Objective: The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults. Conclusions: Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging effects interact with diabetes to accelerate the progression of many common diabetes complications. Each section in this guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.

/pdf/treatment-of-diabetes-in-older-adults-an-endocrine-society-m1rptc5zkq.pdf

Treatment of Diabetes in Older Adults: An Endocrine Society Clinical Practice Guideline

The susceptibility and severity of periodontal diseases is made more severe by diabetes, with the impact on the disease process inversely proportional to the level of glycemic control. Although type 1 diabetes mellitus and type 2 diabetes mellitus have different etiologies, and their impact on bone is not identical, they share many of the same complications. Studies in animals and humans agree that both forms of diabetes increase inflammatory events in periodontal tissue, impair new bone formation, and increase expression of RANKL in response to bacterial challenge. High levels of glucose, reactive oxygen species, and advanced glycation end-products are found in the periodontium of diabetic individuals and lead to increased activation of nuclear factor-kappa B and expression of inflammatory cytokines such as tumor necrosis factor and interleukin-1. Studies in animals, moreover, suggest that there are multiple cell types in periodontal tissues that are affected by diabetes, including leukocytes, vascular cells, mesenchymal stem cells, periodontal ligament fibroblasts, osteoblasts, and osteocytes. The etiology of periodontal disease involves the host response to bacterial challenge that is affected by diabetes, which increases the expression of RANKL and reduces coupled bone formation. In addition, the inflammatory response also modifies the oral microbiota to render it more pathogenic, as demonstrated by increased inflammation and bone loss in animals where bacteria are transferred from diabetic donors to germ-free hosts compared with transfer from normoglycemic donors. This approach has the advantage of not relying upon limited knowledge of the specific bacterial taxa to determine pathogenicity, and examines the overall impact of the microbiota rather than the presumed pathogenicity of a few bacterial groups. Thus, animal studies have provided new insights into pathogenic mechanisms that identify cause-and-effect relationships that are difficult to perform in human studies.

The impact of diabetes on periodontal diseases.

Background

The purpose of this work was to investigate the links between oxidative stress, inflammation and coagulation and their effect on Mediterranean diet–diabetes relationship.



Methods

In 2001–2002, a random sample of 1514 men (18–87 years old) and 1528 women (18–89 years old) was selected to participate in the ATTICA study, where Athens is the major metropolis. A validated questionnaire was used to assess lifestyle and dietary factors. Adherence to Mediterranean diet was recorded using MedDietScore. Among others, oxidative stress and inflammatory biomarkers were recorded. During 2011–2012, the 10-year follow-up was performed. Diabetes incidence was defined according to the American Diabetes Association criteria.



Results

A total of 191 incident cases of diabetes were documented, yielding an incidence of 12.9% (13.4% in men and 12.4% in women). Medium and high adherence was found to decrease diabetes risk by 49% (95% CI: 0.30, 0.88) and 62% (95% CI: 0.16, 0.88), respectively, compared with low adherence. A logarithmic trend between Mediterranean diet and diabetes incidence was also revealed (p for trend = 0.042). Individuals with abnormal waist circumference (>94 for men, >80 for women) were benefited the most. Wholegrain cereals, fruits and legumes had the greatest predictive ability. The anti-diabetic effect of Mediterranean diet correlated with measurements of tumour necrosis factor-α, homocysteine and total antioxidant capacity.



Conclusions

The reported results support the role of Mediterranean diet as a promising dietary tool for the primary prevention of diabetes, by attenuating inflammation and fostering total antioxidant capacity. This dietary pattern may have therapeutic potential for many cardiometabolic disorders associated with inflammation and/or oxidative stress. Copyright © 2015 John Wiley & Sons, Ltd.

Adherence to Mediterranean Diet and 10-year Incidence (2002-2012) of Diabetes: Correlations With Inflammatory and Oxidative Stress Biomarkers in the ATTICA Cohort Study

College is a critical time where students are more prone to engage in risky health behaviors known to negatively affect well-being, such as physical inactivity, stress, and poor dietary habits. A health promoting lifestyle is an important determinant of health status and is recognized as a major factor for the maintenance and improvement of health. This study was designed to assess the health-promoting lifestyle of students in health colleges and non-health colleges in Saudi Arabia. A total of 1656 students participated in this descriptive cross-sectional study. Data gathering was conducted from November 2016 to February 2017 at King Saud University. Participating students completed a self-reported questionnaire that included questions regarding their demographic characteristics and their health-promoting behaviors. The majority of participants were females (70.4%), 20% of the participants were overweight and 11.3%, were obese. The analysis showed that there was a significant difference between health colleges and non-health colleges with regards to the factor of health responsibility. Students at both schools were found to have an inadequate level of adherence to recommendations regarding physical activity and healthy eating habits. The analysis also found that majority of the students in both colleges do not attend educational programs on health care. The model shows that gender, type of college, year in school, and family structure were significant predictors of the health lifestyle of students in Saudi Arabia. The results of the current study indicate that university students are leading unhealthy lives, where the majority of them have unhealthy eating habits and poor physical activity level. Universities are ideal settings for implementing health promotion programs. Therefore, planning and implementing programs to motivate students to be more responsible for their own health, to engage more in physical activity, and to practice healthy eating habits and other forms of wellness are of paramount importance.

/pdf/health-promoting-lifestyle-of-university-students-in-saudi-5gpdx9wp2r.pdf

Health promoting lifestyle of university students in Saudi Arabia: a cross-sectional assessment

Severe falciparum malaria: a case report.

Globally, type 2 diabetes mellitus (T2DM) is considered as one of the most common diseases. The etiology of T2DM is complex and is associated with irreversible risk factors such as age, genetic, race, and ethnicity and reversible factors such as diet, physical activity and smoking. The objectives of this review are to examine various studies to explore relationship of T2DM with different dietary habits/patterns and practices and its complications. Dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM among developing countries. In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. Awareness about diabetes complications and consequent improvement in dietary knowledge, attitude, and practices lead to better control of the disease. The stakeholders (health-care providers, health facilities, agencies involved in diabetes care, etc.) should encourage patients to understand the importance of diet which may help in disease management, appropriate self-care and better quality of life.

Effect of diet on type 2 diabetes mellitus: A review.

Objectives: To find out the frequency of the different causes of Pancytopenia and also to specifically detect the percentage of vitamin B 12 deficieny amongst these patients. Methodology: It is a prospective study carried out in Medical Unit I (Ward 5) of Jinnah Postgraduate Medical Centre Karachi from March to August 2007. A total of 88 patients were included after a detailed history and examinations the information was recorded on Proforma. Findings of aspiration and trephine biopsies were interpreted in the light of history, clinical examination and peripheral blood findings. Results: Out of 88 patients suffering from Pancytopenia, a large number (40.90%) were diagnosed as Megaloblastic Anemia, out of which 77.77 % had vitamin B12 deficiency. Aplastic anemia was found in 28 (31.88%) patients followed by other less common causes. Conclusion: Megaloblastic anemia was found in largest number of patients who were found to have Pancytopenia on initial investigations and majority of such patients were found to be deficient in Vitamin B 12 .

Pancytopenia: megaloblastic anemia is still the commonest cause

Objective: To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. Study Design: A case series. Place and Duration of Study: This study was conducted at Medical Unit-I (Ward 5), Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. Methodology: A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease (e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice) was excluded on the basis of history, relevant clinical examination and investigations. Results: Age of the patients ranged from 13-48 years (mean 26.04±8.33). All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two (51.6%) had serum bilirubin 3-6 mg%, 20 (32.2%) had 6-10 mg% and 10 (16.1%) had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients (45%) had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 (35.4%), splenomegaly in 48 (77.4%) and both hepatomegaly and splenomegaly in 16 (25.8%). Gallbladder wall thickness was increased in 5 (8.06%) patients. There was no evidence of biliary dilatation. Conclusion: A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given.

/pdf/malarial-hepatopathy-in-falciparum-malaria-59hh68d9b1.pdf

Malarial hepatopathy in falciparum malaria.

Introduction: Risky behaviors are those that potentially expose people to harm, or significant risk of harm, which prevent them from reaching their potential in life and which can cause significant morbidity or mortality. Objectives: The objectives of the study were to determine the overall prevalence of risky behaviors among university students; to determine the prevalence of smoking, drifting, fast driving and physical inactivity among university students; and to determine the associations between such behavior and demographic characteristics. Materials and Methods: An observational cross-sectional study conducted in three colleges. The data were randomly collected from 340 students aged 18-30 years from February to March 2015 using a self-administered questionnaire in Arabic. The data were entered using SPSS v 22.0. Mean and standard deviation were calculated for quantitative variables, and frequency and percentages were computed for categorical variables. Chi-square or Fisher's Exact test, as appropriate, were used to test for statistical significance. Results: The overall prevalence of risky behaviors (smoking, drifting, fast driving, and physical inactivity) among students was 47.35%. Overall, 28% of the students were smokers, 25.2% were involved in drifting, 60.9% reported driving fast, and 66.4% were physically inactive. The age between 18-20 years was significantly associated with higher rates of drifting, fast driving, and physical inactivity. Conclusion: The prevalence of risky behaviors among university students was high. Physical inactivity and fast driving were the most common identified risky behaviors. Increasing awareness of these risks in the youth may significantly decrease related morbidities, complications, and even mortalities.

Risky health behaviors among students in Majmaah University, Kingdom of Saudi Arabia

Objectives: Epilepsy is very common in the Kingdom of Saudi Arabia, occurring in 6.54 out of every 1000 individuals. The current study was conducted to determine the level of public awareness of and attitudes toward epilepsy in the city of Majmaah, Saudi Arabia. Subjects and Methods: This descriptive study was conducted in Majmaah, Saudi Arabia. The study population included respondents derived from preselected public places in the city. Stratified random sampling was used, and the sample size was made up of 706 individuals. A structured questionnaire was used for data collection from respondents after receiving their verbal consent. The data were analyzed using SPSS version 2.0. Ethical approval was obtained from the Ethics Committee of Majmaah University. Results: The results showed that 575 (81.4%) of the respondents had heard or read about epilepsy. Almost 50% of the respondents knew someone who had epilepsy, and 393 (55.7%) had witnessed what they believed to be a seizure. Results showed that 555 (78.6%) respondents believed that epilepsy was neither a contagious disease nor a type of insanity. It was found that 335 (47.5%) stated that epilepsy was a brain disease, and almost one-quarter of the respondents said that the manifestation of an epileptic episode is a convulsion. Regarding attitude, 49% and 47.3% of respondents stated that they would not allow their children to interact with individuals with epilepsy and would object to marrying an individual with epilepsy, respectively. Conclusion: Although knowledge about epilepsy is improving, it is still not adequate. The study showed that the attitude toward epilepsy is poor.

/pdf/public-knowledge-and-attitudes-toward-epilepsy-in-majmaah-28hx8y5csb.pdf

Tahir Ansari

Papers

Effect of diet on type 2 diabetes mellitus: A review.

Pancytopenia: megaloblastic anemia is still the commonest cause

Malarial hepatopathy in falciparum malaria.

Risky health behaviors among students in Majmaah University, Kingdom of Saudi Arabia

Public knowledge and attitudes toward epilepsy in Majmaah