Seven Sinful Sisters: Seven Smart Solutions to Stop Diabetes.

This article describes a Seven Sinful Sisters and Smart Solutions (FIVE S) concept, which lists seven contributory factors of diabetes, and seven potential solutions to help prevent its spread. The Seven Sinful Sisters include Sugar, Salt, Saturated fat, Spirits (alcohol), Sitting time (sedentary life style), Steroids (including other drugs) and Stress. Seven Smart salutogenic Solutions are use of Self-restraint, Small size portions, Spices (nutrition -based remedies, including sugar and salt substitutes), Slimnastics (a synonym for aerobic exercise), high Spirit (a positive attitude), health Sleep/Siesta, and enjoyment of Sunday (or Stress management).

Occult metabolic bone disease in chronic pancreatitis.

BACKGROUND: Chronic pancreatitis (CP) leads to malabsorption and metabolic bone disease (MBD). Alcoholic CP (ACP) and tropical CP (TCP) are the two common types of CP. OBJECTIVE: We investigated the presence of occult MBD in patients with CP and compared the same between ACP and TCP. MATERIALS AND METHODS: In this cross-sectional, observational study, we included serial patients of CP in different stages and are grouped as ACP (Group 1; n = 67) and TCP (Group 2; n = 35). We determined serum calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D (25OHD), and intact parathyroid hormone (PTH) levels. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry in the neck of the left femur. MBD was defined by the presence of either low bone mass (Z-score Results: The study participants (85 males; 17 females) had a mean age of 40.8 ± 12.6 years, CP duration of 3.7 ± 4.7 years, and Body Mass Index of 22.5 ± 3.2 kg/m2. A total of 37 (36%) patients had MBD (osteomalacia in 31 and low bone mass in 6). The frequency of MBD was same in the TCP (16/35) and ACP (21/65) groups (P = 0.1940). Elevated PTH (>70 pg/mL) was seen in 14 patients with 25OHD deficiency and low calcium (<8.5 mg/dL) in 29 patients. BMD did not show a significant correlation with the duration of CP. CONCLUSION: Occult MBD is seen in a third of patients with CP and is similar irrespective of the etiology. The disease is silent and mandates active screening in all susceptible individuals.

Prevalence of Multidrug-resistant, Extensively Drug-resistant, and Pandrug-resistant Pseudomonas aeruginosa from a Tertiary Level Intensive Care Unit.

BACKGROUND: Infection by Pseudomonas aeruginosa is common in the Intensive Care Unit (ICU), leading to increased morbidity and mortality. The organism is classified into various phenotypes based on the drug resistance pattern, namely, drug-resistant (DR), multi-DR (MDR), extensively DR (XDR), and pan-DR (PDR). We aim to study the incidence of P. aeruginosa phenotypes in a tertiary level ICU. MATERIALS AND METHODS: We conducted this prospective, observational study for 2 years (January 2014-December 2015) and collected appropriate clinical samples (blood, urine, wound discharge, etc.,) from all the patients admitted to ICU. We excluded patients with known septicemia and P. aeruginosa infection. Group 1 comprised a total 1915 patient samples and Group 2 comprised 100 active surveillance samples, collected from the medical staff and the hospital environment. The data were analyzed using appropriate statistical methods, and a P < 0.05 was considered statistically significant. RESULTS: We isolated 597 pathogenic bacteria out of 1915 specimens, giving a culture positivity rate of 31.2%. Klebsiella (43%), Acinetobacter (22%), and P. aeruginosa (15%) were the top three isolated bacteria. None of the surveillance samples grew P. aeruginosa. Antibiotic resistance studies revealed that 47.7% of P. aeruginosa isolates were DR, 50% were MDR, and 2.3% were XDR phenotype. None of the strains showed PDR phenotype. CONCLUSION: Our data revealed a high prevalence of DR phenotypes of P. aeruginosa in the ICU. Judicious use of antibiotics and strict infection control measures are essential to reduce the prevalence of drug resistance.

Failure to fire after an electrical injury - a complex syndrome in a soldier.

Complex regional pain syndrome (CRPS) is a disorder characterized by an intractable, disabling pain of the affected limb. It is triggered by various injuries and is often resistant to standard therapy. We report a young soldier with CRPS of the right hand sustained from an electrical injury, who had improvement in resting pain with Zoledronic acid. In this report, we discuss the therapeutic options and the role of bisphosphonates in CRPS.

Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes - a retrospective cohort study.

BACKGROUND: Remission of diabetes is seen in more than 60% of patients after bariatric surgery. There is extensive variability in the remission rates between different surgical procedures. We analyzed our database and aimed to develop an easy scoring system to predict the probability of diabetes remission after two surgical procedures i.e. Ileal Interposition coupled with Sleeve Gastrectomy (IISG) or Diverted Sleeve Gastrectomy (IIDSG). METHODS: In this retrospective study, we analyzed records pertaining to patients who underwent IISG (n = 46) and IIDSG (n = 29). The primary outcome measure was diabetes remission (A1c <6.5% and not requiring hypoglycemic drugs). We identified seven preoperative clinical variables (age, duration of diabetes, body mass index, micro and macrovascular complications, use of insulin and stimulated C-peptide) based on our previous reports to be included in the diabetes remission score (DRS). The DRS score (7 - 14) was compared between the patients with and without remission in both the surgery groups. RESULTS: Mean DRS in patients who underwent IISG was 9.2 ± 1.4. Twenty one (46%) had a remission in diabetes. DRS was significantly lower in patients with remission than patients without remission (8.1 ± 0.8 versus 10.2 ± 0.9, p < 0.0001). Mean DRS in patients who underwent IIDSG was 10.4 ± 1.3. Twenty one (72%) had a remission in diabetes. DRS was significantly lower in patients with remission than patients without remission (9.7 ± 0.8 versus 12.0 ± 0.5, p < 0.0001). Patients with a DRS ≥ 10 in IISG group and more than 12 in IIDSG group did not get into remission. CONCLUSION: Preoperative DRS can be a useful tool to select the type of surgical procedure and to predict the postoperative diabetes remission. TRIAL REGISTRATION: NCT00834626.

Comparison of research productivity between metro and non-metro cities in a biomedical journal from India.

BACKGROUND: The research productivity of a place depends on doctors, patients and available infrastructure to carry research activities. AIMS: We aimed to study the publishing trends and research productivity of metro and non-metro cities in the Journal of the Association of Physi cians of India (JAPI). MATERIALS AND METHODS: Bibliometric analysis of research articles published in JAPI between 2000 and 2011was undertaken. The four types of articles (original articles including brief reports, case reports, correspondence and pictorial image) were studied for research productivity. They were analyzed according to subspecialty, publication times and type of research work from both places. Comparison between groups was done using Fisher exact and Mann-Whitney U test. Descriptive statistics were used and a P < 0.05 was considered significant. RESULTS: Of a total of 2977 articles, 1798 were available for analysis. Metros published 46% (825/1798) and non-metros 54% (973/1798). Original articles and case reports constituted 3/4(th) of the published literature from both places. Pictorial images were seen more from non-metro cities (P = 0.03). Mumbai and Delhi were leading from the metros, whereas Varanasi and Chandigarh were leading from the non-metro places. Endocrinology, Neurology, Cardiology and Infectious Diseases constituted the top four subspecialties from both places. Neurology articles were published more from non-metros (P = 0.03). The timelines from submission to publication varied between 12 and 15 months, and were lesser for articles from the metros (P = 0.01). CONCLUSIONS: Metros and non-metro cities are comparable in publishing trends and research productivity. Places with post-graduate institutes contribute majority of the research articles. Faster publication timelines from metros indicate better manuscript content and preparation.

Hansen's disease with McCune-Albright syndrome.

McCune-Albright syndrome (MAS) comprises a triad of fibrous dysplasia of bone, café-au-lait macule, and endocrinopathy. The disease is due to activating mutation of G protein-coupled receptor leading to hyperfunction of glands. Hansen's disease is caused by infection with Mycobacterium leprae and is seen with underlying immunosuppressed conditions in genetically predisposed individuals. We recently encountered a patient with Hansen's disease along with underlying MAS and report the same in this report.

Utility of colour Doppler Sonography in patients with graves' disease / Utilidad de la Sonografía Doppler en color en pacientes con la enfermedad de graves

OBJECTIVE: Assessment of thyroid blood flow gives valuable information about underlying functional status. Colour Flow Doppler Sonography (CFDS) is a powerful tool which displays tissue blood flow and vascularity. Colour Flow Doppler Sonography of the thyroid gland in different subsets of patients with Graves' disease was studied to define its role in initial diagnosis and management. METHODS: Eighty consecutive patients with Graves' disease (both treated and untreated) presented to hospital between August 2007 and February 2008. All patients were evaluated with CFDS of the thyroid for size, vascularity and peak systolic velocity (PSV) of the Inferior Thyroid Artery (ITA). Pertechnate scan and thyroidal autoantibody levels were done in selected cases. The patients were divided into Untreated Graves' disease (n = 31), Graves' disease on treatment but hyperthyroid (n = 26) and euthyroid Graves' disease on therapy (n = 23). Mann-Whitney U-test was used for statistical analysis and a p-value of less than 0.05 was considered significant. RESULTS: Thyroid blood flow, as assessed by PSV of ITA, was significantly higher in untreated Graves' disease than in Graves disease on treatment but hyperthyroid and euthyroid Graves respectively (61.5 ± 19.5 versus 42.9 ± 24.7 versus 32.2 ± 12.9 cm/s, p < 0.05). Parenchymal vascularity of the thyroid gland was higher in hyperthyroid patients than in euthyroid patients irrespective of therapy. In both groups on therapy, the dose of carbimazole correlated with the vascularity of the gland (r = 0.492 versus 0.564, p < 0.05). Colour Flow Doppler Sonography parameters correlated significantly with pertechnate scan results giving comparable sensitivity and specificity. CONCLUSION: Assessment of thyroid blood flow by CFDS is an effective marker in the initial diagnosis of Graves' disease. Vascularity of the gland can predict long term disease course while on medical therapy.

OBJETIVO: La evaluación del flujo sanguíneo tiroideo ofrece una valiosa información acerca del estatus funcional subyacente. La sonografía del flujo con Doppler a color (CFDS) es un poderoso instrumento que muestra el flujo del tejido sanguíneo y la vascularidad. La sonografía con Doppler a color, de la glándula tiroides en diferentes subconjuntos de pacientes con la enfermedad de Graves, fue estudiada para definir su papel en el diagnóstico inicial y el tratamiento. MÉTODOS: Ochenta pacientes consecutivos con la enfermedad de Graves (con y sin tratamiento) acudieron al hospital entre agosto de 2007 y febrero de 2008. Mediante CFDS, a todos los pacientes les fueron evaluados el tamaño del tiroides, la vascularidad y la velocidad del pico sistólico (PSV) de la arteria tiroidea inferior (ATI). En casos seleccionados, se realizaron gammagrafías con pertecnetato y estudios de los niveles de anticuerpos tiroideos. Los pacientes fueron clasificados tomando como criterios: la enfermedad de Graves sin tratamiento (n = 31), la enfermedad de Graves con tratamiento pero hipertiroideos (n = 26), y la enfermedad de Graves eutiroidea bajo terapia (n = 23). La prueba U de Mann-Whitney fue utilizada para el análisis estadístico, y un valor p menor de 0.05 fue considerado significativo. RESULTADOS: El flujo sanguíneo tiroideo tal cual fue evaluado mediante PSV de ATI, fue significativamente más alto en la enfermedad de Graves sin tratamiento que en otros grupos (61.5 ± 19.5 versus 42.9 ± 24.7 versus 32.2 ± 12.9 cm/s, p < 0.05). La vascularidad parenquimal de la glándula tiroides fue mayor en los pacientes hipertiroideos, independientemente de la terapia. En los dos grupos bajo terapia, las dosis de carbimazol estaban en correlación con la vascularidad de la glándula (r = 0.492 versus 0.564, p < 0.05). Los parámetros de la sonografía del flujo con Doppler a color guardaban una correlación significativa con los resultados de la gammagrafía de pertecnetato, arrojando sensibilidad y especificidad comparables. CONCLUSIÓN: La evaluación del flujo sanguíneo del tiroides mediante CFDS es un marcador efectivo en el diagnóstico inicial de la enfermedad de Graves. La vascularidad de la glándula puede predecir el curso de la enfermedad a largo plazo, bajo terapia médica.