Concern between medication non-adherence and diabetes associated depression

Background: Diabetes mellitus is one of the health disorders that acquire mankind immensely. An ominous twin of diabetes mellitus is diabetes associated depression which is often unrecognised in routine diabetic care. The objective of this study was to find the prevalence and correlation between medication adherence and diabetes associated depression.Methods: It is a conducted as cross sectional study using Morisky medication adherence scale to evaluate treatment adherence of type II diabetes mellitus. Patient health questionnaire-9 was used to scale the level of depression among our study subjects. Correlation between measures of treatment non adherence and level of depression was elucidated.Results: Out of 250 patients, 167 (66.8%) (Males -103, Females-64) and 83 (33.2%) (Males-31, Females-52) subjects has medium & low adherence to medication with an average score 6.8 and 4.2 respectively. Total prevalence of depression among diabetics in our study is 41.1% (males-19.2%, females 21.9%). Percentage of patients found to have minor depression was 22.3 % and 18.8 % of depressive subjects falls under major depression category according to PHQ-9 questionnaire with average score of 8.6 for minor depression and 11.9 for major depression. Positive correlation is seen between medication non adherence and diabetes associated depression (Low adherence & Major depression -0.85, Medium adherence &Minor depression -0.79).Conclusions: Unnoticed depression among diabetic individuals reduces treatment adherence and must be addressed in any patient showing poor response to the treatment. Improving treatment adherence helps to combat diabetes as well as depression

Rhabdomyolysis in Community Acquired Bacterial Sepsis – A Retrospective Cohort Study

BACKGROUND AND OBJECTIVES:Rhabdomyolysis is often associated with sepsis and gram positive bacterial pathogens are reported to be the most frequent cause of sepsis induced rhabdomyolysis. We report the pattern of infecting bacterial pathogens and associated causal factors in a South-Indian cohort. DESIGN, SETTING, PARTICIPANTS #ENTITYSTARTX00026; MEASUREMENTS:Retrospective cohort study of adult patients with community acquired bacterial sepsis complicated by rhabdomyolysis from March 2003--August 2008. Rhabdomyolysis was defined as serum creatine kinase >2000 IU/L. The study population was divided into group-I (sepsis with gram positive pathogens), group-II (sepsis with gram negative pathogens) and group-III (culture negative sepsis). RESULTS:103 patients (group I -15, group II- 34 and group III- 54) formed the study cohort. Mean age was 55 years and two-third had diabetes. Mean creatine kinase was 7114 IU/L and mean serum creatinine on admission was 2.4 mg/dl. Causative pathogen of sepsis was identified in 47.5%. Gram negative pathogens were more frequently (33%) associated with rhabdomyolysis than gram positive pathogens (14.5%). Lung was the commonest foci of sepsis (38.8%). 78.6% of the study population had one or more additional causal factor for rhabdomyolysis like statin intake, chronic alcoholism, hypokalemia, hypernatremia and hypophosphatemia. Mortality was 59%. CONCLUSIONS:Gram negative bacterial pathogens were more frequently associated with rhabdomyolysis than gram positive pathogens. Rhabdomyolysis in patients with sepsis is multifactorial and is associated with high mortality

Frequency of additional risk factors for rhabdomyolysis.

<p>Frequency of additional risk factors for rhabdomyolysis.</p

Baseline characteristics of study cohort (n = 103).

<p>Group –I: Gram positive sepsis.</p><p>Group-II: Gram negative sepsis.</p><p>Group-III: Culture negative sepsis.</p