Glycemic Control and Its associated Determinants among Type II Diabetic Patients at Tertiary Care Hospital in North India

Introduction: Good glycemic control has been defined as achieving a target of fasting plasma glucose level of between 80 and 110 mg/dl, or glycosylated haemoglobin (HbA1C) of <7.0%. Poor glycemic control is highly correlated with chronic conditions related to the damaging effects of hyperglycaemia, resulting in serious complications. To restrict and delay the complications of diabetes mellitus, good glycemic control is essential. Objective: To identify the determinants associated with poor glycemic control among Type 2 diabetes mellitus patients. Method: A cross sectional study was conducted among 403 confirmed type 2 diabetic patients who attendedone of the tertiary care hospitals of North India over a period of six months (July- December 2021). The collected data was analysed using IBM SPSS version 28. Chi-square test was applied to compare various determinants of glycemic control. A p-value of <0.05 was considered to be statistically significant. Results: Out of 403 participants, 57.6% had poor glycemic control of diabetic condition. Higher age of participants, illiteracy, being overweight, having positive history of smoking and alcohol, longer duration of diabetes, participants taking both oral and insulin treatment for diabetes, taking medicine irregularly were the significant determinants of poor glycemic control. Conclusion: Higher percentage(57.6%) of poor glycemic control was observed in the study.To improve the glycemic control, efforts should be made towards improving modifiable factors like overweight, smoking, alcohol, regularity of medication etc. Good lifestyle interventions help in control of poor glycemic control.

Prevalence of Internet Addiction and the Effect of Internet Usage on Lifestyle of College Students of Haryana during COVID 19 lockdown period

Introduction: Since 1990, internet usage is increasing day by day and availability of smart mobile phones and electronic gazettes like tablet, laptop etc. has given it an exponential rise. During COVID-19 lockdown period, internet usage pattern has changed a lot as per behaviour of students studying in schools, colleges, educational and coaching institutes etc. To study the prevalence of internet addictionObjective: and the effect of internet usage on lifestyle of college students of Haryana. Total 1035 students, ofMethod: various educational streams in various colleges of Haryana state were included in the study and data was collected by pretested self-designed questionnaire and young's internet addiction test questionnaire was used to assess its effect on life style. Out of 1035 students, 436(42%) participants were belowResults: average users of internet, followed by 369(36%) average users and 230(22%) excessive users of internet. Average of total score of young internet addiction questionnaire was 27.72. Various life style factors like feeling stressed while working, neglects other activities, miss a diet, checks internet many times, obsessed with phone and internet usage per day were found significantly associated with internet addiction(p<0.05). Conclusion : Excessive internet usage during COVID-19 pandemic may lead to various abnormal behavior changes which cause negative effect on various aspects of students like emotional, hyperactivity, depression, sleeping disorder etc.

A longitudinal study of near-miss and maternal mortality at a tertiary centre in rural Uttarakhand: addressing the fourth delay

Background: India is a signatory of the sustainable development goals and is committed to reduce the maternal mortality ratio to less than 70 per lakh live births. Review of maternal deaths and near miss cases is a very important step towards achieving this aim.Methods: A prospective observational study was carried out in a tertiary care centre in rural Uttarakhand for a period of one and half year using WHO criteria for maternal near-miss, in an attempt to assess the quality of obstetric care in the region and to identify the possible delays leading to this.Results: Haemorrhage was the most common cause leading to severe maternal outcome, followed by early pregnancy complications and hypertensive disorders of pregnancy. The mortality index was 15% and maternal near miss to mortality ratio was 7:1. We could identify some type of delay in at least 70% of near miss and mortality cases. Although delay in seeking healthcare was the most common, lack of community participation was identified as an important fourth delay.Conclusions: For substantive reduction of maternal mortality in this region of Uttarakhand, the main action needed is strengthening of primary health care, educating the patients regarding warning signs of pregnancy and strengthening the social status of women in society, increasing community support in women health care.

Clinical study of meningitis in children and role of adenosine deaminase in differentiating tubercular from non-tubercular meningitis

Background: In diseases where cell mediated immunity plays an important role like in tuberculosis, CSF (Cerebrospinal fluid) adenosine deaminase (ADA) activity is increased. Hence, this testing is done especially among children with suspected tubercular meningitis. The objective of this was to study role of Adenosine Deaminase in differentiating tubercular from non-tubercular meningitis.Methods: This was a hospital based cross sectional study was carried out among 50 children of proven meningitis for a period of two years. CSF ADA levels were done for all cases. They were divided into tubercular meningitis and non-tubercular meningitis group and compared.Results: Incidence of tuberculous meningitis (TBM) was found high in the age group 5-8 years. Male:female ratio was 2.3:1. Fever was present in all cases followed by vomiting and neck rigidity. CSF AFB was positive in 3 cases (6%). Neuroimaging was done in all cases in which 3 patients had basal exudate in which 2 patients had TBM and 1 patient was Non-TBM. 3 patients had hydrocephalus in MRI in which 2 had TBM diagnosed and 1 had non-TBM. As per ADA levels, 10 were diagnosed as TBM out of which 8 patients had ADA level ?10 IU/L and 2 had ADA level <10 IU/L which was missed by ADA and later confirmed by other modalities.Conclusions: It was concluded that if ADA level in CSF is ?10IU/l the diagnosis of TBM should be considered.

Incidence of rifampicin resistance, HIV status and efficacy of fluid analysis among tuberculosis suspect pediatric cases

Background: Body fluids are commonly used for diagnosis as sputum is not reliable in children. Hence it is essential to study efficacy of body fluids in comparison to GeneXpert which is a new diagnostic modality. Objectives of this study was to incidence of rifampicin resistance, HIV status and efficacy of fluid analysis among tuberculosis suspect pediatric cases.Methods: Present study was hospital based cross sectional study carried out over a period of two years at Department of Pediatrics, ACPM Medical College and Hospital from February 2016 to January 2018 among children with suspected tuberculosis. Rifampicin resistance was determined by using GeneXpert. Body fluids like CSF, pleural fluid, gastric aspirate etc were analyzed and compared with GeneXpert results.Results: Rifampicin resistance was present in 5 cases i.e. 3.3%. 15.15% Patients were HIV positive and in them 12 were GeneXpert positive with 1 Rif resistance. Different Fluid analysis showed maximum positivity with pleural fluid >TB Lymphadenitis >TBM. GeneXpert done on different body fluids showed extra case detection in different fluid analysis negative patients i.e. 28.6% extra case detection in CSF (2 cases), 87.9% in gastric aspirate (25 cases), 85.4% in induced sputum (35 cases), 14.3% in Lymph node aspirate (1 case), 50% in pleural fluid (2 case).Conclusions: : Rifampicin resistance found in present study is alarming. Among body fluids, FNAC, CSF and pleural fluids can be used reliably for diagnosis of tuberculosis where GeneXpert is not available.

Efficacy of gene xpert over other diagnostic modalities of tuberculosis among children

Background: Diagnosis of tuberculosis is a challenge especially among children. GeneXpert has been recommended as a diagnostic test in children. Objectives of this study was to efficacy of GeneXpert over other diagnostic modalities of Tuberculosis like Sputum smear microscopy, Mantoux testing, X-ray chest among children.Methods: A cross sectional hospital-based study was conducted over a period of 24 months among 150 children. All the patients who were having suspicion of Tuberculosis on the basis of History & Examination (fulfilling inclusion criteria) had been enrolled in the study. After doing all preliminary investigations clinical diagnosis has been made and Gene X'pert was carried out for all the samples collected. Pearson chi square test and Fishers exact test was applied wherever appropriate.Results: There was statistically no significant (p >0.05) difference of GeneXpert positivity within different age groups of Suspected TB patients. GeneXpert was positive in 80% with symptom of Cough lasting more than 2 weeks, in 78.8% with fever more than 2 weeks, in 88.9% with FTT, in 76.5% with H/O Koch's contact, in 77.8% with H/O convulsion, in 69% with significant lymphadenopathy. GeneXpert was positive in all suspected TB patients having ZN staining positive for AFB. In clinically TB diagnosed patients, 86.5% were positive for GeneXpert.Conclusions: GeneXpert is a novel diagnostic modality of choice in all suspected Pulmonary & Extra-pulmonary TB cases among children. It can be used as a primary tool in Pulmonary TB with smear negative samples in pediatric age group.

Lasmiditan: new drug for acute migraine

Migraine is ranked by the World Health Organization as the world’s second leading cause of disability. The current state of knowledge suggests that migraine is a neuronal process involving activation and sensitization of the trigeminal nociceptors and the trigeminocervical complex, as well as cortical spreading depression and abnormal brainstem activity. The present non vascular etiological basis has opened a new horizon in the treatment of acute migraine targeting the trigeminal pathways. Lasmiditan, a highly selective 5-HT1F receptor agonist, acts on the trigeminal system without causing vasoconstriction because of its low a?nity for 5-HT1B receptors. The compound belongs to a new class of drugs “ditans” and its mechanism of action is neuronal without evidence of vasoactive effects as seen with triptans. It lowers plasma protein extravasation decreasing the neurogenic inflammation of the dura and suppress neuronal firing within the trigeminal nucleus caudalis. Also, 5HT1F agonists have shown to decrease c-fos activity within trigeminal nucleus thereby reducing the level of synaptic activation. The onset of action of lasmiditan is fast, shows rapid absorption, oral bioavailability of 40% and linear pharmacokinetics. Most common adverse reactions seen are dizziness, paresthesia, somnolence, nausea, fatigue and lethargy with dizziness being the most recurrently reported adverse event. Clinical trials for lasmiditan to date have been positive, and maiden results suggest that lasmiditan may be a new safe and effective option for acute migraine treatment, especially for patients refractory to or unable to tolerate triptans, and/or for patients with pre-existing cardiovascular disease. With Eli Lilly and Co. having already applied for US FDA approval in Nov 2018, lasmiditan may soon be a new addition to the mounting armoury of drugs against migraine.

Effect of Seed Extract of Amomum Cardamomum on Renal Function in Alloxan Induced Diabetic Rats.

The present work was undertaken to investigation, the effect of ethanolic seed extract of Amomum cardamomum on blood urea nitrogen, creatinine, and uric acid in alloxan induced diabetic rats. Ethanolic seed extract of Amomum cardamomum was administered orally (50 mg/kg body weight) for 7,15,30,45 and 60 days. Treatment with Amomum cardamomum resulted in significant reduction of serum urea (p<0.001), creatinine (p<0.001) and uric acid (p<0.001); while increment in serum total protein (p<0.001) and comparable with that of alloxan induced diabetic rats and control groups. The results clearly show, the decreased urea, creatinine, uric acid and improvement in serum protein activity with the treatments have been attributed to improve renal function.

Nanomedicine : Future Prospective in Disease Diagnosis and Preventions.

Medical practice is about to enter a new era focused on the nanoscale and the practice of ‘‘nanomedicine.’’ Nanomedicine may be defined as the monitoring, repair, construction, and control of human biological systems at the molecular level, using engineered nanodevices and nanostructures. Nanomedicine is, in a broad sense, the application of nanoscale technologies to the practice of medicine, namely, for diagnosis, prevention, and treatment of disease and to gain an increased understanding of complex underlying disease mechanisms The potential medical applications are predominantly in detection, diagnostics (disease diagnosis and imaging), monitoring, and therapeutics. The availability of more durable and better prosthetics and new drug-delivery systems are of great scientific interest and give hope for cancer treatment and minimum invasive treatments for heart disease, diabetes and other diseases. Many novel nanoparticles and nanodevices are expected to be used, with an enormous positive impact on human health. Nanotechnology provides the field of medicine with promising hopes for assistancassistance in diagnostic and treatment technologies as well as improving quality of life. Humans have the potential to live healthier lives in the near future due to the innovations of nanotechnology. Some of these innovations include: Disease diagnosis, Prevention and treatment of disease , Better drug delivery system with minimal side effects , Tissue Reconstruction. The vision is to improve health by enhancing the efficacy and safety of nanosystems and nanodevices. Products based on nanotechnology in medicine and medical technology are reaching the market, with an anticipated enormous positive impact on human health, in the coming years. Ethical and moral concerns also need to be addressed in parallel with the new developments. Today, nanotechnology and nanoscience approaches to particle design and formulation are beginning to expand the market for many drugs and are forming the basis for a highly profitable niche within the industry, but some predicted benefits are hyped.

Study of Patient Dissatisfaction in Government Hospital.

The present study was conducted to know the various reasons for patient dissatisfaction at various places and explanations of service providers for patient dissatisfaction. 400 patients selected from all departments and key service providers at Government Medical College Hospital, Miraj. 364 (91%) patients had one/ more dissatisfaction/s to report. Of the 37 types of dissatisfaction reported, 10 were found to be of serious nature viz. cursory clinical examination (56%), lack of counseling (40%), inadequate privacy during clinical examination (14.28%), lack of explanation regarding drug schedule (43%), unsatisfactory emergency management (32.95%), occurrence of post-operative surgical complications (28.82%), discharged without relief (6.18%) and illegal demand of money, etc. Most of these were ‘acts of omission’ on part of service providers. In terms of legal liability, the ‘service-provider’ constitutes a ‘collective responsibility’ with respect to application of law.

Comparison of saccadic reaction time between normal and glaucoma using an eye movement perimeter.

Aim: To compare the saccadic reaction time (SRT) in both the central and peripheral visual fi eld in normal and glaucomatous eyes using eye movement perimetery (EMP). Materials and Methods: Fift y-four normal and 25 glaucoma subjects underwent EMP and visual fi eld testing on the Humphrey Field Analyser (HFA) 24-2 program. The EMP is based on infrared tracking of the corneal refl ex. Fift y-four test locations corresponding to the locations on the 24-2 HFA program were tested. SRTs at diff erent eccentricities and for different severities of glaucoma were compared between normal and glaucoma subjects. Results: Mean SRT was calculated for both normal and glaucoma subjects. Mann-Whitney U test showed statistically signifi cant (P < 0.001) diff erences in SRT’s between normal and glaucoma subjects in all zones. Conclusion: SRT was prolonged in eyes with glaucoma across diff erent eccentricities.

Epidemiological Assessment of Goiter.

Research Question: 1. What is the magnitude of problem of Goiter? 2. What is the level of iodised salt consumed by school children at school & home? Objectives: 1. To find out incidence of Goiter. 2. To find out level of iodised salt consumed by school children at school & home. Study Design: Cross-sectional study. Settings: School & houseto- house survey of urban & rural area of Raichur district. Participant: School children & general population of both sexes. Sample size: 45173. Statistical analysis: Proportion & Chi-squared test. Results: Total population covered 45173 in five talukas. Males were 23463 & females 21730, adult population 16404, children more than 15 yrs were 28769 & school population was 24984. School boys were 14269 & girls 10715. Highest prevalence of goiter found in Raichur taluka i.e. 5.68% and lowest in Lingsur taluka i.e. 0.86%. Over all prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases). Higher prevalence has been reported among females in age group of 10- 14 yrs 5.25% & 15-19 yrs 4.66% compared to other age groups of village population. School children in Raichur district revealed the prevalence of Goiter 3.66%. Conclusion: Prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases), which is less compared to the National figures. The people are consuming the iodated salt and ban on non-iodated salt may be effectively implemented in study region.

Cotherapy of Tiron and selenium against vanadium induced toxic effects in lactating rats

Vanadium is an important environmental and industrial pollutant. It has a status of reproductive toxicant and is reported to cross placental barrier. The current study was performed to assess the therapeutic efficacy of Tiron and its combination with selenium against vanadium induced toxicity in lactating and suckling rats. Rats were exposed to vanadium at a dose of 7.5 mg/kg/day [p.o.] for 20 days from 0 day of post partom [p.p.]. Tiron [606 mg/kg/day, i.p.] and selenium [0.5 mg/kg/day, p.o.] were administered for 5 days on 21-25 day PP. Vanadium exposure decreased blood sugar level while serum transaminases and serum alkaline phosphatase showed increased values significantly [p

Effect of monothiol along with antioxidant against mercury-induced oxidative stress in rat.

Efficacy of thiol chelators viz. N-acetyl cysteine and D-penicillamine (NAC and DPA) along with nutritional supplements viz. zinc acetate, sodium selenite and magnesium sulphate (Zn, Se and Mg) in the treatment of mercury intoxication was investigated in rats. This is of particular interest since high bonding affinity between mercuric ion and the thiol group exits. The mutual antagonism of mercury and selenium is one of the strongest examples of the interaction in the trace element field. Adult rats of Sprague-Dawley strain were administered a bolus dose of dimethyl mercury (10 mg/kg) orally. A significant rise in the aspartate aminotransferase, alanine aminotransferase, serum alkaline phosphatase, lactate dehydrogenase, gamma glutamyltranspeptidase, bilirubin and creatinine were observed. Single mercury exposure also resulted in a significant increase in lipid peroxides with a concomitant decrease in reduced glutathione level in liver, kidney and brain. A decrease in the enzymatic activities of acetyl cholinesterase in different regions of the brain was observed. These parameters were restored considerably with chelating agents along with nutritional supplementation, but NAC+Se and DPA+Mg offered significant protection in comparison with other combinations.