Assessing the SpO2 in a random population - Looking for the best among fingers.

Context: Pulse oximetry is one of the most revolutionary methods used to monitor the patients in the clinical setting, particularly intensive care and anesthesia. We usually use the index or middle finger to measure SpO2 values, but little is known about the inter-digital differences that exist between the fingers. Aim: We aim to compare the peripheral capillary oxygen saturation among fingers of both hands. A total of 93 healthy volunteers aged between 18 and 50 years participated in the study. Materials and Methods: Their SpO2 values were recorded from each finger with at least 1 minute of resting interval. Their blood pressure, heart rate, and body temperature were recorded as well. Result: A total of 930 measurements were obtained from 93 volunteers. The highest average SpO2 value of right-handed volunteers was measured from the left little finger (98.48 ± 0.62) of right-handed volunteers, and it was statistically significant when compared with the right ring finger, right little finger, left thumb, left index, left middle finger, and left ring finger. The highest average SpO2 from left-handed volunteers was obtained from the right index finger, but it was statistically insignificant. Conclusion: We assume ethnic and climatic differences to play a role in contradictory results noted from previous studies conducted, and this needs to be investigated further. It is recommended that multiple readings may be obtained from other fingers as well before coming to any conclusion as inter-finger variability cannot be ignored.

Erythema annulare centrifugum in a case of chronic myeloid leukemia.

Chronic myeloid leukemia (CML), BCR-ABL1-positive, is classified as a myeloproliferative neoplasm predominantly composed of proliferating granulocytes and determined to have the Philadelphia chromosome/translocation t (9;22)(q34;q11.2). Skin is said to be the mirror to systemic diseases, with skin manifestations ranging from nonspecific cutaneous lesions to specific lesions. The cutaneous manifestations of CML are generally reddish-brown to violaceous papules and nodules, indurated or hemorrhagic plaques, perifollicular acneiform papules, bullae, and palpable purpura. Other unusual manifestations could be erythema nodosum, pyoderma gangrenosum, erythema annulare centrifugum, and so on. Here we present a case of a 50-year-old woman with a history of recurrent pruritic skin lesions and erythema annulare centrifugum as the presenting complaint of CML.

A retrospective study to assess the risk of bladder cancer in type-2 diabetic patients treated with pioglitazone.

INTRODUCTION: Pioglitazone has been a cornerstone of oral hypoglycemic therapy. Concerns have been raised about its association with urinary bladder cancer. Considering the wide usage of this drug, concrete and multiple population-based studies are needed to establish the safety of this drug. The present retrospective study is aimed to assess the association of pioglitazone with urinary bladder cancer. MATERIALS AND METHODS: Clinical records of 4170 patients (2085 pioglitazone users and similar number of nonpioglitazone users) attending the diabetes clinic at a tertiary level teaching hospital were accessed, and the patients were subjected to symptom-directed questionnaire, urine examination, and cystoscopy and bladder biopsy (whenever clinically indicated). The risk of bladder cancer was also assessed with respect to cumulative dose and duration of pioglitazone. RESULTS: We did not observe any increased risk of bladder malignancy with pioglitazone exposure; furthermore, there was no association with cumulative dose and duration of pioglitazone therapy. Pioglitazone was found to be effective and safe in managing glycemic control in diabetic patients.

Should screening voluntary blood donors be used as strategy to diagnose diabetes and diabetic nephropathy?

INTRODUCTION AND AIM: The present study aims to assess the glycemic status during voluntary blood donation as a strategy to detect undiagnosed diabetes mellitus and diabetic nephropathy. MATERIAL AND METHOD: Study was conducted at a tertiary care hospital and medical college. All voluntary blood donors underwent random capillary blood glucose screening and patients who had random blood sugar exceeding 200 mg/dl were subjected to undergo oral glucose tolerance test (OGTT). The subjects thus detected diabetic by capillary blood sugar and OGTT underwent screening diabetic kidney disease with urine albumin to creatnine ratio (UACR). Data collected was statistically analyzed using SPSS 16 using Student's t test. RESULTS: Seven hundred and sixty five males and 443 females were enrolled for the study. Capillary blood sugar of 54 subjects was ≥200 mg/dl. 48 subjects gave consent for OGTT, stratified data showed 22 subjects (12 males and 10 females) were in range of 200-300 mg/dl. 20 subjects (12 males and 8 females) were in range of 300-400 mg/dl, whereas 6 subjects (5 males and 1 female) had blood sugar more than 400 mg/dl. The HbA1C ranges in respective glycemic groups were 200-300 mg/dl - 7.4% to 8.6% (mean - 8.05%), 300-400 mg/dl - 8.7% to 11.8% (mean 9.63%), more than 400 mg/dl - 11.8% to 14.2% (mean - 13%). Male preponderance was observed in all glycemic groups, though the difference was statistically insignificant. Of the 48 diabetic subjects, 13 (27.08%) were detected to have albuminuria, of these 11 (22.91%) had microalbuminuria (UACR 30 - 300 mg/gm), whereas 2 (4.16%) had overt proteinuria (UACR exceeding 300 mg/gm). CONCLUSION: Glycemic screening with random capillary blood glucose screening, 75 gm 2 hour OGTT and HbA1C amongst voluntary blood donors can be used to detect pre diabetes and undiagnosed diabetes mellitus and diabetic nephropathy.

A Comparative Study of Quantitative Smartphone Usages among Controlled and Uncontrolled Type 2 Diabetes Mellitus Population.

BACKGROUND: Smartphones has significantly changed the lifestyle of people and considered as basic need for day to day work. But its usages beyond certain limits adversely affects physical and mental health. Aim of this study is to analyzes the quantitative usages of smartphone among controlled and uncontrolled type 2 diabetes patients. Objective is to correlate the pattern and duration of smartphone usages with the level of glycemic control. METHOD: "RealizD" is a mobile application that observes the pattern of mobile phone usages like 'screen time' (total duration of time spends watching mobile screen for any purpose) and number of times phone picked in a day. It graphically displays the hourly usages and longest duration of phone use in a single stretch. Subjects were patients of type 2 diabetes mellitus(T2DM) divided into 50 "case" with poor glycemic control and 50 "control" with good glycemic control. This application was installed in their smartphones to collect all above data. Subjects were observed for period of 3 months. Demographic data, blood glucose levels and HbA1c was recorded at first and again at second visit 3 months after. Data from application was recorded at second visit as described above. FINDINGS: The average screen time of cases was 160 ± 50.9 minutes per day whereas of controls was 107 ± 22.5 minutes. This difference in the screen time was statistically significant. Higher the screen time more was the HbA1c. The average of number of times a case picked his/her phone in a day was 70.2 ± 20.1 whereas by the controls was 57.3 ± 22.2. The difference was statistically significant. Also, Cases spend 37.3 % versus controls who spend 19.9 % of total screen time between 5 AM to 9 AM. The difference was statistically significant. This indicates that uncontrolled T2DM patients spend more time on phone in morning hours. INTERPRETATION: Smartphones could be best companion if used judiciously. Their unrestricted use adversely affects the health. Among diabetes patient unregulated smartphone usages leads to poor glycemic control and thus could be considered an important factor that need to be addressed.

Teneligliptin-induced hair loss: A case report.

Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the common phenotype of hyperglycemia secondary to various pathophysiologic mechanisms that include reduced insulin secretion, decreased glucose utilization, and increased glucose production. Individuals suffering from Type 2 DM (T2DM) tend to be at a higher risk for the development of both micro as well as macrovascular complications. Management strategy includes an armamentarium of drugs and lifestyle modifications. 35 years old male diagnosed with T2DM was started on a fixed-dose combination of 20 mg Teneligliptin and 1 g metformin once daily. After consuming this dose for a month, he observed no reduction in his blood sugar levels and consequently escalated the dose to twice daily without any consultation or supervision. Subsequently, on next visit OPD his blood sugar was controlled, however, he complained of hair loss from the scalp. This complaint was resolved with the discontinuation of Teneligliptin.

COVID-19 Outcomes in Postmenopausal and Perimenopausal Females: Is Estrogen Hormone Attributing to Gender Differences?

BACKGROUND: Globally, case fatality rate is more in males compared to females. Some studies have suggested. It is hypothesized that estrogen hormone may decrease susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS CoV-2.). OBJECTIVE: The objective of the study was to evaluate the gender differences in SARS CoV-2 outcomes and to analyze if there are any differences in outcomes in premenopausal females compared to postmenopausal females. MATERIALS AND METHODS: Patients tested positive for SARS CoV-2 through real-time reverse transcription-polymerase chain reaction by Thermo Fischer Taqpath assay approved by the Indian Council of Medical Research were included in the study. The data obtained was analyzed for the epidemiological, clinical, and laboratory characteristics from their medical records. RESULTS: The mortality rate in females was 12.6%, whereas mortality in males was 19.4%. In between-group analysis, 8.6% (16/185) of females died in premenopausal age group versus 12.8% (27/211) in postmenopausal group. The proportion of females who expired due to COVID significantly differ by age and postmenopausal status X2 (1, n = 293) = 7.2, the P value is 0.007. The difference is statistically significant at P < 0.05. Postmenopausal women were more likely to expire due to COVID-19 infection compared to premenopausal women. CONCLUSION: The mortality rate in postmenopausal age group was greater than mortality in premenopausal females emphasizing the protection provided by estrogens hormone in them. Postmenopausal women are also at higher risk of severe COVID-19 infection than premenopausal women. Mortality is greater in males compared to females, further strengthening the role of estrogens.

Granuloma annulare: A rare dermatological manifestation of diabetes mellitus.

Granuloma annulare (GA) is usually a self-limited, benign granulomatous disease of the dermis and subcutaneous tissue. It's generalized or disseminated form is associated with underlying diabetes mellitus and at times it precedes the sign and symptoms of diabetes mellitus. We are reporting a case of a 56-year-old female, who is a known case of type 2 diabetes mellitus she presented to us with symmetric lesions on her trunk, arms, and legs. On further evaluation by the dermatologists, it was established to be lesions of GA. This case has been reported to highlight the incidence and the importance of recognition of this common but rarely diagnosed condition.

Ranitidine-induced galactorrhea in a postmenopausal female.

We report a case of drug-induced hyperprolactinemia in a 46 year postmenopausal female presenting as galactorrhea and painful breast engorgement as result of ranitidine exposure. The occurrence of galactorrhea as an adverse effect of ranitidine therapy is scarcely reported in literature and to the best of our knowledge this is first such reported case.

Linezolid-induced dental hyperpigmentation in an adult male being treated for an ulcer caused by atypical mycobacteria.

Mycobacteria are intrinsically resistant to most antibiotics as a result of multiple mechanisms. Linezolid, a member of the oxazolidinones, is a newer class of synthetic antimicrobials which is frequently used to treat mycobacteria. Here, we report a case of a patient with an ulcer on the right arm, caused by atypical mycobacteria, who presented with discoloration of both the upper and lower teeth after being treated with linezolid for a period of 2 months. On detailed evaluation, the patient was found to have linezolid-induced dental hyperpigmentation. This is the first case reported ever in an adult having linezolid-induced dental hyperpigmentation.

Teneligliptin: An Economic and Effective DPP-4 Inhibitor for the Management of Type-2 Diabetes Mellitus: A Comparative Study.

CONTEXT: Increasing diabetic burden worldwide is creating an alarming situation for the management and development of economic resources for it's treatment. Progressive nature of the disease requires allocation of a higher proportion of expenditure on health care initiative of any country. AIM: Present study is designed with an aim to determine the effectiveness of cost-effective DPP-4 inhibitor, Teneligliptin, over the other agent of the same class. MATERIAL AND METHOD: The study was carried out in Postgraduate Department of Medicine, S.N. Medical College, Agra and 112 patients were selected as subjects with a selected inclusion criterion. STATISTICAL ANALYSIS USED: Independent student's t-test was applied to compare the means. Mean standard deviation was calculated for quantitative data. All p values were two-tailed and values p<0.05 were considered statistically significant. RESULT: There was no significant difference in the levels of blood sugar or glycosylated hemoglobin (HbA1c) before and after the treatment of Teneligliptin. CONCLUSIONS: Teneligliptin offered an efficient second line treatment for the management of type-2 Diabetes Mellitus at a reduced average price of INR 39 per day, when compared to other DPP-4 inhibitors.