Evidence-based risk factors for major complications during Ramadan fasting in people with diabetes grouped under IDF-DAR risk categories.

AIM: To identify evidence-based risk factors for major complications during Ramadan fasting in people with diabetes grouped under IDF-DAR risk categories. METHODS: This prospective observational multicenter study was conducted by Baqai Institute of Diabetology and Endocrinology (BIDE) between April-June 2019. People with diabetes having intention to fast during Ramadan were recruited. Demographic data collection along with risk categorization was done during pre-Ramadan visit. Structured education was given on one- to-one basis to each of the study participants. Assessment of complications was done during post Ramadan visit. RESULTS: A total of 1045 people with diabetes participated with near equal gender distribution. Two thirds of study population was grouped into very high- and high-risk categories. Frequencies of major hypoglycemia, major hyperglycemia, hospitalization & need to break the fast were 4.4%, 10.8%, 0.8% & 3.1% respectively. On multivariate analysis, the risk factors found for major hypoglycemia during Ramadan were male gender, use of sedatives & antidepressants & having type1 diabetes mellitus, history of DKA/HHS during last 3 months for major hyperglycemia, major hypoglycemia & hospitalization for breaking of fast while older age, acute illness, and major hypoglycemia were identified factors for hospitalization. CONCLUSION: In this prospective study evidence-based risk factors for fasting related major complications were identified in people with diabetes. It is imperative to recognize these factors during pre-Ramadan risk assessment visit.

Measuring the gap: from Home Office to the National Health Service in the provision of a one-stop shop sexual health service in a female prison in the UK.

The Genitourinary (GU) Medicine Service was transferred from the Home Office to the NHS from April 2006 at this female prison to give prisoners access to the same quality of health care as the general public. Medline search showed no published data on the prevalence of sexually transmitted infections (STIs) among female prisoners in the UK. The main aim was to develop a one stop sexual health shop and to determine the prevalence and risk factors for STIs, to determine the uptake rate for HIV testing, hepatitis B vaccination and cervical cytology along with requests for usage of contraceptive services. Challenges were met when introducing change to bring the services in line with the local GU medicine clinic. Review of the service at one year along with retrospective case note review from May 2006 to August 2007 was done. Of the 545 new patients seen, history of substance abuse, IVDU, sexual abuse, sex worker and past history of hepatitis C virus and chlamydia were 86%, 41%,12%, 6%, 17% and 24% respectively.The uptake rate for both STI screen and blood-borne viruses (BBVs) testing was high at 87% and 69.3% respectively. STI was diagnosed in 19.6%. Prevalence rates were: Trichomonas vaginalis (TV) 8.2%, chlamydia 5.3%, gonorrhoea 0.2%, genital warts 5.3%, HIV 0.8%, hepatitis C virus 12% and hepatitis B virus 11%. The uptake rate for 1(st) dose hepatitis B vaccination and cervical cytology were 70% and 92% respectively, 36 accessed contraceptive services. Provision of one stop shop in a female prison is feasible and practical. STIs, particularly TV, and BBVs prevalence is high among the female inmates. Prevention methods targeting this population needs to be intensified.

Discrimination of bilateral differences in the loci of tactile stimulation is impaired in subjects with Parkinson's disease.

We have compared the abilities of patients with idiopathic Parkinson's disease (PD), while on levodopa (L-dopa), and control subjects to discriminate bilateral differences in the loci of tactile stimulation. On each trial, one of a subject's forearms served as the reference arm and the other as the test arm. The two forearms were supinated and placed side-by-side on a table-top in front of the subject. Seven cutaneous test loci, 3 mm apart, were arrayed proximo-distally on the flexor aspect of each forearm, with the fourth (central) serving as a reference point. On each trial, two punctate tactile stimuli (of intensity well above perceptual threshold) were applied simultaneously to 1) one of the seven test loci on the test forearm and 2) the reference (central) locus on the reference arm. Subjects, with eyes closed, stated which forearm (test or reference) was stimulated more distally. Estimates of the difference limen (DL, a measure of discriminatory threshold) and the point of subjective equality (PSE, the test locus perceived to correspond to the reference locus) were derived from psychophysical functions (ogives). For each subject, one arm was defined as 'better' and the other as 'worse.' Among PD patients, this definition was in terms of the relative severity of clinical motor signs (combined scores for bradykinesia, rigidity and tremor) of the two arms, whereas among controls it was according to relative DL magnitudes (sensory/perceptual performance). The mean DL of the patients significantly exceeded that of control subjects on both the 'better' and 'worse' arms as test side, but mean PSE values did not differ significantly between groups. Thus, our PD patients were impaired in discriminating bilateral differences in the locations of tactile stimulation, while perceiving normally the relative locations of the proximo-distal centers of the two stimulus arrays.

Identification of unilateral elbow-joint position is impaired by Parkinson's disease.

We have compared the ability of patients with idiopathic Parkinson's disease (PD) with that of control subjects to identify unilateral elbow-joint position, in the absence of direct vision of the arm, by visual reference to a graduated angular scale, placed beside the elbow, across a range of test angles of 90-108 degrees. The positioning of the subject's elbow was achieved under either passive (subject relaxed, Experiment 1) or active (subject contracting, Experiment 2) conditions. PD patients' performance (while on L-dopa medication) with the elbows on the sides of "worse" and "better" motor signs was compared with that of controls with, respectively, the left and right elbows. In both experiments, (a) both the individual, overall mean unsigned (with respect to direction) error averaged across all test angles (accuracy), and the SD about this mean (precision), were significantly larger on each side among PD patients than among controls, and (b) the subjective ranges of values employed by PD patients were substantially compressed, on average, by comparison with those of controls. Within-group analyses revealed that (a) among control subjects, but not among PD subjects, individual, overall mean unsigned errors, on each side, averaged across test angles, were significantly smaller under active than under passive conditions, and (b) the subjective ranges employed by PD patients, but not by controls, under active conditions significantly exceeded those under passive conditions. We conclude that these results are generally consistent with the notion that PD impairs unilateral elbow-joint position sense.