Pharmacist led intervention towards management of type 2 diabetes mellitus and assessment of patient satisfaction of care - A prospective, randomized controlled study.

BACKGROUND: Diabetes mellitus, a metabolic disorder characterized by hyperglycaemia is due to impaired insulin secretion and deficiency. Though effective current drug therapies are available for diabetes, yet glycaemic maintenance remains a challenge without medication adherence. This necessitates a holistic approach to improve clinical outcomes for a better patient health care. METHODS: A prospective, interventional, randomized controlled study was conducted among 97 type 2 diabetic patients for 6 months. The primary outcome measures included patient satisfaction of care assessment by diabetes treatment satisfaction questionnaire (DTSQ) and medication adherence by medication adherence rating scale (MARS). Secondary outcomes included assessment of knowledge, attitude, and perception and laboratory parameters. The collected data was analyzed using paired and unpaired T-test. RESULTS: Of 97 patients randomized to group A (n = 49) and group B (n = 48), there were 3 and 1 drop-out in group A and B, respectively. The mean age of patients was found to be 56.82 ± 4.06 years. At the 6thmonth follow up, significant improvement of glycaemic parameters was observed in group A vs B. Mean MARS and DTSQ scores also improved in group A vs. B (P-value <0.05). CONCLUSION: Pharmacist-provided counselling improves patient compliance, quality of life and satisfaction of care in diabetic patients.

Automatic fitting procedures for EPR spectra of disordered systems: matrix diagonalization and perturbation methods applied to fluorocarbon radicals.

Two types of automatic fitting procedures for EPR spectra of disordered systems have been developed, one based on matrix diagonalization of a general spin Hamiltonian, the other on 2nd order perturbation theory. The first program is based on a previous Fortran code complemented with a newly written interface in Java to provide user-friendly in and output. The second is intended for the special case of free radicals with several relatively weakly interacting nuclei, in which case the general method becomes slow. A least squares' fitting procedure utilizing analytical or numerical derivatives of the theoretically calculated spectrum with respect to the g- and hyperfine structure (hfs) tensors was used to refine those parameters in both cases. 'Rigid limit' ESR spectra from radicals in organic matrices and in polymers, previously studied experimentally at low temperature, were analyzed by both methods. Fluorocarbon anion radicals could be simulated, quite accurately with the exact method, whereas automatic fitting on, e.g. the c-C(4)F(8)(-) anion radical is only feasible with the 2nd order approximative treatment. Initial values for the (19)F hfs tensors estimated by DFT calculations were quite close to the final. For neutral radicals of the type XCF(2)CF(2)* the refinement of the hfs tensors by the exact method worked better than the approximate. The reasons are discussed. The ability of the fitting procedures to recover the correct magnetic parameters of disordered systems was investigated by fittings to synthetic spectra with known hfs tensors. The exact and the approximate methods are concluded to be complementary, one being general, but limited to relatively small systems, the other being a special treatment, suited for S=1/2 systems with several moderately large hfs.

Allergenic exposure, IgE-mediated sensitization, and related symptoms in lawn cutters.

AIMS: The aims of the study conducted on lawn cutters were: (1) to evaluate exposure to pollens and molds; and (2) to assess the prevalence rate of IgE sensitization and symptoms in relation to exposure to pollens and molds. METHODS: Environmental assessment was done with the use of personal samplers on eight workers. Our population consisted of 181 municipal park workers, including 128 lawn cutters and 67 control subjects (blue-collar workers in the hospital). A questionnaire was administered, as well as skin prick tests with seven common inhalants including pollens and eight grass molds. The main outcome variables were grass or mold sensitization (at least one of eight molds) and work-related rhinitis, conjunctivitis, and rhinoconjunctivitis. Atopy and exposure to park-related allergens, as well as sensitization to grass pollens, were considered as explanatory factors. Smoking was taken into consideration as a covariant. Both presence and duration of occupational exposure to park-related allergens were considered as parameters of exposure. Duration of exposure (months x years of exposure as lawn cutters) was used as a continuous or as a categorical variable. RESULTS: Environmental monitoring showed that the concentration of pollens and molds decreased in magnitude from samples collected close to lawn cutters faces, short distance away in parks, and in the general environment. There was no difference in the prevalence rates for atopy between lawn cutters (32%) and control subjects (37%). Sensitization rates to grass pollen were also similar in lawn cutters (18%) and in control subjects (22%). However, there was a tendency for prevalence rates of sensitization to molds to be greater among lawn cutters (12% to Alternaria) compared with control subjects (5%). In the logistic model atopy was significantly related to grass sensitization (odds ratio [OR] = 7.2), mold sensitization (OR = 9.3), and sensitization to Alternaria (OR = 5.8). Grass sensitization was a significant risk factor for park-related rhinitis (OR = 5.8), conjunctivitis (OR = 5.0), and rhinoconjunctivitis (OR = 9.4). Exposure for 12 years or more was associated with rhinoconjunctivitis with an OR of 4.1 (95% confidence interval, 1.0-16.7). Smoking was not significantly related to any outcome. CONCLUSION: We conclude that among lawn cutters exposure to pollens and molds is higher than in the general population, atopy is the main determinant of sensitization to these aeroallergens, and sensitization and, to a much lesser extent, exposure to grass are determinants of symptoms.

Ontogeny of substance P in the digestive tract, spinal cord and hypothalamus of the human fetus.

The time of appearance and tissue concentrations of substance P-like immunoreactivity (SP-LI) were studied in 53 human fetuses aged 8-21 weeks. Detectable amounts were present at 8 weeks of gestation in available fragments of spinal cord and intestine. Thereafter, the tissue concentrations were highest in spinal cord, intermediate in hypothalamus and lowest in digestive tract. Except for a significant increase in the intestinal wall, the concentrations did not vary from the 8-14 to the 15-21 week period. At chromatography, SP-LI in extracts of spinal cord and intestine was essentially eluted in the volume of the synthetic undecapeptide. Using the indirect immunofluorescence technique, the localization of SP-LI positive structures in the digestive tract was studied in 5 fetuses aged 12-18 weeks. Scarce cell bodies were observed in the myenteric plexus. Nerve fibers were recognized in the muscular layer, in the myenteric plexus and in connective tissue of pancreas. The present results demonstrate the early appearance of SP-LI positive structures both in central nervous system and in the enteric nervous system in the human fetus. In the age range tested, SP-LI concentrations were noticeably higher in spinal cord and hypothalamus than in the digestive tract.

Ontogeny of somatostatin in the human gastro-intestinal tract, endocrine pancreas and hypothalamus.

The appearance, time and distribution of somatostatin in the pancreas, gastro-intestinal tract and hypothalamus were studied comparatively in human foetuses aged 6--32 weeks, by immuno-cytochemistry and radioimmunoassay. Somatostatin was detected by both methods in all segments including the colon. The first cells were observed, and somatostatin was present in measurable amounts at 8 weeks in pancreas, duodenum and intestine, while the peptide was detected at 12 weeks in antrum and colon, at 14 weeks in fundus, and at 16 weeks in hypothalamus. Subsequently, the largest cell population was located in the pancreas, where peptide concentration and age were positively correlated (P less than 0.01, r = 64). From 15 to 21 weeks of age, the mean somatostatin concentration in pancreas (12.4 +/- 1.84 ng/mg) was clearly higher than in hypothalamus (0.05 +/- 0.02 ng/mg) or in any segment of the gut, where values ranged from 0.36 +/- 0.06 (fundus) to 4.74 +/- 0.83 ng/mg (duodenum). The early appearance time of somatostatin, and its specific distribution with preferential location in the pancreas, suggest that the peptide may play a major role for the development of the foetal digestive tract, and that it may be involved in the regulation of other endocrine secretions, especially in the pancreas.

Immunocytological evidence for oxytocin neurons in the human fetal hypothalamus.

The use of antibodies against oxytocin or neurophysin enabled the detection by immunocytochemistry of oxytocin-neurophysin neurons in the hypothalamus in the human fetus. The perikarya of these neurons are located in the paraventricular and supraoptic nuclei. Immunoreactive neurons occure in the median eminence. The neurophysin immunoreactive neurons were more numerous than the oxytocin immunoreactive neurons. The specificity of the immunocytological reaction was controlled. The first oxytocin-neurophysin neurons are seen as early as the 14th week of gestation.

Immunofluorescence study of LH-RH producing cells in the human fetal hypothalamus.

The use of antibodies to synthetic LH-RH has enabled the detection by immunofluorescence of hypothalamic LH-RH producing cells in the human fetus. The perikarya of these cells are located in the pericommissural and peroptic regions, in the lamina terminalis and in the premamillary region. Reactive axons occur in the median eminence. The first LH-RH producing cells are seen as early as nine weeks of gestation. The specificity of immunocytological reaction has been controlled.