Effects of a comprehensive structured patient education intervention on disease-related knowledge and behaviour change among people living with type 2 diabetes in the Philippines.

Introduction: Addressing the ongoing needs of individuals with diabetes, particularly in low- and middle-income countries like the Philippines, requires a focus on regular follow-ups with healthcare teams, adherence to healthy behaviors, and effective patient education to prevent long-term complications. The aim of this study was to ascertain the impact of a comprehensive educational program for those living with diabetes in the Philippines. Methods: In a prospective study, a convenience sample of patients living with diabetes attending a cardiac rehabilitation or an outpatient diabetes clinic in the Philippines received a 12-week education intervention. Participants completed surveys at pre- and post-intervention assessing disease-related knowledge, health literacy, dietary habits, and tobacco use. Physical activity was measured by steps taken per day using wearable devices and by self-report of minutes of moderate or vigorous-intensity exercise per week. Satisfaction with the educational materials was also evaluated by a survey composed of Likert-type scale and open-ended questions. Descriptive statistics, paired t-tests or chi-square were used for data analysis. Results: Overall, 184 individuals living with diabetes type 2 (mean age = 54.4 ± 12.4, 32% female) completed both assessments. There was significant improvement in disease-related knowledge (p < 0.001), daily steps measured by a wearable device and self-reported minutes of moderate/vigorous-intensity exercise (p < 0.001), and the number of fruit and vegetable servings consumed per day (p = 0.001). No significant changes were observed in health literacy levels. One participant stopped using tobacco at post-education. Educational materials were highly satisfactory to participants. Lack of time, family responsibilities, and poor internet access were the main barriers to learning reported by participants. Suggestions to improve the education provided included assessment of information needs at the start of the education, having short summaries about the topics, follow-ups post-intervention, and inviting family members to sessions. Discussion: Results of this study demonstrated the positive effects a comprehensive structured patient education intervention on disease-related knowledge and behaviour changes among people living with type 2 diabetes in the Philippines.

Acquisition Parameters Influence Diffusion Metrics Effectiveness in Probing Prostate Tumor and Age-Related Microstructure.

This study aimed to investigate the Diffusion-Tensor-Imaging (DTI) potential in the detection of microstructural changes in prostate cancer (PCa) in relation to the diffusion weight (b-value) and the associated diffusion length lD. Thirty-two patients (age range = 50-87 years) with biopsy-proven PCa underwent Diffusion-Weighted-Imaging (DWI) at 3T, using single non-zero b-value or groups of b-values up to b = 2500 s/mm2. The DTI maps (mean-diffusivity, MD; fractional-anisotropy, FA; axial and radial diffusivity, D// and D┴), visual quality, and the association between DTI-metrics and Gleason Score (GS) and DTI-metrics and age were discussed in relation to diffusion compartments probed by water molecules at different b-values. DTI-metrics differentiated benign from PCa tissue (p ≤ 0.0005), with the best discriminative power versus GS at b-values ≥ 1500 s/mm2, and for b-values range 0-2000 s/mm2, when the lD is comparable to the size of the epithelial compartment. The strongest linear correlations between MD, D//, D┴, and GS were found at b = 2000 s/mm2 and for the range 0-2000 s/mm2. A positive correlation between DTI parameters and age was found in benign tissue. In conclusion, the use of the b-value range 0-2000 s/mm2 and b-value = 2000 s/mm2 improves the contrast and discriminative power of DTI with respect to PCa. The sensitivity of DTI parameters to age-related microstructural changes is worth consideration.

Patient education for people living with diabetes in the Philippines: A scoping review of information needs, diabetes knowledge and effectiveness of educational interventions.

BACKGROUND AND AIMS: Despite the growing burden of diabetes in the Philippines, available evidence indicates that its care and control are far from optimal, including patient education. The aim of this scoping review was to synthesize information in the available literature to describe the state of science of patient education for people living with diabetes in the Philippines, specific to educational needs, diabetes knowledge, and effectiveness of educational interventions. METHODS: Medline, Embase, Emcare, CINAHL, Pubmed and American Psychological Association PsycInfo were searched from data inception through July 2021. Studies of any methodology (qualitative/quantitative/mixed methods), sample size, and language were eligible for inclusion. RESULTS: Of 2021 initial citations, 7 studies were included, with all being quantitative in design and with a median Critical Appraisal Skills Program score of 8/12. Information needs were described by one study and related to self-care abilities. Diabetes knowledge was measured in 6 studies and improved significantly after educational interventions. Overall, studies showed that educational interventions significantly impacted self-efficacy, anthropometric measures, hemoglobin A1c levels, utilization of care and routine programme and attitudes regarding their health. CONCLUSIONS: The findings highlight the importance of a comprehensive and culturally appropriate educational intervention for this population. Further research is needed to develop such intervention and assess its effectiveness to change behaviour, such as increasing physical activity.

Promoting Patient Utilization of Outpatient Cardiac Rehabilitation: a joint International Council and Canadian Association of Cardiovascular prevention and rehabilitation position statement

Cardiac rehabilitation (CR) is a recommendation in international clinical practice guidelines given its benefits; however, use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrollment and adherence into implementable recommendations. The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patients' utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A Web call was convened to achieve consensus and confirm strength of the recommendations (based on Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review and public comment. The 3 drafted recommendations were that to increase enrollment, health care providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence, part of CR could be delivered remotely (weak). Ratings (mean ± SD) for the 3 recommendations were 5.95 ± 0.69, 5.33 ± 1.12, and 5.64 ± 1.08, respectively. Interventions can significantly increase utilization of CR and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization and to ensure that CR programs are adequately resourced to serve enrolling patients and support them to complete programs.

Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement.

BACKGROUND: Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its' benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations. METHODS: The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment. RESULTS: The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95 ±â€¯0.69 (mean ±â€¯standard deviation), 5.33 ±â€¯1.12 and 5.64 ±â€¯1.08, respectively. CONCLUSIONS: Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs.

Postural changes revealing orbital venous malformation using ultrasound in blue rubber bleb nevus syndrome.

A 62-year-old white woman presented with a diagnosis of blue rubber bleb nevus syndrome (BRBNS). The right eye appeared enophthalmic, yet the patient complained of episodes of right proptosis on bending forward. The remainder of the examination was unremarkable. Orbital ultrasound (US) in an upright posture revealed a single low reflectivity cavity (4.27 mm x 2.82 mm) of uncertain interpretation. In a forward-leaning posture the lesion increased in size (maximum thickness of 13.72 mm), demonstrating multiple low reflectivity spaces with highly reflective septae. This case first reports the use of US with postural changes to assess the presence of orbital venous malformation in BRBNS. The expansile nature upon postural changes supports the venous origin of the orbital lesion.

Promoting Patient Utilization of Outpatient Cardiac Rehabilitation: A JOINT INTERNATIONAL COUNCIL AND CANADIAN ASSOCIATION OF CARDIOVASCULAR PREVENTION AND REHABILITATION POSITION STATEMENT.

PURPOSE: Cardiac rehabilitation (CR) is a recommendation in international clinical practice guidelines given its benefits; however, use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrollment and adherence into implementable recommendations. METHODS: The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patients' utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A Web call was convened to achieve consensus and confirm strength of the recommendations (based on Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review and public comment. RESULTS: The 3 drafted recommendations were that to increase enrollment, health care providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence, part of CR could be delivered remotely (weak). Ratings (mean ± SD) for the 3 recommendations were 5.95 ± 0.69, 5.33 ± 1.12, and 5.64 ± 1.08, respectively. CONCLUSIONS: Interventions can significantly increase utilization of CR and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization and to ensure that CR programs are adequately resourced to serve enrolling patients and support them to complete programs.

Performance of Diffusion Kurtosis Imaging Versus Diffusion Tensor Imaging in Discriminating Between Benign Tissue, Low and High Gleason Grade Prostate Cancer.

RATIONALE AND OBJECTIVES: To investigate the performance of diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI) in discriminating benign tissue, low- and high-grade prostate adenocarcinoma (PCa). MATERIALS AND METHODS: Forty-eight patients with biopsy-proven PCa of different Gleason grade (GG), who provided written informed consent, were enrolled. All subjects underwent 3T DWI examinations by using b values 0, 500, 1000, 1500, 2000, and 2500 s/mm2 and six gradient directions. Mean diffusivity, fractional anisotropy (FA), apparent kurtosis (K), apparent kurtosis-derived diffusivity (D), and proxy fractional kurtosis anisotropy (KFA) maps were obtained. Regions of interest were selected in PCa, in the contralateral benign zone, and in the peritumoral area. Histogram analysis was performed by measuring mean, 10th, 25th, and 90th (p90) percentile of the whole-lesion volume. Kruskal-Wallis test with Bonferroni correction was used to assess significant differences between different regions of interest. The correlation between diffusion metrics and GG and between DKI and DTI parameters was evaluated with Pearson's test. ROC curve analysis was carried out to analyze the ability of histogram variables to differentiate low- and high-GG PCa. RESULTS: All metrics significantly discriminated PCa from benign and from peritumoral tissue (except for K, KFAp90, and FA). Kp90 showed the highest correlation with GG and the best diagnostic ability (area under the curve = 0.84) in discriminating low- from high-risk PCa. CONCLUSION: Compared to DTI, DKI provides complementary and additional information about prostate cancer tissue, resulting more sensitive to PCa-derived modifications and more accurate in discriminating low- and high-risk PCa.

Seasonal variability of the vitamin C content of fresh fruits and vegetables in a local retail market.

BACKGROUND: Seasonal variation of vitamin C in fresh fruits and vegetables is not reflected in food composition database average values, yet many factors influence content and retention. RESULTS: Fresh fruits and vegetables were sampled on three occasions in each season, from the same local retail outlets, for 1 or 2 years. Vitamin C was significantly higher in winter-sampled spinach (436 mg kg-1 ) compared with spring (298 mg kg-1 ) and summer/fall (180 mg kg-1 ); in potatoes in summer/fall (156 mg kg-1 ) versus winter/spring (106 mg kg-1 ); and in oranges in winter (616 mg kg-1 ), spring (592 mg kg-1 ), and summer (506 mg kg-1 ). Ranges were dramatic among sampling occasions for broccoli, oranges, potatoes, and spinach (700-1210 mg kg-1 , 420-780 mg kg-1 , 70-280 mg kg-1 , and 90-660 mg kg-1 respectively). Mean values for apples, bananas, tomatoes, and potatoes differed from the USDA National Nutrient Database for Standard Reference (SR) average by ≥10% of the daily recommended intake (90 mg). For broccoli, oranges, and spinach, vitamin C was substantially above or below the SR range in 50-100% of the samples. For spinach, the average content did not differ from SR, but vitamin C in winter was 55% higher than SR. CONCLUSION: Database average values for vitamin C in fresh produce can significantly over- or underestimate the content in a specific food supply. © 2018 Society of Chemical Industry.

Analyzing vitamin D in foods and supplements: methodologic challenges.

This report briefly reviews existing methods for analyzing the vitamin D content of fortified and unfortified foods. The existing chemical methods are similar; all are time consuming, require experienced technicians, and have only been validated for a few materials (eg, dairy products or animal feed materials). This report also describes the lack of standard reference materials with certified values for vitamin D that laboratories need to guarantee the accuracy of existing analytic methods. Recently, the US Department of Agriculture, as part of a project to update the vitamin D values in the National Nutrient Database of Standard Reference, established an analytic methods committee to compare several existing vitamin D methods and to characterize 5 control materials (skim milk, processed cheese, cereal, orange juice, and salmon). Initial relative SDs for the 5 materials ranged from 35% to 50%. Elimination of systematic biases related to the methods and the standards yielded much more satisfactory relative SDs of 7% to 12%. This research has shown that existing methods for analyzing the vitamin D content in foods can produce accurate results. A new, simpler, and faster method, however, would greatly benefit the field. To guarantee accuracy, we need certified reference materials for foods.

Alternate routes for drug delivery to the cell interior: pathways to the Golgi apparatus and endoplasmic reticulum.

The targeted delivery of drugs to the cell interior can be accomplished by taking advantage of the various receptor-mediated endocytic pathways operating in a particular cell. Among these pathways, the retrograde trafficking pathway from endosomes to the Golgi apparatus, and endoplasmic reticulum is of special importance since it provides a route to deliver drugs bypassing the acid pH, hydrolytic environment of the lysosome. The existence of pathways for drug or antigen delivery to the endoplasmic reticulum and Golgi apparatus has been to a large extent an outcome of research on the trafficking of A/B type-bacterial or plant toxins such as Shiga toxin within the cell. The targeting properties of these toxins reside in their B subunit. In this article we present an overview of the multiplicity of pathways to deliver drugs intracellularly. We highlight the retrograde trafficking pathway illustrated by Shiga toxin and Shiga-like toxin, and the potential role of the B subunit of these toxins as carriers of drugs, antigens and imaging agents.

Photobiological impact of [{(bpy)2Ru(dpp)}2RhCl2]Cl5 and [{(bpy)2Os(dpp)}2RhCl2]Cl5 [bpy=2,2'-bipyridine; dpp=2,3-Bis(2-pyridyl)pyrazine] on vero cells.

The in vitro photobiology of the supramolecular complexes [{(bpy)2Ru(dpp)}2RhCl2]Cl5 and [{(bpy)2Os(dpp)}2RhCl2]Cl5 [bpy=2,2'-bipyridine; dpp=2,3-bis(2-pyridyl)pyrazine] with African green monkey kidney epithelial (Vero) cells was investigated. Previously, the complexes have been shown to photocleave DNA in the presence or absence of O2. Vero cell replication was uninhibited for cells exposed to the metal complex but protected from light. Vero cells that were exposed to metal complex, rinsed, and illuminated with >460 nm light showed a replication response that was metal complex concentration-dependent. Vero cells exposed to 3.0-120 microM [{(bpy)2Ru(dpp)}2RhCl2]Cl5 and illuminated showed inhibition of cell growth, with evidence of cell death seen for complex concentrations>or=10 microM. Cells exposed to [{(bpy)2Os(dpp)}2RhCl2]Cl5 at concentrations of 5.5-110 microM, rinsed, and illuminated showed only inhibition of cell growth. The impact of [{(bpy)2Ru(dpp)}2RhCl2]Cl5 and [{(bpy)2Os(dpp)}2RhCl2]Cl5 on cell growth following illumination shows the promise of this new structural motif as a photodynamic therapy agent.

New and existing oils and fats used in products with reduced trans-fatty acid content.

The US Food and Drug Administration's final ruling on trans-fatty acid labeling issued in 2003 has caused a rapid transformation in the fat and oil industries. Novel ingredients and improved technologies are emerging to replace partially hydrogenated fats in foods. We present an overview of the structure and formation of trans fatty acids in foods, and a comprehensive review of the newly formulated products and current procedures practiced by the edible oil industry to reduce or eliminate trans fatty acids in response to the Food and Drug Administration's regulations mandating trans fat labeling of foods.

Shiga-like toxin subunit B (SLTB)-enhanced delivery of chlorin e6 (Ce6) improves cell killing.

We used Shiga-like toxin B subunit (SLTB) to deliver the photosensitizer, chlorin e6 (Ce6), to Vero cells expressing the Gb3 receptor. Our aim was to provide an example of carrier-enhanced photodynamic cell killing with which to start a systematic consideration of photosensitizer delivery at the subcellular level. SLTB, in contrast to many other potential protein carriers, is delivered intracellularly to the Golgi apparatus and endoplasmic reticulum (ER). Ce6 was chosen both for its phototoxic properties and its potential for covalent conjugation with SLTB. Ce6-SLTB after cleanup contained < or =10% noncovalently bound Ce6. The noncovalent binding of porphyrins and chlorins to protein conjugates has been well documented, and hence the effective cleanup procedure is a significant accomplishment. We demonstrate that Ce6-SLTB enhances delivery of Ce6 to target cells as compared to free Ce6. In Vero cells, Ce6-SLTB was over an order of magnitude more photodynamically toxic than free Ce6. Moreover, we show that in the case of Ce6-SLTB, photosensitizer accumulation is in a combination of subcellular sites including mitochondria, Golgi apparatus, ER and plasma membrane. The occurrence in nature of diverse B subunit binding sites and the possibilities of varied intracellular delivery make optimized use of B subunit carriers attractive.

A method for the purification of Shiga-like toxin 1 subunit B using a commercially available galabiose-agarose resin.

We describe a procedure for the affinity purification of Shiga toxin 1 subunit B (SLTB) using a commercial galabiose-agarose resin. Recombinant SLTB was purified to 99% homogeneity in a single-step protocol, from the periplasmic extracts of Vibrio cholerae 0395 N1/pSBC54. SDS-PAGE of the affinity purified SLTB showed one band of 8 kDa MW. SLTB purified by this procedure retained its chemical and biological activity as demonstrated by re-binding to the galabiose-agarose resin, and receptor-mediated binding and uptake in Vero cells. The galabiose-agarose resin could isolate roughly 1mg of SLTB/mL of gel. The resin was stable over 3 years and 500 cycles/year of usage. Hence, this method is a straightforward approach to the large-scale preparation of SLTB at a reasonable cost.