A Prospective Study to Identify the Prevalence of Impaired Glucose Tolerance in Patients With Liver Cirrhosis Using Oral Glucose Tolerance Test.

Introduction Diabetes mellitus (DM) is a global health problem that may affect the prognosis of liver cirrhosis by interfering with the various metabolic functions of the body. Hence it is important to know the glycemic status of the patients with liver cirrhosis to anticipate and treat the complications associated with it, which in turn will help in the prognosis. The conventional methods may underestimate impaired glucose tolerance (IGT). Hence, this study was undertaken to identify IGT prevalent among liver cirrhosis patients using an oral glucose tolerance test (OGTT). The aim of our study was to identify the prevalence of IGT in non-diabetic liver cirrhosis patients using OGTT. Materials and methods This was a prospective cross-sectional study done in the Department of General Medicine at Shri BM Patil Medical College and Hospital, Vijayapura. After obtaining institutional ethical committee approval, a sample size of 85 liver cirrhosis patients between the age of 20-80 years who were not known cases of diabetes mellitus were selected from patients attending inpatient and outpatient departments at our hospital. The period of study was from January 2021 to June 2022. Patients were tested with OGTT, and the results were recorded. Results Our study found that IGT was more common in the age group of 40-49 years. All the patients included were males. We found that alcohol-induced liver cirrhosis patients had the maximum of IGT and DM. Our study observed a prevalence of 36.47% of patients with IGT. Our study in addition to IGT, found that DM was more common in 30-39 years, and 24.71% of patients were diagnosed with diabetes mellitus in the 85 patients included in our study. Conclusion We conclude that performing OGTT to find the prevalence of IGT and DM in liver cirrhosis patients will help in diagnosing DM and IGT, aiding in the improvement of the prognosis of the cirrhosis. The glycemic status of the patient may help in deferring the complications associated with poor glucose control. The incidence of potential complications of DM can be reduced by prompt identification and treatment.

Best Practices and Tools for Titrating Basal Insulins: Expert Opinion from an Indian Panel via the Modified Delphi Consensus Method.

AIM: To develop an evidence-based expert group consensus document on the best practices and simple tools for titrating basal insulins in persons with type 2 diabetes mellitus (T2DM). BACKGROUND: Glycemic control is suboptimal in a large proportion of persons with T2DM, despite insulin therapy, thereby increasing the risk of potentially severe complications. Early initiation of insulin therapy and appropriate dose titration are crucial to achieving glycemic targets. Attitudes and practices among healthcare professionals (HCPs) and perceptions about insulin therapy among persons with diabetes contribute largely to suboptimal glycemic control. Improving HCP-patient communication, encouraging the use of additional educational tools, and providing support for the titration process to increase confidence, both at the initiation visit and at home, facilitate the optimization of dose titration. In Indian settings, specific guidelines and a consensus statement are lacking on the optimal insulin initiation dose, frequency of dose titration, and basal insulin profile needed to achieve optimal titration. In clinical practice, physicians and persons with diabetes often do not adhere to the titration algorithms that currently exist for the purpose of achieving optimal titration as they perceive these to be very cumbersome. In this context, a group of experts met at an advisory board meeting and arrived at a consensus on best practices for the titration of basal insulin in persons withT2DM in India, using the modified Delphi methodology. REVIEW RESULTS: After a review of evidence and further discussions, the expert group provided recommendations on insulin initiation dose, ideal period for titration in practice, titration regimen for use in practice, basal insulin profile for titration, and choosing a self-monitoring blood glucose schedule for titration. CONCLUSIONS: In the management of T2DM, insulin can be effectively titrated by following a few simple recommendations. The use of second-generation basal insulin aids in mitigating the risk of hypoglycemic events. The implementation of a simplified titration regimen is crucial to achieving glycemic targets and long-term treatment goals.

Osteomyelitis of Humerus and Intramuscular Abscess Due to Melioidosis.

Melioidosis is a clinically diverse disease caused by gram negative bacterium Burkholderia pseudomallei. It is a potential bioterrorism agent. The high risk group includes the agricultural and construction workers whose contact with contaminated soil and water may expose them to bacteria. The clinical manifestations varies from asymptomatic infection to overwhelming sepsis. To diagnose melioidosis a high index of suspicion along with isolation and identification of the organism from the clinical samples is needed. Early diagnosis and treatment is essential for better outcome. We are reporting a case of melioidosis which presented as osteomyelitis of humerus with intramuscular abscess.

Parathyroid carcinoma presenting with pathologic fracture: case report and review of the literature.

BACKGROUND: Parathyroid carcinoma is a rare neoplasm representing <1% of primary hyperparathyroidism cases. It is often not diagnosed until surgical exploration as a preoperative diagnosis is often not possible. Thus, preoperative staging for most patients is not feasible and this may compromise the treatment strategy. METHODS AND RESULTS: We report a case of a 29-year-old man presenting with avulsion fracture of the right elbow after a trivial fall. Neck exploration revealed an enlarged left lobe focally adherent to the larynx and trachea. Final pathology revealed parathyroid carcinoma with focally positive margin at the site of tracheal invasion. CONCLUSION: Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. The etiology of parathyroid carcinoma is usually obscured, and the initial operation offers the best chance for cure.

Human ocular thelaziasis in Karnataka.

Thelaziasis is an arthropod-born disease of the eye and adnexa caused by Thelazia callipaeda, a nematode parasite transmitted by drosophilid flies to carnivores and humans. Because of its distribution mainly confined to South Asian countries and Russia, it is commonly known as Oriental eye worm. It is often under-reported and not been given its due clinical importance. We report first case of human thelaziasis from Hassan District, Karnataka. Five creamy-white, translucent worms were removed from the conjunctival sac of a 74-year-old male patient. Based on morphological characters, the worms were identified as nematodes belonging to the genus Thelazia and speciation was confirmed by CDC, Atlanta as callipaeda. Rarity of the disease and its ability to cause both extra and intraocular manifestations leading to ocular morbidity is the reason for presenting this case. From the available data, this is the first case report from Karnataka, India.

Design, synthesis and 3D-QSAR studies of new diphenylamine containing 1,2,4-triazoles as potential antitubercular agents.

A new series of new diphenylamine containing 1,2,4-triazoles were synthesized from 4-arylideneamino-5-[2-(2,6-dichlorophenylamino) benzyl]-2H-1,2,4-triazole-3(4H)-thiones 3a-f. The synthesized compounds were screened for in-vitro antimycobacterial and antibacterial activities. The synthesized compounds 4a, 4e and 4d have shown potential activity against Mycobacterium tuberculosis H37Rv strain with MIC of 0.2, 1.6 and 3.125 µM respectively. To investigate the SAR of diphenylamine containing 1,2,4-triazole derivatives in more details, CoMFA (q(2)-0.432, r(2)-0.902) and CoMSIA (q(2)-0.511, r(2)-0.953) models on M. tuberculosis H37Rv were established. The generated 3D-QSAR models are externally validated and have shown significant statistical results, and these models can be used for further rational design of novel diphenylamine containing 1,2,4-triazoles as potent antitubercular agents.

"The clock is ticking": the timely management of a painful skin rash in a seventy-year-old woman.

Necrotizing fasciitis is an uncommon but a potentially fatal condition and can affect any part of the body. Most patients have pre-existing conditions that render them susceptible to infection, although etiology is unclear. Diagnosis is primarily clinical and is often delayed because of the unfamiliarity of the condition among clinicians. Management consists of immediate resuscitation, early surgical debridement, and administration of broad spectrum intravenous antibiotics. We report a case of a 70 year old woman who presented with a painful erythematous rash, was admitted as a case of cellulitis, later developed worsening of symptoms and septic shock, and was diagnosed as necrotizing fasciitis.

Clinical evaluation of sustained-release metronidazole gel versus metronidazole solution as an intracanal medicament in abscessed primary molars.

AIM: To evaluate the efficacy of metronidazole gel versus metronidazole solution against Enterococcus faecalis in abscessed primary molars. STUDY DESIGN: A clinical trial. METHOD: Twenty pulpally involved non-vital carious human primary mandibular second molars with furcal abscess were randomly allocated into two groups to evaluate the efficacy of metronidazole gel (3% w/v) and metronidazole solution (0.5% w/v) against E. faecalis. Subjects in the first experimental group were subjected to treatment with metronidazole gel (3% w/v) and subjects in the second experimental group were treated with metronidazole solution (0.5% w/v). Two microbial samples (pre-operative and post-operative samples) were obtained from the root canals of each subject from both the groups; sub cultured and efficacy of both the groups were evaluated. RESULTS: Overall percentage reduction of the mean colony forming unit (CFU) count of metronidazole gel (3% w/v) group was 96.39% and metronidazole solution (0.5 % w/v) was 90.90%. Results of intergroup t test of the percentage difference of mean CFU counts between both the groups revealed a statistically highly significant difference, i.e. p value--0.008 (p < 0.01). CONCLUSIONS: Metronidazole gel (3% w/v) was more effective than metronidazole solution (0.5% w/v) against E. faecalis.

A rare form of melanoma masquerading as a diabetic foot ulcer: a case report.

Background. Acral lentiginous melanoma (ALM) is a less-common form of melanoma in US, and it accounts for about 5% of all diagnosed melanomas in US. ALM is often overlooked until it is well advanced because of the lesion's location and its atypical appearance in the early stages. We present a case of ALM initially presented as a diabetic foot ulcer. Case Report. An 81-year-old man initially presented to the primary care clinic with a right foot diabetic ulcer. There was a large plantar, dark-colored ulcer that bled easy. Initial excision biopsy revealed Clark's Level IV ALM. Subsequent definitive wide excision and sentinel node biopsy confirmed ALM with metastasis to inguinal lymph nodes (stage IIIb). The treatment included wide margin excision of the lesion with en bloc amputations of 4th and 5th toes, followed by adjuvant chemotherapy. Discussion. The development of ALM may potentially relate to diabetes as a reported higher prevalence of diabetes with ALM patients. Conclusion. The difficulty in early diagnosing of ALM remains as a formidable challenge particularly in diabetic patients who commonly develop plantar foot ulcers due to the diabetic neuropathy. This case reiterates the importance of a thorough foot exam in such patients.

Synthesis and biological evaluation of 4-anilinoquinolines as potent inhibitors of epidermal growth factor receptor.

The mutant receptor tyrosine kinase EGFR is a validated and therapeutically amenable target for genotypically selected lung cancer patients. Here we present the synthesis and biological evaluation of a series of 6- and 7-substituted 4-anilinoquinolines as potent type I inhibitors of clinically relevant mutant variants of EGFR. Quinolines 3a and 3e were found to be highly active kinase inhibitors in biochemical assays and were further investigated for their biological effect on EGFR-dependent Ba/F3 cells and non-small cell lung cancer (NSCLC) cell lines.