Assessment of the cardiac autonomic neuropathy among the known diabetics and age-matched controls using noninvasive cardiovascular reflex tests in a South-Indian population: A case-control study

Aim: Diabetes mellitus is a chronic condition characterized by hyperglycemia. The objective of the study was to estimate the prevalence of cardiac autonomic neuropathy in a rural area of South India, among the known diabetics after comparing them with the age-matched healthy controls, utilizing noninvasive cardiac autonomic neuropathy reflex tests. Materials and Methods: A case-control study was conducted for 4 months (October 2014 to January 2015) at an Urban Health and Training Center (UHTC) of a Medical College located in Kancheepuram district, Tamil Nadu. The study was conducted among 126 diagnosed Type 2 diabetes patients and in 152 age- and sex-matched healthy controls to ensure comparability between the cases and controls and, thus, reduce variability due to demographic variables. All the study subjects (cases and controls) were selected from the patients attending UHTC during the study duration, provided they satisfied the inclusion and exclusion criteria. Study participants were subjected to undergo noninvasive cardiac autonomic neuropathy reflex tests. The associations were tested using paired t-test for the continuous (mean ± standard deviation) variables. Results: The overall prevalence of cardiac autonomic neuropathy among diabetic patients was found to be as 53.2% (67/126). On further classification, positive (abnormal) results were obtained in 56 (sympathetic - 44.4%) and 51 (parasympathetic - 40.5%) diabetic cases. Overall, heart rate variation during deep breathing was found to be the most sensitive test to detect parasympathetic autonomic neuropathy while the diastolic blood pressure response to sustained handgrip exercise was the most sensitive method to detect sympathetic neuropathy dysfunction. Conclusion: The overall prevalence of cardiac autonomic neuropathy among diabetic patients was found to be as 53.2%. Even though cardiac autonomic neuropathy can be detected by various invasive tests, noninvasive tests remain a key tool to detect it in the remote settings in a cost-effective and user-friendly manner without making people visit higher centers

COVID-19-related stigma towards doctors in India: an online cross-sectional study

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to worry and panic in the minds of people all over the world. Consequently, doctors and other frontline healthcare workers have become a target of stigma in the society. In spite of the Indian government appreciating doctors and healthcare workers with gestures, such as an aerial floral salute and asking the citizens to maintain a positive attitude toward doctors, several people are looking down at doctors as probable virus carriers and treating them as a potential threat to the general public. Aims: To assess stigma and discrimination faced by doctors during the COVID-19 pandemic and their psychological wellbeing. Materials and methodology: A cross-sectional study was conducted on doctors, with convenience sampling technique used to collect data. The study tools were presented in Google forms, and the link was circulated by an exponential non-discriminative snowballing method through doctors’ WhatsApp groups across several states of the country. The study tools included participant information sheet, informed consent form, sociodemographic proforma, a self-designed questionnaire related to stigma and discrimination, and the World Health Organization (Five) Well-Being Index (WHO-5). Results: Three hundred and fifty-six (69.94%) out of 509 doctors reported that they had experienced stigma from the society and their families. 95.5% doctors reported that they are proud of their profession despite experiencing stigma. 58.2% doctors reported that they have received appreciation from the society for their work. 5.6% doctors reported that stigma had a serious impact on their wellbeing. Conclusion: The study results show that majority of doctors are facing stigma and discrimination. Addressing stigma and discrimination faced by doctors and other frontline healthcare workers is significant in fighting this pandemic