ABSTRACT
Background:Non-alcoholic fatty pancreas disease (NAFPD) is an emerging clinical entity. NAFPD is characterised by excessive fat deposition in the pancreas in the absence of alcohol consumption. Recent studies suggest that NAFPD might be associated with beta cell dysfunction, insulin resistance and inflammation which might lead to development of diabetes. NAFPD might be used as an initial indicator of glucometabolic disturbances and identify the patients with prediabetes. Methods:This was a cross sectional study in which the glycemic status of 50 patients with NAFPD with ultrasonographic evidence of increased echogenicity of pancreas was assessed and association between glycemic variability and NAFPD was determined. The patients were also assessed for the ultrasonographic evidence of fatty liver.Results:Pre-diabetes was noted in 32% subjects while diabetes was noted in 20% subjects. Thus, 52% patients with NAFPD had abnormal glycemic status. The 48% subjects i.e., 24 patients had normoglycemia. The presence of fattyliver was statistically significant in normoglycemia and diabetes mellitus with p=0.001 and 0.045 respectively. No statistically significant association was noted between fatty liver and prediabetes with p=0.175. No causal relationship was seen between fatty liver and glycemic variability in patients with NAFPD.Conclusions:NAFPD is associated with impaired glycemic status. It is also seen frequently with fatty liver. Its early detection may help to identify the patients with prediabetes who may benefit from timely introduction of interventions to reduce the rising morbidity and mortality due to diabetes mellitus.
ABSTRACT
Background: The objectives of this study was to study the prevalence of thyroid disorders in high risk neonatal populations and to study association of maternal thyroid dysfunction with neonatal thyroid problems and outcome.Methods: This was an observational study, conducted in NICU at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. The study included neonates born to mothers with thyroid disorder or with clinical features suggestive of thyroid dysfunction. Neonates with history of maternal thyroid dysfunction were screened at 72 to 96 hrs of postnatal age. Those with TSH >10 mIU/L or free T4 <1.1 ng /ml were followed up after two weeks. The neonates with clinical features suggestive of thyroid dysfunction were screened at presentation and those with abnormal thyroid profile were followed up after two weeks. Results obtained were statistically analyzed using SPSS 17.0 software.Results: Out of 260 neonates screened, 208 neonates were born to mothers with hypothyroidism, 6 neonates had increased levels of TSH during first week which normalised on follow up during third week. One neonate born to hyperthyroid mother, showed increased TSH levels during first week and 2nd week which declined to normal level on follow up at 3rd week. Out of 51 neonates with clinical features suggestive of thyroid dysfunction, born to euthyroid mothers, 3 neonates had increased levels of TSH on presentation which normalised on further follow up. Thus, majority of high risk neonates at birth show transient hypothyroidism.Conclusions: None of the neonate was labelled as hypothyroid, all the 10 neonates showed transient hyperthyrotropinemia.
ABSTRACT
Background: The present prospective observational study was done to analyse the risk factors leading to minor or major lower extremity amputation (LEA) in diabetic patients.Methods: A 139 patients were divided into Group A (n=113) and Group B (n=26) who underwent minor and major LEA respectively.Results: Majority of the patients in group B were from rural and lower socioeconomic background. Duration of diabetes (p=0.017) and of DFU was significantly longer in group B (P <0.001) The pro-portion of patients with Wagner Grade 4 and 5 ulcer were significantly higher in group B than in group A (P <0.001) Wound infection and maggots were significantly higher in group B though polymicrobial infection was higher in group A. Biochemical investigations were abnormally altered but difference between two groups was not significant.Conclusions: Socioeconomic burden on the society due to LEA can be reduced by making diabetic patients aware of foot hygiene, regular medical check-up for control of diabetes and associated complications.
ABSTRACT
Background: Patients with multidrug-resistant tuberculosis (MDR-TB) incur huge expenditures for diagnosis and treatment; these costs can be reduced through a well-designed and implemented social health insurance mechanism. The State of Chhattisgarh in India successfully established a partnership between the Revised National TB Control Programme (RNTCP) and the Health Insurance Programme, to form a universal health insurance scheme for all, by establishing Rashtriya Swasthya Bima Yojna (RSBY) and Mukhyamantri Swasthya Bima Yojana (MSBY) MDR-TB packages. The objective of this partnership was to absorb the catastrophic expenses incurred by patients with MDR-TB, from diagnosis to treatment completion, in the public and private sector. This paper documents the initial experience of a tailor-made health insurance programme, linked to covering catastrophic health expenditure for patients with MDR-TB. Methods: In this descriptive study, data on uptake of insurance claims through innovative MDR-TB packages from January 2013 to April 2014 were collected. A simple survey of costs for clinical investigation and inpatient care was conducted across two major urban districts in Chhattisgarh. In these selected districts, three health facilities from the private sector and one medical college from the public sector with a functional drug-resistant tuberculosis (DR-TB) centre were chosen by the RSBY and MSBY State Nodal Agency to complete a simple, structured questionnaire on existing market rates. The mean costs for clinical investigations and hospital stay were calculated for an individual patient with MDR-TB who would seek services from the private or public sector. Results: A total of 207 insurance claims for RSBY and MSBY MDR-TB packages were processed, of which 20 were from private and 187 from public health establishments, covered under the health insurance programme, free of charge. An estimated catastrophic expenditure, of approximately US$ 20 000, was saved through the RSBY and MSBY health insurance mechanism during the study period. Conclusion: The innovative RSBY and MSBY MDR-TB insurance package is a step towards reducing catastrophic expenses associated with treatment for MDRTB.