Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) are at higher risk to develop depression. Depression in turn adversely affects glycaemic control and increases the risk of diabetes-related ...complications and mortality. There is a large variation among Indian studies on prevalence of depression in T2DM and associated risk factors. Aim: To assess the prevalence, severity, and determinants of depression among patients with T2DM. Materials and Methods: The study was conducted at a Tertiary Care Hospital during February 2018-February 2019, in North-Indian state of Uttarakhand. Study subjects were patients with T2DM, age >18 years. Based on exclusion and inclusion criterias, a total sample of 290 patients were studied. Presence of depression was assessed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Hamilton Depression Rating Scale (HAM-D) was used to estimate the severity of depression. Unpaired t-test and Mann-Whitney U test were used to compare continuous variables between subjects with and without depression. Chi-Square test was used to analyse categorical data. Binary logistic regression analysis was used to study the association between likelihood of depression and predictor variables. Results: Among 290 (155 males and 135 females, mean age of all subjects 58.2±11.08 years) study subjects with T2DM, 64 (22.1%) were found to have depression using DSM-5 criteria. Out of these 64 patients with depression, 46 were detected to have mild depression, 14 moderate depression and 4 severe depression using HAM-D scale. Subjects with T2DM and depression had: higher proportion of females (62.5% vs. 42.0%; p-value 0.004); lower literacy level (53.1% vs. 67.3%; p-value 0.037); higher frequency of diabetic retinopathy (85.9% vs. 62.8%; p-value <0.001) and diabetic kidney disease (43.8% vs. 27.4%; p-value 0.013); higher Fasting Plasma Glucose (FPG) (217.7±94.62 vs. 190.0±76.45 mg/dL; p-value 0.040); and lower haemoglobin (10.8±2.49 vs. 11.7±2.37 gm/dL; p-value 0.010) compared to the subjects without depression. On binary logistic regression analysis, female gender (OR 2.457, 95% CI 1.368-4.413, p-value 0.003) and diabetic retinopathy (OR 3.842, 95% CI 1.788-8.255, p-value 0.001) remained significantly associated with likelihood of depression. Conclusion: Depression was present in one-fifth of the study subjects with T2DM. Majority of them had mild depression. Female gender and diabetic retinopathy were associated with increased likelihood of depression.
Background: Urinary tract infections (UTIs) are common and more severe among patients with diabetes mellitus (DM). UTI in DM is more likely to be caused by bacteria resistant to various ...antimicrobials. The present study aims to assess the spectrum of bacteria causing UTI and its antimicrobial susceptibility pattern among critically ill patients with DM. Materials and Methods: The present study included 272 patients with DM and UTI, age more than 18 years, admitted in the intensive care unit of a tertiary care hospital in the state of Uttarakhand, India. The pathogens causing UTI were isolated, identified and antimicrobial susceptibility testing was performed using automated VITEK method as described by the Clinical and Laboratory Standards Institute. Results: UTI was caused by Gram-negative bacteria of Enterobacteriaceae family in 89.7% and by Gram-positive bacteria in 10.3% of the study participants. Escherichia coli was the most common Gram-negative bacteria causing UTI followed by Klebsiella pneumoniae and Proteus spp. Enterococcus faecalis was most common Gram-positive isolate. Gram-negative bacteria were highly susceptible to colistin, fosfomycin, carbapenems, and aminoglycosides. Carbapenem resistance was observed in 16.4% of these isolates. Gram-positive bacteria were most susceptible to vancomycin, teicoplanin, linezolid, and fosfomycin. Conclusion: Gram-negative bacteria, particularly E. coli were the most common uropathogens causing UTI in critically ill patients with DM. These bacteria showed good antimicrobial susceptibility to colistin, fosfomycin, carbapenems, and aminoglycosides. Carbapenem-resistance was found in one-sixth of the Enterobacteriaceae isolates. Gram-positive bacteria caused UTI in about 10% of the study participants and were susceptible to vancomycin, teicoplanin, and linezolid.
Background and Aims: There is increasing awareness about an association between type 2 diabetes mellitus (T2DM) and male hypogonadism. However, data are sparse and less uniform with respect to ...factors associated with hypogonadism in males with T2DM. This study aimed to assess the frequency and correlates of hypogonadism in these subjects. Materials and Methods: This cross-sectional study included 130 males with T2DM, age 25-60 years. Study subjects were screened for hypogonadal symptoms using androgen deficiency in aging male (ADAM) questionnaire. Serum total testosterone was measured in subjects with positive ADAM score. Hypogonadism was defined as the presence of positive ADAM score and low serum total testosterone (<3 ng/mL). Clinical and biochemical variables were compared between T2DM subjects with and without hypogonadism. Results: Hypogonadism was observed in 26.9% of the study subjects. Hypogonadal symptoms most frequently observed in patients with T2DM and hypogonadism were erectile dysfunction (96.4%), reduced libido (64.3%) and deterioration in work performance (53.6%). Group with T2DM and hypogonadism had higher (i) duration of T2DM (8.9 ± 5.03 vs. 4.8 ± 4.76 years; P = .001), (ii) frequency of diabetic retinopathy (58.3% vs. 27.3%; P = .008), (iii) frequency of diabetic neuropathy (42.9% vs. 19.7%; P = .024), (iv) proportion of subjects on insulin therapy (46.4% vs. 22.4%; P = .027), and (v) HbA1c (10.9 ± 2.63% vs. 9.3 ± 2.42%; P = .006), compared to group without hypogonadism. Conclusion: Hypogonadism was present in nearly one-fourth of the study subjects with T2DM. Compared to the subjects without hypogonadism, group with hypogonadism had longer duration of diabetes, higher HbA1c, greater frequencies of diabetic retinopathy and diabetic neuropathy, and more subjects on insulin therapy.
Background: Prevalence of overweight-obesity is rising in India. Medical Professionals are vulnerable to overweight-obesity because of the sedentary lifestyle which is frequently adopted due to ...massive work burden. Aim & Objective: To assess prevalence of overweight-obesity and associated factors among MBBS students in a medical institute in north-Indian state of Uttarakhand. Settings and Design: Descriptive cross-sectional study Methods and Material: This study was conducted among 310 M.B.B.S. students at Himalayan Institute of Medical Sciences, Uttarakhand, between March and May 2019. Socio-demographic details were recorded using a structured pro forma. A pre-validated IPAQ questionnaire was used for assessment of physical activity. Anthropometric and clinical parameters were measured using standard techniques. Statistical analysis used: Independent student’s t test and Chi square test were used to compare the quantitative variables and categorical variables, respectively. Pearson’s correlation test was used to study the correlation of BMI with clinical parameters. Results: Among 310 study subjects, 164 (52.9%) were overweight-obese. The prevalence of abdominal obesity was 30.3 percent. Subjects with overweight-obesity, in comparison to normal BMI group, had higher frequency of smoking, higher systolic blood pressure, higher mean arterial pressure, higher pulse pressure and engaged more in high (category 3) physical activity. Conclusions: There was 52.9% prevalence of overweight-obesity in study cohort. Overweight-obese subjects had higher blood pressure and frequency of smoking, both traditional cardiovascular risk factors. Interestingly, more overweight-obese subjects engaged in high physical activity.
ObjectiveThere is limited information on seizures in patients with idiopathic hypoparathyroidism (IH). We assessed seizure characteristics at presentation, subclinical seizures during follow-up, and ...the effect of antiepileptic drug (AED) withdrawal in IH patients.Designs and methodsSeizure characteristics were assessed in 70 patients with IH attending endocrine clinic. Provoked electroencephalography (EEG) was performed for subclinical seizures in 44 of them. AEDs were withdrawn using strict criteria, i.e. i) no seizure during past 2 years, ii) normal EEG, iii) serum total calcium ≥1.8 mmol/l, and iv) feasibility to follow-up regularly after AED withdrawal for at least 9 months (n=14). The effects of AED withdrawal on seizures and serum total calcium were assessed.ResultsSeizures were present in 64.3% of patients, generalized tonic–clonic in 86.7%, and treated with phenytoin (46.7%), valproate (40%), and carbamazepine (26.7%). Most (69/70) patients were seizure-free during the follow-up of 6.6±4.5 years. Ten of 14 (71.4%) patients were successfully withdrawn from AED and remained seizure free during the follow-up period of 13.5±2.4 months (range 9–18). AEDs were restarted because of the recurrence of seizures (n=3) and poor compliance with calcium/vitamin D (n=1). The mean serum total calcium increased from 1.9±0.19 to 2.1±0.14 mmol/l after AED withdrawal (P=0.004).ConclusionSeizures were present in 64.3% of patients with IH and they responded to AED and calcium/1-α-(OH)D during the follow-up. With strict eligibility criteria, it was possible to withdraw AED in 71% of patients with IH. Serum total calcium improved significantly after AED withdrawal.
Abstract
BACKGROUND
Telemedicine use has increased during the COVID-19 pandemic, but uptake among patient populations has not been equitable. Lack of access to technology or broadband connection ...contributes to the digital divide, but additional factors at the provider-level may contribute. We aimed to identify barriers and facilitators to inflammatory bowel disease (IBD) patient use of telemedicine with a focus on trust and the patient-provider relationship.
METHODS
Patients 18 years and older who were seen via telemedicine at a colorectal surgery clinic at a high-volume, tertiary care academic center were contacted for participation in this study. Patient demographics including age at surgery, race, sex, and diagnosis were recorded. Patient health literacy was evaluated using the BRIEF Health Literacy Screening Tool. The Wake Forest Physician Trust Scale (WFPTS) was used to measure patient trust in providers. Individual semi-structured interviews based on developed guides explored barriers and facilitators to telemedicine use. NVivo12 software was used for qualitative analysis and data organization. Coders reviewed each transcript independently, convening after initial review for discussion. Final themes were analyzed by disease process.
RESULTS
Among 29 participants, 24% of patients underwent colorectal surgery for treatment of IBD. 52% identified as female, 67% White, 30% Black, and 4% Latino, which closely mirrors the racial demographics of the study region. 33.3% of patients had limited health literacy (BRIEF score < 17) with an overall mean BRIEF score of 17.6 out of 20 (SD 3.33). The WFPTS scale ranged from 44 to 50, with a mean of 48.5 (SD 2.1) in IBD patients. Among IBD patients, three major themes were identified as important with respect to trust during telemedicine visits: trust in providers, trust in the institution, and trust in the surgical process. Of these, provider-level trust appeared to most influence patient trust in telemedicine. All participants noted that surgeon confidence and reputation affected trust in telemedicine. In the majority of IBD patients, a surgery referral from a trusted provider was an important factor in a patient’s trust and utilization of telemedicine pre and post operatively. Additionally, the duration of the patient encounter, pre-operative education, and the surgeon’s ability to answer questions appeared most relevant to IBD patients.
LIMITATIONS
The generalizability of our results may be limited because all patients were seen via telemedicine at a single institution.
CONCLUSION
Provider-level trust may have an increased role in IBD patients. To improve patient trust and telemedicine engagement in the IBD patient population, providers and healthcare systems should build and integrate interventions that enhance communication and interpersonal skills.
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.
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