Culturally tailored DSMES: A new key for South Asian patients with Type 2 Diabetes Mellitus

South Asians have an exceptionally high risk for developing Type 2 diabetes mellitus. It is very challenging for healthcare providers to successfully manage diabetes and control glucose levels at target due to the unique lifestyle of the South Asian population. Culturally tailored diabetes self-management education and support (DSMES) can be more effective in guiding South Asian patients with Type 2 diabetes. Unique considerations to address lifestyle modification for South Asians include a diet that typically consists of a high carbohydrate to lipids/proteins ratio, preference for high glucose index fruits, regular intake of traditional sweets or desserts, late afternoon tea break followed by late dinner, lack of vigorous exercise (yoga or walking being the preferred activity), lack of DSMES knowledge and skills, and poor access to culturally appropriate resources for diabetes care. We present a 38-year-old male diagnosed with diabetes four years ago who showed poor glucose control before our intervention. Our interventions included education on the importance of blood glucose monitoring, exercise, and diet. Based on our experience with this case, we propose the following recommendations for a tailored approach to DSMES for South Asian patients with Type 2 diabetes: make appropriate dietary changes (decrease total daily caloric intake, decrease the percentage of carbohydrates, addlow glucose index fruits and vegetables, avoid late afternoon tea breaks, eat dinner before 8 PM); incorporate appropriate daily physical activity; and monitor blood glucose daily for prompt feedback.

Survival of dental implants in patients with bone dysplasia: A systematic review

Objective: This study used published studies to assess the survival rate of dental implants placed in patients with bone dysplasia of the maxillofacial region.Material and methods: An electronic search without a specified date range was performed using the MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane databases. No gender or age restrictions were applied.Results: Eighteen publications were found that met the study’s criteria, reporting data on 18 patients with bone dysplasia including cleidocranial dysplasia (CDD), fibrous dysplasia (FD), florid cemento-osseous dysplasia (FCOD), and odonto-maxillary segmental dysplasia (SOMD), who received a total of 130 implants, an average of 7.2 implants/patient (range 1 to 16). The mean age of the patients was 36.7 years (range 15 to 70 years). For implants placed in bone dysplasia, the survival rates were 100% for patients with CDD (n = 8), FD (n = 5), SOMD (n = 2), FCOD with implants inserted far from the lesions (n = 2) and 0% for dental implants inserted within FCOD (n = 1). The mean follow-up was 38.2 months (min 6, max 60).Conclusions: Dental implants placed in patients with dysplastic bone lesions show high survival rates, similar to those in the general population for CDD, FD, and SOMD. For FCOD, the failure rate was 100%.

Microsurgical vasovasostomy: An option for men with post vasectomy psychological distress

Vasectomy is a practical and straightforward approach to birth control. This paper presented a 31-year-old patient who desired to restore his fertility five years after being vasectomized. He met several obstacles. He developed severe psychological distress with symptoms of stress, anxiety, and aggression. He underwent microsurgical vasovasostomy, and vassal patency was confirmed by return of spermatozoa in semen samples 6 and 10 weeks after surgery, and symptoms of psychological distress disappeared. Preoperative vasectomy counseling should include information about vasectomy reversal. At the most, vasectomy reversal can be considered in selected men with psychological problems due to vasectomy. Microsurgical training should be offered to more urological surgeons, especially those who are interested in andrology.

Evaluation of materno-fetal antibody transfer in patients with antiphospholipid syndrome

Introduction: Antiphospholipid syndrome (APS) is characterized by thrombotic events and recurrent pregnancy losses and is considered the most common acquired thrombophilia.Objective: To carry out a narrative review of the transplacental passage and antibodies in patients with APS.Methods: A narrative literature review.Results: When it is not associated with any connective tissue disease, it is said to be primary, and when in association with systemic lupus erythematosus, it is said to be secondary. Gestational morbidity is frequent, and it is crucial to evaluate the passage of these antibodies transplacentally since there are animal models of the syndrome with passive transfer of these antibodies. The transplacental passage of specific antibodies has already been determined in studies, which demonstrated low levels of these antibodies in the maternal serum, but an efficient transplacental passage for the newborn.Conclusions: There are few studies on this maternal-infant passage in patients with APS reviewed here.

Presarcopenia and chronic cough due to chronic obstructive pulmonary disease successfully treated with nutraceutical supplements and physical exercise

Objective: To describe a patient with presarcopenia and chronic cough secondary to chronic obstructive pulmonary disease (COPD) successfully treated with supplements and physical exercise.Case report: A 75-year-old female patient with a positive past medical history of systemic hypertension, dyslipidemia, heart arrhythmia, and smoking during 20 years evolved with chronic cough due to a chronic obstructive pulmonary disease diagnosed ten years ago. She came to our private clinic due to low weight, low energy. Her weight was 44.8 kg, her height 1.57 m, body mass index of 18.18 kg/m2. Laboratory tests showed SDHEA 76.3, vitamin D of 15.6 ng/ml (nr: > 30 ng/ml), C-reactive protein (CRP) of 55 mg/ml. Computed tomography showed bronchiectasis. She had an skeletal muscle mass index of 5.0 kg/m2 (nr: > 5.5 kg/m2) by DXA. A diagnosis of presarcopenia was determined based on DXA evaluation with low muscle mass but normal gait speed handgrip strength. We suggested to the patient to increase physical exercise and prescribed a supplement formula. After five months, she returned asymptomatic, without cough, marked improvement of fatigue, increased energy levels, and weight increased to 50 kg, BMI of 20.28 kg/m2. Laboratory tests showed SDHEA to 140, vitamin D3 to 64.5 ng/ml, reduced CRP reduced to 5 mg/dl, and amlodipine was excluded due to better blood pressure control. Currently, two years later, the patient continues without cough and has dyspnea only with high efforts, without fatigue, and her weight is 52 kg and BMI 21.1 kg/m2. She also reduced her conventional treatment for COPD, using only a bronchodilator on-demand, without topical corticoids.Conclusions: This case illustrates an interesting case of a patient with presarcopenia and chronic cough, refractory to conventional approach, successfully treated with a combination of nutraceuticals and physical exercises.

Study on the mechanism of microporous sheep ADM combined with hUCMSC in promoting wound healing

Objective: To explore the therapeutic mechanism of microporous sheep acellular dermal matrix (ADM) combined with human umbilical cord mesenchymal stem cell (hUCMSC) to promote the healing of full-thickness skin defect.Methods: hUCMSC was co-cultured on microporous sheep ADM to form composite biological dressings. Seventy-two nude mice were selected to make full-thickness skin injury models and randomly divided into 3 groups (hUCMSC + microporous sheep ADM group, sheep ADM group and iodophor gauze group), with 24 mice in each group. The wound healing rate of each group was detected at 14 d, 21 d and 28 d after operation, qRT-PCR technique was used to detect the expression of Bax and Bcl-2 in the wound tissues, and the immunohistochemical staining technique was used to detect the expression of Collagen I and vascular endothelial growth factor (VEGF). Data were analyzed with one-way ANOVA and t test.Results: At 14 d after operation, the wound healing rate of the hUCMSC + microporous sheep ADM group was (65.34 ± 14.72)%, which was significantly higher than that of the iodophor gauze group [(37.54 ± 10.21)%], and higher than that of the sheep ADM group [(49.08 ± 11.16)%], the differences were statistically significant (t = 19.52, 14.72; p < .05). With the gradual healing of the wound, at 28 d after operation, the wound healing rate of the hUCMSC + microporous sheep ADM group was (98.63 ± 15.41)%, which was significantly higher than that of the iodophor gauze group [(81.74 ± 16.27)%], and higher than that of the sheep ADM group [(63.47 ± 14.80)%], the differences were statistically significant (t = -16.42, 20.35; p < .05). The expression of Bax in the wound tissues of the hUCMSC + microporous sheep ADM group was significantly reduced, especially at 21 d after operation, the expression level was 0.25 ± 0.06, which was significantly lower than the iodophor gauze group (0.53 ± 0.16) and the sheep ADM group (0.41 ± 0.12), the differences were statistically significant (t = 3.52, -2.83; p < .05). The expression of Bcl-2 in the wound tissues of the hUCMSC + microporous sheep ADM group was significantly higher than those ofthe other two groups, especially at 21 d after operation, the expression level was 0.63 ± 0.19, which was significantly higher than the iodophor gauze group (0.34 ± 0.09) and the sheep ADM group (0.46 ± 0.13), the differences were statistically significant (t = 5.31, -6.07; p < .05). Immunohistochemical detection showed that the expression of Collagen I and VEGF in the hUCMSC + microporous sheep ADM group was slightly more than that of the sheep ADM group and the iodophor gauze group, but the effect was not remarkable.Conclusions: hUCMSC + microporous sheep ADM composite dressing can promote the healing of the full-thickness skin injury and reduce the production of apoptotic cells by carrying hUCMSC.

Suicide risk in systemic lupus erythematosus: A narrative review

Introduction: Despite the medical and scientific advances, the disease’s restrictions and the perception of personal and social losses related to its course reinforce fear and generate intense suffering in lupus patients. Psychiatric comorbidities, especially major depressive episodes, are highly prevalent during systemic lupus erythematosus. Among them, suicide is a behavior that is much more common than we believe.Objective: To perform a narrative review on suicidal behavior associated with systemic erythematosus lupus (SLE).Results: Studies have shown an increased risk of suicide among patients with chronic diseases and psychiatric disorders, especially depression. However, suicide cannot be attributed only to a higher prevalence of depression and other mental illnesses. Therefore, it is necessary to learn more about the suicide risk factors present in patients with lupus to work on secondary prevention and avoid the premature loss of lives and the additional suffering of families and surrounding communities. The coordination between the studies on suicidal behavior and its intricate network of individual and sociocultural factors and the studies on this multisystem autoimmune disease with a broad manifestation spectrum, lupus, creates new and essential field research.Conclusions: Non-psychiatrist office-based physicians, health clinics, or wards dedicated to the treatment of SLE should recognize and handle the suicide risk factors on their patients to reduce the suffering caused by this disease.

Iatrogenic scleroderma renal crisis: A case report and mini literature review for renal crisis

Background: Systemic sclerosis is a connective tissue disease characterized by fibrosis of the skin and organs, marked changes in microvascular structure, cellular and humoral immune disorders. Renal involvement is more frequent and mainly characterized by moderate proteinuria, elevated serum creatinine levels, and hypertension. The most common kidney involvement in SSc is scleroderma renal crisis (SRC) that is fatal without prompt intervention.Case report: A 52-year-old Caucasian male with known diffuse cutaneous systemic sclerosis was hospitalized with communityacquired pneumonia. On the fifth day after appropriate antibiotic therapy and 60 mg/day methylprednisolone, decreased urine output, arterial hypertension, decreased renal function and pulmonary edema developed. The patient was diagnosed with a scleroderma renal crisis. Emergency hemodialysis was applied to the patient, and captopril 6 × 25 mg/day and nifedipine 2*60 mg/day treatment were given. He received a routine hemodialysis program for about three months. The hemodialysis program was terminated when the patient’s urine quality and quantity increased.Conclusions: SRC, characterized by malignant hypertension, azotemia, microangiopathic hemolytic anemia, and kidney failure, is one of the most important complications of systemic sclerosis with a poor prognosis without prompt intervention. Steroid use is one of the important risk factors that precipitate SRC development. With angiotensin-converting enzyme inhibitors, survival increased after SRC, the need for dialysis decreased, and usually allowed the discontinuation of dialysis treatment within about 6-18 months. Suspicion of SRC in the presence of the above-mentioned findings in patients with a diagnosis or suspected systemic sclerosis can be considered the most important treatment step.

Case report: MPN-eo with balanced rearrangement of MPRIP-PDGFRB t(5;17)(q32;p11), responding to low dose imatinib

We present a young patient with a rare eosinophilic myeloproliferative neoplasm MPN-eo with a balanced rearrangement of MPRIP-PDGFRB t(5;17)(q32;p11). This fusion gene was reported in only one other case in 2015. A personalized molecular test was developed with the diagnostic material of the patient. Our patient is in complete cytogenetic and molecular remission under low dose imatinib, two years after treatment initiation.

Effects of intrauterine infection in different periods on the placenta and endometrial blood vessel formation of pregnant mice and the growth and development of fetal rats

Objective: To investigate the effects of intrauterine infection in different periods on the placenta and endometrial blood vessel formation of pregnant rats and the growth and development of fetal rats.Methods: According to the random number table method, 32 pregnant rats were divided into the early infection group, the mid-term infection group, the late infection group and the control group, with 8 rats in each group. On the 3rd, 9th and 15th day of pregnancy, lipopolysaccharide was injected intraperitoneally to construct intrauterine infection models. The pregnant rats in the control group were intraperitoneally injected with the same dose of 0.9% sodium chloride solution. On the 18th day of pregnancy, the inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], the blood vessel density of placenta and endometrium in the placental tissues of pregnant rats, dead fetus + absorbed fetus, the inflammatory factors IL-6, TNF-α and oxidation reaction indicators [malondialdehyde (MDA) and myeloperoxidase (MPO)] in the fetal rat lung and brain tissues were detected.Results: The changing trend of IL-6 and TNF-α levels in the placental tissues of pregnant rats with intrauterine infection in different periods was: the control group < the late infection group < the mid-term infection group < the early infection group, the differences were statistically significant (p <.05). The changing trend of fetal rat weight, placental weight and placental coefficient in the intrauterine infection groups in different periods was: the control group > the late infection group > the mid-term infection group > the early infection group, the differences were statistically significant (p < .05). The blood vessel density of placenta and endometrium, the mean number of fetuses, brain coefficient and lung coefficient in the late infection group were significantly increased in comparison with the early infection group and the mid-term infection group. The total number and the ratio of dead fetus + absorbed fetus, the levels of IL-6, TNF-α, MDA and MPO in brain and lung tissues were significantly reduced, and the differences were statistically significant (p < .05). The blood vessel density of placenta and endometrium, brain coefficient and lung coefficient of pregnant rats in the mid-term infection group were significantly increased in comparison with the early infection group, and the differences were statistically significant (p < .05). There was no statistically significant difference in the other indicators between the two groups (p > .05).Conclusions: Intrauterine infection in different periods can inhibit placental and endometrial angiogenesis, and affect the survival rate of fetal rats and the growth and development of brain and lung. The reason may be related to the aggravation of fetal inflammatory responses and oxidative stress. The earlier the intrauterine infection occurs, the severer the adverse effects on the fetal rats will be.