Background: Frequency Rhythmic Electrical Modulated System (FREMS) is a non-invasive treatment for chronic pain conditions, but its place in the treatment algorithm for painful diabetic peripheral neuropathy (PDPN) is unknown. Methods: A pilot, open-label, randomised controlled trial in individuals with PDPN inadequately controlled on at least dual neuropathic pain treatments recruited from primary and secondary care. Participants were randomised 1:1 to FREMS + usual care (n = 13) versus usual care (n = 12). Primary outcome was change from baseline in perceived pain (assessed by visual analogue scale) at 12 weeks between treatment groups. Results: Of 25 participants, 14 (56%) were men, and 21 (84%) were White Europeans. Median (IQR) age and duration of diabetes were 64 (56, 68) and 14 (10, 20) years, respectively. At 12 weeks, FREMS showed improvements in perceived pain compared with baseline, although the change was not statistically significant from control group (−4.0[−5.0,0.4] vs. 0[−0.3,0.7], p = 0.087). There were significant improvements in pain with FREMS, assessed by McGill Pain questionnaire (p = 0.042) and Douleur neuropathique-4 questionnaire (p = 0.042).More participants on FREMS had greater than 30 percent reductions in perceived pain compared with controls [7/13(54%) vs 0/12(0%), p = 0.042] and significant improvements in Patient Global Impression of Change (p = 0.005). FREMS intervention had moderate benefits in quality of life, sleep, depression and pain medication use, but these were not statistically significant.Conclusions: FREMS might be used to treat individuals with PDPN inadequately controlled on two classes of neuropathic pain medications and is associated with improvements in pain severity and perceived impact of treatment. A larger, appropriately designed trial assessing its impact in this population is needed.

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Background: Point-of-care tools are invaluable in the emergency department. Arterial lactate has been used for prognostication in subsets of population in the emergency department but not often for a heterogeneous population. Objectives: We aimed to study the use of arterial lactate as a prognostication and disposition tool in an undifferentiated population presenting to the emergency department. Methods: We conducted a prospective study among all consenting emergency department patients with age >18 years, who had an arterial blood gas performed as a part of routine care and had a lactate value ⩾2 mmol/L. We collected data on demographics, comorbidities and patient disposition from the emergency department and 28-day mortality as a follow-up telephonically. Results: We included 469 patients with a median age of 37 years. Sixteen provisional diagnoses were made in the emergency department, and pneumonia/lower respiratory tract infection was relatively higher (13.6%). The median lactate was 4.6 (interquartile range = 3.2–7) with 155 patients (33%) being transferred to intensive care unit and 62 deaths (13.2%) recorded at 28 days. Furthermore, we observed optimum values for lactates at 5 mmol/L predicted intensive care unit admissions and 6 mmol/L predicted mortality. A unit increase in arterial lactate in the emergency department significantly increased mortality by 66% (95% confidence interval = 1.45–1.88; p < 0.001) and had a 2.15 times (95% confidence interval = 1.63–2.83; p < 0.001) significantly higher chance of being transferred to the intensive care unit. Conclusion: Arterial lactate can be used as a prognostication tool for a heterogeneous population presenting to the emergency department. Clinical significance: Point-of-care investigations such as arterial lactate can help the emergency physician make quick decisions on the floor and guide prognostication and disposition.

Background: Acute Kidney Injury (AKI) is one of the major cause of in-hospital mortality rates globally. The current study was conducted to study the etiological profile, severity and management of   acute kidney injury.Methods: The study was a prospective observational study, conducted in the department general medicine, Dhanalakshmi Srinivasan Medical college and Hospital, Permabalur, Tamil Nadu. The study population included all the patients admitted to Intensive Care Unit (ICU) with acute Kidney injury (AKI) between January 2015 to December 2016. All the study participants were recruited to the study by convenient sampling. Descriptive analysis was carried out by frequency and proportion for categorical variables.Results: A total of 100 subjects were included. Participants were almost uniformly distributed in each of a decadal age group till above 60 years. Males (57%) were slightly higher than females (43%). Oliguria was present in 88% of the study population. The most common etiology was acute diarrhoeal disease (44%), followed by multiple infections in 12% and Sepsis in 10% of the subjects. As per RIFLE criteria 46% participants were at risk, 26.0% had injury, 28% had failure. All at risk people were treated conservatively, among injury category, 38.5% were treated by haemodialysis and 3.84% by peritoneal dialysis. In failure group, 60.71% and 3.57% were treated by haemodialysis and peritoneal dialysis respectively.Conclusions: Acute kidney Injury (AKI) can be a consequence of varied aetiologies and all the age groups and both the genders at risk of developing it. RIFLE criteria may be a useful tool in guiding the management.

Type 2 diabetes mellitus (T2DM) is an independent risk factor for osteoporosis. Data regarding dietary calcium intake (DCI) among T2DM patients in South India are limited. Thus, a cross-sectional study was conducted among 205 T2DM patients from 5 randomly chosen diabetes clinics across Erode city, Tamil Nadu. The mean DCI was 583.72 ± 32.23 mg per day, with 78.5% of patients consuming less than the recommended daily allowance. Low physical activity was noted in 45% of the participants. Other variables, low knowledge scores (adjusted odds ratio; 95% confidence interval) (4.65; 1.43-12.16), unemployment (2.76; 1.57-4.62), being elderly (2.05; 1.23-5.27), and female (1.59; 1.09-4.27), were significantly associated with low DCI.

BACKGROUND: Chronic kidney disease (CKD) is a worldwide public health problem associated with an eight- to ten-fold increase in cardiovascular mortality. Among patients with CKD, on drug treatment, we aimed to determine the characteristics, etiology, patterns and rates of drug use, and outcomes and factors determining the outcomes at 6 months. METHODS: We conducted an observational follow-up study on inpatients with CKD at a tertiary care teaching hospital in South India. We collected data on patient characteristics, comorbidities, treatments at baseline, and treatments and outcomes at 6 months. We used Chi-squared tests and Cochran's Q-test to compare categorical variables, t -tests to compare continuous variables, and a multivariable logistic regression analysis to estimate the determinants of the outcome. RESULTS: We recruited 305 patients with the mean age 52.98 (±14.89) years, 73.1% were male and 55.4% patients were from a lower-middle socioeconomic background. About 72.1% were in CKD Stage 5 and 37.0% had diabetic nephropathy. Antihypertensives (84.6%) were the most common drug class prescribed, followed by multivitamins (65.2%), proton-pump inhibitors (64.9%), and antidiabetic drugs (32.5%). There was no significant difference in rates of drug use over 6 months. Increased serum creatinine (odds ratio [OR]: 1.29 [1.04, 1.60]; P = 0.017) and lower estimated glomerular filtration rate (eGFR) (OR: 38.23 [3.92, 372.06]; P = 0.002) predicted progression of CKD, and antiplatelets reduced progression (OR: 0.278 [0.09, 0.85]; P = 0.026). CONCLUSION: Diabetic nephropathy was the most common cause of CKD. There was no change in treatments over 6 months. Low eGFR predicted progression and use of antiplatelets reduced progression of CKD. Large multicenter studies are needed to study the variability in patient characteristics, treatment and outcomes to obtain a national picture, and to enable policy changes.