Blood Sugar Monitoring Research Articles

Preventing Female Virilisation: Role of Antenatal Dexamethasone

Antenatal treatment with dexamethasone in pregnancies affected by congenital adrenal hyperplasias (CAH) therefore suppresses fetal androgen production and prevents virilisation of female infants. Antenatal DXM is reported to be efficacious, preventing or ameliorating virilisation in 80–85% of cases. Materials and methods: In this study, we report a case of patient pregnant at 6 weeks; with a history of 2 children followed up for a classic form of HCS, she is admitted to our department for the administration of dexamethasone to prevent fetal virilization. Case Report: 23-year-old patient pregnant at 6 weeks, not known of having congenital adrenal hyperplasia (CAH), concept of consanguineous marriage 1 degree; she had a history of 2 children followed up for a classic form of HCS, the first died at the age of 1 and 10 months and the 2 child died on D26 of life. After having made a prenatal diagnosis where an analysis of the SRY gene on fetal circulating DNA showed the absence of this gene, which confirms the female sex of the fetus. An obstetrical ultrasound was done which objectified a pregnancy estimated at 6 weeks with suspicion of clitoral hypertrophy (At 16 weeks), in view of this observation the patient was referred to us for additional care and possible dexametasone. On questioning, the patient did not report any signs of hyperandrogenism. All evolving in a context of unquantified moderate weight loss and asthenia without signs of adrenal insufficiency. The clinical examination showed no melanoderma or slate spots, BP= 105/71mmHg, RR = 19 cycles/min. CF=81bpm? BMI = 28.68 kg/m2. Tanner: S5P5. the patient was put on 1.5 mg/d of dexamethasone divided into 3 doses.a monthly measurement of DHEAS and cortisol was requested. The Decrease of plasma concentrations of cortisol and DHEAS in the mother testifies to good fetal adrenal suppression. A low-calorie diet and monitoring of blood pressure and blood sugar to detect signs of under or overdose of corticosteroid .....

Gambaran managemen diri dan dukungan keluarga pasien diabetes mellitus


 DM patient self-management is an action taken by DM patients to manage and control DM which includes activity, diet, exercise, monitoring blood sugar, drug control and foot care. The goal of self-management is to optimize metabolic control in the body, prevent acute and chronic complications, optimize the patient's quality of life and reduce costs incurred for the treatment of DM.
 This research was conducted to find an overview of self-management of diabetes mellitus patients and family support. The sample in this study were 34 respondents. The instruments used were self-management and family support questionnaires. Data is processed with univariate.
 The results of research on self-management as a whole as much as 58.8% are in the high category. The results of the study regarding the description of high family support were as much as 79.4%.
 Conclusion This study shows that most of the respondents have good self-management both in terms of aspects of diet, medication, monitoring blood sugar levels, activities and foot care. The results of the study also provide an overview of family support for diabetes mellitus patients in the good category.

Supersensitive biosensor based on a photonic crystal nanostructure for blood sugar level monitoring with ultra-high quality factor and low detection limit

Diabetes is the most prevalent disease in the world, which poses a serious threat to people's health. In many parts of the world, it is the main cause of death. Therefore, it is crucial to develop a quick and accurate blood sugar concentration detecting equipment because it serves as one of the most significant criteria for the diagnosis of diabetes. This study proposes a unique bio-photonic sensor for monitoring blood sugar levels that uses a one-dimensional binary photonic crystal made of Si/TiN layers. A central cavity layer is inserted between two equal periodic numbers. The sensing sample can be infiltrated in the cavity layer with various sugar concentrations. Based on the transfer matrix approach, the transmittance spectra properties are investigated. The impact of incidence angle (TE and TM polarization) and the sensing layer thickness are carefully investigated to achieve the best performance of the bio-photonic sensor. An ultra- high sensitivity of 4200 nm/RIU is realized for the proposed detector which is not realized for a lot of recently published articles in this field. Furthermore, the proposed sensor has inexpensive cost, tunable design, real-accurate detection and simple structure which is supportive to the industrial design using low-cost product nanofabrication technique. Based on these advantages, the proposed biosensor candidate is a viable and useful tool for determining the blood sugar level, and it may also be used to other biological samples.

Associated factors with depression and sleep quality in T1DM patients: a cross-sectional descriptive study

BackgroundIndividuals with type 1 diabetes (T1DM) may experience sleep problems, usually due to low blood sugar levels during sleep or performance of blood sugar management (e.g., blood sugar monitoring). This study aimed to identify the disease-related characteristics, psychosocial aspects, and related factors underlying sleep quality in patients with T1DM.MethodsThis study employed a descriptive research design. The participants were 159 individuals with T1DM who completed online questionnaires. The data were analyzed using descriptive statistics, correlations, and multiple regression analyses.ResultsThe average score for depression in T1DM patients was 23.77 (SD 5.31), and sleep quality received a score of 4.58 (SD 3.22). Depression was positively correlated with sleep quality and negatively correlated with the total resilience score. The factors linked to depression in T1DM patients were duration of disease, sleep latency, sleep duration, sleep disturbance, and resilience-acceptance of self and life sub-factors, with an explanatory power of 44.4% for the depression variance. The associated factors with sleep quality in T1DM patients were complications, resilience-personal competence sub-factors, and depression, with an explanatory power of 37.4% for sleep quality variance.ConclusionsThe results of this study suggest that to improve sleep quality in patients with T1DM, it is necessary to develop and support disease management to prevent complications and implement interventions for improving resilience and reducing negative emotions such as depression.

Health Literacy and Clinic-Epidemiological Profile of Patients with COVID-19-Associated Mucormycosis: A Questionnaire-Based Study

Background The patient partnership is desirable for the optimal management of comorbidities. This became significant more so during the coronavirus disease 2019 (COVID-19) crisis wherein health infrastructure was overburdened. Objectives The aim of this study was to estimate the clinicoepidemiological profile, health literacy regarding predisposing risk factors, and disease management in patients with COVID-19-associated mucormycosis (CAMCR). Materials and Methods A structured questionnaire-based study on randomly chosen 100 microbiologically proven patients of CAMCR, consisting of 38 multiple choice questions, was designed with each answer having a patient and assessor response to it. Results A male predilection was seen (68%) with rhino-orbital (73%) being the commonest anatomic site. Forty-nine percent of the study participants had pre-existing diabetes of which 62% did not carry out regular blood sugar monitoring and in 18%, blood sugars were controlled prior to COVID-19. Thirty-five percent of patients with mild COVID-19 illness were treated with unwarranted steroids and 56% of patients had fluctuating blood sugar levels, during COVID-19 illness. Seventy-nine percent of patients were not vaccinated against COVID-19, 16% only partially vaccinated. Seventy-one percent of patients were not aware of red flag signs and of mucormycosis with 8% presenting early, on noticing nasal symptoms. Conclusion This study observed diabetes as the most common comorbidity in patients with CAMCR. A lacuna in the health literacy of diabetics presenting with CAMCR was found. Additionally, knowledge regarding glycemic control during COVID-19 illness with or without the use of steroids and awareness of the “red flag” signs of CAMCR were mostly lacking. Interventions to improve awareness amongst patients with diabetes should help in optimal glycemic control, and avoid potential complications like severe COVID-19 illness, and mucormycosis.

Dietary Practices and Related Elements Among Patients With Type 2 Diabetes in Rural Kerala, India

Background: Frequency of type 2 diabetes is very much elevated in Kerala in comparison with other states. Essential and effectual regulation of the illness could avert and thus delay complications. Good dietary practice is an important component in diabetes management. This study aims to assess the regimen applications and related elements among patients with type 2 diabetes in Malappuram district of Kerala. Methods: A cross-sectional survey was done among 304 patients with type 2 diabetes selected by cluster sampling from randomly chosen electoral divisions of Malappuram block panchayat of Kerala. A systematic interview was performed in order to evaluate the frequency and prevalence of quality regimen practices among patients distressed with type 2 diabetes and factors associated with it. Good dietary practice was a single composite outcome created out of 5 independent variables. Results: The prevalence of good dietary practice among patients with type 2 diabetes was 20.4%. Elements like self-announced hardness in following a healthy balanced regimen (adjusted odds ratio [AOR]: 0.19 [0.09-0.41]), physical help from a family member to follow good dietary practices (AOR: 2.89 [1.24-6.75]), companionship of peer or family member in practicing good dietary practice (AOR: 2.23 [1.07-4.66]), and regular blood sugar monitoring (AOR: 2.74 [1.27-5.94]) were remarkably linked with quality regimen practices. Conclusion: Prevalence of good dietary practices within patients with type 2 diabetes was found to be very low. Interventions for improvement in good dietary practices should include methods like regime counselling which can actually guide the patients to outgrow their recognized health issues. During difficult times like these, most of the patients desire great family assistance and help from others who would like to conduct good regimen practices with the patients.

FAKTOR GAYA HIDUP KELUARGA BERISIKO DIABETES MELITUS DI DESA BELIMBING, KECAMATAN REJOTANGAN, KABUPATEN TULUNGAGUNG (Family Lifestyle Factors as The Risk of Diabetes Mellitus in Blimbing, Rejotangan, Tulungagung)

Non-Communicable Diseases (NCD) is the leading cause of death worldwide. Diabetes Mellitus (DM) is one of four non-communicable diseases that can be caused by lifestyle factors. There are 4 family lifestyles that are a risk of causing diabetes mellitus, namely physical activity (exercise habits), diet (habits to consume sugary drinks), smoking habits, and the frequency of monitoring blood sugar levels. This study aims to describe the lifestyle of families at risk of diabetes mellitus in Blimbing Village, Rejotangan District in 2022. The research design used is descriptive quantitative. The population and sample of this study were families who lived in the same house with people has diabetes mellitus as many as 20 samples, provided that they met the inclusion and exclusion criteria. The variable used in this study is a single variable, namely the lifestyle of the family at risk of diabetes mellitus. Furthermore, data collection was carried out using a questionnaire, after which the data was processed by editing, coding, data entry, tabulation, and analyzed by percentage. The results of the research from 20 total respondents can be seen that most of the respondents have a bad lifestyle as many as 13 people (65%), respondents have very bad lifestyle as many as 4 people (20%), and respondents with a good lifestyle as many as 2 people (10%). The conclusion from the results of the study shows that special attention is needed to control the risk of diabetes mellitus seen from the aspect of family lifestyle, most of which have a bad lifestyle in order to start a good lifestyle.

1058. Development of a Steroid Stewardship Bundle to tackle the Glucocorticoid-Induced Hyperglycemia in COVID-19 patients: Results of SUPER Diabetes Study.

Abstract Background Glucocorticoid therapy in COVID-19 patients poses a greater risk of hyperglycemia, leading to an unexpected detrimental effect on treatment outcomes. The Steroid Use in Patients Exhibiting Risk (SUPER) to Diabetes -SUPER Diabetes- study aimed to implement a steroid stewardship bundle to encounter the incidence of Glucocorticoid-Induced Hyperglycemia (GCIH) in COVID-19 patients and to evaluate the effectiveness of the Steroid Stewardship Program. Methods This interventional study included 600 COVID-19 confirmed patients admitted between April 2021and March 2022 in a secondary care hospital in India (stewardship cohort). A six-item Steroid Appropriate Index (SAI) assessed the need for steroid therapy using the parameters like the severity of disease, the onset of symptoms, weight of the patient, CT Thorax score, the preferred route of administration, and the comorbid disorders. This created a steroid stewardship bundle with the following parameters: (1) appropriate selection of the corticosteroid; (2) repeat blood sugar monitoring every 8 hours until discharge from hospital; (3) appropriate duration of therapy (4) proper de-escalation of dose/intravenous to oral switch. The patients were followed until discharge/death to track the incidence of hyperglycemia. The analysis of the effectiveness of SAI and the stewardship bundle was done by comparing this with the clinical outcomes among 300 COVID-19 confirmed patients admitted before implementing the scale (retrospective cohort). Results The majority of the patients included in the stewardship cohort were males (367; 61.1%), and the mean age was 47.3± 17.1 years. The incidence of new-onset of hyperglycemia or a worsened glycemic profile, i.e., Glucocorticoid-Induced Hyperglycemia (GCIH), was more among the retrospective cohort when compared with the stewardship cohort (32.1% vs 6.3%), p< 0.001). The study also revealed that history of diabetes (p< 0.001), age (p=0.002), number of medicines used for treatment (p< 0.001), and the frequency of monitoring of diabetes (p< 0.001) are significantly associated with GCIH. Conclusion Implementing the steroid stewardship bundle significantly improved the appropriate selection and use of corticosteroids, decreasing the incidence of associated adverse events. Disclosures All Authors: No reported disclosures.

Evaluating melting gel coatings for wearable metabolic sensors

New steps have been taken toward finalizing a novel wearable sensor for entirely non-invasive, continuous blood sugar monitoring via the low concentrations of acetone continuously emitted from human skin as a byproduct of metabolic activity. This sensor is based on a chemo-mechanical actuating polymer composite of the well-known conducting polymer polyaniline and cellulose acetate, which is a simple derivative of the incredibly proliferous and benign organic compound cellulose. The improvements reported here revolve around the application of a 65% methyltriethoxysilane – 35% dimethyldiethoxysilane melting gel to one side of the sensor, thereby isolating the sensor from ambient air and any interferents it might contain. Visual inspection shows that the melting gel does not prohibit functionality of the existing polyaniline-cellulose acetate sensor, and FTIR spectroscopy shows that no significant chemical changes are caused by application of the melting gel to the polyaniline-cellulose acetate sensor. • Composite-material wearable metabolic sensors continuously monitor skin-gas emissions. • Novel sensors are chemo-mechanical actuating polyaniline-cellulose acetate composite. • Organically modified siloxane melting gels create impermeable hydrophobic barrier. • Melting gel coatings are applied and consolidated without damaging composite sensors.

Application of Artificial Neural Network and Gray Level Co-occurrence Matrix to detect blood glucose levels through the skin of the hands.

Increased glucose in the blood can cause a buildup so that it cannot be absorbed by all of the body's cells, this problem can cause various disorders in the body's organs. To avoid problems, it is necessary to check the blood glucose level regularly. Monitoring blood sugar levels is currently still using invasive techniques that are painful, non-invasive monitoring is needed. This study develops a non-invasive method to predict blood glucose through image processing. For investigation, several invasive images and glucose levels were taken. Types of samples based on age classification, 20-60 years. For accuracy and simple analysis, 37 images of participants as volunteers, samples were evaluated and investigated under the gray level co-occurrence matrix (GLCM). In this study, an artificial neural network (ANN) was used for all training and hand texture testing to detect glucose levels. The performance of this model is evaluated using Root Mean Square Error (RMSE) and correlation coefficient (r). Clarke Error Grid Analysis (EGA) variance was used in this investigation to determine the accuracy of the method. The results showed that the RMSE was close to the standard value, the regression coefficient was 0.95, and the Clarke EGA analysis: 81.08 % was in the A zone. So that the blood glucose prediction model using the GLCM-ANN method is feasible to apply.

ANALISIS IMPLEMENTASI APLIKASI SISTEM TELEMEDICINE “MY GLUCOSE” PADA MASYARAKAT DI WILAYAH GUNUNGPATI SEMARANG

<p class="Abstract" align="left"><strong>Abstract</strong></p><p class="IndexTerms">This study aims to evaluate the implementation of the "MyGlucose" telemedicine system application in the Gunungpati society, Semarang City, which is used to remotely monitor blood sugar levels in diabetic patients as well as oxygen saturation and body temperature. The method used in this research is to develop the MyGlucose application which consists of measuring blood sugar, SpO2, and body temperature connected to the patient's mobile device and software on the health care provider's side. The research sample consisted of 44 respondents who used the MyGlucose application for the last two months. The results showed that the majority of respondents felt that the MyGlucose application was very helpful in monitoring their blood sugar levels independently without having to visit a doctor regularly. This application also assists patients in monitoring blood sugar levels, as well as providing information about health in the article menu available in the application. Therefore, efforts are needed to improve accessibility and education related to the use of the MyGlucose application in the people of the Gunungpati area, Semarang City. In conclusion, the telemedicine system application "MyGlucose" can be an effective alternative in monitoring blood sugar levels, oxygen saturation and body temperature of diabetes patients independently and helping patients consult a doctor without having to go to the hospital.</p><p class="IndexTerms" align="left"> </p><p class="IndexTerms" align="left"> </p>

Rancangan Model Pemberdayaan Keluarga Pasien terhadap Perawatan Diri (Self Care) Pasien DM Tipe 2

This study aims to develop a design model for family empowerment in treating patients with type 2 DM in the working area of ​​EMC Cikarang Hospital. This study uses a qualitative design with an action research approach through two stages of implementation, namely experimental phenomenology and focused group discussions (FGD). The results of this study identified four themes, namely: (1) Family knowledge about Diabetes Militus; (2) the role of the family in caring for DM patients (DM diet management, OAD consumption regulation at home (PMO), DM wound treatment, and monitoring blood sugar levels); (3) the role of the family when they find out that a family member has DM; and (4) Supportive examination of DM patients. In conclusion, family empowerment can change the attitudes and behavior of patients by empowering families who can assist in the form of self-care for DMT2 patients so that the quality of self-care in DMT2 patients becomes better and improves the patient's health status on an ongoing basis.
 
 Keywords: Type 2 Diabetes Mellitus, Family Empowerment, Self-Care

Behaviours and educational effect on the improvement of self-care among the diabetics

Globally diabetes causes a huge burden due its significant morbidity and mortality. In year 2019 almost 4.2 million people died from diabetic complications. Self-care is essential in management of diabetes since lifestyle modifications can successfully help in preventing diabetes associated complications. People with diabetes should engage in self-care practices to manage their condition. Diabetes education is essential to improve self-care for patients with the disease. The purpose of this research is to review the available information behaviours and educational effect on the improvement of self-care among the diabetics. A key element of diabetic management is sufficient knowledge of the disease as more education can develop a sense of empowerment and improve quality of life of patients. Patients with diabetes have demands that extend beyond just maintaining optimal glucose control and include preventing complications, limiting their impairment, and receiving rehabilitation. Healthy diet, exercise, blood sugar monitoring, adherence to medicine, strong problem-solving abilities, healthy coping mechanisms, and risk-reduction behaviours are the seven fundamental self-care behaviours in people with diabetes that predict positive results. Patient self-care is a cornerstone of diabetes care and is thought to increase patients' effectiveness in managing their condition by increasing awareness of the disease and enhancing prevention. It is evident from the available literature that diabetes education promotes self-care which has positive impact on health outcome and helps in managing the metabolic markers. Self-care among patients can only be encouraged through proper education at all healthcare levels.

Development of Chobmons Prototype: Cholesterol and Blood Sugar Level Monitoring System Based on Internet of Things (IoT) using Blynk Application

In the era of the industrial revolution 4.0, we need remote technology and products that d not created new medical waste piles. An unhealthy lifestyle can cause many diseases, either degenerative diseases, namely over rate cholesterol and blood sugar level. High cholesterol and blood sugar levels are causes of major influence on atherosclerosis, stroke, micro-vascular, and cardiovascular complications. We offer a non-invasive cholesterol and blood sugar monitoring device based on red LED and infrared light absorption using the Nellcor DS-100A sensor. This technology can help reduce cumulative medical waste and help health workers to monitor patients remotely. This study used ten random samples to calibrate cholesterol and blood sugar levels. The coefficient of determination values were 0.9580 and 0.9581, respectively, which gave excellent values so that the study is continued by collecting data. Data retrieval use 20 random sample data to measure cholesterol and blood sugar levels, the average accuracy prototype is 90.26% and 91.16%, respectively. It shows great potential in determining estimation value at cholesterol and blood sugar levels. The monitoring system can show the data on the LCD display in Blynk Application with the average time required of 1.07 s.

Automatic user sentiments extraction from diabetes mobile apps – An evaluation of reviews with machine learning

ABSTRACT Using diabetes mobile apps for self-management of diabetes is one of the emerging strategies for controlling blood sugar levels and maintaining the wellness of patients with diabetes. This study aims to develop a strategy for thematically extracting user comments from diabetes mobile apps to understand the concern of patients with diabetes. Hence, 2678 user comments obtained from the Google Play Store are thematically analyzed with Non-negative Matrix Factorization (NMF) to identify the themes for describing positive, neutral, and negative sentiments. These themes are used as the ground truth for developing a 10-fold cross-validation ensemble Multilayer Artificial Neural Network (ANN) model following the Bag of Word (BOW) analysis of lemmatized user comments. The result shows that a total of 41.24% of positive sentimental users identified the diabetes mobile apps as Effective for Blood Sugar Monitoring (EBSM), 32.36% with neutral sentiments are mostly impressed by the Information Quality (IQ), whereas 40.81% of unhappy users are worried about the Poor Information Quality (PIQ). The prediction accuracy of the ANN model is 89%–97%, which is 5%–48% better than other predominant algorithms. It can be concluded from this study that diabetes mobile apps with a simple user interface, effective data storage and security, medication adherence, and doctor appointment scheduling are preferred by patients with diabetes.

ANALYSIS OF BLOOD GLUCOSE LEVELS IN PEOPLE WITH TYPE II DIABETES MELLITUS (DM) AGED 50-60 YEARS WITH GLUCOMETER METHOD AT ISLAMIC MALAHAYATI MEDAN HOSPITAL YEAR 2022

Diabetes Mellitus (DM) type II is a metabolic disorder disease characterized by an increase in blood glucose due to a decrease in insulin secretion by pancreatic beta cells or impaired insulin function (insulin resistance). Blood glucose is a carbohydrate that circulates in the body in the metabolic process. Monitoring blood sugar levels is needed in establishing a diagnosis, especially for Diabetes Mellitus (DM). Blood glucose levels can be checked when the patient is in a fasting condition or it can also be when the patient comes to check, with the results of the examination of blood glucose levels when >200 mg / dl, while for the results of glucose levels during fasting >126 mg / dl.. This type of research is descriptive. A tool to measure blood glucose levels using the Glucometer Method. The time of the study was carried out from January to March at the Islamic Malahayati Medan Hospital’s Laboratory by taking 10 samples. Data collection is carried out by direct examination of blood glucose levels in patients with Diabetes Mellitus at Malahayati Medan Islamic Hospital in March-April 2022. From the results of examination of blood glucose levels in 10 samples of type II diabetes mellitus (DM) aged 50-60 years with glucometer method at Malahayati Islam hospital Medan 2022 obtained the results that all samples showed an average blood glucose level value above 220 mg / dl and increased from its normal value.
 Keywords: Diabetes Mellitus; Blood Glucose Level

A Comparative analysis of type 2 diabetes management quality indicators in cancer survivors

ObjectiveThis study aimed to assess indicators of type 2 diabetes mellitus (DM) management, including adequate DM control, and treatment rates, in cancer survivors according to the time of DM diagnosis and to compare them with the DM management indicators of a non-cancer control group. MethodsWe used the 2013–2019 data of the Korea National Health and Nutrition Examination Survey for this study. To compare their adequate DM control, and treatment rates, we identified 4918 patients with type 2 DM aged ≥ 30 years and classified them into pre-existing diabetes, pre-existing cancer, and diabetes without cancer groups. Predictors of adequate glycemic control and diabetes treatment were analyzed using binary logistic regression. ResultsDiabetes without cancer group had higher fasting blood glucose and glycosylated hemoglobin A1c levels and lower adequate glycemic control than did the other two groups. The preexisting cancer group had low treatment rates. After adjusting for age, gender, employment status, and duration of diabetes, the preexisting cancer group had 0.51-fold lower odds of receiving treatment, such as insulin injection or oral diabetes medications, than the other two groups (adjusted odds ratio, 0.50; 95% confidence interval, 0.38–0.66) ConclusionsCancer survivors had lower fasting glucose and HbA1c than those with diabetes without cancer. However, as a result of the sub-analysis, the treatment rate of the pre-existing cancer group was significantly lower than that of diabetes without cancer. Based on these results, cancer survivors’ care-related healthcare workers should be aware of the need for monitoring blood sugar even in cancer survivors without underlying diabetes mellitus and pay more attention to early detection and active treatment of diabetes.

Understanding the links between glycemic control, management adherence and hemoglobin level among type 2 diabetes mellitus

Patients with diabetes must be monitored for hyperglycemia due to the risk of macrocellular and microcellular complications. High blood sugar levels force the kidneys to work harder to filter blood, which results in renal leakage. The objective of this study was to establish a relationship between glycemic control, management adherence, and hemoglobin level in patients with type 2 diabetes. This study employed a correlational design with a cross-sectional approach and a sample size of 72 respondents selected using purposive technique. Compliance with diabetes mellitus, which includes diet compliance, exercise compliance, medication compliance, and blood sugar monitoring compliance, is strongly correlated with glycemic control levels. Completely contrary, there was no link between hemoglobin levels and adherence to treatment. Microcellular processes of renal function are linked to the interaction between glycemic control and hemoglobin levels.

Risk factors for COVID-19 associated mucormycosis in India: A case control study.

The COVID-19 pandemic had led to an increase surge of mucormycosis in COVID-19 patients, especially in India. Diabetes and irrational usage of corticosteroid to treat COVID-19 were some of the factors implicated for COVID-19 associated mucormycosis (CAM). We designed this case control study to identify risk factors for mucormycosis in COVID-19 patients. The study was conducted at a private tertiary care center in western India. Data was extracted from records of COVID 19 patients (Jan to May 2021) and divided into two groups: Those with proven or probable mucormycosis, and those without mucormycosis with a ratio of 1:3. A binary logistic regression analysis was done to assess potential risk factors for CAM. A total of 64 CAM and 205 controls were included in the analysis. Age and sex distribution were similar in cases and controls with the majority of males in both the groups (69.9%) and the mean age was 56.4 (±13.5) years. We compared the comorbidities and treatment received during acute COVID-19, specifically the place of admission, pharmacotherapy (steroids, tocilizumab, remdesivir), and requirement of oxygen as a risk factor for CAM. In a multivariate analysis, risk factors associated with increased odds of CAM were new-onset diabetes (v/s non-diabetics, adjusted OR 48.66, 95% CI 14.3-166), pre-existing diabetes (v/s Non-Diabetics, aOR 2.93, 95% CI 1.4-6.1), corticosteroid therapy (aOR 3.64, 95% CI 1.2-10.9) and home isolation (v/s Ward admission, aOR 4.8, 95% CI 2-11.3). Diabetes, especially new onset, along with corticosteroid usage and home isolation were the predominant risk factors for CAM.

Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial

BackgroundOver 80% of the morbidity and mortality related to non-communicable diseases (NCDs) occurs in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, particularly in sub-Saharan African settings. In Uganda, and the majority of LMICs, management of uncontrolled hypertension remains limited in constrained health systems. Intervening at the primary care level, using CHWs to improve medical treatment outcomes has not been well studied. We aim to determine the effectiveness of a CHW-led intervention in blood pressure control among confirmed hypertensive patients and patient-related factors associated with uncontrolled hypertension.MethodsWe will conduct a stepped-wedge cluster randomized controlled trial study of 869 adult patients with hypertension attending two NCD clinics to test the effectiveness, acceptability, and fidelity of a CHW-led intervention. The multi-component intervention will be centered on monthly household visits by trained CHWs for a period of 1 year, consisting of the following: (1) blood pressure and sugar monitoring, (2) BMI monitoring, (3) cardiovascular disease risk assessment, (4) using checklists to guide monitoring and referral to clinics, and (5) healthy lifestyle counseling and education. During home visits, CHWs will remind patients of follow-up visits. We will measure blood pressure at baseline and 3-monthly for the entire cohort. We will conduct individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community.ConclusionThe results of this study will inform community delivered HTN management across a range of LMIC settings.Trial registrationClinicalTrials.govNCT05068505. Registered on October 6, 2021.