Barriers to management of diabetes foot ulcer: Experiential note from a setting with free medical services.

The imperative need for behavioral agreement to overcome barriers of self-management of diabetes foot complication was recently articulated. A few journals have done parallel publications, which thereby stresses the significance of the issue. This article is to add to the "Overcoming barriers to self-management: the person-centred diabetes foot behavioural agreement". It presents experiential note with four tabulated cases of clients who have access to free state-of-the-art medical service; and non-adherence as a barrier to self-management is not due to affordances. It is to draw attention to the deliberately non-adherent patients where behavioral agreement process should be really driven by the client as in the real context of person-centered therapy.

Barriers in determining prevalence of type 2 diabetes mellitus among postpartum GDM: The research and retraining needs of healthcare professionals.

AIM: A large percentage of gestational diabetes (GDM) are undiagnosed, and prevalence of postpartum type 2 diabetes (T2DM) is unknown, especially in developing countries. This study assessed barriers to GDM diagnosis and postpartum follow-up; to determine educational needs. MATERIALS AND METHODS: This was a clinical observational study of records and procedures of antenatal services at two hospitals. Laboratory and medical records were reviewed for availability of data on anthropometrics, blood glucose, gestational age, urinalysis, and lipid profile for GDM register. Antenatal clinic protocol was observed for GDM diagnosis. BMI was derived and data were analyzed using SPSS version 20. RESULTS: Critical barriers attributable to health systems included lack of screening for blood sugar as part of routine antenatal protocol, and lack of GDM registers at both facilities. There was 6.5% registration of pregnancies in first trimester, 22% pre-pregnancy obesity, and 2.6% high blood pressure. Positive glucosuria cases were not followed-up for GDM diagnosis. CONCLUSIONS: There is neither concerted effort to diagnose GDM, nor systematic records of screening and postpartum follow-up. The gap in diabetology knowledge and practice calls for re-training of antenatal healthcare professionals. GDM screening checklist needs to be established and positive results entered into GDM registers for proper management during and after delivery.

Prediabetes and cardiovascular complications study (PACCS): international collaboration 4 years' summary and future direction.

OBJECTIVE: The prediabetes and cardiovascular complications studies proposes to develop a screening protocol for diabetes cardiovascular risk, and strategies for holistic management amongst others. Over 500 participants were recruited in the first 2 years of rural community research screening. Specific for this report, various published findings were reviewed. The objective is to summarize research outcomes and itemize limitations as they constitute basis of future directions. RESULTS: Affordability and availability are major confounding behavioural change wheel factors in the rural community. 4.9% prevalence of prediabetes, which may be lower or non-significantly different in urban areas. Hyperglycaemia co-morbidity with dyslipidaemia (5.0%), obesity (3.1%) and hypertension (1.8%) were observed. Limitation of the study includes participants being mostly over 60 years old, which has created impetus for the Global Alliance on Chronic Diseases agenda on vulnerability of older adults to diabetes being a new direction of the collaboration. Other directions in Australia and Nepal focus on patients with chronic kidney disease with or without cardiovascular complications. This report highlights the need to translational research.

Development of public health program for type 1 diabetes in a university community: preliminary evaluation of behavioural change wheel.

BACKGROUND: Diabetes mellitus, including type 1 is a global public health problem among the young persons. While public health campaign and screening program is a potential strategy, but communication skills, knowledge and opinion of the healthcare personnel are indicated as variables that can impact patient's education, which will lead to better outcome of care. Thus, in designing or planning a program for public health, workforce development considers opinion and behavioural change wheel of prospective personnel. OBJECTIVE: The purpose of this preliminary study was to evaluate if a university academic department has the behavioural change wheel to function as workforce infrastructure for an envisioned program. METHOD: Survey of knowledge, attitude and practice (KAP) of a university community regarding diabetes type 1 was performed. The KAP were translated into behavioural change wheel comprising capacity, motivation and opportunity (CMO). RESULTS: There are baseline indications of the behavioural change wheel potential of the public health department to run a T1D screening program. The number of participants who knew someone with T1D was significantly higher than the subgroup with no such knowledge (p<0.0004) and this improved when age factor is considered (p<0.00005). CONCLUSION: While the public health department of a university community has the behavioural change wheel or CMO to develop a workforce infrastructure for T1D screening program, the experience that comes with age of lecturers will be an important factor to enable such program to succeed.

Metabolic syndrome and prediabetes in ndokwa community of Nigeria: preliminary study.

BACKGROUND: Global prevalence of metabolic syndrome (MS) and diabetes is increasing, but the reference ranges for MS indices have yet to be established for sub-Saharan African countries. As part of the international research collaboration agenda for Prediabetes and Cardiovascular Complications Study (PACCS), a pilot study was conducted in one of the Ndokwa communities of Nigeria in 2013. AIM: The study was to obtain preliminary indication of prevalence and reference values of MS in the rural communities of a low-mid income country. MATERIALS AND METHODS: Seventy-four volunteer participants were recruited, after public lectures in high schools and churches in the community. Body mass index (BMI), blood pressure and waist circumference (WC), blood glucoselevel, and lipid profile were measured. Percentage prevalence MS was determined using commonest three criteria (Third Adult Treatment Panel (ATP III) 2001, International Diabetes Federation (IDF) 2005, and World Health Organization (WHO) 1999). RESULTS: When individual indices of MS are considered separately; the males seem healthier than females. However, the prevalence of high-density lipoprotein (HDL) cholesterol was higher in males than in females. Equal 3% prevalence of MS was seen in both genders using the WHO standard. Other criteria show prevalence of 8% females and 11% males (ATP III), 5% females and 8% males (IDF 2005 European), and 14% females and 17% males (IDF 2005 Ethnic). CONCLUSION: The prevalence of MS is higher in males than females; and relative to ATP III 2001 criteria, either the IDF 2005 European may underestimate MS, or the ethnic specific could overestimate the prevalence. Hence, it is important to define the criteria to be used.

Can Computer Meridian Diagnostic be useful in diagnosis and management of diseases?

The need for the development of appropriate guidelines for effective or safe use of antioxidants and herbs has always been a concern, especially for the alternative medicine practices. Computer Meridian Diagnostic (CMD) is one of emerging computer-based diagnostic technologies available to alternative medicine practitioners. However, case report of the agents monitored with CMD is uncommon; and concerted effort to bring this into conventional medical practice is yet to be. This hypothesis builds on an anecdotal observation of anti-stress effect monitored with CMD, with a view to highlight a potential tool that requires expatiation, as well as proof of concept and validation studies for possible integration in conventional and traditional medicine practices for therapeutic monitoring.

Serum bilirubin and lipoprotein-a: how are these associated with whole blood viscosity?

BACKGROUND: It has been demonstrated that oxidative stress can induce red blood cell rigidity and haemolysis, which in turn can cause hyperviscosity and hyperbilirubinaemia, respectively. However, haemolysis may be associated with a low level of haemoglobin, which reduces whole blood viscosity (WBV). Bilirubin can behave as antioxidant or oxidant, and one uncharted course for diagnostic pathology is how or whether bilirubinaemia and viscosity are associated. Further, oxidative stress is now being assessed using lipoprotein-a (Lp(a)), among other things but whether it is associated with blood viscosity has not been established. AIM: This study investigates the association and correlation of haemoglobin level and WBV with serum Lp(a) and bilirubin levels in a general population of patients. MATERIALS AND METHODS: Sixty-eight cases that were tested for Lp(a), concomitantly with full blood count and liver function, in our archived clinical pathology database were used in this study. WBV levels were determined using a validated formula. Multivariate and univariate analyses as well as correlation were performed. RESULTS: WBV was found to be significantly associated with bilirubin (P<0.02), but not with Lp(a). Haemoglobin concentration was inversely correlated with Lp(a) (P<0.04), but not with bilirubinaemia. CONCLUSION: This pilot study suggests that hyperbilirubinaemia and hyperviscosity are associated and positively correlated. Consideration of whether serum bilirubin (as an indirect index of oxidative stress) can be used in combination with WBV (as index of macrovascular effect of oxidative stress) to assess oxidative damage is recommended.

Seroprevalence of Trypanosoma cruzi in blood donors at the National Blood Transfusion Services--Guyana.

INTRODUCTION: Blood transfusion is an important transmission route of Trypanosoma cruzi (T cruzi), a major parasitic infection in Central and South America. The limited treatment options are most effective in acute Chagas' infection. At present, there is no current data on the prevalence of T cruzi in the blood donor population of Guyana. This information is necessary to protect the supply of the blood donation programme. This study sought to determine the prevalence of T cruzi in the blood supply at the National Blood Transfusion Services of Guyana with the hope of providing knowledge to the on-going surveillance for Chagas' disease worldwide and therefore address the risk of its spread by blood transfusion. METHODS: Two commercialized ELISAs utilizing crude or recombinant T cruzi antigens were used to study 2000 blood samples voluntarily donated for the purpose of altruistic or family replacement donation retrospectively. RESULTS: The results showed that approximately 1 in 286 donations tested positive for antibodies to T cruzi. CONCLUSION: These results indicate that T cruzi continues to be a risk in Guyana and there is a need to continue screening donated blood. Trypanosoma cruzi is a life-long infection and infected persons may be asymptomatic chronic carriers of the disease. Education, housing improvement, and controlled use of insecticides should be introduced to contain Chagas' disease.

Low serum creatinine levels as risk factor of diabetes mellitus: prediabetes considerations.

OBJECTIVE: It has been reported that low serum creatinine level is a risk factor of diabetes. We hypothesize that should this be true, serum creatinine levels would be lower and more prevalent in prediabetes than in normal individuals. MATERIALS AND METHODS: 1017 glucose tolerance tests performed at South West Pathology Service of the New South Wales Health, Australia, in 2008 were sorted into normal (control), prediabetes and diabetes based on decisive interpretation. All cases with creatinine results in the control (n=48), diabetes (n=18) and prediabetes (n=36) groups were selected. RESULTS: Mean levels of serum creatinine levels in the controls (80 +/- 32 micromol/L), diabetes (82 +/- 26 micromol/L) and prediabetes (82 +/- 23 micromol/L) were not statistically significantly different. The prevalence of low levels of serum creatinine is less in prediabetes (11%) than in the control (23%). CONCLUSION: Further studies using a larger number and adjusting for confounding factors is needed to ascertain the role of low serum creatinine level as a risk factor of diabetes.

Biochemical basis of circadian rhythms and diseases: With emphasis on post-traumatic stress disorder.

Circadian rhythms affect several processes in the body physiology. This commentary revisits the topic of 'metabolic basis of diseases' with a view to shed light on how cellular energy requirements feed-forward to a sequential signaling of hormonal response, blood glucose metabolism, antioxidant activities, and pathophysiology. Attempt is made to explain how diseases that may not appear to be closely related, such as bone metabolism and vasculopathy, have an increase in oxidative damage as a common underlying biochemistry. Importantly, this article identifies oxidative damage as an outcome of sleep disturbance and hypothesize that sleep complaint is not merely one of many resulting symptoms of PTSD, but a core feature that arise from trauma and gives rise to the stress biochemistry, which in turn manifests symptomatically. Further, we suggest that the current non-pharmacologic and pharmacologic therapeutic options attenuate oxidative stress. Implication for clinical diagnosis and evaluations is also suggested.

Effects of oral administration of some herbal extracts on food consumption and blood glucose levels in normal and streptozotocin-treated diabetic rats.

Previous studies in our laboratories suggest that oral administration of some herbal extracts reduce blood glucose concentrations in rats, possibly by interfering with food consumption and/or gastrointestinal absorption of food. Accordingly, we monitored the amounts of food consumed and body weights in separate groups of nondiabetic and streptozotocin-treated diabetic rats, orally treated with some plant extracts (20 mg 100 g -1 body weight) daily for 5 weeks. Control animals were administered the vehicle, citrate buffer (0.1 ml 100 g -1 body weight). Separate groups of rats administered allopathic hypoglycemic drugs metformin (50 mg 100 g -1 body weight) or glibenclamide (5 microg 100 g -1 body weight) acted as positive control animals. After 5 weeks, blood glucose concentrations were reduced in all the groups. Tapinanthus nyasicus leaf, Ficus thoningii bark, Solanum incanum fruit, and Morus alba leaf extracts decreased weekly food consumption throughout the 5-week study period. Similar results were obtained for the groups treated with metformin or glibenclamide. However, food consumption was increased by S. incanum root, Aloe chabaudii leaf, or Allium sativum bulb extracts, and this was associated with high prevalence of diarrhea. The herbal extracts and metformin did not affect serum insulin concentration in nondiabetic rats, while glibenclamide increased serum insulin concentration. In conclusion, it may be inferred that the herbal extracts examined produced hypoglycemia, probably by interfering with either food intake or gastrointestinal glucose absorption (as reported for metformin). These findings merit long-term investigation.

Effects of Opuntia megacantha leaves extract on renal electrolyte and fluid handling in streptozotocin (STZ)-diabetic rats.

We previously demonstrated that Opuntia megacantha leaves' extracts can reduce blood glucose levels in diabetes mellitus. For O. megacantha leaves' extracts to have potential in the management of diabetes mellitus, it is necessary to establish its detailed effects on renal function since diabetes is associated with renal fluid and electrolyte disturbances. Therefore, the current study was designed to investigate the influence of the extracts on renal function in male diabetic Sprague-Dawley rats. Rats were made diabetic by an i.p. injection of streptozotocin (STZ, 60 mg/kg in citrate buffer). Vehicle injected animals acted as controls. Separate groups of nondiabetic and diabetic rats were orally administered O. megacantha leaves extracts (20 mg/100 g bw) or normal saline (0.1 ml x 100 g(-1) bw) daily for 5 weeks. Urine volume and total urinary outputs of Na+ and K+ were determined from 24 h samples. O. megacantha leaves' extracts significantly (p < 0.01) increased urinary Na+ output in diabetic and nondiabetic rats resulting in significantly (p < 0.01) low plasma concentration by comparison with untreated animals. Treatment with the extract significantly increased FE(Na+) and GFR in all groups. The urinary K+ outputs in nondiabetic was slightly lowered, but did not reach statistically significance. O. megacantha leaves' extracts did not alter plasma aldosterone and AVP concentrations in diabetic and nondiabetic rats in nondiabetic animals. It is concluded that O. megacantha leaves extracts modulate renal water and sodium handling. The mechanisms are not clear.

Effects of Opuntia megacantha on blood glucose and kidney function in streptozotocin diabetic rats.

The purpose of the study was to investigate the effects of Opuntia megacantha leaf extracts on blood glucose concentrations and kidney function in normal and streptozotocin (STZ)-diabetic rats. STZ-diabetic and non-diabetic rats were orally administered extracts of O. megacantha leaves (20 mg/100 g body weight) daily for 5 weeks and respective control rats were administered normal saline (0.1 ml/100 mg body weight). Urine volume, urinary outputs of Na+, K+ and creatinine were monitored daily over the 5-week period. Plasma concentrations of Na+, K+, urea and creatinine and the glomerular filtration rate (GFR) as assessed by creatinine clearance were determined after 5 weeks. Plasma glucose concentrations in STZ-diabetic and non-diabetic rats were reduced by the administration of leaf extracts of O. megacantha. However, leaf extracts increased urinary Na+ output in STZ-diabetic and non-diabetic rats, concomitantly with a reduction in plasma concentration of the ion. O. megacantha leaf extracts significantly increased plasma creatinine and urea concentrations in non-diabetic and STZ-diabetic rats. Administration of the leaf extract was also associated with an increased GFR in STZ-diabetic rats (from 1.8 +/- 0.3 ml/min to 2.8 +/- 0.3 ml/min, n = 8) although the rate was unaltered in non-diabetic rats. The results suggest that leaf extracts of O. megacantha not only reduce blood glucose levels, but may be toxic to the kidney as shown by the elevation in plasma urea and creatinine concentrations and the reduction of plasma Na+ concentration.

Orally administered, insulin-loaded amidated pectin hydrogel beads sustain plasma concentrations of insulin in streptozotocin-diabetic rats.

We report successful oral administration of insulin entrapped in amidated pectin hydrogel beads in streptozotocin (STZ)-diabetic rats, with a concomitant reduction in plasma glucose concentration. The pectin-insulin (PI) beads were prepared by the gelation of humilin-pectin solutions in the presence of calcium. Separate groups of STZ-diabetic rats were orally administered two PI beads (30 micrograms insulin) once or twice daily or three beads (46 micrograms) once daily for 2 weeks. Control non-diabetic and STZ-diabetic rats were orally administered pectin hydrogel drug-free beads. By comparison with control non-diabetic rats, untreated STZ-diabetic rats exhibited significantly low plasma insulin concentration (0.32+/-0. 03 ng/ml, n=6, compared with 2.60+/-0.44 ng/ml in controls, n=6) and increased plasma glucose concentrations (25.84+/-1.44 mmol/l compared with 10.72+/- 0.52 mmol/l in controls). Administration of two PI beads twice daily (60 micrograms active insulin) or three beads (46 micrograms) once a day to STZ-diabetic rats increased plasma insulin concentrations (0.89+/-0.09 ng/ml and 1.85+/- 0.26 ng/ml, respectively), with a concomitant reduction in plasma glucose concentration (15.45+/-1.63 mmol/l and 10.56+/-0.26 mmol/l, respectively). However, a single dose of PI beads (30 micrograms) did not affect plasma insulin concentrations, although plasma glucose concentrations (17.82+/-2.98 mmol/l) were significantly reduced compared with those in untreated STZ-diabetic rats. Pharmacokinetic parameters in STZ-diabetic rats show that the orally administered PI beads (30 micrograms insulin) were more effective in sustaining plasma insulin concentrations than was s.c. insulin (30 micrograms). The data from this study suggest that this insulin-loaded amidated pectin hydrogel bead formulation not only produces sustained release of insulin, but may also reduce plasma glucose concentration in diabetes mellitus.

Effects of chronic oral nickel chloride administration on glycaemia and renal function in normal and diabetic rats.

Effects of nickel on glycaemia are conflicting. We have investigated the effects of oral administration of nickel chloride for 5 weeks on glycaemia and renal function in normal and streptozotocin-diabetic rats. The results show increase (P< 0.05) in plasma glucose and sodium and decrease (P< 0.05) in insulin concentrations only in normal experiment by comparison with normal control. Plasma potassium concentration was elevated (P< 0.05) only in diabetic experiment by comparison with diabetic control. Plasma urea levels were raised (P< 0.05) in both groups of experiments by comparison with respective controls and plasma creatinine level was elevated (P< 0.05) only in diabetic experiment. GFR was reduced (P< 0.05) only in normal experiment by comparison with control. Kidney weights in normal and diabetics were not effected by nickel chloride administration. Total food and water intakes in normal and diabetic experiments were lower by comparison with respective controls. These were accompanied by failure to increase body weights. In addition, total urine volume and sodium were reduced in normal and diabetic experiments. Urine potassium was lower only in normal experiment by comparison with normal control. We conclude that chronic nickel chloride administration induces hyperglycemia possibly through reduction in blood insulin levels and could be toxic to renal function.

Serum albumin concentrations in rural Zimbabweans.

Primary infections, protein malnutrition or simply poor food intake which decrease albumin synthesis often prevail in rural Zimbabwe. Therefore, we postulated that serum albumin levels in rural folk may not compare with published values. To investigate this, blood samples were collected from 1,502 consenting participants aged between 16 and 90 years from randomly selected rural areas in Mashonaland West, Midlands, Matebeleland South and Matebeleland North provinces in Zimbabwe. The effects of smoking, alcohol consumption and pregnancy on serum albumin levels were also investigated. The mean age in years did not differ significantly between females and males (32.5 +/- 0.44, n = 943 vs 33.84 +/- 0.62, n = 559). Serum preserved with sodium azide at -4 degrees C was analyzed for albumin using a Quick Lab 2 Analyzer (Ames Quick Lab) by the bromocresol green dye binding method. Only small differences of albumin concentrations (means +/- S.E.M.) were noted for each studied area and results were pooled. The normal serum albumin ranges were 27 to 52 g/L for females and 26 to 52 g/L for males and were different from those reported for developed countries. The albumin levels in females were significantly (p < 0.01) lower than in males (39.29 +/- 0.20 g/L, n = 943 vs 40.09 +/- 0.25 g/L, n = 559). However, the concentrations of the protein in males who smoked (38.66 +/- 0.38 g/L, n = 174) were significantly low (p < 0.01) by comparison with non smokers. Smoking did not alter albumin levels in females (38.27 +/- 0.53 g/L, n = 87) perhaps because they smoked fewer cigarettes.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute chloroquine administration increases renal sodium excretion.

The effect of a 2-hour intravenous chloroquine infusion (0.015, 0.030 and 1.25 micrograms min-1) on renal fluid and electrolyte handling was investigated in the saline infused, Inactin anaesthetized rat. Blood pressure and glomerular filtration rate were not affected by chloroquine administration, remaining around 128 mmHg and 2.4 ml min-1, respectively throughout the 5-hour post-equilibration period. Chloroquine produced an increase in Na+ and Cl- excretion without affecting the urine flow. By 1 hour after the start of treatment (0.03 micrograms chloroquine min-1) the Na+ excretion rate had increased to 14.5 +/- 2.1 mumol min-1 (n = 6), and was significantly (P < 0.01) greater than in control animals (8.6 +/- 1.0 mumol min-1) at the corresponding time. Parallel but lesser increases in Cl- excretion rates were also observed. The plasma aldosterone and corticosterone levels following either 10, 30 or 120 minutes infusion of chloroquine at 0.03 micrograms min-1 did not differ statistically from each other or from control values. It is concluded that acute chloroquine administration induces an increase in Na+ excretion. The mechanism of this natriuresis cannot be established from the present study, but is likely to involve altered tubular handling of Na+.