Gender differences and barriers women face in relation to accessing type 2 diabetes care: A systematic review

The objectives of this systematic review were to find out whether gender differences exist in the domain of access to type 2 diabetes care and to identify the barriers faced by women in accessing type 2 diabetes care. A PubMed search was conducted for English articles published between January 01, 2005, and April 30, 2017, that looked into the above-mentioned topics. The search showed 219 articles, which were scrutinized and 21 articles were chosen for final review. Five articles dealt with gender differences, 14 articles dealt with barriers faced by women in accessing type 2 diabetes care and two articles dealt with both aspects. To accomplish the first objective, major areas studied by articles dealing with gender differences in accessing type 2 diabetes care were identified. In each of those areas, articles which reported gender differences were noted. Six out of these seven articles which dealt with gender differences (87%) reported that gender differences were present in the areas of type 2 diabetes care they studied. These articles also reported that women faced more difficulty in accessing type 2 diabetes care. To accomplish the second objective, data from articles dealing with barriers faced by women in accessing type 2 diabetes care were carefully analyzed and potential themes and theme categories were identified. Results showed that women faced personal, sociocultural, health system, economic, psychological, and geographical barriers in accessing type 2 diabetes care. Since this systematic review could identify only limited studies, evidence from more studies would help to confirm and generalize our findings.

Effect Of Siravyadha In The Pain Managent Of Gridhrasi- A Case Study

Introduction: Gridhrasi is a condition characterized by Ruk, Toda, Stambha, Spandana in Sphik pradesha and radiates downwards to Kati, Prusta, Uru, Janu, Jangha and Pada. Gridhrasi can be compared with Sciatica. Siravyadhais the major line of treatment mentioned in Ayurveda classical texts. Case study: A female patient aged 35 years; presenting with cardinal clinical signs and symptoms of Gridhrasi visited OPD with history of eight years and worsen in last two days. She was examined thoroughly and detailed history of illness was recorded. She was treated with Siravyadha atantara kandara gulpha sandhi by following proper Purva, Pradhana and Paschyat karma. Observation and Result: patient got relief in subjective parameters i.e. Ruk and Stambha. There was marked improvement in SLR test, mild improvement in Rt. Lateral Flexion and Backward extension of lumbar spine Movement. Forward Flexion and Lt. Lateral flexion of lumbar spine Movement remained unchanged. Conclusion: Siravyadha is administered in Tridoshadushti and Sarvangagatadushti. In Ghridrasi, Rakta and Kandara are Dushya and Vyana vata is major Dosha. Siravyadha corrects these imbalances by letting out the vitiated blood. The procedure was simple, economical and can be done in OPD level. It gives immediate relief of pain and stiffness.

Biomass Fuel Use and Risk of Cataract: Systematic Review and Meta-Analysis.

Aims: There is an increasing recognition of the putative association between the use of biomass fuels and the risk of cataracts. However, the exact strength of this association is currently unknown. Our aim was to synthetically quantify the association between biomass fuel use and cataract. Study Design: Systematic review and meta-analysis. Methodology: Using results from the MEDLINE®, Scopus®, Web of Science® and Google® searches, we conducted a random-effects meta-analysis of the published studies. We also conducted subgroup meta-analyses, meta-regressions and sensitivity analyses to determine the contribution of potential confounders to between-study heterogeneity which was measured by the tau-squared and I2 statistics. Summary effect sizes (SES) were estimated using the DerSimonian and Laird method and the 95% confidence intervals (CI) and 95% prediction intervals (PI) were also estimated. Publication bias was examined using funnel plots and Egger’s test. Results: In spite of significant between-study heterogeneity (I2 70%, p=8.1x10-5), biomass fuel use was associated with a significantly increased risk of cataract (SES 2.12; 95% CI 1.61-2.80; 95% PI 0.88-5.09). Age-, gender- and other methodological differences did not significantly contribute to between-study heterogeneity but Indian studies showed a statistically significant association between biomass fuel use and cataract. Statistically homogeneous studies (n = 8) showed an SES of 2.01 (95% CI and PI 1.67-2.41). Conclusion: Synthetic evidence from observational studies indicates that biomass fuel use may increase the risk of cataract. Public health initiatives aimed at avoidance of biomass fuel use may reduce the burden of cataracts especially in settings where biomass fuels are commonly used.

Effect of indoor air pollution during cooking on peak expiratory flow rate and its association with exposure index in rural women.

Routine exposure to domestic cooking fuels is an important source of indoor air pollution causing deterioration of lung function. We conducted a community based cross-sectional study in 760 non-smoking rural women involved in household cooking with four types of cooking fuels i.e. Biomass, Kerosene stove, Liquid Petroleum Gas (LPG) and Mixed (combination of two and more cooking fuels). Peak Expiratory Flow Rate (PEFR) less than 80% of the predicted was considered as abnormal PEFR. The overall prevalence of abnormal PEFR was found to be 29.1% with greater predominance among biomass fuel users (43.3%) with high risk ratio (1.86) as compared to kerosene (0.63), LPG (0.75) and mixed (0.66) fuel users. However the pair wise comparison of different groups of cooking fuels by Marascuilo procedure reported significant differences within different groups except kerosene - mixed group. The study also demonstrated a negative correlation between observed PEFR and exposure indices in different cooking fuels (r=–0.51). Our results indicate that prolonged exposure to cooking fuels particularly biomass fuels as a source of cooking adversely affects PEFR in nonsmoking rural women.

Solitary Rectal Ulcer Syndrome: A Case Series.

A retrospective analysis of the clinical profile, endoscopic features and management of 22 children (age 18 months – 18 years) diagnosed as solitary rectal ulcer syndrome is presented. The majority (81.8%) were ≥8 years of age. Rectal bleeding was the presenting feature in all the children. Mucorrhea, constipation, tenesmus and rectal prolapse were observed in 77.3%, 63.6%, 59% and 13.6% children, respectively. Colonoscopy showed classical single rectal ulcer in 68.2% and multiple ulcers in 22.7%. Polypoidal and erosive lesions were documented in 4.5% each. The medical management comprised of bowel training and high fibre diet for all children. The other modalities included oral 5-amino salicylate (59%), sucralfate enema (4.5%) and rectal mesalamine in 9%. 64% children recovered and 13.6 % had recurrence of symptoms.

Head injuries in children resulting from the fall of television.

Case records of children admitted with head injury due to TV fall in a pediatric tertiary care hospital in Chennai, during March 2007 – February 2008 were analysed retrospectively. Out of the 11 children admitted 6 (54%) were in 1-2 yr age group. Bleeding from the ear, nose and throat was the commonest, finding followed by a skull fracture, seen on imaging studies. These were observed in 9 (81.81%) and 8(72.8%) children respectively. There was no mortality.

Chronic abdominal pain in children.

Chronic abdominal pain (CAP) continues to be a diagnostic and therapeutic challenge. It affects about 10% of school-going children and adolescents. Few Indian studies have reported an organic cause in 30%–40% of children with recurrent abdominal pain. In developing countries, parasitic infestations such as giardiasis and ascariasis are an important cause of recurrent abdominal pain but their frequency has decreased over time. There is a paucity of data from India on the aetiology, epidemiology and management strategies for CAP, and there is no consensus on the clinical approach to this problem. We present a practical approach to CAP in children. The first step is to elicit a detailed history and do a thorough physical examination so as to categorize CAP according to the site of pain (epigastric, periumbilical or left lower quadrant), the predominant symptom associated with pain (dyspepsia, isolated pain or altered bowel habits) and to differentiate the pain as organic or functional based on the characteristics of pain and presence or absence of alarm signs. The second step is to do appropriate investigations, restricted to simple tests when functional pain is suspected (Level I) and more investigations (Level Ia) if there are alarm signs and pain appears to be organic in nature. Invasive investigations such as gastrointestinal endoscopy (Level II) may be reserved for those with possible organic pain. Level III investigations need to be done in a small percentage of children and include EEG, workup for food allergy and porphyria. The third step is management of organic CAP according to the aetiology, while for functional CAP the pharmacological and, rarely, psychological intervention is more difficult but should be done discreetly and tailored to the needs of the child.

Primary intestinal lymphangiectasia.

Primary intestinal lymphangiectasia (PIL) is a rare disease of intestinal lymphatics presenting with hypoproteinemia, bilateral lower limb edema, ascites, and protein losing enteropathy . We report a series of 4 children from Chennai, India presenting with anasarca, recurrent diarrhea, hypoproteinemia and confirmatory features of PIL on endoscopy and histopathology.

Effect of cadmium chloride on liver, spleen and kidney melano macrophage centres in Tilapia mossambica.

To study the toxic effect of a heavy metal on the occurrence of melano macrophage centres (MMC) of liver, spleen and kidney. Tilapia mossambica were exposed to median lethal concentration of cadmium chloride for 120 hours. Routine histological method was adopted to prepare the tissue sections and to identify the pigments viz: hemosiderin and melanin. The average number and size of melano macrophage centres (MMC) were significantly increased compared with the control. It is evident in the present study that in the MMC of all three tissues examined lipofuscin is absent.

Evaluation of chronic abdominal pain--a test of "patience".

A 4 year old girl with chronic abdominal pain of 6 months duration was provisionally diagnosed as eosinophilic gastroenteritis based on endoscopic biopsy This case is reported for its rarity.

Gastrointestinal bleeding in a toddler secondary to chronic renal failure and hyper-gastrinemia.

A 3-year-old girl with H. pylori negative duodenal ulcer with hypergastrinemia secondary to chronic renal failure presenting with upper gastrointestinal bleed as the cardinal manifestation is unusual in toddlers and the case is presented for its rarity.

Pericardial tamponade in neonate following migration of a sialastic central venous catheter.

Central venous catheters constitute an essential part of most neonatal intensive care units (NICU). However, they are known to be associated with several complications. We here with report a rare lethal complication of pericardial effusion with cardiac tamponade occurred in a term neonate following central venous line.

Diabetic ketoacidosis in children.

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM). The frequency of DKA at the onset of DM correlates inversely with the incidence of type 1 DM and is more common in young children, children without a first degree relative with type 1 DM and individuals whose families are from a lower socioeconomic status. The mortality rate for DKA in children is 0.15%-0.3%. A high index of suspicion with timely administration of appropriate intravenous fluids, rational use of sodium bicarbonate, continuous rather than bolus insulin infusion and monitoring in an intensive care unit are associated with a better outcome.

Crohn's disease presenting as palatal ulcer.

Crohn's disease (CD) in children younger than 5 years of age is termed as early onset inflammatory bowel disease (EO-IBD). We report a 4 yr 6 mo-old child with EO-IBD, who presented with palatal ulcer, an extra intestinal manifestation of Crohn's disease as the dominant feature.