BackgroundDepression and anxiety are common in diabetic patients; however, in recent years the frequency of these symptoms has markedly increased worldwide. Therefore, it is necessary to establish the frequency and factors associated with depression and anxiety, since they can be responsible for premature morbidity, mortality, risk of developing comorbidities, complications, suffering of patients, as well as escalation of costs. We studied the frequency of depression and anxiety in Mexican outpatients with type 2 diabetes and identified the risk factors for depression and anxiety.Methods and FindingsWe performed a study in 820 patients with type 2 diabetes. The prevalence of depression and anxiety was estimated using the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale, respectively. We calculated the proportions for depression and anxiety and, after adjusting for confounding variables, we performed multivariate analysis using multiple logistic regressions to evaluate the combined effect of the various factors associated with anxiety and depression among persons with type 2 diabetes. The rates for depression and anxiety were 48.27% (95% CI: 44.48–52.06) and 55.10% (95% CI: 51.44–58.93), respectively. Occupation and complications in diabetes were the factors associated with anxiety, whereas glucose level and complications in diabetes were associated with depression. Complications in diabetes was a factor common to depression and anxiety (p<0.0001; OR 1.79, 95% CI 1.29–2.4).ConclusionsOur findings demonstrate that a large proportion of diabetic patients present depression and/or anxiety. We also identified a significant association between complications in diabetes with depression and anxiety. Interventions are necessary to hinder the appearance of complications in diabetes and in consequence prevent depression and anxiety.

BackgroundTraditional plant treatment for diabetes has shown a surging interest in the last few decades. Therefore, the purpose of this study was to assess the hypoglycemic effect of the aqueous extract of C. papaya leaves in diabetic rats. Several studies have reported that some parts of the C. papaya plant exert hypoglycemic effects in both animals and humans.MethodsDiabetes was induced in rats by intraperitoneal administration of 60 mg/kg of streptozotocin (STZ). The aqueous extract of C. papaya was administered in three different doses (0.75, 1.5 and 3 g/100 mL) as drinking water to both diabetic and non-diabetic animals during 4 weeks.ResultsThe aqueous extract of Carica papaya (0.75 g and 1.5 g/100 mL) significantly decreased blood glucose levels (p<0.05) in diabetic rats. It also decreased cholesterol, triacylglycerol and amino-transferases blood levels. Low plasma insulin levels did not change after treatment in diabetic rats, but they significantly increased in non-diabetic animals. Pancreatic islet cells were normal in non-diabetic treated animals, whereas in diabetic treated rats, C. papaya could help islet regeneration manifested as preservation of cell size. In the liver of diabetic treated rats, C. papaya prevented hepatocyte disruption, as well as accumulation of glycogen and lipids. Finally, an antioxidant effect of C. papaya extract was also detected in diabetic rats.ConclusionsThis study showed that the aqueous extract of C. papaya exerted a hypoglycemic and antioxidant effect; it also improved the lipid profile in diabetic rats. In addition, the leaf extract positively affected integrity and function of both liver and pancreas.

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Background Ozone therapy has been used widely to decrease pain related to osteoarthritis, but the effectiveness of this treatment has not been evaluated. Objective To evaluate the effectiveness of ozone therapy in the reduction of pain in patients with knee osteoarthritis, according to the type of intervention and duration of the effect. Type Meta‐analysis. Literature Survey We performed an online search using PUBMED, DIALNET, SCIELO, MEDIGRAPHIC, and ISCO3 databases. We searched for articles published up to January 2018. Participants We selected eight studies including a total of 355 patients and 363 controls. Methodology Only randomized‐controlled trials that assessed the efficacy of intraarticular or periarticular infiltrations with ozone to treat knee osteoarthritis in humans were included in the analysis. The results are expressed as standardized mean difference and 95% confidence intervals. The meta‐analysis was performed in accordance with the statement of Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Synthesis We observed that ozone treatment had a therapeutic effect when compared with placebo (d = −0.81, 95% CI −1.06 to −0.55, I2 = 34.79, P(Q) = .47) or other noninvasive treatments. No significant effects were found in favor of the ozone treatment when compared with the use of hyaluronic acid or platelet‐rich plasma. However, the use of ozone had a significant short‐term benefit reducing knee pain (d = −2.26, 95% CI −2.26 to −3.72, I2 = 97, P(Q) < .001). Pain relief benefits lasted between 3 and 6 months. Conclusion Our results indicate that intraarticular infiltrations of ozone can be used as an optional effective treatment for the management of pain related to knee osteoarthritis. There are short‐term effect benefits that peak at around 1 month of treatment, with a gradual decline in efficacy after 3 to 6 months of treatment. More studies are needed to improve our understanding of the efficacy of this interventional treatment. Level of Evidence I

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BackgroundThe aim of this study was to evaluate the actions of coenzyme Q10 (CoQ10) on rats with a cholesterol-rich diet (HD) and high doses of atorvastatin (ATV, 0.2, 0.56 or 1.42 mg/day).MethodsTwo experiments were done, the first one without coenzyme Q10 supplementation. On the second experiment all groups received coenzyme Q10 0.57 mg/day as supplement. After a 6-week treatment animals were sacrificed, blood and liver were analyzed and liver mitochondria were isolated and its oxygen consumption was evaluated in state 3 (phosphorylating state) and state 4 (resting state) in order to calculate the respiratory control (RC).ResultsHD increased serum and hepatic cholesterol levels in rats with or without CoQ10. ATV reduced these values but CoQ10 improved even more serum and liver cholesterol. Triacylglycerols (TAG) were also lower in blood and liver of rats with ATV + CoQ10. HDL-C decreased in HD rats. Treatment with ATV maintained HDL-C levels. However, these values were lower in HD + CoQ10 compared to control diet (CD) + CoQ10. RC was lessened in liver mitochondria of HD. The administration of ATV increased RC. All groups supplemented with CoQ10 showed an increment in RC. In conclusion, the combined administration of ATV and CoQ10 improved biochemical parameters, liver function and mitochondrial respiration in hypercholesterolemic rats.ConclusionsOur results suggest a potential beneficial effect of CoQ10 supplementation in hypercholesterolemic rats that also receive atorvastatin. This beneficial effect of CoQ10 must be combined with statin treatment in patient with high levels of cholesterol.

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