Long-term diabetic complications

Maturity-onset diabetes of the young (MODY) is a monogenic, autosomal dominant form of diabetes that typically presents before the age of 25. It is caused by mutations in single genes involved in insulin production and glucose regulation, leading to various subtypes, including Hepatocyte Nuclear Factor 1 Alpha-MODY (HNF1A-MODY), Glucokinase-MODY (GCK-MODY), Hepatocyte Nuclear Factor 4 Alpha-MODY (HNF4A-MODY), and Hepatocyte Nuclear Factor 1 Beta-MODY (HNF1B-MODY), each with unique clinical characteristics and treatment responses. For instance, HNF1B-MODY is often associated with renal anomalies, while HNF1A and HNF4A subtypes commonly respond well to sulfonylureas. Unlike Type 1 and Type 2 diabetes, MODY usually manifests as mild to moderate hyperglycemia, making tailored treatment essential. Genetic testing plays a critical role in diagnosis, guiding personalized management strategies that may include specific medications, lifestyle adjustments, and vigilant monitoring to mitigate complications. Preventive care, routine health checkups , and comprehensive patient education are crucial for effective MODY management, ultimately enhancing the quality of life for individuals living with this condition.

Il meeting si svilupperà in 3 sessioni. Nella prima sessione si parlerà del sale nella storia
dell’umanità e nell’alimentazione. Nella seconda sessione parleremo del rischio cardiovascolare
con particolare riferimento all’ipertensione arteriosa, alla dislipidemia, all’obesità. Nella terza
sessione ci occuperemo del paziente anziano, delle vaccinazioni e del monitoraggio glicemico.

The fractures involving the ankle are common injuries that treated by orthopaedic surgeons. Patients with diabetes who sustain an ankle fracture are at increased risk for complications including higher rates of in hospital mortality, in-hospital postoperative complications and length of stay. There is special concern about the surgical treatment of closed ankle fractures in the diabetic population due to the belief that there may be a greater risk of infection and complications. Medical literature supports the fact that diabetes mellitus impairs the patient's immune, renal, vascular and nervous systems leading to chronic complications. A common problem in the diabetic patient is the development of ulcers in the foot and ankle region secondary to sensory deficits. Frequently, these ulcers become infected and jeopardize the prognosis of the affected limb. The problem is accentuated when a bone fracture is involved because altered blood flow to the extremity retards soft tissue hea...

Primary Study Objective: Purpose of the study was to assess to risk factors of diabetes type II and complications in diabetic patient of tertiary care hospital. Methods/Design: Cross sectional study conducted to evaluate the risk factors associated with diabetes Mellitus. Setting: Tertiary hospitals of Islamabad and Azad Kashmir was selected for the current study. Participants: 50 patients assessed without any gender discrimination age between 35 to 85 years for risk factors and complications. Intervention: Data was collected from patients that were bed ridden admitted in hospitals. A total of 50 patients were included in this study with age limit more than 35 years and without any discrimination of gender. Primary Outcome Measures: In tertiary care hospitalized patient's obesity, inactivity and family history were the major risk factor for diabetes mellitus type 2 and we calculated the obesity, inactivity and family history percentage in diabetic patients 63%, 49% and 67% respectively. Results: Percentage of risk factors calculated the obesity, inactivity and family history in diabetic patients 63%, 49% and 67% respectively. Macro vascular complications in patients with diabetes mellitus type 2 were stroke 3%, angina 8%, hypertension and cognitive impairment have highest percentages i.e., 78%. 46% patients were suffering from ulceration; gangrene and amputation have percentages 19% and 3% respectively. Patients with microvascular complications of diabetic nephropathy were assessed for their albuminuria 25%, edema 32% and incontinence 28%. Conclusion: These complications can be avoided if patients of DM type 2 adopt a healthy lifestyle, do exercise and monitor their blood glucose levels regularly. Patients should also control their blood pressure to avoid damage to their microvasculature.

The common presenting symptoms of pancreatic cancer are abdominal pain, weight loss, and jaundice. Pancreatic adenocarcinoma presenting with diabetic ketoacidosis is a very rare emergent clinical condition. However, pancreatic ductal cystadenocarcinoma presenting with diabetic ketoacidosis was not reported. We describe a 60-year-old man with pancreatic cystadenocarcinoma presenting with diabetic ketoacidosis as the initial manifestation. It must be kept in mind that in diabetic ketoacidosis cases, the precipitating factor may be pancreatic ductal cystadenocarcinoma.

Background: Uncontrolled Diabetes mellitus (DM) has important negative health consequences. Chronic hyperglycemia is associated, in the long term with dysfunction and insufficiency of several organs including Macro and Micro Vascular Complication. Therefore, the present study aimed to detect the prevalence and risk factors of macro and micro vascular complication among controlled and uncontrolled DM patients in Sana'a city /Yemen. Methods: This study was carried out by the collection of specimens from 225 of patients with confirmed DM internal medicine and diabetes clinics", Al-Aulaqi specialized laboratories, Republican Teaching Hospital Authority, and Baghdad laboratories in Sana'a City-Yemen. from June 2022 to June 2023. The patients questionnaire included type of diabetes, complications of diabetes and risk factors after insure from taken checkups or from paper of the patients. Also taken the blood tests and checkups from records of the laboratories and patient's papers. Results : A total of 225 patients with DM including type 1(T1) and type 2(T2) in addition to gestational diabetes mellitus(GDM), 176 uncontrolled DM patients compared with 49 controlled DM patient. All complications prevalence between DM patents were more spread in uncontrolled DM patients compared with 49 controlled DM patients and the most prevalence of them was peripheral neuropathy and retinopathy. The risk factor that decrease the glucose in the blood as well as complication were diet, physical activity, and insurance status all of this risk factors were more prevalence among controlled DM compared with uncontrolled DM patients. While the risk factor that increase the glucose in the blood s well s complication were qat chewing and smoking, this two risk factors were more prevalence in uncontrolled DM compared with controlled DM patients. Conclusion:. Control of risk factors and control of glucose in the blood help to decrease the severity of diabetes and associated macro and micro vascular complications. The study recommended that DM patients should have regular HbA1c and regular risk factors such as diet and physical activity and quit qat chewing and smoking to avoid dangerous complications associated with diabetes disease.

Roux-en-Y gastric bypass (RYGB) is a highly effective bariatric surgery for morbid obesity, but long-term nutritional deficiencies remain a significant concern. This paper evaluates the prevalence, risk factors, and management strategies for nutritional deficiencies post-RYGB, utilizing clinical data and literature review. Key findings highlight deficiencies in vitamin B12, iron, calcium, and vitamin D as the most common sequelae, necessitating lifelong supplementation and monitoring.

Besides, the Journal publishes selected important medical abstracts which have recently been accepted for publication elsewhere, along with their Arabic translation to facilitate communication. The Journal will also publish the activities and news of the Arab Board of Health Specializations.

The high prevalence of UTIs among DM patients, which attribute to various impairments in the immune system (low urinary concentration of interleukin-8 and interleukin-6, lower urinary leucocyte cell count). In addition, poor metabolic control and incomplete bladder emptying due to autonomic neuropathy may all contribute to the enhanced risk of UTIs in these patients DM is associated with UTIs through its effect on the host immune system. Therefore detect the incidence of bacterial UTIs in controlled and uncontrolled DM patients in Sana'a City-Yemen, Determine the suitable antibiotics susceptibility against bacterial UTIs in controlled and uncontrolled DM patients, Explore the relationship between bacterial UTIs and the main risk factors in controlled and uncontrolled DM patients. In this cross-sectional study , urine sample were collected from 225 participants from Prof. Mohammed Bamashmous Internal Medicine, Republication Authorized Teaching, Al-Olaqi Specialized Laboratories and Baghdad Laboratories The sample was processed by physical, chemical and microscopic examination and cultured in CLED agar, Maconky agar and blood agar, after incubation the sample in 37 0 C aerobically was proceed by Gram stain and biochemical test. Among the 225 analyzed samples, 49 (21.8%) were showing sterile urine samples, while 9 (4.0%) showed mixed growth of bacteria possibly due to improper collection of the sample. The remaining 122 (54.2%) samples were positive(significant)with colony count 10 5 CFU|ml, 34 (15.1%)ware positive(suspected) with colony count 10 3-10 4 CFU\ml , 11 (4.9%)ware non-significant with colony countless than10 2 for The number of subjects with UTI was clearly higher in the uncontrolled glycemic group (𝑛 =158, 89.8%) in comparison to the controlled glycemic group (𝑛 =18, 10.2%). Our results showed that T2DM was more prevalent (145,78.7%) than T1DM (39,17.3%)and GDM (9,4%) in uncontrolled DM than controlled DM. The women's show high spread of UTIs than men especially in uncontrolled DM than controlled DM this was significant < 0.05. The prevalence and the distribution of Gramnegative more than Gram-positive bacteria isolated from the clinical samples for both controlled and uncontrolled glycemia groups. E.coli (77,49.4%) was the dominant and significant in UTIs <0.01 The high prevalence of UTI confirms that uncontrolled DM is significantly associated with more UTI and regulation of glucose helped to reducing the complications and urinary tract infection. Diabetic patients especially uncontrolled women, are recommended to subuit mid-stream urine specimens at regular intervals for culture and routine investigations even the absence of any urinary tract symptoms

Background: Uncontrolled Diabetes mellitus (DM) has important negative health consequences. Chronic hyperglycemia is associated, in the long term with dysfunction and insufficiency of several organs including Macro and Micro Vascular Complication. Therefore, the present study aimed to detect the prevalence and risk factors of macro and micro vascular complication among controlled and uncontrolled DM patients in Sana'a city /Yemen. Methods: This study was carried out by the collection of specimens from 225 of patients with confirmed DM internal medicine and diabetes clinics", Al-Aulaqi specialized laboratories, Republican Teaching Hospital Authority, and Baghdad laboratories in Sana'a City-Yemen. from June 2022 to June 2023. The patients questionnaire included type of diabetes, complications of diabetes and risk factors after insure from taken checkups or from paper of the patients. Also taken the blood tests and checkups from records of the laboratories and patient's papers. Results : A total of 225 patients with DM including type 1(T1) and type 2(T2) in addition to gestational diabetes mellitus(GDM), 176 uncontrolled DM patients compared with 49 controlled DM patient. All complications prevalence between DM patents were more spread in uncontrolled DM patients compared with 49 controlled DM patients and the most prevalence of them was peripheral neuropathy and retinopathy. The risk factor that decrease the glucose in the blood as well as complication were diet, physical activity, and insurance status all of this risk factors were more prevalence among controlled DM compared with uncontrolled DM patients. While the risk factor that increase the glucose in the blood s well s complication were qat chewing and smoking, this two risk factors were more prevalence in uncontrolled DM compared with controlled DM patients. Conclusion:. Control of risk factors and control of glucose in the blood help to decrease the severity of diabetes and associated macro and micro vascular complications. The study recommended that DM patients should have regular HbA1c and regular risk factors such as diet and physical activity and quit qat chewing and smoking to avoid dangerous complications associated with diabetes disease.

Aims

To synthesise and evaluate new amino biaryl-urea (3a-h) and Schiff base urea derivatives (5a-h) for their in vitro antidiabetic activity against α-glucosidase and α-amylase.
Materials and Methods

A series of Schiff base urea derivatives were synthesised through a two-step procedure: condensation of 4-chloro-o-phenylenediamine with isocyanates to form amino biaryl-urea derivatives (3a-h), followed by reaction with 2-hydroxy-naphthaldehyde. The new compounds were characterized using 1H and 13C NMR, as well as high-resolution mass spectrometry. Inhibition assays were conducted to determine IC50 values of all compounds against α-amylase and α-glucosidase.
Results

Derivatives 3g and 3h exhibited the strongest enzyme inhibition, with IC50 values of 10.06 ± 0.32 µM (α-amylase) and 21.23 ± 1.27 µM (α-glucosidase), respectively. These compounds displayed activity comparable to the standard drug acarbose. Docking studies revealed that 3g interacts with key residues TRP59 and GLN63 of α-amylase, supporting the experimental findings.
Conclusions

The di-fluoro and di-chloro substituents in compounds 3g and 3 h enhance their antidiabetic activity, suggesting their potential as effective inhibitors of carbohydrate-metabolizing enzymes. Further studies are warranted to explore the therapeutic applications of these derivatives.

Background and objectives Diabetic foot ulcers (DFUs) present significant challenges due to their chronicity and potential complications. This study aims to compare the efficacy of platelet-rich plasma (PRP) versus normal saline dressing (NSD) in promoting wound healing and reducing complications among diabetic patients. Materials and methods This comparative study enrolled diabetic patients with foot ulcers, randomly assigned to either PRP or NSD treatment groups. Demographic data, ulcer characteristics, and treatment outcomes were meticulously recorded and analyzed. Statistical tests, including paired and independent samples t-tests, chi-square tests, and descriptive statistics, were employed to assess differences between the groups. Results Both groups exhibited similar age distributions, with PRP showing a slightly wider range. Sex distribution was identical between the NSD and PRP groups. PRP therapy demonstrated significant wound size reduction compared to NSD, with notable improvements in ulcer healing rates and reduced rates of complications and surgical interventions. Microbiological analysis revealed comparable infection rates between groups, with PRP potentially reducing infection-related complications. Interpretation and conclusion PRP therapy appears to offer superior efficacy over NSD in promoting DFU healing, as evidenced by substantial reductions in ulcer size and lower rates of complications. This study supports PRP as a promising treatment modality for DFUs, potentially enhancing clinical outcomes and reducing healthcare burdens.

The high prevalence of UTIs among DM patients, which attribute to various impairments in the immune system (low urinary concentration of interleukin-8 and interleukin-6, lower urinary leucocyte cell count). In addition, poor metabolic control and incomplete bladder emptying due to autonomic neuropathy may all contribute to the enhanced risk of UTIs in these patients DM is associated with UTIs through its effect on the host immune system. Therefore detect the incidence of bacterial UTIs in controlled and uncontrolled DM patients in Sana'a City-Yemen, Determine the suitable antibiotics susceptibility against bacterial UTIs in controlled and uncontrolled DM patients, Explore the relationship between bacterial UTIs and the main risk factors in controlled and uncontrolled DM patients. In this cross-sectional study , urine sample were collected from 225 participants from Prof. Mohammed Bamashmous Internal Medicine, Republication Authorized Teaching, Al-Olaqi Specialized Laboratories and Baghdad Laboratories The sample was processed by physical, chemical and microscopic examination and cultured in CLED agar, Maconky agar and blood agar, after incubation the sample in 37 0 C aerobically was proceed by Gram stain and biochemical test. Among the 225 analyzed samples, 49 (21.8%) were showing sterile urine samples, while 9 (4.0%) showed mixed growth of bacteria possibly due to improper collection of the sample. The remaining 122 (54.2%) samples were positive(significant)with colony count 10 5 CFU|ml, 34 (15.1%)ware positive(suspected) with colony count 10 3-10 4 CFU\ml , 11 (4.9%)ware non-significant with colony countless than10 2 for The number of subjects with UTI was clearly higher in the uncontrolled glycemic group (𝑛 =158, 89.8%) in comparison to the controlled glycemic group (𝑛 =18, 10.2%). Our results showed that T2DM was more prevalent (145,78.7%) than T1DM (39,17.3%)and GDM (9,4%) in uncontrolled DM than controlled DM. The women's show high spread of UTIs than men especially in uncontrolled DM than controlled DM this was significant < 0.05. The prevalence and the distribution of Gramnegative more than Gram-positive bacteria isolated from the clinical samples for both controlled and uncontrolled glycemia groups. E.coli (77,49.4%) was the dominant and significant in UTIs <0.01 The high prevalence of UTI confirms that uncontrolled DM is significantly associated with more UTI and regulation of glucose helped to reducing the complications and urinary tract infection. Diabetic patients especially uncontrolled women, are recommended to subuit mid-stream urine specimens at regular intervals for culture and routine investigations even the absence of any urinary tract symptoms

Besides, the Journal publishes selected important medical abstracts which have recently been accepted for publication elsewhere, along with their Arabic translation to facilitate communication. The Journal will also publish the activities and news of the Arab Board of Health Specializations.

Background/Objectives: Advanced destruction of the ankle and subtalar joints due to neuropathy, chronic infection, or inflammatory conditions presents a major surgical challenge, often resulting in limb amputation. This descriptive retrospective study aims to evaluate outcomes of reconstructive surgery in patients, in whom limb preservation was prioritized over amputation despite significant soft tissue and osseous involvement. Methods: Between January 2013 and December 2022, 31 reconstructive procedures were performed on 29 patients (16 women and 13 men) with severe hindfoot deformities. Etiologies included Charcot arthropathy (55%), osteomyelitis (25%), combined pathology (10%), and rheumatoid deformity with skin defect (10%). Surgical procedures included tibiotalocalcaneal arthrodesis (39%), astragalectomy with tibiocalcaneal arthrodesis (32%), tibiotalar arthrodesis (23%), and multistage procedures (6%). Fixation methods varied based on the extent of deformity and infection. The union was assessed via radiographs and CT imaging, and outcomes were statistically analyzed using Fisher’s exact test. Results: Successful arthrodesis was achieved in 74% of cases (23/31). The union rate was significantly influenced by the type and level of fixation (p = 0.0199), with the lowest rate observed in tibiotalocalcaneal arthrodesis using external fixation (17%). Complications included surgical site infection or abscess in 42% of cases, requiring reoperation in 35%. Limb amputation was ultimately necessary in five patients (16%). Conclusions: Despite high complication rates, limb-preserving reconstructive surgery remains a viable alternative to amputation in selected high-risk patients with severe hindfoot pathology. Appropriate preoperative planning, tailored surgical strategy, and patient compliance are essential to achieving functional limb salvage and restoring weight-bearing capacity.

Diabetic foot ulcers (DFU) are chronic skin ulcers associated with deep tissue destruction around the foot and ankle region with varying degrees of lower extremity vasculopathy and neuropathy. Diabetic foot ulcer is associated with a high rate of morbidity, disability, mortality and psycho-social cost.

Introduction: Diabetic foot ulcer (DFU) is a major cause of lower limb amputations. Many treatment recommendations have been proposed. This study was conducted to evaluate the effectiveness of topical sucralfate when combined with mupirocin ointment, in the treatment of diabetic foot ulcer in comparison to topical mupirocin alone, in terms of healing rates. Methods: This open-labeled randomized study was conducted on 108 patients to evaluate the effectiveness of topical sucralfate and mupirocin combination, compared to topical mupirocin alone. The patients were administered the same parenteral antibiotic, and wounds were subjected to daily dressing. The healing rates (determined by the percentage reduction in wound area) in the two groups were calculated. The mean healing rates in both groups were expressed in percentage and compared using the Student's t-test. Results: A total of 108 patients were included in the study. Male-to-female ratio was 3:1. The incidence of diabetic foot was the highest (50.9%) in the age group of 50-59 years. The mean age of the study population was 51 years. The incidence of diabetic foot ulcers was highest in the months of July-August (42%). A total of 71.2% patients had random blood sugar levels between 150-200 mg/dL, and 72.2% patients had diabetes for five to 10 years. The mean±standard deviation (SD) of the healing rates in the sucralfate and mupirocin combination group and the control group were 16.2±7.3% and 14.5±6.6%, respectively. Comparison of the means by Student's t-test failed to show a statistical difference in healing rates between the two groups (p=0.201). We concluded that the addition of topical sucralfate does not show any obvious benefits in terms of healing rates in diabetic foot ulcers as compared to mupirocin alone.

Besides, the Journal publishes selected important medical abstracts which have recently been accepted for publication elsewhere, along with their Arabic translation to facilitate communication. The Journal will also publish the activities and news of the Arab Board of Health Specializations.

Background: Uncontrolled DM has important negative health consequences. Chronic hyperglycemia is associated, in the long term with dysfunction and insufficiency of several organs including Macro and Micro Vascular Complication. Therefore, the present study was aimed to detect the prevalence and risk factors of macro and micro vascular complication among controlled and uncontrolled DM patients in Sana'a city \Yemen. Methods: This study was carried out by the collection specimens from 225 of patients with confirmed diabetes mellitus (DM) attending to Prof. Mohammed Bamashmous" internal medicine and diabetes clinics", Al-Aulaqi specialized laboratories, Republicon Teaching Hospital Authority, and Baghdad laboratories in Sana'a City-Yemen. from June 2022 to June 2023. The patients questionnaire including type of diabetes , complication of diabetes, risk factors after insure from taken checkup or from paper of the patients. Also taken the blood tests and checkups from records of the laboratories and from patient's papers. Results : A total of 225 patients with DM include type 1(T1) and type 2(T2) in addition to gestational diabetes mellitus(GDM), 176 uncontrolled DM patients compared with 49 controlled DM patient. All complication prevalence between DM patents were more spread in uncontrolled DM patients compared with controlled DM patients and the most prevalence of them was peripheral neuropathy and retinopathy. The risk factor that decrease the glucose in the blood as well as complication were diet, physical activity, and insurance status all of this risk factors were more prevalence among controlled DM compared with uncontrolled DM patients. While the risk factor that increase the glucose in the blood s well s complication were qat chewing and smoking , this two risk factors were more prevalence in uncontrolled DM compared with controlled DM patients. Conclusion:. Control of risk factor and control of glucose in the blood help to decrees the severity of diabetes and associated macro and micro vascular complication. The study recommended that DM patients should be regular HbA1c and regular the risk factors such as diet and physical activity and quit qat chewing and smoking to avoid dangerous complication associated with diabetes disease.

Diabetic nephropathy (DN) is the leading cause of chronic kidney diseases and end stage renal failure. We had designed this study to find out the prevalence of diabetic nephropathy and its risk factors among Yemeni patients with type 2-diabetes mellitus. Methods: This study was carried out in Al-Kuwait University Hospital (KUH), Sana'a City (Yemen), on the period between 4 of November 2011 to 1 of December th st 2012. Five hundred (500) Type 2 diabetic patients (diagnosed according to ADA criteria for diagnosis of diabetes) were selected). Two overnight urine samples per patient were analyzed. Albumin concentration was measured by an automated immunoturbidity assay. Diabetic nephropathy was defined according to American Diabetic Association when using the random collection technique, normal albumin excretion should be defined as <30 mcg/mg of creatinine; micro albuminuria(MA) 30 to 299 mcg/mg of creatinine, and macro albuminuria(MAA) is >300 mcg/mg of creatinine.Information obtained also included age, diabetes duration, sex, body mass index, blood pressure, serum total high-density and low-density lipoprotein cholesterol, triglycerides, serum creatinine, and glycated hemoglobin (HbA1C). Results revealed that in Five hundred type-2 diabetic patients (280 females and 220 males). 332 patients (66.4%) were normalbuminuric (NA), 168 (33.5%) had diabetic nephropathy, 106 (21.2%) of them had MA and 62 (12.4%) had MAA. There was significant difference among patients with diabetic nephropathy (DNP) (both MA, and MAA) and those without nephropathy regarding age, male gender, BMI or the time actually elapsed since the diabetes were diagnosed. 38.8% of patients with NA and 75% ofpatients with DNP had hypertension. DNP patients were more frequently smokers and former smokers, than NA patients (21.9% VS 33.9%). There was significant correlation between NA patients, and DNP patients regarding poor glycemic control (42.7% VS 64.8%), serum (se) TG (19.5% VS 55.9%), se HDL cholesterol(18.6% VS 61.3%) and se LDL cholesterol (19.2% VS 49.4%) (P O.005). In conclusions, Prevalence of DNP is high among type 2-diabetic Yemeni patients and high BP was the commonest co-morbidity. These findings highlight an urgent need to develop strategies for prevention, detection and treatment of DNP that could contribute to decreasing the rising incidence of CVD and CRF.

Background: Diabetes and chronic kidney disease (CKD) are major public health burden in a developing country like Bangladesh. Chronic hyperglycemia in diabetes mellitus (DM) leads to serious microvascular complications. Aim: To assess gender-based differences in the prevalence and severity of microvascular complications and chronic kidney disease (CKD) among diabetic patients at a tertiary-level hospital in Bangladesh. Method: This cross-sectional study was conducted at the outpatient department of a tertiary-level hospital in Bangladesh between July 2022 to December 2022 and included 282 diabetic patients (182 males and 100 females). Data were collected using structured questionnaires from medical records, and laboratory test results. Demographic details, clinical characteristics, biochemical parameters, and microvascular complications were assessed. CKD stages were determined using estimated glomerular filtration rate (eGFR). Results: Out of 282 diabetic patients (182 males, 100 females) with most aged between 40-60 years, the highest age group among males was 50-60 years (38%) and among females that was 40-50 years (36%). Females were more likely to be from urban areas (68% versus 52%, p= 0.024) and showed non-significant trends toward higher rates of hypertension (34.3% versus 26.5%) and family history of diabetes (52% versus 40.9%). Biochemical parameters-including renal status, lipid levels, and glycemic markers were compared between sexes. However, females had significantly lower mean eGFR (22.88 ml/minute/1.73m² versus 27.8 ml/minute/1.73m², p= 0.006), with 46.1% in CKD Stage IV compared to 35.4% of males. Among males, advanced CKD stages were significantly associated with proliferative diabetic retinopathy (p<0.001) and neuropathy (p= 0.008). Conclusion: These results are clear indication that there is considerable difference in prevalence of different microvascular diabetic complications related to chronic kidney disease between male and female. There are social, economic, and perhaps metabolic reasons for these differences.

This study investigates factors associated with non-adherence to continuous drug therapy in individuals 40 years and older. A populationbased survey was conducted in Cambé, Paraná State, Brazil. Treatment adherence was assessed with the four-item Morisky et al. medication adherence scale. The study also assessed sociodemographic variables and health services access and use of medication. Among 1,180 interviewees, 78% reported use of medication, with continuous use in 55%. The study analyzed 639 individuals, the majority female, ranging from 40 to 59 years of age, with low schooling, and from socioeconomic stratum C (on a scale from A to E). Prevalence of non-adherence was 63.5%. Mean therapeutic complexity was 8.1. After adjusted analysis, the following factors remained associated with non-adherence: not being assisted by community health workers, discontinuous access to medication, and high frequency of medication throughout the day. The results indicate high prevalence of non-adherence, with potentially negative impacts for individuals and society. Medication Adherence; Pharmacoepidemiology; Therapeutics; Chronic Diseases Resumo O presente estudo investiga os fatores associados a não adesão à terapia medicamentosa contínua em indivíduos de 40 anos e mais de idade. Foi realizado um inquérito de base populacional em Cambé, Paraná, Brasil. A adesão à terapia foi avaliada pela escala de quatro itens de Morisky et al. e analisaram-se também variáveis sociodemográficas, de utilização dos serviços de saúde e do uso de medicamentos. Foram entrevistados 1.180 indivíduos, dos quais 78% utilizaram medicamentos nos 15 dias anteriores à entrevista e em 55% registrou-se o uso contínuo. A amostra do estudo consistiu em 639 indivíduos, com predominância do sexo feminino, idade entre 40 e 59 anos, baixa escolaridade. A prevalência de não adesão foi de 63,5%. Após análise ajustada, permaneceram associados a não adesão: não ser acompanhado pelo agente comunitário de saúde, ter tido descontinuidade no acesso aos medicamentos e a elevada frequência de utilização dos medicamentos ao longo do dia. Os resultados indicam uma alta prevalência da não adesão com possíveis impactos negativos para os indivíduos e para a sociedade.

Aim: To assess sex-specific analyses and trends in the prevalence, awareness, treatment and control of hypertension in non-diabetic and type 2 diabetic patients. Methods: A total number of 5665 men and 6174 women of age 3564 years in 1987, 1992 and 1997 were randomly sampled. Blood pressure measurements and a questionnaire on the presence or absence of type 2 diabetes, blood pressure history and treatment modalities were applied. Two criteria of hypertension measurements were applied based on the minimum of 130/80mmHg and maximum of 160/95mmHg. Statistical analyses were based on ANOVA or logistic regression to test the difference between study-year and age-group. Results: The prevalence rate for hypertension in non-diabetic patients decreased for both sexes within the study years, with men having the higher rates; whereas diabetic trend increased in hypertensive with the rates higher in women. Awareness of hypertension was more evident in diabetic than non-diabetic patients, with women showing more awareness. Treatment with control was better for women, and increased favorably during the years. In both sexes, diabetic patients with increased blood pressure sought treatment more than non-diabetic hypertensive. Conclusion: Pharmacological treatment modality of high blood pressure may tremendously abate morbidity and mortality in non-diabetic and diabetic individuals presenting with hypertension, but standard for optimal control of blood pressure may not be achieved in a clinical or community setting. What may be necessary are changes in lifestyle, substantial pharmacological and non-pharmacological treatment to improve the diagnosis for this extant expansive patient community.

1 MSc, Department of Nursing, Nursing and Midwifery School, Islamic Azad University Isfahan, Isfahan Branch (Khorasgan), Isfahan, Iran 2 Associate Professor, Department of Nursing, Nursing and Midwifery School, Islamic Azad University Isfahan, Isfahan Branch (Khorasgan), Isfahan, Iran * Corresponding author: Shayesteh Salehi, Associate Professor, Department of Nursing, Nursing and Midwifery School, Islamic Azad University Isfahan, Isfahan Branch (Khorasgan), Isfahan, Iran. E-mail: sh.salehi@khuisf.ac.ir

Background: Diabetes mellitus (DM) causes significant morbidity and mortality in sub-Saharan Africa (SSA), including Somalia. Among diabetic patients, diabetic foot ulcers (DFUs) constitute the largest proportion of admissions, amputations, and mortality. The aim of this study is to assess the prevalence of diabetic foot ulcers and subsequently determine factors associated with it among diabetic patients at three major hospitals in Somalia. Methods: An institutional-based cross-sectional study was conducted among 193 diabetic patients between August and November 2022. All eligible diabetes patients who were attending De Martini Hospital, Madina General Hospital, and Deynile General Hospital during the study period were included in the study. Patients were interviewed using a structured questionnaire. We collected demographic, clinical, and behavioral variables from all participants. A bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. An odds ratio with a 95% confidence interval was computed to determine the level of significance. Result: The mean age of the study's participants was 50.9 ± 13.6 years. The prevalence of diabetic foot ulcer was 15%. Patients who were either overweight or obese (OR 4.63, CI: 2.08-10.30), had a lack of family support in managing diabetes (OR 3.33, CI: 1.74-6.36), and did not check their feet regularly were more likely to develop DFU (OR 1.99, CI:1.08-3.66). Conclusion: Increased body mass index, lack of family support, and not checking feet regularly were associated with DFUs. The high prevalence of DFUs and the plethora of needs of people with DFUs pose challenges for health care. A coordinated health care system is necessary to meet the needs of diabetic patients and prevent DFUs.

Abstract
Background and aims
The outcome of a diabetic foot ulcer (DFU) may be affected by many factors, including the clinical anatomy
of the ulcer, metabolic control, the presence of complications, and infections. This study evaluates the effect
of metabolic factors, the clinical anatomy of the ulcer at presentation, and antibiotic appropriateness on
treatment outcomes in terms of amputation in patients with diabetic foot (DF).
Materials and methods
This is a cross-sectional observational study involving data collected from patients with IPD diagnosed with
type 2 diabetes mellitus and DFU at a tertiary care DF specialty hospital in Maharashtra, India.
Results
Data from a total of 106 patients were included for analysis. Fifty-two patients healed without
amputation while 54 underwent either minor or major amputation. Patients who did not require amputation
had a statistically significant higher incidence of cellulitis, ulcers at the heel and lateral malleolus, and
ulcers classified as Wagner grade 1 or 2. In contrast, factors significantly associated with amputation
included lower weight and BMI, multiple ulcers at presentation, ulcers involving the second, third, fourth, or
fifth toe, midfoot, or medial malleolus, ulcers graded 3, 4, or 5, and additional surgery performed during the
same hospital admission. The most commonly collected specimen was pus, followed by tissue and bone. The
most frequently isolated microorganisms were Escherichia (E.) coli and Klebsiella. All microorganisms were
sensitive to Piperacillin-Tazobactam and matched the initially prescribed antibiotic, which was chosen as
per the hospital antibiogram. Angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor
blockers (ARBs) were prescribed more frequently in the non-amputation group while insulin use was higher
in the amputation group, although there was no significant difference in the use of metabolic drugs between
the two groups.
Conclusion
The anatomical location of the wound, advanced grade, number of ulcers, additional procedures, nutritional
status, and the presence of Coagulase-negative Staphylococcus aureus in tissue are significant predictors of
amputation.
Categories: General Surgery, Endocrinology/Diabetes/Metabolism, Orthopedics
Keywords: amputation, diabetic foot, diabetic foot ulcers, surgery, treatment outcome

In diabetes mellitus (DM), the ability of the myocardium to fully relax and fill with blood during diastole is impaired. Clinical observations by various authors confirm the presence of myocardial hypertrophy in patients with diabetes; in particular, an increase in the thickness of its posterior wall and interventricular septum has been established. In this regard, of undoubted interest is the study of the relationships between the frequency, structure, and severity of pathogenetic morphometric disorders of the heart in animals with experimental models of alloxan and streptozotocin diabetes. This study aimed to study morphometric changes in the heart in animals at different stages of development using models of experimental alloxan and streptozotocin diabetes. In this study, 450 rats with experimental diabetes were studied (intravenous administration of alloxan 35 mg kg-1): Model 1:  alloxan diabetes (group A): divided into subgroups: A1: 6 months of observation (50 animals in each subgroup); A2: 12 months; A3: 24 months; Model 2: streptozotocin diabetes (group C): C1: 6 months; C2: 12 months; C3: 24 months. CI: control group of intact rats: CI1: 6 months (30 individuals per subgroup); CI2: 12 months; KI3: 24 months. They received a single injection of sterile saline solution into the femoral vein. Morphometric studies, volumetric ratios of tissue components were determined using an ocular measuring grid for cytohistostereometric studies. Avtandilova Statistical methods were used for studying the significance of the linear correlation coefficient (Pearson) and the rank coefficient (Spearman), then checked based on Student's t-test. In this study, upon extraction, the animal's heart was processed, dried, and weighed on a torsion balance. Weight in animals KI1 heart weight was 3.5 g with a total weight of 195.4 g. In animals with intravenous administration of alloxan, the heart weight (p < 0.05) was in the range of 3.7-3.9 g with a total weight of 194.4 -195.7 g in streptozotocin diabetes, the weight of rats heart (p < 0.05) was 4.0-4.1 g with a total weight of 193.2-193.5 g. In a morphometric study of experimental animals' right and left ventricles and pulmonary arteries, the indicators were higher in group A3. The volume of right ventricle in alloxan-induced diabetes was significantly (p < 0.05) greater than in the control groups. In the case of morphometric indicators of the rats heart with streptozotocin diabetes, pronounced ultrastructural changes distinguished cardiomyocytes. Lysis of cristae and outer mitochondrial membranes with the formation of myelin figures and dense protein bodies, were observed for alloxan diabetes at 24 months. Processes of hypertrophy of cardiomyocytes prevailed; nuclei volume increased (p < 0.05) by 34.6%, and euchromatin content and mitochondria increased by 23.8%.

Diabetic foot ulcers (DFU) are chronic skin ulcers associated with deep tissue destruction around the foot and ankle region with varying degrees of lower extremity vasculopathy and neuropathy. Diabetic foot ulcer is associated with a high rate of morbidity, disability, mortality and psycho-social cost.

Objective: Inadequate glycemic control amongst patients with Type 2 diabetes mellitus (T2DM) indicates a major public health problem and a significant risk factor for the progression and complications caused by diabetes. Glycemic control is the main therapeutic objective for preventing organ damage and other complications arising from diabetes. Methods: 225 type 2 diabetic patients (previously diagnosed as having type 2 DM) where included in this cross sectional study, which is conducted in

Indian medicinal plants are profoundly used in the ancient Siddha system of medicine. These plants are attaining an immense interest in the field of research, due to their safety, efficacy and easy acessibility. Avirai Kudineer is being widely used in this traditional system of medicine whose scientific aspects are only minimally explored. The current review focuses on the phytochemical screening and various in-vitro and in-vivo studies on Cassia auriculata (Avirai), Cassia fistula (Kondrai), Syzygium cumini (Naval), Salacia reticulata (Kadalazhinjil), Saussurea lappa (koshtam), Terminalia arjuna (Marutham) and Cyperus rotundus(Korai kizhangu) which are the ingredients of Avirai Kudineer. The present analysis is based on the anti-diabetic studies of the ingredients categorizing them as inhibitors of carbohydrates digesting enzymes (alpha-amylase inhibitors, alpha-glucosidase inhibitors), inhibitors of intestinal glucose absorption and stimulators of insulin secretion and cellular uptake enhancers of glucose. The review validates that all ingredients of Avirai kudineer have anti-hyperglycemic potential based on the data collected in Siddha literature and recent researches and therefore vouches Avirai Kudineer as a successful Siddha formulation in the treatment and improving the quality of life of both Pre-diabetic and Diabetic patients.

Introduction: Diabetes is chronic disease affecting all aspects of daily life and hence is a priority health care strategy. Its treatment needs a bio-psychosocial approach. One of the major problems in its management is patient noncompliance to therapeutic regimens. This qualitative phenomenological study aimed at assessing to patient experiences of factors facilitating selfmanagement. Materials and Methods: Patients were recruited from the "Glands and Metabolism Research Center" and "Alzahra hospital" in Isfahan in 2006. A purposive sample of 11 diabetic patients volunteered to participate in the study. Unstructured one-on-one interviews were conducted and interview data were transcribed and analyzed for themes using the Collizi method. Results: Themes, identified as facilitators to patient adherence to the therapeutic regimen are fear, satisfaction, support, objective alarm, feedback. Conclusion: The research highlights that factors such as patient satisfaction of treatment, insight into nature of disease, patient anxiety, family involvement as a major source of support, feedback on test results and the self-management process should be considered in designing heath care strategies to facilitate changes in behavior and enhance motivation.

Spinal cord injury: rehabilitation LEVEL OF RECOMMENDATION AND EVIDENCE: A: Strong consistency experimental or observational studies. B: Fair consistency experimental or observational studies. C: Case reports (uncontrolled studies). D: Opinion lacking critical evaluation, based on consensus, physiological studies or animal models. OBJECTIVES: Offering information about the treatment and rehabilitation for patients with spinal cord injuries.

Background and purpose: Cardiovascular diseases and more importantly the ischemic heart diseases (IHD) have been the most serious health problems during the late 20 th and early 21 st centuries. The purpose of this study was to determine the effect of education on modifying the life style of patients with

Introduction: The strongest environmental risk factor for diabetes, obesity, is related to socio-economic status. Due to lack of education in India, several myths and social stigma add to the problems of managing Diabetes Mellitus. The purpose of the project is to establish association of educational of the patient with complications and control of diabetes mellitus.

Materials and Methods: An epidemiological cross sectional study of descriptive observational nature was conducted at the Diabetic OPD in a tertiary care centre in Eastern part of India on 303 patients. Patients of both sexes suffering from diabetes mellitus attending the Diabetic OPD in the tertiary care hospital and selection on random basis. The patients were asked to fill a pretested predesigned questionnaire prepared by Stanford Patient Education Research Centre.

Observations and Results: Though the timing of taking pill regularly is high of lower socioeconomic classes, regular exercise and probability of complications is higher for the lower education level and it gradually decreases as the Education level increases.

Conclusion: Treatment can be improvised by spreading awareness about the disease and its complications along with proper education on exercise, following diet plans and treatment regimens

Background: Type 2 diabetes mellitus is increasing very rapidly in India, yet studies regarding knowledge, attitude and practices in diabetes in various Indian communities, especially in the Northeastern region, are limited. It is essential to understand the current gaps in knowledge and problems with the attitude and perceptions of the general population regarding diabetes to effectively plan public health policies. Objective: To assess the knowledge, attitude and practice of type 2 diabetes mellitus (T2DM) patients

Diabetic neuropathy (DN) is one of the most complex and progressive disorders, characterized by symmetrical distal degeneration of peripheral nerves, resulting in features of pain and sensory loss. This study aimed to find out the effects of physiotherapy intervention on physical function, balance, and postural control of persons with DN. Materials and Methods: A computerized electronic search was performed using PEDro, Pubmed, CINAHL, and EMBASE with keywords including physiotherapy intervention, physical exercise, rehabilitation techniques, balance training, diabetic neuropathy, and diabetic peripheral neuropathy. The inclusion criteria consisted of studies that were randomized clinical trials, crossover trials, or controlled trials published in the English language from 2015 to 2021, identifying DN as the primary concern, and physiotherapy intervention as one of the treatment options. Results: The primary search of the database turned up an entire set of 58 studies, among which 11 studies were selected as potentially meeting the inclusion criteria. Ultimately, four studies were retained for the final results of the review. The evaluations provided evidence to suggest that physiotherapy has positive effects on subjects with diabetic peripheral neuropathy. Conclusion: After reviewing, it has been revealed that balance and strength training are applicable for improving balance, gait, and physical function in DN patients.

Vitamin B12 also named as Cobalamin, is a water-soluble vitamin. It acts fundamental role in Neurological function, Optimal Haemopoiesis and DNA Synthesis. The deficiency of Vitamin B12 features as the haematological and neuro cognitive dysfunction. Diabetic patients have been demonstrated highly prevalent of Vitamin B12 deficiency. The purpose of the current study to review the literature related to the prevalence of Vitamin B12 deficiency in type 2 diabetic patients. The studies assess that the prevalence of Vitamin B12 deficiency is ranges about 5.8 to 52% in diabetic patients. Such as the study of D. Malla et al reported as high as 50.95% prevalence of Vitamin B12 deficiency in diabetic patients. However, the patients enrolled in the study are on metformin treatment. Several Studies reported that the deficiency of Vitamin B12 may associated with the treatment of Metformin and old age population. Metformin is known as the initial hypoglycaemic drug to treat Type 2 Diabetes Mellitus. It prescribed by many health practitioners as front-line treatment for T2DM. It is used as monotherapy or combined with other drugs according to the need with some of the mild or self-limiting side effect of the drug. However, studies reported that the prevalence of vitamin B12 deficiency is highly associated with dose and duration of metformin treatment in diabetic patients. Old age population may associate due to the low absorption capacity of the micronutrient in that period of lifecycle. The deficiency of vitamin B12 leads to various complication related to peripheral neuropathy which diagnose as diabetic neuropathy. The literature indicates the necessity of screening status of serum Vitamin B12 in patient of diabetes regularly will help to be aware.

I would like to express my sincere gratitude to the patients who participated in this study. Many thanks go to my academic supervisor Ms. Lungiswa Tsolekile for the mentorship, patience, assistance and technical guidance throughout this study despite your busy schedule. You were always available to make this project a success. Many thanks also go to Prof. S. Rusakaniko my Tackling Infections to Benefit Africa (TIBA) grant supervisor for all the support and mentorship. I would like to acknowledge the partial funding I got from TIBA and the opportunities they created for me which all enhanced my research skills and knowledge. Special thanks goes to my ever supporting and loving wife Martha Chipinduro who was always there to support and encourage me to soldier on even when the morale was down. Last but not least I would like to thank Zvifadzo Matsena and L. Mahere for their statistical guidance. http://etd.uwc.ac.za/ vi DEFINITION OF KEY CONCEPTS Risk factors: Contributory risks that lead to getting diabetes mellitus as well as facilitate disease progression, such as family history of diabetes, obesity and overweight, inactive lifestyles, poor dietary intake. The risk factors are divided into modifiable and non-modifiable risk factors. In the thesis, modifiable risk factors are those that can be subjected to change in order to influence their effect on diabetes incidence or disease progression whilst the nonmodifiable risk factors are not amenable to change. Obesity: Abnormal or excessive fat accumulation that may impair health. In the study, obesity was defined as body mass index greater than 30kg/m 2. Body mass index was calculated from weight and height measured objectively using a bathroom scale and stadiometer, respectively. Overweight: The term refers to BMI greater or equal to 25 and less than 30kg/m 2. Healthy lifestyle: In this study, the term refers to the adoption of the following habits as a way of living; 150 minutes of moderate physical activity such as brisk walking, jogging and gardening per week, eating a healthy diet high in fiber and low in carbohydrates and nonsmoking High fiber diet: In this study a high fiber diet was measured qualitatively and subjectively as consuming vegetables as a large portion of main meals most of the time with 5 servings of fruit per day. Low carbohydrate diet: In this study, low carbohydrate diet refers to consumption of unrefined carbohydrates in small quantities during main meals, snacking on non-carbohydrate based foods, taking less than one teaspoon of sugar with tea or coffee, drinking less than 3 times per day as well as not consuming fizzy drinks http://etd.uwc.ac.za/ vii ABSTRACT Introduction: The control of type 2 diabetes mellitus (T2DM) is pivoted on adherence to a healthy lifestyle (healthy diet, physical activity and non-smoking). Zimbabwe reports a high burden of T2DM related complications suggesting an increased inability by patients to control their blood glucose levels. This study, therefore, sought to describe the healthy lifestyle practices of T2DM patients in Harare, Zimbabwe and associate these practices with their glycated haemoglobin (HBA1C) levels, a marker for the control of diabetes. Methodology: A descriptive cross-sectional study was done. Participants were T2DM patients who were 18 years and older from two tertiary hospital diabetes clinics in Harare. Data collection was done using a structured questionnaire which was interviewer-administered along with height, weight and HBA1C measurements. Descriptive statistics were used to describe the study populations. Chi square test was used to calculate statistically significant associations between healthy lifestyle behaviours and demographics or HBA1C levels at the significant level of 0.05%. Results: A response rate of 96.9% (158/163) was observed in the study. A total of 150 out of 158 (94.9%) participants had complete data for analysis. Participants had a median age of 54 years (IQR 45-65), mean body mass index (BMI) of 27.2 kg/m 2 (SD 3.7) and mean HBA1C levels of 7.6% (SD 1.4). There were more female (55.3%) than male (45.7%) participants while 57.7% (95% CI 49-65) had diabetes related complications. A total of 41%, 95% CI 49-65) 67% 95% CI 59-74) and 100% 95% CI 98-100) were conforming to physical activity, diet and non-smoking, respectively. Diet was the only healthy lifestyle component significantly associated with HBA1C levels (p=0.004). Conforming to a comprehensive healthy lifestyle was significantly associated with gender (p=0.026), understanding diabetes health education (p=0.003) and diabetes related complications (p=0.002) but not significantly associated with HBA1C levels (p=.0.461). Conclusion: T2DM patients attending diabetes clinics in Harare had low levels of conformity to healthy lifestyle practices despite the majority of patients reporting that they understood diabetes health care education. Future studies need to elicit the barriers to uptake of healthy lifestyle practices among T2DM patients and assess interventions for behavioral change.

I would like to express my sincere gratitude to the patients who participated in this study. Many thanks go to my academic supervisor Ms. Lungiswa Tsolekile for the mentorship, patience, assistance and technical guidance throughout this study despite your busy schedule. You were always available to make this project a success. Many thanks also go to Prof. S. Rusakaniko my Tackling Infections to Benefit Africa (TIBA) grant supervisor for all the support and mentorship. I would like to acknowledge the partial funding I got from TIBA and the opportunities they created for me which all enhanced my research skills and knowledge. Special thanks goes to my ever supporting and loving wife Martha Chipinduro who was always there to support and encourage me to soldier on even when the morale was down. Last but not least I would like to thank Zvifadzo Matsena and L. Mahere for their statistical guidance. http://etd.uwc.ac.za/ vi DEFINITION OF KEY CONCEPTS Risk factors: Contributory risks that lead to getting diabetes mellitus as well as facilitate disease progression, such as family history of diabetes, obesity and overweight, inactive lifestyles, poor dietary intake. The risk factors are divided into modifiable and non-modifiable risk factors. In the thesis, modifiable risk factors are those that can be subjected to change in order to influence their effect on diabetes incidence or disease progression whilst the nonmodifiable risk factors are not amenable to change. Obesity: Abnormal or excessive fat accumulation that may impair health. In the study, obesity was defined as body mass index greater than 30kg/m 2. Body mass index was calculated from weight and height measured objectively using a bathroom scale and stadiometer, respectively. Overweight: The term refers to BMI greater or equal to 25 and less than 30kg/m 2. Healthy lifestyle: In this study, the term refers to the adoption of the following habits as a way of living; 150 minutes of moderate physical activity such as brisk walking, jogging and gardening per week, eating a healthy diet high in fiber and low in carbohydrates and nonsmoking High fiber diet: In this study a high fiber diet was measured qualitatively and subjectively as consuming vegetables as a large portion of main meals most of the time with 5 servings of fruit per day. Low carbohydrate diet: In this study, low carbohydrate diet refers to consumption of unrefined carbohydrates in small quantities during main meals, snacking on non-carbohydrate based foods, taking less than one teaspoon of sugar with tea or coffee, drinking less than 3 times per day as well as not consuming fizzy drinks http://etd.uwc.ac.za/ vii ABSTRACT Introduction: The control of type 2 diabetes mellitus (T2DM) is pivoted on adherence to a healthy lifestyle (healthy diet, physical activity and non-smoking). Zimbabwe reports a high burden of T2DM related complications suggesting an increased inability by patients to control their blood glucose levels. This study, therefore, sought to describe the healthy lifestyle practices of T2DM patients in Harare, Zimbabwe and associate these practices with their glycated haemoglobin (HBA1C) levels, a marker for the control of diabetes. Methodology: A descriptive cross-sectional study was done. Participants were T2DM patients who were 18 years and older from two tertiary hospital diabetes clinics in Harare. Data collection was done using a structured questionnaire which was interviewer-administered along with height, weight and HBA1C measurements. Descriptive statistics were used to describe the study populations. Chi square test was used to calculate statistically significant associations between healthy lifestyle behaviours and demographics or HBA1C levels at the significant level of 0.05%. Results: A response rate of 96.9% (158/163) was observed in the study. A total of 150 out of 158 (94.9%) participants had complete data for analysis. Participants had a median age of 54 years (IQR 45-65), mean body mass index (BMI) of 27.2 kg/m 2 (SD 3.7) and mean HBA1C levels of 7.6% (SD 1.4). There were more female (55.3%) than male (45.7%) participants while 57.7% (95% CI 49-65) had diabetes related complications. A total of 41%, 95% CI 49-65) 67% 95% CI 59-74) and 100% 95% CI 98-100) were conforming to physical activity, diet and non-smoking, respectively. Diet was the only healthy lifestyle component significantly associated with HBA1C levels (p=0.004). Conforming to a comprehensive healthy lifestyle was significantly associated with gender (p=0.026), understanding diabetes health education (p=0.003) and diabetes related complications (p=0.002) but not significantly associated with HBA1C levels (p=.0.461). Conclusion: T2DM patients attending diabetes clinics in Harare had low levels of conformity to healthy lifestyle practices despite the majority of patients reporting that they understood diabetes health care education. Future studies need to elicit the barriers to uptake of healthy lifestyle practices among T2DM patients and assess interventions for behavioral change.

Purpose: To evaluate the impact of several factors on the patient's perception on quality of life in a group of patients with type 2 diabetes mellitus (T2DM). Patients and methods: In this cross-sectional study, 198 patients with T2DM were enrolled according to a consecutive-case population-based study design. In all participants, the perception on the quality of life was measured using the quality of life index-diabetes version III proposed by Ferrans and Powers. We evaluated the impact of several anthropometric and diabetes-related (ie, diabetes history and quality of glycemic control) factors on the patient's perception on the quality of life. Results: The presence of diabetes complications was associated with a decreased quality of life: retinopathy (1 vs 5 points; P,0.001), chronic kidney disease (-1 vs 5 points; P,0.001), and neuropathy (-1 vs 5 points; P,0.001). A significant reverse correlation was found between the patient's quality of life and depression's severity (Spearman's r=-0.345; P,0.001) and body mass index (Spearman's r=-0.158; P=0.026). A positive association between the quality of life and the quality of diabetes-related self-care activities was found (Spearman's r=0.338; P,0.001). No significant association was found between the patient's quality of life and the quality of glycemic control, diabetes duration, age, gender, or smoking status. Conclusion: To improve the patient's quality of life, special care should be given to the modifiable diabetes-related factors: the prevention and treatment of diabetes complications, treatment of depression, and weight loss in obese and overweight patients.

Diabetes mellitus, a chronic metabolic disorder characterized by elevated blood glucose levels, has reached epidemic proportions worldwide. This review provides a comprehensive assessment of the current landscape of diabetes therapies and outlines future prospects for improving the management and treatment of this condition. The current scenario highlights a multifaceted approach to diabetes management, with a focus on lifestyle interventions, oral antidiabetic drugs, insulin therapy, and emerging technologies like continuous glucose monitoring and closed-loop systems. While these approaches have significantly improved the lives of people with diabetes, several challenges persist. These include medication adherence, hypoglycemia risk, and the financial burden of diabetes care. Novel therapies, such as GLP-1 receptor agonists and SGLT-2 inhibitors, have shown promise in addressing these challenges by providing better glucose control, cardiovascular benefits, and weight reduction. The future prospects for diabetes therapies are exciting, with ongoing research into cell-based therapies, including pancreatic islet transplantation and stem cell-derived beta cells. Personalized medicine approaches, driven by genetics and artificial intelligence, hold the potential to optimize treatment regimens and predict individual responses to various therapies. Furthermore, advancements in telemedicine and digital health technologies will enhance patient selfmanagement and remote monitoring.

Background and aims: Diabetic foot is the most common cause for hospitalization among diabetic patients whose treatment is costly in the world. In developed countries, over 5% of diabetic patients are involved in diabetic foot, and if it is not treated quickly and appropriately, it wil be led to blood infection, gangrene, and amputation. The present study aimed at investigating the wound severity and its association with predisposing factors in patients with diabetic foot. Methods: This is a descriptive analytic study in which 94 patients with diabetic foot, referring to governmental and non-governmental clinics in Isfahan, were selected through convenient sampling. Data were collected by a three-section questionnaire. The first section contained demographic characteristics, and the second was on wound severity based on Wagner scale. The third section was associated with wound formation predisposing factors. Data were analyzed by descriptive statistics and by SPSS software through Spearman correlation test, Kruskal Wallis and Mann-Whitney. Results: Wound severity, based on Wagner scale, was in grade two in most of diabetic food patients (75%). There is a significant association between wound severity and the factors such as BMI(P=0.041), smoking (P=0.041), FBS (0.026), two hour postprandial glucose (P=0.016), and wound depth (P=0.041). Conclusion: Based on the findings, diabetic food wound severity was moderate among the subjects and predisposing factors were FBS, 2-hour postprandial blood glucose, smoking, and wound depth. It is recommended to detect and modify these factors among the patients to prevent amputation and probable complications.

Materials and methods: A hospital-based cross-sectional study was conducted in 320 patients with T2DM using a random sampling technique. Semi-structured questionnaires, document reviews, and physical examinations were used to collect the data. Logistic regression and receiver operating characteristic curve analyses were used to identify associations between the severity of DR and socio-demographic and physiological risk factors. Results: Among the 320 participants in this study, all of whom were suffering from T2DM, the mean age was 50.05 ± 8.6 years and DR was detected in 94 patients (29.4%). The risk factors identified for DR were age (odds ratio [OR] = 1.184), body mass index (OR = 2.067), systolic blood pressure (OR = 1.112), diastolic blood pressure (OR = 1.224), fasting blood glucose (OR = 2.694), 2 h after breakfast sugar test (OR = 2.396), hemoglobin A1c (OR = 18.759), total cholesterol (OR = 9.213), triglycerides (OR = 7.749), low-density lipoprotein cholesterol (OR = 5.485), high-density lipoprotein cholesterol (OR = 16.728), serum creatinine (OR = 1.929), and duration of DM (OR = 1.170), as these risk factors were found to be significantly associated with DR (p < 0.05). Conclusion and recommendation: The identification of risk factors associated with DR in patients with T2DM is clinically significant, as it reveals that self-management of DM can reduce the complications of DR.

誗AIM: To measure the interleukin8 ( IL8) and tumor necrosis factor 琢 ( TNF 琢) levels in vitreous samples obtained the patients undergoing pars plana vitrectomy (PPV) due to diabetic retinopathy (DR), then to compare these results with those of the control group and to state their impact on DR pathogenesis. 誗METHODS: From Istanbul Bilim University Ophthalmology Department, 57 eyes of 57 diabetes mellitus ( DM ) patients who had been diagnosed with proliferative diabetic retinopathy and 22 cases of macular hole, with no proliferative vitreoretinopathy were included in the study as the study and the control groups respectively. All of the 79 patients underwent a 3 port, 20 gauge PPV. Vitreous samples of 0. 5mL were aspirated with vitrector at the beginning of the PPV operation before the intraocular infusion and being diluted. Samples were transferred to the freezer to be stored at -70益. Results of IL-8 and TNF-琢 were calculated as pg / mL with ELISA method. 誗RESULTS: IL 8 levels [ 82 ...

Background: This study aims to address the effects of gold nanoparticles (AuNPs) on diabetic myopathy in streptozotocin (STZ)-induced diabetic rats. Materials and methods: Adult male rats were separated into three groups (n ¼ 15): non-diabetic control (ND), diabetic (D), and diabetic treated with AuNPs (2.5 mg/kg, D þ AuNPs) intraperitoneally for 4 weeks. A single injection of 50 mg/kg STZ was used to induce diabetes. Results: Treatment with AuNPs lowered blood glucose levels. Skeletal muscle mRNA expression of two musclespecific E3 ubiquitin-ligases enzymes, F-box-only protein 32 (FBXO32) and muscle RING-finger protein-1 (MuRF1) were upregulated in the D group. Diabetic rats showed significant increases in the skeletal muscle expression levels of plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1), and a decrease in glucose transporter 4 (GLUT4) expression. Superoxide dismutase (SOD) activity decreased and malondialdehyde (MDA) level increased in skeletal muscles of D group. Compared to the D group, expression levels of FBXO32, MuRF1, PAI-1 TNF-α, and TGF-β1 were decreased in the D þ AuNPs group, and mRNA of GLUT4 increased. Furthermore, in D þ AuNPs group, skeletal muscle MDA levels decreased while SOD activity increased. Conclusion: In experimental models, AuNPs can ameliorate muscle atrophy by reducing hyperglycemia, inflammation, and oxidative stress, and by suppressing the ubiquitin-proteasome proteolytic process.

Type 2 Diabetic Retinopathy (T2DR) is one of the most common impediments of diabetes that affect the blood vessels of the retina, leading to loss of vision. At the advance proliferative stage of diabetic retinopathy, retina triggers the abnormal angiogenesis, which is instigated due to the increased expression of growth factors such as vascular endothelial growth factor (VEGF), Insulin-like growth factor (IGF-1). Existing therapies are solely directed towards advanced T2DR stages often following permanent damage and are therefore highly anticipated for treatments that are preventive or address early pathology. It is suggested that apoptosis is experienced at the early stages of T2DR in specific retinal ganglions and retinal neurodegeneration probably involves an inadequate level of BDNF. Neuroprotection therapeutic strategies, including somatostatin, brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are more substantial. BDNF, a Neurotrophic factor derived from brain, also known as ANON2, BULN2 is a neurotrophin, and previous studies have reported decreases in BDNF levels in diabetic retina, causing damage to neurons, resulting in neurodegeneration due to its abuse of retinal neurons through the TrkB / ERK / MAPK pathway. MicroRNA (miRNAs) is a class of small, endogenous transcripts of RNA shaped like hairpin with a length of 21 to 25 nucleotides. As stated in the literature, miRNAs bind their target mRNAs to the 5′ end through a completely complementary seed of 7-8 nucleotides and a less complementary area at the 3′ end, which leads to translational repression or mRNA degradation. Finally, this review will helps us to better understand molecular mechanisms through which miRNAs may be viewed as diagnostic or predictive biomarkers and, most importantly, therapeutic targets.

To evaluate the antidiabetic activity of aqueous extract, of the whole plant of Cressa cretica L. Diabetes was induced by intravenous injection of Streptozotocin at dose of 60 mg/kg. Aqueous extract of the Cressa cretica L. at a dose of 200 mg/kg 400 mg/kg...

Jamás me imaginé escribir un libro sobre el pie diabético. Y heme aquí, con una sensación extraña de interés desmesurado y curiosidad altamente retadora por pisar territorios requisitorios de conocimiento puro y pragmático sobre una de las derivaciones más complicadas de la enfermedad llamada diabetes. En efecto, generalmente el pie diabético es una derivación de la diabetes con características muy particulares y hasta benignas. La diabetes es capaz de afectar prácticamente todos los órganos del cuerpo de manera progresiva, de ahí que sea considerada como una enfermedad crónica e incurable, que avanza conforme el tiempo avanza. Ojo: no todos los diabéticos acaban con pie diabético, eso es muy importante aclararlo desde el principio. Otra cosa cierta: Una vez que el pie diabético es diagnosticado, si la diabetes no se controla, la enfermedad del pie sigue su progreso, así como sus complicaciones.

Benigna muy entre comillas ya que, a comparación de otras afectaciones de la diabetes, su manifestación inicial y progreso subsecuente pueden ser monitoreados de manera visual y palpable. Cuando la diabetes empieza a afectar el riñón, la vista, el intestino o el sistema nervioso, difícilmente el paciente se da cuenta del problema en el que se va metiendo si no controla los niveles de azúcar. Benigna entre comillas porque el pie diabético, además de ser muy doloroso en etapas avanzadas, puede derivar en amputaciones de dedos, pies o piernas. Además de la muerte. Benigna porque el diabético que sufre de pie diabético tiene la oportunidad de enfrentar a la diabetes con dieta y medicinas y, en la medida que se le gana terreno a la diabetes, se irá recuperando sólidamente del pie diabético y la diabetes. En pocas ocasiones se puede hacer ejercicio con pie diabético, de ahí que primero se cura el pie (o la zona afectada) y después se sigue con el tratamiento, principalmente a base de dieta y ejercicio; incluso después de haber sufrido algún tipo de amputación.