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  Citation statistics : Table of Contents
   2020| January-April  | Volume 11 | Issue 1  
    Online since December 18, 2019

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Thiamine-responsive megaloblastic anemia syndrome: A case report
Omkar Patil, Karnam Guruswamy Ravikumar, Sundaramoorthy Gopi, Thulasi Raman, Venkatesan Radha, Viswanathan Mohan
January-April 2020, 11(1):45-48
Thiamine-responsive megaloblastic anemia (TRMA) syndrome is a rare autosomal recessive disorder characterized by a cardinal triad consisting of megaloblastic anemia, sensorineural deafness, and diabetes mellitus. TRMA is caused by mutations in the gene SLC19A2 encoding a high-affinity thiamine transporter, which disturbs the active thiamine uptake into cells. We report here on a 1-year and 9-month-old female baby with megaloblastic anemia, thrombocytopenia, and diabetes mellitus. Our patient had significant sensorineural hearing loss that was late to appear. Diagnosis was based on clinical features and dramatic response of anemia, thrombocytopenia, and glycemic control to thiamine therapy. In view of the clinical history of the patient, targeted gene sequencing of genes causing monogenic diabetes was performed. The genes selected comprised 40 gene loci and were sequenced by Illumina sequencing platform. We found a novel homozygous deletion mutation of complete exon 2 of the SLC19A2 gene (ENST00000236137), which we believe has not been described to be associated with TRMA. Exon 2 of SLC19A2 gene includes amino acid from 69 to 269. Thiamine resulted in rapid normalization of the hemoglobin level with improvement in glycemic control. TRMA syndrome should be kept in mind in the differential diagnosis of megaloblastic anemia, deafness, and diabetes mellitus. Early introduction of high-dose thiamine can reverse anemia and allow more glycemic control for diabetes. We conclude that genetic analysis confirms the diagnosis of TRMA. As exogenous thiamine is shown to reverse some of the clinical features of the disease, a genetic diagnosis of TRMA syndrome is extremely important.
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Foot practices in patients with type 2 diabetes: Where do we stand?
Tehseen Fatima, Zahid Miyan, Nadeem Naeem, Musarrat Riaz, Abdul Basit
January-April 2020, 11(1):8-12
Background: Diabetic foot ulcer is a major cause of morbidity, mortality, hospitalisation, poor quality of life and socio-economic burden in diabetic patients. Educating patients about foot care and improving foot care practices can help in the prevention of foot ulcer and thus reduce the rate of lower extremity amputations. Objective: The aim of this study is to evaluate the knowledge and practices regarding foot care in diabetic patients presenting with foot ulcers in a tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at a specialised foot clinic of Baqai Institute of Diabetology and Endocrinology, a tertiary care hospital of Karachi, Pakistan. All patients with type 2 diabetes presenting with a history of foot ulcers were included in the study after taking informed consent. Only those patients with either already diagnosed diabetes mellitus or diagnosed in the clinic according to the American Diabetes Association diagnostic criteria were included in the study. Information regarding history, physical examination, Hba1c levels were collected in all patients through hospital HMS software. Ankle-brachial index and vibration perception threshold were done as part of foot examination in every patient. X-ray and tissue culture/sensitivity were done where indicated. The Nottingham assessment of functional foot care revised 2015 questionnaire was used to evaluate patients’ foot care knowledge and practices before presenting to our institute. The interview was conducted by a trained healthcare professional on one-to-one basis. Patients who scored >70% had good knowledge and practices of foot care, those between 50% and 70% had average and those who scored <50% had poor knowledge and practices of foot care. Results: A total of 358 patients were included in the study. Out of which 243 were male and 115 were female. The average age was 54.43 ± 11.4 years, and the mean duration of diabetes was 13.35 ± 8.30 years, and the mean HbA1c was 9.60 ± 2.30. All the patients included were of type 2 diabetes mellitus. Out of the total respondents, 153 (43.2%) respondents had never received any foot care education from any healthcare professional prior to the development of ulcer and presenting to this institute, ten (0.8%) had received some information of foot care from print or electronic media or through family and friends, whereas 191 (54%) received foot care education formally by a health care professional. Only 148 (41.6%) got their feet examined by some healthcare professional before developing foot ulcer, while 196 (55.1%) never got their feet examined before presenting to this institute. Overall, 7% of the study participants had good foot care knowledge and practices, 55.3% had average and 37.7% had poor foot care knowledge and practices. Conclusion: Knowledge and practices of foot care were found to be unsatisfactory in most of the patients. This is of utmost importance to introduce foot care education programs at primary as well as tertiary care level with regular periodic physician reinforcement to reduce the incidence of diabetic foot ulceration and amputations.
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Erectile dysfunction in diabetes mellitus: A review
Deepak K Jumani, Omkar Patil
January-April 2020, 11(1):1-7
The International Diabetes Federation estimates that globally there are 425 million people with diabetes. Estimates of the prevalence of erectile dysfunction (ED) in men with diabetes range from 20% to 85% in different studies. Among men with ED, those with diabetes are likely to experience the problem 10–15 years earlier than men without diabetes. This review aims to provide an update of the epidemiology, pathophysiology and management of ED in diabetes patients in India. The proposed mechanisms of ED in diabetic patients include elevated advanced glycation end-products and increased levels of oxygen-free radicals, impaired nitric oxide (NO) synthesis, increased endothelin B receptor binding sites and ultrastructural changes, upregulated RhoA/Rho-kinase pathway, NO-dependent selective nitrergic nerve degeneration and impaired cyclic guanosine monophosphate-dependent kinase-1. Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome and excessive alcohol consumption. Therefore, the promotion of healthful lifestyles would yield great benefits in reducing the burden of ED. The treatment of diabetic ED is multimodal. The treatment of the underlying hyperglycaemia and comorbidities is of utmost importance to prevent the progression of the disease. The peripherally acting oral phosphodiesterase type 5 inhibitors are the mainstay of oral medical treatment of ED in diabetics. Vacuum erection devices are an additional a non-invasive treatment option. The local administration of vasoactive medication through urethral suppository or intracorporal injection can be effective with minimal side-effects.
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Dietary fatty-acid profile of south Indian adults and its association with type 2 diabetes––CURES 151
Nagarajan Lakshmipriya, Rajagopal Gayathri, Shobana Shanmugam, Ramprasad Srinivasan, Kamala Krishnaswamy, Raman G Jeevan, Ranjit Unnikrishnan, Ranjit Mohan Anjana, Vasudevan Sudha, Viswanathan Mohan
January-April 2020, 11(1):13-24
Background: Both the quantity and the quality of fat are major determinants of chronic diseases risk. This paper looks at the fatty-acid composition of Indian foods reported in the diets of urban Asian Indians and its association with type 2 diabetes. Materials and Methods: Adults aged 20–80 years (n = 1688) were selected from the Chennai Urban Epidemiological Study. The dietary intake of the study subjects was assessed using a validated food frequency questionnaire. The fatty-acid profile of common foods reported by the population was measured from pooled food samples and substituted in nutrient database for calculation of daily foods, nutrient, and fatty-acid intake. Statistical analysis was performed using Statistical Package for the Social Sciences software. Results: Of the foods tested potato chips and Indian sweet mysorepak had the highest amount of fat 46.7g and 42.2g/100g, respectively, whereas the Indian sweet sweet pongal had the lowest fat of 3.9g/100g. Palmitic acid in saturated fatty acid (SFA), oleic acid in monounsaturated fatty acid (MUFA), and linoleic among poly unsaturated fatty acids (PUFA) were commonly reported fatty acids in most foods. Dietary fats provided almost 1/4th of the daily caloric intake of the subjects. Compared to national recommendations, the intake of MUFA and α linolenic acid was very low. Higher intake (>median) of calories (%E) from SFA (P = 0.007) and PUFA (P = 0.008) were associated with an increased risk of type 2 diabetes, whereas MUFA (P = 0.017) showed an inverse association. Conclusion: Improvement of the dietary fat profile in our population can be achieved by formulating and propagating guidelines on the selection and appropriate use of cooking oils, and increased consumption of nuts and oilseeds.
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Prevalence and risk factors for impaired glucose regulation among first-degree relatives of patients with type 2 diabetes mellitus in Maiduguri, Northeastern Nigeria
Haliru Ibrahim, Fabian H Puepet, Salisu B Muazu, Bilkisu M Mubi, Ibrahim D Gezawa, Shettima K Mustapha, Bukar Bakki, Abdullahi M Talle, Godspower C Michael, Ibrahim Aliyu
January-April 2020, 11(1):25-31
Background/Purpose: Owing to genetic predilection of type 2 diabetes mellitus (T2DM), the risk of developing impaired glucose metabolism is thought to be higher in first-degree relatives (FDRs) of those with T2DM. The aim of this study was to estimate the prevalence of impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) and its associated risk factors in FDRs of patients with T2DM. Materials and Methods: This is a cross-sectional descriptive study of 320 cases (FDRs of T2DM outpatients) aged ≥25 years (145 males and 175 females) and 160 controls (76 males, 84 females) who were age and sex matched. All subjects underwent anthropometric, physical activity, and laboratory assessments after an overnight fast. Oral glucose tolerance test with 75g anhydrous glucose was administered. Fasting plasma glucose of 6.1–6.9 mmol/L and 2-h post-fasting glucose value of 7.8–11.0 mmol/L were used to define IFG and IGT, respectively. Statistical analysis was carried out using the Statistical Package for the Social Sciences software, version 20 (SPSS, Chicago, Illinois), and P value of <0.05 was considered significant. Results: The mean (standard deviation) age of the cases and controls was 38.4 (12.3) and 38.9 (10.3) years, respectively, P = 0.66. The prevalence rates of both IGT and IFG in cases and controls were (28.1% vs. 18.1%, P = 0.019 and 10.3% vs. 5.6%, P = 0.0001). The prevalence of IGT and IFG was found to be higher among females, P < 0.05. Multivariate analysis revealed abnormal waist circumference, being FDR, and elevated systolic blood pressure as risk factors for both the IGT and IFG, P < 0.05. Conclusion: FDRs of patients with T2DM are at higher risk of IGT or IFG. The risk increases with the development of obesity and elevated blood pressure in them.
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Prevalence of oral lesions in patients with type 2 diabetes in north Kerala population
Jinisha Madathil, Haris Padippurakkakath Salim, Anita Balan, Chandni Radhakrishnan, Nileena Raghavendra Kumar
January-April 2020, 11(1):32-38
Objective: To assess the prevalence of oral lesions in Type 2 Diabetic patients. Methods: The study was conducted in Outpatient Department and Diabetic Clinic of Government Medical College, Kozhikode and Department of Oral Medicine and Radiology, Government Dental College, Kozhikode over a period of 1 year. A total of 800 individuals 400 Type 2 Diabetes Mellitus patients and 400 healthy individuals were enrolled in this study. An oral clinical examination was carried out for all participants using a mouth mirror, visible light source and cotton gauze. Results: Prevalence of oral lesions was significantly high P<0.05 in Type 2 DM patients than the controls in the study sample. In the present study ,the prevalence of oral mucosal lesions was significantly higher in Type 2 Diabetic Patients (38%) than in control subjects (25%) (P=0.000). No significant (P>0.05) association was found between Type 2 Diabetes Mellitus and Potentially malignant oral mucosal lesions and also no association was found between oral lesions and metabolic control of the disease. Conclusion: This study showed that the prevalence of oral lesions was higher in Type 2 diabetic than non - diabetics and provides evidence that diabetes can have a negative influence on oral health.
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Pharmacist’s contribution to medication adherence among patients with type 2 diabetes in endocrinology clinic
Winifred A Ojieabu
January-April 2020, 11(1):39-44
Background: Elderly people are prone to have chronic diseases requiring continuous medications. Adherence is a key factor in managing these patients. Improved adherence to medicines has a positive impact on the reduction of their hospital visits and health-related quality of life. Objective: This study investigated the potential of the pharmacists to improve medication adherence and to optimize treatment outcomes among patients with type 2 diabetes. Materials and Methods: A randomized controlled study comprising patient- and physician-focused intervention was carried out at the endocrinology clinic of Olabisi Onabanjo University Teaching Hospital in Nigeria. At baseline and six months, each group had 75 eligible patients. Patient’s self-reported adherence level to medications was assessed with modified Morisky four-item adherence scale, clinical variables were determined, and the likely reasons for nonadherence and required information were assessed. Outcome measures: Variation in adherence scores, mean clinical variables and improved patients’ knowledge base. Results: No significant differences were observed in adherence scores between control and intervention groups at baseline. High and low adherence scores in both groups were 33.3% versus 36.0% (P = 0.873) and 26.7% versus 25.3% (P = 1.000), respectively. Patients’ response at the end of intervention revealed significant score differences across board between the groups. High and low adherence scores in both groups were 34.7% versus 88.0% (P = 0.001) and 21.3% versus 2.7% (P = 0.002), respectively. Conclusion: The intervention was successful in improving adherence scores, clinical variables, patients’ knowledge base, and indication of pharmacists’ potential to bring about positive outcomes among patients with chronic diseases. There is a need for professional collaboration in disease management for the improved outcomes of patients.
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