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

Prospective Cohort Study

https://publications.hse.ru/mirror/pubs/share/folder/myodg9xfxt/direct/143360779.pdf

Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents.

Untreatable bacterial infections become treatable due to the discovery of antibiotics in the previous century but their inappropriate and irrational uses ultimately led to emergence of resistant microbial population. Genes responsible for conferring resistance are transferred horizontally via conjugation; transduction or transformation. Tetracyclines and beta lactams represent 50% each of the total antibiotics used in feeds and global antibiotic consumption respectively. Due to development of antibiotic resistance there may be failure of the resistant bacteria to respond to the prescribed treatment; risk of infectious diseases becoming uncontrollable; financial burden; advanced therapeutic approaches may get jeopardized and ultimately resistant organisms may spread to distant countries and continents. Both intrinsic and acquired resistance mechanisms are involved in bacterial antibiotic resistance. Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE) are among the most striking antibiotic resistant microbes in the recent years. Factors driving antibiotic resistance include: inadequate national commitment; improper surveillance; irrational use of drugs; poor disease prevention and insufficient diagnostics and therapeutics etc. Limiting infectious diseases; judicious uses of antibiotics; precise selection and completing the full course of antibiotics; and regular surveillance, monitoring and continuous vigilance are the steps to limit antibiotic resistance. The most common antibiotic-resistant organisms sourced from animals are some strains of E. coli; Salmonella etc., which can also infect humans. Disc diffusion method and Minimum inhibitory concentration (MIC) methods; gas chromatography (GC); High-performance liquid chromatography (HPLC) with UV mass spectrometry (MS) and nano quantity analyte detectors; microfluidic methods and electrochemical methods; European Union four-plate test (EU4pt); Frontier Post Test (FPT) are used to detect antibiotic residues. Use of penicillin or sulphonamides has raised public health and industrial issues. Prevention and control measures require involvement of various governmental agencies for accurate testing and screening; surveillance and monitoring. Along with this alternative therapeutic approaches viz. bacteriophages; virophage and mycophage; avian egg yolk antibody; cytokines and herbal; panchgavya and vaccine therapy; and diagnostics are the need of hours. The present review discusses all these aspects of antibiotic resistance and their solutions ultimately for social benefit with particular reference to emerging antibiotic resistance in animals and humans, its challenges, detection, antibiotic residues, prevention and control measures along with current and future scenario at International level, which would be helpful for formulating strategies for safeguarding health of animals as well as humans.

Antibiotic resistance - an emerging health problem: causes, worries, challenges and solutions - a review

| Identification of animal species of origin in meat and meat products is a matter of great concerns such as religious, economical, legal as well as medical aspects. Thus, several analytical techniques have been suggested for the identification of meat species either in individual or in mixed samples to protect consumers from the fraudulent and bad habits of marketing. DNA-based techniques especially the techniques based on polymerase chain reaction (PCR) are recognized as the most appropriate methods employed for species identification in raw and processed meat. PCR techniques including randomly amplified polymorphic DNA (PCR-RAPD), restriction fragment length polymorphism (PCR-RFLP), PCR with species-specific primers, real-time PCR and PCR-nucleotide sequencing allow identification of meat species under different processing conditions. But the variability of DNA content on the level of species as well as target tissue make the DNA-based methods somewhat unsuitable for the quantification of exact percentages of different species in meat and meat products. For these reasons the proteomic approaches depending on identification of different peptide biomarkers has been developed and employed to give information on the different composition of food. To broad the knowledge about these technologies, this review is compiled in an attempt to provide an overview of the possible PCR-based analytical techniques that could help in identifying the meat species of origin in meat and meat products and threw the light on the identification of species specific peptide biomarkers by proteomic technologies as a new and attractive alternative that could overcome some of the limitations that faced DNAbased methods especially when used for meat exposed to intensive heating of processing as well as for meat mixtures.

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Identification of different animal species in meat and meat products: trends and advances.

Nutraceuticals from Fruits and Vegetables at a Glance: A Review

Flu viruses have mainly affected humans, birds and pigs worldwide. During the past 10 years these viruses are in limelight at a global level due to pandemic threats of Avian/Bird Flu and Swine Flu and their public health impacts, with added pandemic of swine flu virus recently. The current ongoing episodes of bird flu and swine flu are beyond the control, when and where or which country they start with nobody can predict. The continuous evolution and emergence of new strains indicate that the flu viruses are becoming more and more dangerous and this situation has posed a challenge to researchers to discover effective vaccines and therapeutics. Moreover, the role of pig as 'mixing bowl' for the virus to get reassorted has added to the complicated epidemiological scenario. The swine flu H1N1 reassorted subtype caused the first global pandemic in last 40 years, resulting in substantial illness, hospitalizations of millions of peoples and thousands of deaths throughout the world. A pace is there within these novel and emerging flu viruses and the scientific community, where the scientific community has to win the race so as to save the mankind. In this review, a brief overview on swine flu is presented highlighting the characteristics of the causative virus, the disease and its public health consequences, advances made in its diagnosis, vaccine and control, precautionary measures to be adapted in the wake of an outbreak.

Swine flu is back again: a review.

Growth in poultry sector is being challenged due to increased incidence and re-emergence of diseases caused due to evolution of several viral pathogens and use of live vaccines. Piles of economic losses are encountered due to these diseases. Avian Infectious Bronchitis (IB), caused by Corona virus, is OIE-listed disease and characterized by respiratory, renal and urogenital involvements, causing high mortality. Economic losses are encountered due to loss of productive performance of both egg and meat-type chickens. Variant viruses evolve due to spontaneous mutations and recombinations, causing disease in vaccinated flocks of all ages. Serotyping and genotyping are the common methods of classification of IBV strains. The virus has 4 clusters, grouped into 7 serotypes and the most important strains are Massachusetts, Connecticut, Arkansas, Gray, Holte and Florida along with numerous others, distributed round the globe. Several conventional and molecular diagnostic methods have been described for the diagnosis of IB in chickens. 'All-in/all-out' operations of rearing along with good biosafety measures forms the basis of prevention, whereas vaccination forms the backbone of IB control programme. Both live and inactivated (oil emulsified) conventional vaccines are available. The new generation vaccines (recombinant and vector-based) developed against locally prevailing IBV strains may be more helpful and avoid the reversion of virulence in live vaccine viruses. The present review deals with all these perspectives of this important emerging poultry pathogen.

Ruchi Tiwari

Papers

Antibiotic resistance - an emerging health problem: causes, worries, challenges and solutions - a review

Identification of different animal species in meat and meat products: trends and advances.

Nutraceuticals from Fruits and Vegetables at a Glance: A Review

Swine flu is back again: a review.

Emergence of Avian Infectious Bronchitis Virus and its variants need better diagnosis, prevention and control strategies: a global perspective.