Correlation of awareness of the disease with glycaemic control and diabetic complications among patients attending a tertiary care hospital

Introduction. The awareness level among diabetic patients varies across patient population based on many factors such as differences in the literacy of the study population, socioeconomic status, availability of diabetes education. Hence, it is important to study the same in our set-up to plan appropriate preven- tive strategies. The present research work attempted to assess the awareness level about diabetes and its complications among diabetic patients attending a tertiary care teaching hospital.  Materials and methods. This is a hospital based, cross- sectional study, done in diabetic patients attending a tertiary care teaching hospital in South India. The awareness level of the patient was assessed using a pretested questionnaire. The questionnaire had 25 questions (knowledge — 18, attitude — 4 and prac- tice — 3) and each correct answer was given a score of ‘one’ and each wrong answer was given a score of ‘zero’. Patients were assessed clinically for the presence of micro and macrovascular complications and basic investigations were carried out. Metabolic control is assessed by HbA1c level.  Results. A total of 150 patients were included in the study. Approx. 52.6% of patients scored between 14 and 18 (sufficient awareness), 6.6% of patients had satisfactory awareness (KAP score 19–20) and 4% of patients had highly satisfactory awareness (KAP score > 20). Only eight patients had a score less than 10 (highly insufficient awareness) and 31.3% had insufficient awareness (KAP score 10–13). A positive correlation between educational qualification and awareness level was observed (r = 0.495, p < 0.001). Mean awareness score of patients who received diabetes education from physician and dietitian was significantly high when compared to other sources of patient education. Mean awareness scores were lower for those with various diabetic complications. There is a statistically signifi- cant negative correlation observed between awareness and HbA1c values (r = 0.527, p < 0.001).  Conclusion. Majority of the patients had sufficient awareness about the disease and about one-third of the patients had insufficient awareness about diabetes. The awareness level of the patients about the disease had a strong influence on the metabolic control, diabetic complications and also correlated with their educational status.

Association of serum uric acid level with estimated glomerular filtration rate in diabetic patients

Background and Objective: Uric acid may be a novel and important player in the pathogenesis of microvascular complications in diabetes mellitus. The objective of this study was to investigate the association between eGFR and uric acid in patients with type 2 diabetes mellitus. Materials and Methods: A cross-sectional study was done in type 2 diabetic patients of both genders above the age of 18 years. Demographic characteristics collected include age, gender, body weight, height, and duration of diabetes. Laboratory investigations data collected included serum creatinine, blood urea nitrogen, serum uric acid, urine albumin, urine creatinine, urine albumin creatinine ratio, HbA1c, and blood glucose. GFR was calculated using the Modification of Diet in Renal Disease formula (4 variable formula). Results: A total of 63 patients were included in the study. Among them, 35 (55.6%) were males and 28 were females (44.4%). Mean age of the patients was 61.63 ± 10.37 years. Out of 63 patients, 52 had normal uric acid level and 11 patients had elevated uric acid level. eGFR was 81.32 ± 17.53 ml/min in patients with normal uric acid level, whereas it was 61.63 ± 26.18 ml/min in patients with elevated uric acid level. The difference is statistically significant (P = 0.03). Urine albumin creatinine ratio was 12.2 ± 40.92 μg/mg in patients with normal uric acid level and was 47.04 ± 76.58 μg/mg in patients with elevated uric acid level, the difference being statistically significant (P = 0.035). There was a significant negative correlation between uric acid and eGFR (r = -31, P = 0.014), whereas statistically significant correlation was not seen between uric acid level and urine albumin creatinine ratio. Uric acid level was 0.312 ± 0.072 mmol/L in normoalbuminuric patients (55 patients), whereas it was 0.343 ± 0.092 mmol/L in patients with microalbuminuria (8 patients). Conclusion: Serum uric acid is independently and negatively associated with GFR in patients with type 2 diabetes mellitus and thus supporting the concept that uric acid may be involved in the pathogenesis of diabetic nephropathy

Case report - Gitelman's syndrome

Gitelman's syndrome is primarily renal tubular hypokalemic metabolic alkalosis with hypocalciuria and magnesium deficiency, a benign disorder, inherited as autosomal recessive traits

Critical Evaluation of Drug Promotional Literature for Drugs Used in Cardiovascular Diseases

Objective: This study was conducted to critically evaluate the drug promotional literature pertaining to drugs used in cardiovascular disorders using WHO criteria for ethical promotion of drugs. Methods: The brochures were collected from physicians to whom it was circulated by the pharmaceutical representatives. These promotional literatures are tested against WHO criteria for ethical medicinal drug promotion. The claims, which are written on those promotional literatures, were categorized as claims about efficacy, safety, cost and convenience. Pictures, graphs and tables in the promotional literature were analysed based on their relevance, area covered and number. Area covered for providing abbreviated prescribing information or brief prescription information (BPI) is calculated. Results: A total of 309 drug promotional literature pertaining to cardiovascular drugs collected. Analysis of these literature showed that none of the promotional literature fulfilled all the WHO criteria. All the materials mentioned INN and brand name of the product. The criteria presented least were adjuvants, overdosage information and cost of the drug. Majority of the literatures mentioned name and address of the manufacturer. Brief prescribing information was provided only in 13.9% of the literature. Area devoted for BPI was negligible when compared to the total area occupied for displaying colorful pictures, table, graphs etc. Among the pictures displayed in the literature, 37.7% of the pictures found to be totally irrelevant to the drug to be promoted. Among the drugs promoted, 47.1% were fixed dose combinations (FDCs) and the remaining were single drug preparations. Most of the claims were for efficacy claims. These claims in majority of the cases are exaggerated and without scientific basis.Conclusion: None of the promotional literatures fulfilled all the WHO criteria for ethical promotion of drugs.     Â

Carbamzepine-induced toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN), also known as Lyell\u2032s syndrome, is a widespread life-threatening mucocutaneous disease where there is extensive detachment of the skin and mucous membrane. Many factors involved in the etiology of TEN including adverse drug reactions. Here we are reporting a case of toxic epidermal necrolysis in an adult male patient after receiving carbamazepine in a 38 year old male. On the18th day of carbamazepine, patient developed blisters which first appeared on the trunk, chest and arms. The erythematous rash was covering almost all over the body with epidermal detachment of 70% body surface area. There was loss of eye lashes, congestion of conjunctiva with mucopurulent discharge and exposure keratitis. The clinical impression was TEN induced by carbamazepine. Carbamazepine was stopped immediately. He was treated with high dose intravenous betamethasone and systemic and topical antibiotics. After one month, the progression of the skin lesions halted and he was discharged

Korelacja między wiedzą o cukrzycy a kontrolą glikemii i powikłaniami cukrzycy u chorych leczonych w specjalistycznym szpitalu klinicznym

Wstęp. Poziom wiedzy na temat cukrzycy wśród chorych na tę chorobę jest zróżnicowany w zależności od wielu czynników, takich jak poziom wykształcenia, status społeczno-ekonomiczny, dostęp do edukacji diabetologicznej. Ocena tych czynników ma więc istotne znaczenie w opracowaniu skutecznych strategii prewencyjnych. Opisane badanie przeprowadzono w celu oceny wiedzy na temat cukrzycy i jej powikłań wśród pacjentów specjalistycznego ośrodka klinicznego.  Materiał i metody. Było to przekrojowe badanie obejmujące chorych leczonych w szpitalu klinicznym w południowych Indiach. Wiedzę na temat cukrzycy oceniano, stosując zweryfikowany wcześniej kwestionariusz KAP. Składał się on z 25 pytań (18 pytań dotyczących wiedzy o cukrzycy, 4 pytania dotyczące postawy wobec choroby i 3 pytania dotyczące realizowania zasad samoopieki w praktyce). Każde pytanie oceniano jednakowo: za prawidłową odpowiedź przyznawano 1 punkt, za błędną — 0 punktów. U wszystkich chorych przeprowadzono badanie przedmiotowe pod kątem obecności powikłań mikro- i makronaczyniowych oraz podstawowe badania dodatkowe. Kontrolę metabo- liczną oceniano na podstawie wartości HbA1c. Wyniki. Do badania włączono ogółem 150 chorych. Około 52,7% z nich uzyskało w kwestionariuszu KAP 14–18 punktów (dostateczna wiedza o cukrzycy), 6,7% chorych miało dobrą wiedzę na temat choroby (19–20 punktów), a u 4% chorych poziom wiedzy oceniono jako bardzo dobry ( > 20 punktów). Tylko 5,3% chorych uzyskało mniej niż 10 punktów (bardzo słaba wiedza), a 31,3% miało niedo- stateczną wiedzę o chorobie (10–13 punktów). Stwierdzono dodatnią korelację między wykształceniem a wiedzą o cukrzycy (r = 0,495; p < 0,001). Średni wskaźnik wiedzy o cukrzycy był istotnie wyższy w grupie chorych, którym informacje na temat choroby przekazali lekarz lub dietetyczka, niż wśród osób, które korzystały z innych źródeł wiedzy. Osoby, u których występowały różne powikłania cukrzycy, uzyskały w kwestionariuszu mniej punktów. Zaobserwowano istotną statystycznie ujemną korelację między wiedzą o cukrzycy a wartościami HbA1c (r = 0,527; p < 0,001).  Wnioski. Większość chorych cechowała się dostateczną wiedzą na temat swojej choroby, ale u około jednej trzeciej respondentów poziom wiedzy o cukrzycy był niedostateczny. Wiedza pacjentów na temat cukrzycy w znacznym stopniu wpływa na kontrolę metaboliczną oraz występowanie powikłań cukrzycy. Jest ona także skorelowana z poziomem wykształcenia chorych.

Carbamzepine-induced toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a widespread life-threatening mucocutaneous disease where there is extensive detachment of the skin and mucous membrane. Many factors involved in the etiology of TEN including adverse drug reactions. Here we are reporting a case of toxic epidermal necrolysis in an adult male patient after receiving carbamazepine in a 38 year old male. On the 18th day of carbamazepine, patient developed blisters which first appeared on the trunk, chest and arms. The erythematous rash was covering almost all over the body with epidermal detachment of 70% body surface area. There was loss of eye lashes, congestion of conjunctiva with mucopurulent discharge and exposure keratitis. The clinical impression was TEN induced by carbamazepine. Carbamazepine was stopped immediately. He was treated with high dose intravenous betamethasone and systemic and topical antibiotics. After one month, the progression of the skin lesions halted and he was discharged