPN symptoms have been treated with conventional medical management (CMM) including glycemic control, general risk factor management, as well as pharmaceutical agents. These treatment approaches are often unsuccessful in the long-term1. Spinal cord stimulation (SCS) has been demonstrated as an effective treatment for painful DPN of the lower extremities with multiple publications dating back to 1996 showing benefits of SCS for pain relief and improved Quality of Life (QoL) in DPN patients (Figure 1)2-18. Method(s): A systematic literature review of the robust body of evidence for SCS in the treatment of painful DPN was conducted. Publications were selected for inclusion by two independent reviewers using defined selection criteria. Additional relevant publications from outside the search dates were included. Result(s): SCS was first documented as an effective treatment for DPN in three single-arm studies published between 1996 and 20122,4,5, one of which was followed-up to thirty-six months18, and another to seven-years3. These studies paved the way for two RCTs published in 20146,7, one of which was followed-up to five-years in two publications8,10, and another7 was followed-up with analyses on QoL9 and an evaluation of the effects of burst SCS17. Two meta-analyses were published in 2020 and 202111,12. A post-hoc analysis of a multi-center single-arm study on high frequency (10kHz) SCS to treat DPN was published in 202013 and followed by an RCT published in 202114 with additional 1-year follow-up15,16. Collectively these studies demonstrate that SCS is an effective therapy for patients with painful DPN by reducing pain and increasing QoL for DPN patients (Figure 1). Conclusion(s): This review of a large body of evidence shows a decades-long history of the effectiveness of SCS for symptom relief in patients suffering from painful DPN. Future research on the effectiveness of new waveforms and novel methods of energy delivery to the spinal cord are needed. The study of outcomes in addition to pain relief is also needed, which may better illustrate the breadth of effects of SCS therapy on the underlying disease factors. Increasing awareness of the current evidence is essential to increasing therapy adoption by expanding payer support and influencing referring health care provider behavior. Disclosure: Eric Grigsby, MD: AE Mann Foundation: Consulting Fee: Self, Bioness Inc.: Consulting Fee: Self, Medallion Therapeutics: Consulting Fee: Self, Medtronic: Consulting Fee: Self, SPR Therapeutics: Consultant: Self, Tenex Health: Consultant: Self, Voyager Therapeutics: Consultant: Self, Xalud: Consulting Fee: Self, AE Mann Foundation: Consulting Fee: Self, Medallion Therapeutics: Consulting Fee: Self, Bioness Inc.: N/A: Self, Medallion Therapeutics: N/A: Self, SPR Therapeutics: N/A: Self, Abbott / St. Jude Medical: N/A: Self, Tenex: N/A: Self, Vertos: N/A: Self, Xalud: N/A: Self, AE Mann Foundation: Consulting Fee: Self, Bioness Inc.: Consulting Fee: Self, Medtronic, Inc.: N/A: Self, Collegium Pharmaceutical, Inc.: Trustee: Self, Flowonix Medical: Served on speakers' bureau: Self, Jazz Pharmaceuticals: Served on speakers' bureau: Self, Jazz Pharmaceuticals: Trustee: Self, Spinal Restoration, Inc.: Trustee: Self, Jazz Pharmaceuticals: N/A: Self, Alfred Mann Foundation: N/A: Self, Boston Scientific: N/A: Self, CNS Therapeutics: N/A: Self, Collegium Pharmaceutical, Inc.: N/A: Self, Flowonix Medical: N/A: Self, Jazz Pharmaceuticals: N/A: Self, Medtronic, Inc.: N/A: Self, Myoscience: N/A: Self, NeurAxon Inc.: N/A: Self, Spinal Restoration, Inc.: N/A: Self, St. Jude Medical, Inc.: N/A: Self, Abbott Laboratories: Consultant: Self, Alfred Mann Foundation: Consulting Fee: Self, Cervel Neurotech, Inc.: Consultant: Self, CNS Therapeutics: Consultant: Self, Covidien: Consultant: Self, Cumberland Pharmaceuticals, Inc.: Consultant: Self, Flowonix Medical: Consultant: Self, Jazz Pharmaceuticals: Consultant: Self, Mainstay Medical: Consultant: Self, Medtronic, Inc.: Consultant: Self, Myoscience: Consultant: Self, NeuroPhage Pharmaceuticals: Consultant: Self, Nevro Corp: Consultant: Self, Palyon: Consultant: Self, Spinal Modulation: Consultant: Self, SPR Therapeutics: Consultant: Self, St. Jude Medical, Inc.: Consultant: Self, Tenex Health, Inc.: Consultant: Self, VertiFlex Inc.: Consultant: Self, Vertos Medical, Inc.: Consultant: Self, Xalud Therapeutics, Inc.: Contracted Research: Self, Medtronic, Inc.: Served on speakers' bureau: Self, Flowonix Medical: Served on advisory board: Self, Medtronic, Inc.: N/A: Self, Jazz Pharmaceuticals: N/A: Self, Medtronic, Inc.: Ownership Interest: Own Stock, Stock Options, Future Stock Options: Self, Nevro Corp: Ownership Interest: Own Stock, Stock Options, Future Stock Options: Self, Rachel Slangen, PhD: None, Lisa Johanek, PhD: Medtronic: Salary/Employee: Self, Maddie LaRue, PHD: Medtronic: Employee:, Cecile de Vos, PhD: None, Melissa Murphy: Medtronic: Consulting Fee:, Relievant: Consulting Fee:Copyright © 2023
ABSTRACT
Background: Diabetes mellitus (DM) represents one of the most common metabolic diseases in the world, with rising prevalence in recent decades. Most cases are generally classified into two major pathophysiological categories: type 1 diabetes mellitus (DM1), which progresses with absolute insulin deficiency and can be identified by genetic and pancreatic islet autoimmunity markers, and type 2 diabetes mellitus (DM2), which is the most prevalent form and involves a combination of resistance to the action of insulin with an insufficient compensatory response of insulin secretion. In the last two decades, in parallel with the increase in childhood obesity, there has also been an increase in the incidence of DM2 in young people in some populations. Other forms of diabetes may affect children and adolescents, such as monogenic diabetes (neonatal diabetes, MODY – maturity onset diabetes of the young, mitochondrial diabetes, and lipoatrophic diabetes), diabetes secondary to other pancreatic diseases, endocrinopathies, infections and cytotoxic drugs, and diabetes related to certain genetic syndromes, which may involve different treatments and prognoses. DM1 is considered an immuno-mediated disease that develops as a result of gradual destruction of insulin-producing pancreatic beta cells that eventually results in their total loss and complete dependence on exogenous insulin. Clinical presentation can occur at any age, but most patients will be diagnosed before the age of 30 years
ABSTRACT
As we all know, diabetes is a global problem that has been growing over the years. According to the International Diabetes Federation, more than 425 million people worldwide suffer from this disease, and the majority of them are those with type 2 diabetes. Diabetic polyneuropathy is a very common disease, which causes a decrease in the quality of life of patients due to sensory and motor disorders, severe pain. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Photobiomodulation (PBM) therapy is a therapeutic method that can produce a range of physiological effects in cells and tissues using certain wavelengths. The reparative benefits of PBM therapy include wound healing, bone regeneration, pain reduction, and the mitigation of inflammation. Advances in the development of laser instruments, including the use of high-intensity lasers in physiotherapy, have recently led to controllable photothermal and photomechanical treatments that enable therapeutic effects to be obtained without damaging tissue. The combination of PBM therapy with acupuncture may provide new perspectives for investigating the underlying therapeutic mechanisms of acupuncture and promote its widespread application.
ABSTRACT
For decades, the macrovascular system was in the focus of diagnostic and therapeutic medicine. The relevance of microvascular pathology was widely underestimated but is revealed in a new break-through cardiological study. Increasing knowledge reveals the microvascular system as the essential target structure of chronic magnesium-depletion, mediating smoldering chronic disease processes. Microvascular dysfunction could be the common basis for the association of chronic magnesium deficiency and polytopic diseases of high-energy dependent organs: diabetic retinopathy, renal failure - diabetic and other -, microvascular = non-Alzheimer dementia, diastolic cardiac dysfunction (HFpEF - heart failure with preserved ejection fraction) - analog arterial hypertension - microvascular angina, atrial fibrillation but also diabetic foot and diabetic neuropathy. In early studies the actual COVID-19 pandemic is related to microvascular pathomechanisms. Following earlier results reporting better survival of intensive care patients with highly normal magnesium as well as epidemiological associations we recommended for all patients from the beginning of the COVID 19 epidemic high-dose magnesium supplementation 15 - 25 mmol (and zinc 20 mg, vitamin D 2,000 IE each/day). In the context of COVID-19, we can assume four constellations of possibly positive effects of this magnesium strategy: 1. Due to our own limited cohorts the most evident: Tolerance of immunization with Biontech/Pfizer COVID-19 vaccine was distinctly better in our cohort of over 412 vaccinations compared with published data. 2. Rare, but a few patients with more intense adverse reactions had low magnesium and/or abnormal microvascular results in pulse wave analysis. 3. COVID patients (also elderly) with documented high serum magnesium - and pre-supplemented - recovered well from the disease. 4. Two post-Corona, long-COVID patients with symptoms of fatigue, reduced mental concentration, and dizziness reacted well after repeated parenteral magnesium infusion. Whether SARS-Cov-2-antibody formation correlates with magnesium or zinc values is topic of running investigations. Systematic prospective investigations are warranted. But due to the circumstances - considering that there are no evidence-based alternatives - for healthy individuals, for persons at risk, for patients at risk of magnesium depletion as well as for COVID-19 vaccination candidates, optimizing of magnesium is justified (Global Mg COVID-19 project) - and in terms of other health concerns, the prevention of chronic microvascular disease entities also justifies supplementation. Personalized magnesium dosage in medical office should be oriented by practical serum Mg/Ca (mmol/mmol) target 0.4 - including calcium. This approach seems to us to be expedient and more successful didactically. (outpatient medicine: Mg/Ca in serum;intensive care: ionized magnesium).
ABSTRACT
Objective: Chronic fatigue significantly affects the aging population, especially individuals with chronic conditions such as diabetes mellitus (DM). Patients with DM experience a range of comorbidities and complications that may impact quality of life (QOL). Current QOL tools are not specific to problems associated with diabetes and aging. The aim of this study was to explore the impact of DM on fatigue using the Norfolk QOL-Fatigue (QOL-F), a 35-item validated questionnaire sensitive to physical, cognitive and emotional aspects of fatigue. We hypothesize that cognitive and physical measures of fatigue are increased in DM patients. Methods: Subjects 18 to 79 years old, with type 1 or 2 DM from Hampton Roads, Virginia were recruited. Participants were administered the Norfolk QOL-F questionnaire, both in person and, during the COVID pandemic, online through Redcap survey interface. The questionnaire is divided into 5 domains (physical and cognitive problems from fatigue, subjective fatigue, reduced regular activities, activities of daily life (ADLs) and depression). Demographic and clinical information were collected. Participants with DM were compared with matched healthy controls (HC). Presence of neuropathy was assessed with the validated Norfolk QOL-Diabetic Neuropathy (DN) questionnaire. Results: Four hundred DM and 80 age, gender and race matched HC subjects were included. DM subjects had higher BMI (32.23±7.77 vs. 29.02±5.17 p=0.0011). DM participants reported significantly higher QOL-F scores (50.01±28.59 vs. 25.42±19.32 p< 0.0001). These differences were observed in all domains of the QOL-F (p< 0.0001 for all comparisons). Within the DM group, participants with DN where significantly more fatigued than those without DN (59.25±26.87 vs 27.65±18.59 p< 0.0001). These differences were observed in all fatigue domains. On multivariate regression analysis, only younger age and female gender were correlated with higher fatigue scores. Subjects interviewed after COVID pandemic were significantly more fatigued than subjects interviewed before the pandemic. However, these two groups were not well matched. Discussion/Conclusion: This study shows that the Norfolk QOL-F questionnaire can identify increased levels of fatigue in patients with chronic diseases such as DM. This may be especially relevant to physicians as they address the main concerns of this patient population, including physical limitations, disruption of ADLs and depression. Paradoxically, older subjects reported better fatigue scores. Potential explanations include differences in perception of fatigue symptoms and generational differences in everyday responsibilities and life stressors. These findings warrant further investigation.
ABSTRACT
Our review article aimed for analysis of pathogenesis, diagnostyics and treatment of polyneuropathies manifesting in the course of COVID-19. The reasons for hyposmia and taste disturbances are considered in the subjects with this coronavirus infection as well as relationship between these clinical manifestations and severity of the viral infection. Special attention is given to description of autoimmune mechanisms of Guillain-Barré syndrome and polyneuropathies of critical conditions associated with COVID-19. Some data report about clinical deterioration of diabetic and alcoholic neuropathy during the SARS-CoV-2 infection. Inclusion of group B vitamins, together with C and D vitamins, is recommended to the schedules of combined treatment for polyneuropathies in these patients. Early diagnostics of polyneuropathies, especially, Guillain-Barré syndrome, is required during COVID-19 pandemics, thus helping to administer rational therapy and promoting better quality of life in the patients.