Investigating Ayurvedic Strategies: An In-Depth Examination of Managing Diabetes across Different Types.

In light of the escalating global concern surrounding diabetes mellitus, contemporary medical practices predominantly hinge on pharmaceutical interventions, accompanied by inherent side effects and enduring limitations. This investigation accentuates a discernible research void regarding the amalgamation of Ayurvedic principles an age-old traditional medical system with prevalent approaches to diabetes management. Despite Ayurveda's promising potential in furnishing a comprehensive and personalized strategy for diabetes treatment, the imperative for further research and collaboration between Ayurvedic practitioners and contemporary healthcare professionals becomes evident. Existing scholarly works underscore the potential advantages of Ayurveda in delivering holistic diabetes care, encompassing not only glycemic control but also fostering overall well-being. Nevertheless, a closer examination reveals specific limitations, challenges, and gaps in current research, necessitating targeted efforts to enable a more exhaustive exploration of Ayurvedic interventions within diabetes management. This comprehensive review scrutinizes Ayurvedic recommendations pertaining to dietary practices, lifestyle adjustments, and herbal therapeutics, shedding light on their plausible efficacy. It serves as a clarion call for heightened research endeavors, aiming to bridge existing gaps and carve a pathway toward an integrated, patientcentric paradigm in diabetes care. In summary, as diabetes prevalence continues to rise globally, the study underscores the limitations of current pharmaceutical-centric approaches and highlights the need for extensive research and collaboration to unlock the full potential of Ayurvedic principles in providing a more holistic and personalized framework for diabetes management. The review navigates through Ayurvedic recommendations, emphasizing the urgency for intensified research efforts to fill existing gaps and pave the way for a seamlessly integrated, patient-focused approach to diabetes care.

Incidence of vitreous loss and visual outcome following cataract surgery by surgeons with various levels of experience at a tertiary eye care center in North India.

Purpose: To determine the incidence of vitreous loss and visual outcome after a vitreous loss during cataract surgery performed by surgeons with various levels of experience in adults >40 years of age at a tertiary eye care center in North India. Methods: The study was conducted at a tertiary eye care center in North India. This was an observational, retrospective, cross-sectional study of patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. All adult cataract cases who were operated on from August 1, 2011 to July 31, 2014 and who experienced vitreous loss during their surgery were included in the study. The visual outcomes of these patients who experienced vitreous loss during cataract surgery in uncomplicated cataract and were managed using standard automated vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, small-incision, and phacoemulsification) as well as at different levels of skill of the operative surgeon (consultant, short term fellow, and long-term fellow). Details of the postoperative period and best-corrected visual acuity (BCVA) were collected from patient records by the principal investigator on day 1, 1 week, 4 weeks, 6 weeks, and 3 months post cataract surgery. Results: Vitreous loss occurred in 374 out of 18,430 patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. The overall incidence of vitreous loss in our study was found to be 2.03% with consultants having a rate of 1.66%, short-term fellows at 5.19%, and long-term fellows at 2.02%. Two hundred eighty-eight patients of the 374 cases followed up for 3 months at the hospital and 75.69% of these patients had a final visual acuity of ≥6/18. Conclusion: In an institute with a structured training program for residents/trainees, the vitreous loss rate is low during cataract surgery. Early intervention and proper management with the standard microsurgical technique by experienced hands can improve the final visual outcome in eyes with vitreous loss. Cystoid macular edema and corneal edema were the most common causes of poor postoperative vision.

Evaluation of ELISA and PCR in parallel to single intradermal cervical tuberculin test (SICT) for diagnosis of tuberculosis in buffaloes.

Bovine tuberculosis is an economically important disease with very high zoonotic potential. Single intradermal cervical tuberculin test (SICT) is considered a gold standard assay for the diagnosis of bovine tuberculosis. However, bovines especially buffaloes may produce a false negative result when the animal becomes cell-mediated immune (CMI) anergic in the advanced stage of the disease. In the present study, ELISA and PCR assays were successfully demonstrated to be useful in diagnosing tuberculosis especially in the CMI anergic buffaloes infected with Mycobacterium bovis. ELISA and PCR assays are able to detect 8.94% and 8.13%, respectively, more animals as positive in comparison to standard SICT assay in a selected population of 123 buffaloes. The moderate agreement between SICT and ELISA (k: 0.528; 0.249-0.807), a substantial agreement between SICT and PCR (k: 0.648; 0.364-0.931), and high agreement between ELISA and PCR (k: 0.856; 0.697-1.0) highlight that ELISA and PCR, if used in parallel with SICT, will provide better sensitivity over single assay. Reduction of false negative reactors may help in minimizing the zoonotic threat from bovine tuberculosis especially in disease endemic region where human and livestock interface is quite high.

Comparison of Curcuma Caesia extracts for bioactive metabolite composition, antioxidant and antimicrobial potential.

The objective of this study was to compare the antioxidant and antibacterial activity of Curcuma caesia rhizome extracts and to characterise its bioactive metabolites by Fourier Transform-Infrared (FTIR) spectroscopy and Gas Chromatography-Mass Spectroscopy (GC-MS). Extracts were prepared using methanol, acetone and ethyl acetate by cold percolation methods. Compared to other extracts, methanol extract discovered to have the greatest antioxidant capacity. Analysis of FTIR spectra of all the extracts of Curcuma caesia shows the existence of several functional groups such as phenol, aldehydes and carboxylic group. But in methanol extract C≡C stretching bond, nitro compound and conjugated aldehyde were also presented. GC-MS extract assessment showed that sesquiterpene and monoterpenes were primarily presented. This research provides an efficient basis for separating the innovative bioactive compound from plant and assessing their effectiveness for antioxidant and antibacterial operations in particular.[Figure: see text].

Clinical Characteristics of COVID-19 Patients in a Regional Population With Diabetes Mellitus: The ACCREDIT Study.

Objective: To identify clinical and biochemical characteristics associated with 7- & 30-day mortality and intensive care admission amongst diabetes patients admitted with COVID-19. Research Design and Methods: We conducted a cohort study collecting data from medical notes of hospitalised people with diabetes and COVID-19 in 7 hospitals within the Mersey-Cheshire region from 1 January to 30 June 2020. We also explored the impact on inpatient diabetes team resources. Univariate and multivariate logistic regression analyses were performed and optimised by splitting the dataset into a training, test, and validation sets, developing a robust predictive model for the primary outcome. Results: We analyzed data from 1004 diabetes patients (mean age 74.1 (± 12.6) years, predominantly men 60.7%). 45% belonged to the most deprived population quintile in the UK. Median BMI was 27.6 (IQR 23.9-32.4) kg/m2. The primary outcome (7-day mortality) occurred in 24%, increasing to 33% by day 30. Approximately one in ten patients required insulin infusion (9.8%). In univariate analyses, patients with type 2 diabetes had a higher risk of 7-day mortality [p < 0.05, OR 2.52 (1.06, 5.98)]. Patients requiring insulin infusion had a lower risk of death [p = 0.02, OR 0.5 (0.28, 0.9)]. CKD in younger patients (<70 years) had a greater risk of death [OR 2.74 (1.31-5.76)]. BMI, microvascular and macrovascular complications, HbA1c, and random non-fasting blood glucose on admission were not associated with mortality. On multivariate analysis, CRP and age remained associated with the primary outcome [OR 3.44 (2.17, 5.44)] allowing for a validated predictive model for death by day 7. Conclusions: Higher CRP and advanced age were associated with and predictive of death by day 7. However, BMI, presence of diabetes complications, and glycaemic control were not. A high proportion of these patients required insulin infusion warranting increased input from the inpatient diabetes teams.

Effect of temperature and pressure on antimycobacterial activity of Curcuma caesia extract by supercritical fluid extraction method.

Background: Supercritical fluid extraction (SFE) is an advanced technique using CO2as a solvent and plant-based drug exploration is a topic of growing interest. Curcuma caesia is a medicinal herb with many medicinal potential. Hence, in the present study, the effect of temperature (40°C-60°C) and pressure (10-20 MPa) on extraction yield and antimycobacterium potential of C. caesia Roxb. dry rhizome powder using supercritical fluid extraction method were evaluated. Methods: The extract of C. caesia by SFE was accomplished using temperature range (40°C-60°C) and pressure range (10-20 MPa). The chemical profile of the extracts were investigated by Gas Chromatography Mass Spectrometry (GCMS) and the antimycobacterial activity of the extracts were analyzed against Mycobacterium smegmatis strains MTCC06 and MTCC994. Compounds found in the extract were further checked by in silico analyses with two protein target 4DRE and 3UCI. Results: Extraction yield ranged from 3.0 to 5.6 g/25g dry substrate, with the highest value being achieved at 50°C and 15 MPa. The results of GCMS analyses revealed the presence of beta-elemene, curzerenone, boldenone, and 2-cyclohexen-1-one, 4-ethynyl-4-hydroxy-3, 5, 5-trimethyl in the extracts. The extract obtained at 50°C temperature and 15 MPa pressure showed the highest zone of inhibition against M. smegmatis strains MTCC06 and MTCC994, that is, 15.6 mm and 13.6 mm, respectively. Active constituents present in the extracts showed good binding energy with 4DRE and 3UCI by in silico analysis. Conclusion: This study identified the effect of temperature and pressure on yield C. caesia extract by SFE method. Furthermore, the effect of different extracts on antimycobacterial potential and docking study validated the antimycobacterial potential.

An Overview of Phytotherapeutic Approaches for the Treatment of Tuberculosis.

Tuberculosis (TB) is highly infectious disease causing morbidity and death. Its causative organism is a contagious bacterium, Mycobacterium tuberculosis. The incidence of tuberculosis is increasing worldwide due to the emergence of drug resistance bacteria. The resistance is being developed in Mycobacterium tuberculosis against both the first line as well as the second line drugs used for the treatment. The tuberculosis control programme is being complicated and failed to get the desired impact due to the development of multi-drug resistant (MDR) and extensively-drug resistant (XDR) strains of Mycobacterium tuberculosis. So, there is a critical requirement to discover and produce newer anti-TB drugs with unique drug targets. Medicinal plants have been used for curing the diseases from ancient time. Medicinal plants are the novel sources for the production of alternate medicines for the treatment of TB caused by MDR and XDR strains. Plants produce a number of different kinds of secondary metabolites such as Alkaloids, Coumarins, Flavonoids, Polyphenols, Terpenoids, Quinines, etc. which have antimicrobial activity; thus may be useful in control of tuberculosis. These compounds do not contribute directly in growth and development but used by the plants for their defense. On the basis of various sources in the literature, about 72 phytochemicals constituents responsible for anti tubercular activity isolated from different plants have been explained along with their structure. Most effective isolated compounds from plants are plumbagin, maritinone, 3, 3'-biplumbagin, aloe emodin, epigallocatechin and umckalin. These phytochemicals are helpful for the treatment of MDR, XDR type of tuberculosis. This review describes an overview of the current synthetic medicines used for treatment of TB and the work carried out on anti tubercular plants along with their phytochemicals.

Slowing and stopping of wave in dispersive metamaterial loaded helical guide.

We propose a dispersive metamaterial loaded helical waveguide (DMLHG) structure that supports slowing and stopping of Electromagnetic (EM) wave. Analytical and computational characterizations have been done to visualize various modal characteristics in detail using the Drude model as a dispersive parameter. It is observed that metamaterial insertion enhances helical guide slow wave behaviour and it supports both forward wave (FW) and backward wave (BW) as well as mode degeneracy. Obtained mode degeneracy mechanism leads to trapping of EM wave. The proposed guide structure provides a dynamic control of wave velocity by varying its physical parameters. Two possible structures are designed and simulated using CST Microwave Studio Software. The simulation results verify the presence of similar characteristics as observed in analytical study such as FW, BW, mode-degeneracy, but in slightly shifted frequency spectrum.

Propagation characteristics of an extremely anisotropic metamaterial loaded helical guide.

In this study, we report slow wave propagation characteristics of an extremely anisotropic metamaterial loaded helical guide (EAMLHG). An analytical expression has been theoretically derived and numerically computed to get exact solutions of all possible guided modes of propagation. Anisotropy is defined in terms of positive longitudinal permittivity (ϵz > 0) and negatives transverse permittivity value (ϵt < 0). The waveguide supports hybrid (HE) mode propagation and possesses characteristics of backward wave (BW) mode, forward wave (FW) mode, zero-group velocity and mode-degeneracy. The large value of effective index of BW mode and mode-degeneracy mechanism leads to slowing and trapping of electromagnetic (EM) wave. Closed-form guided mode energy propagation expressions has been also derived and computed which exhibits zero power flow at mode degeneracy point. A comparative study is also carried out between extremely anisotropic metamaterial helical waveguide (EAMLHG) and conventional extremely anisotropic metamaterial cylindrical guide (EAMCG), which reveals enhanced slow wave behaviour. Engineering feasible design and analysis is also presented by combining alternate disks of silver and glass as an extremely anisotropic medium which exhibits lossy and dispersive properties. This type of waveguide can find applications as a filter, phase shifter, and delay lines in microwave to THz applications and, as an optical buffer in optoelectronics applications.

Sociodemographic and Clinical Predictors of Self-Management among People with Poorly Controlled Type 1 and Type 2 Diabetes: The Role of Illness Perceptions and Self-Efficacy.

Self-management is critical if people with diabetes are to minimise their risk of macrovascular and microvascular complications, yet adherence to self-management recommendations is suboptimal. Understanding the predictors of optimal diabetes self-management in specific populations is needed to inform effective interventions. This study investigated the role of demographic and clinical characteristics, illness perceptions, and self-efficacy in explaining adherence to self-management recommendations among people with poorly controlled diabetes in North West of England. Illness perceptions and self-efficacy data were collected using validated questionnaires and clinical data were obtained from hospital records. Correlations were used to investigate bivariate relationships between independent variables and self-management, and multiple regression techniques were used to determine demographic and psychosocial predictors of self-management. Various demographic and clinical characteristics were associated with adherence to self-management recommendations. In particular, employment status explained 11% of the variation in adherence to foot care whilst diabetes treatment category explained 9% of exercise and 21% of the variations in SMBG recommendations. Also, 22% and 8% of the variations in overall self-management were explained by illness perceptions and self-efficacy beliefs, respectively. Illness perceptions and self-efficacy beliefs of people with poorly controlled diabetes are important predictors of their self-management behaviours and could potentially guide effective interventions.

A cost-benefit analysis of twice-daily consultant ward rounds and clinical input on investigation and pharmacy costs in a major teaching hospital in the UK.

OBJECTIVES: Misuse of investigations, medications and hospital beds is costing the National Health Service (NHS) billions of pounds with little evidence that approaches centred on reducing overuse are sustainable. Our previous study demonstrated that twice-daily consultant ward rounds reduce inpatient length of stay and suggested a reduction in overuse of investigations and medications. This study aims to assess the impact of daily consultant ward rounds on the use of investigations and medications and estimate the potential cost benefit. SETTINGS: The study was performed on two medical wards in a major city university teaching hospital in Liverpool, UK, receiving acute admissions from medical assessment and emergency departments. PARTICIPANTS AND INTERVENTION: The total number of patients admitted, investigations performed and pharmacy costs incurred were collected for 2 years before and following a change in the working practice of consultants from twice-weekly to twice-daily consultant ward rounds on the two medical wards. OUTCOME MEASURES: We performed a cost-benefit analysis to assess the net amount of money saved by reducing inappropriate investigations and pharmacy drug use following the intervention. RESULTS: Despite a 70% increase in patient throughput (p<0.01) the investigations and pharmacy, costs per patient reduced by 50% over a 12-month period (p<0.01) and were sustained for the next 12 months. The reduction in investigations and medication use did not have any effect on the readmission or mortality rate (p=NS), whereas, the length of stay was almost halved (p<0.01). Daily senior clinician input resulted in a net cost saving of £336,528 per year following the intervention. CONCLUSIONS: Daily consultant input has a significant impact on reducing the inappropriate use of investigations and pharmacy costs saving the NHS more than £650K on the two wards over a 2-year period.

Evaluation of antidiarrheal activity of ethanolic extract of Holarrhena antidysenterica seeds in rats.

AIM: The present study was conducted to evaluate the antidiarrheal effect of ethanolic extract of Holarrhena antidysenterica (Family - Apocynaceae) seeds against induced diarrhea in Wistar albino rats. MATERIALS AND METHODS: The extract was evaluated for castor oil and Escherichia coli induced diarrhea. Extract was given at 100, 200, 400 mg/kg body wt. orally in both protocols. Standard antidiarrheal Loperamide was used at 5 mg/kg body wt. orally in castor oil induced protocol, while standard antibiotic Gentamicin at 8 mg/kg body wt. intraperitoneally was used in E. coli induced diarrhea. In castor oil induced protocol, the percentage inhibition of defecation was calculated for each group, whereas in E. coli induced protocol, change in fecal consistency, and body weight was recorded for each individual rat for 3 days. RESULTS: The severity of castor oil induced diarrhea was reduced significantly (p<0.05) with H. antidysenterica seeds extract at 200 and 400 mg/kg body wt. which showed equivalent effectiveness like that of Loperamide treated groups. Similarly in E. coli induced diarrhea protocol, the mean change in body weight was significantly (p<0.05) higher in positive control, whereas no significant variation was observed in negative control, Gentamicin treated and H. antidysenterica treated group at 200 mg/kg and 400 mg/kg body wt., respectively. CONCLUSION: The study concluded that ethanolic extract of H. antidysenterica seeds effectively controlled diarrhea and decreased the severity of clinical signs of castor oil and E. coli induced diarrhea in Wistar rats.

Infraclavicular brachial plexus block: Comparison of posterior cord stimulation with lateral or medial cord stimulation, a prospective double blinded study.

BACKGROUND: Infraclavicular approach to the brachial plexus sheath provides anesthesia for surgery on the distal arm, elbow, forearm, wrist, and hand. It has been found that evoked distal motor response or radial nerve-type motor response has influenced the success rate of single-injection infraclavicular brachial plexus block. AIM: We conducted this study to compare the extent and effectiveness of infraclavicular brachial plexus block achieved by injecting a local anesthetic drug after finding specific muscle action due to neural stimulator guided posterior cord stimulation and lateral cord/medial cord stimulation. METHODS: After ethical committee approval, patients were randomly assigned to one of the two study groups of 30 patients each. In group 1, posterior cord stimulation was used and in group 2 lateral/medial cord stimulation was used for infraclavicular brachial plexus block. The extent of motor block and effectiveness of sensory block were assessed. RESULTS: All four motor nerves that were selected for the extent of block were blocked in 23 cases (76.7%) in group 1 and in 15 cases (50.0%) in group 2 (P:0.032). The two groups did not differ significantly in the number of cases in which 0, 1, 2, and 3 nerves were blocked (P>0.05). In group 1, significantly lesser number of patients had pain on surgical manipulation compared with patients of group 2 (P:0.037). CONCLUSION: Stimulating the posterior cord guided by a nerve stimulator before local anesthetic injection is associated with greater extent of block (in the number of motor nerves blocked) and effectiveness of block (in reporting no pain during the surgery) than stimulation of either the lateral or medial cord.

The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards.

Excess average length of stay (ALoS) not only results in an increased cost to hospitals but also increases the risk of hospital-acquired infection and thromboembolism. Various factors suggested to affect ALoS have yet to demonstrate a significant impact in clinical practice. Increased consultant input has been identified as an important factor influencing ALoS. As a result, a radical and innovative consultant job plan, replacing twice-weekly with twice-daily ward rounds (WRs) on a university teaching hospital's two medical words has been designed. The number of discharges (NoDs) significantly increased (p < 0.01), ALoS reduced (p < 0.01), whereas, readmission rate and mortality remained unchanged (p = NS) over 12 months following twice-daily WRs compared to two other wards with twice-weekly WRs. This innovative model resulted in almost doubling the NoDs and halving the ALoS. This study suggests that ALoS can be reduced and sustained with a cultural and behavioural shift in consultant working patterns, without affecting readmission rate or inpatient mortality.

Addison's disease presenting with idiopathic intracranial hypertension in 24-year-old woman: a case report.

INTRODUCTION: Idiopathic intracranial hypertension can rarely be associated with an underlying endocrine disorder such as Cushing's syndrome, hyperthyroidism, or with administration of thyroxine or growth hormone. Though cases of idiopathic intracranial hypertension associated with Addison's disease in children have been reported, there is only one documented case report of this association in adults. We describe a case of an acute adrenal insufficiency precipitated by idiopathic intracranial hypertension in a Caucasian female. CASE PRESENTATION: A 24-year-old Caucasian woman was acutely unwell with a background of several months of generalised fatigue and intermittent headaches. She had unremarkable neurological and systemic examination with a normal computerised tomography and magnetic resonance imaging of the brain. Normal cerebrospinal fluid but increased opening pressure at lumbar puncture suggested intracranial hypertension. A flat short synacthen test and raised level of adrenocorticotrophic hormone were consistent with primary adrenal failure. CONCLUSION: Addison's disease can remain unrecognised until precipitated by acute stress. This case suggests that idiopathic intracranial hypertension can rarely be associated with Addison's disease and present as an acute illness. Idiopathic intracranial hypertension is possibly related to an increase in the levels of arginine vasopressin peptide in serum and cerebrospinal fluid secondary to a glucocorticoid deficient state.

The effect of therapeutic irradiation on LactoSorb absorbable copolymer.

Bioabsorbable implants continue to gain popularity in providing temporary internal fixation due to their many advantages over metallic internal fixation. Coincident with the presence of internal fixation devices, it may be necessary to use radiotherapy to treat tumors. While metal implants can alter the distribution of the radiotherapy beam, bioabsorbable polymer implants are, essentially, tissue equivalent. This ionizing irradiation, in sufficiently high dose, can affect polymers through chain scission and cross-linking and accelerate the hydrolysis of absorbable polymers. However, little is known about the effects of therapeutic doses on such materials. This study exposed LactoSorb (Biomet, Inc., Warsaw, IN) absorbable copolymer to doses of x-ray irradiation in a clinically relevant manner, in vitro, with individual doses of 2 Gy administered five days per week for up to eight weeks, yielding a total cumulative dose of up to 80 Gy. Specimens were tested both mechanically and for inherent viscosity. Overall, the LactoSorb specimens withstood exposure to the irradiation exceedingly well, providing empirical evidence of the suitability of this material for temporary internal fixation when subsequent radiotherapy in the region is probable.