Success with lifestyle monotherapy in youth with new-onset type 2 diabetes

BACKGROUND:

Evidence is lacking to support the efficacy of lifestyle modification as first-line therapy in the clinical management of type 2 diabetes mellitus (T2DM) in adolescents.

METHODS:

A retrospective chart review of youth diagnosed with T2DM between 1999 and 2008 was conducted. The authors describe the percentage of youth presenting with glycosylated hemoglobin (HbA_1c) of <9% who achieved/maintained target glycemic control (HbA_1c ≤7.0%) with lifestyle monotherapy during the year following diagnosis.

RESULTS:

Among the 275 youth with T2DM, 38% (n=104) presented with an HbA_1c <9% and were prescribed lifestyle monotherapy at diagnosis. Of the 80 youth who had sufficient follow-up data over 12 months, 54% successfully maintained target glycemic control solely with lifestyle management. The mean HbA_1c score at diagnosis was lower in youth who where successful on lifestlye monotherapy compared with those who were not successful.

CONCLUSIONS:

A significant proportion of youth newly diagnosed with T2DM presenting with an HbA_1c <9% effectively achieved/maintained target glycemic control with lifestyle recommendations alone for 12 months.     

Type III-B open tibial fractures in Mozambique

Summary. We have studied prospectively 50 cases of open tibial fractures Type-III B. Treatment was based on the principles of debridement, wound irrigation, fracture stabilisation (generally by external fixation) and ‘early bone coverage’ without skin sutures. The cases were divided into two groups: Group 1: Eight fractures with segmental bone defects treated by bone transport using the Ilizarov technique or by intertibial-fibular bone grafting, and group 2: Forty-two fractures with defects of soft tissue coverage without segmental bone defects treated with simple closure or myoplasty. Union was achieved in Group 1 in an average of 16 months (range 6 – 21.5), and in an average of 5.6 months (range 3 – 10) in Group 2. The most frequent complication was malunion in angulation which occurred in 11 cases (22%). There was an equinus contracture of the ankle in 8 cases (16%) and chronic osteomyelitis occurred in 5 (10%). Adequate union was achieved in all but one case.

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Résumé. Les auteurs ont étudié de fa?on prospective 50 cas de fracture ouverte du tibia de type III-B. Le traitement était basé sur le débridement. I’irrigation de la plaie, la stabilisation de la fracture (habituellement par fixateurs externes) et recouvrement osseux précoce sans suture cutanée. Les cas ont été divisés en deux groupes: groupe 1: fracture avec perte de substance osseuse (n = 8) et groupe 2: fracture avec perte de couverture des parties molles sans perte de substance osseuse (n = 42). Les défects osseux ont été traités par le transfert osseux selon la technique d’Ilizarov ou par greffe inter-tibio-péronière. Dans le groupe 1, la consolidation a été obtenue en moyenne en 12 mois (de 6 à 21,5 mois). Le groupe 2 a été traité par myoplastie ou fermeture simple et la consolidation a été obtenue en moyenne en 5,6 mois (de 3 à 10 mois). La complication la plus fréquente a été le cal vicieux dans 11 cas (22%). Dans 8 cas (16%) a persisté un équin du pied et dans 5 cas (10%) une ostéomyélite chronique. La consolidation définitive a toujours été obtenue sauf dans un cas.

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Accepted: 7 March 1996     

Predicting anesthesia times for diagnostic and interventional radiological procedures

We studied anesthesia times for diagnostic and interventional radiology using anesthesia billing data and paper radiology logbooks. For computerized tomography and magnetic resonance imaging procedures, we tried to predict future anesthesia times by using historical anesthesia times classified by Current Procedural Terminology (CPT) codes. By this method, anesthesia times were estimated even less accurately than operating room cases. Computerized tomography and magnetic resonance imaging had many different CPT codes, most rare, and CPT codes reflected organs imaged, not scanning times. However, when, anesthesia times were estimated by expert judgment, face validity and accuracy were good. Lower and upper prediction bounds were also estimated from the expert estimates. For interventional radiology, predicting anesthesia times was challenging because few CPT codes accounted for most cases. Because interventional radiologists scheduled their elective cases into allocated time, the necessary goal was not to estimate the time to complete each case but rather the time to complete each day's entire series of elective cases including turnover times. We determined the time of day (e.g., 4 pm) up to when interventional radiology could schedule so that on 80% of days the anesthesia team finishes no later than a specified time (e.g., 6 pm). Both diagnostic and interventional radiology results were similarly less accurate when Version 9 of the International Classifications of Diseases' procedure codes was used instead of CPT.     

Social and Institutional issues in the Adoption of School-based Technology-aided Sexual Health Education Program

Objective: School-based sexual health education interventions can reach young people of diverse backgrounds and equip them with knowledge and skills for protecting themselves against HIV/AIDS, unwanted pregnancies, and live healthy and responsible lives. However, given that school-based sexual health education intervention are health projects implemented in educational settings, variety of social and institutional issues can present challenges. This study aimed to obtain rich insights into the facilitating or inhibiting mediators for the implementation of a school-based sexual health education intervention in Uganda.Method: This study conducted 16 qualitative interviews to investigate the mediators for the implementation of the school-based sexual health education intervention based on experiences of two Ugandan schools: the school which successfully completed the implementation of the intervention, and the school which abandoned the intervention half-way the implementation.Results: Rather than the technological aspects, results indicate that the implementation was strongly influenced by interplay of social and institutional mediators, which were more favourable in the “successful” school than in the “failure school”. These mediators were: perceived students’ vulnerability to HIV and unwanted pregnancies; teachers’ skills and willingness to deliver the intervention, management support; match with routine workflow, social-cultural and religious compatibility, and stakeholder involvement.Conclusion: Rather than focusing exclusively on technological aspects, experiences from this evaluation suggest the urgent need to also create social, institutional, and religious climate which are supportive of school-based computer-assisted sexual health education. Evidence-based recommendations are provided, which can guide potential replications, improvements, and policy formulation in subsequent school-based sexual health education interventions.Key words: sexual health education, school health education, adolescents’ sexual health, teacher-student sex education, informatics     

Altered inhibition of negative emotions in subjects at family risk of major depressive disorder

Unaffected 1st degree relatives of patients with major depressive disorder (MDD) are more likely to develop MDD than healthy controls. The aim of our study was to establish neuronal correlates of familial susceptibility in the process of inhibition of emotional information. Unaffected 1st degree relatives of patients with MDD (N = 21) and matched healthy controls (N = 25) underwent a functional magnetic resonance imaging procedure with an inhibition task. Blood oxygenated level dependent signal was evaluated for the two groups during inhibition of positive, negative and neutral information. In a 2 × 3 ANOVA unaffected relatives of patients with MDD were compared to healthy controls, jointly and separately for all three levels of emotional valence of the information. The interaction between group and emotional valence of the inhibited information was significant, indicating “a negative neural drift” in unaffected relatives of patients with MDD. The unaffected relatives of patients with MDD displayed an increased activation during inhibiting of negative material in the right middle cingulate cortex and the left caudate nucleus (p < 0.05, family wise error corrected). There was no difference between the two groups in terms of inhibiting positive or neutral stimuli. Our findings provide the first evidence that unaffected relatives of patients with MDD differ from the standard population in terms of neural correlates of inhibition of negative emotional information. Overactivation of cingulate cortex and caudate nucleus may indicate a learnt strategy aimed at coping with increased susceptibility to negative information schemata and may have future consequences for therapy.     

Plants used to manage type II diabetes mellitus in selected districts of central Uganda

Background

Chronic diseases such as diabetes mellitus are increasing in incidence in sub-Saharan Africa. African traditional medicine is part and parcel of the health care system in Uganda. Majority of the indigenous population will have visited a traditional health care practioner or self-administered herbal medicines before seeking conventional health care. However, documentation of the various medicinal plants is still lacking, necessitating a well-organized information search for such knowledge through research. Such information can lay a firm and clear foundation for scientific investigation of the purported therapeutic benefits of the said plants. The objective of this study was to collect names of medicinal plants used to manage diabetes mellitus type II in selected districts of central Uganda.

Methods

In this ethnobotanical survey, names, of plants used to manage diabetes mellitus type II as well as the methods of preparation, routes of administration and the plant parts used in the districts of Mukono, Kampala, Wakiso and Masaka in the central region of Uganda were documented using a researcher administered questionnaire. Participants were recruited using a snow ball approach in which one individual directed us to another. Informant consensus was determined for each of the plants mentioned.

Results

A total of 18 names of medicinal plants were recorded of which Aloe vera var, Solanum indicum and Vernonia amygydalina were the most commonly mentioned plants and thus had the highest informant consensus. Leaves were the main parts that were used to prepare the herbal medicine while water as the solvent used in all the preparations. In all the cases, only the oral route was used for administration of the medicines.

Conclusion

Documentation of medicinal plants used to manage diabetes can further improve on the formalization process of the Ugandan traditional medicine system as well as lay a basis for further scientific investigation with emphasis on the plants whose informant consensus is high.     

In utero and lactational exposure to ammonium perchlorate in drinking water: effects on developing deer mice at postnatal day 21

The effects of in utero and lactational exposure to ammonium perchlorate (AP), a component of rocket fuel and a thyroid toxicant, on developing deer mice (Peromyscus maniculatus) were evaluated. Breeding pairs were dosed continuously with 0, 1 nM, 1 micro M, or 1 mM AP in drinking water, from cohabitation until pups were euthanized at postnatal day (PND) 21. Pups from the second litter were used for evaluation in this study. No significant differences were observed in any analysis performed when litter means were used in statistical analysis. All reported significant differences occurred when statistical analysis was performed on individual pup data. Body weights were significantly different between treatments at PND 5 and PND 20, with the 1- micro M body weights being lower than that of controls. Body weight and liver weight in the 1-mM group were significantly higher than the 1- micro M weights at PND 21 when analyzed by analysis of variance (ANOVA). However, there were no significant differences in liver weights when analyzed with body weight as the covariate. Heart weights were significantly different between males and females. Male heart weights in the 1- microM and 1-mM groups were significantly lower than in controls when analyzed by analysis of covariance (ANCOVA) with body weight as the covariate. Litter size and survival percentage were not significantly different among treatments. Although significant differences were observed only when the individual pup was used as the experimental unit, these data suggest that AP exposure at different concentrations may variably alter body weight and male heart weight during mammalian development.