Diabetic retinopathy: an Indian perspective

Diabetic retinopathy (DR) can be defined as damage to microvascular system in the retina due to prolonged hyperglycaemia. The prevalence of DR in the Chennai Urban Rural Epidemiology (CURES) Eye Study in south India was 17.6 per cent, significantly lower than age-matched western counterparts. However, due to the large number of diabetic subjects, DR is likely to pose a public health burden in India. CURES Eye study showed that the major systemic risk factors for onset and progression of DR are duration of diabetes, degree of glycaemic control and hyperlipidaemia. Hypertension did not play a major role in this cross-sectional analysis. The role of oxidative stress, atherosclerotic end points and genetic factors in susceptibility to DR has been studied. It was found that DR was associated with increased intima-media thickness and arterial stiffness in type 2 Indian diabetic subjects suggesting that common pathogenic mechanisms might predispose to diabetic microangiopathy. Curcumin, an active ingredient of turmeric, has been shown to inhibit proliferation of retinal endothelial cells in vivo. Visual disability from DR is largely preventable if managed with timely intervention by laser. It has been clearly demonstrated that in type 2 south Indian diabetic patients with proliferative DR who underwent Pan retinal photocoagulation, 73 per cent eyes with good visual acuity (6/9) at baseline maintained the same vision at 1 yr follow up. There is evidence that DR begins to develop years before the clinical diagnosis of type 2 diabetes. Our earlier study demonstrated that DR is present in 7 per cent of newly diagnosed subjects, hence routine retinal screening for DR even at the time of diagnosis of type 2 diabetes may help in optimized laser therapy. Annual retinal examination and early detection of DR can considerably reduce the risk of visual loss in diabetic individuals

PEMANFAATAN SAO ENDA SEBAGAI CAGAR BUDAYA SELALEJO DI DESA SELALEJO TIMUR KECAMATAN MAUPONGGO KABUPATEN NAGEKEO

Kabupaten Nagekeo. Penelitian ini bertujuan untuk mengetahui pemanfaatan Sa’o Enda sebagai Cagar Budaya Selalejo di Desa Selalejo Timur Kecamatan Mauponggo Kabupaten Nagekeo. Metode penelitian yang  digunakan  adalah deskriptif kualitatif. Subjek penelitian sebanyak lima orang yang terdiri dari informan kunci satu orang dan informan pendukung empat orang.Teknik pengumpulan data adalah wawancara, observasi, dan dokumentasi.Teknik analisis data dalam penelitian ini melalui tahapanya itu: 1) Pengumpulan data, 2) Reduksi data, 3) Pemaparan data, 4) Penarikan kesimpulan. Hasil penelitian:Masyarakat Selalejo menganggap rumah adat Sa’o Enda sebagai cerminan kehidupan yang bersifat profan dan sakral, sehingga segala norma yang mengikatnya menjadi suatu kesepakatan yang harus diwajibakan dalam ritual atau upacara adat. Di dalam rumah adat Sa’o Enda juga terdapat simbol-simbol yang mengandung makna tersendiri bagi masyarakat adat Selalejo. Adapun teori  yang digunakan untuk mendeskripsikan pemanfaatan Sa’o Enda sebagai Cagar Budaya Selalejo di Desa Selalejo Timur yaitu teori antropogi simbolik yang digagaskan oleh Geertz. Geetz menjelaskan bahwa teori simbolik memandang kebudayaan sebagai suatu sistem simbol yang dimiliki oleh suatu masyarakat yang membutuhkan interpretasi terhadap makna dari simbol yang ada. Kesimpulannya dari penelitian ini adalah bahwa Sa’o Enda merupakan salah satu warisan budaya yang dimanfaatkan sebagai tempat penyimpanan benda-benda pusaka dan sebagai tempat pelaksanaan ritual adat.     &nbsp

Psammomatous ossifying fibroma of frontal sinus: a case report with review of literature

Psammomatoid Ossifying Fibroma (POF) is a rare, slowly progressive benign tumor of the extragnathic craniofacial bones representing a subgroup of related fibro-osseous lesions with a tendency towards locally aggressive behaviour unique to the nasal cavity, paranasal sinuses, orbit and is often misdiagnosed. Histologically they are benign, but clinically they are locally aggressive. We report a case of a 17 year-old boy who presented with psammamatous ossifying fibroma of the frontal sinus. The location of this tumor made this case unusual

Prevalence and Risk Factors of Diabetic Nephropathy in an Urban South Indian Population: The Chennai Urban Rural Epidemiology Study (CURES 45)

OBJECTIVE— The aim of this study was to determine the prevalence of diabetic nephropathy among urban Asian-Indian type 2 diabetic subjects. RESEARCH DESIGN AND METHODS— Type 2 diabetic subjects (n 1,716), inclusive of known diabetic subjects (KD subjects) (1,363 of 1,529; response rate 89.1%) and randomly selected newly diagnosed diabetic subjects (NDD subjects) (n 353) were selected from the Chennai Urban Rural Epidemiology Study (CURES). Microalbuminuria was estimated by immunoturbidometric assay and diagnosed if albumin excretion was between 30 and 299 g/mg of creatinine, and overt nephropathy was diagnosed if albumin excretion was 300 g/mg of creatinine in the presence of diabetic retinopathy, which was assessed by stereoscopic retinal color photography. RESULTS— The prevalence of overt nephropathy was 2.2% (95% CI 1.51–2.91). Microalbuminuria was present in 26.9% (24.8 –28.9). Compared with the NDD subjects, KD subjects had greater prevalence rates of both microalbuminuria with retinopathy and overt nephropathy (8.4 vs. 1.4%, P 0.001; and 2.6 vs. 0.8%, P 0.043, respectively). Logistic regression analysis showed that A1C (odds ratio 1.325 [95% CI 1.256 –1.399], P 0.001), smoking (odds ratio 1.464, P0.011), duration of diabetes (1.023, P0.046), systolic blood pressure (1.020, P 0.001), and diastolic blood pressure (1.016, P0.022) were associated with microalbuminuria. A1C (1.483, P 0.0001), duration of diabetes (1.073, P 0.003), and systolic blood pressure (1.031, P 0.004) were associated with overt nephropathy. CONCLUSIONS— The results of the study suggest that in urban Asian Indians, the prevalence of overt nephropathy and microalbuminuria was 2.2 and 26.9%, respectively. Duration of diabetes, A1C, and systolic blood pressure were the common risk factors for overt nephropathy and microalbuminuria

Increased Awareness about Diabetes and Its Complications in a Whole City: Effectiveness of the “Prevention, Awareness, Counselling and Evaluation” [PACE] Diabetes Project [PACE-6]

Abstract Aims and Objectives : To determine the effectiveness of a large scale multipronged diabetes awareness program provided through community involvement in Chennai. Material and Methods: Mass awareness and free screening camps were conducted between 2004-2007 at various locations of Chennai as part of the Prevention, Awareness, Counselling and Evaluation [PACE] Diabetes Project. During a 3-year period, 774 diabetes awareness camps were conducted to reach the public directly. After the PACE project was completed, 3,000 individuals, representative of Chennai, were surveyed in 2007 using a systematic stratified random sampling technique. The results were compared to a similar survey carried out, as part of the Chennai Urban Rural Epidemiology Study [CURES] in 2001 - 2002, which served as a measure of baseline diabetes awareness. Results: Awareness of a condition called “diabetes” increased significantly from 75.5% in 2001-2002 (CURES) to 81% (p < 0.001) in 2007 (PACE). 74.1% of the citizens of Chennai are now aware that the prevalence of diabetes is increasing as compared to 60.2% earlier [p<0.001]. Significantly more people felt that diabetes could be prevented (p<0.001), and that a combination of diet and exercise were needed to do so (p<0.001). Respondents reporting obesity, family history of diabetes, hypertension and mental stress as risk factors increased significantly after PACE (p<0.001). More people were able to correctly identify the eyes (PACE 38.1% compared to CURES -16.1%, p < 0.001), kidney (PACE 42.3% compared to CURES 16.1%, p < 0.001), heart (PACE 4.6% compared to CURES 5.8%, p < 0.001) and feet (PACE 35.0% vs CURES 21.9%, p < 0.001) as the main organs affected by diabetes. Conclusion: Through direct public education and mass media campaigns, awareness about diabetes and its complications can be improved even in a whole city. If similar efforts are implemented state-wise and nationally, prevention and control of non-communicable diseases, specifically diabetes and cardiovascular disease, is an achievable goal in India.

IMPROVED FINGERPRINT COMPRESSION TECHNIQUE WITH DECIMATED MULTI-WAVELET COEFFICIENTS FOR LOW BIT RATES

In this paper, a multi-wavelet transform with decimated frequency bands is proposed to be used in the Set Partitioning in Hierarchical Trees (SPIHT) algorithm to improve fingerprint image compression. Either shuffled or unshuffled multi-wavelets can be used for SPIHT algorithm. In both the cases, the quality of the compressed images at lower bit rates either remained the same or slightly improved compared to wavelets. To improve the performance at lower bit rates, a method which utilizes the decimated version of multi-wavelet for the initialization of lists in SPIHT algorithm is used. The multi-wavelet used for the proposed work is SA4 (Symmetric-Antisymmetric). The algorithm was tested and verified using NIST, Shivang Patel, NITGEN and other databases. An overall improvement in performance particularly at lower bit rates (0.01 to 0.09) compared to a multi-wavelet without decimation was obtained using this method. The improvement was 0.798dB, 0.857dB and 0.859dB for the images in NITGEN database for a multi-wavelet decimated by 2, 4 and 8 respectively. Similar performances were observed for other databases. It was further observed that the PSNR was highest when the multi-wavelet was decimated by a factor of 4

The Chennai Urban Rural Epidemiology Study (CURES) - study design and methodology (Urban Component) (CURES - 1)

The report of World Health Organization (WHO) shows that India tops the world with the largest number of diabetic subjects. This increase is attributed to the rapid epidemiological transition accompanied by urbanization, which is occurring in India. There is very little data regarding the influence of affluence on the prevalence of diabetes and its complications particularly retinopathy in the Indian population. Furthermore, there are very few studies comparing the urban / rural prevalence of diabetes and its complications. The Chennai Urban Rural Epidemiology Study (CURES) is designed to answer the above questions. CURES is initially planned as a cross-sectional study to evolve later into a longitudinal study. Subjects for the urban component of the CURES have been recruited from within the corporation limits of Chennai City. Chennai (formerly Madras), the largest city in Southern India and the fourth largest in India has been divided into 10 zones and 155 wards. 46 wards were selected by a systematic random sampling method to represent the whole of Chennai. Twenty thousand and one individuals were recruited for the study, this number being derived based on a sample size calculation. The study has three phases. Phase one is a door to door survey which includes a questionnaire, anthropometric, fasting capillary blood glucose and blood pressure measurements. Phase two focussed on the prevalence of diabetic complications particularly retinopathy using standardized techniques like retinal photography etc. Diabetic subjects identified in phase one and age and sex matched non-diabetic subjects will participate in these studies. Phase three will include more detailed studies like clinical, biochemical and vascular studies on a sub-sample of the study subjects selected on a stratified basis from phase one. CURES is perhaps one of the largest systematic population based studies to be done in India in the field of diabetes and its complications like retinopathy, nephropathy and neuropathy

Prevention Awareness Counselling and Evaluation (PACE) Diabetes Project: A Mega Multi-pronged Program for Diabetes Awareness and Prevention in South India (PACE - 5)

Objective: The Prevention Awareness Counselling Evaluation (PACE) Diabetes Project is a large scale community based project carried out to increase awareness of diabetes and its complications in Chennai city (population : 4.7 million) through 1) public education 2) media campaigns 3) general practitioner training 4) blood sugar screening and 5) community based “real life” prevention program Methods: Education took place in multiple forms and venues over the three-year period of the PACE project between 2004 - 2007. With the help of the community, awareness programs were conducted at residential sites, worksites, places of worship, public places and educational institutions through lectures, skits and street plays. Messages were also conveyed through popular local television and radio channels and print media. The General Practitioners (GPs) program included training in diabetes prevention, treatment and the advantages of early detection of complications. Free random capillary blood glucose testing was done for individuals who attended the awareness programs using glucose meter. Results: Over a three-year period, we conducted 774 education sessions, 675 of which were coupled with opportunistic blood glucose screening. A total of 76,645 individuals underwent blood glucose screening. We also set up 176 “PACE Diabetes Education Counters” across Chennai, which were regularly replenished with educational materials. In addition, we trained 232 general practitioners in diabetology prevention, treatment and screening for complications. Multiple television and radio shows were given and messages about diabetes sent as Short Message Service (SMS) through mobile phones. Overall, we estimate that we reached diabetes prevention messages to nearly two million people in Chennai through the PACE Diabetes Project, making it one of the largest diabetes awareness and prevention programs ever conducted in India. Conclusion: Mass awareness and screening programs are feasible and, through community empowerment, can help in prevention and control of non-commuincable diseases such as diabetes and its complications on a large scale