scholarly journals Impact of Educational Chronic Care Model on Diabetic Patients: A Prospective Cohort Study

2020 ◽  
Author(s):  
Ahmed Mahmoud Elmalky ◽  
Abdulsalam S. Alharbi ◽  
Abdulkarim M. Alsaqabi

Abstract Background Lack of knowledge and understanding about diabetes are important barriers to cure. Treatment of diabetes alone without education is not sufficient. Nowadays, health education could reach us on mobiles. Aim Our aim is how to make advice-giving becomes a system to treat our patients. The theme of this study is diabetes education. And to know how far the prompt well-structured education could affect the clinical status and the quality of life of a poorly controlled diabetic patients. Methods702 patients with type 1 diabetes were followed for 2 years (2017, 2018), by condensed friendly education and training sessions. Our activities were mainly through direct individual approach and social media, structured in the form of visits. The study was done in a specialized clinics of diabetes (SDC) in a tertiary university hospital. We evaluated the clinical status, psychological, sociocultural and satisfaction of the patients, pre and post education. We assessed our patients at the beginning of the study, throughout, and at the time of discharge. Quantitative and qualitative data were compared statistically by paired t test and chi-square test at 0.05 level of significance. Results96.7% of our patients were completely satisfied by what they have achieved through this project. The average HbA1C become less than eight in 54% of patients. Patients with HbA1C 8-9%, BP <140/80, and LDL <3.36 mmol/l, were 46%, 51% and 79% respectively. The average blood pressure for 56% of patients was 132/77. The average LDL level among 71% of patients was 2.25. 27% of patients had average discharged HbA1c of 7.3. Net promotor score of SDC was 85%, were promotors, passives and detractors were 87.8%, 9.5% and 2.8% respectively. P value <0.05Conclusion Education self-management support programs are cost-effective and superior to usual care. Education programs were more effective in lowering HbA1c. Attendees finding it valuable and enjoyable.

2015 ◽  
Vol 22 (07) ◽  
pp. 887-895
Author(s):  
Santosh Kumar ◽  
Muhammad Aslam ◽  
Maria Maria ◽  
Saleem Saleem

Stroke is one of the leading factors of morbidity and mortality worldwide. Toreduce the incidences of stroke, it is essential to identify and modify the risk factors for stroke.Risk factors can be modifiable and non modifiable. The aim of study was to ascertain theoutcome of stroke patient admitted in all Medical Wards in Liaquat University Hospital HyderabadObjective: To see the mortality, morbidity, disability and co-infection in stroke patients. StudyDesign: Prospective study. Period: One year. Setting: Medical Wards of Liaquat UniversityHospital Hyderabad / Jamshoro. Material and Methods: 200 Patients were enrolled in ourstudy to see the excepted outcome like mortality, Disability, Bed Sores, UTI & Pneumonia andDehydration in Stroke patients. All the patients were Young Adults, greater than 12 years inage and old aged patients, with Ischemic & Hemorrhagic stroke. On categorical variable suchas sex, mortality, morbidity chi-square test was applied at 95% confidence interval and the P-value ≤0.05 was considered as statically significant while the mean ±SD will be calculated forquantitative variables. Results: Mean age of the patient in our study was 57.03 years with thestandard deviation of ±7.35 years. Gender distribution shows most of the patients in our studywere male, i.e. 75% while, only 25% of the patients were female. Ischemic Stroke was foundin 126(63%) patients while, hemorrhagic stroke was found in 74(37%) patients. Regardingoutcome, mortality was found in 5% patients, disability 2%, UTI 2%, pneumonia 15%, Coinfection4%, Bed Sores 21.5% and dehydration was present in 50.5% patients. Conclusion:The study concludes that maximum patients had Ischemic Stroke. Among these patientsdehydration was the most common entity followed by bed Sores, pneumonia, mortality, Coinfection,disability and UTI.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S128-S128
Author(s):  
Deniz Akyol ◽  
Ayşe Uyan Önal ◽  
Uğur Önal ◽  
Damla Akdağ ◽  
Cansu Bulut Avşar ◽  
...  

Abstract Background In this study it was aimed to compare the effects of qSOFA (Quick Sequential Organ Failure Assessment) score with modified qSOFA score (PLoS One. 2018 Sep 26;13(9):e0204608) for predicting one month survival in patients with diagnosed septic shock (SS) in a tertiary-care educational university hospital in a developing country. Methods Modified qSOFA was created by adding age factor (>50 years=1 point) to patients with qSOFA scale 1 or 2 or 3 who had SS (sepsis+hypotension+adrenergic agent) and consulted by Infectious Diseases consultants between December 2013-December 2018. Arterial lactate level of >2 mmol/L criterion was added as an including criteria for SS according to 3rd International Sepsis and Septic Shock Consensus Statement after 23rd February 2016. Statistical analysis was performed via Chi-square test and a p-value <0.05 was considered significant. Results The number of patients with qSOFA score of 1 or 2 or 3 from 527 patients are in Table1 [some of the cases were diagnosed as septic shock according to elder definition (without lactate criterion) and there was a subgroup with qSOFA score 1]. Among the >50-year aged group, the 30-day survival rate was lower in patients with qSOFA3 vs. qSOFA 2 vs. qSOFA 1 (Table1, 3x2 Chi Square test, P = 0.0057). Among the <50 years group, the qSOFA one month survival rate was lower in patients with qSOFA 3 vs. qSOFA 2 vs. qSOFA 1 (Table, 3x2 Chi Square Test, P = 0.0052). According to modified qSOFA, there was a significant difference for one month survival among SS cases with scores of 1, 2, 3 and 4 (12/21 57% vs. Fifty/126 40% vs. 78/269 29% vs. 22/111 20%, 4x2 Chi-square test, P = 0.0003). On the other hand, there was no significant difference in terms of one month survival when we performed subgroup analysis in qSOFA score 1, 2, or 3 subgroups, as ≤50 years vs. >50 years (table, Chi-square test, 12/21 vs. 39/97 P = 0.224, 11/29 vs. 75/244 P = 0.526, 3/25 vs. 22/111 P = 0.572). Conclusion In terms of survival at one month, there was a significant difference between qSOFA score 1, 2, 3 and 4 subgroups. In patients with qSOFA score of 1 or 2 or 3, being under 50 years did not have a significant effect on one-month survival. Modified qSOFA may be beneficial to foresee the probable mortality but these findings need to be validated in larger cohorts Disclosures All authors: No reported disclosures.


2017 ◽  
Vol 24 (02) ◽  
pp. 308-314
Author(s):  
Farhat Bashir ◽  
Farzana Rehman ◽  
Samina Ghaznavi ◽  
Jamal Ara

Diabetes mellitus is a modifiable risk factor for generalized atherosclerosis.Measurement of carotid intima media thickness by Doppler ultrasonography can be used tomeasure the extent of atherosclerosis. Objectives: To determine the association of carotidatherosclerosis in patients with type 2 diabetes mellitus and its relationship with glycemiccontrol. Study Design: Cross-sectional comparative study. Period: 12 months June 2015 toMay 2016. Setting: Creek General Hospital in the Department of Medicine and Radiology,Karachi, Pakistan. Method: The subjects were selected from diabetic patients presenting tothe Out-Patient Department and controls from their attendants. All subjects had a detailedhistory, physical examination and laboratory investigations recorded. The variables includedage, gender, weight, BMI, blood pressures, fasting and post prandial blood sugars, HbA1cand lipid profile. All individuals underwent B-mode ultrasound for carotid Doppler studies. Asingle operator conducted all the Doppler studies. The carotid intima media thickness wasmeasured and the presence of carotid plaque was recorded for each subject. The data wasentered on SPSS ver 20.0. Numbers and percentages were calculated for categorical datawhile mean±standard deviation was calculated for continuous data. The carotid intima mediathickness and its association with diabetes were analyzed by Student’s t test. P-value of <0.05was considered significant. Among the diabetic patients the relationship of glycemic controland carotid intima media thickness was analyzed through student’s t-test. P-value of <0.05was considered significant. The association of presence of carotid plaque for diabetic and nondiabeticsubjects was assessed by Chi-square test. P-value of <0.05 was taken as significant.Association of carotid plaque among diabetic patients with satisfactory and unsatisfactoryglycemic control was also assessed through the Chi-square test and p-value of<0.05 wasconsidered significant. Result: Out of the total study population of 237 subjects, which consistedof 119 diabetic and 118 normal controls, there were 105 male and 132 female patients. Themean fasting blood sugar was 113.3±55.2 mg/dl, mean random blood sugar was 185.9±102.0mg/dl, mean HbA1c was 6.98±2.5 %. Mean ±SD of carotid intima media thickness was0.91±0.17 mm. Results revealed that diabetes has significant association with the thicknessof carotid intima media (p-value<0.000). A total of 28 individuals (11.8%) had a carotid intimamedia thickness that was classified as a localized carotid artery plaque. The presence of carotidplaque also showed a significant association with the presence of diabetes. The degree ofglycemic control showed no relationship with carotid intima media thickness. The presenceof carotid plaque also showed no association with degree of glycemic control. Conclusion:CIMT measured by Doppler ultrasonography was found to be significantly associated with thepresence of diabetes mellitus. There was no relationship of glycemic control with CIMT amongthe diabetic patients.


2021 ◽  
Vol 9 (11) ◽  
pp. 27-34
Author(s):  
Mansour M.A. Ghaleb ◽  

Background: Diabetes mellitus is one of the most common chronic diseases in nearly all countries. The most common type is type 2 diabetes.Dietarypractices of diabetes mellitus patients type 2 in relation with demographic variables at private and government hospitals in Sanaa city, Yemen the objective of present study. A hospital-based cross - sectional descriptive study conducted from October 2018 to May 2019, among adultsfrom both gender attended to the selected hospital in Sanaa to receive health service. A prepared questionnaire was used for data collection. Data analyzed by using SPSS softwareversion 20 was used. Descriptive statistics were performed to describe the socio-demographic and dietary practices variables. Data described by frequencies and percentages and presented in tables. Chi square test was used to test differences in dietary practicesin relation with demographic variables. Test considered to be significant p value < 0.05. The sample was formed of 200 adult diabetic patients, more than half (53.5%) were females. Ages of participant ranged between 25 years and 80 years, with a mean of 52 ± 11 years. Illiterate women represented 62% of total women, while illiterate men represented 13% of total men. Nearly half of participants had poor dietary practices (45.5%) towards diabetes.There was a better score of good & acceptable dietary practices tend to be more in private hospitals.There is a need to strengthen good dietary practices through health education.


2021 ◽  
pp. 1-5
Author(s):  
Ashish Chauhan ◽  
Rajeev Kumar Gupta ◽  
V.V. Agarwal

BACKGROUND: To determine the efficacy of streptokinase in diabetic versus non-diabetic patients presenting with acute ST Elevation Myocardial Infarction (STEMI). METHOD AND RESULTS: This is a hospital based observational study conducted in the department of Cardiology, S.M.S. MEDICAL COLLEGE and associated hospital, Jaipur, Rajasthan between March 2016 to August 2017. Two hundred one consecutive patients of acute STEMI admitted to the Cardiology department were enrolled in the study to maintain 95% CI and 80% power of study. Patients with acute STEMI within 12 hours of chest pain without contraindications to fibrinolytic therapy (streptokinase) were included. ECG was done before and at 90 minutes after the start of streptokinase. ST-segment resolution equal to or more than 70% at 90 minutes on ECG was taken as successful reperfusion. The data was analysed by using software SPSS version 10. The quantitative variables were presented as mean and standard deviation while qualitative variables as frequency and percentage. Chi square test was used to estimate significance and p-value of <0.05 was considered significant. Out of 201 patients, 127(63.2%) were non-diabetics and 74(36.8%) were diabetics. The age of presentation of these patients was 32-75yr (meanage=55.59yr). Of these patients, 80% (N=160) were male and 20% (N=40) were female. Among the 74 diabetic patients, streptokinase was not effective in any patients. So streptokinase is non-efficacious in diabetic patients. Among the 127 non diabetic patients, streptokinase was effective in 79 (62.2%). Among the risk factors, smoking and hypertension were found in 84.6% and 62.7% of the patients respectively. So, we found smoking as the most common risk factor followed by HTN and DM in our patients. HTN was found significantly more in diabetic patients (94.59%) vs (44.09% in non-diabetic patients). On angiography, 58.7% patients had SVD, 34.8% had DVD and 6.5% had TVD. Five (2.5%) of these were found to have LM disease. Coronary angiography showed SVD, DVD, TVD in 44(59.46%), 17(22.97%) and 13(17.57%) of diabetic vs 74(58.27%), 53(41.73%) and 0(0%) of non-diabetic patients. So, triple vessel disease is significantly higher in diabetic patients. CONCLUSION: This study shows that streptokinase is significantly more efficacious in non-diabetics as compare to diabetic patients presenting with acute STEMI. It is more efficacious in male than female (M=47.82%; F=5%). We found that the window period of presentation was significantly higher in diabetic patient because of atypical symptoms that may lead to a delay in seeking medical advice and streptokinase was significantly more efficacious in non-diabetics as compare to diabetic patients.


Author(s):  
Tamojit Chatterjee ◽  
Shrutakirti Ghosh ◽  
Rinki Saha ◽  
Sandip Samaddar

Introduction: Conjunctiva is a transparent mucous membrane that lines inside of the eyelids and covers the sclera. It is composed of non keratinised, stratified columnar epithelium with goblet cells. Normal microbial flora constitutes organisms which are present in eyelids and conjunctiva without causing any disease. At birth eyes are sterile but they are later infected by various organisms. Gram positive organisms are mostly prevalent in ocular flora. Diabetes mellitus is a multifactorial disease that can affect all ocular structures. Aim: To compare the microbial flora between diabetic and non diabetic patients and to study there sensitivity to antibiotics. Materials and Methods: This was an analytical study conducted on a total of 100 patients attending Department of Opthalmology of Medical College and Hospital, Kolkata, India between June 2019 to July 2019. They were not using any topical ocular preparation. Conjunctival swab was taken from upper fornix of the patients and cultured and the results obtained were analysed using Chi-Square test. Results: Conjunctival flora of a total of 100 patients, 30 diabetic and 70 non diabetic, were screened. Among the 30 diabetic patients, there were 15 (50%) male and 15 (50%) female. The most common isolated bacteria in diabetic and non diabetic groups were staphylococcus aureus (diabetic 70%, non diabetic 85.7%). There was a statistically significant difference in microbial flora pattern between the diabetic and non diabetic group. There was higher proportion of staphylococcus epidermidis among diabetic patients compared to non diabetic patients (p-value<0.01) and there was a higher proportion of staphylococcus aureus among non diabetics (p-value<0.01). Conclusion: Present study found statistically significant difference in the microbial flora between diabetics and non diabetics. This will help the clinician to plan for the antibiotic prophylaxis before surgery for patients attending the Out Patient Department (OPD).


Author(s):  
Vivek Chakole ◽  
Shilpa Shankar ◽  
Sneha Kota ◽  
Jayashree Sen ◽  
Sheetal Madavi ◽  
...  

Aim: To study the efficacy of oral clonidine on intraoperative bleeding and consumption of inhalational agent in patients undergoing FESS under general anesthesia. Study Design: Prospective, comparative observational study. Place and Duration of Study: Department of Anesthesiology, AVBRH, from June 2020 to May 2021. Methodology: A total of 30 patients fulfilling inclusion criteria scheduled for FESS were randomly allocated into 2 groups of 15 each; GROUP C (Clonidine group, n=15) who received tab clonidine 5 mcg/kg, 90 minutes before surgery and GROUP M (Multivitamin group, n=15) who received multivitamin tablet. Mean ± standard deviation (SD) or absolute values were used to indicate data; comparison of qualitative data were done using Chi-square test and Fisher’s exact test and quantitative variables using the student ‘t’ Test. P value < 0.05 was taken as statistically        significant. Results: Bleeding was considerably less in the group C [1.65 ± 0.4] as compared to group M [2.20 ± 0.6] and is statistically significant [ P value = 0.006]. The mean MAC value (%) of sevoflurane consumption is lesser in the group C [1.25 ±0.25] than the group M [1.30 ±0.20] but not statistically significant (P value = 0.55). The mean dose (microgram) of fentanyl requirement was more in group M [ 120 ±20] than the group C [100 ± 25] and this was statistically significant (P value = 0.02). Conclusion: Oral Clonidine can be used as an excellent premedication and provides cost effective method to attain controlled hypotension as there is lesser requirement of costly inhalational agent and other analgesic drugs. Also, it maintains better hemodynamic stability with fewer side effects.


Author(s):  
Chyntia Olivia Maurine Jasirwan ◽  
Irsan Hasan ◽  
Andri Sanityoso Sulaiman ◽  
Rino Alvani Gani

Background: GeneXpert has been used for Mycobacterium tuberculosis testing, but is currently available for HCV RNA testing. GeneXpert assay is expected to be more accurate, efficient, and cost-effective for HCV viral load quantification. This study  intended to evaluate the new method quantification of plasma HCV RNA by the GeneXpert in comparison to the Roche Cobas TaqMan 96  as standard diagnostic tools.Method: A total of 54 HCV-infected plasma samples with anti-HCV positive were examined by GeneXpert assay, followed with Cobas TaqMan 96 for quantification of HCV RNA. Correlation was performed by Pearson test (in log10) and diagnostic test by Chi-square test. Sensitivity and specificity of the GeneXpert assay measured by calculating 2x2 contingency table.  Bland-Altman plot were generated to assess the mean difference between the two assays.Results: GeneXpert has strong correlation to the Roche Cobas TaqMan 96 (R=0.993; P value 0.001). GeneXpert has sensitivity of 100% (95% CI: 90–100%) and specificity of 90% (95% CI: 54.1–99.5%). The Bland Altmand plot showed that one sampel has 1 log difference with the Roche Cobas TaqMan 96 measurement result.Conclusion: There was a strong correlation in the measurement of HCV RNA by GeneXpert and moreover its assay also has an excellent overall performance compared to Cobas TaqMan 96. Thus, it can be considered as a reliable tools for HCV virological response monitoring.


Author(s):  
Tamojit Chatterjee ◽  
Shrutakirti Ghosh ◽  
Rinki Saha ◽  
Sandip Samaddar

Introduction: Conjunctiva is a transparent mucous membrane that lines inside of the eyelids and covers the sclera. It is composed of non keratinised, stratified columnar epithelium with goblet cells. Normal microbial flora constitutes organisms which are present in eyelids and conjunctiva without causing any disease. At birth eyes are sterile but they are later infected by various organisms. Gram positive organisms are mostly prevalent in ocular flora. Diabetes mellitus is a multifactorial disease that can affect all ocular structures. Aim: To compare the microbial flora between diabetic and non diabetic patients and to study there sensitivity to antibiotics. Materials and Methods: This was an analytical study conducted on a total of 100 patients attending Department of Opthalmology of Medical College and Hospital, Kolkata, India between June 2019 to July 2019. They were not using any topical ocular preparation. Conjunctival swab was taken from upper fornix of the patients and cultured and the results obtained were analysed using Chi-Square test. Results: Conjunctival flora of a total of 100 patients, 30 diabetic and 70 non diabetic, were screened. Among the 30 diabetic patients, there were 15 (50%) male and 15 (50%) female. The most common isolated bacteria in diabetic and non diabetic groups were staphylococcus aureus (diabetic 70%, non diabetic 85.7%). There was a statistically significant difference in microbial flora pattern between the diabetic and non diabetic group. There was higher proportion of staphylococcus epidermidis among diabetic patients compared to non diabetic patients (p-value <0.01) and there was a higher proportion of staphylococcus aureus among non diabetics (p-value <0.01). Conclusion: Present study found statistically significant difference in the microbial flora between diabetics and non diabetics. This will help the clinician to plan for the antibiotic prophylaxis before surgery for patients attending the Out Patient Department (OPD).


2021 ◽  
Vol 10 (02) ◽  
pp. 129-132
Author(s):  
Naimatullah Khan ◽  
Javed Iqbal Khan ◽  
Tariq Mehmood ◽  
Aqeel Peter

Objective: To assess the dyslipidemia in newly diagnosed diabetic patients and compare it with or without micro albuminuria. Study Design and Setting: Cross-sectional study at Department of Medicine, Military Hospital Rawalpindi from 01 March 2015 to 31 August 2015. Methodology: A total of 150 patients who fulfilled the inclusion criteria were included after taking informed consent and approval from hospital ethical committee. Blood sample was obtained from each patient and samples were sent to hospital laboratory and reports were assessed by pathologist. Presence or absence of microalbuminuria, trigiyceridemia (200-499 mg/dl), raised LDL-C (>160 mg/dl) and decreased HDL-C (<40 mg/dl) were noted by researcher himself on a pre-designed performa. The collected data was analyzed statistically by using SPSS version 12.Quantitative variables like age, TG, LDL HDL levels were presented in form of mean ± S.D. Qualitative variables like gender, diabetes mellitus, micro albuminuria and dyslipidemia were presented as frequencies and percentages. Chi-square test was applied to find association between dyslipidemia and micro albuminuria. P value = 0.05 was considered as statistically significant. Results: Mean ± SD of age was 47.97±7.08 years. Out of 150 patients 60% were male and 40% were female. Dyslipidemia was found in 42% patients. Highly significant association was found between dyslipidemia and micro albuminuria, i.e. (P=0.0001). Conclusion: The frequency of dyslipidemia among newly diagnosed diabetic patients with micro albuminuria was significantly higher than in subjects without micro albuminuria


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