scholarly journals Adverse perinatal outcome in diabetic mother treated with oral hypoglycemic agents vs. insulin

2017 ◽  
Vol 6 (6) ◽  
pp. 2252
Author(s):  
Leena Das ◽  
Bijay Kumar Meher ◽  
Sagar Parida ◽  
Deepti Damayanty Pradhan ◽  
Lucy Das ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Perinatal Outcomes ◽  
Educational Background ◽  
Diabetic Mother ◽  
Hypoglycemic Agents ◽  
Care Hospital ◽  
Oral Hypoglycemic Agents ◽  
Significant Difference

Background: Insulin has been the primary mode of therapy in diabetic mother for glycemic control as oral hypoglycemic agents (OHA) were initially thought to have teratogenic effect. Recent data supports the use of certain OHA; this study was designed to compare the perinatal outcomes in infants born to diabetic mother treated with insulin vs. oral hypoglycemic agents and to find out the relation of adverse perinatal events to glycemic control in both groups.Methods: This prospective observational study was conducted in a tertiary care hospital. 108 neonates born to diabetic mother between October 2014 to September 2016 were taken for study immediately after delivery after excluding the mothers who were treated with lifestyle modification and/or dietary modification alone only. 60 mothers had received insulin and 48 OHA for glycaemic control. Glycemic control was assessed by HbA1C estimation on the day of delivery. The infants were followed up in neonatal care unit for perinatal complications. Main outcome measure(s): birth weight, gestational age, respiratory problems, birth injury, birth asphyxia, congenital anomalies, hypoglycemia, hypocalcaemia, hyperbillirubinemia.Results: Out of 108 infants, 27 were born to pregestational and 81 to gestational diabetic mothers. 60(55.5%) were treated with insulin and rest with OHA, 53(49.1%) had optimal glycemic control. Both the groups had similar glycemic control in the third trimester. None of the perinatal outcomes showed significant difference between insulin and OHA group except neonatal hyperbillirubinemia. (p=0.013, RR=8 and OR=0.106). Within the optimal glycemic control (HbA1C <8), LGA has significant association with the insulin group than OHA (p=0.012, RR=2.217 and OR=4.2018).Conclusions: As compared to insulin, oral hypoglycemic agents have similar glycemic control and no adverse perinatal outcomes and can be used in pregnant mothers with diabetes mellitus from poor socioeconomic and educational background for its low cost and better patient compliance. Within the glycemic control, maternal treatment with insulin showed significant difference in LGA compared to OHA which needs further studies for validation.

scholarly journals Clinico-radiological Observations in Meconium Aspiration Syndrome

2018 ◽  
Vol 56 (209) ◽  
pp. 510-515 ◽  
Author(s):  
Susana Lama ◽  
Shyam Kumar Mahato ◽  
Nagendra Chaudhary ◽  
Nikhil Agrawal ◽  
Santosh Pathak ◽  
...  
Keyword(s):  
Apgar Score ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Birth Asphyxia ◽  
Meconium Aspiration Syndrome ◽  
Care Hospital ◽  
Radiological Findings ◽  
Female Ratio ◽  
Meconium Aspiration ◽  
Significant Difference

Introduction: To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal. Methods: An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied. Results: Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02) Conclusions: Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.

scholarly journals Prescribing pattern of drugs in chronic kidney disease patients on hemodialysis at a tertiary care hospital

2017 ◽  
Vol 6 (4) ◽  
pp. 928
Author(s):  
Narayana Murthy B. V. ◽  
Satyanarayana V.
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Tertiary Care ◽  
Hypoglycemic Agents ◽  
Phosphate Binders ◽  
Care Hospital ◽  
Oral Hypoglycemic Agents ◽  
Prescribing Pattern ◽  
Cross Sectional ◽  
Mortality And Morbidity

Background: CKD (chronic kidney disease) is a general term for heterogeneous disorders affecting kidney structure and its function. It is defined as either kidney damage or a decreased glomerular filtration rate of less than 60 mL/min/1.73m2 for 3 or more months. Objective of present work is to study the drug utilization pattern in chronic kidney disease patients undergoing hemodialysis.Methods: After taking the clearance and approval from the institutional ethics committee, a cross sectional prospective observational study conducted on chronic kidney disease (CKD) patients undergoing hemodialysis, in the department of nephrology, of Rajarajeshwari Medical College and Hospital, Bangalore. The data was analyzed descriptively.Results: Study included 52 patients, among them 41 males, 11were females, with a mean age of 47.6yrs. In our study large number pt were suffering from hypertension (HTN) 88.46% (46), in them the calcium channel blocker (CCB) 08.48% (38) was most commonly prescribed anti hypertensive drug. Around 1/3 of pt suffering from diabetes mellitus (DM) 36.53% (19) most of these patients were treated with them treated with oral hypoglycemic agents (OHA), and less than half of pt treated with insulin01.56% (07). Other drugs like phosphate binders (calcium carbonate & acetate) used in 11.16% (50), aspirin in 08.70% (39), statins in 10.04% (45) pt were being most commonly prescribed drugs.  Totally 448 drugs were prescribed In 52 pts Ie about 8.61 drugs / prescription, showing poly pharmacy.Conclusions: Patients undergoing hemodialysis with CKD will be having multiple diseases associated, regular monitoring and counseling regarding these diseases and its complication may reduce the incidence of CKD and the mortality and morbidity associated. The poly pharmacy noted in the study found inevitable because of the multifactorial etiologiesinvolved and needful multi-interventional approach towards it.

scholarly journals A study of neonatal outcome in infants born to diabetic mothers at a tertiary care hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 489
Author(s):  
Syeda Kausar Anjum ◽  
Yashodha H. T.
Keyword(s):  
Glycemic Control ◽  
Gestational Diabetes ◽  
Tertiary Care Hospital ◽  
Heart Diseases ◽  
Tertiary Care ◽  
Diabetic Mother ◽  
Care Hospital ◽  
Increased Risk ◽  
Diabetic Mothers ◽  
In Pregnancy

Background: Diabetes is the most common medical complication in pregnancy, affecting about 0.5-5% of all pregnancies. In developing countries, management of diabetes in pregnancy still poses a challenge. Infants of diabetic mother are at increased risk of periconceptional, fetal, neonatal and long-term complications. Methods: It was a prospective hospital-based study conducted in tertiary care hospital, Bangalore during a period of one year to assess the outcome in infants of diabetic mother and association of various complications to maternal glycemic status. Results: The incidence of diabetes in pregnant mothers in our hospital was 2.8%. Diabetic mothers with gestational diabetes mellitus (GDM) were 86 (86%) and with pre-gestational diabetes were 14 (14%). Various complications like hypoglycemia, hypocalcemia, polycythemia, hyperbilirubinemia, macrosomia, prematurity, respiratory distress syndrome, TTNB, congenital heart diseases were observed in infants of diabetic mothers. Among them hypoglycemia was the most commonly observed complication with frequency of 54%, followed by hypocalcemia which was seen in 43%, polycythemia in 35% and macrosomia in 15%. Significant association was found between various complications and glycemic control in mothers.Conclusions: High frequency of complications is seen in infants born to diabetic mothers. Hence, these babies should be delivered at hospitals where special neonatal care is available for management of high risks babies. Screening for GDMs should be performed in all pregnant women. Strict glycemic control in mother, planned pregnancy, proper antenatal care and strict monitoring in babies is required to prevent morbidity and mortality in infants of diabetic mother.

scholarly journals Clinico-social parameters of diabetes among patientsutilizing emergency medical services

2016 ◽  
Vol 5 (1) ◽  
pp. 219 ◽  
Author(s):  
Rajhans Prasad A. ◽  
Kulkarni Priya Y. ◽  
Kelkar Dhananjay S. ◽  
Jog Sameer A. ◽  
Ranade Gouri ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Tertiary Care ◽  
Hypoglycemic Agents ◽  
Medical Services ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Oral Hypoglycemic Agents ◽  
Major Purpose ◽  
Medical Background ◽  
Emergency Medical

Background: Diabetes mellitus (DM) is increasing in its potential in developing countries. Rise in diabetic patients calling emergency medical services (EMS) is expected. It calls for thorough assessment of patients with DM utilizing EMS. In the present study, was to assess magnitude of DM among patients utilizing EMS and its clinico-social parameters.Methods: It was hospital record based observational study of patients calling EMS delivered by a tertiary care hospital in Pune, Maharashtra, India during 1st January 2013 to 31st December 2014. Patients with incomplete records were excluded. A person with medical background was trained to extract required information from hospital records. Patients with previously diagnosed DM were considered those who were on diet, oral hypoglycemic agents or taking insulin therapy and newly diagnosed patients with DM were considered those with the value of glycemia on admission >200 mg/dl in first 24 hours. Data analysis was done using SPSS 15.0 software.Results: 45.8% (894/1951) were Patients with DM out of that 78.19% (699/894) were known to have DM while 28.81% (195/1951) were new cases of DM. 5.1% (100/1951) patients had uncontrolled DM. DM was significantly more in >60 years age group and in urban residents (p<0.001). Patients with DM were significantly more to have breathlessness, altered sensorium and dyspnoea as major purpose to call EMS (p<0.001, <0.001 and 0.045 respectively). Other co-morbidities in the form of Hypertension, other cardiovascular abnormalities, COPD, CKD and history of CVA were significantly more among Patients with DM (p<0.001, except for COPD, p=0.027).Conclusions: There was a high burden of patients with DM on EMS. EMS teams should be well trained to diagnose and manage such emergencies. Mass awareness of screening for DM and its proper management will help to decrease such burden.

scholarly journals The clinical evaluation of the infants of diabetic mothers (IDMS) born in a tertiary care hospital

2017 ◽  
Vol 4 (4) ◽  
pp. 1228
Author(s):  
Mohan Makwana ◽  
Jagdish Chand Dabi ◽  
Jai Prakash Soni ◽  
Ratan Lal Bhati ◽  
Harish Kumar Mourya ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Clinical Evaluation ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Diabetic Mother ◽  
Cardiac Anomaly ◽  
Care Hospital ◽  
Infants Of Diabetic Mothers ◽  
A Prospective Study ◽  
Diabetic Mothers

Background: The clinical evaluation of the infants of diabetic mothers (IDMs) born in a tertiary care hospital. It was a prospective study carried out at tertiary care hospital. Methods: 34 infants born of diabetic mother over the period from January 2012 to December 2012 were included in the study.Results: Infants born of the diabetic mothers who had suboptimal glycemic control during pregnancy had maximal functional and structural complication. Respiratory Distress was the commonest complication seen in 20 (58.82%) IDMs followed by Hypoglycemia in 15 (44.11%) and congenital anomalies in 16 (47.05%) cases. Septal hypertrophy was the most common cardiac anomaly observed in 6 (17.64%) PDA in 3 (8.82%), only 1 (2.94%) IDM had combination of ASD, Fallot variant and VSD is seen in 2 (5.88%) of infant.Conclusions: In current study, metabolic and structural complication are more common in the infant of the diabetic mother with poor glycemic control.

scholarly journals DRUG UTILIZATION STUDY ON ORAL HYPOGLYCEMIC AGENTS IN TYPE 2 DIABETIC PATIENTS OF TERTIARY CARE HOSPITAL

2020 ◽  
pp. 179-182
Author(s):  
SARAGADAM BHUVANESWARI
Keyword(s):  
Tertiary Care ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Oral Hypoglycemic Agents ◽  
Type 2 Diabetic Patients ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitor ◽  
Type 2 Diabetic

Objective: The main objective of the study is to determine the patient demographic characteristics, inspect prescription patterns of oral hypoglycemic agents, distribution of comorbid conditions in the outpatient department (OPD) of Visakha Institute of Medical Sciences (VIMS), Visakhapatnam. Method: A prospective observational study was conducted in patients with established type 2 diabetes mellitus (n=185) visiting OPD which were interviewed using a structured questionnaire during the period September– December 2019. Results: Majority of the type 2 diabetic patients in VIMS were treated with double drug therapy. The most commonly prescribed class of oral hypoglycemic agents were biguanides (metformin) followed by sulfonylureas (glimepiride), thiazolidinediones (pioglitazone), alpha-glucosidase inhibitor (voglibose), and dipeptidyl peptidase-4 inhibitor (vildagliptin).

Association of Rugae Pattern with Skeletal Malocclusion in Orthodontic Patients Visiting Tertiary Care Hospital

2020 ◽  
Author(s):  
Sarwat Memon
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Class Iii ◽  
Chi Square ◽  
Cross Sectional ◽  
Skeletal Malocclusion ◽  
Palatal Rugae ◽  
Significant Difference ◽  
Orthodontic Patients

Background: The palatal rugae are special constructions that are inalterable in their position and pattern during the lifestyles of an individual. This imparts them an exceptional role in the forensic dentistry and may play potential role in malocclusion identification. This study was aimed to see association of rugae pattern with sagittal skeletal malocclusion in orthodontic patients visiting tertiary care hospital. Methods: This cross-sectional examination was completed on pretreatment records (lateral Cephalometric radiographs and maxillary dental casts) of 384 subjects at the orthodontic department of Ziauddin Dental Hospital, Karachi. The study duration was from January to July 2019. The samples were sub-divided into three sagittal skeletal groups based on ANB angle proposed by Steiner’s on lateral Cephalometric radiographs (Class I with ANB angle between 0° to 4°; Class II: ANB angle greater than 5°; Class III: ANB angle less than 0°). The shapes of three most-anterior primary rugae were then evaluated bilaterally using Kapali et al., Classification. Chi Square test was applied to find association of rugae pattern among sagittal skeletal malocclusions groups. Results: Circular and curved rugae shapes were the most prevalent in all skeletal malocclusions. The primary palatal rugae pattern was seen to be significantly different among three skeletal malocclusion groups (p<0.05). The right and left sided palatal rugae pattern showed significant difference in all three skeletal malocclusion groups (p<0.05). Conclusion: The present study showed no specific palatal rugae pattern associated with sagittal skeletal malocclusion. Further studies on larger sample and use of modern 3D technologies to scan the maxillary casts are required for results that are more precise.

Real-World Clinical Effectiveness and Tolerability of Hydroxychloroquine 400 Mg in Uncontrolled Type 2 Diabetes Subjects who are not Willing to Initiate Insulin Therapy (HYQ-Real-World Study)

2019 ◽  
Vol 15 (6) ◽  
pp. 510-519 ◽  
Author(s):  
Amit Gupta
Keyword(s):  
Body Weight ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Real World ◽  
Antidiabetic Drugs ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Good Glycemic Control ◽  
Hs Crp ◽  
Change In Mean

Objective: The epidemic of T2DM is rising across the globe. Systemic inflammation plays a pivotal role in the pathogenesis and complications of T2DM. Combination of two or more oral hypoglycemic agents (OHA) is widely prescribed in patients with T2DM, however many patients have poor glycemic control despite receiving combination therapy. The new antidiabetic drugs are relatively costly or many patients have anxiety over the use of injectable insulin. The objective of this observational study was to investigate the effectiveness and tolerability of hydroxychloroquine (HCQ) in T2DM patients uncontrolled on multiple OHA and despite high sugar level not willing to initiate insulin therapy in a real-world clinical setting. Methods: A prospective, investigator-initiated, observational, single-centred study was conducted where 250 patients (18-65 years) with T2DM for more than 5 years, with uncontrolled glycemia despite on a combination of multiple OHA, HbA1c between ≥7% and <10.5%, FPG >130 mg/dL or PPG >180 mg/dL and BMI between >25 and <39 kg/m2, were prescribed hydroxychloroquine sulphate 400 mg once daily for 48 weeks. Percentage of drugs used at the baseline were as follows: metformin 2000 mg (100%), glimepiride 4 mg (100%), pioglitazone 30 mg (100%), sitagliptin 100 mg (100%), canagliflozin 300 mg (52.4%), empagliflozin 25 mg (22.8%), dapagliflozin 10 mg (17.6%) and voglibose 0.3 mg (62%). Mean change in HbA1c, blood glucose and hs-CRP at baseline, week 12, 24 and 48 were assessed using the paired t-test. Results: After 48 weeks of add-on treatment with HCQ, almost all SGLT-2 inhibitors were withdrawn; metformin dose was reduced to 1000 mg, glimepiride reduced to 1 mg and sitagliptin reduced to 50 mg OD. Patients continued to have good glycemic control. HbA1c was reduced from 8.83% to 6.44%. Reduction in FPG was 40.78% (baseline 177.30 mg/dL) and PPG was reduced by 58.95% (baseline 329.86 mg/dL). Change in mean body weight was -4.66 Kg. The reduction in glycemic parameters and mean body weight was significant (p < 0.0001). Hs-CRP was significantly reduced from 2.70±1.98 mg/L to 0.71±0.30 mg/L 9 (p < 0.0001). More reduction in glycemic parameters and body weight was observed among the patients with higher hs-CRP (> 3 mg/L) as compared to patients with baseline hs- CRP ≤ 3 mg/L. Most common adverse events reported with the drug therapy were GI irritation (3.6%) and hypoglycemia (2%). None of the patients required medical assistance for hypoglycemia. Conclusion: Add-on treatment of HCQ effectively improved glycemic control in T2DM patients uncontrolled on multiple antidiabetic drugs. By virtue of its antidiabetic and anti-inflammatory properties, it may emerge as a valuable therapeutic intervention for the patients with T2DM.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

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