Pub Date : 2023-09-02DOI: 10.15226/2374-6890/10/1/001162
Samir H. Assaad-Khalil, Samir George Samna, Ibrahim Naguib Elebrashy, Mamdouh El-Nahas, M. Hesham El Hefnawy, Lobna Farag Eltoony, Khaled Elsayed Elhadidy, Fawzy AF Elmessallamy, Magdy Helmy Megallaa, Walaa A Khalifa, Tamer M. Elsherbiny, Noha G. Amin, Mohamed Hassan Zeitoun, Michael Safwat
Background: Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia resulting from insulin resistance and/or deficiency. It is associated with numerous complications, including microvascular and macrovascular complications. Micronutrient deficiencies are commonly observed in individuals with diabetes due to the metabolic changes that occur in the body and the increased renal excretion. Several studies have shown that diabetes patients are at an increased risk of developing micronutrient deficiencies such as vitamin D, thiamine, vitamin B12, folate, magnesium, and zinc. The consequences of micronutrient deficiencies in diabetic patients can be significant. The aim of this study was to achieve a consensus on the use of complementary pharmacological therapies in the management of diabetic complications, through a modified Delphi methodology. Methods: A three-round modified Delphi Procedure was conducted to define recommendations regarding the role of Pharmaco-Complementary medicine in the management of Diabetic complications using a web-based questionnaire. The questionnaire included a set of 65 questions. The level of Consensus was defined based on the level of agreement among the panelists on specific scientific statements. Strong Consensus was defined as ≥80% agreement, Moderate Consensus with Agreement between 65% and up to 79%, and Low Consensus level with statements below 65% agreement. Results: Eighteen experts in the field of diabetes participated in the development of this consensus. Three rounds of voting were held, followed by data analysis and consensus level calculation. Out of 47 statements, a total of 33 statements achieved moderate – strong consensus (moderate: 65% - 79% agreement, strong: ≥80% agreement). Conclusion: Experts concluded that the use of pharmaco-complementary medications such as CoQ10, Benfotiamine, Magnesium, and EPA can potentially improve glycemic control, insulin sensitivity, and manage diabetic complications. This consensus can serve as a valuable tool for clinicians in managing diabetes, and its complications, and can provide direction for future research. Keywords: Diabetes, Consensus; Pharmaco-complementary, Delphi, Complications
{"title":"Expert Consensus on the Role of Pharmaco-complementary Medicine for the Management of Diabetic Complications Using Modified Delphi Method","authors":"Samir H. Assaad-Khalil, Samir George Samna, Ibrahim Naguib Elebrashy, Mamdouh El-Nahas, M. Hesham El Hefnawy, Lobna Farag Eltoony, Khaled Elsayed Elhadidy, Fawzy AF Elmessallamy, Magdy Helmy Megallaa, Walaa A Khalifa, Tamer M. Elsherbiny, Noha G. Amin, Mohamed Hassan Zeitoun, Michael Safwat","doi":"10.15226/2374-6890/10/1/001162","DOIUrl":"https://doi.org/10.15226/2374-6890/10/1/001162","url":null,"abstract":"Background: Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia resulting from insulin resistance and/or deficiency. It is associated with numerous complications, including microvascular and macrovascular complications. Micronutrient deficiencies are commonly observed in individuals with diabetes due to the metabolic changes that occur in the body and the increased renal excretion. Several studies have shown that diabetes patients are at an increased risk of developing micronutrient deficiencies such as vitamin D, thiamine, vitamin B12, folate, magnesium, and zinc. The consequences of micronutrient deficiencies in diabetic patients can be significant. The aim of this study was to achieve a consensus on the use of complementary pharmacological therapies in the management of diabetic complications, through a modified Delphi methodology. Methods: A three-round modified Delphi Procedure was conducted to define recommendations regarding the role of Pharmaco-Complementary medicine in the management of Diabetic complications using a web-based questionnaire. The questionnaire included a set of 65 questions. The level of Consensus was defined based on the level of agreement among the panelists on specific scientific statements. Strong Consensus was defined as ≥80% agreement, Moderate Consensus with Agreement between 65% and up to 79%, and Low Consensus level with statements below 65% agreement. Results: Eighteen experts in the field of diabetes participated in the development of this consensus. Three rounds of voting were held, followed by data analysis and consensus level calculation. Out of 47 statements, a total of 33 statements achieved moderate – strong consensus (moderate: 65% - 79% agreement, strong: ≥80% agreement). Conclusion: Experts concluded that the use of pharmaco-complementary medications such as CoQ10, Benfotiamine, Magnesium, and EPA can potentially improve glycemic control, insulin sensitivity, and manage diabetic complications. This consensus can serve as a valuable tool for clinicians in managing diabetes, and its complications, and can provide direction for future research. Keywords: Diabetes, Consensus; Pharmaco-complementary, Delphi, Complications","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134969676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-02DOI: 10.15226/2374-6890/10/1/001161
Lobna F. Eltoony, Walaa A Khalifa, Hani M. Mobarkout, Nagla M. Ahmad, Khaled E Elhadidy, Mohammad A. Mashahet, Ehab Salem, Ahmed M. Abbas, Omar M Shaaban, Hend M. Yousef, Usama A Sharaf El Din
Background: Despite the high prevalence of diabetes mellitus in Egypt, the real prevalence and epidemiology of gestational diabetes mellitus (GDM) in Upper Egypt is still lacking. Objective: This study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate the foetal and maternal outcomes of this disease. Methods: This prospective cohort study was conducted between July 2014 and July 2018. Universal screening for GDM among all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group of India (DIPSI) criteria. Those with GDM were followed up until the end of purpureum. Maternal and foetal outcomes were recorded. Results: GDM was diagnosed in 956 out of 7141 pregnant women (13.4%). Previous history of GDM, macrosomic babies, and family history of diabetes were all significantly higher in GDM women (P<0.001 each). However, no definite risk factors were observed in about half of the GDM women. 29% of GDM women responded to medical nutrition therapy (MNT) alone. When the oral glucose tolerance test (OGTT) was repeated Postpartum, diagnosis of DM was established in 14.3% of the cohort, while 25.7% had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of GDM cases lack risk factors. Universal screening using OGTT should be routinely performed to all attendant pregnant ladies. Discrete MNT is not an enough management in most of GDM cases. Keywords: GDM; Postpartum OGTT; diabetes; MNT; foetal outcome; maternal outcome.
{"title":"Universal Screening of Gestational Diabetes Mellitus In Upper Egypt: Prospective Cohort Study of The Prevalence, Risk Factors, and Short-Term Outcomes","authors":"Lobna F. Eltoony, Walaa A Khalifa, Hani M. Mobarkout, Nagla M. Ahmad, Khaled E Elhadidy, Mohammad A. Mashahet, Ehab Salem, Ahmed M. Abbas, Omar M Shaaban, Hend M. Yousef, Usama A Sharaf El Din","doi":"10.15226/2374-6890/10/1/001161","DOIUrl":"https://doi.org/10.15226/2374-6890/10/1/001161","url":null,"abstract":"Background: Despite the high prevalence of diabetes mellitus in Egypt, the real prevalence and epidemiology of gestational diabetes mellitus (GDM) in Upper Egypt is still lacking. Objective: This study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate the foetal and maternal outcomes of this disease. Methods: This prospective cohort study was conducted between July 2014 and July 2018. Universal screening for GDM among all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group of India (DIPSI) criteria. Those with GDM were followed up until the end of purpureum. Maternal and foetal outcomes were recorded. Results: GDM was diagnosed in 956 out of 7141 pregnant women (13.4%). Previous history of GDM, macrosomic babies, and family history of diabetes were all significantly higher in GDM women (P<0.001 each). However, no definite risk factors were observed in about half of the GDM women. 29% of GDM women responded to medical nutrition therapy (MNT) alone. When the oral glucose tolerance test (OGTT) was repeated Postpartum, diagnosis of DM was established in 14.3% of the cohort, while 25.7% had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of GDM cases lack risk factors. Universal screening using OGTT should be routinely performed to all attendant pregnant ladies. Discrete MNT is not an enough management in most of GDM cases. Keywords: GDM; Postpartum OGTT; diabetes; MNT; foetal outcome; maternal outcome.","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134969653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-12DOI: 10.15226/2374-6890/10/1/001160
Louise A. Mawo, A. Zemsi, M. Etoa, M. Dehayem, O. Njoya, E. Sobngwi, F. Ankouane, Pierre Z. Ongolo, J. Mbanya
Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic comorbidities like type 2 diabetes mellitus (T2DM). The aim of this study was to determine the proportion of simple steatosis and non-alcoholic steatohepatitis, which are components of NAFLD, among newly diagnosed T2DM patients. This cross-sectional study was undertaken at the Central Hospital, Cameroon from March 2020 to September 2020 and it included all recently diagnosed T2DM patients, who had an alcohol consumption <140g (14 drinks/week) for women and <210g (21 drinks/week) for men, and without any signs of liver cirrhosis on abdominal ultrasound. All patients underwent a clinical examination with blood samples taken for lipid profile and transaminases measurements and an abdominal ultrasound assessment using a LOGIQ V5 Expert ultrasound machine. A total of 98 (53 males and 45 females) out of 128 eligible patients consented to participate in the study. The mean age was 50.31±10.51. NAFLD was present in 56.1% (55/98) patients; with mild and homogeneously diffused in 92.7% (51/55) and 94.5% (52/55) respectively. There were no significant differences in lipids profiles and transaminases between those with or without steatosis. Factors associated with fatty liver disease were body mass index ≥ 30 kg / m2 (P = 0.0002), waist circumference ≥ 94 cm for men or ≥ 80cm for women (P = 0.004). In conclusion, NAFLD is a common feature in newly diagnosed T2DM in our setting. There is a need for more attention towards NAFLD by primary care physicians, specialists and health policy makers
{"title":"Epidemiological and Clinical Aspects of Simple Steatosis and Non-Alcoholic Steato- Hepatitis Among Newly Diagnosed Type 2 Diabetes Patients at The Central Hospital in Yaoundé, Cameroon","authors":"Louise A. Mawo, A. Zemsi, M. Etoa, M. Dehayem, O. Njoya, E. Sobngwi, F. Ankouane, Pierre Z. Ongolo, J. Mbanya","doi":"10.15226/2374-6890/10/1/001160","DOIUrl":"https://doi.org/10.15226/2374-6890/10/1/001160","url":null,"abstract":"Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic comorbidities like type 2 diabetes mellitus (T2DM). The aim of this study was to determine the proportion of simple steatosis and non-alcoholic steatohepatitis, which are components of NAFLD, among newly diagnosed T2DM patients. This cross-sectional study was undertaken at the Central Hospital, Cameroon from March 2020 to September 2020 and it included all recently diagnosed T2DM patients, who had an alcohol consumption <140g (14 drinks/week) for women and <210g (21 drinks/week) for men, and without any signs of liver cirrhosis on abdominal ultrasound. All patients underwent a clinical examination with blood samples taken for lipid profile and transaminases measurements and an abdominal ultrasound assessment using a LOGIQ V5 Expert ultrasound machine. A total of 98 (53 males and 45 females) out of 128 eligible patients consented to participate in the study. The mean age was 50.31±10.51. NAFLD was present in 56.1% (55/98) patients; with mild and homogeneously diffused in 92.7% (51/55) and 94.5% (52/55) respectively. There were no significant differences in lipids profiles and transaminases between those with or without steatosis. Factors associated with fatty liver disease were body mass index ≥ 30 kg / m2 (P = 0.0002), waist circumference ≥ 94 cm for men or ≥ 80cm for women (P = 0.004). In conclusion, NAFLD is a common feature in newly diagnosed T2DM in our setting. There is a need for more attention towards NAFLD by primary care physicians, specialists and health policy makers","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139360250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-24DOI: 10.15226/2374-6890/10/1/001159
Aim This is an investigator initiated observational comparative medical program, to test the efficacy of Cerebrolysin® intake for 1 month versus 2 months, in patients clinically diagnosed with type 2 diabetes mellitus (T2DM) and suffering from peripheral neuropathy. Methods Patients aged ≥ 18 years old, clinically diagnosed with mild or moderate painful diabetic polyneuropathy, received Cerebrolysin® for 1 or 2 months according to investigators’ decision. Demographic data, detailed medical history, and laboratory results were collected at baseline. All enrolled patients were evaluated for Toronto Clinical Scoring System (TCSS), Visual Analogue Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) at baseline and end of the program (1 month/2 month). Results VAS, TCSS, and LANSS were significantly improved for all 136 enrolled patients at the end of their treatment with Cerebrolysin® for 1 or 2 months, regarding gender, duration since diagnosis of T2DM (more than or less than 10 years) and HbA1c ≤ 9% or ˃ 9%, with a very highly statistically significant difference (p-value ˂ 0.001). They were slightly improved more in patients received Cerebrolysin® for 1 month more than for 2 months. There was no statistically significant difference for gender, duration of diagnosis with diabetes mellitus less or more than 10 years, and HbA1c ≤ 9% & ˃ 9% regarding the change of VAS, TCSS, and LANSS as dependent variables, using Linear stepwise regression. While there was noticed improvement in VAS, TCSS, and LANSS with use of Cerebrolysin® for 1 month more than 2 months, Regression Coefficient (B (95% of Confidence interval)) B=0.794 (0.29-1.29), B=1.472 (0.87-2.074), B=2.143 (0.45-3.83) and p-value = 0.002, p-value ˂ 0.001, p-value = 0.13 respectively. There was no adverse event (AE) or serious adverse event (SAE) reported during the program. Conclusion: Cerebrolysin® is considered effective in the management of peripheral neuropathy in patients with T2DM Abbreviations: Adverse Event (AE), Advanced Glycation End products (AGE), Contract Research Organization (CRO), Diabetic Peripheral Neuropathy (DPN), Diacylglycerol (DAG), estimated Glomerular Filtration (eGFR), Fasting Blood Sugar (FBS), Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), Peripheral Vascular Disease (PVD), Pin- Prick Threshold (PPT), Protein Kinase C (PKC), Statistical Analysis Plan (SAP), Serious Adverse Event (SAE), Standard Deviation (SD), Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), Toronto Clinical Scoring System (TCSS), Traumatic Brain Injury (TBI), Visual Analogue Scale (VAS).
{"title":"Is Cerebrolysin effective in reducing symptoms of Diabetic Peripheral Neuropathy?","authors":"","doi":"10.15226/2374-6890/10/1/001159","DOIUrl":"https://doi.org/10.15226/2374-6890/10/1/001159","url":null,"abstract":"Aim This is an investigator initiated observational comparative medical program, to test the efficacy of Cerebrolysin® intake for 1 month versus 2 months, in patients clinically diagnosed with type 2 diabetes mellitus (T2DM) and suffering from peripheral neuropathy. Methods Patients aged ≥ 18 years old, clinically diagnosed with mild or moderate painful diabetic polyneuropathy, received Cerebrolysin® for 1 or 2 months according to investigators’ decision. Demographic data, detailed medical history, and laboratory results were collected at baseline. All enrolled patients were evaluated for Toronto Clinical Scoring System (TCSS), Visual Analogue Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) at baseline and end of the program (1 month/2 month). Results VAS, TCSS, and LANSS were significantly improved for all 136 enrolled patients at the end of their treatment with Cerebrolysin® for 1 or 2 months, regarding gender, duration since diagnosis of T2DM (more than or less than 10 years) and HbA1c ≤ 9% or ˃ 9%, with a very highly statistically significant difference (p-value ˂ 0.001). They were slightly improved more in patients received Cerebrolysin® for 1 month more than for 2 months. There was no statistically significant difference for gender, duration of diagnosis with diabetes mellitus less or more than 10 years, and HbA1c ≤ 9% & ˃ 9% regarding the change of VAS, TCSS, and LANSS as dependent variables, using Linear stepwise regression. While there was noticed improvement in VAS, TCSS, and LANSS with use of Cerebrolysin® for 1 month more than 2 months, Regression Coefficient (B (95% of Confidence interval)) B=0.794 (0.29-1.29), B=1.472 (0.87-2.074), B=2.143 (0.45-3.83) and p-value = 0.002, p-value ˂ 0.001, p-value = 0.13 respectively. There was no adverse event (AE) or serious adverse event (SAE) reported during the program. Conclusion: Cerebrolysin® is considered effective in the management of peripheral neuropathy in patients with T2DM Abbreviations: Adverse Event (AE), Advanced Glycation End products (AGE), Contract Research Organization (CRO), Diabetic Peripheral Neuropathy (DPN), Diacylglycerol (DAG), estimated Glomerular Filtration (eGFR), Fasting Blood Sugar (FBS), Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), Peripheral Vascular Disease (PVD), Pin- Prick Threshold (PPT), Protein Kinase C (PKC), Statistical Analysis Plan (SAP), Serious Adverse Event (SAE), Standard Deviation (SD), Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), Toronto Clinical Scoring System (TCSS), Traumatic Brain Injury (TBI), Visual Analogue Scale (VAS).","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136251964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-12DOI: 10.15226/2374-6890/10/1/001158
Introduction: The occurrence of an adrenal insufficiency post adrenalectomy usually attests of the success of the operative act. After the adrenalectomy, we could expect a compensatory secretion by the controlateral adrenal gland. However, the integrity of the residual function of the remaining gland depends on the initial secretory character of the mass and on its length. The aim of this study was to evaluate the residual function of the controlateral gland after a unilateral adrenalectomy. Method: This was a 13-month prospective study in Yaoundé Central Hospital. We included in the study, all patients who underwent an adrenalectomy. The adrenal function was assessed in preoperative by the measurement of 8am plasmatic cortisol after a dexamethasone suppression test, while in postoperative periods it was the measure of the baseline plasmatic cortisol at 8am. The latter was possibly completed with a stimulation test with Synacthene 0.25μg. The association between the variables was searched using the Fischer test. A significance threshold of 0.05 was adopted. Results: Seven patients (4 women and 3 men) underwent surgery indicated for an adrenal mass. Median age was 44,7 years [17 – 69 years]. The discovery mode was mainly weight gain (28.6 %) or unexplained weight loss (28.6 %). The median delay to diagnosis was 8months [8 days – 24 months]. In the preoperative period, the median cortisol level after dexamethasone suppression test was 329.9 ng/ml, amongst which 2/7 patients had hypercortisolism. The median values of normetanephrines and metanephrines were 7nmol/L and 71.4 nmol/L, respectively. Pathology described: corticosurrenalomas (2), adrenal adenomas (2), pheochromocytomas (2) and adrenalitis (1). In early postoperative, the median 8 h cortisol was 45.5 ng/ml [34.5-167.1ng/ml]. In late postoperative, the median cortisol value was 95 ng/ml, and strictly normal in 3/6 patients. There was no association between recovery of residual adrenal function and age, tumor size, initial preoperative cortisol value, treatment received preoperatively, and postoperative complications. Conclusion Adrenal insufficiency persists in almost half of the patients in late postoperative. Thus, hydrocortisone supplementation should be maintained as long as possible.
{"title":"Pattern of The Evolution of The Contralateral Adrenal Gland’s Function After Unilateral Adrenalectomy","authors":"","doi":"10.15226/2374-6890/10/1/001158","DOIUrl":"https://doi.org/10.15226/2374-6890/10/1/001158","url":null,"abstract":"Introduction: The occurrence of an adrenal insufficiency post adrenalectomy usually attests of the success of the operative act. After the adrenalectomy, we could expect a compensatory secretion by the controlateral adrenal gland. However, the integrity of the residual function of the remaining gland depends on the initial secretory character of the mass and on its length. The aim of this study was to evaluate the residual function of the controlateral gland after a unilateral adrenalectomy. Method: This was a 13-month prospective study in Yaoundé Central Hospital. We included in the study, all patients who underwent an adrenalectomy. The adrenal function was assessed in preoperative by the measurement of 8am plasmatic cortisol after a dexamethasone suppression test, while in postoperative periods it was the measure of the baseline plasmatic cortisol at 8am. The latter was possibly completed with a stimulation test with Synacthene 0.25μg. The association between the variables was searched using the Fischer test. A significance threshold of 0.05 was adopted. Results: Seven patients (4 women and 3 men) underwent surgery indicated for an adrenal mass. Median age was 44,7 years [17 – 69 years]. The discovery mode was mainly weight gain (28.6 %) or unexplained weight loss (28.6 %). The median delay to diagnosis was 8months [8 days – 24 months]. In the preoperative period, the median cortisol level after dexamethasone suppression test was 329.9 ng/ml, amongst which 2/7 patients had hypercortisolism. The median values of normetanephrines and metanephrines were 7nmol/L and 71.4 nmol/L, respectively. Pathology described: corticosurrenalomas (2), adrenal adenomas (2), pheochromocytomas (2) and adrenalitis (1). In early postoperative, the median 8 h cortisol was 45.5 ng/ml [34.5-167.1ng/ml]. In late postoperative, the median cortisol value was 95 ng/ml, and strictly normal in 3/6 patients. There was no association between recovery of residual adrenal function and age, tumor size, initial preoperative cortisol value, treatment received preoperatively, and postoperative complications. Conclusion Adrenal insufficiency persists in almost half of the patients in late postoperative. Thus, hydrocortisone supplementation should be maintained as long as possible.","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136038780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-19DOI: 10.15226/2374-6890/9/1/001157
E. Morla, Rosario Almanzar, Carmen A. Rosario, Lunisol Rivera, M. Burgos, M. Ramos, J. Sansary
Background The Children HospitalDr.Robert Reid Cabral, the principal children hospital in the Dominican Republic has no recent data on type 1 diabetes (T1D) incidence in children, therefore a study was undertaken to determine this in people aged <15 years (y). Methods Data were collected on all new T1D diagnoses between 2010-2019 from the The Children Hospital Dr. Robert Reid Cabral that care for children with T1D. Diagnosis was made according to standard American Diabetes Association criteria. No secondary ascertainment source was available. Significances around sex, age and incidence were assessed using the Chi-square (X2) and Pairwise Pearson Correlations tests. Results There were 513 new cases of T1D diagnosed in children aged < 15 y; a mean of 51.3 per year. Mean ± standard deviation age of T1D diagnosis was 8.5 ± 3.8 y, and there was also a not significant female preponderance ( p< 0.35). New cases were consistently highest in the 10-14 y (48.5%), and lowest in the 0-4 y age group (18.6%). Overall, mean crude annual incidence was 1.73 per 100,000 population, with no significant trend of increase or decrease.
{"title":"Incidence of type 1 diabetes in the children’s hospital dr. Robert reid cabral, 2010-2019. Dominican republic","authors":"E. Morla, Rosario Almanzar, Carmen A. Rosario, Lunisol Rivera, M. Burgos, M. Ramos, J. Sansary","doi":"10.15226/2374-6890/9/1/001157","DOIUrl":"https://doi.org/10.15226/2374-6890/9/1/001157","url":null,"abstract":"Background The Children HospitalDr.Robert Reid Cabral, the principal children hospital in the Dominican Republic has no recent data on type 1 diabetes (T1D) incidence in children, therefore a study was undertaken to determine this in people aged <15 years (y). Methods Data were collected on all new T1D diagnoses between 2010-2019 from the The Children Hospital Dr. Robert Reid Cabral that care for children with T1D. Diagnosis was made according to standard American Diabetes Association criteria. No secondary ascertainment source was available. Significances around sex, age and incidence were assessed using the Chi-square (X2) and Pairwise Pearson Correlations tests. Results There were 513 new cases of T1D diagnosed in children aged < 15 y; a mean of 51.3 per year. Mean ± standard deviation age of T1D diagnosis was 8.5 ± 3.8 y, and there was also a not significant female preponderance ( p< 0.35). New cases were consistently highest in the 10-14 y (48.5%), and lowest in the 0-4 y age group (18.6%). Overall, mean crude annual incidence was 1.73 per 100,000 population, with no significant trend of increase or decrease.","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43767636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-22DOI: 10.15226/2374-6890/9/1/001156
M. E. Hefnawy, H. Ramadan, Dina Rabie, A. Effat
Aim: This is a prospective, pilot, open-label, interventional, comparative, randomized study, enrolled 60 patients with type 2 diabetes mellitus (T2DM) to assess the effect of different doses of oral vitamin B containing Benfotiamine 300 mg versus intramuscular B vitamins containing watersoluble Thiamine HCl. Methods Patients ≥ 18 years with T2DM with Peripheral Neuropathy, divided into 3 groups; A & B (Benfotiamine 300 mg) and group C (Thiamine HCl), which were sub-divided to include patients with HbA1c less or more than 8 %. Patients were evaluated at baseline, after 2.5 hours, six days, and two weeks. Results Blood vitamin B1 increased from baseline to after 2.5 hours (T2) by 57%, 79% and 33% in group A, B and C respectively, with statistically significant difference in each group (p value < 0.001). Vitamin B1 continued to increase after six days (T6) in patients of groups A & B by 98% and 165% respectively, while dropped in patients of group C from 33% at T2 to 6% at T6, with p-value ≤ 0.001 between the three groups. Diabetic Neuropathic Symptom Score (DNS) decreased in mean value in all groups after 14 days of treatment by 64.4%, 53.7% and 48.6% in group A, B and C respectively, indicating improvement of peripheral neuropathy. Safety: There was no AE or SAE reported during the study. Conclusion: Oral Benfotiamine 300 mg is safe and more effective than intramuscular Thiamine HCl, in increasing vitamin B1 blood level in patients with diabetic peripheral neuropathy, which in turn relieves peripheral neuropathy. Clinical Trial Registration Number: NA Keywords: Benfotiamine, Bioavailability, Thiamine, Diabetic Peripheral Neuropathy Abbreviations : Adverse Event (AE), Advanced Glycation End products (AGE), Analysis of Variance (ANOVA), Alanine Transaminase (ALT), Body Mass Index (BMI), Case Report Form (CRF), Diabetic Neuropathic Symptom score (DNSS), Diacylglycerol (DAG), Dipeptidyl Peptidase 4 Inhibitor (DPP-4 I), Good Clinical Practice (GCP), Informed Consent Form (ICF), Intent to Treat (ITT), Institutional Review Board (IRB), Ministry of Health (MOH), National Institute of Diabetes and endocrinology (NIDE), Nuclear Factor kappaB (NF-κB), Per Protocol (PP), Protein Kinase C (PKC), Research and health Development (RHD), Serious Adverse Event (SAE), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), Transient Ischemic Stroke (TIA)
{"title":"Oral Benfotiamine 300 mg Versus Intramuscular Thiamine in Diabetic Patients with Peripheral Neuropathy","authors":"M. E. Hefnawy, H. Ramadan, Dina Rabie, A. Effat","doi":"10.15226/2374-6890/9/1/001156","DOIUrl":"https://doi.org/10.15226/2374-6890/9/1/001156","url":null,"abstract":"Aim: This is a prospective, pilot, open-label, interventional, comparative, randomized study, enrolled 60 patients with type 2 diabetes mellitus (T2DM) to assess the effect of different doses of oral vitamin B containing Benfotiamine 300 mg versus intramuscular B vitamins containing watersoluble Thiamine HCl. Methods Patients ≥ 18 years with T2DM with Peripheral Neuropathy, divided into 3 groups; A & B (Benfotiamine 300 mg) and group C (Thiamine HCl), which were sub-divided to include patients with HbA1c less or more than 8 %. Patients were evaluated at baseline, after 2.5 hours, six days, and two weeks. Results Blood vitamin B1 increased from baseline to after 2.5 hours (T2) by 57%, 79% and 33% in group A, B and C respectively, with statistically significant difference in each group (p value < 0.001). Vitamin B1 continued to increase after six days (T6) in patients of groups A & B by 98% and 165% respectively, while dropped in patients of group C from 33% at T2 to 6% at T6, with p-value ≤ 0.001 between the three groups. Diabetic Neuropathic Symptom Score (DNS) decreased in mean value in all groups after 14 days of treatment by 64.4%, 53.7% and 48.6% in group A, B and C respectively, indicating improvement of peripheral neuropathy. Safety: There was no AE or SAE reported during the study. Conclusion: Oral Benfotiamine 300 mg is safe and more effective than intramuscular Thiamine HCl, in increasing vitamin B1 blood level in patients with diabetic peripheral neuropathy, which in turn relieves peripheral neuropathy. Clinical Trial Registration Number: NA Keywords: Benfotiamine, Bioavailability, Thiamine, Diabetic Peripheral Neuropathy Abbreviations : Adverse Event (AE), Advanced Glycation End products (AGE), Analysis of Variance (ANOVA), Alanine Transaminase (ALT), Body Mass Index (BMI), Case Report Form (CRF), Diabetic Neuropathic Symptom score (DNSS), Diacylglycerol (DAG), Dipeptidyl Peptidase 4 Inhibitor (DPP-4 I), Good Clinical Practice (GCP), Informed Consent Form (ICF), Intent to Treat (ITT), Institutional Review Board (IRB), Ministry of Health (MOH), National Institute of Diabetes and endocrinology (NIDE), Nuclear Factor kappaB (NF-κB), Per Protocol (PP), Protein Kinase C (PKC), Research and health Development (RHD), Serious Adverse Event (SAE), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), Transient Ischemic Stroke (TIA)","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49478493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-13DOI: 10.15226/2374-6890/8/1/001151
Yuri Oda, Kazuki Ikura, T. Babazono
Aims The aim was to examine whether the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score are predictors of wound healing in patients with diabetic foot ulcers (DFUs). Materials and Methods This was a hospital-based, single-center, observational, longitudinal cohort study of 349 Japanese patients (84 women, 265 men; mean (standard deviation) age 62.8 (12.8) years) with DFUs. The endpoint was complete wound healing. The classical Cox proportional model and competing-risks model were used to calculate the hazard ratios (HRs) and the 95% confidence interval (CI) for reaching the endpoint. Results During a median (range) follow-up of 2.3 (0.03-62.3) months, 220 patients (63.0%) reached the endpoint. In the multivariate Cox proportional hazards model, higher PNI was identified as an independent predictor for the endpoint (HRs 1.22, 95% CI 1.01-1.48, p=0.038). In the multivariate competing-risks model analysis, both higher PNI (HRs 1.26, 95% CI 1.03-1.53, p=0.024) and lower CONUT score (HRs 0.80, 95% CI 0.65-0.99, p=0.045) were identified as independent predictors for the endpoint. Similar results were obtained when the PNI and the CONUT score were treated as categorical variables (≥ median or less). Conclusions Nutritional status, as assessed using the PNI and CONUT score, is a novel clinical predictor for wound healing in patients with DFUs. Keywords: Diabetic foot ulcer; Nutritional assessment; Prognostic nutritional index; Controlling Nutritional Status.
目的探讨预后营养指数(PNI)和控制营养状态(CONUT)评分是否能预测糖尿病足溃疡(DFUs)患者的伤口愈合。材料和方法这是一项基于医院、单中心、观察性、纵向队列研究，纳入了349名日本患者(84名女性，265名男性;平均(标准差)年龄为62.8(12.8)岁。终点是伤口完全愈合。采用经典Cox比例模型和竞争风险模型计算达到终点的风险比(hr)和95%置信区间(CI)。结果在中位(范围)随访2.3(0.03-62.3)个月期间，220例(63.0%)患者达到终点。在多变量Cox比例风险模型中，较高的PNI被确定为终点的独立预测因子(hr 1.22, 95% CI 1.01-1.48, p=0.038)。在多变量竞争风险模型分析中，较高的PNI (HRs 1.26, 95% CI 1.03-1.53, p=0.024)和较低的CONUT评分(HRs 0.80, 95% CI 0.65-0.99, p=0.045)被确定为终点的独立预测因子。当PNI和CONUT评分作为分类变量(≥中位数或更小)时，得到了类似的结果。结论:通过PNI和CONUT评分评估的营养状况是预测DFUs患者伤口愈合的一个新的临床预测指标。关键词:糖尿病足溃疡;营养评估;预后营养指数;控制营养状况。
{"title":"Nutritional Assessment Using the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) Score Predicts Wound Healing In Patients with Diabetic Foot Ulcers","authors":"Yuri Oda, Kazuki Ikura, T. Babazono","doi":"10.15226/2374-6890/8/1/001151","DOIUrl":"https://doi.org/10.15226/2374-6890/8/1/001151","url":null,"abstract":"Aims The aim was to examine whether the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score are predictors of wound healing in patients with diabetic foot ulcers (DFUs). Materials and Methods This was a hospital-based, single-center, observational, longitudinal cohort study of 349 Japanese patients (84 women, 265 men; mean (standard deviation) age 62.8 (12.8) years) with DFUs. The endpoint was complete wound healing. The classical Cox proportional model and competing-risks model were used to calculate the hazard ratios (HRs) and the 95% confidence interval (CI) for reaching the endpoint. Results During a median (range) follow-up of 2.3 (0.03-62.3) months, 220 patients (63.0%) reached the endpoint. In the multivariate Cox proportional hazards model, higher PNI was identified as an independent predictor for the endpoint (HRs 1.22, 95% CI 1.01-1.48, p=0.038). In the multivariate competing-risks model analysis, both higher PNI (HRs 1.26, 95% CI 1.03-1.53, p=0.024) and lower CONUT score (HRs 0.80, 95% CI 0.65-0.99, p=0.045) were identified as independent predictors for the endpoint. Similar results were obtained when the PNI and the CONUT score were treated as categorical variables (≥ median or less). Conclusions Nutritional status, as assessed using the PNI and CONUT score, is a novel clinical predictor for wound healing in patients with DFUs. Keywords: Diabetic foot ulcer; Nutritional assessment; Prognostic nutritional index; Controlling Nutritional Status.","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44402744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-28DOI: 10.15226/2374-6890/8/1/001150
Dr. Raisa Minhas, Dr. Jenan Obaid, Dr. Atif Munir Nizami, Dr. Naji Alamuddin, D. Alromaihi
Aims The study aimed to assess the effectiveness of the Flash Glucose Monitor (FGM) in empowering patients with Type 1 Diabetes Mellitus (T1DM) to fast safely during the month of Ramadan. Methods In this prospective interventional study, eligible adult patients with T1DM were monitored with FGM and completed a survey after Ramadan. Time in range, glucose variability, changes in HbA1c, and renal function was evaluated. IRB approval and informed consent were acquired prior to the study. For data analysis (SPSS) Version 25 was used. Results The study included 8 adults (5 females, 3 males). The use of FGM enabled 25% of patients who were not able to fast in the previous year to fast in the current year.The median frequency of hypoglycemic episodes increased during Ramadan from 8 to 24 (p-value 0.049), however. Glucose variability during Ramadan was reduced by 4.05 ± 7.00 % but was not significant (p-value 0.17). The time in range before Ramadan was 51.00% ±10.75, during Ramadan was 53.42% ±14.83,and post-Ramadan was 55.85%± 10. HbA1cand creatinine did not change before and after Ramadan, (p-values of 0.465 and 0.315 respectively) indicating that glycemic control and renal function were maintained. Conclusion Active glucose monitoring using FGM coupled withstructured pre-Ramadan counseling and patient education aids in empowering patient to fast safely and maintain glycemic control during month of Ramadan and avoid complications including DKA and severe hypoglycemia. Keywords: Diabetes Mellitus; Flash glucose monitoring; Fasting, Ramadan; Time in Range.
{"title":"The Utility of Flash Glucose Monitoring for Patients with Type 1 Diabetes Mellitus during Fasting in Ramadan","authors":"Dr. Raisa Minhas, Dr. Jenan Obaid, Dr. Atif Munir Nizami, Dr. Naji Alamuddin, D. Alromaihi","doi":"10.15226/2374-6890/8/1/001150","DOIUrl":"https://doi.org/10.15226/2374-6890/8/1/001150","url":null,"abstract":"Aims The study aimed to assess the effectiveness of the Flash Glucose Monitor (FGM) in empowering patients with Type 1 Diabetes Mellitus (T1DM) to fast safely during the month of Ramadan. Methods In this prospective interventional study, eligible adult patients with T1DM were monitored with FGM and completed a survey after Ramadan. Time in range, glucose variability, changes in HbA1c, and renal function was evaluated. IRB approval and informed consent were acquired prior to the study. For data analysis (SPSS) Version 25 was used. Results The study included 8 adults (5 females, 3 males). The use of FGM enabled 25% of patients who were not able to fast in the previous year to fast in the current year.The median frequency of hypoglycemic episodes increased during Ramadan from 8 to 24 (p-value 0.049), however. Glucose variability during Ramadan was reduced by 4.05 ± 7.00 % but was not significant (p-value 0.17). The time in range before Ramadan was 51.00% ±10.75, during Ramadan was 53.42% ±14.83,and post-Ramadan was 55.85%± 10. HbA1cand creatinine did not change before and after Ramadan, (p-values of 0.465 and 0.315 respectively) indicating that glycemic control and renal function were maintained. Conclusion Active glucose monitoring using FGM coupled withstructured pre-Ramadan counseling and patient education aids in empowering patient to fast safely and maintain glycemic control during month of Ramadan and avoid complications including DKA and severe hypoglycemia. Keywords: Diabetes Mellitus; Flash glucose monitoring; Fasting, Ramadan; Time in Range.","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47739572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-26DOI: 10.15226/2374-6890/8/1/001149
Timothy Johnson DO, Chheki Sherpa MD, G.Ohel Md
Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED) is a rare condition that diffusely affects many organ systems. Chronic mucocutaneous candidiasis is one of the features of APECED, which needs to be treated and monitored to prevent severe complications. This case demonstrates esophageal structuring and resultant esophageal perforation, in the setting of chronic mucocutaneous candidiasis. Learning Points • Chronic mucocutaneous candidiasis (CMC) can be present without overt esophageal thrush • CMC can result in esophageal lesions causing significant morbidity. • APECED patients with dysphagia should be assessed for chronic candida esophagitis and treated accordingly. • Patients with recurrent candida esophagitis should be considered for intermittent topical and systemic antifungal prophylactic therapy. • Esophageal perforation due to candidiasis is most often seen in the setting of immunocompromised states. Background Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disease caused by mutations of the AIRE (autoimmune regulator) genes [1, 2, 6, 7]. It is characterized by the clinical trial of chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenal insufficiency [7]. APECED has been reported worldwide, but is more prevalent in some historically- isolated homogeneous populations in Finland (1/25000), Sardinia, and Iranian Jews (1/9000) [7]. APECED is also seen at a lower incidence in Norway, Sweden, Slovenia, Great Britain, Italy, Ireland, and North America [7]. Most patients have CMC from early childhood [2, 3]. Rarely, untreated esophageal candidiasis may lead to complications such as esophageal stricture, rupture and or fistula formation [4, 5].
{"title":"Esophageal Tear with Pneumomediastinum Secondary to Esophageal Candidiasis in a Patient with Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED)","authors":"Timothy Johnson DO, Chheki Sherpa MD, G.Ohel Md","doi":"10.15226/2374-6890/8/1/001149","DOIUrl":"https://doi.org/10.15226/2374-6890/8/1/001149","url":null,"abstract":"Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED) is a rare condition that diffusely affects many organ systems. Chronic mucocutaneous candidiasis is one of the features of APECED, which needs to be treated and monitored to prevent severe complications. This case demonstrates esophageal structuring and resultant esophageal perforation, in the setting of chronic mucocutaneous candidiasis. Learning Points • Chronic mucocutaneous candidiasis (CMC) can be present without overt esophageal thrush • CMC can result in esophageal lesions causing significant morbidity. • APECED patients with dysphagia should be assessed for chronic candida esophagitis and treated accordingly. • Patients with recurrent candida esophagitis should be considered for intermittent topical and systemic antifungal prophylactic therapy. • Esophageal perforation due to candidiasis is most often seen in the setting of immunocompromised states. Background Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disease caused by mutations of the AIRE (autoimmune regulator) genes [1, 2, 6, 7]. It is characterized by the clinical trial of chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenal insufficiency [7]. APECED has been reported worldwide, but is more prevalent in some historically- isolated homogeneous populations in Finland (1/25000), Sardinia, and Iranian Jews (1/9000) [7]. APECED is also seen at a lower incidence in Norway, Sweden, Slovenia, Great Britain, Italy, Ireland, and North America [7]. Most patients have CMC from early childhood [2, 3]. Rarely, untreated esophageal candidiasis may lead to complications such as esophageal stricture, rupture and or fistula formation [4, 5].","PeriodicalId":73731,"journal":{"name":"Journal of endocrinology and diabetes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49659894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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