Beyond the Spectrum of Disease
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:1] [Pages No:51 - 51]
Keywords: COVID-19, Economic, Social
DOI: 10.5005/jp-journals-10070-7034 | Open Access | How to cite |
Early Initiation of Insulin Therapy in Newly Diagnosed Patients with Type 2 Diabetes and Exploring the Legacy Effect—A Single-arm Prospective Observational Study
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:3] [Pages No:52 - 54]
Keywords: Early insulin initiation, Intensive glycemic control, Metabolic memory
DOI: 10.5005/jp-journals-10070-7031 | Open Access | How to cite |
Background: Early insulin has the potential to not only provide glycemic benefit and β-cell salvage but also reduce microvascular and macrovascular complications. Several reports have shown that the short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetes mellitus (T2DM) patients with mild to moderate hyperglycemia. Thus, we hypothesize that a 2-month intensive glycemic control using glargine in newly diagnosed T2DM patients will provide glycemic and legacy benefit. Objective: To assess whether 2-month treatment with insulin in newly diagnosed T2DM patients (HbA1c >9%) brings about long-term glycemic control even after stopping insulin after 2 months and also reduction in requirement of other antidiabetic agents. Method: A prospective single-arm observational study included subjects initiated on insulin, which was stopped after 2 months and lifestyle modification was advised along with oral antidiabetes drugs thereafter. For the initial 2 months, the patients were reviewed weekly and fasting capillary blood glucose was aimed to be maintained between 80 and 130 mg/dL. The included subjects were followed up every 3 months, for a period of 1 year for glycemic parameters. Results: The study included patients who demonstrated intensive glycemic control with early insulin use. These patients who were followed up over a year in interval of 3 months demonstrated a steep reduction in glycemic indices with time. A steady reduction in mean antidiabetic medications in the subjects was seen over the time period. Conclusion: Early insulin initiation may result in long-term benefits. Optimum glycemic control in the early stage of diabetes using insulin provides legacy effects and good metabolic memory.
Estimation of Disease Activity in Rheumatoid Arthritis: A Correlation Study between Clinical, Inflammatory Markers and Power Doppler Ultrasonography
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:2] [Pages No:55 - 56]
Keywords: CRP, ESR, Rheumatoid arthritis, USG Power Doppler
DOI: 10.5005/jp-journals-10070-7038 | Open Access | How to cite |
Objective: To correlate between clinical, inflammatory markers and power Doppler (PD) ultrasonography (USG) to assess the disease activity in rheumatoid arthritis (RA) patients. Methods: Sixty consecutive patients with RA were included. Demographic and clinical data, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) were recorded. All patients underwent an USG PD by an experienced ultrasonologist. USG joint effusion, synovitis, and PD signal were graded from 1 to 3 in a small joint of both hands (metacarpophalangeal, proximal interphalangeal, and wrist). Joint count and joint index for effusion, synovitis, and PD signal were recorded for a total of 22 joints. Result: Among 60 patients, 41 were female and 19 were male. The correlation coefficient between ESR with tender joint, swollen joint, USG synovitis, and USG hyperemia was 0.13, 0.13, 0.58, and 0.33, respectively. The correlation coefficient between CRP with tender joint, swollen joint, USG synovitis, and USG hyperemia was 0.46, 0.07, 0.36, and 0.27, respectively. Conclusion: USG PD is an important tool along with clinical assessment and inflammatory marker to assess the disease activity in RA patients.
A Study on the Clinico-etiological Profile of Cirrhosis of the Liver and Prognostic Value of the MELD Score on Short-term Survival
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:3] [Pages No:57 - 59]
Keywords: Autoimmune hepatitis, Chronic liver disease, Cirrhosis of the liver, MELD score ,Wilson's disease
DOI: 10.5005/jp-journals-10070-7044 | Open Access | How to cite |
Introduction: Although there are a large number of patients with chronic liver disease (CLD) in India, the clinico-etiological profile of cirrhosis of the liver and exact prognostic value of the model for end-stage liver disease (MELD) score on short-term survival is scarce, and it needs further evaluation. Aims: To study the etiology of cirrhosis of the liver; observe the clinical manifestations at the time of presentation and the subsequent development of complications in patients having cirrhosis; and calculate the MELD score and assess its usefulness as a prognostic marker in short-term survival of patients with cirrhosis. Methodology: A prospective longitudinal study was performed on 50 patients who presented to our institution with CLD. Patients were subjected to clinical examination and laboratory investigations. The severity of the liver disease was assessed by the MELD score. Results: Alcohol was the most common etiological factor for cirrhosis in 60% patients followed by cryptogenic in 22%, autoimmune hepatitis in 6%, Wilson's disease in 6%, alcohol with hepatitis B in 4%, and hepatitis C in 2% patients. Patients with a MELD score of 40 or more have 0% 3-month survival rate. The 3-month survival rate in patients having a MELD score of 30 to 39 is 50%, followed by 75% in patients having a MELD score of 20 to 29. Patients with a MELD score ≤9 have 100% 3-month survival rate. Conclusion: Alcohol was the most common etiological factor for cirrhosis in our study. Three-month survival rates were inversely related to the MELD score.
A Case of Rectal Malignancy Presenting with Paraneoplastic Myopathy and Hyperpigmentation of Skin: An Interesting Case Report
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:3] [Pages No:60 - 62]
Keywords: Colorectal cancer, Paraneoplastic syndrome, Proximal myopathy, Skin hyperpigmentation
DOI: 10.5005/jp-journals-10070-7030 | Open Access | How to cite |
Colorectal cancer manifests usually with a change in bowel habit or a bleeding per rectum. Much less commonly, colorectal cancer may present as part of paraneoplastic syndrome. Paraneoplastic syndromes may help in the timely diagnosis of the case. The authors describe a case report of a 60-year-old woman with a hyperpigmented skin rash and proximal muscle weakness who was subsequently diagnosed with rectal carcinoma in the setting of progressive muscle weakness.
Optimizing Noncardiac Prescription in a Cardiac Patient
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:7] [Pages No:63 - 69]
Keywords: Comorbidities, Drug interactions, Efficacy, Safety
DOI: 10.5005/jp-journals-10070-7032 | Open Access | How to cite |
Comorbidities are present in greater than 75% of cardiac patients. While choosing therapy for such patients it is important to keep in mind the complex interactions of various drugs in the background of comorbidities. Safety should be the prime concern though the efficacy of the drugs should not be compromised too much. This article touches upon the therapy of cardiac patients with anemia, diabetes mellitus, kidney disease, thyroid disorders, sleep disorders, psychiatric illness, or malignancies. Drug class, dosage, drug route, or contraindications have been highlighted for optimal management.
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:2] [Pages No:70 - 71]
Keywords: Biomarker, COVID-19, Cytokines
DOI: 10.5005/jp-journals-10070-7037 | Open Access | How to cite |
Cytokine storm is said to occur when increased levels of cytokines are disproportionately produced, with systemic effect and collateral damage to vital organs. It can be caused by both intrinsic (autoimmune) or extrinsic (COVID-19) diseases. In the absence of pathogens, cytokine storm can occur due to immune hyperactivation as a result of inappropriate triggering. Interleukin-6, tumor necrosis factor α, and interleukin-18 are cytokines of clinical importance in cytokine storm. Interleukin-18, a biomarker of severity, correlates with hyperferritinemia and disease flare. The underlying condition should be detected and treatment should be individualized.
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:2] [Pages No:72 - 73]
DOI: 10.5005/jp-journals-10070-7035 | Open Access | How to cite |
A Review of Endocrine Orchestra in the Times of COVID Pandemic
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:2] [Pages No:74 - 75]
DOI: 10.5005/jp-journals-10070-7036 | Open Access | How to cite |
In Response to Management of Hyperglycemia in Inhospital COVID-19 Patients: A Review
[Year:2020] [Month:September-December] [Volume:7] [Number:3] [Pages:1] [Pages No:76 - 76]
DOI: 10.5005/jp-journals-10070-7033 | Open Access | How to cite |