Poor Control Research Articles

Relationship between Knowledge with Hypertension Control Behavior in Sumuragung Village, Sumberrejo, Bojonegoro

Introduction: Hypertension is a non-communicable disease whose case trend continues to increase from year to year. Although hypertension is a disease that is suffered by many people in Indonesia, in reality there are still many people who do not understand about hypertension and do not apply hypertension control behavior. The formation of health behavior can be influenced by individual knowledge in viewing a disease. Insufficient knowledge of hypertension can have an impact on hypertension that is difficult to cure and is fatal to the emergence of various complications. Objective: To determine the relationship between knowledge with hypertension control behavior in hypertensive patients in Sumuragung Village, Sumberrejo District, Bojonegoro Regency. Method: This study was conducted in Sumuragung Village, Sumberrejo District, Bojonegoro Regency in December 2022-January 2023. The research design used was quantitative with a cross sectional study approach and obtained a sample of 91 respondents with hypertension aged 45 years or more. The sampling technique used probability sampling with the simple random sampling method. Meanwhile, the data collection technique was carried out door to door and the instrument used was an interview using a questionnaire sheet that had been tested for validity and reliability. Data were analyzed univariately in the form of frequency distribution and bivariate using the Chi Square test. Result: It was found that there were 45 respondents who had good knowledge about hypertension and good hypertension control behavior and there were 18 respondents who had poor knowledge and poor hypertension control behavior. From the results of the chi square test obtained a p value of 0.001. Conclusion: There is a relationship between knowledge with hypertension control behavior in hypertensive patients in Sumuragung Village, Sumberrejo District, Bojonegoro Regency.

The anesthetic management of a child with ohtahara syndrome and severe stridor: a case report

BackgroundOhtahara syndrome is a progressive developmental and epileptic encephalopathy that manifests in the early infantile period. This rare condition is characterized by intractable seizures, psychomotor retardation, and poor prognosis. To date, there are a handful of case reports regarding the anesthetic management of children with Ohtahara syndrome. However, limited reports exist of patients with Ohtahara syndrome who present with difficult airways. This report describes our airway findings and general anesthetic management of a pediatric patient with Ohtahara syndrome undergoing diagnostic bronchoscopy for severe inspiratory stridor.Case presentationA 14-month-old, 9 kg, male patient with Ohtahara syndrome presented with a year-long history of severe inspiratory stridor and was scheduled for bronchoscopy with lavage. On exam, the patient had noisy breathing, was non-verbal with developmental delay, and had poor head control with significant central hypotonia. The patient was induced with ketamine and general anesthesia was maintained with propofol. Bronchoscopic evaluation was completed uneventfully and revealed a diagnosis of laryngotracheomalacia. The patient’s breathing was maintained spontaneously throughout the procedure and no seizures were noted. In the post anesthesia care unit, the patient’s respiratory and cardiovascular function were stable.ConclusionsThis report documents the unusual finding of severe inspiratory stridor in a 14-month-old child diagnosed with Ohtahara syndrome and our anesthetic management during their diagnostic bronchoscopy. Currently, documentation of complex airway pathology present in patients with Ohtahara syndrome is limited and should be further evaluated. This will assist pediatric anesthesiologists as these patients may require careful preoperative assessment, thoughtful airway management, and surgical alternatives on standby.

User Acceptability Testing of Mobile Application in Indian Local Languages for Cardiovascular Risk Stratification and Modification among Patients with Type 2 Diabetes

Introduction: Cardiovascular disease is the leading cause of death in patients with type 2 diabetes. Digital health tools like mobile application have fast emerged as a technology capable of closing the gap in cardiovascular disease self- management and revolutionizing the way healthcare is traditionally delivered. One of the causes for low app engagement of Apps in India is perhaps that few of these apps are available in local languages. The goal is to reach as many diabetic patients as possible while avoiding linguistic hurdles.  Methodology: The ‘healthy heart’ mobile app was developed and translated into Hindi and Marathi languages for CVD risk stratification and risk management among Type 2 diabetes mellitus patients. User acceptability testing of the app on its design, presentation, content, and user- friendliness was undertaken. The feedback on utility of the app for CVD risk stratification and modification was assessed. A total 100 multilingual app users profile were noted for CVD Risk Status, Life Style Practices and CVD Risk Factors.  Results: The Healthy Heart multi-lingual app was successfully developed for CVD risk classification and risk management among Type 2 diabetes mellitus patients. The patients had the choice to select the desired language of the app from the versions available in English, Hindi and Marathi. The Mobile App's Home Screen displayed the CVD risk score and category, a health tracker to monitor compliance with WHO recommendations regarding diet, physical activity, addictions, medication adherence, diabetic, and CVD Risk Profile. The majority of respondents rated the App's design, presentation, content, and user- friendliness favorably and emphasized the utility of App for CVD self-management and risk reduction. Characteristics of Type 2 Diabetic patients demonstrated poor compliance for total fruits and vegetable intake, total fat intake and total salt intake, physical activity Guidelines apart from poor control for blood pressure, glycemic control and lipid targets.  Conclusion: The multilingual mobile App for CVD risk stratification, self-management and CVD risk reduction among diabetic patients was successfully developed in Hindi and Marathi language. User acceptability testing results were found to be favorable for the mobile app.

Aberrant type 2 dopamine receptor availability in violent offenders with psychopathy

Psychopathy is characterized by antisocial behavior, poor behavioral control and lacking empathy, and structural alterations in the corresponding neural circuits. Molecular brain basis of psychopathy remains poorly characterized. Here we studied type 2 dopamine receptor (D2R) and mu-opioid receptor (MOR) availability in convicted violent offenders with high psychopathic traits (n = 11) and healthy matched controls (n = 17) using positron emission tomography (PET). D2R were measured with radioligand [11C]raclopride and MORs with radioligand [11C]carfentanil. Psychopathic subjects had lowered D2R availability in caudate and putamen, and striatal D2R availability was also associated with degree of psychopathic traits in this prisoner sample. No group differences were found in MOR availability, although in the prisoner sample, psychopathic traits were negatively correlated with MOR availability in the amygdala and nucleus accumbens. We conclude that D2R signaling could be the putative neuromolecular pathway for psychopathy, whereas evidence for alterations in the MOR system is more limited.

Vagus Nerve Stimulation for Intractable Focal Epilepsy

Abstract Background Epilepsy is a common neurological condition affecting 0.5-1% of the population. Despite the advances in the medical management of epilepsy 25-35% of patients have poor control of their seizures or have unacceptable side effects from the medication. Aim and Objectives To make up-to-date recommendations for the value of vagus nerve stimulation (VNS) in patients suffering from intractable focal epilepsy and not candidates for surgical resection. Subjects and Methods Eight studies were included in the present meta-analysis. The flow diagram of the study selection processes. The total number of patients in the eight included studies was 266. The follow-up periods ranged from 12–124 months. Because of significant heterogeneity (I2 = 94 %) among the included studies, a sensitivity analysis was performed. Result 59.4% of all the included patients showed a 50% or greater reduction in seizure frequency after VNS. The patients with > 50% reduction in seizure frequency ranged from 25–66% among the eight included studies. Non-significant improvement in seizure frequency after VNS. Conclusion After VNS, the frequency of seizures was reduced by 50% in about 59.4% of the patients with intractable focal seizures. The present study's random effects forest plot, however, indicated that the reduction in seizure frequency following VNS was not statistically significant. The effectiveness of VNS in reducing seizure frequency in the population under study is therefore still unknown,.

Synthesis of 4A Zeolite Molecular Sieves by Modifying Fly Ash with Water Treatment Residue to Remove Ammonia Nitrogen from Water

The widespread presence of ammonia nitrogen (NH4+–N) pollutants poses a serious threat to water environment health. In this study, a novel zeolite (WTR–CFA zeolite) with excellent adsorption performance is synthesized using CFA as the raw material and water treatment residue (WTR) as the aluminum source through an ultrasonic–assisted alkali melt hydrothermal method. Compared with traditional CFA–zeolite, WTR–CFA zeolite only generates 4A zeolite with a single crystal phase, and the peak shape is sharp, which results in better crystallization. WTR–CFA zeolite perfectly solves the technical problems of the low utilization rate and poor controllability of the crystal form in traditional artificially synthesized zeolites. The maximum NH4+–N adsorption capacity of WTR–CFA zeolite is 29.80 mg/g, which is higher than that of most adsorbents reported in previous studies. After five cycles of adsorption regeneration, the regeneration efficiency of WTR–CFA zeolite only decreased from 98.84% to 97.12%, which demonstrates excellent environmental value. The adsorption isotherms and kinetics of NH4+–N conform to the Langmuir model and quasi–second order kinetic model, respectively, which indicates that ion–exchange–dominant chemical adsorption plays a major role in the adsorption mechanism. In summary, this study combines the use of CFA and WTR resources with the treatment of aquatic pollution to reduce material synthesis costs, control the crystal structure of WTR–CFA zeolite, and increase adsorption capacity. This approach achieves the goals of “waste treatment and turning waste into treasure”.

The Association Between Vitamin D Status and Glycemic Control in Children and Adolescents with Type 1 Diabetes

Low vitamin D levels are common in children and adolescents with type 1 diabetes. Although a link between vitamin D status and glycemic control is suggested, the direct association with poor control is unclear. This study assessed the prevalence of low vitamin D (deficiency and insufficiency) and its relationship with HbA1c in youth with type 1 diabetes. A cross-sectional study at Benghazi Medical Center, Libya, from June to September 2018 included 63 patients (33 females, 30 males), aged 6-18 years. Data on socio-demographics, HbA1c, and vitamin D levels were collected. Vitamin D levels were categorized as deficient (<10 ng/ml), insufficient (10-19 ng/ml), or sufficient (≥20 ng/ml). Glycemic control was classified as good (HbA1c ≤ 7.5%), fair (7.6%-8.5%), or poor (≥8.6%). Analysis using SPSS version 18 showed patients had a mean age of 12 years (±3.9), BMI of 19.18 kg/m² (±3.70), diabetes duration of 4.90 years (±3.03), average HbA1c of 10.10% (±2.5), and mean vitamin D level of 17.70 ng/ml (±10.8). Deficient vitamin D was found in 27% of patients, with 36.5% insufficient and 36.5% sufficient. A weak negative correlation (r= -0.112, p=0.38) was observed between 25-hydroxyvitamin D and HbA1c. Low vitamin D levels, including deficiency and insufficiency, were prevalent in youth with type 1 diabetes. However, vitamin D status did not significantly impact glycemic control in this study.

Self-organizing recruitment of compensatory areas maximizes residual motor performance post-stroke.

Whereas the orderly recruitment of compensatory motor cortical areas after stroke depends on the size of the motor cortex lesion affecting arm and hand movements, the mechanisms underlying this reorganization are unknown. Here, we hypothesized that the recruitment of compensatory areas results from the motor system's goal to optimize performance given the anatomical constraints before and after the lesion. This optimization is achieved through two complementary plastic processes: a homeostatic regulation process, which maximizes information transfer in sensory-motor networks, and a reinforcement learning process, which minimizes movement error and effort. To test this hypothesis, we developed a neuro-musculoskeletal model that controls a 7-muscle planar arm via a cortical network that includes a primary motor cortex and a premotor cortex that directly project to spinal motor neurons, and a contra-lesional primary motor cortex that projects to spinal motor neurons via the reticular formation. Synapses in the cortical areas are updated via reinforcement learning and the activity of spinal motor neurons is adjusted through homeostatic regulation. The model replicated neural, muscular, and behavioral outcomes in both non-lesioned and lesioned brains. With increasing lesion sizes, the model demonstrated systematic recruitment of the remaining primary motor cortex, premotor cortex, and contra-lesional cortex. The premotor cortex acted as a reserve area for fine motor control recovery, while the contra-lesional cortex helped avoid paralysis at the cost of poor joint control. Plasticity in spinal motor neurons enabled force generation after large cortical lesions despite weak corticospinal inputs. Compensatory activity in the premotor and contra-lesional motor cortex was more prominent in the early recovery period, gradually decreasing as the network minimized effort. Thus, the orderly recruitment of compensatory areas following strokes of varying sizes results from biologically plausible local plastic processes that maximize performance, whether the brain is intact or lesioned.

Proportion and Potential Risk Factors of Poor Glycemic Control among Patients with Type 2 Diabetes Mellitus: Experience of a Tertiary Center in Baghdad, Iraq, 2020

Background: Diabetes Mellitus is the most prevalent metabolic disorder worldwide. Effective diabetes self-management and keeping the Glycosylated hemoglobin level within the normal range could decrease the burden on the health system by reducing hospital admissions and diabetic complications, lowering the financial strain on the health system. Objective: To recognize the potential risk factors of poor glycemic control in patients having type 2 Diabetes Mellitus in Baghdad, Iraq. Patients and Methods: This cross-sectional study was conducted in the Diabetes and Endocrine Center at Al-Kindy Teaching Hospital, Baghdad, Iraq, from June to November 2020. The total number of the study's participants was 234. Based on the cutoff point of glycosylated hemoglobin of 7, the patients with glycosylated hemoglobin of ≥7 were considered uncontrolled, and those with glycosylated hemoglobin of <7 were considered controlled. Results: The proportion of cases with uncontrolled diabetes was 68.4% (160). The remaining 74 patients had controlled diabetes. Age, sex, marital status, and employment status were not significantly associated with the control status (P>0.05). The binary analysis showed a significant association observed between the control status and level of education (P=0.001), income (P=0.001), presence of comorbidities (P=0.028), positive family history (P=0.03), dyslipidemia (P=0.001), cholesterol level (P=0.002), high triglyceride level (P=0.001), and low-density lipoprotein-cholesterol level (P=0.025). The smoking status, body mass index, and high-density lipoprotein-cholesterol level were not significantly associated with the control status (P>0.05). The disease characteristics, including the disease duration, fasting blood glucose, type of medication, self-monitoring, healthy diet, physical activity, and medication adherence, were significant factors (P<0.001). The multivariate regression method showed that dyslipidemia, FBS≥130, physical inactivity, and poor medication adherence were significant predictors for uncontrolled DM (P-value = 0.03, 0.001, 0.03, and 0.043, respectively). Conclusion: The most important potentially modifiable risk factors for poor diabetes control were dyslipidemia, physical inactivity, and poor adherence to the management protocol. Enhancing the education of patients and their healthcare providers on these factors is crucial to improving the patients’ control status.

Risk Factors Associated with Asthma Control and Quality of Life in Patients with Mild Asthma Without Preventer Treatment, a Cross-Sectional Study.

To study risk factors for uncontrolled asthma and insufficient quality of life (QoL) in patients with mild asthma, ie those without preventer treatment. Patients aged 18-75 years with a doctor's diagnosis of asthma randomly selected from primary and secondary care in Sweden. Mild asthma was defined as self-reported current asthma and no preventer treatment. Data were collected from self-completed questionnaires in 2012 and 2015. Well-controlled asthma was defined as Asthma Control Test (ACT) ≥20 points and no exacerbation and uncontrolled asthma as ACT<20 points and/or at least one exacerbation in the previous six months. QoL was measured by the Mini Asthma Quality of Life Questionnaire (Mini-AQLQ), where a total mean score of ≥ 6 indicated sufficient and < 6 insufficient QoL. Multivariate logistic regression analyses were performed using asthma control and Mini-AQLQ as dependent variables. Asthma control was dichotomized as controlled and uncontrolled asthma and the Mini-AQLQ as sufficient QoL (mean score ≥6) and insufficient QoL (mean score <6). Among 298 patients, 26% had uncontrolled asthma, 40% insufficient QoL and 20% both uncontrolled asthma and insufficient QoL. Age ≥60 years, obesity, daily smoking, rhinitis and inadequate knowledge of asthma self-management were independently associated with poor asthma control. Factors independently associated with insufficient QoL were age ≥60 years, overweight, obesity, rhinitis, sinusitis and inadequate knowledge of asthma self-management. Age ≥60 years, obesity, rhinitis and inadequate knowledge of asthma self-management were independently associated with both uncontrolled asthma and insufficient QoL. Among asthma patients without preventer medication, 26% had uncontrolled asthma and 40% had insufficient asthma-related QoL. Older age, obesity, and rhinitis were risk factors for both poor asthma control and a reduced QoL, but having good knowledge of asthma self-management reduced this risk. Our findings suggest that this group of patients requires further attention and follow-up.

Research-based Analytical Procedures to Evaluate Diabetic Biomarkers and Related Parameters: In Vitro and In Vivo Methods.

The degenerative tendency of diabetes leads to micro- and macrovascular complications due to abnormal levels of biochemicals, particularly in patients with poor diabetic control. Diabetes is supposed to be treated by reducing blood glucose levels, scavenging free radicals, and maintaining other relevant parameters close to normal ranges. In preclinical studies, numerous in vivo trials on animals as well as in vitro tests are used to assess the antidiabetic and antioxidant effects of the test substances. Since a substance that performs poorly in vitro won't perform better in vivo, the outcomes of in vitro studies can be utilized as a direct indicator of in vivo activities. The objective of the present study is to provide research scholars with a comprehensive overview of laboratory methods and procedures for a few selected diabetic biomarkers and related parameters. The search was conducted on scientific database portals such as ScienceDirect, PubMed, Google Scholar, BASE, DOAJ, etc. Conclusion: The development of new biomarkers is greatly facilitated by modern technology such as cell culture research, lipidomics study, microRNA biomarkers, machine learning techniques, and improved electron microscopies. These biomarkers do, however, have some usage restrictions. There is a critical need to find more accurate and sensitive biomarkers. With a few modifications, these biomarkers can be used with or even replace conventional markers of diabetes.

Prevalence and Associated Factors of Uncontrolled Hypertension Among Patients Attending Primary Healthcare Centers in Riyadh, Saudi Arabia.

Background Hypertension (HTN) is a global health issue as it causes significant mortality and morbidity among the worldwide population. Various treatments are available, but many patients are unable to control the disease. There are various factors like medication non-adherence and lifestyle habits that contribute to this problem. There is a need for evidence-based interventions to address HTN effectively, especially in regions like Saudi Arabia, where there is limited data on uncontrolled HTN. This study aimed to assess the prevalence of uncontrolled HTN and contributing factors to poor blood pressure control among patients in Primary Health Centers (PHCs) in Riyadh, Saudi Arabia. Methodology An analytical cross-sectional study was conducted using an interviewer-administered questionnaire among all patients aged 18 years and above who have uncontrolled HTN and who visited the PHCsof Riyadh's first health cluster in Saudi Arabia. Data was cleaned in Microsoft Excel and analyzed using IBM SPSS 29. Results The study comprised 516 patients with HTN. The majority were males (53.1%, n=274) compared to females (46.9%, n=242), with an average age of 58 years (SD=10.5). Notably, most patients were obese (63.2%, n=326), and 62.4% (n=322) had uncontrolled HTN. Multivariate analysis identified sociodemographic factors like higher education (p-value = 0.013, adjusted odds ratio (AOR) = 0.795) as protective against uncontrolled HTN, while employment (p-value = 0.031, AOR = 1.786) increased the risk of uncontrolled HTN. Risk factors such as smoking (p-value = 0.001, AOR = 3.011) and salt restriction (p-value = 0.021, AOR = 0.643) significantly influenced HTN control. Management-related predictors like stopping medication after feeling better (p-value = 0.001, AOR = 3.196) were also found significant. Conclusion This study revealed a high prevalence of uncontrolled HTN, especially among males and obese individuals. Sociodemographic factors like higher education were protective, while employment increased the risk of the disease. Further, smoking, salt restriction, and medication adherence significantly impacted HTN control, highlighting the importance of tailored interventions.

Four Years And More Than 200,000 Deaths Later: Lessons Learned From The COVID-19 Pandemic In US Nursing Homes.

Nursing home residents and staff were disproportionately affected by the COVID-19 pandemic, drawing attention to long-standing challenges of poor infection control, understaffing, and substandard quality of care in many facilities. Evolving practices and policies during the pandemic often focused on these challenges, with little effect. Despite the emergence of best practices to mitigate transmission of the virus, even the highest-quality facilities experienced outbreaks, indicating a larger systemic problem, rather than a quality problem at the facility level. Here we present a narrative review and discussion of the evolution of policies and practices and their effectiveness, drawing on evidence from the United States that was published during 2020-23. The lessons learned from this experience point to the need for more fundamental and nuanced changes to avoid similar outcomes from a future pandemic: greater integration of long-term care into public health planning, and ultimately a shift in the physical structure of nursing homes. More incremental measures such as vaccination mandates, higher staffing, and balancing infection control with resident quality of life will avoid some adverse outcomes, but without more systemic change, nursing home residents and staff will remain at substantial risk for repetition of the poor outcomes from the COVID-19 pandemic.

Human neural stem cells transplanted during the sequelae phase alleviate motor deficits in a rat model of cerebral palsy

AimsCerebral palsy (CP) is the most common physical disability in children, yet lacks an ideal animal model or effective treatment. This study aimed to develop a reliable CP model in neonatal rats and explore the effectiveness and underlying mechanisms of human neural stem cells (hNSCs) transplantation during the sequelae phase of CP. MethodsVasoconstrictor endothelin-1 (ET-1) was administered intracranially to the motor cortex and striatum of rats on postnatal day 5 to establish a CP model. hNSCs (5 × 105/5 μL) pretreated with hypoxia (5% O2 for 24 h) were transplanted near the infarct 3 weeks after ET-1 injury (the sequelae phase). The distribution and differentiation of hNSCs were observed after transplantation. Changes in neurotrophic factors, neurogenesis, angiogenesis, axonal plasticity, and motor function were analyzed. ResultsNeurobehavioral tests showed poor muscle strength and postural control in young ET-1 rats. Motor deficits of the left forelimb and gait abnormalities persisted into adulthood. Histopathological findings and MRI indicated the atrophy of the cortex, striatum, and adjacent corpus callosum in ET-1 rats. At 56 days after transplantation, hNSCs were widely distributed in the ipsilateral hemisphere, and differentiated into neurons, oligodendrocytes and astrocytes. Transplantation of hNSCs increased BDNF and VEGF expression, EdU+ cell number in the SVZ area, RECA-1+ vessel density and GAP-43 intensity around the lesion in ET-1 rats. The cylinder test revealed a significant increase in the left forelimb motor function from 28 days after transplantation, and the staircase and CatWalk tests showed improvements in fine motor function and gait parameters. ConclusionsIntracerebral injection of ET-1 modelled key functional and histopathological features of CP. hNSCs transplanted during the sequelae phase of CP resulted in long-term improvement in motor performance, possibly attributed to its capacity to stimulate neurotrophic factors, facilitate neurogenesis, angiogenesis, and promote axonal plasticity.

The Functional Role of microRNAs and mRNAs in Diabetic Kidney Disease: A Review.

Diabetes is a group of diseases marked by poor control of blood glucose levels. Diabetes mellitus (DM) occurs when pancreatic cells fail to make insulin, which is required to keep blood glucose levels stable, disorders, and so on. High glucose levels in the blood induce diabetic effects, which can cause catastrophic damage to bodily organs such as the eyes and lower extremities. Diabetes is classified into many forms, one of which is controlled by hyperglycemia or Diabetic Kidney Disease (DKD), and another that is not controlled by hyperglycemia (nondiabetic kidney disease or NDKD) and is caused by other factors such as hypertension, hereditary. DKD is associated with diabetic nephropathy (DN), a leading cause of chronic kidney disease (CKD) and end-stage renal failure. The disease is characterized by glomerular basement membrane thickening, glomerular sclerosis, and mesangial expansion, resulting in a progressive decrease in glomerular filtration rate, glomerular hypertension, and renal failure or nephrotic syndrome. It is also represented by some microvascular complications such as nerve ischemia produced by intracellular metabolic changes, microvascular illness, and the direct impact of excessive blood glucose on neuronal activity. Therefore, DKD-induced nephrotic failure is worse than NDKD. MicroRNAs (miRNAs) are important in the development and progression of several diseases, including diabetic kidney disease (DKD). These dysregulated miRNAs can impact various cellular processes, including inflammation, fibrosis, oxidative stress, and apoptosis, all of which are implicated during DKD. MiRNAs can alter the course of DKD by targeting several essential mechanisms. Understanding the miRNAs implicated in DKD and their involvement in disease development might lead to identifying possible therapeutic targets for DKD prevention and therapy. Therefore, this review focuses specifically on DKD-associated DN, as well as how in-silico approaches may aid in improving the management of the disease.

مدى إنتشار عوامل الخطر وارتباطها في تطور إعتلال الشبكية السكري في قسم طب العيون، مركز طبرق الطبي، ليبيا

Diabetic retinopathy is a condition of the eyes that can affect people with diabetes. This is the degree at which the retina's blood vessels are damaged by high blood sugar. These vascular structures can expand and rupture. Additionally, the vessels might close, preventing the circulation of blood. Sometimes, abnormally new blood vessels might grow on the retina. Any of the foregoing changes could impair your vision. The aim of this study is to identify risk factors that may enhance the development of diabetic retinopathy and explore strategies for reducing the possibility of visual impairment caused by this condition. A prospective cross-sectional study of diabetic patients registered at the Eye Department of Tobruk Medical Center in Tobruk, Libya between (01.06.2023 to 29.02.2024). Data was collected using a self-administered questionnaire. Grading of DR (diabetic retinopathy) was done by slit-lamp examination and fundoscopy by an ophthalmologist. Descriptive analysis included percentage, mean of age, and p-value by using SPSS 25. Result: There were 85 diabetic patients, with a mean age of 63.5 and an age range of 31 to 85 years. Of these, 98.8% were of Libyan nationality and 96.4% were place of residencein Tobruk. Forty-three women were present. Compared to individuals with diabetes for less than ten years, those with diabetes for eleven to fifteen years had an almost five-fold increased chance of having diabetic retinopathy disease (DR). Patients with poor diabetes control (HbA1c &gt; 9) had a 25-fold increased chance of developing PR compared to those with adequate control (HbA1c &lt; 7.5). Conclusion: Patients with uncontrolled diabetes and those with the disease for a longer period of time are more likely to develop diabetic retinopathy and experience visual impairment. Key word: Diabetic retinopathy, poor diabetes control, longer period of diabetes, Tobruk, Libya.

Survival of type 1 diabetes mellitus patients on disease control programme

Survival among children diagnosed with T1DM in SSA has been estimated to be very poor with average duration of survival at 1 year. With care and increasing availability of insulin through philanthropic projects like the Changing Diabetes in Children (CDiC), there is improved survival of children and adolescents with T1DM in the low and medium income countries (LMICS). We aimed to investigate the survival rates of patients with type 1 diabetes mellitus (T1DM) on a national programme at specialized T1DM clinics. Furthermore, the study sought to determine the associated factors for patients with T1DM to stay on the programme. The median duration for registered patients with T1DM on the programme was 99 (μ≔ 600, Min—Max ≔ 1—16864) days. Findings show that the hemoglobin A1C (HbA1c) poor control, body mass index (BMI), hypertension, hospital and residence were significantly associated with time in days to dropout from the programme. Of these predictors, being underweight and the centre of registration (Nsambya Hospital) had poor T1DM prognostics, while residing in the central region and being at least 15 years were associated with better T1DM control and management, hence a greater likelihood to stay on the T1DM programme.

Constipation - A Disregarded Symptom in Patients Undergoing Radiotherapy for Head and Neck Cancer – A Clinical Audit on Management

Background: In clinical practice, constipation in patients undergoing Radiotherapy (RT) for head and neck cancer is not only very common, but many a times left unattended. Unrelieved constipation results in patient distress and poor compliance to treatment. Most of the patients are empirically treated with poor symptom control. The aim of this audit was to find out the burden of constipation and to treat them effectively. Methods: Standard based clinical audit was undertaken in the department of Radiation Oncology from July 2021 to January 2022, in patients with complaints of constipation who are undergoing RT for head and neck cancers. The intervention planned (criteria) was to follow the European Society for Medical Oncology (ESMO) 2018 flowchart for the management of constipation, which were divided into 4 checkpoints for the ease of quantification – 1. history taken, 2. documentation of type of laxative used, 3. review for symptom relief and 4. maintenance therapy prescription. The standard set was 65%. Results: A total of 48 patients in the initial assessment (retrospective) and 44 patients in the re-assessment (prospective) were evaluated. The mean age in both the audit was 54 years, 32 (66.6%) patients in the initial assessment and 26 (60%) patients in the re-assessment reported constipation during RT. Comparing the pre intervention and post intervention, the 4 checkpoints of the ESMO flowchart were never addressed (0%) as compared to 92%, 92%, 77% and 77% respectively. The mean number of days for complete symptom relief were 7 v/s 2 days respectively. Mean number of days to report constipation was 5 days v/s 3 days respectively. The mean number of active reviews till complete symptom relief was 0 v/s 2 times. Conclusion: Empirical management of constipation occurring during RT for head and neck cancers gives poor results. Guideline based treatment help manage the constipation better thus enhancing the patient care.

No Man Is an Island: Resiliency Among Older African American Men Living with HIV

ABSTRACT African American men face chronic illness earlier in life and earlier death due to higher severity of illness and poor control of chronic diseases than their white male counterparts. Preexposure and post-exposure prophylaxis PrEP and PREP have improved the odds of survival among those living with HIV. However, the anti-retroviral treatments, though effective, are only as effective as early prevention and detection and in cases where patients can adhere to treatment regimens. The mean age of participants (N = 11) was 56.44 (SD = 5.175, range = 47–63). The current study employs qualitative methodology to propose an ecosystems-driven intersectional model to identify resilience and the influence of personal, social, and societal forces shaping the lives of older African American men living with HIV. Findings determine stigma, community violence, and structural barriers to care as crucial stress areas. Participants discussed self-advocacy and family as constituent elements of resilience. Several implications for practice and research emerged. Practice must design and deploy assessment instruments to include exposure to racism and violence, including emotional and structural violence. Practice must include advocacy at the micro, meso, and macro levels. Assessment must also be self-reflexive. Organizational assessment should involve internal and structural reviews of barriers to meeting client preferences.

Neuronal DNA repair reveals strategies to influence CRISPR editing outcomes.

Genome editing is poised to revolutionize treatment of genetic diseases, but poor understanding and control of DNA repair outcomes hinders its therapeutic potential. DNA repair is especially understudied in nondividing cells like neurons, which must withstand decades of DNA damage without replicating. This lack of knowledge limits the efficiency and precision of genome editing in clinically relevant cells. To address this, we used induced pluripotent stem cells (iPSCs) and iPSC-derived neurons to examine how postmitotic human neurons repair Cas9-induced DNA damage. We discovered that neurons can take weeks to fully resolve this damage, compared to just days in isogenic iPSCs. Furthermore, Cas9-treated neurons upregulated unexpected DNA repair genes, including factors canonically associated with replication. Manipulating this response with chemical or genetic perturbations allowed us to direct neuronal repair toward desired editing outcomes. By studying DNA repair in postmitotic human cells, we uncovered unforeseen challenges and opportunities for precise therapeutic editing.