Insulin Initiation with Insulin Degludec/Insulin Aspart versus Insulin Glargine in Oral Antidiabetic Drugs Failure Patients with Type 2 Diabetes Mellitus: A Real-World Study from India

Context: Oral antidiabetic drug (OAD) failure is an indication for starting insulin therapy, but there is still a dilemma as to whether basal insulin or a premixed/co-formulation analog should be the choice. Aim: To compare the safety and efficacy of once daily (OD) insulin degludec/insulin aspart (IDegAsp) to OD insulin glargine (IGlar U100) in insulin-naïve Indian subjects with type 2 diabetes mellitus (T2DM), inadequately controlled with OADs alone. Setting and design: Retrospective study. Methods and material: Data was retrieved from the author’s clinic database of OAD failure patients (18-80 years), who were started either with (IGlar U100, n = 120) or IDegAsp (n = 89) OD over and above the standard of care. Data of fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and glycated hemoglobin (HbA1c) from baseline and at last follow-up visits were collected. Statistical analysis used: Baseline characteristics and change in study parameters during the follow-up period were computed between two groups (IGlar U100 vs. IDegAsp) by unpaired t-test and paired t-test, respectively. ANCOVA test was used to compute percentage reduction in body weight, body mass index (BMI), FPG, PPG and HbA1c in between two groups (IGlar U100 vs. IDegAsp). Results: IDegAsp caused a significantly greater reduction in FPG, PPG and HbA1c as compared to the IGlar U100 arm. There was no significant difference in the proportion of patients with hypoglycemia between IDegAsp and IGlar U100 groups (p = 0.208). No episodes of severe hypoglycemia were reported. Conclusion: Comparison of IDegAsp and IGlar U100 OD in T2DM patients indicated that both were relatively safe but the former controlled FPG and PPG levels more effectively

Quinary Prevention and Lower Segment Cesarean Section

Lower segment cesarean section (LSCS) is a safe mode of delivery and has definite indications. However, at times, patients do not accept the advice to undergo elective or emergency LSCS, as appropriate. This leads to avoidable complications and cost. This communication discusses the style and salient features of counseling patients to understand and accept LSCS, as part of informed consent-taking. This discussion is geared towards obstetric care providers who encounter LSCS hesitancy in spite of having explained the indication(s) for surgery

Principles of Ethics in Medical Research

Principles of Ethics in Medical Researc

Effect of Alcohol on Clinical Outcomes and Its Relationship with Semen Parameters

Background: The incidence of infertility is 10-15% globally and this has risen in recent years. Alcohol has been consumed in India for centuries, both in rural and urban areas, with prevalence rates ranging from 20% to 38% in males, according to various reports. Studies in northern India found the 1 year prevalence of alcohol use to be between 25% and 40%. In southern India, the prevalence of current alcohol use varies between 33% and 50%, with a higher prevalence among the lesser educated and the poor. Aim: To determine the effect of alcohol on seminal parameters. Design: Retrospective study. Setting: Morpheus Lucknow Fertility Center, Lucknow, Uttar Pradesh. Time duration: From January 2017 to December 2020. Sample size: Total 130 patients consisting of 57 patients as nonalcoholic control and 73 patients as alcoholic. Main outcome measure(s): The outcome of interest was seminal parameters, including count, motility, volume and morphology. Method: The study included two subject groups, controls and alcoholics. Subjects in the control group were volunteers who were free from any disease and who had never consumed alcoholic drinks and who had never smoked. Subjects in the alcoholic group were nonsmokers who had consumed a minimum of 180 mL of alcohol (brandy and whisky, both 40-50% alcohol content) per day for a minimum of 5 days per week in the past year. Semen samples were collected after at least 48 hours but no more than 7 days of sexual abstinence. Semen parameters - volume, count, motility and morphology - were analyzed. Results: In the alcoholic group, volume (p < 0.005), count (p < 0.005), percentage of rapid progressively motile sperm (p < 0.005), were statistically significantly decreased, while percentage of nonprogressive sperm and percentage of immotile sperm (p < 0.005) were statistically significantly increased, compared with the control group. The percentages of slow progressively motile sperm and morphology were not statistically significant. Conclusions: The present study found statistically significant results that chronic alcoholism suppresses semen quality, at the seminiferous tubular level. Alcohol decreases semen volume, total sperm concentration, motility of sperm and viability of sperm. This study has proved beyond doubt that chronic alcohol consumption has a detrimental effect on the quality of semen, which in turn, may have effect on their reproductive outcomes

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Safeguarding Our Adolescents from Inappropriate Use of Smart Gadgets: Hacks and Heuristics

Adolescents (children aged 11-19 years) are at the greatest peril when it comes to use of smart gadgets. These gadgets are essential for literacy and development, but also have the potential to cause addiction and other unwanted effects. Finding the right balance is the key. Thus, there is a considerable need to devise, enlist and convey to parents, various hacks and heuristics that can be used by them to optimize the use of smart gadgets by their teenager children. This communication should prove helpful for all health care professionals who are directly or indirectly involved in adolescent health care

Democracy in Diabetes Care: Acting Upon the Three A’s – Accessibility, Affordability and Awareness

Diabetes care is the right of every individual living with diabetes. In this communication, we describe the epidemiology of diabetes in India, draw parallels between democracy and diabetes, and call for the democratization of diabetes care. We highlight the three A’s – Accessibility, Affordability and Awareness—that are essential for democratic diabetes care and share best practices towards this end

Status of Urinalysis in Nigeria: Way Forward

Urinalysis serves as a diagnostic procedure employed to assess the condition of a patient\u27s urinary system, encompassingthe examination of physical, chemical and microscopic attributes within a urine sample. In Nigeria, urinalysis stands asa frequently utilized diagnostic modality, widely accessible within health care facilities and is generally cost-effective.Nevertheless, despite its widespread availability, certain obstacles persist that hinder its effective utilization. Through thisreview, we aim to emphasize the significance of urinalysis in the diagnosis of kidney diseases within low-income nations,while also addressing the impediments that hinder its proper application. We also propose a range of requisite measuresfor enhancement

A Study of Erectile Dysfunction in Male Diabetes Patients and its Correlation with Platelet-Lymphocyte Ratio

Introduction: Erectile dysfunction (ED) constitutes a large burden on society given its high prevalence and impact on quality of life. Diabetes is a common cause of organic ED. Prevalence of ED in diabetes ranges from 35% to 85% depending on the study, versus 26% in general population. Platelet-lymphocyte ratio (PLR) has been detected as an important marker for inflammation. Some studies have identified its role in ED but more research is needed. Material and methods: It was a hospital-based prospective observational study. According to International Index of Erectile Function (IIEF)-5 questionnaire, patients were divided into 4 categories: mild ED with score 17 to 21, mild-to-moderate ED with score 12 to 16, moderate ED with score 8 to 11 and severe ED with score 1 to 7. Presence of ED and its severity was correlated with age, residence, duration of diabetes, glycemic status, lipid profile, PLR, complications, body mass index (BMI), etc. Results: Prevalence of ED in male diabetes patients was found to be 72.4%. Among 110 cases with ED, 8 had mild ED (7.2%), 27 had mild-to-moderate (24.5%), 27 had moderate ED (24.5%) and 48 had severe ED (43.6%). Prevalence of ED was found to be proportional to age. Majority of cases in ED group were those with long-standing diabetes. Correlation of ED with complication of diabetes, like nephropathy and retinopathy, was significant, whereas it was not significant with neuropathy. Significant correlation of ED was found with BMI and PLR. Conclusion: ED prevalence was high among the diabetes patients and it increased with age and duration of the disease. Presence of diabetic complications was significantly associated with ED. BMI was significantly associated with development of ED. PLR was significantly higher in ED group and closely related to severity of ED