Effectiveness of Medical Nutritional Therapy in the Management of Type 2 Diabetes Mellitus.

AIM: To assess the effect of medical nutritional therapy (MNT) provided by dieticians on medical and clinical outcomes for adults with Type 2 Diabetes Mellitus. OBJECTIVE: To compare effectiveness of MNT administered monthly to MNT administered once in 03 months. METHOD: The study was conducted at the Department of Endocrinology in a tertiary care hospital. 98 men and women of the age group above 18 years were recruited in the study. 49 consenting individuals were randomly assigned to each of the 02 groups namely Group A and Group B. Group A consisted of 02 visits with dietician (including the initial visit) in the first month and thereafter every monthly. Group B consisted of initial visit with the dietician and there after every 03 monthly. An additional 49 adults with type 2 Diabetes mellitus at one site who had no facility for a contact with dietician were included as a comparison group.Medical outcome measures including fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) and serum lipid levels were compared and analysed. Clinical outcomes included Body weight, Height and Body mass index (BMI).Data was collected at the entry to the study and at 03 and 06 months interval. RESULT: In our study, the baseline fasting plasma glucose (FPG), HbA1C, total cholesterol and BMI was more or less similar in all 3 groups. There was a sustained decrease in all the four parameters in Group A which received the maximum nutritional therapy over a period of 06 months (A mean decrease of FPG 15.2 mg/dL, HbA1C 0.59%, total cholesterol 19.6 mg/dL, BMI 0.5 kg/m2 from baseline at 03 months and a mean decrease of FPG 33.4 mg/dL, HbA1C 1.24%, total cholesterol 40.8 mg/dL, BMI 1.1 kg/m2 from baseline at 06 months was seen). However, in Group B which received intermitted nutritional therapy, the decrease in these parameters were observed initially but over a period of 06 months, they increased to more or less near the baseline value months (A mean decrease of FPG 12.9 mg/dL, HbA1C 0.73%, total cholesterol 16.1 mg/dL, BMI 0.5 kg/m2 from baseline at 03 months but a mean increase of FPG 3.2 mg/dL and a mean decrease of HbA1C 0.24%, total cholesterol of 4.3 mg/dL and BMI 0.15 kg/m2 from baseline at 06 months was seen). In Group C which had no means of access to nutritional therapy, there was a subtle decrease in FPG and gradual increase in HbA1C, total cholesterol and BMI at 03 months but all four parameters increased significantly higher than the baseline value at the end of 06 months months (A mean decrease of FPG 6.2 mg/dL and mean increase of HbA1C 0.31%, total cholesterol 16.0 mg/dL, BMI 0.3 kg/m2 from baseline at 03 months and a mean increase of FPG 5.9 mg/dL, HbA1C 0.73%, total cholesterol 31.1 mg/dL, BMI 0.81 kg/m2 from baseline at 06 months was seen). CONCLUSION: Our study has clearly indicated that medical nutritional therapy is of great importance in the holistic management of Type 2 Diabetes mellitus in adults. MNT has got the advantage of not only maintaining a strict glycemic control (in terms of FPG and HbA1C reduction) but also in the lowering of cholesterol and BMI which are the main contributors to cardiovascular (CVD) events among people with type 2 Diabetes mellitus. Also, people who were given frequent MNT had a clear advantage over those who received intermittent MNT in terms of all the measured parameters.

Leukocytoclastic vasculitis as a cutaneous manifestation of ChAdOx1 nCoV-19 corona virus vaccine (recombinant).

With the present COVID-19 vaccination drive across the world, adverse skin reactions post COVID-19 vaccine is expected. Majority of these reactions seen were transient or local injection site reactions. However, as the larger population is being vaccinated, certain uncommon dermatological presentations including leukocytoclastic vasculitis, pityriasis rosea, and exacerbation of pre-existing autoimmune diseases are now being reported. Among all the COVID-19 vaccines, most of these reactions are seen with messenger ribonucleic acid-based Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273) vaccine. We report two cases of leukocytoclastic vasculitis following ChAdOx1 nCoV-19 corona virus vaccine (recombinant) that bring out potential new dermatological manifestations of recombinant corona virus vaccine being administered across the European, South American, and Asian countries. It is important for all health care workers and patients to be aware of the corona virus vaccine associated adverse cutaneous reactions.

Open-label randomized control trial of hydroxychloroquine in patients with moderate to severe coronavirus disease 2019 infection.

BACKGROUND: At onset of coronavirus disease 2019 (COVID-19) pandemic, hydroxychloroquine (HCQ) was repurposed for treatment of patients based on reports that it had in vitro activity. The aim of this study was to find out if HCQ reduces number of days of hospitalization when given to patients with moderate to severe COVID-19 infections who require hospitalized care. METHODS: This was an open-label randomized control trial of HCQ administered 400 mg twice on day 1, then 400 mg once daily from day 2 to day 5 in patients with moderate to severe COVID-19 infection. Assessment was not blinded. Standard of care was given to both arms.Primary outcome was number of days of hospitalization till discharge or death. RESULT: One hundred ten patients (55 in each arm) were included. Mean age was 58 years. Baseline characteristics were well matched. There was no difference in the primary outcome (13.67 vs 13.89; p = 0.98). Number of deaths were more in HCQ arm (RR: 1.81; 95% CI: 1.13-2.93; p = 0.03). There was no difference in number of days on oxygen or normalization of oxygen saturation, number who needed ventilator, days to ventilator requirement and days on ventilator. Twenty-nine patients in control arm received remdesivir. When adjusted analysis was done after removal of these patients, there was no difference in primary or secondary outcomes. Number of deaths in adjusted analysis were not significant (RR: 1.28; 95% CI: 0.87-1.88; p = 0.37). CONCLUSION: HCQ does not change the number of days of hospitalization when compared with control.

Myositis in a patient with coronavirus disease 2019: A rare presentation.

The world is presently struggling with coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A patient with COVID-19 typically presents with fever, non-productive cough, dyspnea, and myalgia. A 49-year-old female presented with complaints of subacute onset and progressive symmetrical proximal muscle weakness of both upper limbs and lower limbs with no sensory, cranial nerve deficit. She had elevated creatine phosphokinase levels of 906 U/L, an aspartate aminotransferase level of 126 IU/L, a lactate dehydrogenase level of 354 U/L, and an erythrocyte sedimentation rate of 68 mm/1 hr, and magnetic resonance imaging of the pelvis and thigh revealed muscle edema suggestive of myositis. Her reverse transcriptase-polymerase chain reaction result for SARS-CoV-2 was positive. Her evaluation for other causes of myositis was negative. She was managed with intravenous immunoglobulins and supportive care. She showed rapid improvement in symptoms and motor weakness. To our knowledge, this is the first reported case of COVID-19 related disabling myositis in India.

Survey of prevalence of anxiety and depressive symptoms among 1124 healthcare workers during the coronavirus disease 2019 pandemic across India.

BACKGROUND: A prospective study was conducted during the second phase of the coronavirus disease 2019 (COVID-19) pandemic in India to assess the prevalence of anxiety and depressive symptoms among healthcare workers (HCWs) and factors that influence the outcome. METHODS: A self-administered questionnaire was completed by 1124 HCWs during the COVID-19 pandemic (March 30, 2020, to April 2, 2020). Demographic data, questions on COVID-19 and scores of the Hospital Anxiety and Depression Scale were analysed using the chi-square test (Bonferroni correction) and binary logistic regression. RESULTS: The study consists of 1124 HCWs, including 749 doctors, 207 nurses, 135 paramedics, 23 administrators and ten supporting staff members. The prevalence of anxiety and depressive symptoms were reported as 37.2% and 31.4%, respectively. The risk factors for anxiety were female gender (30.6% vs 45.5%), age group (20-35 years) (50.4% vs 61.2%), unmarried (21.2% vs 30.6%) and job profile (nurse) (14.7% vs 26.4%). The protective factor was having service of more than 20 years (23.4% vs 14.8%). The risk factors for depression were age group (20-35 years) (51.3% vs 61.3%) and employed at a primary care hospital (16.2% vs 23.4%). The protective factors were job profile (doctor) (69.9% vs 59.6%) and having service of more than 20 years (22.3% vs 15.5%). CONCLUSION: Approximately one-third of the HCWs reported anxiety and depressive symptoms. The risk factors for anxiety symptoms were female gender, younger age and job profile (nurse) and for depressive symptoms were younger age and working at a primary care hospital. Future research studies should identify strategies for providing a safer and supportive work environment for HCWs to face epidemics/pandemics.

Psychological Health Among Armed Forces Doctors During COVID-19 Pandemic in India.

BACKGROUND: A pandemic poses a significant challenge to the healthcare staff and infrastructure. We studied the prevalence of anxiety and depressive symptoms among armed forces doctors in India during the COVID-19 pandemic and the factors that contribute to these symptoms. METHODS: The study was conducted from March 30, 2020, to April 2, 2020, using a self-administered questionnaire questionnaire using the hospital anxiety and depression scale (HADS), which was sent through Google Forms. Responses were received from 769 respondents. Data were analyzed for demographic details and HADS scores using the chi-square test and backward logistic regression. RESULTS: Anxiety and depressive symptoms were seen in 35.2% and 28.2% of the doctors, respectively. In doctors with anxiety symptoms, significant associations were observed with age (20-35 years, 39.4%, P = 0.01), gender (females, 44.6%, P < 0.001), duration of service (0-10 years, 38%, P = 0.03), and clinical versus non-clinical specialties (non-clinical, 41.3%, P < 0.001) as opposed to marital status, education level, and current department of work.In doctors with depressive symptoms, significant associations were observed with age (P = 0.04), clinical versus non-clinical specialties (P < 0.001), duration of service (0-10 years, 30.1%, P = 0.03), and doctoral degree (P = 0.04) as opposed to gender, marital status, education level, and current working department. CONCLUSION: The study revealed a high prevalence of anxiety and depressive symptoms among armed forces doctors. The main contributing factors are female gender, young age group, non-clinical specialties, and having a doctoral degree.