BackgroundLong intervals between patient visits and limited time with patients can result in clinical inertia and suboptimal achievement of treatment goals. These obstacles can be improved with a multidisciplinary care program. The present study aimed to assess the impact of such a program on glycemic control and cardiovascular risk factors.MethodsIn a randomized, parallel-group trial, we assigned 263 patients with poorly controlled type 2 diabetes mellitus (T2DM) to either a control group, standard care program, or a multidisciplinary care program involving a senior family physician, clinical pharmacy specialist, dietician, diabetic educator, health educator, and social worker. The participants were followed for a median of 10 months, between September 2013 and September 2014. Glycated hemoglobin (HbA1c), fasting blood glucose (FBG), lipid profiles, and blood pressure (BP) were measured. The assignment was blinded for the assessors of the study outcomes. The study registry number is.ResultsIn the intervention group, there were statistically significant (p < 0.05) post-intervention (relative) reductions in the levels of HbA1c (−27.1%, 95% CI = −28.9%, −25.3%), FBG (−17.10%, 95% CI = −23.3%, −10.9%), total cholesterol (−9.93%, 95% CI = −12.7%, −7.9%), LDL cholesterol (−11.4%, 95% CI = −19.4%, −3.5%), systolic BP (−1.5%, 95% CI = −2.9%, −0.03%), and diastolic BP (−3.4%, 95% CI = −5.2%, −1.7%). There was a significant decrease in the number of patients with a HbA1c ≥10 (86 mmol/mol) from 167 patients at enrollment to 11 patients after intervention (p < 0.001). However, the intervention group experienced a statistically significant increase in body weight (3.7%, 95% CI = 2.9%, 4.5%). In the control group, no statistically significant changes were noticed in different outcomes with the exception of total cholesterol (−4.10%, p = 0.07). In the linear regression model, the intervention and the total number of clinic visits predicted HbA1c improvement.ConclusionsImplementation of a patient-specific integrated care program involving a multidisciplinary team approach, frequent clinic visits, and intensified insulin treatment was associated with marked improvement in glycemic control and cardiovascular risk factors of poorly controlled T2DM patients in a safe and reproducible manner.Trial registrationISRCTN Identifier: ISRCTN83437562 September 19, 2016 Retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s12875-017-0677-2) contains supplementary material, which is available to authorized users.

The traditional medicine based on medicinal plants in the Kingdom of Arabia Saudia presents a strong relationship belonging to natural remedies, health, diet, and folk healing practice recognized by a specific culture. The aim of the current study is to carry out an ethnobotanical review on medicinal plants used in traditional medicine in the Kingdom of Arabia Saudia including information on plant species, used parts, preparation method as well as medical uses. Earlier published data in journals, textbooks, periodicals, websites, and databases written in pharmacological evidence of Suadi medicinal plants were based on gathering information. The present review work reported that 96 species belonging to 47 families have been used in Saudi Pharmacopeia. Amaranthaceae has the highest number of plant species (7) Followed by Asteraceae, Apocynaceae, and Fabaceae with 5 plant species in each. The inventoried plant species in the current work are frequently used for the treatment of various illnesses and to ensure the medication safety of Saudi people. The biological analysis of plant form used in Saudi natural remedies showed the dominance of herb and subshrub form with a percentage of 43% and 30% respectively. The most used preparation method of plant drugs, which used in Saudi Alternative medicine was decoction and infusion. The whole plant, leaves, seeds, and aerial parts were the most useful plant parts in natural preparation in Saudi traditional medicine with a percentage of 29%, 28%, 7%, and 5% respectively as reported in the present review work. The present review work gives big data about medicinal plants used in traditional medicine in the Kingdom of Saudi Arabia including data about plant species, used parts, preparation method as well as medical uses.

Withania frutescens L. is a wild perennial woody plant used by the local population for diverse therapeutic purposes. This work aims to study for the first time the potential inhibitory effect of this plant hydroethanolic extract on α-amylase and α-glucosidase activities using in vitro methods and its antidiabetic and antihyperglycemic activities using alloxan-induced diabetic mice as a model for experimental diabetes. Two doses were selected for the in vivo study (200 and 400 mg/kg) and glibenclamide, a well-known antidiabetic drug (positive control) in a subacute study (28 days) where the antihyperglycemic activity was also assessed over a period of 12 h on diabetic mice. The continuous treatment of diabetic mice with the extract of Withania frutescens for 4 weeks succeeded to slowly manage their high fasting blood glucose levels (after two weeks), while the antihyperglycemic test result revealed that the extract of this plant did not control hyperglycemia in the short term. No toxicity signs or death were noted for the groups treated with the plant extract, and it shows a protective effect on the liver and kidney. The in vitro assays demonstrated that the inhibition of alpha-amylase and alpha-glucosidase might be one of the mechanisms of action exhibited by the extract of this plant to control and prevent postprandial hyperglycemia. This work indicates that W. frutescens have an important long term antidiabetic effect that can be well established to treat diabetes.

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Purpose To assess the impact of different surface treatments on the push-out bond strength between fiber post and a composite resin core material. Material and methods Seventy-two glass-fiber posts were randomly assigned into six groups according to the method of surface treatment: Control (no treatment), silane, sandblasting, hydrofluoric acid, hydrogen peroxide, and hydrogen peroxide with sandblasting. Two posts from each group were inspected under a scanning electron microscope to assess the surface modifications and 10 posts were employed for the push-out test. Each post was placed vertically in the middle of a cylindrical putty matrix and a dual-cure composite resin material was applied for core build-up. Two discs of each specimen were cut using a low-speed diamond saw (total 120 discs). The push-out test was executed using a universal testing machine at a crosshead speed of 0.5 mm/min. Statistical analysis was performed using one-way ANOVA and Tukey’s test ( p ≤ 0.05). The mode of failure of each disc was evaluated under SEM. Results The sandblasting and hydrofluoric acid groups presented significantly higher bond strength than control and hydrogen peroxide groups. The hydrogen peroxide groups exhibited significantly the lowest bond strength of all groups. There was no significant difference between the control and silane groups. All groups showed predominantly adhesive failure except the hydrogen peroxide with sandblasting, where the cohesive failure of the post was predominant. Conclusions Sandblasting and hydrofluoric acid surface treatments demonstrated superior results to silane and hydrogen peroxide. The combined method of hydrogen peroxide and sandblasting could weaken the fiber post and lead to clinical fractures.