Diabetes mellitus is a chronic metabolic disorder marked by hyperglycemia due to insulin deficiency, insulin resistance, or both. It precipitates significant complications, including cardiovascular diseases, neuropathy, nephropathy, and retinopathy, necessitating meticulous management through pharmacological interventions and lifestyle modifications.

Effective management includes regular monitoring of blood glucose levels, adherence to a balanced diet, physical activity, and medication or insulin therapy. Advances in diabetes research are continually improving treatment protocols and outcomes for individuals with this condition.

Diabetes is the leading cause of end-stage kidney disease worldwide, responsible for nearly 40% of new cases needing renal replacement therapy. Managing diabetes in individuals with advanced kidney disease on renal replacement therapy presents challenges due to unique aspects of their assessment and treatment.

Standard glycemic assessment using glycated hemoglobin may not be reliable in these patients because of altered red blood cell turnover or iron/erythropoietin deficiency, which affects red blood cell longevity. Therefore, continuous glucose monitoring can be advantageous for more precise glycemic assessment and better therapy adjustment.

Tahseen A Chowdhury, Department of Diabetes, The Royal London Hospital, London, UK et. al. conducted a study to evaluate diabetes management in people with advanced chronic kidney disease.

Individuals with advanced kidney disease are at a higher risk of hypoglycemia due to several physiological factors and therapeutic options are limited due to a lack of experience or licensing. Insulin therapy is the cornerstone of treatment for those with diabetes and advanced kidney disease since many other drug classes are contraindicated.

Glycemic control targets should be tailored based on co-morbidity and frailty, and continuous glucose monitoring should be used in dialysis patients to minimize the risk of hypoglycemia. 

Post-transplant diabetes is prevalent in solid organ transplant patients and significantly increases mortality and morbidity risks for kidney transplant recipients. Therefore, screening for and managing this condition in the post-transplant period is crucial to improve patient outcomes.

Reference

Chowdhury TA, Mukuba D, Casabar M, Byrne C, Yaqoob MM. Management of diabetes in people with advanced chronic kidney disease. Diabet Med. 2024 Jul 11:e15402. doi: 10.1111/dme.15402. Epub ahead of print. PMID: 38992927.

Santiago, DR.- The Metropolitan Hospital of Santiago (HOMS) has set a new benchmark in medical innovation by performing the first fenestrated aortic endoprosthesis surgery in the Dominican Republic.

Led by vascular and endovascular surgeon Dr. Andrés Marín, with support from renowned Mexican vascular surgeon Dr. Gabriel Hernández, the procedure aims to correct an aortic aneurysm. It involves implanting a modified prosthesis that opens holes to connect with the visceral arteries, supplying blood to the main organs of the abdomen.

Dr. Marín highlighted the significant advantage of this surgery: patients can walk within hours and leave the hospital the day after the operation, unlike open surgeries that require lengthy stays in intensive care.

“This represents a great advance for the country and the hospital, which is innovating to benefit the health of Dominicans,” Dr. Marín stated.

Fenestrated aortic endoprosthesis surgery offers an alternative to conventional high-risk surgical methods, significantly reducing morbidity and mortality while enabling the treatment of complex cases.

Dr. Marín emphasized that this surgical technique had not been performed in the country before due to its complexity. However, this achievement showcases the advanced training of local surgeons, placing Dominican vascular medicine at the forefront alongside developed countries.

The Ministry of Health, Wellness and the Environment said on Friday that its Epidemiology Unit has recorded 119 dengue fever cases so far in 2024 and that of those cases, 23 were in June and 82 last month.

“Based on the epidemiological data, the number of lab confirmed cases of dengue fever has exceeded the threshold of the number expected indicating that there is a dengue fever outbreak in St Vincent and the Grenadines,” the ministry said.

The ministry is urging the public to adhere to all the basic precautionary measures to prevent the spread of vector borne diseases during the summer vacation.

“As we approach the month of August, the public is reminded that we are still within the hurricane season and August is expected to be hotter than normal.

“These weather patterns can create ideal breeding sites for the aedes aegypti mosquito. This mosquito carries dengue fever, Zika and Chik V,” the ministry said in a press statement.

It said that to combat the further spread of the dengue virus, the government has implemented increased public awareness and health education interventions as well as increased surveillance including the use of GIS mapping for more targeted source reduction.

SOURCE: CMC

The post St Vincent and the Grenadines confirms dengue outbreak appeared first on Barbados Today.

Wall Street Journal reporter Evan Gershkovich and American veteran Paul Whelan were among those released from Russia on Thursday in a large prisoner swap.

A third U.S. citizen, Russian-American journalist Alsu Kurmasheva, was also released.

US-RUSSIAN PRISONER EXCHANGES OVER THE YEARS: SEE THE LIST

A plane carrying the freed Americans landed at Joint Base Andrews in Maryland late Thursday night, where they were greeted by President Joe Biden and Vice President Kamala Harris.

The newly released prisoners were then flown to San Antonio, Texas, for evaluation and rehabilitation at Brooke Army Medical Center, a premier military medical facility, according to reports.

Although the prisoners are safely back on U.S. soil and have been reunited with their families, they may experience mental health challenges stemming from the trauma of detainment, said experts.

"Besides the obvious threats to one’s safety and the horrifying prospect of confinement, a situation like this is fraught with uncertainty," Dr. Norman Blumenthal, director of the Ohel Zachter Family National Trauma Center in New York, told Fox News Digital. 

WSJ REPORTER EVAN GERSHKOVICH RELEASED BY RUSSIA IN PRISONER SWAP; PAUL WHELAN ALSO BEING FREED

"Ambiguity in and of itself induces stress — and that, coupled with their very predicament, can create a marked escalation of trauma." (None of the experts cited here have treated the released Americans.)

Dr. Karen DeCocker, a psychiatric mental health nurse practitioner director at Stella Centers in Chicago, noted that being held captive can lead to several types of trauma. 

"This varies from person to person based on prior history and the experiences encountered during captivity," she told Fox News Digital.

TRUMP’S ATTEMPTED ASSASSIN WAS A ‘LONER,’ FBI SAYS, AS EXPERTS SHARE TELLTALE SIGNS IN OTHERS ACROSS AMERICA

While each person reacts differently to trauma, Blumenthal predicted that the freed prisoners would likely experience an "initial thrill and exhilaration" from their liberation. 

"The celebrations and enthusiastic reunions with loved ones can temporarily overshadow the trauma," he noted. 

"As life returns to normal and routines set in, that is often when the frightening flashbacks and intrusive recollections can become disruptive and destabilizing."

Dr. Marc Siegel, senior medical analyst for Fox News and clinical professor of medicine at NYU Langone Medical Center, said it is likely the prisoners experienced physical and mental abuse, sleep deprivation, dehydration, malnutrition and possibly infections.

Jonathan Alpert, a psychotherapist and author based in New York City, said that Gershkovich, Whelan and Kurmasheva, along with the other released prisoners, may suffer from both acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). 

WHAT IS PTSD? SYMPTOMS THAT CAN EMERGE AFTER EXPERIENCING A TRAUMATIC EVENT

ASD is a short-term mental health condition that typically occurs within a month after a traumatic experience, according to Cleveland Clinic’s website.

"Acute stress disorder may include flashbacks, nightmares, intense fear and high anxiety," Alpert told Fox News Digital.  

It can also include feelings of numbness or detachment.

PTSD occurs when such symptoms persist for a month or longer, and the anxiety becomes chronic, according to Alpert.

FDA PANEL REJECTS MDMA-ASSISTED THERAPIES FOR PTSD DESPITE HIGH HOPES FROM VETERANS

PTSD may include many of the same symptoms as ASD, and can impair the person’s ability to function in daily activities.

The freed prisoners may also experience depression, anger and difficulty trusting others, said Alpert.   

"I've also seen people have trouble focusing and making decisions in light of a trauma," he added.

It could also be challenging for the former prisoners to reintegrate into their normal environments and social groups, Alpert said.

Symptoms of trauma are "not universal," Siegel told Fox News Digital.

"There are differences, and not everyone experiences PTSD," he said. 

"Common symptoms include flashbacks, nightmares, depersonalization and derealization, anxiety and depression."

DeCocker noted that symptoms can be both mental and physical — including the following five points.

"Individuals may experience dissociation, where they feel disconnected from their thoughts, feelings or sense of identity," DeCocker told Fox News Digital. 

TRUMP ASSASSINATION ATTEMPT COULD HAVE WIDESPREAD MENTAL HEALTH IMPACT, EXPERTS SAY: ‘VICARIOUS TRAUMA’

"This can manifest as feeling detached from oneself (depersonalization) or from the world around them (derealization)."

Some trauma survivors may feel a sense of guilt for having survived a traumatic experience when others did not, or for putting themselves or others in situations that led to captivity, DeCocker said. 

They may also feel guilty about the stress and anxiety that family members and loved ones experienced during their imprisonment. 

"Issues with trust, intimacy and personal relationships often occur with survivors and their families," DeCocker told Fox News Digital. 

"The impact of their captivity often comes from their inability to relate the experience to others."

Trauma survivors may experience feelings of shame, worthlessness or confusion about their identity, according to DeCocker. 

"In this case, where there was an exchange of prisoners, there may be added complexity," she said.

It's not uncommon for trauma survivors to have negative beliefs about themselves or the world, according to DeCocker. 

"Generalizations about the world being unsafe or out of their control can occur," she said. "Threats are often seen in everyday experiences."

Potential physical symptoms could include chronic pain, such as headaches or muscle pain, in addition to persistent fatigue and lack of energy, according to Nikki Bishop, a licensed clinical psychologist and clinical director at SunCloud Health in Chicago.

"A person may also experience gastrointestinal issues such as stomach pain, nausea and changes in appetite," she told Fox News Digital. 

TRUMP’S ATTEMPTED ASSASSIN WAS A ‘LONER,’ FBI SAYS, AS EXPERTS SHARE TELLTALE SIGNS IN OTHERS ACROSS AMERICA

"Additionally, cardiovascular risks could occur, such as increased blood pressure, heart palpitations and increased risk of heart disease."

To cope with painful feelings, people can sometimes turn to substance use, process addictions, eating disorders and even food addiction as a means of trying to numb the pain, Bishop added.

Given the high-profile release, Gershkovich and Whelan will likely receive a large amount of media attention, Alpert noted — "but it’s important that they have the space and privacy they need to process this on their own timeline."

DeCocker agreed, stressing the importance of taking extensive time to heal and recover. 

"There is no rush to reintegrate," she told Fox News Digital. "Time is best devoted toward rest and restoring a sense of balance and normalcy."

Embracing daily routines and structure can help with that, DeCocker said.

The freed prisoners may also want to avoid spending too much time on social media and the news in the early days to avoid retriggering discussions and events, she advised.

One "tried-and-true method" of coping is to retell the events to supportive people who act as listeners, not solvers, according to Blumenthal. 

"Putting the experience into words can help with healing and adjusting to the more mundane aspects of life and routine," he said.

If symptoms are interfering with day-to-day functioning, Alpert recommends seeking professional help.

"In the case of a severe trauma, such as being held prisoner and wrongly convicted, symptoms may not surface right away," he pointed out. 

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"It can be helpful to get ahead of it and speak to a specialist." 

All forms of professional help are useful, DeCocker noted. Those include talk therapy, psychiatric support, interventional treatment modalities specific to treating trauma, and physical treatments and therapies to heal the body.

Other treatments may include cognitive behavioral therapy, relaxation techniques, and medications such as beta blockers, antidepressants and potentially psychedelics, according to Siegel.

Support from loving family members and friends is also key, the doctor added.

For more Health articles, visit www.foxnews/health

Most people do have an "inherent resilience and capacity to hope," Blumental said.

"These and other freed hostages may, on their own, mobilize and harness strength and heroic reformulations of their recent incarceration to go on and resume normal functioning."

Scott McDonald of Fox News Digital contributed reporting.

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Good morning and happy Friday. We discuss a new innovative immunotherapy, and we take a look at some of the earnings highlights yesterday.

FDA approves immunotherapy for soft-tissue cancer

The Food and Drug Administration has approved a T cell immunotherapy from Adaptimmune Therapeutics for a rare cancer that arises in the body’s soft tissues, extending the power of immunotherapies to difficult-to-reach sarcomas.

Continue to STAT+ to read the full story…