Association of non-alcoholic fatty liver disease with chronic kidney disease in type 2 diabetes mellitus

Background: Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. NAFLD is considered a disease of no consequence. Data on the effect of NAFLD on renal dysfunction in T2DM is sparse. Author aimed to study the association of NAFLD with CKD in Indian T2DM subjects.Methods: In an observational cross-sectional study at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India from February 2017 to March 2018. 197 out of 268 randomly selected type 2 diabetes mellitus (T2DM) subjects were selected for the study after considering the inclusion and exclusion criteria. CKD was defined as estimated GFR <60 ml/min per 1.73 m2 and/or albumin to creatinine ratio ≥30 mg/g. NAFLD was diagnosed using ultrasonography. The association between NAFLD and CKD was analyzed using SPSS (version 24.0).Results: On ultrasonography 133 (67.5%) T2DM subjects had NAFLD. Diabetic with NAFLD (133, 67.51%) had significantly more history of hypertension (p 0.006), higher systolic (p 0.03) and diastolic BP (p 0.009), higher BMI (p <0.001), waist circumference (p <0.001), fasting glucose (p 0.03), triglyceride (p<0.001) and higher urinary albumin-to-creatinine ratio (p <0.001). Diabetics with CKD (61, 30.96%), were older (p 0.03), hypertensive (p <0.001) and had higher fasting glucose (p 0.003). Subjects with CKD had a higher prevalence of underlying NAFLD (78.69% vs 62.5%, p 0.03) as compared with diabetics with no CKD. T2DM subjects with NAFLD had more than two times (OR 2.88 (1.1-6.78), p 0.03) the risk of developing CKD after multivariate analysis as compared to subjects without NAFLD.Conclusions: NAFLD is a risk factor for development of CKD in patients of type 2 diabetes mellitus. Screening and early preventive measures may go long way in reducing morbidity

Acute cyanide Intoxication: A rare case of survival

A 30-year-old male jewellery factory worker accidentally ingested silver potassium cyanide and was brought to the emergency department in a state of shock and profound metabolic acidosis. This patient was managed hypothetically with use of injection thiopentone sodium intravenously until the antidote was received. Cyanide is a highly cytotoxic poison and it rapidly reacts with the trivalent iron of cytochrome oxidase thus paralysing the aerobic respiration. The result is severe lactic acidosis, profound shock, and its fatal outcome. The patient dies of cardio-respiratory arrest secondary to dysfunction of the medullary centres. It is rapidly absorbed, symptoms begin few seconds after exposure and death usually occurs in <30 min. The average lethal dose for potassium cyanide is about 250 mg. We used repeated doses of thiopentone sodium till the antidote kit was finally in our hands, hypothesising that it contains thiol group similar to the antidote thiosulphate. Moreover, it is an anticonvulsant. We were successful in our attempts and the patient survived though the specific antidotes could be administered after about an hour

Development, validation, and usability testing of prototype mobile application for oral health promotion during pregnancy in India

Background: Oral diseases are a silent epidemic. Objectives: The objectives of the study were to develop, validate, and assess the usability of an oral health prototype mobile application for oral health promotion among pregnant women in India. Materials and Methods: A cross-sectional study was conducted in Tertiary Care Hospital in Delhi, India, after obtaining Ethical Clearance from the Institutional Ethical Committee Board. The study was conducted in three phases: development of the prototype app, its validation, followed by usability testing of the app. Mobile app was validated by 30 pregnant women and 30 subject experts using Heuristic Analysis Scale and usability testing by 30 pregnant women based on System Usability Scale (SUS). Data were analyzed with IBM SPSS version 21.0. Results: Majority (over 90%) of pregnant women and subject experts strongly acknowledged that the app educated the users using positive motivation strategies, instilling comprehensive knowledge and faced no issues with the appropriate functionality of the app. The prototype app scored 73.75 on SUS, indicating high usability. Conclusion: This study holistically explored various dimensions of oral health care in pregnant women. Its novelty is proven by the fact that the content of the prototype application has been phase wise developed and validated by pregnant women and subject experts. Usability testing of the app indicated its high acceptability and ease of use among pregnant women in India

Comparative study of Diabetic Neuropathy Examination Scoring &Nerve Conduction Velocity in patients of Diabetic Neuropathy

Background and aims: Diabetes Mellitus (DM) is a metabolic disease affecting the worldwide population. It causes Neuropathy with significant morbidity (Paraesthesia, hyperesthesia, gait disturbance, distal weakness, insensitive extremities, predisposition to foot ulcers and even leading to amputations). The pain associated with diabetic neuropathy has a substantial impact on the quality of life. Diabetic Neuropathy Examination Scoring&nbsp; (DNE Scoring) and Electrophysiological study (NCV study) help in early diagnosis, treatment, and decreasing the morbidity caused due to DM. Aim:The main objective of the study was to examine the correlation between Clinical examination(DNE Scoring) and Electrophysiological study(NCV) in patients with Diabetic Neuropathy. Material and methods: A total of 52 patients were studied from January 2019 to June2020 between the age group of 40-89years. Meticulous history, Clinical examination (DNE scoring), and NCV Study were done. Result and Conclusion :NCV testing and DNE Scoring helps in early diagnosis and management and retard the progression with better control. The ideal diagnosis of Diabetic sensorimotor polyneuropathy (DSPN) is made by both the compatible clinical findings and the related electrophysiological changes.The usefulness of Diabetic neuropathic examination (DNE scoring) and its correlation with NCV is helpful in early diagnosing of diabetic neuropathy.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp

Prevalence of Nonalcoholic Fatty liver Disease (NAFLD) and its association with Cardio-metabolic risk factors in Type 2 Diabetes Mellitus

Backgroun: Type 2 diabetes mellitus (T2DM) and Nonalcoholic fatty liver disease (NAFLD) have risen globally to epidemic proportions. The study was aimed to determine the prevalence of NAFLD and its association with cardio-metabolic risk factors in T2DM subjects. Method: In a case control study, 212 consecutive, T2DM subjects with age ≥ 30 years, were evaluated from December 2017 to December 2018 at Mahatma Gandhi Medical College &amp;Hospital, Jaipur, Rajasthan. Subjects with history of significant alcohol consumption, evidence of cirrhosis, hepatotoxic drugs, and other known causes of fatty liver were excluded. The T2DM subjects were divided into (1) NAFLD - patients with USG evidence of fatty changes in the liver (2) Non-NAFLD – patients without any USG evidence of fatty changes in the liver. Coronary artery disease was screened by any past medical history of CAD or electrocardiographic or angiography evaluation. Continuous variables were expressed as mean with standard deviation. Comparison of continuous data between subgroups was done by using Independent student’s t-test or Mann Whitney U test. All statistical analysis was carried out by SPSS version 25. Result:55.66% diabetics had comorbid NAFLD. Both study groups had comparable mean age (p 0.719) and gender distribution (p 0.482). Subjects with NAFLD had significantly higher BMI (p 0.0001), mean waist circumference (p &lt;0.001), waist hip ratio (p &lt;0.001), systolic BP (p 0.001), diastolic BP (p 0.024), HbA1c (p 0.021), total cholesterol (p 0.0426) &amp; triglyceride (p 0.02). Mean LDL (p 0.054), VLDL (p 0.235) &amp; HDL (p 0.113) values were comparable in two study groups, suggesting no significant association with NAFLD. 32 (15.09%) subjects had coronary artery disease (CAD). Diabetics with NAFLD had significantly higher CAD (22.03% vs 9.57%, p 0.02).Conclusion: Diabetics with NAFLD had significantly higher cardio-metabolic risk factors, leading to increased associated risk of CAD

Early empiric antibiotic use in COVID-19 patients: results from the international VIRUS registry

Objectives: COVID-19 escalated inappropriate antibiotic use. We determined the distribution of pathogens causing community-acquired co-infections, the rate, and factors associated with early empiric antibiotic (EEAB) treatment among hospitalized COVID-19 patients. Methods: The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry including 68,428 patients from 28 countries enrolled between January 2020 and October 2021 were screened. After exclusions, 7830 patients were included in the analysis. Azithromycin and/or other antibiotic treatment given within the first 3 days of hospitalization was investigated. Univariate and multivariate analyses were performed to determine factors associated with EEAB use. Results: The majority (6214, 79.4%) of patients received EEAB, with azithromycin combination being the most frequent (3146, 40.2%). As the pandemic advanced, the proportion of patients receiving EEAB regressed from 84.4% (786/931) in January-March 2020 to 65.2% (30/46) in April-June 2021 (P < 0.001). Beta-lactams, especially ceftriaxone was the most commonly used antibiotic. Staphylococcus aureus was the most commonly isolated pathogen. Multivariate analysis showed geographical location and pandemic timeline as the strongest independent predictors of EEAB use. Conclusions: EEAB administration decreased as pandemic advanced, which may be the result of intensified antimicrobial stewardship efforts. Our study provides worldwide goals for antimicrobial stewardship programs in the post-COVID-19 era