Home Telemonitoring of Patients With Type 2 Diabetes: A Meta-Analysis and Systematic Review

Telehealth has emerged as an evolving care management strategy that is playing an increasingly vital role, particularly with the onset of the coronavirus disease 2019 pandemic. A meta-analysis of 20 randomized controlled trials was conducted to test the effectiveness of home telemonitoring (HTM) in patients with type 2 diabetes in reducing A1C, blood pressure, and BMI over a median 180-day study duration. HTM was associated with a significant reduction in A1C by 0.42% (P = 0.0084). Although we found statistically significant changes in both systolic and diastolic blood pressure (−0.10 mmHg [P = 0.0041], and −0.07 mmHg [P = 0.044], respectively), we regard this as clinically nonsignificant in the context of HTM. Comparisons across different methods of transmitting vital signs suggest that patients logging into systems with moderate interaction with the technology platform had significantly higher reductions in A1C than those using fully automatic transmission methods or fully manual uploading methods. A1C did not vary significantly by study duration (from 84 days to 5 years). HTM has the potential to provide patients and their providers with timely, up-to-date information while simultaneously improving A1C.

Ayurveda and Management of COVID-19 in Rural Indian Population: A pilot, double blind, randomized control trial

Background The SARS-CoV-2 virus responsible for the COVID-19 pandemic is a highly contagious and rapidly mutating virus. The COVID-19 pandemic has affected millions globally over the last 18 months and continues to overwhelm the healthcare system in several countries to date. The healthcare and scientific community has been vigorously searching for ways to manage the disease. Several solutions based on traditional systems of medicine like Ayurveda are also being explored for their effectiveness in managing COVID-19. The study explored the efficacy of a 19 ingredient Ayurvedic polyherbal formulation called NOQ19, on the recovery of mild, RT-PCR positive COVID-19 patients. Methods This was a prospective, double blind, randomized control trial that included 92 patients with a RT-PCR positive mild case of COVID-19. The patients were enrolled from rural areas of Karnataka, a state in India. The patients were randomized between the NF2 and placebo arms, in a 1:1 ratio, and were provided their respective intervention, along with the standard of care treatment (SOC). The trial took place at the Community Care Center, Konnanuru, Hassan, Karnataka. The study duration was around 2 months and the follow-up period for an individual patient was 14 days. RT-PCR analysis was done at baseline, Day 3, 7 and 10. Blood markers to track inflammation were assessed at baseline, Day 3 and 7. Result A statistically significant difference was observed between the two groups with regards to the percentage of population who turned RT-PCR negative on Day 3 and Day 10. On all three assessment time points (Day 3, 7 and 10), the NF2+SOC arm showed a greater percentage of population who were RT-PCR negative compared to the placebo+SOC arm: Day 3 (NF2 -19%, Placebo - 0%) ; Day 7 (NF2- 41%, Placebo - 19%) ; Day 10 (NF2-73%, Placebo 44%). No significant changes were observed in blood markers for both the groups. Conclusion NF2 administered along with standard of care treatment aided early recovery from COVID-19 as demonstrated by a higher percentage of population who were RT-PCR negative on Day 3, 7 and 10. No side effects were observed during the entire study duration. Early recovery of patients is essential for rational usage of limited healthcare resources in a pandemic.

The efficacy of an Ayurvedic polyherbal formulation in the symptomatic management of mild COVID-19 cases: A double blind, randomized controlled trial

PurposeThe COVID-19 pandemic, caused by the SARS-CoV-2 virus has infected millions of people globally, overwhelming the pharmaceutical industry and health care systems. The resulting crisis has highlighted the need for modern and traditional medicine systems to work together to find effective solutions quickly. Modern systems of medicine are primarily oriented towards symptomatic treatment, whereas the traditional systems of medicine such as Ayurveda emphasize prevention as well as treatment.Patients and methodsNF2 is polyherbal Ayurvedic formulation consisting of 19 ingredients from 13 herbs. 50 patients with confirmed symptomatic or asymptomatic case of COVID-19, reporting to the study site were invited to participate in a double blinded, randomized placebo-controlled clinical trial. The study duration was around 3 months, and the intervention period for an individual patient was 10 days.ResultsSignificant improvements were observed in the NF2 arm in comparison to the placebo arm. On Day 5, the population in the NF2 arm showed a complete recovery from sputum formation, sore throat, headache and fever. By Day 10, 90-100% of the population in the NF2 arm showed a complete recovery from all symptoms, unlike the control arm.ConclusionNF2 facilitated a complete recovery from all clinical features of COVID-19 faster, when compared to the control. No side effects were observed during the entire study duration.

Assessment of Fluoride Release through Dentin Adhesive in the Alkasite Restorative Material and Giomer

This study evaluated the fluoride release of alkasite restorative material (ARM) and giomer penetrating the dentin adhesive layer. Twenty specimens were prepared for each restorative material, and dentin adhesive with uniform thickness was applied to half of them. The prepared specimens were placed in a polyethylene tube containing 2.0 mL of deionized water and deposited in a 37.0°C water bath for the study duration. The amount of fluoride release was measured on the 1st, 3rd, 7th, 14th, 21st, and 28th days after deposition. The dentin adhesive applied to the ARM and giomer could not completely block the fluoride release; however, it significantly reduced its amount. The cumulative amount of fluoride release of the ARM after 28 days was higher than that of the giomer regardless of the application of dentin adhesive.

دور الصحافة الالكترونية في نشر قضايا الهجرة (دراسة تحليلية لصحيفة الانتباهة الالكترونية السودانية )

This study aimed at answering the research questions on the ways of this newspaper participation in the transmission of the information which is presented in all types of newspaper writing, reviewing the issues which concern the visitors. Some 110 editing stuffs were on the immigration and Sudanese who work abroad, representing the study sample in the context of the study duration. The study used the historical and descriptive methodologies, selecting a sample of the study society, because it is difficult to represent all the society in the study. It also used the content analysis for the sample of the study representing types of editing which transmitted in (Al-Intibahah) electronic newspaper during the first five months of 2013. The important results of the analysis are: most of the writing types are the reports, most of the samples concentrated on the social field, most of them are on negative attitudes on the Sudanese immigrants and their immigration for working abroad and most of the writing types had negative stance towards the immigration and immigrants' issues.

COVID-19 and pregnancy- review of cases from a tertiary public hospital in Mumbai

Background: In December 2019 a novel strain of coronavirus, was first isolated by the Chinese Center for Disease Control and Prevention. This strain connected to the cluster of acute respiratory illness cases from Wuhan, China was later officially named as severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). On 30th January 2020, WHO declared the outbreak of SARS-Cov-2 a public health emergency of international concern, and on 11th March 2020 declared it to be a pandemic. Pregnant women are known to be at higher risk of severe morbidity and mortality from respiratory infections such as influenza and SARS, making a strong case for pregnant women to be considered an at-risk population for COVID-19. This study aimed to assess the clinical picture, obstetric outcome and neonatal outcome in COVID positive pregnant cases.Methods: We did a retrospective observational cohort study in the department of Obstetrics and Gynecology at a tertiary teaching hospital in Mumbai.Results: In the study duration, 148 were diagnosed as COVID positive (~12%). 9 patients had COVID related symptoms on admission. The obstetric outcome in symptomatic patients was noted to be good. We noted 79.01% of the pregnancies reached term. Cesarean section rate in COVID positive patients was comparable to non-COVID patients in the study duration. Neonatal outcome was only 4 babies of COVID positive mothers were diagnosed positive.Conclusions: Our study shows pregnancy outcomes are not significantly worsened by the COVID-19 infection in spite of the risk factors associated with pregnancy per se and influenza infection in pregnancy.

Adaptive Design For Identifying Maximum Tolerated Dose Early To Accelerate Dose-Finding Trial

Purpose: The early identification of maximum tolerated dose (MTD) in phase I trial leads to faster progression to a phase II trial or an expansion cohort to confirm efficacy.Methods: We propose a novel adaptive design for identifying MTD early to accelerate dose-finding trials. The early identification of MTD is determined adaptively by dose-retainment probability using a trial data via Bayesian analysis. We applied the early identification design to an actual trial. A simulation study evaluates the performance of the early identification design.Results: In the actual study, we confirmed the MTD could be early identified and the study period was shortened. In the simulation study, the percentage of the correct MTD selection in the early identification Keyboard and early identification Bayesian optimal interval (BOIN) designs was almost same from the non-early identification version. The early identification Keyboard and BOIN designs reduced the study duration by about 50% from the model-assisted designs. In addition, the early identification Keyboard and BOIN designs reduced the study duration by about 20% from time-to-event model-assisted designs.Conclusion: We proposed the early identification of MTD maintaining the accuracy to be able to short the study period.

Outcomes of Carotid Endarterectomy with Primary Closure

Background: Cerebrovascular ischemic cases are 3rd leading cause of fatality and neurologic dysfunction in adults. Atherosclerotic lesions outside the carotid cranial circulation are main cause of cerebral ischemia in almost 10-20 percent cases and carotid endarterectomy (CEA) has been proved beneficial for patients with severe carotid artery stenosis to prevent acute cerebrovascular events. Current study is conducted to assess the short-term outcomes of carotid endarterectomy among patients in terms of morbidities and mortalities at our institution during the study period. Material and Methods: This cross-sectional analytical study was carried out at Combined Military Hospital, Rawalpindi during August 2019 to July 2021 to analyze the short-term outcomes of carotid endarterectomy (CEA) with primary closure. All the patients who underwent carotid endarterectomy (CEA) with primary closure during study duration were included in the study. Patients who received selective shunting if Electro Encephalogram (EEG) changes noted were excluded from study. Data was collected after taking verbal consent by using preformed questionnaire. Frequency of morbidities like bleeding, infection, stroke, transient ischemic attacks (TIA), myocardial infarction, repeat operation and revision with stent were noted within postoperative period of one month. Frequency of mortalities in one-month postoperative period among patients undergoing carotid endarterectomy was also calculated. Data was entered and analyzed by using SPSS version 22. Results: Total 198 patients who underwent carotid endarterectomy with primary closure during study duration were included in the study. Age range of the study participants was between 35 to 80 years. Male patients were 107 (54.04%). The comorbidities evaluated in the study participants showed that 172 (86.87%) patients were hypertensive and 73 (36.87%) has diabetes mellitus. The most frequent postoperative morbidities among patients were bleeding and repeat operation. Conclusion: It is concluded that carotid endarterectomy with primary closure is a safe and effective surgical means of stroke prevention.

Top-Down Approach to Area Development Plan Maturation

In maturing an Area Development Plan (ADP), most of the data used are incomplete, too fragmented, or sometime due to time constraint; need to be deduced down to assumptions. Due to this fact, an ADP is bound to have updates, even during the course of maturing it. This is where the issue starts. Since the conventional approach is "bottom-up", room to accommodate changes is limited; at times require the whole proposal to be reworked. This is because it focuses on getting the best development concept for a given field first before rolling it up to study the network/interrelationship between fields. A "top-down" approach in maturing an ADP intends to better assist any given team to be agile whilst focusing on value added solutions from a strategic bird's eye point of view. The approach in discussion was adopted and tested to a regional ADP study in year 2020 which initially involves more than 1000 fields (discovered, prospects, and leads). This approach allows for any changes throughout the course of maturing the ADP because, its main focus is to get the best network/interrelationship between fields first, before focusing on the development concept of each of the fields. Other benefits that can be observed by adopting the approach in discussion is a shorter study duration. Based on the case study, the study duration was reduced from 10 months to 6.5 months. With shorter duration too, can help the Company in better manage its manpower resources to focus on things that matters.