Manoeuvres for management of diabetes

Type 2 diabetes is the scourge of our times. Globally there are over 425 million diabetics which is projected to rise to 629 million by 2045, suffering devastating consequences resulting in significant morbidity and mortality.1-3Bringing blood sugars down can be challenging. Dietary control, lifestyle modifications and exercise can help but these can be difficult to implement.4 Medically, drugs are the usual method of bringing blood sugar levels under control but they come with their attendant risks and ongoing costs.5 Apart from drugs, the main arsenal against diabetes is exercise but due to one reason or another it is not very popular or practical. In the absence of antidiabetic medications and episodic exercises there seems to be no alternative left. So, when a person is unable to exercise or is not on hypoglycaemic agents, he is rendered defenceless against the deleterious effects of raised blood sugar levels. Regardless, muscles form the frontline defence against diabetes since muscles are the main modifiable factor in utilization of glucose by the body which they can do even in the absence of insulin.6,7 Hence, muscles need to be the first line agents to fight diabetes. However, the muscles need to be activated when the blood sugars are high, that is, within minutes or hours after meals rather than exercising in the morning or evening when the blood sugar may be relatively low. The question is ‘How do we get the muscles to start using up glucose right when it enters the blood stream?’ This is where the manoeuvres described below can help since these can be done almost anytime and anywhere. Following are the proposed manoeuvres:Calf contractions: Alternate contractions of calf muscles of each leg while sitting, giving a good squeeze to the calf muscles. Alternatively, one or both calves can be contracted and held for some time. This manoeuvre can be done even while lying in bed.Pectoral pressure: One or both pectorals can be contracted and held for 30-60 seconds-longer the better. The strength of contractions will depend on one’s motivation and ability. Alternatively, moderate contractions can be maintained for a longer duration.Shoulder squeezes: The back has some of the strongest muscles which can be used to ‘pulverise’ the sugars. In this method the person can sit slightly bent forwards and the shoulders are pulled back and held in that position for 30-60 seconds.These manoeuvres can be done either singly or combined with other manoeuvres described or with dietary modifications, regular exercises or medications for greater efficacy.Of course, like the antidiabetic medications, these manoeuvres need to be titrated, especially when combined with hypoglycaemic agents, otherwise they can lead to hypoglycaemia.8 Even without antidiabetic medication they have the ability to cause hypoglycaemia, if done excessively. Once the muscles get used to these manoeuvres it will be easier for them to use glucose and keep blood sugars down

Perceptions and Practices of Administrators and Teachers in Jesuit Secondary Schools in the Hazaribag Province of India Regarding Ideal Ignatian Educators

The growing number of complex learning contexts and needs of students has challenged the quality of education at all levels. The need to offer the most satisfactory and meaningful education to all students consistently attracts researchers, policymakers, and educators to comprehensively understand what comprises successful learning, and in particular, what qualities do effective teachers have around the world. Though some developed countries have made significant progress toward quality education, many developing countries experience numerous obstructions to guaranteeing quality education to students. Most importantly, India, due to its economic, cultural, and social divides, still grapples with equity and the quality of education. In particular, Jharkhand State, which has predominantly an indigenous population, due to its social and educational backwardness, greatly requires teachers with skills and qualities that ensure effective learning of all students in every school. In this endeavor, Jesuit schools network, a private Catholic school network in the State of Jharkhand, India, too still battles with the challenges of low-quality teachers in their schools. Jesuit schools experience the challenging task of upholding success for all students. Thus, to respond to the need of Jesuit schools, this study attempted to investigate the perceptions and practices of administrators and teachers in Jesuit secondary schools in the Province of Hazaribag, India, to discern the ideal for Ignatian secondary educators. This study used works by Stronge (2002, 2007), and Jesuit Secondary Education Association (JSEA, 2011), and the Jesuit Schools Network (JSN, 2015a) as the two conceptual lenses to examine the topic. A mixed-methods approach was adopted to thoroughly investigate the topic. The researcher-constructed survey data comprised the major component of the study, and to arrive at a comprehensive understanding of the topic, it was further examined from semistructured interviews and classroom observational data. Results showed that the majority of participants upheld teaching qualities enumerated in Stronge, the Jesuit Secondary Education Association, and the Jesuit Schools Network as important for quality teaching and learning in Jesuit schools. Additionally, results indicated that qualities such as “teacher as a caring person,” “teacher as a competent person,” “teacher as a committed person,” “teacher as a student-centered person,” and “teacher as a collaborative person” are important to ensure quality learning for all students in Jesuit secondary schools in Hazaribag, India

Assessment of the iliolumbar artery: its structural variations and applied aspect

Background: The Iliolumbar artery normally arises from the posterior division of Internal iliac artery. The main artery and its two branches supply the iliacus and lumbar region and other vital structures in that area. However, various studies conducted depict the differences in the pattern of its origin and course. Thus, the goal of this study was to discover the various origins of the iliolumbar artery, as well as its relationships with other surgically significant anatomical structures; the importance of which can prevent any intraoperative hemorrhages during surgery.Methods: The study was conducted in Department of Anatomy Lady Hardinge Medical College between 2019-2021. Pelvis of 12 formalin fixed adult cadavers (8 females, 4 males) were dissected to observe the iliolumbar artery. Its origin, caliber and course were measured using a digital vernier caliper. The relationship of iliolumbar artery was established with obturator nerve, lumbosacral trunk and sympathetic chain.Results: Iliolumbar artery was originating from trunk of internal iliac artery in 70.83% cases in which the mean distance of origin and mean caliber was more on right side. In the remaining 29.17% cases where the Iliolumbar artery was arising from posterior division of internal iliac artery, the mean distance of origin and mean caliber was higher on left side. The truncal origin of iliolumbar artery was predominant in females.Conclusions: The variant origin of the iliolumbar artery and its clinic-anatomical relationships have been highlighted to reduce iatrogenic artery trauma during surgery.

Screening for retinopathy, risk factors, adherence to treatment and complications among diabetic and hypertensive individuals attending a primary care centre in Puducherry, India

Background: The increasing prevalence and incidence of diabetes and hypertension with increasing age and adult age group are at high risk of developing diabetic and hypertensive retinopathies.Methods: The study was conducted in a rural area of Puducherry, data collection was carried over a period of six months. Self-reported patients of diabetes and hypertension were included in the study and predesigned questionnaire was used to collect the information about socio-demographic details, risk factors, physical activity, history related to DM/HTN and history of fundus examination.Results: Majority of patients screened for diabetes 56% and hypertension 47% was by government hospital. The proportion of diabetics and hypertensives who had undergone fundus examination to rule out diabetic and hypertensive retinopathy was found to be 29.3% (12) and 14.5% (10). Complications such as neuropathy and retinopathy were given by 36.5% (15) and 2.4% (1) of diabetic patients Two third of the patients 64.1% had sedentary life style.Conclusions: Health care providers need to plan for larger coverage of fundus examination among diabetic and hypertensive patients

Combination Versus Monotherapy for Carbapenem-Resistant Acinetobacter Species Serious Infections: A Prospective IPTW Adjusted Cohort Study

Introduction: International guidelines recommend definitive combination antibiotic therapy for the management of serious infections involving carbapenem-resistant Acinetobacter (CRAB) species. The commonly available combination options include high-dose sulbactam, polymyxins, tetracyclines, and cefiderocol. Scanty prospective data exist to support this approach. Methods: Patients with CRAB bacteraemia, ventilator-associated pneumonia (VAP), or both were categorized based on whether they received combination therapy or monotherapy. The 30-day mortality was compared between the two groups. Inverse probability treatment weighting (IPTW) was done using propensity score (PS) for a balanced comparison between groups. Results: Between January 2021 and May 2023, of the 161 patients with CRAB bacteraemia (n = 55, 34.2%), VAP (n = 46, 28.6%), or both (n = 60, 37.3%) who received appropriate intravenous antibiotic therapy, 70% (112/161) received monotherapy, and the rest received combination therapy. The overall 30-day mortality was 62% (99/161) and not different (p = 0.76) between the combination therapy (31/49, 63.3%) and monotherapy (68/112, 60.7%) groups. The propensity score matching using IPTW did not show a statistical difference (p = 0.47) in 30-day mortality for receiving combination therapy with an adjusted odds ratio (OR) P of 1.29 (0.64, 2.58). Conclusion: Combination therapy for CRAB infections needs further study in a randomised controlled trial, as this observational study showed no difference in 30-day mortality between monotherapy and combination therapy

Intravenous doxycycline, azithromycin, or both for severe scrub typhus

BACKGROUND: The appropriate antibiotic treatment for severe scrub typhus, a neglected but widespread reemerging zoonotic infection, is unclear. METHODS: In this multicenter, double-blind, randomized, controlled trial, we compared the efficacy of intravenous doxycycline, azithromycin, or a combination of both in treating severe scrub typhus. Patients who were 15 years of age or older with severe scrub typhus with at least one organ involvement were enrolled. The patients were assigned to receive a 7-day course of intravenous doxycycline, azithromycin, or both (combination therapy). The primary outcome was a composite of death from any cause at day 28, persistent complications at day 7, and persistent fever at day 5. RESULTS: Among 794 patients (median age, 48 years) who were included in the modified intention-to-treat analysis, complications included those that were respiratory (in 62%), hepatic (in 54%), cardiovascular (in 42%), renal (in 30%), and neurologic (in 20%). The use of combination therapy resulted in a lower incidence of the composite primary outcome than the use of doxycycline (33% and 47%, respectively), for a risk difference of −13.3 percentage points (95% confidence interval [CI], (21.6 to −5.1; P=0.002). The incidence with combination therapy was also lower than that with azithromycin (48%), for a risk difference of −14.8 percentage points (95% CI, −23.1 to −6.5; P<0.001). No significant difference was seen between the azithromycin and doxycycline groups (risk difference, 1.5 percentage points; 95% CI, −7.0 to 10.0; P=0.73). The results in the per-protocol analysis were similar to those in the primary analysis. Adverse events and 28-day mortality were similar in the three groups. CONCLUSIONS: Combination therapy with intravenous doxycycline and azithromycin was a better therapeutic option for the treatment of severe scrub typhus than monotherapy with either drug alone. (Funded by the India Alliance and Wellcome Trust; INTREST Clinical Trials Registry–India number, CTRI/2018/08/015159.

The Global Burden of Snakebite: A Literature Analysis and Modelling Based on Regional Estimates of Envenoming and Deaths

Janaka de Silva and colleagues estimate that globally at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite

Snake Bite in South Asia: A Review

Snake bite is one of the most neglected public health issues in poor rural communities living in the tropics. Because of serious misreporting, the true worldwide burden of snake bite is not known. South Asia is the world's most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Despite increasing knowledge of snake venoms' composition and mode of action, good understanding of clinical features of envenoming and sufficient production of antivenom by Indian manufacturers, snake bite management remains unsatisfactory in this region. Field diagnostic tests for snake species identification do not exist and treatment mainly relies on the administration of antivenoms that do not cover all of the important venomous snakes of the region. Care-givers need better training and supervision, and national guidelines should be fed by evidence-based data generated by well-designed research studies. Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment centre, where cost of treatment can constitute an additional hurdle. The deficiency of snake bite management in South Asia is multi-causal and requires joint collaborative efforts from researchers, antivenom manufacturers, policy makers, public health authorities and international funders