Evaluation of Madras Diabetes Research Foundation-Indian Diabetes Risk Score in detecting undiagnosed diabetes in the Indian population: Results from the Indian Council of Medical Research-INdia DIABetes population-based study (INDIAB-15)

Background & objectives: Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India. Methods: Data were acquired from the Indian Council of Medical Research–INdia DIABetes (ICMR–INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS. Results: We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under

Prevalence of Undiagnosed Diabetes and Impaired Glucose Tolerance in a Semi-urban Population from Calicut City

Though the prevalence of Diabetes is increasing worldwide, a thorough knowledge of the prevalence of undiagnosed Diabetes a pre-diabetes is lacking. This study from India is to evaluate the prevalence of asymptomatic diabetes among adults with comorbidities and without any history of Diabetes. Prevalence of asymptomatic individuals with Diabetes and impaired glucose tolerancewas 3% and 15%, respectively. The high prevalence found in the study raises concern over the health care indices and the need for urgent public health action to control the pandemic. Regular screening for Diabetes in adults is required to prevent complications of long-term diabetes

Validation of HIV risk screening tool to identify infected adults and adolescents greater than 14 years at community level in Tanzania and Zambia

Introduction: There are several risk factors being used to identify undiagnosed HIV-infected adults. As the number of undiagnosed people gets less and less, it is important to know if existing risk factors and risk assessment tools are valid for use. Methods: Data from the Tanzania and Zambia Population-Based HIV Impact Assessment (PHIA) household surveys which were conducted during 2016 was used. We first included 12 risk factors (being divorced, separated or widowed; having an HIV+ spouse; having one of the following within 12-months of the survey: paid work, slept away from home for ≥1-month, having multiple sexual partners, clients of sex workers, sexually transmitted infection, being tuberculosis suspect, being very sick for ≥3-months; ever sold sex; diagnosed with cervical cancer; and had TB disease into a risk assessment tool and assessed its validity by comparing it against HIV test result. Sensitivity, specificity and predictive value of the tool were assessed. Receiver Operating Characteristic (ROC) curve comparison statistics was also used to determine which risk assessment tool was better. Results: HIV prevalence was 2.3% (2.0%-2.6%) (n=14,820). For the tool containing all risk factors, HIV prevalence was 1.0% when none of the risk factors were present (Score 0) compared to 3.2% when at least one factor (Score ≥1) was present and 8.0% when ≥4 risk factors were present. Sensitivity, specificity, PPV, and NPV were 82.3% (78.6%-85.9%), 41.9%(41.1%-42.7%), 3.2%(2.8%-3.6%), and 99.0%(98.8%-99.3%), respectively. The use of a tool containing conventional risk factors (all except those related with working and sleeping away) was found to have higher AUC (0.65 vs 0.61) compared to the use of all risk factors (p value <0.001). Conclusions: The use of a screening tool containing conventional risk factors improved HIV testing yield compared to doing universal testing. Prioritizing people who fulfill multiple risk factors should be explored further to improve HIV testing yield.

Medical Thoracoscopy: Diagnostic Role in the Management of Undiagnosed Pleural Effusions and its Complications

Introduction: Cases of undiagnosed exudative pleural effusions are common in clinical practice and pose a diagnostic challenge for pulmonologists. Medical thoracoscopy allows both direct visualizations of pleural space for diagnostic evaluation and chemical pleurodesis for therapeutic purposes. Objectives: This study investigated the diagnostic role of medical thoracoscopy in the cases of undiagnosed exudative pleural effusions and complications of thoracoscopic pleural biopsy. Patients and methods: Between December 2016 and August 2019, 195 patients of undiagnosed exudative pleural effusions underwent medical thoracoscopy in our institute. Pleural biopsies were taken and sent for histopathological and microbiological examination. Results: The diagnostic yield of medical thoracoscopy in this study was 89.7%. Definite diagnosis was achieved in 175 out of 195 patients of the study population and only 20 (10.3%) patients were failed to be diagnosed by medical thoracoscopy. Histopathological results of thoracoscopic pleural biopsy among the study population revealed tubercular pleuritis in 31.79% (62 patients), metastatic adenocarcinoma in 23.07% (45 patients), malignant mesothelioma in 18.46% (36 patients), parapneumonic effusions in 6.66% (13 patients), metastatic squamous cell carcinoma in 5.64% (11 patients), small cell carcinoma in 3.07% (6 patients), malignant lymphoma in 0.51% (1 patient), and rheumatoid pleuritis in 0.51% (1 patient). Only 19.4% (38 patients) had minor complications like pain, minor bleeding, subcutaneous emphysema, and re-expansion pulmonary edema. Conclusion: Thoracoscopy is a safe, well-tolerated procedure with minimal risk allowing the accurate diagnosis of undiagnosed pleural effusion. Besides determining the underlying cause, it also provides unique therapeutic approaches like pleurodesis to patients with malignant pleural effusions.

Indian Diabetes Risk Score (IDRS): An effective tool to screen undiagnosed diabetes

Background: Diabetes is an insidious public health problem. India has the second largest number of adults living with diabetes worldwide (77 million). Indian Diabetes Risk Score (IDRS) is a simple, cost-effective and feasible tool for mass screening programme at community level. Aim & Objective: To assess diabetes risk in adults aged 30 years and above and to identify high risk subjects for screening undiagnosed diabetes in an urban population of Meerut. Settings and Design: Community based cross-sectional study. Methods and Material: All adults who were ?30 years of age and non-diabetic were interviewed using pre-designed, pre-tested questionnaire for their socio-demographic profile and lifestyle. Fasting Blood glucose of all study subjects were done to screen undiagnosed diabetics. Statistical analysis used: Centers for Disease Control (CDC), Epi Info TM 7.2.3.1 was used. Pearson’s Chi Square were applied. Results: 33.4% were found to have high diabetes risk. Risk of diabetes increases with age. 7.6% of the study subjects were found to be diabetic and were unaware of their diabetic status. Physical inactivity and increasing waist circumference were found to be significantly associated with risk of diabetes. Diabetes risk was also significantly associated with positive family history. Conclusions: Screening and early identification of high risk individuals would help in early diagnosis and treatment to prevent or to delay the onset of diabetes mellitus and its complications.

Prevalencia e incidencia de hipertensión arterial en Perú: revisión sistemática y metaanálisis / Prevalence and incidence of arterial hypertension in Peru: a systematic review and meta-analysis

RESUMEN Objetivo. Determinar la prevalencia e incidencia de hipertensión arterial, y la prevalencia de diagnóstico previo de hipertensión arterial (autorreportado) en población general adulta del Perú. Materiales y métodos. Revisión sistemática y metaanálisis de estudios epidemiológicos disponibles en LILACS, EMBASE, MEDLINE y Global Health. Se incluyeron estudios que siguieron un muestreo aleatorio de la población general adulta. El tamizaje y estudio de los manuscritos fue realizado por dos investigadores de forma independientemente. Se hizo metaanálisis de efectos aleatorios para cuantificar la prevalencia e incidencia global. Los manuscritos fueron evaluados con la escala Newcastle-Ottawa para evaluar el riesgo de sesgo. Resultados. Se tamizaron 903 artículos, y se incluyeron 15 manuscritos para prevalencia, 8 para prevalencia de diagnóstico previo, y 4 para incidencia de hipertensión. El metaanálisis mostró una prevalencia agregada de hipertensión de 22,0% (IC 95%: 20,0% - 25,0%; I 2=99,2%). Esta prevalencia fue menor en estudios nacionales [20,0% (IC 95%: 17,0% - 22,0%; I 2 =99,4%] que en subnacionales [24,0% (IC 95%: 17,0% - 30,0%; I 2 =99,2%]. La prevalencia global de diagnóstico previo de hipertensión fue 51,0% (IC 95%: 43,0% - 59,0%; I 2=99,9%). La incidencia global fue de 4,2 (IC 95%: 2,0 - 6,4; I 2=98,6%) por cada 100 personas-año. Los manuscritos estudiados no presentaron alto riesgo de sesgo. Conclusiones. Nuestros hallazgos muestran que uno de cada cinco peruanos tiene hipertensión, y que aparecen cuatro nuevos casos por 100 personas en un año, además solo la mitad de los pacientes hipertensos tienen el diagnóstico previo de su condición.

ABSTRACT Objective . To determine the prevalence and incidence of arterial hypertension, as well as the prevalence of previous diagnosis of arterial hypertension (self-reported) among the adult population of Peru. Materials and methods. Systematic review and meta-analysis of epidemiological studies available in LILACS, EMBASE, MEDLINE and Global Health. Studies were included if they followed a random sampling approach in adult population. Screening and assessment of manuscripts was carried out independently by two researchers. A random-effects meta-analysis was conducted to quantify the overall prevalence and incidence of hypertension. The Newcastle-Ottawa scale was used to assess the risk of bias in the manuscripts. Results. A total of 903 papers were screened, and only 15 were included in the estimation of hypertension prevalence, 8 in the assessment of previous hypertension diagnosis, and 4 for incidence estimations. The pooled prevalence of hypertension was 22.0% (95% CI: 20.0% - 25.0%; I2=99.2%). This estimate was lower in national studies [20.0% (95% CI: 17.0% - 22.0%; I2=99.4%] than in sub-national studies [24.0% (95% CI: 17.0% - 30.0%; I2=99.2%]. The pooled prevalence of previous hypertension diagnosis was 51.0% (95% CI: 43.0% - 59.0%; I2=99.9%). The pooled incidence of hypertension was 4.2 (95% CI: 2.0 - 6.4; I2=98.6%) per 100 person-years. The included studies did not present high risk of bias. Conclusions. Our findings show that one in five Peruvians has hypertension, and that four new cases appear per 100 persons per year; in addition, only half of the subjects with hypertension are previously diagnosed.

Role of pleural biopsy in patients of undiagnosed exudative pleural effusion

Introduction: Sometimes etiological diagnosis of pleural fluid is not possible by cytology, biochemical and microbiological examinations and labeled as undiagnosed exudative pleural effusion. Our aim of this study to make an etiological diagnosis in such undiagnosed exudative cases with pleural biopsy. Material and method: In this study patients with undiagnosed exudative pleural effusion, where the diagnosis was not made by laboratory investigations were included. Pleural tissue was obtained by Abram’s Needle and sent for histopathology and culture to find mycobacterium tuberculosis. Result: Out of 45 patients 34 (75.5%) were males and 11 (24.5%) were females. The side of pleural effusion was right-sided in 30 (66.6%) and left-sided in 15 (33.4%). The mean value of polymorphs and lymphocytes count was 7.24% and 92.76% respectively. Pleural fluid was hemorrhagic in 10 (22.22%) patients, straw-colored in 30 (71.11%) patients, and clear in 5 (11.11%) patients. The mean level of glucose was 65.66 mg/dl, the lowest being nil and highest being 110 mg/dl. The mean level of protein was 5.54 gm/dl (range 3.7-7.21 gm/dl). The mean value of the pH of pleural fluid was 65.44. Histopathology showed granulomatous inflammation compatible with tuberculosis in 24 (53.3%) cases, metastatic malignancy in 7 (15.5%) cases, chronic inflammation in 10 (22.3%) cases. In 4 (8.9%) cases pleural tissue was inadequate to give any opinion. Among 7 cases of malignancy, 5 (71.42%) cases showed adenocarcinomas and 2 (28.58%) cases showed squamous cell carcinoma. Conclusion: This study suggests that tuberculosis and malignancy are the two common etiologies for exudative pleural effusion. The role of pleural biopsy is pivotal as it helps in making the diagnosis in the majority of cases where other laboratory investigations fail to provide a diagnosis.

Role of diagnostic laparoscopy in chronic abdominal pain

Background: Chronic idiopathic pain syndromes are amongst the most challenging and demanding conditions to treat across the whole age spectrum. Despite these patients having undergone numerous diagnostic work-ups, their pain remains a challenge to all known diagnostic and treatment methods.Methods: To evaluate role of diagnostic laparoscopy in chronic abdominal pain a prospective observational study was done. The present study was conducted on patients with undiagnosed chronic abdominal pain coming to the Department of Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. 75 patients with chronic abdominal pain who attend the General Surgery Department (OPD) were included in the study. Patients were included in the study after taking their voluntary informed consent. The categorical variables were assessed using Pearson chi-square. The quantitative variables were assessed using T-test. The test was considered significant only if the p value comes out to be less than 0.05.Results: Based on the findings of the study after performing diagnostic laparoscopy for 75 patients with chronic abdominal pain it was found that most common finding was of appendicitis (32%) followed by abdominal Koch’s (24%) and post-operative pain relief using VAS showed p value of less than 0.05 at 3 months of follow up post diagnostic laparoscopy.Conclusions: The present study concluded that laparoscopy is an effective diagnostic role in evaluating patients with chronic abdominal pain, in whom conventional methods of investigations have failed to elicit a certain cause. The advantage of diagnostic laparoscopy over non-invasive methods is the ability to perform therapeutic procedure at the same time in cases of chronic abdominal pain. Diagnostic laparoscopy is safe, cosmetically better and having less morbidity.

Prevalence of Undiagnosed Hypertension and Its Associated Factors Among the University Staff

@#Introduction: Hypertension is a public health concern that is associated with heart disease. This study aims to investigate the prevalence of undiagnosed hypertension and its associated factors among the staff in a private university in Selangor, Malaysia. Methods: 100 respondents participated in this cross-sectional study. Blood pressure, Body Mass Index (BMI), percentage body fat (%BF), visceral fat rating (VFR), and waist circumference (WC) were measured. Questionnaires regarding knowledge, attitude, and practice (KAP) of salt diet validated from WHO/PAHO and Food Frequency Questionnaires regarding sodium intake validated from IPH Malaysia were administered. Statistical data was analysed using SPSS. Results: The prevalence of undiagnosed hypertension was 24%. About 66% of the participants had excessive sodium intake. The mean sodium intake was 2869.43±930.75mg/d. Simple linear regression showed that BMI. %BF, VFR, and WC were significantly correlated with systolic blood pressure (SBP). Age and sodium intake were not correlated with SBP. After controlling all the variables in multiple linear regression, VFR remained as a significant contributor to SBP (adjusted R2=0.419, F=18.833, p=<0.001). Soy sauce, omelette, fried rice, and nasi lemak were the main contributors of sodium intake. A lack of knowledge on the negative impacts of high salt diet was significantly associated with high dietary sodium intake (>2400mg/d). Conclusion: Our study found a high prevalence of undiagnosed hypertension among the private university staff. The association between VFR and SBP is an important finding for community study. Increased awareness on the excessive salt consumed and its association with health is needed to reduce the sodium intake.

Comparison between Diagnostic Yield of Pleural Fluid ELISPOT and Thoracoscopic Guided Pleural Biopsy in Undiagnosed Pleural Effusion

Context: Despite recent advances in the available diagnostic modalities, diagnosis of pleural tuberculosis remains a challenge because of the low yield of conventional methods. Pleural biopsy is the gold standard for confirmation of diagnosis, which is invasive and cumbersome. The concentration of mycobacterial peptide-specific activated lymphocytes at the site of infection can be utilized as the basis for using IGRA (interferon-gamma release assays) based evaluation of undiagnosed exudative pleural effusions.  Aim: To evaluate the performance of IGRA (Enzyme-linked Immunospot (ELISPOT) in pleural fluid for the diagnosis of pleural tuberculosis in histopathologically confirmed cases. Settings and Design: A prospective observational study compared the utility of ELISPOT with thoracoscopy guided pleural biopsies for the diagnosis of tubercular pleural effusions. Methods and Material: Forty-two consecutive cases of undiagnosed pleural effusions were enrolled and subjected to thoracoscopy guided pleural biopsy. Thirteen patients were confirmed to have tuberculosis, 27 had malignancy, and 2 had normal pleura. A total of 1x103 pleural fluid mononuclear cells (PFMCs) were cultured in the presence of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) for 24 hours. The individual spots were then counted using an automated analyzer ELISPOT reader system.  Results: The number of spots developed in the pleural fluid was significantly higher in tubercular pleural effusions as compared to non-tubercular effusions (CFP-10:154.76±14.61 vs 49.24±8.9; ESAT-6: 150.3±17.27 v/s 45.34±8.23, p<0.001). At a cut-off value of more than 67 spots taken as positive for tuberculosis, the sensitivity of the test was 100% (95% CI 75.29% to 100.00%), specificity was 96.5% (95 % CI 82.24% to 99.91%), positive predictive value was 92.86% (95 % CI 65.45% to 98.89%) and negative predictive value was 100%.  Conclusions: ELISPOT can be a useful non-invasive test for the evaluation of undiagnosed pleural effusions and making a diagnosis of pleural tuberculosis with confidence.

A Prospective Study on Prevalence and Percentage of Undiagnosed Type 2 Diabetics Patients Undergoing Elective Surgery

xIntroduction: The major form of diabetes mellitus is Type 2diabetes. It accounts for 90 percent of the diabetic population.Patients with diabetes mellitus (DM) are prone to adverseoutcomes. It is observed that one fifth of the patientsundergoing surgery are diabetic.Methodology: This study was conducted in the Department ofSurgery in the Department of General Surgery, Ananta Instituteof Medical Sciences and Research Centre, Rajsamand. 289total numbers of cases were included in this study. Each casehas Type 2 DM.Results: In our study, 289 total numbers of cases wereincluded. Among the 289 cases 53.9% were male & 46.1%were female. Incidence of Diabetic Mellitus in undiagnosed &diagnosed cases was found 41.5% & 58.5% respectively.Conclusion: This study concludes that there is a strong needof awareness about diabetes and early diagnosis of diabetes toreduce its various complications.

Role of Rigid Thoracoscopy in Undiagnosed Pleural Effusion: A Prospective Study

Background: Medical thoracoscopy is a minimally invasive, safe, and cost-effective procedure that allows complete visualizationof pleural space, enabling diagnostic and therapeutic procedures such as pleural biopsy and talc insufflations. Conservativeestimates suggest that 25% of patients seen in general pulmonologist’s practice involve pleura, of these 25% are unable to beattributed to a specific diagnosis, even after thoracentesis and closed pleural biopsy.Aim: The aim of this study was to evaluate the diagnostic yield of rigid thoracoscopy in undiagnosed pleural effusion.Methods: This prospective observational descriptive study was conducted in Thanjavur Medical College Hospital, Tamil Nadu,in the Department of Thoracic Medicine between July 2017 and December 2018. Rigid thoracoscopy equipment was used forinvestigation. 12 undiagnosed pleural effusion patients after thoracentesis who fulfilled inclusion and exclusion criteria wereincluded in the study.Results: Of the 12 patients, six were male and six were female; seven had right-sided pleural effusion and five had left sidedpleural effusion. Investigation reports were inconclusive except for suggesting an exudative effusion. Cytological examinationsof pleural fluid were inconclusive in all the patients. After thoracoscopy, tuberculosis was diagnosed in five cases, metastasesin three cases, mesothelioma in two cases, and inflammatory pathology in two cases.Conclusion: Thoracoscopy is a safe procedure with high diagnostic yield in undiagnosed exudative pleural effusion (EPE).Asimple, minimally invasive low-cost investigation reduces the need for more invasive and much more expensive thoracotomy.Our study proved that rigid thoracoscopy remains the investigation of choice in all undiagnosed EPE for accurate diagnosisand management.

The Risk Factors for Undiagnosed and Known Hypertension among Malaysians

@#Background: The prevalence of known hypertension has resulted from the progression of undiagnosed hypertension. This study is targeted to examine and compare the risk factors based on the estimated odds ratios of modifiable and non-modifiable risk factors on different outcome levels of hypertension. Methods: A nationwide representative secondary data from the Fourth National Health of Morbidity Survey (NHMS IV) which consists of 24,632 non-institutionalised Malaysian population conducted by the Ministry of Health in 2011 has been used. Odds ratio (OR) with 95% confidence interval has been estimated using multinomial logistic regression. Results: Obese and overweight respondents exhibit increased likelihood of having undiagnosed and known hypertension. Physically inactive, ex-smokers and unclassified drinkers are found having higher likelihood to have known hypertension. However, current drinkers are found to have higher likelihood of having undiagnosed hypertension. Elderly, retirees, home makers and lower educated respondents are shown higher odds to have undiagnosed hypertension. Likewise, the likelihood of having known hypertension has been found to increase among the elderly and other Bumiputra. Conclusion: Through this research, significant predictors which consist of obese and overweight respondents, current drinkers, older respondents (above 65 years old) and primary educated respondents are having higher likelihood to have undiagnosed hypertension.

Etiology and outcome of mono-articular arthritis: a follow up study

Background: Monoarthritis is a common rheumatological complaint. Inspite of investigations, many cases remain undiagnosed. Prompt investigation and treatment is important in acute arthritis especially septic arthritis else joint destruction, permanent disability or even death can result. This study was conducted to etiologically categorise patients as inflammatory, non-inflammatory and infective arthritis and to study the outcome.Methods: This observational prospective study conducted at a tertiary care hospital in Mumbai enrolled 40 patients above the age of 12 yrs presenting with first episode of mono-articular arthritis. They were treated with standard treatment guidelines and followed up every 3 monthly for one year. Outcome was assessed using ESR, CRP values and Health Assessment Questionnaire.Results: Mean age at diagnosis was 38 years with a male to female ratio of 1.4:1. Acute and chronic mono-articular arthritis cases were 16.2% and 83.7% respectively. Knee joint was most commonly involved (38%). Etiologically inflammatory, infectious and non-inflammatory cases were 59.5%, 29.7% and 10.8% respectively. In 21% cases etiology was tuberculosis. 27 % evolved into oligoarthritis over one year. The serial ESR, CRP values and Stanford Health Assessment Questionarre scores decreased significantly across all etiological groups with treatment.Conclusions: Knee is the most commonly affected joint in mono-articular arthritis. Tuberculosis is the most common etiology. Irrespective of the etiology, if patients are treated according to standard guidelines promptly mono-articular arthritis has a good response to therapy as assessed by the health assessment questionnaire (HAQ) and serial measurements of proinflammatory markers like ESR, CRP.

Performance of the Achutha Menon Centre Diabetes Risk Score in Identifying Prevalent Diabetes in Tamil Nadu, India

BACKGROUND: The Achutha Menon Centre Diabetes Risk Score (AMCDRS), which was developed in rural Kerala State, South India, had not previously been externally validated. We examined the performance of the AMCDRS in urban and rural areas in the district of Vellore in the South Indian state of Tamil Nadu, and compared it with other diabetes risk scores developed from India. METHODS: We used the data from 4,896 participants (30 to 64 years) of a cross-sectional study conducted in Vellore (2010 to 2012), to calculate the AMCDRS scores using age, family history, and waist circumference. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV), and the area under the receiver operating characteristic curve (AROC) were calculated for undiagnosed and total diabetes. RESULTS: Of the 4,896 individuals surveyed, 274 (5.6%) had undiagnosed diabetes and 759 (15.5%) had total diabetes. The AMCDRS, with an optimum cut-point of ≥4, identified 45.0% for further testing with 59.5% sensitivity, 60.5% specificity, 9.1% PPV, 95.8% NPV, and an AROC of 0.639 (95% confidence interval [CI], 0.608 to 0.670) for undiagnosed diabetes. The corresponding figures for total diabetes were 75.1%, 60.5%, 25.9%, 93.0%, and 0.731 (95% CI, 0.713 to 0.750), respectively. The AROC for the AMCDRS was not significantly different from that of the Indian Diabetes Risk Score, the Ramachandran or the Chaturvedi risk scores for total diabetes, but was significantly lower than the AROC of the Chaturvedi score for undiagnosed diabetes. CONCLUSION: The AMCDRS is a simple diabetes risk score that can be used to screen for undiagnosed and total diabetes in low-resource primary care settings in India. However, it probably requires recalibration to improve its performance for undiagnosed diabetes.

Undiagnosed Type 2 Diabetes Mellitus and Its Risk Factors among Malaysians: Findings of a Nationwide Study

​The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide and many of these affected individuals remain unidentified. Undiagnosed T2DM may impose substantial public health implications because these individuals remain untreated and at risk for complications. The objective of this study was to determine the national prevalence of undiagnosed T2DM and to identify the associated risk factors. A nationwide cross-sectional study was conducted involving 17,783 respondents. Two-stage stratified sampling design was used to select a representative sample of the Malaysian adult population. Structured validated questionnaires with face to face interviews were used to obtain data. Respondents, who claimed that they were not having diabetes, were then asked to perform a fasting blood glucose finger-prick test by Accutrend GC machine. The prevalence of undiagnosed T2DM was 8.9% (n=1587). The highest percentage of undiagnosed T2DM was found among males (10.2%), 55-59 years old (13.4%), highest education attainers of primary school (11.1%), Indians (10.3%), married (10.3%), working (8.9%) and living in the urban areas (9.2%). Multivariate analyses showed that factors associated with undiagnosed T2DM were gender, age group, ethnicity, marital status, obesity and hypertension. This study found an increasing trend of undiagnosed T2DM in Malaysia compared to 2006. This finding is alarming as risk factors associated with undiagnosed diabetes were related to most of the socio-demographic factors studied. Therefore, early diabetic screening is crucial especially among adults aged 30 and above to prevent more serious complications of this disease.​

The status of glucose intolerance in breast cancer patients without DM history after systemic treatment with surgery and/or chemo-therapy / 中国肿瘤临床

Objective:To determine the status of glucose intolerance in breast cancer patients without DM history after combined treatment with surgery and/or chemotherapy through an oral glucose tolerance test (OGTT). Methods:All 121 breast cancer patients more than 3 months after combined treatments with surgery and/or chemotherapy and without the diagnosis of diabetes underwent OGTT and fasting. Then, 2 h glucose levels were measured to identify glucose tolerance and diabetes. Meanwhile, six patients with a history of diagnosed diabetes did not undergo OGTT. Results:The median ages of all breast cancer patients and the mean duration after combined treatments with surgery and/or chemotherapy were 50.4 years and 19 months, respectively. Among the 121 breast cancer pa-tients without the history of diabetes, the incidences of diabetes, prediabetes, and normal glucose intolerance were 19.8%(24 cases), 45.5%(55 cases) and 34.7%(42 cases), respectively. Among all breast cancer patients, the incidences of previously diagnosed diabetes, undiagnosed diabetes, and prediabetes were 4.72%, 18.9%, and 43.3%, respectively. The ratio of previously undiagnosed diabetes was about 80%. About 80.0% of undiagnosed diabetes and 74.5% of prediabetes met the criteria for elevated 2 h plasma glucose levels through OGTT instead of elevated fasting glucose levels. Conclusion: Breast cancer patients during follow-up after combined treat-ments with surgery and/or chemotherapy highly suffer from glucose intolerance, with high incidences of undiagnosed diabetes and pre-diabetes. OGTT should be made for breast cancer patients after combined treatments for early diagnosis, prevention, and treatment of di-abetes.

Advantage of Systematic Blood Cell Count 2 Days Post-delivery for the Diagnosis of Postpartum Maternal Anaemia.

Aims: To evaluate the advantage of full blood cell count as performed 48h post-delivery for the diagnosis of postpartum maternal anaemia. Study Design: Observational retrospective study. Methodology: According to the usual local protocol, haemoglobin assessment is made in all mothers at entry in the labour room (D0), and 2 days post-delivery (D2). The relationship between haemoglobin decrease, anaemia onset, and obstetrical anamnesis has been evaluated by multiple logistic regression analysis. Results: Four hundred and seven (407) parturient women were included. Of them 13.3% (n=54) had >2g haemoglobin loss and were considered having developed undiagnosed postpartum haemorrhage (UDPPH); 10.3% (n=42) had anaemia with <10g/dL haemoglobin at D2. The identified risk factors for postpartum anaemia onset were episiotomy (OR 11.8; 95%CI 4.71-17.5; P <0.001), foetal distress (OR 5.99; 95%CI 2.20- 16.3; P <0.001), duration of labour (OR 1.21; 95%CI 1.05-1.40; P<0.008), and presence of perineal and/or vaginal tears (OR 2.9; 95%CI 1.18-7.13; P =0.02). Conclusion: Systematic haemoglobin control in all patients 2 days after vaginal delivery allows the detection and subsequent treatment of UDPPH-related anaemia.

Sudden Death from an Non-diagnosed Paraganglioma after Surgery: A Case Report / 대한법의학회지

Extra-adrenal paragangliomas and pheochromocytomas are rare but clinically important tumors, which produce, store, release, and metabolize catecholamines resulting in unexpected life-threatening effects. It is neither easy nor difficult to clinically diagnose these tumors despite the availability modern clinical methods because signs and symptoms such as recurrent episodes of paroxysmal hypertension and headache are nonspecific. Only a few cases of unexpected death in which the deceased had a non-diagnosed paraganglioma or pheochromocytoma have been reported. Death in these cases is usually sudden and occurs during emergency room care or during a major or minor abdominal operation, without prodromal symptoms. Death is considered to occur because of paroxysmal hypertension, cerebrovascular attacks, abrupt hemorrhage into the tumor parenchyma, or acute left ventricular failure. We report the case of a 73-year-old man who died 12 hours after undergoing decompression surgery for spinal stenosis. A medico-legal autopsy revealed that death in this case resulted from an undiagnosed paraganglioma around the abdominal aorta.