Remote assessment and reinforcement of patient awareness of role of lifestyle modification and treatment adherence in polycystic ovary syndrome using an online video based educational module

Objective: To evaluate the role of an online, video-based, structured, educational module in increasing awareness in women with polycystic ovary syndrome (PCOS). Material and Methods: Patients with PCOS were assessed for baseline awareness about PCOS, quantified as "awareness score", using a validated questionnaire. Topics assessed included factual and conceptual knowledge of the disease and awareness of behaviour-related lifestyle modification and therapy compliance in PCOS. An educational video module was shown to the participants which covered normal menstrual physiology, symptomatology, pathophysiology and natural history of PCOS, a comparative animation of healthy versus unhealthy lifestyle, indications of pharmacological intervention, and role of treatment adherence. The questionnaire was re-administered after exposure to the educational module, and effectiveness of the teaching method was evaluated by comparing pre and post test scores. Results: The total number of subjects was 41. Baseline knowledge was "fair" in 17.1%, "moderate" in 48.8% and "good" in 34.1%. Significant increase in awareness scores was noted among participants regarding PCOS after exposure to the learning module from 15.09±4.31 to 18.60±3.85 (p<0.00001) with a large effect size (Cohen's d=0.85). Most (48.8%) of the respondents had baseline awareness in the "moderate" range (scores between; 11-17) whereas post intervention scores improved to the "good" category for 63.4% of the women. Conclusion: The educational module was effective in significantly increasing knowledge about PCOS. Patient education is likely to help reinforce the message about lifestyle modification and continued compliance and may aid in promoting a patient-driven healthcare model in PCOS.

Decreased Mortality After Long-Term Treatment With Dipeptidyl Peptidase-4 Inhibitors: A Retrospective Study of U.S. Veterans With Type 2 Diabetes.

OBJECTIVE: The prevalence of chronic kidney disease (CKD) in the United States is 13% of the general population. Among those with CKD, diabetic nephropathy is the leading cause of end-stage renal disease. This is a retrospective study examining the effect of long-term use of dipeptidyl peptidase-4 (DPP-4) inhibitors on all-cause mortality and progression of renal disease in the veteran population. METHODS: Data was extracted using the Veterans Administration Informatics and Computing Infrastructure. A large cohort of veterans diagnosed with type 2 diabetes mellitus were used to identify patients on DPP-4 inhibitors and without DPP-4 inhibitors. Groups were compared to determine the effect of DPP-4 inhibitors on the progression of CKD and all-cause mortality. Data were analyzed using SAS. RESULTS: Subjects in the treatment group (n = 40 558) had baseline variables (age, body mass index, race) similar to the control group (n = 40 558). Diabetes control improved in the treatment group (HgbA1c, 8.3% [67 mmol/mol] to 7.8% [62 mmol/mol]; P < .001) but not in the control group (HgbA1c, 7.4% [57 mmol/mol] to 7.3% [56 mmol/mol]). New diagnoses of heart failure and coronary artery bypass grafts were clinically significant (odds ratios = 0.66 and 0.52). No change in progression of CKD was seen in either group. All-cause mortality was reduced by 59%. CONCLUSION: We conclude that DPP-4 inhibitors are associated with a significant reduction in all-cause mortality independent of glucose control, albeit with no clear cause, including obtainable cardiovascular outcomes. Our data is consistent with prior trials in that DPP-4 inhibitors did not show a significant change in serum creatinine or microalbuminuria.

Lip morphometry in 600 North Indian adults: a data base study for sexual dimorphism.

The study comprised lip morphometry of 600 North Indian adults (300 males and 300 females). The aim of the study was to create base data of various linear and vertical measurements of the upper and lower lips and width of the mouth. This standard may serve as a guideline for sexual dimorphism as well as for restoration or enhancement of esthetic and plastic surgery for the lips in the north Indian population, which will enable the surgeon to offer a better cosmetic result. Prior informed written consent from all the subjects was obtained. The exclusion and inclusion criteria for the subjects were predefined. The analysis shows the sexual dimorphism in most parameters of lips being greater in males. The results were compared with the available data for north white Americans, Malays, Malaysian Indians, Italians, western Indians and Caucasians. In the population under study, the measurements differ in all dimensions with Malays, Italians and Caucasians and show resemblance to the Malaysian Indians. Knowledge of the proportion between the upper and lower lips helps in surgical correction of the region. This study highlights the applied significance of observations of the present study to forensic, namely racial and sex dimorphic, criteria of identification.

Gastric antral vascular ectasia (watermelon stomach) in a patient with Sjögren's syndrome.

Gastric antral vascular ectasia (GAVE), a rare yet treatable cause of upper gastrointestinal bleeding, has been described in a variety of autoimmune diseases. We describe a patient who had typical Sjögren's syndrome and iron deficiency anemia requiring blood transfusion. An endoscopy showed characteristic findings of GAVE. After several fulguration therapies with argon-plasma coagulator, the mucosal lesions improved and her hemoglobin levels returned to normal.