Sheffield One-Stop Service: A potential model to improve the screening uptake of diabetic peripheral neuropathy and other microvascular complications of diabetes.

The world is experiencing an enormous rise in the prevalence of diabetes, which is associated with massive healthcare costs that threaten to overwhelm many healthcare systems. Most of the diabetes expenditure is attributed to the management of chronic diabetes complications, including diabetic peripheral neuropathy (DPN)/diabetic foot complications, chronic kidney disease, sight-threatening retinopathy and cardiovascular diseases. Of these complications, the most overlooked is DPN. Most consultations around the world do not even involve taking off shoes and socks to carry out a foot examination, and even when carried out, the peripheral neurological examination using the 10-g monofilament diagnoses DPN when it is already at an advanced stage. Thus, all too often diabetes complications are diagnosed late, resulting in devastating outcomes, particularly in low- to middle-income countries. There is, therefore, an urgent need to instigate new strategies to improve microvascular screening uptake using a holistic protocol for annual diabetes health checks outside the busy diabetes clinic. One such approach, the Sheffield One-Stop Microvascular Screening Service, which involves modern point of care devices to diagnose DPN, has been shown to be feasible and effective, resulting in high uptake and early management of diabetes complications. This article outlines the advantages of this One-Stop Microvascular Screening Service and a plan to trial an adapted version of this service to a resource-limited country, the Philippines. If successful, this model has the potential for implementation in other countries around the world.

Effectiveness of Bacille Calmette-Guerin vaccination policies in reducing infection and mortality of COVID-19: a systematic review.

BACKGROUND: COVID-19 vaccination has been advocated as the most effective way to curb the pandemic. But with its inequitable distribution and slow rollout, especially in low- to middle- income countries, it will still take a long time before herd immunity is achieved. Alternative measures must therefore be explored to bolster current COVID-19 vaccination efforts. In particular, the Bacille Calmette-Guerin vaccine has been studied extensively as to its proposed conferment of non-specific immunity against different infections, including COVID-19. The aim of this study, therefore, is to evaluate the current evidence on the effectiveness of national BCG vaccination policies in reducing infection and mortality of COVID-19. METHODS: A systematic review was conducted between April to August 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA-P) guidelines. Literature was retrieved from PubMed, Cochrane, HERDIN, Web of Science, EBSCO, and Western Pacific Region Index Medicus (WPRIM). Studies conducted from January 2020 to August 2021 that fell within Level 1A to 2C of the Oxford Center for Evidence-Based Medicine were included in the review. Quality assessment was performed using the appropriate Joanna Briggs Institute critical appraisal tool and a quality assessment checklist for ecological studies adapted from Betran et al. RESULTS: A total of 13 studies were included in this review. Nine studies reported significant association between BCG vaccination policies and COVID-19 outcomes, even when controlling for confounding variables. In addition, among other mandated vaccines, such as pneumococcal, influenza, diphtheria-tetanus-pertussis, and measles, only BCG vaccination showed significant association with decreased COVID-19 adverse outcomes. However, other factors also showed positive association with COVID-19 outcomes, particularly markers of high economic status of countries, higher median age, and greater population densities. CONCLUSION: The lower incidence and mortality of COVID-19 in countries with mandated BCG vaccination may not solely be attributable to BCG vaccination policies, but there is still some evidence that demonstrates a possible protective effect. Clinical trials must be continued before recommendations of BCG vaccinations are to be used as an alternative or booster vaccine against COVID-19.

Effectiveness of Healthy Foodie Nutrition Game Application as Reinforcement Intervention to Previous Standard Nutrition Education of School-Aged Children: A Randomized Controlled Trial.

OBJECTIVE: Games promoting nutrition education are helpful tools to improve nutrition knowledge. Healthy Foodie is an interactive web-based nutrition game for Filipino children. This study aimed to determine the effectiveness of Healthy Foodie on the nutrition knowledge of children aged 7 to 10 years old. METHODOLOGY: This study had 2 phases. In Phase 1, we developed and validated the Healthy Foodie nutrition game application and Nutrition Knowledge Questionnaire involving 46 participants. The Nutrition Knowledge Questionnaire was divided into 2 15-item questionnaires: Part 1 pertained to Food Group Knowledge and Part 2 on Food Frequency Knowledge. Phase 2 was the implementation of the game and questionnaire. This was a randomized controlled trial conducted in two elementary schools in Manila, involving 360 participants divided equally into control and experimental groups. RESULTS: For Phase 1, internal consistency of the questionnaire using the Kuder-Richardson Formula 20 was 0.75 for part 1 and 0.70 for Part 2. In Phase 2, comparing the adjusted posttest mean Food Group Knowledge scores, there was statistically higher score (F=111.84, p=0.0001) in the experimental group (11.57±0.20) compared to the control (8.51±0.20). In the adjusted posttest mean Food Frequency Knowledge scores, there was a statistically higher score (F=56.12, p=0.0001) in the experimental group (10.70±0.15) compared to the control (9.07±0.15). CONCLUSION: A nutrition game-based intervention such as Healthy Foodie is effective as a reinforcement intervention to previous standard nutrition education of school-aged children.

Health-Related Quality of Life (HRQoL) of Adult Filipinos with Graves' Disease cured by Radioiodine Therapy compared to those controlled by Antithyroid Drugs at University of Santo Tomas Hospital: A Pilot Study.

OBJECTIVE: The study aims to develop and validate the Filipino version of Thyroid-disease specific quality of life Patient Reported Outcome (ThyPROph) questionnaire, and to conduct a pilot study comparing the quality of life of patients with Graves' disease at University of Santo Tomas Hospital (USTH) after receiving radioactive iodine ablation (RAI) or anti-thyroid drug (ATD) using the validated ThyPROph. METHODOLOGY: This study has 2 phases. Phase 1 is the development and validation of the ThyPROph with prior translation and pretesting to Graves' disease patients. Phase 2 is the pilot study involving 58 euthyroid patients with Graves' disease recruited to answer the validated ThyPROph. All of the participants completed the ThyPROph. A cross sectional comparative design was used to compare health-related quality of life (HRQoL) under two modes of treatment for Graves' disease: RAI and ATD. Likewise, correlation of the domains with the demographics was determined using Pearson correlation coefficient and Spearman rank signed test. RESULTS: For the phase 1 study, internal consistency exists across all domains of ThyPROph with Cronbach's alpha of 0.839. Overall, discriminant validity falls within range of 0.028-0.606 and convergent validity showed moderate correlations. Phase 2 study showed that there is a significant difference in the domains "goiter symptoms" (p=0.0209), "emotional susceptibility" (p=0.0067) and "impaired daily life" (p=0.0463). The HRQoL is significantly better in the RAI group based on these three domains. Statistically significant correlations exist between goiter grade and goiter symptoms domain (p=0.0001), gender and impaired daily life domain (p=0.016), cosmetic complaints domain with age (p=0.002), marital status (p=0.046), and disease duration (p=0.005). LIMITATIONS: Results are not powered to achieve the primary objective because complications of Graves' disease were excluded. The reliability of the domains is reduced. A prospective randomized study is more ideal. CONCLUSION: Quality of life of patients with Graves' disease as assessed by ThyPROph is significantly better with RAI compared to ATD. RAI therapy can be considered as the better treatment option in our setting especially for patients who have noticeable goiters with symptoms attributable to their goiters, and those with emotional instability.

Prevalence of Hyponatremia in Hypothyroid Patients during Radioactive ¹³¹I Ablation for Differentiated Thyroid Cancer: Single Institution Experience.

BACKGROUND: Hyponatremia developing in hypothyroid patients has been encountered in clinical practice; however, its prevalence has not been well established. METHODS: Thirty patients diagnosed with differentiated thyroid cancer, rendered hypothyroid after surgery and levothyroxine withdrawal, and who are for radioactive iodine (RAI) ablation were included. Serum sodium concentrations were measured twice, at the time of admission for RAI ablation, and before discharge after increased oral fluid intake. The outcome measures were to determine the prevalence of hyponatremia among hypothyroid patients prior to RAI ablation and after oral hydration post-RAI, and to correlate the serum sodium levels pre-RAI and post-RAI with thyroid-stimulating hormone (TSH) concentration and age. RESULTS: Thirty patients were included, with ages from 23 to 65 years old (median, 40). Two patients (6.7%) were hyponatremic prior to RAI ablation, and eight patients (26.7%) had mild hyponatremia (130 to 134 mEq/L) after RAI and hydration. There was no significant correlation between TSH levels and serum sodium levels prior to or after RAI. There was also no significant correlation between pre- and post-RAI sodium concentration and age. CONCLUSIONS: The prevalence of hyponatremia pre-RAI was 6.7%, and 26.7% post-RAI. No significant correlation was noted between TSH concentration and age on pre- or post-RAI sodium concentrations. Routine measurement of serum sodium post-RAI/isolation is still not advised. Measurement of sodium post-RAI may be considered in patients who are elderly, with comorbid conditions or on medications.

Managing diabetes in Asia: overcoming obstacles and the role of DPP-IV inhibitors.

Asia bears the world's greatest burden of type 2 diabetes (T2DM) and prevalence is increasing rapidly. Compared to other races, Asians develop T2DM younger, at a lower degree of obesity, suffer longer from its complications and die earlier. Curbing this epidemic requires an integrated, risk-based, and multidisciplinary approach. Inadequately managed T2DM has macrovascular and microvascular sequelae, Asians with T2DM being particularly susceptible to diabetic nephropathy. Earlier and more intensive monitoring and management of risk factors are required, especially for patients with, or at risk of, renal impairment. Particular challenges of T2DM management in Asia include: lack of access to specialist healthcare, insufficient clinical evaluation and delayed diagnosis. As in Caucasians, conventional treatment modalities are limited by deteriorating glycaemic control with disease progression and there is an unmet need for efficacious, safe, cost-effective and convenient pharmacotherapies for treating different stages of T2DM and preventing its complications, particularly in high-risk patients. There is a trend towards increasing use of DPP-IV inhibitors, which are no less efficacious and safe in Asians than Caucasians and may have some advantages over existing oral antidiabetic agents, particularly for certain high-risk groups. Such agents may play a significant future role in the management of T2DM.

Oral hypoglycaemic agents for diabetes in pregnancy - an appraisal of the current evidence for oral anti-diabetic drug use in pregnancy.

INTRODUCTION: The use of oral hypoglycaemic drugs in pregnancy is not recommended because of reports of foetal anomalies and other adverse outcomes in animal studies and in some human cases. However, recent studies have suggested that some oral hypoglycaemic drugs may be used in pregnancy. This review will examine these studies critically. METHODS: Literature review of articles obtained from a PubMed search of peer-reviewed journals on oral hypoglycaemic drug use in pregnancy. RESULTS: In two prospective studies, one of which was a randomised controlled trial, glibenclamide was as effective and safe as insulin in gestational diabetes. In several studies, metformin did not increase foetal anomalies or malformations when used during pregnancy in women with polycystic ovary syndrome (PCOS). In one prospective study on infants born to mothers who used metformin in pregnancy, follow-up for 18 months showed no adverse effects. In several prospective and retrospective studies on women with PCOS, metformin was shown to prevent early pregnancy loss, decrease insulin resistance, reduce insulin and testosterone levels, and decrease the incidence of gestational diabetes when these women got pregnant while on metformin and continued to take it throughout their pregnancy. In a single small study, acarbose did not cause any adverse effects during pregnancy. CONCLUSIONS: Recent evidence shows promising findings in the safety and efficacy of some oral hypoglycaemic agents in treating pregnant diabetics. However, larger clinical studies will be needed to ensure the safety and efficacy of these drugs in pregnancy.