RESUMO
BACKGROUND: Acanthosis nigricans (AN) is one of the signs suggestive of high insulin resistance (IR). IR is one of the mechanisms involved in pathogenesis of diabetes mellitus type-2 (DM Type-2). Thus, early detection of IR in children may allow us time to intervene well before the development of DM Type-2. In this study, 62% of children having AN had high IR. In children having both, AN and high body mass index (BMI), the incidence of IR was about 80%. This suggests that these easily detectable parameters alone can be useful in screening children at high risk of developing DM Type-2 in future. These simple criteria thus hold promise for use in high throughput screening programs for diabetes. CONTEXT: A pilot study conducted by the authors showed that children with AN have a high incidence of IR. The detection of IR in children may allow us time to intervene well before the development of DM Type-2. Detection of DM Type-2 by hyperglycemia may be too late to prevent the onset of microvascular changes. AIMS: This study aims to determine whether easily observable presence of AN can be used to screen for increased IR in children, and thereby to detect this important risk factor for DM Type-2. SETTINGS AND DESIGN: Cross-sectional, observational study. Two schools, one with children belonging to average economic background and the other, a residential school with children of affluent parents. Selection of children was done randomly. SUBJECTS AND METHODS: The study was conducted among 507 children in the age group of 10-18 years. Physical examination for the detection of AN, height and weight measurements, waist circumference, fasting plasma glucose, fasting plasma insulin, and lipid profile was done. Homeostatic model assessment of insulin resistance was calculated. STATISTICAL ANALYSIS USED: Data analysis was performed using descriptive statistics and inferential statistical methods. The association between categorical variables was done by Chi-square test. RESULTS: The presence of AN positively correlated with high IR, and when combined with increased BMI, the incidence rate of IR is 80%. CONCLUSIONS: AN can be used as a screening method to identify children at risk of DM Type-2-since those who have high IR have a high possibility of having DM Type-2 in future. Hence, early screening and simple, but effective interventional strategies can be instituted at this age, which may prevent or delay diabetes in the long run.
RESUMO
There have been multiple incidents where doctors have been assaulted by patient relatives and hospital facilities have been vandalized. This has led to mass agitations by Physicians across India. Violence and vandalism against health-care workers (HCWs) is one of the biggest public health and patient care challenge in India. The sheer intensity of emotional hijack and the stress levels in both practicing HCWs and patient relative's needs immediate and detail attention. The suffering of HCWs who are hurt, the damage to hospital facilities and the reactionary agitation which affects patients who need care are all together doing everything to damage the delivery of health care and relationship between a doctor and a patient. This is detrimental to India where illnesses and Injuries continue to be the biggest challenge to its growth curve. The expert group set by The Academic College of Emergency Experts and The Academy of Family Physicians of India makes an effort to study this Public Health and Patient Care Challenge and provide recommendations to solve it.
RESUMO
Family medicine is undergoing a sudden revival in India. There is significant lack of clarity regarding the opportunities, advantages, and challenges available in family medicine, especially in the private sector. This article is addressed to young doctors aspiring to specialize in family medicine. It is an attempt to shed light on the present scenario of family medicine in the corporate sector in India and make young doctors aware of the prospects in this area.
