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Insulin Availability and Affordability in the Urban Municipality of Antananarivo, Madagascar
Sitraka Angelo Raharinavalona,
Rija Eric Raherison,
Thierry Razanamparany,
Solofo Andrianarivelo Ralamboson,
Hanta Marie Danielle Vololontiana,
Andrinirina Dave Patrick Rakotomalala
Issue:
Volume 6, Issue 1, March 2021
Pages:
1-4
Received:
13 December 2020
Accepted:
21 December 2020
Published:
12 January 2021
Abstract: Background: Insulin is classified as an "essential drug". It should be available in all pharmacies at an affordable price. This remains a major problem in low income countries like ours. Aim: Our study aims to describe the insulin availability and affordability in the Urban Municipality of Antananarivo, Madagascar. Methods: It was a cross sectional study over a period of 3 months at all pharmacies existing in the Urban Municipality of Antananarivo. Insulin availability was assessed according to the classification of the World Health Organization. Affordability was assessed from the ratio between the monthly cost of insulin treatment and the Malagasy monthly health expenditure, and the ratio between the monthly cost of insulin treatment and the guaranteed minimum inter-professional wage in Madagascar. Result: We had retained 79 pharmacies. Insulin availability in private pharmacies was higher than in public hospital pharmacies. Human insulin had a high availability rate: short-acting (70.89%) and mixed (78.08%). Availability of analogue insulin was low: fast-acting (7.59%) and long-acting (34.18%). To buy insulin, a patient was spending monthly 18.75 to 236.24% of the equivalent of guaranteed minimum inter-professional wage. All pharmacies had refrigerators to store insulin. Conclusion: The availability of insulin in the Urban Municipality of Antananarivo was high while diabetic patients have low financial affordability. A good governance health policy and multisectoral actions would be necessary.
Abstract: Background: Insulin is classified as an "essential drug". It should be available in all pharmacies at an affordable price. This remains a major problem in low income countries like ours. Aim: Our study aims to describe the insulin availability and affordability in the Urban Municipality of Antananarivo, Madagascar. Methods: It was a cross sectional...
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A Case of Pheochromocytoma Revealed by an Etonogestrel Contraceptive Implant Use
Sitraka Angelo Raharinavalona,
Nathan Ratsimarisolo,
Rija Eric Raherison,
Solofo Andrianarivelo Ralamboson,
Hanta Marie Danielle Vololontiana,
Andrinirina Dave Patrick Rakotomalala
Issue:
Volume 6, Issue 1, March 2021
Pages:
5-8
Received:
13 December 2020
Accepted:
21 December 2020
Published:
12 January 2021
Abstract: Background: Pheochromocytoma (PH) is a rare tumor developed at the expense of the adrenal medulla and secreting catecholamines. It is also a rare cause of curable hypertension in adults. Case information: We reported a case of PH in a 39-year-old Malagasy woman, with no particular history. The clinic was dominated by the onset of paroxysmal hypertension associated with headache, palpitations, and sweating. Its clinical manifestations were revealed by the insertion of an etonogestrel contraceptive implant. Despite the removal of the contraceptive implant and the taking of an antihypertensive drug based on a calcium channel blocker, the hypertension persisted with a paroxysmal character and always associated with the Menard triad. Results: The diagnosis was made against the elevation of urinary metanephrines and normetanephrines and the presence of a heterogeneous left adrenal mass on computed tomography. Surgical resection of the tumor made it possible to perform an immunohistochemical examination confirming the diagnosis. Without surgical complications, the patient's blood pressure as well as urinary metanephrine and normetanephrine, normalized without taking any antihypertensive drug. Conclusion: Hormonal contraception could be wrongly blamed the cause of hypertension. Then she would just be a triggering factor. Thus, any atypical hypertension following the use of a hormonal contraceptive must encourage the search for a secondary cause such as PH.
Abstract: Background: Pheochromocytoma (PH) is a rare tumor developed at the expense of the adrenal medulla and secreting catecholamines. It is also a rare cause of curable hypertension in adults. Case information: We reported a case of PH in a 39-year-old Malagasy woman, with no particular history. The clinic was dominated by the onset of paroxysmal hyperte...
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Recurrent Parathyroid Adenoma at the Same Site Importance of ROLL
Ayesha Ammar,
Kahkashan Bashir,
Muhammad Faheem,
Sadaf Batool,
Noreen Marwat,
Naseer Ahmed,
Shazia Fatima
Issue:
Volume 6, Issue 1, March 2021
Pages:
9-15
Received:
1 December 2020
Accepted:
15 December 2020
Published:
15 January 2021
Abstract: Background: Recurrent hyperparathyroidism is defined by the re-appearance of parathyroid hormone (PTH) and high blood calcium levels more than 6 months after successful initial surgery for primary hyperparathyroidism. Many causes are associated with recurrent hyperparathyroidism and one of the main reasons is the presence of parathyroid adenoma. Radio-guided occult lesion localization (ROLL) has emergent role in per-operative localization of pathological lesions. ROLL has established role in breast cancer, axillary and thyroid surgery. ROLL is a valuable addition in parathyroid exploration especially in small sized parathyroid adenomas. ROLL is safe and efficient techniques helping in more accurate lesion centricity. Case presentation A 35 years old female was referred to our Nuclear Medicine department due to recurrently raised Calcium and PTH levels. She had complaints of generalized aches and pains with no visible neck nodule. Her Ultrasound neck showed no abnormal lesion while 99m Tc MIBIscan showed an area of increased radiotracer uptake in the right side of neck. Focused surgical neck exploration was done and a parathyroid adenoma was removed. Conclusions Parathyroid adenoma is a most common cause of primary hyperparathyroidism and usually presents symptomatically with high calcium and parathyroid hormone levels. Parathyroid adenoma is diagnosed by imaging and laboratory studies. One stop management is the surgical removal of 3 and a half removal of parathyroid gland and only sparing half of the gland.
Abstract: Background: Recurrent hyperparathyroidism is defined by the re-appearance of parathyroid hormone (PTH) and high blood calcium levels more than 6 months after successful initial surgery for primary hyperparathyroidism. Many causes are associated with recurrent hyperparathyroidism and one of the main reasons is the presence of parathyroid adenoma. Ra...
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Polyherbal Formulation (PDBT Capsules) Containing Extracts of Ayurvedic Plants for Treatment of Prediabetes
Pallavi Londhe,
Rohini Waghmare,
Amit Nakanekar,
Kuldip Kohli,
Pratima Arun Tatke
Issue:
Volume 6, Issue 1, March 2021
Pages:
16-23
Received:
7 December 2020
Accepted:
6 January 2021
Published:
18 January 2021
Abstract: In Prediabetes blood sugar levels are found to be higher than normal levels. It is considered as pre stage of diabetes as people with prediabetes, if remain undiagnosed, have chances of developing type 2 diabetes. Studies show that if diabetes is treated in the prediabetic stage, it results in complete cure of diabetes. The objective of the present study was to investigate effect of PDBT capsules containing extracts of well-known Ayurvedic plants such as Zingiber officinale, Tinospora cordifolia, Pterocarpus marsupium, Gymnema sylvester, and Momordica charantia on prediabetic condition induced in Wistar rats. High fat fructose diet was fed to male Wistar rats to induce prediabetes. After induction on 11th week of study, the prediabetic rats were divided in different groups. Treatment groups received Pioglitazone (3 mg/kg) (standard control), test formulation, PDBT capsule (200mg/kg) (test group) along with high fat fructose diet. Normal diet control group received normal diet and high fat fructose diet control group received only high fat fructose diet. The different biochemical parameters, blood glucose levels and body weights were monitored. Animals were sacrificed at the end of study period. Histopathological studies on the major organs such as liver, kidney, pancreas was performed. High fat fructose diet induced of prediabetes in rats. Significant decrease in levels of fasting blood glucose and biochemical parameters in treatment groups was observed. The histopathological study showed no abnormalities. The present research show that PDBT capsules can be efficiently used in prediabetes treatment. Hence, PDBT capsule can be a potential agent for the treatment of prediabetes.
Abstract: In Prediabetes blood sugar levels are found to be higher than normal levels. It is considered as pre stage of diabetes as people with prediabetes, if remain undiagnosed, have chances of developing type 2 diabetes. Studies show that if diabetes is treated in the prediabetic stage, it results in complete cure of diabetes. The objective of the present...
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Vitamin D Status in Different Categories of Glucose Intolerance in Bangladeshi Adults
Mohammad Firoj Hossain,
Mohammad Shahed-Morshed,
Mohammed Fariduddin,
Tahniyah Haq,
Shahjada Selim,
Muhammad Abul Hasanat,
Mohammad Habibul Ghani,
Anil Yadav,
Ibrahim Faisal,
Anil Kumar Shah
Issue:
Volume 6, Issue 1, March 2021
Pages:
24-30
Received:
5 January 2021
Accepted:
18 January 2021
Published:
28 January 2021
Abstract: Background and aims: Although vitamin D deficiency (VDD) is inversely associated with glucose intolerance, very limited data are available in Bangladesh. Thus, the study aimed to determine vitamin D status of Bangladeshi adults based on the glucose intolerance status. Materials & Methods: This cross-sectional study was carried out among 70 newly detected DM, age-group & sex-matched 76 newly detected pre-diabetes and 74 healthy control with normal glucose tolerance (NGT) based on American Diabetes Association, 2018 criteria. Participants were included consecutively from the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU) over a period of 1 year by convenient sampling to see serum 25(OH)D which was measured by high performance liquid chromatography (HPLC) method. Results: Vitamin D levels decreased with increasing degrees of glucose intolerance [NGT: 16.82±6.57; prediabetes: 15.54±8.58; T2DM: 11.01±6.03 ng/ml, p<0.001] but significantly lower in T2DM than other two groups [T2DM vs. prediabetes, p=0.001; T2DM vs. control, p<0.001; prediabetes vs. control, p=NS]. The highest frequency of vitamin D deficiency was among individuals with T2DM (64.3%) followed by NGT (29.7%) and prediabetes (28.9%) [p<0.001]. Only HbA1c had predictive association with vitamin D deficiency [OR (95%CI)=2.061 (1.178, 3.608), p=0.011]. Only DM but not pre-diabetes had predictive association with vitamin D deficiency compared with NGT [DM: OR (95%CI)=4.255 (2.117, 8.552), p<0.001; prediabetes: OR (95%CI)=0.963 (0.477, 1.946), p=0.916]. Conclusion: Vitamin D level was lower and frequency of vitamin D deficiency was higher in patients with DM. Only HbA1c and DM had predictive association with vitamin D deficiency.
Abstract: Background and aims: Although vitamin D deficiency (VDD) is inversely associated with glucose intolerance, very limited data are available in Bangladesh. Thus, the study aimed to determine vitamin D status of Bangladeshi adults based on the glucose intolerance status. Materials & Methods: This cross-sectional study was carried out among 70 newly de...
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Pathologic Fracture and Vitamin D Deficiency in Pediatric Patient with Osteogenesis Imperfecta Type IV
Arya Wisnu Prayoga,
I Made Arimbawa,
I Wayan Bikin Suryawan,
I Made Dharma Yuda
Issue:
Volume 6, Issue 1, March 2021
Pages:
31-35
Received:
5 January 2021
Accepted:
19 January 2021
Published:
28 January 2021
Abstract: Osteogenesis imperfecta (OI) is a hereditary disorder characterized by increased tendency for bone fractures due to high fragility. The clinical and radiological features of OI manifest in different age groups, although the disease is congenital in nature. Clinical manifestation of OI included laxity of the ligaments, blue sclera, growth retardation, and scoliosis. The most important oral finding in OI is the presence of yellowish-brown-colored brittle teeth characteristic of dentinogenesis imperfecta. A 13 years-old male brought to hospital with chief complaints of fracture upper and lower limbs. The fractures due to minor trauma when he felled from standing position. He also complained about dentition. Teething is said to be disturbed, imperfect and brown colour. Radiology examination showed complete fracture et regio left femur. Bone Marrow Density examination showed low bone mass. Laboratory examination showed hypocalcemia, vitamin D insufficiency and normal parathyroid hormone. On the 5th days of hospitalization patient got surgery from orthopedic specialist for primary treatment of the fracture. The others treatment were given included zolendronat acid, calcitriol and calcium carbonate medication until patient discharged from hospital. Osteogenesis imperfecta could be treated and had well prognostic with the early diagnosed and proper treatment. Management of osteogenesis imperfecta involve multidisciplinary such as pediatric endocrinologists, orthopedics, medical rehabilitation, child development and nutrition.
Abstract: Osteogenesis imperfecta (OI) is a hereditary disorder characterized by increased tendency for bone fractures due to high fragility. The clinical and radiological features of OI manifest in different age groups, although the disease is congenital in nature. Clinical manifestation of OI included laxity of the ligaments, blue sclera, growth retardatio...
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Dietary Calcium or Vitamin D Intake and Type 2 Diabetes Mellitus Incidence: A Dose-Response Meta-analysis
Lingling Li,
Qianwen Li,
Junhao Wang,
Hao Wang,
Yongjuan Xin,
Shenshen Zhang,
Ying Cao,
Mengyao Zhou,
Wenjie Yang
Issue:
Volume 6, Issue 1, March 2021
Pages:
36-45
Received:
2 February 2021
Accepted:
15 February 2021
Published:
4 March 2021
Abstract: Background: Dietary Calcium and vitamin D intake may have effects on the onset risk of type 2 diabetes mellitus (T2DM), whereas the results of existing studies are inconsistent. We performed a meta-analysis of prospective studies to evaluate the association between dietary calcium orvitamin D intakeand the onset risk of T2DM. Methods: We searched PubMed, Web of Science, and Embase for relevant studies published through 5 Jan 2021. The relative risks (RRs) with 95% confidence intervals (CIs) of T2DM in relation to dietary calcium and vitamin D intake were pooled with a fix or random-effects model. Results: 22 cohort studies were included in this meta-analysis, which comprising 31027 cases and 448578 participants. We found dietary calcium (RR: 0.84; 95% CI: 0.76–0.93) rather than dietary vitamin D (RR: 1.00; 95% CI: 0.92–1.08) reduced the onset risk of T2DM. Subgroup analysis showed the efficacy of dietary calcium intake is only in Asian, women and older population. Dose-response analysis revealed that each 300 mg/day increase in dietary calcium intake reduces the risk of T2DM by 8%. However, the increasing dietary vitamin D intake does not affect the risk of T2DM. Conclusions: Dietary calcium intake reduces the onset risk of T2DM but dietary vitamin D has no effect.
Abstract: Background: Dietary Calcium and vitamin D intake may have effects on the onset risk of type 2 diabetes mellitus (T2DM), whereas the results of existing studies are inconsistent. We performed a meta-analysis of prospective studies to evaluate the association between dietary calcium orvitamin D intakeand the onset risk of T2DM. Methods: We searched P...
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The National Jordanian Experts Consensus on Diagnosis and Treatment of Prediabetes
Mohamad Omar Abu Hijleh,
Firas Annabi,
Mousa Abujbara,
Abdelkarim Alkhawaldeh,
Fares Haddad,
Jihad Haddad,
Muwafaq Alhyari,
Harry Howlett,
Nadim Jarrah,
Nadima Shegem,
Murad Al-Naqshbandi
Issue:
Volume 6, Issue 1, March 2021
Pages:
46-53
Received:
6 February 2021
Accepted:
23 February 2021
Published:
4 March 2021
Abstract: Background and aims: The prevalence of prediabetes is increasing in Jordan and the Middle East region, which is leading to increased risk of type 2 diabetes and micro- and macro-complications. The aims of the expert panel were to understand and evaluate the current prediabetes situation and practice in Jordan and make recommendations to standardize the management of patients with prediabetes in Jordan. Methods: A panel of diabetes experts met to discuss and review all the current literature related to the region and international guidelines on prediabetes. The panel evaluated and developed a comprehensive understanding, addressing the definition, screening, diagnosis, pharmacological treatment, and management of prediabetes with consideration of local factors. Results: The experts relied on international data to establish criteria with cut-off values for screening and diagnosis to identify asymptomatic patients with prediabetes and diabetes. The panel made protocol recommendations, including lifestyle modifications, and developed potential treatment algorithms to provide guidance on the overall management for Jordanian prediabetic patients. Conclusion: The panel of experts reached consensus recommendations with a tailored detection, screening, and treatment algorithm in anticipation for a country wide adoption and implementation. These recommendations would help increase awareness of prediabetes in Jordan and create local guidelines to better serve Jordanian physicians in the management of patients with prediabetes.
Abstract: Background and aims: The prevalence of prediabetes is increasing in Jordan and the Middle East region, which is leading to increased risk of type 2 diabetes and micro- and macro-complications. The aims of the expert panel were to understand and evaluate the current prediabetes situation and practice in Jordan and make recommendations to standardize...
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Subacute Thyroiditis Associated with COVID-19: A Case Report
Om Prakash Mehta,
Sumit Rauniyar,
Muhammad Naeem Afzal,
Rakshya Upreti,
Shri Kant Kushwaha
Issue:
Volume 6, Issue 1, March 2021
Pages:
54-57
Received:
26 January 2021
Accepted:
17 March 2021
Published:
30 March 2021
Abstract: Background: Subacute Thyroiditis is a self-limiting thyroidal illness caused by viral infection with clinical course divided into three phases: hyperthyroidism, hypothyroidism followed by euthyroidism. Several viral infections have been linked to be associated with subacute thyroiditis but often no etiology can be found. Objective: The aim of this study is to explore a possible link between subacute thyroiditis and Coronavirus disease (COVID-19) infection. Method: Here we describe a case of subacute thyroiditis which occurred during the recovery phase of initial flu like illness. The initial illness was mild and was treated symptomatically. Later, the patient presented with features of hyperthyroidism and neck pain during recovery of initial flu like illness. Result: Two weeks after the onset of initial illness, the patient presented with neck pain, palpitation, sweating, and weight loss along with mid-line tenderness in neck. Thyroid function test revealed suppressed TSH and elevated free T4 along with reduced uptake on radionuclide thyroid scan. He was treated with NSAIDs and B-blocker which resulted in dramatic improvement in neck pain. Conclusion: Since Subacute thyroiditis is a self limiting disorder, it is often under reported. But It is important to recognize the disorder as it can directly impact on the morbidity and mortality related to other associated primary disorder like respiratory illness. Clinician must be aware about the possibility of thyroiditis in patient developing fever and neck pain and look for it.
Abstract: Background: Subacute Thyroiditis is a self-limiting thyroidal illness caused by viral infection with clinical course divided into three phases: hyperthyroidism, hypothyroidism followed by euthyroidism. Several viral infections have been linked to be associated with subacute thyroiditis but often no etiology can be found. Objective: The aim of this ...
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