Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research-INdia DIABetes study is to ...estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state.
We used a stratified multistage design to obtain a community-based sample of 57 117 individuals aged 20 years or older. The sample population represented 14 of India's 28 states (eight from the mainland and six from the northeast of the country) and one union territory. States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015. Capillary oral glucose tolerance tests were used to diagnose diabetes and prediabetes in accordance with WHO criteria. Our methods did not allow us to differentiate between type 1 and type 2 diabetes. The prevalence of diabetes in different states was assessed in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state. We used multiple logistic regression analysis to examine the association of various factors with the prevalence of diabetes and prediabetes.
The overall prevalence of diabetes in all 15 states of India was 7·3% (95% CI 7·0-7·5). The prevalence of diabetes varied from 4·3% in Bihar (95% CI 3·7-5·0) to 10·0% (8·7-11·2) in Punjab and was higher in urban areas (11·2%, 10·6-11·8) than in rural areas (5·2%, 4·9-5·4; p<0·0001) and higher in mainland states (8·3%, 7·9-8·7) than in the northeast (5·9%, 5·5-6·2; p<0·0001). Overall, 1862 (47·3%) of 3938 individuals identified as having diabetes had not been diagnosed previously. States with higher per-capita GDP seemed to have a higher prevalence of diabetes (eg, Chandigarh, which had the highest GDP of US$ 3433, had the highest prevalence of 13·6%, 12.8-15·2). In rural areas of all states, diabetes was more prevalent in individuals of higher SES. However, in urban areas of some of the more affluent states (Chandigarh, Maharashtra, and Tamil Nadu), diabetes prevalence was higher in people with lower SES. The overall prevalence of prediabetes in all 15 states was 10·3% (10·0-10·6). The prevalence of prediabetes varied from 6·0% (5·1-6·8) in Mizoram to 14·7% (13·6-15·9) in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history of diabetes were independent risk factors for diabetes in both urban and rural areas.
There are large differences in diabetes prevalence between states in India. Our results show evidence of an epidemiological transition, with a higher prevalence of diabetes in low SES groups in the urban areas of the more economically developed states. The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measures.
Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Parkinsonism has a complex and multifactorial aetiology and the role of post viral infection parkinsonism has been documented. The recent pandemic has made it clear that COVID-19 causes respiratory ...disease and affects multiple organs, which includes the central nervous system. Here we report three cases of post COVID parkinsonism occurring in older adults, age 60 years and above, and their response to levodopa-carbidopa.
India has nearly 120 million elderly people with various physical, psychosocial, economic, and spiritual problems. While the functionally and cognitively fit can access usual health-care facilities ...provided by the government, these people need active aging program to keep them independent. Health ministry has created geriatric centers and geriatric clinics in most of the states; however, these centers may not serve the functionally and cognitively impaired elderly. There is great need for mobile units, day-care centers and hospices, and need for training of personnel in home nursing. Routine care clinics cannot handle the burden of geriatric population to address their multimorbidity and several other age-related problems. There is a need for a rapid training of health-care professionals of various disciplines in geriatric care. Government must support nongovernmental organizations and other agencies which provide day care, home care, and palliative care so that these services become affordable to all the elderly.
Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has recently attracted widespread attention due to its limited treatment options and significant morbidity and mortality rates. This study ...aimed to examine the relationship between risk factors and antimicrobial resistance in individuals with and without diabetes for the development of carbapenemase-producing K. pneumoniae infections.
Between May 2019 and January 2021, a prospective study involving patients with and without diabetes who were infected with K. pneumonia, was carried out in a tertiary care hospital. Six hundred K. pneumoniae isolates were collected from various clinical samples, such as pus/wound samples, urine, respiratory samples, blood, and body fluids. An antimicrobial susceptibility test in K. pneumoniae was performed and compared between diabetics and nondiabetics. Univariate and multivariate logistic regression were used to identify independent risk factors for K. pneumoniae infections in the diabetic group and nondiabetic group separately. Multiplex PCR was used to detect genes that produce carbapenemase.
A total of 600 patients were infected with K. pneumoniae, with 300 (50%) being diabetic and 300 (50%) being nondiabetic. We found that diabetics had higher antimicrobial resistance to numerous routinely used drugs for infection than the nondiabetic group. In the multivariate analysis of the variables, it was found that immunosuppressive therapy, prior antibiotic use, mechanical ventilation, and urinary catheter use were all significant risk factors influencing the development of K. pneumoniae infections in diabetic patients. Diabetics had a higher prevalence of carbapenemase-producing K. pneumoniae than nondiabetics. Outcome measures in K. pneumoniae patients revealed that the diabetic group had considerably higher infection-related mortality.
We found that CRKP infection was associated with higher resistance to antibiotics in the diabetic group. Furthermore, the diabetic group had a higher prevalence of carbapenemase-producing K. pneumoniae than the nondiabetic group. Crucially, in order to lower mortality without worsening antibiotic resistance and metabolic damage, more focus has to be placed on sensible and efficient antibiotic and supportive care therapies.
Drought is a major abiotic factor causing rice yield loss in rainfed and drought-prone areas, so screening of the cultivars for drought tolerance is crucial. Our study screens 10 commercial rice ...cultivars grown in the mid-hills of Nepal and four pipeline genotypes. Our objective is to identify the superior drought-tolerant cultivar and suitable indices for screening. The 14 rice genotypes were evaluated under both drought stress and non-stress conditions in randomized complete block design with three replications. The yield reduction for the cultivars ranged from 12-54% during water-stressed conditions. The drought indices mean productivity, geometric mean productivity and stress tolerance index showed a positive and high correlation with grain yield. Based on drought indices, genotype NR 119 showed the highest mean productivity, geometric mean productivity, stress tolerance index and lowest yield loss. Further, principal component analysis bolsters our results by clustering similar drought indices and drought-tolerant cultivars. The NR 119 is followed by Chaite 5 and Chaite 4 as a drought-tolerant genotype, therefore, we recommend it for drought-prone areas of the mid-hill region of Nepal. We identified mean productivity, stress tolerance index and geometric mean productivity as important drought indices, so we recommend using this for drought screening.
Abstract
Invasive pulmonary aspergillosis is the most common cause of invasive fungal infection. Vasculitis secondary to bacterial, fungal, viral, and parasitic infections is documented in the ...literature. There are no reported cases of antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis secondary to pulmonary aspergillosis. Here, we present a case of pulmonary aspergillosis who developed ANCA-positive vasculitis.
Objectives: To study the prevalence of Geriatric giants among elderly attending Geriatric clinic of YMCH and to study the various factors (like Age, gender, co-morbidity, etc.) associated with these ...Geriatric giants. Method: This retrospective study was conducted in a tertiary care referral centre, from the year 2018 to 2019, Ethics committee approval was taken wide letter no. YEC-1/29/2020 (Protocol YEC2/162). Two hundred two geriatric patients, presenting to the geriatric clinic with geriatric giants, with various co-morbidities, their data was recorded. Falls in the previous year and urinary incontinence were recorded. Polypharmacy is considered as concurrent use of more than four drugs. Diagnosis of dementia and depression was conducted according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition diagnostic criteria. All the proportions were expressed as percentages; mean ± SD were used for Numerical Data. Factors such as age group, gender, morbidity index (number of morbidity present) which are related to geriatric giants were assessed using the Chi-square test. Results: The frequency of urinary incontinence was 75.7%, depression was 69.3%, falls were 67.3%, dementia was 47.5%, and polypharmacy was 33.6%. When all the participants were divided into four groups age-wise, respectively (60-69, 70-79, 80-89, 90-99 years), all syndromes were significantly increased with age. While a significant number of cases in the 60-69 years age group did not have any syndromes, more than 50% of cases in ≥80 years had more than three geriatric syndromes simultaneously. Conclusion: The frequency and coincidence of geriatric giants, except for polypharmacy, increases with age. Therefore, clinicians other than the geriatricians taking care of older people should be aware of these syndromes as well as their treatment mechanisms.
The interaction of genetic and epigenetic mechanisms is one of the underlying causes of phenotypic variability in complex diseases such as type 2 diabetes (T2D). To explore the influence of genetic ...and epigenetic changes in T2D, we examined the effect of methylation of CpG-SNP sites on allele-specific expression (ASE) in one-carbon metabolism pathway genes in T2D. Case-control study was conducted on 860 individuals (430 T2D and 430 controls). CpG-SNPs shortlisted through in silico analysis were genotyped using tetra ARMS PCR and validated using Sanger DNA sequencing. Global DNA methylation was carried out using RP-HPLC. Promoter DNA methylation and CpG site-specific methylation were carried out using bisulfite sequencing. mRNA expression and ASE were examined by SYBR green and TaqMan assay, respectively. Four exonic CpG-SNPs of MTHFD1, MTRR, and GGH genes were identified in folate pathway genes. Among these, MTHFD1 rs2236225 showed significant association with T2D independent of obesity, displayed ASE, and correlated with CpG-SNP site-specific methylation when compared with controls. Our results demonstrate that SNP rs2236225 in the CpG site of MTHFD1, which regulates allele-specific gene expression in PBMCs is methylation dependent and may perturb one-carbon metabolism pathway in T2D subjects.
The interaction of genetic and epigenetic mechanisms is one of the underlying causes of phenotypic variability in diseases like type 2 diabetes. The authors identified the methylation-dependent CpG-SNP in the MTHFD1 gene as a regulator of allele-specific gene expression in peripheral blood mononuclear cells, which may perturb one-carbon metabolism in diabetes.
Diabetes-related distress and glycemic indicators are the most common concerns for patients with diabetes mellitus and have a major impact on diabetic patients' lifestyle, mental well-being, and ...healthcare access. The principal aim of research in this field is to ascertain the correlation between distress associated with diabetes and glycemic indicators. this helps in developing interventions that can enhance the overall physical and mental well-being of individuals with diabetes.
The objective is to assess the diabetes distress and glycemic indicators among patients with foot ulcers and to find the correlation between diabetes distress and glycemic parameters.
A descriptive correlational study was conducted among 159 patients with foot ulcers who were admitted to the hospital by using a non-probability purposive sampling method. The severity of diabetes distress was evaluated utilizing the four-subscale Diabetes Distress Scale (DDS-17). Glycemic indicators are calculated through the assessment of random blood sugar, fasting blood sugar (FBS), and glycosylated hemoglobin (HbA1c).
The study revealed that most participants were above 60 years old and were male. Of the samples, 52% had moderate distress. All the subscales of diabetes distress are correlated to the overall DDS score. A negative correlation (r= -0.162, p < 0.041) was found between emotional burden and FBS which was statistically significant, whereas FBS is positively related to HbA1c (r=0.194, p=0.015).
The significant correlation between DDS scores, the subscales of diabetes distress, and glycemic indicators highlights the criticality of incorporating diabetes distress management into comprehensive strategies for managing diabetes. Moreover, the research underscores the necessity of employing multidisciplinary strategies when attending to diabetic patients to prevent complications.
The world's population has been evolving rapidly; every country in the world is facing this drastic progression in the number and the percentage of the elderly in their net population. As the ...chronological age advances, physiological and psychosocial decline will be evident among all older adults. The potentially relevant literature was identified using appropriate search terms in electronic databases such as PubMed MEDLINE, Scopus, ProQuest, Web of Science, CINAHL, IndMed, and Google Scholar. Articles published from 2006 to 2019, reported the prevalence and the risk factors for depression among older adults living in the community, old age homes, or hospitals of the South Asian countries. Articles were published in the languages other than English and those reporting the categorised or mean depressive scores were excluded from the review. After quality check for all the retrieved articles from different databases, 120 articles were included for the meta‐analysis. The data were extracted based on a validated data extraction form, and the reviewer contacted the authors for clarification of the missing data whenever required. The estimates were pooled using the random effect model for meta‐analyses. Sub‐group and sensitivity analyses were also performed. The overall pooled estimate (random effect models) of the prevalence of depression among the elderly was 42.0% (95% CI: 0.38–0.46), Chi‐squared P‐value <0.001, and I2 99.14%. The pooled estimate of the prevalence was higher in the community settings than the old age homes (44.0%; 95% CI: 39.0–49.0 vs. 42.0%; 95% CI: 34.0–49.0). Depression is a common problem among the elderly population and the pooled estimate of depression would give directions to the healthcare providers, policymakers, and future researchers to plan some measures (either pharmacological or non‐pharmacological interventions) to effectively tackle the burden of geriatric depression in the future.
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