Aims
To determine the prevalence of diabetic retinopathy (DR) in patients with T2DM having low estimated glomerular filtration rate (eGFR).
Methods
A cross-sectional retrospective data analysis of ...T2DM patients’ records who were screened for DR across Apollo Sugar Clinics from June 2016 to December 2016. DR was diagnosed through fundus examination; patients having eGFR values were grouped into eGFR < 60 and eGFR ≥ 60 mg/ml/1.73 m
2
. Appropriate statistical tests were applied to identify the association of eGFR and DR, and significance was set at 2-tailed
p
≤ 0.05.
Results
A total of 1547 T2DM patients were screened; mean (SD) age was 56.7 (10.0) years. Among them, data of 443 patients with eGFR were included in the analysis. Mean eGFR was 91.2 mg/ml/1.73 m
2
; 12.5% patients had eGFR ≤ 60 mg/ml/1.73 m
2
and 87.5% had ≥ 60 mg/ml/1.73 m
2
. DR was observed in 79 (17.8%) patients; it was higher in males (62%) than in females (38%). Further, the proportion of patients with DR was significantly higher in patients with eGFR ≤ 60 mg/ml/1.73 m
2
compared with that in patients with eGFR ≥ 60 mg/ml/1.73 m
2
(38% vs. 15%;
p
< 0.001).
Conclusion
Association of DR with low eGFR in patients with T2DM may suggest presence of diabetes kidney disease in a community, thus reaffirming the significance of DR screening in community diabetes practices.
Aim
To report on glycated haemoglobin (HbA1c) values among individuals with normal glucose tolerance (NGT) at different age groups, using data acquired from a large national survey in India.
...Materials and methods
Data on glycaemic parameters at different age groups were obtained from the Indian Council of Medical Research–INdia DIABetes (ICMR–INDIAB) study, in adults aged ≥ 20 years representing all parts of India. Age-wise distribution of HbA1c was assessed among individuals with NGT (n = 14,222) confirmed by an oral glucose tolerance test using the World Health Organization (WHO) criteria. Results were validated in another large epidemiological study (n = 1077) conducted in Chennai, India.
Results
Among NGT individuals, HbA1c increased gradually with age from 5.16 ± 0.71% (33 mmol/mol) in the age group of 20–29 years to 5.49 ± 0.69% (37 mmol/mol) in those aged 70 + years. In the validation study, conducted in another study population, HbA1c was 5.35 ± 0.43% (35 mmol/mol) in age group of 20–29 years and 5.74 ± 0.50% (39 mmol/mol) in those aged 70 and above. In the INDIAB study, for every decadal increase in age, there is a 0.08% increase in HbA1c and this increase was more significant in females (females: 0.10% vs. males: 0.06%) and in urban (urban: 0.10% vs. rural: 0.08%) population.
Conclusions
HbA1c levels increase steadily with age. This suggests that age-specific cutoffs be used while utilizing HbA1c to diagnose diabetes and prediabetes, so as to minimize the risk of overdiagnosis and unnecessary initiation of treatment in elderly people who could have physiological increase in HbA1c levels.
This research paper is the result of a study which explores the perception of primary school teachers about program management and the quality of learning materials, training packages and ICT ...equipment in the in-service training program called 'Samarthya' which is organized by Sarva Shiksha Abhiyan (SSA) in Odisha (Samarthya, 2011-12). To carry out the study, the descriptive survey type research design was adopted. A sample of 420 teachers who were working in primary schools in Odisha was randomly selected and the data was collected through a self-made questionnaire. The results revealed regarding program management, are that the majority of teachers (89.04%) received information about the inservice training program well in advance and also, more than 90% of the teachers reported that the distance between the training centers and their school is reasonable. Regarding the quality of teaching materials for learning, 90% of the teachers reported that there was provision of learning materials and packages including kits. Half of the teachers (50.79%) reported that the language of the training package was easy to understand. Also, most teachers (86.43%) reported the unavailability of math and science kits during training.
FRI517 BIUX2X2 Dash, Kalpana; Ayyagari, Usha
Journal of the Endocrine Society,
10/2023, Letnik:
7, Številka:
Supplement_1
Journal Article
Recenzirano
Odprti dostop
Abstract
Disclosure: K. Dash: None. U. Ayyagari: None.
A Rare Presentation of Solitary Thyroid Nodule - Microfilaria: Case reportDash Kalpana,* Ayyagari Usha***Department of Endocrinology & ...Metabolism, Apollo Hospitals, Bilaspur. Chhattisgarh, India.** Smriti Speciality Klinics, Chennai, IndiaTel: +919827143474, Email: drkdash@rediffmail.com. Introduction: Filariasis is a debilitating public health problem in the tropics most commonly presenting with asymptomatic microfilaremia. Clinical manifestations include lymphangitis/lymphadenitis in lower limbs(elephantiasis), peritoneum, scrotum(hydrocele), and rarely in breast (breast lump), pleural effusion, bone marrow, and thyroid (painless nodule or thyroiditis). Diagnosis is by demonstrating microfilaria in peripheral blood or tissue biopsy or detection of filarial antigen/antibody in blood. Adult worms are found in lymphatics, subcutaneous tissue, peritoneal and pleural fluid, heart, brain, scrotum, breast, and rarely, thyroid. Filariasis may rarely present as superficial swellings at unusual sites. We present a case of filarial thyroid nodule, a rare manifestation of filarial disease. Clinical Case: Female, 72, presented with painless swelling over the thyroid for 6 months. She had no significant past medical history, was otherwise asymptomatic, clinically and biochemically euthyroid, with normal hemogram, RFT, and LFT. Clinical examination revealed a firm, non-tender nodule measuring 35x45mm, moves with deglutition. On USG of neck, a nodular hypoechoic lesion of 41x45mm was seen over right lobe of thyroid with calcification. FNAC was done for suspected carcinoma & showed histiocytes, hurthle cells, giant cells and a single viable Microfilarial form of Wuchereria bancrofti. She was treated with Diethylcarbamazine citrate & made a full recovery with resolution of the nodule. Discussion: We report a rare manifestation of filarial disease as a painless thyroid nodule. Circulating microfilaria reach the thyroid tissue, followed by rupture of vasculature causing local inflammatory reaction and subsequent nodular transformation. Diagnosis presents challenges as the endemic species in India exhibit nocturnal periodicity and it is difficult to find microfilariae in blood and fine-needle aspirates during the day. Case reports of microfilaria in thyroid aspirates from nodules or thyroiditis are rare. Clinical Lesson: The differential diagnosis for a painless thyroid nodule includes possible malignant disease, with the associated stress of further investigation and treatment. However, accurate diagnosis of filarial disease, rare as it may be, even in endemic areas, obviates the need for surgery as evidenced by the resolution of the nodule with medical treatment in our case.
Presentation: Friday, June 16, 2023
Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and ...inter-regional variations.
The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program-Adult Treatment Panel III guidelines.
A total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2-12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9-16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8-37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9-30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7-41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9-84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1.
The prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India.
Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Abstract
A 53-year old male patient with T2D and hypertension for 13 years, presented to Apollo Sugar Clinic, Raipur with recurrent abdomen pain, but no vomiting, constipation, diarrhea or fever. The ...patient has a past history of asthmatic bronchitis, recurrent eosinophilia, and one month prior to hospitalization, recovered from erythematous maculopapular serpentine rash measuring 6.0 x 1.5 cm over the abdomen post anti-allergic treatment. The patient was neither suffering from immunosuppressive condition nor was on immunosuppressant therapy, had normal vitals but the laboratory findings revealed high total leukocyte count and raised absolute eosinophil count (52%). The provisional diagnosis was made as hypereosinophilic enteritis in a long-standing T2D and hypertension. Immunological tests antinuclear antibody (ANA) and antineutrophil cytoplasmic antibodies (ANCA) resulted in positive ruling out vasculitis. Stool examination detected rhabditiform larvae of S Stercoralis and diagnosed as Strongyloides hyper infestation syndrome. The patient was managed with IV antibiotics, IV fluids, IV insulin and when abdomen pain reduced started with the oral diet. To remove larvae load, unlike routine treatment, the patient was put on albendazole and ivermectin for three consecutive days. After 15 days follow-up patient was completely asymptomatic; at 6 weeks TLC, stool test, ANCA and ANA titer were negative indicating no parasite load. These antibodies detected could be due to molecular mimicry triggered by parasite antigens which may help in diagnosing and monitoring the disease course. ANA and ANCA positive results have been rarely reported in the past for S stercoralis. This unique case of S stercoralis infestation in T2D may enlighten the health care physicians to investigate for this infestation in immunocompromised T2D patients with pain abdomen. Precise diagnosis with timely management can prevent steroid therapy due to eosinophilic enteritis which can be harmful to the patients.
Hirsutism is a common endocrinological disorder in clinical practice. The causes vary from simple idiopathic hirsutism to most complicated malignant ovarian and adrenal tumors. Most common cause of ...hirsutism in endocrine clinic is due to a disorder known as PCOS (polycystic ovarian syndrome). Hirsutism poses embarrassment to the women. The purpose of this short review is to identify the common diseases associated with hirsutism, an approach to working through the differential diagnosis, investigations helping in diagnosis and the commonly available treatment modalities for the various forms of hirsutism. The review will provide the physician about the most efficient, cost effective and safe clinical approach to management of hirsutism.
Purpose
The study aims to investigate the effect of the dialogue embedded synectics model of teaching on the creative thinking of students.
Design/methodology/approach
The research design of the ...study was a nonequivalent control group design of quasi experimental research. This study collected data from 80 students in the seventh grade from two different government schools in Bathinda, Punjab, India, which were selected using a random method. The subjects of experimental group were taught by the investigator using the dialogue embedded synectics model of teaching and the subjects of control group were taught by their teacher using the traditional teaching method, i.e. the Herbartian method. The data collections were done using the creative thinking test developed by Baqer Mehdi (1995). The data analysis techniques used
t
-test.
Findings
Key finding indicates that the dialogue embedded synectics model of teaching is effective in enhancing the creative thinking of students as compared to the traditional method.
Originality/value
The present work is unique in terms of development of an innovative pedagogy, i.e. the dialogue embedded synectics model of teaching, which has the potential to encourage students' creative thinking, a key concern for society in the 21st century. Therefore, it is suggested to conduct similar type of studies on this innovative pedagogy and this model of teaching may be used by teachers for enhancing creative thinking of seventh class students.
Aim: The purpose of this study was to profile young-onset (defined as up to age 40 years) diabetes patients in India.
Methods: The current analysis is a retrospective data analysis of young-onset ...diabetes patients. Young age diabetes is defined as patients diagnosed with diabetes between 18 to 40 years of age. T1DM and other secondary diabetes were excluded while profiling these patients. Patient’s data was extracted from EMRs of Apollo Sugar Outpatient clinics (n=35) from January 2018 to October 2019. Descriptive statistics were applied to analyze the data and report the results.
Results: Of the total 85568 diabetes patient’s records, 4152 (5%) young diabetes patients were identified as fulfilling the criteria of T2DM of early-onset. Males were 2495 (60%) and females were 1657(40%). Mean blood pressure was 122/78 mmHg, average BMI was 28.4 kg/m2, 15% had hypertension, 39% had dyslipidemia and 1% had CAD. Positive family history was recorded in 5% of patients, and 1% were recorded to have current or past smoking. Mean HbA1c was 8.4%, FBG and PPBG were 190 mg/dL and 273mg/dL. Mean cholesterol 179mg/dL, HDL 40mg/dL, LDL 111 mg/dL, and TG 232 mg/dL and creatinine 0.9mg/dL. The average no of antidiabetes drugs prescribed was 2. Nearly 36% of the patients were on oral agents and insulins, 30% were on statins.
Conclusions: In our cross-sectional analysis 5% of patients over 18 month’s period had a diagnosis fulfilled the criteria for early-onset diabetes. There was a male preponderance. The average BMI was considerably higher. The majority had poor control and greater than a third of patients were on insulin. Other comorbidities such as hypertension and dyslipidemia were also prevalent. The higher BMI poor control and presence of comorbidities are ominous predicting a higher progression to complications given the longer disease burden in these patients. Our data indicate the need for further efforts in preventing detecting and treating diabetes in this young group of patients.
Disclosure
N. Nk: None. C. Dwarakanath: None. V. S: None. M. Rm: None. N. Bs: None. S. Das: None. K. Dash: None. S. Paladugu: None. K. Seshadri: None.
Abstract
Disclosure: K. Dash: None. N. Kumari: None. M. Harpal: None. T. Surekha: None. B. A. t: None.
Introduction: As per IDF 2022, 537 million adults (20-79 years) are living with diabetes & the ...number is increasing in an alarming way. 1in 10 people are suffering from diabetes and over 3 in 4 adults with diabetes live in low and middle-income countries. Adequate control of the disease is required by educating patients and developing their skills to manage their treatment to prevent complications through continue diabetic education program (DEPs). Aim & Objectives: To measure the change in HBA1C, FBG & PPBG (primary end point) value, who are in continue DEPs Sugar 360 (long term, 1 year sugar plan), Sugar 90 (long term-6 months sugar plan) vs. conventional method (SA-1- short term sugar plan, only one visit )with normal follow up along with standard of care treatment. Secondary end points such as total cholesterol and body weight were also taken into consideration. Methods: Data of 100 type 2 diabetes mellitus patients who had attended diabetes OPD & had at least two follow ups having knowledge about diabetes were included in the study. Visual impairment, psychological impairment and newly diagnosed DM patients were excluded from the study. Data on biochemical parameters of metabolic control such as FBG, PPBG, HBA1c, total cholesterol, TG & BMI were collected. Within subjects design non-parametric and for quantitative data repeated measures ANOVA was used. Results: Mean age is 51.32 years in DEPs patients and mean age is 57.29 years in conventional treatment patients. Significant decrease in HBA1c (9.1% vs. 7.2%), FBG (161.2 mg/dl vs. 119.1 mg/dl), PPBG (244.6 mg/dl vs. 172.2 mg/dl), total cholesterol (175.8mg/dl vs. 159.8mg/dl) & triglyceride (217.5 mg/dl vs. 182.1 mg/dl) were noted in the follow up visit in both groups. However patients on DEPs has better adherence to the follow-up visits and better understanding of disease, blood glucose control measures and lifestyle change. Conclusion: Intensive DEPs was found useful & effective as regards to biochemical than compared with normal conventional treatment in terms of adherence knowledge & control of disease.
Presentation: Saturday, June 17, 2023
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