Glucose control and vascular complications in veterans with type 2 diabetes

Santanu Guha, S. Harikrishnan*, Saumitra Ray, Rishi Sethi, S. Ramakrishnan, Suvro Banerjee, V.K. Bahl, K.C. Goswami, Amal Kumar Banerjee, S. Shanmugasundaram, P.G. Kerkar, Sandeep Seth, Rakesh Yadav, Aditya Kapoor, Ajaykumar U. Mahajan, P.P. Mohanan, Sundeep Mishra, P.K. Deb, C. Narasimhan, A.K. Pancholia, Ajay Sinha, Akshyaya Pradhan, R Alagesan, Ambuj Roy, Amit Vora, Anita Saxena, Arup Dasbiswas, B.C. Srinivas, B.P. Chattopadhyay, B.P. Singh, J. Balachandar, K.R. Balakrishnan, Brian Pinto, C.N. Manjunath, Charan P. Lanjewar, Dharmendra Jain, Dipak Sarma, G. Justin Paul, Geevar A. Zachariah, H.K. Chopra, I.B. Vijayalakshmi, J.A. Tharakan, J.J. Dalal, J.P.S. Sawhney, Jayanta Saha, Johann Christopher, K.K. Talwar, K. Sarat Chandra, K. Venugopal, Kajal Ganguly, M.S. Hiremath, Milind Hot, Mrinal Kanti Das, Neil Bardolui, Niteen V. Deshpande, O.P. Yadava, Prashant Bhardwaj, Pravesh Vishwakarma, Rajeeve Kumar Rajput, Rakesh Gupta, S. Somasundaram, S.N. Routray, S.S. Iyengar, G. Sanjay, Satyendra Tewari, Sengottuvelu G., Soumitra Kumar, Soura Mookerjee, Tiny Nair, Trinath Mishra, U.C. Samal, U. Kaul, V.K. Chopra, V.S. Narain, Vimal Raj, Yash Lokhandwala

CSI position statement on management of heart failure in India.

There is an excessive burden of diabetes complications in low-resource settings. We conducted a systematic review to determine the nature and frequency of diabetes complications in newly diagnosed with type 2 diabetes. A systematic search was performed using Medline, CINAHL and Global Health online databases from inception to July 2020. Articles reporting prevalence of microvascular or macrovascular complications within six months of type 2 diabetes diagnosis and published in English or French from low- and middle-income countries (LMICs) were eligible for analysis. Data were extracted using a standardized data extraction tool. Descriptive statistics were used to describe the prevalence of micro and macrovascular complications in newly diagnosed type 2 diabetes. Assessment of heterogeneity was conducted using the inconsistency index (I2) and Cochran-Q chi2 statistical tests. Publication bias was assessed by the Funnel plot and Egger test. A total of 3 292 records underwent title or abstract screening and 95 articles underwent full text review. Thirty-three studies describing 13 283 participants (aged 20 years and older) met the inclusion criteria. The eligible studies were from Asia (n = 24), Africa (n = 4), Oceania (n = 2), South America (n = 2) and the Caribbean (n = 1). For microvascular complications, the median prevalence (interquartile range) of retinopathy, nephropathy and neuropathy were 12% (6%-15%), 15% (7%-35%) and 16% (10%25%) respectively. For macrovascular complications, the median prevalence (interquartile range) was 10% (7%-17%) for ischaemic heart disease, 6% (1%-20%) for peripheral arterial disease and 2% (1%-4%) for stroke. There was evidence of substantial heterogeneity between studies for all outcomes (I2 > 90%. We found a high prevalence of complications in newly diagnosed type 2 diabetes in LMICs. Findings suggest that many people live with diabetes and are only diagnosed when they present with complications in LMICs. Research is needed to guide timely and effective identification of people living with diabetes in these settings.

/pdf/prevalence-of-microvascular-and-macrovascular-complications-1cppjxy5.pdf

Prevalence of microvascular and macrovascular complications of diabetes in newly diagnosed type 2 diabetes in low-and-middle-income countries: A systematic review and meta-analysis

Introduction: Vascular complications are the major cause of morbidity in patients with diabetes mellitus. Screening for these complications is crucial in early detection and tertiary prevention. He...

https://journals.sagepub.com/doi/pdf/10.1177/2150132720959962

Prevalence of Vascular Complications Among Type 2 Diabetic Patients in a Rural Health Center in South India.

When is a patient brain dead

Tropical endomyocardial fibrosis is the commonest form of endemic restrictive cardiomyopathy that affects mainly children and adolescents, and is geographically restricted to some poor areas in the tropical and subtropical regions of the world such as Africa, Latin America and Asia including southern districts of India especially in the coastal belt of Kerala state. Sub-endocardial fibrosis affecting the apices and the inflow tracts of the right or left ventricle, or both; and varying degree of atrioventricular valve regurgitation defines the disease. Chronic systemic venous hypertension and severe pulmonary hypertension are characteristic features of right ventricular and Left ventricular endomyocardial fibrosis respectively. Due to lack of resources for research in the disease endemic areas, the exact epidemiology, etiology and pathogenesis remain unknown, and the natural history is incompletely understood. Various infections and toxic factors were postulated regarding its etiology. During the last few years, incidence of the disease has decreased considerably because of the significant improvement in the living standards of the people with the corresponding decline in the childhood malnutrition, infections, worm infestations and associated eosinophilia. It is a condition with high morbidity and mortality, for which no effective therapy is available. However, surgical management improves the natural history of this disease to some extent. We have conducted a systematic review of the most intriguing aspects of epidemiology, natural history, clinical picture and management of endomyocardial fibrosis, proposing new ways to increase research into this challenging and neglected cardiovascular disease. We relied primarily on articles in the MEDLINE database with either ‘‘endomyocardial fibrosis’’ or ‘‘endomyocardial sclerosis’’ in the title.

Tropical endomyocardial fibrosis: an overview -

Background: Diabetes is a serious public health problem that threatens the quality of life. Studies have shown that its prevalence is rapidly increasing. In India many studies have been done on diabetes and its complications but most of the studies have been done in urban area. There is limited data on diabetes from rural area. Our study is an attempt to provide data on diabetes in rural area that will guide health care professionals in managing the disease appropriately. The aim of the study was to determine the prevalence of chronic complications in newly diagnosed type 2 diabetes mellitus (T2DM) patients from rural area of western Uttar Pradesh, India. Methods: The study was conducted on 306 newly diagnosed type 2 diabetes mellitus patients. Each patient was screened for diabetic complications, hypertension, dyslipidemia, and body mass index. Standard protocols were used to make the diagnosis of retinopathy, neuropathy and nephropathy. Results: There were 174 males and 132 females. Majority were less than 60 years of age. 20.26% of patients had neuropathy 15.36%, retinopathy and 5.56%, nephropathy. Risk factors of macro-vascular complication such as hypertension, obesity, and dyslipidemia were observed in 38.9, 55.9%, and 54.6% of patients respectively. Coronary artery disease was noticed in 9.15%. Conclusions: Present study shows that high prevalence of micro vascular complications was present at diagnosis along with cardiovascular risk factors among T2DM patient from rural area of western Uttar Pradesh, India.

Chronic complications in newly diagnosed patients with type 2 diabetes mellitus in rural area of western Uttar Pradesh, India

Chest injury, also known as chest trauma, is any form of physical injury to the chest including the ribs, heart, large vessels of thorax and lungs etc. Chest injuries accounts for 25% of all deaths from injuries due to trauma. Chest injuries are caused by blunt mechanisms, such as motor vehicle collisions, fall from height or penetrating mechanisms such as stab injury, machine injury or gunshot injuries. In 2000, Pape et al described the thoracic trauma severity score (TTSS), a scale that included both anatomical and functional parameters for assessment of severity of chest trauma. TTSS combines the patient’s age, resuscitation parameters and radiological assessment of thorax. TTSS employs 5 specific parameters: rib fractures, lung contusions, PaO2/FiO2 ratio, age, and pleural involvement. These parameters are scored from 0 to 5. The TTSS is calculated by adding the score of each of these five parameters; minimum score is 0 and maximum score is 25. Severity of chest injury is calculated by adding these coding severity points in TTSS. Higher the sum of all ABSTRACT

/pdf/a-study-to-validate-thoracic-trauma-severity-score-in-chest-45wdk7b8b1.pdf

A study to validate thoracic trauma severity score in chest trauma patients

Background: Hair dye poisoning is not rare but is an emerging poisoning in India. The main component of hair dye causing toxicity is para phenylene diamine (PPD). Due to its easy availability and low cost, it is becoming a common mode of self-poisoning in rural area. A prospective study was planned to assess the clinical profile and outcome in patients with hair dye poisoning. Methods: This prospective observational study was conducted on 260 patients of para-phenylene-diamine (hair dye) poisoning, hospitalized in the medical unit of UP Rural Institute of Medical Science and Research, Saifai from January  2011-2014 over a period of  4 years. The diagnosis of PPD poisoning was based on history of ingestion and clinical manifestations. All cases were thoroughly evaluated for different complications and were treated accordingly. Results: Out of 260 cases enrolled, majority were females and were in the age group of 21-30 years. The intent of poisoning was suicidal in 100% cases. Cervico-facial edema was the most common presentation followed by respiratory distress, hypotension and generalised bodyache. Nephro-toxicity was observed in 58.46% cases. Myocarditis was observed in 11.53% cases. Mortality in PPD poisoning was high (21.53%) due to cardiotoxicity and renal failure Conclusions: Hair dye (PPD) poisoning is hepato-nephro as well as myo and cardiotoxic.

Study of hair dye poisoning and its outcome in tertiary care rural institute

Fulminant myocarditis is an unusual manifestation of cardiotoxicity with severe elapid snake envenoming and is meagrely reported with snake bite due to Indian common krait. We report a 12-year-old boy who was admitted in complete locked-in state and hemodynamic instability after severe neurotoxic snake envenoming by Bungarus caeruleus (Indian common krait). His hospital course was complicated with recurrent episodes of sustained ventricular tachycardia requiring defibrillation; and cardiogenic shock requiring inotropes, vasopressors and intraaortic balloon counterpulsation. Severe heart failure features secondary to fulminant toxic myocarditis persisted even after full neurological recovery requiring prolonged standard medical heart failure therapy. Patient subsequently achieved full clinical recovery and regained normal left ventricular systolic function. We also reviewed the literature on cardiac manifestations, possible mechanisms and treatment of patients with cardiotoxicity due to elapid snake bites. The importance of anticipating severe cardiovascular complications is highlighted to help formulate appropriate therapeutic strategy.

Indian common krait envenomation presenting as fulminant myocarditis and coma: a case report

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