Search results for: type 2 diabetic mellitus

Authors: O. Poleshchuk, E. Komarov

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This paper presents a regression model for interval type-2 fuzzy sets based on the least squares estimation technique. Unknown coefficients are assumed to be triangular fuzzy numbers. The basic idea is to determine aggregation intervals for type-1 fuzzy sets, membership functions of whose are low membership function and upper membership function of interval type-2 fuzzy set. These aggregation intervals were called weighted intervals. Low and upper membership functions of input and output interval type-2 fuzzy sets for developed regression models are considered as piecewise linear functions.

Keywords: interval type-2 fuzzy sets, fuzzy regression, weighted interval

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Authors: Birendra Kumar Bista, Rhitik Bista, Prafulla Koirala, Lokendra Mandal, Nikrsh Raj Shrestha, Vivek Kattel

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Introduction: Poorly controlled diabetes is associated with cause and poor outcome of stroke. High blood sugar reduces cerebral blood flow, increases intracranial pressure, cerebral edema and neuronal death, especially among patients with poorly controlled diabetes.1 SGLT2 inhibitors are associated with 50% reduction in hemorrhagic stroke compared with placebo. SGLT2 inhibitors decrease cardiovascular events via reducing glucose, blood pressure, weight, arteriosclerosis, albuminuria and reduction of atrial fibrillation.2,3 No study has been documented in low income countries to see the role of post stroke SGLT2 inhibitors on diabetic patients at and after ICU admission. Aims: The aim of the study was to measure the 12 months outcome of diabetic patients with acute stroke admitted in ICU set up with naïve SGLT2 inhibitors add on therapy. Method: It was prospective cohort study carried out in a 250 bedded tertiary neurology care hospital at the province capital Biratnagar Nepal. Diabetic patient with acute stroke admitted in ICU from 1st January 2022 to 31st December 2022 who were not under SGLT2 inhibitors were included in the study. These patients were managed as per hospital protocol. Empagliflozin was added to the alternate enrolled patients. Empagliflozin was continued at the time of discharged and during follow up unless contraindicated. These patients were followed up for 12 months. Outcome measured were mortality, morbidity requiring readmission or hospital visit other than regular follow up, SGLT2 inhibitors related adverse events, neuropsychiatry comorbidity, functional status and biochemical parameters. Ethical permission was taken from hospital administration and ethical board. Results: Among 147 diabetic cases 68 were not treated with empagliflozin whereas 67 cases were started the SGLT2 inhibitors. HbA1c level and one year mortality was significantly low among patients on empaglifozin arm. Over a period of 12 months 427 acute stroke patients were admitted in the ICU. Out of them 44% were female, 61% hypertensive, 34% diabetic, 57% dyslipidemia, 26% smoker and with median age of 45 years. Among 427 cases 4% required neurosurgical interventions and 76% had hemorrhagic CVA. The most common reason for ICU admission was GCS<8 (51%). The median ICU stay was 5 days. ICU mortality was 21% whereas 1 year mortality was 41% with most common reason being pneumonia. Empaglifozin related adverse effect was seen in 11% most commonly lower urinary tract infection in 6%. Conclusion: Empagliflozin can safely be started among acute stroke with better Hba1C control and low mortality outcome compared to treatment without SGLT2 inhibitor.

Keywords: diabetes, ICU, mortality, SGLT2 inhibitors, stroke

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Authors: Oseyemi O. Olubomehin, Edith O. Ajaiyeoba, Kio A. Abo, Eleonora D. Goosen

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Diabetes is a major degenerative disease of global concern and it is the third most lethal disease of mankind, accounting for about 3.2 million deaths annually. Lowering postprandial hyperglycemia by inhibition of carbohydrate hydrolyzing enzyme such as alpha-amylase is one of the therapeutic approaches to treat Type 2 Diabetes. Alpha-amylase inhibitors from plants have been found to be effective in managing postprandial hyperglycemia. In continuation of our anti-diabetic activities of this plant, bioassay-guided fractionation and isolation using 0.1-1.0 mg/mL furnished djalonenol, a monoterpene diol with a significant 53.7% α-amylase inhibition (p<0.001) from the stem bark which was comparable to acarbose which gave a 54.9% inhibition. Spectral characterization using Infra-red, Gas Chromatogrphy-Mass spectrometry, 1D and 2D NMR of the isolated compound was done to elucidate the structure of the compound.

Keywords: alpha-amylase inhibitor, hyperglycemia, postprandial, diabetes

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Authors: Budur Almutairi

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Introduction: There is an alarming increase in the number of diabetic patients in Saudi Arabia during the last twenty years. The World Health Organization (WHO) reports that the country ranks seventh in the world for the rate of diabetes. It is also estimated that around 7 million of the population are diabetic and almost around 3 million have pre-diabetes. The prevalence is more in urban area than in rural and more in women than in men and it is closely associated with the parallel rise in obesity rates. Diabetes is found to be contributing to the increasing mortality, morbidity and vascular complications and becoming a significant cause of medical complications and even death. The trends shown by the numbers are worrying as the prevalence is steadily doubling every two decades and particularly in Saudi Arabia, this could soon reach 50% in those over 50 years of age. The economic growth and prosperity have shown notable changes in the lifestyle of the people. Most importantly, along with an increased consumption of fast foods and sugar-rich carbonated soft drinks, eating habits became less healthy and the level of physical activity is decreased. The simultaneous technological advancement and the introduction of new mechanical devices like, elevators, escalators, remotes and vehicles pushed people to a situation of leading a more sedentary life. This study is attempting to evaluate the success of the campaign that introduced through popular social media in the country. Methodology: The Ministry of Health (MoH) has initiated a novel method of campaign activity to generate discussion among public about diabetes. There were mythical monsters introduced through popular social media with disguised messages about the condition of diabetes has generated widespread discussions about the disease among the general public. The characters that started appearing in social media About 600 retweets of the original post was testimonial for the success of the Twitter campaign. The second most successful form of campaign was a video that adopted a very popular approach of using Dark Comedy in which, the diabetes was represented through a twisted negative character that talks about his meticulous plans of how he is going to take the common people into his clutches. This fictional character gained more popularity when introduced into twitter and people started interacting with him raising various questions and challenging his anti-social activities. Major findings: The video generated more than 3,200,000 views ranking 9th in You Tube’s most popular video in Saudi Arabia and was shared 7000 times in a single week. Also, the hashtag got over 4,500,000impressions and over one million visits. Conclusion: Diabetes mellitus in Saudi Arabia is emerging as an epidemic of massive proportions, threatening to negate the benefits of modernization and economic revival. It is highly possible that healthy practices connected with the prevention and management of DM can easily be implemented in a manner that does not conflict with the cultural milieu of Saudi Arabia.

Keywords: campaign, diabetes, Saudi, social media

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Authors: Kumaressan Ragunathan, Arisudhan Anantharachagan

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Gestational diabetes mellitus (GDM) is the subtype of diabetes that has been rapidly increasing in numbers in Australia. The annual percentage of GDM has increased more than 50 percent in the last decade. According to Diabetes Australia, more than five hundred thousand women in Australia will be diagnosed with GDM. Globally, the prevalence of GDM ranges from single-digit to more than 45%. The prevalence of GDM has increased significantly last five years after the introduction of new diagnostic criteria. Hence, we have decided to investigate the trend in GDM prevalence in a tertiary maternity unit at Western Australia and compare it to national prevalence. Data is derived from STORK Perinatal Database which has been used by Maternity services in Western Australia to populate information on pregnancy and labour. We have selected data from 2015 until 2020, which includes 17508 women. Among 17508 women, 3850 women were diagnosed with GDM. In 2015, we had a total of 2213 deliveries with 345 of them were complicated by GDM. GDM prevalence was 15.6% compared to the Australian national prevalence of 12%. In 2016, total deliveries increased to 2759 with 590 of were with GDM. GDM prevalence was 21.4% compared to the Australian national prevalence of 12%. In 2017, total deliveries further increased to 3049 with 675 with GDM. GDM prevalence was 22.1%, with an Australian national prevalence of 13%. In 2018, total deliveries continued to increase, with numbers reaching 3231 with 749 with GDM. GDM prevalence was 23.2%, with an Australian National prevalence of 14%. In 2019, total deliveries were 3110, with 712 complicated by GDM. GDM prevalence was 22.9%, with Australian national prevalence 14%. In 2020, total deliveries 3146 with 819 complicated by GDM. GDM prevalence increased to 26% and we were unable to compare this to national standard as national prevalence has not been released. Among 3890 women with GDM, 2482 (64%) of them required insulin. Apart from that, a total 1642(42%) from the GDM group were delivered via the Caesarean section. 2121 (55%) women with GDM required induction of labour. Overall, we demonstrated an increase in the prevalence of GDM in our unit from 2015 until 2020. Our prevalence is also higher compared to national prevalence. This could be contributed by the increasing number of obesity and in addition, our unit accepts referrals of women with a body mass index (BMI) of more than 40. Hence, further studies are required to look at other risk factors like ethnicity, socio-economic status, health literacy and age, which could contribute to this high prevalence.

Keywords: gestational diabetes mellitus, prevalence, Western Australia, Australia

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Authors: Desi Meriyanti, Delina Puspa Rosana Firdaus, Ristia Rinati

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Nowadays, the presence of free radicals become a big concern due to its negative impact to the body, which can triggers the formation of degenerative diseases such as cancer, heart disease cardiovascular, diabetic mellitus and others. Free radical oxidation can be prevented by the presence of antioxidants. Naturally, the human body produces its own antioxidants. Because of the free radicals exposure are so intense, especially from the environment, it is necessary to supply antioxidants needed from outside, through the consumption of functional foods with high antioxidant content. Gethuk is one of the traditional snacks in Indonesia. Gethuk is made from cassava with minimal processing such as boiling, destructing, and forming. Gethuk is classified as a familiar snack in the community, so it has a potential for developing, especially into a functional food. The low content of antioxidants in gethuk can be overcome with the development of a product called Gethuk Marillo. Gethuk Marillo is gethuk with the addition of natural antioxidants from mangosteen pericarp extract which has a high content of xanthones, these compounds are classified into flavonoids and act as antioxidants in the body. Gethuk Marillo served along with tamarillo fruit sauce which is also high in antioxidants such as anthocyanin. The combination between 300 grams gethuk Marillo and sauce contain flavonoid about 31% of human antioxidant needs per day. Gethuk Marillo called as a functional food because of high flavonoids content which can prevent degenerative diseases namely cancer, as many studies that the xanthone and anthocyanins compounds can effectively prevent the formation of cancer cells in human body.

Keywords: Gethuk marillo, xanthones, anthocyanin, high antioxidants, anti-cancer

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Authors: Radmila Maksimovic, Sonja Ketin, Rade Biocanin, Jelena Maksimovic

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The abnormal conditions of life and work genetic factors often play a major role in incidence of diabetes-diabetes, heart disease and vascular disease, jaundice, and post traumatic stress. Trauma and post traumatic stress are most common in the displaced persons,and the focus of this paper is to shed light on this issue in former Yugoslavia, Yugoslavia and now in our country. This is caused by increased beta-cell sensitivity to viruses, the development of autoimmune antibodies against its own pancreascells, degenerative changes in cells that r esult in change of structure and insulin. In this paper, we dealt with traumatic events and long-term psycho social consequences for internally displaced persons, several years after displacement, and found a high level of PTSD symptoms. This stress is present in almost 1/3 of internally displaced persons, and every sixth person is suffering from PTSD in the past. Respondents generally suffer from symptoms of intrusion, but there was a large number of symptoms, avoidance and increased arousal. We also found that gender, age andeducation related to the symptoms. Females, and older respondents and internally displaced persons with lower levels of education how a higher level of PTSD symptoms, especially symptoms of intrusion and increase darousal. It is a highly traumatized sample in which more than 1/2 of respondents experienced more than three traumatic events in life,although the number of traumas experienced before, during and after the conflict varies.We found that during the war, internally displaced persons haveexperienced more traumatic events compared with the periodbefore and after the conflict. Trauma are different in type. No significant correlation between the number of experienced trauma and PTSD, suggesting that it is necessary to further study the structure of past traumas and the intermediary effects of certain risk factors and protective factors.

Keywords: living environment, displaced persons, jaundice, diabetes, trauma, diabetic hypertension, post-traumatic stress (PTSD), treatment

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Authors: Kiran Sharma, Viktor Kunder, Zerha Rizvi, Ricardo Soubelet

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Platelet rich plasma (PRP) has been recognized as a method of treatment in medicine since the 1980s. It primarily functions by releasing cytokines and growth factors that promote wound healing; these growth promoting factors released by PRP enact new processes such as angiogenesis, collagen deposition, and tissue formation that can change wound healing outcomes. Many studies recognize that PRP aids in chronic wound healing, which is advantageous for patients who suffer from chronic diabetic foot ulcers (DFUs). This scoping review aims to examine literature to identify the efficacy of PRP use in the healing of DFUs. Following PRISMA guidelines, we searched randomized-controlled trials involving PRP use in diabetic patients with foot ulcers using PubMed, Medline, CINAHL Complete, and Cochrane Database of Systematic Reviews. We restricted the search to articles published during 2005-2022, full texts in the English language, articles involving patients aged 19 years or older, articles that used PRP on specifically DFUs, articles that included a control group, articles on human subjects. The initial search yielded 119 articles after removing duplicates. Final analysis for relevance yielded 8 articles. In all cases except one, the PRP group showed either faster healing, more complete healing, or a larger percentage of healed participants. There were no situations in the included studies where the control group had a higher rate of healing or decreased wound size as compared to a group with isolated PRP-only use. Only one study did not show conclusive evidence that PRP caused accelerated healing in DFUs, and this study did not have an isolated PRP variable group. Application styles of PRP for treatment were shown to influence the level of healing in patients, with injected PRP appearing to achieve the best results as compared to topical PRP application. However, this was not conclusive due to the involvement of several other variables. Two studies additionally found PRP to be useful in healing refractory DFUs, and one study found that PRP use in patients with additional comorbidities was still more effective in healing DFUs than the standard control groups. The findings of this review suggest that PRP is a useful tool in reducing healing times and improving rates of complete wound healing in DFUs. There is room for further research in the application styles of PRP before conclusive statements can be made on the efficacy of injected versus topical PRP healing based on the findings in this study. The results of this review provide a baseline for further research in PRP use in diabetic patients and can be used by both physicians and public health experts to guide future treatment options for DFUs.

Keywords: diabetic foot ulcer, DFU, platelet rich plasma, PRP

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Authors: Leilei Liang

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Leadership is commonly classified as formal leadership and informal leadership, which ignores and neglects the effects of 3rd type leadership. The emergence of 3rd type of leadership is closely related to special relations. To figure out the mechanism and effects of 3rd type leadership as well as the impacts of formal leadership and informal leadership on employee performance, this study collects data from 350 participants through a survey and proposes three hypotheses respectively from the perspective of expectation theory. The analytical results provide strong evidence for two of the three hypotheses, which demonstrate the positive correlation between formal leadership and individual performance and the negative relationship between 3rd type leadership and individual performance. This study contributes to leadership literature by putting forward the concept of the 3rd type of leadership. In addition, the effects of formal leadership, informal leadership, and 3rd type leadership on individual performance are discussed respectively in this study.

Keywords: formal leadership, informal leadership, 3rd leadership, individual performance, expectation theory

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Authors: Ki Ok Choi, Sung Ho Hong, Dong Suck Kim, Don Mook Choi

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Rack type warehouses are different from general buildings in the kinds, amount, and arrangement of stored goods, so the fire risk of rack type warehouses is different from those buildings. The fire pattern of rack type warehouses is different in combustion characteristic and storing condition of stored goods. The initial fire burning rate is different in the surface condition of materials, but the running time of fire is closely related with the kinds of stored materials and stored conditions. The stored goods of the warehouse are consisted of diverse combustibles, combustible liquid, and so on. Fire detection time may be delayed because the residents are less than office and commercial buildings. If fire detectors installed in rack type warehouses are inadaptable, the fire of the warehouse may be the great fire because of delaying of fire detection. In this paper, we studied what kinds of fire detectors are optimized in early detecting of rack type warehouse fire by real-scale fire tests. The fire detectors used in the tests are rate of rise type, fixed type, photo electric type, and aspirating type detectors. We considered optimum fire detecting method in rack type warehouses suggested by the response characteristic and comparative analysis of the fire detectors.

Keywords: fire detector, rack, response characteristic, warehouse

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Authors: Chun-Chin Huang

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Individuals with prediabetes increase the risk of developing type 2 diabetes. Exercise is a potent stimulator of skeletal muscle glucose uptake and thus good for maintaining glucose homeostasis. That could be a conducive method to improve blood glucose regulation and prevent type 2 diabetes without medication intake. The aim of this study was to summarize mechanisms of insulin resistance and investigate the beneficial effects of acute and chronic aerobic exercise on glycemic control in prediabetes and type 2 diabetes. Aerobic exercise regulates glucose homeostasis and reduces blood glucose, insulin concentrations. Therefore, the type of aerobic exercise brings positive effects to prediabetes and type 2 diabetes.

Keywords: insulin resistance, glucose sensitivity, impaired fasting glucose, impaired glucose tolerance

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Authors: Ramji Kalidoss, Snekhalatha Umapathy, V. Dhinakaran, J. M. Mathana

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Chemi-resistive sensors used in breathalyzers have become a hotspot between the international breath research communities. These sensors exhibit a significant change in its resistance depending on the temperature it gets heated thus demanding high power leading to non-portable instrumentation. In this work, numerical simulation to identify the suitable combination of substrate and heater profile using COMSOL multiphysics was studied. Ni-Cr and Pt-100 joule resistive heater with various profiles were studied beneath the square and circular alumina substrates. The temperature distribution was uniform throughout the square substrate with the meander shaped pt100 heater with 48 mW power consumption for 200 oC. Moreover, this heater profile induced minimal stress on the substrate with 0.5 mm thick. A novel Graphene based ternary metal oxide nanocomposite (GO/SnO2/TiO2) was coated on the optimized substrate and heater to elucidate the response of diabetes biomarker (acetone). The sensor exhibited superior gas sensing performance towards acetone in the exhaled breath concentration range for diabetes (0.25 – 3 ppm). These results indicated the importance of substrate and heater properties along with sensing material for low power portable breathalyzers.

Keywords: Breath Analysis, Chemical Sensors, Diabetes Mellitus, Graphene Nanocomposites, Heater, Substrate

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Authors: Von Jerick Tenorio, Jonald Lucero, Marivic Vestal, Edwin Tiempo

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In patients with hostile aortic neck anatomy, the risks of proximal seal complications and stent migration remain with EVAR despite improved endograft technology. This case report discusses how the technical challenges of the hostile neck anatomy, proximal penetrating atherosclerotic ulcer (PAU) and tortuous femoral access were addressed. The CT aortogram of a 63-year-old hypertensive and diabetic man with recurring abdominal discomfort revealed a fusiform infra-renal aneurysm measuring 8.8 cm in length and 5.7 cm in diameter. The proximal landing zone only has a 3 mm healthy neck with a conicity of > 10% and a thrombus of 4 mm thick. Proximal to the aneurysm is a PAU with a circumferential mural thrombus. The right femoral artery is tortuous with > 90o angulation. A 20% oversized Endurant II endograft and Aptus Heli-FX EndoAnchors were deployed as prophylaxis for type I endoleaks and endograft migration consequent to the conical neck and proximal aneurysm extension consequent to the PAU. A stiff Backup Meier guide wire facilitated the deployment of the endograft. Coil embolization of the right internal iliac artery was performed as prophylaxis for type II endoleaks. EndoAnchors can be used as an adjunct to EVAR as prophylaxis for proximal seal complications and stent migration in patients with hostile aortic aneurysm neck anatomy and concomitant proximal PAU.

Keywords: endoAnchors, endoleaks, EVAR, hostile neck

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Authors: Kirstin Griffin

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During a period of increased anxiety and stress, communication became the essential tool to help the public stay informed and feel prepared during the Covid-19 pandemic. However, certain groups of patients were not feeling as reassured. The news and media blasted the message that patients with diabetes were “high-risk" in regards to contracting the Covid-19 infection. Routine clinics were being cancelled, GP practices were closing their doors, and patients with type 1 diabetes were understandably scared. The influx of calls to diabetes specialists nurses from concerned patients highlighted the need for better and more specialised information. An Application specifically for patients with type 1 diabetes was created to deliver this information, and it proved to be the essential communication tool that was desperately needed. The Application for patients with type 1 diabetes aimed to deliver specialist information to patients in regards to their diagnosis, management, and ongoing follow-up commitments. The Application gives practical advice on multiple areas of diabetes management, including sick-day rules and diabetic emergencies, as well as up-to-date information on technology, including setting up Libre devices and downloading glucose meters to facilitate attending virtual clinics. Delivery of this information in an easy-to-understand and comprehensive way is intended to improve patient engagement with diabetes services and ultimately empower patients in the control of their own disease. The application also offers a messaging service to allow the diabetes team to send out alerts to patient groups on specific issues, such as changes to clinics, or respond to recent news updates regarding Covid-19. The App was launched in NHS Fife in June 2020 and has amassed 800 active users so far. There is growing engagement with the App since its launch, with over 1000 user interactions in the last month alone. Feedback shows that 100% of users like the App and have found it useful in the management of their diabetes. The App has proven to be an essential tool in communication with one of the most vulnerable groups during the Covid-19 pandemic, and its ongoing development will continue to increase patient engagement and improve glycaemic control for patients with type 1 diabetes. The future of chronic disease management should involve digital solutions such as apps to further empower patients in their healthcare.

Keywords: diabetes, endocrinology, digital healthcare, medical apps

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Authors: Xuran Zhang, Huiru Chen

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In recent years, China has made great efforts to cultivate and develop the housing rental market, especially the rental-type public housing, which has been paid attention to by all sectors of the society. This paper takes Hangzhou rental-type public housing as the research object, and divides it into three development stages according to the different supply modes of rental-type public housing. Through data collection and field research, the paper summarizes the spatial characteristics of rental-type public housing from the five perspectives of spatial planning, spatial layout, spatial integration, spatial organization and spatial configuration. On this basis, the paper proposes the optimization of the spatial layout. The study concludes that the spatial layout of rental-type public housing should be coordinated with the development of urban planning. When planning and constructing, it is necessary to select more mixed construction modes, to be properly centralized, and to improve the surrounding transportation service facilities.  It is hoped that the recommendations in this paper will provide a reference for the further development of rental-type public housing in Hangzhou.

Keywords: Hangzhou, rental-type public housing, spatial distribution, spatial optimization

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Authors: Hashaam Akhtar

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IFNλR1 and IL10R2 collectively construct a heterodimer, which is an acknowledged functional receptor for all type III interferons (IFNs). Expression of IFNλR1 is highly tissue specific, which can help in making type III IFNs a drug of choice as comparable to its analogue, type I IFNs, for treating hepatitis C in the near future. Although, expression of IFNλR1 also varies with the concentration of type I IFNs, but in this study it was shown that the expression of IFNλR1 varies with the protein titers of IFN-α, IFN-λ3 and the newly discovered IFN-λ4. High dosage of IFN-α reduces the expression of IFNλR1 in HepG2 cells, which can affect the antiviral activity of type III IFNs in vivo. We premeditated an experimental strategy to differentiate monocytes into dendritic cells (DCs), type I and type II macrophages in vitro and quantified the expression of the IFNλR1 by qPCR. The exposure of newly discovered IFN-λ4 to macrophages and DCs also raised the expression of its own receptor, which shows that expression of IFN-λ4 protein in hepatitis C patient may augment type I treatment and help ease off viral titers. The results of this study may contribute in some understanding towards the mechanisms involved in the selective expression of IFNLR1 and exceptionalities associated with the receptor.

Keywords: IFNLR1, Interferon Lambda 4 (IFN-λ4), Mononuclear Phagocyte Cells (MPCs), expression

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Authors: Omowunmi Amao

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Sansevieria liberica belongs to the family Agavaceae (Ruscaceae or Dracaenaceae). They are widely distributed throughout the tropics. Literature review suggests that in Nigeria, the leaves and roots of Sansevieria liberica are used in traditional medicine for the treatment of asthma, abdominal pains, colic, diarrhea, eczema, gonorrhea, hemorrhoids, hypertension, monorrhagia, piles, sexual weakness, snake bites, and wounds of the foot. In this context, the standardized Methanolic extract of roots of Sansevieria liberica is hypothesized for the evaluation of the hypoglycemic activity. Material and Methods: Inbreed adult male sprague-Dawley albino rats were used in the experiment. The suspension of standardized Methanol extract (ME) of Sansevieria liberica was treated for hypoglycemic activity in oral glucose tolerance test (OGTT) method. The suspension of standardized Methanolic extract (ME) of Sansevieria liberica was also treated for hypoglycemic activity in streptozotocin-induced diabetic rats. Results: The Methanolic extract (ME) of Sanseviera liberica root (100 mg/kg, 200mg/kg, and 400 mg/kg) showed potential hypoglycemic activity in diabetic rats, and further in OGTT method. Furthermore, Methanolic extract of Sanseviera liberica root showed significant (P<0.05) increase in final body weight, total hemoglobin, insulin, albumin and high-density lipoprotein levels, however, decrease in fluid intake, glycosylated hemoglobin, urea, creatinine, total cholesterol, triglyceride and low-density lipoprotein levels. Additionally, it improved oxidative stress in terms of reducing lipid peroxidase and superoxide dismutase, and elevating catalase activity. Conclusions: These findings suggest that the Methanolic extract of Sanseviera liberica root was found to be potential hypoglycemic, and would be a promising candidate for the treatment of diabetes.

Keywords: diabetes, Sanseviera liberica, hypoglycemic activity, diabetes and metabolism

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Authors: Soumaya Mrabet, Taieb Ach, Imen Akkari, Amira Atig, Neirouz Ghannouchi, Koussay Ach, Elhem Ben Jazia

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Introduction: Celiac disease (CD) and type 1 diabetes mellitus (T1D) are complex disorders with shared genetic components. The association between CD and T1D has been reported in many pediatric series. The aim of our study is to describe the epidemiological, clinical and evolutive characteristics of adult patients presenting this association. Material and Methods: This is a retrospective study including patients diagnosed with CD and T1D, explored in Internal Medicine, Gastroenterology and Endocrinology and Diabetology Departments of the Farhat Hached University Hospital, between January 2005 and June 2016. Results: Among 57 patients with CD, 15 patients had also T1D (26.3%). There are 11 women and 4 men with a median age of 27 years (16-48). All patients developed T1D prior to the diagnosis of CD with an average duration of 47 months between the two diagnosis (6 months-5 years). CD was revealed by recurrent abdominal pain in 11 cases, diarrhea in 10 cases, bloating in 8 cases, constipation in 6 cases and vomiting in 2 cases. Three patients presented cycle disorders with secondary amenorrhea in 2 patients. Anti-Endomysium, anti-transglutaminase and Anti-gliadin antibodies were positive respectively in 57, 54 and 11 cases. The biological tests revealed anemia in 10 cases, secondary to iron deficiency in 6 cases and folate and vitamin B12 deficiency in 4 cases, hypoalbuminaemia in 4 cases, hypocalcemia in 3 cases and hypocholesterolemia in 1 patient. Upper gastrointestinal endoscopy showed an effacement of the folds of the duodenal mucosa in 6 cases and a congestive duodenal mucosa in 3 cases. The macroscopic appearance was normal in the others cases. Microscopic examination showed an aspect of villous atrophy in 57 cases, which was partial in 10 cases and total in 47 cases. After an average follow-up of 3 years 2 months, the evolution was favorable in all patients under gluten-free diet with the necessity of less important doses of insulin in 10 patients. Conclusion: In our study, the prevalence of T1D in adult patients with CD was 26.3%. This association can be attributed to overlapping genetic HLA risk loci. In recent studies, the role of gluten as an important player in the pathogenesis of CD and T1D has been also suggested.

Keywords: celiac disease, gluten, prevalence, type 1 diabetes

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Authors: Hayden R Schott, John M Felder III

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Introduction: Chronic lower extremity wounds in the diabetic and vasculopathic populations are associated with a high degree of morbidity.When wounds require more extensive treatment than can be offered by wound care centers, more aggressive solutions involve local tissue transfer and microsurgical free tissue transfer for achieving definitive soft tissue coverage. These procedures of autologous tissue transfer (ATT) offer resilient, soft tissue coverage of limb-threatening wounds and confer promising limb salvage rates. However, chronic osteomyelitis and recalcitrant soft tissue infections are common in severe diabetic foot wounds and serve to significantly complicate ATT procedures. Stimulan is a resorbable calcium sulfate antibiotic carrier. The use of stimulan antibiotic beads to treat chronic osteomyelitis is well established in the orthopedic and plastic surgery literature. In these procedures, the beads are placed beneath the skin flap to directly deliver antibiotics to the infection site. The purpose of this study was to quantify the success of Stimulan antibiotic beads in treating recalcitrant infections in patients with diabetic foot wounds receiving ATT. Methods: A retrospective review of clinical and demographic information was performed on patients who underwent ATT with the placement of Stimulan antibiotic beads for attempted limb salvage from 2018-21. Patients were analyzed for preoperative wound characteristics, demographics, infection recurrence, and adverse outcomes as a result of product use. The primary endpoint was 90 day infection recurrence, with secondary endpoints including 90 day complications. Outcomes were compared using basic statistics and Fisher’s exact tests. Results: In this time span, 14 patients were identified. At the time of surgery, all patients exhibited clinical signs of active infection, including positive cultures and erythema. 57% of patients (n=8) exhibited chronic osteomyelitis prior to surgery, and 71% (n=10) had exposed bone at the wound base. In 57% of patients (n=8), Stimulan beads were placed beneath a free tissue flap and beneath a pedicle tissue flap in 42% of patients (n=6). In all patients, Stimulan beads were only applied once. Recurrent infections were observed in 28% of patients (n=4) at 90 days post-op, and flap nonadherence was observed in 7% (n=1). These were the only Stimulan related complications observed. Ultimately, lower limb salvage was successful in 85% of patients (n=12). Notably, there was no significant association between the preoperative presence of osteomyelitis and recurrent infections. Conclusions: The use of Stimulanantiobiotic beads to treat recalcitrant infections in patients receiving definitive skin coverage of diabetic foot wounds does not appear to demonstrate unnecessary risk. Furthermore, the lack of significance between the preoperative presence of osteomyelitis and recurrent infections indicates the successful use of Stimulan to dampen infection in patients with osteomyelitis, as is consistent with the literature. Further research is needed to identify Stimulan as the significant contributor to infection treatment using future cohort and case control studies with more patients. Nonetheless, the use of Stimulan antibiotic beads in patients with diabetic foot wounds demonstrates successful infection suppression and maintenance of definitive soft tissue coverage.

Keywords: wound care, stimulan antibiotic beads, free tissue transfer, plastic surgery, wound, infection

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Authors: Kalakotla Shanker, G. Krishna Mohan

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Nowadays, nanoparticles are being used in pharmacological studies for their exclusive properties such as small size, more surface area, biocompatibility and enhanced solubility. In view of this, the present study aimed to evaluate the antihyperglycemic potential of biologically synthesized silver nanoparticles (BSSNPs) and Gymnema sylvestre (GS) extract. The SEM and SEM analysis divulges that the BSSNPs were spherical in shape. EDAX spectrum exhibits peaks for the presence of silver, carbon, and oxygen atoms in the range of 1.0-3.1 keV. FT-IR reveals the binding properties of active bio-constituents responsible for capping and stabilizing BSSNPs. The results showed increased blood glucose, huge loss in body weight and downturn in plasma insulin. The GS extract (200 mg/kg, 400 mg/kg), BSSNPs (100 mg/kg, 200 mg/kg) and metformin 50 mg/kg were administered to the diabetic rats. BSSNPs at a dose level of 200 mg/kg (b.wt.p.o.) showed significant inhibition of (p<0.001) blood glucose levels as compared with GS extract treated group. The results obtained from study indicate that the BSSNP shows potent anti-diabetic activity.

Keywords: biological silver nanoparticles, G. sylvetre, gymnemic acid, streptozotocin, Wistar rats, antihyperglycemic activity, anti-hyperlipidemic activity

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Authors: Victor Arokia Doss, Kuberapandian Dharaniyambigai, K. Julia Rose Mary

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Advanced Glycation End (AGE) products are the end products due to the reaction between excess reducing sugar present in diabetes and free amino group in protein lipids and nucleic acids. Thus, non-enzymic glycation of molecules such as hemoglobin, collagen, and other structurally and functionally important proteins add to the pathogenic complications such as diabetic retinopathy, neuropathy, nephropathy, vascular changes, atherosclerosis, Alzheimer's disease, rheumatoid arthritis, and chronic heart failure. The most common non-cross linking AGE, carboxymethyl lysine (CML) is formed by the oxidative breakdown of fructosyllysine, which is a product of glucose and lysine. CML is formed in a wide variety of tissues and is an index to assess the extent of glycoxidative damage. Thus we have constructed a mathematical and computational model that predicts the effect of temperature differences in vivo, on the formation of CML, which is now being considered as an important intracellular milieu. This hybrid model that had been tested for its parameter fitting and its sensitivity with available experimental data paves the way for designing novel laboratory experiments that would throw more light on the pathological formation of AGE adducts and in the pathophysiology of diabetic complications.

Keywords: advanced glycation end-products, CML, mathematical model, computational model

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Authors: Manjunath A. P., Al-Ajmi G. M., Al Shukri M., Girija S

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Introduction: This study aimed to compare the ability of hysteroscopy and ultrasonography to diagnose uterine polyps. To correlate the ultrasonography and hystroscopic findings with various clinical factors and histopathology of uterine polyps. Methods: This is a retrospective study conducted at the Department of Obstetrics and Gynaecology at Sultan Qaboos University Hospital from 2014 to 2019. All women undergoing hysteroscopy for suspected uterine polyps were included. All relevant data were obtained from the electronic patient record and analysed using SPSS. Results: A total of 77 eligible women were analysed. The mean age of the patients was 40 years. The clinical risk factors; obesity, hypertension, and diabetes mellitus, showed no significant statistical association with the presence of uterine polyps (p-value>0.005). Although 20 women (52.6%) with uterine polyps had thickened endometrium (>11 mm), however, there is no statistical association (p-value>0.005). The sensitivity and specificity of ultrasonography in the detection of uterine polyp were 39% and 65%, respectively. Whereas for hysteroscopy, it was 89% and 20%, respectively. The prevalence of malignant and premalignant lesions were 1.85% and 7.4%, respectively. Conclusion: This study found that obesity, hypertension, and diabetes mellitus were not associated with the presence of uterine polyps. There was no association between thick endometrium and uterine polyps. The sensitivity is higher for hysteroscopy, whereas the specificity is higher for sonography in detecting uterine polyps. The prevalence of malignancy was very low in uterine polyps.

Keywords: endometrial polyps, hysteroscopy, ultrasonography, premalignant, malignant

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Authors: Chih-Jer Lin, Chun-Ying Lee, Ying Liu, Chiang-Ho Cheng

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The main objective of this article is to present the semi-active vibration control using an electro-rheological fluid embedded sandwich structure for a cantilever beam. ER fluid is a smart material, which cause the suspended particles polarize and connect each other to form chain. The stiffness and damping coefficients of the ER fluid can be changed in 10 micro seconds; therefore, ERF is suitable to become the material embedded in the tunable vibration absorber to become a smart absorber. For the ERF smart material embedded structure, the fuzzy control law depends on the experimental expert database and the proposed self-tuning strategy. The electric field is controlled by a CRIO embedded system to implement the real application. This study investigates the different performances using the Type-1 fuzzy and interval Type-2 fuzzy controllers. The Interval type-2 fuzzy control is used to improve the modeling uncertainties for this ERF embedded shock absorber. The self-tuning vibration controllers using Type-1 and Interval Type-2 fuzzy law are implemented to the shock absorber system. Based on the resulting performance, Internal Type-2 fuzzy is better than the traditional Type-1 fuzzy control for this vibration control system.

Keywords: electro-rheological fluid, semi-active vibration control, shock absorber, type 2 fuzzy control

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Authors: H. Emari, Z. Emari

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The purpose of this paper is to design an applied framework for strategic thinking which can be applied in all managerial levels and all types of organizational environments. No special applied frame has been presented for this thinking. This paper presents a theoretical framework for the thinking type of a manager by making a historical research and studying the scientific documents about thinking of a strategist. In the new theoretical framework it has been tried to suggest the best type of thinking for a strategist after analyzing the environment of his decisions. So, in this framework, the traditional viewpoint about strategic thinking, which has considered it as a special type of right-brain thinking against other types of right-brain thinking and suggested it for a strategist, was put aside and suggests that the strategist should use a suitable type of thinking under different conditions.

Keywords: strategic thinking, systemic thinking, lateral thinking, intuitive thinking, hybrid thinking

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Authors: Barenten Suciu

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In this paper, a theoretical study on the forced vibration of one degree of freedom system equipped with inerter, working under load-type or displacement-type excitation, is presented. Differential equations of movement are solved under cosinusoidal excitation, and explicit relations for the magnitude, resonant magnitude, phase angle, resonant frequency, and critical frequency are obtained. Influence of the inertance and damping on these dynamic characteristics is clarified. From the obtained results, one concludes that the inerter increases the magnitude of vibration and the phase angle of the damped mechanical system. Moreover, the magnitude ratio and difference of phase angles are not depending on the actual type of excitation. Consequently, such kind of similitude allows for the comparison of various theoretical and experimental results, which can be broadly found in the literature.

Keywords: displacement-type excitation, inerter, load-type excitation, one degree of freedom vibration, parallel connection

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Authors: Brock Liden, Eric Janowitz

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Introduction: Diabetic peripheral neuropathy (DPN) affects 70% of individuals with diabetes1. DPN causes a loss of protective sensation, which can lead to tissue damage and diabetic foot ulcer (DFU) formation2. These ulcers can result in infections and lower-extremity amputations of toes, the entire foot, and the lower leg. Even after a DFU is healed, recurrence is common, with 49% of DFU patients developing another ulcer within a year and 68% within 5 years3. This case series examines the use of sensory insoles and newly available plantar data (pressure, temperature, step count, adherence) and remote patient monitoring in patients at risk of DFU. Methods: Participants were provided with custom-made sensory insoles to monitor plantar pressure, temperature, step count, and daily use and were provided with real-time cues for pressure offloading as they went about their daily activities. The sensory insoles were used to track subject compliance, ulceration, and response to feedback from real-time alerts. Patients were remotely monitored by a qualified healthcare professional and were contacted when areas of concern were seen and provided coaching on reducing risk factors and overall support to improve foot health. Results: Of the 40 participants provided with the sensory insole system, 4 presented with a DFU. Based on flags generated from the available plantar data, patients were contacted by the remote monitor to address potential concerns. A standard clinical escalation protocol detailed when and how concerns should be escalated to the provider by the remote monitor. Upon escalation to the provider, patients were brought into the clinic as needed, allowing for any issues to be addressed before more serious complications might arise. Conclusion: This case series explores the use of innovative sensory technology to collect plantar data (pressure, temperature, step count, and adherence) for DFU detection and early intervention. The results from this case series suggest the importance of sensory technology and remote patient monitoring in providing proactive, preventative care for patients at risk of DFU. This robust plantar data, with the addition of remote patient monitoring, allow for patients to be seen in the clinic when concerns arise, giving providers the opportunity to intervene early and prevent more serious complications, such as wounds, from occurring.

Keywords: diabetic foot ulcer, DFU prevention, digital therapeutics, remote patient monitoring

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Authors: Hossam M. Abdallah, Ali M. El-Halawany, Gamal A. Mohamed, Khalid Z. Alshali, Zainy M. Banjar, Hany A. El-Bassossy

Abstract:

Hypertension and vascular dysfunction are major components and complications of many diseases like metabolic syndrome. In addition, vascular dysfunction is considered the initial step in diabetic atherosclerosis, the main etiology for mortality and a great percent of morbidity in diabetic patients. In spite of the significant developments in antidiabetic therapy, diabetic complications, particularly seen in long-term diabetes, continue to be seriously deleterious. Herbal drugs are prescribed widely in treatment of different aliment because of their effectiveness, fewer side effects and relatively low cost. Nine plants belong to five different families grown in Kingdom of Saudi Arabia were evaluated for their effect on exaggerated vasoconstriction and impaired relaxation in aortae isolated from metabolic syndrome rats. The aerial parts of Onopordum ambiguum Fresen. (OA), Astragalus abyssinicus Steud. (AA), Pulicaria Arabica Cass. (PA), Echinops sheilae Kit Tan (ES), Aizoon canariense L. (AC), Cleome viscosa L. (CV), Chrozophora oblongifolia (Delile) A.Juss. ex Spreng (CO), Centaurea pseudosinaica Mouterde (CP) and Tephrosia nubica Baker (TN) were dried and extracted with methanol. The effect of thirty minute incubation with the total extracts (10-330 µg/ml) or their fractions on the exaggerated vasoconstriction response to phenylephrine (10nM to 10microM) and impaired vasodilation to acetylcholine (10-330 µg /ml) of aortae isolated from metabolic syndrome animals was studied. Incubating aortae isolated from metabolic syndrome animals with total methanol extract of OA, AA, PA, AC, CV, and TN at concentrations (10-330 microgram/ml) in the organ bath led to concentration dependent alleviation of exaggerated vasoconstriction response to phenylephrine without having beneficial effect on impaired vasodilation to acetylcholine. In conclusion, addition of OA, AA, PA, AC, CV and TN to the standard therapies may provide superior means to alleviate the associated vascular complications.

Keywords: vascular dysfunction, exaggerated vasoconstriction, metabolic syndrome, Saudi plants

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Authors: Eman A. Gani, Loay E. George, Faisel G. Mohammed, Kamal H. Sager

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Digital retinal images are more appropriate for automatic screening of diabetic retinopathy systems. Unfortunately, a significant percentage of these images are poor quality that hinders further analysis due to many factors (such as patient movement, inadequate or non-uniform illumination, acquisition angle and retinal pigmentation). The retinal images of poor quality need to be enhanced before the extraction of features and abnormalities. So, the segmentation of retinal image is essential for this purpose, the segmentation is employed to smooth and strengthen image by separating the background and damaged areas from the overall image thus resulting in retinal image enhancement and less processing time. In this paper, methods for segmenting colored retinal image are proposed to improve the quality of retinal image diagnosis. The methods generate two segmentation masks; i.e., background segmentation mask for extracting the background area and poor quality mask for removing the noisy areas from the retinal image. The standard retinal image databases DIARETDB0, DIARETDB1, STARE, DRIVE and some images obtained from ophthalmologists have been used to test the validation of the proposed segmentation technique. Experimental results indicate the introduced methods are effective and can lead to high segmentation accuracy.

Keywords: retinal images, fundus images, diabetic retinopathy, background segmentation, damaged areas segmentation

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Authors: Seyed Reza Alvani, Norzarina Mohd Zaharim

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Diabetes mellitus is one of the chronic, progressive illnesses that has reached a widespread level all over the world and considered an extreme life-threatening condition in South East Asian countries region include Malaysia. Co-morbid psychological factors like diabetes-related distress and low level of psychological well-being are related to high levels of blood sugar and hypo/hyperglycemia complications. As a result, the implementation of any effective psychological interventions among diabetes patients is necessary. One such intervention is cognitive behavioural therapy (CBT) that is approved and suggested by many professionals as an empirically-supported technique of treatment for people how are suffering from diabetes around the world where there is no clear evidence of using this technique in Malaysia. The target of this study was to see whether or not participation in group CBT would end in an improvement of psychological well-being (by decreasing the levels of depression and anxiety) and diabetes-related distress followed by lower level of blood sugar level. The sample of the present study was 60 type 2 diabetes adults (ages 20-65) with HbA1c ≥ 7 from Universiti Sains Malaysia (USM) clinic. All participants were selected by the convenience sampling technique. Participants completed Well-Being Questionaire (W-BQ) and Distress Scale (DDS-17) after signing written consent form. Those participants who were interested to join CBT groups were placed to the experimental groups, and people who were not interested were assigned to the control group. The experimental groups (n = 30) received group CBT, whereas participants in the control group (n = 30) did not receive any kind of psychological intervention. For testing the effect of intervention, mixed between-within ANOVA used. The entire intervention program took three months, and a significant improvement in the level of psychological well-being and decline in the level of diabetes distress observed among participants from experimental group, but not for those in the control group. Additionally, the result of the study suggested that group CBT could help participants in experimental group achieve more acceptable HbA1c levels in comparison with those in the control group. Malaysian Ministry of Health, researcher and governors should give due interest and commitment to psychological care as a pathway to diabetes mitigation among Malaysian adults.

Keywords: cognitive behavioral therapy, diabetes related distress, diabetes type 2, Malaysia, well-being

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Authors: Brahmanage S. Rangika, Dinithi C. Peiris

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Boiled Aqueous Flower Extract (AFE) of Nyctanthes arbor-tristis L. (Family: Oleaceae) is used in traditional Sri Lankan medicinal system to treat diabetes. However, this is not scientifically proven and the mechanisms by which the flowers reduce diabetes have not been investigated. The present study was carried out to examine the hypoglycemic potential and toxicity effects of aqueous flower extract of N. arbor-tristis. AFE was prepared and mice were treated orally either with 250, 500, and 750 mg/kg of AFE or distilled water (Control). Fasting and random blood glucose levels were determined. In addition, the toxicity of AFE was determined using chronic oral administration. In normoglycemic mice, mid dose (500mg/kg) of AFE significantly (p < 0.01) reduced fasting blood glucose levels by 49% at 4h post treatment. Further, 500mg/kg of AFE significantly (p < 0.01) lowered random blood glucose level of non-fasted normoglycemic mice. AFE significantly lowered total cholesterol and triglyceride levels while increasing the HDL levels in the serum. Further, AFE significantly inhibited the glucose absorption from the lumen of the intestine and it increases the diaphragm uptake of glucose. Alpha-amylase inhibitory activity was also evident. However, AFE did not induce any overt signs of toxicity or hepatotoxicity. There were no adverse effects on food and water intake and body weight of mice during the experimental period. It can be concluded that AFE of N. arbor-tristis posses safe oral anti diabetic potentials mediated via multiple mechanisms. Results of the present study scientifically proved the claims made about the uses of N. arbor-tristis in the treatment of diabetes mellitus in traditional Sri Lankan medicinal system. Further, flowers can also be used for as a remedy to improve blood lipid profile.

Keywords: aqueous extract, hypoglycemic hypolipidemic, Nyctanthes arbor-tristis flowers, hepatotoxicity

Procedia PDF Downloads 345