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Background Teledermatopathology has the potential to link underserved areas to experts across the country and assist in making quick diagnoses, which may improve health care costs and delivery. Despite these potential benefits, teledermatopathology is not used routinely for primary diagnosis in the United States. Objective To assess the current status of and address the potential for improving health care by the use of teledermatolopathology for primary diagnosis. Methods Current available literature and online resources were reviewed to address 3 major variables that hinder the widespread use of teledermatopathology: diagnostic accuracy, licensure requirements, and reimbursement. Results Recent studies show similar diagnostic accuracy for this technology compared to conventional microscopy. State-to-state variation and ambiguity in laws serve as the biggest hurdles to the widespread use of teledermatopathology. More states are recognizing the importance of the implementation of specific laws regarding telemedicine. More studies are required to evaluate the systems that offer specific telemedicine licenses, in addition to those that pay for telemedicine services specifically. Limitations This study reviewed current legislation concerning teledermatopathology; these laws are subject to revision. Conclusion Improving diagnostic accuracy and limiting variations in policy and reimbursement may encourage more pathologists to use teledermatopathology technology.

Nut consumption has been found to decrease risk of coronary heart disease and diabetes and to promote healthy body weights possibly related to their favorable macronutrient profile. We therefore assessed the effect of pistachios on postprandial glucose and insulin levels, gut hormones related to satiety and endothelial function. In this randomized crossover study, 20 subjects with metabolic syndrome consumed five study meals over 5–10 weeks. The meals differed in fat type and quantity, but were matched according to available carbohydrates (CHOs). Three meals had 50 g available CHO: white bread (WB50g), white bread, butter and cheese (WB+B+Ch) and white bread and pistachios (WB+P). Two meals had 12 g available CHO: white bread (WB12g) and pistachios (P). Within each group of available CHO meals, postprandial glucose levels were the highest following the white bread-only meals, and glucose response was significantly attenuated when butter and cheese or pistachios were consumed (P

The health benefits of garlic (Allium sativum) as a naturopathic remedy have been well documented, but topical application of garlic has been linked to allergic and irritant contact dermatitis. We present a case of severe irritant contact dermatitis due to application of a fresh garlic necklace to the neck of infant for treatment of nasal congestion.

The intake of nuts has been linked to a reduced risk of cardiovascular disease (CVD) and diabetes in large cohort studies. One potential contributing mechanism may be the ability of nuts to improve post-meal glycemic response. We, therefore, examined the effect of nuts alone and in combination with white bread on postprandial glycemia.30, 60 and 90 g (approximately 1, 2 and 3 ounces) of mixed nuts were consumed with and without 50 g available carbohydrate from white bread by 10-14 normoglycemic and 5-10 type 2 diabetic subjects. Glycemic response (GR) was assessed by calculating the incremental area under the 2 h blood glucose curve. All three doses of mixed nuts, when fed alone, significantly reduced the glycemic response in both normoglycemic and diabetic patients. Furthermore, in the normoglycemic subjects, adding nuts to white bread progressively reduced the GR of the meal by 11.2 ± 11.6%, 29.7 ± 12.2% and 53.5 ± 8.5% for the 30, 60, and 90 g doses (P = 0.354, P = 0.031 and P 0.001, respectively), while in subjects with type 2 diabetes, the effect was half of that seen in the non-diabetic subjects (P = 0.474, P = 0.113 and P = 0.015, respectively).Nuts alone have little effect on post-meal blood glucose response. Furthermore, when taken with bread, nuts progressively reduce the glycemic response in a dose-dependent manner. While these findings support a short-term benefit for nuts in postprandial glucose response, more studies are required to determine whether these acute benefits result in long-term improvements in glycemic control.

Aims/hypothesis Sugar has been suggested to promote obesity, diabetes and coronary heart disease (CHD), yet fruit, despite containing sugars, may also have a low glycaemic index (GI) and all fruits are generally recommended for good health. We therefore assessed the effect of fruit with special emphasis on low GI fruit intake in type 2 diabetes. Methods This secondary analysis involved 152 type 2 diabetic participants treated with glucose-lowering agents who completed either 6 months of high fibre or low GI dietary advice, including fruit advice, in a parallel design. Results Change in low GI fruit intake ranged from −3.1 to 2.7 servings/day. The increase in low GI fruit intake significantly predicted reductions in HbA1c (r = −0.206, p = 0.011), systolic blood pressure (r = −0.183, p = 0.024) and CHD risk (r = −0.213, p = 0.008). Change in total fruit intake ranged from −3.7 to 3.2 servings/day and was not related to study outcomes. In a regression analysis including the eight major carbohydrate foods or classes of foods emphasised in the low GI diet, only low GI fruit and bread contributed independently and significantly to predicting change in HbA1c. Furthermore, comparing the highest with the lowest quartile of low GI fruit intake, the percentage change in HbA1c was reduced by −0.5% HbA1c units (95% CI 0.2–0.8 HbA1c units, p

The dietary pattern of humans has shifted towards a diet in which refined grains, meat, added fats and sugar are common and vegetable protein and fibre intake is low. This change in diet and the shift to a sedentary lifestyle is largely responsible for the increased prevalence of obesity and chronic diseases including type 2 diabetes, heart disease and cancer. Over the past forty years, traditional dietary approaches have been investigated as a remedy to these chronic diseases. In addition to high fibre diets, other dietary tools such as the dietary glycaemic index have been developed, which also link carbohydrate metabolism to chronic diseases. The current body of scientific literature supports the notion that high fibre diets are important in prevention and management of the aforementioned chronic diseases. However, these benefits may be amplified when dietary fibre intake is in the context of a low GI diet.

CHD is the leading cause of worldwide mortality. The prevalence of heart disease has been linked to the adoption of a sedentary lifestyle and the increased dietary dependence on saturated fats from animal sources and the intake of refined foods. Elevated blood cholesterol level is one of the major risk factors for CHD. While cholesterol-lowering drug therapy (statins) has been effective in reducing the risk of heart disease, there are those individuals who are unwilling or because of muscle pains or raised levels of liver or muscle enzymes are unable to take cholesterol-lowering medication. Fortunately, there is evidence linking a number of dietary components to CHD risk reduction. The strength of this evidence has prompted various regulatory bodies to advocate diet as the first line of defence for primary prevention of heart disease. It was therefore decided to combine four dietary components that have been shown to lower blood cholesterol concentrations (nuts, plant sterols, viscous fibre and vegetable protein) in a dietary portfolio in order to determine whether the combined effect is additive. In a metabolically-controlled setting this dietary portfolio has proved to be as effective as a starting dose of a first-generation statin cholesterol-lowering medication in reducing the risk of CHD. The dietary portfolio has also been shown to be effective in sustaining a clinically-significant effect in the long term under a ‘real-world’ scenario. However, success of the diet depends on compliance and despite the accessibility of the foods adherence has been found to vary greatly. Overall, the evidence supports the beneficial role of the dietary portfolio in reducing blood cholesterol levels and CHD risk.

Dietary non-oil-seed pulses (chickpeas, beans, peas, lentils, etc.) are a good source of slowly digestible carbohydrate, fibre and vegetable protein and a valuable means of lowering the glycaemic-index (GI) of the diet. To assess the evidence that dietary pulses may benefit glycaemic control, we conducted a systematic review and meta-analysis of randomised controlled experimental trials investigating the effect of pulses, alone or as part of low-GI or high-fibre diets, on markers of glycaemic control in people with and without diabetes.We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for relevant controlled trials ofor=7 days. Two independent reviewers (A. Esfahani and J. M. W. Wong) extracted information on study design, participants, treatments and outcomes. Data were pooled using the generic inverse variance method and expressed as standardised mean differences (SMD) with 95% CIs. Heterogeneity was assessed by chi (2) and quantified by I (2). Meta-regression models identified independent predictors of effects.A total of 41 trials (39 reports) were included. Pulses alone (11 trials) lowered fasting blood glucose (FBG) (-0.82, 95% CI -1.36 to -0.27) and insulin (-0.49, 95% CI -0.93 to -0.04). Pulses in low-GI diets (19 trials) lowered glycosylated blood proteins (GP), measured as HbA(1c) or fructosamine (-0.28, 95% CI -0.42 to -0.14). Finally, pulses in high-fibre diets (11 trials) lowered FBG (-0.32, 95% CI -0.49 to -0.15) and GP (-0.27, 95% CI -0.45 to -0.09). Inter-study heterogeneity was high and unexplained for most outcomes, with benefits modified or predicted by diabetes status, pulse type, dose, physical form, duration of follow-up, study quality, macronutrient profile of background diets, feeding control and design.Pooled analyses demonstrated that pulses, alone or in low-GI or high-fibre diets, improve markers of longer term glycaemic control in humans, with the extent of the improvements subject to significant inter-study heterogeneity. There is a need for further large, well-designed trials.

Postprandial hyperglycemia has been associated with increased oxidative stress and the development of diabetes, heart disease and all-cause mortality.To assess the effect of novel maize-based dietary fibers on postprandial glycemia and to assess the correlation between a rapid in vitro digestibility system and the blood glucose response.In a clinical study, 12 healthy volunteers were fed seven test beverages containing maize-based fiber ingredients (25g total carbohydrate) along with 2 control meals on separate occasions in random order. Capillary blood samples were obtained and the relative glycemic and insulinemic responses were assessed by calculating the incremental area under the 2 h blood response curves. In vitro digestibility studies of the test fibers and control were also undertaken to determine if these correlated with the clinical findings.All test fibers resulted in significantly lower glycemic and insulinemic responses for the incremental area under the curve (iAUC) and at all time points compared with the control (P0.05). The in vitro digestibility curves were comparable to the cumulative in vivo iAUCs. In vitro data expressed as percent digestion correlated significantly with the in vivo iAUC for the first 30min of the test meal (P0.05).These novel maize-based dietary fibers all produce lower postprandial glycemic and insulinemic responses than the control. While further assessment is necessary in beverage and foods containing these fibers, they may be effective in applications for dietary strategies to control diabetes and other chronic diseases. In addition, the in vitro digestibility assay correlated well with in vivo data and may be useful in guiding product development.

As Western populations age, the burden of associated chronic diseases, including diabetes, cardiovascular disease (CVD), and cancer will increase dramatically. In the United States in the next 50 years, it is projected that the percentage of adults with type 2 diabetes will exceed 30%, with the vast majority older than 65 years. It is therefore important to determine the best possible dietary and lifestyle modifications to prevent and control this disease and its associated complications. Although few data are available regarding the optimal nutritional regimen for the elderly with type 2 diabetes, as a general rule, the use of nutrient-dense, low glycemic index, high-dietary fiber foods with possibly higher protein intake is recommended.

Objectives Pulses are low glycemic index (GI) foods and have been associated with reduced risk of heart disease, diabetes and some cancers. However the blood glucose and insulin responses of hummus, a food containing chickpea, have not been thoroughly tested. Methods Ten healthy subjects each consumed 11 breakfast study meals in randomized order over a period of 15 weeks. Hummus was consumed alone at three doses (2.7 g, 10.8 g and 25 g available carbohydrate [avCHO] portions) and with 50 g avCHO from white bread at three doses (2.7 g, 5.4 g and 10.8 g avCHO portions). The responses elicited by hummus alone were compared with 25 g avCHO portions of white bread, while those after hummus plus white bread were compared with 50 g avCHO from white bread. Plasma glucose and serum insulin responses were monitored over two hours and the GI and insulin index (II) calculated using standard methodology. Results The GI and II of hummus were 15 ± 3 and 52 ± 13, respectively, and were significantly lower than white bread (P

Background: Pulses and chick peas are some of the lowest glycemic index (GI) foods and in clinical studies have been shown to improve glycemic control in type 2 diabetes. Hummus, composed of chick peas, vegetable oil and tahini, has a healthy macronutrient profile and is a popular and commonly consumed product. However few studies have assessed the potential health benefits of hummus consumption. The aim of present study was to determine the glycemic index of hummus and to assess the dose response effect of hummus on the post-prandial blood glucose and insulin responses when consumed alone or when combined with a high carbohydrate food. Methods: 10 healthy participants consumed breakfast study meals, in random order, on eleven occasions over a 6-10wk period: Study Meals: Phase 1: 1-3. White Bread (WB) Control (1) (25g available carbohydrate [avCHO]) 4. Hummus (1 serving [28g]) (2.7g avCHO) 5. Hummus (4 servings [112g]) (10.8g avCHO) 6. Hummus (9 servings [259g]) (25g avCHO) Phase 2: 7,8. WB Control (2) (5...

Objective Low-carbohydrate diets may be useful for weight loss. Diets high in vegetable proteins and oils may reduce the risk of coronary heart disease. The main objective was to determine the longer term effect of a diet that was both low-carbohydrate and plant-based on weight loss and low-density lipoprotein cholesterol (LDL-C). Design, setting, participants A parallel design study of 39 overweight hyperlipidaemic men and postmenopausal women conducted at a Canadian university-affiliated hospital nutrition research centre from April 2005 to November 2006. Intervention Participants were advised to consume either a low-carbohydrate vegan diet or a high-carbohydrate lacto-ovo vegetarian diet for 6 months after completing 1-month metabolic (all foods provided) versions of these diets. The prescribed macronutrient intakes for the low-carbohydrate and high-carbohydrate diets were: 26% and 58% of energy from carbohydrate, 31% and 16% from protein and 43% and 25% from fat, respectively. Primary outcome Change in body weight. Results 23 participants (50% test, 68% control) completed the 6-month ad libitum study. The approximate 4 kg weight loss on the metabolic study was increased to −6.9 kg on low-carbohydrate and −5.8 kg on high-carbohydrate 6-month ad libitum treatments (treatment difference (95% CI) −1.1 kg (−2.1 to 0.0), p=0.047). The relative LDL-C and triglyceride reductions were also greater on the low-carbohydrate treatment (treatment difference (95% CI) −0.49 mmol/L (−0.70 to −0.28), p

Raisins are popular snacks with a favourable nutrient profile, being high in dietary fibre, polyphenols and a number of vitamins and minerals, in addition to being rich in fructose. In light of evidence demonstrating improvements in glycaemic control with moderate fructose intake and low-glycaemic index (GI) fruits, our aim was to determine the GI, insulin index (II) and postprandial responses to raisins in an acute feeding setting. A total of ten healthy participants (four male and six female) consumed breakfast study meals on four occasions over a 2- to 8-week period: meal 1: white bread (WB) (108 g WB; 50 g available carbohydrate) served as the control and was consumed on two separate occasions; meal 2: raisins (R50) (69 g raisins; 50 g available carbohydrate); and meal 3: raisins (R20) (one serving, 28 g raisins; 20 g available carbohydrate). Postprandial glucose and insulin were measured over a 2 h period for the determination of GI, glycaemic load (GL) and II. The raisin meals, R50 and R20, resulted in significantly reduced postprandial glucose and insulin responses when compared with WB (P

Diets rich in fruits and vegetables (FV) have been associated with a reduced risk of chronic disease, including cardiovascular disease. Unfortunately, public health campaigns to increase FV intake have had limited success. A number of mixed concentrated FV products have been studied, which may help certain individuals improve nutrient status. However, the possible health benefits of FV supplements have not been systematically reviewed. We, therefore, undertook a systematic search of MEDLINE and EMBASE to identify clinical interventions that examined the effect of commercially available concentrated mixed FV supplements on cardiovascular disease risk factors. Twenty-two reports, which used commercially available products, were identified. None of the studies reported any serious adverse effects. Overall, daily consumption of FV supplements significantly increased serum concentrations of the major antioxidant provitamins and vitamins found in plant foods (β-carotene, vitamins C and E) and folate. Functional changes, such as reduced serum homocysteine and markers of protein, lipid, and DNA oxidation, were also reported; in addition, the health advantages on markers of inflammation, immunity, and endothelial function are promising. Limitations of the available studies were related to the diversity of studies conducted with respect to design and study population and the variability in the measured outcomes and assays utilized. While mixed FV supplements may serve as an efficacious complement for individuals who have difficulty achieving their daily FV intake requirement, further research on additional retail preparations is warranted. Key teaching points: Mixed fruit and vegetable supplements produced from plant foods may serve as an efficacious complement to the habitual diet in individuals who have suboptimal intake or variety of nutrient-dense fruits and vegetables. Current research indicates that fruit and vegetable concentrates significantly increase serum levels of antioxidant provitamins and vitamins (β-carotene, vitamins C and E) and folate and reduce homocysteine and markers of oxidative stress. Mechanistic studies and larger, randomized, placebo-controlled double-blind trials in both healthy and high-risk populations are necessary to better understand the health effects of these supplements.

Obesity is rapidly becoming a global epidemic. As it is a significant risk factor for several chronic diseases, including type 2 diabetes and cardiovascular disease, it is imperative to study dietary and lifestyle approaches that help reduce its prevalence. Recently, due to its possible link to appetite control and metabolism, several clinical studies have assessed the effect of low glycemic index (GI) and glycemic load (GL) diets on weight loss. To determine the application of GI/GL in the prevention and treatment of obesity, we searched several databases and identified 23 clinical trials that examined low GI/GL diets and weight loss as the primary outcome measure. In general, these studies showed much inconsistency in their findings. While a few studies found significantly greater weight loss on the low GI/GL diets, most of the other studies showed a non-significant trend that favored low GI/GL diets; suggesting that factors other than GI/GL may play a role. It would be helpful if a pooled analysis were undertaken to clarify the current findings and outline the limitations of these studies. There is also a need for more long-term randomized, controlled trials that not only focus on weight loss but also on weight maintenance and body composition.

The ability of nuts to improve the blood lipid profile and reduce the risk of CHD is now well established. The interest that health effects of nuts have gained recently has brought the possible benefits of consuming nuts, such as improvement in the conditions of the metabolic syndrome, and their potential to prevent and control diabetes into focus. Results from cohort studies have associated nut consumption with a reduced risk of developing diabetes and CVD. However, few randomised controlled trials have assessed the effect of nuts on diabetes control, and those that have been undertaken have shown improvements in blood lipids but not in the glycaemic control. Diabetes agencies are increasingly recognising the importance of controlling postprandial glycaemia fluctuations. Acute feeding studies indicate that nuts have minimal effects on rising postprandial blood glucose levels when eaten alone, and diminish the postprandial glycaemic response when consumed with high-glycaemic index carbohydrate foods in both normoglycaemic and type 2 diabetic individuals. Nuts have a healthy nutritional profile, high in MUFA and PUFA, are a good source of vegetable protein and are rich in fibre, vitamins and minerals. Incorporation of nuts in the diet may therefore improve the overall nutritional quality of the diet. While more research is required to establish the ability of nuts to improve glycaemic control in the long run, early data indicate that the inclusion of nuts in the diets of individuals with diabetes and the metabolic syndrome is warranted, in view of their potential to reduce CHD risk.

The glycemic index (GI) is a physiological assessment of a food's carbohydrate content through its effect on postprandial blood glucose concentrations. Evidence from trials and observational studies suggests that this physiological classification may have relevance to those chronic Western diseases associated with overconsumption and inactivity leading to central obesity and insulin resistance. The glycemic index classification of foods has been used as a tool to assess potential prevention and treatment strategies for diseases where glycemic control is of importance, such as diabetes. Low GI diets have also been reported to improve the serum lipid profile, reduce C-reactive protein (CRP) concentrations, and aid in weight control. In cross-sectional studies, low GI or glycemic load diets (mean GI multiplied by total carbohydrate) have been associated with higher levels of high-density lipoprotein cholesterol (HDL-C), with reduced CRP concentrations, and, in cohort studies, with decreased risk of developing diabetes and cardiovascular disease. In addition, some case-control and cohort studies have found positive associations between dietary GI and risk of various cancers, including those of the colon, breast, and prostate. Although inconsistencies in the current findings still need to be resolved, sufficient positive evidence, especially with respect to renewed interest in postprandial events, suggests that the glycemic index may have a role to play in the treatment and prevention of chronic diseases.

Background Low-carbohydrate, high–animal protein diets, which are advocated for weight loss, may not promote the desired reduction in low-density lipoprotein cholesterol (LDL-C) concentration. The effect of exchanging the animal proteins and fats for those of vegetable origin has not been tested. Our objective was to determine the effect on weight loss and LDL-C concentration of a low-carbohydrate diet high in vegetable proteins from gluten, soy, nuts, fruits, vegetables, cereals, and vegetable oils compared with a high-carbohydrate diet based on low-fat dairy and whole grain products. Methods A total of 47 overweight hyperlipidemic men and women consumed either (1) a low-carbohydrate (26% of total calories), high–vegetable protein (31% from gluten, soy, nuts, fruit, vegetables, and cereals), and vegetable oil (43%) plant-based diet or (2) a high-carbohydrate lacto-ovo vegetarian diet (58% carbohydrate, 16% protein, and 25% fat) for 4 weeks each in a parallel study design. The study food was provided at 60% of calorie requirements. Results Of the 47 subjects, 44 (94%) (test, n = 22 [92%]; control, n = 22 [96%]) completed the study. Weight loss was similar for both diets (approximately 4.0 kg). However, reductions in LDL-C concentration and total cholesterol–HDL-C and apolipoprotein B–apolipoprotein AI ratios were greater for the low-carbohydrate compared with the high-carbohydrate diet (−8.1% [ P = .002], −8.7% [ P = .004], and −9.6% [ P = .001], respectively). Reductions in systolic and diastolic blood pressure were also seen (−1.9% [ P = .052] and −2.4% [ P = .02], respectively). Conclusion A low-carbohydrate plant-based diet has lipid-lowering advantages over a high-carbohydrate, low-fat weight-loss diet in improving heart disease risk factors not seen with conventional low-fat diets with animal products. Trial Registration clinicaltrials.gov Identifier:NCT00256516

aims: Because of the high risk for the development of type 2 diabetes after gestational diabetes, clinical practice guidelines recommend screening with an OGTT between 6 weeks and 6 months after delivery for women who had gestational diabetes during pregnancy. The aim of this study was to evaluate trends over time in post-partum screening for diabetes after gestational diabetes. Methods: The study used administrative data sources that provide detailed information on the health care utilisation of all residents of the Canadian province of Ontario (population=12 million). All women aged 17 to 49 without pre-existing diabetes who delivered between April 1994 and March 2008 were identified. Each woman who had gestational diabetes was matched with one who did not on age, region and year/quarter of delivery. For each year/quarter and for each group, the frequency of OGTTs and of any test that might be used to diagnose type 2 diabetes (i.e., OGTT, fasting glucose, random glucose or A1c) was determined up to 6 months post-partum. results: Screening with OGTTs after pregnancy with gestational diabetes increased from between 4 and 7% of pregnancies per year/quarter at the beginning of the study to between 13 and 17% of pregnancies at the end. This markedly exceeded the secular trend seen after pregnancies without gestational diabetes, where screening frequency increased from between 0 and 0.3% of pregnancies at the beginning to between 0.3 and 0.6% of pregnancies at the end. The use of any potential test that might diagnose type 2 diabetes after gestational diabetes increased from between 26 and 28% of pregnancies at the beginning of the study period to between 35 and 40% of pregnancies at the end. conclusion: Although an increasing number of women with pregnancies complicated by gestational diabetes were receiving OGTTs post-partum, the overwhelming majority of women were not receiving these tests. Even when considering a variety of tests that might have been used to diagnose type 2 diabetes, fewer than 40% of women with gestational diabetes were tested. This finding of inadequate screening in a high-risk population suggests that a large number of women of child-bearing age with type 2 diabetes remain undiagnosed.