Important co-morbidity in patients with diabetes mellitus in three clinics in Western Kenya

SETTING: Diabetes clinics in three hospitals in Western Kenya: Moi Teaching and Referral Hospital and two associated district hospitals. OBJECTIVE: To determine the proportion of diabetes patients with a history of tuberculosis (  TB), human immunodeficiency virus (HIV  ) infection and tobacco smoking. DESIGN: A descriptive study using routinely collected data from patient records in the three diabetes clinics. RESULTS: Of 1376 patients analyzed, 750 (55%) were female. The mean age of the patients in the clinics was 53.5 years (95%CI 52.2–54.8), with an average duration of diabetes of 8.1 years (95%CI 7.6–8.7). Of all patients, 5.6% reported a history of TB, similar to the frequency about 20 years earlier (1990) in Tanzania. Only 30% of the patients reported knowing their HIV status; 6% were HIV-positive. A history of tobacco smoking was reported by 3.8% of the patients. CONCLUSION: The HIV epidemic does not seem to have significantly changed the relationship between TB and diabetes mellitus (DM) in this cohort of diabetes patients. The frequency of HIV and TB in this special population was comparable to that in the general population, and only a small proportion of patients reported a history of tobacco smoking

To address emerging infections, we must invest in enduring systems: The kinetics and dynamics of health systems strengthening

Clinical pharmacology uses foundational principles of pharmacokinetics (PK) and pharmacodynamics (PD) to address medication use spanning a continuum from molecules to the masses. In the realm of infectious diseases, PK/PD attributes are considered especially important, because subtherapeutic dosing of antibiotics has been associated with poorer clinical outcomes in patients and increased incidences of drug resistance in populations. In consideration of these PK/PD principles, we will describe the analogous relationship between health systems strengthening, including for educating healthcare providers about emerging infections, and the tenets of therapeutic drug monitoring

Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya : a prospective comparison of point of care diagnostic methods.

Background: Early diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting. Methods: Eligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference. Results: Six hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity. Conclusions: POC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify sensitive and specific POC GDM screening strategies using adverse pregnancy outcomes as end points are required

Modern Social Life and Mental Health

Indian society today is a society in transition. The age-old misconception that the Indian economy is predominantly rural is now eroding. It is true that one's village culture, community, caste, and familial ties still majorly impact the average Indian's way of life. However, due to both the ‘push' and ‘pull' forces of migration, the former, over time, have become more and more amalgamated with urbane and metropolitan influences stemming from, among others, the mass proliferation of white-collar jobs and the explosion of social media platforms. This hybridization of schemas often causes cognitive dissonance for a said individual in multiple facets of his/her personal and/or professional life. Since industry and service sector jobs are majorly concentrated in urban areas of the country, this individual now has an entirely new set of psycho-social adjustment problems to deal with. Another reason for why the work-life of India is drastically different from that of other countries is that organizations in India, at least the well-established ones, often have two to three generations working simultaneously, which combined with the rapidly growing average life-expectancy; thanks to cheap quality public health-care, which is estimated to increase to four to five generations shortly. The major problem to be expected by the future, and even to an extent, current HR managers is that multiple generations profess dramatically different superegos and/or value systems. DOI: 10.5281/zenodo.387396

Modern Social Life and Mental Health

Indian society today is a society in transition. The age-old misconception that the Indian economy is predominantly rural is now eroding. It is true that one’s village culture, community, caste, and familial ties still majorly impact the average Indian’s way of life. However, due to both the ‘push’ and ‘pull’ forces of migration, the former, over time, have become more and more amalgamated with urbane and metropolitan influences stemming from, among others, the mass proliferation of white-collar jobs and the explosion of social media platforms. This hybridization of schemas often causes cognitive dissonance for a said individual in multiple facets of his/her personal and/or professional life. Since industry and service sector jobs are majorly concentrated in urban areas of the country, this individual now has an entirely new set of psycho-social adjustment problems to deal with. Another reason for why the work-life of India is drastically different from that of other countries is that organizations in India, at least the well-established ones, often have two to three generations working simultaneously, which combined with the rapidly growing average life-expectancy; thanks to cheap quality public health-care, which is estimated to increase to four to five generations shortly. The major problem to be expected by the future, and even to an extent, current HR managers is that multiple generations profess dramatically different superegos and/or value systems. DOI: 10.5281/zenodo.387396

Structural brain abnormalities in postural tachycardia syndrome: A VBM-DARTEL study

Postural tachycardia syndrome (PoTS), a form of dysautonomia, is characterized by orthostatic intolerance, and is frequently accompanied by a range of symptoms including palpitations, lightheadedness, clouding of thought, blurred vision, fatigue, anxiety, and depression. Although the estimated prevalence of PoTS is approximately 5–10 times as common as the better-known condition orthostatic hypotension, the neural substrates of the syndrome are poorly characterized. In the present study, we used magnetic resonance imaging (MRI) with voxel-based morphometry (VBM) applying the diffeomorphic anatomical registration through exponentiated lie algebra (DARTEL) procedure to examine variation in regional brain structure associated with PoTS. We recruited 11 patients with established PoTS and 23 age-matched normal controls. Group comparison of gray matter volume revealed diminished gray matter volume within the left anterior insula, right middle frontal gyrus and right cingulate gyrus in the PoTS group. We also observed lower white matter volume beneath the precentral gyrus and paracentral lobule, right pre- and post-central gyrus, paracentral lobule and superior frontal gyrus in PoTS patients. Subsequent ROI analyses revealed significant negative correlations between left insula volume and trait anxiety and depression scores. Together, these findings of structural differences, particularly within insular and cingulate components of the salience network, suggest a link between dysregulated physiological reactions arising from compromised central autonomic control (and interoceptive representation) and increased vulnerability to psychiatric symptoms in PoTS patients

Sustainable Development and Business Models of Entrepreneurs in the Organic Food Industry

The business case for a sustainable firm, in particular the business case for new entrepreneurial initiatives responding to environmental demands, is increasingly receiving attention from practitioners and scholars. This article contributes to existing literature on business models, sustainable development and entrepreneurship, by applying components of business models to the practices of entrepreneurs that have a goal of environmental sustainability and a focus on the mass market (i.e. ecopreneurs). We define the ecopreneurial business model and specify four varieties of this business model, which consist of different combinations of environmental scope and a focus on the mass market and profitability. The distinguishing factor of the ecopreneurial business model is that it transforms disvalue into value, thereby creating greater customer value for environmentally concerned consumers. The results are based on a substantial set of interviews among ecopreneurs in the organic food and beverage industry in the Netherlands

Implementation of a low-cost unna boot alternative as adjunctive treatment for Kaposi Sarcoma

There are 6 million people living with HIV; 70% reside in Sub-Saharan Africa (SSA). Furthermore, 1.1 million deaths occur due to opportunistic infections (OIs) that can be minimized with antiretroviral therapy. In Kenya, Kaposi Sarcoma (KS) is an especially debilitating OI that presents with dermatologic lesions; magnifying the stigma that patients with HIV face physically and psychosocially. Dermatology research is underway to determine the effectiveness of an unna boot (medicated, layered compression dressing) to speed the healing of these lesions with anecdotal success. Commercially available unna boot products are too expensive and not readily available in SSA. Clinicians from Purdue University College of Pharmacy and the AMPATH Consortium hope to address this need in SSA. A pharmacy student was tasked with developing a low-cost unna boot as a service learning project during an eight-week advanced pharmacy practice experience in Eldoret, Kenya. This project began with an extensive literature review to determine the utility and feasibility of an unna boot, and resulted in the development of a modified kit costing significantly less than commercial products, potentially improving quality of life for this population. This poster describes the implementation and methodology of the local unna boot’s creation, a summation of the service learning project, and the impact on a pharmacy student, clinicians, and patients in SSA

Diabetes in sub-Saharan Africa – from policy to practice to progress: targeting the existing gaps for future care for diabetes

The global prevalence and impact of diabetes has increased dramatically, particularly in sub-Saharan Africa. This region faces unique challenges in combating the disease including lack of funding for noncommunicable diseases, lack of availability of studies and guidelines specific to the population, lack of availability of medications, differences in urban and rural patients, and inequity between public and private sector health care. Because of these challenges, diabetes has a greater impact on morbidity and mortality related to the disease in sub-Saharan Africa than any other region in the world. In order to address these unacceptably poor trends, contextualized strategies for the prevention, identification, management, and financing of diabetes care within this population must be developed. This narrative review provides insights into the policy landscape, epidemiology, pathophysiology, care protocols, medication availability, and health care systems to give readers a comprehensive summary of many factors in these domains as they pertain to diabetes in sub-Saharan Africa. In addition to providing a review of the current evidence available in these domains, potential solutions to address the major gaps in care will be proposed to reverse the negative trends seen with diabetes in sub-Saharan Africa