XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

The study group.

Plants are a source of large amount of drugs comprising to different groups such as antispasmodics, emetics, anti-cancer, antimicrobials etc. A large number of the plants are claimed to possess the antibiotic properties in the traditional system and are also used extensively by the tribal people worldwide. It is now believed that nature has given the cure of every disease in one way or another. Plants have been known to relieve various diseases in Ayurveda. Therefore, the researchers today are emphasizing on evaluation and characterization of various plants and plant constituents against a number of diseases based on their traditional claims of the plants given in Ayurveda. Extraction of the bioactive plant constituents has always been a challenging task for the researchers. In this present review, an attempt has been made to give an overview of certain extractants and extraction processes with their advantages and disadvantages.

https://www.researchgate.net/file.PostFileLoader.html?id=52ecff43cf57d71b748b45c9&assetKey=AS%3A272427580362754%401441963204700

Phytochemical screening and Extraction: A Review

Recently, there has been growing interest in research into the role of plant-derived antioxidants in food and human health. The beneficial influence of many foodstuffs and beverages including fruits, vegetables, tea, coffee, and cacao on human health has been recently recognized to originate from their antioxidant activity. For this purpose, the most commonly methods used in vitro determination of antioxidant capacity of food constituents are reviewed and presented. Also, the general chemistry underlying the assays in the present paper was clarified. Hence, this overview provides a basis and rationale for developing standardized antioxidant capacity methods for the food, nutraceutical, and dietary supplement industries. In addition, the most important advantages and shortcomings of each method were detected and highlighted. The chemical principles of these methods are outlined and critically discussed. The chemical principles of methods of 2,2′-azinobis-(3-ethylbenzothiazoline-6-sulphonate) radical (ABTS·+) scavenging, 1,1-diphenyl-2-picrylhydrazyl (DPPH·) radical scavenging, Fe3+–Fe2+ transformation assay, ferric reducing antioxidant power (FRAP) assay, cupric ions (Cu2+) reducing power assay (Cuprac), Folin-Ciocalteu reducing capacity (FCR assay), peroxyl radical scavenging, superoxide anion radical (O
 2
 ·−
 ) scavenging, hydrogen peroxide (H2O2) scavenging, hydroxyl radical (OH·) scavenging, singlet oxygen (1O2) quenching assay and nitric oxide radical (NO·) scavenging assay are outlined and critically discussed. Also, the general antioxidant aspects of main food components were discussed by a number of methods which are currently used for detection of antioxidant properties food components. This review consists of two main sections. The first section is devoted to main components in the foodstuffs and beverages. The second general section is some definitions of the main antioxidant methods commonly used for determination of antioxidant activity of components in the foodstuffs and beverages. In addition, there are given some chemical and kinetic basis and technical details of the used methods.

Antioxidant activity of food constituents: an overview

Moringa oleifera Lam. is a small or medium-sized tree, about 10 m high, cultivated throughout India. It is a multipurpose tree, used as vegetable, spice, a source of cooking and cosmetic oil and as a medicinal plant. It is reported to contain alkaloids, flavonoids, anthocyanins, proanthocyanidins and cinnamates. It possesses anti-inflammatory, antioxidant, antimicrobial, antihyperlipidaemic, antifertility, anticancer, antihepatotoxic and antiulcer activities. Further, activity guided phytochemical and phytoanalytical studies may lead to development of novel agents to be used in various disorders. An overview of chemical constituents present in the plant and their pharmacological actions are given in the present paper.

/pdf/phyto-pharmacology-of-moringa-oleifera-lam-o-an-overview-1rjqbjxxnu.pdf

Phyto-pharmacology of Moringa oleifera Lam.ó An overview

The present investigation was carried out to study the anti-arthritic activity of ethanolic extract of seeds of Moringa oleifera Lam. (MOEE) in adjuvant-induced arthritis in adult female Wistar rats. During the experimental period, body weight, paw edema volume (primary lesion) and arthritic index (secondary lesion) was observed. On the 21st day, serum from each animal was used for estimation of Rheumatoid Factor (RF) value and levels of selected cytokines (TNFα, IL-1, and IL-6). Whole blood was used for measurement of erythrocyte sedimentation rate (ESR). Liver homogenate was utilized for assessment of oxidative stress and histopathology was performed to measure degree of inflammation in synovial joint. Our results suggest that, percentage reduction in body weight was less, paw edema volume and arthritic index score was decreased significantly as compared to diseased control animals. Serum levels of RF, TNF-α, IL-1, and IL-6 also showed decreased levels as compared to those in the diseased control group....

https://www.tandfonline.com/doi/pdf/10.1080/15476910601115184

Protective Effect of Ethanolic Extract of Seeds of Moringa oleifera Lam. Against Inflammation Associated with Development of Arthritis in Rats.

Modern synthetic medicines are very effective in curing diseases but also cause a number of side effects. Crude drugs are less efficient with respect to cure of diseases but are relatively free from side effects. Parasites have been of concern to the medical field for centuries and the helminths considered causing considerable problems for human beings and animals. A large number of medicinal plants are claimed to possess anthelmintic property in traditional systems of medicine and are also utilized by ethnic groups worldwide. Following the folk claims, several medicinal plants have been scrutinized for this activity using various in vitro and in vivo methods. The present review summarizes some important pharmacological and preliminary studies on medicinal plants, products thereof and isolated principles from them, which can be investigated further to achieve lead molecules in the search of novel herbal drugs.

/pdf/a-review-on-anthelmintic-plants-12obriqvme.pdf

A Review on Anthelmintic Plants

We have studied the effects of various angiotensin-converting enzyme (ACE) inhibitors on intraocular pressure (IOP) of rabbits with experimentally induced ocular hypertension and their mechanism of action. Acute ocular hypertension was induced by infusion of 5% glucose (15 ml/kg) through marginal ear vein, whereas chronic glaucoma was induced by injection of alpha-chymotrypsin into the posterior chamber of the eye. IOP was measured by tonometer. All ACE inhibitors were instilled topically in the eye in a sterile solution. The effect of ACE inhibitors also was studied on serum cholinesterase (true and pseudo) and the enzyme ACE in vitro. Enalaprilat, ramiprilat, and fosinopril produced a time-dependent decrease of IOP in both acute and chronic models of ocular hypertension in rabbits. The decrease in IOP was observed for >4 h, and the extent of decrease was comparable to that with both pilocarpine and betaxolol. Prodrugs enalapril and ramipril failed to produced any change in IOP. Losartan also produced a significant decrease in IOP in the chronic model of ocular hypertension in rabbits. All the three ACE inhibitors were found to inhibit ACE activity in aqueous humor. The enzyme cholinesterase was found to be inhibited by enalaprilat, ramiprilat, and fosinopril. However, atropine did not alter the IOP-lowering effect of enalaprilat in rabbits. Indomethacin pretreatment produced slight but significant inhibition of the IOP-lowering effect of enalaprilat in rabbits. Our data suggest that ACE inhibitors enalaprilat, ramiprilat, and fosinopril produce a significant ocular hypotensive effect in acute and chronic models of ocular hypertension in rabbits. Inhibition of ACE in aqueous humor, and in ocular tissues, resulting in reduced angiotensin II formation, could be one of the major mechanisms responsible for the IOP reduction by ACE inhibitors in rabbits.

Oculohypotensive effect of angiotensin-converting enzyme inhibitors in acute and chronic models of glaucoma.

Several experimental, pathological, epidemiological, and clinical studies have clearly depicted that diabetes mellitus results in cardiac functional and structural changes. Diabetic cardiomyopathy results in both structural and functional alterations in the myocardium. Several mechanisms have been implicated in the pathophysiology of diabetic cardiomyopathy. Of these, metabolic disturbances, myocardial fibrosis, small vessel disease, and cardiac autonomic neuropathy are the major players in the pathophysiology of diabetic cardiomyopathy. This review is intended to discuss various such pathophysiological mechanisms of diabetic cardiomyopathy. We have also described the systolic and diastolic dysfunctioning and its corelation to structural changes in diabetes.

Anita A. Mehta

Papers

Phyto-pharmacology of Moringa oleifera Lam.ó An overview

Protective Effect of Ethanolic Extract of Seeds of Moringa oleifera Lam. Against Inflammation Associated with Development of Arthritis in Rats.

A Review on Anthelmintic Plants

Oculohypotensive effect of angiotensin-converting enzyme inhibitors in acute and chronic models of glaucoma.

Diabetic cardiomyopathy: Pathophysiological mechanisms and cardiac dysfuntion