8 research outputs found
The BALM framework of clinical excellence: an adoptable model for sub-Saharan Africa.
No full textClinical excellence is the ability to provide rigorous, evidence-based, and rewarding care to the right patients. The BALM (brilliance, attitude, leadership, and materials) framework is a novel model for adjudicating clinical excellence. There are a few models and frameworks for evaluating clinical excellence, but each has its flaws and does not consider the peculiarities of economically-challenged regions such as sub-Saharan Africa. Coincidentally, such low-resource areas have an urgent need for a framework to assess clinical excellence because of their low health-related indices. The five-step mode of professional excellence is a well-recognised tool and was the model upon which the BALM framework was built.
So, the BALM framework determines to what extent, using the five-step stages of novice, advanced beginner, competent, proficient, and expert, a clinician has achieved in each of the four critical domains, namely brilliance, attitude, leadership and materials. Therefore, a clinician, who strives for excellence, aims to be an “expert” in each of the domains of the BALM framework. The framework is concise, practical, easy to use, and multidimensional, although it still needs to be applied widely to assess its reproducibility
Insulin resistance and non-alcoholic fatty liver disease: a review of the pathophysiology and the potential targets for drug actions
No full textInsulin resistance refers to the reduced physiological effects of insulin on various tissues. Insulin resistance has been implicated in the pathophysiology of non-alcoholic fatty liver disease (NAFLD), which is a spectrum of diseases ranging from hepatic steatosis on one end to steatohepatitis, liver cirrhosis and hepatocellular carcinoma on the other end. In most parts of the developed world, it is now the most commoncause of chronic liver disease and the most commonindication for liver transplantation. A similar findingis emerging in the developing world due to the rising prevalence of obesity and widespread adoption of Western lifestyles. Despite these epidemiological data, there are no universally approved medications for the treatment of NAFLD. The pathophysiological mechanisms of NAFLD essentially include adipose tissue insulin resistance, hepatic insulin resistance, inflammation and fibrosis. At the subcellular level, mitochondrial dysfunction, oxidative changes and endoplasmic reticulum dysfunction have been documented. Several drugs have been tested in vitro and in animal studies to target these pathophysiological mechanisms. Some are presently going through clinical trials, while others have already gone through clinical trials with variable results. Other potential target sites of drug development for the treatment of NAFLD are based on the complex pathophysiology of the disease. Insulin resistance plays an important role in the development of NAFLD. There are potential targets in the pathophysiology of NAFLD that can be explored in the development of medications for the disease
Clinical Profiles of Thyroid Dermopathy: A Dermato-Endocrinological Perspective
No full textThyroid disorders sometimes have extra-thyroidal manifestations. Hyperthyroidism is a clinical syndrome resulting from excessive secretion of thyroid hormones. The most common cause is Graves’ disease. About 0.5–4.3% of patients with Graves’ disease have an infiltrative dermopathy called thyroid dermopathy, which is due to excessive deposition of glycosaminoglycans from activated fibroblasts. Skin fibroblasts are activated by thyroid stimulating hormone receptor antibodies the whole process being initiated by T lymphocytes. Rarely, thyroid dermopathy is also found in other thyroid disorders such as Hashimoto thyroiditis. The diffuse non-pitting edema variant is the most common clinical presentation. Other variants include the nodular, plaque, mixed, and elephantiasis types. Usually, the main concerns of the patients are cosmetic, discomfort, and difficulty in wearing shoes. Thyroid dermopathy usually presents after the diagnosis of Graves’ disease, but it may also present together or sometime after this condition. Rarely, thyroid dermopathy presents before the diagnosis of Graves’ disease is made. Apart from the shin and feet, other sites that can be affected include the arms, forearms, back, thighs, pinna, and nose. The management is multidisciplinary, involving dermatologists and endocrinologists. Usually, controlling the thyroid dysfunction does not translate into regression of the skin lesions. However, many patients have their thyroid dermopathy regress spontaneously, while others usually require local therapy. Other therapeutic options include systemic therapy such as pentoxifylline, compressive physiotherapy, and surgery
A systematic review and meta-analysis of the etiology and treatment patterns of thyrotoxicosis in Africa
No full textThyrotoxicosis is one of the most common endocrine disorders seen in clinical practice. This study aims to determine the etiologies and treatment modalities of thyrotoxicosis in Africa. The study design is a systematic review with a meta-analysis. Medical databases and the gray literature were systematically searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies done in Africa on the etiology and treatment of thyrotoxicosis were selected. In Africa, it is still believed that autoimmune diseases, generally, are not as common as what is seen in the western world. The frequency of Graves’ disease is reportedly lower in Africa. The treatment of thyrotoxicosis depends on the cause. Therefore, it is of substantial importance to establish the etiology following the diagnosis of the clinical syndrome.</p
Antidiabetic drugs and the risk of cancer: beneficial, neutral, or detrimental?
No full textThe prevalence of diabetes mellitus is rapidly rising, especially in low- and middle-income countries. Also, early-onset diabetes is on the rise, and millions of individuals have to be on antidiabetic medications for a prolonged period. Therefore, more people are getting exposed to the adverse effects of antidiabetic medications
Reprotoxic activities of vildagliptin administration in male Wistar rats
No full textVildagliptin is an oral hypoglycemic agent used in the management of diabetes. Some oral antidiabetic drugs have been implicated in reproductive toxicity.The objective of this study was to investigate the effects of daily administration of vildagliptin at different dosages (0.35 mg/kg B.W., 0.70 mg/kg B.W. and 1.40 mg/kg B.W.) to male Wistar rats for 8 weeks. Sperm parameters, serum concentrations of testosterone, follicle stimulating hormone and luteinizing hormone and the histology of the testis of the rats were assessed. Another set of rats were also treated for 8 weeks and allowed to recover and the same parameters were assessed in them. Fertility study was conducted by determining their litter size. The results showed that vildagliptin administration significantly reduced sperm count and motility of the treated rats. It also significantly increased the number of abnormal sperms. Serum level of testosterone was significantly decreased while luteinizing hormone and follicle stimulating hormone levels showed no significant change. The histoarchitecture of the testis of the treated rats appeared visibly normal. The litter size was also significantly reduced. Most of the changes observed were dose dependent. However, these parameters were restored towards normal in the recovery group. Our results suggest that vildagliptin adversely affected sperm parameters, affected litter size and disrupted the pituitary – gonadal axis. These changes were however reversed upon cessation of drug administration
Erectile Dysfunction among Nigerian Men with Diabetes: a Systematic Review
No full textBackground
Diabetes mellitus is a chronic metabolic disorder with multiple microvascular and macrovascular complications. Some of the complications of diabetes such as erectile dysfunction are a result of an interplay of both microvascular and macrovascular complications. Erectile dysfunction is the inability to achieve or sustain an erection adequate for satisfactory sexual activity. Erectile dysfunction is relatively common in men with diabetes yet there is a paucity of information on erectile dysfunction among Nigerian men with diabetes. Materials and Methods: Twelve studies on erectile dysfunction in Nigerian men with diabetes with a total sample size of 1777 fulfilled the eligibility criteria and were recruited into the systematic review. The International Index of Erectile Function (IIEF) questionnaire was used to assess erectile dysfunction in all the studies. Results: The prevalence of erectile dysfunction among Nigerian men with diabetes is 48.4-98.0%. The factors significantly associated with the presence of erectile dysfunction among Nigerian men with diabetes are longer duration of diabetes, poor glycaemic control, older age, peripheral arterial disease, autonomic neuropathy and obesity. Conclusion: The prevalence of erectile dysfunction among Nigerian men with diabetes is high. Close attention needs to be paid to glycaemic control in these patients to reduce the complications
