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1.
Artigo | IMSEAR | ID: sea-216340

RESUMO

People with type 2 diabetes mellitus (T2DM) have a higher risk of developing chronic liver disease (CLD) and its complications. T2DM, obesity, and insulin resistance are all strongly associated with nonalcoholic fatty liver disease (NAFLD). Conversely, people suffering from cirrhosis have reduced glucose tolerance in approximately 60% of cases, diabetes in 20% of cases, and insulin-mediated glucose clearance is lowered by 50% as compared with those who do not have cirrhosis. An exploratory review was conducted using existing published evidence from clinical studies on dosing and titrations of individual insulin formulations in people with CLD to optimize insulin dosage titration for minimizing hypoglycemia risk. This article discusses current hyperglycemia treatment techniques for patients with CLD as well as the consensus recommendations on insulin use in special populations with T2DM and hepatic impairment. Based on available evidence and expert diabetologists’ recommendations, careful insulin dose titration, customized glycemic targets, and frequent glucose screening are recommended for optimal glycemic management without hypoglycemia in CLD. Long-acting insulin should be avoided or used when short-acting insulin fails to provide adequate glycemic control with raised fasting blood sugar levels. While the patient’s glucose profile is being evaluated, the prandial insulin dose can be lowered by 25% initially. The dose can be titrated based on the patient’s postprandial glycemic expression and whether their food intake meets the Child–Pugh scores A and B categories. Titrating premixed insulins is difficult for patients in class C since their appetite and overall health are constantly compromised and in flux.

2.
Artigo | IMSEAR | ID: sea-216252

RESUMO

Background: The available evidence was systematically reviewed to evaluate the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2i) on cardiovascular (CV) and renal outcomes in people with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) or multiple risk factors (MRF), with or without heart failure (HF), and per estimated glomerular filtration rate (eGFR) rate at baseline. Methods: We comprehensively searched three electronic databases to retrieve publications up to 30th November 2019, which were screened for inclusion. The data extracted for the outcomes according to baseline ASCVD, HF, and eGFR levels were meta-analyzed using fixed effects model. Results: Of the 735 screened citations, 15 primary and secondary publications from five CV or renal outcome trials were included. SGLT2is reduced the risk of CV death or hospitalization for HF (HHF), HHF alone, and composite renal-specific outcome, irrespective of ASCVD and HF at baseline. The three-point major adverse cardiovascular events (3P-MACE) risk was reduced by 14% (p<0.001) in patients with ASCVD and by 10% (p = 0.018) in those without baseline HF compared with their counterparts. SGLT2is significantly reduced the risk of MACE (18%) in patients with mild kidney dysfunction (eGFR within the range of 60–<90 mL/min/1.73 m2 and <60 mL/min/1.73 m2 ). Conclusion: SGLT2is are effective for both secondary and primary prevention of composite CV outcomes, and secondary prevention of MACE. The upcoming evidence may strengthen the primary prevention benefits of SGLT2is.

3.
Artigo | IMSEAR | ID: sea-201348

RESUMO

Background: Pertaining to increasing incidence of HIV/AIDS among youths, it becomes a need of the hour to make them aware about every aspects of disease. Students of secondary and higher secondary school can be targeted for achieving this goal. The objective of the study was to assess the knowledge about HIV/AIDS among the school students before and after giving educational intervention.Methods: An educational interventional study was carried out among school going adolescents of one of the school situated in the field practice area of one of the rural teaching hospitals of Gujarat. Pre-designed and pre-tested proforma was used for pre and post test study. Educational intervention in the form of power point presentation was conducted on various aspects of HIV/AIDS.Results: Around 163 students participated in the study. Mean age of the students were 16.6±0.7 yrs. Among them, 148 (90.8%) have heard about HIV/AIDS and only 26.3% could tell correctly about full form of HIV/AIDS before intervention. After giving educational intervention this percentage was raised to 89.2% which was significant statistically. Knowledge on almost all the aspects viz. modes of transmission and preventive aspects were significantly raised among the student after giving educational session.Conclusions: Correct knowledge about etiological and preventive aspects were lacking among the students before intervention. Various misconceptions which were prevalent among them were cleared by giving educational intervention. Secondary and Higher secondary schools can be selected as a platform for raising overall awareness about HIV/AIDS.

4.
Artigo | IMSEAR | ID: sea-206768

RESUMO

Background: This study was conducted to evaluate the acceptance, safety, efficacy, complications and expulsion rate of post-partum intrauterine contraceptive device (PPIUCD) insertion among post-partum pregnant women in a rural tertiary care center. Objective of this study was assessment of the efficacy and safety of post-partum IUCD insertion. Comparing the complications and client satisfaction in both groups (intra caesarean insertion versus vaginal route of insertion).Methods: This is a prospective study conducted at one of the rural tertiary care teaching institution. A total of 150 patients with caesarean or vaginal deliveries had PPIUCD insertions and they were followed up for a period of one year. The outcome measures analyzed were menstrual irregularities, vaginal discharge, pelvic infection and perforation and efficacy measures - failure, expulsion and removal. Data are expressed in frequency and percentage. Chi square test was used for comparison and P value <0.05 was considered significant.Results: The study shows that PPIUCD is an effective intervention in both caesarean and vaginal delivery with non-significant differences in safety and efficacy depending on the route of insertion. There was no case of perforation and no significant risk of infection in either caesareans or delivery. Spontaneous expulsion occurred in two cases inserted by vaginal route. Missing string incidence is high in the caesarean group compared to vaginal insertion.Conclusions: PPIUCD is a safe, effective and long term reversible method of contraception and should be encouraged by public awareness and community acceptance.

5.
Artigo | IMSEAR | ID: sea-189940

RESUMO

Introduction:Diabetes Mellitus is a heterogeneous group of metabolic disorder characterized by chronic hyperglycemia with disturbance of carbohydrate, fat and protein metabolism resulting from defect in insulin secretion, insulin action or both. The two broad categories of DM are Type 1 & Type 2. Due to paucity of dramatic symptoms, poor health awareness & the prevailing socio-economic condition type 2 diabetes frequently goes undiagnosed for many years and such patients are at increased risk of developing macro-vascular and micro-vascular complications(1). This was clearly seen in UK Prospective Diabetes Study where 50% of patients had diabetic complications at presentation (3). Lipid abnormalities play an important role in causation of diabetic atherosclerosis (4, 5) and contribute significantly to complication of diabetes.Materials & Methods: A prospective analytical study of 200 patients was undertaken at Department of Internal Medicine, AMC MET MMC Ahmedabad. Prior approval by IRB of AMC MET MMC was taken. Patients presenting to OPD were analyzed in terms of Age, Sex & Obesity related to dyslipidemia & data analyzed using Paired T test with reference study.Observations: Mean age of study population was 54 yrs. Male patients were 54.55 yrs&females were 54.80 yrs mean age. Abnormal HDL 80%, LDL 57%, VLCL 56%, Cholesterol in 37% were found. 66% of pts had BMI > 25 & were classified as obese. Conclusions: Majority of patients were 40-60 yrs age group which is a high risk age group for development of atherosclerosis & cerebrovascular events & of them >50% of pts were having altered lipid profile which is a significant risk factor for morbidities related to diabetes. Hence control of dyslipidemia in diabetics with lipid lowering agents should begiven due consideration when planning a treatment regimen

6.
Ann Card Anaesth ; 2018 Apr; 21(2): 205-207
Artigo | IMSEAR | ID: sea-185716

RESUMO

Absent superior vena cava (SVC) is an asymptomatic congenital systemic venous anomaly which is rarely detected and compatible with normal life. Undiagnosed absent SVC may cause problems during cardiac catheterization or cardiac surgery. We present our surgical experience in a patient with tetralogy of Fallot who had undiagnosed absent SVC.

7.
Artigo em Inglês | IMSEAR | ID: sea-153095

RESUMO

Background: Designing health care policies and programmes requires knowledge about health care seeking behaviour, so that appropriate interventions can be implemented. Health care seeking behaviour is influenced by the individual self, diseases, and the availability and accessibility of health services. Dependent on these determinants health care seeking behaviour is a complex outcome of many factors operating at various levels. Aims & Objective: Present study aimed at exploring possible differences in health care seeking behavior in rural and urban Ahmedabad. Material and Methods: A Cross-sectional study was carried out over a period of one year (April 2011-March 2012) in urban and rural area of Ahmedabad district. Total 500 houses from each were surveyed using pre-designed and pre-tested proforma by house to house visits. Head of the family from each household was interviewed. Information regarding morbidity and health seeking behaviour was collected during household survey. Results: Maximum number of respondents belonged to age group 25-39 years in urban (49.8%) and rural (53.8%). Rural people preferred government and trust hospitals (51.1%) more as compared to urban (44.1%). Significant difference was observed in place for treatment of acute illness from faith healers. More rural people (29.2%) took treatment from faith healers than urban (22.8%). Majority of rural people (59.6%) took treatment for chronic illness from private practitioner than urban (51.4%). More urban people (57.4%) were using cash savings for treatment than rural people while borrowing and selling assets for treatment was more in rural people (57.4%) The result was statistically significant. Insurance coverage for illness was significantly low both in urban and rural area. Conclusion: Difference in health seeking behaviour was noticed among urban and rural communities. As far as treatment of chronic illnesses is concerned more infrastructure investments should be made to improve accessibility to government health care facilities, especially in rural areas. There is a need to make the rural people more aware regarding availability of various health insurance schemes.

8.
Indian J Hum Genet ; 2013 Apr; 19(2): 219-232
Artigo em Inglês | IMSEAR | ID: sea-149433

RESUMO

BACKGROUND: Human leukocyte antigen (HLA) is comprised of a highly polymorphic set of genes which determines the histocompatibility of organ transplantation. The present study was undertaken to identify HLA class I and class II allele, genotype and haplotype frequencies in renal transplant recipients and donors from West Central India. MATERIALS AND METHODS: HLA typing was carried out using Polymerase Chain Reaction-Sequence Specific Primer in 552 live related and unrelated renal transplant recipients and donors. RESULTS: The most frequent HLA class I and class II alleles and their frequencies in recipients were HLA-AFNx0101 (0.1685) and AFNx0102 (0.1649), HLA-BFNx0135 (0.1322), and HLA-DR beta 1 (DRB 1)FNx0115 (0.2192), whereas in donors, these were HLA-AFNx0102 (0.1848) and AFNx0101 (0.1667), HLA-BFNx0135 (0.1359), and HLA-DRB1FNx0115 (0.2409). The two-locus haplotype statistical analysis revealed HLA-AFNx0102-B61 as the most common haplotype with the frequency of 0.0487 and 0.0510 in recipients and donors, respectively. Further, among the three locus haplotypes HLA-AFNx0133-BFNx0144-DRB1FNx0107 and HLA-AFNx0102-BFNx0161-DRB1FNx0115 were the most common haplotypes with frequencies 0.0362 and 0.0326, respectively in recipients and 0.0236 and 0.0323, respectively in donors. Genotype frequency revealed a high prevalence of genotype HLA-AFNx0102/AFNx0124 in recipients (0.058) compared to donors (0.0109) whereas low prevalence of HLA-AFNx0101/AFNx0102 in recipients (0.0435) than in donors (0.0797). The phylogenetic and principal component analysis of HLA allele and haplotype frequency distribution revealed genetic similarities of various ethnic groups. Further, case control analysis provides preliminary evidence of association of HLA-A genotype (P < 0.05) with renal failure. CONCLUSION: This study will be helpful in suitable donor search besides providing valuable information for population genetics and HLA disease association analysis.


Assuntos
Alelos , Etnicidade/genética , Genótipo , Antígenos HLA/classificação , Antígenos HLA/genética , Haplótipos , Humanos , Índia , Transplante de Rim/imunologia , Polimorfismo Genético
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