A Randomized controlled trial to assess the effectiveness of group-based Diabetes Self-Management Education (DSME) program on glycemic control and self-care activities among type-2 diabetics in South-East Delhi

Introduction: India has the second-largest population of diabetes globally. The long-term complications due to poor glycemic control are concerning. Diabetes Self-Management Education (DSME) is a fundamental component in managing diabetes better. Objectives: This study was conducted to compare the effectiveness of group-based DSME in achieving glycemic control and improving self-care practices among people with type-2 diabetes as against the usual care. Methods: A nonblinded parallel-arm RCT among adults (? 30 years) diagnosed with Type-2 DM. Written informed consent was taken from each patient before enrollment. The sample size is estimated to be 85 in each arm according to the formula for equivalence design for an RCT. Randomization was done using a computer-generated random number table. The control arm received usual care, while the intervention group received group-based DSME in addition to usual care. At the end of 6 months, the change in glycemic control and self-care activity scores were compared between the two arms. Results: A total of 139 individuals (intervention =69; control =70) were analyzed. The proportion of females (62.1%) was higher than males (37.9%). There was no statistically significant difference at baseline. At end line, HbA1c showed a reduction from 9.3% to 6.9% in the intervention arm (P<0.001), which was greater than that in the control arm (p=0.017). All the self-care components showed a statistically significant improvement, except the medication score. Conclusions: Group-based DSME effectively increases self-care practices among people with diabetes, resulting in better glycemic control.

Fibre Reinforced Composite Resin Prosthesis As Interim Replacement For Congenitally Missing Permanent Mandibular Central Incisors:a Case Report

Hypodontia or tooth agenesis is the most common prevalent craniofacial malformation in humans. It may occur as a part of a recognized genetic syndrome or as a nonsyndromic isolated trait. Both environmental and genetic factors are involved in the etiology of hypodontia, with the latter playing a more significant role. It may be noted that bilateral agenesis of mandibular central incisors is very rare and very few cases have been reported in literature.A 12 year old child reported with congenitally missing permanent mandibular central incisors of idiopathic etiology in which the missing teeth were replaced by acrylic teeth as pontic using fiber reinforced composite. The Patient had no hereditary predisposition or any associated syndrome. The aim of enhancing esthetics and attaining functional space maintenance was thus obtained in a single sitting chair side procedure.

Tuberculosis diagnosed / managed at NGMC, Teaching Hospital, Kohalpur: a joint private-public effort.

INTRODUCTION: Medical colleges both in public and private sector in Nepal have been supporting national TB control program (NTP) in its effort to control TB and its eventual elimination. Official collaboration between Nepalganj Medical College (NGMC), a private sector medical college and NTP was developed in 2000; a joint private-public initiative to contain TB. OBJECTIVES: This study has been done with the objectives a) to review the TB cases diagnosed/managed at NGMC Teaching Hospital (TH), Kohalpur, in Financial Year 2063/2064 (Shrawan 63 Asad 64) and b) to assess the contribution of NGMC, TH, Kohalpur towards TB control. METHODOLOGY: This is record based review of TB cases diagnosed, categorized, treated at NGMC TH, Kohalpur and referred to respective health facilities in Financial Year 2063/2064 (Shrawan 63 Asad 64). And case detection with respect to detected TB cases in Midwestern Region and entire country. RESULTS: Around 13% of detected TB cases for Mid Western Region and 1.5 % of detected TB cases at national level were diagnosed at NGMC, TH, Kohalpur. 35% of cases were of pediatric TB; lymph node TB, pleural effusion & abdominal TB were common form of extra pulmonary (EP) TB seen in children. 20.8%, 44.8% and 34.4% of cases in adults were of sputum smear (SS) + pulmonary TB (PTB), SS- PTB & EPTB respectively; pleural effusion, lymph node TB, Miliary & abdominal TB were common form of EPTB seen in adults. CONCLUSION: Contribution of NGMC, TH, Kohalpur towards case detection seems to be significant. The role of medical colleges in TB control can not be underestimated.

Human neurocysticercosis managed at Nepalganj Medical College, Teaching Hospital, Kohalpur, Nepal.

INTRODUCTION: Neurocysticercosis is the most common parasitic infection of the central nervous system. It is endemic in Central Europe, South Africa, South America and parts of Asia including Nepal. OBJECTIVE: This study has been conducted with the objectives to know the diagnostic criteria for neurocysticercosis and the outcome of treated cases. METHODOLOGY: This retrospective study was done at Nepalganj Medical College, Teaching Hospital, Kohalpur, by reviewing the record of the patients managed as case of neurocysticercosis in one financial year. RESULTS: All patients presented with seizure as a main symptom started in adult life. The mean age was 21 years; 80% were male and 20% female. The diagnosis seemed to be based on clinical presentation, CT scan findings and high index of suspicion. All were put on albendazole, steroids and anticonvulsant drugs; 93% was discharged when fits got controlled, one patient left against medical advice. Follow up record was not available to comment on resolution. CONCLUSION: Neurocysticercosis is difficult to diagnose and has a significant socioeconomic impact because of chronic morbidity, variable mortality, decreased productivity of affected persons, and high cost of medical diagnosis and treatment. It is therefore suggested to develop criteria for diagnosis of neurocysticercosis to be followed at national level.

Tuberculosis: an unusual presentation.

Patient with tuberculosis may present with atypical, unusual or complex features. The reported case is of 31 years lady admitted with fever, breathlessness and features of cardiac failure. She was detected to have right lower lung consolidation, minimal bilateral pleural effusion, features suggestive of sub-acute pericarditis and subsequent chest x-ray revealed miliary mottling as well. Later on Acid Fast Bacilli were detected in sputum and pleural fluid. Clinicians need to keep complex presentation of TB in mind to manage the case at its earlier stage to avoid residual complication.

Situs inversus with dextrocardia with multiple cardiac lesions in adult.

Situs inversus with dextrocardia is the malposition most likely to occur with structurally normal heart; generally discovered on routine chest x-ray or physical examination performed for other reasons. These persons experience normal longevity of life and have similar risk of getting acquired disease as that of other person of same age and sex group. Symptoms related to acquired disorder may also lead to discovery of such cardiac malposition. Incidence of congenital cardiac anomalies in dextrocardia with situs inversus is very low globally but its figure in Nepal is not known. We report an adult of 43 years age having situs inversus with dextrocardia associated with multiple cardiac lesions i.e. ventricular septal defect, aortic regurgitation, mitral regurgitation and tricuspid regurgitation. Key words: Situs Inversus Totalis, Dextrocardia, Congenital Cardiac Anomalies, Nepal.