'Daily 2-only meals and exercise' lifestyle modification for remission of type 2 diabetes mellitus: A therapeutic approach.

This case series has documented five patients diagnosed with type 2 diabetes (T2D), referred to the various Diabetes Reversal Centers of the 'World free of obesity and diabetes' campaign in Maharashtra, India. It demonstrates the therapeutic effects of lifestyle modification for remission of diabetes along with weight reduction and reversal of insulin resistance. This resulted in reduction of their glycated haemoglobin level, which signified the long-term effects of this lifestyle modification. Diabetes reversal by lifestyle modification is a healthier option and must be encouraged in all the patients in the pre-diabetes group (HbA1c- 5.7-6.4%) and those with newly diagnosed type 2 diabetes mellitus (HbA1c- >6.5%) without any complications, thus promoting good health seeking behaviour. There are pieces of evidence of complete diabetes reversal of the patients with HbA1c ranging from 8 to 15% by just lifestyle modification and also without any complications among the patients registered under the 'World free of obesity and diabetes' campaign. India is a low-middle-income country with prevalence of T2D on rise. It is thus necessary to provide the community with a cost-effective and sustainable solution for primary and secondary prevention of this lifestyle disease.

Reduction in HbA1c through lifestyle modification in newly diagnosed type 2 diabetes mellitus patient: A great feat.

A 45-year-old male, resident of Texas, U.S.A, was diagnosed with type-2 diabetes mellitus on September 05, 2020 with HbA1c 14.9%. His physician prescribed oral hypoglycemic agents (OHA) starting immediately due to his high HbA1c levels. However, the patient was reluctant to be on lifelong medications. Thus, he chose conservative management of lifestyle modification by enrolling in "World free of Obesity and Diabetes" campaign that advised "only two meals a day and exercise" regime for diabetes reversal. He followed the plan very meticulously and his HbA1c was successfully reduced by 9.8% (HbA1c from 14.9% to 5.1%) within 3 months without any medications. The patient follows the regime without any burden of compromising his quality of life and has maintained his HbA1c to 4.6% till April 2021. Diabetes reversal by lifestyle modification is a healthier option, and must be encouraged in all the patients in prediabetes group (HbA1c: 5.7%-6.4%) and those with newly diagnosed type 2 diabetes mellitus (HbA1c: >6.5%) without any complications, thus promoting good health-seeking behavior. American Diabetes Association (ADA) suggests that metformin should be started to the prediabetes and newly diagnosed group of patients along with lifestyle modifications. However, there are evidences of complete diabetes reversal of the patients with HbA1c ranging from 8%-15% by just lifestyle modification and that too without any complications among the patients registered under "World free of obesity and diabetes" campaign, which challenges the current prescribed guidelines for the management of type 2 diabetes mellitus.

Effectiveness of early clinical exposure in improving attitude and professional skills of medical students in current Indian medical education set up.

INTRODUCTION: As a part of education reforms Medical Council of India has introduced early clinical exposure (ECE) as an important intervention in Medical teaching. It is stated in the literature, ECE helps to relieve stress of the students pertaining to patient handling, developing real-time clinical reasoning ability, communication skills, professional attitude, and patient empathy. With this view, this study was planned to assess effectiveness of early clinical exposure in improving attitude and professional skills in the current Indian medical education set up. METHODS: This cross-sectional study was carried out amongst 820 students for three years duration. Students were randomly divided into two groups viz. ECE exposed group (Group A) and Traditional teaching exposed group (Group B). We conducted periodical sessions (Each duration: 60 minutes). We used a validated 10-point questionnaire for feedback collection. RESULTS: Using perception-based 10-point questionnaire based on Likert scale we found, 93.21% of students strongly agreed that the method of ECE teaching aroused interest in learning. 86.03% of students strongly agreed that the method of ECE teaching technique helped in better retention of topic. 89.91% of students strongly agreed that the method of ECE teaching imparts better clinical context. 92.75% of students strongly agreed that the method of ECE teaching allows better assimilation of knowledge gained during learning. With ECE-based teaching 87.42% of students found highly satisfied while 81.22% of students found highly competent about the knowledge and skills thus acquired via this teaching methodology. 95.11% of students liked ECE teaching methodology and these students enjoyed it a lot and with interest. CONCLUSION: This study concluded that early clinical exposure is the most important teaching tool in improving attitude and professional skills in the current Indian medical education set up.

Knowledge, Attitude and Practices towards Medical Research amongst the Postgraduate Students of Pravara Institute of Medical Sciences University of Central India.

BACKGROUND: Health research training is an essential component of medical education and a vital exercise to help develop physician research skills. OBJECTIVES: This study was carried out to assess the knowledge, attitude, and practices towards health research amongst the postgraduate students of Pravara Institute of Medical Sciences University of central India. MATERIALS AND METHODS: A cross-sectional study was carried out from August to October 2012. A total of 116 postgraduate students were interviewed. Knowledge, attitude, and practices related to health research were assessed using a predesigned, pretested and validated questionnaire. Results were analyzed in the form of percentage and proportions whenever appropriate. RESULTS: In present study, the concept of research hypothesis was known to only 18.9% of the postgraduate students, whereas 17.2 and 21.5% students knew the full form of MEDLARS and MEDLINE respectively. Majority (91.4%) students believed that patient outcome improves with continued medical research and 70.7% are willing to participate in workshop for research methodology. Lack of time due to vast curriculum of postgraduate subjects (59.5%), lack of research curriculum (25%), and inadequate facilities (25.8%) were stated as major obstacles for pursuing research. CONCLUSION: Postgraduate students have inadequate knowledge, but have positive attitudes towards health research. Postgraduate training and research facilities at the institution need to undergo major transformation in order to encourage meaningful research by postgraduate trainees.

Study of socio-demographic determinants of esophageal cancer at a tertiary care teaching hospital of Western Maharashtra, India.

BACKGROUND: Esophageal cancer has a peculiar geographical distribution and shows marked differences in incidence within a particular geographical region. Presently, as there seems little prospect of early detection of this cancer, an understanding of the etiological factors may suggest opportunities for its primary prevention. OBJECTIVES: The present study was carried out to find out the socio-demographic determinants of esophageal cancer in a tertiary care teaching hospital of western Maharashtra, India. MATERIALS AND METHODS: A retrospective hospital record-based study was carried out for the period of five years (2007-2011) in the department of Radiotherapy of Pravara Rural Hospital, Loni, western Maharashtra, India. A total of 5879 patients were diagnosed with cancer, of them, 207 (3.52%) patients had esophageal cancer. Data was collected on the basis of the patients' record in the hospital and analyzed in the form of percentage and proportions whenever appropriate. RESULTS: Out of total 5879 patients who were diagnosed with cancer during the five studied years, 207 (3.52%) patients had esophageal cancer, of which 121 (58.46%) were males and 86 (41.54%) were females, which show predominance of males over females. Most of the patients (28.50%) belonged to lower class, while only 9.66% were from upper class. Majority of the patients (54.14%) had a history of tobacco chewing, followed by smoking (cigarette, bidi, or both) in 36.94% and alcohol in 21.65%. CONCLUSION: The present study shows that esophageal cancer constitutes 3.52% of cancer cases. There is a need to screen the high-risk group of people, improve socio-economic status, and efforts must be made to introduce a set of preventive measures that have the potential to significantly reduce the burden of disease and to help bridge the gap between research and public awareness.

Prevalence of Pulmonary Tuberculosis Among HIV Positive Patients Attending Antiretroviral Therapy Clinic.

BACKGROUND: Tuberculosis (TB) is the most common serious opportunistic infection in HIV positive patients and is the manifestation of AIDS in more than 50% of cases in developing countries. TB can occur at any time during the course of HIV infection. AIM: To describe the socio-demographic profile and prevalence of pulmonary tuberculosis (HIV/TB co-infection) among HIV positive patients been attended at the antiretroviral therapy clinic (ART) clinic at tertiary care teaching hospital of western Maharashtra, India. MATERIALS AND METHODS: A cross-sectional study was carried out at the ART clinic of Pravara Rural Hospital, Loni, from June 2011 to May 2012. A total of 1012 HIV positive patients, who attended ART clinic, receiving ART treatment during the study period, were included in the analysis. The statistical analysis was performed using SPSS software (Version 17.0). RESULTS: This study showed 1012/172 (17%) prevalence of pulmonary tuberculosis among HIV positive patients, of which 87 (50.58%) were males and 85 (48.42%) were females. Low CD4 count (< 50/µl) had statistically significant association with HIV/TB co-infection as compared to HIV infection only (P < 0.0001). CONCLUSION: The study showed that 17% of HIV infected persons had tuberculosis co-infection. More strategic preventive measures that enhance body immunity among HIV patients are highly needed as early as possible before they develop active tuberculosis.

Vaginal birth after cesarean section.

BACKGROUND: The rate of primary cesarean section (CS) is on the rise. More and more women report with a history of a previous CS. A trial of vaginal delivery can save these women from the risk of repeat CS. AIMS: The study was conducted to assess the safety and success rate of vaginal birth after CS (VBAC) in selected cases of one previous lower segment CS (LSCS). MATERIALS AND METHODS: The prospective observational study was carried out in a tertiary care teaching hospital over a period of two years. One hundred pregnant women with a history of one previous LSCS were enrolled in the study. RESULTS: In the present study, 85% cases had a successful VBAC and 15% underwent a repeat emergency LSCS for failed trial of vaginal delivery. Cervical dilatation of more than 3 cm at the time of admission was a significant factor in favor of a successful VBAC. Birth weight of more than 3,000 g was associated with a lower success rate of VBAC. The incidence of scar dehiscence was 2% in the present study. There was no maternal or neonatal mortality. CONCLUSION: Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas.

Knowledge and attitude of medical undergraduate, interns and postgraduate students in India towards emergency contraception.

BACKGROUND: Although India was the first country in the world to have national family planning policy, the acceptance of contraceptive methods has been unsatisfactory. Many women in their peak reproductive years, who wish to control their fertility, are not aware about the different methods of contraceptives available. Unregulated fertility results in unplanned pregnancies. Emergency contraceptive pills can avoid many such unplanned pregnancies. AIM: The study was to assess the knowledge and attitude about emergency contraception (EC) among the undergraduate, interns and postgraduate medical science university students. MATERIALS AND METHODS: A cross-sectional study was carried out among 180 medical students which include undergraduate (final year MBBS), interns, and postgraduate students (60 from each group) studying at Rural Medical College and Pravara Rural Hospital of Pravara Institute of Medical Sciences University of central India by a convenient sample method over a period of February 2009 to May 2009. Data were collected by pre-designed, pre-tested, self-administered questionnaire. Data was analyzed in the form of percentage and proportions and Chi-square test was applied. RESULTS: In this study, a total of 180 respondents, of which 110 (61.2%) were male and 70 (38.8%) were female. The knowledge about EC was highest (47.6%) among postgraduates in comparison to interns (43.3%) and undergraduate students (41.6%). Overall positive attitude toward EC was observed among 73.8% of the respondents. CONCLUSIONS: Considering the role of a medical graduate as counselor and health-care provider, the technical knowledge about different aspects of EC among the study population was inadequate.

Seroprevalence of transfusion transmissible infections among voluntary blood donors at a tertiary care teaching hospital in rural area of India.

BACKGROUND: Blood transfusion is a life-saving measure in various medical and surgical emergencies. Transfusion medicine, apart from being important for the medical treatment of each patient, also has great public health importance. OBJECTIVES: The present study was conducted to estimate the prevalence of transfusion transmitted infections in voluntary blood donors at a rural tertiary care teaching hospital in western Maharashtra, India. MATERIALS AND METHODS: All voluntary donors reporting to the blood bank were screened for HBsAg, Hepatitis C Virus (HCV), HIV and Syphilis by using the appropriate enzyme-linked immunosorbent assay. HIV infection was confirmed using a standard immunoblotting technique. Hepatitis B Virus (HBV) was tested for surface antigen (HBsAg) and HCV by the immunechromatographic method. The Venereal Disease Reference Laboratory (VDRL) test was used for estimation of syphilis infection. The study was designed for a duration of two years between January 2009 to December 2010. Medical reports of the donors were accessed from the hospital records and analyzed. RESULTS: A total of 5661 voluntary blood donors were screened, of which 5394 (95.28%) were males and 267 (4.72%) were females. The overall seroprevalence of HBV and HCV were 1.09% and 0.74% respectively; for HIV and syphilis the seroprevalence was estimated to be 0.07% for each. CONCLUSION: Blood is still one of the main sources of transmission of infections. HIV, hepatitis B, hepatitis C viruses and syphilis are prevalent among voluntary donors in rural India.

Study of knowledge and attitude regarding prenatal diagnostic techniques act among the pregnant women at a tertiary care teaching hospital in Mumbai.

BACKGROUND: Sex ratio, an important social indicator measuring extent of prevailing equity between males and females in society, is defined as number of females per 1000 males. Changes in sex ratio reflect underlying socioeconomic, cultural patterns of a society. As per 2011 census sex ratio in India is 914/1000 males, which continues to be significantly adverse towards women. OBJECTIVES: This study was conducted to assess the knowledge and attitude regarding Prenatal Diagnostic Techniques (PNDT) Act among the pregnant women at a tertiary care teaching hospital in Mumbai. MATERIALS AND METHODS: A cross-sectional study was carried out in the antenatal ward of Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai during the period of January to April 2008. A total of 143 women were included and a pre-designed and pre-tested questionnaire was used to get information regarding socio-demographic details of the pregnant women. They were asked regarding the knowledge and attitude towards the PNDT Act. Data was analyzed by using Statistical Package of Social Sciences (SPSS) 16.0. RESULTS: In the present study, out of 143 women, 105 (73.5%) knew about sex determination. Even out of those who had heard, the correct knowledge regarding PNDT act was very less. Sonography as a technique for sex determination done at private hospital was known to the majority of women. CONCLUSION: Education of women about gender equality and recommendations under PNDT act in order to improve declining sex ratio in our country must be done. Wide publicization in the media of the Act must be scaled up.