Drug-related problems among type II diabetes mellitus patients with hypertension: a cross-sectional study

Patients with type II diabetes mellitus(T2DM)and hypertension(HTN)are at increased threat for long experiencing various problems related to medicine as they frequently received different medications for managing their condition.Recently,there were no studies done locally on drug-related problems(DRPs)among T2DM patients with HTN.Thus,this study aims to assess the DRPs among T2DM patients with HTN admitted at Kibuye Referral Hospital(KRH).DRPs were drug safety problems,drug effectiveness problems and other drug problems.Methods:A retrospective cross-sectional study involved patients'files with T2DM and HTN,who were admitted at KRH from January 2013 to December 2017.The identification and classification of DRPs were based on pharmaceutical care network Europe(PCNE)classification system version 8.02.A simple random sampling technique was used to choose study participants from the target population.Data that met inclusion and exclusion criteria were analyzed using STATA version 13.The Fisher exact test(bivariate analysis)and logistic regression(multivariate)were used to test association and p-value≤0.05 was considered as statistically significant.An adjusted odd ratio(AOR)with a confidence interval(CI)of 95% was determined using binary logistic regression.Results:Findings revealed that the prevalence of DRPs was 81.29%(313/385)and most of them each patient had at least two DRPs(69.05%).The patients aged above 55 years old were more likely to develop DRPs than those with age below 35 years(AOR=1.2;P=0.02;95%CI:0.2-2.3).Nevertheless,there was no significant association between DRPs and middle age(between 35 and 54 age of old).The patients who consumed more than or equal to 5 drugs were 2.4 times more likely to develop DRPs than those who took the number of medicines less than 5(AOR=15.4;P<0.001;95%CI:8.8-26.8).Also,traditional medicines use(AOR=1.9;P=0.016;95%CI:1.1-3.5)and having drug-related complication(AOR=2.4;P<0.001;95%CI:1.9-3)had shown significant associations.The total causes of DRPs identified were 1626 and most causes of DRPs were arisen from drug use(45.01%)and prescribing(37.83%).The drug/dose selections were the most frequent causes of DRPs(36.97%).Conclusion:Since the prevalence of DRPs were relatively high,various factors influencing DRPs were established and most causes of DRPs were arising from drug use&drug prescribing among T2DM patients with HTN.Early detection needed to enhance patient’s life quality.Conducting studies in other hospitals needed to establish the national planning of DRPs to eradicate DRPs among patients T2DM with HTN.

EFFECT OF ACUPUNCTURE ON PLASMA STRESS HORMONE LEVELS OF HYPOTHALAMUS-PITUITARY-ADRENAL AXIS IN TYPE II DIABETES WITH CONCURRENT ACUTE CEREBRAL INFARCTION PATIENTS

Objective: To observe the effect of acupuncture on the contents of stress hormones of the hypothalamus pituitary adrenal axis (HPA) in treatment of type II diabetes with concurrent acute cerebral infarction patients. Methods: 60 cases of inpatients were randomly and evenly divided into treatment group (conventional medication plus acupuncture) and control (conventional mediation) group. Plasma corticotropin releasing hormone (CRH), adrenocorticotropin hormone (ACTH) and corticosteroid (CS) contents before and after treatment were measured using radioimmunoassay (RIA) and compared with those of healthy subject group (n=30). Results: Plasma CRH, ACTH and CS levels in patients of both treatment group and control group at admission were significant higher than those of normal subject group (P<0.05). After treatment for 15～30 days, results showed that plasma CRH, ACTH and CS levels in both treatment and control groups lowered significantly in comparison with those of pre treatment (P<0.05 or 0.01); while those of treatment group were even more lower (being closer to the normal values) than those of control group (P<0.05 or 0.01). Conclusion: Acupuncture therapy can reduce the stress state of HPA in type II diabetes with concurrent acute cerebral infarction patients, i.e. regulate the neuroendocrine immunological net, which may be one of the mechanisms for acupuncture treatment of cerebral stroke.

Epidemiological Analysis of Type II Diabetes Mellitus among Hail Residents, Saudi Arabia

Type II diabetes is a global health concern. This epidemic is elevating in increasing rates in Saudi Arabia. Thus, the study investigates a number of risk factors of Type II diabetes in Hail region, one of Saudi Arabia’s highest regions in diabetes records among adults. Data are collected using diabetic subjects from the Diabetes Registry Records in King Khalid Hospital at the city of Hail, Saudi Arabia, where 200 subjects’ records from 2014 to 2018 were included. A binary logistic regression was utilized to assess the association between age, gender, obesity, hypertension, family history, hypercholesterolemia, and hyperglyceridemia as risk factors and Type II diabetes. Some risk factors yielded statistical significant associations such as age (OR = 486.00 for 61 and older;OR = 468.00 for 51 - 60;and OR = 130.50 for 41 - 50;p-values ≤ 0.01), obesity (OR = 3.088;p-value ≤ 0.01), and hypertension (OR = 8.476;p-value ≤ 0.01), while gender, family history, hypercholesterolemia, and hyperglyceridemia were insignificant risk factors in our study. Proper intervention measures targeting diabetes risk factors may tackle or delay this public health issue.

Health Management of Patients with Type II Diabetes and its Influence on Chronic Complication

Objectives:To explore the application of health management in patients with type II diabetes and to analyze and compare the incidence of chronic complications.Methods:the relevant research work was carried out in our hospital.During September 2018 to September 2019,100 patients with type II diabetes were randomly divided into two groups:one group was given routine nursing intervention,the other group was given health management,and they were named control group and experimental group respectively.Each group had 50 patients,the influence of different nursing methods on the incidence of chronic complications in patients was explored.Results:In the one-year followup results,the corresponding complications of patients mainly include cardiovascular disease,kidney disease,cerebrovascular disease,fundus disease and peripheral neuropathy.The incidence of complications in the experimental group is 10.00%,while that in the control group is 32.00%.in comparison,the incidence in the experimental group is lower,and the data difference between the two group is small(P<0.05),which exists significance.Conclusion:The application of health management method in type II diabetes has significant effect,which can reduce the incidence of chronic complications,improve the quality of life of patients,and has positive significance for clinical development.

EFFECTS OF ACUPUNCTURE ON THE HIGH HEMAGGLUTINATION STATE, BLOOD-SUGAR-RAISING HORMONE AND IMMUNOCYTE FACTOR LEVELS IN TYPE-II DIABETES PATIENTS

Objective: To investigate the effect of acupuncture on high hemagglutination state, blood sugar raising hormone and immunocyte factor levels in type II diabetes patients. Methods: A total of 120 inpatients and outpatients were randomly divided into acupuncture plus medication group (n=52) and medication group (n=50). In addition, 18 type II diabetes patients formed acupuncture group for comparing their therapeutic effects. Main acupoints used were Pishu (BL 20), Geshu (BL 17), Yishu, Shenshu (BL 23), Zusanli (ST 36), Sanyinjiao (SP 6), etc.. combined with other acupoints according to different sydroms. These acupoints were stimulated by manipulaing the filiform needles with uniform reinforcing and reducing method for 15 min and then stimulated electrically for 15 min with an electroacupuncture therapeutic apparatus. Western medicines used were Glipizide, Dimethyldiguanide Hydrochloride, etc.. The treatment was given once daily, with 10 sessions being a therapeutic course, 2～3 courses altogether. Indexes of external thrombosis length (ETL), platelet agglutination rate (PAgR), fibrinogen (FG), activated partial thromboplastin time (APTT), fasting blood glucose (FBG), prothrombin time(PT), adrenocoticortropic hormone (ACTH), cortisol (CS), growth hormone (GH), glucagon (GL), tumor necrosis factor alpha (TNF α), interleukin 6 (IL 6), insulin (INS) and C peptide (C P) were determined using radioimmunoassay. Results: After 2～3 courses of treatment, both acupuncture group and medication plus acupuncture group could significantly improve high hemagglutination state, lower blood sugar raising hormone level, regulate immunocyte factor level and raise the sensitivity of insulin, which were apparently superior to those of medication group (P<0.05～0.01). Conclusion: Acupuncture therapy can effectively regulate plasma blood sugar raising hormone, immunocyte factor levels, increase the sensitivity of insulin to target cells, resist blood coagulation and improve microcirculation.

Simple Renal Cyst with Clustering of Small Stones in an Elderly Patient withType II Diabetes Mellitus

Intracystic renal stones are rare.The authors wishto report here an aged case of type 2 diabetes mellituscomplicated with sohtary renal cyst with intracysticstones.

Compliance with Oral Anti-Diabetic Treatment in Lome

Objective: The objective of this study was to assess adherence to antidiabetic therapy in type II diabetic patients and factors associated with Lomé. Method: This was a descriptive observational study conducted among diabetics in diabetes care centers from May 1, 2020 to October 1, 2020, for a period of 6 months. Results: A total of 300 patients were questioned. The mean age was 56.61 years (standard deviation = 11.7). The sex ratio was 0.6. All the patients were on drug treatment, 83.4% of whom were on metformin and 37.5% on Glibenclamide. In 58.3% of the cases, the patients were on dual therapy and 96.2% had an abovenormal glycated hemoglobin value. There was a medication adherence problem with poor adherence in 30.7%. Being aged 50 and over (ORC = 1.78, p = 0.048), playing sports (ORR = 1.87, p = 0.046), have reaching a higher level of education (ORR = 5.78, p = 0.005) significantly increased the chances of patients having a good/minimal problem of adherence. Conclusion: Diabetes affects in Togo, more women than men with a predominance of those aged 50 and over. Adherence to therapy remains a challenge.

Ocular surface changes in type II diabetic patients with proliferative diabetic retinopathy

AIM: To detect and analyze the changes on ocular surface and tear function in type II diabetic patients with proliferative diabetic retinopathy(PDR), an advanced stage of diabetic retinopathy(DR), using conventional ophthalmic tests and the high-resolution laser scanning confocal microscopy.METHODS: Fifty-eight patients with type II diabetes were selected. Based on the diagnostic criteria and stage classification of DR, the patients were divided into the non-DR(NDR) group and the PDR group. Thirty-six patients with cataract but no other ocular and systemic disease were included as non-diabetic controls. All the patients were subjected to the conventional clinical tests of corneal sensitivity, Schirmer I test, and corneal fluorescein staining. The non-invasive tear film break-up time(NIBUT) and tear interferometry were conducted by a Tearscope Plus. The morphology of corneal epithelia and nerve fibers was examined using the high-resolution confocal microscopy.RESULTS: The NDR group exhibited significantly declined corneal sensitivity and Schirmer I test value, as compared to the non-diabetic controls(P 【0.001). The PDR group showed significantly reduced corneal sensitivity, Schirmer I test value, and NIBUT in comparison to the non-diabetic controls(P 【0.001).Corneal fluorescein staining revealed the progressively injured corneal epithelia in the PDR patients. Moreover,significant decrease in the corneal epithelial density andmorphological abnormalities in the corneal epithelia and nerve fibers were also observed in the PDR patients.CONCLUSION: Ocular surface changes, including blunted corneal sensitivity, reduced tear secretion, tear film dysfunction, progressive loss of corneal epithelia and degeneration of nerve fibers, are common in type II diabetic patients, particularly in the diabetic patients with PDR. The corneal sensitivity, fluorescein staining scores,and the density of corneal epithelial cells and nerve fibers in the diabetic patients correlate with the duration of diabetes. Therefore, ocular surface of the patients with PDR should be examined regularly by conventional approaches and confocal microscopy to facilitate early diagnosis and treatment of keratopathy.

Screening of Diabetic Retinopathy in Patients with Type 2 Diabetes in a Community of the Paraíba Semi-Arid Using Original Score

Introduction: Diabetic retinopathy (DR) is neglected in the planning of health services in Brazil. The purpose of this study was to investigate the frequency of Diabetic Retinopathy in patients with type 2 diabetes mellitus (DM2) registered in the Unified Health System (SUS) of the semi-arid of Paraíba (PB-Brazil), using a score developed by the researchers to track this condition. Methods: A cross-sectional study was carried out, in which DM2 patients registered at SUS in the city of S?o Mamede-PB was recruited. Ophthalmological and clinical data were collected, including: body mass index (BMI), waist circumference (WC), waist circumference/height ratio (WC/stature), smoking history, physical activity, time of diabetes and its control, blood pressure values and comorbidities. With these data, an original score for DR screening (DRSS) was performed. Qualitative variables were expressed by absolute and relative frequencies, and quantitative variables were expressed by means and standard deviations. p value ≤ 0.05 was used to reject the null hypothesis. Results: Ninety seven (64.7%) type 2 diabetic patients were recruited. Participants were predominantly women (64.9%), with a mean age of 65.8 years, of short stature (mean of 1.56 m), high BMI, with a predominance of the WC/stature ratio equal to or greater than 0.60, smokers and patients with systemic arterial hypertension (SAH). The main ophthalmological findings were: vascular changes compatible with Grade I/II Hypertensive Retinopathy (72.1%) and cataracts in about 50% of the eyes. The prevalence of DR was 12.4%. According to the DRSS results, it was found that most patients (85.6%) had a high risk score equal to or greater than 60 of developing DR. It was observed that the variables: WC, physical activity, time of diabetes and SAH showed a significant association with the risk of developing DR. In addition, BMI and WC/height ratio with higher values had a high risk of developing DR. Conclusion: There was association between medium and high DRSS risk diabetics with the probability of developing DR, recommending that all people with these characteristics should be referred to the specialist in order to screen for DR and other morbidities caused by diabetes.

Effect of Hyperglycemia on Erythrocyte Carbonic Anhydrase and Lactic Acid in Type II Diabetic Subjects

Background: Carbonic anhydrase (CA) is a ubiquitous enzyme catalyzing the reversible hydration of CO2 to and H+. CA plays a crucial role in CO2 transport, acid-base balance, and in linking local acidosis to O2 unloading from hemoglobin and also facilitates lactate shuttling across the monocarboxylate transporters (MCT). The study aimed to investigate the influence of hyperglycemia on erythrocyte carbonic anhydrase activity and lactic acid in type II diabetic patients. Method: Red blood cell carbonic anhydrase activity was determined in washed lysed-hemolysate by the action of the enzyme on the substrate p-nitrophenyl acetate. The absorbance of released p-nitrophenol was recorded at 345 nm. Glycated Hemoglobin was determined by ion exchange method (Spectrum Diagnostic Kit). Blood glucose, lactate, cholesterol and triglyceride were determined using Accutrend GCT meter (Roche, Germany) with cobias® test strips. Results: The present study showed that hyperglycemia significantly (p < 0.05) increased both erythrocyte carbonic anhydrase activity and blood lactate level in type II diabetic patients. Conclusion: We may conclude that hyperglycemia may be responsible for the increased activity of carbonic anhydrase activity and blood lactate concentration.

Sleep Disturbance among Type II Diabetic Patients and Influence of Glycemic Control

Background: Experimental and observational studies have indicated that poor sleep quantity and quality are associated with an increased risk of chronic diseases including insulin resistance. Additionally, sleep disorders have been reported to aggravate diabetes due to decreased glucose metabolism and elevated cortisol levels as well as it can increase the risk for the development of diabetes. Objectives: To assess the sleep quality and its determinants and impact on glycemic control of type II diabetic patients. Methods: A cross sectional study was adopted among a representative sample of patients diagnosed with type II Diabetes seen in Prince Mansour Military Hospital Diabetic Center in Taif throughout the study period (March-July 2021). A self-administered questionnaire was utilized in the present study including 5 main parts: demographic data of the patients, medical and social history, the Pittsburgh Sleep Quality Index (PSQI) to assess the subjective sleep quality, weight and height measurements and the most recent glycated hemoglobin (HbA1c) level. Results: The study included 270 type II diabetic patients out of a targeted 282 with a response rate of 95.7%. Most of them aged either between 51 and 60 years (34.8%) or over 60 years (42%). Females represent 63% of them. Majority of patients (87.8%) had HbA1c ≥ 7%, indicating uncontrolled blood glucose levels. Overall, poor sleep quality, based on PSQI was observed among 41.1% of type II diabetic patients. Results of multivariate logistic regression analysis revealed that compared to patients whose income was lower than 5000 SR/month, those with income of 50,001 - 1000 and >15,000 SR/month were at lower significant risk for having poor sleep (Adjusted odds ratio “AOR” = 0.44, 95% confidence interval “CI” = 0.22 - 0.86, p = 0.016 and AOR = 0.21, 95% CI = 0.06 - 0.77, p = 0.019;respectively). Opposed to diabetic patients with a duration of less than one year of DM, those with a duration exceeding 10 years were at almost 6-folds higher risk for poor sleep quality (AOR = 6.39, 95% CI = 1.12 - 36.43, p = 0.037). Patients with a history of social stressors were at a higher significant risk for poor sleep quality compared to those without such a history (AOR = 4.99, 95% CI = 1.71 - 14.67, p = 0.003). Conclusion: A considerable proportion of type II diabetic patients attending the diabetic center, Prince Manasour Military hospital in Taif, Kingdom of Saudi Arabia expressed poor sleep quality. However, there was no association between glycemic control level and poor sleep quality.

Research of Type 2 Diabetes Patients’ Problem Areas and Affecting Factors

Background: The study was descriptively conducted in order to determine problem areas and the affecting factors among the Type II diabetes patients. Methods: The study was carried out between August and October, 2011 in the Endocrinology Polyclinic in Adiyaman, Turkey. The population of the study was made up by Type II diabetes patients who were diagnosed with diabetes at least one year ago and came to Endocrinology Polyclinics at the study period. The sample of the research consisted of 188 patients who were recruited using random sampling method, were diagnosed as diabetes for at least one year. Data were collected through a Personal Information Form and Problem Areas in Diabetes (PAID) Scale. The data obtained were assessed in SPSS packet programme by using arithmetic average, percentage, variance analysis and t-test. Results: It was found out that the participant patients had serious problems in diabetes and their mean PAID score was 68.17 ± 16.16. The difference between patients BMI values and mean PAID scores was statistically significant (p Conclusion: It was established that the patients included in the study experienced a serious diabetes problem. In addition to the results, this study could be used to help develop nursing interventions.

Incidence of Diabetes in Hepatitis C Patients in Remote Areas of Pakistan:Effect of Co-Morbidity on HCV Treatment Outcomes at Selected Secondary Care Hospitals

The management of Hepatitis C(HCV)varies greatly due to co-morbidities.Association of Type II Diabetes Mellitus(T2DM)and HCV infection is momentous,however,only limited studies available from remote areas of Pakistan.This study aimed to assess the incidence of T2DM in Hepatitis C patients,and to measure the treatment outcomes of anti-HCV therapy in co-morbidity of diabetic patients in remote areas of Khyber Pakhtunkhwa Pakistan.A cross-sectional retrospective analysis of HCV patients(n=449)was conducted in the District Hospitals of Bannu and Lakki Marwat,Pakistan.Patients diagnosed of HCV infection and having T2DM as comorbidity were included in the study.The demographic information and laboratory parameters,such as viral load(VL),hemoglobin(Hb),alanine amino transferase(ALT),and platelet count were collected to measure treatment outcomes.T2DM was found in 33.18%of patients and significant association(p˂0.05)was found with HCV infection as a co-morbidity.Sofosbuvir(SOF)and Ribavirin(RBV)therapy reduced the mean(SD)VL(×10^(3))from baseline 357.1±26.23 IU/mL to 14±2.3 IU/mL and 1.3±0.3 IU/mL at 3rd and 6th months of therapy,respectively.Conventional Interferon and Ribavirin(RBV)therapy reduced VL from a baseline 234.57±13.5 IU/mL to 72±7.9 IU/mL and 62±3.7 IU/mL at 3rd and 6th months of therapy,respectively.PEG-Interferon+Ribavirin(RBV)therapy reduced baseline VL from 337±16.27 IU/mL to 18±2.8 and 4±1 at 3^(rd) and 6^(th) month of therapy,respectively.Similarly,Hb,ALT,and platelet count showed variations in all the studied groups.T2DM was highly prevalent and significantly associated with HCV in patients of 40 years or above and SOF+RBV combination therapy showed a better response,both in the diabetic and non-diabetic HCV patients compared to earlier the therapies.To further confirm the finding,a study using a larger population of HCV patients with T2DM should be conducted.

Corn phytochemicals and their health benefits

Whole grain has a wide range of phytochemicals exhibiting health benefits of lowering risk of chronic diseases.As commonly consumed grain product,corn has unique profiles of nutrients and phytochemicals when compared with other whole grains.Corn nutrients and phytochemicals include vitamins(A,B,E,and K),minerals(Mg,P,and K),phenolic acids(ferulic acid,coumaric acid,and syringic acid),carotenoids and flavonoids(anthocyanins),and dietary fiber.More and more scientific evidences have shown that regular consumption of whole grain corn lowers the risk of developing chronic diseases such as cardiovascular disease,type 2 diabetes,and obesity and improves digestive health.Further studies on bioactive compounds of corn related to health are needed.

Disease Prevention and Alleviation by Human Myoblast Transplantation

Myoblast implantation is a unique, patented technology of muscle regeneration being tested in Phase III clinical trials of muscular dystrophy, ischemic cardiomyopathy, Phase II trial of cancer, and Phase I trial of Type II diabetes. Differentiated and committed, myoblasts are not stem cells. Implanted myoblasts fuse spontaneously among themselves, replenishing genetically normal myofibers. They also fuse with genetically abnormal myofibers of muscular dystrophy, cardiomyopathy, or Type II diabetes, transferring their nuclei containing the normal human genome to provide stable, long-term expression of the missing gene products. They develop to become cardiomyocytes in the infracted myocardium. Myoblasts transduced with VEGF165 allow concomitant regeneration of blood capillaries and myofibers. They are potent biologics for treating heart failure, ischemic cardiomyopathy, diabetic ischemia, erectile dysfunction, and baldness. Myoblasts, because of their small size, spindle shape, and resilience, can grow within wrinkles and on skin surfaces, thus enhancing the color, luster and texture of the skin “plated” with them. They can be injected subcutaneously as a cellular filler to reduce wrinkles. Intramuscular injection of myoblasts can augment the size, shape, consistency, tone and strength of muscle groups, improving the lines, contours and vitality to sculpt a youthful appearance. This highly promising technology has great social economic values in treating hereditary, fatal and debilitating disease conditions.

Therapeutic molecules for multiple human diseases identified from pigeon pea(Cajanus cajan L.Millsp.)through GC–MS and molecular docking

Molecular mechanism behind the therapeutic potential of pigeon pea over the human diseases such as rheumatoid arthritis,breast cancer,type II diabetes,malaria,measles and sickle cell disease were revealed through docking of GC–MS identified phyto-compound ligands with candidate disease proteins.Of the 242 ligands,three dimensional structures of 47 compounds had to be drawn using ChemSketch and the remaining structures were retrieved from PubChem and docked with the active sites of candidate proteins.The molecules identified through docking were further subjected to ADMET analysis and promising drug candidates were identified for each disease.This paper presents a precise account of the chemoprofile of pigeon pea leaves,stems and seeds,interaction of these molecules with target proteins and suggests 26 highly potential molecules which are drug candidates for multiple human diseases.Pigeon pea seeds are especially proven as invaluable source for therapeutic molecules.