Comparison of IDRS and ADA Diabetes Risk Assessment Tools Reveals Different Rsk Score in Same Population: A Cross-Sectional Analysis in a Tertiary Care Hospital

Background: To identify individuals at high risk of developing type2 diabetes (T2DM), use of a validated risk-assessment tool is currently recommended. Nevertheless, recent studies have shown that risk scores that are developed in the same country can lead to different results of an individual. The Objective of study was to reveal whether two different risk-assessment tools predict similar or dissimilar high-risk score in same population. Method: This cross-sectional analytical study was carried upon 336 non-diabetic adults visiting the outpatient department (OPD) of Medicine, MARKS Medical College & Hospital, Bangladesh from October 2018 to March 2019. Woman having previous history of Gestational Diabetes Mellitus (GDM) were also included. Both the Indian Diabetes risk Score (IDRS) and the American Diabetes (ADA) Risk Score questionnaire were used to collect the data on demographic and clinical characteristics, different risk factors of an individual subject, and to calculate predicted risk score for developing T2DM. Results: Among 336 subjects, 53.6% were female. The mean (±SD) age of the study subjects was 38.25±1.12 years. The average IDRS predicted risk score of developing T2DM was more in female subjects than male [p<0.05]. Whereas the ADA predicted increased risk score of developing type 2 diabetes was more in male subjects than female (p<0.05). IDRS categorized 37.2 % of individuals at high risk for developing diabetes; [p=0.10], while the ADA risk tool categorized 20.2% subjects in high risk group; [p<0.001]. Conclusions: The results indicate that risk for developing type 2 diabetes varies considerably according to the scoring system used. To adequately prevent T2DM, risk scoring systems must be validated for each population considered.

Periodontal Health Status and its Impact on the Quality of Life among Diabetics attending Medical and Dental Out Patient Departments of a Tertiary Care Centre of Nepal

Background: Diabetics are more prone to periodontal diseases leading to poor oral function affecting their quality of life. The objective of the study was to assess the impact of periodontal health on the quality of life among diabetics using the short version of the Oral Health Impact Profile (OHIP -14). Methods: It was a descriptive cross-sectional study. Data was collected using translated and validated Nepalese version of OHIP-14 questionnaire and clinical examination for periodontal status (Community Periodontal Index and Loss of Attachment index) was done using mouth mirror and World Health Organization probe under natural light. Data was entered and analyzed using SPSS version 11.5. Mann- Whitney U test and Kruskal-Wallis tests were used to compare OHIP-14 scores between genders and periodontal status respectively. Statistical significance was established at p<0.05. Results: One hundred and forty-five subjects with confirmed diabetes participated in the study. Overall, 41% were male participants were as 59% were females. Majority of the participants had calculus with CPI score 1 (n=131, 90.3%) and another majority had loss of attachment 3-5 mm with LOA score 1 (n=55, 37.9%). There was no significant difference in mean scores between two genders (p=0.231). The OHIP scores among participants with highest CPI and LOA scores had statistically significant difference (p=0.011 and p=0.006 respectively). Conclusions: Periodontal status was poor among diabetics with significant impact on their oral health related quality of life. Glycemic control along with periodontal maintenance is required to enhance quality of life among such patients. This might be possible with comprehensive medical approach for diabetic patients.

Prevalence of Vitamin B12 Deficiency In Patients With Type II Diabetes Mellitus On Metformin

Background: Diabetes Mellitus is one of the most encountered disease in our out patient department and metformin is the first drug of choice to treat Diabetes mellitus. As metformin is one of the cheapest drug, many patients use these drug for long period of time with consultation and without consultations with doctors. Patients under long term metformin use are not aware of Vitamin B12 deficiency and its associated signs and symptoms. In Nepal due to poverty, lack of education and awareness on diabetes mellitus we doctors find much difficult to explain patients on the consequences of diseases. So I decided to do this study which could be much easier to explain patients on effect of metformin of vitamin B12 levels and the consequences life style modifications and supplement of Vitamin B12 to the patients. Methods: This is a Cross-Sectional Study done in the patients with Type 2 diabetes were selected based on inclusion and exclusion criteria. Basic biochemical investigation were sent the lab of the National academy of medical science. Serum B12 assay were done. Vitamin B12 deficiency is defined as values <150pg/ml. Association between vitamin B12 deficiency with duration of metformin therapy, duration of diabetes, with age, sex were done. Results: The mean vitamin B12 level is low as the duration of metformin treatment increases. The sex, age relation with development of vitamin B12 deficiency was not significant. In my study out of 210 patients 107 patients were having severe vitamin B12 deficiency level and 63 patients had a borderline Vitamin B12 deficiency level which shows that the deficiency increases as per longer use of metformin, which shows prevalence of 50.95%. Conclusions: Vitamin B12 deficiency occurs in type 2 diabetes mellitus patients treated with long term metformin. The duration of metformin therapy significantly affects the development of vitamin B12 deficiency. As a treating physician we always need to explain our patients about the side effect of metformin and regular follow up and investigations must be done to early diagnosis of vitamin B12 deficiency to improve the quality of life.

Utility of hsCRP as an add onn to Lipid Profile for Cardiovascular Risk Stratification in Adults with Type 2 Diabetes Mellitus

Introduction: Dyslipidemia is common in Diabetes and is predictive of cardiovascular events. But, myocardial infarction in the setting of normal lipids levels is not uncommon. hsCRP has been studied elaborately and is found to be a stronger predictor of heart attack and stroke than LDL cholesterol. We conducted this study to observe the level of hsCRP in adults with Type 2 Diabetes and its association with lipid parameters. Methods: It is a cross sectional study including 168 Type 2 Diabetes patients conducted in department of biochemistry and internal medicine at B.P. Koirala Institute of Health Sciences, Dharan, Nepal for duration of one year. The ethical clearance was taken from the institutional ethical review board and patients were enrolled after taking informed consent. Venous blood was collected and serum lipid profile and hsCRP were measured. Results: The means±SD for age, TC, HDL-C, LDL-C and HDL/LDL ratio of patients were 52.2±11.9 years, 182.9±41.9 mg/dl, 41.6±8 mg/dl, 94.9±20 mg/dl, and 0.47±0.18 respectively. The medians of TG and hsCRP were 152.5 (109, 195) mg/dl and 1.9 (0.9, 2.8) mg/dl respectively. hs-CRP was found to have significant positive correlation with TC (r=0.286), LDL (r=0.652) and TG (r=0.299) and significant negative correlation with HDL (r= -0.614) and HDL/LDL ratio (r= -0.646). Only 33% of patients were categorised as having increased CVS risk according to high LDL levels but altogether 75% of patients had increased CVS risk according to hsCRP levels. Conclusion: hsCRP can be considered as an add on to lipid profile while predicting CVS complications in patients with Type 2 Diabetes Mellitus in our population.

Osteoporosis, need for paradigm sit in Nepal health policy

No abstract available.

Hypogonadotropic-hypogonadism (Kallman Syndrome) in Young Adult

Background: Kallmann syndrome (KS) is a rare disorder first described in 1856 and later studied by Kallmann in 1944. It is now designated as olfactogenital dysplasia with an association between agenesis of the olfactory bulbs and hypogonadism. The prevalence of KS is still unknown. The reported incidence is 1 in 8000 to 1 in 10 000 in men and rare in women. More than 24 genes are underlying KS that have been identified. Mutations in these genes are thought to interfere with the expression of cell markers that guide migrating neurons, leading to failed migration of GnRH neurons and olfactory neurons to the forebrain during fetal development. The main clinical characteristics of KS include hypogonadotropic hypogonadism and anosmia or hyposmia. Less common phenotypes include cardiovascular anomalies, unilateral renal agenesis, cleft palate and cleft lip, cryptorchidism and osteoporosis. Magnetic resonance imaging (MRI) can show abnormalities of the olfactory system and other forebrain structures. Other exceptions may be discovered using MRI because of its high resolution and multiplanar capabilities, such as pituitary abnormalities.

Perceived self-efficacy and self-care practices among diabetic patients in a Tertiary Hospital, Nepal

Background: Diabetes Mellitus (DM) is a major public health problem worldwide and Nepal is not an exception. Complications of DM are in rise which results in major disabilities and poor quality of life. But evidences show that adoption of self-care practices can prevent those complications leading a healthy and quality life. Self-care practice is closely related to self-efficacy. Thus, present study aimed to assess perceived self-efficacy and self-care practices and to examine relationship between perceived self-efficacy and self-care practice of patients with Diabetes. Methods: This analytical cross-sectional study conducted in Patan Hospital among 100 patients was reviewed and approved by Institutional Review Committee. Samples were selected purposively and data was collected by face to face interview technique. Diabetes Self-Efficacy Scale and self-care practice questionnaire was used to measure self-efficacy and self-care practice, respectively. Results: Fifty nine percent and 81% of participants had moderate level of perceived self-efficacy and good self-care practice, respectively. There was significant moderate positive (r=0.62, p<0.001) correlation between perceived self-efficacy and self-care practice even after controlling the variables (e.g. age, gender and participation in educational program regarding self-care). Conclusion: The self-efficacy of participants was moderate and self-care practice was good. However, self-care practice was very low on foot care and exercise. The significant positive relationship between perceived self-efficacy and self-care practice highlights the need for conducting educational activities for patients with DM to increase self-efficacy thereby increasing self-care practice.

Adequacy of Thyroid Homone Replacement in a Tertiary Care Hospital in Nepal-An Observational Study

Background: The therapeutic goal in hypothyroidism is to achieve patients’ well-being and restore serum thyrotropin (TSH) to levels within the reference range. However, inadequate or over replacement is common in patients receiving levothyroxine. The Objective is to assess the treatment outcome of hypothyroid patients visiting outpatient clinic of medicine department of Kathmandu University Hospital, Dhulikhel, Nepal. Method: This is a cross sectional study on diagnosed Primary Hypothyroid patients who were taking levothyroxine replacement for at least six months. Patients were defined as euthyoid if their TSH was in the normal range (0.3-3.6 mmol/L) according to the hospital laboratory. Similarly patients were defined as over treated if TSH is <0.3 mmol/L and undertreated if TSH is >3.6 mmol/L. Results: A total number of 126 patients were enrolled for this study where mean age of participants was 40.88 ± 11.47 years and only 15 (11.1%) were male. Mean duration of hypothyroidism was 3.45 ± 2.57 years and mean Levothyroxine dose was 58.93 ± 26.89 mcg. In this study, nearly 70% of participants have normal TSH level. Similarly, 21% of participants have higher level of TSH and 9% have low TSH level. Multivariate logistic regression analysis did not show any significant co relation between treatment outcome and various variables. Conclusion: Treatment of hypothyroidism with levothyroxine being most effective, easily available, simple regimen and not costly, still one third of patients are not meeting the treatment outcome. However, being the pioneer study from Nepal, this study suggests improved treatment outcomes compared to similar studies from other countries.

Psycho-sexual Disorders in Clinic Diabetes mellitus Patients of a Teaching Hospital of Eastern Nepal

Background: Diabetes mellitus, a chronic disease, is frequently associated with sexual dysfunctions. Identification and management of these dysfunctions are important for overall wellbeing of the patient, though usually neglected. We lack data on this regard from Nepal. Objective: To estimate prevalence of psycho-sexual disorders (with emphasis on erectile dysfunction) in the patients with diabetes mellitus visiting ‘Diabetes clinic’ of a tertiary care teaching hospital in eastern Nepal. Method: It is a hospital-clinic based prevalence study. This study analyzed consecutive diabetes mellitus clinic patients’ response to self response questionnaires ‘Arizona Sexual Experience Scale’ (ASEX) for over all sexual dysfunction and ‘5- Item Version of the International Index of Erectile Dysfunction’ (IIEF-5) for erectile dysfunction. ‘Diabetes mellitus’ diagnosis was made based on the ADA guidelines 2010. Results: Among 100 male clinic diabetes patients, majorities were married, above age 50 years and all diagnosed as type 2 diabetes mellitus. Out of total, 48% had sexual dysfunction by the ASEX and many subjects had erectile dysfunction by the IIEF-5. Conclusion: Psychosexual dysfunctions, mainly erectile dysfunction are common among diabetic patients. Hence, assessment should include attention to sexual problems as well during management of diabetes mellitus.

Use of parathyroid hormone analog (Teriparatide) in patients with chronic hypoparathyroidism after total thyroidectomy: a case report

Background: Hypoparathyroidism and hypocalcemia is a common postoperative complication, after total thyroidectomy due to thyroid cancer. Standard treatment with supplementation of calcium and vitamin D analogs, usually treat this condition. In some patients, hypoparathyroidism is refractory to standard treatment plus intermittent calcium infusions with persistent low serum calcium levels and associated clinical complications. Attempts have been made to add recombinant human parathormone (rhPTH) to the treatment schedule. To our knowledge, this is the first time that we encounter a patient suffering from treatment-refractory postsurgical hypoparathyroidism who was treated with teriparatide. Case presentation: Male (31 years) with postoperative hypoparathyroidism, after total thyroidectomy due to papillary thyroid cancer, several weeks after the surgery still required intermittent intravenous calcium infusions because of tetany symptoms. He had persistent hypocalcemia despite oral treatment with up to 1 ug calcitriol and 4 g calcium per day necessitating additional intravenous administration of calcium gluconate intermittently. This time, Teriparatide treatment was introduced at once daily 50 micrograms (mcg) subcutaneous injection, while doses of calcium and calcitriol were gradually decreased depending on the response of serum total and ionized calcium taken periodically, which resulted in total resolution of hypocalcemia symptoms and the achievement and maintenance of laboratory normocalcaemia in just 5 days. Conclusion: Treatment refractory chronic hypoparathyroidism may be seen in some cases after total thyroidectomy. Furthermore, the use of recombinant human parathyroid hormone analog (Teriparatide) allows for the control of recurrent hypocalcemia reducing the daily dosage of calcium and vitamin D. Finally, regular intravenous calcium administration was no more needed.