Economic Burden of Diabetic Tuberculosis Patients from 3 Malaysian Hospitals | Chapter 15 | Innovations in Medicine and Medical Research Vol. 1

Aim: To assess the impact of diabetes mellitus (DM) on the cost of the tuberculosis (TB) treatment.

Study Design: Prevalence based cohort.

Place and Duration of Study: Penang General Hospital, Hospital USM, and – Univesiti Malaya Medical Center; 2005 – 2008. 

Methods: Study patients were placed in the TB only, DM only, or DM-TB groups, with each group including 200 patients. Information related to demographics, chronic disease comorbidity, duration of hypertension (HTN) and DM, and economic variables were obtained from the patients’ medical files both at the beginning and end of the study period. The economic burden of DM-TB patients was assessed from hospitalization periods, frequency of clinic visits, and diagnostic requests.

Results: Durations of DM and HTN were 9.2 and 5.6 years, respectively, for the DM only group compared to 5.3 and 1.1 years, respectively, for DM-TB subjects. For both diabetic groups, diabetes preceded HTN, with onset of HTN occurring approximately 4 years after patients were diagnosed diabetic. Approximately 86% of DM only subjects suffered additional comorbidity, and 44.5% had three or more coexisting chronic diseases compared to 56% and 11.4%, respectively, in the DM-TB group. The hospitalization period was 10.2 days for the DM-TB group compared to 7 and 4 days for the TB only and DM only groups, respectively; however, 43% of TB only subjects needed surgical intervention compared to 17% in the DM-TB group. The total cost wasRM4530 (US$1234.3) for the DM-TB group compared to RM3082.8 (US$840) and RM6945.26 (US$1892.40) for the TB only and DM only groups, respectively.

Conclusions: DM antedated HTN in our patients. Durations of both DM and HTN were longer for the DM only group. The number of diagnosed chronic diseases and overall treatment cost was higher in the DM-TB group compared to TB only group, but lower compared to the DM only group. The TB only group required the most surgical intervention.

Author(s) Details

Daud M. I. Aweis  
Pharmacy and Medical Supply Division, Ahmadi Hospital, Kuwait Oil Company, Kuwait and School of Pharmaceutical Sciences, USM, 11800 Penang, Malaysia.

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Maternal Risk Factors Predisposing to Congenital Heart Disease | Chapter 12 | Current Trends in Medicine and Medical Research Vol. 3

Background: Congenital Heart Diseases (CHD) are defined as malformations of the heart and great vessels that develop in utero which may manifest at birth or later in childhood. They can be caused by numerous genetic and environmental factors.  Genetic factors are nonmodifiable.  However, identification  of  modifiable  environmental  risk  factors  is  important  to  develop  population  based prevention strategies to reduce the incidence of CHD.

Objectives: The primary objective of the study was to find an association of the maternal lifestyles with CHD in new-borns. The secondary outcome of the study was to identify maternal factors that can be modified for the primary prevention of CHD.

Materials  and  Methods: This  prospective  study  involved  cardiovascular  system  examination  of newborns after delivery in term gestations in 1394 singleton pregnancies. The maternal risk factors considered were age, prepregnancy Body Mass Index  (BMI),  consanguineous  marriage,  caffeine intake, diabetes, stress and intake of periconceptional Folic acid tablets.

Results: In  this  study,  22  (1.58%)  out  of  1394  pregnancies  resulted  in  Congenital  Heart  Defects. Teenage pregnancy (p value= 0.0002), consanguineous marriage (p value=0.0004), overt diabetes mellitus (p value=0.0001), caffeine intake (p value=0.0031), prepregnancy BMI>24(p value=0.0001), maternal stress (p value<0.0001, history of previous congenital malformations (p value=0.004) and non intake of folic acid tablets in the first trimester (p value=0.0023 were found to be the most likely risk factor associated with CHD.

Conclusion: Community  education  programmes  should  be  initiated  in  the  high-risk  population  to prevent teenage pregnancies and consanguineous marriages.   Maternal counseling for periconceptional control of blood glucose, adequate weight maintenance, intake of folic acid tablets, avoidance of stress and caffeine is needed to prevent CHD. The results of numerous studies suggest that in reducing the incidence of CHD, public health strategy needs to focus on avoidance of teenage pregnancy and consanguineous marriages. Pregnancy associated with stress should be monitored more closely.  Prepregnancy  maternal  BMI,  coffee  intake  and  folic  acid  deficiency  have  to  be corrected. Maternal overt diabetes and hyperglycemia during pregnancy needs to be screened and managed timely to reduce the incidence of CHD.

Author(s) Details

Dr. Jayavelan Ramkumar

Department of Cardiothoracic Surgery, Sri Ramachandra Medical College and University, Chennai-600116, India.

Benjamin M. Sagayaraj

Department of Pediatrics, Saveetha Medical College, Saveetha University, Chennai-602105, India.

Dr. Nidhi Sharma

Department of Obstetrics and Gynaecology, Saveetha Medical College, Saveetha University, Chennai-602105, India.

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Effect of Cymbopogon citratus Stapf (DC) on Type 2 Diabetes Mellitus-induced Dyslipidemia: Current Knowledge | Chapter 11 | Current Trends in Medicine and Medical Research Vol. 3

Introduction: Diabetic dyslipidemia (DD)  is  a collection  of  quantitative,  qualitative and  kinetic  lipid abnormalities associated with diabetes mellitus that together caused the lipid profile to become more atherogenic.  It  consists  of  elevated  serum  concentration  of  triglyceride-cholesterol  (TG-C),  a  high serum level of small dense low density lipoprotein-cholesterol (sd LDL-C), low level of high-density lipoprotein-cholesterol (HDL-C) and normal to slightly elevated level of total low density lipoprotein-cholesterol (LDL-C).

Aims: Diabetic  dyslipidemia  is  a  recognized  risk  factor  for  coronary  heart  disease  (CHD). Plant medicinal  agents  such  as Cymbopogon  citratus (C.  citratus)  have  shown  potential  as alternative therapies for reducing cardiovascular risk factors. The aim of this study was to investigate the effect of C. citratus leaf extract on the atherogenic index of plasma (AIP) in diabetic dyslipidemic rats (n=35).

Materials and Methods: A C. citratus extract was prepared by ethanol extraction of leaf material. Rats were divided into seven groups (n=5) as follows: (a) Normal diet control, (b) Hyperlipidemic diet (HLD)  control,  (c)  HLD  +  65 mg/kg  streptozotocin  (STZ)  control  (d)  HLD  +  STZ  +  250mg/kg C. citratusextract (CCE), (e) HLD + STZ + 500mg/kg CCE, (f) HLD + STZ + 1000mg/kg CCE, and (g) HLD + STZ + 5mg/kg atorvastatin + 600μg/g glibenclamide. Animals were treated with HLD for 14 days and then injected intraperitoneally with 65mg/kg STZ. Confirmed diabetic dyslipidemic animals were  treated  intragastrically  with  CCE  at  doses  of  250,  500,  and  1000mg/kg,  with  5mg/kg atorvastatin, and with 600μg/g glibenclamide for 30 days.

Results: The extract, which tested positive for tannins, saponins, alkaloids, flavonoids, etc. lowered fasting  blood  glucose  and  glycosylated  hemoglobin  levels,  and  dose-dependently  decreased  the serum levels of T-chol, LDL, VLDL, and β-HMG-CoA reductase, while simultaneously increasing HDL levels. The AIP was lowered in a dose-dependent manner by 33, 43.7, and 52.4% in groups treated with 250, 500, and 1000 mg/kg of CCE respectively.

Conclusion: The  results  indicate  that  the C.  citrates extract  had  an  ameliorative  effect  on hyperglycemia, hyperlipidemia, obesity, and atherogenic index of plasma.

Author(s) Details

Christopher Edet Ekpenyong

Department of Human Physiology, Faculty of Basic Medical Sciences, University of Uyo, Nigeria.

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