To Assess the Effect of Dsme on Hba1c Levels in Diabetic Patients.

Diabetes mellitus (DM) is a chronic metabolic disease with debilitating complications. Diabetic Patients should follow self-care activities like healthy diet, physical activity, self-monitoring of blood glucose, treatment compliance in order to achieve good glycaemic control, control the progression of the disease, reduce complications, and quality of life improvement. We aimed to assess the effect of diabetes self-management education program on HbA1c levels in patients with diabetes. MATERIAL: The present study was conducted at a tertiary care centre in central Rajasthan after written consent. Adults with 18 years and above age with Diabetes were included. Patients who refused to give consent, critically ill patients, pregnant females, patients with severe cognitive impairment and whose HbA1c targets were achieved were excluded. It was an open label randomised control study. Simple randomization was done. Cases were then provided with Diabetes self-management education (DSME). The information was provided in local language. One twenty patients were studied during the period from 01/12/2020 to 1/12/2021. All patients underwent complete history taking, physical examination, routine laboratory examination and HbA1c levels. After providing the cases with DSME, all patients were followed up at 6 months. HbA1c level was measured again at 6 months. Pre and post test data of both control and intervention arm were collected. Data was analysed using Statistical package for social science (SPSS) software ver. 2021 and student t test and chi square tests were applied. OBSERVATION: The mean age of participants was 49.07 years, male patients represented 57.5%. About two-thirds were from urban areas. 59.16% were diabetics for 5-10 years. After the DSME program, there was a statistically significant decrease in HbA1c level in intervention group compared to controls (p value<0.05). 56% used oral hypoglycaemic agents, 24% used insulin and 20% used combination therapy of oral hypoglycaemic agents and insulin. Hypertension was the most common co-morbidity followed by dyslipidaemia among patients. There was no significant difference in age, gender and duration of diabetes between the two groups. DISCUSSION: DSME plays a significant role in enabling patients to undertake self-management activities to combat their diabetes-related complications and potential premature deaths. CONCLUSION: DSME may prevent the onset and the progression of diabetic complications. It is important and promising to raise the self-management capacity of Type 2 Diabetes mellitus patients in low-resource settings.

Clinical Study of Cardiac Autonomic Dysfunction and QT Dispersion in Newly Diagnosed HIV/AIDS Patients and its Correlation with CD(4) Count.

Objectives: To evaluate the cardiac autonomic dysfunction and QT dispersion in newly diagnosed HIV/AIDS patients and to correlate the cardiac autonomic dysfunction with CD4 count. Methods: It was a prospective study conducted on 50 patients (25 HIV positive without AIDS and 25 HIV with AIDS) and 50 healthy controls in the department of General Medicine, JLN Hospital, Ajmer. Autonomic function was assessed by Ewing battery of autonomic function tests and QT dispersion was calculated. Results: In the present study 16% of HIV positive with AIDS had abnormal autonomic dysfunction and 4% of HIV positive without AIDS had abnormal autonomic dysfunction. 48% of patients in AIDS group and 16% of patients in HIV positive without AIDS group showed abnormal QT dispersion. There was no statistically significant correlation with CD4 count. Conclusion: Apart from opportunistic infections, autonomic dysfunction itself can contribute to mortality and morbidity in HIV/AIDS patients. Our study showed that cardiac autonomic dysfunction is a common and relevant clinical problem. It is significantly affected in both HIV positive without AIDS and HIV positive with AIDS groups. QT dispersion is a sensitive predictor of cardiac dysautonomia. But there is no statistically significant correlation with CD4 count.

Infantile (Preductal) Coarctation of Aorta Presenting as Cerebellar Infarct - A Rare Presentation.

Coarctation of aorta is a common congenital heart defect. The diagnosis may be missed unless a highindex of suspicion is maintained, and is often delayed until the patient develops congestive heart failure (CHF), (common in infants) or hypertension (common in older children). It seldom goes undiagnosed till adulthood and frequently leads to complications as a result of long-standing high blood pressure. Intracranial haemorrhage, premature coronary artery disease, aortic aneurysms and rupture have all been reported. But it is rare to see a patient with preductal (infantile) coarctation survive childhood and presents with an infarct in adulthood. We herein present a case report of a young woman who came with vomiting and giddiness and was diagnosed as a case of cerebellar infarct due to a concealed preductal (infantile) coarctation of aorta.

Plasmodium vivax malaria--is it really benign?

It is believed that most of the serious and life threatening complications are caused only by P falciparum infection while P vivax infections are relatively mild and run a benign course and usually not required hospitalisation but in the last few years hospitalisation rate and complications are also increasing in P vivax infection; so we planned this study to evaluate the severity and complicated presentation of P vivax malaria. This hospital-based study conducted in Jawahar Lal Nehru Hospital Ajmer, India. One hundred and two indoor patients with isolated P vivax malaria were included in this study with exclusion of other causes of fever including P falciparum malaria. All patients of severe and complicated P vivax malaria were admitted and treated as severe P falciparum malaria. Severe complications like significant hepatomegaly, thrombocytopenia, acute renal failure, severe anaemia, leucopoenia, electrolyte disturbance, acute respiratory distress syndrome, cerebral malaria, multiorgan dysfunction, hepatic dysfunction, pancytopenia, and death seen in 21.57%, 18.63%, 11.76%, 8.82%, 5.88%, 5.88%, 3.92%, 2.94%, 1.96%, 1.96%, 0.98%, 1.96% patients respectively. A significant proportion of morbidity and mortality in malaria also observed in P vivax infection as seen in P falciparum infection and require hospitalisation.