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Complications associated with diabetes are a consequence of acute disturbance in glucose metabolism in a human body. The most significant complication of diabetes is bone disorders which contributes to high levels of bone disability. This study included 118 diabetic patients, 56 males, 62 females, and 60 healthy non-diabetic controls, 30 males, 30 females. The patients and controls were age matched. Circulating levels of bone function markers (osteoprotegerin, vitamin D, PTH, total calcium and inorganic phosphorus) were determined in all subject groups. The data obtained from this study showed that the serum levels of osteoprotegerin had significantly increased in both diabetic male & female in both age ranges which were 496.3±61.46 pg/mL & 335.7±29.33 pg/mL; 329.8±48.78 pg/mL & 219.9±18.72 pg/mL respectively, in comparison with its level in control matched age ranges 294.6±26.19 pg/mL & 226.8±28.07 pg/mL; 215.7±31.85 pg/mL & 171.9±14.19 pg/mL respectively. Serum calcium concentration had non-significantly increased both in the diabetic males and females in both age ranges which were 11.10±0.46 mg/dL & 11.76±0.74 mg/dL; 10.33±0.33 mg/dL & 10.28±0.48 mg/dL respectively, when compared with its level in control matched age ranges 10.46±0.34 mg/dL & 10.14±0.35 mg/dL;9.69±0.41 mg/dL & 10.08±0.45 mg/dL. Serum vitamin D, parathyroid hormone (PTH) and inorganic phosphorus concentrations had significantly decreased both in the diabetic male and female subjects in both age ranges which were 5.78±1.30 ng/mL and 2.47±0.12 ng/mL; 9.47±1.98 ng/mL, and 10.70±2.11 ng/mL; 74.78±7.42 pg/mL & 67.83±3.69 pg/mL;42.94±2.00 pg/mL & 15.51±1.98 pg/mL; 4.34±0.27 mg/dL & 4.76±0.35 mg/dL; 4.38±0.21 mg/dL; 5.12±0.44 mg/dL respectively when compared with their level in control matched age ranges 13.07±2.13 ng/mL & 15.53±3.40 ng/mL; 57.49±5.64 pg/mL & 62.61±3.71 pg/mL; 5.12±0.44 mg/dL & 5.35±0.37 mg/dL respectively. The current results suggest that circulating levels of osteoprotegerin play a crucial role in biological mechanism of type (II) diabetes, and are possible biomarkers of insulin resistance and progression of many serious health problems associated with diabetes.

The current investigation aimed to test the alterations of the levels of obestatin hormone, lipid profile and cardiac function markers in relation to hyperglycemia in patients with non-insulin diabetes mellitus. The study included 118 diabetic subjects (56 males, 62 females) and 60 healthy non-diabetic subjects (30 males, 30 females). Diabetic and healthy subjects were age-matched. Serum levels of obestatin, lipid profile markers including total cholesterol (STC), triglycerides (STG), low and high density lipoproteins (LDL-C and HDL-C), as well as cardiac function markers including, creatine kinase and lactate dehydrogenase enzymes were determined in all subjects. The findings revealed a remarkable decrease in the level of serum obestatin in both diabetic males and females with both age ranges (40-59 and 60-80 years). On the other hand, the results showed that serum STC, LDL-C, and STG levels were statistically significantly elevated, while that for HDL-C was significantly decreased in diabetic males and females with both age ranges. Concerning the cardiac markers, the results found out that the levels of CK-MB and LDH were significantly increased in type 2 diabetic males and females with both age ranges. The results suggested that a low concentration of obestatin is a significant risk factor for type 2 DM, with a key role for this hormone in the pathogenesis. Accordingly, altered levels of obestatin could be used as an important indicator for type 2 DM. The current study also suggests a direct relationship between lipid profiles, except for HDL, the decreased obestatin level, the increased cardiac function markers, and hyperglycemic status in type 2 DM.

This study aimed at the investigation of abnormal liver and renal functions by biochemical manifestations of underlying metabolic abnormalities in relation to hyperglycemia in non-insulin-dependent diabetic patients. The study comprised 118 diabetic patients (56 males, 62 females) and 60 age-matched healthy non-diabetic controls (30 males, 30 females). All subjects were tested for serum levels of liver enzymatic indicators, which include aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP), as well as non enzymatic parameters, including total bilirubin and total proteins.Also, serum levels of renal function markers, including microalbumin, creatinine, urea, and uric acid were measured.
The findings of this study stated that serum ALT, AST, and ALP levels were significantly higher in diabetic males and females with both age ranges (40-59 & 60-80 years). Serum total bilirubin level showed a significant decrease in diabetic males and females of both age groups. However, total proteins level showed a significant increase in diabetic males and females of both age groups. The results also showed that the level of microalbumin in urine as well as those of creatinine, urea, and uric acid in the serum were significantly higher in diabetic males and females. The present study concludes that there is a bidirectional relationship of enzymatic and non enzymatic liver and renal functions markers with the hyperglycemic status in Type 2 diabetes mellitus.

In this article a proposal of a non‐traditional methodology in achieving optimal flexibility with minimal inventory risk will be applied. The non‐traditional methodology will be able to achieve different levels of the production schedule changes with maximum flexibility and minimal inventory risk. The basic principle, implementation methodology as well as its effectiveness and benefits will be discussed. In order to overcome the risk of achieving flexible manufacturing or enhancing supply chain management, this article will address issues on methods to accommodate production sequence changes which include total production quantity change in a short lead time. The study uses the Family Ordering System methodology which has proven capable in solving manufacturing flexibility issues by reducing the total manufacturing lead time. Family Ordering System provides the flexibility of model changes and reduces production line stoppage as a result of part shortage by carrying extra inventory of unique parts.

There are a variety of structural and systems frameworks for describing the building blocks of country's public health and health systems. In this paper, we propose a conceptual framework for a holistic view of a country's health service providers in order to inform the plan for Defence Health Engagement activities with partner countries. This includes all potential government ministries involved in healthcare provision, the independent, private sector and the non-government organisation/charity sector. The framework provides a visualisation to support the analysis of a country's health services providers. We propose that recognising and analysing the different contributions of all these national health providers is essential for understanding the wider political economy of a nation's health systems. This can inform a plan of Defence Health Engagement for capacity building in crisis response, development and health systems strengthening.

There are a variety of structural and systems frameworks for describing the building blocks of country's public health and health systems. In this paper, we propose a conceptual framework for a holistic view of a country's health service providers in order to inform the plan for Defence Health Engagement activities with partner countries. This includes all potential government ministries involved in healthcare provision, the independent, private sector and the non-government organisation/charity sector. The framework provides a visualisation to support the analysis of a country's health services providers. We propose that recognising and analysing the different contributions of all these national health providers is essential for understanding the wider political economy of a nation's health systems. This can inform a plan of Defence Health Engagement for capacity building in crisis response, development and health systems strengthening.

There are a variety of structural and systems frameworks for describing the building blocks of country's public health and health systems. In this paper, we propose a conceptual framework for a holistic view of a country's health service providers in order to inform the plan for Defence Health Engagement activities with partner countries. This includes all potential government ministries involved in healthcare provision, the independent, private sector and the non-government organisation/charity sector. The framework provides a visualisation to support the analysis of a country's health services providers. We propose that recognising and analysing the different contributions of all these national health providers is essential for understanding the wider political economy of a nation's health systems. This can inform a plan of Defence Health Engagement for capacity building in crisis response, development and health systems strengthening.

On 8 June 2013, the Vice President of Zambia stated that his government 'is fully committed to reducing chronic undernutrition by 50 per cent in the next ten years…' What are the challenges to meeting this goal? Zambia has both a high consumption of groundnuts and high levels of aflatoxin contamination of this commodity. Recent studies indicate an association between stunting and aflatoxin exposure. If the association exists, then Zambia faces serious challenges to reaching its target of 50 per cent reduction in chronic undernutrition. Recent efforts to identify atoxigenic strains for biocontrol in maize and groundnuts give cause for cautious optimism. Nonetheless, the challenges ahead demand both a high level of political will to achieve effective multisectoral collaboration and the willingness of the agricultural and health sectors to undertake rigorous monitoring of aflatoxin contamination and growth of young children, as well as the agricultural sector's commitment to reduce substantially levels of aflatoxin contamination and to promote agricultural diversification. ; Peer Review

SummaryThis investigation was part of a longitudinal study of mental development of seventeen Jamaican children who were admitted to hospital with severe protein energy malnutrition. The children were compared with 20 adequately nourished children who were admitted to hospital for other reasons.Previous research had shown that, 1 month after the children left hospital, both groups had similar scores on a modified Caldwell Inventory of Home Stimulation. When, in the present investigation, the inventory was repeated 24 months later, scores remained similar in both groups. When compared with data collected from a survey in a poor neighbourhood, again the scores of the neighbourhood children were similar to those of the malnourished group. The malnourished children were however living in poorer houses and had failed to catch up to the other groups in nutritional status.Comparison of these findings with those from other countries suggests that the ecology of malnutrition differs in different cultures and that Jamaican mothers of malnourished children are characterized by poverty rather than poor maternal–child relationships.It also appears that, at this age, poor levels of home stimulation were not a major factor in producing the deficit in development manifested by the malnourished group.

Introduction: As of January 2020, 115,600 refugees remain in Greece; most are Afghani, Iraqi or Syrian nationals. This qualitative research study explores the views of key stakeholders providing healthcare for refugees in Greece between 2015 and 2018. The focus was on identifying key barriers and facilitators to healthcare access for refugees in Greece. Methods: 16 interviewees from humanitarian and international organisations operating in Greece were identified through purposive and snowball sampling. Semi-structured interviews were conducted between March and April 2018. Data were analysed using the Framework Method. Results: Key themes affecting healthcare access included the influence of socio-cultural factors (healthcare expectations, language, gender) and the ability of the Greek health system to respond to existing and evolving demands; these included Greece's ongoing economic crisis, human resource shortages, weak primary healthcare system, legal barriers and logistics. The evolution of the humanitarian response from emergency to sustained changes to EU funding, coordination and comprehensiveness of services affected healthcare access for refugees. Conclusion: The most noted barriers cited by humanitarian stakeholders to healthcare access for refugees in Greece were socio-cultural and language differences between refugees and healthcare providers and poor coordination among stakeholders. Policies and interventions which address these could improve healthcare access for refugees in Greece with coordination led by the EU.