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.
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.
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