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2.
Glob Chang Biol ; 30(1): e17066, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38273563

ABSTRACT

Groundwater is a vital ecosystem of the global water cycle, hosting unique biodiversity and providing essential services to societies. Despite being the largest unfrozen freshwater resource, in a period of depletion by extraction and pollution, groundwater environments have been repeatedly overlooked in global biodiversity conservation agendas. Disregarding the importance of groundwater as an ecosystem ignores its critical role in preserving surface biomes. To foster timely global conservation of groundwater, we propose elevating the concept of keystone species into the realm of ecosystems, claiming groundwater as a keystone ecosystem that influences the integrity of many dependent ecosystems. Our global analysis shows that over half of land surface areas (52.6%) has a medium-to-high interaction with groundwater, reaching up to 74.9% when deserts and high mountains are excluded. We postulate that the intrinsic transboundary features of groundwater are critical for shifting perspectives towards more holistic approaches in aquatic ecology and beyond. Furthermore, we propose eight key themes to develop a science-policy integrated groundwater conservation agenda. Given ecosystems above and below the ground intersect at many levels, considering groundwater as an essential component of planetary health is pivotal to reduce biodiversity loss and buffer against climate change.


Subject(s)
Ecosystem , Groundwater , Biodiversity , Fresh Water , Environmental Pollution
3.
Environ Monit Assess ; 196(2): 221, 2024 Jan 31.
Article in English | MEDLINE | ID: mdl-38291219

ABSTRACT

This study investigates the fish assemblage in a temporarily-closed sandbar estuary along India's west coast, across different zones and seasons. Moderate species diversity (54 species), low species abundance, varying fish diversity from lower to upper estuarine gradient (higher counts in lower zones, and decreasing from middle to upper zones), and higher prevalence of marine migrants (estuarine use) and piscivorous species (feeding mode) were the significant characteristics of the estuary. Distinct spatial, seasonal, and estuarine mouth state-based variations were recorded in the estuary, based on diversity indices and count of taxa. Peak diversity and abundance were noted during the pre-monsoon, and during the open mouth state of the estuary. The entire estuarine gradient is anthropogenically impacted by a multitude of stressors, except at the estuarine mouth region, which is favored by marine connectivity. The fish assemblage structure in Poonthura estuary (PE) has thus far remained unaffected by anthropogenic disturbances. Nevertheless, growth and nursery function of the estuary have been significantly compromised. The predominance of juvenile fish in the ecosystem, and prevailing anthropogenic stressors from point and non-point sources underscore the necessity for long-term maintenance of the population of coastal species, as well as a need for developing and implementing urgent management strategies for this fragile ecosystem.


Subject(s)
Ecosystem , Estuaries , Animals , Environmental Monitoring , Fishes , Seasons
4.
Gene ; 898: 148098, 2024 Mar 10.
Article in English | MEDLINE | ID: mdl-38128794

ABSTRACT

The mitogenome of Lepidopygopsis typus, an evolutionarily distinct, endangered, cyprinid fish from the Western Ghats Biodiversity Hotspot, was characterized. Total length of the mitogenome was 16,729 bp, and comprised of 13 protein coding, 22 tRNA and two rRNA genes. Thirteen protein coding genes contributed a total nucleotide length of 11,408 bp, which coded for a total of 3794 amino acids and accounting for 68.2 % of the mitogenome. A maximum likelihood phylogenetic tree based on mitogenomes of members of cyprinid subfamilies Torinae, Schizothoracinae and Schizopygopsinae, recovered L. typus in a well-resolved clade of Torinae with members of the Western Ghats endemic genus Hypselobarbus as sister taxa. Selection analysis suggested that the branch of L. typus and Hypselobarbus spp. was under intensified selection with reference to other members of Torinae. There were 19 codons under diversifying selection in L. typus, which could be the result of positive selection for adapting to high-altitude, upstream tributaries of Periyar River, where the species has a restricted distribution. With respect to Hypselobarbus spp., L. typus was under relaxed selection with about 68 % of codons experiencing neutral evolution. Restricted distribution, low population size and relaxation in selection can likely trigger extinction in L. typus, and therefore urgent conservation and monitoring plans are required to secure the future of this evolutionary distinct, and globally endangered species.


Subject(s)
Cyprinidae , Genome, Mitochondrial , Animals , Phylogeny , Cyprinidae/genetics , Biodiversity , Codon/genetics
5.
Sci Rep ; 13(1): 18724, 2023 10 31.
Article in English | MEDLINE | ID: mdl-37907560

ABSTRACT

Sri Lanka's biota is derived largely from Southeast Asian lineages which immigrated via India following its early-Eocene contact with Laurasia. The island is now separated from southeastern India by the 30 km wide Palk Strait which, during sea-level low-stands, was bridged by the 140 km-wide Palk Isthmus. Consequently, biotic ingress and egress were mediated largely by the climate of the isthmus. Because of their dependence on perennial aquatic habitats, freshwater fish are useful models for biogeographic studies. Here we investigate the timing and dynamics of the colonization of-and diversification on-Sri Lanka by a group of four closely-related genera of cyprinid fishes (Puntius sensu lato). We construct a molecular phylogeny based on two mitochondrial and two nuclear gene markers, conduct divergence timing analyses and ancestral-range estimations to infer historical biogeography, and use haplotype networks to discern phylogeographic patterns. The origin of Puntius s.l. is dated to ~ 20 Ma. The source of diversification of Puntius s.l. is Sri Lanka-Peninsular India. Species confined to perhumid rainforests show strong phylogeographic structure, while habitat generalists show little or no such structure. Ancestral range estimations for Plesiopuntius bimaculatus and Puntius dorsalis support an 'Out of Sri Lanka' scenario. Sri Lankan Puntius s.l. derive from multiple migrations across the Palk Isthmus between the early Miocene and the late Pleistocene. Species dependent on an aseasonal climate survived aridification in rainforest refugia in the island's perhumid southwest and went on to recolonize the island and even southern India when pluvial conditions resumed. Our results support an historical extinction of Sri Lanka's montane aquatic fauna, followed by a recent partial recolonization of the highlands, showing also that headwater stream capture facilitated dispersal across basin boundaries.


Subject(s)
Biological Evolution , Cyprinidae , Animals , Sri Lanka , Phylogeny , Cyprinidae/genetics , Phylogeography
6.
Mar Environ Res ; 192: 106189, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37820480

ABSTRACT

A trophic model was constructed for the Poonthura Estuary, a small, anthropogenically impacted estuary along the south-western coast of India. An Ecopath with Ecosim based trophic modelling approach, based on observations made between 2016 and 2020, revealed that the Poonthura Estuary had a low total system throughput (3044.2 t km-2 year-1), low ascendancy (15%), high Finn's cycling index (17.9%), low primary production/total biomass (5.2 t km-2 year-1), high mean transfer efficiency (12.4%), and low eco-exergy (14,455.46 gm detritus equivalent m-2). These values indicated that the estuary is an immature, less organized, and unhealthy system. The evaluation of Ecological Network Analysis, and ecosystem health indices revealed that the ecological structure and functioning of the estuary are impaired to a large extent from multiple anthropogenic stressors. The Poonthura Estuary trophic model revealed the total primary production/respiration value as 0.46, indicative of the massive pollution that the system is subjected to, particularly from organic sources. Small benthic carnivores were the most important keystone groups recorded from the Poonthura Estuary, despite their low biomass. The comparison of ecological indices of Poonthura Estuary, with those recorded for other small estuaries from various geographical locations, suggested dissimilar trophic functioning and food web structures from estuaries with similar physical features. Our study is a pioneering step to reveal the ecosystem status and functioning of small, anthropogenically disturbed estuaries, besides offering theoretical and scientific basis for the management, supervision and restoration of the Poonthura Estuary as well as other small estuaries, around the world.


Subject(s)
Ecosystem , Estuaries , Biomass , Food Chain , Environmental Monitoring
7.
J Fish Biol ; 103(6): 1445-1451, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37667092

ABSTRACT

Fusiliers of the family Caesionidae comprise a group of Indo-Pacific reef fishes important in the live bait and artisanal fisheries in many parts of its range, particularly in the Indian Ocean region. Using newly generated mitochondrial COI sequences of 10 species of caesionid fishes from the Laccadive archipelago, we carried out a molecular phylogenetic analysis, which has helped improve our understanding of the diversity, distribution, and systematics of this poorly known group of fishes. The two speciose genera within Caesionidae, Caesio and Pterocaesio, were revealed to be paraphyletic, and as a result, four names earlier considered as subgenera within Caesionidae (Flavicaesio, Odontonectes, Pisinnicaesio, and Squamosicaesio) were elevated to the status of distinct genera. We also discovered the presence of a new lineage in the Central Indian Ocean, sister to Caesio caerulaurea and Caesio xanthalytos, but distinct from both in several morphological characters and a genetic distance of between 2% and 3% in the mitochondrial COI gene. We describe this lineage as Caesio idreesi, a new species, with a distribution spanning the Laccadive Sea and the Bay of Bengal. Our genetic data also helped confirm the first confirmed records of two species, Pisinnicaesio digramma and Squamosicaesio randalli, from the Central Indian Ocean, and a new distribution record for C. xanthalytos in the Laccadive Sea. Combined, these results have helped bridge key biodiversity knowledge gaps of the family Caesionidae and form an excellent baseline for further investigations on their taxonomy, systematics, and life history.


Subject(s)
Fishes , Mitochondria , Animals , Phylogeny , Indian Ocean , Fishes/genetics , Mitochondria/genetics , Genes, Mitochondrial , Pacific Ocean
8.
Indian J Psychiatry ; 65(5): 586-594, 2023 May.
Article in English | MEDLINE | ID: mdl-37397837

ABSTRACT

Context Background: Hyperthyroidism has a major impact on mental health. Aims: We intended to determine the magnitude of the unmet need for mental health support in patients with hyperthyroidism attending an endocrinology clinic. Settings and Design: General Hospital Endocrine Department, Prospective Study. Methods and Material: In a naturalistic, prospective study, consecutive (n = 176) hyperthyroid patients were assessed for anxiety (generalized anxiety disorder, GAD-7), depression (Patient Health Questionnaire PHQ-9), functional impairment (work and social adjustment scale, WSAS), and quality of life (EuroQol ED5D) using standardized instruments. Statistical Analysis Used: Percentages, mean and standard deviation (SD), Chi-square, Student's t-test, ANOVA, Spearman's correlation. Results: A considerable proportion (40.5%) of patients had moderate and severe anxiety, around half (50.6%) had moderate or severe depression, and 20.8% had severe functional impairment at presentation. Mean EQ5D score was 59.6 ± 23.5. The scores of anxiety, depression, and functional impairment were significantly correlated with each other and negatively correlated with QOL. Following treatment of hyperthyroidism, improvement in psychiatric symptoms was noted which could be correlated with the lowering of T4. However, a significant proportion of patients continued to have psychiatric symptoms and functional impairment despite achieving euthyroidism. There was no correlation between the severity of hyperthyroidism to persistence of mental health parameters. Conclusions: Our findings of high prevalence and persistence of impairment of mental health and functional status of patients with hyperthyroidism have highlighted the unmet needs for these patients.

9.
J Fish Biol ; 103(1): 113-117, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37170471

ABSTRACT

The deep-sea spiny eels of the genus Notacanthus Bloch 1788 are currently represented by six valid species, of which only one, Notacanthus indicus, has been described so far from the Arabian Sea, part of the Western Indian Ocean. This paper reports the discovery of a new species, described herein as Notacanthus laccadiviensis, from the outer reef drop-off, off the Kavaratti Island, Lakshadweep Archipelago, Arabian Sea. The new species differs from its congeners in the shape of the head; morphology of dorsal, pectoral and anal fins; number of gill rakers; number of vertebrae; and body colour, and specifically from N. indicus (the only known congener from the Indian Ocean) in the unusual morphology of the dorsal fin, and number of rays in the dorsal and pectoral fins.


Subject(s)
Fishes , Perciformes , Animals , Indian Ocean , Gills , Eels , Perciformes/anatomy & histology
10.
J Fish Biol ; 102(3): 680-688, 2023 Mar.
Article in English | MEDLINE | ID: mdl-36602224

ABSTRACT

The syngnathiform genus Corythoichthys comprises a group of taxonomically complex, tail-brooding (Syngnathinae) pipefishes widely distributed in the Indo-Pacific region. Due to the presence of overlapping interspecific morphological characters, reliable taxonomic information on Corythoichthys is still lacking. Using 52 CO1 sequences, including seven newly generated, a phylogenetic analysis was carried out to understand the genetic diversity, distribution and 'species groups' within the genus Corythoichthys. Species delimitation using Automatic Barcode Gap Discovery (ABGD) analysis confirmed the presence of 13 species which include 'species-complexes' previously considered as a single taxon. Our results revealed the presence of three species groups, 'C. amplexus', 'C. conspicillatus' and 'C. haematopterus' and four unidentified/undescribed species in the wider Indo-Pacific realm. Interestingly, 60 sequences and a mitogenome identified as Corythoichthys in GenBank are misidentified at the genus level. Based on our findings, we suggest that the taxonomy and systematics of Corythoichthys need to be re-examined and validated using integrative methods, and care should be taken while selecting specimens for genetic studies.


Subject(s)
Biodiversity , Classification , DNA Barcoding, Taxonomic , Smegmamorpha , Animals , Indian Ocean , Phylogeny , Smegmamorpha/classification , Smegmamorpha/genetics , Species Specificity , Classification/methods
11.
Environ Sci Pollut Res Int ; 30(11): 29635-29662, 2023 Mar.
Article in English | MEDLINE | ID: mdl-36417074

ABSTRACT

The fish guild structure of 96 fish species inhabiting the Vembanad Lake, an open, large, well-mixed coastal estuary along the south-west coast of India, was studied based on samples from upper (freshwater), middle (estuarine), and lower (saline) zones representing three major seasons (monsoon, post-monsoon, and pre-monsoon). Functional group assessment revealed seven ecological guilds (marine estuarine opportunists, freshwater, marine estuarine dependent, estuarine, catadromous, anadromous, and amphidromous), six feeding guilds (detritivore, zooplanktivore, herbivore, zoobenthivore, omnivore, and carnivore), three vertical distribution guilds (demersal, benthopelagic, and pelagic), five reproductive-mode functional groups (oviparous with pelagic eggs, oviparous with benthic eggs, oviparous guarders, viviparous and ovoviviparous), and five flow-preference guilds (rheophilic A1, eurytopic, rheophilic A2, rheophilic B, and rheophilic C). The estuary was characterized by high species diversity, low individual species abundance, complex guild structure, varying fish diversity from upper to lower estuary and higher proportion of marine rather than 'true' estuarine species. The absence of a significant relationship between season and fish guild structuring could be due to high resource availability in the estuary and low ecological connectivity between upper and lower estuarine zones as a result of anthropogenic interventions in the middle zone. Salinity variations considerably influenced the fish guild formation in the estuary. A drastic change in the hydrography of the estuary over the past sixty years due to topographical alterations has transformed the fish guilds resulting in a considerable increase in freshwater species and a reduction in marine and estuarine-dependant species.


Subject(s)
Estuaries , Lakes , Animals , Fishes , India , Seasons , Ecosystem
12.
Zootaxa ; 5138(1): 89-97, 2022 May 16.
Article in English | MEDLINE | ID: mdl-36101034

ABSTRACT

A second subterranean species of Pangio is described from an old dug-out well in Kerala, Southern India. The new species, Pangio pathala is unique within the genus in possessing the highest number (27) of caudal vertebrae. Pangio pathala is distinguished from P. bhujia, the only subterranean Pangio species known so far, in having four pectoral-fin rays (vs. three), five anal-fin rays (vs. six), 67 vertebrae (40 abdominal and 27 caudal vertebrae) (vs. 6263), and a raw genetic distance of 8.18.7% in the mitochondrial cytochrome oxidase subunit 1 gene. This paper also provides an additional record of Pangio bhujia from a location 40 km south of the type locality.


Subject(s)
Cypriniformes , Lepidoptera , Animals , Cypriniformes/genetics , Eels , India
13.
Environ Sci Pollut Res Int ; 29(38): 58278-58296, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35364792

ABSTRACT

Invasive alien species (IAS) influence the trophic organisation and food web structure in an invaded ecosystem, and therefore, it is imperative to quantify the resultant ecological impacts. The globally recognised ecosystem modelling platform, Ecopath with Ecosim, was used to delineate the impacts of IAS on a tropical freshwater pond ecosystem in India. We analysed the trophic interactions, consumption patterns, prey overlap and mixed trophic impacts of three co-existing invasive alien fish species, African catfish (Clarias gariepinus), suckermouth catfish (Pterygoplichthys pardalis) and Mozambique tilapia (Oreochromis mossambicus), on other functional groups in the ecosystem. Together, the three IAS shared 11% of the total energy consumption and about 50% of the energy consumption by the fish species/groups. There was no predation mortality for African catfish and suckermouth catfish, and a very low estimate for the same was recorded for tilapia (0.64 year-1). The IAS shared high mean prey overlap with the native fish groups (Garra sp., Etroplus suratensis, Systomus sarana, Chanda nama and various small species of the cypriniform genera Puntius, Rasbora and Devario) indicating a substantial competition between alien and native species in the ecosystem. Consequently, the three IAS exhibited higher mean negative mixed trophic impacts on these functional groups. A very high Finn's cycling index (39.59%), a low relative ascendency (28.5%) and a very low system robustness (0.07) were observed compared to similar ecosystems, and the baseline values. These indices exposed the vulnerability of the ecosystem towards perturbations, which could be due to the presence of multiple alien invasive species. Mitigating the impacts of IAS should involve a combination of approaches, including eradication through draining and harvesting, high-density stocking of similar trophic level fish in the pond, and local and national level policy interventions.


Subject(s)
Ecosystem , Fishes , Introduced Species , Models, Biological , Animals , Food Chain , Fresh Water
15.
Kidney360 ; 3(2): 279-286, 2022 02 24.
Article in English | MEDLINE | ID: mdl-35373132

ABSTRACT

Background: Health care providers who care for patients with CKD must be able to provide effective counseling about a kidney-friendly diet. Nutrition is underemphasized in medical curricula, and the kidney diet is one of the most challenging diets. We hypothesized that participation in an experiential educational program in kidney diet would result in improved knowledge of the underlying principles behind it and provide concrete examples of how to explain this diet to patients. Methods: The first part of this study was a knowledge assessment administered to all US nephrology fellows during the 2020 National Board of Medical Examiners Nephrology In-Training Examination. We later opened the assessment to a broader, global audience via social media. Respondents included trainees, practicing nephrologists, dieticians, and other health professionals. Participants self-identified willingness to participate in the second part of the study, the Kidney Diet Challenge (KDC). The 5-day challenge included daily webinars by experts in nutrition. Daily surveys captured self-reported adherence to the diet. Social media was used to engage with participants. All participants received a follow-up knowledge assessment. Results: Among the nephrology fellows (n=317), the median pretest score was 2 out of 5 (40%) questions correct, and results did not differ by year of training (P=0.31). Of the participants (n=70) who completed the 5-day challenge and responded to the post-challenge survey, the distribution of the number of correct answers improved after the KDC (median [25th, 75th percentile]: 3 [2, 3] versus 3 [2, 4]; P<0.001). Statistics from our official hashtag for this study (#kidneydietchallenge) showed that we achieved 406,241 reaches and 1,004,799 impressions, with a total of 974 posts using this hashtag. Conclusions: The KDC is an immersive, experiential educational tool that enabled a global population to learn how to counsel their patients better about adherence to a complex kidney diet.


Subject(s)
Fellowships and Scholarships , Nephrology , Curriculum , Humans , Kidney , Nephrologists , Nephrology/education
16.
Environ Sci Pollut Res Int ; 29(25): 37969-37988, 2022 May.
Article in English | MEDLINE | ID: mdl-35067889

ABSTRACT

We present for the first time, data on fish assemblage structure for ten temporarily closed estuaries (TCEs) along the south-western coast of India. Fish community structure differed significantly between TCEs based on species presence/absence, estuarine use and feeding mode. Marine migrant and freshwater stragglers dominated the 'fish guilds', while piscivores and zoobenthivores were the major feeding guilds, in all estuaries. We used the Estuarine Fish Community Index (EFCI) and a Combined Anthropogenic Pressure Index (CPI) to determine the ecological quality of TCEs. The application of functional guilds and EFCI successfully represented the use of TCEs by fish communities, and also the functional similarities existing between fish assemblages of these estuaries, despite considerable taxonomic, physical and chemical differences. EFCI indicated that the ecological health of TCEs in south-western India ranges from 'poor' to 'good'. We also established a significant relationship between CPI, EFCI and ecological quality in various TCEs using the Generalized Linear Model (GLM).


Subject(s)
Estuaries , Fishes , Animals , Ecosystem , Fresh Water , India
17.
Mol Biol Rep ; 49(1): 351-361, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34724129

ABSTRACT

BACKGROUND: The taxonomic status and geographical distribution of M. tengara are vague. No genetic diversity and phylogenetic study have been done till now to resolve its identity and distribution. In the present study, an integrated taxonomic approach has been applied to clarify the taxonomic status, identity, and distribution of bagrid catfish, Mystus tengara. METHODS AND RESULTS: Comparative morphometric evaluation of M. tengara identified in the present study from distant geographical locations revealed variations of the traits in response to body length and environment, without significant genetic distance. The observed morphometric traits of M. tengara were found to be overlapping with available morphometric traits of M. tengara, M. carcio and M. vittatus. Maximum likelihood and Bayesian phylogenetic analysis based on mitochondrial cytochrome c oxidase (COI) gene also could not resolve their identity, and five paraphyletic clades comprising of M. tengara, M. vittatus, and M. carcio from India, Nepal, and Bangladesh were observed. Morphological and genetic evidence along with comparative evaluation of M. tengara, from its type locality, we consider M. tengara identified in the present study to be true, with its distribution extending from North East India to West Bengal, North India, Central India, Northern peninsular India, and Bangladesh. CONCLUSION: The observation of paraphyletic subclades and evaluation of genetic distance between subclades reveals the presence of four cryptic species. Further confirmation on the identity of M. vittatus and M. carcio, by an integrated taxonomic approach based on fresh specimens collected from the type locality, is required.


Subject(s)
Catfishes/anatomy & histology , Catfishes/classification , Electron Transport Complex IV/genetics , Animals , Bangladesh , Bayes Theorem , Catfishes/genetics , Fish Proteins/genetics , India , Likelihood Functions , Mitochondrial Proteins/genetics , Nepal , Phylogeny , Phylogeography
18.
Biol Lett ; 17(8): 20210212, 2021 08.
Article in English | MEDLINE | ID: mdl-34343438

ABSTRACT

The Indian subcontinent has an origin geologically different from Eurasia, but many terrestrial animal and plant species on it have congeneric or sister species in other parts of Asia, especially in the Southeast. This faunal and floral similarity between India and Southeast Asia is explained by either of the two biogeographic scenarios, 'into-India' or 'out-of-India'. Phylogenies based on complete mitochondrial genomes and five nuclear genes were undertaken for ricefishes (Adrianichthyidae) to examine which of these two biogeographic scenarios fits better. We found that Oryzias setnai, the only adrianichthyid distributed in and endemic to the Western Ghats, a mountain range running parallel to the western coast of the Indian subcontinent, is sister to all other adrianichthyids from eastern India and Southeast-East Asia. Divergence time estimates and ancestral area reconstructions reveal that this western Indian species diverged in the late Mesozoic during the northward drift of the Indian subcontinent. These findings indicate that adrianichthyids dispersed eastward 'out-of-India' after the collision of the Indian subcontinent with Eurasia, and subsequently diversified in Southeast-East Asia. A review of geographic distributions of 'out-of-India' taxa reveals that they may have largely fuelled or modified the biodiversity of Eurasia.


Subject(s)
Oryzias , Animals , Asia, Southeastern , Biodiversity , India , Phylogeny
19.
Trends Ecol Evol ; 36(10): 875-878, 2021 10.
Article in English | MEDLINE | ID: mdl-34253386

ABSTRACT

Groundwater depletion is a significant global issue, but its impact on the often-enigmatic subterranean biodiversity and its conservation remains poorly understood. In the Western Ghats biodiversity hotspot of India, poor governance of groundwater resources is threatening its evolutionarily distinct subterranean freshwater fauna, some taxa of which represent Gondwanan relics.


Subject(s)
Biodiversity , Groundwater , Animals , Fishes
20.
Article in English | MEDLINE | ID: mdl-34162582

ABSTRACT

This case presentation describes a 65-year-old woman with metastatic malignant insulinoma who experienced frequent episodes of hypoglycaemia causing significant distress and burden to her quality of life. The report describes how medical management was altered and how the patient was supported in order to alleviate these burdens. In particular, the report highlights the first documented use of flash glucose monitoring in insulinoma, which was beneficial in reducing the discomfort of lancet use and anxiety associated with hypoglycaemic episodes. This case demonstrates the benefits of an individualised approach, collaboration with other specialisms and recommends further evaluation of the use of flash glucose monitoring in palliative care.

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