Cross-sectional pilot study about the health status of diabetic patients in city of Misurata, Libya

Background

Being a leading cause of death worldwide, epidemiological studies about diabetes mellitus have encouraged governments to initiate or improve local diabetes monitoring and prevention strategies.

Objective

The main objective of this study was to examine the profile of diabetic patients in the city of Misurata, the third largest city in Libya.

Methods

260 diabetic cases of both gender randomly selected from the total number of patients admitted to the centre of diabetes and endocrine disorders, Misurata -Libya for the period between January to March 2008. Data collected from patients'' files and by directly questioning the patients. SPSS software version 13 was used for the statistical analysis and presentation of the data.

Results

87% of all patients were type 2 diabetics, while only 9.9% were type 1. 73% of all patients had family history of diabetes. 52% of all diabetic patients were obese, with more obesity in females (70% of females) than males (33.8% of males). Obesity was more pronounced in type 2 patients (56.8%) than in type 1 patients (11.5%). 38% of all patients were treated with insulin while 35.4% were treated with oral hypoglycemics. Meanwhile 32.6% of type 2 diabetic patients were treated with insulin. Only 9.2% of all patients had fasting blood sugar below 140 mg/dl, whereas 55% had levels in the range of 140–180 mg/dl, while 35.8% had levels above 180 mg/dl. Microvascular complications included retinopathy (16.2% of all patients), neuropathy (11.2%), nephropathy (1.5%) and combination of neuropathy and retinopathy (6.5%).

Conclusion

High percentage of risk factors including obesity, family history of diabetes, hypertension and microvascular complications requires a Libyan national policy for the surveillance, prevention and control of diabetes and its complications.     

Epistaxis in Kaduna,Nigeria: a review of 101 cases

Background

Epistaxis is defined as a hemorrhage from the nostril, nasal cavity, or nasopharynx. Sufferers and clinicians may develop significant anxiety despite the fact that majority of patients are treated successfully by the first attending physician.

Objective

To review aetiology and management outcomes of epistaxis in a resource constrained setting.

Methodology

A retrospective review of 101 patients seen with epistaxis at the National Ear Care Centre, Kaduna over 7years (January 2002– December 2008).

Results

The age of patients ranged between 2 and 75years. The incidence of epistaxis of 0.5% was recorded out of total patient visit and slight male preponderance with a male:female ratio of 1.4:1. Dry-hot and cold harmattan weather had the highest prevalence. Trauma and infections were the main aetiological factors identified but over 40% of cases are idiopathic in origin. About 25% presented with active bleeding and 11% required admission. All were managed conservatively. Less than 2% received blood transfusion.

Conclusion

Epistaxis is a common emergency that requires prompt intervention to reduce further morbidity and prevent mortality. Non operative intervention was a satisfactory approach in this study.     

Positron emission tomography to assess hypoxia and perfusion in lung cancer

In lung cancer, tumor hypoxia is a characteristic feature, which is associated with a poor prognosis and resistance to both radiation therapy and chemotherapy. As the development of tumor hypoxia is associated with decreased perfusion, perfusion measurements provide more insight into the relation between hypoxia and perfusion in malignant tumors. Positron emission tomography (PET) is a highly sensitive nuclear imaging technique that is suited for non-invasive in vivo monitoring of dynamic processes including hypoxia and its associated parameter perfusion. The PET technique enables quantitative assessment of hypoxia and perfusion in tumors. To this end, consecutive PET scans can be performed in one scan session. Using different hypoxia tracers, PET imaging may provide insight into the prognostic significance of hypoxia and perfusion in lung cancer. In addition, PET studies may play an important role in various stages of personalized medicine, as these may help to select patients for specific treatments including radiation therapy, hypoxia modifying therapies, and antiangiogenic strategies. In addition, specific PET tracers can be applied for monitoring therapy. The present review provides an overview of the clinical applications of PET to measure hypoxia and perfusion in lung cancer. Available PET tracers and their characteristics as well as the applications of combined hypoxia and perfusion PET imaging are discussed.     

Exercise-induced left bundle branch block: an infrequent phenomenon: Report of two cases

Exercise-induced left bundle branch block(EI-LBBB)is infrequent phenomenon.We present two patients with angina pectoris who developed EI-LBBB during exercise tolerance test.The first patient with typical angina pectoris had significant obstructive coronary artery disease(CAD)requiring percutaneous coronary intervention of multiple lesions including placement of drug eluting stents.The second patient had atypical chest pain without signs of CAD at all.EI-LBBB occurred at a heart rate of 80 bpm and 141 bpm in the first and second patient,respectively.EI-LBBB remained visible through the test till the recovery period in the first patient at a heart rate of 83 bpm and disappeared at 96bpm in the second patient.Both patients with this infrequent phenomenon are discussed and the literature is reviewed.     

How does patient‐clinician information engagement influence self‐reported cancer‐related problems?

BACKGROUND:

Past research has linked patient‐physician communication with improved emotional, physical, and social health. One component of communication, patient‐clinician information engagement (PCIE), predicts improved short‐term patient‐reported outcomes, such as treatment satisfaction, through perceptions of feeling informed. However, to the authors' knowledge, the relation between PCIE and longer term cancer‐related problems has not been examined previously. The authors examined the influence of PCIE on self‐reported problems associated with cancer diagnosis and treatment based on a longitudinal survey among a randomly selected sample from the 2005 Pennsylvania Cancer Registry.

METHODS:

In total, 1293 respondents were surveyed who were diagnosed with colorectal, breast, or prostate cancers during 2006 and 2007. The baseline response rate was 64%, and the retention rate was 65%. The authors predicted an index of cancer‐related problems at 1‐year follow‐up with the baseline cancer‐related problem index and PCIE, controlling for demographic and clinical factors using regression analyses. The mean age of participants was 65 years, approximately 50% were women, and 86% were white.

RESULTS:

Having more cancer‐related problems and PCIE at baseline significantly predicted more cancer‐related problems at follow‐up. In addition, baseline cancer‐related problems and PCIE interacted significantly (P = .01): PCIE was associated with more cancer‐related problems at follow‐up among participants who reported more symptoms rather than fewer symptoms at baseline.

CONCLUSIONS:

If respondents reported engaging more with their physicians at baseline, then they reported experiencing more cancer‐related issues at follow‐up; this pattern was stronger among those who reported more baseline problems. The current results indicated that increased discussion of cancer information with physicians may maintain the salience of these problems in cancer survivors' minds over time. Cancer 2011. © 2011 American Cancer Society.     

Oral Cancer Screening at Workplace in India��One-year Follow-up

Background:

Oral cancer remains the commonest form of cancer and cancer-related deaths among Indian males due to popularity of avoidable risk factors such as tobacco and alcohol use. A workplace oral cancer screening and tobacco cessation study was commenced on World No Tobacco Day 2007 at a chemical industry in rural Maharashtra.

Aims:

The objectives were to screen the employees for oral neoplasia and to correlate it with their tobacco consumption pattern. In addition, the objective was to provide tobacco cessation services at the workplace.

Materials and Methods:

This is an interventional cohort study among 104 employees of a chemical industrial unit in rural Maharashtra. Naked eye examination of the oral cavity was performed for all employees by a doctor irrespective of the tobacco habits at the beginning and at the end of 1 year. In between, the tobacco users were regularly examined during each follow-up.

Statistical analysis used:

Through personal interviews of the participants, data were manually recorded and were transferred to electronic data base. Data analysis was conducted in STATA™ 8.2 on intention to treat basis.

Results and Conclusions:

Among the 104 employees, 50 (48.08%) were current tobacco users at the beginning of the program. Oral precancers were seen exclusively among 20 (40%) tobacco users. After 1 year of workplace tobacco cessation intervention, 80% of oral precancers regressed. This shows that screening of the oral cavity at the workplace is effective when combined with tobacco cessation.     

Noonan syndrome and neurofibromatosis type I in a family with a novel mutation in NF1

Noonan syndrome (NS) and neurofibromatosis type I (NF1) belong to a group of clinically related disorders that share a common pathogenesis, dysregulation of the RAS‐MAPK pathway. NS is characterized by short stature, heart defect, pectus deformity and facial dysmorphism, whereas skin manifestations, skeletal defects, Lisch nodules and neurofibromas are characteristic of NF1. Both disorders display considerable clinical variability. Features of NS have been observed in individuals with NF1 –a condition known as neurofibromatosis–Noonan syndrome (NFNS). The major gene causing NFNS is NF1. Rarely, a mutation in PTPN11 in addition to an NF1 mutation is present. We present the clinical and molecular characterization of a family displaying features of both NS and NF1, with complete absence of neurofibromas. To investigate the etiology of the phenotype, mutational analysis of NF1 was conducted, revealing a novel missense mutation in exon 24, p.L1390F, affecting the GAP‐domain. Additional RAS‐MAPK pathway genes were examined, but no additional mutations were identified. We confirm that NF1 mutations are involved in the etiology of NFNS. Furthermore, based on our results and previous studies we suggest that evaluation of the GAP‐domain of NF1 should be prioritized in NFNS.     

A curriculum to teach medical students to care for people with disabilities: development and initial implementation

Background  

Effective communication skills and professionalism are critical for physicians in order to provide optimum care and achieve better health outcomes. The aims of this study were to evaluate residents' self-assessment of their communication skills and professionalism in dealing with patients, and to evaluate the psychometric properties of a self-assessment questionnaire.     

Effectiveness of the universal prevention program 'Healthy School and Drugs': Study protocol of a randomized clustered trial

Background  

Substance use is highly prevalent among Dutch adolescents. The Healthy School and Drugs program is a nationally implemented school-based prevention program aimed at reducing early and excessive substance use among adolescents. Although the program's effectiveness was tested in a quasi-experimental design before, many program changes were made afterwards. The present study, therefore, aims to test the effects of this widely used, renewed universal prevention program.     

Exploring types of focused factories in hospital care: a multiple case study

Background  

Focusing on specific treatments or diseases is proposed as a way to increase the efficiency of hospital care. The definition of "focus" or "focused factory", however, lacks clarity. Examples in health care literature relate to very different organizations.