ABSTRACT

Diabetes is defined as a disease that has the blood glucose levels are too high. The foods after digestion gets converted to Glucose and then are absorbed in the liver to metabolise. The hormones Insulin secreted from pancreas helps to transport the glucose into the cells and provides energy (Wild , 2004). The term “immunity” was first medically used by a Dutch physician, Van Sweiten in 1775. He used the term “Immunitas” to refer effects seen by early attempts at variolisation (Moulin & Anne-Marie, 1989). The Merriam-Webster dictionary, states the definition of immunity as: “the quality or state of being immune, especially: a condition of being able to resist a particular disease especially through preventing development of a pathogenic microorganism or by counteracting the effects of its products”.

The Innate and Adaptive immune system affects the cellular functions chemotaxis, phagocytosis, and killing of pathogens by monocytes, macrophages, and neutrophils. And improvement in these functions can be seen when the Diabetes Mellitus is controlled and blood glucose levels normalize.

The nutrition is specially to kept in mind to reduce the Hyperglycemia and also immunity boosting foods be added in the daily diet. The present study will describe the Management of Diabetes Mellitus is effective with Nutritional Immunology.

ABSTRACT

Background

Diabetic foot ulcer (DFU) is the main risk factor for nontraumatic lower-limb amputation. We hypothesized that by reversing the offending local tissue factors resulting from the low tissue supply of oxygen, inefficient fuel metabolism and acidosis, we can eradicate the infection and help to promote healing. This might be enhanced with the help of an innovated local preparation (PEDYPHAR®) through its enriched alkaline ointment base and the regenerating growth factors of Royal Jelly (RJ) plus the antimicrobial, immune-modulatory nutritional and other biochemical properties of RJ and Panthenol. We conducted this study to test the safety and efficacy of PEDYPHAR ointment as an adjuvant in limb salvage management for patients with limb-threatening diabetic foot wounds.

Methods

A prospective, randomized, controlled open-label study design with a mean follow-up period of 12 weeks. One hundred and nineteen eligible patients with diabetic foot wounds presenting to 3 outpatient clinics in Egypt were randomized to be treated with the local application of either PEDYPHAR or Panthenol ointment under dressing after conservative debridement of necrotic tissue and irrigation with warm normal saline.

Results

At the end of the 12-week follow-up period, PEDYPHAR showed a higher rate of complete healing of limb-threatening wounds in the intent-to-treat population, 11 of 34 (32.4%) in PEDYPHAR-treated group versus 3/25 (12%) in the Panthenol-treated (control) group (p=0.034* [*indicates it is statistically significant]).

Conclusion

We can conclude that PEDYPHAR could be an effective and safe conservative local adjuvant treatment for cases of diabetic foot infection.

ABSTRACT

Background: The frequency of hyperglycemia in pregnancy is high in Bangladesh, but very little is known about the current knowledge and practice about the hyperglycemia in pregnancy in our practicing doctors.

Objective: To assess the knowledge and practice of the doctors across the country who are involved in the management of hyperglycemia in pregnancy.

Methods: Structured preformed data collection sheets were sent to the doctors who are taking care hyperglycemia in pregnancy (endocrinologists, obstetricians, and others) through email and postage. The questionnaire focused on their knowledge and practice pattern on hyperglycemia in pregnancy. In total, 950 doctors of Bangladesh were invited to join the survey, and 262 (24.89%) responded.

Result: Among the participants, 42.3% (111) were endocrinologists, 27.10% (71) obstetrician/gynecologist, and 30.53% (80) were other physicians, including internists, diabetes family physicians, etc. The majority of our doctors are aware of the adverse outcomes of hyperglycemia in pregnancy and advocates universal screening, follow ADA guideline, use insulin for the management of hyperglycemia in pregnancy, more than half prefer to continue metformin if it has been used for other causes, favored the caesarian section as the preferred method of delivery, half of the GDM mothers are lost to follow up after delivery.

Conclusion: Findings of this study may serve a baseline for the management of hyperglycemia in pregnancy. The doctors involved in the management of hyperglycemia in pregnancy require more training for knowledge building and improvement of rational practice.

ABSTRACT

The following principle is very effective for adjusting insulin doses.  Depending on when injected, each component of the insulin regimen has a maximal effect on a specific period of the 24 hour cycle, e.g., overnight, morning, afternoon, evening.  The glucose pattern in that period determines whether the dose of that component of the insulin regimen requires adjusting.  A registered nurse trained to adjust insulin doses using this principle reduced HbA1c levels from 11.0% to 7.2% in 111 patients referred by their providers over 9-12 months of clinic visits.  FDA cleared computerized algorithms based on this principle produce a report within 30 seconds after glucose readings are downloaded that provide recommendations for insulin dose adjustments that the provider can modify or accept. These computerized algorithms were utilized in smaller studies in which glucoses were measured either remotely or by continuous glucose monitoring (CGM).  With remote monitoring (no clinic visits), a nurse practitioner lowered HbA1c levels from 10.0% to 7.6% in 6 months.  With CGM, a clinical pharmacist decreased time spent with glucoses >250 mg/dl from 44% to 23% and increased time in the target range of 70-180 mg/dl from 29% to 51% over a mean of 3 months.  HbA1c levels fell from 11.5% to 8.3%.  This innovative approach for adjusting insulin doses should improve diabetes control with subsequent beneficial effects on diabetes complications and resultant lowering of health care costs.

ABSTRACT

The design and effectiveness of m-health mobile-based self-care management and nutrition informatics interventions on type 2 diabetes mellitus at home settings

Methods: A systematic search of PubMed and Scopus) was conducted. Studies globally published in English from 2010 to 2020 and studies done in Type 2 diabetes and ages 18-75 were included in this. The intervention study such as Randomized controlled trials (RCTs) of mobile-based self-management interventions for type 2 diabetes patients and studies where charting of any of the patient-level outcomes was analyzed. The reviewer screened the studies and reviewed them with another reviewer independently. The data was extracted, and the quality of the studies was assessed. The scoping study methodology using the operational framework of Arksey, and O’Malley are used to present study outcomes and twenty-seven pointers PRISMA-SCR checklist is used Mobile based self-management interventions seem to have positive effects on self-care and management and pertinent outcomes for patients with type 2 diabetes mellitus. Overall progress in physiologic indicators, selfcare and improvement in quality of patient life with Type 2 Diabetes. Though, the studies emphasized results in small populations, with little indication of future scaling of the intervention. Moreover, the results indicate a need for further research into self-management which includes nutrition informatics in self-care management regime, and it needs to focus on region wise availability of nutrition informatics. This will also help in the co-management of diabetes and cardiovascular disease. Self-management is an effective means of improving health outcomes in low- and middle-income countries (LMIC) and therefore mobile led selfcare management interventions with nutritional informatic can be advantageous. 

Self-care or Selfcare management in Chronic Care Management (CCM) can improve health outcomes and it has potential to reduce risk of diabetic complications. Use of Mobile phone-based technology or m-health interventions for various global programs focusing on selfcare management. There are numerous studies focusing on improving self-efficacy, self-care activities, health-related quality of life and clinical outcomes for patients. However, m-health applications developed are mostly clinical and does not focus on self-care aspect such as nutrition, diet, exercise along with testing of blood glucose level. The m-health application healthcare has the potential to improve support for patients with type 2 diabetes mellitus and it is important to improve patient outcomes by improving selfcare, comprehensive selfcare management and incorporating nutrition informatics, psychological support can assist patient to cope up with diabetes and by adhering to self-care activities. Most studies addressed healthy lifestyle behaviors like physical activity, testing of glucose. However, integrated management diabetes with management of signs and symptom and nutrition regime can the most challenging self-care behaviors for patients and can improve health outcome. Some of the incredible steps in the management and prevention of diabetes encompass turning research into the real world, collaborative efforts that involve physicians, empowering the community, and access to diabetes prevention and management efforts. The other steps include enhancement of healthcare access, collaborative efforts that involve diabetes educators, physicians, public health scientists, and nurses in the prevention and management efforts of the disease (Muralidharan et al., 2017). Mobile phone technology has presented a huge acceptance across different socioeconomic groups and ages and provides distinct prospects in healthcare that include prevention of Type 2 Diabetes and self-management. The future appears to lie within the mobile health applications (mHealth) that utilize entrenched technology to highlight enhanced utilization of smartphones to help in preventing and managing chronic disorders like diabetes type 2. A study conducted by Muralitharan, and co-researchers indicated that the use of mHealth alongside counseling showed a substantial enhancement in the management of Type 2 Diabetes. Additionally, it showed that diabetes coaching via mobile phones along with analyzed data that were presented to the physicians using evidence-based guidelines had a significant implication on glycemic control (Muralitharan et al., 2017). Despite the field of mHealth being new, with its wide adaptability and ubiquitous nature shows an incredible ability to counter the immense burse on costs of healthcare that stem from non-communicable illnesses. There is no doubt that an efficacious platform for diabetes type 2 is supposed to have a user interface that is visually appeasing, involve both the healthcare provider and user, can transfer data in real-time, and have the mean to inspire the users to consistently engage with the app. It has been evident that mHealth technology with the support given by healthcare experts can translate into enhanced patient outcomes for patients diagnosed with Diabetes Type 2. 

ABSTRACT

Non Communicable diseases (NCD) such as Diabetes and Hypertension has increased every year in Thailand as other countries in the world. That made the patients were suffered and decreased quality of life. This study of qualitative research aimed to develop a Nursing service model among patients with NCD, King Narai Hospital by using Evidence-based practice (EBP) concept of Soukup (Soukup, 2000).  The sample included 30 patients with NCD--Diabetes, and Hypertension, 15 persons of a multidisciplinary team. The instrument was semi-structure interview of NCD quality clinic that was developed from the standard manual of NCD Clinic Plus of NCD, MOPH, Thailand (2016). The data were collected by NCD situational analysis, interviewed patients with Diabetes, and Hypertension, and multidisciplinary team. Furthermore, the EBP concept of Soukup (2000) was applied to develop a Nursing service model among patients with NCD, King Narai Hospital, Lop Buri, Thailand. Content analysis was implemented for data analysis. The results showed that the nursing service model among patients with NCD, King Narai Hospital that was developed comprising 6 components: directions and policies, information system, system adjustment, and service process, self-management support system, decision support system, and arranging linking service to the community. Conclusion: Nursing service model among patients with NCD that was developed, there were 6 components according to the standard manual of NCD Clinic Plus of NCD, MOPH, Thailand (2016). There was a little word of some component to improve. It will be launched to improve the quality of care among patients with NCD, Narai Hospital, Lop Buri, Thailand, and other areas.

ABSTRACT

Lifestyle modifications are well needed to prevent many diseases or required to overcome/control many. Despite the best approach adapted so far, has not proven successful. Most of the diseases are linked with genes, which are simply molecular blueprints used in the construction of cells, tissues, and organs. The environment serves as a contractor engaging these blueprints to characterize a cell’s life. Now, the science of signal transaction focuses upon the pathways linking environmental cues, affecting cytoplasmic /cellular processes which can alter gene expression and thereby controlling its fate. The new science of Epigenetics has completely upended our conventional understanding of genetic control. Thorough knowledge and its application will surely enable to understand /prevent/control many diseases.

ABSTRACT

Statement of the Problem: The use of wide array of chemical peel agents for rejuvenation of wrinkle, pigmentary disorder, acneiform eruption and pre-malignant epidermal neoplasm had been for long. Due to lot of complications, downtime, variable healing rate after different chemical peeling, it is necessary to have a well defined standard practice protocol for a consistently safe and predictable result. It is thus necessary to understand fully the step-by-step guide of different categories of peel agents, to avoid confusion, for a safe and effective practice. 

Methodology & Theoretical Orientation:

Systemic review studies is used to search for “various ingredients names”, including all commercially available prescription based products. through databases of Cochrane Library, Medline, PubMed, SCOPUS and Google Scholar. The author also utilising a commonly used qualitative analysis by other than reviewing literature, also used clinical history taking, interview & observation over social event,  and forming focus group to gather data. Using the security framework & lenses of analysis of the social science/behaviour to understand what are the patient inclination, social behaviour and preferences, its performance, relevance, functionality & efficiency, if it can be optimised for as many a  chemical peel agents to treat four conditions stated.

Finding:

Chemical peel is the 3rd most commonly performed noninvasive cosmetic procedure in the USA with 1.3 million done in 2016. There has been a paradigm shift with laser largely supplanting more risky deep peel. Despite this the superficial peel has proliferated in popularity & product diversity. When used for appropriate indication with proper technique, nearly all peeling agents have demonstrated excellent clinical efficacy. And, they remain an indispensable cost-effective tool in the dermatologist’s aesthetic toolbox.

Conclusion & Significance:

Available literatures reveal 1) chemical peels are the 3rd most commonly performed noninvasive cosmetic procedure in US, > 1.8 M in 2016. 2) Indications for treatment are 4 broad categories: chrono- & photoaging; acneiform eruptions; dyspigmentation; and pre-malignant epidermal neoplasm, 3) selection of peeling agent is determined by treatment indication, desired depth of ablation,  pertinent examination findings, Fitzpatrick skin type, and relevant dermatological history, 4) for the right indication with proper technique, all peel solutions & depth have demonstrated excellent success in improving skin tone & texture, and cost effective versus invasive procedures. 5) peels should remain an indispensable tools in Dr’s aesthetic toolbox. 

Recommendation:

Available evidence show the superficial peel is great for both institutional & home care treatment. Medium peel is useful for clinic use. Deep peel for deeply sited issue but this role has been taken over by laser due to more predictable treatment result with less risk.

ABSTRACT

Introduction: Diabetes Mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose levels. In traditional Chinese medicine, diabetes is considered Yin deficiency and Heat retention. Purpose: the purpose of this study is to demonstrate that diabetes patients have chakras ‘energies deficiencies and the replenishment of these chakras ´energies centers are important to reduce the glucose of the patients, enabling them to reduce the intake of medications and/or insulin, in both diabetes type 1 and 2. Methods: retrospective study analyzing 265 files of patients in an acupuncture clinic in Brazil and from these study, it was found that 15(5.6%) of them had diabetes diagnosis. From these patients, it was analyzed how many patients did chakras ‘energy centers measured and 12 ( 80%) did these measurement. Results: The result of this study was that all the patients had deficiency in energy from 1 to 6 chakra, but had energy in the seventh chakra ( 91,6%) and only one patient had deficiency in all 7 chakra ( 8,4%). All patients received treatment with Chinese dietary counseling, auricular acupuncture with apex ear bloodletting, homeopathies medications according to the theory created by the author entitled Constitutional Homeopathy of the Five Elements based on Traditional Chinese Medicine and crustal based medications. All of them had reduction in the glycaemia reducing the necessity of the use of medications, insulin and have freer to eat what want to eat without elevating the blood glucose Conclusion: patients with diabetes have chakras ‘energies centers in the weakest level of energy and the replenishment of these chakras ‘energies centers are important to treat the energies disharmony that is leading to the hyperglycemia symptoms.

ABSTRACT

Hyperglycemia at diabetes mellitus (DM) is the main cause of vascular complications, due to an increase in the formation of reactive oxygen species and the development of oxidative stress. It makes advisable to use antioxidants in the complex treatment of diabetes. In modern antioxidant therapy, various drugs are used, such as a-lipoic acid, a-tocopherol, vitamin C, selenium, etc. Therefore, the search of new effective antioxidants is of great importance.

In this work, we studied the effect of new synthetized at our laboratory antioxidant "Selenophan" (AO) in comparison with well-known vitamins C and E on the glucose concentration in the whole blood of Wistar rats. Selenophan is a bis- (3- (3,5-di-tert-butyl-4-hydroxyphenyl) propyl) selenide with antioxidant activity (Patent of Russian Federation 2 586 067 (2015)).

Methodics. All animals were divided into 6 groups: the first three groups were controls (C): the 1-st – pure control (C; n = 9), the 2-nd (C + AO; n = 7) and the 3-d (C + vit. C, E; n = 7), which consisted of healthy animals. Rats of the 4-th (DM; n = 9), 5-th (DM + AO; n = 11), and 6-th (DM + vit. C, E; n = 10) groups were injected into the interscapular region with a 10% alloxan solution at the rate of 0.1 ml/100 g of body weight to produce diabetes, while the animals of the first three groups were injected with physiological saline in the same volume. One week before the injection of alloxan and during the 1st week after it the animals of the 2nd and 5th groups, got per os an oily solution of the antioxidant "Selenofan" once a day at a dose of 0.1 ml/100 g of body weight, while the rats of the 3-d and the 6-th groups received vitamins C and E at a dose of 100 mg/kg and 40 mg/kg, respectively. All groups of animals were kept in standard vivarium conditions without limiting food and water consumption.

Results. It was found that on the 1st day after the injection of alloxan, the blood glucose concentration in animals of the 4-th group was significantly higher than in the control, that indicated the development of diabetes mellitus. The oral intake of Selenofan in rats of the 5-th group compare to previous group caused the significant decrease of glucose concentration in the blood which did not differ from C and C+AO (C - 3.6 ± 0.07; C + AO - 3.9 ± 0.12; DM - 20.4 ± 2.5*; DM + AO - 3.7 ± 0.16 mmol/L). Thus, antioxidant "Selenofan" did not cause any changes in blood glucose in healthy animals, while produced a strong hypoglycemic effect in rats with DM.  

The intake of vitamins C and E also did not affect the blood glucose concentration in healthy animals (the 3-d group), however, in rats with an alloxan model of diabetes resulted in a significant decrease of this parameter (group 6) in comparison with DM rats on standard diet (group 4) only on days 1 and 3 (C + vit. C, E - 5.5 ± 0.16; DM - 20.4 ± 2.5 *; DM + vit. C, E - 11.2 ± 1.7* mmol/L). It should be noted that on the 6-th day of observation, the blood glucose concentration in the diabetic rats treated with vitamins did not differ from the level of this monosaccharide in the blood of rats with DM that consumed standard food.

Thus, under conditions of diabetes mellitus, the artificial antioxidant "Selenofan" had a more pronounced and prolonged hypoglycemic effect than natural antioxidants - vitamins C and E, that indicates the expediency of its use in the complex therapy of this pathology.

ABSTRACT

A wearable smart jacket prototype capable of detecting the miner's pulse, location, presence of hazardous gas, temperature / humidity, was proposed to secure the lives of coal miners in Pakistan [1]. Monitoring of patient health can be performed by using advanced wireless technologies such as IoT, ZigBee, Wi-Fi, Bluetooth with auxiliary sensors such as DHT11, HC-05, LM35 and heart rate connected to the Arduino board [2]. Polymeric fiber optic sensors adapted to the jacket with textile technology [3].  The key components of most wearable glucose sensors are sensing nanomaterials such as metal, carbon and conductive polymers [4]. In this study, sodium azide inflated the life jacket in a sudden reflex, and the sweat that occured at the pressure points of the jacket stimulated the glucose sensors. The measured blood glucose was reflected on the digital display and transferred to the doctor's report by telemedicine signalling with radio waves. The signaling of the radio waves was provided by the superconducting boron mineral fiber. Respiratory rate, blood pressure and fever can be monitored simultaneously with digital displays on the life jacket. The prototype aid jacket will provide ease of use also in pandemic situations.  

ABSTRACT

Diabetes mellitus (DM) is now one of the most common non-communicable diseases and is the leading cause of morbidity and mortality, despite advances in its medical management [1]. Several factors are responsible for the soaring epidemic of type 2 diabetes mellitus (T2DM) which constitutes the major burden of diabetes [3]. It is closely linked to sedentary life and inappropriate food intake. In Africa, the prevalence is higher due to late diagnosis, scarcity of screening and diagnostic resources, poor control of blood sugar, and other precipitating factors. It is estimated that every 30 seconds a lower limb or part of a lower limb is lost somewhere in the world as a consequence of diabetes [2]. Effective management of diabetes requires sustained glycemic control to lower the risk of complications in people with diabetes which is usually hampered by economic constraints in developing countries.

Diet and lifestyle factors are central to its prevention and control of it. There is considerable evidence demonstrating that the consumption of omega-3 polyunsaturated fatty acid is associated with significant health benefits in the management of diabetes. However, despite the promising experimental investigations, currently the clinical evidence for the usage of omega-3 supplementation for the management of T2DM and its complications is both conflicting and limited. Therefore, in this conference I hope we share recent and updated evidence regarding the diabetes management.

ABSTRACT

Conclusion: Serum cystatin C and microalbumin both could be considered as marker for early detection of nephropathy in T2DM patients. The more prominent rise in serum cystatin C values provides an earlier diagnosis of diabetic nephropathy among T2DM patients.

ABSTRACT

Metabolic syndrome is a group of risk factors that cause many diseases such as diabetes and heart disease.

There are many risk factors responsible for this syndrome, and the presence of 3 or more of them speeds up the process of predicting different diseases and the speed of treatment.

In addition to the nature of food and daily activity, metabolic syndrome has hormonal and non-hormonal causes. Among the hormonal causes is an imbalance in some hormones, especially thyroid hormones.

Where the majority of scientific studies have proven that the increased activity of TSH, a hormone secreted by the pituitary gland and stimulates the secretion of thyroid hormones, inhibits the process of metabolism and then leads to the accumulation of many substances, especially sugar, and this explains the close relationship between thyroid dysfunction and diabetes. The correct diagnosis may be the reason for developing a fruitful treatment strategy that addresses this hormonal error, so that will be a reason to get rid of excess glucose and eliminate diabetes, and this is what will be presented in this review.

ABSTRACT

This study was carried out to determine the effect of bee honey on blood glucose level of Sudanese type 2diabetic patients (non- insulin dependent) who were newly discovered. In this study, specific doses of honey or a mixture of sugars that represents the main sugars in honey (fructose, glucose, sucrose) in the same proportions as that found in the honey sample were used. Glucose doses were also given to diabetic patients and the effects on blood glucose levels were compared with honey and sugars mixtures. Forty one diabetic patients and 10 healthy non diabetic volunteers agreed to take part in the study. Blood samples were taken from all subjects before doses of sugars were given to determine the level of glycated hemoglobin (Hb A1c) and fasting blood glucose levels. Subjects were involved in 3 tests; in the first test, 29 patients were given 108g of honey (containing 75g of sugars) after taking fasting blood samples. Further blood samples were taken after 60, 120, and180 min. to determine the blood glucose levels. A week later, the same test was repeated with an equivalent dose, i.e a total of 75g, of sugars mixtures (fructose 41g, glucose 30.8g,sucrose 3.2g) instead of honey and blood glucose levels were determined at the time intervals mentioned above. The same test using honey (36g, which contained 25g sugars), or 25g of sugars mixture (containing 13.7g fructose, 10.3g glucose, and 1.1g sucrose) were repeated on 21 diabetic patients and 10 healthy volunteers enrolled as control. Comparison of the results of the above tests showed that, honey and sugars mixtures at high doses (75g) gave comparable or similar levels of glucose in the blood. After 2 and 3 hours, blood glucose dropped slightly but still higher than the fasting level. However, giving honey and sugars mixture at low doses (25g) did not cause significant rise in blood glucose after 1 hour, and the blood glucose level dropped below the fasting level after 3 hours. Glucose doses were given as 50g or 25g to diabetic patients and to the healthy non-diabetic controls and the blood glucose levels were determined as mentioned above. The comparison of the blood glucose levels, after giving honey (equivalent to 75g sugars), sugars mixture (75g), or glucose (50g) showed that the glucose resulted in sharp peak after 1 hour which remained high 2 hours later as compared to honey and sugars mixtures. When comparing the effects of low doses of honey (equivalent to 25g sugars), sugars mixture (25g), and glucose (25g); it was found that both honey and sugars mixtures did not raise the blood glucose level significantly, up to 3 hours; whereas the dose of glucose alone gave sharp rise after 1 hour and remained relatively higher than the levels obtained by honey and the sugars mixtures. Thus, from this study, it can be concluded that, low doses of pure honey, approximately 3 table spoons can be recommended as a sweetener for diabetic patients in addition to its high nutritional value instead of using the so-called diabetic food which offers no metabolic advantage over moderate amounts of sugars containing counterparts and which often have side effects