IS RENAL IMPAIRMENT CONCEALED IN ELDERLY DIABETICS????

Objective: To compare and evaluate the renal profile of elderly and younger diabetics.Methods: This cross sectional study was conducted in a tertiary care teaching hospital. Patients with type-2-diabetes were grouped into elderly (age≥60years) and younger diabetics. Patients' demographics, duration of diabetes and serum creatinine were recorded. Cockcroft-Gault formula was used to calculate creatinine clearance (Clcr). Statistical analysis was done using Students'‘t' test and Pearson's correlation. Regression analysis to adjust for covariables was done wherever required.Results: A total of 477 diabetics were included (elderly n=320, young n=157). Body mass index (BMI) was significantly lower (p=0.003) and duration of diabetes was significantly longer (p=0.001) among elderly. Significant difference was noted in serum creatinine (1.06±0.32 vs 0.95±0.29 mg/dl; p=0.0002) and Clcr (57.82±17.41 vs 88.07±24.60 ml/min; p=0.001) between elderly and younger diabetics. Only 4.7% of elderly, whereas 47.8% of young had normal Clcr. Clcr showed a negative correlation with age in elderly (r=-0.389, p<0.001) and young (r=-0.396, p<0.001) and positive correlation with BMI in elderly (r=0.401, p<0.001) and young(r=0.337, p<0.001). Regression analysis of Clcr in elderly and young showed a positive correlation for BMI and inverse relationship for age and duration of diabetes mellitus.Conclusion: Almost 95% of the elderly and 50% of younger diabetics had impaired creatinine clearance. Renal impairment was concealed in most of them since mean serum creatinine was 1 mg/dl. Indian elderly diabetics should be considered renally impaired and drugs for all conditions need adjustment for creatinine clearance

Arecanut and Tobacco use Among School Children

BackgroundAreca nut is the fourth most commonly used psychoactive substance in the world after caffeine, alcohol and nicotine. Its use is considered a benign and socially acceptable habit among most Indians. Like tobacco, chewing areca nut also leads to oral and oropharyngeal cancers. Chewing of these substances usually starts early in life leading to a multitude of problems in adulthood. This study was conducted among high school students to determine the prevalence and explore the awareness of health hazards associated with these substances.Method  This cross sectional study was carried out in Vantamuri village, South India. All consenting school children of 7th, 8th and 9th class were interviewed individually using a pretested questionnaire about their chewing habits. This was followed by a thorough oral cavity examination for all.ResultsOut of 392 participants 62.5% were boys. Mean age of all participants was 14.8 ± 1.13 years.  The prevalence of areca nut usage among boys and girls was 27.3% and 6.1% while it was 2.4% for gutka (contains tobacco) amongst boys.  Majority of students started chewing between 13 and 14 years. About 49% of users were chewing these substances regularly for more than a year. Addictive tendencies were seen in two users. 43% of users chewed the same product used by their family members (

Assessment of knowledge, practice and perception of menstruation among adult women in the reproductive age group, in Mangalore, India

Background: Women often lack knowledge regarding reproductive health including menstruation which can be due to socio-cultural barriers in which they grow up. The present study is aimed at assessing the level of knowledge regarding menstruation and hygienic practices and perceptions during menstruation.Methods: It was a cross sectional study, conducted among 110 adult women to assess their knowledge regarding menstruation, practices followed during menstruation and their perceptionof menstruation. The collected data was analyzed using SPSS version 17. 0. Chi square test was applied. P<0.05 was considered to be significant.Results: Only 52% of the study population has satisfactory knowledge regarding menstruation. Women between 15 to 20 years of age and those from the middle and higher socio-economic groups seem to possess maximum knowledge regarding menstruation. Women of the higher socio-economic group practice better sanitary measures during menstruation with 100% of them using pads, as compared to women of lower socio economic group who showed a trend of using cloth (87.5%). Women of the upper socio-economic class (42.78%) had better perception towards menstruation (p<0.05).Conclusions: It is very important that lower socio-economic group should be educated about the importance of maintaining hygiene during menstruation by proper health education and equip them with skills regarding safe and hygienic practices to prevent the risk for reproductive tract infections

Lymphatic Filariasis and Mass Drug Administration

BackgroundA third of world’s filariasis cases occur in India. As a result Mass Drug Administration (MDA) was commenced in 1997 with the aim of eliminating this disease by 2015. However the coverage of MDA was not satisfactory. The underlying reasons for the poor coverage need to be identified. This study was conducted to assess the awareness of health personnel of lymphatic filariasis and the MDA programme.Method  This cross-sectional study was conducted in Kundapura taluk of Karnataka state in India during the 6th round of the MDA which was held between December 11 to 13, 2009. 78 health personnel who were posted for drug distribution were selected by convenience sampling. After obtaining informed consent health personnel were interviewed individually using a semi-structured questionnaire. Performance of health personnel was assessed according to points scored for their responses.ResultsThe mean age of all participants were 22.7± 8.9 years, 74(94.1%) were females and 58(74.4%) were nursing students. Only 17 (21.8%) participants had prior experience before taking part in this round of MDA. Only 4 (5.1%) participants achieved good scores while 45 (57.7%) got average scores. Performance scores were significantly better among paramedical workers (

Psychiatry as a career choice: Perception of students at a private medical college in South India

Background and Aim: People with mental illness are often subjected to stigma and discrimination. The poor popularity of Psychiatry as a field of specialty has been a global concern. Any preconceived notions, perceptions and formative influences among medical students could have strong influence on their future choice of career. This study aimed to determine the students′ perception of Psychiatry as career choice and the factors influencing their perception and career choice. Subjects and Methods: Following approval from Institutional Ethics Committee and necessary permissions, consenting medical students at a private medical college in Mangalore, India were surveyed using a pilot-tested questionnaire. The responses were compiled and data analyzed using Statistical Package for the Social Sciences (SPSS) version 10. Chi-square test was performed and P < 0.05 was considered significant. Results: Of the 250 participants, 152 (60.8%) were males while 96 (38.4%) were females aged 17-25 years. Only 28 (11.2%) wanted to pursue Psychiatry as a career while 97 (38.8%) considered it as an option although not their first choice. There was no association between gender and completion of Psychiatry postings on the decision regarding Psychiatry as a career. However, an exposure to a mentally ill person had a statistically significant association with Psychiatry as career choice (P < 0.001). Conclusion: Very few students aspire for Psychiatry. Targeted interventions including focused approach and creating an interest during undergraduate posting may inspire more students to take up Psychiatry

Development of a Modified Disability Questionnaire for Evaluating Disability Caused by Backache in India and Other Developing Countries

Study Design Prospective observational study. Purpose To evaluate the disability domains relevant to Indian patients with low backache and propose a modified disability questionnaire for such patients. Overview of Literature The Oswestry Disability Index (ODI) is a self-reported measurement tool that measures both pain and functional status and is used for evaluating disability caused by lower backache. Although ODI remains a good tool for disability assessment, from the Indian perspective questions related to weight lifting and sexual activity of ODI are questioned in some of the earlier studies. Activities of daily living in Indian patients vary substantially from those in other populations and include activities like bending forwards, sitting in floor and squatting which are not represented in the ODI. Methods In this prospective observational study, a seven-step approach was used for the development of a questionnaire. Thirty patients were interviewed to identify the most challenging issue they faced while performing their daily activities (by free listing) and understand how important the questionnaire items were in terms of the standard ODI. Thus, a comprehensive disability questionnaire comprising 14 questions was developed and administered to 88 patients. Both qualitative (interviews) and quantitative methods (to establish the validity, reliability, and correlation with the Visual Analog Scale [VAS] and Rolland Morris disability questionnaire) were used to identify the 10 questions that best addressed the disability domains relevant to Indian patients. Results According to free listing, four new questions pertaining to bending forward, sitting on the floor, walking on uneven surfaces, and work-related disabilities were included. In the second phase, wherein the questionnaire with 14 items was used, 56.8% patients did not answer the questions related to sexual activity, whereas 23.8% did not answer those related to walking on uneven surfaces. The modified questionnaire demonstrated good internal consistency (Cronbach’s alpha=0.892) and correlation with the Rolland Morris questionnaire (Cronbach’s alpha=0.850, p>0.05), as well as with the VAS score for disability (Cronbach’s alpha=0.712, p>0.05) and pain (Cronbach’s alpha=0.625, p>0.05). Conclusions A modified disability questionnaire that was designed by adding two questions related to bending forward and work status and removing questions related to sexual activity and weight lifting or traveling (depending on the occupation) can help evaluate disability caused by back pain in Indian population

Proportion of depression and its determinants among type 2 diabetes mellitus patients in various tertiary care hospitals in Mangalore city of South India

Background: Depression is found to be common among patients with diabetes and it is associated with poor outcomes in disease control. This study was carried out to find out the proportion and determinants associated with depression among patients with established type 2 diabetes mellitus (T2DM) in various tertiary care hospitals in Mangalore city of south India. Materials and Methods: This study was conducted in one government and three private tertiary care hospitals in Mangalore in December 2010. All consenting patients with confirmed diagnosis of T2DM were interviewed and screened for depression by administering the 9-item PRIME-MD Patient Health Questionnaire (PHQ-9). Results: Of the 230 T2DM patients, 119 (51.7%) were males. The mean age of all participants was 53.61 ± 10.7 years. The median duration of T2DM was found to be 12.1 ± 7.35 years. Among the participants, 71 (30.9%) met the criteria for moderate depression, 33 (14.3%) for severe depression, and the remaining 126 (54.8%) had no clinically significant depression. Only 26 (11.3%) patients were already aware that they were depressed, of whom just 3 had taken medical consultation. Among the risk factors, depression was found to be significantly associated with older age, female gender, low socioeconomic status, unskilled and retired employment status, having complications due to T2DM or comorbidities like hypertension and coronary artery disease, being overweight and being on insulin syringe injections. Conclusion: This study found a high proportion of depression among patients with T2DM. Therefore the care of individuals with diabetes mellitus (DM) should include the screening and possible treatment of depression in order to achieve and sustain treatment goals