SAJDVD: VOLUME 14, ISSUE 1, JULY 2017
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  1. From the Editor’s Desk
    Authors: Mahomed, FA
    From: South African Journal of Diabetes and Vascular Disease, Vol 14, Issue 1, July 2017
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  2. Podiatric interventions and phototherapy in the management of chronic diabetic foot ulceration: a review to compare the average healing time
    Authors: Sithole, H Abrahamse
    From: South African Journal of Diabetes and Vascular Disease, Vol 14, Issue 1, July 2017
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    Abstract: Diabetic foot ulceration is a serious complication of diabetes mellitus and an important risk factor for lower-limb amputations. Diabetes is characterised by chronic hyperglycaemia related to the resistance of target cells to the action of insulin, which leads to degenerative disorders caused by macro- and microangiopathy, and neuropathy. These factors favour the occurrence of lower-limb ulcers and delay their healing. The slow healing rate of chronic diabetic foot ulceration has a negative impact on the patient’s quality of life. There is a need therefore for the development of new treatment modalities to improve the healing rate and outcomes of diabetic ulcerations.
    The management and treatment of chronic diabetic ulcerations can last an extended period due to the lack of response to treatment or the general nature of the ulcer. Current podiatric protocols for the management of chronic ulcers affecting the lower limb involve a dynamic approach, which includes mechanical debridement of granulation and dead tissue, antibiotics to treat infection, change of footwear, mechanical off-loading using total-contact casts and orthotic devices, as well as foot-care education.
    Phototherapy is an alternative treatment modality that is under investigation for the management of chronic diabetic foot ulceration. It has been found to significantly increase the healing rate of ulcers when used in combination with other conventional treatments. The continuous management and on-going surveillance and monitoring of chronic diabetic foot ulcers with various combination therapies, including phototherapy, may improve the healing time as so improve a patient’s quality of life and physical activities.
    The aim of this review is to compare the average healing time of diabetic foot ulcers when treated with standard podiatric treatment protocols and when treated in combination with phototherapy in terms of diabetic foot-ulcer management.
     
  3. Applying the bioecological model to understand factors contributing to psychosocial well-being and healthcare of children and adolescents with diabetes mellitus
    Authors: Given Hapunda, Amina Abubakar, Fons van De Vijver
    From: South African Journal of Diabetes and Vascular Disease, Vol 14, Issue 1, July 2017
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    Abstract: We discuss the bioecological model of Urie Bronfrenbreener and its application to diabetes care and the psychosocial well-being of children with diabetes in sub-Saharan Africa. Using empirical evidence, this article demonstrates that the bioecological model provides an important framework for understanding diabetes care needs and the interventional strategies required to enhance the well-being of children living with diabetes. It also discusses clinical and research implications. The advantage of applying the bioecological model in drawing up interventional strategies for those living with diabetes is that it targets large-scale public health interventions, unlike medical intervention, which focuses on a single individual.
     
  4. EIntegrating the pieces of a complex puzzle to achieve a comprehensive approach towards optimal care of the patient with diabetes
    Authors: S Pillay, C Aldous
    From: South African Journal of Diabetes and Vascular Disease, Vol 14, Issue 1, July 2017
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    Background: Diabetes mellitus (DM) is ravaging both patients’ health and healthcare economies of countries worldwide, especially in developing countries. Mitigation of the diabetes-related tsunami of complications could occur through optimal control of DM. Control of this disease begins at our local healthcare facilities and requires a comprehensive, standardised and holistic approach to care.
    Methods: The diabetes clinic at Edendale Hospital is a busy regional clinic situated in Pietermaritzburg, KwaZulu-Natal. In order to improve diabetes care, the following integrated package of changes was made to this resource-limited clinic: (1) introduction of a fully operational multidisciplinary treatment team; (2) intensive nurse and clinician education on DM and its management according to local South African diabetes guidelines; (3) intensive patient education from all members of the team; (4) introduction of essential basic equipment into the clinic; (5) introduction of a patient clerking datasheet to ensure standardisation and comprehensive diabetes care for all patients visiting the clinic; and (6) development of a customised computer program to audit and analyse data over time in order to identify areas of poor performance within the care of the patient, and to monitor patient progress.
    Conclusion: This article describes the development and implementation of the above six steps as a holistic patient-care package at the clinic. The overall management plan of diabetes care proposed within the clinic could provide the blueprint for other resource-limited diabetes clinics in developing countries.

  5. Effects of a PPAR-gamma receptor agonist and an angiotensin receptor antagonist on aortic contractile responses to alpha receptor agonists in diabetic and/or hypertensive rats
    Authors: Ibrahim Tugrul , Turhan Dost , Omer Demir , Filiz Gokalp , Ozlem Oz, Necip Girit , Mustafa Birincioglu
    From: South African Journal of Diabetes and Vascular Disease, Vol 14, Issue 1, July 2017
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    Aim: The aim of this study was to investigate the effects of pioglitazone and losartan pre-treatment on the aortic contractile response to the alpha-1 agonist, phenylephrine, and the alpha-2 agonist, clonidine, in L-NAME-induced hypertensive, STZ-induced diabetic, and hypertensive diabetic rats.
    Methods: Male Wistar rats were randomly allocated to four groups: control, diabetic (DM), hypertensive (HT) and hypertensive diabetic (HT + DM) groups. Three weeks after drug application, in vitro dose–response curves to phenylephrine (Phe) (10-9–10-5 M) and clonidine (Clo) (10-9–10-5 M) were recorded in aortic rings in the absence (control) and presence of pioglitazone (10 μM) and/or losartan (10 μM).
    Results: Pioglitazone and losartan caused a shift to the right in contractile response to phenylephrine in all groups. The sensitivity of the aortic rings to phenylephrine was decreased in the presence of pioglitazone and/or losartan in all groups. The contractile response of clonidine decreased in the presence of pioglitazone and/or losartan in the control, HT and DM groups.
    Conclusion: The sensitivity of aortic rings to alpha-1 and alpha-2 adrenoceptors was decreased in the presence of pioglitazone and/or losartan in diabetic and hypertensive rats. Concomitant use of PPAR-gamma agonists, thiazolidine-diones, and angiotensin receptor blockers may be effective treatment for diabetes and hypertension.

  6. Is the relationship of body mass index to severity of coronary artery disease different from that of waist-to-hip ratio and severity of coronary artery disease? Paradoxical findings
    Authors: Amir Farhang Zand Parsa, Bahareh Jahanshahiy
    From: South African Journal of Diabetes and Vascular Disease, Vol 14, Issue 1, July 2017
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    Background: Although for decades there has been controversy regarding the relationship between obesity and coronary artery disease (CAD), it has been assumed that high body mass index (BMI) is a risk factor for CAD. However, the findings of some recent studies were paradoxical.
    Objectives: The aim of this study was to find a relationship between high BMI and waist-to-hip ratio (WHR) with sever-ity of CAD.
    Methods: This study was a cross-sectional, prospective study where 414 patients with suspected coronary artery disease, in whom coronary angiography was performed, were enrolled. The mean ± SD of their ages was 61.2 ± 27.4 years (range 25–84), and 250 (60.4%) were male. Regarding cardiovascular risk factors, 113 (27.3%) patients had a history of diabetes mellitus (DM), 162 (39.1%) had hypercholesterolaemia, 238 (57.4%) had hypertension, 109 (26.3%) were current smokers and 24 (5.8%) had a family history of CAD. The mean ± SD of the patients’ BMI was 26.04 ± 4.08 kg/m2 (range 16–39) and means ± SD of their WHR ranged from 0.951 ± 0.07 to 0.987 ± 0.05. The mean ± SD of the severity of CAD according to the SYNTAX and Duke scores were 17.7 ± 9.6 (range 0–64) and 3.2 ± 1.7 (range 0–12), respectively.
    Results: In this study, findings showed a negative correlation between the severity of CAD and BMI, according to both SYNTAX and Duke scores (p ≤ 0.001 and p = 0.001, respectively). However, there was a positive correlation between WHR and severity of CAD, according to the Duke score (p = 0.03).
    Conclusion: BMI had a negative correlation with the severity of CAD, but waist-to-hip ratio had a positive correlation with severity of CAD.

  7. Association of homocysteinaemia with hyperglycaemia, dyslipidaemia, hypertension and obesity
    Authors: Dudu Sengwayo, Mpho Moraba, Shirley Motaung
    From: South African Journal of Diabetes and Vascular Disease, Vol 14, Issue 1, July 2017
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    Aim: Hyperhomocysteinaemia and the metabolic syndrome are associated with increased cardiovascular risk. We investigated whether there is a link between the metabolic syndrome or its components and homocysteine levels in a population without cardiovascular disease.
    Methods: From the population sample of 382 participants (286 females and 96 males) we isolated those reflecting the metabolic syndrome and determined their homo-cysteine levels. We then evaluated the association of homocysteine with hyperglycaemia, hypertriglyceridaemia, hypercholesterolaemia, hypertension and obesity, using a significance level of p = 0.05. Enzymatic methods were used for all biochemical parameters.
    Results: We found the statistical relationship between homocysteine and the metabolic syndrome as follows: hyperglycaemia (p = 0.175), hypertriglyceridaemia (p = 0.442), hypercholesterolaemia (p = 0.480), obesity (p = 0.080); and hypertension: systolic pressure (p = 0.002) and diastolic pressure (p = 0.033).
    Conclusion: We found no statistically significant association between baseline plasma homocysteine levels and the metabolic syndrome, except for hypertension.

  8. Diabetes News
    From: South African Journal of Diabetes and Vascular Disease, Vol 14, Issue 1, July 2017
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