A Study of Polypharmacy in Patients with Co-Existing Diabetes Mellitus Type II and Hypertension in a Tertiary Care Center

Introduction Polypharmacy is most commonly defined as the use of five or more medications daily by an individual. In India, the prevalence of polypharmacy varies from 5.82 % to 93.14% in different states. Concerns about polypharmacy include increased adverse drug reactions, drug interactions, prescribing cascade, and higher costs. Methods It is a non-interventional, observational, descriptive study carried out in 240 patients attending the medicine outpatient department of a tertiary care hospital, over a one-and-a-half-year duration. Results The study was carried out in 240 patients whose mean age was 53.97 ± 7.62 years, out of which 52.5% were male and 47.5% were female. 62% of the study population were from low socioeconomic status and 38 % were from the middle class. The mean duration in years for hypertension and diabetes was 7.1± 4.3years and 7.94+ 4.66 years respectively. Apart from various antihypertensive and antidiabetic medicines prescribed the study population was also prescribed Vitamins (51.6%), Hypolipidemics (42.5%), Miscellaneous (41.6%), Antiplatelets (40%), H2 blockers/PPI (35.8%), and Antibiotics (22.5%). Polypharmacy (5 or more than 5 drugs) was seen in 33.75% of the study population. Conclusion Polypharmacy has been found to be integral in patients suffering from hypertension with coexisting diabetes mellitus and other comorbidities. It is essential to practice judicious prescribing especially in patients with multiple conditions.

EVALUATION OF THE ACCURACY OF ANTIDIDIABETIC AGENTS IN PATIENTS WITH DIABETES MELLITUS TYPE II IN THE INPATIENT INSTALLATION OF ONE OF THE PRIVATE AREA HOSPITALS EAST BEKASI 2020

Introduction: The selection of appropriate drugs in patients with diabetes mellitus can control the blood sugar levels of a patient. When blood sugar levels can be controlled, then the incidence of complications can be avoided and the numbers of mortality and morbidity in diabetes mellitus will be decreased. The goal of this study is to determine the profile of the use of oral antidiabetic, insulin, or a combination, as well as to assess rationality the use of antidiabetic agents in patients with diabetes mellitus type 2 (DMT2) in the inpatient installation of one of the private hospitals in Bekasi 2020. Method: The research design used was an observational, descriptive, retrospective approach. Data derived from the medical records of DMT2 patients treated as inpatients at a private hospital in Bekasi Timur 2020. Results: Results for profile use of the drug antidiabetic agents most widely used in sequence, i.e., drug combinations of insulin with insulin, oral with oral, and insulin with oral. The evaluation of the accuracy of the use of the drug is set based on four parameters, namely the proper indication of 100%, the right drug of 58,33%, the right of the patient to 100%, and the right dose of 97,62%. Conclusion: It can be concluded that the evaluation of the use of the drug in patients with DMT2 still needs to be done so that the numbers of mortality and morbidity in patients with diabetes mellitus decrease.

Fixed, Dilated, and Conversing—Unreactive Pupil With Preserved Consciousness Indicating Acutely Rising Intracranial Pressure due to Traumatic Intraparenchymal Contusions: Case Report and Review of the Literature

Patients with fixed and dilated pupils (FDPs) due to rising intracranial pressure (ICP) typically experience a deterioration in consciousness. We describe an exceptional case of a patient with bifrontal contusions who developed worsening edema and a unilaterally FDP while maintaining consciousness and the ability to communicate. A 58-year-old man with history of hypertension and diabetes mellitus type II presented after being assaulted, with bifrontal contusions and right frontal intraparenchymal hemorrhage. On hospital day 8, his right pupil became fixed (NPi 0) and dilated (4.8 mm). The patient was drowsy, arousable to tactile stimuli, answering questions, oriented to place and time, following commands on his right side, maintaining Glasgow Coma Scale of 14 (E4, V5, M6). He described complete loss of vision and could not identify objects or count fingers. His gaze was dysconjugate with impaired vertical excursion and inability to fully abduct to the right side. Corneal reflexes were intact bilaterally. Hypertonic saline and mannitol produced no improvement in his pupillary exam. Head computed tomography showed worsening midline shift and interval increase in subfalcine herniation related to increased peri-hematoma edema. We performed an emergent right-sided decompressive hemicraniectomy with durotomy and duraplasty. His pupil became reactive 5 hours after surgery. While FDP without deterioration of consciousness has been described due to traumatic subdural and epidural hematomas, we report this unusual constellation as a sign of rising ICP and impeding herniation due to intraparenchymal contusions, highlighting that any pupillary change warrants prompt work-up and intervention.

The association of cytochrome 7A1 and ATP-binding cassette G8 genotypes with type 2 diabetes among Jordanian patients

Objectives Increased cholesterol levels were found to be associated with diabetes mellitus type II (DM2). The cholesterol is metabolized by cytochrome 7A1 (CYP7A1) and transported in the intestine by ATP-binding cassette G8 (ABCG8). Genetic variants in CYP7A1 and ABCG8 genes can affect the cholesterol levels. The aim of this study is to compare the frequency of CYP7A1 rs3808607 and ABCG8 rs11887534 and rs4148217 genotypes between healthy and DM2 subjects from Jordanian population. Methods A total of 117 DM2 patients and 100 healthy controls, of Jordanian Arabic origin, were genotyped for CYP7A1 rs3808607 and ABCG8 rs11887534 and rs4148217 genetic variants using polymerase chain reaction (PCR) followed by restriction fragment length polymorphism technique. Results The study showed that homozygosity of rs3808607 (A-204C) genotype in CYP7A1 was significantly higher in DM2 patients (ANOVA, p<0.05) with an odd ratio of 2.66, but rs11887534 (G55C) and rs4148217 (C1199A) genetic polymorphisms in ABCG8 were found in comparable frequencies in both healthy and DM2 subjects. Conclusions The results of this study indicate that CYP7A1 rs3808607 genetic polymorphism is associated with DM2. Further clinical studies are required to confirm this finding among DM2 patients of Jordanian origin.

To Assess the Prevalence of Cognitive Impairment in Type II Diabetes Mellitus: An Observational Study

Introduction: Diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia that affects various body systems. Elevated blood glucose levels cause brain malfunction, sorbitol which damages blood vessels, and degeneration of the nerves that can lead to dementia or cognitive impairment. Cognitive impairment can result in nonadherence of patients to diabetes treatment, such as medication, diet and exercise. Purpose: The purpose of this study was to assess the prevalence of cognitive impairment in type II diabetes mellitus. Methodology: 50 participants of age group 30 - 60 years, both male and female were included in this study. Cognitive impairment was assessed with the English version of the Montreal Cognitive Assessment (MoCA) tool. The MoCA scoring according to Dementia and Driving Safety: A clinical guideline, Version 3, 2014. Result: Among the 50 patients who were assessed, 24 (48%) were cognitively impaired. 20 (40%) of the subjects were age group of 51-60 years, and males participants 11(22%) outnumbered females 9 (18%). The majority of patients (40%) had diabetes type II for < 2 years. Conclusion: There was strong correlation found between Type II DM and cognitive impairment. Key words: Prevalence, Cognitive impairment, Diabetes mellitus Type II, Montreal Cognitive assessment (MoCA).

The level of peripheral myelin protein and vitamin D in blood serum among patients suffering diabetes mellitus type II and hearing impairment

Topicality: While diabetes mellitus is often observed hearing impairment, including sensorineural hearing loss (SNHL). On the other hand, metabolic changes, disorders of the hemostasis system, lack of vitamins and minerals can lead to the development of SNHL. Aim: to examine the level of peripheral myelin protein (PMP) and vitamin D in patients with diabetes mellitus type II with hearing impairment. Materials and methods: Were examined 43 patients with diabetes mellitus type II, who, according to subjective audiometry, revealed SNHL of the I-II degree according to the International Classification. We divided patients into two groups: group 1st included 22 patients without complications, group 2nd – 21 patients with complications of diabetes mellitus and sudden changes in blood sugar levels in the anamnesis. As a comparison group were examined 15 patients with SNP without high blood sugar. The control group consisted of 15 healthy individuals. Results and discussion: When analyzing the results of the study, it was found that in patients with diabetes mellitus and SNHL (groups 1st and 2nd) there was a significant increase of the level of PMP comparing with the control and the comparison group. Moreover, in group 2nd (with complicated diabetes mellitus) the increase of the level of PMP in the blood serum was reliably more significant than in group 1st. In patients with diabetes mellitus group 1st the level of PMP was from 2.3 to 9.8 ng/ml (average value of 7.2±0.5 ng/ml), in group 2 PMP had a level of 8.5 to 37.2 ng/ml (average value of 24.3±1.7 ng/ml). This is significantly (P<0.01) more than in the control group. Elevated levels of PMP in patients with diabetes mellitus may indicate the processes of demyelination, damage of neural structures, which are more pronounced in the complicated course of diabetes, which, obviously, have some significance in the development of SNHL in diabetes mellitus type II. As for the content of vitamin D, certain reductions in its level were observed in all groups of examined patients with SNHL. However, in patients with SNHL without diabetes mellitus, this decrease was not differing significantly from the control values. But in both groups of patients with SNHL on the background of diabetes mellitus, this difference was significant, especially in group 2nd. Decreasing the level of vitamin D in blood serum, more expressed at the complicated course of diabetes mellitus in patients with SNHL testifies of a certain role of this vitamin in deepening of metabolic disturbances at such patients, and consequently – faster and more expressed development of complications. While the analysis of the distribution of patients with deviation of PMP level and vitamin D, it was found that in groups of patients with diabetes, especially in group 2nd with a complicated course, in blood serum there was significantly more often than in the comparison group a lack of vitamin B and increasing of PMP. Moreover, in group 2nd deviations from the norm in the level of PMP were also significantly more often than in group 1st. In the group of SNHL without diabetes mellitus (group 3rd) vitamin D deficiency was observed only in 13.3% of cases. A deficiency of vitamin D in group 2nd occurred significantly more often not only comparing with the control and comparison group, but also relatively to group 1st, with a milder course of diabetes. Thus, in group 2nd in patients with diabetes and SNHL, the lack of vitamin D occurred in 26.6% and its deficiency – in 73.3% of cases. In general, a decrease of vitamin D levels occurred in 100% of patients in group 2nd and in 80% in group 1st, while in group 3rd – 30%. Thus, researches have shown that in all studied groups of patients with SNHL on the background of diabetes mellitus type II there are deviations from the norm in the content of PMP and vitamin D in the blood serum. Moreover, the most pronounced disorders were found in the examined, who also had a complicated course of diabetes mellitus type II, the episodes of hypoglycemia in the anamnesis. This indicates the possible role of a complicated course of diabetes mellitus type II on the development of disorders (including demyelinating processes) in the neural structures of the auditory analyzer. Conclusions: In patients with diabetes mellitus type II and sensorineural hearing loss there is a significant increase in the content of PMP in blood serum, more pronounced in complicated diabetes, which may indicate the processes of demyelination and damage of neural structures. In patients with sensorineural hearing loss on the background of diabetes mellitus type II there is a significant (P <0.01) reduced levels of vitamin D compared with the control, the severity of reducing indicates its lack and even deficiency, especially occurred on the background of complications of diabetes mellitus. Patients with diabetes mellitus type II with sensorineural hearing loss, who have a complicated course, polyneuropathy, episodes of a severe changes of sugar levels in anamnesis, there is a significant (P<0.05) more pronounced increasing levels of PMP and decreasing of vitamin D than in patients with milder course of disease. The obtained data may indicate an important role of demyelinating processes and vitamin D deficiency in the development of sensorineural hearing impairment among patients with diabetes mellitus type 2.

Late Presentation of Neglected Autoimmune Polyglandular Syndrome

A 60-year-old male patient, weighing 40 kg, having a BMI of 13, who was also a known case of Diabetes Mellitus Type II was shifted to the Orthopaedic Ward last month due to a fall, which led him to develop an intertrochanteric fracture in the femur. While the treatment of the patient was in an ongoing status for his fracture, his Diabetes was seen to be poorly controlled, with his blood glucose levels being constantly evaluated to be in a state of severe hypoglycaemia to slightly increased levels of blood glucose. On examination, the patient showed clear signs of being malnourished. He was in a bad and dishevelled state, he had creases on the palmar aspects of his hands and hyperpigmentation on his buccal mucosa. Furthermore, his lab reports revealed abnormalities in nearly every lab test ordered. Not only did he have elevated ACTH levels, but there was also a failure of Cortisol stimulation. His DEXA Scan showed that he was predisposed to develop severe osteoporosis and his malnourished condition was supportive of promoting that condition even more. The patient was diagnosed to be suffering from Autoimmune Polyglandular Syndrome, Type II. This is a rare condition of one of its kind where there is a pre-existence of autoimmune adrenal insufficiency along with either autoimmune thyroid disease or autoimmune diabetes mellitus. Since this condition is rare, it tends to often get overlooked upon diagnosis, leading to misdiagnosis because almost all of the presenting features or the symptoms of the prevalent endocrinological disorders present in this condition mimic either hypothyroidism, or diabetes, or adrenal insufficiency alone, and thus lead to further consequences when the condition does not resolve despite persistent treatment, such as the case in this patient. This paper reviews the background of the patient and the causes that possibly could have made him reach this advanced stage of the disease. The paper also reflects upon the disease, Autoimmune Polyglandular Syndrome Type II, as a whole and elaborates on the symptoms and signs which the patient tens to confuse with other endocrinological diseases. Lastly, this paper shall also review the appropriate management plan for the patient to ease his symptoms and accelerate his recovery process.