Prevalence of anemia in patients with Type 2 Diabetes Mellitus at Gandhinagar, Gujarat, India

Introduction: Anemia is a common finding in diabetes. Number of factors contributes to an increased prevalence of anemia in diabetes. Aim: To determine the prevalence of anemia in our patients with diabetes. Material and methods: The present study was conducted at the Gayatri Hospital, Gandhinagar. The subjects for the study included 200 adult patients with age more than 30 years and having diabetes mellitus type 2, attending the outdoor patient department (OPD) or admitted in ward as indoor patient department (IPD) of Gayatri Hospital. Blood specimens were collected and processed for determination of blood glucose, serum creatinine, and hemoglobin, HbA1C. Results: Anemia was present in 18% patients of diabetes. The prevalence of anemia was almost similar between women (18.60%) and men (17.54%). 74% of anaemic patients had a serum creatinine <110 μmol/l and 72% of anaemic patients had a calculated creatinine clearance of >60 ml/min. Conclusion: Every fifth individual in a population of diabetes mellitus could be anemic. Identifying and treating anemia would make a great impact in managing various complications of diabetes mellitus.

Perceptions of patients towards euthanasia A medico-legal perspective

Background: Euthanasia is a matter of debate since its origin and till now. Few countries have proper legislation for the same while in India, the matter is always remain unnoticed. Present study was aimed to analyze perceptions of patients towards euthanasia. Materials and methods: A cross sectional study was conducted among 107 patients after obtaining their informed written consent for participation in the survey regarding euthanasia and its medicolegal perspectives. All patients were subjected to pre-tested and validated questionnaire (Likert type scale) related to euthanasia after obtaining their socio-demographic details. Results: Out of 107 responses, only 100 responses were considered for analysis and rest of 7 were discarded. Out of 100 patients, maximum (33%) were in between 31 to 40 years of age, 66% were male, 82% were Hindu, and 71% were married. 51% were agreed that person should be kept alive as long s possible regardless of his age, disease, disabilities and personal preferences. 40% believed that supporting death with dignity means supporting active and passive euthanasia. 61% suggested that freedom of choice also applicable to freedom of choice to live or die. 55% disagreed that some patients should be allowed to die instead of making heroic efforts to prolong their lives. 73% believed that demanding or helping in euthanasia is crime. 52% were unsure regarding legalization of euthanasia. 78% believed that legalization of euthanasia may create moral and ethical problems. Conclusion: Perceptions of patients were varied but conclusion can be drawn that many of them believed that legalization of euthanasia may create moral and ethical problems.

Consent in medical practice Perceptions of patients towards legal aspects of informed consent.

Background: Informed consent is way of providing necessary information to the patients and helping them for decision making. All the pros and cons of procedure must be explained to the patients in the language he or she can understand. Just taking signature of patient on consent form without proper explanation and understanding of him is violating entire process of informed consent. Materials and methods: A cross sectional, observational study was conducted over 121 patients aged 18 years and above who came to Gayatri Hospital, Gandhinagar after obtaining their informed written consent for participation in survey regarding informed consent. All participants were subjected to pretested and validated questionnaire (Likert type scale) regarding legal aspects of informed consent. Results: Out of 121 participants, only 100 participants’ responses were included for analysis. Among 100 participants 73 were male and 27 were female. 78% agreed that informed consent is must for any procedure. 61% agreed that signing consent form is just a formality. 91% believed that informed consent is protective shield for doctors. 88% believed that informed consent is legally necessary. Only 52% agree that consent form is meant to protect patients’ rights. 77% felt that signing consent form Parmar P, Rathod GB, Rathod S, Parikh A. Consent in medical practice – Perceptions of patients towards legal aspects of informed consent. IAIM, 2016; 3(4): 105-110. Page 106 eliminate patients’ right to compensation. 82% wanted to know everything but letting decision left on doctor. Conclusion: The study concluded that there is a vide gap between actual concept of informed consent and perceptions of patients for the same. Patient awareness programs must be conducted by appropriate authority with help of media and television to improve their knowledge and preserve their rights.

A Study of Metabolic Syndrome and its Components in Type 2 Diabetes Mellitus Subjects and their Asymptomatic First-degree Relatives.

Objectives: To study clinical profile of metabolic syndrome and its individual components in type 2 diabetes mellitus subjects and their asymptomatic first-degree relatives. To identify risk factors of glucose intolerance. Material and methods: Randomly selected type 2 diabetes mellitus (T2DM) subjects age >40 years (n = 20, 10 males, 10 females) and their asymptomatic first-degree relatives age >30 years (excluding pregnant women) (n = 80; 46 males; 34 females) subjected to regression analysis with reference to components of metabolic syndrome (waist circumference, serum triglyceride, serum high-density lipoprotein (HDL), fasting plasma glucose, hypertension) and other variables. Student t-test was used for comparison of results. Results: Among T2DM subjects: Ninety percent were hypertensive, 85% had low HDL, 30% males and 80% females had central obesity, 85% had metabolic syndrome. Among asymptomatic first-degree relatives of T2DM subjects: 48.7% had metabolic syndrome; hypertension, low HDL, central obesity, impaired glucose tolerance, T2DM were present in 52.5%, 68.7%, 48.7%, 26.2%, 35%, respectively. In subjects with abnormal glucose level (n = 49) 59.18% subjects and in subjects with normal glucose level (n = 31) 32.25% met the criteria for metabolic syndrome (p = 0.023). Impaired fasting glucose, increased hip circumference and low HDL independently determined two hours glycemia value in OGTT. (R2 = 0.7; p = 0.001). Conclusion: In T2DM and their asymptomatic first-degree relatives, hypertension and low HDL were commonest components of metabolic syndrome, females were more obese. Glucose intolerance was significantly associated with other components of metabolic syndrome. Impaired fasting glucose, increased hip circumference and low HDL levels were risk factors for glucose intolerance.

Efficacy and Safety of Azithromycin for Uncomplicated Typhoid Fever: An Open Label Non-comparative Study.

An open-labelled, non-comparative study was conducted in 117 children aged 2- 12 years to evaluate the efficacy and safety of azithromycin (20mg/ kg/day for 6 days) for the treatment of uncomplicated typhoid fever. Of the patients enrolled based on a clinical definition of typhoid fever, 109 (93.1%) completed the study. Mean (SD) of duration of fever at presentation was 9.1(4.5) days. Clinical cure was seen in 102 (93.5%) subjects, while 7 were withdrawn from the study because of clinical deterioration. Mean day of response was 3.45±1.97. BACTEC blood culture was positive for Salmonella typhi in 17/109 (15.5%) and all achieved bacteriological cure. No serious adverse event was observed. Global well being assessed by the investigator and subjects was good in 95% cases which was done at the end of the treatment. Azithromycin was found to be safe and efficacious for the management of uncomplicated typhoid fever.

Drug treatment in elderly diabetic.

Diabetes causes greater decline in physical and functional status in elderly diabetic than in a younger one. Also the rise of MI, stroke and hypertension is also higher. In elderly diabetics management is always on challenging task due to atypical disease presentation, classical symptoms often absent, presence of other coexisting conditions delays the diagnosis, dietary advice not followed properly and due to non-compliance of drug therapy. The antidiabetic drugs which are often used are: sulfonylureas, metformin, thiazolidinediones, meglitinides, alpha-glucosidase inhibitors, insulin. Advantages and disadvantages of these drugs are discussed in a nutshell. Moreover control of hypertension, CAD risk reduction and practice pearls eg, lifestyle changes and goals setting for HbA(1c) are important.

Mental performance in Down syndrome.

Psychological assessment, using standard psychometric tests, was carried out in 375 cases of clinically diagnosed Down syndrome to study the degree of mental handicap. There were 160 (42.7%) cases in the severely retarded group, while 43 (11.5%) were profoundly retarded, 124 (33.1%) were moderately retarded, 34 (9.1%) were mildly retarded and 7 (1.9%) belonged to the category of borderline intelligence.