Context: Managing diabetes efficiently demands a simple, safe, convenient and economical therapy. This study was done to understand the simplicity, safety, convenience and cost effectiveness of using pen versus syringe devices in patients on long-term insulin therapy. Design: This prospective observational study was conducted at the endocrine outpatient department of a universityaffiliated teaching hospital in North India. The investigator interviewed patients using a self-made questionnaire after obtaining consent; patients were scored based on their answers. A high score represented a poor response. A total of 90 completed questionnaires (45 from each group) were obtained. Results: Mean simplicity, safety and convenience score among the pen users was 5.31 ± 0.51, 5.4 ± 0.89 and 4.13 ± 1.04 respectively, as compared to 9.78 ± 1.43, 8.09 ± 2.02 and 8.67 ± 0.56 in syringe users respectively. The difference in these scores was statistically significant (p=0.0001). All patients felt that treatment using pen device was costlier when compared to using syringes, with pen users spending Rs1,756 per month on their insulin therapy, as compared to syringe users, who spent Rs590 per month. Among insulin pen users, 22.2% had optimal glycated haemoglobin levels (6–7.5%) as compared to 2.2% among syringe users, and this difference was statistically significant (p=0.007). Conclusions: An insulin pen is simple, safe and convenient to use, and may provide better glycaemic control. Treatment with a pen device is costlier, which may be due to the higher use of analogue insulin among pen users.
A 35−year−old woman presented with coughing, left−sided chest pain, and high−grade intermittent fever that had persisted for 3 weeks. She had received a course of antibiotics for a week, with− out any response. At admission, the clinical examination was un− remarkable except for toxemia. The chest examination did not reveal any abnormality. A chest radiograph showed mediastinal widening and chest computed tomography revealed a cyst 8 10 4 cm in size communicating with the mid−esophagus, with an air±fluid level. An infected esophageal duplication cyst was diagnosed and the patient underwent surgery. Due to exten− sive adhesions, however, only partial excision of the cyst was achieved, and only a partially successful attempt could be made to suture the defect in the esophageal wall. Ten days after sur− gery, the patient developed chest pain, with a spiking fever. A contrast study revealed an esophageal leak into the posterior mediastinum (Figures 1 a). An upper endoscopic examination re− vealed a tear 7 ± 8 mm long in the mid−esophagus (Figures 2 a).After the patient had provided informed consent, metallic clips (Olympus, Tokyo, Japan) were applied to close the leak (Fig− ures 2 b). The first clip was only able to catch one wall of the leak− age site, but the use of two more clips led to successful approxi− mation of the edges of the leak. The patient was kept nil per os for 72 h and given broad−spectrum antibiotics. A repeat contrast study on day 15 (Figures 1 b) and endoscopic examinations on days 7 and 21 revealed complete healing of the leak. The histolo− gy of the excised cyst showed features of a congenital duplication cyst. DiscussionEsophageal duplication cysts generally present in childhood [1,2]. Patients with duplication cysts in the upper third of the esophagus, as in the case described here, rarely reach adult life without experiencing any symptoms [3]. Mediastinitis occurs rarely in these patients [2]. The present patient presented for the first time with a mediastinal fluid collection at 35 years of age. Due to adhesions around the cyst, complete excision was not possible, and an attempt was made to close the esophageal defect, which failed. In these circumstances, a repeat exploration can be fraught with complications, and it was therefore decided to use Hemoclips to close the esophageal defect.
Background: Urothelial carcinoma is the most common invasive cancer of the urinary tract. Lately, there has been an increased incidence of urothelial neoplasia due to exposure to a wide range of potentially carcinogenic substances. Studies of involved factors led to the concept of existence of a so-called malignization terrain, which claims that individual genetic predisposition and chronic exposure to carcinogens act synergistically leading to the appearance of urothelial carcinomas of the bladder. Aim of the research was to find out the common etiological factors of bladder cancer in this part of India.Methods: The study included 100 patients of bladder carcinoma reporting to Sri Guru Ram Das Hospital, Amritsar from March 2018 to December 2019. A detailed history was taken to have the insight of various etiological factors of the disease. The data was entered in Microsoft excel spreadsheet and analysis was done using statistical package for social sciences (SPSS) version 21.0.Results: The most common blood group associated with CA UB was A +ve (39%) followed by B +ve (29%). 89% of the cases of CA UB were non-smokers predominantly attributed to type of patients coming to our tertiary care institute which are from a rural background (73%) and are mostly Sikhs (80%) and Sikhs are traditionally non-smokers. 80% were farmers by occupation who have exposure to pesticides, insecticides, weedicides and herbicides routinely.Conclusion: In our study majority of the patients turned out to be non-smokers and A +ve blood group in contrast to the strong predilection of smoking and bladder cancer.
AIMTo investigate the role of a novel minimally invasive endoscopic technique in the management of tight near-total corrosive strictures of the proximal esophagus involving the hypopharynx.METHODSTwo patients with near-total corrosive strictures of the proximal esophagus involving the hypopharynx were managed with the novel endoscopic technique. The technique involved passing a 0.025-inch flexible guide-wire across the stricture, and stricture dilatation, using 10F coaxial diathermy and balloon dilators, followed by electro-incision of the proximal aspect of the residual eccentric stricture by means of a novel approach using a wire-guided sphincterotome.RESULTSBoth patients were successfully managed on an outpatient department basis with the complete relief of symptoms and resolution of strictures on endoscopy and an esophagogram. No adverse events were seen during or after the procedure. There was no recurrence of symptoms at a follow-up of over a year in both cases. There was a significant improvement in the body mass index of both patients after the procedure.CONCLUSIONWe report a novel flexible endoscopic technique for the management of complex hypopharyngo-esophageal strictures. In experienced hands, the procedure is relatively simple, safe and effective with a durable response.
Background: Post ureteral stenting, symptoms occurs of lower urinary tract which impact quality of life in around 80% of patients, urgency, frequency, dysuria, suprapubic pain, hematuria. α1-Adrenoceptors are found in highest density in the distal ureter. α1-Adrenoceptor antagonists dilates the lumen of the ureter and reduces the spasms by decreasing the peristaltic frequency and inhibiting basal tone of the ureter, leading to improvement in stent-related symptoms. This study was conducted to study effect of tamsulosin, a selective α1A- and α1D-adrenoceptor antagonist in relieving ureteric stent related symptomsMethods: A randomized double blinded placebo-controlled study conducted from February 2019 to August 2020 in Department of Surgery SGRD University, Amritsar. We enrolled 60 patients with each group of 30 patients (Group A placebo and Group B Tamsilosin 0.4 mg). IPSS (irritative and obstructive), quality of life (QoL) and visual analog scale VAS) pain score were calculated based on post-operative day one versus at Stent removal day (Post-operative day 21) at 3 weeks observations. analysis was done using Statistical package for social sciences (SPSS) version 23.0. Student ‘t’test (unpaired) and Chi-square test.Results: IPSS, QoL and VAS showed improvement with significant relieve of symptoms in patients on tamsulosin compared to placebo at time of stent removal.Conclusions: The study concluded that administration of tamsulosin a selective α1-blocker is useful in decreasing lower urinary tract symptoms in patients undergoing ureteral stenting.
Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. India achieved elimination at the national level in 2005. But it still had world’s leprosy burden in 2015 and currently has a prevalence rate of 0.81 per 10,000. The aim of our study was thus to identify the risk factors associated with the development of leprosy and assess their effect on the treatment outcome of the disease, especially in a low endemic state like Punjab.Methods: A retrospective study conducted across Punjab by assessing the medical records of 55 leprosy admissions that were diagnosed, treated, and monitored at a tertiary hospital and those living in leprosy homes, from a time period of 2015 to 2018. Data was analysed using SPSS 25 software and presented in the form of figures and percentages.Results: Maximum number of leprosy patients under study belonged to upper lower socioeconomic class (46.2%) according to The Modified Kuppuswamy Scale. 48.7% of the patients were migrants to the state of Punjab. Overall, 24 patients (61.5%) were successfully treated. 20.5% were relapse cases while 7.7% default and 2.6% failure cases were seen.Conclusions: This study shows the current status of disease in an otherwise low endemic state. Leprosy is associated with a lower socioeconomic status due to lesser access to health services and lower levels of education. The high rate of disease, lower case reporting and treatment outcomes, as compared to the national averages is a cause for alarm thus more health seeking practices need to be encouraged.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.