Vitamin D supplementation in type 2 diabetes patients with pulmonary tuberculosis may lead to earlier sputum smear conversion. In a study of 30 patients with both conditions and vitamin D deficiency, those receiving weekly vitamin D and daily calcium (group 1) showed smear conversion after 6 weeks on average, versus 8 weeks for the non-supplemented group. While the difference was not statistically significant, vitamin D appeared to provide a trend toward faster clinical improvement when added to standard antituberculosis treatment. Larger studies are needed to validate if vitamin D deficiency screening and supplementation could benefit similar patients.
This study investigated hypocalcemia in patients with acute gastroenteritis at Liaquat University Hospital in Hyderabad, Pakistan. The study included 66 patients with acute gastroenteritis and 66 healthy control subjects. The mean serum calcium level was significantly lower in patients with acute gastroenteritis (6.8455 ± 1.8266 mg/dL) compared to the control group (9.2167 ± 0.4534 mg/dL). Hypocalcemia was observed in 62 (94%) of gastroenteritis patients but only 13 (20%) of controls. The results demonstrated that low serum calcium or hypocalcemia is common in patients with acute gastroenteritis.
This randomized controlled trial compared the efficacy of pentoxifylline and prednisolone in treating severe alcoholic hepatitis. 68 patients were divided into two groups - one received pentoxifylline and the other received prednisolone for 4 weeks, followed by a tapering dose of prednisolone over 7 weeks. More patients died in the prednisolone group (12 patients) compared to the pentoxifylline group (5 patients) by 3 months. Patients receiving prednisolone also had more life-threatening complications like hepatorenal syndrome and gastrointestinal bleeding. The study suggests pentoxifylline is superior to prednisolone for treating severe alcoholic hepatitis due to its reduced mortality and renopro
Transplantation of Autologous Bone Marrow- Derived Stromal Cells in Type 2 Di...CrimsonpublishersITERM
Type 2 Diabetes is a debilitating metabolic disorder which is also the seventh leading cause of death worldwide. Current therapeutic regimes to date have failed to achieve significant long-term glycemic control even with intensive insulin therapy as revealed by deregulated Hb1Ac and C-peptides levels. In the current study, we have evaluated the effect of regenerative cellular therapy for functional recovery from Diabetic pathophysiology. 10 patients with a median age of 51 years were selected for the study and subjected to bone marrow isolation. These samples were processed under sterile conditions for the enrichment of mononuclear cells (BM MNCs) from bone marrow. After strict quality control and characterization of cells, 2 x 106 cells/kg of BM MNCs were infused back into the patient through the anterior pancreaticoduodenal artery. We performed an evaluation of clinical parameters like Body Mass Index, Fasting Plasma Glucose, Fasting Plasma Insulin, HbA1c and C-peptide levels, and followed up the patients for 12 months. Our study showed a reduction in insulin dependency by ≥ 50%.
Rice bran is fabricated from the rice milling enterprise and contains about 10% of the entire weight of rough rice. It is especially composed of aleurone, pericarp, subaleurone layer, and germ. Rice bran is a fertile supply of nutrients, minerals, vital fatty acids, dietary fiber, and different sterols. The quantification of γ-oryzanol in rice bran can be conducted by many methods that require drawing out of rice bran oil (RBO) from the bran, accompanied by way of evaluation of the quantity of γ-oryzanol in the RBO with the aid of high-performance liquid chromatography. RBO is the oil drain out of the outer rigid surface of rice called chaff (rice husk). It is identified for its excessive smoke factor of 232°C (450°F) and soft taste, making it pleasant for excessive-temperature cooking strategies such as blend and deep frying. It is healthy for human expenditure, which is employed in the system of vegetable ghee. Wax was drawn out of RBO and palpanese extract, which is employed for carnauba wax in makeup, confectionery, shoe lotions, and sharpening compounds. It is accepted as a food preparation oil in numerous Asian countries, along with Bangladesh, Japan, India, and China. Regarding the importance of RBO, this overview intends to pay attention at the phytochemistry and therapeutic functions of RBO.
Antihyperglycemic effects of short term resveratrol supplementation in type 2...zanet1
1) The study examined the effects of short term resveratrol supplementation in patients with type 2 diabetes who were receiving standard antidiabetic treatment. 66 patients were randomly assigned to receive either 1 g per day of resveratrol or a placebo for 45 days.
2) Resveratrol treatment significantly decreased systolic blood pressure, fasting blood glucose, HbA1c, insulin, and insulin resistance compared to baseline. HDL was also significantly increased.
3) In contrast, the placebo group had slightly increased fasting glucose and LDL compared to baseline. Liver and kidney function markers were unchanged with resveratrol treatment.
This document provides an introduction to Type 2 diabetes, including:
- Type 2 diabetes is caused by insulin insensitivity and a failure of pancreatic insulin secretion to compensate. It is associated with obesity and other cardiovascular risk factors.
- Without treatment, hyperglycemia can cause symptoms like polyuria and weight loss. Insulin deficiency increases risk of ketoacidosis or hyperosmolar coma.
- Type 2 diabetes significantly increases risk of cardiovascular disease like heart attacks and strokes. Management focuses on controlling multiple risk factors to reduce complications.
- Without control, hyperglycemia increases risk of eye, kidney and nerve damage. Treatment aims to lower blood glucose and control associated risks to improve health outcomes. Effective management of Type
Effect of Dietary Counseling in Chronic Renal Failure Patients on HemodialysisNeeleshkumar Maurya
This study examined the dietary intake and nutritional status of 50 chronic kidney disease patients undergoing hemodialysis treatment. The average daily dietary intake of patients was found to be 1580 calories, 204 grams of carbohydrates, 54 grams of protein, and 49 grams of fat. These levels of intake were significantly below recommended levels and declined over the course of treatment. Patients also consumed inadequate amounts of fruits, vegetables, and dairy products compared to recommended exchange levels. The results indicate that hemodialysis patients suffer from poor appetite and malnutrition due to inadequate nutrient intake.
This study investigated hypocalcemia in patients with acute gastroenteritis at Liaquat University Hospital in Hyderabad, Pakistan. The study included 66 patients with acute gastroenteritis and 66 healthy control subjects. The mean serum calcium level was significantly lower in patients with acute gastroenteritis (6.8455 ± 1.8266 mg/dL) compared to the control group (9.2167 ± 0.4534 mg/dL). Hypocalcemia was observed in 62 (94%) of gastroenteritis patients but only 13 (20%) of controls. The results demonstrated that low serum calcium or hypocalcemia is common in patients with acute gastroenteritis.
This randomized controlled trial compared the efficacy of pentoxifylline and prednisolone in treating severe alcoholic hepatitis. 68 patients were divided into two groups - one received pentoxifylline and the other received prednisolone for 4 weeks, followed by a tapering dose of prednisolone over 7 weeks. More patients died in the prednisolone group (12 patients) compared to the pentoxifylline group (5 patients) by 3 months. Patients receiving prednisolone also had more life-threatening complications like hepatorenal syndrome and gastrointestinal bleeding. The study suggests pentoxifylline is superior to prednisolone for treating severe alcoholic hepatitis due to its reduced mortality and renopro
Transplantation of Autologous Bone Marrow- Derived Stromal Cells in Type 2 Di...CrimsonpublishersITERM
Type 2 Diabetes is a debilitating metabolic disorder which is also the seventh leading cause of death worldwide. Current therapeutic regimes to date have failed to achieve significant long-term glycemic control even with intensive insulin therapy as revealed by deregulated Hb1Ac and C-peptides levels. In the current study, we have evaluated the effect of regenerative cellular therapy for functional recovery from Diabetic pathophysiology. 10 patients with a median age of 51 years were selected for the study and subjected to bone marrow isolation. These samples were processed under sterile conditions for the enrichment of mononuclear cells (BM MNCs) from bone marrow. After strict quality control and characterization of cells, 2 x 106 cells/kg of BM MNCs were infused back into the patient through the anterior pancreaticoduodenal artery. We performed an evaluation of clinical parameters like Body Mass Index, Fasting Plasma Glucose, Fasting Plasma Insulin, HbA1c and C-peptide levels, and followed up the patients for 12 months. Our study showed a reduction in insulin dependency by ≥ 50%.
Rice bran is fabricated from the rice milling enterprise and contains about 10% of the entire weight of rough rice. It is especially composed of aleurone, pericarp, subaleurone layer, and germ. Rice bran is a fertile supply of nutrients, minerals, vital fatty acids, dietary fiber, and different sterols. The quantification of γ-oryzanol in rice bran can be conducted by many methods that require drawing out of rice bran oil (RBO) from the bran, accompanied by way of evaluation of the quantity of γ-oryzanol in the RBO with the aid of high-performance liquid chromatography. RBO is the oil drain out of the outer rigid surface of rice called chaff (rice husk). It is identified for its excessive smoke factor of 232°C (450°F) and soft taste, making it pleasant for excessive-temperature cooking strategies such as blend and deep frying. It is healthy for human expenditure, which is employed in the system of vegetable ghee. Wax was drawn out of RBO and palpanese extract, which is employed for carnauba wax in makeup, confectionery, shoe lotions, and sharpening compounds. It is accepted as a food preparation oil in numerous Asian countries, along with Bangladesh, Japan, India, and China. Regarding the importance of RBO, this overview intends to pay attention at the phytochemistry and therapeutic functions of RBO.
Antihyperglycemic effects of short term resveratrol supplementation in type 2...zanet1
1) The study examined the effects of short term resveratrol supplementation in patients with type 2 diabetes who were receiving standard antidiabetic treatment. 66 patients were randomly assigned to receive either 1 g per day of resveratrol or a placebo for 45 days.
2) Resveratrol treatment significantly decreased systolic blood pressure, fasting blood glucose, HbA1c, insulin, and insulin resistance compared to baseline. HDL was also significantly increased.
3) In contrast, the placebo group had slightly increased fasting glucose and LDL compared to baseline. Liver and kidney function markers were unchanged with resveratrol treatment.
This document provides an introduction to Type 2 diabetes, including:
- Type 2 diabetes is caused by insulin insensitivity and a failure of pancreatic insulin secretion to compensate. It is associated with obesity and other cardiovascular risk factors.
- Without treatment, hyperglycemia can cause symptoms like polyuria and weight loss. Insulin deficiency increases risk of ketoacidosis or hyperosmolar coma.
- Type 2 diabetes significantly increases risk of cardiovascular disease like heart attacks and strokes. Management focuses on controlling multiple risk factors to reduce complications.
- Without control, hyperglycemia increases risk of eye, kidney and nerve damage. Treatment aims to lower blood glucose and control associated risks to improve health outcomes. Effective management of Type
Effect of Dietary Counseling in Chronic Renal Failure Patients on HemodialysisNeeleshkumar Maurya
This study examined the dietary intake and nutritional status of 50 chronic kidney disease patients undergoing hemodialysis treatment. The average daily dietary intake of patients was found to be 1580 calories, 204 grams of carbohydrates, 54 grams of protein, and 49 grams of fat. These levels of intake were significantly below recommended levels and declined over the course of treatment. Patients also consumed inadequate amounts of fruits, vegetables, and dairy products compared to recommended exchange levels. The results indicate that hemodialysis patients suffer from poor appetite and malnutrition due to inadequate nutrient intake.
DIETARY INTAKE AND NUTRITIONAL STATUS IN HEMODIALYSIS PATIENTSNeeleshkumar Maurya
This study analyzed the dietary intake and nutritional status of 50 chronic kidney disease patients undergoing hemodialysis treatment over the course of a year. The average daily dietary intake of calories, protein, carbohydrates and other nutrients was found to be significantly lower than recommended levels. Intake of fruits, vegetables, and dairy products was also inadequate. Over the study period, dietary intake and nutritional status declined, as indicated by decreasing levels of hemoglobin, serum albumin and other biomarkers. The results suggest that hemodialysis patients suffer from malnutrition due to inadequate dietary intake, placing them at higher risk for health complications.
Effects of souvenaid on plasma micronutrient levels and fatty acid profiles i...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
A Study on the Presence of Islets Cell Autoantibodies in NonInsulin Requiring...iosrjce
This study examined the presence of islet cell autoantibodies in 120 non-insulin requiring young diabetic patients in Bangladesh and compared them to 60 non-diabetic controls. The study found statistically significant higher levels of islet cell antibodies (ICA) in diabetic patients compared to controls, with the highest levels in patients diagnosed between ages 20-24. There was a moderate negative correlation between age of diabetes onset and ICA levels. No significant difference was found in glutamic acid decarboxylase 65 (GAD65) levels between patients and controls. This suggests that ICA may be present in young diabetic patients in Bangladesh and correlate with earlier age of diagnosis, while other autoantibodies may also contribute to
The document summarizes a study that investigated the effects of hydro-alcoholic extract of Urtica dioica supplementation on blood lipids, hepatic enzymes, and nitric oxide levels in patients with type 2 diabetes. 50 female patients with type 2 diabetes were divided into a control group that received placebo and an intervention group that received Urtica dioica extract for 8 weeks. The results showed that the intervention group had significantly decreased fasting plasma glucose, triglycerides, and SGPT levels, and significantly increased HDL, nitric oxide, and SOD levels compared to the control group after treatment. The study encourages the use of Urtica dioica extract as an antioxidant agent for additional therapy of diabetes.
Anti diabetic drugs in patients with diabetespharmaindexing
This study evaluated 93 diabetic patients with comorbidities to assess rational use of antidiabetic medications. The most common comorbidity was hypertension (48% of patients). Insulin was the most prescribed antidiabetic drug (64.4% of patients). Patient information materials on diabetes management were provided. The study aims to improve treatment of diabetes and comorbidities through rational prescribing and patient education.
Anaemia in Chronic Renal Failure Patients Undergoing Haemodialysis: A across ...Neeleshkumar Maurya
ABSTRACT Chronic renal failure disease is frequently associated with anaemia and the level of anaemia correlates with the stage of chronic kidney disease (CKD). A cross-sectional study was conducted in 44 chronic kidney disease patients in the department of medicine, M.L.B. Medical College, Jhansi during the period January to June, 2018. The study was evaluating the profile of anaemia and to find the association between the severity of anaemia and ckd-5 patients time period of taking on haemodialysis. Haemoglobin, blood urea, serum albumin, serum creatinine levels were examined using standard techniques. There was a significant difference in the haemoglobin of CKD patients taking 30 days regular interval 3 times values (P <0.05). All 44 patients (100%) were anaemic there was no significant correlation between the severity of anaemia and serum creatinine levels (P > 0.82) the most frequent anaemia in chronic kidney disease patients was a malnourished type of a moderate degree anaemic (7 10mg/dl). A significant correlation was not found between the severity of anomie and serum creatinine levels 30 day interval of CKD of patients on haemodialysis. Keywords: - haemodialysis, anomie, serum creatinine, haemoglobin, malnutrition.
This document provides guidelines for the diagnosis, treatment and prevention of Clostridium difficile infections (CDI). It summarizes key recommendations with evidence grading. For diagnosis, it recommends nucleic acid amplification tests over toxin enzyme immunoassays, and only testing diarrheal stool samples. It stratifies treatment based on disease severity into mild-moderate (treat with metronidazole), severe (vancomycin with/without metronidazole), and complicated (vancomycin orally and rectally with intravenous metronidazole). It also covers recurrent CDI treatment, managing CDI in patients with comorbidities, and infection control practices like contact precautions and environmental disinfection. The guidelines
Frequency of prediabetes and influence of various riskSamiullah Shaikh
This study aimed to determine the frequency of prediabetes and observe the influence of various risk factors on the development of prediabetes. The study found that 29.4% of subjects had prediabetes. Several risk factors were strongly correlated with prediabetes, including high BMI, family history of diabetes, history of gestational diabetes, history of delivering a high birth weight baby, low HDL cholesterol, and high triglycerides. The results suggest screening those with risk factors can help identify individuals at high risk of developing diabetes.
A Study on Biomarkers in a Spatially Distributed Type – 2 Diabetes mellitus G...IOSRJPBS
Diabetes, a dreaded disease already ravaged a huge population worldwide, whether it is inherited through generations or invited by the people by their uncontrolled way of life is still obscure. Biomarkers assay is a boon to the diseased to opt proper prophylactic measures to curb or eradicate diseases. The elevated levels of various biomarkers related to inflammation of vital organs, liver function, kidney function and other vital parameters in our diabetic cases reveals the extent of organ(s) damage in these subjects. It is also evident that the levels of various biomarkers are similar in our diabetic subjects, irrespective of their habits or habitats.
This study evaluated the effects of drinking Moringa oleifera tea on blood sugar levels in 43 individuals with normal or hyperglycemic blood sugar levels. For those with normal blood sugar levels, their levels did not significantly change after drinking the tea. However, for those with hyperglycemic levels, their blood sugar levels significantly dropped an average of 28 mg/dl after drinking the tea. The results suggest Moringa oleifera tea may be beneficial for managing hyperglycemia.
Evaluation of the Acute Effect of Daru Haridradi Kashaya in the Management of...ijtsrd
Diabetes mellitus is a category of metabolic disorders that are characterized by elevated blood glucose levels resulting from insulin synthesis defects, insulin activity, or both. It is correlated with “Madhumeha” describe under the Prameharoga in Ayurveda. This scientific study has been conducted to evaluate the acute effect of Daruharidradikashaya. Daruharidra, Harithaki, Vibhitaki, Amalaki, Mustha and Devadara are ingredients of it.In clinical study ten were selected and given instruction for same diet, lifestyle and antidiabetic drugs for two weeks and specially advised to have same dinner enriched with fiber and protein before the blood test. Then kept fasting for 10 hours. After first week 120ml of Daruharidradi Kashayawas given to the patient while blood drawing for Fasting Blood Sugar FBS test. Then Oral Glucose Tolerance Test OGTT was done. In their second visit 120ml of Luke warm water was given on behalf of the drug and repeated same procedure. FBS and OGTT levels were separately measured and average levels are considered.Also a non parametric test called “Wilcoxon Sign Rank Test” was applied for testing the difference between two dependent samples. Since p values are not less than 0.05, efficacy of the Daruharidradi Kashaya has not been shown statistically significance at 5 percent significant level for all the periods of times. The effectiveness of the drug has not been statistically significant for the remaining periods of times. So it can be concluded that the acute action of Daruharidradi Kashayais not effective for reduce blood glucose level for the remaining period of times. Daruharidradi Kashaya has chronic effectiveness for Diabetes mellitus. So there may be some issues with the acute effect of it. Therefore, for a perfect conclusion, the study sample should be expand under more numbers of patients and the study setting should be IPD inward patient department of the hospital. There is an open field for new researchers to increase this study sample and repeat this procedure. T. K. G. Punchihewa | R. V. Ekneligoda | P. P. Uyanege "Evaluation of the Acute Effect of Daru Haridradi Kashaya in the Management of Blood Glucose Level in Diabetes Mellitus Type 2 – A Pilot Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38604.pdf Paper Url: https://www.ijtsrd.com/biological-science/pathology/38604/evaluation-of-the-acute-effect-of-daru-haridradi-kashaya-in-the-management-of-blood-glucose-level-in-diabetes-mellitus-type-2-–-a-pilot-study/t-k-g-punchihewa
This study investigated calcium and vitamin D intake in healthy children. 184 children with intake below recommendations were randomly assigned to receive dietary counseling plus calcium/vitamin D supplements (Group 1) or counseling alone (Group 2). After 4 months, Group 1 showed improved intake of both nutrients and optimal vitamin D levels, while Group 2 only improved calcium intake and had lower vitamin D levels. The study concludes that counseling alone is not sufficient to achieve adequate vitamin D intake.
The relationship between gastrin hormone level and microalbumin urea in patie...Alexander Decker
This study examined the relationship between gastrin hormone levels and microalbumin urea in 67 patients with type 2 diabetes mellitus and 25 controls. The patients were divided into three groups based on diabetes duration: less than 10 years, 10-20 years, and over 20 years. Both gastrin hormone levels and microalbumin urea levels were measured. There were significant differences found between gastrin levels and microalbumin urea levels for each diabetes duration group compared to controls. Specifically, gastrin levels were higher in patients with microalbuminuria compared to those without, and this difference increased with longer diabetes duration.
Serum Total Bilirubin levels in Diabetic Retinopathy - A case control studyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Microalbuminuria And Serum Creatinine Levels In Diabetic And Non Diabetic Gro...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document outlines 36 shots for a film about an online stalking scenario. It begins with shots establishing the protagonist logging onto social media and accepting a friend request from someone with no mutual friends. Later shots show the protagonist being watched through her webcam by the stalker without her knowledge. The film builds an ominous tone as the stalker is shown accessing private information and videos of the protagonist without her consent. Later shots show the stalker contacting the protagonist directly, implying a real-life threat. The film ends by teasing that the stalker may confront the protagonist in person.
This document summarizes research on vitamin D deficiency and cardiovascular risks. It discusses how vitamin D metabolism and mechanisms of action may impact cardiovascular outcomes. Several studies are cited showing associations between vitamin D deficiency and increased risks of hypertension, diabetes, heart disease, and mortality. However, the document also notes controversies in the research and calls for more rigorous randomized controlled trials. It outlines objectives and methods for a study examining vitamin D levels in patients with ischemic heart disease. The conclusion is that vitamin D levels correlate with cardiovascular disease and supplementation may help outcomes, but more clinical trials are still needed.
From Burnout to Engagement: Strategies to Promote Physician Wellness and Work...Modern Healthcare
Slides from a Modern Healthcare presentation.
http://www.modernhealthcare.com/article/20150225/INFO/302259999/webinar-from-burnout-to-engagement-strategies-to-promote-physician
Faced with long hours, unrelenting administrative burdens and the pressure to treat patients quickly, a growing number of physicians are experiencing burnout, a condition characterized by loss of empathy, exhaustion, and a low sense of accomplishment. According to a Mayo Clinic survey from 2012, nearly one in two U.S physicians reported at least one symptom of burnout, up from 22% in 2001. For hospitals with stressed caregivers, the stakes are high. Burned out, dissatisfied physicians are far more likely to make medical errors and are less able to communicate effectively with patients and co-workers. They're also at a higher risk for substance abuse and are more likely to leave clinical practice altogether.
Do I Have PTSD? - The Signs & Symptoms of Post-Traumatic Stress DisorderDeborah Davis
A lot of people can suffer from PTSD (or post-traumatic stress disorder) after experiencing a traumatic event like natural disasters and serious accidents. Among the most common of the many symptoms are: experiencing flashbacks, bad dreams and having difficulty sleeping. Learn the other symptoms of PTSD in order to help someone you know who might be suffering from it. Check out these slides from Nungkari Treatment Centre.
DIETARY INTAKE AND NUTRITIONAL STATUS IN HEMODIALYSIS PATIENTSNeeleshkumar Maurya
This study analyzed the dietary intake and nutritional status of 50 chronic kidney disease patients undergoing hemodialysis treatment over the course of a year. The average daily dietary intake of calories, protein, carbohydrates and other nutrients was found to be significantly lower than recommended levels. Intake of fruits, vegetables, and dairy products was also inadequate. Over the study period, dietary intake and nutritional status declined, as indicated by decreasing levels of hemoglobin, serum albumin and other biomarkers. The results suggest that hemodialysis patients suffer from malnutrition due to inadequate dietary intake, placing them at higher risk for health complications.
Effects of souvenaid on plasma micronutrient levels and fatty acid profiles i...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
A Study on the Presence of Islets Cell Autoantibodies in NonInsulin Requiring...iosrjce
This study examined the presence of islet cell autoantibodies in 120 non-insulin requiring young diabetic patients in Bangladesh and compared them to 60 non-diabetic controls. The study found statistically significant higher levels of islet cell antibodies (ICA) in diabetic patients compared to controls, with the highest levels in patients diagnosed between ages 20-24. There was a moderate negative correlation between age of diabetes onset and ICA levels. No significant difference was found in glutamic acid decarboxylase 65 (GAD65) levels between patients and controls. This suggests that ICA may be present in young diabetic patients in Bangladesh and correlate with earlier age of diagnosis, while other autoantibodies may also contribute to
The document summarizes a study that investigated the effects of hydro-alcoholic extract of Urtica dioica supplementation on blood lipids, hepatic enzymes, and nitric oxide levels in patients with type 2 diabetes. 50 female patients with type 2 diabetes were divided into a control group that received placebo and an intervention group that received Urtica dioica extract for 8 weeks. The results showed that the intervention group had significantly decreased fasting plasma glucose, triglycerides, and SGPT levels, and significantly increased HDL, nitric oxide, and SOD levels compared to the control group after treatment. The study encourages the use of Urtica dioica extract as an antioxidant agent for additional therapy of diabetes.
Anti diabetic drugs in patients with diabetespharmaindexing
This study evaluated 93 diabetic patients with comorbidities to assess rational use of antidiabetic medications. The most common comorbidity was hypertension (48% of patients). Insulin was the most prescribed antidiabetic drug (64.4% of patients). Patient information materials on diabetes management were provided. The study aims to improve treatment of diabetes and comorbidities through rational prescribing and patient education.
Anaemia in Chronic Renal Failure Patients Undergoing Haemodialysis: A across ...Neeleshkumar Maurya
ABSTRACT Chronic renal failure disease is frequently associated with anaemia and the level of anaemia correlates with the stage of chronic kidney disease (CKD). A cross-sectional study was conducted in 44 chronic kidney disease patients in the department of medicine, M.L.B. Medical College, Jhansi during the period January to June, 2018. The study was evaluating the profile of anaemia and to find the association between the severity of anaemia and ckd-5 patients time period of taking on haemodialysis. Haemoglobin, blood urea, serum albumin, serum creatinine levels were examined using standard techniques. There was a significant difference in the haemoglobin of CKD patients taking 30 days regular interval 3 times values (P <0.05). All 44 patients (100%) were anaemic there was no significant correlation between the severity of anaemia and serum creatinine levels (P > 0.82) the most frequent anaemia in chronic kidney disease patients was a malnourished type of a moderate degree anaemic (7 10mg/dl). A significant correlation was not found between the severity of anomie and serum creatinine levels 30 day interval of CKD of patients on haemodialysis. Keywords: - haemodialysis, anomie, serum creatinine, haemoglobin, malnutrition.
This document provides guidelines for the diagnosis, treatment and prevention of Clostridium difficile infections (CDI). It summarizes key recommendations with evidence grading. For diagnosis, it recommends nucleic acid amplification tests over toxin enzyme immunoassays, and only testing diarrheal stool samples. It stratifies treatment based on disease severity into mild-moderate (treat with metronidazole), severe (vancomycin with/without metronidazole), and complicated (vancomycin orally and rectally with intravenous metronidazole). It also covers recurrent CDI treatment, managing CDI in patients with comorbidities, and infection control practices like contact precautions and environmental disinfection. The guidelines
Frequency of prediabetes and influence of various riskSamiullah Shaikh
This study aimed to determine the frequency of prediabetes and observe the influence of various risk factors on the development of prediabetes. The study found that 29.4% of subjects had prediabetes. Several risk factors were strongly correlated with prediabetes, including high BMI, family history of diabetes, history of gestational diabetes, history of delivering a high birth weight baby, low HDL cholesterol, and high triglycerides. The results suggest screening those with risk factors can help identify individuals at high risk of developing diabetes.
A Study on Biomarkers in a Spatially Distributed Type – 2 Diabetes mellitus G...IOSRJPBS
Diabetes, a dreaded disease already ravaged a huge population worldwide, whether it is inherited through generations or invited by the people by their uncontrolled way of life is still obscure. Biomarkers assay is a boon to the diseased to opt proper prophylactic measures to curb or eradicate diseases. The elevated levels of various biomarkers related to inflammation of vital organs, liver function, kidney function and other vital parameters in our diabetic cases reveals the extent of organ(s) damage in these subjects. It is also evident that the levels of various biomarkers are similar in our diabetic subjects, irrespective of their habits or habitats.
This study evaluated the effects of drinking Moringa oleifera tea on blood sugar levels in 43 individuals with normal or hyperglycemic blood sugar levels. For those with normal blood sugar levels, their levels did not significantly change after drinking the tea. However, for those with hyperglycemic levels, their blood sugar levels significantly dropped an average of 28 mg/dl after drinking the tea. The results suggest Moringa oleifera tea may be beneficial for managing hyperglycemia.
Evaluation of the Acute Effect of Daru Haridradi Kashaya in the Management of...ijtsrd
Diabetes mellitus is a category of metabolic disorders that are characterized by elevated blood glucose levels resulting from insulin synthesis defects, insulin activity, or both. It is correlated with “Madhumeha” describe under the Prameharoga in Ayurveda. This scientific study has been conducted to evaluate the acute effect of Daruharidradikashaya. Daruharidra, Harithaki, Vibhitaki, Amalaki, Mustha and Devadara are ingredients of it.In clinical study ten were selected and given instruction for same diet, lifestyle and antidiabetic drugs for two weeks and specially advised to have same dinner enriched with fiber and protein before the blood test. Then kept fasting for 10 hours. After first week 120ml of Daruharidradi Kashayawas given to the patient while blood drawing for Fasting Blood Sugar FBS test. Then Oral Glucose Tolerance Test OGTT was done. In their second visit 120ml of Luke warm water was given on behalf of the drug and repeated same procedure. FBS and OGTT levels were separately measured and average levels are considered.Also a non parametric test called “Wilcoxon Sign Rank Test” was applied for testing the difference between two dependent samples. Since p values are not less than 0.05, efficacy of the Daruharidradi Kashaya has not been shown statistically significance at 5 percent significant level for all the periods of times. The effectiveness of the drug has not been statistically significant for the remaining periods of times. So it can be concluded that the acute action of Daruharidradi Kashayais not effective for reduce blood glucose level for the remaining period of times. Daruharidradi Kashaya has chronic effectiveness for Diabetes mellitus. So there may be some issues with the acute effect of it. Therefore, for a perfect conclusion, the study sample should be expand under more numbers of patients and the study setting should be IPD inward patient department of the hospital. There is an open field for new researchers to increase this study sample and repeat this procedure. T. K. G. Punchihewa | R. V. Ekneligoda | P. P. Uyanege "Evaluation of the Acute Effect of Daru Haridradi Kashaya in the Management of Blood Glucose Level in Diabetes Mellitus Type 2 – A Pilot Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38604.pdf Paper Url: https://www.ijtsrd.com/biological-science/pathology/38604/evaluation-of-the-acute-effect-of-daru-haridradi-kashaya-in-the-management-of-blood-glucose-level-in-diabetes-mellitus-type-2-–-a-pilot-study/t-k-g-punchihewa
This study investigated calcium and vitamin D intake in healthy children. 184 children with intake below recommendations were randomly assigned to receive dietary counseling plus calcium/vitamin D supplements (Group 1) or counseling alone (Group 2). After 4 months, Group 1 showed improved intake of both nutrients and optimal vitamin D levels, while Group 2 only improved calcium intake and had lower vitamin D levels. The study concludes that counseling alone is not sufficient to achieve adequate vitamin D intake.
The relationship between gastrin hormone level and microalbumin urea in patie...Alexander Decker
This study examined the relationship between gastrin hormone levels and microalbumin urea in 67 patients with type 2 diabetes mellitus and 25 controls. The patients were divided into three groups based on diabetes duration: less than 10 years, 10-20 years, and over 20 years. Both gastrin hormone levels and microalbumin urea levels were measured. There were significant differences found between gastrin levels and microalbumin urea levels for each diabetes duration group compared to controls. Specifically, gastrin levels were higher in patients with microalbuminuria compared to those without, and this difference increased with longer diabetes duration.
Serum Total Bilirubin levels in Diabetic Retinopathy - A case control studyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Microalbuminuria And Serum Creatinine Levels In Diabetic And Non Diabetic Gro...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document outlines 36 shots for a film about an online stalking scenario. It begins with shots establishing the protagonist logging onto social media and accepting a friend request from someone with no mutual friends. Later shots show the protagonist being watched through her webcam by the stalker without her knowledge. The film builds an ominous tone as the stalker is shown accessing private information and videos of the protagonist without her consent. Later shots show the stalker contacting the protagonist directly, implying a real-life threat. The film ends by teasing that the stalker may confront the protagonist in person.
This document summarizes research on vitamin D deficiency and cardiovascular risks. It discusses how vitamin D metabolism and mechanisms of action may impact cardiovascular outcomes. Several studies are cited showing associations between vitamin D deficiency and increased risks of hypertension, diabetes, heart disease, and mortality. However, the document also notes controversies in the research and calls for more rigorous randomized controlled trials. It outlines objectives and methods for a study examining vitamin D levels in patients with ischemic heart disease. The conclusion is that vitamin D levels correlate with cardiovascular disease and supplementation may help outcomes, but more clinical trials are still needed.
From Burnout to Engagement: Strategies to Promote Physician Wellness and Work...Modern Healthcare
Slides from a Modern Healthcare presentation.
http://www.modernhealthcare.com/article/20150225/INFO/302259999/webinar-from-burnout-to-engagement-strategies-to-promote-physician
Faced with long hours, unrelenting administrative burdens and the pressure to treat patients quickly, a growing number of physicians are experiencing burnout, a condition characterized by loss of empathy, exhaustion, and a low sense of accomplishment. According to a Mayo Clinic survey from 2012, nearly one in two U.S physicians reported at least one symptom of burnout, up from 22% in 2001. For hospitals with stressed caregivers, the stakes are high. Burned out, dissatisfied physicians are far more likely to make medical errors and are less able to communicate effectively with patients and co-workers. They're also at a higher risk for substance abuse and are more likely to leave clinical practice altogether.
Do I Have PTSD? - The Signs & Symptoms of Post-Traumatic Stress DisorderDeborah Davis
A lot of people can suffer from PTSD (or post-traumatic stress disorder) after experiencing a traumatic event like natural disasters and serious accidents. Among the most common of the many symptoms are: experiencing flashbacks, bad dreams and having difficulty sleeping. Learn the other symptoms of PTSD in order to help someone you know who might be suffering from it. Check out these slides from Nungkari Treatment Centre.
GCE Sociology Revision (AQA)- Unit 2 Education- Ethhnic differences in achiev...Haleema Begum
For AQA GCE Sociology Unit 2: Education, Revision. Print out as a handout, it is a good way to revise. Application, Interpretation and Analysis tips are also included. All derived from the AS Sociology Revision Guide. Good luck!!!
9 Ways to Be More Productive - Backed by ScienceD B
Everyone wants to be more productive. Officevibe created a presentation to help explain science-based ways to be more productive. All of them are simple to do and free.
You can read the entire article on our blog:
https://www.officevibe.com/blog/how-to-be-more-productive-at-work-infographic
Download our free resources about engagement and happiness:
https://www.officevibe.com/resources
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Anger management involves understanding the roots of anger, learning skills to manage anger such as relaxation techniques, and improving interpersonal relationships. The group discusses understanding what triggers anger, myths about anger, physiological signs of anger, and techniques for dealing with anger like expressing it appropriately rather than suppressing it or escalating conflict. The overall goal is to increase the positive aspects of anger and decrease the negative functions by developing coping skills and problem-solving approaches.
Edema is the accumulation of excessive body fluid in interstitial spaces or serous cavities due to diseases rather than being a disease itself. It can be classified based on its range (generalized vs local) or cause (renal, hepatic, cardiac, etc.). Edema develops due to an imbalance in fluid exchange between plasma and tissues or due to renal sodium and water retention. Causes include increased capillary pressure, decreased plasma proteins, obstructed lymphatics, increased capillary permeability, and renal issues. Edema fluid characteristics depend on capillary permeability and it can be pitting or recessive with distribution influenced by factors like gravity. Edema generally harms tissues but may help dilute toxins in
Cloud computing security from single to multipleKiran Kumar
This document discusses security issues with single cloud providers and proposes a multi-cloud approach. It notes that relying on a single cloud provider poses risks from service availability failures and potential malicious insiders. The proposed system advocates using multiple cloud storage providers ("multi-clouds") to improve data integrity, availability, and reduce intrusions. Code examples demonstrate encryption, file uploads/downloads, and a class diagram is presented. The conclusion reiterates that multi-cloud can help decrease security risks for cloud computing users.
The document discusses biodiversity from several perspectives:
- It defines biodiversity as the variety of life on Earth, including genetic, species, and ecosystem diversity.
- Biodiversity is the result of billions of years of evolution but is now seriously threatened by human activities like habitat loss and climate change.
- Maintaining biodiversity is important for ecological, economic, and moral reasons, and countries have legal obligations to protect biodiversity.
Complementary and Alternative Medicine in Association with Type 2 Diabetes Me...PranatiChavan
Type 2 Diabetes Mellitus is a clinical condition that is associated with energy metabolism, particularly carbohydrate and fat management in the organism. An increase in the prevalence of diabetic population and the association of decreasing patient compliance and medication adherence leads to prefer a new concept for the management of disease complications.
The use of complementary and alternative medicine (CAM) has proved to be effective for controlling diabetes.
Objectives: The purpose of this review is to perform an overview of CAM use, to emphasize its importance for managing diabetic complications and to get outfits of CAM.
Discussion: A literature survey was done by using various articles related to CAM and Diabetes mellitus. The focus was kept on
the frequency of CAM use, the methods they use, the factors related to the use of CAM, the sources of information about CAM
treatment, and the effect of the method used for disease management.
Conclusion: This review concluded that CAM therapy found to have adept at reducing blood glucose, maintaining a healthy
body, and relieving symptoms of DM. From the study, the relevance of CAM for managing Diabetic complications was verified
And the future need to perform scientific researches on CAM use was analyzed.
Article Type: Editorial
Title: Challenges Met by Healthcare Professionals (Nurses) at the time of Covid-19 Pandemic
Year: 2021; Volume: 1; Issue: 2; Page No: 3 – 4
Author: Sumathi Senthilvel
DOI: 10.55349/ijmsnr.20211234
Affiliation: Associate Editor, IJMSNR, Formerly Assistant Professor in Nursing, Department of Fundamental Nursing, Amrita College of Nursing. Ponekkara, Kochi, Kerala. Email ID: AssociateEditor@ijmsnr.com
Article Summary: Submitted : 26-October-2021
Revised : 10-November-2021
Accepted : 02-December-2021
Published : 31-December-2021
Background: Diabetic Retinopathy is a non-communicable disease and metabolic disorder. It is a public health problem in Worldwide. In this paper, finding influencing factors and how much probability to development of DR among known T2DM patients.
Materials and Methods: This was a hospital-based cross-sectional and observational study among T2DM patients, with and without DR in the diabetes clinic with sample of 150 patients. Statistical analysis used chi-square and binary logistic regression analysis was used to identify correlates of DR after controlling of confounders.
Results: In this present study, among 150 patients, 39 (26%) patients had DR. Smoking habit was strongly associated with development of DR (AOR=15.39, p=0.002), patients had history of hypertension was associated with DR (AOR=1.10, p=0.016), medication, in that insulin users were strongly associated with DR (AOR=5.72, p=0.002), duration of diabetes mellitus with >10 years was associated with DR (AOR=1.18, p=0.001), total cholesterol with abnormal was 5-fold more increase in risk with the development of DR (AOR=5.86, p=0.065) but not significant, high hba1c with >6.5% was associated with the progression of DR (AOR=1.34, p=0.035), and fasting blood sugar with abnormal was associated with the progression of DR (AOR=1.01, p=0.027) except age but, showed positive association with DR. Probability of developing DR in a T2DM patient was 98%.
Conclusion: From this study, we revealed that influencing variables were hba1c, smoking habit, intake of tablet/insulin, duration of DM, history of hypertension and fasting blood sugar. The chance/probability of developing retinopathy was very high among known diabetes patients those who had longer duration of DM. Hence, we have recommended a periodic eye screening is mandatory in T2DM patients.
Keywords: diabetes mellitus, diabetic retinopathy, influencing factors, probability, multivariate analysis
Relationship between Severity of Periodontal Disease and Control of Diabetes ...Dr. Anuj S Parihar
Background: Both diabetes mellitus (DM) and periodontitis
are chronic diseases affecting large number of the population
worldwide. Changes in human behavior and lifestyle over the
last century have resulted in a dramatic increase in the incidence
of diabetes in the world. This study was designed to evaluate the
relationship between severity of periodontal disease and control of
diabetes (glycated hemoglobin [HBA1c]) in patients with Type 1
DM in a hospital based study.
Materials and Methods: Fifty patients (n = 50) with Type 1
diabetes were enrolled in the study. They were divided into three
groups based on the degree of glycemic control by measuring
HbA1c levels as: “Good” (HBA1c ≤7) Group A, fair (HBA1c = 7-8)
Group B and poor (HBA1c >8) Group C. All enrolled patients
underwent detailed history and dental checkup. Evaluation for
periodontal disease was done by measuring dental plaque (plaque
index), inflammation of gums (gingival index), probing pocket
depth (PPD), and clinical attachment level.
Results: Type 1 diabetics with poor glycemic control had
increased gingival inflammation (P < 0.05), more dental plaque
(P < 0.05), increased PPDs (P < 0.05) and attachment loss
(P < 0.05) as compared to those with fair and good glycemic
control, respectively.
Conclusion: Severity of periodontal disease increases with poor
glycemic control in patients with Type 1 DM.
Key Words: Glycated hemoglobin levels, periodontal disease,
Type 1 diabetes mellitus
Vitamin D status in children with type 1 diabetes mellitusAzad Haleem
The document discusses vitamin D and its role in type 1 diabetes (T1D). It finds that children with T1D have significantly lower levels of vitamin D compared to healthy children. Vitamin D levels were also lower in patients with longer diabetes duration and poorer glycemic control. However, no significant association was found between vitamin D levels and BMI. The document recommends vitamin D supplementation may help improve outcomes for T1D patients and that further research is needed to better understand the relationship between vitamin D and T1D.
This document contains 4 scientific articles that discuss the role of vitamin D in infectious diseases:
1) The first article finds that vitamin D supplementation is associated with reductions in inflammatory cytokines in adults with cystic fibrosis hospitalized for a pulmonary exacerbation.
2) The second article finds a high rate of vitamin D deficiency in critically ill children and an association between lower vitamin D levels and increased illness severity.
3) The third article reviews evidence that vitamin D supplementation may have benefits for tuberculosis and viral respiratory infections based on randomized controlled trials.
4) The fourth article discusses a study finding that bolus-dose vitamin D can help prevent childhood pneumonia in areas where vitamin D deficiency and pneumonia are highly prevalent.
This document presents a study on the correlation between vitamin D levels and diabetic retinopathy. It begins with an introduction stating that diabetes prevalence is increasing globally and that longer duration of diabetes increases risk of retinopathy. It then discusses the aims and objectives of studying the association between vitamin D levels and retinopathy severity. The methodology section outlines how cases and controls will be selected from patients with and without diabetes and retinopathy and the inclusion/exclusion criteria. The document reviews several previous studies that found inverse relationships between vitamin D levels and retinopathy severity or progression.
This study investigated hypocalcemia in patients with acute gastroenteritis at Liaquat University Hospital in Hyderabad, Pakistan. The study included 66 patients with acute gastroenteritis and 66 healthy control subjects. The mean serum calcium level was significantly lower in patients with acute gastroenteritis (6.8455 ± 1.8266 mg/dL) compared to the control group (9.2167 ± 0.4534 mg/dL). Hypocalcemia was observed in 62 (94%) of gastroenteritis patients but only 13 (20%) of controls. The results demonstrate that low serum calcium is common in patients with acute gastroenteritis.
This study investigated hypocalcemia in patients with acute gastroenteritis at Liaquat University Hospital in Hyderabad, Pakistan. The study included 66 patients with acute gastroenteritis and 66 healthy control subjects. The mean serum calcium level was significantly lower in patients with acute gastroenteritis (6.8455 ± 1.8266 mg/dL) compared to the control group (9.2167 ± 0.5534 mg/dL). Hypocalcemia was observed in 62 (94%) of gastroenteritis patients but only 13 (20%) of controls. The results indicate that low serum calcium is common in patients with acute gastroenteritis.
The effect of vitamin D add-on therapy on the improvement of.pdfFinnyOktaria
This study evaluated the effect of add-on vitamin D therapy on quality of life and clinical symptoms in patients with chronic spontaneous urticaria. 80 patients were randomly assigned to receive either a low dose (4200 IU/week) or high dose (28000 IU/week) of vitamin D supplementation for 12 weeks. Both groups showed significantly reduced urticaria severity scores and improved quality of life. However, the high dose group showed greater improvements in scores at weeks 6 and 12. Vitamin D levels increased significantly in both groups over 12 weeks, but rose higher in the high dose group. No significant differences were seen in medication scores between groups. The results suggest add-on therapy with 28000 IU/week of vitamin D
Study on achievement of target LDC-C in Dyslipidimic patientspharmaindexing
This study analyzed 80 dyslipidemic patients to assess achievement of target LDL-C levels as recommended by ATP III guidelines. The majority of patients had high LDL-C levels and were receiving statin therapy. Based on risk factors, patients were categorized as CHD, high risk non-CHD, or low risk non-CHD. Only 22.5% of patients achieved their target LDL-C levels, which was unsatisfactory. More aggressive lipid management is needed to help more patients reach targets through interventions like pharmacist counseling and medication adjustments.
This randomized controlled trial investigated whether early administration of a single high dose of 540,000 IU of vitamin D3 would reduce 90-day mortality in critically ill patients with vitamin D deficiency. 1360 patients screened vitamin D deficient and underwent randomization to receive either vitamin D3 or placebo within 12 hours of ICU admission. 1078 patients had baseline vitamin D deficiency (<20 ng/mL) confirmed by liquid chromatography-tandem mass spectrometry and comprised the primary analysis population. The trial found no significant difference in 90-day mortality between those receiving vitamin D3 (23.5%) versus placebo (20.6%), and no differences in other clinical or safety outcomes.
Comparative Evaluation of the Effect of Doxycycline As An Adjunct to Non-Surg...QUESTJOURNAL
Background: The association between diabetes and periodontal disease has long been discussed with conflicting conclusions. Earlier studies demonstrating the relationship between diabetes and severity of periodontal disease has been equivocal. However, recent studies have clearly proven that diabetes increases the risk of periodontal disease progression. Less clear is the impact of periodontal disease on diabetes. It has been hypothesised that periodontal therapy may improve the metabolic control of diabetes. Aim: To determine the effect of doxycycline as an adjunct to non-surgical periodontal therapy in improving the metabolic control of poorly controlled type 2 diabetic subjects with chronic generalized periodontitis. Method: 30 poorly controlled type 2 diabetic subjects with chronic generalized periodontitis and receiving antidiabetic therapy were selected for the study. The subjects were randomly allotted to either of two treatment groups containing 15 subjects each: Group 1 (scaling and root planing(SRP)+ 15 days Doxycycline) or Group 2 (scaling and root planing(SRP). The Glycated haemoglobin (HbA1c) values, Gingival Index(GI), and Probing pocket depth of both the groups were assessed at baseline and after 3 months. Results: Both the treatment groups exhibited reductions in HbA1c, G I and Probing pocket depth compared to baseline over time. The amount of reduction in the glycated haemoglobin and gingival parameters was higher in Group I compared to group 2 after 3 months. Conclusion: Both treatments improved glycemic control in patients with type 2 diabetes; however, the reduction in HbA1c values reached statistical significance only in the group receiving doxycycline as an adjunct to scaling and root planing.
This document summarizes a study that assessed the knowledge, attitudes, and practices of 100 patients with type 2 diabetes in Pakistan. The study found:
1) Patients had low overall awareness and knowledge about diabetes, glycemic control, risk factors, and complications. The mean correct answers regarding these topics ranged from 33.5-69%.
2) While 61% checked their blood sugar regularly, few knew the target glucose values. Only 18% understood diabetic diet.
3) Awareness of risk factors like hypertension, smoking, and obesity was higher at 69-92% but target values were unknown.
4) 23% first presented with complications and awareness of eye and renal complications was low at
Heart diseases due to hyperlipidemia (primary or secondary) can lead to cause chest pain, heart attacks,
strokes, cardiac arrhythmias, cardiac failure. Because of these risks, treatment is often recommended for people with
hyperlipidemia, because it is well known factor to increase incidence of heart diseases. This may lead to
development of atherosclerotic plaques which is major etiological factor for establishing coronary artery disease
(CAD). Hypolipidemic drugs used in allopathy include Statins, Fibric acids, Niacin, and Resins but all have their
low compliance due to frequent side effects. Medicinal herbs like Onion and Ginger are hypolipidemic agents
commonly used as flavoring agents and making foods spicy and tasty. We have compared hypolipidemic potential
between these two medicinal herbs. The study was conducted at Ghurki Trust teaching hospital, Lahore from
January to June 2018. Eighty secondary hyperlipidemic patients were enrolled after getting written consent which
was approved by Ethics committee of the hospital. They were divided in two equal groups comprising 40 patients in
each group. Group-I was treated by Ginger 10 grams daily in three divided doses for 2 months. Group-II was
advised to take Onion 200 grams daily in divided amount with each meal i.e.; breakfast, lunch, and dinner for two
months. After two months therapy it was observed by statistical analysis that 10 grams ginger reduced TC (total
cholesterol) of 38 hyperlipidemic patients 12.4 gm/dl and LDL-C (low density lipoprotein cholesterol) 27.3 mg/dl.
In group-II, onion reduced TC in 35 patients 17.9 mg/dl and LDL-C 14.8 mg/dl. Changes in tested parameters are
significant biostatistically with p-values <0.01 to <0.001. We concluded from this research work that Onion and
Ginger reduces risk of CAD by decreasing plasma total cholesterol and LDL cholesterol.
This document outlines a prospective study on the effect of pandemic restrictions on quality of life and medication adherence in diabetes patients. It discusses the introduction, aims and objectives, methodology, results and conclusion of the study. The study aims to assess the impact of COVID-19 pandemic restrictions on quality of life and medication adherence in 110 diabetes patients in Bangalore, India over 6 months. Preliminary results show that quality of life was reduced for most patients due to restrictions, while medication adherence decreased initially but increased after counselling. New diabetes cases and complications were also observed due to reduced activity and increased weight during the pandemic. The study concludes that the prevalence of diabetes has increased overall due to pandemic restrictions.
The document discusses vitamin D, its production, metabolism, and biological functions. It notes that vitamin D acts more like a hormone than a vitamin, as it is synthesized in one part of the body, transported through the bloodstream, and exerts effects in distant tissues by binding to receptors. The document also summarizes several studies that found associations between low vitamin D levels and increased risks of various diseases such as colorectal cancer, metabolic syndrome, and type 2 diabetes.
This research article studied the effects of quercetin (QCT) on experimentally induced diabetes in rats. Rats were divided into three groups: a control group, a diabetic group induced with streptozotocin (STZ), and a QCT-treated group that received QCT before and after STZ induction. Blood glucose levels increased significantly in the diabetic group but decreased in the QCT-treated group. Histological analysis found that STZ caused pancreatic beta cell degeneration and inflammation in the diabetic group. QCT treatment reversed many of these changes in the pancreas and increased beta cell numbers. Immunohistochemistry revealed that STZ increased iNOS and caspase-3, markers of inflammation and apoptosis, while QCT
Similar to 34 effect of-vit_d_supplematation_in_type_2_diabetes_patients_with_pulmonary_tuberculosis (20)
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. Original article
Effect of vitamin D supplementation in type 2 diabetes patients with
pulmonary tuberculosis
Sunil Kumar Kota a,
*, Sruti Jammula b
, Siva Krishna Kota c
, Prabhas Ranjan Tripathy d
,
Sandip Panda e
, Kirtikumar D. Modi a
a
Department of Endocrinology, Medwin Hospitals, Hyderabad, Andhra Pradesh, India
b
Department of Pharmaceutics, Roland Institute of Pharmaceutical Sciences, Berhampur, Orissa, India
c
Department of Anaesthesia, Central Security Hospital, Riyadh, Saudi Arabia
d
Department of Anatomy, Kalinga Institute of Medical Sciences, Bhubaneswar, Orissa, India
e
Department of Cardiology, JIPMER, Puducherry, India
1. Introduction
Current estimates of diabetes suggest that 285 million of
world’s adult population (6.4%) are suffering from diabetes [1].
India has 50.8 million and China has 43.2 million diabetics [2]. The
largest age group involved is 40–59 years. By 2030 it is projected
that 438 million of world’s adult population (7.8%) will be diabetics
with major chunk from India and China [1,3]. The largest age group
will move to 60–79 years age group.
Non-communicable disease including diabetes mellitus ac-
count for 60% of all deaths [4]. World health organization
estimates that there were 9.4 million cases of tuberculosis (TB)
equivalent to 139 cases per 100,000 population and 1.8 million
deaths from the disease [5]. India (1.98 million) and China (1.3
million) constitute 35% of TB cases worldwide. Number of
infectious cases in India is 0.87 million catering to a fifth of the
global burden of TB [5].
Calcitriol, the active form of vitamin D induces antimycobac-
terial activity in vitro [6]. A recent systematic review and meta
analysis suggests that individuals with TB had a lower level of 25
(OH) D than non TB individuals [7]. In North India (278N), 96%
neonates, 91% of healthy school girls, 78% healthy hospital staff and
84% pregnant women were found to have hypovitaminosis D (25
OHD < 20 ng/ml). In south India (138N), hypovitaminosis D is
equally prevalent among different population groups [8].
Based on basic and animal studies, vitamin D and calcium have
also been suspected as modifiers of diabetes risk [9]. There is
accumulating evidence to suggest that altered vitamin D and
calcium homeostasis may also play a role in the development of
type 2 diabetes mellitus (T2DM). A systematic review and meta
Diabetes & Metabolic Syndrome: Clinical Research & Reviews 5 (2011) 85–89
A R T I C L E I N F O
Keywords:
Vitamin D deficiency
Type 2 diabetes
Pulmonary tuberculosis
Sputum smear conversion
A B S T R A C T
Aim: Diabetes and vitamin D deficiency are widely prevalent in India. Studies have proven correlation
between low vitamin D levels and pulmonary tuberculosis (PTB) and low vitamin D levels and insulin
resistance. We evaluated the effects of vitamin D supplementation on type 2 diabetes mellitus patients
with pulmonary tuberculosis (PTB).
Methods: Forty-five subjects (M:F = 34:11) were screened. Inclusion criteria were age >15 years, newly
diagnosed PTB cases with uncontrolled diabetes, serum vitamin D < 20 ng/ml. The patients with vitamin
D level < 20 ng/ml were randomly assigned to 2 groups. Group 1 subjects received oral cholecalceferol
(60,000 units/week) and calcium carbonate (1 g/day) along with anti tubercular treatment (ATT), while
group 2 subjects did not. Sputum was checked at interval of 2 weeks for 12 weeks. Primary end point was
time to achieve sputum smear conversion.
Results: Fifteen patients having vitamin D > 20 ng/ml were excluded. Age of the patients was 42.9 Æ 13.2
years and serum vitamin D levels were 18.4 Æ 15.3 ng/ml. Sputum smear conversion was 6 weeks in group 1
versus 8 weeks in group 2 (p = 0.067). Glycated hemoglobin levels reduced from 11.1 Æ 1.3 to 7.7 Æ 0.9 in
group1 versus 10.3 Æ 1.2 to 7.8 Æ 1.1 (p > 0.1).
Conclusion: Vitamin D can serve as adjuvant treatment of tuberculosis in diabetics with vitamin D
deficiency. Further studies are required to validate this observation and define a cut off for vitamin D level
to prevent immunological alterations.
ß 2012 Diabetes India. Published by Elsevier Ltd. All rights reserved.
* Corresponding author at: Department of Endocrinology, Medwin Hospitals,
Chiragh Ali Lane, Nampally, Hyderabad 500001, Andhra Pradesh, India.
Tel.: +91 9959369777; fax: +91 40 66623441.
E-mail address: hidocsunil@ibibo.com (S.K. Kota).
Contents lists available at SciVerse ScienceDirect
Diabetes & Metabolic Syndrome: Clinical Research &
Reviews
journal homepage: www.elsevier.com/locate/dsx
1871-4021/$ – see front matter ß 2012 Diabetes India. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dsx.2012.02.021
3. analysis suggests that deficiency of vitamin D and calcium
negatively influences glycemia in T2DM [9].
2. Methods
2.1. Study subjects
The study was done in Medwin hospital, Hyderabad. The study
protocol and procedures were approved by the hospital ethical
committee. All participants were provided with full information
about the study’s purpose and they gave informed consent to
participate in the study.
All the patients presenting to the department of general
medicine, endocrinology and diagnosed with pulmonary tubercu-
losis (PTB) prior to commencement of antitubercular therapy (ATT)
were screened to participate in the study. Patients included were
>15 years age, newly diagnosed PTB cases, poorly controlled type 2
diabetes mellitus (T2DM) with HbA1C > 7% and serum vitamin
25(OH) D < 20 ng/ml. Diagnosis of PTB was made when patients
met with one of the following criteria. (a) At least 2 positive report
from 3 sputum smears (spot, morning, spot), (b) one positive smear
and typical pictures of lung infiltration by TB on chest X-ray.
Patients were excluded when age < 15 years, patients already on
ATT, serum 25 (OH) D > 20 ng/ml, patients with diseases affecting
vitamin D metabolism such as malabsorption, renal failure,
patients with prolonged immobilization.
2.2. Data collection
Baseline detailed clinical evaluation included history, lifestyle,
physical activity, dietary habits, fracture and falls, with clinical
assessment including anthropometry, chest examination, chest
radiography, sputum examination (for microscopy), blood sample
(complete blood count, erythrocyte sedimentation rate, serum
calcium, phosphorous, albumin, 25 (OH) D, renal parameters,
glycemic profile). Then patients were reviewed monthly till the
end of 12 weeks. Sputum was checked at the interval of 2 weeks.
2.3. Procedures
All the patients received intensive phase antimicrobial treat-
ment comprising of isoniazid, rifampicin, pyrazinamide and
ethambutol. Along with ATT, patients were randomized to receive
oral cholecalciferol sachets (60,000 IU/week) and calcium carbon-
ate (1000 mg/day) or not. All the patients were adjusted for oral
hypoglycemic agents and insulin for glycemic control.
2.4. Statistical analysis
After meticulous examination of the original study forms, data
were collected into a database in the mean Æ standard deviation
format. Online Graphpad Quickcalc software (http://www.graph-
pad.com/quickcalcs/index.cfm) was used to perform statistical
analyses. Analysis of variance (ANOVA) and the unpaired t test were
used to calculate differences among groups. p value < 0.05 was
considered significant.
3. Results
Total of 45 patients of 45 patients of T2DM with newly detected
PTB (male:female = 34:11). Fifteen patients with serum 25 (OH)
D > 20 ng/ml were excluded. Remaining 30 patients were divided
into group-1, who received vitamin D and group-2, who did not
receive same. So the prevalence of vitamin D deficiency in T2DM
with PTB was 30/45 (66.66%), with 25/34 males (73.5%) and 5/11
females (45.5%) were deficient in vitamin D levels. Mean age of the
study patients was 39.5 Æ 18.9 years (range 22–63 years) with mean
fasting blood sugar 230.5 Æ 30.3 mg/dl, post lunch blood sugar
320.5 Æ 45.6 mg/dl, HbA1C 10.4 Æ 4.4% and 25 (OH) D 12.1 Æ 4.3 ng/
ml.
Baseline characteristics of the both groups are depicted in Table
1. Tables 2 and 3 depict the follow up data for patients under group
1 and 2. Table 4 depicts the comparative data of the patients under
both groups.
4. Discussion
In subjects receiving 60,000 IU cholecalciferol per week along
with ATT, duration of sputum conversion to 100% negative for AFB
was 6 weeks compared to 8 weeks in subjects not receiving
cholecalciferol. It was accompanied by significant increase in
serum 25 (OH) D concentration in patients under the intervention
group. Thought the difference in achievement of sputum smear
negativity between was not significant, it showed a trend towards
early improvement in patient receiving oral cholecalciferol.
A trial by Martineau et al. [10] demonstrated that administra-
tion of four doses of 2.5 mg vitamin D (100,000 IU, 1 mg = 40 IU)
did not affect time to sputum culture conversion in the whole
study group, but it significantly hastened sputum culture
conversion in patients with tt genotype of the Taq 1 vitamin D
receptor polymorphism. Human vitamin D receptor is polymor-
phic; carriage of the t allele of the TaqI vitamin D receptor
polymorphism is associated with an increase in calcitriol-induced
phagocytosis of Mycobacterium tuberculosis (Mtb) in vitro [11]
and more rapid sputum culture conversion in patients with
pulmonary tuberculosis [12]. By contrast, carriage of the f allele of
the FokI vitamin D receptor polymorphism is associated with a
reduction in transcriptional activity [13], reduction of calcitriol-
induced phagocytosis [11], and slower sputum culture conversion
in pulmonary tuberculosis [13]. Our study population may be a
mixture of both alleles reflecting insignificant difference.
Several case series have reported that daily doses of 625 mg
(25,000 IU) to 2.5 mg (100,000 IU) vitamin D improve patients’
Table 1
Baseline characteristics of the patients under both groups.
Parameters Group 1
(n = 15, M:F = 9:6)
Group 2
(n = 15, M:F = 11:4)
Age (years) 38.4 Æ 19.6 40.2 Æ 17.7
Weight (kg) 49.1 Æ 4.5 44.6 Æ 5.6
Hb (gm/dl) 10.9 Æ 1.2 10.5 Æ 1.6
ESR (mm/1st hour) 98.6 Æ 22.7 89.6 Æ 19.6
Duration of T2DM (in years) 10.1 Æ 2.3 12.1 Æ 2.9
FBS (mg/dl) 237.2 Æ 33.2 223.8 Æ 19.6
PLBS (mg/dl) 316.6 Æ 43.7 326.6 Æ 49.6
HbA1C (%) 11.1 Æ 1.3 10.3 Æ 1.2
25-(OH) D (ng/ml) 12.8 Æ 4.5 11.1 Æ 4.7
Group 1: patients receiving vitamin D supplementation in the form of oral calciferol
(60,000 U/week). Group2: patients not receiving vitamin D supplementation. Hb:
hemoglobin; ESR: erythrocyte sedimentation rate; T2DM: type 2 diabetes mellitus;
FBS: fasting blood sugar; PLBS: post lunch blood sugar; HbA1C: glycated
hemoglobin.
Table 2
Follow up data of patients under group 1.
4 weeks 8 weeks 12 weeks
Sputum smear conversion No Yes Yes
FBS (mg/dl) 160.3 Æ 30.2 150.5 Æ 25.3 143.2 Æ 22.3
PLBS (mg/dl) 240.7 Æ 39.9 210.9 Æ 33.5 199.8 Æ 32.1
HbA1C (%) – – 7.7 Æ 0.9
25 (OH) D (ng/ml) 20.3 Æ 4.3 22.3 Æ 5.9 25.4 Æ 6.9
ESR (mm/1st hour) 72.3 Æ 18.5 64.3 Æ 18.5 51.1 Æ 12.5
S.K. Kota et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 5 (2011) 85–8986
4. response to antimicrobial treatment for pulmonary tuberculosis
[14]. Randomised controlled trials investigating doses of up to
125 mg/day vitamin D or equivalent in active tuberculosis have
shown no clinical benefit [15,16], but a trial investigating a higher
dose regimen (250 mg/day, 10,000 IU/day) reported reduced time
to sputum smear conversion in the intervention group [17]. We
provided vitamin D at the dosage of 60,000 IU/week, and report a 2
weeks reduction in sputum smear conversion.
Calcitriol modulates the host response to mycobacterial
infection by induction of reactive nitrogen and oxygen inter-
mediates [18] suppression of matrix metalloproteinase enzymes
implicated in the pathogenesis of pulmonary cavitation [19], and
induction of the antimicrobial peptide cathelicidin [20,21] which
induces autophagy [22]. Calcitriol modulates immune responses
by binding vitamin D receptors expressed by antigen-presenting
cells and activated lymphocytes to regulate transcription of genes
responsive to vitamin D. Some studies have reported that vitamin
D supplementation leads to increase in lymphocyte to monocyte
ratio, a biomarker of disease resolution in animal models.
To maintain uniformity all sputum samples of the study
population was analysed in our hospital laboratory. One of the
largest of trials [16] reported that administration of three doses of
2.5 mg (100,000 IU) vitamin D3 at baseline, 5 months, and 8
months did not influence clinical severity score or time to sputum
smear conversion in 365 patients in Guinea Bissau; however,
patients’ mean baseline concentration of 25-hydroxyvitamin D
was more than 70 nmol/l (28 ng/ml, 1 nmol/l = 2.5 ng/ml), and the
dosing regimen used was too low to influence serum 25-
hydroxyvitamin D concentrations at follow-up. A trial in 67
patients in Indonesia [17] reported enhanced sputum smear
conversion at 42 days, but not at 56 days, after initiation of
antimicrobial treatment in patients receiving 250 mg (10,000 IU)
vitamin D3 daily. The vitamin D content of the study preparation
was not verified, and participants’ serum 25-hydroxyvitamin D
concentrations were not reported before or after supplementation.
After 6 weeks in group1 and 8 weeks in group 2, the subjects
maintained the sputum smear negativity through the study period
of 12 weeks. Strict compliance to ATT might be the positive factor
in our study subjects.
However sputum smear conversion has limited value as a
biomarker of treatment response in PTB because microscopy is less
sensitive and less specific than culture for detection of vital MTb
bacilli in sputum [23]. Multivariate analysis shows that sputum
culture conversion, but not sputum smear conversion is indepen-
dently related to long term risk of treatment failure or relapse [24].
A recent study [10] has utilized this parameter as the biochemical
marker of improvement. We also utilized smear negativity as the
biomarker for treatment response and ended up in having
insignificant difference between the 2 groups, though it was
earlier in patients receiving vitamin D supplementation. Defect in
both humoral immunity (low complement factor 4, decreased
cytokine response after stimulation) and cellular immunity
(chemotaxis, phagocytosis, killing) observed in patients with
diabetes might be an additional factor in delay in response to
treatment [25].
Though a greater decline in glycemic parameters was
observed in patients receiving vitamin D, it was not statistically
significant. Studies have shown inverse relation between serum
25 (OH) D and 1 h post prandial glucose [26]. Vitamin D affects
exclusively the insulin response to glucose stimulation, whereas
it does not influence basal insulinemia [27]. Pancreatic b cells
express Vitamin D receptor (VDR) and 1-a-hydroxylase enzyme
needed for activation of vitamin D [28]. 1,25 (OH)2 D promotes
transcriptional activation of human insulin gene. Insulin
secretion is a calcium-dependent process [29]; therefore,
alterations in calcium flux can have adverse effects on b cell
secretory function. It is speculated that inadequate calcium
intake or vitamin D insufficiency may alter the balance between
the extracellular and intracellular b cell calcium pools, which
may interfere with normal insulin release, especially in response
to a glucose load [9]. Vitamin D may have a beneficial effect on
insulin action either directly, by stimulating the expression of
insulin receptor and thereby enhancing insulin responsiveness
for glucose transport [30], or indirectly via its role in regulating
extracellular calcium and ensuring normal calcium influx
through cell membranes and adequate intracellular cytosolic
calcium pool.
VDR are present on skeletal muscle and vitamin D directly
activates peroxisome proliferator activator receptor d [31], a
transcription factor implicated in the regulation of fatty acid
metabolism in skeletal muscle and adipose tissue [32]. Calcium is
essential for insulin- mediated intracellular processes in insulin-
responsive tissues such as skeletal muscle and adipose tissue [33],
with a very narrow range of intracellular cytosolic calcium needed
for optimal insulin-mediated functions [34]. In people without
diabetes, hypocalcemia is associated with impairment of insulin
release. Insulin receptor phosphorylation leading to insulin signal
transduction and increased glucose transporter-4 activity are
calcium dependent processes. Changes in intracellular cytosolic
Table 4
Comparative data of patients under both groups. NS: not significant. p < 0.05-statistically significant.
Baseline 12 weeks
Group1 (vitamin
D supplemented)
Group 2 (vitamin D
not supplemented)
p Group1 (vitamin D
supplemented)
Group 2 (vitamin D
not supplemented)
p
Number of patients 15 15 – 15 15 –
Hb (10 g/dl) 10.9 Æ 1.2 10.5 Æ 1.6 0.6 13.5 Æ 1.3 11.3 Æ 0.8 0.004
25-(OH) D (ng/ml) 12.8 Æ 4.5 11.1 Æ 4.7 25.4 Æ 6.9 10.2 Æ 0.9 0.0001
Change in ESR from baseline
(mm/1st hour)
– – – 39.6 Æ 12.4 24.0 Æ 14.9 0.004
FBS (mg/dl) 237.2 Æ 33.2 223.8 Æ 19.6 0.6 143.2 Æ 22.3 146.5 Æ 21.4 NS
PLBS (mg/dl) 316.6 Æ 43.7 326.6 Æ 49.6 0.7 199.8 Æ 32.1 197.5 Æ 35.6 NS
HbA1C (%) 11.1 Æ 1.3 10.3 Æ 1.2 0.4 7.7 Æ 0.9 7.8 Æ 1.1 NS
Duration for sputum smear
negativity
0 0 – 6 weeks 8 weeks NS
Table 3
Follow up data of patients under group 2.
4 weeks 8 weeks 12 weeks
Sputum smear conversion No Yes Yes
FBS (mg/dl) 169.3 Æ 29.8 155.5 Æ 23.9 146.5 Æ 21.4
PLBS (mg/dl) 245.8 Æ 33.9 220.3 Æ 22.9 197.5 Æ 35.6
HbA1C (%) – – 7.8 Æ 1.1
25 (OH) D (ng/ml) 10.9 Æ 1.4 11.1 Æ 1.6 10.2 Æ 0.9
ESR (mm/1st hour) 75.6 Æ 19.1 66.4 Æ 19.5 55.5 Æ 13.6
S.K. Kota et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 5 (2011) 85–89 87
5. calcium in primary insulin target tissues may contribute to
peripheral insulin resistance [35] via impaired insulin signal
transduction [35,36], leading to decreased glucose transporter-4
activity [35,37]. Changes in intracellular cytosolic calcim modulate
adipocyte metabolism, which may promote triglyceride accumu-
lation via increased de novo lipogenesis and inability to suppress
insulin-mediated lipolysis leading to fat accumulation [38] Studies
have proven inverse relation between insulin resistance and serum
vitamin D levels.
Vitamin D also improves systemic inflammation by (1)
interacting with vitamin D response elements in the promoter
region of cytokine genes to interfere with nuclear transcription
factors implicated in cytokine generation and action [39], (2)
Down-regulating activation of nuclear factor-k B [40], which is an
important regulator of genes encoding proinflammatory cytokines
implicated in insulin resistance [40] (3) by upregulating expression
of calbindin [41], a cytosolic calcium-binding protein found in
many tissues including pancreatic bcells [42] it interferes with
cytokine generation. Calbindin has been shown to protect against
cytokine-induced apoptosis that may occur after a rise in cytosolic
free calcium [43]. Effects of calcium on cytokines changes in
intracellular cytosolic calcium may lead to cytokine-induced
apoptosis [44].
None of our patients had hypercalcemia or any other major
adverse events. Narang et al. [45], who reported hypercalcaemia in
19 of 30 patients with smearpositive pulmonary tuberculosis
taking a daily dose of 10–95 mg vitamin D. There was much less
hypercalcemia in study by Martineau et al. [10], they showed that
serum corrected calcium concentration declined in both interven-
tion and control arms after initiation of antimicrobial treatment.
Such a decline might have resulted from a reduction in
granulomatous burden in patients responding to treatment,
leading to a decrease in extrarenal 1-alpha hydroxylation of 25-
hydroxyvitamin D and a fall in serum 1,25-dihydroxyvitamin D
concentrations. In a study by Ho-Pham et al., vitamin D
insufficiency was found to be a risk factor for TB in men, but
not in women [46]. We did not see any preferential affection by PTB
in our patients.
The limitations of our study were (a) smaller number of
participants, (b) lack of follow up after the study period, use of
sputum smear conversion rather than sputum culture conversion
as a marker for cure, (c) no division as per vitamin D levels of
deficiency, insufficiency and sufficiency, (d) we did not measure
albumin and uncorrected for albumin calcium levels could be
driven by albumin levels which are known to be low in PTB
patients.
Never the less, we believe that our study points to the role of
vitamin D in the ever growing number of diabetes and PTB. It also
calls for the need to do multicentric studies involving larger
number of patients with a longer follow up.
5. Conclusion
Severe hypovitaminosis D is more prevalent in diabetic
patients with pulmonary tuberculosis. Better improvement in
such patients after vitamin D supplementation emphasizes the
utility of vitamin D as adjuvant treatment of tuberculosis in
selected diabetic patients with vitamin D deficiency. Vitamin D
may be the missing link between emerging epidemic of
tuberculosis and diabetes. Further studies are required to validate
this observation and define a cut off of vitamin D level to prevent
immunological alterations.
Conflict of interest
None declared.
Acknowledgements
All the authors would like to express their heartfelt thanks to Dr.
Jagadeesh Tangudu, M Tech, MS, PhD and Sowmya Jammula, M Tech
for their immense and selfless contribution towards manuscript
preparation, language editing and final approval of text.
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