IN VIVO ANTIDIABETIC SCREENING OF KABAU (ARCHIDENDRON BUBALINUM (JACK) I. C NIELSEN) SEEDS

Objective: Study described the screening potential antidiabetic activity of kabau seed extract and fraction. Methods: The powdered crude drugs weighing 1349.32 grams were extracted with a solvent with solvents with escalating polarity by using soxhletation. The solvents used were n-hexane, ethyl acetate, and 96% ethanol. Screening activity using three variations on doses on the three extracts using the glucose test tolerance method, then the alloxan induction and high-fat feed induction testing methods using selected doses, decreasing blood glucose levels using the GOD PAP enzyme and decreasing MDA levels and increased levels of the enzyme SOD. Extracts that have potential antidiabetic activity are fractionated using liquid-solid fractionation; then the fraction is screened for antidiabetic activity using the glucose test tolerance method. Results: Screening for antidiabetic activity on the three extracts using the glucose test tolerance method showed that the ethanol extract at a dose of 250 mg/kg BW. The three extracts were then screened for the next mechanism using the alloxan induction method and high-fat feed induction, the decrease in blood sugar levels by the GOD-PAP method showed a good decrease in the ethanol extract by 202.94±2 mg/dl, the three extracts showed good less significant, in the SOD enzyme method, the ethanol extract gave a good value such as the positive control value. Testing on fraction can decrease in blood sugar; the results showed that the ethanol extract and methanol fraction gave a small AUC 0-150 (32695,3 and 33167,71), where the value was close to the result of the glibenclamide 30238,48. Conclusion: The antidiabetic activity of the extract showed that the ethanol extract was better with the glucose test tolerance method, with alloxan induction animal models and high-fat feed induction. In the methanol fraction derived from 96% ethanol extract, it provides a good reduction in blood sugar levels in the screening method with a glucose test tolerance

How to Monitor Blood Glucose

Blood glucose testing provides important information about the effectiveness of the diabetes management plan and assists nurses to monitor the clinical situation and take appropriate action. Nurses should consider the rationale for performing a blood glucose test every time they test a patient’s blood glucose level and commit to acting on the results, including whether the results are abnormal for the patient.

Implementation, interrupted: Identifying and leveraging factors that sustain after a program interruption

BackgroundMany implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform targeted re-implementation strategies.MethodsThis study took place in two public health centers with tuberculosis (TB) units in Uganda that previously implemented diabetes mellitus (DM) screening in 2017. In 2019, we conducted interviews with clinic staff to determine current DM practices. We mapped themes identified in the interviews to a Social Ecological Model with three levels: outer setting, inner setting, and individuals.ResultsWe conducted nine interviews with clinic staff. Respondents explained that DM screening ceased due to disruptions in the supply chain for glucose test strips. This outer setting interruption had cascading effects on the inner setting and individuals. The lack of screening supplies limited the staff’s opportunities to perform DM screening within the inner setting level, which was associated with diminished self-efficacy within the individual level. However, culture, compatibility and individual beliefs about DM screening sustained throughout the interruption.ConclusionsWe identified factors that diminished and sustained within and between ecological levels during a program interruption. Using this approach, other programs facing interruptions can identify factors and cascading effects of the interruption to target them for re-implementation.

Predictors of Treatment Requirements in Women with Gestational Diabetes: A Retrospective Analysis

The diagnosis of gestational diabetes is usually very stressful for pregnant women, especially because they fear that insulin treatment may become necessary. Knowledge about personal risk factors predicting the probability of insulin treatment could therefore help to improve acceptance of the diagnosis and therapy adherence. The aim of this study was to find potential risk factors for insulin dependency and treatment requirements using information available at the time of diagnosis of gestational diabetes during pregnancy. We included 454 singleton pregnancies diagnosed ≥24 weeks of gestation. Multivariate regression analysis was used to evaluate independent associations of metabolic, anthropometric and fetal ultrasound parameters with the general need for insulin treatment and further stratified treatment options: diet (n = 275), bolus insulin only (n = 45), basal insulin only (n = 73) and multiple daily injections (n = 61). Receiver operator characteristics and cut-off values for independent variables were generated. Treatment groups differed significantly concerning pre-pregnancy weight and BMI as well as fasting glucose and 1 h glucose test values. Significant cut-offs for insulin dependency were HbA1c level of 5.4%, FPG of 5.5 mmol/L and 1 h glucose of 10.6 mmol/L. At time of diagnosis, certain patient characteristics and measurements can help to predict treatment necessities and therefore improve individualized counselling.

Who is getting screened for diabetes according to body mass index and waist circumference categories in Peru? a pooled analysis of national surveys between 2015 and 2019

Background At the population level we would expect that people with obesity undergo diabetes screening tests more often than people with overweight and much more often than people with normal weight. We described the trends of diabetes screening according to body mass index (BMI) and waist circumference (WC) in Peru. Methods Pooled analysis of health national surveys (2015–2019); men and women aged 35–70 years. We used relative frequencies to study: among those who have had a glucose test in the last year, how many there were in each BMI and WC category. We fitted a Poisson model to study whether people with high BMI or WC were more likely to have had a glucose test. Results People with overweight (PR = 1.34; 95% CI: 1.29–1.38), obesity (PR = 1.57; 95% CI: 1.51–1.63) and central obesity (PR = 1.63; 95% CI: 1.35–1.96) were more likely to have had a glucose test. At the sub-national level, there was one (of twenty-five) region in which men with obesity were more often screened for diabetes than men with overweight and much more than men with normal weight. There were seven regions in which women with obesity were the most often screened for diabetes. Conclusions Consistent with a risk-based prevention approach, people with obesity would be screened for diabetes more often than those with overweight and those with normal weight. This ideal profile was only observed in few regions. Diabetes screening strategies should be strengthened and homogenised, so that they reach those at high risk of diabetes.

Association of early glycemic change with short-term mortality in lobar and non-lobar intracerebral hemorrhage

The association between early glycemic change and short-term mortality in non-diabetic patients with acute intracerebral hemorrhage (ICH) is unclear. We retrospectively investigated non-diabetic patients with lobar (n = 262) and non-lobar ICH (n = 370). Each patient had a random serum glucose test on hospital admission and a fasting serum glucose test within the following 48 h. Hyperglycemia was defined as serum glucose ≥ 7.8 mmol/l. Four patterns were determined: no hyperglycemia (reference category), persistent hyperglycemia, delayed hyperglycemia, and decreasing hyperglycemia. Associations with 30-day mortality were estimated using Cox models adjusted for major features of ICH severity. Persistent hyperglycemia was associated with 30-day mortality in both lobar (HR 3.00; 95% CI 1.28–7.02) and non-lobar ICH (HR 4.95; 95% CI 2.20–11.09). In lobar ICH, 30-day mortality was also associated with delayed (HR 4.10; 95% CI 1.77–9.49) and decreasing hyperglycemia (HR 2.01, 95% CI 1.09–3.70). These findings were confirmed in Cox models using glycemic change (fasting minus random serum glucose) as a continuous variable. Our study shows that, in non-diabetic patients with ICH, early persistent hyperglycemia is an independent predictor of short-term mortality regardless of hematoma location. Moreover, in non-diabetic patients with lobar ICH, both a positive and a negative glycemic change are associated with short-term mortality.

Edukasi Home Pharmacy Care terhadap Kepatuhan dan Kontrol Glukosa Darah pada Pasien Diabetes Melitus

Penyakit Diabetes Melitus (DM) termasuk penyakit yang bersifat kronis akibat terjadinya peningkatan kadar glukosa darah. Kepatuhan minum obat merupakan faktor penting dalam mengontrol kadar glukosa darah. Salah satu intevensi yang dapat dilakukan oleh apoteker secara komprehensif untuk pasien dengan penyakit kronis adalah edukasi apoteker melalui home pharmacy care (HPC). Tujuan penelitian ini adalah untuk mengetahui pengaruh edukasi apoteker melalui HPC pada pasien DM dalam meningkatkan kepatuhan dan kontrol glukosa darah puasa (GDP). Penelitian ini menggunakan rancangan quasi-experimental pretest-posttest with control group design yang dilakukan pada bulan Agustus-November 2020. Subyek uji dalam penelitian ini adalah pasien DM tipe 2 yang mengikuti program Prolanis di Puskesmas Mlati II Sleman, Yogyakarta. Total subyek uji dalam penelitian ini sebanyak 60 pasien dari 65 pasien yang terbagi menjadi kelompok kontrol (30 pasien) dan intervensi (30 pasien) yang dipilih dengan metode simple random sampling. Pengukuran tingkat kepatuhan dilakukan dengan menggunakan instrumen kuesioner ProMAS dan glucose test untuk mengukur kadar GDP. Data dianalisis menggunakan uji Chi square untuk meniliai perbedaan karakteristik pasien, uji Wilcoxon untuk membandingkan data pretest dan posttest pada masing-masing kelompok dan uji Mann Whitney untuk membandingkan tingkat kepatuhan dan ketercapaian GDP pada kedua kelompok. Hasil penelitian menunjukkan bahwa edukasi melalui HPC dapat meningkatkan kepatuhan p=0,002 (p<0,05) dan kontrol GDP dengan rata-rata penurunan kadar GDP kelompok intervensi adalah 53,67±24,31 mg/dL dan p=0,021 (p<0,05). Kesimpulan dari penelitian ini adalah pemberian edukasi melalui HPC dapat meningkatkan kepatuhan dan ketercapaian kadar glukosa darah puasa

Treatment of Ruptured Meningocele Post-Brachial Plexus Surgery: Potential Life-Threatening Complication-An Unique Case Report of Management of Ruptured Meningocele Post-Brachial Plexus Surgery to Avoid Dreadful Complication

Introduction: Formation of meningocele in brachial plexus injury is known and can be diagnosed on magnetic resonance imaging (MRI). It is mainly reported in brachial plexus root avulsion injuries and does not require specific treatment. We report accurate diagnosis and management of dreadful complication due to rupture of meningocele post-brachial plexus exploration. Case Report: A 23-year-old engineer presented at 4 months post-bike accident right side extended brachial plexus injury involving C5, C6, and C7. On MRI, he had meningocele in C6-7 root region. We performed supraclavicular exploration of brachial plexus and distal nerve transfers for shoulder abduction and elbow flexion. During surgery, the meningocele was ruptured. As the cyst was deep and extending toward apex of lung, the diagnosis of fluid drained had to be distinguished from pleural fluid with cerebrospinal fluid (CSF). We found hemo-glucose test and beta-2-transferrin levels are mandatory to confirm the diagnosis. Post-surgery, the patient had drainage of almost 500 cc of CSF from wound every day for 3 days. This was managed by repeat MRI and finally lumbar puncture drainage helped to seal the meningocele in neck. Conclusion: Meningocele in brachial plexus injury is common but rupture of cyst can be fatal. To confirm the origin of fluid, beta-2-transferin level is more specific test than the hemo-glucose test. Lumbar puncture and drainage away from neck can be more reliable modality of treatment in case of intraoperative rupture of such cysts if drainage is excessive postoperatively. Keywords: Meningocele rupture, cerebrospinal fluid leak, accurate diagnosis, management.

RESULTS OF QUICK DETECTION OF DIABETES ON ELDERLY AT SOME COMMUNES IN THAI NGUYEN CITY

Objectives: Describe the rate of diabetes by rapid detection on elderly in some communes of ThaiNguyen city.Materials and Methods: A cross-sectional study had been conducted on 520 elderly.Results: The rate of diabetes in the elderly in the 7 studied communes is 23.6%, of which 12.1% isnew discovery through rapid test. The proportion of subjects with pre-diabetes accounts for 19.5%,of which 8.3% are fasting blood glucose disorders and 11.2% are impaired glucose tolerance. Thehighest prevalence of diabetes is found in the age group 60-69 (26.6%); in which, Tich Luong wardhas the highest rate of diabetic subjects (32.8%) and Linh Son commune has the lowest rate ofdiabetic subjects (15.4%). There were 417 subjects (80.19%) that complied with the required fastingtime with the highest blood sugar test result of 16.3 mmol /l, of which 35.5% of subjects who fastedfor 8 hours or more had blood glucose test ≥7 mmol /l. As a result, adding a glucose tolerance testrevealed 13 more subjects (accounting for 11.4%) with diabetes.Conclusion: It is necessary to apply the rapid testing for blood sugar to all at-risk subjects, elderlyin community.