Prevalence of non-alcoholic fatty liver disease among diabetes, prediabetes and healthy population.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a global emerging health issue, which is due to extra fat deposition in the liver that poses a serious risk of liver cirrhosis. Our study assessed the glycaemic status and NAFLD in health patients coming for a regular health check-ups. Material and Methods: This descriptive study was done on 192 healthy populations aged 30-70 years who underwent general health check-ups. History, clinical examination, heamtological and radiological workup were done and data were statistically evaluated. Results: The age of the study population was between 30 and 70 years with an average age of 50 years and the study sample size was 190. Prevalence of prediabetes was 35.93%, diabetes at 17.18% and euglycaemics were 45.83% in our study group. Among diabetics and prediabetics, 30% and 31% were having raised transaminase. Among euglycaemics, around 19% had raised transaminase. On ultrasound scans among the diabetic group, the prevalence of fatty liver was 57.6% whereas in the prediabetic group it was 46.4%. Among the normal euglycaemic group, 22.7% had fatty liver. Conclusion: NAFLD is multifactorial and associated with diabetes and can progress to cirrhosis of the liver if untreated. There is a need to have more focus on screening, awareness, nutritional counselling and treatment at the primary care level.

Barriers and facilitators of providing standard of care diabetes management at primary care level in geriatric population.

Background: Geriatric population is gradually increasing and is expected to grow till 20% by 2050 from the current 8.6%, and so is diabetes prevalence and other comorbidities. To improve diabetes control, better coordination of provider, patient and health system is needed. It has been found that almost half of the diabetes patients do not achieve treatment targets. So, it is essential to assess the perceived barriers as well as facilitators from patients' and physicians' perspectives. The aim of the study was assessment of needs, care, barriers and facilitators to achieve treatment goals for patients and physicians. Materials and Methods: This observational, cross-sectional study was conducted by the Department of Geriatrics among 100 elderly diabetes patients and 50 physicians after obtaining ethical approval. All participants were interviewed based on a predefined, structured questionnaire with multiple options to grade or choose from. Results: Polypharmacy, mobility issues and dementia were the most common geriatric issues. Hypertension (HTN), arthritis and coronary artery disease (CAD) were the commonest comorbidities. Also, 73% reported that they followed dietary advice, but only 22% accepted that they were doing exercise regularly. Moreover, 5% mentioned that they were taking alcohol, and 15% confirmed of smoking. Also, 47% of patients felt that diabetes was well controlled. Remaining 53% patients gave reasons for poor diabetes control; the most common reason was not following a proper diabetic diet plan in 42% of patients and lack of exercise as instructed was reported by 22% as the reason for their poor diabetic control. Nineteen percent of patients accepted of not measuring their blood glucose as instructed. Among urban doctors, the three most common factors were not being consistent with lifestyle interventions, followed by no regular self-monitoring of blood glucose and no regular follow-up. Top three interventions suggested were to engage or encourage the family members of patients to become involved in diabetes care, provide more convenient diabetes brochures or education materials to patients and improve multidisciplinary and multispeciality collaboration in diabetes control. Conclusion: Diabetes in elderly needs proactive health system and coordinated care. Doctor-patient relationship with good communication skills, family support and multidisciplinary care is needed to improve diabetes care. Health education with a focus on diet control, exercise and other lifestyle modifications are essential factors in improving diabetes care.

The Pattern of Valvular Heart Diseases in India During Pregnancy and Its Outcomes.

INTRODUCTION: The incidence of rheumatic heart disease is very high in India. The data on the pattern of valvular heart diseases during pregnancy and its outcomes is very scarce. Again, the data in the Indian scenario, the differences in outcomes between different grades of valvular heart diseases and its impact on pregnancy outcomes is very less. We planned to study the different patterns of valvular heart diseases during pregnancy and their outcomes with respect to cardiac complication and perinatal outcomes. MATERIALS AND METHODS: It was a hospital-based prospective observational study. We recruited 71 patients after taking written informed consent. All patients were with term gestation and valvular heart diseases. We did 2D echocardiography to analyze the valve lesion and assess the valve lesion with its maternal and perinatal outcomes. RESULTS: The mean age of participants in the study was 27 + 5.2 years. A total of 54 patients (76.1%) were less than 30 years and 17 (23.9%) were more than 30 years of age. Six patients (8.5%) presented with New York Heart Association (NYHA) class I, 39 patients (54.9%) presented with NYHA class II, 25 patients (35.2%) presented with NYHA class III and one patient (1.4%) presented with NYHA class IV. The most common etiology of valvular heart diseases was found to be rheumatic in 62 patients (87.3%). The most common valve involved was the mitral valve (69%). New-onset atrial fibrillation (AF) was reported in 26.8% patients and pulmonary edema developed in 15.5% patients. Live birth was observed in 66 patients (93%) compared to stillbirth reported in five patients (7%). CONCLUSION: No significant difference in maternal and perinatal outcomes between moderate and severe grades of different valvular heart diseases.

Computed tomography in the evaluation of laryngotracheal stenosis.

Faryngottacheal trauma of varied etiology may involve the mucosal integrity soft tissue structure and cartilagenous, framework at more than one level Computed tomography provides crucial and definitive evaluation of the extent of cartilagenous and soft tissue injury and status of the taryngeal auway Results of this study corroborated well with surgical findings and were helpful in planning further management Here in the present series we assess the role of CT in the evaluation of 25 patients with laryngotracheal stenosis.

Osteoma of the paranasal sinuses.

Osteamas of the paranasal sinuses are rare, They often appear as a coincidental finding on X-ray in patients having radiographs for same other reasons. Tomographic evaluation is the mainstay surgical access and its subsequent follow up. We report a series of 20 cases of osteamas of the paranasal sinuses who underwent surgery for their symptoms. Wide exposure at surgery is necessary for complete or near complete removal. Tumour close to the dura, optic-nerve and internal carotid artery may be left Close and long period offollow-up is essential, especially when the tumour is partially left behind. In our experience, the rate of growth of tumour is very slow and a wait and watch policy can he adopted for very small tumours and those that are incompletely resected.