Health-Related Quality of Life Among Type 2 Diabetes Mellitus Patients Using the 36-Item Short Form Health Survey (SF-36) in Central Ethiopia: A Multicenter Study

Introduction

Diabetes, one of the major global health emergencies of the 21st century, can affect a patient's quality of life. A compromised quality of life has adverse effects on self-care practices, resulting in inadequate glycemic control and an increased susceptibility to complications. In Ethiopia, there is a paucity of information regarding the quality of life of patients with type 2 diabetes mellitus. Therefore, this study aimed to assess health-related quality of life in type 2 diabetes mellitus patients.

Methods

A cross-sectional study was conducted among type 2 diabetes mellitus patients attending diabetes follow-up clinics in selected public hospitals in Addis Ababa using short form- 36 (SF-36) health survey measures. Descriptive statistics were used to summarize the characteristics of the study participants. Simple and multiple linear regressions were done to identify significantly associated factors with health-related quality of life.

Result

A total of 309 patients participated in this study. The mean scores of the physical and mental component summaries were 40.15 (SD = 7.27) and 48.11 (SD = 8.87), respectively. Being old, being overweight or obese, living with type 2 diabetes mellitus for more than fifteen years, taking combined medication, having diabetes-related complications, and having comorbidities were factors that reduced the mean score of the physical component summary (p-value<0.05). Being obese and diabetes related complication were factors that negatively affect mental component summary (p-value <0.05). On the other hand, being married was factors that positively affect mental component summary (p-value <0.05).

Conclusion

Older age, being married, obesity, overweight, longer duration of diabetes, using combined medications, diabetic-related complications, and co-morbidities were factors associated with health-related quality of life. Healthcare providers should strengthen counseling patients on lifestyle modifications such as diet modifications, and weight reduction.

The obesogenic side of Genistein

Genistein (GN) has been highly recommended for its medicinal properties like anticancer, antidiabetic, antihyperlipidemic, antiviral, and antioxidant activities among others. Recently, scientists realized that Genistein is an endocrine disruptor. It is an obesogen that interferes with the endocrine system causing obesity through many mechanisms like inducing adipocyte differentiation, lipid accumulation, and transformation of some stem cells into adipocytes (bone marrow mesenchymal stem cells for example) in vitro. Animal studies show that GN upregulates genes associated with adipogenesis like CCAAT/enhancer binding protein alpha (Cebpα), CCAAT/enhancer binding protein beta (Cebpβ), and PPARγ. In silico studies reveal a strong binding affinity for estrogen receptors. All these findings were contingent on concentration and tissues. It is beyond dispute that obesity is one of the most frustrating medical conditions under the sun. The pathophysiology of this disease was first attributed to a high-calorie diet and lack of physical activity. However, studies proved that these two factors are not enough to account for obesity in both children and adults. This mini review highlights how Genistein interaction with the peroxisome proliferator-activated receptor gamma protein can cause obesity.

Cryopreservation of bioflavonoid-rich plant sources and bioflavonoid-microcapsules: emerging technologies for preserving bioactivity and enhancing nutraceutical applications

Bioflavonoids are natural polyphenolic secondary metabolites that are medicinal. These compounds possess antitumor, cardioprotective, anti-inflammatory, antimicrobial, antiviral, and anti-psoriasis properties to mention a few. Plant species that contain bioflavonoids should be preserved as such. Also, the bioactivity of the bioflavonoids as neutraceutical compounds is compromised following extraction due to their sensitivity to environmental factors like light, pH, and temperature. In other words, the bioflavonoids' shelf-life is affected. Scientists noticed that bioflavonoids have low solubility properties, poor absorption, and low bioavailability following consumption. Researchers came up with methods to encapsulate bioflavonoids in order to circumvent the challenges above and also to mask the unpleasant order these chemicals may have. Besides, scientists cryopreserve plant species that contain bioflavonoids. In this review, we discuss cryopreservation and bioflavonoid microencapsulation focusing mainly on vitrification, slow freezing, and freeze-drying microencapsulation techniques. In addition, we highlight bioflavonoid extraction techniques, medicinal properties, challenges, and future perspectives of cryopreservation and microencapsulation of bioflavonoids. Regardless of the uniqueness of cryopreservation and microencapsulation as methods to preserve bioflavonoid sources and bioflavonoids' bioactivity, there are challenges reported. Freeze-drying technology is costly. Cryoprotectants damage the integrity of plant cells, to say the least. Researchers are working very hard to overcome these challenges. Encapsulating bioflavonoids via coaxial electrospray and then cryopreserving the micro/nanocapsules produced can be very interesting.

Predictors of Virological Failure after Adherence-Enhancement Counseling among First-Line Adults Living with HIV/AIDS in Kombolcha Town, Northeast Ethiopia

BACKGROUND

HIV virological failure is a common challenging problem, even after adherence-enhancement counseling. However, there have been few studies on the determinants of virological failure after adherence-enhancement counseling among adult patients on antiretroviral therapy in Ethiopia in general, and there is variation across clients and settings for unknown reasons. Therefore, this study aimed to identify predictors of virological failure after adherence-enhancement counseling among adults living with HIV/AIDS.

METHODS

A case-control study was conducted in the town of Kombolcha from January 1, 2019 to March 30, 2019 using simple random sampling for 338 participants. Data were collected through face-to-face interviews for social and personal characteristics and document review for clinical profiles. Descriptive statistics were used for frequency, proportions, and summary measures. Binary logistic regression analysis was carried out to identify the predictors of virological failure after adherence-enhancement counseling among adults. For multivariate logistic regression,P<0.05 was considered statistically significant. AORs are presented with 95% CIs.

RESULTS

The odds of virological failure after adherence-enhancement counseling were higher following poor antiretroviral medication adherence (AOR 7.3, 95% CI 2.57-20.79) and for patients who had had a first high viral load (≥10,000 copies/mL, (AOR 5, 95% CI 1.86-13.56) and a history of opportunistic infection (AOR 3.7, 95% CI 1.11-8.44) compared with their counterparts.

CONCLUSION

Poor antiretroviral medication adherence during adherence-enhancement counseling session, first viral load ≥10,000 copies/mL, and recent history of opportunistic infection were predictors of virological failure. Therefore, efforts should be strengthened to improve adherence to antiretroviral medication, which helps to boost immunity and suppress viral replication.

Another dengue fever outbreak in Eastern Ethiopia-An emerging public health threat

Background

Dengue Fever (DF) is a viral disease primarily transmitted by Aedes (Ae.) aegypti mosquitoes. Outbreaks in Eastern Ethiopia were reported during 2014–2016. In May 2017, we investigated the first suspected DF outbreak from Kabridahar Town, Somali region (Eastern Ethiopia) to describe its magnitude, assess risk factors, and implement control measures.

Methods

Suspected DF cases were defined as acute febrile illness plus ≥2 symptoms (headache, fever, retro-orbital pain, myalgia, arthralgia, rash, or hemorrhage) in Kabridahar District residents. All reported cases were identified through medical record review and active searches. Severe dengue was defined as DF with severe organ impairment, severe hemorrhage, or severe plasma leakage. We conducted a neighborhood-matched case-control study using a subset of suspected cases and conveniently-selected asymptomatic community controls and interviewed participants to collect demographic and risk factor data. We tested sera by RT-PCR to detect dengue virus (DENV) and identify serotypes. Entomologists conducted mosquito surveys at community households to identify species and estimate larval density using the house index (HI), container index (CI) and Breteau index (BI), with BI≥20 indicating high density.

Results

We identified 101 total cases from May 12–31, 2017, including five with severe dengue (one death). The attack rate (AR) was 17/10,000. Of 21 tested samples, 15 (72%) were DENV serotype 2 (DENV 2). In the case-control study with 50 cases and 100 controls, a lack of formal education (AOR [Adjusted Odds Ratio] = 4.2, 95% CI [Confidence Interval] 1.6–11.2) and open water containers near the home (AOR = 3.0, 95% CI 1.2–7.5) were risk factors, while long-lasting insecticide treated-net (LLITN) usage (AOR = 0.21, 95% CI 0.05–0.79) was protective. HI and BI were 66/136 (49%) and 147 per 100 homes (147%) respectively, with 151/167 (90%) adult mosquitoes identified as Ae. aegypti.

Conclusion

The epidemiologic, entomologic, and laboratory investigation confirmed a DF outbreak. Mosquito indices were far above safe thresholds, indicating inadequate vector control. We recommended improved vector surveillance and control programs, including best practices in preserving water and disposal of open containers to reduce Aedes mosquito density.

In 2017 an outbreak of Dengue fever (DF) was reported in Kabridahar Town, Ethiopia. This mosquito transmitted disease was recently detected in Ethiopia only four years prior, with this being the first time it was identified in the area. In response, our team was dispatched to confirm the presence of the disease, identify potential causes, and implement mitigation and control measures. We identified and compared suspected cases and suspected non-cases to identify the potential risk factors of infection. Laboratory confirmation of infection and disease-type was also performed. Due to the entomological nature of disease transmission, additional entomological investigations were conducted at the households of both groups to understand its influence at the household level. Through these measures, we were able to establish the presence of DF in Kabridahar Town and identify risk factors leading to infection. Risk factors included a lack of formal education and open water containers near the home, while the presence of long-lasting insecticide-treated nets were found to be protective. Mitigation and control measures were implemented to combat or promote the identified risk and protective factors respectively. Cases counts began to reduce five days after the onset of these measures. Recommendations were made based on our findings to prevent future outbreaks. The last case was recorded ten days after implementation of the mitigation and control measures.