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   2021| July-December  | Volume 1 | Issue 2  
    Online since February 26, 2022

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Diabetes and cancer: Treacherous associations
Rahul Saxena, Manisha Naithani, Rohit Saluja
July-December 2021, 1(2):31-37
Diabetes and cancer are two severe, heterogeneous, and multifactorial chronic diseases. The frequency of these diseases occurring in the same individual is increasing worldwide at an alarming rate. Multiple research studies indicate the presence of shared modifiable and non-modifiable risk factors between the two diseases. Hyperinsulinemia is one such condition which favors cancer development in patients with diabetes as insulin shares some pre-eminent metabolic and mitogenic effects. While the drugs which are used to treat diabetes exhibit a lower risk of cancer development, the drugs taken to treat cancer may either cause diabetes or worsen pre-existing diabetes. Other hypothesized mechanisms comprehending the relationship between diabetes and cancer include insulin resistance, insulin-like growth factor-1, hyperglycemia, and dyslipidemia. Meta-analyses of many studies indicate that diabetes and cancer are the two sides of the same coin. There may also be a risk of escalation of one disease while treating the other. This phenomenon of reverse effect has been reported in cases of liver and pancreatic cancer, which leads to the progression of diabetes. In our review, we highlight some of the most promising mechanisms which attempt to comprehend this relationship between the two diseases. We conclude that diabetes and cancer have a very complex relationship that requires more clinical attention and better-designed studies.
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How well a culturally adapted diabetes self-management education program (DSME) improves the glycemic control and distress among diabetes patients?
M Anjali, Meenakshi Khapre, Ravi Kant, TJ Asha
July-December 2021, 1(2):38-40
Diabetes self-management education (DSME), considered as the cornerstone of treatment for all people with diabetes, helps people with diabetes, or newly diagnosed diabetics, learn how to successfully manage their disease. The goal of DSME is to help people practice diabetes self-care behaviors daily and be as healthy as possible.
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Maternal pulse waveform in second trimester and risk of preeclampsia
Sharan Raj S, Niruby Rasendrakumar, Nidhi Sharma
July-December 2021, 1(2):46-50
Background: Preeclampsia is a multisystem heterogeneous disorder occurring in 4%–7% of all pregnancies. Objectives: This study was conducted to define the relation between arterial stiffness and perinatal outcome in a tertiary care center. The relationship between maternal pulse wave augmentation index and adverse perinatal outcome is explored in this study. Materials and Methods: Peripheral pulse waveform of the brachial artery and mean arterial pressure measurement was performed in the second trimester in women with singleton pregnancy. Preeclampsia was recorded in (7%) of all pregnancies. Results: Abnormal peripheral pulse wave augmentation in the second trimester is a good tool for the prediction of preeclampsia (sensitivity 91.23% and specificity 99.06%, P < 0.05). Conclusion: Increased peripheral augmentation index (>2 SD) and mean arterial pressure measurement in combination have better detection rates for early-onset preeclampsia and fetal growth restriction (FGR).
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Metabolic syndrome among Nigerians with type 2 diabetes mellitus: A comparative study of the diagnostic criteria
Taoreed A Azeez, Jokotade Adeleye, Enigbokan A Omololu, Bolaji Adejimi, John S Oladapo
July-December 2021, 1(2):51-58
Background: Metabolic syndrome is associated with increased cardiovascular death. The objectives of this study were to find the frequency of metabolic syndrome among Nigerians with type 2 diabetes and to compare the modified National Cholesterol Education Program on the detection, evaluation, and treatment of high blood cholesterol in adults—Adults Treatment Panel III (NCEP ATP III) criteria and the International Diabetes Federation (IDF) criteria. Materials and Methods: The study involved 134 participants. Sixty-seven were cases with type 2 diabetes, whereas the rest were the controls without type 2 diabetes. Ethical approval was granted by the Institutional Ethics Review Committee. Anthropometric, clinical, and laboratory parameters were obtained using standard protocols. Data were analyzed with SPSS version 22. Means were compared with Student’s t-test, whereas proportions were compared with Pearson’s χ2 test. Point biserial correlation was used to determine the association between the dichotomous variables and interval variables. Agreement between the criteria was tested with Cohen’s kappa test. Results: Type 2 diabetes was associated with a higher prevalence of hypertension and truncal obesity. The frequency of metabolic syndrome was lower with the IDF criteria compared with the modified NCEP criteria (65.7% vs. 71.6%). Although there was a strong agreement between the IDF and the modified NCEP criteria (κ=0.862; P<0.0001), the IDF criteria missed 8.3% of diabetic individuals diagnosed with metabolic syndrome by the modified NCEP criteria. Cardiovascular risk is better predicted when the modified NCEP criteria were used to diagnose metabolic syndrome. Conclusion: Metabolic syndrome is very common among Nigerians with type 2 diabetes, and it is better diagnosed with the modified NCEP ATP III criteria.
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Thyroid function tests in euthyroid pregnant and non-pregnant women
Arya Padmakumar, Lucetta Amelia Dias, Nidhi Sharma
July-December 2021, 1(2):41-45
Background: Pregnancy is associated with significant but reversible changes in thyroid functions, which may exacerbate thyroid disorders or improve thyroid disorders. Objectives: The present study was done to find out changes in thyroid function tests in each trimester in normal pregnant women when compared with non-pregnant women in a tertiary healthcare center. Materials and Methods: A cross-sectional study of 80 euthyroid women in the age group of 16–40 years was done. Twenty were non-pregnant and 20 were from first, second, and third trimesters each. Serum level measurement of T3, T4, and TSH was done with chemiluminescence technique. Results: The results of the study showed a progressive decrease in the mean values of FT3 and FT4, with a significant decrease in FT3 (P-value < 0.0001) and FT4 (P-value =0.0129) only in the third trimester. There was a progressive increase in the mean TSH levels through the pregnancy; however, there was no significant increase when compared with the non-pregnant women. Conclusion: There is a significant increase in serum T3 and T4 in pregnancy. Specific reference intervals should be used to identify the patients at risk and to take early interventions of treatment.
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Carbon monoxide poisoning with reversible cardiomyopathy: A case of accidental exposure in the foothills of Himalayas
Mayank Agarwal, Ravi Kant, Arnav Kalra,   Dheeraj
July-December 2021, 1(2):64-67
Carbon monoxide (CO) can cause intoxication without the victim being aware of it. Its exposure is common in Northern India but is infrequently reported because the clinical features are non-specific. In CO poisoning, myocardial injury is a significant predictor of mortality. We present a case of a middle-aged male, found unconscious inside a closed room on a winter morning. Upon presentation, the patient was drowsy with hypotension. CO oximetry showed carboxyhemoglobin (CO-Hb) of 28.6% and brain imaging, suggestive of hypodensities in bilateral globus pallidus. The patient was managed with high flow oxygen following which his sensorium improved gradually but hypotension persisted with echocardiography showing global left ventricular dysfunction. A session of hyperbaric oxygen therapy was given after which he improved hemodynamically with resolution of cardiac dysfunction over the next 3 days. We highlight the importance of early diagnosis of cardiomyopathy as CO-induced cardiomyopathy may be reversed if timely intervention is done.
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Cardiac tamponade is a rare presentation of unknown primary malignancy
Manjunath Totaganti, Yumkham M Devi, Pradeep Chakravarthy, Divanshee Sharma
July-December 2021, 1(2):61-63
Pericardial effusion is one of the common medical conditions in clinical practice. It can present as ranging from asymptomatic to shock as in cardiac tamponade. Underlying etiology is diverse, including infections, metabolic, autoimmune, and neoplastic. Cardiac tamponade is a medical emergency, making it crucial for identification. It is treated with immediate pericardiocentesis for symptomatic management, followed by identifying the underlying cause. Here we present an interesting case, presented as cardiac tamponade with underlying malignancy.
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A rare adverse effect of telmisartan: Headache
Ravi Kant, Prakash Tendulkar, Divanshee Sharma, Manjunath Totaganti
July-December 2021, 1(2):59-60
Hypertension is one of the most common noncommunicable diseases prevalent in the community. Its treatment is largely dependent on pharmacological and nonpharmacological strategies. The pharmacological treatment is often associated with vivid side effects both common and rare adverse events. Here we report a rare adverse effect of a common antihypertensive drug, Telmisartan. The adverse event was suspected based on temporal association of starting the drug and appearance of headache. It was further strengthened by disappearance once the drug was withdrawn.
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