Diabetic foot ulcers (DFUs) represent a significant and serious challenge associated with diabetes. It is estimated that approximately one third of individuals with diabetes will develop DFUs at some point in their lives. This common complication can lead to serious health issues if not properly managed. The early diagnosis and treatment of DFUs are crucial to prevent severe complications, including lower limb amputation. DFUs can be categorized into two states: ischemia and infection. Accurate classification is required to avoid misdiagnosis due to the similarities between these two states. Several convolutional neural network (CNN) models have been used and pre-trained through transfer learning. These models underwent evaluation with hyperparameter tuning for the binary classification of different states of DFUs, such as ischemia and infection. This study aimed to develop an effective classification system for DFUs using CNN models and machine learning classifiers utilizing various CNN models, such as EfficientNetB0, DenseNet121, ResNet101, VGG16, InceptionV3, MobileNetV2, and InceptionResNetV2, due to their excellent performance in diverse computer vision tasks. Additionally, the head model functions as the ultimate component for making decisions in the model, utilizing data collected from preceding layers to make precise predictions or classifications. The results of the CNN models with the suggested head model have been used in different machine learning classifiers to determine which ones are most effective for enhancing the performance of each CNN model. The most optimal outcome in categorizing ischemia is a 97% accuracy rate. This was accomplished by integrating the suggested head model with the EfficientNetB0 model and inputting the outcomes into the logistic regression classifier. The EfficientNetB0 model, with the proposed modifications and by feeding the outcomes to the AdaBoost classifier, attains an accuracy of 93% in classifying infections.

The incidence of cataracts is significantly higher in diabetic individuals, particularly in younger age groups, with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification (PCO), chances of progression of diabetic retinopathy (DR), zonular weakness, and vitreous prolapse and diabetic macular edema. Selection of an appropriate intraocular lens (IOL) is crucial for visual rehabilitation and monitoring DR. The choice of IOL in diabetic cataract patients is a challenging scenario. Square-edge IOLs are favored for their capacity to mitigate PCO, whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR. The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation, particularly in the presence of advanced retinopathy. Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications. Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes. This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

Introduction Pressure ulcers, also known as bedsores, are a significant concern for bedridden individuals, presenting both physical and socioeconomic challenges. Factors such as prolonged immobility, chronic medical conditions, and poor nutrition contribute to their development. Despite extensive research in some regions, studies comparing diabetic and non-diabetic populations remain limited, particularly in low-income settings. This study aimed to investigate the risk factors and frequency of pressure ulcers among bedridden patients, addressing this gap in understanding and guiding targeted interventions. Materials and methods A cross-sectional study was conducted across four government hospitals in Peshawar, Pakistan. A total of 388 bedridden patients with pressure ulcers were included, and data were collected through a questionnaire. The questionnaire covered demographics, comorbidities, duration of bedbound status, BMI, and caregivers\' awareness of pressure ulcer care. Data analysis was performed using SPSS version 22.0 (Armonk, NY: IBM Corp.), with qualitative data presented as frequencies and percentages and quantitative data as mean and standard deviation. Chi-square tests were utilized for significance, with p<0.05 considered significant. Results Of the 388 patients analyzed, 230 (59.3%) were diabetic, highlighting the prevalence of diabetes among pressure ulcer cases. The majority of diabetic patients with ulcers were over 41 years old, and 293 (75.5%) had comorbidities. Surgical intervention was the primary cause of ulcers in 213 (54.8%) cases, followed by stroke in 77 (19.8%) cases. Notably, 252 (65%) of caregivers exhibited inadequate knowledge regarding ulcer care. Stage II ulcers were prevalent in both diabetic and non-diabetic cohorts. Conclusions Pressure ulcers are poorly controlled complications observed in bedridden individuals, highlighting a critical need for comprehensive preventive measures and caregiver education to alleviate the burden of pressure ulcers, especially in diabetic patients. Factors such as prolonged immobility, surgical interventions, and insufficient caregiver knowledge contribute to the development of pressure ulcers. Understanding these complexities is essential for implementing effective care approaches and mitigating the impact of pressure ulcers.

BACKGROUND: Ticagrelor monotherapy after short-term (1-3 months) dual antiplatelet therapy (DAPT) with aspirin and ticagrelor can reduce bleeding without increasing ischemic events after percutaneous coronary intervention (PCI). However, its effect in diabetic and non-diabetic individuals has not been evaluated as a meta-analysis so far.
METHODS: This systematic review and meta-analysis were conducted covering PubMed, ISI Web of Science, and Scopus without date restrictions for English published clinical trials. The authors searched the mentioned databases, wherein the screening led to 151 studies, of which 40 were assessed for eligibility, and finally, three studies were included. These trials compared ticagrelor monotherapy after a short duration of aspirin plus ticagrelor with conventional 12 months DAPT.
RESULTS: The results showed that the risk of major bleeding (based on Bleeding Academic Research Consortium (BARC) type 3 or 5) for ticagrelor monotherapy subjects was lower in both diabetics and non-diabetics. It was especially significant in non-diabetic patients (HR 95%CI: 0.79(0.64, 0.98); p=0.029). In cardiovascular events assessment, the pooled estimate on cardiac deaths was significantly lower in diabetic subjects treated by ticagrelor monotherapy (HR 95%CI: 0.71(0.51, 1); p=0.05), while this reduction was not significant for non-diabetics (p=0.843) in comparison to patients treated by 12 months DAPT. However, there was no significant decrease or rise in myocardial infarction (MI) and ischemic stroke in patients treated by short-term DAPT strategy.
CONCLUSIONS: In conclusion, discontinuing aspirin after short-duration DAPT could minimize the incidence of cardiac death and BARC type 3 or 5 bleeding in diabetic and non-diabetic patients who underwent PCI, with no increase in MI and ischemic stroke.

UNASSIGNED: Caregivers\' burden and health-related quality-of-life (HRQoL) associated with Diabetes Mellitus (DM) are affected by several factors, including socio-demographic characteristics of the patients and their caregivers. Unfortunately, studies evaluating the influence of socio-demographic characteristics on caregivers and patients with DM in this environment are limited. This study therefore aimed at assessing the level of the burden imposed on the primary caregivers, the level of HRQoL of Individuals with Diabetes Mellitus (IDM) and the influence of socio-demographic characteristics on these variables among IDM attending the Family Medicine clinic of Wesley Guild Hospital, Ilesa, Osun State, Nigeria.
UNASSIGNED: Seventy-eight consenting IDM and their corresponding primary caregivers were recruited over 13-weeks in this hospital-based cross-sectional descriptive study. The Well-Being Questionnaire and Zarit Burden Interview were administered on IDM and their corresponding caregivers to assess HRQoL and burden of care. Data were analysed on SPSS 17 using descriptive statistics and Pearson chi-square test at p<0.05.
UNASSIGNED: Mean ages of respondents were 70.4±6.33 and 23.7±7.58 years for diabetics and caregivers, respectively. The majority of the diabetic respondents were females (61.5%), married (66.7%), and retired (64.1%). The majority of the caregivers were females (87.2%), petty traders/students (71.8%) and unmarried (87.2%). Over half (51.3%) of the diabetic respondents and their caregivers had \'good\' HRQoL and \'high\' caregivers\' burden.
UNASSIGNED: The caregiver being a female, having primary education, being single and having a nuclear family relation of the IDM influenced good HRQoL, whereas being a low-income earner and an uneducated IDM influenced high caregivers\' burden.

UNASSIGNED: A change in posture brings about a significant alteration in cardiovascular functions. The squat test has been used to study autonomic function in White Europeans but not Black Africans. The aim of this study is to determine the cardiovascular effects of postural stress in Black African non-diabetics and Type-2 diabetics.
UNASSIGNED: Blood pressure (BP) and heart rate (HR) was measured in 40 non-diabetics and 40Type-2 diabetics in sitting, standing from sitting, squatting and standing from squatting positions Difference in BP and HR between consecutive positions was tested using 2- way mixed ANOVA. Proportions of those who showed orthostatic hypotension and hypertension were compared with Fishers exact test. Significance was set at p <0.05.
UNASSIGNED: BP and HR changes evoked by standing from sitting were not different, however squatting evoked greater increase in BP in diabetics(change (Δ) SBP: 5.85±9.95 vs 17.40±13.75mmHg: Δ DBP: 0.15 ± 6.89 vs 5.10 ± 7.59 mmHg:Δ MABP:2.02 ± 6.98 vs 8.63 ± 9.34 mmHg ,p <0.05) and standing from squatting evoked greater fall BP in diabetics (ΔSBP: -9.80±13.89 vs -24.35±16.03 mmHg; Δ MABP:-2.02±6.98 vs -8.63±9.34 mmHg: Δ PP: -2.28 ±15.35 vs -14.50 ±11.96 mmHg, p < 0.05) while Δ HR did not differ. A higher proportion of diabetics showed SBP and DBP orthostatic hypertension.
UNASSIGNED: Relative to the non-diabetics, diabetics showed greater BP but not HR responses to postural stress.

BACKGROUND: Diabetes, a chronic condition affecting various organs, is frequently associated with abnormal lipid metabolism, notably increased cholesterol and triglyceride levels. These lipid abnormalities are closely linked to the development and advancement of cardiovascular disease (CVD). Although regular physical activity (PA) has consistently shown benefits in reducing CVD risk in the general population, its precise influence on CVD risk among patients with diabetes remains uncertain, particularly regarding dose-response relationships.
OBJECTIVE: This study aimed to summarize the evidence from prospective studies on the association between PA and CVD morbidity and mortality in individuals with diabetes and explore the optimal levels for public health recommendation.
METHODS: We systematically reviewed prospective cohort studies in PubMed, Embase, and Web of Science up to December 2022, with inclusion criteria specifying the studies published in English and included adult participants diagnosed with diabetes. A random effects model was used to pool the relative risk (RR) with the corresponding 95% CI comparing the highest with the lowest PA categories in each study for qualitative evaluation. In addition, linear and spline regression analyses were used to estimate dose-response associations.
RESULTS: The meta-analysis included 12 prospective cohort studies, involving a total of 109,820 participants with diabetes. The combined results revealed that higher levels of PA were associated with a reduced risk of CVD. The RR of CVD for the highest compared with the lowest PA category was 0.62 (95% CI 0.51-0.73). In addition, there were 4 studies describing leisure-time PA, and the pooled RR was 0.68 (95% CI 0.52-0.83) for the highest versus the lowest activity. The linear regression model revealed that each 10 MET (metabolic equivalent of task)-hours per week of incrementally higher PA was associated with a 19% (95% CI 11.6-25.7) and a 6.9% (95% CI 4.5-9.3) reduction in CVD morbidity and mortality. Additionally, spline regression curves showed nonlinear relationships between PA levels and the risk of CVD and CVD mortality (both Pnonlinearity<.001), with a limited reduction in CVD risk and some further reduction in CVD mortality above 20 MET-hours per week of PA levels.
CONCLUSIONS: For patients with diabetes, especially type 2 diabetes, there was a dose-response relationship between increased PA and reduced risk of CVD morbidity and mortality. The observed PA threshold is consistent with the recommended level for the general population. Gradually moving from inactivity to a guideline-recommended PA level could therefore significantly reduce the burden of CVD in patients with diabetes.

UNASSIGNED: Hemoglobin A1c (HbA1c) serves as a pivotal marker for long-term glycemic control. The Diabetes Control and Complications Trial (DCCT) established its relevance, yet gaps exist in understanding potential seasonal variations in HbA1c levels among diabetic patients. The study highlights the need to explore potential seasonal variations in HbA1c levels and their impact on diabetic patients.
UNASSIGNED: This is an observational study conducted in a tertiary care hospital from January to December 2019, the study analyzed HbA1c levels in 8138 patients. Blood samples were collected using Potassium EDTA-containing vials and processed with an automated analyzer. Seasonal variations were explored using time series analysis.
UNASSIGNED: Mean HbA1c levels peaked during the monsoon (June to September) and were lowest in autumn (October to November). Subgroup analysis revealed differences in patients with HbA1c values below and above 6.5 %. Those with controlled blood sugar showed higher levels in winter (December to February) and monsoon (June to September), while patients with HbA1c values ≥ 6.5 % exhibited significantly lower levels in monsoon (June to September) and autumn (October to November) compared to summer (March to May).
UNASSIGNED: In contrast to global trends, Indian patients demonstrated distinct seasonal variations in HbA1c levels. The highest levels during the monsoon (June to September) may be linked to reduced outdoor activity and dietary changes. The study emphasizes the need for tailored diabetes management considering seasonal influences. Further extensive, longitudinal studies across diverse Indian regions are recommended to comprehensively grasp the impact of seasonal changes on diabetes outcomes.

Diabetic ureteral injury (DUI) is a condition characterized by damage to the ureter, causing functional and morphological changes in the urinary system, which have a significant impact on a quality of life and requires appropriate medical treatment. The present study describes to novel design of luteolin (LT), a type of natural flavonoid, encapsulated selenium nanoparticles (Se NPs) to attain therapeutic potential for DUI. The physico-chemical characterizations of prepared Se NPs have benefitted zeta potential (-18 mV) and particle size (10-50 nm). In vitro assays were demonstrated the potential of LT-SeNPs by HEK 293 cells stimulated by STZ for DUI. Cytotoxicity assays on HEK 293 and NIH-3T3 showed >90% cell viability, which demonstrates the suitability of the nanoformulation for DUI treatment. The LT-SeNPs significantly inhibits the NLRP3 inflammasome through Nrf2/ARE pathway, which benefits for DUI treatment. The developed LT-SeNPs could be an effective formulation for the DUI therapy.

Nerves in patients with diabetic neuropathy (DN) show increased susceptibility to local anesthetics, potentially requiring a decreased dose. We investigated whether the minimum effective anesthetic concentration (MEAC) of mepivacaine for successful axillary block is lower in patients with DN than in those without. This prospective observational study included patients with DN (n = 22) and without diabetes (n = 22) at a tertiary care center. Patients received an ultrasound-guided axillary block with 30 mL of mepivacaine for anesthesia. The mepivacaine concentration used in each patient was calculated using Dixon\'s up-and-down method. A block was considered successful if all four sensory nerves had a score of 1 or 2 within 30 min with no pain during surgery. The primary outcome was the MEAC of mepivacaine, and the secondary outcomes included the minimal nerve stimulation intensity for the musculocutaneous nerve and the occurrence of adverse events. The MEAC50 was 0.55% (95% CI 0.33-0.77%) in patients without diabetes and 0.58% (95% CI 0.39-0.77%) in patients with DN (p = 0.837). The MEAC90 was 0.98% (95% CI 0.54-1.42%) in patients without diabetes and 0.96% (95% CI 0.57-1.35%) in patients with DN (p = 0.949). The stimulation threshold for the musculocutaneous nerve was significantly different between groups (0.49 mA vs. 0.19 mA for patients with vs. without diabetes; p = 0.002). In conclusion, the MEAC of mepivacaine for a successful axillary block is not lower in patients with DN.