medical topics contents

A
ACCULTURATION
ACTION SCIENCE
ACUTE CARE OF THE ELDERLY
ADDICTION CARE
ADHERENCE/COMPLIANCE
ADOLESCENT HEALTH
ADVANCE DIRECTIVES
AGEISM
ALZHEIMER’S DISEASE
ANIMAL-ASSISTED THERAPY
APPLIED RESEARCH
B
BASIC RESEARCH
BEHAVIORAL RESEARCH
BIOFEEDBACK
BOYKIN AND SCHOENHOFER: NURSING AS CARING THEORY
BREASTFEEDING
C
CANCER IN CHILDREN
CARDIOVASCULAR RISK FACTORS
CAREGIVER
CARING
CASE STUDY METHOD OF RESEARCH
CAUSAL MODELING
CEREBRAL ISCHEMIA
CHILD AND ADOLESCENT DELINQUENTS
CHILDBIRTH EDUCATION
CHILD LEAD EXPOSURE LEVELS
CHRONIC ILLNESS
CINAHL DATABASE
CLINICAL CARE CLASSIFICATION SYSTEM
CLINICAL DECISION MAKING
CLINICAL JUDGMENT
CLINICAL NURSING RESEARCH
CLINICAL PREVENTIVE SERVICES
CLINICAL TRIALS
COGNITIVE APPRAISAL
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COLLABORATIVE RESEARCH
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COMMUNITY MENTAL HEALTH
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CONCEPT ANALYSIS
CONCEPTUAL MODEL
CONTENT ANALYSIS
CONTINUING CARE RETIREMENT COMMUNITIES
CORONARY ARTERY BYPASS GRAFT SURGERY
COST ANALYSIS OF NURSING CARE
CRITICAL CARE NURSING
CULTURAL/TRANSCULTURAL FOCUS
D
DATA ANALYSIS
DATA-COLLECTION METHODS
DATA MANAGEMENT
DATA STEWARDSHIP
DELIRIUM
DELPHI TECHNIQUE
DEPRESSION AND CARDIOVASCULAR DISEASES
DEPRESSION IN FAMILIES
DEPRESSION IN OLDER ADULTS
DEPRESSION IN WOMEN
DESCRIPTIVE RESEARCH
DIABETES
DISCOURSE ANALYSIS
DOCTORAL EDUCATION
E
EATING DISORDERS
ELDER MISTREATMENT
ELECTRONIC NETWORK
EMERGENCY NURSING
EMPATHY
END-OF-LIFE PLANNING
ENTERAL TUBE PLACEMENT
EPILEPSY
ETHICS OF RESEARCH
ETHNOGERIATRICS
ETHNOGRAPHY
EVALUATION
EVIDENCE-BASED PRACTICE
EXPERIMENTAL RESEARCH
EXPLORATORY STUDIES
F
FACTOR ANALYSIS
FAILURE TO THRIVE (CHILD)
FALLS
FAMILY CAREGIVING AND THE SERIOUSLY MENTALLY ILL
FAMILY HEALTH
FATIGUE
FEMINIST RESEARCH METHODOLOGY
FETAL MONITORING
FEVER
FITZPATRICK’S LIFE-PERSPECTIVE RHYTHM MODEL
FORMAL NURSING LANGUAGES
FUNCTIONAL HEALTH PATTERNS
G
GENETICS
GLOBAL NURSING RESEARCH
GRANDPARENTS RAISING GRANDCHILDREN
GRANTSMANSHIP
GROUNDED THEORY
H
HEALTH CARE–ASSOCIATED INFECTIONS
HEALTH CONCEPTUALIZATION
HEALTH DISPARITIES: FOCUS ON RACIAL AND ETHNIC MINORITIES
HEALTH POLICY AND HEALTH SERVICES DELIVERY
HEALTH SERVICES RESEARCH
HEMODYNAMIC MONITORING
HENDERSON MODEL
HERMENEUTICS
HISTORY OF NURSING RESEARCH
HIV/AIDS CARE AND TREATMENT
HIV RISK BEHAVIOR
HOME CARE TECHNOLOGIES
HOME HEALTH SYSTEMS
HOMELESS HEALTH
HOSPICE
HYPERTENSION
I
IMMIGRANT WOMEN
INSTITUTIONAL REVIEW BOARD AND INFORMED CONSENT
INSTRUMENTATION
INSTRUMENT TRANSLATION
INTERNATIONAL CLASSIFICATION OF NURSING PRACTICE
INTERPERSONAL COMMUNICATION
J
JOB SATISFACTION
JOHNSON’S BEHAVIORAL SYSTEM MODEL
K
KANGAROO CARE (SKIN-TO-SKIN CONTACT)
KING’S THEORY OF GOAL ATTAINMENT
L
LEININGER’S THEORY OF CULTURE CARE DIVERSITY AND UNIVERSALITY
M
MATERNAL ANXIETY AND PSYCHOSOCIAL ADAPTATION DURING PREGNANCY
MEASUREMENT AND SCALES
MENOPAUSE
MENTAL HEALTH IN PUBLIC-SECTOR PRIMARY CARE
MENTAL STATUS MEASUREMENT
MENTORING
META-ANALYSIS
MIDDLE RANGE THEORIES
MILD COGNITIVE IMPAIRMENT
MORAL DISTRESS
MORAL RECKONING
MOTHER–INFANT/TODDLER RELATIONSHIPS
MUSIC THERAPY
N
NARRATIVE ANALYSIS
NATIONAL INSTITUTE OF NURSING RESEARCH
NEUMAN’S SYSTEMS MODEL
NEUROBEHAVIORAL DEVELOPMENT
NEWMAN’S THEORY OF HEALTH
NIGHTINGALE, FLORENCE
NURSE ENGAGEMENT
NURSE-LED GROUP CLINIC VISITS
NURSE AND PHYSICIAN INTERDISCIPLINARY COLLABORATION
NURSE STAFFING
NURSING ASSESSMENT
NURSING DIAGNOSES, INTERVENTIONS, AND OUTCOMES
NURSING EDUCATION
NURSING INFORMATION SYSTEMS AND INFORMATICS
NURSING OCCUPATIONAL INJURY AND STRESS
NURSING PRACTICE MODELS
NURSING PROCESS
NUTRITION IN THE ELDERLY
NUTRITION IN INFANCY AND CHILDHOOD
O
OBESITY
OBSERVATIONAL RESEARCH DESIGNS
OREM’S SELF-CARE THEORY
ORGANIZATIONAL CULTURE
ORGANIZATIONAL DESIGN
OSTEOPOROSIS
OUTCOME MEASURES
P
PAIN
PALLIATIVE CARE
PARENTING
PARSE’S HUMANBECOMING SCHOOL OF THOUGHT
PARTICIPANT OBSERVATION
PATIENT CARE DELIVERY MODELS
PATIENT CONTRACTING
PATIENT EDUCATION
PATIENT ENGAGEMENT AND PATIENT-CENTERED CARE
PATIENT SAFETY
PATIENT SATISFACTION
PEDIATRIC PRIMARY CARE
PENDER’S HEALTH-PROMOTION MODEL
PEPLAU’S THEORETICAL MODEL
PHENOMENOLOGY
PHILOSOPHY OF NURSING
PHYSICAL RESTRAINTS
PHYSIOLOGY
PILOT STUDY
POPULATION HEALTH
POSTPARTUM DEPRESSION
PREGNANCY
PREVENTION OF PRETERM BIRTH, PRETERM LABOR, AND LOW BIRTH WEIGHT
PRIMARY NURSING
Q
QUALITATIVE RESEARCH
QUALITY OF CARE
QUALITY OF LIFE
QUALITY AND SAFETY EDUCATION FOR NURSES
QUANTITATIVE RESEARCH
QUASI-EXPERIMENTAL RESEARCH
R
RELIABILITY
REMINISCENCE
REPLICATION STUDIES
RESEARCH DISSEMINATION
RESEARCH INTERVIEWS (QUALITATIVE)
RESEARCH IN NURSING ETHICS
RESEARCH UTILIZATION
RESOURCEFULNESS
RESPONSIVENESS
ROGERS’S SCIENCE OF UNITARY HUMAN BEINGS
ROY ADAPTATION MODEL
RURAL HEALTH
S
SAMPLING
SCHIZOPHRENIA
SECONDARY DATA ANALYSIS
SELF-EFFICACY
SELF-MANAGEMENT
SELF-TRANSCENDENCE
SERIOUS MENTAL ILLNESS
SHIVERING
SIMULATION
SLEEP SCIENCE
SMOKING CESSATION
SNOMED CLINICAL TERMS
SOCIAL SUPPORT
SPIRITUALITY
STATISTICAL TECHNIQUES
STORY THEORY
STRESS
STROKE
STRUCTURAL EQUATION MODELING
SUBSTANCE USE DISORDERS IN PROFESSIONAL NURSES
SYMPTOM MANAGEMENT THEORY
SYSTEMATIC REVIEW
T
TELEHEALTH
TERMINAL ILLNESS
THEORETICAL FRAMEWORK
THERMAL BALANCE
TIME SERIES ANALYSIS
TRANSITIONAL CARE
TRANSITIONS AND HEALTH
TRANSLATIONAL RESEARCH
TRIANGULATION
U
UNCERTAINTY IN ILLNESS
UNLICENSED ASSISTIVE PERSONNEL
V
VALIDITY
VETERANS’ HEALTH
VIOLENCE
VIRTUAL NURSE CARING
VULNERABLE POPULATIONS
W
WANDERING
WATSON’S HUMAN CARING SCIENCE
WEIGHT MANAGEMENT
WELLNESS
WOMEN’S HEALTH
WORKPLACE VIOLENCE

Landmarks in Kidney Transplantation కిడ్నీ మార్పిడి లో ప్రసిద్ధ గుర్తులు

Landmarks in Kidney Transplantation
1902 First successful experimental kidney transplant
1906 First human kidney transplant – xenograft
1933 First human kidney transplant – allograft54 1950 Revival of experimental kidney transplantation
1950–1953 Human kidney allografts without immunosuppression, in Paris and Boston
1953 First use of live related donor, Paris
1954 First transplant between identical twins, Boston
1958 First description of leukocyte antigen Mac
1959–1962 Radiation used for immunosuppression, in Boston39 and Paris
1960 Effectiveness of 6-mercaptopurine (6-MP) in dog kidney transplants
1960 Prolonged graft survival in patient given 6-MP after irradiation
1962 First use of tissue matching to select a donor and recipient
1966 Recognition that positive crossmatching leads to hyperacute rejection
1967 Creation of Eurotransplant
1967 Development of kidney preservation
1973 Description of the transfusion effect
1978 First clinical use of cyclosporine
1978 Application of matching for HLA-DR in renal transplantation
1987 First of new wave of immunosuppressive agents appears (tacrolimus)
1997 Transgenic pigs produced

కిడ్నీ మార్పిడి లో ప్రసిద్ధ గుర్తులు

1902 మొదటి విజయవంతమైన ప్రయోగాత్మక మూత్రపిండ మార్పిడి

1906 మొదటి మానవ మూత్రపిండ మార్పిడి - xenograft

1933 మొదటి మానవ మూత్రపిండ మార్పిడి - అల్లోగ్రాఫ్ట్ 54 1950 ప్రయోగాత్మక మూత్రపిండ మార్పిడి యొక్క పునరుద్ధరణ

1950-1953 మానవ మూత్రపిండాల ప్రతిరక్షకాలు ఇమ్యునోసంప్రెషన్ లేకుండా, పారిస్ మరియు బోస్టన్లలో

1953 బతికి ఉన్న  దాత మొదటి ఉపయోగం, ప్యారిస్

1954 బోస్టన్ ఒకే రకం కవలల మధ్య మొదటి మార్పిడి

1958 ల్యూకోసైట్ యాంటీజెన్ మాక్ యొక్క మొదటి వివరణ

1959-1962 రేడియోధార్మికత రోగనిరోధకత కోసం ఉపయోగించబడింది, బోస్టన్   మరియు ప్యారిస్లో

1960 ల ఎఫెక్టివ్నెస్ ఆఫ్ 6-మెర్కాప్టోపరిన్ (6-MP) లో కుక్క మూత్రపిండ మార్పిడి

1960 లో రేడియేషన్ తర్వాత 6-MP ఇచ్చిన రోగులలో సుదీర్ఘమైన గ్రాఫ్ట్ మనుగడ

1962 దాత మరియు గ్రహీతని ఎంచుకోవడానికి కణజాలం యొక్క మొదటి ఉపయోగం

1966సానుకూల క్రాస్మాచింగ్ అనేది హైప్రాకుట్ తిరస్కరణకు దారితీస్తుందని  గుర్తింపు

1967 యురోట్రాన్స్ప్లాంట్ సృష్టి

1967 మూత్రపిండాల సంరక్షణ అభివృద్ధి

1973 ట్రాన్స్ఫ్యూషన్ ఎఫెక్ట్ యొక్క వివరణ

1978సైక్లోస్పోరిన్ యొక్క మొదటి క్లినికల్ ఉపయోగం

1978 HLA-DR కొరకు మూత్రపిండ మార్పిడి కొరకు సరిపోయే అప్లికేషన్

1987 రోగ నిరోధక ఏజెంట్ల కొత్త తరంగం కనిపిస్తుంది (టాక్రోలిమస్)

1997 ట్రాన్స్జెనిక్ పందులు ఉత్పత్తి

Some common complications of GDM

Some common complications of GDM GDM యొక్క కొన్ని సాధారణ సమస్యలు

Type of complications   సమస్యల రకం	Name of specific problemనిర్దిష్ట సమస్య పేరు
Diabetes complications (maternal complications)  డయాబెటిస్ సమస్యలు (ప్రసూతి/ సమస్యలు)	Diabetic ketoacidosis Worsening of diabetic nephropathy Deterioration of diabetic retinopathy Hypoglycemia (when using insulin)
Obstetric complications (maternal complications)	Spontaneous abortion Pregnancy-induced hypertension  Premature birth Shoulder dystocia Hydramnios Caesarean section delivery GDM recurrence in subsequent pregnancies Increased risk of developing type 2 diabetes Bradytocia due to macrosomia  Induction of childbirth
Perinatal complications (fetal complications)	Fetal distress/fetal death Macrosomia Congenital malformations Birth injury due to shoulder dystocia Bone fracture Nerve palsy Delayed fetal development Neonatal hypocalcemia  Neonatal hyperinsulinemia  Neonatal hypoglycemia Neonatal hyperbilirubinemia  Neonatal polycythemia Newborn respiratory distress syndrome Hypertrophic cardiomyopathy Delayed intrauterine fetal development
Offspring’s complications (fetal complications)	Obesity/diabetes Impaired fine and gross motor functions Increased incidence of inattention and/or hyperactivity

Risk for Diabetes,

बॉडी मास इंडेक्स (> 30 किग्रा / मी 2) में वृद्धि हुई

गर्भवती आयु (एलजीए) शिशु के लिए बड़े या मोटापे का इतिहास> 4.5 किलोग्राम

पिछली गर्भावस्था में जीडीएम का इतिहास

मधुमेह का पारिवारिक इतिहास, विशेष रूप से पहली डिग्री सापेक्ष में

दक्षिण एशियाई (मुख्य रूप से भारतीय, बांग्लादेशी और पाकिस्तानी), मध्य पूर्वी और काले कैरेबियन जैसे नस्ल (टी 2 डी एम का उच्च जोखिम है)

पॉलीहाइड्रमनिओस (गर्भ में अम्नीओटिक तरल पदार्थ का उच्च स्तर)

इट्रोजेनिक: ग्लूकोकार्टिकोइड और एंटीसाइकोटिक दवा

पॉलीसिस्टिक अंडाशय सिंड्रोम और अकान्थोसिस निग्रिकन्स  के पिछले इतिहास

पिछला अस्पष्टीकृत मरे हुए बच्चे

పెరిగిన BMI  శరీర ద్రవ్యరాశి సూచిక (> 30 కిలోల / మీ 2)

గర్భధారణ వయస్సు (LGA)  కు తగినట్టు శిశువుకు పెద్ద లేదా ఊబకాయం చరిత్ర> 4.5 కిలోలకంటే ఎక్కువ బరువు శిశువు

మునుపటి గర్భంలో GDM/జెస్టేషనల్  డయబెటిస్  చరిత్ర

మధుమేహం యొక్క కుటుంబ చరిత్ర ప్రత్యేకంగా మొదటి డిగ్రీ సంబంధిత కుటుంబ సభ్యులలో డయబెటిస్

దక్షిణాసియా (ప్రధాన భారతీయ, బంగ్లాదేశీ, మరియు పాకిస్తానీ), మధ్యప్రాచ్య, మరియు నల్ల కరీ బియన్ వంటి జాతికి చెందిన వారు (T2DM అధిక ప్రమాదం)

పాలీహైడ్రామినియోస్ (గర్భంలో అధిక స్థాయి అమ్నియోటిక్ ద్రవం) గనక ఉండి ఉంటే

ఐయాట్రోజెనిక్: గ్లూకోకార్టికాయిడ్లు మరియు యాంటిసైకోటిక్ మందుల ఉపయోగం

పాలిసిస్టిక్ అండాశయ సిండ్రోమ్ మరియు ఆక్టాసిస్ నైజికాన్స్ యొక్క గత చరిత్ర

మునుపటికి  కారణం చెప్పలేని నిర్జీవ జననం

Increased body mass index (>30 kg/m 2 )
History of large or obese for gestational age (LGA) infant > 4.5 kg
History of GDM in a previous pregnancy
Family history of diabetes particularly in first- degree relative
Ethnicity (who have high risk of T2DM) like South Asian (mainly Indian, Bangladeshi, and Pakistani), Middle Eastern, and the Black Caribbean
Polyhydramnios (high level of amniotic fluid in the womb)
Iatrogenic: glucocorticoids and antipsychotic medication
Past history of polycystic ovary syndrome and acanthosis nigricans
Previous unexplained stillbirth

డయాబెటిస్ విద్య నిర్వహణ యొక్క కోణాలు,मधुमेह शिक्षा प्रबंधन के कोण

Aspects of management Diabetes education

Establish an understanding of diet and physical activity therapy

Where appropriate, encourage capillary blood glucose monitoring

Foot care education

Identification and treatment of hypoglycemia Glycemic control to prevent diabetic complications

Establish glycemic targets based on

HbA 1c

Fasting and 2-hour postmeal glucose levels

Cardiovascular risk reduction • Smoking cessation

Lipid treatment to achieve target levels for primary and secondary prevention

Hypertension control to normal range

Routine complication screening

Annual retinal examinations, with an ophthalmologist check biennially

Annual foot examination

Annual microalbuminuria testing

Appropriate strategies to reduce weight if obesity present

 Identify and treat sleep apnea

 Identify and treat mood disorders, if present

డయాబెటిస్ విద్య నిర్వహణ యొక్క కోణాలు

ఆహారం మరియు శారీరక శ్రమ చికిత్సను అవగాహన చేసుకోండి

తగిన విధంగా, రక్తం గ్లూకోజ్ పర్యవేక్షణను ప్రోత్సహిస్తుంది

ఫుట్ వేర్/ఎలాంటి పాదరక్షలు వాడాలనే విద్య

హైపోగ్లైసీమియా/లో షుగర్  యొక్క గుర్తింపు మరియు చికిత్స డయాబెటిక్ సమస్యలను నివారించడానికి గ్లైసెమిక్ నియంత్రణ

ఆధారంగా గ్లైసెమిక్ లక్ష్యాలను ఏర్పాటు

HbA 1c/ హెచ్బి ఎ 1 సి

ఉపవాస మరియు 2-గంటల పోస్ట్ మీల్ గ్లూకోజ్ స్థాయిలు

ప్రాథమిక మరియు ద్వితీయ నివారణ కోసం లక్ష్య స్థాయిలను సాధించడానికి

కార్డియోవాస్కులర్ రిస్క్ తగ్గింపు

స్మోకింగ్ విరమణ/పొగత్రాగడం/పొగాకు ఆపడం

లిపిడ్ చికిత్స

సాధారణ శ్రేణికి అధిక రక్తపోటు నియంత్రణ

రొటీన్ సంక్లిష్ట/కాంప్లికేషన్ స్క్రీనింగ్

ఒక నేత్ర వైద్యుడు పరిశీలనతో వార్షిక/ప్రతి సంవత్సరం రెటినల్ పరీక్షలు ఒకవేళ రేటినోపతి మొదలై ఉంటె,

ద్వివార్షికంగా/రెండు సంవత్సరాలకొకసారి  అందరికి

రొజూ పాదాల పరీక్ష /వార్షిక పాదాల /ఫుట్ పరీక్ష

యాన్యువల్/ వార్షిక మైక్రోఅల్బ్యుమినూరియా పరీక్ష

ఊబకాయం ప్రస్తుత ఉంటే బరువు తగ్గించేందుకు తగిన వ్యూహాలు

  స్లీప్ అప్నియాను/నిద్రలో శ్వాస ఆగిపోవడం గుర్తించండి మరియు చికిత్స చేయండి

 మూడ్ డిజార్డర్లను/మానసిక  రుగ్మతలు ఉన్నట్లయితే, గుర్తించండి మరియు చికిత్స చేయండి

मधुमेह शिक्षा प्रबंधन के कोण

भोजन और शारीरिक गतिविधि के उपचार को प्रोत्साहित करें

उचित रूप से, रक्त ग्लूकोज निगरानी की निगरानी करता है

फुटवियर / फुटवियर का उपयोग करने के लिए शिक्षा

चीनी की मधुमेह समस्याओं और चीनी में निदान हाइपोग्लाइसीमिया को रोकने में ग्लिसेमिक नियंत्रण

ग्लाइसेमिक लक्ष्यों की स्थापना के आधार पर

एचबीए 1 सी / एचबी ए 1 सी

उपवास और 2 घंटे बाद के ग्लूकोज के स्तर

बुनियादी और माध्यमिक रोकथाम के लिए लक्ष्य स्तर प्राप्त करना

कार्डियोवास्कुलर जोखिम में कमी

धूम्रपान सेवानिवृत्ति / धूम्रपान / तम्बाकू रोकना

लिपिड उपचार

सामान्य श्रेणी के उच्च रक्तचाप नियंत्रण

सामान्य परिसर / संरचना स्क्रीनिंग

नेत्र रोग विशेषज्ञ की परीक्षा के साथ, अगर रेटिनोपैथी प्रतिवर्ष / वार्षिक रेटिनल टेस्ट की शुरुआत होती है,

द्विवार्षिक / हर दो साल

मौसमी टेस्ट / वार्षिक फुट / फुट टेस्ट

वार्षिक / वार्षिक माइक्रोक्रोबिनरी टेस्ट

यदि मोटापा वजन कम करने के लिए उचित रणनीतियों मौजूद है

  स्लीप एपनिया / नींद श्वास को पहचानें और उसका इलाज करें

 मूड विकारों / मानसिक विकारों को पहचानें और उनका इलाज करें

The top ten Diabetic countries , where is India ?

The Diabetes Epidemic

Picture of insulin

Isaac Yonemoto. - Transferred from en.wikipedia to Commons. First upload to en.wp by Takometer

Insulin Monomer created with en:pymol, en:inkscape, and en:gimp from NMR structure 1ai0 in the en:pdb. Ref: Chang, X., Jorgensen, A.M., Bardrum, P., Led, J.J

from Wikipedia 

The structure of insulin. The left side is a space-filling model of the insulin monomer, believed to be biologically active. Carbon is green, hydrogen white, oxygen red, and nitrogen blue. On the right side is a ribbon diagram of the insulin hexamer, believed to be the stored form. A monomer unit is highlighted with the A chain in blue and the B chain in cyan. Yellow denotes disulfide bonds, and magenta spheres are zinc ions.

Diabetes Diagnosis

ADA Diabetes classification a picture

The complexity of the endocrine system

 When  Best and Banting discovered Insulin

hope was  Diabetes will be cured!But Alas! our hopes were dashed because the endocrine system is so intermeshed with the Psycho, neuro, immune, systems.
 even without taking  those  things into the discussion the  hormones which affect the sugar  themselves are  many and  their actions  very complex and  sometimes  unpredictable

Hormones Synthesized and Secreted by Dedicated Endocrine Glands

Pituitary Gland

Growth hormone (GH)

Prolactin

Adrenocorticotropic hormone (ACTH)

Thyroid-stimulating hormone (TSH)

Follicle-stimulating hormone (FSH)

Luteinizing hormone (LH)

Thyroid Gland

Tetraiodothyronine (T 4 ; thyroxine)

Triiodothyronine (T 3 )

Calcitonin

Parathyroid Glands

Parathyroid hormone (PTH)

Islets of Langerhans (Endocrine Pancreas)

Insulin

Glucagon

Somatostatin

Adrenal Gland

Epinephrine

Norepinephrine

Cortisol

Aldosterone

Dehydroepiandrosterone sulfate (DHEAS)

Hormones Synthesized by Gonads

Ovaries

Estradiol-17β

Progesterone

Inhibin

Testes

Testosterone

Antimüllerian hormone (AMH)

Inhibin

Hormones Synthesized in Organs with a Primary Function Other Than Endocrine

Brain (Hypothalamus)

Antidiuretic hormone (ADH; vasopressin)

Oxytocin

Corticotropin-releasing hormone (CRH)

Thyrotropin-releasing hormone

Gonadotropin-releasing hormone (GnRH)

Growth hormone–releasing hormone (GHRH)

Somatostatin

Dopamine

Brain (Pineal Gland)

Melatonin

Heart

Atrial natriuretic peptide (ANP)

Kidney

Erythropoietin

Adipose Tissue

Leptin

Adiponectin

Stomach

Gastrin

Somatostatin

Ghrelin

Intestines

Secretin

Cholecystokinin

Glucagon-like peptide-1 (GLP-1)

Glucagon-like peptide-2 (GLP-2)

Glucose-dependent insulinotropic peptide (GIP; gastrin inhibitory peptide)

Motilin

Liver

Insulin-like growth factor-1 (IGF-I)

Hormones Produced to a Significant Degree by Peripheral Conversion

Lungs

Angiotensin II

Kidney

1α,25-dihydroxyvitamin D

Adipose, Mammary Glands, Other Organs

Estradiol-17β

Liver, Sebaceous Gland, Other Organs

Testosterone

Genital Skin, Prostate, Other Organs

5-Dihydrotestosterone (DHT)

Many Organs

T 3

The Role of Physical Activity in the Prevention of Type 2 Diabetes

The Role of Physical Activity in the Prevention of Type 2 Diabetes
Dinesh Nagi

Mostly excerpted  from

 Exercise and Prevention of Type 2 Diabetes

 Due to considerable expense associated with complications of type 2 diabetes.2 Primary prevention of type 2 diabetes is, therefore, of particular interest to health economists as it has in-built secondary and tertiary prevention of complications related to diabetes.
let us look at
recently published randomized trials, which have used lifestyle intervention, including physical activity, to reduce or prevent type 2 diabetes.

 However, we must remember that these studies were performed in subjects at high risk of future diabetes and not in those with normal glucose tolerance.
 Therefore findings of these trials may not be applicable to the population at large.
Therefore, in any community-based or public health approach to prevent diabetes and related diseases such as coronary heart disease, this is important for effective utilization of resources.

Type 2 diabetes has a number of disease characteristics which make it potentially a preventable disease.

 Considerable knowledge exists about risk factors for diabetes which are potentially modifiable
 Although there is a strong genetic predisposition to this disease, environmental factors play an important role in the development of clinical diabetes.
It is also clear that both insulin resistance and defective insulin secretion contribute to the development of diabetes,
 Although the relative contribution of each of these two components varies in different populations and individuals within a population.
In most subjects predisposed to develop type 2 diabetes, there is generally a long but variable period during which minor degree of glucose intolerance exists
 This stage of pre-diabetes can be recognized by performing an oral glucose tolerance test and is known as impaired glucose tolerance (IGT).
 It can also be diagnosed by measuring fasting plasma glucose, known as impaired fasting glucose (IFG).
 Subjects thus identified are at a higher risk of future diabetes compared with those whose glucose tolerance is normal.
 Identification of subjects at high risk of diabetes provides us with an opportunity to modify the disease process, either to delay or prevent it from becoming clinically manifest. As in type 2 diabetes, insulin resistance and defective insulin secretion contribute to the development of IGT and IFG.

Both of these defects can be modified through lifestyle interventions and/or pharmacological therapies.
 In spite of this, it has only recently been shown that type 2 diabetes can be prevented.
 Behaviour modification through diet and exercise are attractive and have the added advantage of modifying other associated conditions such as coronary artery disease, hypertension, and obesity.

 However, lifestyle modifications are extremely difficult to sustain over the lifetime of a given individual.

In addition, it is likely that different strategies may need to be adopted in different ethnic groups to improve adherence to measures which will promote healthy lifestyles.
 It has been known for some time that physical inactivity is associated with increased risk of type 2 diabetes. 
The results of various epidemiological and observational studies showed that regular physical activity had a protective effect on the development of type 2 diabetes.
These studies were remarkable for their consistent findings in the protective effects of physical activity on the occurrence of type 2 diabetes.
 In addition, some of the studies also showed a dose-response relationship between the frequency of physical activity and the degree of protective effect.
 These studies suggested a causative role for physical inactivity in type 2 diabetes.

the incidence of diabetes was negatively related to the frequency of exercise
. The age-adjusted risk of diabetes in men who exercised at least once a week was 0.64 compared to those who exercised less frequently.
 The protective effect of exercise was unrelated to baseline body mass index (BMI) and was more marked in obese subjects.

 leisure time physical activity, expressed as the number of calories expended was found to be inversely related to the development of diabetes.
The age-adjusted risk of diabetes was 6 percent lower for each 500 kcal expended.
 These beneficial effects of exercise remained significant when adjusted for the confounding effects of obesity, blood pressure and parental history of diabetes.

women who participated in a vigorous physical activity at least once a week had a 33 percent lower risk of diabetes compared with those who did not take part in such activities.

 in both men and women in the highest quintile of physical activity, the risk of diabetes was approximately half compared with the rest.
self-reported moderate intensity exercise undertaken for 40 min per week was associated with 56 percent lower risk of type 2 diabetes.
They also found that high levels of cardiorespiratory physical fitness (O2 consumption in a respiratory chamber) also had a protective effect on the development of diabetes.
In subjects who were at high risk of diabetes, with even a moderate degree of physical activity taken once a week for more than 40 min, the risk of diabetes was 64 percent lower than those who did not take part in physical activity.

 The major concern in the use of lifestyle intervention to prevent diabetes has been around the issue of long-term sustainability of this intervention.

The study by Eriksson et al.,  showed that it was possible for subjects to comply with a behavior modification for up to 6 years, with good outcomes even after a 12-year follow-up.

 Lifestyle interventions in the form of diet and physical activity for up to 6 years significantly reduced the development of diabetes. The effects of diet or exercise were similar, i.e. both reduced the risk of diabetes.
 In general, lifestyle interventions were equally effective irrespective of age or Gender.
They were more advantageous in older people with a lower body mass index, compared with younger persons and those with higher body mass index.
Of major interest were the findings that both lifestyle intervention and metformin were similarly effective in restoring fasting glucose, but lifestyle intervention was more effective in restoring post-load glucose values.

 STOP-NIDDM study, acarbose was evaluated in a placebo controlled trial in subjects with IGT.27 After a mean follow-up of 3.3 years, the absolute risk reduction was 9 percent in acarbose group and relative risk was reduced by 36 percent when diabetes was confirmed with a second OGTT.

The results of the XENDOS trial have been published, in which orlistat and lifestyle intervention reduced risk of diabetes by 37 per cent compared with lifestyle alone.

 pharmacological interventions may appear to be a more attractive option for preventing diabetes. However, lifestyle interventions have the potential to impact multiple disease states.
Diabetes prevention is a major public health issue in populations with high prevalence of type 2 diabetes, such as Asian Indians, as the rates of diabetes are projected to double over the next 20 years.

 It remains for the health policymakers to make this a public health issue and urgent intervention trials are needed in these populations.
\The results of the Diabetes Prevention Trial in the Indian population are currently underway and we await the results with eagerness. However, lifestyle interventions in different racial groups may be particularly challenging,
 when intervening with lifestyle measures, different strategies may need to be adopted in different racial groups.
 In a study reported from Tanzania in people of Hindu religion, simple dietary advice to eat less and exercise more in the form of walking for 30 min per day, resulted in protection from progression to diabetes

 In most studies of lifestyle interventions, there was a tendency towards a reduction in risk factors for cardiovascular disease such as total and LDL cholesterol and triglyceride and a decrease in systolic and diastolic blood pressure.
A high priority is not only to prevent or delay the onset of diabetes, but to reduce the future risk of macrovascular disease as well so that excess morbidity and mortality from manifestations of cardiovascular disease can be reduced.

 There would appear to be a greater urgency to develop strategies to prevent type 2 diabetes, given that diabetes seems to be appearing at a younger and younger age and in some countries in children and adolescents.
 On the other hand, for the results of clinical trials to prevent diabetes to be meaningful, the results need to be generalizable, but the methods need to be affordable, practical and acceptable so that these can be easily implemented.

the following conclusions and recommendations may seem logical: Increase physical activity in the population at large by low-cost, low-key, but effective interventions (population approach).

  More intensive intervention should be aimed at those at high risk and a strategy is needed to identify these individuals (high risk approach).
Those who are at high risk may need to be categorized in terms of their preference and ability to comply with various interventions so that intervention can be targeted.
 This may be crucial for the cost-effective utilization of resources, as some people may not choose to or be able to increase physical activity and therefore, may rely predominantly on dietary and/or pharmacological manipulations.
 In a given population both approaches will be required to complement each other, as interventions in high-risk people are more likely to be successful if all the population is geared to some sort of low-key interventions.
 However, this would need a clear and effective strategy to identify those at high risk by easy and effective means to target intervention.

స్వయంప్రతిష్పం/ఆటనోమిక్ నెర్వ్ సిస్టం పనిచేయకపోవడం సూచించే లక్షణాలు మరియు దోషాలు Symptoms and signs suggestive of autonomic dysfunction in diabetes mellitus

Symptoms and signs suggestive of autonomic dysfunction
 స్వయంప్రతిష్పం/ఆటనోమిక్  నెర్వ్ సిస్టం  పనిచేయకపోవడం సూచించే లక్షణాలు మరియు దోషాలు 
 Sympathetic  సింపథెటిక్   నాడీ వ్యవస్థ                          Parasympathetic   పారాసింపథెటిక్                                                              
                                                                 
 Failure of pupils to dilate in the dark   
చీకటిలో కనుపాప వ్యాకోచం చెందకపోవడం                              Fixed dilated pupils
                                                                                             మారని వ్యాకోచించిన  ప్యూపిల్
 Fainting, orthostatic dizziness
                                                                                            Lack of pupillary accommodation
మూర్ఛ, ఆర్థోస్టాటిక్ మైకము                                           కంటిపాపపై వసతి లేకపోవడం

                                       
Constant heart rate with orthostatic hypotension         Sweating during mastication of certain foods
ఆర్థోస్టాటిక్ హైపోటెన్షన్తో స్థిరమైన హృదయ స్పందన రేటు
                                                                             కొన్ని ఆహారాలు నమలే సమయంలో స్వేటింగ్/చెమట

Absent piloerection   గైర్హాజరు
  గగురుపాటు                                                        Decreased gut motility    తగ్గిన గట్ చలనము
Absent sweating చెమట పట్టుట కరువవడంతో
                                                                                      Dry eyes and mouth పొడి కళ్ళు మరియు నోరు
Impaired ejaculation   /బలహీనమైన స్ఖలనం                             Dry vagina /పొడి యోని
Paralysis of dartos muscle   
డార్టోస్ కండరాల పక్షవాతం                                          Impaired erection /ఇంపెయిర్డ్ అంగస్తంభన
                                                                                                        బలహీనమైన అంగస్తంభన

                                                                                            Difficulty with emptying urinary bladder;
                                                                                   మూత్రాశయం  ఖాళీ చేసేందుకు  కష్టపడడం;

                                                                                                recurrent urinary tract infections
                                                                                    పునరావృత మూత్ర మార్గము అంటువ్యాధులు

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