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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