Dietary Practices Among Type 2 Diabetes Patients Visiting a Non-communicable Disease (NCD) Clinic in a District of Western India: A Cross-Sectional Study

BACKGROUND AND AIMS: Diabetes is becoming a major public health problem in the country. One of the most important lifestyle modifications necessary for diabetic patients is maintaining healthy dietary choices. These modifications in dietary practices are supposed to be followed lifelong, along with medication, for better glycemic control. Despite understanding the importance of dietary control and physical activity in the management of diabetes, adherence to these practices is poor. This study aimed to assess the dietary practices of type 2 diabetes mellitus (T2DM) patients and various factors that determine adherence to these healthy dietary practices. The secondary objective was to find the perceptions of participants about the role of diet in controlling diabetes and to find the perception-practice gap among study participants. METHODOLOGY: It was a hospital-based cross-sectional study conducted among 450 T2DM patients visiting the non-communicable disease (NCD) clinics of tertiary care hospitals and community health centres (CHCs) of the study district. Dietary practice was assessed using a modified UK Diabetes and Diet Questionnaire (UKDDQ), considering the food patterns in the study area. Statistical tests like chi-square and ordinal logistic regression were applied using Jamovi software for univariate and multivariate analyses. RESULTS: The healthiest food choices were abstinence from alcohol consumption (100%), avoiding processed meat (92.21%), high-fibre breakfast (70.4%), and daily consumption of vegetables (68.2%). Improper dietary practices were regular sugary drinks (38%) and high-glycemic-index food items (22.4%). The mean (SD) of the composite score was 68.02 (8.7) and the median score (interquartile range (IQR)) was 69 (60-76). Tertile analysis of the composite score revealed that with the increase in age, patients were less likely to be in the intermediate or upper tertile score (β = -0.0219, p = 0.016). Being female (odds ratio (OR) =0.603, CI: 0.395-0.917, p = 0.019) and living in a three-generation family made the patients less likely to be in the upper tertile score. CONCLUSION: Nearly half of the participants had an overall healthy score. Dietary practices were healthy among the participants of lower ages, males, and those living in nuclear and joint families. The highest perception-practice gap was seen for fruit and rice consumption

Study of effect of propranolol, atenolol and celiprolol on exercise induced changes in heart rate, blood pressure and peak expiratory flow rate in healthy human volunteers

Background: Beta blockers are known to cause attenuation of sympathetic stimulation mediated increase in cardiovascular parameters. Very few studies are available in Indian set-up comparing these changes between different beta blockers available in market. The objective of the study was to compare efficacy and safety of propranolol, atenolol and celiprolol on heart rare, blood pressure and airway resistance, both at rest and during exercise.Methods: A prospective interventional study was carried out involving 72 healthy volunteers in the clinical pharmacology laboratory. Participants were divided in three groups of 24 each and given single oral doses of propranolol 40 mg, Atenolol 50 mg and celiprolol 40 mg was given to the participants. Exercise given in the form of step ladder test and hand grip dynamometer and effect on the different parameters like HR, SBP, DBP and PEFR were recorded before and immediately after exercise and compared.Results: All the three drugs were effective in attenuating the exercise induced cardiovascular parameters (p 0.05). No adverse effects were reported in the study participants.Conclusions: All the three drugs are effective in attenuating cardiovascular changes after sympathetic stimulation like exercise and there was no significant difference among them

Physiologically based pharmacokinetic modeling of transdermal selegiline and its metabolites for the evaluation of disposition differences between healthy and special populations

A physiologically based pharmacokinetic (PBPK) model of selegiline (SEL), and its metabolites, was developed in silico to evaluate the disposition differences between healthy and special populations. SEL is metabolized to methamphetamine (MAP) and desmethyl selegiline (DMS) by several CYP enzymes. CYP2D6 metabolizes the conversion of MAP to amphetamine (AMP), while CYP2B6 and CYP3A4 predominantly mediate the conversion of DMS to AMP. The overall prediction error in simulated PK, using the developed PBPK model, was within 0.5–1.5-fold after intravenous and transdermal dosing in healthy and elderly populations. Simulation results generated in the special populations demonstrated that a decrease in cardiac output is a potential covariate that affects the SEL exposure in renally impaired (RI) and hepatic impaired (HI) subjects. A decrease in CYP2D6 levels increased the systemic exposure of MAP. DMS exposure increased due to a reduction in the abundance of CYP2B6 and CYP3A4 in RI and HI subjects. In addition, an increase in the exposure of the primary metabolites decreased the exposure of AMP. No significant difference between the adult and adolescent populations, in terms of PK, were observed. The current PBPK model predictions indicate that subjects with HI or RI may require closer clinical monitoring to identify any untoward effects associated with the administration of transdermal SEL patch

Valued Information Resources when making Diagnoses: The experiences of Medical Students in a Clinical Reasoning Course

OBJECTIVES: The clinical reasoning process, aimed at making an accurate diagnosis, represents a complex activity. No studies to date have reported on how medical students harness existing information resources in their clinical reasoning courses to arrive at correct diagnoses. This study fills that gap. METHODS: Cross Sectional Study. An anonymous survey asked students to recall their most useful information resources halfway through their three clinical reasoning courses. Students then were asked to evaluate the comparative usefulness of these selected resources. Finally, students reported on those resources that they no longer found useful. This survey sought to learn what information resources medical students value so that librarians can provide the best possible instructional and collection resources. RESULTS: 69 of the 107 students enrolled in the Clinical Reasoning 2 course completed the three-part survey (64.5% response rate). Students frequently mentioned finding point-of-care tools, general web browsers, journal articles, course materials, and textbooks to be useful. When forced to rank their preferences students added medical society websites and the diagnostic tool Diagnosaurus in AccessMedicine. Students halfway through their three courses no longer found medical licensure exam review guides, patient-oriented sources, or course lecture notes to be helpful. CONCLUSIONS: Medical students halfway their three clinical reasoning courses provided surprising results as well as some expected results in this cross sectional study

An assessment of sociodemographic factors and family planning practices in Jamnagar, Gujarat, India: a cross sectional study

Background: India was the first country in the world to launch a National Family Planning Programme in 1952. It was purely a demographic programme with the sole objective of reducing the birth rate to stabilize the population. As per 2011 census population increased with the growth rate of 17.7%. Thus even after 63 years of programme & many more new advances & updates in programme, India could not reach its target of at least 60% of couple protection rate. So there would be some definite factors prohibiting its use.Methods: A cross section study of 450 reproductive age group women was conducted to find out the factors of unmet need of contraception & socio demographic profile.Results: In present study couple protection rate was 57.11%, majority being permanent sterilization. The selection of contraception was influenced by her husband in 43.24% & by mother-in-law in 62.16%.Conclusions: The study revealed that almost half of the couple population was using the contraception that included temporary as well as permanent methods of contraception

Staging Orthodontic Aligners for Complex Orthodontic Tooth Movement

The recent trend in orthodontics has shown an increased shift toward aligner therapy. For years, orthodontists have used fixed preadjusted appliances for orthodontic treatment. Even though fixed appliances have been highly efficient in the treatment of orthodontic malocclusions, they are not as esthetic as clear aligners. The purpose of this article is to review the staging of orthodontic tooth movement (OTM) with aligner therapy