A prospective study of complications in newly diagnosed type 2 diabetes mellitus patients of lower socioeconomic group with special reference to microvascular complication and metabolic syndrome

Background: All these metabolic derangements exist for many years in the asymptomatic phase of type 2 diabetes and they predispose to development of complications even before clinical diagnosis. Metabolic syndrome is considered to be a precursor of type 2 diabetes. Present study is primarily aimed to study the prevalence of micro vascular complications and metabolic syndrome in newly diagnosed type 2 diabetes mellitus patients of low socio-economic group.Methods: This is a cross sectional prospective study conducted in the dept. of general medicine Konaseema institute of medical science Amalapuram, Andhra Pradesh, India from November 2016 to October 2018. Based on exclusion and inclusion criteria 103 patients were enrolled for this study. Various parameters like age, sex, body mass index, waist circumference, lipid profile, systolic and diastolic blood pressure, neuropathy, nephropathy and retinopathy was measured.Results: The mean age of the patient was 48±10.0 years. Fasting and 2 hours OGTT was 174.6±46.8 mg/dl and 255.6±75.6 mg/dl. The mean of total cholesterol was 204.7±41.9 (mg/dl), Triglycerides was 218±83.4 (mg/dl) and HDL was 44±5.3 (mg/dl). Symptomatic neuropathy constituted 35.6% in 51-60 age group and 27.1% in 31-40 and 41-50 age groups. Objective neuropathy constituted highest (36.6%) in 51-60 age group. Retinopathy constituted highest (60%) in 51-60 age group and nephropathy constituted 26.3 % in 21-30 and 51-60 age groups.Conclusions: Prevalence of microvascular complications in newly diagnosed diabetics of low socioeconomic group were as follows: symptomatic neuropathy-57.3%, objective neuropathy-39.8%, retinopathy-4.9%, nephropathy-18.4%. These were similar to published studies from general population from the same geographical area

EFFECTIVENESS OF PHYSICAL THERAPY SERVICES THROUGH TELEMEDICINE DURING THE COVID-19 PANDEMIC: SYSTEMATIC REVIEW

The Covid-19 pandemic has greatly impacted physical therapy services. In the context of the physical distancing strategy, physical therapy services at health care centers are very limited. Telemedicine or telerehabilitation offers a solution that is expected to be realized by physical therapy services so that it can be accessed by patients with impaired function and movement from home and can reduce the risk of the getting Covid-19 virus infection during this pandemic. This study aims to systematically review the effectiveness of physical therapy services through telemedicine or telerehabilitation during Covid-19 pandemic. The method used is a systematic review done by searching for articles from Science Direct, Scopus, and Proquest with the keywords "Effective AND Physical Therapy AND Telemedicine OR Telerehabilitation AND Coronavirus". The inclusion criteria are articles published from April 2020 to April 2021, full-text articles, and in English. Research subjects are physical therapy patients who use telemedicine or telerehabilitation. The exclusion criteria were articles that had topics outside of physical therapy services through telemedicine or telerehabilitation during the Covid-19 pandemic. The literature search yielded 30 potential articles and 8 of them met the eligibility criteria. All selected studies show that physical therapy services through telemedicine or telerehabilitation have a good result on the recovery process of movement and body function of patients with cardiorespiratory, musculoskeletal, and neuromuscular disorders during the Covid-19 pandemic. This method of remote health care delivery allows patients to carry out an exercise program at home and reduces their risk of getting Covid-19 virus infection.Â

Altered joint moment strategy during stair walking in diabetes patients with and without peripheral neuropathy

© 2016 The Authors. Aim: To investigate lower limb biomechanical strategy during stair walking in patients with diabetes and patients with diabetic peripheral neuropathy, a population known to exhibit lower limb muscular weakness. Methods: The peak lower limb joint moments of twenty-two patients with diabetic peripheral neuropathy and thirty-nine patients with diabetes and no neuropathy were compared during ascent and descent of a staircase to thirty-two healthy controls. Fifty-nine of the ninety-four participants also performed assessment of their maximum isokinetic ankle and knee joint moment (muscle strength) to assess the level of peak joint moments during the stair task relative to their maximal joint moment-generating capabilities (operating strengths). Results: Both patient groups ascended and descended stairs slower than controls (p < 0.05). Peak joint moments in patients with diabetic peripheral neuropathy were lower (p < 0.05) at the ankle and knee during stair ascent, and knee only during stair descent compared to controls. Ankle and knee muscle strength values were lower (p < 0.05) in patients with diabetic peripheral neuropathy compared to controls, and lower at knee only in patients without neuropathy. Operating strengths were higher (p < 0.05) at the ankle and knee in patients with neuropathy during stair descent compared to the controls, but not during stair ascent. Conclusion: Patients with diabetic peripheral neuropathy walk slower to alter gait strategy during stair walking and account for lower-limb muscular weakness, but still exhibit heightened operating strengths during stair descent, which may impact upon fatigue and the ability to recover a safe stance following postural instability

Evaluation of the Effect of Duration of Diabetes Mellitus on Peripheral Neuropathy Using the United Kingdom Screening Test Scoring System, Bio-thesiometry and Aesthesiometry

Background: and Objectives: Risk factors predisposing to foot ulceration in diabetic subjects are multiple. Long duration of diabetes mellitus is a major risk factor, likewise peripheral neuropathy (PN), which globally, is recognized as the commonest risk factor for foot disease in diabetic subjects. Objectives: To evaluate the effect of duration of diabetes mellitus on peripheral neuropathy using the United Kingdom Screening Test (UKST) Scoring System, Bio-thesiometry and Aesthesiometry, in Nigerian diabetic subjects without current or previous foot ulceration. Subjects and methods: One hundred and twenty (120) diabetes mellitus (DM) subjects with and without symptoms of peripheral neuropathy receiving care at the medical outpatient department (MOPD) and the diabetic clinic of the Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria, were recruited consecutively as they presented. Data collected included subjects age (years), gender, age at first diagnosis of DM, duration of DM (years) and baseline fasting venous plasma glucose. The United Kingdom Screening Test (UKST) symptom score was used to separate the participants into two groups those with symptoms of PN and those without and the subjects further assessed by three methods the UKST Signs score, Bio-thesiometry and Aesthesiometry to determine the presence of PN. Results: Among the 120 diabetic participants, 83(69.2%) had neuropathic symptoms (the symptomatic participants) while 37(30.8%) were asymptomatic (the asymptomatic participants). The different methods of diagnosing PN increasingly detected PN with increasing duration of diabetes. For the symptomatic group, the UKST method detected PN least in those with duration of DM 15 years while for the asymptomatic group, it detected PN in 25.0% of those with duration of DM 15 years. For the symptomatic group, Aesthesiometry detected PN in 65.2% of those with duration of DM 15 years. For the asymptomatic group, it  detected PN in 29.2% of those with duration of DM 15 years. Likewise, for the symptomatic group, Bio-thesiometry detected PN in 47.8% of those with duration of DM 15 years. For the asymptomatic group, it detected PN in 16.7% of those with duration of DM 15 years.Conclusion: Long duration of diabetes mellitus and peripheral neuropathy are risk factors for foot complication in Nigerians with diabetes mellitus. Diabetic subjects with long duration of diabetes (>10 years) almost always have associated peripheral neuropathy, and should be recognized as a special group at high risk for foot disease from DM. Specific preventive programs should target this group to reduce the rate of avoidable loss of limbs to diabetes.Key Words: Diabetic foot ulceration, peripheral neuropathy, United Kingdom Screening Test, Aesthesiometry, Biothesiometry

Bronchopulmonary dysplasia: clinical aspects and preventive and therapeutic strategies

Abstract Background Bronchopulmonary dysplasia (BPD) is the result of a complex process in which several prenatal and/or postnatal factors interfere with lower respiratory tract development, leading to a severe, lifelong disease. In this review, what is presently known regarding BPD pathogenesis, its impact on long-term pulmonary morbidity and mortality and the available preventive and therapeutic strategies are discussed. Main body Bronchopulmonary dysplasia is associated with persistent lung impairment later in life, significantly impacting health services because subjects with BPD have, in most cases, frequent respiratory diseases and reductions in quality of life and life expectancy. Prematurity per se is associated with an increased risk of long-term lung problems. However, in children with BPD, impairment of pulmonary structures and function is even greater, although the characterization of long-term outcomes of BPD is difficult because the adults presently available to study have received outdated treatment. Prenatal and postnatal preventive measures are extremely important to reduce the risk of BPD. Conclusion Bronchopulmonary dysplasia is a respiratory condition that presently occurs in preterm neonates and can lead to chronic respiratory problems. Although knowledge about BPD pathogenesis has significantly increased in recent years, not all of the mechanisms that lead to lung damage are completely understood, which explains why therapeutic approaches that are theoretically effective have been only partly satisfactory or useless and, in some cases, potentially negative. However, prevention of prematurity, systematic use of nonaggressive ventilator measures, avoiding supraphysiologic oxygen exposure and administration of surfactant, caffeine and vitamin A can significantly reduce the risk of BPD development. Cell therapy is the most fascinating new measure to address the lung damage due to BPD. It is desirable that ongoing studies yield positive results to definitively solve a major clinical, social and economic problem

A Prospective Analysis Of Perioperative Pain Following VPT on Permanent Teeth With Mature Apices

Vital pulp therapy (VPT) remains a treatment option for cariously exposed teeth that reach the dental pulp. To our knowledge no study has examined whether perioperative pain predicts the outcome of VPT. The aim of this study is to examine the between perioperative pain and the progression of pulpal disease into a more inflamed or necrotic state. Direct pulp caps or partial pulpotomies using MTA were performed on permanent teeth with carious pulpal exposures. Patients were contacted at 24 hours, one week and three months following treatment and data was collected on pain experienced and analgesic intake using a standardized questionnaire. At six and 12 months after treatment an in-person clinical exam was performed on each subject which included standard vitality tests along with exposure of a periapical radiograph. Success was defined as an asymptomatic, functional tooth that does not present with any clinical or radiographic pathology and has not had previous root canal treatment. Statistical analysis was performed using logistic regression. Results from this study support a correlation between perioperative pain at 3 months and the outcome of VPT.Master of Scienc

Microvascular Complications and Metabolic Syndrome in Newly Diagnosed Type 2 Diabetics of Low Socio-Economic Group

CONCLUSION: Prevalence of microvascular complications in newly diagnosed diabetics of low socioeconomic group were as follows: symptomatic neuropathy – 57.3%, objective neuropathy – 39.8%, retinopathy – 4.9%, nephropathy – 18.4%. These were similar to published studies from general population from the same geographical area. • Prevalence of metabolic syndrome (76.6%) and measures of obesity in newly diagnosed diabetics in an unexpected manner had a similar trend in low socioeconomic group when compared to data from various studies among general population. • Significant association (P < 0.01) was noted between metabolic syndrome and sex with an increasing trend in females. Similarly association (P < 0.05) was found between metabolic syndrome and diastolic blood pressure, HDL and BMI. • Majority of females of low socioeconomic group had high BMI (89%), and had high prevalence of metabolic syndrome (87.3%) when compared to males of the same class. Significant association (P < 0.01) was found between sex and lifestyle with majority of females leading a sedentary lifestyle. 65 • High prevalence of family history (55.3%) indicates that genetic component could play a major role in the pathogenesis of diabetes in low socioeconomic group diabetics. • Average generation gap for onset of diabetes based on clinical diagnosis was 16 years in low socioeconomic group. • Only 23.6% of subjects presented themselves for screening and 76.7% of diabetics were detected by chance during health visits to doctor for some other disease. SUMMARY: Microvascular complications and metabolic syndrome are well known facts related to type 2 diabetes. However there is paucity of data regarding the disease characteristics in low socioeconomic group. This is the reason for designing a cross sectional study of this type. Aims and objectives were to find the prevalence of microvascular complications and metabolic syndrome in newly diagnosed type 2 diabetics of low socioeconomic group. Another objective of this study was to find out the generation gap of onset of diabetes in low socio economic group. The data was collected from a sample of 103 newly diagnosed diabetic subjects belonging to low socioeconomic group. The data was analyzed statistically. The results of the study revealed a prevalence of symptomatic neuropathy (57.3%), objective neuropathy (39.8%), retinopathy (4.9%), nephropathy (18.4%) and metabolic syndrome (76.6%). Sex, diastolic blood pressure, HDL and lifestyle were important risk factors associated with metabolic syndrome in this study. One would expect a higher prevalence of microvascular complications in low socioeconomic group, because of the tendency to seek the health facility after a delayed period. This is due to lack of awareness about symptoms of diabetes and its complications and low educational level. Also another expectation is lower prevalence of metabolic syndrome in low socioeconomic group since they consume less calorie rich diet and involve in labour intense jobs. However, contrary to these expectations the prevalence of microvascular complications was similar in trend with the studies from general population in the same geographical area. Also the prevalence of metabolic syndrome was similar to the trend observed from studies in general population in India. Hence low socioeconomic group people are not different from general population as far as microvascular complications or metabolic syndrome is concerned. They should be subjected to screening for microvascular complications at the time of diagnosis itself. Low socioeconomic group females were at more risk of diabetes and cardiovascular disease because of metabolic syndrome, obesity risk factors, and sedentary lifestyle when compared to males. Future health policies of the government targeting low socioeconomic group population should focus more on creating awareness, not only about diabetes and its complications but also about promoting active lifestyle. Since the onset of diabetes was one to two decades earlier in subsequent generations in this study and majority of the study subjects were diagnosed by chance during health visits for other diseases, focus should be more on detecting cases earlier by targeted screening and initiating appropriate prevention strategies

Väga väikese gestatsioonivanusega enneaegsed lapsed Eestis: ravitulem ja prognostilised tegurid

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Meditsiini arenguga on suurenenud VVGV (sünd <32. täisrasedusnädalat) vastsündinute elulemus, kuid lapsed on ohustatud erinevatest arenguhäiretest. VVGV laste tervisetulemit 2 aasta vanuses peetakse perinataalabi kvaliteedi oluliseks indikaatoriks. Uurimistöö eesmärkideks oli kirjeldada VVGV laste ravitulemit ja ägedat respiratoorset haigestumist Eestis, leida ebasoodsa tulemi riskitegurid ning hinnata riigi peri- ja neonataalabi kvaliteeti. Rahvastikupõhine edasivaatav kohortuuring hõlmas aastatel 2007-2008 sündinud 360 VVGV last. Perinataalsed andmed saadi neonataalsest uuringuregistrist. Varast tulemit esmase haiglaravi lõpul võrreldi 264 VVGV lapse võrdluskohordiga aastatest 2002-2003. Hilist tulemit enneaegsusele korrigeeritud 2 aasta vanuses hinnati 2007. aastal sündinud 155-l VVGV lapsel ja võrreldi ajalisena sündinud laste tulemiga. Järelkontrollil hinnati laste somaatilist, neurosensoorset ja arengulist tulemit. Äge respiratoorne haigestumus selgitati vanemate küsitluse teel. Uuringuperioodidel suurenes oluliselt VVGV laste elulemus (78 vs 85%), kusjuures perinataalabi oli hilisemal perioodil proaktiivsem ja neonataalne ravi vähem invasiivne. Elulemuse paranemisega püsis neonataalsete haigustega elulejate osakaal muutumatuna, kuid võrreldes kõrge sissetulekuga riikidega suhteliselt suurena. Järelkontrollil esines mõõdukas/raske arenguhäire 12%-l VVGV lastest: tserebraalparalüüs 8%-l, kognitiivse arengu mahajäämus 5%-l ja kõne arengu mahajäämus 10%-l. Kognitiivse, kõne ja motoorse arengu keskmine koondskoor Bayley testil oli VVGV lastel 0,5 SD võrra madalam kui ajalisena sündinutel. Samuti olid oluliselt väiksemad VVGV laste keskmine kaal, pikkus ja peaümbermõõt ning ägeda respiratoorse haigestumise korral esines neil oluliselt enam vilistavat hingamist ning haiglaravi vajadust. Ebasoodsa tervisetulemi peamiseks riskiteguriks oli hiliseid puudeid ennustavate neonataalsete haiguste põdemine esmasel haiglaravil. VVGV laste elulemus Eestis on võrdväärne arenenud meditsiiniabiga riikidega, kuid laste varane haigestumus ja tervisehäirete esinemine 2 aasta vanuses jääb osaliselt suuremaks. Tervishoiu peamiseks väljakutseks on vähendada VVGV enneaegsete neonataalset haigestumist, säilitades suure elulejate osakaalu.Advances in perinatal care have improved the survival of VLGA (born <32 weeks' gestation) infants dramatically, but these infants remain at substantial risk for a wide spectrum of long-term morbidities. Therefore, it is mandatory that any assessment of quality of care for VLGA infants includes the long-term outcome. The aims of the studies were to describe outcome and acute respiratory morbidity of VLGA infants in Estonia, to identify risk factors for adverse outcome, and to benchmark the quality of perinatal services in the country. A nationwide prospective cohort study comprised 360 live-born VLGA infants born in Estonia in 2007–2008. Perinatal data were collected to the neonatal research register. A historical cohort of 264 VLGA infants born in 2002–2003 was selected for analysis of changes in the short-term outcome. A sub-cohort of 155 surviving VLGA infants born in 2007 was compared with a matched full-term control group at 2 years of corrected age. The infants underwent physical, neurological, and developmental assessment. Acute respiratory morbidity was identified by parental interviews. The survival until discharge increased significantly (78% in 2002-2003 vs 85% in 2007-2008) with proactive perinatal management and less invasive neonatal care and without concomitant increases in neonatal morbidity. However, the morbidity rates were higher when compared with comparable data from high income countries. At follow-up, neurodevelopmental impairment was noted in 12% of VLGA infants, with 8% affected by cerebral palsy, 5% with cognitive delay, and 10% with language delay. The mean Cognitive, Language, and Motor Composite Scores assessed using the Bayley-III scales were in VLGA group in excess of 0.5 SD lower than in full-term infants. Wheezing during respiratory infections and somatic growth failure were significant problems among VLGA infants. Major neonatal morbidities, predictive of poor long-term outcome, were the main risk factors for adverse outcomes. The results showed that for VLGA infants in Estonia, the survival is comparable and the rates of early morbidities and impairments at 2 years are partly higher when compared to similar studies from high income countries. The challenge for perinatal services in Estonia is to reduce neonatal morbidity of VLGA infants without compromising their survival

Characteristics of Chemotherapy-induced Neuropathy: Clinical Studies on Cisplatin and Docetaxel

Peripheral neurotoxicity is an important side-effect of several chemotherapeutic agents. These agents may cause a usually axonal neuropathy, which may ultimately lead to severe and disabling symptoms and signs. Besides describing in this review the pathogenesis, the clinical presentation, the neurophysiological findings and the nerve biopsies, we also recount the relation between cumulative dosage/dosage per cycle and neuropathy for the cytostatic drugs for which neurotoxicity is an important side-effect: cisplatin, vincristine, paclitaxel, docetaxel and suramin. With the development of strategies to circumvent toxicities of other organs and \\vith the use of combinations of neurotoxic agents such as cisplatinlpaclitaxel, neurotoxicity is an important and dose limiting side-effect of many treatment regimens. Detailed knowledge of the neurologic side-effects of these drugs is essential for the management of their neurotoxicity. The review concludes with a short discussion of neuro-protective agents. Although several nerve growth factors, gluthation and ethiofos hold promise as possible neuroprotective factors, the clinical data on these drugs are still limited. New trials are needed to confirm the value of these drugs. If neurotoxicity can indeed be prevented or delayed, this may lead to more effective treatment regimens