effect of sociostructural and collaborative decision-making on diabetes self-management

Diabetic self-management is important for controlling the diabetes complications and promoting health-related quality of life in these patients. The objective of this study was to examine a hypothetical model regarding influences of sociostructural determinants, collaborative decision-making and patient's beliefs system on diabetes self-management. In a cross-sectional descriptive study from Dec 2010 to Mar 2010, 500 patients of Iranian adult patients with type II diabetes attended the outpatient diabetic clinics of the Shariati Hospital in Tehran were selected by convenience sampling. Data were collected by The Demographical Information, Social- Economical Status and Diabetic History Questionnaire and eleven self-reported scales of this research. Structural equation modeling [SEM] with LIZREL software applied for data analysis. The modified model had a desirable fitness to the observed data. Patient's beliefs system directly influenced the diabetes self-management. Sociostructural determinants influenced diabetes self-management indirectly via collaborative decision-making and Patient's beliefs system. In addition, collaborative decision-making significantly influenced patient's beliefs system that thereby impacted diabetes self-management. Sociostructural determinants, collaborative decision-making and patient's beliefs system are integrated and cooperatively affect on diabetes self-management. Comprehensive intervention schedules required to improve these agents for encouragement the type II diabetes self-management

Changes of bone density in pediatric patients with beta-thalassemia major after allogenic hematopoietic stem cell transplantation

Thalassemia major and its treatment by stem cell transplantation can have deleterious effects on bone integrity. This study assesses the adverse effects of transplantation on growing bones of pediatric thalassemic patients. Bone mineral density [BMD] of 20 patients from three thalassemia classes whose mean [SD] age was 7.4 [3.8] years were tested with a Norland XR-46 device at baseline [before transplantation], 6 and 12 months after transplantation. At 6 and 12 months after transplantation we observed no significant changes in mean BMD. There were no Z-scores less than -2 among patients. Class 3 thalassemia did not negatively impact BMD. Calcium [Ca], phosphorous [P] and ferritin levels were not significantly related to patients' BMD scores. Transfusion duration and chelation therapy showed positive significant relationships to BMD [g/ cm2], but no significant relation with the BMD Z-score. The deleterious relation between corticosteroid use and changes in BMD was not significant. In contrast, patients who developed acute graft versus host disease [aGVHD] after transplantation showed significant adverse effects on BMD of their femur [P = 0.020] and spine [P = 0.027]. Stem cell transplantation in pediatric thalassemic patients who do not develop aGVHD does not appear to have any significant positive or negative effects on BMD

Retrograde trans-femoral approach for successful percutaneous angioplasty in a diabetic patient with ischemic hand ulcer: a case report

Hand ischemia is a rare complication of diabetes and some other chronic vascular diseases. Critical hand ischemia causes painful limbs and disability and requires urgent revascularization. There have been a few reports of successful trans-brachial percutaneous angioplasty in the upper extremity in the radial or ulnar artery. Herein, we report the results of the endovascular treatment of a 68-year-old diabetic patient with an ischemic hand ulcer due to the severe stenotic lesions of the infra-brachial arteries. The patient underwent successful angioplasty via the retrograde trans-femoral technique to avoid the drawbacks. At the first week of post-procedural follow-up, the patient's finger was warm with a well-healing wound and reduced pain. In the next two months, he had no complaint of pain or active ulceration; the ulcer was well healed, and the hand was warm. The present case shows that history taking and physical examination should be followed by upper-extremity arteriography for the evaluation of hand ischemia. The trans-femoral approach enabled us to perform percutaneous catheterization for both diagnostic and interventional purposes. Not only is this strategy useful even for the severe stenotic disease of the distal parts of below-the-elbow arteries but also it avoids the unpleasant complications of antegrade brachial cannulation

[Novel treatments of diabetic foot ulcers]

Diabetic foot ulcer is one of the most important chronic complication of diabetes, which led to prolonged hospitalization and finally amputation of the foot, has psychological and economic burden to individuals and families and the health system. Ischemia, Neuropathy and infection are three pathological factors which lead to diabetic foot complications. Although all diabetic foot ulceration are not preventable; physician knowledge, clinical examination of foot problems, treatment of small lesions, patient education and appropriate foot wear recommendation reduced the number of foot ulcer associated to diabetes. Components of basic concepts of the diabetic foot treatment including the infection control, establishing appropriate arterial blood flow and removing pressure and stress from painfuI areas [Offloading]. Along with standard treaments, there are supplementary therapies which accelerate the wound healing process such as novel dressings including hydrogel, Platelet-rich plasma [PRP], growth factors, stem cells, HBOT, VAC, and new herbal therapy [Angipars[TM]]. For compiling of current article, we have searched related sources through the databases of PubMed, Ovid, Google Scholar, Elsevier, UpToDate, Cohrane Library addition to printed journals in this field. It could be concluded that although various developments have been made in the field of diabetic foot ulcers has been made, most of them had the relative effects and complement each others; more effective treatments would be considered necessary

Individual, psycho-social and disease-related risk factors in diabetic neuropathy

Neuropathy is the mostly prevalent of complications and the major cause of amputation, pain and disability in patients with diabetes. The purpose of this study was to investigate the role of individual, psycho-social, and disease-related risk factors in neuropathy of type 2 diabetes patients. In this retrospective cross-sectional study, 271 patients with type 2 diabetes were selected by convenience sampling in diabetic outpatient clinics of Tehran University of Medical Sciences and the Iranian Diabetic Association. The data were collected by demographical and disease characteristics questionnaires and DASS-42, QOLS, DSMS, and DKS scales. Then, the data were analyzed by r binary logistic regression along with PASW software. Socio-economic status, glycosylated hemoglobin, body mass index, diabetes self-management, depression, quality of life, diabetes knowledge, and diabetes duration were significantly able to differentiate diabetic patients with neuropathy from diabetic patients without neuropathy [p<0.001]. Gender, treatment type and patient age were not significantly able to differentiate two groups [p>0.05]. The total regression model explained that 95.2% of cases were classified correctly. Inappropriate socio-economic status, glycosylated hemoglobin over 9%, being overweight and obesity, poor diabetes self-management, clinical depression, low quality of life, poor diabetes knowledge, and longer diabetes duration contribute to the incidence of neuropathy in patients with type 2 diabetes and attention must be paid to them for neuropathy prevention.

Evaluation of [99m]Tc-Ubiquicidin 29-41 Scintigraphy in Differentiation of Bacterial Infection from Sterile Inflammation in diabetic foot

Ubiquicidin [UBI] 29-41 is a synthetic antimicrobial peptide that binds with the microbial cell membrane at the location of infection. This study was conducted to evaluate its probable efficacy as an infection-imaging agent with potential to differentiate bacterial infection from sterile inflammation in humans. Fifteen diabetic foot patients [10 males and 5 females] with suspected bacterial infection, prior to starting antibiotic treatment, were selected for this study. First a routine three phase bone scan and later a [99m]Tc-UBI scan was performed for all the patients. 555-740 MBq of [99m]Tc-UBI was injected intravenously. A 10 minute dynamic study was followed by spot views of the suspected region of infection and corresponding normal areas [liver and kidneys] at 60 and 120 min. Whole-body anterior and posterior images were also acquired. To interpret the studies as positive or negative, visual score [0 -3] was used, with scores of 0 [minimal or no uptake; equivalent to soft tissue] and 1 [mild; less uptake than in liver] being considered negative and scores of 2 [moderate; uptake equal to or greater than that in liver] and 3 [intense uptake equal to or greater than that in kidneys] being considered positive. Of 15 studies performed with [99m]Tc-UBI, all had positive bacterial cultures. The result of bone scan was positive for osteomyelitis in 12 patients [80%]. [99m]Tc-UBI Scintigraphy was positive in 6 patients, but negative in nine. The sensitivity of [99m]Tc-UBI for detection of infection was therefore 40%. From 12 patients who had positive bone scans, only 6 had a positive [99m]Tc-UBI [50%] indicating the sensitivity of 50% for [99m]Tc-UBI in osteomyelitis cases. 99mTc-UBI was not positive in any patient who had evidence of soft tissue infection in the bone scan. Although [99m]Tc-UBI 29-41 was well tolerated by all the patients without any side effects, considering low sensitivity of this agent, this radiopharmaceutical is not of great value for diabetic foot infection diagnosis

Localized myxedema of the toe: a rare presentation of Graves' dermopathy

Infiltrative dermopathy is an uncommon manifestation of Graves' disease. The most frequent location of infiltration is the lower extremities, especially the pretibial areas and on the dorsum of the foot. Rarely the hand, elbow, arm, and forearm are affected. We report a 66-year-old man with Graves' disease of nine years duration who presented with dermopathy and nonpitting edema of the toe with no involvement of the pretibial portion since four years ago. Radiologic studies of the foot were normal, without subperiosteal bone formation or reaction. Skin biopsy was consistent with pretibial myxedema. This presentation of myxedema and limitation to a localized area for several years is very unusual

[Prevalence of diabetes mellitus in Iran in 2000]

Diabetes mellitus is one of the chronic metabolic diseases with several organ damages that dearese life span. Prevalence of known diabetes appears to be increasing in most countries, presumably due to increasing the prevalence of risk factors such as obesity, lower physical activity and improved diagnosis. WHO expect the number of adults [20 years and older] with diabetes rises up to 300 millions in 2025. In view of the worldwide geographic differences in diabetes and lack of documented informations about prevalence of diabetes in Iran, we assigned this study. The base of our study for assessment of prevalence of diabetes in Iran was results of ?Health and Disease Study in Iran, 1999?. We used epidemiologic model [DisMod] for estimating the incidence of diabetes in Iran. The prevalence of diabetes in over 20 years of Iranian population in 2000, was 1.6 million or 4.67%. Also it is estimated up to 100000 persons have been affected by type II diabetes. The true limitation of our study was limitations of documents about estimated of proportion of true prevalence to prevalence of known diabetes