High Mortality among Premature Neonates with Positive Blood Culture Neonatal Sepsis in a Tertiary Hospital, Tanzania: A Call for Action

Well-documented vital signs are key in the prediction of sepsis in low- and middle-income countries. We determined prevalence, associated factors, and outcomes of positive blood culture sepsis in premature neonates at Bugando Medical Centre Mwanza, Tanzania. Temperature, oxygen saturation, heart rate, respiratory rate, and random blood glucose were repeatedly recorded at admission, 8 h, and 24 h in all 250 neonates enrolled. Clinical and microbiological data were collected from patient records followed by descriptive data analysis. The mean age of the neonates was 3 ± 5.2 days, with the majority (90%) aged <10 days. The prevalence of positive blood culture sepsis was 21.2% (95% CI: 16.1–26.2). The fluctuation of the random blood glucose (RBG) (aOR = 1.34, 95% CI: (1.07–1.67), p = 0.010), low oxygen saturation (aOR = 0.94, 95% CI: (0.88–0.99), p = 0.031), premature rupture of membrane aOR = 4.28, 95% CI: (1.71–10.71), p = 0.002), gestational age < 34 weeks (aOR = 2.73, 95% CI: (1.20–6.24), p = 0.017), and home delivery (aOR = 3.90, 95% CI: (1.07–14.19), p = 0.039) independently predicted positive blood culture. Significantly more deaths were recorded in neonates with a positive blood culture than those with a negative blood culture (32.1% vs. 5.1%, p < 0.001). In limited-resource settings, clinicians should use the vital signs and clinical information to initiate timely sepsis treatment among preterm neonates to prevent deaths and other morbidities.

Effect of glucose on reduced glutathione level in Malay uncomplicated type 2 diabetes patients

Background: Increasing blood sugar level may increase free radical compounds in type 2 diabetes. Free radical compounds can cause oxidative stress, thereby decreasing endogenous antioxidants such as reduced glutathione (GSH). Objective: This study aimed to determine whether random blood glucose levels affect GSH in type 2 diabetes patients within the Malay race. Methods: This study was observational with case-control, involving 25 patients with uncomplicated type 2 diabetes (receiving metformin and/or glimipiride) and 25 healthy controls. Random blood glucose levels were determined using ACCU-CHECK® Kit. Blood GSH levels were determined by Sigma GSH Assay Kit. Results: Results show that type 2 diabetes patients have a significantly lower random blood glucose level compared with those of age-matched normal subjects (p<0.0001). Type 2 diabetic patients had significantly lower levels of GSH (p=0.00) than those of age-matched normal subjects. We found a moderate negative correlation (r=-0.437 and p=0.02) between the level of random blood glucose and the level of GSH. Conclusion: The depletion of GSH during hyperglycemia may neutralize the free radicals indirectly generated by the abundant of glucose.

Safety evaluation of an antimalarial herbal product from Andrographis paniculata (AS201-01) in healthy volunteers

Objectives Andrographis paniculata tablets (AS201-01) have previously been shown to have potent bioactivity as an antimalarial and to produce no unwanted side effects in animal models. Here, we present the phase 1 clinical trial conducted to evaluate the safety of AS201-01 tablets in healthy volunteers. Methods The study was a randomized, double-blind controlled cross-over, a placebo-controlled design consisting of a 4-day treatment of AS201-01 tablets. A total of 30 healthy human volunteers (16 males and 14 females) were divided into two groups, and each group was given 4 tablets, twice daily for 4 days. Group 1 received AS201-01, while group 2 received placebo tablets. Volunteers were given a physical examination before the treatment. The effects of AS201-01 on random blood glucose, biochemical, and hematological as well as urine profiles were investigated. Results There were no changes in observed parameters as a result of AS201-01 being administered. Statistical analysis showed no significant difference (p>0.05) between the test and control group regarding hematology profile, biochemical profile, and random blood glucose. Increased appetite and better sleep, which categorized as grade 1 adverse event was reported after treatment with AS201-01 tablet Conclusions The outcome supports our previous observation that the AS201-01 tablet, given twice a day for 4 days, is safe and nontoxic.

PERBANDINGAN PROFIL GLUKOSA DARAH PASIEN STROKE ISKEMIK DAN STROKE HEMORAGIK DI RSUP FATMAWATI TAHUN 2018

Stroke is the death of brain cells due to lack of blood flow and oxygen to the brain by blockage or rupture of an artery. Stress hyperglycemia in acute stroke may worsen the clinical outcome and the prognosis of stroke. The purpose of this study is to find out and compare blood glucose profile between ischemic stroke and hemorrhagic stroke. This is an observational analytic cross-sectional research using consecutive sampling. Data was obtained through medical record from January to December 2018 in RSUP Fatmawati with each group of stroke consisting of 74 samples. Data was processed using SPSS 2017. Mann-Whitney test shows a significant difference in random blood glucose levels between ischemic stroke and hemorrhagic stroke (p = 0.024), with the median value of random blood glucose level during ischemic stroke is 115.50 mg / dL and hemorrhagic stroke is 136.50 mg / dL. The results also shows a significant difference in fasting blood glucose levels between ischemic stroke and hemorrhagic stroke (p = 0.042), with the median value of fasting blood glucose level for ischemic stroke is 116.50 mg / dL and hemorrhagic stroke is 125.50 mg / dL. A significant difference is also seen in 2 hours post-prandial glucose level between ischemic stroke and hemorrhagic stroke (p = 0.028), with the median value of 2 hours post-prandial glucose level of ischemic stroke is 130 mg / dL and hemorrhagic stroke is 147.50 mg / dL. Keywords: Ischemic Stroke; Hemorrhagic Stroke; Random Blood Glucose; Fasting Blood Glucose; 2 Hour Post-Prandial Blood Glucose AbstrakStroke adalah kematian sel-sel otak akibat hilangnya pasokan darah dan oksigen ke otak karena adanya hambatan atau ruptur arteri yang menuju otak. Pada stroke fase akut dapat terjadi hiperglikemia reaktif yang dapat memperburuk keluaran klinis dan prognosis stroke. Penelitian ini dilakukan untuk mengetahui dan membandingkan profil glukosa darah antara stroke iskemik dan stroke hemoragik. Penelitian ini bersifat analitik observasional dengan desain potong lintang dan pemilihan sampel consecutive sampling. Data didapat dari rekam medis periode Januari-Desember 2018 di RSUP Fatmawati dengan masing-masing kelompok stroke sebanyak 74 sampel. Pengolahan data dilakukan dengan program SPSS tahun 2017. Uji Mann-Whitney menunjukkan adanya perbedaan bermakna kadar Glukosa Darah Sewaktu antara stroke iskemik dengan stroke hemoragik (p = 0,024), dengan nilai median Glukosa Darah Sewaktu stroke iskemik adalah 115,50 mg/dL dan stroke hemoragik adalah 136,50 mg/dL. Hasil juga menunjukkan adanya perbedaan bermakna kadar Glukosa Darah Puasa antara stroke iskemik dan stroke hemoragik (p = 0,042), dengan nilai median Glukosa Darah Puasa stroke iskemik adalah 116,50 mg/dL dan stroke hemoragik adalah 125,50 mg/dL, serta adanya perbedaan bermakna kadar Glukosa Darah 2 Jam Post-Prandial antara stroke iskemik dan stroke hemoragik (p = 0,028), dengan nilai median Glukosa Darah 2 Jam Post-Prandial stroke iskemik adalah 130 mg/dL dan stroke hemoragik adalah 147,50 mg/dL.

Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

Background Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. Methods A cross—sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients’ files. Results A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30–87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. Conclusion In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.

A Mediterranean lifestyle is associated with favourable cardiometabolic markers in people with non-dialysis dependent chronic kidney disease

Adherence to a Mediterranean lifestyle may be a useful primary and secondary prevention strategy for chronic kidney disease (CKD). This cross-sectional study aimed to explore adherence to a Mediterranean lifestyle and its association with cardiometabolic markers and kidney function in 99 people aged 73⋅2 ± 10⋅5 years with non-dialysis dependant CKD (stages 3–5) at a single Australian centre. Adherence was assessed using an a priori index, the Mediterranean Lifestyle (MEDLIFE) index. Cardiometabolic markers (total cholesterol, LDL-cholesterol, HbA1c and random blood glucose) and kidney function (estimated GFR) were sourced from medical records and blood pressure measured upon recruitment. Overall, adherence to a Mediterranean lifestyle was moderate to low with an average MEDLIFE index score of 11⋅33 ± 3⋅31. Adherence to a Mediterranean lifestyle was associated with employment (r 0⋅30, P = 0⋅004). Mediterranean dietary habits were associated with cardiometabolic markers, such as limiting sugar in beverages was associated with lower diastolic blood pressure (r 0⋅32, P = 0⋅002), eating in moderation with favourable random blood glucose (r 0⋅21, P = 0⋅043), having more than two snack foods per week with HbA1c (r 0⋅29, P = 0⋅037) and LDL-cholesterol (r 0⋅41, P = 0⋅002). Interestingly, eating in company was associated with a lower frequency of depression (χ2 5⋅975, P = 0⋅015). To conclude, Mediterranean dietary habits were favourably associated with cardiometabolic markers and management of some comorbidities in this group of people with non-dialysis dependent CKD.

Prevalence and Determinants of Masked Hypertension in Nigeria: The REMAH Study

Background Estimating the burden of hypertension in Nigeria hitherto relied on clinic blood pressure (BP) measurement alone. This excludes individuals with masked hypertension (MH) i.e. normotensive clinic but hypertensive out-of-clinic BP. Method In a nationally representative sample of adult Nigerians, we obtained clinic BP using auscultatory method and out-of-clinic BP by self-measured home BP with semi-automated oscillometric device. Clinic BP was average of 5 consecutive measurements and home BP was average of 3 days duplicate morning and evening readings. MH was clinic BP &lt; 140 mmHg systolic and 90 mmHg diastolic and home BP ≥ 135 mmHg systolic and/or 85 mmHg diastolic. Result Among 933 participants, the prevalence of sustained, masked and white-coat hypertension was 28.3, 7.9 and 11.9 % respectively. Among subjects whose clinic BP were in the normotensive range (n=558), the prevalence of MH was 13%; 12% among untreated and 27% among treated individuals. The mutually adjusted odds ratios of having MH among all participants with normotensive clinic BP were 1.33 (95% confidence interval, 1.10–1.60) for a 10-year higher age, 1.59 (1.09–2.40) for a 10 mm Hg increment in systolic clinic BP, and 1.16 (1.08–1.28) for a 10mg/dl higher random blood glucose. The corresponding estimates in the untreated population were 1.24 (1.03–1.51), 1.56 (1.04–2.44) and 1.16 (1.08– 1.29), respectively. Conclusion MH is common in Nigeria and increasing age, clinic systolic BP and random blood glucose are the risk factors.

High prevalence of diabetes in young people in Bangalore, India

Background and aims: The burden of diabetes in India is increasing, especially in cities. We conducted a cross- sectional survey of the prevalence of diabetes and a measure of prediabetes in an urban population in Bangalore, India.Methods: Screening was conducted free of charge and without need for a prior appointment in 32 screening sites throughout Bangalore. Diabetes was defined either on the basis of a self-reported prior diagnosis or as undiagnosed diabetes on the basis of a random blood glucose measurement of >11.1 mmol/L (200 mg/dL). A second index of dysglycaemia, termed prediabetes, was defined as a random blood glucose measurement of >7.8 mmol/L (140 mg/dL) but less than 11.1 mmol/L.Results: The study population comprised 3,691 subjects, screened over a period of 15 months. Previously diagnosed diabetes was present in 818 patients (22.2%), previously undiagnosed diabetes in 67 patients (1.8%) and the additional measure of prediabetes in 221 patients (6%). Accordingly, almost one-third of subjects (30%) had diabetes or prediabetes by our criteria. Diabetes (diagnosed or undiagnosed) and prediabetes were more common in older subjects than younger subjects, as would be expected.Conclusions: We observed high rates of dysglycaemia in a large urban population in Bangalore. Our data add to previous reports of a substantial burden of abnormal glucose regulation in this setting. Additional public health initiatives are required to protect the citizens of Bangalore from diabetes and its future complications.

Relationship of surfactant protein-D with random blood glucose and extra pulmonary infections in type-2 diabetes mellitus

Objectives: To compare surfactant protein-D levels in type 2 diabetics and non-diabetics, and to explore its link with random blood glucose and extra-pulmonary infections. Methods: The case-control study was conducted in 2012-13 at the Dow University of Health Sciences, Karachi, and comprised diabetic cases and non-diabetic controls. Extra pulmonary infections, body mass index and random blood glucose levels were noted and serum surfactant protein-D was analysed using enzynme-linked immunosorbent assay. Data was analysed using SPSS 20. Results: Of the 120 subjects, 60(50%) each were cases and controls. Significant negative correlation was found between surfactant protein-D and infections (rs= -0.495, p=0.0001). A negative association between random blood glucose and surfactant protein-D was found, but it was not significant (p=0.15). Relative risk for extra-pulmonary infections in diabetics was 2 times higher than the controls (odds ratio: 2.10, p=0.04). Conclusion: Serum surfactant protein-D was found to have negative association with extra-pulmonary infections. Key Words: Extra-pulmonary infections, Hexokinase method, Random blood glucose, Continuous...