Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges

Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses. Over the past century, insulin formulations have undergone significant modifications and bioengineering, resulting in a diverse range of available insulin products. These products show distinct pharmacokinetic and pharmacodynamic profiles. Consequently, various insulin regimens have em-erged for the management of type 2 diabetes, including premixed formulations and combinations of basal and bolus insulins. The utilization of different insulin regimens yields disparate clinical outcomes, adverse events, and, notably, patient-reported outcomes (PROs). PROs provide valuable insights from the patient's perspective, serving as a valuable mine of information for enhancing healthcare and informing clinical decisions. Adherence to insulin therapy, a critical patient-reported outcome, significantly affects clinical outcomes and is influenced by multiple factors. This review provides insights into the clinical effectiveness of various insulin preparations, PROs, and factors impacting insulin therapy adherence, with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.

Validity and reliability of the Arabic version of the Self-Efficacy for Managing Chronic Disease scale in rheumatoid arthritis patients

BACKGROUND AND OBJECTIVES

Rheumatoid arthritis (RA) is an autoimmune inflammatory condition that causing disability and affection of patient's quality of life (QoL). Self-efficacy investigation helps us to detect the requirements of chronically affected patients and evaluation of self-care management programs. The aim of our study was to test validity and reliability of Self-Efficacy for Managing Chronic Disease (SEMCD-Arabic) in RA patients.

METHOD

This study included 248 RA patients, carried out at Rheumatology and Rehabilitation Department. The SEMCD-Arabic Validity was assessed by correlating the SEMCD-Arabic scale with the validated Arabic version of the modified Health Assessment Questionnaire HAQ (MHAQ), the Arabic version of the Multidimensional Assessment of Fatigue (MAF) scale, and the Arabic version of Short Form 36 version 2 for quality of life (SF QoL). Internal consistency, test-retest reliability was assessed.

RESULTS

Convergent validity was confirmed by a positive correlation between (physical, mental) component of SF QoL and SEMCD-Arabic (r = 0.918, r = 0.925) respectively, and negative correlation between MAF and SEMCD-Arabic (r =  - 0.657) and MHAQ with SEMCD-Arabic (r =  - 0.595). Discriminant validity confirmed by a significant negative correlation between visual analogue scale (VAS) for pain, disease activity scale (DAS28), Morning stiffness, patient health, physician health, age, duration, and SEMCD-Arabic (r =  - 0.1-0.7) (P < 0.001). Test-retest reliability was estimated which revealed a high interclass correlation coefficient (ICC = 0.87-0.997) indicating excellent agreement and internal consistency is acceptable as the Cronbach's alpha value (0.660 to 0.78).

CONCLUSION

The SEMCD-Arabic questionnaire can be used as a valid and reliable measure for assessment of patient's self-efficacy in RA. Key Points • The SEMCD-Arabic questionnaire has a statistically significant validity in correlation with different clinical manifestations MHAQ, SF QoL, and MAF. • The Arabic SEMCD is highly reliable with a Cronbach's alpha of 0.660 to 0.78.

Trends in pattern of tuberculosis in Sharkia Governorate at Ministry of Health and Population Chest Hospitals from 2016 to 2019

Abstract

Background

Tuberculosis is a communicable disease that is one of the leading cause of death from a single infectious agent (ranking above human immunodeficiency virus/acquired immunodeficiency syndrome). The aim of this work was to study the trend of applying the tuberculosis control program at the ministry of health and population chest hospitals, Sharkia, Egypt.

Results

This retrospective cross-sectional study was carried out using medical records from the tuberculosis registry at Ministry of Health and Population chest hospitals, Sharkia Governorate. The investigated variables included demographic characteristics, type of tuberculosis infection, and affected organs. All data were coded and statistically analyzed. A total 1404 cases of tuberculosis were notified between 2016 and 2019 with male predominance, where 67.1% were males and 32.9% were females. The highest number of tuberculosis patients was from the reproductive age groups. During the 4-year study period, the highest percentage of cases was new cases and the highest frequency of cases was during 2017 and the lowest frequency was during 2016. There was a decline in the total number of cases in 2018 and 2019 after sharp increase of total cases in 2017: pulmonary tuberculosis cases showed a sharp decline in 2017; however, there was an increase in extrapulmonary tuberculosis cases during 2017 then a slight decrease in 2018 and 2019. Of the pulmonary tuberculosis cases, 83.8% were smear-positive tuberculosis.

Conclusions

Pulmonary smear-positive and new cases were the most common among the recorded cases of tuberculosis. Productive age groups represented large percentage of the studied cases of tuberculosis. Lymph node and bones were the most common sites of extrapulmonary tuberculosis among reported cases in this study.

Cactus and lupin extracts as prospective anticancer agents compared with utoral drug

The ethanolic extracts of many plants have been used in alternative medicine. The present study aimed at evaluating the antioxidant, cytotoxicity, and anticancer potential of cactus and lupin ethanolic extracts compared to utoral drug (UT) on the colon Caco-2 cancer cell line. Bioactive components, cytotoxicity of Caco-2 cell cycle, and gene regulation of apoptosis genes were studied by HPLC, flow cytometer, and RT-PCR, respectively. Lupin extract (LE) contained high bioactive components and antioxidant potential. The predominant phenol, flavonoid, and sterol in LE were rosmarinic acid (2,004.8 μg/ml), quercetin (9,912 µg/g), and ergosterol (2.77 µg/g). LE and its mixture with utoral showed high cytotoxicity and effective potential in regulation of gene expression of proapoptotic and antiapoptotic genes in Caco-2 cells. In conclusion, LE and cactus extract (CE) could be considered as natural preparations with high anticancer properties against Caco-2 cells. LE had the highest anticancer potential among the tested preparations. PRACTICAL APPLICATIONS: The study demonstrated that lupine and cactus extracts have high potential as anticancer substances. These natural extracts can be used to prepare therapeutic mixtures or foods.

Maternal vitamin D level and vitamin D receptor gene polymorphism as a risk factor for congenital heart diseases in offspring; An Egyptian case-control study

Vitamin D & vitamin D receptor (VDR) signaling play a very crucial role in early embryonic heart development. We construct this case-control study to investigate the association between maternal serum vitamin D level & VDR gene Fok1 polymorphism and risk of congenital heart defects (CHD) in offspring. Fifty mothers who had term neonates with CHD were considered as cases. Fifty age-comparable healthy mothers who had neonates without CHD were contemplated as controls. Maternal serum 25 hydroxyvitamin D [25(OH) D] level was tested using ELISA. Maternal VDR gene Fok1 polymorphism was analyzed using PCR-based RFLP-assay. There was a significant decrease in maternal vitamin D level (P = 0.002) and a significant increase in vitamin D deficient status (P = 0.007) among cases when compared to controls. VDR gene Fok1 genotypes distribution frequency were in accordance with Hardy Weinberg equilibrium (HW) among controls. A significant increase in VDR gene Fok1 F/f & f/f genotypes and f allele were observed in cases compared to controls with estimated odds ratio (95% confidence interval) & P-value of 3 (1-8) & P = 0.006, 11 (1-97) & P = 0.01 and 3 (2-6) & P = 0.001 respectively. There was a significant decrease in maternal vitamin D level in neonates with cyanotic CHD (P = 0.000) compared to those with a cyanotic CHD while there was no significant difference in VDR Fok1 genotype (P = 0.18) & allele (P = 0.05) distribution between two groups. We concluded that maternal vitamin D deficiency and VDR gene Fok1 F/f, f/f genotype and f allele were associated with increased risk of CHD in offspring.

The ecological characteristics of Anopheles mosquitoes associated with low malaria transmission in Siwa oasis, Egypt

The ecology of Anopheles sergentii and An. multicolor was investigated over eight months to examine the entomological factors maintaining the low Plasmodium vivax transmission in Siwa oasis. The two species were encountered as larvae while the dominant species, Anopheles sergentii was also collected as adults. Breeding sites were characterized for the two species in six localities. Larvae of both species were common during June and November. In Bahi El Din as an indicator village with a higher endemicity, An. sergentii females were endophilic but more common inside animal sheds than in houses, attracted more to donkey-baited traps than to human hosts, more endophagic as human biters and were more common in May/June and November. Female survivorship was higher in November than in the other months. Vector potential of An. sergentii was predicted and revealed that the species characteristics (low human contact, short survival and zoophilic feeding behavior) are responsible for maintaining such low and unstable malaria in Siwa oasis.

Comparison of the life table characteristics of Anopheles sergentii (Diptera: Culicidae) from two malarious areas in Egypt

Life table characteristics were examined for the malaria vector, An. serenti from two Faiyum villages: Tersa (T) and El Nazlah (N) from Siwa oasis (Sw) under constant laboratory conditions at 25 degrees C and 70% RH. Females of T, N and Sw completed 4, 5, and 2 gonotrophic cycles (gc) respectively. The first gc required a significantly longer period (p<0.05) than the subsequent ones. Development times for Sw immatures were longer (p<0.05) than for the other colonies. Life expectancies at emergence for males of the 3 colonies were significantly shorter than for their respective females. Generation time was shorter (p<0.05) for T (mean = 31.15 days) than for Sw (37.81 days) or N (43.64 days) colonies. The birth rate of Sw colony (mean = 0.33 female female/female) was significantly higher (p<O.05) than those of the other colonies. The other biological parameters: fecundity, egg hatch times and rates, survivorship from egg eclosion to adult emergence, male and survivorships, net reproductive rate, intrinsic rate of increase all showed no colony variations. The study concluded that variation among colonies in certain biological aspects may not reflect strain differences.

Selection for fenitrothion--resistance in Culex pipiens L larvae (Diptera: Culicidae)

Laboratory selection of Culex pipiens larvae by fenitrothion pressure for 24 generations resulted in 25.67 fold increase in resistance to this compound. Adults resulted from the selected larvae also acquired resistance (32.3 fold) to fenitrothion. Stability of resistance was tested and indicated that regression in resistance only occurred at lower level that regression in resistance only occurred at lower level of selection. Cross resistance to malathion and DLD slightly increased by 2.1-fold and 1.25-fold respectively that may be manifestations of vigour tolerance. It is considered that the positive results obtained here increase the probability of development of such resistance in the field. However, results of cross-resistance are encouraging as they indicate that eventual development of resistance to fenitrothion does not preclude the use of other insecticides against the resistant population.

The mode of inheritance of fenitrothion resistance in Culex pipiens L. larvae (Diptera:Culicidae)

The genetics of fenitrothion resistance in Cx. pipiens larvae was studied to determine its mode of inheritance. A laboratory susceptible and fenitrothion-resistant larval strains were used. Reciprocal crosses between the resistant and susceptible strains showed an F1 generation of partial dominance with slight cytoplasmic effect. The F2 generation underwent segregation into three genotypes, viz. susceptible, hybrid and resistant in the ratio of 1:2:1. The progenies of backcrosses to resistant and susceptible parents were in a 1:1 ratio of the same phenotypes as the parents and hybrids involved. After selection, the progeny of the back-crosses to resistant parent exhibited full resistance. It is concluded that fenitrothion resistance in Cx. pipiens larvae is due to monofactorial inheritance with partial dominance and slight cytoplasmic effect.

Dopamine and octopamine in whole body extracts of the bulb mite

Using high performance liquid chromatography with electrochemical detection, whole body extracts of the bulb mite, Rhizoglyphus echinopus (Fumouze and Robin), were found to contain the biogenic amines dopamine and octopamine at concentrations of 4.3 +/- 0.6 and 2.3 +/- 1.4 ng g-1 wet weight, respectively. Adrenaline, noradrenaline, tyramine, N-methyldopamine, N-acetyldopamine, and 5-hydroxytryptamine, if present, were below the limits of detectability. This is the initial demonstration of the presence of octopamine in a mite species.

Radiographic spectrum of rectocolonic calcification from schistosomiasis

Rectocolonic calcification was detected radiographically in 17 sites in 14 patients undergoing excretory urography for the assessment of urinary schistosomiasis. The right colon was involved in 11 sites, the rectum in four, and the left colon in two. The pattern of calcification varied according to the degree of bowel distension. A laminar pattern was common to all sites and occurred when the rectum or colon was distended with air, feces, or barium. A laminar or irregular amorphous density was found in the empty colon, whereas the calcified, empty rectum had a corrugated pattern. Rectocolonic calcification is probably the most common radiographic manifestation of schistosomal infestation of the gastrointestinal tract.

Trophic specificity of the gustatory fibers upon taste bud regeneration

24 adult dogs were classified into six groups; in 2 animals of each group the lingual nerve was transected distal to the point of entry of the chorda tympani and its proximal end was sutured to the distal end of the glossopharyngeal nerve. In the other 2 animals transtympanic chorda tympani neurectomy was performed before suturing the lingual and glossopharyngeal nerves. Invasion of the papillae by regenerating fibers from the 8th postoperative week onwards was followed by reappearance of taste buds only in lingual glossopharyngeal anastomosis with intact chorda tympani. The difference in number of taste buds, size and number of constituent cells between the two operative procedures was statistically significant from the 8th week onwards. The significance of these findings was discussed.

Histological and histochemical study on the development of foliate papillae in guinea pigs

The present work was carried out to study the development of foliate papillae in guinea pigs and the associated changes in the activity of true cholinesterase enzyme. Histological and histochemical differentiation were found to start in the early intrauterine life and were completed before birth. The activity for the true cholinesterase enzyme was detected as early as the 22nd day of gestation while histological differentiation started 2-3 days later. The findings obtained and their possible significance were discussed.

Effect of indomethacin on the histological structure and cholinesterase activity of taste buds

The present work was undertaken to study the effect of indomethacin on the histological structure and cholinesterase activity of taste buds. 16 adult rabbits were divided into four groups; 2 animals of each group were given a daily oral dose of indomethacin and the other 2 animals were used as controls. The animals were sacrificed at 7, 12, 17 and 30 days, respectively. The areas containing circumvallate and foliate papillae were excised for the study of their histological structure and cholinesterase activity. Administration of indomethacin was followed by a decrease in cholinesterase activity and a shrinkage of the reactive zones of the perigemmal, intragemmal and subgemmal plexuses; the cholinesterase activity eventually disappeared on the 17th day. On the 30th day, it reappeared in the above-mentioned sites. The taste buds did not show any degenerative changes and were similar to those of the controls. The significance of these findings is discussed.

Effect of vincristine on the histological structure of taste buds

10 adult rabbits were arranged in five batches, 2 animals of nearly the same body weight in each group. 1 animal in each group was injected with vincristine sulfate whereas the other animal was similarly injected with the dissolving medium and used as a control. The animals were sacrificed 2 days after the last injection, and the areas containing the circumvallate and foliate papillae were examined. Injection of vincristine was followed by a decrease in number and in cell contents of vallate and foliate taste buds. Most of the taste buds which persisted after vincristine injection were full of necrotic debris which represented the remnants of degenerated cells. Possible reasons for degeneration of taste buds after vincristine injections were put forewards.

Myelination and cholinesterase activity of chick embryo spinal cord

This work was undertaken to study the myelination and cholinesterase activity of the developing white matter of chick embryo spinal cord from the 6th day of incubation until hatching. Myelination of the white matter was always preceeded by the aggregation of neuroglial cells. The sequence of myelination in the cervical and thoracic segments was from before backwards, whereas in the lumbosacral segments it was from behind forewards. Myelination of the ventral column extended craniocaudally, whereas in the posterior column is extended caudocranially. True cholinesterase activity was encountered in the spinal white matter only before and during the process of myelination and was closely associated with the sites of neuroglial aggregations. No pseudocholinesterase activity could be seen in the white matter before myelination. However, during the period of active myelination, enzymatic activity was seen only at the sites of formed myelin and after myelination of all tracts; the whole white matter reacted positive for the enzyme. The significance of these findings is discussed.