DISCRIPTIVE STUDY OF MUCORMYCOSIS AND COVID 19 IN TERCIARY CARE CENTRE , THANJAVUR, INDIA.

Introduction: Corona virus disease 2019 (COVID-19) infection and its associated Bacterial and Fungal infections are more in number in this Second Wave. Among them the Mucormycosis is more in number in Post COVID-19 and during treatment of COVID-19 . Increased incidence related with usage of Steroids and Oxygen in the management of Covid19. Early Endoscopic Debridement and Inj. Amphotericin plays major role. Objectives: Study about the various Types of Mucormycosis, Iinvolvement of various Para Nasal Sinuses, Orbital involvement and its association with Steroid Usage, Oxygen Theraphy and Diabetes Mellitus and Effectiveness of Earlier Surgical Debridement. Study Design: Discriptive Study, Analytical Study. Materials And Methods: Study was conducted in Government Thanjavur Medical College, Tamil Nadu, India in MucorMycosis ward and ENT Department from May 2021 - July 2021. Total Number of patients are 241. . All cases are Evaluated, Processed, and Classied into various types. Rhino-Orbital type of cases are taken for Endoscopic Sinus Surgery followed by Amphotericin injection and discharged and followed regularly. Results: Mucormycosis of Nose and Paranasal Sinus involvement are more in numbers, followed by Rhino –Orbital Mucormycosis, and RhinoCerebral types. Pulmonary, Cutaneous and Intestinal MucorMycosis are very few only. Males are more affected. Most of the cases associated with Diabetes. Excellent Recovery and Reduced Recurrence in Earlier Surgical Debridement cases than later cases. Discussion: Sino Nasal type of Mucormycosis are more in number. Very early Diagnosis with Suspicious Clinical Symptoms and Signs and Supportive Evidence by Radiological investigation especially by MRI is very important. Earlier Surgery and Adequate Amphotericin coverage plays vital role. HPE and Fungal Culture is Essential. Glycemic Control is Mandatory for Good Results. Steroid use and Oxygen theraphy are not having Signicant relationin development of Mucor in our study. Regular weekly Follow-up, Endo- Clearance, Nasal Douching with Hypertonic Saline and Solvage theraphy with Tablet Posaconazole, and Diabetes Management Signicantly reduces the Recurrence. Conclusion: Earlier Diagnosis and Effective Surgical Debridement and Adequate Antifungal treatment and Good Glycemic Control is the Mainstay of Mucormycosis Mangement. Regular Follow-up is necessary for Reduction of Recurrence.

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MUCORMYCOSIS EFFECTS ON TURBINO SEPTAL COMPONENTS-OUR EXPERIENCE.

10.36106/ijsr/3731645 ◽

2021 ◽

pp. 56-59

Author(s):

B. Ganesh Kumar ◽

Gerald Parisutham ◽

Prince Peter Dhas ◽

K. Ramesh Babu

Keyword(s):

Fungal Infection ◽

Middle Turbinate ◽

Inferior Turbinate ◽

Septal Deviation ◽

Sinus Surgery ◽

Fungal Culture ◽

Posterior Half ◽

Uncontrolled Diabetes ◽

Number Of Patients

Introduction: Mucormycosis is a aggressive and most dangerous type of oppurtunistic Fungal infection. This disease starts commonly from Nose and Para nasal Sinuses. Many a times Middle Turbinate alone and some time both Middle and Inferior Turbinate are affected. This Fungi invades the Arteries more than the Veins and produce Thrombus and further reduces blood supply to concerned region and later on resulting in Necrosis of soft and Hard tissues , which was seen clinically as Black coloured “ Eschar”, the characteristic Endoscopic nding of Mucormycosis. Objectives: To Study about the effects Mucormycosis in the Turbinate, Septum and Floor of Nasal Cavity and to know the Effect of Septal Deviation in development of Sinusitis and further development of Mucormycosis. Study Design: Analytical Study, Retrospective Study. Materials And Method: This study was conducted in Govt Thanjavur Medical College, in Department of E.N.T and Head and Neck Surgery, from May 2021 to July 2021. Total Number of cases taken for study was 81 cases. Cases with Orbital and Pterygo Palatine Fossae and Infra Temporal Fossae involvement and Intra cranial involvement are excluded from the study. All cases are subjected to DNE and classied according to ndings. All cases under went Endoscopic Sinus Surgery and tissues sent for HPE and Fungal culture, followed by Systemic Amphotericin and Regular Post Operative Follow up for 4-6 weeks. Results: Males are involved more in numbers (48) than Females. Commonest age group involved are 21 to 40years. Strong Positive association present between Post Covid-19 status and Diabetes. Middle Turbinate involved in more number (34cases), followed by Inferior Turbinate (21 cases) and Septum (18 cases). Most common Anatomical factor present are High Septal Deviation (60 cases) and Osteo Meatal Complex (OMC) crowding (56 cases). Discussion: Mucormycosis is a Fulminant Fungal infection, which is common in Immunodecient individuals. Patients with Uncontrolled Diabetes Mellitus, on Prolonged Steroid therapy and Post COVID_19 status are very much prone for this infections. Angio invasion to Arteries and the resultant formation of Thrombi and Gangrene of involved areas is characteristic of Mucor. Black coloured dead tissue is called as ESCHAR. Depending upon the Arterial involvement Anterior half of Middle Turbinate or Posterior half of Middle Turbinate is involved, Posterior half of septum or entire septum is also involved. High septal deviation gives indirect disturbances to Osteo Meatal Complex functions resulting in development of Sinusitis and further chances of developing Mucormycosis. Early Surgical debridement of dead tissues followed by Inj.Amphotericin is very important in restriction of Disease spread. Proper management of predisposing factors and Postoperative Regular Weekly follow up and Endo Cleaning reduces the Recurrences. Conclusion:In our Study Males are affected more in numbers. 21-40 years are affected more. High Septal Deviation and OMC crowding are present in more number of patients which was responsible for the development of Acute Sinusitis. Post Covid status and Uncontrolled Diabetes was the commonest Predisposing factor the development of Mucormycosis. Middle Turbinate was involved more in numbers followed by Inferior Turbinate and Septum. Routine Examination followed by Nasal Septal Correction plays a major preventive role in development of sinusitis and further dreaded complications like Mucormycosis. Adequate Glycemic Control and Inj Amphotericin plays important role in the management of Mycormycosis. Regular Follow up with Endo Cleaning is reduces the chances of Recurrence.

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Abstract P050: Association Between Glycemic Control and Short-term Mortality Varies Across the Spectrum of Coronary Artery Disease

Circulation ◽

10.1161/circ.135.suppl_1.p050 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Sridharan Raghavan ◽

Wenhui G Liu ◽

P. Michael Ho ◽

Mary E Plomondon ◽

Anna E Baron ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Glycemic Control ◽

Diabetes Management ◽

Significant Risk ◽

Short Term ◽

Increased Risk ◽

Short Term Mortality ◽

Artery Disease

Background: Diabetes is a significant risk factor for cardiovascular disease, but optimal glycemic control strategies remain unclear. In particular, trials of intensive glycemic control have highlighted a tension between increased mortality risk and macrovascular benefits. In this study we aimed to assess whether the burden of coronary artery disease (CAD) modifies the association between glycemic control and short-term mortality. Methods: We studied veterans with diabetes who underwent elective cardiac catheterization between 2005 and 2013 in a retrospective analysis of data from the VA Clinical Assessment, Reporting, and Tracking (CART) Program. Primary exposures were time-varying HbA1c over two years of follow-up after index catheterization, categorized as <6%, 6-6.49%, 6.5-6.99%, 7-7.99%, 8-8.99%, and >=9%, and burden of CAD, categorized as no CAD, non-obstructive CAD, or obstructive CAD. Primary outcome was two-year all-cause mortality. A total of 17394 participants had, on average, five HbA1c measurements over two years of follow-up. We used multivariable Cox proportional hazards regression to estimate the association between HbA1c and mortality, adjusting for demographic and clinical covariates and CAD burden, and including a term for interaction between HbA1c and CAD burden. Results: In adjusted models with 6.5 ≤ HbA1c ≤ 6.99% as the reference category, HbA1c < 6% was associated with increased risk of mortality (HR 1.55 [1.25, 1.92]), whereas HbA1c categories above 7% were not. We observed significant interaction between glycemic control and CAD burden (interaction p=0.0005); the increased risk of short-term mortality at HbA1c < 6% was limited to individuals with non-obstructive and obstructive CAD (Figure 1). Conclusions: HbA1c below 6% was associated with increased risk of short-term mortality, but only in individuals with CAD. CAD burden may thus inform individualized diabetes management strategies, specifically treatment de-escalation in individuals with any angiographically-defined CAD.

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A study on symptom improvement and efϑicacy of formoterol plus budesonide in the asthma management in northern parts of Tamil Nadu

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v12i1.4177 ◽

2021 ◽

Vol 12 (1) ◽

pp. 742-748

Author(s):

Mani Dhandayuthapani ◽

Murugesh Shivashankar ◽

Uma K

Keyword(s):

Tamil Nadu ◽

Asthma Management ◽

Symptom Improvement ◽

Asthmatic Patients ◽

Severe Asthmatic ◽

Number Of Patients ◽

One Year ◽

Experienced Symptom

The purpose is to study the asthma symptom improvement and efficacy of formoterol (LABA) and Budesonide (ICS) combination in the asthma management in northern districts of Tamilnadu. It is a multicentric, non-comparative, questionnaire and random sampling study was conducted in 145 mild to severe asthmatic patients. They were in Formoterol plus budesonide combination inhalation drugs available in DPI and pMDI. Among the 145 asthmatic patients, 45 patients, 6 patients and 94 patients were in DPI, nebuliser and pMDI devices respectively. During drug initiation, The Asthmatics were in mild (27%), Moderate (57%) and Severe (16%) stages. After one year of follow-up, the number of patients in the mild is 84%, moderate 14% and severe 2%. Among 45 DPI Asthmatic patients, 29 patients, 15 patients and 1 patient have reported the handling the devices as easy, medium and hard respectively. On the other hand, 94 pMDI asthmatic patients, 38 patients, 48 patients and 8 patients have reported the handling of devices as easy, medium and hard respectively. The treatment resulted in 77 patients as good, 65 as satisfactory and 3 as same. After one year, all the 145 asthmatic patients adhered with the treatment and experienced symptom improvement with 53% patients as good, 45% patients as satisfactory and 2% patients as same. The treatment of formoterol and budesonide combination in the northern districts of Tamilnadu have effectively controlled the asthmatic symptoms and improved the quality of life in asthmatics. Moreover, the patient's adherence to the treatment is good in the northern parts of Tamilnadu.

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Clinical Features, Biochemical Profile, and Response to Standard Treatment in Lean, Normal-Weight, and Overweight/Obese Indian Type 2 Diabetes Patients

The Review of Diabetic Studies ◽

10.1900/rds.2021.17.68 ◽

2021 ◽

Vol 17 (2) ◽

pp. 68-74

Author(s):

Ahmad Faraz ◽

Hamid Ashraf ◽

Jamal Ahmad

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycemic Control ◽

Diabetes Management ◽

Normal Weight ◽

Cross Sectional ◽

Northern India

BACKGROUND: Much evidence is available on the relationship between type 2 diabetes mellitus (T2D) and obesity, but less on T2D in lean individuals. AIM: This study was conducted in 12,069 T2D patients from northern India to find out which clinical and biochemical features are related to lean, normal weight, and overweight/obese T2D patients. METHODS: The study was conducted at two endocrine clinics in northern India as a retrospective cross-sectional study. The records of all patients who attended these clinics from January 2018 to December 2019 were screened. After screening 13,400 patients, 12,069 were labelled as type 2 diabetes mellitus according to the criteria of the American Diabetes Association, 2020, and were included in the study. The patients were subdivided into the three groups by their body mass index (BMI): lean (BMI < 18), normal weight (BMI = 18-22.9), overweight/obese (BMI ≥ 23). The study evaluated how the three subgroups responded to standard diabetes management, including antidiabetic medication and lifestyle interventions. RESULTS: Of a total of 12,069 patients 327 (2.7%) were lean, 1,841 (15.2%) of normal weight, and 9,906 (82.1%) overweight/obese. Lean patients were younger, but had more severe episodes of hyperglycemia. All three subgroups experienced significant improvements in glycemic control during follow-up; HbA1c values were significantly lowered in the overweight/obese group during follow-up compared with baseline. CONCLUSIONS: While overweight/obese patients could benefit from the improvements in glycemic control achieved by lowering HbA1c, lean and normal-weight patients had more severe and difficult-to-control hyperglycemia.

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The influence of demographic, social-educational determinants and diabetes management on agreement between glucometer and logbook and its impact on glycemic control in patients with type 1 diabetes: a follow-up study

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-019-0443-9 ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Rebeca Cavalcante ◽

Alessandra S. M. Matheus ◽

Aneliza Zanette ◽

Bruna Braga ◽

Bruna Duarte ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Diabetes Management ◽

Follow Up Study

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Outcomes and experience of telemedicine in the management of diabetes mellitus during COVID-19 pandemic

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20211467 ◽

2021 ◽

Vol 8 (5) ◽

pp. 621

Author(s):

Shahjada Selim ◽

Hafiza Lona

Keyword(s):

Urban Areas ◽

Diabetes Management ◽

Cost Effective ◽

Barriers To Access ◽

Number Of Patients ◽

Study Population ◽

Male Patients ◽

Enhance Patient Care ◽

Video Calling

Background: Telemedicine has been promoted as an economical and effective way to enhance patient care, but the experience and its outcome in the diabetes management are not well understood. Thus, this study aims to assess the experiences and outcomes of diabetes management by tele-consultation.Methods: A comparative study included 958 patients with T2DM attending the clinics for diabetes management. Of them 467 (48.75%) patients consulted the endocrinologists through telemedicine and 491 (51.25%) patients attended the clinics physically during the study period.Results: The mean age was 58.5±4.3 years in telemedicine group and 55.8±5.1 years in the physically attending group. Male patients comprised about half [46.03% in telemedicine group; 51.32% in physically attending group)] of the study population and around half [55.46% in telemedicine, 44.54% in physically attending group] of them came from urban areas. The majority of patients were on MNT along with 2 or more OADs [42.18% versus 40.53%; p 0.90]. Among telemedicine users, 59.74% visited the clinic as regular follow up visits and the highest number of patients [49.67% (232)] used video calling, apps, WhatsApp. About 62.21% (291) of the telemedicine users did not face any difficulties in communication. Two-fifths of the participants (40.02%) required assistance for communication; 74.09% of the patients could understand the advices and instructions of the physicians and 76.45% found it cost effective and more than four-fifths of them admitted that telemedicine could save time. The majority of patients with T2DM (91.43%) were satisfied with telemedicine service.Conclusions: For most patients with T2DM, telemedicine can be as good, or even better than, in-person care, especially for those who face geographical and time barriers to access during COVID-19 pandemic and may be afterword. population.

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Improved Glycemic Control With a Digital Health Intervention in Adults With Type 2 Diabetes: Retrospective Study (Preprint)

10.2196/preprints.28033 ◽

2021 ◽

Author(s):

Gretchen Zimmermann ◽

Aarathi Venkatesan ◽

Kelly Rawlings ◽

Michael Scahill

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Diabetes Management ◽

Digital Health ◽

Management Program ◽

Health Intervention ◽

Diabetes Management Program ◽

Program Engagement

BACKGROUND Traditional lifestyle interventions have shown limited success in improving diabetes related outcomes. Digital interventions with continuously available support and personalized educational content may offer unique advantages for self-management and glycemic control. OBJECTIVE In the present study, we evaluate changes in glycemic control among participants with type 2 diabetes who enrolled in a digital diabetes management program. METHODS The study employed a single-arm, retrospective design. A total of 950 participants with a HbA1c baseline value of at least 7.0% enrolled in the Vida Health Diabetes Management Program. The intervention included one-to-one remote sessions with a Vida provider and structured lessons and tools related to diabetes management. Hemoglobin A1c (HbA1c) was the primary outcome measure. A total of 258 (27.2%) participants had a follow-up HbA1c completed at least 90 days from program start. Paired t-tests were utilized to evaluate changes in HbA1c between baseline and follow-up. Additionally, a cluster-robust multiple regression analysis was employed to evaluate the relationship between high and low program engagement and HbA1c change. A repeated measures ANOVA was used to evaluate difference in HbA1c as a function of measurement period (ie, pre-Vida enrollment, baseline, and post-enrollment follow-up). RESULTS We observed a significant reduction in HbA1c of -0.81 points between baseline (M = 8.68, SD = 1.7) and follow-up (M = 7.88, SD = 1.46), t(257) = 7.71, P = .00). Among participants considered high-risk (baseline HbA1c >= 8), there was an average reduction of -1.44 points between baseline (M = 9.73, SD = 1.68) and follow-up (M = 8.29, SD = 1.64), t(139) = 9.14, P = .00). Additionally, average follow-up HbA1c (M = 7.82, SD = 1.41) was significantly lower than pre-enrollment HbA1c (M = 8.12, SD = 1.46), F(2, 210) = 22.90, P = .00. There was also significant effect of engagement on HbA1c change, β = -.60, P = .00, such that high engagement was associated with a greater decrease in HbA1c (M = -1.02, SD = 1.60) compared to low-engagement, (M = -.61, SD = 1.72). CONCLUSIONS The present study revealed clinically meaningful improvements in glycemic control among participants enrolled in a digital diabetes management intervention. Higher program engagement was associated with greater improvements in HbA1c. The findings of the present study suggest that digital health intervention may represent an accessible, scalable, and effective solution to diabetes management and improved HbA1c. The study was limited by a non-randomized, observational design and limited post-enrollment follow-up data.

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