Metabolic syndrome in patients with type 1 diabetes mellitus at a tertiary centre in North India: A five year follow up study.

BACKGROUND AND AIMS: Metabolic syndrome (MS) is prevalent in the Indian population and has been traditionally linked to Type 2 diabetes mellitus (T2DM). Its presence is now being increasingly recognized in patients with Type 1 diabetes mellitus (T1DM). Presence of MS may increase the risk of diabetes related complications. This study was designed to determine the prevalence of MS in a cohort of patients with T1DM at baseline and at 5 years of follow up. METHODS: Longitudinal cohort study in a tertiary care center in North India. Patients with T1DM attending the Diabetes of the Young (DOY) Clinic from January 2015 to March 2016 included. Microvascular and macrovascular complications assessed. The cohort was followed after a period of 5 years. RESULTS: We included 161 patients (males, 49.4%) with a median (IQR) age of 23 (18-34) years and median (IQR) diabetes duration of 12 (7, 17) years. At baseline, 31 (19.2%) patients had MS. Patients with MS were more likely to have microvascular complications: retinopathy (p = 0.003), neuropathy (p = 0.02) and nephropathy (p = 0.04). Independent predictors of MS: insulin sensitivity (IS) (adjusted OR (aOR) 0.02 [95% CI, 0.003-0.118]), body weight (aOR 1.05 [95% CI, 1.007-1.108]), diastolic blood pressure (aOR 1.08 [95% CI, 1.01-1.15]) and duration of diabetes (aOR 1.09 [95% CI, 1.02-1.16]). On follow-up (n = 100), 13 (13%) had MS. CONCLUSIONS: One in 5 patients with T1DM suffers from MS, and is therefore predisposed to its attendant risks, calling for early identification and targeted interventions.

Pharyngocutaneous Fistula Following Primary and Salvage Laryngectomy: Aetiology and Predictive Factors.

Laryngeal cancer treatment is often wrought with challenges, pharyngocutaneous fistula formation (PCF) in patients undergoing either primary or salvage laryngectomy for laryngeal and hypopharyngeal for squamous cell carcinoma is an important one. We aimed to study the factors before and at the surgery that are associated with PCF formation in a South Indian tertiary care hospital. A retrospective chart review of 127 patients who underwent total laryngectomy (TL) between May 2014 and April 2019 at our centre were done. Data was collected, including patient age and gender, comorbidities (Diabetes mellitus, COPD and hypothyroidism), smoking, tumor stage and site, prior tracheostomy, prior radiation, concurrent neck dissection and type of pharyngoplasty, Preoperative hemoglobin and albumin levels, surgical margin status and development of a PCF was also done. Further details specific to the development of a PCF were recorded for that subset of patients including the length of time to fistula, mode of closure, time of closure and modality of management. The overall incidence of PCF was 16.5% (21 of 127 patients), and the median time from TL to the diagnosis of PCF was 6 days (range, 3-20 days). The analysis was done separately for laryngectomies without any pharyngeal reconstruction (112/127 patients). In patients treated with a primary TL, the incidence of PCF was 12.20% (10 of 82) and 26.66% (8 of 30) after salvage TL. Subset analysis for type of pharyngoplasty repair showed 12% (15/127) underwent different types of vascularised/muscular flap for smaller residual pharyngeal mucosa, of which 20% (3/15) developed PCF and one patient developed haematoma needing exploration and re-suturing. The predictive factors for PCF were hypopharynx cancer (P < 0.05), surgical margin positivity (P < 0.0001), female gender (P < 0.05), absence of prior tracheostomy (P < 0.05) and tumor extension into pyriform sinus mucosa (P < 0.05). Preoperative patient factors of gender and site of primary along with histological margin positivity and extension of tumor to the pyriform sinus mucosa were significant risk factors for PCF formation. Pre-Op radiotherapy remains a strong clinical suspicion but not statistically significant.

Online Health Information Seeking Behaviour Due to COVID-19 Pandemic-Induced Health Related Anxiety among the General Population in India.

BACKGROUND: Persons with anxiety regarding health may have an increased tendency to seek online health information especially during a pandemic. The primary objective of this study was to determine COVID-19 induced health anxiety among the general population in India using Google Trends data. METHODS: Online health information seeking behaviour with respect to high-risk comorbid conditions for severe COVID-19 disease during the pandemic period was compared to that of the previous year. Correlation between the COVID-19 incidence and online health information seeking behaviour was also computed to explore if the observed health anxiety was due to the pandemic. RESULTS: Overall, the online health information seeking behaviour was highest for diabetes both during (81.46±8.84) and before the pandemic (64.47±9.48). A significant increase (p<0.001) in the information seeking behaviour during the pandemic was observed with all the four high-risk comorbid conditions including diabetes (+16.99), hypertension (+22.57), lung disease (+21.79), and cardiovascular disease (+14.08). The behaviour with respect to diabetes (r=0.39), hypertension (r=0.48) and lung disease (r=0.69) showed significant positive correlation with the COVID-19 incidence. The observed health anxiety was regardless of prevalence, urbanization and literacy rates of individual states. CONCLUSIONS: The general population in India has increased its online health information seeking behaviour during the pandemic and this may be due to an underlying health anxiety due to COVID-19.

Socio-Demographic and Clinical Correlates of Exclusive Breastfeeding practices up to Six Months of Age.

BACKGROUND: According to the recommendations from The World Health Organization, exclusive breast feeding (EBF) should be given to infants for the first six months for healthy growth and development. However, developing countries have a wide range of variation in the practice of EBF. From this study, we aim to estimate the duration of EBF and find the impact of socio-demographic characteristics on EBF. MATERIALS AND METHODS: This study was conducted at PSG Institute of Medical Sciences and Research, Coimbatore in the month of July 2018. Mothers with children aged below 4 years attending the paediatric outpatient department were included in the study. Kaplan-Meier curve analysis and logistic regression analysis were employed. RESULTS: Our analysis indicates that the prevalence of EBF was 58.4% among infants up to 6 months of age with mean duration of EBF 4.52 months. It was observed that mothers of a younger age (15-24 years) and with lower socio-economic status were negatively associated with the practice of providing EBF to infants up to six months of age. CONCLUSION: The findings clearly indicate that the interventions related to EBF up to six months of age should be targeted at women in the lower socio-economic status and at younger ages.