Maintaining a good glycemic control is crucial in the management of diabetes mellitus (DM) as it is associated with the reduction in both macro and microvascular complications of the disease. Self-monitoring of blood glucose (SMBG), which provides the day-today blood glucose levels, is a simple and practical tool for maintaining a good glycemic control. Although SMBG is widely practiced in other countries, its use in India is very limited. Even when used, it is not carried out is a structured manner. There seems to be a lack of education about the purpose of SMBG and the correct process and schedule to be followed. This highlights the unmet need for country-specific SMBG recommendations. In order to fulfil this need, a panel of expert endocrinologists/ diabetologists came together under the aegis of Research Society for the Study of Diabetes in India (RSSDI). They reviewed the current literature, combined the evidences with their clinical knowledge and expertise, and developed consensus recommendations for SMBG practice in India. This document provides a comprehensive review of the current literature on SMBG and presents the recommendations made by the expert panel.

Purpose: Transgender (trans) women of color's HIV vulnerabilities are shaped by social exclusion and intersectional stigma. There is a dearth of tailored HIV prevention interventions with trans women of color in Canada. The objective of the study was to explore trans women of color's HIV prevention priorities and to pilot test an intervention developed from these priorities.Methods: We conducted a qualitative implementation science study to develop HIV intervention strategies with trans women of color in Toronto, Canada. First, we conducted a focus group with trans women of color (n=8) to explore HIV prevention priorities. Second, we held a consultation with trans women of color community leaders (n=2). Findings informed the development of the TRANScending Love (T-Love) arts-based workshop that we pilot tested with three groups of trans women of color (n=18). Workshops were directly followed by focus groups to examine T-Love products and processes.Results: Focus group participants called for researchers to shift the focus away from trans women's bodies and HIV risks to address low self-acceptance produced by intersecting forms of stigma. The community leader consultation articulated the potential for strengths-focused arts-based approaches to address self-worth. T-Love participants described how workshops fostered self-acceptance and built connections between trans women of color.Conclusions: Findings demonstrate the feasibility and acceptability of an arts-based strategy with trans women of color to elicit group-based sharing of journeys to self-acceptance, fostering feelings of solidarity and connection. Providing opportunities for dialogue and reflection about individual and collective strengths may reduce internalized stigma among trans women of color.

Alström syndrome is a rare ciliopathy affecting about 1 in 1,000,000 individuals. It is characterised by cone-rod dystrophy, insulin resistance, diabetes mellitus, cardiomyopathy, renal failure and hypogonadism. Progressive multi-organ dysfunction eventually leads to death. Only about 800 patients with this disorder have been identified so far. The diagnosis of Alström syndrome is critical as it can easily be overlooked because of the many features it shares with metabolic syndrome. The gene affected in this autosomal recessive disease is ALMS1, the protein product of which is involved in intracellular trafficking and ciliary function. Alström syndrome is being studied as a model which would potentially shed light on the pathophysiology of diabetes mellitus. In this report, we describe a patient with features of Alström syndrome and a clinical picture suggestive of a recurrent, severe, steroid responsive myopathy which, to the best of our knowledge, has not been reported so far.

BackgroundThere are few data on excess direct and indirect costs of diabetes in India and limited data on rural costs of diabetes. We aimed to further explore these aspects of diabetes burdens using a clinic-based, comparative cost-of-illness study.MethodsPersons with diabetes (n = 606) were recruited from government, private, and rural clinics and compared to persons without diabetes matched for age, sex, and socioeconomic status (n = 356). We used interviewer-administered questionnaires to estimate direct costs (outpatient, inpatient, medication, laboratory, and procedures) and indirect costs [absence from (absenteeism) or low productivity at (presenteeism) work]. Excess costs were calculated as the difference between costs reported by persons with and without diabetes and compared across settings. Regression analyses were used to separately identify factors associated with total direct and indirect costs.ResultsAnnual excess direct costs were highest amongst private clinic attendees (INR 19 552, US$425) and lowest amongst government clinic attendees (INR 1204, US$26.17). Private clinic attendees had the lowest excess absenteeism (2.36 work days/year) and highest presenteeism (0.06 work days/year) due to diabetes. Government clinic attendees reported the highest absenteeism (7.48 work days/year) and lowest presenteeism (−0.31 work days/year). Ten additional years of diabetes duration was associated with 11% higher direct costs (p < 0.001). Older age (p = 0.02) and longer duration of diabetes (p < 0.001) were associated with higher total lost work days.ConclusionsExcess health expenditures and lost productivity amongst individuals with diabetes are substantial and different across care settings. Innovative solutions are needed to cope with diabetes and its associated cost burdens in India.

BackgroundWe launched a patient engagement strategy to facilitate research involvement of the retinoblastoma (childhood eye cancer) community in Canada. To inform our strategy, we aimed to uncover the experiences with retinoblastoma, knowledge of retinoblastoma and research engagement among retinoblastoma survivors and parents.MethodsFocus groups were held in Toronto and Calgary, including both in‐person and remote participants (via videoconference). Discussions centred on experience with retinoblastoma, knowledge of the disease and engagement with research. Focus group transcripts were evaluated by inductive thematic analysis.ResultsFour focus groups (3 in Toronto, 1 in Calgary) were held with a collective total of 34 participants. Retinoblastoma had a substantial impact on the life of participants, but overall, patients reported being able to adapt and persevere. Experiential knowledge of retinoblastoma was identified as distinct from the theoretical knowledge held by their clinicians. Participants indicated they often acted as a knowledge broker, communicating information about the cancer to their social networks. Participants were willing to engage in research as partners, but recognized barriers such as time and appropriate training.ConclusionsPatients view their experiential knowledge of retinoblastoma as valuable to improving care and directing research. There is a unique role for research engagement in meeting the educational needs of patients.

Intraoperative monitoring of the electroencephalogram (EEG) is commonly used for detection of cerebral ischemia during carotid endarterectomy. Although real-time interpretation of analog EEG recordings may be considered the "gold standard" for ischemia detection, various signal-processing techniques have been used to ease the interpretation of intraoperative EEG. Several reviews of various EEG-processing techniques are now available. 1,2 Appropriate monitoring of intraoperative EEG for cerebral ischemia assumes that anesthetic depth remains relatively constant, because changes in anesthetic depth or surgical stimulation are known to have profound effects on the EEG. 3 We report the case of a patient having a carotid endarterectomy in which the processed EEG showed a significant loss of "power," and a shift of the spectral edge frequency to lower frequencies during anesthetic emergence. If the EEG had been recorded under conditions of a stable anesthetic when the carotid artery was clamped, the record could have been interpreted as cerebral ischemia. Case ReportA 65-yr-old woman with a history of hypertension and asymptomatic bilateral 90% carotid artery stenosis presented for elective right carotid endarterectomy. Routine physical examination, laboratory values, electrocardiogram, and chest radiograph were otherwise within normal limits.In addition to application of routine monitors, a left radial artery catheter was inserted. EEG electrodes were placed in an approximation of the International 10-20 system using an electrode-embedded nylon cap (Electro-cap International Inc., Eaton, OH). An eight-channel EEG (Neurotrac II, Moberg Medical, Ambler, PA) in a monopolar montage (F3, F4, C3, C4, P3, P4, T5 and T6 referred to CZ) was recorded continuously and stored digitally. Low-and high-filter settings were 0.5 and 30 Hz, respectively. A 2 MHz-pulse wave transcranial Doppler (TCD) probe (Multigon Industries Inc., Yonkers, NY) was applied over the right temporal window to insonate the ipsilateral middle cerebral artery.Following intravenous 100 µg fentanyl and 2 mg midazolam, general anesthesia was induced using 250 mg sodium thiopental, and tracheal intubation was facilitated with succinylcholine. Anesthesia was maintained using N 2 O and isoflurane. Neuromuscular blockade was achieved with 10 mg vecuronium and reversed with 3.5 mg neostigmine and 0.6 mg glycopyrrolate. All hemodynamic and anesthetic data were monitored continuously and recorded every minute by a computer-based data acquisition system (Lifelog from MI 2 , Rosemont, PA).The patient underwent a routine carotid endarterectomy with general anesthesia. Before and after application of the carotid cross clamps, systolic blood pressure was maintained within the patient's normal range between 120 and 150 mmHg. Phenylephrine was used to increase systolic blood pressure to approximately 180 mmHg during carotid artery cross clamping. Because there were no EEG changes indicative of ischemia with carotid artery clamping, no shunt was inserted (fig. 1, upper; precl...

Indigenous peoples experience high rates of suicide from historical and ongoing colonization. This systematic review examines the effectiveness, involvement of Indigenous peoples, and cultural content of interventions addressing suicide among Indigenous adults in Canada, the United States, New Zealand, and Australia. Through a systematic search of scholarly articles and grey literature, 10 articles met the inclusion criteria. In nine studies, Indigenous people made decisions at the study design level and implemented and delivered research activities, and eight studies included cultural content. There were statistically significant reductions in suicide outcomes in four studies, and in self-harm and hopelessness in two studies each. Study quality was largely weak ( n = 9) or moderate ( n = 1). There is a paucity of high-quality data on interventions addressing suicide among Indigenous adults and strengthened reporting of health research involving Indigenous peoples in interventions.

Background Type 2 diabetes mellitus (T2DM) is associated with a significant burden on both patients and the healthcare system. This study aimed to evaluate the demographics of patients with T2DM receiving different strengths of glimepiride and metformin combination along with insulin. This study also examined the concomitant conditions and therapies, duration of therapies, dosage titration, glycated hemoglobin (HbA1c) levels, hypoglycemic events, and weight changes during the course of therapy. Methods This retrospective, multicenter (347), observational study included adult patients with T2DM who received glimepiride and metformin combination along with insulin. Data related to demographic characteristics, duration of disease, co-morbidities, concomitant medications, and dosage pattern was collected from medical records authenticated by physicians during routine care. Results A total of 7058 patients were included in the study. The median age of included patients was 55 years and around 29% were aged >60 years and 60% were men. The majority of patients (83.3%) had insulin treatment initiation after glimepiride and metformin combination while other patients (16.7%) received glimepiride and metformin combination after insulin initiation. The mean HbA1c levels significantly decreased with a mean change of 1.33%. In one-third of the patients, down-titration of the insulin dose was done, indicating the insulin-sparing effect with the addition of the glimepiride and metformin combination. The most common comorbid condition was hypertension (64.7%). Of 3705 patients, 33.2% patients had weight loss and 66.8% had weight gain. A total of 432 patients reported hypoglycemic events. Physician global evaluation of efficacy and tolerability showed a good to excellent on the scale (97.3% and 96.6%). Conclusion This study presented good HbA1c lowering with glimepiride and metformin combination with insulin, ensuring a positive clinical outcome. Good to excellent efficacy and tolerability were observed in patients with T2DM across the age groups, in early as well as long-standing disease.