Providing Diabetes Education through Phone Calls Assisted in the Better Control of Hyperglycemia and Improved the Knowledge of Patients on Diabetes Management.

Purpose: A recent single-arm pilot study from our group showed a significant decrease in HbA1C in Type-2 diabetes individuals provided with SMS and phone call-based education on glycemic control. Considering the preference of participants to phone call-based education, a randomized control trial (RCT) with parallel design was conducted to determine the impact of phone call-based diabetes educational intervention on the control of hyperglycemia and improvement in the knowledge about diabetes management. Objectives: To determine the impact of phone call-based educational intervention on the control of hyperglycemia and improvement in the knowledge about diabetes management. Methodology: The study was conducted for a period of 12 months on a total of 273 Type-2 diabetic patients (interventional group (n = 135); non-interventional group (n = 138)) who had provided consent to participate. Subjects in the case group received weekly phone calls on diabetes education; whereas the control group received no education. HbA1C investigations were carried out at baseline and at every fourth month until the completion of the study period for the subjects in both the groups. The impact of phone call-based education was measured by comparing HbA1C values as well as by measuring the questionnaire-based knowledge scores on diabetes management. Results: At the end of the study period, there was a significant reduction in HbA1C in 58.8% participants (n = 65) and a manifold (2-5-fold) increase in knowledge on diabetes management among participants in the case group (n = 110). However, no significant difference in HbA1C and knowledge score was observed in participants from the control group (n = 115). Conclusion: Phone call-based diabetes education is a viable option to empower patients for better management of Type-2 diabetes.

The need and art of establishing skill and simulation centers to strengthen skill-based medical education: Learning insights and experience.

Background: Evidence-based medicine seeks to improve medical education, which requires high competency levels in various clinical skills such as examination of patients and execution of clinical techniques on patients by integrating skill and simulation-based teaching and learning as supplementary to traditional methods of bedside clinical teaching. Hence, a safely prepared and controlled environment with trained interdisciplinary teams is very essential in providing such effective medical education to students as well as health-care professionals. The ongoing skill and simulation center project aims to provide teaching, training, and learning in various clinical procedures for both medical students and clinicians. Materials and Methods: The project management cycle framework was used which included the phases of planning, designing, training, and implementation. Having picked the model for the proposed skill and simulation center, that is, redefining medical education with skill and simulation-based teaching, training, and learning, it was decided to establish this skill and simulation center. Results: The functional skill and simulation center unit with the state-of-the-art infrastructure along with a trained multidisciplinary team was achieved. There are also academic programs, which include the demonstration of various clinical and surgical skills and workshops on simulation-based medical education. Conclusion: It was possible to establish a comprehensive skill and simulation center and achieve best practices in medical education by optimal investment in infrastructure and improving the available human resources. Detailed planning is required, across a variety of domains. We hope our experiences shared in this article will help other medical colleges and hospitals across the region, both nationally and globally, toward establishing similar educational facilities.

RésuméContexte: La médecine factuelle vise à améliorer la formation médicale, ce qui nécessite des niveaux élevés de compétence dans diverses compétences cliniques telles que examen des patients et exécution de techniques cliniques sur les patients en intégrant l'enseignement et l'apprentissage basés sur les compétences et la simulation en complement aux méthodes traditionnelles d'enseignement clinique au chevet du patient. Par conséquent, un environnement préparé et contrôlé en toute sécurité avec des équipes interdisciplinaires formées est trèsessentielle pour dispenser une formation médicale efficace aux étudiants et aux professionnels de la santé. Le projet de centre de compétences et de simulation en coursvise à fournir un enseignement, une formation et un apprentissage dans diverses procédures cliniques pour les étudiants en médecine et les cliniciens. Matériel et méthodes: Le Le cadre du cycle de gestion de projet a été utilisé, qui comprenait les phases de planification, de conception, de formation et de mise en œuvre. Avoir choisi le modèle du centre de compétences et de simulation proposé, c'est-à-dire la redéfinition de l'enseignement médical avec un enseignement, une formation et une formation basés sur les compétences et la simulation, et apprentissage, il a été décidé de créer ce centre de compétences et de simulation. Résultats: l'unité centrale de compétences fonctionnelles et de simulation à la pointe de la technologie infrastructure ainsi qu'une équipe multidisciplinaire formée a été mise en place. Il existe également des programmes académiques, qui comprennent la démonstration de divers compétences cliniques et chirurgicales et ateliers sur la formation médicale basée sur la simulation. Conclusion: il a été possible d'établir une compétence globale et centre de simulation et atteindre les meilleures pratiques en éducation médicale par un investissement optimal dans les infrastructures et l'amélioration de la disponibilité humaine Ressources. Une planification détaillée est nécessaire, dans une variété de domaines. Nous espérons que nos expériences partagées dans cet article aideront d'autres facultés de médecine et les hôpitaux de la région, tant au niveau national que mondial, en vue de créer des établissements d'enseignement similaires. Mots clés: mannequins, éducation médicale, planification, compétence et simulation, enseignement, formation.

Design, Synthesis, Characterization, and Crystal Structure Studies of Nrf2 Modulators for Inhibiting Cancer Cell Growth In Vitro and In Vivo.

Nrf2 is one of the important therapeutic targets studied extensively in several cancers including the carcinomas of the colon and rectum. However, to date, not many Nrf2 inhibitors showed promising results for retarding the growth of colorectal cancers (CRCs). Therefore, in this study, first, we have demonstrated the therapeutic effect of siRNA-mediated downmodulation of Nrf2 on the proliferation rate of CRC cell lines. Next, we have designed, synthesized, characterized, and determined the crystal structures for a series of tetrahydrocarbazoles (THCs) and assessed their potential to modulate the activity of Nrf2 target gene NAD(P)H:quinone oxidoreductase (NQO1) activity by treating colorectal carcinoma cell line HCT-116. Later, the cytotoxic potential of compounds was assessed against cell lines expressing varying amounts of Nrf2, viz., breast cancer cell lines MDA-MB-231 and T47D (low functionally active Nrf2), HCT-116 (moderately active Nrf2), and lung cancer cell line A549 (highly active Nrf2), and the lead compound 5b was tested for its effect on cell cycle progression in vitro and for retarding the growth of Ehrlich ascites carcinomas (EACs) in mice. Data from our study demonstrated that among various compounds 5b exhibited better therapeutic index and retarded the growth of EAC cells in mice. Therefore, compound 5b is recommended for further development to target cancers.

Intervention through Short Messaging System (SMS) and phone call alerts reduced HbA1C levels in ~47% type-2 diabetics-results of a pilot study.

PURPOSE: Despite extensive research and newer methods of interventions, the incidence and prevalence of diabetes is increasing at an alarming rate. Currently, according to world health organization (WHO) statistics, 422 million individuals are suffering from diabetes worldwide. In India, recent estimates have reported a significant increase in the number of diabetics in the last decade. Poor dietary habits, minimal adherence to treatment regimens, lack of timely education are some of the contributing factors for increasing incidence and huge economic burden; which can be handled by life style behavior modifications backed up by hand holding through continuous education. Prior studies have demonstrated the efficacy of various self-management tools and educational programs in better disease management behaviors among individuals with diabetes. Among various self-management tools, educating the individuals and alerting them using mobile phone calls and short messaging system (SMS) are widely accepted due to (a) the increasing mobile phone users and (b) availability of short messaging systems in local languages in the recent years. Therefore, a pilot study was conducted to determine the benefit of educating patients through phone calls and SMS in the self-management of diabetes. OBJECTIVES: The objective of the study is to determine the feasibility and utility of SMS and phone call-based interventions in the management of diabetes by comparing the HbA1c values. METHODOLOGY: The study was conducted for a period of 14 months from December 2017 till Feb 2019. Out of 380 individuals initially enrolled into the study, 120 had completed the 14-months period. Diabetes education through SMS and phone calls was provided on regular basis, and HbA1C levels at baseline, 8-months and 14-months quantified. In addition, feedback on patients' satisfaction and utility of the SMS / Phone calls was collected using questionnaires. RESULTS: Data from our study demonstrated that after 8-months of intervention through phone calls, a significant increase in the number of individuals with HbA1c in the range of 5.1 to 7.0 was observed (from 27 individuals at base line to 37 individuals after 8-months intervention). Much more significant improvement in the number of individuals with lower HbA1c was observed at 14-months of intervention, indicating the benefit of regular phone call-based system in managing diabetes. A Chi square (χ2) test was performed to examine if the frequencies in the cells varied at baseline and at 8 and 14 months. CONCLUSION: Chronic diseases like diabetes needs awareness and education to patients in adopting disease self-management practices. As mobile phone users are increasing in number, providing diabetes management education through mobile phone intervention could be a viable strategy for controlling diabetes.

Factors Contributing to Development and Reversal of LVH: A Pilot Study.

INTRODUCTION: Left Ventricular Hypertrophy (LVH) often reflects as a physiological adaptation to chronic pressure overload. It has been identified as a strong independent risk factor of all-cause mortality and adverse cardiac events. Since not all subjects with hypertension develop LVH, understanding the clinical factors contributing to the development of LVH and the appropriate diagnostic and treatment strategies may help clinicians in conducting more definitive evaluation and managing the disease effectively. AIM: To assess the incidence of LVH in hypertensive subjects and the factors influencing its development and reversal. The study also evaluated the most effective diagnostic technique and therapy that could improve the disease symptoms and prognosis. MATERIALS AND METHODS: The prospective study, conducted at Jagadguru Sri Shivarathreeshwara (JSS) Medical College JSS University, Mysore, India, included 50 patients with hypertension. Detailed history of the recruited subjects was collected from patient records and through physical examination. Demographic and clinical characteristics such as age, gender, BMI, and stage of hypertension (stage I HTN and stage II HTN) were also obtained. Funduscopic examination was done for all patients for evidence of hypertensive retinopathy. Echocardiography (ECHO), electrocardiography (ECG), and chest X-Ray were used for detection of LVH. The patients were reviewed after six months and reassessment of LVH was carried out. Statistical analysis was conducted using SPSS software and R 3.2 package. RESULTS: Angiotensin-Converting Enzyme (ACE) inhibitors were found to be more effective in the treatment of LVH when compared to calcium channel blockers and beta blockers. ECHO was found to be the best method to diagnose LVH. In patients with stage I HTN, 47.1% had normal LVM. Around 53% of the subjects with stage I HTN and all with stage II HTN had abnormal LVM. Retinal changes were noted in 96.2% of abnormal LVM patients and 50% of normal LVM patients. A positive association between BMI and LVH (OR: 1.39) was also noted. CONCLUSION: BMI may positively influence LVH regression. The presence of retinopathy, in addition to LVH, suggests an increased chance of regression with anti-hypertensive treatment.

Evaluation of Protein Kinase Cß and PPARγ Activity in Diabetic Rats Supplemented with Momordica charantia.

INTRODUCTION: The present study was taken up to compare and evaluate the effect of Momordica charantia supplementation with pioglitazone on PKC-ß and PPAR-γ activity in kidneys of diabetic rats. The hypoglycaemic and lipid lowering effect of Momordica charantia were screened in laboratory animal model and its potency was compared with a Thiazolidinedione (TZD) group antidiabetic drug like pioglitazone. MATERIALS AND METHODS: Adult healthy albino rats of Wistar strain aged 3-4months, weighing between 170-250gm of either sex were divided into 4 groups; Group 1 (normal controls), Group 2 (diabetic controls), Group 3 (diabetic rats treated with pioglitazone) and Group 4 (diabetic rats treated with bitter melon juice). Type 1 Diabetes was induced in rats by intraperitoneal injection of streptozotocin at a dose of 55 mg/kg body weight, following which glucose levels were estimated by Accu chek- active glucometer on day 0, 7, 14, 21 and 28 days to assess the efficacy of Bitter Melon Juice (BMJ) and pioglitazone. After 28 days of treatment, the rats were sacrificed and blood collected from abdominal vena cava was used for estimation of triglycerides by Glycerol 3 phosphate oxidase phenol aminophenazone method and cholesterol by Cholestrol oxidase phenol aminophenazone method. PKC-ß and PPAR-γ were estimated in the dissected kidneys by using double sandwich ELISA based kits on an automated plate reader. RESULTS: BMJ significantly reduced blood glucose levels in group 4 as compared to diabetic controls (p<0.001). Total cholesterol and triglycerides were significantly reduced in both group 3 and 4. In Group 4, there was reduction in PKC-ß levels, when compared to Group 3(p=0.004). PPAR-γ levels were increased in both Group 3 and 4, when compared to Group 2. CONCLUSION: The results suggest that BMJ has hypoglycaemic and lipid lowering effect in diabetic animal models. BMJ increases PPAR-γ activity and decreases PKC-ß activity in kidneys of diabetic rats, thereby preventing the complications of diabetes mellitus. Fresh BMJ mimics action of pioglitazone belonging to TZD group thus showing a potential for further research in identifying the active molecules responsible for glucose and lipid lowering action.

Metabolic syndrome among diabetics and pre-diabetics of Jenu Kuruba tribe in Mysore district (JKDHS-2)--An evidence of metabolic abnormalities leading to increase in CVD's among Jenu Kuruba tribal population.

BACKGROUND: Metabolic syndrome is a cluster of clinical and metabolic abnormalities. In diabetics, other components of metabolic syndrome are an added risk factor for cardiovascular disease and all these cause mortality. Epidemiological transition is happening all over the world and tribes are not spared either. Identifying the extent of metabolic syndrome and its components in diabetics is vital for the prevention of cardiovascular diseases and other morbidities. OBJECTIVE: To estimate the prevalence of Metabolic Syndrome among diabetics and pre-diabetics of Jenu Kuruba tribe and compare the mean values of various components of metabolic syndrome among diabetics and pre-diabetics. METHODS: A community based cross sectional study was carried out among 7500 Jenu Kuruba tribal population in two phases. In phase I, total of 7500 subjects were screened for diabetes and hypertension and in phase II, a total of 249 diabetics and 310 pre-diabetics were identified and evaluated for metabolic syndrome. RESULTS: Prevalence of metabolic syndrome was estimated using NCEP ATP-III criteria. Metabolic syndrome was found in 84 (33.7%) of diabetics and 113 (36.4%) of pre-diabetic study subjects. Metabolic syndrome was highest in the 41-50 year age group. Lipid parameters such as total cholesterol, triglycerides and VLDL were significantly higher and HDL levels were significantly lower among subjects with metabolic syndrome as compared to subjects without metabolic syndrome. CONCLUSIONS: One third of diabetics and pre-diabetics had definable metabolic syndrome. Dyslipidemia is a significant component of metabolic syndrome. Epidemiological transitions are happening among Jenu Kuruba tribes and non-communicable diseases are on the raise among them.