Long-term diabetic complications

In this study majority of respondents had history of raised blood pressure, raised sugar level and raised total blood cholesterol and has to be addressed. A total number of 1995 of participants were involved in this study with written consent of all. Our research design is Descriptive study. Semi-structured questionnaire from WHO was used to conduct the study as well as for hypertension BP cuffs were used to monitor Blood pressure of respondents and for diabetic’s lab referrals were given and results (if taken) were recorded. This study helped us update our knowledge about the prevalence of Hypertension, Diabetes and Hypercholesterolemia

Resumo:O Diabetes Mellitus (DM) é uma doença caracterizada pela elevação da glicose no sangue que pode ocorrer devido ao mau funcionamento na secreção ou na ação do hormônio insulina. A dificuldade de adesão ao tratamento med icamentoso tem sido um dos principais problemas enfrentados pelas equipes de saúde. Dois principais fatores que podem influenciar na adesão ao tratamento do DM são o acesso ao tratamento e a falta de conhecimento no manejo da doença. Diante do exposto, esta revisão tem por objetivo abordar os principaisproblemas relacionados à adesão a farmacoterapia do DM tipos 1 e 2.Este estudo é uma pesquisa bibliográfica coletada entre os anos 2012 e 2017.A adesão à medicação também é condicionada a fatores como, poder econômico, nível de instrução eperfil do paciente (criança, idoso, gestante e deficiente). É perceptível a importância do profissional farmacêutico na atenção básica assim co mo seu aprimoramento quanto profissional. Ações de esclarecimento contínuo da população devem ser feitas de forma rot ineira garantindo assim o entendimento adequado da doença e dos benefícios ofertados gratuitamente pelo Ministério da Saúde em parceria co m o SUS e governos. Abstract (Barriers to drug therapy of Diabetes Mellitus): Diabetes Mellitus (DM) is characterized by elevated blood glucose levels, what may occur due to malfunctioning in the secretion or action of insulin. The difficu lty of adhesion to drug treatment is amidst the main problems faced by health professionals. Two main factors that may influence adhesion to the treatment include access to treatment and lack of knowledge in the management of the disease. In view of the above, this review aims to address the main problems related to adherence to pharmacotherapy of DM types 1 and 2. Here we reviewed data published between 2012 and 2017. Adhesion to med ication is also conditioned by factors such as, economic power, level of education and patient profile (child, elderly, pregnant and disabled). The presence of the pharmacist in basic care is of paramount impo rtance, as well as his professional improvement. Actions of continuous education with the population should be done routinely, thus ensuring adequate understanding of the disease and the benefits offered free of charge by the Ministry of Health in partnership with the SUS and governments.

In today's world, the use of sensor technology to make portable devices can help patients in detecting or monitoring diseases. One such problem is the onset of foot ulcers in diabetic patients. Diabetes often leads to improper circulation of blood to a person's feet, which results in diabetic foot ulcers. This leads to gangrene formation and loss of sensation in the patient's foot. If ignored, leads to lower leg amputation. The proposed system is a device which is developed and evaluated to identify the patients who are likely to develop diabetic foot ulcers at an early stage. This is accomplished by fixing pressure sensors in five pressure points of the foot. The foot pressure readings are converted into corresponding voltage output by the sensor. These voltage readings are amplified using an amplification unit. The voltage data are read using a data acquisition device. The output of the device decides whether the person has the probability to develop diabetic foot ulcer or not.

Background and aim
The islets of Langerhans is an important endocrine gland which regulate the blood glucose level. The micro anatomic studies in human fetal pancreatic islets were significant since there were controversies regarding their origin and time of appearance. The role of maternal insulin in the development of fetal pancreatic islet cells  and their significance in the fetal period is clinically important. Pregnant mothers with diabetes seems to protect their children from diabetes by the early stimulation of beta cells. So the incidence of diabetes in children of diabetic mothers  were less when compared to diabetic fathers.
Materials and Methods
Thirty five autopsy specimens were collected from the department of pathology medical college, Trivandrum, Kerala. The gestational age of the fetuses range from 10-40 weeks. The histological examination of the specimens were done is the department of anatomy, Govt. Medical College, Trivandrum.
Result
According to the present study both acini and islets were developed  from the endodermal secretary tubules. Acini and islets were appeared by 12 weeks, and beta cells appeared by 14 weeks. At 28 weeks alpha cells appeared and the cytoplasm of beta cells contained granules. At 32 weeks well defined islets and the granules appeared in the  cytoplasm of alpha cells.
Conclusions
The fetal pancreatic islets and acini had a common endoderimal origin- the secretary tubules. The islets and acini appeared by 12 weeks, the beta cells by 14 weeks. A diabetic mother  can protect their children from diabetes to some extend than a diabetic father.

Key words:
, ,

AIM: The objective of the current study was to assess the influence of oral multivitamins supplementation on
some oxidative stress parameters (serum Vitamin A, C, E, Zinc, Malondialdehyde (MDA)) and lipid profile among
Sudanese patients with type- 2 diabetes mellitus (T2DM).
MATERIAL AND METHOD: Three hundred Sudanese patients with T2DM and Hundred healthy subjects (control
group) were enrolled in this cross-sectional study. Blood was collected after overnight fasting for 10-12 hrs.
Fasting plasma glucose (FBG), lipid profiles, Glycosylated haemoglobin (HbA1c%), Serum zinc, Malondialdehyde
(MDA), Vitamins A, E, and C levels were measured using standardised laboratory techniques. Data was collected
with the help of a structured questionnaire and direct interview.
RESULTS: Biochemical parameters of the study population were shown a highly significant difference (P value <
0.05), between the means of serum vitamin A, C, E, Zinc, MDA, HbA1c, triglycerides, HDL, FBG, total cholesterol
and LDL. Significant differences in serum vitamin A, C, E, Zinc, MDA, triglycerides, HDL and FBG between people
with diabetes who used multivitamins and diabetics who did not use it (P-value < 0.05).
CONCLUSION: The study observed a significant increase in serum levels of vitamin A, C & E and other
biomarkers parameters in patients with T2DM who take oral multivitamins supplements; such improvement may
lead to minimising the diabetic complications. Further studies are needed to explore the possible therapeutic role
of multivitamins supplements for T2DM patients.

Background: Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. Methods: A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King's classification respectively. Results: The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King's classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Conclusion: Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot.

Maesa indica belonging to family Myrsinaceae, commonly known as
Atki  is  a  large  shrub.  Ethnobotanical  studies  of  Kolhapur  district
revealed that stem bark of M.  indica is used in the treatment a
diabetes. The literature survey revealed that there is no experimental
evidence of antidiabetic effect of the plant. Therefore the present
study was carried out to investigate antidiabetic effect of M.  indica
stem  bark  in  streptozotocin  induced  diabetic  rats.  The  Plant  was
subjected to pharmacognostic, physico-chemical and phytochemical
evaluations  which  will  assist  in  standardization  for  authenticity,
quality  and  identification  of  the  herbal  products.  Treatment  with
2ml/kg stem bark distillate to diabetic rats resulted in significant
reduction  in  blood  glucose  level.  The  preset  study  clearly
demonstrated that the plant is having potential hypoglycemic activity
which  may  be  beneficial  for  the  management  and  treatment  of
diabetes mellitus. It also shows good alpha glucosidase inhibition
activity.

To test the potential of Infrared (IR) thermography
in diagnosing as well as predicting type 2 diabetes
and its complications compared with biochemical assay of
HbA1c as standard. As per American Diabetes Association
criteria, threshold for diagnosis of diabetes was set as
HbA1c C 6.5 % (7.7 mmol L-1). The total subjects
(n = 62) were studied out of which control (n = 32) and
diabetic subjects (n = 30). IR camera was used to capture
the thermal images of the skin for diagnosis of the disease;
receiver operating characteristic (ROC) curve was used to
set temperature (C) as threshold for statistically significant
body regions under t test. In diabetic group, HbA1c showed
negative correlation with carotid region (r = -0.471,
p\0.01) and the mean skin temperature was lower than
the normal group at body regions namely knee
(p = 0.002), tibia (p = 0.003), forehead (p = 0.014), and
palm (p = 0.019). The palm region showed highest area
under the curve of 0.711 (95 % CI: 0.581–0.842) and the
threshold was set as B33.85 C, thereby sensitivity (90 %) and specificity (56 %) was obtained in determining the
undiagnosed diabetes with positive predictive value of
65 %, negative predictive value of 85 % and accuracy of
73 %. As HbA1c increases, skin temperature decreases.
Skin temperature enables early detection of diabetes as
compared to HbA1c. The decrease in skin temperature may
be due to the decrease in the basal metabolic rate, poor
blood perfusion and high insulin resistance. Thermography
can be used as a diagnostic as well as prognostic tool for
the diabetes.

[AMAZON LINK BELOW TO BOOK ITSELF -- TOC and book summary in downloadable .pdf] 

In the modern jungle of burgers, couches, and remote controls, obesity is an enormous and growing epidemic. Weight-loss books and diet gurus urge us to "listen to our bodies," but our instincts are designed for the African savannah, not food courts. The sugary and fatty foods that we, as hunter-gatherers, are programmed to forage used to be hard to come by. Now they're as close as the vending machine down the hall.

Radical changes are necessary and, fortunately, are biologically easier than small or gradual changes in diet. Barrett tells us how to reprogram our bodies, break food addictions, and ignore our attraction to "supernormal stimuli"—artificial creations that appeal to our instincts more than the natural objects they mimic. Barrett delves into scientific research—from animal ethology to evolution—to show the disastrous direction in which our instincts have led us, and how, using our intellect, we can get back on course.  . . . . . . . .An elegantly written and eye-opening analysis of what makes us fat. -- Steven Pinker, PhD, Johnstone Professor of Psychology, Harvard University, and author of How the Mind Works
. . . . . . .
In this cogent, clearly argued, and thought-provoking book, Barrett shows how we are paying the price for our own plenty. -- David Spiegel, M.D. Medical Director, Center for Integrative Medicine, Stanford University School of Medicine; author of Living Beyond Limits
. . . . . . . .
Offers us a way to understand the pandemic of obesity that we find ourselves in. -- John Ratey, M.D. Clinical Associate Professor of Psychiatry Harvard Medical School, co-author of Driven to Distraction

Ethnopharmacological Relevance: Natural antioxidants due to their
radical  scavenging  and  lipid  peroxidation  ability  are  considered  as
possible  protection  against  delayed  wound  healing  in  diabetic
condition.
The Aim of the Study:  The objective of our study was to evaluate
the  antidiabetic  and  wound  healing  activity  of  the  leaf  extract  of
Catharanthus roseus L in mice.
Materials  and  Methods:  The  methanolic  extract  of  leaf  of
Catharanthus roseus  L  at a dose of 200 mg/kg and 400 mg/kg body
weight  was  induced  through  intraperitonial  in  mice. To  create
wounds, a single full thickness 1.0 cm diameter superficial excision
was  made  on  the  mid-dorsum  of  each  mouse.  The  measurement  of
the  wound  diameter  was  taken  on  1,  3,  7  and  10  days by  using
transparency paper and permanent marker.
Results: The plant drugs increased the rate of wound contraction and
significantly  decrease  the  glucose  level  in  blood.  The  results  were
compared with control group of mice that were kept  on only saline
water. The wound closure was optimal at the dose of200 mg/kg body
weight. The extract of Catharanthus roseus L significantly increased
the wound contraction and formation of collagen fibres in the mice
compared with controls (P < 0.001).
Conclusion:  The  methanolic  extract  of  Catharanthus  roseus  L
significantly  increases  the  wound  contraction  in  mice  that  promises
to overcome the delayed wound healing in diabetic condition.

Long-term usage of Metformin is associated with lower serum vitamin B12 levels. The lower than normal levels could worsen neurological complications of diabetes, including diabetic neuropathy and poor cognition. Guidelines advise periodic monitoring of vitamin B12 but do not specify frequency, treatment targets or treatment modality. This
commentary aims to review the prevalence and the severity of the presentation and to provide evidence-based answers to those clinical questions not answered by current guidelines.

Diabetic retinopathy (DR), commonly classified as a microvascular complication of diabetes, is now recognized as a neurovascular complication or sensory neuropathy resulting from disruption of the neurovascular unit. Current therapies for DR target the vascular complication of the disease process, including neovascularization and diabetic macular edema. Since neurodegeneration is an early event in the pathogenesis of DR, it will be important to unravel the mechanisms that contribute to neuroretinal cell death in order to develop novel treatments for the early stages of DR. In this review we comment on how inflammation, the metabolic derangements associated with diabetes, loss of neuroprotective factors, and dysregulated glutamate metabolism may contribute to retinal neurodegeneration during diabetes. Promising potential therapies based on these specific aspects of DR pathophysiology are also discussed. Finally, we stress the importance of developing and validating new markers of visual function that can be used to shorten the duration of clinical trials and accelerate the delivery of novel treatments for DR to the public.

Introduction: The diagnosis of obstructive airway disease in diabetic patients may pose difficulties due the superimposition of restriction associated with diabetes on the pure obstructive pattern predominantly found in these patients. Aims: To evaluate the status of pulmonary function in diabetics (NIDDM – Non Insulin Dependent Diabetes Mellitus) with COPD (Chronic Obstructive Pulmonary Disease) or asthma. Methods: 45 Subjects (15 Diabetics with COPD, 15 Diabetics with Asthma & 15 healthy non diabetic, non smoking subjects with no chest complaints taken as the control group) underwent clinical evaluation, biochemical assessment of glycemic control, pulmonary function tests (Spirometry, DLCO and plethysmography lung volume measurements). Results: Spirometry showed pure obstruction in 20% patients whereas 66.67% patients had restriction which was confirmed in 20% on plethysmography. COPD patients had decreased DLCO/VA% (% Diffusion Lung Capacity of Carbon Monoxide corrected for Alveolar Volume) (P<0.0001), increased TLC % (Total Lung Capacity) (P<0.05), RV/TLC % (Residual Volume/ Total Lung Capacity %) (P<0.0001) along with increased severity of airflow limitation (measured by FEV1% (Forced Expiratory Volume in 1st second)) which correlated with DLCO/VA % (P<0.05). Asthmatics had near normal DLCO/VA%, TLC%, increased RV/TLC% (P<0.05) & also demonstrated correlation of FEV1% with duration of diabetes (P<0.05) and RV/TLC% (p<0.05) & also of FVC % (Forced Vital Capacity %) with duration of diabetes (P<0.05). Conclusion: Diabetics with COPD or asthma showed variable pulmonary function findings rather than the expected pure obstructive pattern and FEV1% and FVC% decline associated with diabetes might be responsible for these variable spirometric findings in addition to the severity of the airway disease.

BACKGROUND AND OBJECTIVES: Diabetic neuropathy is a major cause of neuropathy worldwide and may lead to amputations and incapacity. This study aimed at a detailed and updated review on diabetic neuropathy, focusing on its classification, diagnostic investigation and treatment. CONTENTS: It is estimated that 371 million people aged from 20 to 79 years, worldwide, have diabetes mellitus and that at least half of them are unware of the diagnosis. Its prevalence in Central and South America was estimated in 26.4 million people, corresponding to approximately 6.5% of the population. Among microvascular complications, diabetic neuropathy is the most prevalent, leading to the highest rates of hospitalization, atraumatic amputations and incapacity. Diabetic neuropathy may have different clinical presentations, being distal symmetric polyneuropathy its most frequent presentation and major mechanism to the development of diabetic foot. Predominantly it presents with positive (burning, tingling) and negative (numbness, loss of sensitivity) sensory symptoms. In general it is associated to autonomic signs and symptoms and seldom there is motor manifestation. Approximately 20% of patients with distal symmetric polyneuropathy have neuropathic pain, which sometimes becomes chronic and disabling. CONCLUSION: Early and accurate diagnosis allows for adequate treatment , preventing progression of neuropathy and severe complications. For such, it is necessary to obtain an acurate clinical history, in addition to thorough neurological tests and additional tests, to identify signs of nervous fibers involvement. Its treatment depends on adequate glycemic control and neuropathic pain treatment, when present.

The nature has provided abundant plant wealth for all the living creatures, which possess medicinal virtues. Therefore, there is a necessity to explore their uses and to ascertain their therapeutic properties. In that way, the Traditional Siddha Medicine plays a vital role in preventing the progress of the disease. Saint Yugi (one of the Founders of Traditional Indian Siddha system of Medicine) describes 21 types of Mega noigal, which includes Madhu megam (Madhu – Sweet, Megam – Disease) [1, 2]. Diabetes mellitus is compared with Madhu megam in Siddha literature. Diabetes mellitus is a complex and a diverse group of disorders that disturbs the metabolism of carbohydrate, fat and protein. The number of diabetes mellitus cases has been increasing worldwide in recent years. Insulin is a key player in the control of glucose homeostasis. Lack of insulin affects carbohydrate, fat and protein metabolism. Management of diabetes without side effects is still a great challenge to the medical community [3]. The aim of the present study is to investigate the in-vitro Anti-Diabetic activity of the selected Herbo- Mineral drug, having its reference in age old Siddha classic text “Sarabhendhirar Vaithiya Ratnavali”. Thus, validating the traditional claim of the Herbo-mineral drug exhibits a significant inhibitory effect on In-vitro glucose diffusion and the result is being discussed.

My life as I had known it would become what the physician and historian Chris Feudtner termed transmuted. He argued diabetes as a disease concept had transmuted, changing over time by society’s interference in its natural progression.  And so began my transmutation, as I reflect upon my life, the life of a young man as a diabetic whose natural progression was altered less by the disease and more by society’s attempts to define and control it.

differences in the expression of immune markers in normal mucosa and in SLT-induced leukoplakia lesions. Results: There was a significant difference in the immunolabeling of all markers between normal mucosa and SLT-induced lesions (p<0.001). The leukoplakia lesions in chronic SLT users demonstrated a significant increase in the number of Langerhans cells and in the absence of epithelial dysplasia. Conclusion: The increase in the number of these cells represents the initial stage of leukoplakia. Key words: Smokeless

Diabetes mellitus is one of the most important health problems worldwide, showing high indices of prevalence and mortality. It is also rapidly emerging as a major health-care problem in India, especially in urban areas where the prevalence of Type 2 diabetes has been reported as 12% of the adult population. A histopathological study was carried out on wistar rat in which comparative remedial effectiveness was studied of 2 different medicines Diabcure and Glibenclamide. The rats were divided into 4 groups with 6 rats in each group and were treated accordingly Group 1: Control rats given physiological saline solution 10mL/Kg body wt, Group 2: Rats injected Streptozotocin (45mg/kg ip body wt.) intraperitonially, Group 3: Rats injected Streptozotocin (45 mg/kg ip body wt.) intraperitonially + Polyherbal Formulation Diabcure (PHFD) (125 mg/kg body wt.) administered orally using an intragastric tube. Group 4: Rats injected (45 mg/kg ip body wt.) intraperitonially + Glibenclamide (125mg/kg body wt.) administered orally using an intragastric tube. After 30 days of the treatment the rats were sacrificed and blood glucose level was determined along with the histopathological study of the liver, pancreas and kidney was carried out. Histopathological changes were observed in Streptozotocin treated rats showed fatty changes, necrosis, vacuolization, space formation and loss of cell boundaries in liver, proximal tubular necrosis, tubular degeneration and glomerular swelling in kidney and reduced islet cells and necrosis of pancreas. Oral administration of aqueous extract of Polyherbal Formulation Diabcure (PHFD) (125 mg/kg body weight) and Glibenclamide to Streptozotocin treated rats brought back the above-mentioned changes to near normal. But the histopathological study revealed that Diabcure was more effective then Glibenclamide.

Background: Nurse–physician communication has been shown to have a significant impact on the job satisfaction and retention of staff. In areas where it has been studied, communication failure between nurses and physicians was found to be one of the leading causes of preventable patient injuries, complications, death and medical malpractice claims. 
Objective: The objective of this study is to determine perception of nurses and physicians towards nurse-physician communication in patient care and associated factors in public hospitals of Jimma zone, southwest Ethiopia. 
Methods: Institution based cross-sectional survey was conducted from March 10 to April 16, 2014 among 341 nurses and 168 physicians of public hospitals in Jimma zone. Data was collected using a pre-tested self-administered questionnaire. Data was entered into EpiData version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 16.0 for analysis. Factor analysis was carried out. Descriptive statistics, independent sample t-test, linear regression and one way analysis of variance were used. Variables with P-value < 0.05 were considered as statistically significant.
Results: The response rate of the study was 91.55%. The mean perceived nurse-physician communication scores were 50.88±19.7% for perceived professional respect and satisfaction, and 48.52±19.7% for perceived openness and sharing of patient information on nurse-physician communication. Age, salary and organizational factors were statistically significant predictors for perceived respect and satisfaction. Whereas sex, working hospital, work attitude individual factors and organizational factors were significant predictors of perceived openness and sharing of patient information in nurse-physician communication during patient care.
Conclusion: Perceived level of nurse-physician communication mean score was low among nurses than physicians and it is attention seeking gap. Hence, the finding of our study suggests the need for developing and implementing nurse-physician communication improvement strategies to solve communication mishaps in patient care. 
KEY WORDS: Communication, Nurse-Physician, Nurse-Physician Communication, Perceived Nurse-Physician Communication

The nature has provided abundant plant wealth for all the living creatures, which possess medicinal virtues. Therefore, there is a necessity to explore their uses and to ascertain their therapeutic properties. In that way, the Traditional Siddha Medicine plays a vital role in preventing the progress of the disease. Saint Yugi (one of the Founders of Traditional Indian Siddha system of Medicine) describes 21 types of Mega noigal, which includes Madhu megam (Madhu – Sweet, Megam – Disease) [1, 2]. Diabetes mellitus is compared with Madhu megam in Siddha literature. Diabetes mellitus is a complex and a diverse group of disorders that disturbs the metabolism of carbohydrate, fat and protein. The number of diabetes mellitus cases has been increasing worldwide in recent years. Insulin is a key player in the control of glucose homeostasis. Lack of insulin affects carbohydrate, fat and protein metabolism. Management of diabetes without side effects is still a great challenge to the medical community [3]. The aim of the present study is to investigate the in-vitro Anti-Diabetic activity of the selected Herbo- Mineral drug, having its reference in age old Siddha classic text “Sarabhendhirar Vaithiya Ratnavali”. Thus, validating the traditional claim of the Herbo-mineral drug exhibits a significant inhibitory effect on In-vitro glucose diffusion and the result is being discussed.

Diabetes is a multifactorial metabolic syndrome and is one of the shared long-lasting illnesses globally. It is linked to long-term microvascular and macrovascular complications that contribute to disability, compromised quality of life, and reduction in lifespan, which eventually leads to death. This disease is not only incurring significant economic burden but also adversely affects the patients, caregivers, communities, and the society at large. The interruption of diabetes progress and its complications is a primary focus of scientific communities. In spite of various diagnostic modalities for diabetes, there is a limited marker to investigate the risk and progress of its complications. Netrin has recently received more attention as a biomarker of diabetes and a broader range of long-term complication. Therefore, the impetus of this review is to exhaustively discuss the role of Netrin as a potential biomarker and its therapeutic implication in diabetes and diverse sets of microvascular and macrovascular complications of diabetes. It also discourses the possible mechanisms of Netrin for the said pharmacological effect for a better understanding of the development and progression of diabetes and its complications in relation to this protein. It enables protective measures to be applied at the subclinical stage and the responses to preventive or therapeutic measures to be scrutinized. Besides, it might also facilitate the appraisal of novel therapeutic options for diabetes and various complications through modifying the endogenous Netrin and provide surrogate endpoints for intervention.

To say that accuracy is of paramount importance in academic publishing is little short of a platitude. Nevertheless, the question of how accuracy can be ensured is not a trivial one in the real world, given the landscape of competing interests and a plethora of practical constraints and limitations. Though the primary responsibility lies with authors themselves, the framework of peer review, managed and overseen by editors, was developed in part to ensure robustness and resilience of the system as a whole. Analysing how often and why the system fails is inherently difficult as in most instances the specific processes are not visible to parties not directly involved in the handling of a prospective paper. For this reason it is important to encourage the reporting of case studies which should inform avenues for potential improvement. The present manuscript describes an example which illustrates well a number of flaws of the peer review framework as it exists today. In particular, I detail a number of serious errors in an article recently published in a leading journal, which include conclusions not supported by evidence, methodological flaws, and ill-conceived statistical analysis, alarmist and exaggerated manner in which the findings are communicated in the media, and the poor handling of these issues by the journal's editorial board. In conclusion, the research community should exert a concerted effort to report, discuss, and document instances of criticisms of published scientific work being silenced.

Nephropathy is an important comorbidity associated with diabetes leading to chronic kidney disease. We studied the effect of Ocimum sanctum in comparison to Olmesartanmedoxomil, Pitavastatin and their combination in prevention of this comorbidity. Male Wistar rats were given streptozotocin to induce diabetes and randomly divided into groups. Group 1 (Control group) received Metformin (94.5mg/kg/day)+Distilled Water, Group 2 received Metformin (94.5mg/kg/day) +Ocimum sanctum (250 mg/kg/day), Group 3 received Metformin (94.5mg/kg/day) + Olmesartanmedoxomil(1.80 mg/kg/day), Group 4 received Metformin (94.5mg/kg/day) + Pitavastatin (0.18 mg/kg/day) and Group 5Metformin (94.5mg/kg/day) + Olmesartanmedoxomil (1.80 mg/kg/day)    + Pitavastatin (0.18 mg/kg/day). The effects of Metformin alone and with Ocimum sanctum, Olmesartanmedoxomil, Pitavastatin and their combination on blood glucose and renal function test parameters were assessed. All groups showed decrease in fasting plasma glucose and glycosylated hemoglobin. Serum urea and creatinine were increased in the Control group. However, significant improvement in all the parameters studied were seen when Ocimum sanctum, Olmesartan or Pitavastatin were added. Histopathological examination of kidney showed mesangial proliferation, tubular swelling, thickened glomerular basement membrane, hypertrophy in glomerular tufts andhydropic degeneration in control group and improvement in all treatment groups. The best results were seen in Ocimum sanctum and Olmesartan+Pitavastatin groups. Metformin alone does not prevent derangement of renal function and histological changes in the kidney in diabetes mellitus. These changes can be prevented by addition of Olmesartan and Pitavastatin or Ocimum sanctum

Background Nurse-physician communication has been shown to have a significant impact on the job satisfaction and retention of staff. In areas where it has been studied, communication failure between nurses and physicians was found to be one of the leading causes of preventable patient injuries, complications, death and medical malpractice claims. Objective The objective of this study is to determine perception of nurses and physicians towards nurse-physician communication in patient care and associated factors in public hospitals of Jimma zone, southwest Ethiopia. Methods Institution based cross-sectional survey was conducted from March 10 to April 16, 2014 among 341 nurses and 168 physicians working in public hospitals in Jimma zone. Data was collected using a pre-tested self-administered questionnaire; entered into EpiData version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 16.0 for analysis. Factor analysis was carried out. Descriptive statistics, independent sample t-test, linear regression and one way analysis of variance were used. Variables with P-value < 0.05 were considered as statistically significant. Results The response rate of the study was 91.55%. The mean perceived nurse-physician communication scores were 50.88±19.7% for perceived professional respect and satisfaction, and 48.52±19.7% for perceived openness and sharing of patient information on nurse-physician communication.

Objective: The purpose of this study was to understand the relationship between oxidative stress markers malondialdehyde (MDA), antioxidant Vitamins A, E, and C and the glycated hemoglobin levels with Type 2 diabetes mellitus.
Methods: The current study is a cross-sectional study group, comprised no diabetic individuals (100 healthy) as control groups and diabetic patients (300) as cases groups, attending the Khartoum-Sudan for routine follow-up during 2013–2015. The data were collected with the help of structured questionnaire and direct interview to collect information. Blood specimens were collected from both groups, and plasma levels of MDA, serum zinc, antioxidant Vitamins (A, E, and C), and glycated hemoglobin (HbA1c) were determined. Odds ratio and the 95% confidence interval (95% CI) were calculated for the presence of mutation between cases and controls and analyzed by SPSS program, version 13.
Results: The results of this study indicate a highly significant difference between the means of HbA1c% of the test group (n= 300) and the control group (n= 100). Mean±SD: 7.5±1.4 versus 4.9±0.3, respectively (p= 0.001). Significant positive correlation between HbA1c and MDA (p= 0.003). Significant correlation between HbA1c% and plasma Vitamins A, E, and C of the test group, respectively (p= 0.002),(p= 0.0008), and (p= 0.01).
Conclusion: There was significant correlation between HbA1c% with Malondialdehyde (MDA) and antioxidant Vitamins (A, C, and E).

The formation of advanced glycation end-products (AGEs), also called the Maillard reaction, occurs ubiquitously and irreversibly in patients with diabetes mellitus and its consequences is especially relevant to many inflammatory events leading to vascular dysfunctions and organ injury.  The present review intend to highlight some aspects relevant to nitric oxide synthases, advanced glycation end-products and their receptors as well as  the mechanisms by which AGEs is able to modulate the synthesis of nitric oxide (NO), either by NO quenching, modification of enzyme structure or up- and down-regulation of gene expression. Finally, other RAGE ligands different from AGE, but relevant in the context of inflammation, are presented as new modulators of nitric oxide synthesis.

To identify challenges children and youth with type 1 diabetes encounter from their own perspectives. Type 1 diabetes requires lifestyle changes involving diet modification, monitoring blood glucose, counting carbohydrates and administering insulin. Learning self-care and developing positive attitudes can improve glucose management and promote long-term benefits. Therefore, understanding challenges of youth living with type 1 diabetes from their own perspective is an important first step in improving diabetes outcomes for this age group. Qualitative descriptive design using focus groups to identify the experiences and challenges of children and youth living with type 1 diabetes. Six focus groups were held over a four-month period in 2010; each participant attended one focus group. A total of 16 children and youth with type 1 diabetes participated. The focus group discussions were audio recorded, transcribed verbatim and analysed for common themes according to qualitative methodology. To assure trustworthiness, investigators independently coded interviews and themes were refined and adjusted until consensus was reached. Three themes emerged after analysing transcripts from the focus groups that embody challenges children and youth with type 1 diabetes faced: (1) low blood glucose; (2) self-care activities; and (3) feeling different and/or alone. Data indicated type 1 diabetes is challenging for this age group. These challenges must be addressed to assist youth in learning to manage their disease and promote healthy outcomes. It is important for nurses to discuss challenges, understand perspectives of this age group, listen to their concerns, work with them to develop strategies promoting health, minimise complications, reduce or eliminate feeling different or alone and assist parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; efforts to be supportive.

Maesa indica belonging to family Myrsinaceae, commonly known as Atki is a large shrub. Ethnobotanical studies of Kolhapur district revealed that stem bark of M.  indica is used in the treatment a diabetes. The literature survey revealed that there is no experimental evidence of antidiabetic effect of the plant. Therefore the present study was carried out to investigate antidiabetic effect of M.  indica stem bark in streptozotocin induced diabetic rats. The Plant was subjected to pharmacognostic, physico-chemical and phytochemical evaluations which will assist in standardization for authenticity, quality and identification of the herbal products. Treatment with 2ml/kg stem bark distillate to diabetic rats resulted in significant reduction in blood glucose level. The preset study clearly demonstrated that the plant is having potential hypoglycemic activity which may be beneficial for the management and treatment of diabetes mellitus. It also shows good alpha glucosidase inhibition act...

The aim of the present work was to evaluate the antidiabetic activity of ethanol and aqueous extract of leaves of Gardenia latifolia. The samples were studied for their effect on inhibition of alpha amylase, alpha glucosidase and glucose transport across yeast cells. The significant results were observed in the crude extracts. The α-glucosidse & α-amylase inhibition was in a dose dependent manner and glucose transport differs with the sample and glucose concentration. From the results of the study, it is inferred that, Gardenia latifolia leaves possesses antidiabetic activity. However, these effects need to be confirmed using in vivo models and clinical trials for its effective utilization as therapeutic agents.

Diabetes is a metabolic disorder characterized by hyperglycemia (excessive amount of glucose) and is associated with abnormal lipid and protein metabolism. This was the first study done in Vindhyan region. The population size selected in this study was 400 (190 cases of diabetes and 210 healthy control). Anthropometric data has been collected during sample collection. Genetic polymorphism study of ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and the observed genotype frequencies, allele frequencies and carriage rates for ENPP1 K121Q polymorphism. We found an overall distribution of ENPP1 K121Q genotypes which was not significantly different in the healthy control (HC) group as compared to the disease group. Type 2 diabetes is a multifactorial disorder; so, we can conclude that in our population, ENPP1 is not associated with type 2 diabetes pathophysiology in Central Indian population. Higher body mass index (BMI) is an indicator of obesity, and in this investigation we found out that BMI is significantly higher in female diabetic patients group as compared to healthy control females (P = 0.0388); meanwhile in male patients, BMI was not significantly different in case and control samples. This indicates that obesity could also be associated with type 2 diabetes. Smoking and physical activity data was generated through questionnaire organized during sampling, and the findings suggest that physical activity could be a protective factor which decrease diabetes susceptibility, meanwhile smoking have very little or no effect over diabetes susceptibility.

The formation of advanced glycation end-products (AGEs), also called the Maillard reaction, occurs ubiquitously and irreversibly in patients with diabetes mellitus and its consequences are especially relevant to many inflammatory events leading to vascular dysfunctions and organ injury.

The purpose of this study was to determine the specific features of the morphological restructuring of the myocardium in the early stage of experimental diabetes mellitus (DM). Experimental type 1 DM rat model was developed by intraperitoneal injection of alloxan solution at a dose of 30 mg per 100 g body mass. After 1 month, 3 mL of blood was drawn by heart puncture and the plasma separated by centrifugation for biochemical analysis. Plasma glucose, insulin, and glycosylated haemoglobin in whole blood were determined. Light microscopy and morphometric studies were conducted of histological slices of the hearts of experimental animals. The investigation of heart morphology showed a statistically significant alteration in chamber wall thickness in the right auricle in rats with alloxan-induced DM. A change in cardiomyocyte diameter in myocardium slices was observed in all chambers of DM rats except for the left ventricle. Average cardiomyocyte diameter in rats with experimental DM increased by 26.6% and 15.5% in the right auricle and right ventricle, respectively, while average cardiomyocyte diameter in the left auricle decreased by 20.8%. Histological investigation of the heart following alloxan injection demonstrated, under the epicardium, distended vessels of the venous collecting microcirculatory system. Aggregation and agglutination of red blood cells and endothelial cell destruction were found in some vessels. In the early stage of DM development, structural alterations in the microcirculatory channels and myocardiocytes can be observed in the heart. These structural alterations were most evident in the right chambers of the heart. Anat Rec, 298:396–407, 2015. V C 2014 Wiley Periodicals, Inc.

Context: Diabetes mellitus is a progressive disease. In poor glycemic control, it can cause severe and non-reversible complications. A proper educational intervention from health care providers is needed for patients to decrease the progression of diabetes and its complications. Aims: To evaluate the effect of pharmacist-led educational intervention on predictors of diabetic neuropathy in patients. Methods: From two tertiary care hospitals, diabetic patients were randomly selected and divided into the control and intervention groups. The control group contained 200 patients who were getting traditional treatment from hospitals. In contrast, the intervention group included 200 patients who were receiving conventional treatment together with separate counseling sessions with pharmacists. The study continued for one year, and four follow up visits for both groups. A pre-validated data collection form was used to collect data for the signs and symptoms of diabetic neuropathy. Statistical Package for the Social Sciences version 24 was used to analyze the data. Results: The average HbA1c values decreased by up to 1.96% in the control group and 3.41% in the intervention group from baseline data. A statistically significant (p<0.05) difference in HbA1c among both of the study groups at every follow-up. The results of univariate and multivariate regression analysis showed that a statistically significant difference was observed in the improvement of signs and symptoms of diabetic neuropathy among both of the study groups. Conclusions: Statistically significant reduction in the sign and symptoms of diabetic neuropathy was observed in the intervention group at the end of one year.

Diabetic dermopathy is a cutaneous manifestation commonly seen in diabetes patients and was initially described by Melin in 1964. These lesions are well-demarcated, hyperpigmented macules or papules with atrophic depression and were commonly sighted on shins of the tibia with bilateral asymmetrical distribution and rarely seen on arms, thighs and abdomen. The incidence of DD ranges from 0.2 to 55%. It has been frequently associated with microangiopathic complications of diabetes such as nephropathy, retinopathy and polyneuropathy. Although the exact mechanism of occurrence is unknown, it may be related to impaired wound healing due to decreased blood flow, local thermal trauma or local subcutaneous nerve degeneration. Diagnosis is made by clinical examination and the differential diagnosis includes stasis dermatitis, early lesion of necrobiosis lipoidica and purpuric dermatitis. Prevention of dermopathy lesions includes optimized glucose control. No active treatment is recommended or proven effective and DD is known to resolve on its own as time passes. Modified collagen and high glycerine-based lotion have shown marked improvement in skin color changes due to diabetic dermopathy. Diabetic dermopathy is known to have a strong association with microangiopathic complications; the presence of such lesions must raise strong suspicion and prompt investigation for severe underlying pathology. Enhanced scrutinized glycemic control in diabetic dermatopathy patients can even lead to abatement in further progression to microvascular complications and improved long-term patient outcomes.

Background and Objective: Today, diabetes is a global problem which affects more than 400 million people worldwide. Adherence to treatment in diabetic patients is one of the key factors in the process of treatment and recovery of these people. The purpose of this study was to determine the adherence to treatment in diabetic patients and it's affecting factors. Materials and Methods: This descriptive-analytical study was conducted on 320 diabetic patients with an average age of 59.8±14.35 years in 2017, in Rasool Akram and Firoozgar Hospitals of Iran University of Medical Sciences. Data were collected by A Two-part questionnaire includes adherence to treatment of chronic diseases and the correlations were verified by Spearman test. Results: Average total score of adherence to treatment was 43. 11±33.13, which 62.82% of patients had poor adherence to treatment, 33.22% had moderate adherence to treatment, 2.96% had good adherence to treatment and 1% had good adherence to treatment. 52.5% of patients had diabetic foot and Adherence to the treatment was inversely associated with the onset of the diabetic foot. Conclusion: Adherence to treatment in diabetic patients was significantly low. There are some factors affecting adherence to treatment in diabetic patients that these factors should be identified for each patient.

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.

Objective: Background reliable information about the prevalence of
dyslipidemia in hypertensive and non hypertensive diabetic patients
in local region is essential to the development of regional health
policies for prevention and control of this condition. An attempt was
made in Puducherry region to examine the lipid profile parameters in
the diabetic patients with and without hypertension and thereby to
create awareness on the importance of closely watching their lipid
parameters frequently from the age of 30-70.  Method:  Totally case
sheets of 105 Puducherry patients are referred covering hypertensive
and non hypertensive diabetic patients. To ascertain the significance
of each parameters student’s t-test has been done. Results: It is found
that el evated serum triglycerides (TG), very low density lipoprotein
(VLDL) and Cholesterol/High density lipoprotein Ratio
(CHOL/HDL) but normal cholesterol, low density lipoprotein (LDL)
and HDL in diabetic patients of all age groups. In both gender Serum
triglycerides are significantly elevated in diabetics of all age groups
compared to non diabetics. Plasma VLDL is significantly elevated in
female diabetic patients between the age group of 30-40 years and
60-70 years compare to non diabetics and other age groups. Plasma
VLDL is significantly elevated in male diabetic patients also between
the age group of 30-50 years compare to non diabetics and other age
groups.  Conclusion:  Serum TG and VLDL was found to be more
significantly increased in diabetic patients with  hypertension
compared to without hypertension. Similarly serum TG is also
elevated in non diabetic hypertensive patients.

2005 Mann Award for best clinical paper at the American Orthopaedic Foot and Ankle Society Conference, Boston, MA.

Patients with diabetes mellitus may develop plantar flexion contractures (equinus) which may increase forefoot pressure during walking. In order to determine the relationship between equinus and forefoot pressure, we measured forefoot pressure during walking in 27 adult diabetics with a mean age of 66.3 years (SD 7.4) and a mean duration of the condition of 13.4 years (SD 12.6) using an Emed mat. Maximum dorsiflexion of the ankle was determined using a custom device which an examiner used to apply a dorsiflexing torque of 10 Nm (SD 1) for five seconds.

Simple linear regression showed that the relationship between equinus and peak forefoot pressure was significant (p < 0.0471), but that only a small portion of the variance was accounted for (R2 = 0.149). This indicates that equinus has only a limited role in causing high forefoot pressure. Our findings suggest caution in undertaking of tendon-lengthening procedures to reduce peak forefoot plantar pressures in diabetic subjects until clearer indications are established.