Higher Prevalence Of Diabetes Mellitus Research Articles

#401 Cardiovascular risk evaluation in lupus nephritis and ANCA-associated vasculitis

Abstract Background and Aims Individuals with lupus nephritis (LN) and renal ANCA-associated vasculitis (AAV) have amplified cardiovascular risks. Early recognition and intervention for metabolic disease may mitigate cardiovascular risk. We aimed to evaluate the prevalence of cardiovascular metabolic risk evaluation among adults with kidney disease due to LN and AAV treated with immunosuppressants. Method Retrospective cohort study of 219 patients with kidney LN (n = 175) and AAV (n = 44) diagnosed between November 2015 and December 2022. The outcomes were the prevalence of cardiovascular metabolic risk evaluation (HbA1c, fasting glucose and lipid) during the first two years of treatment. Results The median age was 48.6 (33.3, 60.9) years. Table 1 showed that the AAV group had lower eGFR and higher prevalence of diabetes mellitus, hypertension, and hyperlipidemia. Glycemic evaluation was more frequent during the first year than the second year (81.0% versus 61.2%, p < 0.001) for the cohort, as well as the LN (79.2% versus 61.7%, p < 0.001) and AAV groups (88.4% versus 58.8%, p = 0.003). Lipid evaluation was more frequent during the first year than the second year for the cohort (60.5% versus 50.3%, p = 0.04) and for AAV (81.4% versus 47.1%, p = 0004), but not the LN group (55.1% versus 51.0%, p = 0.52). Conclusion Cardiovascular metabolic risk evaluation during lupus nephritis (LN) and ANCA-associated vasculitis (AAV) long-term follow-up should be optimized.

Clinical characteristics of pyogenic liver abscess with and without biliary surgery history: a retrospective single-center experience

Background & aimsPyogenic liver abscess (PLA) is a common hepatobiliary infection that has been shown to have an increasing incidence, with biliary surgery being identified as a trigger. Our aim was to investigate the clinical characteristics and treatments of PLA patients with and without a history of biliary surgery (BS).MethodsThe study included a total of 353 patients with PLA who received treatment at our hospital between January 2014 and February 2023. These patients were categorized into two groups: the BS group (n = 91) and the non-BS group (n = 262). In the BS group, according to the anastomosis method, they were further divided into bilioenteric anastomoses group (BEA, n = 22) and non-bilioenteric anastomoses group (non-BEA, n = 69). Clinical characteristics were recorded and analyzed.ResultsThe percentage of PLA patients with BS history was 25.78%. The BS group exhibited elevated levels of TBIL and activated APTT abnormalities (P = 0.009 and P = 0.041, respectively). Within the BS group, the BEA subgroup had a higher prevalence of diabetes mellitus (P < 0.001) and solitary abscesses (P = 0.008) compared to the non-BEA subgroup. Escherichia coli was more frequently detected in the BS group, as evidenced by positive pus cultures (P = 0.021). The BS group exhibited reduced treatment efficacy compared to those non-BS history (P = 0.020). Intriguingly, the BS group received a higher proportion of conservative treatment (45.05% vs. 21.76%), along with reduced utilization of surgical drainage (6.59% vs. 16.41%).ConclusionsPatients with BS history, especially those who have undergone BEA, have an increased susceptibility to PLA formation without affecting prognosis.

A Multidisciplinary Approach to End-Stage Limb Salvage in the Highly Comorbid Atraumatic Population: An Observational Study.

Background: The use of free tissue transfer (FTT) is efficacious for chronic, non-healing lower extremity (LE) wounds. The four pillars of managing patient comorbidities, infection control, blood flow status, and biomechanical function are critical in achieving successful limb salvage. The authors present their multidisciplinary institutional experience with a review of 300 FTTs performed for the complex LE limb salvage of chronic LE wounds. Methods: A single-institution, retrospective review of atraumatic LE FTTs performed by a single surgeon from July 2011 to January 2023 was reviewed. Data on patient demographics, comorbidities, preoperative management, intraoperative details, flap outcomes, postoperative complications, and long-term outcomes were collected. Results: A total of 300 patients who underwent LE FTT were included in our retrospective review. Patients were on average 55.9 ± 13.6 years old with a median Charlson Comorbidity Index of 4 (IQR: 3). The majority of patients were male (70.7%). The overall hospital length of stay (LOS) was 27 days (IQR: 16), with a postoperative LOS of 14 days (IQR: 9.5). The most prevalent comorbidities were diabetes (54.7%), followed by peripheral vascular disease (PVD: 35%) and chronic kidney disease (CKD: 15.7%). The average operative LE FTT time was 416 ± 115 min. The majority of flaps were anterolateral thigh (ALT) flaps (52.7%), followed by vastus lateralis (VL) flaps (25.3%). The immediate flap success rate was 96.3%. The postoperative ipsilateral amputation rate was 12.7%. Conclusions: Successful limb salvage is possible in a highly comorbid patient population with a high prevalence of diabetes mellitus, peripheral vascular disease, and end-stage renal disease. In order to optimize patients prior to their LE FTT, extensive laboratory, arterial, and venous preoperative testing and diabetes management are needed preoperatively. Postoperative monitoring and long-term follow-up with a multidisciplinary team are also crucial for long-term limb salvage success.

Impact of the diagnosis of metabolic dysfunction-associated fatty liver disease and non-alcoholic fatty liver disease in patients undergoing liver transplantation for hepatocellular carcinoma.

Whether the diagnosis of non-alcoholic fatty liver disease or metabolic dysfunction-associated fatty disease has a different impact on liver transplant recipients with hepatocellular carcinoma is not yet clear. Data from a two-center retrospective cohort study were collected to compare and investigate the differences between non-alcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease in clinicopathologic parameters and prognosis among liver transplant recipients with hepatocellular carcinoma. A total of 268 liver transplant recipients with hepatocellular carcinoma were included. The prevalence among pre- and post-transplant metabolic dysfunction-associated fatty liver disease was 10.82% and 30.22%, while for non-alcoholic fatty liver disease, it was 7.09% and 26.87%, respectively. The clinicopathological parameters were similar between the two pre-transplant groups. In contrast, the post-transplant group with metabolic dysfunction-associated fatty liver disease exhibited a higher prevalence of diabetes mellitus and a greater body mass index. However, the other parameters were similar between the two post-transplant groups (p > 0.05). Factors such as the largest tumor size > 4cm, microvascular invasion, lack of tumor capsule, post-transplant metabolic dysfunction-associated fatty liver disease, and decreased post-transplant lymphocyte percentage were related to an increased risk of recurrence. In patients undergone liver transplantation for hepatocellular carcinoma, the diagnosis of metabolic dysfunction-associated fatty disease is more strongly associated with metabolic abnormalities than the diagnosis of non-alcoholic fatty liver disease and is an independent predictor of hepatocellular carcinoma recurrence.

Utilization of dental care and dentate status in diabetic and nondiabetic patients across US states: An analysis using the 2020 Behavioral Risk Factor Surveillance System.

This study examines the differences, by state, in dental care utilization and tooth retention between adults with and without diabetes mellitus (DM). We conducted a secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System, an annual, state-based, random telephone survey of noninstitutionalized US civilian adults. The predictor variable was DM status. The outcome variables were time since the last dental appointment and tooth loss. We utilized multiple multinomial logistic regression models followed by postestimation procedures to determine state-level adjusted proportions for dental visits within the last year and complete teeth retention among DM and non-DM adults. Among adults with DM, 60.0% reported dentist visits within a year of survey participation, while 53.6% had complete tooth retention. As education and income levels increased, dental attendance and tooth retention increased among adults with DM. Most Southern states had a higher prevalence of DM, a lower proportion of dentist visits, and worse tooth retention among DM adults. Nationally, DM individuals were 4.3 percentage points less likely to visit a dentist and were 7 percent less likely to have complete teeth retention than non-DM adults. Compared with the national average, 25/50 states had greater disparities in dental visits between DM and non-DM adults, and 27/50 states had greater disparities in tooth loss between DM and non-DM adults. State-level variations indicate geographical and dental coverage influences on DM and dental outcomes. There is a need for state-specific interventions to improve dental access and outcomes for adults with DM.

Verification of 2021 IDF-DAR risk assessment tool for fasting Ramadan in patients with diabetes attending primary health care in The Kingdom of Bahrain: The DAR-BAH study

BackgroundThere is a high prevalence of diabetes mellitus among Muslim adult patients. Those Muslims are required to fast the holy month of Ramadan. However, the Islam religion exempted some people with medical issues. It was not clear if all the patients with diabetes were considered medically unfit to fast Ramadan. Therefore, IDF-DAR group created a new risk calculator to categorize the patients with diabetes to advise with or against fasting accordingly. ObjectiveThis study is validating the IDF-DAR tool in assessing the accuracy of IDF-DAR risk calculator tool on adult patients with diabetes visiting primary health care in the Kingdom of Bahrain. The study will facilitate the health care professionals’ decision to exempt the patients from fasting. MethodsIt is a prospective, randomized study for Ramadan 1444/2023 to assess the new IDF-DAR risk score tool that predicts the complications and the negative outcome of fasting during Ramadan. It included pre- and post-Ramadan questionnaires. 757 patients were selected randomly from the patients list of the central diabetes clinics in primary health care for pre-Ramadan risk assessment scoring. Post-Ramadan a phone a questionnaire was done to evaluate the ability of fasting and the occurrence of adverse events. ResultsOut of the 757 participants, 611 were included in the study. The mean age of the studied population was 59.8 years and 52.8 % of them were female. 630 (95.3 %) had type 2 diabetes. According to the new IDF-DAR risk calculator, 184 (27.8 %) were categorized as low risk (≤3 score), 252 (38.1 %) as moderate risk (3–6 score), and 225 (34 %) as high risk (>6 score). The percentage of patients completed their 30 days fasting successfully without reporting adverse events in the low, moderate, and high-risk groups were 92.4 %, 89.3 %, 74.7 % respectively. There was significant increased risk in breaking the fast between the low-risk group and high-risk group with a p-value of <0.001. Similarly, there was significant increased risk in breaking the fast between the moderate-risk group and high-risk group with p-value of <0.001. The main reason of breaking the fast was hypoglycemic attacks. The leading factors that play a significant role in increasing the risk of adverse events during fasting Ramadan were type 1 diabetes mellitus, the presence of previous hypoglycemia attacks, the presence of renal impairment, and negative previous Ramadan experience. ConclusionThe new IDF-DAR risk calculator is a good tool to predict both the ability to fast Ramadan and the probability of experiencing adverse events (mainly hypoglycemia) in people with diabetes mellitus in Kingdom of Bahrain.

Combination of curcuminoid and collagen marine peptides for healing diabetic wounds infected by methicillin-resistant Staphylococcus aureus

Background and Aim: The high prevalence of diabetes mellitus in Indonesia indirectly reflects the high risk of developing chronic wounds that are susceptible to infection. Methicillin-resistant Staphylococcus aureus (MRSA) is an infectious pathogen that is resistant to various antibiotics. Therefore, antibiotic therapy is ineffective enough to treat chronic hyperglycemic wounds caused by MRSA infection. Curcuminoids have anti-inflammatory and antibacterial effects by inhibiting the enzymatic pathways involved in the pathogenesis of inflammation. Collagen is a tissue regeneration inducer. The combination of these two ingredients is expected to be an alternative therapy for MRSA-infected hyperglycemic chronic wounds without the risk of antibiotic resistance. The aim of this study was to investigate the efficacy of hydrolacin-gel in wound healing and inhibiting the growth of MRSA bacteria, as well as to determine the optimal concentration of curcuminoids combined with collagen marine peptides (CMPs). Materials and Methods: Hydrolacin-gels were prepared by homogenizing curcuminoid nanoemulsions and CMPs. The evaluation of preparation includes stability tests and antibacterial activity tests. Wound diabetic mice were treated with various combinations of curcuminoid and CMPs. Wound healing was observed based on malondialdehyde levels as a marker of oxidative stress and histopathological changes in the skin wound. Results: Hydrolacin-gel was formulated by combining curcuminoid nanoemulsion (more water soluble) and CMPs, with the ratio of formula 1 (1:2, curcuminoid 43.3 mg and CMPs 5.58 mg), formula 2 (1:1, curcuminoid 86.8 mg and CMPs 3.72), and formula 3 (2:1, curcuminoid 130.2 mg and CMPs 1.87 mg) calculated based on the effective dose of curcuminoid 200 mg/kg body weight (BW) and CAMPs 0.9 g/kg BW. Hydrolacin-gel had a potential antibacterial activity against MRSA. Hydrolacin-gel induced wound tissue repair and reduced oxidative stress caused by inflammation in diabetic-infected MRSA. Hydrolacin-gel could be used for healing MRSA-infected diabetic wounds, especially formula 3 with the ratio of curcuminoid: CMPs = 2:1. Conclusion: Hydrolacin-gel combining curcuminoid nanoemulsion and CMPs effectively inhibited the inflammatory process and increased re-epithelialization in MRSA-infected diabetic wound healing. Hydrolacin-gel with curcuminoid (130.2 mg) and CMPs (1.87 mg) at a concentration ratio of 2:1 appeared to be the best formula against MRSA infection in diabetic wounds. Keywords: collagen marine peptides, curcuminoids, diabetic, methicillin-resistant Staphylococcus aureus, wound.

IJCM_44A: Analysis of Health System and Community Readiness for Adhering to Government Guidelines on Gestational Diabetes Mellitus in India

Background: GDM affects approximately 7% of all pregnant women worldwide. India has one of the highest prevalence of Diabetes Mellitus in the world. In a field study in Tamil Nadu, the prevalence of GDM was 17.8% in the urban, 13.8% in the semi urban and 9.9% in the rural areas. It is estimated that at any given time, approximately 4 million women in India are affected by GDM. Though there is availability of national guidelines, screening and management of GDM is challenging and controversial in India due to conflicting guidelines and treatment protocol. There are huge challenges in GDM management both at the individual and provider level. Objective: To understand the challenges and possible solutions for successfully implementing the GDM program Methodology: Data were collected from both public and private health facilities in two districts of Maharashtra. Self-administered questionnaire, IDIs and FGDs were conducted with medical officers and staff of PHCs, RH, SDH and District Hospital. Thematic analysis was done. Results: There were lack of training to Staff and Doctor of the government and private health system regarding GDM guidelines. Infrastructure was lacking for conducting the OGTT. Staff were not willing to conduct OGT and MNT(Medical nutrition therapy) on regular basis. Conclusion: Improvement in infrastructure, manpower and training of the staff is needed. Training in OGTT and MNT is must for the filed staff. More involvement of private players is needed for better implementation of GoI guidleines.

IJCM_279A: Evaluation of diabetes mellitus as a risk factor for urinary tract infection in women: A case control study

Background: Diabetes mellitus (DM) disrupts insulin production and function leads to hyperglycaemia and subsequently exacerbating the risk of complications. Studies highlight hyperglycaemia’s impact on neutrophil function, predisposing diabetic patients to severe infections like pneumonia, urinary tract infections (UTIs), and skin issues. Objectives: To quantify DM’s contribution to UTI development, and to assess the risk of contracting UTI conferred by diabetes mellitus in otherwise healthy women and to characterize the UTI in the cases. Methodology: The case control study was conducted among 200 participants (100 cases with UTI and 100 controls without UTI) from 3 hospitals affiliated to Kasturba Medical College, Mangalore. The data were collected using a structured proforma. Chi – square test and students ‘t’ test was used for comparison of the results across the groups. Results: Patients with urinary tract infections (UTI) showed a higher prevalence of diabetes mellitus (DM) (27.66%) compared to controls (7.45%). The UTI patients were 4.75 times more likely to have DM. Diabetic UTI cases exhibited elevated glycated haemoglobin (HbA1C) and random blood sugar levels than controls. Complicated UTIs were more prevalent in diabetic (77%) than non-diabetic (60%) UTI cases, with E. coli being the most common infecting organism. Conclusion: The uncontrolled diabetes mellitus confers an increased risk of developing UTI and the risk of developing UTI caused by organisms which are not known to cause infections in people with normal immunity (like Candida species). Additionally, diabetics show a higher proportion of complicated UTI cases as compared to non-diabetics.

IJCM_315A: Pesticide exposure and Diabetes Mellitus - A Community based Analytical Cross-sectionalstudy among agricultural workers in Madurai east community block, Tamil Nadu

Background: World Health Organization (WHO) states that diabetes mellitus (DM) is the ninth leading cause of death in 2019¹. The study by Velmurugan et.al² in 2021 in rural Tamil Nadu shows a high prevalence of DM among agricultural workers (15.0%) compared to non-farming communities (8.7%). Pesticides, a source of Endocrine Disrupting Chemicals (EDCs) play a major etiological role in Diabetes Mellitus among them. Hence the need for present study. Objectives: 1. To estimate the prevalence of diabetes mellitus among agricultural workers in Madurai East Block 2. To find the association between pesticide exposure and other variables with DM. Methodology: A community-based cross-sectional study was conducted among 150 agricultural workers in Madurai East using multistage cluster sampling during august to November 2023.Sample size was calculated using Velmurugan et.al study². After obtaining informed consent, study population was interviewed using semi-structured validated (containing details about sociodemographics, pesticide exposure questionnaire, diabetic status) followed by anthropometric measurements in the previous day evening and advised 8 hrs fasting that night. Next day morning by 6 am, second visit was made to check fasting capillary blood glucose (CBG) using Accu-Chek glucometer. Data was analyzed using SPSS software version 21.0. Results: The mean age of the study population was 50.63 ± 13.36 years. Females constituted 66% (n=99). The mean years of agricultural work was 26.55 ± 13 years. The overall prevalence of DM among study population was 29.3%. The prevalence was slightly higher in pesticide applicators (33.33%) than agricultural workers (29.1%). Except for age, the chi-square test showed no significant association between pesticide exposure, gender, family history of DM, with DM. Conclusion: Higher Diabetic prevalence among agricultural workers demands further research to prove the hypothesis of pesticide exposure and development of diabetes.

EARLY OUTCOME OF LEFT VENTRICULAR FUNCTION AFTER CORONARY ARTERY BYPASS SURGERY: A SINGLE-CENTER EXPERIENCE

Patients with ischemic heart disease and low ejection fraction often exhibit improved outcomes following coronary artery bypass grafting (CABG). Our study aimed to assess the impact of CABG on left ventricular (LV) systolic function and identify predictors of adverse postoperative outcomes. We conducted a prospective cross-sectional study involving 110 CABG patients with a mean age of 56.1 ± 12.2 years and preoperative left ventricular ejection fraction (LVEF) below 50%. Patients were categorized into two groups: group I (n=76, LVEF &gt; 35%) and group II (n=34, LVEF &lt; 35%). In group II, there was a significantly higher prevalence of diabetes mellitus (DM) (p = 0.05) and Euro SCORE II compared to group I (p &lt; 0.001). However, other clinical predictors showed no significant difference between the two groups. Both groups exhibited a significant improvement in LVEF post-surgery (p = 0.05), with comparable in-hospital mortality rates recorded. The study identified DM, significant diastolic dysfunction, and intra-aortic balloon pump (IABP) insertion as predictors of in-hospital mortality (p = 0.001, 0.03, and &lt; 0.001, respectively). These findings suggest a noticeable enhancement in LV systolic function post-CABG, contributing to improved survival rates. However, patients with DM, significant diastolic dysfunction, and those requiring IABP insertion during the perioperative period are at higher risk of mortality. Therefore, targeted attention and specialized care are essential for optimizing outcomes in these high-risk patients.

Gap analysis of diabetes-related foot disease management systems in Pacific Islands Countries and Territories

BackgroundPacific Island Countries and Territories (PICTs) are known to have high prevalence of Diabetes Mellitus and high incidence of diabetes-related foot disease. Diabetes-related foot disease can lead to lower limb amputation and is associated with poor outcomes, with increased morbidity and mortality. The purpose of this study was to gain a better understanding of diabetes-related foot disease management in selected countries in PICTs and to identify potential barriers in management of diabetes-related foot disease management in the region.MethodsA cross-sectional survey was sent to eleven hospitals across six selected PICTs. The survey instrument was designed to provide an overview of diabetes-related foot disease (number of admissions, and number of lower limb amputations over 12 months) and to identify clinical services available within each institution. Two open-ended questions (free text responses) were included in the instrument to explore initiatives that have helped to improve management and treatment of diabetes-related foot diseases, as well as obstacles that clinicians have encountered in management of diabetes-related foot disease. The survey was conducted over 6 weeks.ResultsSeven hospitals across four countries provided responses. Number of admissions and amputations related to diabetes-related foot disease were only reported as an estimate by clinicians. Diabetes-related foot disease was managed primarily by general medicine physician, general surgeon and/or orthopaedic surgeon in the hospitals surveyed, as there were no subspecialty services in the region. Only one hospital had access to outpatient podiatry. Common themes identified around barriers faced in management of diabetes-related foot disease by clinicians were broadly centred around resource availability, awareness and education, and professional development.ConclusionDespite the high prevalence of diabetes-related foot disease within PICTs, there appears to be a lack of functional multi-disciplinary foot services (MDFs). To improve the outcomes for diabetes-related foot disease patients in the region, there is a need to establish functional MDFs and engage international stakeholders to provide ongoing supports in the form of education, mentoring, as well as physical resources.

The Knowledge, Attitudes, and Practices Regarding Diabetic Ketoacidosis Among Diabetic Patients in the Northern and Western Regions of Saudi Arabia.

Background and objective Diabetes mellitus (DM) is a chronic debilitating metabolic diseasecaused by insulin deficiency. Diabetic ketoacidosis (DKA) is a potentially fatal complicationcharacterized by acute hyperglycemia and metabolic acidosis. In light of the high prevalence of DM in Saudi Arabia, we sought to investigate the knowledge, attitudes, and practices of the Saudi general population about DKA. Methods An online self-administered questionnaire was distributed through popular social media platforms among diabetics in the Saudi population. The survey questions involved demographic data; diabetesstatusincluding the time of diagnosis, current medications, and the latest HbA1c level; and an assessment of theknowledge about DKA through queries related to diagnostic criteria, definition, risk factors, symptoms, and preventive measures. Results Our study involved 400 participants, and 42.5% of them were able to correctly identify DKA as an emergency requiring immediate medical attention. Regarding the awareness of DKA's symptoms among the participants, 33.8% correctly identified excessive thirst as a key indicator, followed closely by frequent urination (31.8%), and the characteristic fruity breath odor (31.3%). As for the awareness of the participants of the causes of DKA, 33.8%correctly linked forgetting insulin injections to DKA development. Encouragingly, 39.8% of participants identified regular blood sugar monitoring as the most effective way to prevent DKA. Conclusions Most patients in our study demonstrated limited knowledge of DKA. However, a significant portion of them was able to identify it as an emergency. To prevent such events, raising awareness about DM and its complications may serve as the first step toward better outcomes in diabetic patients. We believe our findings can be used to devise quality-improving interventions in this field.

Increasing Awareness of Diabetes Mellitus in The Elderly in Lamongan Regency Through Community Service

Purpose – The Indonesian government had a chronic disease management program, PROLANIS, targeted for diabetes and hypertension since 2010 to prevent chronic disease patients from severe complications through monitoring and control measures. The purpose of this community service was to improve the health status of diabetic patients who participate in PROLANIS in Sukodadi and Sukolilo Villages, Lamongan Regency, through analysis of blood glucose levels. Design/methodology/approach – To overcome the problems previously mentioned, community service has been proposed. This service includes educating participants about metabolic syndrome and health checks. The main aim of this educational program is to increase public awareness about diabetes mellitus. The blood examination aims to determine the prevalence of diabetes mellitus in these villages. This educational program involves direct mentoring and outreach methods, such as the creation of booklets, educational videos, and PPTs. Findings and Discussions – In Sukodadi and Sukolilo Villages, community service was organized as a response to the high prevalence of diabetes mellitus. The program included blood tests and educational sessions for participants enrolled in the PROLANIS initiative. Analysis of the data revealed that the average blood sugar level of the participants was 143.1 mg/dl, slightly above the normal blood sugar level tolerance limit of 140 mg/dl. Nevertheless, the results indicate that the blood sugar levels of the participants can be effectively managed and kept below the diabetes tolerance threshold of &lt;200 mg/dl. Originality/value – Our community services in Sukodadi and Sukolilo Village, Lamongan Regency, showed that most elderly women with diabetes mellitus are retired. As people age, their risk of high blood glucose levels increases. Despite the average glucose level of PROLANIS participants being higher than normal, it can still be controlled. Our findings can guide the government to organize diabetes management programs and help service providers carry out prevention measures.

(141) Can a Nocturnal Penile Tumescence and Rigidity Test Detect Organic Aetiology of Erectile Dysfunction? A Peripheral and Penile Vascular Study

Abstract Introduction In the diagnostic workup of erectile dysfunction (ED) the Nocturnal Penile Tumescence and Rigidity test (NPTR) is being used less and less because of its inconvenience but also in part because of the intrinsic limits of this test. In particular, the NPTR has been considered very useful to diagnose psychogenic ED when it is positive (normal) but less informative when it is negative (pathological) because of the high incidence of false negatives. Other tests have been suggested to better diagnose an organic ED, especially the dynamic Penile Colour-Doppler Ultrasound (PCDU) to study the penile vascular response and detect a vasculogenic ED. Objective The purpose of the study was to explore the value of a pathological NPTR by investigating relationship between the NPTR result and the peripheral vascular health at the carotid, brachial and cavernous arteries. Methods We conducted an observational study involving patients with ED who had undergone a NPTR as part of their ED diagnostic workup. We assessed their peripheral vascular health through (1) the measurement of the intima-media thickness at the carotid arteries (cIMT), (2) the measurement of the flow-mediated dilation at the brachial artery (FMD), and (3) performing a PCDU. Results Globally, our patients presented with a normal cIMT, FMD and Peak Systolic Value (PSV) in the PCDU. The group with pathological NPTR were significantly older than patients with normal NPTR (55.6 vs 44.1 years, p=0.002), had a higher prevalence of hypertension (50.0 vs 6.8%, p=0.001), longer hypertension duration (8.0 vs 1.3 years, p=0.035), a higher prevalence of diabetes mellitus (42.9 vs 6.8%, p= 0.004), higher blood glucose (111 vs 92 mg/dl, p=0.004) and higher blood triglycerides levels (188 vs 96 mg/dl, p=0.002). Furthermore, they showed lower PSV (46.2 vs 71.0 cm/s, p=0.002) while we did not find significant differences as regards cIMT and FMD between the two groups. Interestingly, the prevalence of patients with pathological PSV (&amp;lt;35 cm/s) was higher among patients with a pathological NPTR but without reaching the statistical significance. However, when adopted an age-dependant cut-off described in the literature (PSV &amp;lt; age x 0.7 + 6.73) the difference between the two groups became significant (50.0 vs 11.4%, p=0.005). Finally, the correlation analysis showed a significant correlation between PSV and the cIMT (-0.352, ρ=0.009), the maximum number of events in the RPTR record (+0.344, ρ=0.012), and the mean tip tumescence (+0.303, ρ=0.036). When corrected for age, these associations lost their statistical significance. Conclusions This study demonstrates the diagnostic value of a pathological NPTR which suggests an organic aetiology of the ED and associates with pathological findings in the PCDU. Age appears to be one of the most important risk factors for ED, even when other risk factors are present. Finally, when using a PCDU to diagnose vasculogenic ED, a cut-off of 35 cm/s might be less sensitive than an age-dependent cut-off to detect early impairments of penile endothelial function. Disclosure No.

Self-Apposing Stents in Coronary Chronic Total Occlusions: A Pilot Study

This pilot study assessed the 12-month angiographic and clinical outcomes of self-apposing (SA) stents in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Self-apposing (SA) stents may decrease incomplete strut apposition and stent strut coverage that are common after CTO PCI. We compared 20 patients who underwent CTO PCI using SA drug-eluting stents (DESs) with 20 matched control patients who underwent CTO PCI using balloon-expandable (BE)-DESs. All patients were followed up clinically for 12 months and had coronary angiography with optical coherence tomography at the end of the follow-up period. The primary end points were stent strut malapposition and strut coverage. The secondary end point was composite major adverse cardiovascular events (MACEs) at 12 months. Both groups had high prevalence of diabetes mellitus, and most of the treated lesions were complex, with 62% having a J-CTO score of ≥3. All CTO PCI techniques were allowed for recanalisation, and 75% of the procedures were guided by intravascular ultrasound. At 12 months, the SA-DES group had fewer malapposed struts (0% [interquartile range (IQR) 0%-0%] vs 4.5% [IQR 0%-20%]; p<0.001) and uncovered struts (0.08% [IQR 0%-1.6%] vs 8.2% [IQR 0%-16%]; p<0.001). However, they showed significantly higher rates of MACEs due to clinically-driven target lesion revascularisation (45% vs 15%; p=0.038). In this pilot study, compared with conventional BE-DESs, SA-DESs used in CTO PCI were associated with fewer malapposed and uncovered stent struts but also with significantly higher rates of in-stent restenosis and MACEs, mainly caused by clinically driven target lesion revascularisation.

Prevention and control of diabetes mellitus complications in productive population in rural

In Pekalongan Regency, Central Java, Indonesia, cases of productive population with diabetes mellitus have rapidly increased over the past three years. With regard to individual-based problems prevention and management, this is not sufficiently balanced. From the standpoint of the provider, this study examines attempts to prevent and control diabetes mellitus in productive population, including obstacles and limitations. With a focus on three rural areas (Wiradesa, Tirto I and Kedungwuni I Sub-Districts), qualitative study included 75 productive-age diabetics and 30 breadwinners. In-depth interviews and focus group discussions were used to gather data, which was then thematically analyzed. Three rural locus with the highest prevalence of diabetes mellitus in productive population were found in the results. Through screening for non-communicable diseases at integrated service post (Posyandu), chronic disease management programs and cross-sectoral activities, there are numerous initiatives for the prevention and management of complications. The challenges include constantly changing programmers, programmers with many assignments, inadequate target awareness and low motivation, as well as a worse recording and reporting system. Such that fundamental information on both individual and public health cannot be accessed. Based on individual emphasis, recording and reporting, several programs for complication prevention and management are required to identify the range of non-communicable diseases.

A Step towards understanding coronary artery disease: a complication in idiopathic pulmonary fibrosis

BackgroundIdiopathic pulmonary fibrosis (IPF) is a relatively rare disease with increasing incidence trends. Cardiovascular disease is a significant complication in IPF patients due to the role of common proatherogenic immune...

Ayurvedic management of Prameha - A Single Case Study

Diabetes mellitus (DM) type 2 is one of the global problems of the present day and it is gaining more attention. It is expected to continue as a major health problem and leads to serious complications. India is one of the top 5 countries with the highest prevalence of DM. The IDF Diabetes Atlas (2021) reports that 10.5% of the adult population (20-79 years) has diabetes, with almost half unaware that they are living with the condition. By 2045, IDF projections show that 1 in 8 adults, approximately 783 million, will be living with diabetes, an increase of 46%.[1] The signs and symptoms of diabetes can be correlated to Prameha of Ayurveda. The management of Prameha is mentioned in Ayurveda as preventive and curative aspects. Ayurveda has recommended an appropriate use of Oushadha Yogas along with proper Pathya (wholesome) Ahara, and Viharas. On the same principles a patient was treated at OPD basis, this case report analyses the same. A male patient, aged 45 years, diagnosed case of Prameha 5 years back presented with dryness in the mouth, increased frequency of micturition, Excessive thirst, weakness of the body, and burning sensation at the sole. The treatment planned was use of Shamana Oushadhis along with proper Pathya (wholesome) Ahara, and Vihara for three months. After three months of treatments results were compared. There was a marked reduction in signs and symptoms like burning sensation, numbness, excessive thirst, and increased micturition.

Prevalence of Diabetes Mellitus and Chronic Complications of Diabetes Mellitus in District Buner Khyber Pakhtunkhwa, Pakistan

Background: Diabetes Mellitus (DM) is a significant global public health concern, particularly in developing countries like Pakistan. The Buner District of Khyber Pakhtunkhwa, Pakistan, presents a unique demographic and geographical setting for studying the prevalence and chronic complications of DM. Objective: This study aimed to assess the prevalence of diabetes mellitus and its chronic complications in the Buner District, Khyber Pakhtunkhwa, Pakistan, and to understand the demographic distribution of the disease. Methods: A comprehensive, area-specific study was conducted from March 2022 to August 2022, involving 753 patients across eight localities in the Buner District. Data were collected using questionnaires, interviews, and observations at various medical centers. Participants included individuals from both rural and urban areas, with a demographic split of 486 males (64.54%) and 267 females (35.45%). The study also investigated six types of chronic complications associated with DM. Data analysis was performed using Microsoft Excel 2016 and SPSS version 25. Results: The study found that the prevalence of diabetes mellitus in the Buner District was significantly high, with a higher incidence in urban areas compared to rural ones. The prevalence of chronic complications of DM varied, with cardiovascular conditions being the most prominent, followed by neuropathy, nephropathy, ocular conditions, and foot diseases. Conclusion: The study highlights a high prevalence of diabetes mellitus and its chronic complications in the Buner District, with urban areas showing a higher incidence. The findings underscore the need for targeted healthcare strategies and interventions in this region to address the growing burden of DM.