Comparison of teneligliptin and other gliptin-based regimens in addressing insulin resistance and glycemic control in type 2 diabetic patients: a cross-sectional study.

INTRODUCTION: The objective of this study was to compare the effects of teneligliptin-based regimens and other gliptin-based regimens with respect to insulin resistance and glycemic control in patients with type 2 diabetes mellitus (T2DM). METHODS: We enrolled T2DM subjects, inadequately controlled with metformin and glimepiride and taking one of the gliptins, and divided them into two groups, i.e. group 1 (teneligliptin-based regimens) and group 2 (other gliptin-based regimens). Fasting plasma insulin, adiponectin levels, homeostatic model assessment for insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), and fasting blood glucose (FBG) were measured and compared. Costs of different gliptins were noted, and mean cost of per day therapy was compared. RESULTS: Eighty-six subjects participated in this study (43 each in group 1 and group 2). No significant differences were observed in FBG, HbA1c, insulin levels, and HOMA-IR, but the trend was in favor of teneligliptin-based regimens. A significantly higher number of subjects achieved HbA1c target in group 1 (P < 0.001). Teneligliptin had significantly lower cost of per day therapy as compared to other dipeptidyl peptidase-4 inhibitors. CONCLUSION: Teneligliptin seems to be cost-effective and safer option in T2DM subjects who were not adequately controlled with metformin and sulfonylureas. However, further prospective studies are needed.

Role of Meditation in Ameliorating Examination Stress Induced Changes in Cardiovascular and Autonomic Functions.

Background: Examination stress is a very well-known model of psychological stress in students. It induces changes in systolic (SBP) and diastolic blood pressure (DBP), along with changes in heart rate variability (HRV) and baroreflex sensitivity (BRS), due to autonomic perturbations. Purpose: To find out if Raj Yoga meditation (RYM) practice affects autonomic and cardiovascular function in healthy young subjects during periods of examination stress. Our primary objective was to evaluate the effect of one month of supervised RYM practice on ameliorating examination-induced changes in cardiovascular and autonomic function. The secondary objective was to measure the stress levels of medical students before and after RYM. Methods: Pre-training measurements of SBP, DBP, HRV, and BRS were done, and the Medical Student Stressor Questionnaire (MSSQ) was administered to 80 participants one month before examinations. They were then trained in RYM. Post-training assessment of the same parameters was done after examinations and also after two months. Results: In our study, RYM training decreased DBP (p = 0.01) but not SBP. BRS showed a trend towards an increase after RYM practice, but it was not statistically significant (p = 0.44). The standard deviation of the NN interval (SDNN) (p = 0.03), low-frequency (LF) nu (0.003), and high-frequency (HF) nu (0.04) showed a statistically significant change. Average RR, median RR, average rate, square root of the mean squared differences of successive NN intervals (RMSSD), pRR, total power, LF (µs2), and LF/HF ratio were not statistically significantly different between the three groups. There was a statistically significant decline in MSSQ scores for MSSQ I (p = 0.04), MSSQ II (p = 0.04), and MSSQ IV (p = 0.03). Conclusion: Short-term practice of supervised RYM during stressful periods is protective for the cardiovascular and autonomic systems and decreases stress in medical students.

Association of blood donor characteristics and in vitro haemolysis of packed red blood cell concentrates during storage.

BACKGROUND AND OBJECTIVES: Blood donor variability can affect the storage properties of packed red blood cells (PRBCs). This study aimed to determine the association of donor characteristics with in vitro storage haemolysis of PRBCs. MATERIALS AND METHODS: In the prospective observational study, a total of 109 whole blood donors were enrolled using the purposive sampling method. A pre-donation sample was collected for haemoglobin (Hb) and serum uric acid (UA) levels. PRBC aliquots were tested for potassium, lactate dehydrogenase (LDH), Hb, haematocrit, plasma Hb and haemolysis on days 1, 21 and 35 of storage. The association of these parameters with donor age, sex, donation status, dietary pattern and body mass index was determined. RESULTS: Mean haemolysis was significantly higher in PRBCs from donors with UA levels ≤6 mg/dL than donors with UA levels >6 mg/dL on day 35 of storage (0.22 ± 0.11 vs. 0.18 ± 0.07, p = 0.03). Median plasma Hb (mg/L) was significantly higher in PRBCs from first-time donors on day 21 (586 vs. 509, p = 0.05) and day 35 (1507 vs. 1358, p = 0.02) of storage in comparison to frequent donors. Significantly higher mean potassium (p = 0.04 day 1; p = 0.02 day 21) and median LDH values (p = 0.02 day 1, p = 0.05 day 21) were observed in PRBCs from male donors. A statistically significant positive association was observed between donor UA and LDH levels of PRBCs on day 35 of storage (ß coefficient: 715.52, p-value: 0.003) on multiple regression analysis. CONCLUSION: In vitro haemolysis of PRBCs is affected by blood donor characteristics.

Prevalence and predictors of low bone mineral density among adults aged 50 years and above in Chandigarh, India.

Background: Osteoporosis, defined as skeletal disorder characterized by reduced bone density and strength, is prevalent in both developing and developed countries. Dual energy X-ray absorptiometry (DEXA) is an effective tool to diagnose low bone mineral density (BMD). Objective: This study objective was to know the prevalence and predictors of low BMD in a community-based screening program among the adult population using DEXA scan. Methods: In this community-based study conducted between January and June 2016, a population-based screening program was offered to both males and females of age 50 years and above. BMD was measured to derive T-scores and classify as normal, osteopenic, and osteoporotic individuals. Results: A total of 455 subjects were enrolled where 62.4% proportion was women; 42.6% subjects were in the age group of 50 to 59 years. The prevalence of osteoporosis and osteopenia was 20.9% and 48.1%, respectively. Hypertension (23.7%) and diabetes (8.4%) were common comorbidities. Age and gender (female) were independent predictors of low BMD. Conclusion: Osteoporosis/osteopenia is present in both genders with increasing trend with age advancement. Institution of timely screening will prevent the morbidity associated with fractures due to low BMD.

Contraceptive awareness and practices in reproductive age couples: A study from urban slums of Punjab.

Introduction: Developing countries are characterised by high birth rates and explosive population growth. With a lower contraceptive usage rate among eligible couples and resistance towards family planning methods, the goal of population stabilisation looks distant. The present study was conceived to assess knowledge, attitude and practices regarding contraceptive usage and to identify the barriers in reproductive-age couples in an urban slum area. Methods: The present study was cross-sectional in nature and was conducted in an urban slum. Three hundred married subjects were enrolled through a convenient sampling technique. One member of the married couple was interviewed for the present study. Data were collected through a semi-structured proforma. Results: 67% of the participants were using one or another contraceptive. Higher contraceptive usage was seen in more educated participants. Awareness was higher in males regarding contraception. Condom was the most known method for contraception. Three fourth of the participants agreed with two-child norm. Preference for a male child was less than 50% in both genders. Current users of condoms and oral contraceptive pills were 71.8% and 7.1%, respectively. Wanting children, fear of side effects and lack of knowledge were cited as reasons for not choosing family planning methods. Conclusion: With a suboptimal level of awareness and attitude among respondents regarding contraceptive methods, there exists a gap between awareness and practice. Misconceptions regarding contraceptive methods can be allayed through health education, involvement of the community and religious leaders and peer counselling.

Development and psychometric testing of the Knowledge, Attitude, and Practice Questionnaire to assess knowledge, attitude, and practices regarding COVID-19 among patients attending COVID screening outpatient department in a tertiary care hospital in North India.

Background: COVID-19 pandemic has hit the world leading to major disruptions globally. Due to its highly contagious nature and associated mortality, a wide array of emotional and behavioral reactions were seen which indirectly reflected the knowledge, attitudes, and practices (KAP) of individuals. Understanding the KAP of individuals is fundamental when it comes to decreasing future COVID cases. Aim: The study aimed to develop a Knowledge, Attitude, and Practice Questionnaire regarding COVID-19 (COVID-KAPQ) among patients attending screening outpatient department (OPD) in a tertiary care hospital in North India and evaluate its psychometric properties. Materials and Methods: The study procedure consisted of step-wise procedure starting with item generation, expert evaluation for categorization of items into domains of KAP and testing for psychometric properties. The items were generated and evaluated by the Delphi method based on 8 experts. Reliability and validity were assessed using data from 200 patients attending COVID screening OPD. Content validity was evaluated using content validity index (CVI); construct validity was examined using exploratory factor analysis and Cronbach's alpha coefficient was computed for internal consistency. Results: The final COVID-KAPQ consisted of three domains and 29 items. Cronbach's alpha coefficient for the entire questionnaire was 0.734, 0.710 for knowledge domain, 0.614 for attitudes domain, and 0.759 for practice domain. CVI ranged from 0.86 to 1. Five factors each for knowledge and attitudes domain and two factors for practice domain were extracted by principal factor analysis and varimax rotation, with a cumulative contribution of 70.19%, 71.54%, and 66.77% variance in KAP domain. Conclusions: A questionnaire COVID-KAPQ (KAP regarding COVID-19) was developed. Psychometric testing indicated that it had adequate validity and reliability for use in COVID research in the general population. This questionnaire might help the public health researchers to map the level of KAP in the population and plan awareness and prevention strategies accordingly.

Introducing Communication Skills Training among Interns using Attitude, Ethics, and Communication Module.

Background: Communication skills are the backbone for patient care services such as patient interviews, counseling the patient, and explaining treatment options. The present study was conceived to evaluate the communication training program and perceptions of medical interns and faculty regarding the same. Methodology: Sixty medical interns were included in this cross-sectional study. Training on communication skills was imparted which was later assessed on the basis of Kalamazoo scale. Attitude of the interns regarding communication skill training was assessed using Rees and Sheard Scale. The attitude of faculty regarding introduction of communication skill was also assessed. Results: The mean score on Kalamazoo Consensus Scale was 19.65 ± 4.97 with a range of 10-29. Females had a higher score (21.09 ± 5.80) as compared to males (17.88 ± 3.21), but this was not statistically significant (P = 0.157). The mean score for positive and negative attitude scale was 59.15 ± 5.51 and 25.20 ± 9.60. Conclusion: The ability to communicate effectively is a core competency expected of medical graduates and communication skills training of medical students and interns with the help of didactic lectures, role plays, and videos, etc., can go a long way in improving their communication skills.

Online medical teaching during COVID-19: Perspectives from teachers and taught.

BACKGROUND: Online teaching has been practiced after lockdown due to Coronavirus Disease 2019 (COVID-19) pandemic which has replaced conventional classroom teaching. The aim of the present study was to know the perceptions regarding online learning as perceived by both teachers and students during COVID-19 pandemic. MATERIALS AND METHODS: The present study was cross-sectional and questionnaire-based. Web-based respondent-driven sampling technique was used to recruit participants for the present study. Three hundred and thirty-two students and 130 teachers of varying ages and gender participated in the study. The link of web-based questionnaire was sent to respondents through WhatsApp/Facebook. Responses from all the participants were tabulated and analyzed using univariate analysis (Chi-square test). RESULTS: Prerecorded lectures (38.9%) and Webinar apps (35/8%) were the most common modules of online teaching by students. One-third (34.3%) had the convenience to attend lectures from home whereas 44.3% had difficulty in concentration. Commonly cited disadvantage by students was inability to do practical work (37.9%). Regarding teaching faculty, 43.8% had no prior knowledge of online teaching. Sixty percent of teachers had 4 h/week of online teaching. No face-to-face interaction (67.7%) and internet issues (26.9%) were commonly stated barriers by faculty. CONCLUSION: The pandemic has pushed the teachers and students toward newer teaching avenues. However, more needs to be done to supplement the existent teaching pattern and preparedness of teaching faculty by incorporating online assignments and assessment methods, strengthening digital infrastructure in medical schools, and training support for teachers.

Prevalence of mental health disorders among health-care providers of COVID-19 positive and suspected cases.

Background: Health-care providers (HCP) engaged in demanding work like being involved in the care of COVID-19 positive and suspected cases are likely to have a lot of stress, anxiety, depression, and other mental health issues. It will be noteworthy to have an idea about the magnitude of the mental health problems in them to formulate effective intervention strategies for their well-being. Aims and Objectives: The aim of this study is to determine whether frontline HCP engaged in the treatment and care of COVID-19 positive and suspect cases experienced increased mental health problems. Methodology: Two hundred and fifty-one frontline HCPs engaged in COVID-19 duty and 97 nonfrontline (controls) HCP were assessed and compared using tools like General Health Questionnaire 12, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. Appropriate statistical tools such as analysis of variance and Chi-square were used. Results: Frontline HCP who were directly involved in COVID-19 duty had a higher proportion (28.3%) of psychological morbidities as compared to 19.6% among controls; HCP-frontline had significantly 2.17 times chances of having psychological distress compared to HCP controls. Among, HCP-frontline 13.1% had clinical depression, whereas in the HCP control, this was 6.2%. Further, 20.3% of HCP frontline and 10.3% of HCP control had clinical anxiety, and the difference between the two groups was statistically significant (P = 0.0011). Conclusion: Frontline HCPs working in demanding work such as COVID-19 patient care are susceptible to psychological distress, anxiety, and depression which warrant urgent attention.

Alternate-day add-on therapy with dapagliflozin in patients with type 2 diabetes mellitus: potential benefits and concerns.

INTRODUCTION: Factors such as compliance, cost and safety play a major role in achieving the long-term goal in the management of type 2 diabetes mellitus (T2DM). Dapagliflozin carries a great potential of becoming an alternate-day therapy because of its favorable pharmacological properties. AREAS COVERED: In this review, we have discussed and hypothesized the potential of dapagliflozin as an alternate-day add-on drug in T2DM patients. We have discussed the properties by virtue of which it carries a potential to become an alternate-day therapy. We have also explained the potential benefits and concerns of using this approach. EXPERT OPINION: Alternate-day add-on therapy with dapagliflozin could be a promising approach in reducing the cost, improving the treatment satisfaction and reducing the adverse effects. However, this propsed indication demands an in-depth investigation among T2DM subjects who are not able to achieve glycemic control with standard monotherapy or combination therapy. Pilot studies or some small-scale investigator-initiated trials or academic clinical trials may be carried out to explore this concept. At the same time, large industry sponsored multicenter clinical trials including pharmacoeconomic analyses may be planned to have a more detailed investigation.

Stress, Coping, and Resilience Among Home-Quarantined Persons During the COVID-19 Pandemic: Findings From a Community Study.

Objective: To assess stress, coping, and resilience among home-quarantined individuals via a community survey during the coronavirus disease 2019 (COVID-19) pandemic.Methods: In this cross-sectional study, a combined list was generated of all contacts of positive COVID-19 cases, traced by a contact tracing team, and international travelers who had entered the country after March 8, 2020 (2 weeks before the air travel shutdown on March 22, 2020 in India). This community-based study was conducted among people who were quarantined in their homes and international travelers who arrived in the country after declaration of lockdown. Stress and coping were assessed via the 12-item General Health Questionnaire, 10-item Perceived Stress Scale, and Brief Resilient Coping Scale. The participants with higher perceived stress scores (≥ 14) were asked to seek help from telemedicine services. Study data were collected from April 8, 2020, to May 20, 2020.Results: The mean age of the 153 study participants was 40.10 years, and 41.8% were women. Poor coping was identified in 25.5% of the sample, and moderate/high stress was present in 49.7%. Significantly higher stress was noted in women (P = .007). Higher age, joint family structure, and contacts of COVID cases were significant predictors of moderate/severe perceived stress in the logistic regression.Conclusions: Adequate psychological supportive services should be provided to home-quarantined persons through provision of information, rapid communication, and timely supplies of general and medical items.

Psychiatric morbidity and substance use in migrant workers: A population based study.

BACKGROUND: The prevalence of mental health problems and substance abuse in the migrant population is higher than the general population. AIMS AND OBJECTIVES: To assess the prevalence and pattern of mental health issues and substance use in the migrant population and highlight the association with the reverse migration of migrant workers. METHODOLOGY: The field staff visited the shelter homes for migrant population in four cities of Northern India (Chandigarh (UT), Bhatinda (Punjab), Panchkula (Haryana) and Jaipur (Rajasthan). After maintaining the social distance and wearing masks by the staff and migrants, written informed consent was taken for participation in the study. The socio-demographic details of reverse migrants were noted down and Hindi version of Patient Health Questionnaire (PHQ-9) for mental health problems and screening tool for pattern of substance abuse was administered. Geographically matched undisplaced were also administered these tools. RESULTS: A total of 275 reverse migrants and 276 undisplaced were included in the study. The prevalence of ever use for all the substances among reverse migrants was 44.4% (122/275) and among undisplaced, it was 45.3%. The prevalence of alcohol, tobacco and cannabis was higher than the general population. The prevalence of at least one diagnosis on PHQ-9 is 13.45% (reverse migrants 19.3% and undisplaced 7.6) and the prevalence of other depressive disorder is significantly higher in reverse migrants (17.1%) than undisplaced (4.0%). CONCLUSION: The study concludes that prevalence of mental health issues and substance abuse in migrant population is significantly higher than the general population and the prevalence of at least one diagnosis and other depressive disorder is significantly higher in reverse migrants than undisplaced.

Transport characteristics and predictors of mortality among neonates referred to a tertiary care centre in North India: a prospective observational study.

OBJECTIVE: The paucity of specialised care in the peripheral areas of developing countries necessitates the referral of sick neonates to higher centres. Organised interhospital transport services provided by a skilled and well-equipped team can significantly improve the outcome. The present study evaluated the transport characteristics and predictors of mortality among neonates referred to a tertiary care centre in North India. DESIGN: Prospective observational study. SETTINGS: Tertiary care teaching hospital in North India. PATIENTS: 1013 neonates referred from peripheral health units. MAIN OUTCOME MEASURES: Mortality among referred neonates on admission to our centre. RESULTS: Of the 1013 enrolled neonates, 83% were transferred through national ambulance services, 13.7% through private hospital ambulances and 3.3% through personal vehicles. Major transfer indications were prematurity (35%), requirement for ventilation (32%), birth asphyxia (28%) and hyperbilirubinaemia (19%). Hypothermia (32.5%, 330 of 1013), shock (19%, 192 of 1013) and requirement for immediate cardiorespiratory support (ICRS) (10.4%, 106 of 1013) on arrival were the major complications observed during transfer. A total of 305 (30.1%, N=1013) deaths occurred. Of these, 52% (n=160) died within 24 hours of arrival. On multivariate logistic analysis, unsupervised pregnancy (<4 antenatal visits; p=0.037), antenatal complications (p<0.001), prematurity ≤30 weeks (p=0.005), shock (p=0.001), hypothermia (p<0.001), requirement for ICRS on arrival (p<0.001), birth asphyxia (p=0.004), travel time >2 hours (p=0.005) and absence of trained staff during transfer (p<0.001) were found to be significant predictors of mortality. CONCLUSION: The present study depicts high mortality among infants referred to our centre. Adequate training of peripheral health personnel and availability of pre-referral stabilisation and dedicated interhospital transport teams for sick neonate transfers may prove valuable interventions for improved outcomes.

Coping With Craving and Withdrawal Due to Substance Use Disorders During the COVID-19 Lockdown.

OBJECTIVE: Substance use disorder (SUD) is a chronic remitting and relapsing disorder, and abrupt discontinuation of the substance due to nonavailability in the absence of treatment precipitates withdrawals and craving. The objective of this study was to assess the craving and withdrawal coping mechanisms used by patients with SUDs as a result of disruption in availability of substances and medications due to sudden lockdown in response to coronavirus disease 2019. METHODS: A survey was administered via telephone from June 25, 2020, to July 15, 2020, to patients who had previously attended the substance use clinic of a tertiary care teaching hospital in North India from January 1, 2020, to March 21, 2020 (up to the time of lockdown). Sociodemographic and clinical details were obtained from case record files. A 16-item questionnaire was developed to collect information on coping with craving and withdrawal symptoms. A total of 215 patients were registered in the substance use clinic during this period for the treatment of SUDs, and of those, 43 could not be contacted due to various reasons such as wrong contact numbers, patient expired (not related to substance withdrawal), or not willing to talk. The mean age of the subjects was 37.05 (SD = 13.22) years, and men outnumbered women. The remaining 172 patients were contacted via telephone, and responses were gathered regarding withdrawal symptoms and coping with craving. RESULTS: More than two-thirds of the patients were still maintaining abstinence from their primary substance of abuse during lockdown. A large number of patients (n = 41, 43.2%) reported difficulty in obtaining prescribed medication for detoxification without renewal of their prescription. More than 66% of patients reported that they were able to control their craving, and many kept themselves busy with household activities. CONCLUSIONS: The majority of patients who had completed the acute phase of withdrawals were able to maintain abstinence in the absence of renewal of prescribed medication and substance of abuse due to sudden disruption in supply. The patients were able to use certain strategies to control their craving.

Factors Leading to Reverse Migration Among Migrant Workers During the COVID-19 Pandemic: A Multicenter Study From Northwest India.

OBJECTIVE: To examine the various psychosocial factors associated with reverse migration among migrant workers during the coronavirus disease 2019 (COVID-19) lockdown in India. METHODS: A cross-sectional multicenter study was conducted at 4 sites in Northwest India. The migrant workers were recruited from various shelter homes, and information was gathered from reverse migrant workers and controls using various tools including a sociodemographic profile; knowledge, attitudes, and practices questionnaire; and reasons for migration and reverse migration questionnaires. A total of 275 reverse migrant workers and 276 controls participated in the study. RESULTS: There was a considerable difference between reverse migrant workers and controls regarding the question of whether it was safe to travel during lockdown (76.0% vs 26.4%, respectively). The most common route of spread of COVID-19 infection was through touching and sneezing, and symptoms were fever, dry cough, and sore throat in both groups. Reverse migrant workers had low self-esteem and were reluctant to participate in customs of their migration city. A large number of reverse migrant workers reported that they had no money to survive, worried about family back home at their village, felt pressured by family members to come back to the village, and had been terminated from their job. CONCLUSIONS: Reverse migrant workers had the attitude that it was safe to travel during the lockdown. About one-fifth of the reverse migrant workers reported no place to live and fear of getting an infection. The reverse migrant workers also reported feeling low and gloomy, restless, and uncertain about the future and fear of death. Lack of jobs was a major factor driving migrant workers from their native homes.

Relationship Between Statin-associated Muscle Symptoms, Serum Vitamin D and Low-density Lipoprotein Cholesterol - A Cross-sectional Study.

INTRODUCTION: Statin-associated muscle symptoms (SAMS) can lead to medication non-adherence among statin users. There is a complex relationship between SAMS, vitamin D and low-density lipoprotein cholesterol (LDL-C). The objective of this study was to evaluate the relationship between vitamin D, LDL-C and occurrence of SAMS. METHODS: This was a cross-sectional study in patients using statins. Thorough patient histories were taken, a clinical examination was conducted and SAMS were recorded. Levels of vitamin D, creatine phosphokinase (CPK) and LDL-C were measured. These parameters were compared amongst statin users with SAMS and those without SAMS. Levels of vitamin D and LDL-C were converted into percentiles and their relationship with SAMS was evaluated in terms of odds ratio. Receiver operating characteristics (ROC) were drawn, taking vitamin D and LDL-C as predictors of SAMS. RESULTS: A total of 121 statin users were enrolled in this study. Thirty-eight patients (31.4%) presented with SAMS. Significantly lower levels of serum vitamin D were observed amongst statin users with SAMS compared with those without SAMS (19.8 ± 9.67 ng/mL versus 25.0 ± 14.6 ng/mL; 95% confidence interval -10.4 to -0.07; p=0.04). With vitamin D levels less than or equal to 5th, 10th and 25th percentile, the chances of occurrence of SAMS were significantly higher, but not at the 50th percentile (corresponding vitamin D level of 20.21 ng/mL). LDL-C did not show any conclusive relationship with SAMS. ROC curves showed a significant discrimination for vitamin D levels, but not for LDL-C. CONCLUSION: Statin users with low levels of vitamin D are at increased risk of developing SAMS. However, LDL-C status of statin users failed to predict any meaningful association with SAMS. Given the small sample size of this study, these results should be regarded as preliminary.