Evaluation of the secondary complications in patients of type-ii diabetes mellitus (TIIDM) on allopathic, alternative or combination of medicine system: A cross sectional study.

Progression of diabetes mellitus may leads to secondary complications. Management of such complication is a major challenge for diabetologists. Objective of current study was to evaluate the development of chronic complications in patients of type-II diabetes by comparing their treatment options. This cross sectional study was conducted in outpatient facilities of Karachi from July 2017 to July 2018. 201 type -II DM patients were enrolled in the study. Study was divided into four arms of treatment; herbal, homeopathic, allopathic and combination. Outcome measures were development of acute and chronic complications. Data was analyzed by SPSS 22 version. Finding of study reveals that relative risk reduction of diabetic coma is 50% (p=0.0001) with combination treatment, relative risk reduction of retinopathy is 52% (p=0001) with herbal treatment, relative risk reduction of nephropathy is 58% (p=0.0001) with combination treatment, relative risk reduction of hypertension is 49% (p=0.0001) with herbal treatment, relative risk reduction of myocardial infarction is 15% (p=0.0001) with herbal treatment and relative risk reduction of neuropathies is 27% (p=0.0001) with combination treatment and relative risk reduction of other complications is 12% with allopathic treatment (p=0.20). Finding of study reveals that risk of acute and chronic complications in type-II DM patients is low if they use either herbal system of medicine or combination of different systems of medicine.

Association Between Primary Payer Status and Survival in Patients With Stage III Colon Cancer: An National Cancer Database Analysis.

BACKGROUND: Colon cancer is the third most frequent cancer diagnosis, and primary payer status has been shown to be associated with treatment modalities and survival in cancer patients. The goal of our study was to determine the between-insurance differences in survival in patients with clinical stage III colon cancer using data from the National Cancer Database (NCDB). MATERIALS AND METHODS: We identified 130,998 patients with clinical stage III colon cancer in the NCDB diagnosed from 2004 to 2012. Kaplan-Meier curves and multivariable Cox regression models were used to determine the association between insurance status and survival. RESULTS: Patients with private insurance plans were 28%, 30%, and 16% less likely to die than were uninsured patients, Medicaid recipients, and Medicare beneficiaries, respectively. Medicare patients were 14% were less likely to die compared with uninsured patients. Patients receiving chemotherapy were, on average, 65% less likely to die compared with the patients not receiving chemotherapy. CONCLUSION: Private insurance and a greater socioeconomic status were associated with increased patient survival compared with other insurance plans or the lack of insurance. Future research should continue to unravel how socioeconomic status and insurance status contribute to the quality of care and survival of oncologic patients.

Clinical features and treatment of vulvar Merkel cell carcinoma: a systematic review.

BACKGROUND: Merkel cell carcinoma is a rare and aggressive neoplasm originating from mechanoreceptor Merkel cells of the stratum basale of the epidermis. Cases affecting the vulva are exceedingly rare, with the currently available literature primarily in case report form. BODY: Systematic review of the PubMed database returned 17 cases of Merkel cell carcinoma affecting the vulva. Patients presented at a mean age of 59.6 years with a firm, mobile vulvar mass. Symptoms of pain, erythema, pruritus, edema, and ulceration have been reported. Tumor histology is consistent with that of neuroendocrine tumors and typical Merkel cell carcinomas. Neuroendocrine and cytokeratin immunostains are frequently utilized in histopathological workup. Surgical management was the unanimous first-line therapy with adjuvant radiation in most cases. Recurrence occurred in 70.6% of patients at a mean follow-up of 6.3 months. Mortality was at 47.0% at a mean of 7.8 months after initial operation. CONCLUSION: Merkel cell carcinoma affecting the vulva is an extremely rare and highly aggressive neoplasm. The present review of published cases serves to comprehensively describe the clinical course and treatment approaches for vulvar Merkel cell carcinoma.