High Prevalence of Depressive Symptoms in Patients With Type 1 and Type 2 Diabetes in Developing Countries: Results From the International Diabetes Management Practices Study

OBJECTIVEDepression is common in people with diabetes, but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS).RESEARCH DESIGN AND METHODSIDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the 9-item Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms.RESULTSOf 9,865 patients eligible for analysis, 2,280 had type 1 and 7,585 had type 2 diabetes (treatment: oral glucose-lowering drugs [OGLD] only, n = 4,729; OGLDs plus insulin, n = 1,892; insulin only, n = 964). Depressive symptoms (PHQ-9 score ≥5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs-only, 36.6% for OGLDs-plus-insulin, and 46.7% for insulin-only subgroups. Moderate depressive symptoms (PHQ-9 score 10–19) were observed in 8–16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms. In type 1 diabetes and in the type 2 diabetes OGLDs-only group, depression was associated with poor glycemic control.CONCLUSIONSDepressive symptoms are common in patients with diabetes from developing countries, calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction.     

An Evaluation on Levels of Knowledge,Attitude and Behavior of People at 65 Years and Above About Alternative Medicine Living in Ankara

The aim was to determine the knowledge, attitude and behavioral levels of people at and above 65 years of age, living in Ankara (Turkey) about alternative medicine. The study was carried out between March – April 2010 through survey application of 200 participants by selective random sampling from the population. Data obtained as a result of the survey were analyzed by SPSS program. The study revealed that 83.5% of the participants believed in alternative therapy methods but 16.5% of them did not. It is concluded that herbal therapy methods are the most frequently used methods with a 63% rate among other alternative therapy methods. When status of the participants was analyzed it was found that it was found that 69% received the information about alternative medicines from their family while 53.5% received it from television This study revealed that alternative medicine is profoundly used by people above 65 years of age in Ankara.     

Fecal Bacteriotherapy for Clostridium difficile Infections — Its Time Has Come

Clostridium difficile treatment failures and recurrences occur at rates of 22.3% and 22.1%, respectively. For patients who have refractory/recurrent disease, there are limited treatment options. The use of a fecal suspension from a healthy donor instilled via a nasogastric tube, during colonoscopy, or by enema in a patient with recurrent or refractory C. difficile infection has shown a response rate of 75 to 100% with minimal adverse effects. There are multiple published case series that provide variations in administration procedures. The main barrier is the need for institutions and clinics to develop protocols to ensure this treatment modality is available to patients with this debilitating and potentially fatal disease.     

The Misuse of Prescribed Drugs During the Syrian Crisis: a Cross-sectional Study

International Journal of Mental Health and Addiction -     

Sleep and neighborhood socioeconomic status: a micro longitudinal study of chronic low-back pain and pain-free individuals

Journal of Behavioral Medicine - Individuals with chronic low back pain (cLBP) frequently report sleep disturbances. Living in a neighborhood characterized by low-socioeconomic status (SES) is...     

Extended-Spectrum β-Lactamases (ESBLs): Characterization,Epidemiology and Detection

β-lactamases of Enterobacteriaceae are the most important mechanism of resistance against β-lactam drugs. Two types of β-lactamases can confer resistance against 3rd generation cephalosporins. Chromosomally mediated β-lactamases are inducible and are not inhibited by clavulanic acid. Resistance due to these enzymes is non-transferable. The 2nd type of enzyme is plasmid-mediated β-lactamases, which are inhibited by clavulanic acid. These enzymes are more important clinically as these can be transferred between various species of Enterobacteria ceae. These enzymes are called extended-spectrum β-lactamases (ESBLs). ESBL-producing Enterobacteriaceae have been responsible for numerous outbreaks of infection throughout the world and pose challenging infection control issues. Antibacterial choice is often complicated by multi-resistance. ESBLs can confer resistance against all β-lactam drugs except carbapenems and cephamycins. Nursing home patients may be an important reservoir of ESBL-containing multiple antibiotic-resistant organisms. Use of broad-spectrum oral antibiotics and probably poor infection control practices may facilitate spread of this plasmid-mediated resistance. In addition to known populations at risk, ambulatory patients with chronic conditions represent another patient population that may harbor ESBL-producing organisms. Various methods can be used for detection of ESBLs in the laboratory. These tests include double disc diffusion test, Vitek ESBL test, E Tests, MIC Determination, genetic method, and isoelectric focusing (IEF).     

The Impact of Method on Kidney Graft and Patient Survival in Kidney-Pancreas Transplantations for Type I Diabetes Mellitus

Patients who develop end-stage renal disease (ESRD) associated with Type I Diabetes Mellitus may receive kidney alone (KA) transplantation, simultaneous pancreas-kidney (SPK) transplantation, or a pancreas after kidney (PAK) transplantation. The goal of this study is to examine the long-term impact of pancreas transplantation on kidney graft and patient survival rates. A total of 85 transplantation cases, consisting of 30 that received living donor KA, 21 that received SPK, and 34 that received PAK, from 2003–2010 at Akdeniz University Organ Transplantation Institute were retrospectively screened. There was a graft loss in 4 cases from the KA group, and in 1 case from each of the SPK and PAK groups. The five-year kidney graft survival rates were 86.7% in KA, 95.2% in SPK, and 97.1% in PAK. There was a single patient loss in both KA and SPK. The kidney survival percentages were higher in SPK and PAK groups compared to the KA group. Therefore, SPK should be the primary preference in these patients; however, for the cases that have a living donor, pancreas transplantation should be considered after kidney transplantation, or the patients can be followed-up on with close blood sugar control.Key words: Kidney, Pancreas, Transplantation, Kidney survival, Patient survivalThe discovery of insulin in 1921 enabled the transition from diabetic ketoacidosis and diabetic coma to an increasing number of patients with prolonged life expectancies in the clinical course of diabetes mellitus (DM). However, with prolonged lifetime, increases in the neurological, ocular, and renal complications of DM have become evident. With a 40% rate, DM is the leading cause of end-stage renal disease (ESRD) in the United States.¹ In patients with type I DM-related kidney failure, kidney transplant is highly more preferable in terms of the negative effects of long-term dialysis on the patient survival and quality of life compared with the benefits of kidney transplants.² In patients who develop type I DM-related kidney failure, kidney-alone transplantation (KA) from a living donor or a cadaver, simultaneous pancreas-kidney transplantation (SPK), or pancreas-after-kidney transplantation (PAK) are among the transplantation alternatives. The 10-year life expectancy in patients receiving hemodialysis for ESRD, and in those undergoing living donor or a cadaveric renal transplantation, was reported to be 4.4, 32.9, and 59.3% in the United States, respectively.³ Similarly, while the average life expectancy for diabetes patients waiting for kidney transplantation was 8 years, the average life expectancy after kidney transplantation was determined to be 22 years.² When pancreas transplantation is added to kidney transplantation, prolonged kidney and patient survival rates can be attained along with other benefits, such as protection from the secondary effects of diabetes and an increase in patients'' quality of life. While the 4-year mortality rate in the selected dialysis patients on the waitlist for pancreas-kidney was 40%, it was 10% in patients who received SPK transplantation.⁴ The goal of this study is to compare the impact of the KA, SPK, and PAK transplantation methods on kidney graft and patient survival rates in patients with ESRD associated with type I diabetes.