Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Anasarca sparing one limb

Upper extremity deep vein thrombosis commonly refers to thrombosis of the axillary and/or subclavian veins. This condition may lead to some serious complications like pulmonary embolism if the diagnosis and treatment are delayed. We introduce here one such case where the diagnosis of this rare condition was difficult because of the atypical clinical manifestation but the chylous ascites provided a valuable clue which led to early diagnosis and treatment of this patient

Anasarca sparing one limb

Upper extremity deep vein thrombosis commonly refers to thrombosis of the axillary and/or subclavian veins. This condition may lead to some serious complications like pulmonary embolism if the diagnosis and treatment are delayed. We introduce here one such case where the diagnosis of this rare condition was difficult because of the atypical clinical manifestation but the chylous ascites provided a valuable clue which led to early diagnosis and treatment of this patient

β cell function and insulin resistance in lean cases with polycystic ovary syndrome

<p>Obesity is a major factor in development of insulin resistance (IR) and metabolic features in polycystic ovary syndrome (PCOS) patients. Nearly two-thirds patients with PCOS (30 of 37 confirmed cases of PCOS) in our previous community based study were lean, in contrast to Caucasians. Metabolic parameters including IR and β cell function have not been characterized well in this group of lean PCOS. To study the metabolic features including IR and β cell function in lean PCOS patients, 53 patients with BMI, <23 kg/m² were compared with 71 obese PCOS and 45 age and body mass index matched controls. Lean patients had similar β cell function and IR as compared to controls and obese patients, though the latter group had more metabolic abnormality. Fasting c-peptide and its ratio to glucose were significantly higher in lean patients compared to controls. In subset of subjects with five point OGTT, disposition index and Matsuda index (MI) showed significant negative correlation with BMI and blood pressure. MI also negatively correlated with waist, WHR, and HOMAB. High fasting C-peptide is probably a class effect as is seen in both lean and obese PCOS.</p

Impact of lockdown on self-care management among patients with type 2 Diabetes Mellitus residing in Lucknow city, India – A cross-sectional study

Objective: To assess the effect of nationwide lockdown and its associated repercussion on the self-care management of Type 2 Diabetes Mellitus (T2D). Methods: Response from 1406 diabetic patients was collected against a 16 item questionnaire. Data was collected on diabetic self-management practices, behavioral aspects, psychological implications, drug availability and awareness towards the pandemic. Emphasis was on choices made by patients in the absence of guidance from physicians and impact of stress and blood sugar levels on other variables. The data was analyzed using Chi-square tests at P < 0.05. Results: About 27% were under stress, 14.7% and 30.8% reported a change in dietary and sleep pattern. About 83% could not consult a doctor and as a result 13% stopped taking medications. Patients with stress slept less, observed a change in dietary patterns and had uncontrolled blood sugar levels (P = 0.0001). On the contrary those without stress spent time with family and were occupied with a hobby (P = 0.0001). Those with controlled blood sugar levels exercised more and had normal sleep patterns. Fluctuation with doses was observed among those with uncontrolled blood sugar levels in the absence of physicians consultation (P = 0.001). Conclusion: Even though majority of study participants were not able to consult their physicians yet nearly 2/3rd were practicing Self-Monitoring of Blood Glucose (SMBG), more than half were exercising regularly, more than 2/3rds continued taking their medications and majority were following appropriate diet pattern. Stress management is a key factor during these times due to its association with other variables

Systemic sclerosis and COVID-19 vaccine safety: short-term insights from the global COVID-19 vaccination in autoimmune disease (COVAD) survey

The safety profile of COVID-19 vaccines is understudied in patients with systemic sclerosis (SSc). We compared short-term adverse events (AEs) 7 days following vaccination in patients with SSc vs other rheumatic (AIRDs), non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HCs). The COVID-19 Vaccination in autoimmune diseases (COVAD) self-reporting e-survey was circulated by a group of > 110 collaborators in 94 countries from March to December 2021. AEs were analyzed between different groups using regression models. Of 10,679 complete respondents [73.8% females, mean age 43 years, 53% Caucasians], 478 had SSc. 83% had completed two vaccine doses, Pfizer-BioNTech (BNT162b2) (51%) was the most common. Minor and major AEs were reported by 81.2% and 3.3% SSc patients, respectively, and did not differ significantly with disease activity or different vaccine types, though with minor symptom differences. Frequencies of AEs were not affected by background immunosuppression, though SSc patients receiving hydroxychloroquine experienced fatigue less commonly (OR 0.4; 95% CI 0.2-0.8). Frequency of AEs and hospitalisations were similar to other AIRDs, nrAIDs, and HC except a higher risk of chills (OR 1.3; 95% CI 1.0-1.7) and fatigue (OR 1.3; 95% CI 1.0-1.6) compared to other AIRDs. COVID-19 vaccines were largely safe and well tolerated in SSc patients in the short term. Background immunosuppression and disease activity did not influence the vaccination-related short-term AEs