Screening for autonomic neuropathy using validated non-invasive scale among diabetes patients treated in the selected primary health centres of Puducherry, India: an operational research

Background: Diabetes autonomic neuropathy (DAN) is a complication of diabetes which has direct implications on the mortality of diabetes patients. American Diabetes Association (ADA-2017) guidelines recommend early recognition and treatment of DAN. In this regard, we conducted a study among diabetic patients treated in the selected PHCs of Puducherry to determine the proportion with DAN and to assess the factors associated with DAN.Methods: A cross-sectional analytical study was conducted among diabetics and information on socio-demographic details, morbidity and behavioural risk factors were elicited using semi-structured interview schedule. The COMPASS-31 questionnaire was administered to assess the autonomic neuropathy symptoms. The data was captured using EpiCollect mobile app and analysed using Stata 12.0 software. The proportion of DAN was expressed as percentage with 95% confidence interval. The association between independent factors and DAN was assessed using multivariate generalized linear models. The prevalence ratio with 95% CI was used to express the strength of association.Results: Of the total 303 individuals with diabetes, 32 {10.6% (95% CI: 7.3%-14.6%)} were screened positive for autonomic neuropathy using COMPASS-31 scale. The number of individuals with diabetes who needed to be screened (NNS) for finding one with autonomic neuropathy was 10 (303/32).Conclusions: One in ten individuals with diabetes was screened positive for autonomic neuropathy. With good yield, there is need for including autonomic neuropathy screening as a component in the comprehensive care provided to diabetes patients in the primary health centres.

Evaluation of revised national tuberculosis control programme in rural Puducherry

Background: WHO estimates that annually 3 million deaths occurs due to tuberculosis and will reach to more than one billion in 2020. In India, more than 40% of population is infected. The revised national tuberculosis control programme (RNTCP) uses directly observed treatment, short-course (DOTS) therapy strategy to reduce mortality and morbidity, reduce transmission. Compliance to DOTS therapy is one of the important factors that affect the treatment outcome. Hence this study was done to assess the drug compliance rate of adults registered under RNTCP in the past one year and first three months after starting the study and to explore the factors associated with drug compliance.Methods: A longitudinal study was done in Bahour Commune Panchayat with subjects registered under RNTCP from January 2011 to March 2012. They were followed-up by house visit, interviewed using a semi-structured questionnaire.Results: The mean age was 44±13 years, 35 (68.6%) males were illiterate. About 60 (85.7%) belong to Class IV socio-economic status; 15 (29.4%) and 33 (64.7%) of adults had smoking and alcohol intake respectively; 03 (04.3) were diabetic. The treatment compliance rates were cured 64.3% (45/70), completed 27.1% (19/70), default 2.9% (02/70), failure 5.7% (04/70).Conclusions: Male being diseased in the productive age-group, will not only affect the health of the patient but also affect the family’s economic status. Most of the males gave history of alcohol intake, for which they require constant motivation for compliance to the treatment.

Regularity, treatment adherence and outcome among diabetic patients in primary care: an overview

Early detection and compliance to prescribed treatment is the cornerstone to avert life threatening complications among those with non-communicable diseases (NCD). Assessing regularity of visits, adherence to medication and its correlates can help in devising effective strategies to improve medication adherence. The objective of the study was to review about regularity, treatment adherence and outcome among diabetic patients in primary care. In this literature review, electronic data sources viz. Pub Med, Proquest, Google Scholar, Research gate with the use of the keywords or Mesh words like “Diabetes,” “Primary Health care” “Treatment adherence” “Regularity of treatment” “process of care indicators” and “outcome indicators” were searched. The searches were limited to studies reported in English and were available as free full text from January 2009 to June 2018. Related articles including descriptive cross-sectional, cohort, randomized controlled trials, qualitative studies and systematic reviews were also extracted and refined further. From our review it’s clearly evident that the level of Diabetic care in terms of regularity and follow-up is suboptimal compared to standards established in developed nations. There is a wide scope for improvement in diabetic care as demonstrated successfully in many nations using regular clinical audit, which needs future introspection.

Cases of mucocele treated in the Dental Department of Penang Hospital

A mucous cyst is a benign, self limiting mucous containing cyst of the salivary glands commonly occuring in the oral cavity. Mucocele may develop following the obstruction of the salivary flow from secretory apparatus of the salivary gland. Mucoceles commonly occur on the lower lip but may occur in other locations too. The objective of the study was to determine the factors associated with mucocele in patients attending the dental clinic of Penang Hospital from January 2000 to December 2005. This is a retrospective record review analysis of all the total 35 cases treated during this period, comprising of 20 males (57.1%) and 15 females (42.9%) with Malays as the largest group of patients treated and, mainly students had seek treatment. Mucocele was frequently treated in patients aged 21 to 24 year old. The site of the mucocele was the lower lip and all of the cases were treated surgically. The size of the mucocele ranged from 0.5 to 5 centimetres with 1.0 cm as the most common size. Most of the patients gave a history of spontaneous development (71.4%), followed by lip biting (25.7%) and trauma (2.9%). Lip biting was more common among students (55.6%) as compared to others. There were only two recorded cases of recurrence.