Awareness of diabetic retinopathy among physicians and optometrists in a district of West Bengal.

A cross sectional study was done to ascertain the current knowledge among physicians and optometrists regarding diabetic retinopathy in a district of West Bengal. We obtained response from 242 physicians and 36 optometrists working in government health units. The questionnaire comprised of three sections covering magnitude of problem, risk factors and management. The responses were analysed and graded. In different sections, knowledge of 74 - 78% physicians and 83 - 86% optometrists was graded as not acceptable. Existing lack of knowledge among physicians and optometrists regarding diabetic retinopathy needs correction.

Hyperthyroidism.

Hyperthyroidism is a clinical situation where there is excess thyroid hormones in the circulation due to increased synthesis of hormone from a hyperactive thyroid gland. Common causes are Graves' disease, toxic multinodular goitre and toxic solitary nodule. Excess thyroid hormones in the circulation are also found in thyroiditis (hormone leakage) and excess exogenous thyroxine intake. Thyrotoxicosis is the term applied when there is excess thyroid hormone in the circulation due to any cause. Thyrotoxicosis can be easily diagnosed by high serum level of thyroxine (T4) and triiodothyronine (T3) and low serum level of thyroid stimulating hormone (TSH). Hyperthyroidism is confirmed by high isotope (I 131 or Tc99) uptake by the thyroid gland, while in thyroiditis it will be low. Treatment of hyperthyroidism depends on the underlying cause. Antithyroid drugs, 1131 therapy and surgery are the options of treatment of hyperthyroidism. Surgery is the preferred treatment for toxic adenoma and toxic multinodular goitre, while 1131 therapy may be suitable in some cases. Antithyroid drugs and 1131 therapy are mostly preferred for Graves' disease. Beta-adrenergic blockers are used for symptomatic relief in most patients of thyrotoxicosis due to any cause. Other rare causes of hyperthyroidism like, amiodarone induced thyrotoxicosis, choriocarcinoma, thyrotropin secreting pituitary tumour are difficult to diagnose as well as to treat.

Subclinical thyrotoxicosis.

Subclinical thyrotoxicosis as a definite entity has been recognised with the development of highly sensitive immunometric TSH assays. The condition is characterised by suppressed TSH in presence of normal T3 and T4. It may be due to exogenous or endogenous causes. The risks may be osteoporosis and atrial fibrillation. Exogenous subclinical thyrotoxicosis must be prevented by optimising laevothyroxine dosage. Endogenous subclinical thyrotoxicosis may or may not be treated depending upon the clinical situation and existing comorbidities.

Prevalence of diabetes in various habitats of West Bengal, India.

The epidemiological profile data were collected for diabetes mellitus from the people living in three habitats (rural, industrial and urban) having considerable difference in their lifestyle and socio-economic status. Every 5th (occasionally 4th or 6th) member from each habitat was sampled; no restriction regarding age was kept during screening; OGTT (oral glucose tolerence test) was performed 2 hours after 75 g glucose, in those whose FBS (fasting blood sugar) was >90 mg/dl. Diagnosis of diabetes mellitus was ascertained, if the FBS was >120 mg/dl and/ or postglucose value was >200mg/dl. The per cent prevalence (among all aged people) of diabetes mellitus in rural, industrial and urban habitats were found to be: 1.66 +/- 0.58 (male 1.99 +/- 0.88, female 1.3 +/- 0.75); 3.00 +/- 0.74 (male 3.17 +/- 1.04, female 2.80 +/- 1.04) and 4.8 +/- 0.98 (male 5.31 +/- 1.43, female 4.27 +/- 1.32) respectively.

Prevention of type 2 diabetes in the prediabetic population.

Prevention of diabetes has been tried by several groups with varying degree of success. Prediabetic population are the ideal target for the purpose. In this study, prediabetic subjects are selected from the high-risk groups, like those having obesity, family history of diabetes, past history of gestational diabetes, hypertension, dyslipidaemia; and are included in the study when their fasting plasma glucose was found to be below 110 mg/dl and 2 hours postglucose (75g) plasma glucose remained between 110 and 200 mg/dl. After giving advice for lifestyle changes to all for a period of 3 months, those who had their blood glucose values in the impaird glucose tolerance (IGT) range were given either metformin, rosiglitazone or acarbose, the rest continued with diet and exercise only. Total follow-up period was 3 years. All groups maintained blood sugar in the euglycaemic range till the end of the 3-year period.

Exercise in prediabetes.

Exercise as a therapeutic modality in the management of type 2 diabetes is well established. However, exercise has emerged as an important tool to prevent, or at least, to delay the onset of type 2 diabetes. This has been borne out by a few recent clinical trials. Exercise improves insulin sensitivity besides having beneficial effects on many cardiovascular risk factors. A sedentary adult at high risk for developing diabetes may benefit from at least 30 minutes of daily moderate-intensity exercise.

Prevention of microvascular and macrovascular complications in diabetes mellitus.

Microvascular and macrovascular complications in relation to diabetes mellitus are responsible for major morbidity and mortality condition. Prevention of these complications should be the aim while managing diabetes. Retinopathy, nephropathy and neuropathy are microvascular complications and macrovascular complication affects heart, brain and foot. In preventing retinopathy, glycaemic and blood pressure control is essential. Laser photocoagulation therapy can prevent loss of vision in non-proliferative or proliferative diabetes mellitus. The aim of preventing nephropathy lies on meticulous glycaemic control, dietary protein limitation and vigorous control of blood pressure. The highest priority at present to prevent diabetic neuropathy is the education of patients and their physicians about the potential for detection and treatment of early neuropathy. Glycaemic control is beneficial in reducing the frequency of progression of neuropathy. Macrovascular complication (cardiovascular, cerebrovascular, peripheral vascular) can be prevented with some intervention strategies eg, discouraging smoking habit, proper diet, regular physical activity, strict glycaemic and blood pressure control, lowering low density lipoprotein cholesterol level and aspirin therapy. Amputation in diabetic foot can be dealt with a number of prevention strategies eg, careful self examination, to use specially fitted shoes, minimisation of trauma, earlier detection and aggressive management by local debridement, provision of special support and early antibiotic therapy.

Mason diabetes--report of a family.

A 48-year-old Hindu housewife was presented with increased appetite, thirst, frequency of micturition, weakness, cramps in the legs, tingling in the fingers, decline in bladder-bowel control and dimness of vision. She was a patient of diabetes. On investigations and history, she was diagnosed as a case of type 2 diabetes transmitted in three generations as an autosomal dominant trait.

True hermaphroditism: a report of two cases.

Two cases with true hermaphroditism are described. A 2 year old child presented with ambiguous genitalia, and had bilateral ovotestis in the labioscrotal folds. A 20 year old boy presented with grade V gynaecomastia and periodical bleeding as well as seminal discharge after phallic stimulation; he had right sided ovotestis, normal size uterus, left ovary and hypoplastic fallopian tubes. Male gender was assigned to both. Cytogenetically both were 46XX. Gonadectomy was done in both the cases. Bilateral mastectomy and hysterectomy was done in the second case.