bluuebunny/crossref_metadata_2025 huggingface dataset:
An Effective Deep Learning Model to Discriminate Coronavirus Disease From Typical Pneumonia
Authors: Waleed Jumana , Azar Ahmad Taher , Albawi Saad , Al-Azzawi Waleed Khaild , Ibraheem Ibraheem Kasim , Alkhayyat Ahmed , Hameed Ibrahim A. , Kamal Nashwa Ahmad
Published: March 2023

Current technological advances are paving the way for technologies based on deep learning to be utilized in the majority of life fields. The effectiveness of these technologies has led them to be utilized in the medical field to classify and detect different diseases. Recently, the pandemic of coronavirus disease (COVID-19) has imposed considerable press on the health infrastructures all over the world. The reliable and early diagnosis of COVID-19-infected patients is crucial to limit and prevent its outbreak. COVID-19 diagnosis is feasible by utilizing reverse transcript-polymerase chain reaction testing; however, diagnosis utilizing chest x-ray radiography is deemed safe, reliable, and precise in various cases.
Ballistic Performance of Epoxy-Ramie Composite - SiC Layered Body Armor Using Finite Element Analysis
Authors: Safaat Ahmat , Sutikno
Published: March 2023

Composite body armor has widely used as bulletproof material combined with hard plates made from ceramic or metals. That replaced the use of full-metals body armor that heavy, rigid, and restricts the user's movement. This study investigates the ballistic performance of SiC-based hard layer body armor on its possible impact position using finite element analysis. The body armor panel consists both of soft and hard layers. The soft layer is made from epoxy-ramie composite which is a natural fiber composite. The hard layer made from hexagonal chip l SiC with 4 mm thickness in an array. There are three possible impact points on the chip which are the center of the chip, between two chips, and between three chips. The soft layer is varied at a range of 6-25 mm depending on its capability to comply with the latest NIJ 0101.07-2019 criteria for RF1. NIJ has several criteria for ballistic performance. This paper discusses panel penetration and Back-face Deformation (BFD) based NIJ. Besides, this paper also discusses the impact of energy absorption and velocity reduction of the bullet by the panel.
Approach to the Choice of Polymer Material of a Drill Pipe Protector
Authors: Yakhimovich Valery A. , Breki Alexander , Kolotiy Aleksandr
Published: March 2023

The drilling conditions are becoming more severe, which leads to the need to select new polymeric materials that can withstand heavy loads, provide a longer resource and are more resistant to high temperatures. To solve the problem, a set of laboratory tests on standard and specialized tribological equipment is proposed. The friction force, wear resistance under various conditions and according to various criteria, hardness at normal and elevated temperatures, thermal field during tests, change in the roughness of a steel counterbody as a result of tests are evaluated. Wear resistance is determined using a PBD-40 friction machine. Samples are cylindrical bodies with a diameter of (5.0 ± 0.5) mm, a height of 10.0 mm from the materials under study. The samples are fixed in the designed fixture. As a result of the tests, the average values ​​of the parameters for the investigated materials were determined, and the effects arising from friction were noted. The criteria for choosing a material have been formulated and the most suitable material for the tread has been selected.
Synthesis and Electromagnetic Wave Absorption Properties of Micro Composites Reduced Graphene Oxide/Ferrite Based Dendrocalamus Asper Charcoal and Natural Ferrite
Authors: Mashuri  , Aswin Adam , Suyatno Suyatno
Published: March 2023

Keywords: bamboo, micro composite, natural ferrite, reduced graphene oxideAbstract. Reduced graphene oxide/ferrite (rGO/Fe3O4) micro composites as radar absorber materials have been successfully synthesized from Petung bamboo (Dendrocalamus Asper) and iron sand using a mechanical mixing method. Reduced graphene oxide (rGO) as dielectric material was synthesized from Petung bamboo charcoal using the carbonization method, and Fe3O4 as magnetic material was synthesized from iron sand using the extraction-milling method. The as-prepared samples rGO/Fe3O4 (1:1, 1:2, 1:3, 2:1, 3:1 wt%) was made by dry mixing and mechanically pressed. Magnetics and morphology of samples were characterized by vibrating sample magnetometry (VSM) and scanning electron microscopy (SEM). Microwave absorption was measured using a vector network analyzer (VNA) at 8 – 12 GHz. The results of measurement by using VNA showed that at the micro-scale, rGO had a higher absorption power with maximum reflection loss (RLm) value of -12.98 dB at matching frequency (fm) 10.15 GHz compared with Fe3O4 (RLm value of -4.25 dB at fm 10.42 GHz) at a thickness of 2 mm. The rGO/Fe3O4 (3:1 wt.%) microcomposites radar wave absorber shows the best absorption with maximum reflection loss (RLm) value of −14.30 dB at matching frequency (fm) 10.15 GHz at a thickness of 2 mm. Natural materials and the controlled rGO/Fe3O4 microcomposites structure with simple synthesis methods shows the great potential application in high performance microwave absorbing materials.
Estimation of the Possibility of Application of Polymer-Composite Materials in Oil Field Equipment under Abrasive Action
Authors: Shishkova Margarita , Kovalev Mark , Tokarev Vasiliy , Vasyutkin Sergey
Published: March 2023

Currently, composites with a polymer matrix are most widely used in various industries, including the oil and gas sector, as an alternative to traditional metal materials. The most widespread of non-metallic pipes in the Russian Federation are pipelines made of fiberglass. One of the clear advantages of polymeric materials over metal products is their corrosion resistance. At the same time, upon contact with liquids containing abrasive particles, composites with a polymer matrix can degrade with varying degrees of intensity. Such as type of degradation like hydroabrasive wear of pipelines is common and can lead to equipment failure. Various linings are applied to the inner surface of fiberglass pipes to minimize hydroabrasive wear. This study attempts to assess the durability of coated and uncoated composite polymer materials under conditions of hydroabrasive wear, as well as to compare the properties with other materials currently used in industry.
Physical Properties Modification of Co-Precipitated CoLa0.1Fe1.9O4 Nanoparticle with Different Fe3+ Raw Material
Authors: Prasetya Nurdiyantoro Putra , Utari  , Iriani Yofentina , Purnama Budi
Published: March 2023

Lanthanum-substituted cobalt ferrite nanoparticles (CoLa0.1Fe1.9O4) with different Fe3+ cation sources i.e., using standard chemical lab (sample A) and a Bengawan Solo River fine sediment (sample B), were synthesized using the co-precipitation method. FTIR analysis showed that the absorption of the two nanoparticles sample appeared at a peak of v1=586.39 cm-1, whereas the v2 appear at 461.97/cm and 435.93/cm respectively. It is suggested that the La3+ cation has succeeded in replacing the original structure of the cobalt ferrite. X-ray diffraction analysis showed that nanoparticles produce using a standard chemical lab (sample A) have smaller crystallite sizes, D=18.16 nm than the natural source of fine sediment (sample B), D=24.56 nm, respectively. Furthermore, the VSM results showed that the magnitude coercive field of Hc = 3100 Oe and Hc = 100 Oe for samples A and B, respectively. Meanwhile, the obtained saturated magnetization Ms of 15.55 emu/g for sample A and the Ms is 58.40 emu/g for sample B. This result informs that if a hard magnetic material is desired then the use of lab raw materials is more promising, while if soft magnetic is desired then a natural source of fine sediment is more appropriate to use.
Canada west coast topo-bathymetric digital elevation model, British Columbia
Authors: Kung R , Douglas K , Stacey C D
Published: March 2023

The joint Natural Resources Canada/Department of Fisheries and Oceans Marine Spatial Planning Program requires the highest resolution bathymetric elevation data and adjacent land-based topographic elevation data that are available. This digital elevation model of
Canada's west coast compiles the best data available from multiple government agencies to create a regional model gridded at 10 metre spacing. The transitions between the marine and terrestrial areas are near-seamless creating a surface of elevations for non-navigational scientific research,
cartographic, and general marine spatial planning use. The product is available on the Federal Geospatial Platform at: https://open.canada.ca/data/en/dataset/e6e11b99-f0cc-44f7-f5eb-3b995fb1637e
Cost of Care and Impact on Quality of Life of Upper Urinary Tract Infections in South India with a Focus on Diabetics and Extended-Spectrum Beta-Lactam Producing Organisms
Authors: Daniel Ebenezer , Yadav Bijesh , Jeyaseelan Lakshmanan , Babu Malavika , Raj Mani Selvin Sundar , Mathuram Alice Joan , Sathyendra Sowmya , Hansdak Samuel George , Iyyadurai Ramya , Sahni Rani Diana , Sudarsanam Thambu David
Published: March 2023

Background and Objectives:

Upper urinary tract infections (UTIs) that require in-patient care can be expensive. Comorbid conditions such as diabetes as well as UTI due to extended-spectrum beta-lactamase (ESBL) producing bacteria may affect costs. The quality of life of patients with this condition has not been described.

Methods:

This was a cost of illness study that prospectively evaluated patients admitted with upper UTI to a medical ward in a tertiary care hospital. Direct medical and nonmedical costs, indirect costs were collected to make the total cost per admission. Quality of life was assessed using the World Health Organization Quality of Life-BREF score. We also compared costs between those with and without diabetes or ESBL infection.

Results:

Between March 2016 and July 2017, 92 eligible patients were included in the study. The average age was 55.8 years; two thirds were diabetics. The mean overall cost of a single admission for upper UTI was INR.88, 330.2 (1370.4 USD). This was INR.96, 193.0 (1492.6 USD) and INR.1, 03,154.9 (1600.4 USD) among those with diabetes mellitus and ESBL infection, respectively. The cost was higher among those with diabetes and ESBL than those without; this difference reached statistically significance for the ESBL group. The quality of life was affected in all domains; the psychological being most affected among diabetics and ESBL infected.

Conclusions:

The mean total cost of admission for an upper UTI in a tertiary care hospital in South India was INR 88,330 (1370.4 USD). This is higher if the patient has diabetes or ESBL organism causing the UTI. Quality of life is clearly reduced especially in the psychological domain.
A Retrospective Cross Sectional Study on Clinical Profile of Neonatal Seizures in a Tertiary Care Government Hospital, Western India
Authors: Nagadia Qury , Pandav Ghosha , Nagadia Urja , Prajapati Nisha , Patel Nehal , Thanvi Rashmi
Published: March 2023

Background:

Convulsion during the first few weeks of life in a newborn is a frequent problem. Such disturbances may have many causes contributing to their etiology and have prognostic significance as well.

Objective:

This study aimed to determine the etiology, effect of gestational age, onset, types, and mortality of neonatal convulsions. We also aimed to evaluate the clinical parameters, computed tomography (CT) brain scan, neurosonogram, metabolic profile, and cerebrospinal fluid analysis as well as the response of antiepileptic drugs and outcome in these babies.

Materials and Methods:

A retrospective cross-sectional study was done at the neonatal intensive care unit of a tertiary care teaching hospital. The study group comprised 358 neonates with neonatal seizures (163 inborn and 195 referred) admitted over 2 years. Data were entered in Microsoft Excel and analyzed in SPSS version 12 (Chicago, Illinois, USA).

Results:

Out of 10,232 live births, 163 had seizures in the neonatal period, giving an incidence of 15.9/1000 live births. The most common type of seizure was tonic accounting for 33.2%. The most common etiology was perinatal asphyxia – 50.8%, followed by central nervous system infection – 20.1%. One hundred and twenty-six out of 358 patients expired contributing to mortality of 35.1%. All the newborns with perinatal asphyxia had seizures within the first 7 days.

Conclusions:

Improvement in antenatal and perinatal care with early identification of high-risk mothers will reduce the incidence of birth asphyxia and thereby of neonatal convulsions. Subtle seizures are most common and should not be missed. CT brain scan and neurosonogram are useful in the early detection of cerebral edema, ischemic hypodensities, and hemorrhage which contributes to prognostic significance.
Decision-making Process in the Selection of Home Hemodialysis Treatment by Adult Patients with End-stage Renal Disease in the United Kingdom
Authors: Ekpenyong Mandu Stephen , Alfred Stephen Hope , Foluke Bosu-Arije Stella , Jallow Oley , Manju C. Pallam , Mathew Nyashanu
Published: March 2023

Introduction:

In the UK, the number of people diagnosed with renal disease is on the increase. As a result, there will be more people in need of renal replacement therapy (RRT). Despite the mounting evidence showing that home hemodialysis (HHD) treatment is clinical and cost-effective as well as amendable to suit patients' lifestyle, the number of patients choosing this dialysis modality is low. The aim of this study is to explore factors influencing decision-making process in the selection of HHD treatment for adult patients with end-stage renal disease in the UK.

Methods:

A systematic literature review methodology was utilized to review, critique, and synthesize the literature on the low uptake of HHD among adult patients. Systematic searches involving the databases Google Scholar, EMBASE, MEDLINE, PsycINFO, and CINAHL were carried out for articles published from 2008 to 2021. A search was conducted from June 1 through December 23, 2020. Eight articles met the study inclusion criteria. We followed preferred Reporting Items for Systematic Reviews and Meta-analyses in designing the research and reporting.

Results:

This systematic review revealed that patient information needs, dialysis education, training and support, and patient decision-making preference were the major factors influencing decision-making of adult patients.

Conclusion:

Deciding over which dialysis modality to choose can be challenging for many adult patients. Dialysis education, training, and support should not stop at the predialysis stage but should continue during treatment.
Test and Item Information of Oral Health Literacy Adult Questionnaire
Authors: Gurung Deepak , Bhardwaj Vinay Kumar , Fotedar Shailee
Published: March 2023

Context:

Item response theory (IRT), is a psychometric measure of trait considering each response positioned on a continuum.

Aim:

Assessment of item and test information Oral Health Literacy Adults Questionnaire (OHL-AQ) using IRT in the patient visiting the tertiary institution of Himachal Pradesh.

Settings and Design:

A descriptive cross-sectional study conducted on patients visiting the outpatient department.

Methods:

Data were obtained from the participant and recorded on a structured schedule using OHL-AQ.

Statistical Analysis:

The two-assumption essential for IRT are unidimensionality and local independence of items. Unidimensional dichotomous IRT consists of three models and three parameters of difficulty discrimination and guessing. Item response interpretation is based on item characteristic curves, test characteristic curve (TCC), and test information function, and analyses were conducted using the statistical software package STATA version 14.

Results:

The selection of 3PL model is based on the likelihood ratio test which is higher (χ
2 = 133.62, P < 0.0001) than other models (χ
2 = 130.41, P < 0.0001). The parameter estimate of pseudo-guessing is 0.02 indicating mild degree of guessing and represent the smallest probability of correct response. The TCC of the study shows that 95% of the randomly selected respondent scored between 3.23 and 14. The median probability of correct response is 8.16 when both difficulty and discrimination parameter is equal.

Conclusion:

IRT is an estimated probability of a response to a given item. Our study showed that OHL-AQ measures higher levels of OHL more precisely compared to lower levels. The OHL-AQ scale is the precise measure of both high and low levels of OHL.
Diet adherence and factors associated with nonadherence among Type 2 diabetics at an urban health center in Tamil Nadu, India
Authors: Selvam Janani , Thangaraj Prabha , Hemalatha Kumarasamy , Subbian Pandi
Published: March 2023

Introduction:

Diabetes is a slow epidemic causing threat to public health worldwide. Several studies have been done to assess the medication adherence among patients with diabetes. The present study has focused on dietary adherence and attempted to identify factors associated with nonadherence to a diabetic diet.

Materials and Methods:

A cross-sectional study was conducted among 284 patients with type 2 diabetes visiting the outpatient department of an urban health-care center in Tamil Nadu, India. A semi-structured questionnaire was used for data collection. Summary of Diabetes Self-Care Activities tool was used to assess adherence for medication and physical activity while Perceived Dietary Adherence Questionnaire tool was used to assess the adherence to diabetic diet.

Results:

The dietary adherence was high in only 4.2% (95% confidence interval [CI]: 2.20–7.26) of the patients with diabetes while 73.2% (95% CI: 67.69–73.30) and 22.5% (95% CI: 17.81–27.84) had medium and low adherence to diabetic diet, respectively. Adherence to medication and exercise were 91.5% and 63.4%, respectively. The duration of diabetes, higher body mass index, presence of comorbidity, history of diabetic complication, and adherence to exercise were associated with better compliance to diet while socioeconomic status was not.

Conclusion:

The present study has identified poor adherence to diabetic diet in spite of good medication adherence. The practice of spacing of carbohydrate food and intake of Omega-3 fats needs to be improved while the consumption of food rich in other fats should be decreased. Dietary fiber intake can also be better. The findings can help plan future study to identify barriers to diet adherence and also effective methods to improve dietary practices among the patients with diabetes.

The following core competencies are addressed in this article:

Medical knowledge, Patient care, Systems-based practice, Practice-based learning and improvement.
Effectiveness of coronavirus disease-19 vaccination on disease transmission, hospitalization, and clinical outcomes in adults in North India
Authors: Agrawal Ruchi , Agrawal Yogesh , Saini Manu , Singh Yogesh , Mathur Shikha , Tak Amit
Published: March 2023

Introduction:

Covaxin and Covishield vaccines have been rapidly rolled out in India to curb the Coronavirus disease-19 (COVID-19) pandemic. The present study tested the effectiveness of COVID-19 vaccination in adults in North India. Effectiveness was tested by considering disease transmission and post-COVID outcomes in infected individuals.

Materials and Methods:

This study was conducted in the Department of Physiology at MGM College, Jaipur (Rajasthan, India), after approval from the Ethics Committee. Vaccinated and nonvaccinated groups were compared for disease transmission, hospitalization, and clinical outcomes. Researchers collected data using questionnaires circulated through Google forms. The association between attributes was tested using the Chi-squared test. The significance level was considered at 5%.

Results:

Vaccination significantly reduced disease transmission of COVID-19 (χ
2 = 4.51; P = 0.034). However, no significant differences were seen in the Reverse transcription polymerase chain reaction positivity, chest computed tomography findings, and hospitalization. Similarly, COVID-related symptoms and their severity did not differ significantly between the two groups. The proportion of vaccinated individuals increases with age (χ
2 = 41.68; P < 0.001). Youths and older adults were vaccinated once and twice, respectively (χ
2 = 41.77; P < 0.001). The severity of adverse effects postimmunization (AEFI) was similar in all age groups (χ
2 = 13.22; P < 0.21). Males and females were equally vaccinated (χ
2 = 1.13; P < 0.288). However, males took two doses compared to females (χ
2 = 6,57; P < 0.01). Adverse effects postimmunization were more severe in females than males (χ
2 = 13.10; P < 0.001). Researchers found no association between the number of vaccine doses and the severity of AEFIs (χ
2 = 16.42; P = 0.06).

Conclusion:

The present study concludes the beneficial effect of vaccination in reducing disease transmission. However, vaccination showed no effectiveness in mitigating other COVID-related outcomes.

The following core competencies are addressed in this article:

Medical knowledge, systems-based practice, practice-based learning, and improvement.
A community-based study on willingness and predictors to receive precautionary dose of COVID-19 vaccine in Puducherry
Authors: Dakshinamurthy Senkadhirdasan , Chellamuthu Lalithambigai , Rajendran Govindaraj
Published: March 2023

Introduction:

World Health Organization has proposed yearly boosters for high-risk adults and biannual boosters for the general population. Research on the acceptance of current COVID-19 immunization has been done, but only a little information is available on booster dose acceptance in India. The objectives of this study were to assess the willingness to receive precautionary doses of the vaccine among adults and to identify the sociodemographic predictors to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19 in Puducherry.

Methods:

A community-based, cross-sectional study was conducted for 2 months in the field practice area of a private medical college in Puducherry. Individuals, ≥18 years residing for >6 months in the selected villages/wards and willing to give consent were included in the study. Individuals with absolute/relative contraindications for COVID-19 vaccination were excluded from the study. The sample size was 632, and a multistage sampling technique was employed. A semi-structured questionnaire was utilized for face-to-face interviews.

Results:

Among 632, 86.4% were vaccinated with two doses of COVID-19 vaccines. Out of 609 adults who have been fully vaccinated against COVID-19, 83.6% exhibited willingness to receive precautionary doses of the vaccine. Common factors influencing willingness to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19 which were fear of postvaccine complications in 37%, less awareness about the precautionary dose among 14%, waiting for others to get vaccinated first in 7%, and 2% expressed as their personal desire for not being vaccinated. Education and socioeconomic status of the individuals were found to be significantly associated (P < 0.05) with the willingness to receive precautionary doses. Gender, marital status, and residence of the study population were significantly associated with higher odds for willingness to receive precautionary doses.

Conclusion:

Most of the adult population in this study completed the second dose of the COVID-19 vaccine and were willing to receive a third dose.

The following core competencies are addressed in this article:

Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge, Interpersonal and communication skills, and Professionalism.
Screening, Diagnosis, and Management of GDM
Authors: Bagias Christos , Xiarchou Aggeliki , Saravanan Ponnusamy
Published: March 2023

Gestational diabetes mellitus (GDM) is characterized by an imbalance between insulin supply and resistance, resulting in maternal hyperglycemia first diagnosed during pregnancy. The increasing incidence of GDM parallels the obesity epidemic. There is no universal consensus on optimal screening and diagnostic criteria but it is widely accepted that pregnancies complicated by GDM are at high risk of short- and long-term adverse outcomes for both mother and offspring. Early intervention with lifestyle changes and medical treatment has been shown to prevent perinatal complications. At the same time, the application of clinical guidelines to real world clinical practice may be challenging as it is affected by socioeconomic diversities.
Survey of Diabetologists and Obstetricians’ Practice Patterns Related to Care for Gestational Diabetes Mellitus During the COVID-19 Pandemic in India
Authors: Bhavadharini Balaji , Uma Ram , Anjana Ranjit M. , Mohan Viswanathan
Published: March 2023

Aim:

There are limited data on the management of gestational diabetes mellitus (GDM) during the coronavirus disease 2019 (COVID-19) pandemic. This survey was carried out in India to understand the practice patterns of diabetologists and obstetricians (OBs) during the pandemic.

Materials and Methods:

An online questionnaire was designed, and the link to the survey was shared with doctors through email. Questions were related to the diagnosis and management of GDM both before and during the COVID-19 pandemic.

Results:

A total of 117 diabetologists and 90 OBs from different parts of India participated in the survey. During the COVID-19 pandemic, diabetologists carried out higher random glucose and HbA1c tests and lower numbers of oral glucose tolerance tests (OGTTs), but differences compared with before COVID-19 were nonsignificant. The OBs reported doing a significantly lower number of OGTTs (85.6% vs. 95.6%, P = 0.02) and significantly more HbA1c tests (16.7% vs. 5.6%, P = 0.03) and self-monitoring of blood glucose (59.4% vs. 37.1%, P < 0.0001) during the pandemic, than earlier. Although 97% of all the doctors surveyed reported using some form of telemedicine, several challenges were identified.

Conclusion:

The COVID-19 pandemic has resulted in changes in the management of women with GDM. The use of digital technologies could help improve the care of women with GDM during such pandemics.
Diabetes Care during Humanitarian Crises due to Floodings and Earthquakes in IDF-MENA Region
Authors: Odhaib Samih A. , Masood Shabeen N. , Belkhadir Jamal , Sandid Mohamad , Shaikh Zaman , Farooq Farah N. , Naz Fizza , Masood Faryal T. , Ayub Ayesha , Bilal Ahmed
Published: March 2023

Background:

Diabetes care in humanitarian crises after the devastating 2005 earthquake in Pakistani Jammu and Kashmir, and in 2022 huge floodings across Pakistan is challenging due to many topographic reasons related to the terrain and the infrastructure

Materials and Methods:

In this article, 197 articles were reviewed from PubMed and Google Scholar using conveniently related search terms in the titles and abstracts published from (2000-2022). Additional information was retrieved from the official sites of active international aid organizations and news agencies.

Results:

It was found that the preparedness plans for proper diabetes care in disaster and non-disaster settings are unsatisfactory in malfunctioning healthcare infrastructures and the non-availability of life-saving medications like insulins. These plans are not fulfilling the needs of the people living with non-communicable diseases like diabetes and hypertension. The role of the international aid organizations after 2005 was directed toward immediate care of traumatic conditions and their complications, infectious diseases control, mental health, care for the elderly, and orphanage care but not covering the diabetes care.

Conclusions and Recommendations:

The healthcare authorities should adjust a disaster preparedness plan for the country, integrating noncommunicable disease control as a pivotal part and mitigating the current deficit in diabetes care for people in need in different humanitarian crises.
Accessibility and Availability of Insulin
Authors: Saad Michele Abi , Masood Shabeen Naz , Al Bache Nizar , Odhaib Samih Abed , Belkhadir Jamal , Shegem Nadima
Published: March 2023

Introduction:

One hundred years after its discovery, insulin is still inaccessible for many people living with diabetes. In the recent World Health Organization (WHO) 2021 report on Barriers to Insulin Availability, WHO highlights the alarming state of global access to insulin. According to International Diabetes Federation (IDF), as reported in IDF Atlas, 10th edition, 73 million adult people with diabetes (PWD) live in Middle East and North Africa (MENA) Region.

Materials and Methods:

A survey was conducted in the International Diabetes Federation (IDF) MENA Region through its Member Associations in 2021. Eighteen countries out of 21 participated. Questions were about insulin support, beneficiaries, local production, insurance coverage, average cost, minimum wage, and barriers to access.

Results:

Fifty percent of countries had full government support and 44% had partial. In 56 % of countries, support is limited to human insulin, and the majority is restricted to citizens. Some PWDs have difficulties accessing insulin: low-income persons, refugees, noncitizens, or living in remote areas. Approximately 61% of countries have national social security funds and 61% private insurance coverage for insulin. In five countries, there is a law prohibiting nongovernmental organizations to receive international donations of insulin. Local production exists in only five countries surveyed. There is a wide variation in the cost of insulin from $1.42 to 100 and in the minimum wage ($7–2667). Additional barriers to access were delivery, storage, cost, electricity, war conditions, displacements, and sanctions.

Conclusion:

Although government support is available in the majority of countries, it is still mainly through the provision of human insulin and restricted to citizens. Many barriers affect access to insulin and its costremains unaffordable. Disparities exist between countries within the same classification of income. Mapping the current situation will help to improve it and monitor change. This document can be informative for PWD living or visiting any of these countries and can help understand cross-border travel for medical treatment, and local and regional policies.
Design and Methodology of a Randomized Crossover Trial to Test the Effect of Low and High dAGE Diets on Metabolic Risk Factors and Inflammatory Markers among Overweight and Centrally Obese Asian Indian Adults
Authors: Bai Mookambika Ramya , Vedantham Srinivasan , Shobana Shanmugam , Nagarajan Lakshmi Priya , Rajagopal Gayathri , Gunasekaran Geetha , Nagamuthu Gayathri , Chandrashekaran Anitha , Gokulakrishnan Kuppan , Sandhya Narasimhan , Regin Bhaskaran Sarojam , Ganeshjeevan Ramajeevan , Muthuswamy Balasubramanyam , Anjana Ranjit Mohan , Unnikrishnan Ranjit , Krishnaswamy Kamala , Mohan Viswanathan , Sudha Vasudevan
Published: March 2023

Background:

Heat processing of foods accelerates the formation of advanced glycation end products (AGEs). Dietary AGEs (dAGEs) could exacerbate the risk for diabetes, by adversely affecting glucose metabolism. Asian Indian diets have not been evaluated for AGEs and their effect on metabolic risk factors.

Objective:

As a proof of concept, we report the dAGE content of Indian foods to further plan the design and methodology of a study that would evaluate the effect of high and low dAGE diets on metabolic risk factors such as insulin resistance, glycemia, lipid profile, and inflammatory markers in overweight and centrally obese Indian adults without diabetes.

Materials and Methods:

This randomized crossover trial includes 50 overweight and centrally obese adults aged 25–45 years with body mass index (BMI) ≥23 kg/m2 and waist circumference (WC) ≥90cm in men and ≥80cm in women. Participants will be provided 12 weeks each of low and high dAGE diets (with the dAGE content being measured by enzyme-linked immunosorbent assay), matched for calories and macronutrients with a 2-week washout period in between the two diets. Low dAGE diets use steaming, boiling, and pressure cooking compared to deep frying, stir frying, and roasting in high dAGE diets. Biochemical measures will be assessed both at baseline and the end of each diet using standard protocols. The difference in outcome measures will be evaluated (analysis of variance and paired t test) using SAS (version 9.2).

Results:

The dAGE content was found to be 49709 ± 5239 vs. 26178 ± 4327 mg/day (mean ± standard deviation [SD]) in high and low dAGE diets, respectively (P < 0.001). Baseline demographic and biochemical characteristics did not differ between low and high dAGE diet interventions.

Conclusion:

The study trial will throw light on the effect of high and low dAGE diets on metabolic risk factors in overweight and centrally obese Indian adults, potentially leading to a novel dietary strategy to prevent diabetes in this population.
An Unusual Side Effect of Metformin—Nightmare and Abnormal Dreams
Authors: Agrawal Prabhat Kumar , Gautam Ashish , Pursnani Nikhil , Parihar Awantika , Singh Boentika
Published: March 2023

Background and Aims:

Metformin is universally accepted as first-line oral hypoglycemic agent for type 2 diabetics, with a low side effect profile and very few serious complications reported till date.

Materials and Methods:

A 30-year-old male, newly diagnosed diabetic was started sitagliptin + metformin (50/500) combination two times daily and presented with the complaint of nightmare and abnormal dreams.

Results:

On stopping metformin, the patient does not experience nightmares and abnormal dreams.

Conclusion:

We found an unusual side effect of metformin causing nightmare and abnormal dreams.
Injection Site Acanthosis Nigricans in Type 1 Diabetes Mellitus and Hepatocellular Carcinoma
Authors: Reddy Devireddy Sandeep , Thaduri Krishna Reddy , Paidipally Srinivas Rao , Danda Vijay Sheker Reddy
Published: March 2023

Many injection site cutaneous complications such as lipohypertrophy and atrophy are known to occur in type 1 diabetic individuals. Acanthosis nigricans (AN) with insulin injection is a rare complication described in few case reports. It is also described as a paraneoplastic manifestation of malignancies such as hepatocellular carcinoma (HCC). Here we describe a case of injection site acanthosis in a type 1 diabetic with underlying HCC. This case report highlights the importance of knowledge on proper injection technique to prevent such unfortunate complications. High degree of suspicion of underlying malignancies is warranted in atypical presentation of AN.
Pregnancy Outcome in Women with Type 1 and Type 2 Diabetes Mellitus in Dubai Hospital
Authors: Saquib Shabnam , Tambawala Zenab Y. , Waheed Seema , Hubaishi Nawal M.
Published: March 2023

Aim and Objectives:

Pregestational diabetes mellitus (PGDM) affects less than 1% of the obstetric population. It has a significant impact on maternal and fetal morbidity and mortality. This study aimed at evaluating antenatal care and pregnancy outcomes in women with PGDM who delivered in Dubai Hospital during 2017–2019.

Materials and Methods:

A retrospective analysis of all women with diabetes mellitus who delivered in a tertiary care hospital at Dubai from January 1, 2017, to December 31, 2019, was conducted. Maternal characteristics, type of diabetes mellitus, prepregnancy and antenatal glycemic control, mode of delivery, birth weight, and perinatal outcomes were evaluated during the study period. We also compared glycated hemoglobin (HbA1c) levels prepregnancy and during the antenatal period in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), with its impact on maternal and fetal outcomes.

Results:

There were 7284 women who delivered during the study period at our hospital, out of whom 28 women (18.8%) had T1DM and 121 women (81.2%) had T2DM. A total of 144 (96.6%) patients were booked in the antenatal-diabetes mellitus combined clinic. Seventy-nine (53%) women had measured HbA1c within six months before pregnancy. Only 53% women preconceptionally had HbA1c levels <6.5%; however, by the third trimester, 74% of women achieved HbA1c <6.5%. Antenatally, 26 women were associated with essential hypertension, 10 with nephropathy, and eight with retinopathy and 12 women developed preeclampsia. Forty-six (30%) women had preterm delivery at less than 37 weeks. This was significantly higher in T1DM versus T2DM (50% vs. 27%, P value = 0.01). The cesarean section rate was 62%, and 50% of them were due to repeat elective cesarean section. Twelve babies born were more than 4kg, and one of them weighed more than 5kg (5.270kg). There were five cases with stillbirth, no neonatal death was recorded within seven days, and the perinatal mortality rate was 30/1000.

Conclusion:

The interval prevalence of PGDM in our cohort was 2%. Achieving HbA1c levels <6.5% in two-third of the women with diabetes mellitus by the third trimester resulted in a prevalence of macrosomia (8%) similar to the general population.
Peyroni's Disease Maybe Initial Presentation of Diabetes Mellitus
Authors: Agrawal Prabhat , Gautam Ashish , Parihar Awantika , Singh Boentika
Published: March 2023

We report a case of a 30-year-old man presenting with complaint of pain during coitus. On history taking and examination, Peyronie's disease was diagnosed in which the connective tissue of the corpus cavernosum is affected. It is characterized by excessive fibrosis and formation of plaque, causing deformities in the erect state such as curvature, indentation, shortening, and narrowing with a hinge effect, also penile pain with erection. On the basis of deranged blood sugar, he was diagnosed as a case of type 2 diabetes mellitus. We are reporting this case because after control of hyperglycemia, the symptoms and signs of Peyronie's disease slightly improved.
Werner Syndrome
Authors: Dos Remedios Monteiro Ana Soraya Palmira , Pavithran Praveen V. , Nampoothiri Sheela , Yesodharan Dhanya
Published: March 2023

A 36-year-old male presented with young-onset diabetes and advanced peripheral vascular disease. He had a history of bilateral juvenile cataracts and premature aged appearance. Closer scrutiny unraveled multiple endocrine and nonendocrine abnormalities. Genetic studies revealed a novel pathogenic variant (homozygous c.3233+2T>c) confirming and expanding the mutation spectrum of Werner syndrome. This report highlights the need for precise diagnosis, which has important implications for prognosis and genetic counseling.
Diabetic Striatopathy
Authors: Agrawal Prabhat Kumar , Singh Akhilesh Kumar , Pursnani Nikhil , Verma Upendra Kumar
Published: March 2023

Diabetic striatopathy is a rare clinico-radiological phenomenon characterized by hemichorea/hemiballismus, hyperglycemia, hyperosmolarity in the absence of ketoacidosis. It is due to lesion in contralateral basal ganglia which is evident as T1 hyperintensity in MRI brain study. Here we are reporting a case of hemichorea /hemiballismus which was associated with hyperglycemia. Our patient improved significantly once blood glucose was controlled adequately. As it carries good prognosis, we are reporting this rare case to illustrate the importance of recognition of this rare syndrome.
A Study of Lifestyle Modifications with and Without Metformin in Prediabetic Subjects
Authors: Basavareddy Asha , Sarala Narayana , Nanjappa Venkatarathnamma P. , Eshwarappa Sumathi M.
Published: March 2023

Purpose:

Prediabetes is a stage in the natural history of impaired glucose metabolism rather than as a distinctive clinical entity. The primary objective was to compare the effect of lifestyle modifications (LSMs) with and without metformin in prolonging the onset of diabetes mellitus in prediabetics.

Materials and Methods:

This study is an open label, parallel group comparative study conducted from 2016 to 2020. One hundred and four prediabetic subjects were assigned to two groups: group I (51) LSM and group II (53) metformin 500 mg along with LSM. Baseline investigations included fasting blood sugar (FBS), post-prandial blood sugar (PPBS), HbA1c, and lipid profile, followed up for 12 months.

Results:

The baseline parameters were comparable between the groups. In both the groups, there was a significant reduction in abdominal circumference, total cholesterol, triglycerides, low-density lipoprotein, FBS, PPBS, and HbA1c between baseline and 1 year. There was no significant difference between groups I and II in reduction of all the above-mentioned parameters. The outcomes of prediabetic subjects after 1 year of treatment in both the groups were comparable. Only one (2.1%) subject had more than 126 mmHg FBS in the LSM group. The adverse effects observed were dizziness, nausea, flatulence, myalgia, abdominal pain, and heart burn, which were mild to moderate in intensity and in most patients it subsided with time.

Conclusion:

LSM alone was equivalent to LSM along with metformin in effective control of blood sugars. Lipid profile and weight may be significantly reduced.
Diabetic Retinopathy and the Principles of Screening
Authors: Karadeniz Sehnaz
Published: March 2023

Diabetes-related eye problems are a growing eye health concern globally, and diabetic retinopathy (DR) is one of the leading causes of preventable blindness. Ideally, people with diabetes should have an initial comprehensive eye examination, including fundus examination through dilated pupils, and then followed up with recommended intervals. However, in reality, this cannot be achieved because of the limitations in the human resources and health facilities, among others. On the other hand, fundus screening for DR justifies the suggested principles for screening for combating a disease. DR screening programs at the local/regional/national level can serve as an effective way for the diagnosis and treatment of vision-threatening DR in people with diabetes. These programs need to be tailored according to the human resources and the infrastructure of the community; they will serve, and they should have a monitoring system in place, as well. The availability, accessibility, and affordability of the treatment should also be ensured for people with vision-threatening DR.
A Cross-Sectional Survey of Diabetes Care Providers’ Perceptions and Potential Barriers to the use of Continuous Glucose Monitoring Technology in Singapore
Authors: Yap Phoebe X. C. , Koh Leroy , Gallagher Paul J. , Lum Zheng Kang
Published: March 2023

Context:

Given the large disease burden of diabetes in Singapore, we felt a need to study the reasons for the low uptake of continuous glucose monitoring (CGM) in Singapore, despite its recognized benefits and international recommendation.

Aims:

The aim of this article is to identify perceptions of diabetes care providers (DCPs) and extent of barriers to promoting CGM uptake in Singapore.

Settings and Design:

This is a cross-sectional study in Singapore.

Materials and Methods:

A cross-sectional online survey of DCPs over 21 years of age, who provided direct outpatient care to diabetes patients in Singapore and spent minimally 50% of their total patient care time on diabetes care services, was conducted.

Statistical Analysis Used:

K-means cluster analyses grouped respondents by their diabetes technology and CGM attitudes, barriers to employing CGM clinically, and perceived barriers by patients for CGM uptake and adherence. Fisher's exact tests and Kruskal–Wallis tests assessed for inter-group demographic differences.

Results:

From a total sample of 47 respondents, analyses formed three clusters, describing DCPs’ willingness to recommend CGM uptake. All respondents agreed cost is the top barrier. Willing (48.9% of sample) and Unwilling (23.4%) DCPs reported minimal and many barriers to employing CGM clinically, respectively, whereas Eager DCPs (27.7%) reported none. Eager and Willing DCPs, who perceived cost as the only barrier by patients, had more positive diabetes technology and CGM attitudes versus the Unwilling DCPs that perceived many barriers by patients.

Conclusion:

Local DCPs agreed on the role of CGM in optimizing glycemic control, and that cost is the top barrier against CGM uptake.
Evaluation of Neutrophil–lymphocyte Ratio and Platelet–lymphocyte Ratio as Markers of Diabetic Kidney Disease in Bangladeshi Patients with Type 2 Diabetes Mellitus
Authors: Kamrul-Hasan A.B.M. , Mustari Marufa , Asaduzzaman Md. , Gaffar Md Abu Jar , Chanda Palash Kumar , Rahman Mohammad Motiur , Hannan Mohammad Abdul , Akter Farhana , Saifuddin Mohammad , Selim Shahjada
Published: March 2023

Background:

The roles of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) as novel surrogate markers of diabetic kidney disease (DKD) are promising.

Objective:

The aim of this study was to evaluate whether NLR and PLR can predict DKD in type 2 diabetes mellitus (T2DM).

Subjects and Methods:

This cross-sectional study was conducted from July 2018 to June 2019, among 312 patients with T2DM recruited from eight tertiary hospitals throughout Bangladesh. Complete blood count (CBC) was performed in fully automated hematology analyzers, and NLR and PLR were calculated. The urine albumin-to-creatinine ratio (ACR) was measured in a random single-voided urine sample. The diagnosis of DKD was made based on the presence of albuminuria (ACR ≥30 mg/g) and/or reduced estimated glomerular filtration rate (eGFR <60mL/min/1.73 m2) in the absence of signs or symptoms of other primary causes of kidney damage.

Results:

Among 312 study subjects, 150 (48.1%) had DKD. The mean age (51.9 ± 11.9 vs. 48.6 ± 9.6 years), fasting plasma glucose (10.3 ± 4.1 vs. 9.2 ± 3.0 mmol/L), 2-h postprandial plasma glucose (14.6 ± 5.6 vs. 12.8 ± 4.5 mmol/L), glycated hemoglobin (HbA1c) (9.2 ± 2.1 vs. 8.4 ± 1.9%), and serum triglyceride (213.6 ± 109.9 vs. 185.5 ± 100.8) were higher (P ≤0.05 in each instance) in subjects with DKD in comparison to those without DKD. DKD group had higher mean absolute neutrophil count (6.0 ± 2.0 vs. 5.4 ± 1.9 ×109/L, P = 0.022), platelet count (310.4 ± 87.3 vs. 287.0 ± 78.7 ×109/L, P = 0.013), NLR (2.16 ± 1.1 vs. 1.92 ± 0.96, P = 0.040), and PLR (115.45 ± 57.07 vs. 101.02 ± 40.06, P = 0.010). The levels of hemoglobin, total leukocyte count, absolute lymphocyte count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width were similar in the two groups.

Conclusion:

In this study, we found higher NLR and PLR in subjects with DKD than those without DKD. NLR and PLR may be considered as cheap, readily available alternative markers of DKD in resource-poor settings.