Indian Journal Of Clinical Practice

Gestational Diabetes Pattern and Risk of Incident Diabetes

Dr Veena Aggarwal — 2024-09-14

EDITORIAL

Person-Centered Care: Inspiration from the Upanishads

Dr Sanjay Kalra — 2024-09-14

GUEST EDITORIAL

Systematic Review of the Role of Albuminuria on Kidney Function in Type 2 Diabetes

Dr THAI HAU KOO — 2024-09-14

Objective: This systematic review explores the impact of albuminuria on renal function in patients with type 2 diabetes
(T2D), assessing its role in diagnosing diabetic kidney disease (DKD) and its correlation with reduced glomerular filtration
rate (GFR). Materials and methods: A systematic review was conducted following PRISMA guidelines. Searches in PubMed,
Embase, Cochrane Library, and Medline included studies from 2019 to 2023. Inclusion criteria were adults (≥18 years) with
T2D, studies assessing impact of albuminuria on kidney function, including randomized controlled trials, observational
studies, or meta-analyses. Primary outcomes included albuminuria progression, renal function decline (estimated GFR [eGFR]
or creatinine clearance), and DKD progression. Secondary outcomes evaluated the safety and tolerability of interventions
managing albuminuria in T2D patients. Two reviewers independently extracted data and assessed risk of bias. Results: From
1,748 records, nine studies involving 9,91,285 patients were included. Studies consistently showed higher albuminuria levels
to be significantly associated with reduced eGFR and increased DKD progression risk. Conclusions: Our findings underscore
albuminuria as a crucial indicator of kidney damage and eGFR as a key marker for DKD severity in T2D patients. This review
highlights the need for patient-centered care in managing T2D to reduce renal complications and calls for further research
to comprehensively understand DKD outcomes

Dyslipidemia – A Risk Factor for Osteoporosis in Women: A Cross-Sectional Study

Dr RAJESH KUMAR MEENA — 2024-09-14

Background: Osteoporosis has been extensively studied in postmenopausal women but there is a paucity of studies for
detection of osteoporosis in premenopausal women. Recent studies point out that dyslipidemia could be a risk factor
for osteoporosis in postmenopausal women. It is unclear whether dyslipidemia in premenopausal women is a risk
factor for osteoporosis after menopause. This study is an attempt to find whether dyslipidemia in premenopausal and
postmenopausal women is associated with decreased bone mineral density (BMD). Methods: The study was conducted
from November 2013 to March 2014 at Lady Hardinge Medical College, New Delhi. Sixty patients (30 premenopausal
and 30 postmenopausal) who were not having any comorbidity and not on any drug affecting lipid or bone metabolism
were evaluated for lipid profile and BMD. Result: In premenopausal women, there was a negative correlation between very
low-density lipoprotein cholesterol (VLDL-C), triglycerides (TGs), and BMD (lumbar vertebra) while a positive correlation
was observed between high-density lipoprotein cholesterol (HDL-C) and BMD, which was statistically significant (VLDLBMD r −0.363, p = 0.049; TRI-BMD r −0.363, p = 0.049; HDL-BMD r 0.359, p = 0.05). Similarly, in postmenopausal women,
the negative correlation between VLDL, TG, and BMD was statistically significant (TG-BMD r −0.377, p = 0.04; LDL-BMD
r 0.415, p = 0.02), as was the positive correlation between HDL and T-score (HDL-BMD r 0.366, p = 0.04). Conclusion: There
is statistically significant correlation between BMD and serum lipid levels in both premenopausal and postmenopausal
women. Lipid profile variables show a significant association with BMD and can be used as risk factors for osteoporosis.

Clinicoepidemiological Profile and Micronutrient Deficiencies in Children with Severe Acute Malnutrition

Dr RAM SINGH YADAV — 2024-09-14

Introduction: Malnutrition is widely prevalent in developing countries and is considered a common denominator
in infant and under-5 mortalities. Most child deaths are associated with inappropriate feeding practices and specific
micronutrient deficiencies during the first year of life. There is a lack of data about severe acute malnutrition (SAM) and
specific micronutrient deficiencies in India; hence, the present study was conducted to study the iron profile, including
folic acid, and vitamin B12 levels and their correlation with the clinicoepidemiological profile of children with SAM.
Materials and methods: This hospital-based cross-sectional study included 95 children with SAM, aged 6 months to 5 years.
A predesigned structured proforma was used to collect information. Data concerning clinical examination and history given
by the mother and a reliable attendant was collected. The quantitative data were expressed as mean and standard deviation
and qualitative data as percentage and proportion. The difference in proportion was analyzed by the Chi-square test and
the difference in means was analyzed by ANOVA. P-value <0.05 was taken as significant. All calculations were done by
Microsoft Excel, Primer. SPSS Software [version 21] was used for doing statistical analysis. Results: In the present study,
a total of 95 SAM patients were included with mean age 19.74 months and an F:M ratio of 1.2:1. Weight-for-height was
found to be the most reliable criterion to identify children with SAM (78.95%). Edema was present in 18 (18.95%) patients.
Around 68.42% of patients had mid-upper arm circumference (MUAC) <11.5 cm; 25.26% of children were found completely
immunized, remaining 74.74% were either partially immunized or unimmunized. According to the Kuppuswamy scale for
the socioeconomic class, more than two-thirds of the parents belonged to the upper-lower class. About 44.21% of children
received exclusive breastfeeding till 6 months of age, while complementary feeding was started in only 25.26% of children
at 6 months of age. Anemia was present in 93 children with a prevalence of 97.89%. Of these, 30 patients had vitamin B12
deficiency anemia, 20 patients had iron deficiency anemia, and 6 patients had folate deficiency anemia. Conclusions: Severe
acute malnutrition is an important preventable and treatable cause of morbidity and mortality in children below 5 years of
age in India. Although malnutrition is highly prevalent in Indian children, there are very limited data that use biochemical
indexes to characterize the epidemiology of micronutrient deficiencies in children with SAM. A detailed understanding of
micronutrient deficiencies and clinical and epidemiological profile of children may help in micronutrient supplementation
and fortification programs and targeting the basic causes of pediatric mortalities.

A Unique Case Report on “Bilateral Optic Neuropathy as a Rare Manifestation of Spontaneous Intracranial Hypotension

Dr K SANKAVI GAUTHAM — 2024-09-14

Spontaneous intracranial hypotension (SIH) is an uncommon condition characterized by low cerebrospinal fluid (CSF) volume
through a dural defect leakage, which results in multiple debilitating clinical manifestations. Although ocular manifestations
are common, vision impairment due to SIH is not commonly reported. Optic neuropathy is a rare yet significant complication
of SIH. This case documents the association between optic neuropathy and SIH, highlighting the diagnostic challenges and
the complexities of managing this condition.

Unravelling the Complexities of Diabetic Behavior: A Multifaceted Exploration of Psychological, Behavioral, and Societal Factors

Dr RITWIK GHOSH — 2024-09-14

Diabetes management is a complex process influenced by various behavioral factors, which are crucial for developing effective
interventions that promote optimal disease management and improve patient outcomes. This article explores the diverse
behavioral manifestations associated with diabetes, shedding light on the psychological, physiological, and societal factors
that underpin this complex interplay. Utilizing the mnemonics "DIABETES" and "DISTORTION", we interpret the behavioral
dimensions of diabetes, emphasizing the need for holistic approaches addressing both physical and mental health. Our
exploration reveals that diabetic behavior is shaped by a range of factors, including depression, impulsivity, anxiety, binge
eating, emotional dysregulation, externalizing problems, somatic symptoms, sleep problems, substance abuse, denial, insulin
stigma, suppression, taboo, oppositional behavior, resistance to therapy, template thinking, imitative behavior, oppression,
and negativism. These factors interact and influence one another, resulting in a complex web of behavioral challenges that
hinder effective diabetes management. By unravelling the underlying psychopathology and cognitive distortions that shape
diabetic behavior, we can develop more personalized, holistic, and culturally sensitive approaches to diabetes care. The
article highlights the need for integrated interventions that address the psychological, social, and cultural determinants of
health, promote patient empowerment, and foster a proactive approach to diabetes management. Ultimately, this multifaceted
exploration of diabetic behavior can inform the development of innovative strategies that improve health outcomes, enhance
quality of life, and reduce the burden of diabetes on individuals and society.

Effect of Background Diuretic Therapy on the Clinical Efficacy of SGLT2 Inhibitors in Patients of Heart Failure with Reduced Ejection Fraction: Current Evidence

Dr KAMAL KISHOR — 2024-09-14

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a fundamental therapy for heart failure with reduced ejection fraction
(HFrEF). The clinical efficacy of SGLT2 inhibitors in the presence of background diuretic therapy has been questioned, mainly
because of the overlapping diuretic mechanism of action. However, recently, data analysis from two landmark trials, DELIVER
and EMPEROR-Reduced, has attempted to settle this question. Both analyses demonstrate a consistent benefit of SGLT2
inhibitors across a wide range of background diuretic therapy. This brief communication sheds light on the key findings from
these scientific studies

Nutritional Recommendations in Gestational Diabetes

Dr SNIGDHA SINGH — 2024-09-14

EXPERT OPINION

Consent

IJCP — 2024-09-14

MEDICOLEGAL

CSI NIC Mid Term Meet: NIC 2024

IJCP — 2024-09-14

CONFERENCE PROCEEDINGS

News and Views

IJCP — 2024-09-14

AROUND THE GLOBE