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  Citation statistics : Table of Contents
   2015| January-March  | Volume 5 | Issue 1  
    Online since January 5, 2015

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Precipitating factors, outcomes, and recurrence of diabetic ketoacidosis at a university hospital in Damascus
Zaynab Alourfi, Hakam Homsi
January-March 2015, 5(1):11-15
DOI:10.4103/2231-0770.148503  PMID:25625084
Aims : To study precipitating factors, outcomes, and recurrence of diabetic ketoacidosis (DKA) at a University hospital at Damascus, the capital of Syria. Patients and Methods : Medical records between 2006 and 2012 were reviewed. One hundred and fifteen admissions for 100 patients with DKA were included. All fulfilled the American Diabetic Association DKA diagnostic criteria. Results: Of 115 admissions of DKA, there were 92 single admission and 23 recurrent admissions (eight patients). The order of precipitating factors of recurrent DKA or single admissions were the same with different percentage. The first and second factors were infection (74% and 48%) and treatment problems (17% and 24%), respectively.Complications rate was significantly higher in the intensive care unit (41.6%), compared to the ward admissions (14.2%). Overall in-hospital mortality rate was 11.3%. The severity of medical conditions that provoke DKA with aging, not the metabolic complications of hyperglycemia or ketoacidosis, were behind this high mortality rate. Patients who died were significantly (P = 0.004) older than patients who were discharged alive. Conclusion: Results concerning precipitating factor were similar to the results of many other studies. However, mortality rate was higher which might be explained by the severity of underlying precipitating illness.
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Physicians' perception about electronic medical record system in Makkah Region, Saudi Arabia
Hani Abdulsattar Shaker, Mian Usman Farooq, Khalid Obeid Dhafar
January-March 2015, 5(1):1-5
DOI:10.4103/2231-0770.148499  PMID:25625082
Objectives: The study was done to determine the physicians' perception about electronic medical record system (EMRS) in the context of its productivity in order to improve its functionality and advantages. Materials and Methods: This cross-sectional survey was performed from July to August 2009 with structured questionnaire of 15 closed-ended questions with five points Likert scaling starting from strongly disagree to strongly agree as 1-5, reflecting the perception of physicians about EMRS. The physicians of the Makkah region working in six different hospitals were selected. "Positive" response means if percent of responses were rated 4 or 5 (agree/strongly agree), "neutral" if rated 3, and negative if rated 1 or 2 (strongly disagree/disagree). Descriptive data analysis techniques were used. Results: We selected 317 completed questionnaires. Majority of subjects were from King Fahd Hospital, Jeddah (83, 26.3%), residents (147, 46.4%), male (200,63.1%), expatriates (207, 65%), and age group 36-45 years (133, 42%) were dominant. The stem regarding importance of computers for practicing medicine and EMRS to improve quality of practice was appreciated by majority, that is, 77.7 and 71.2%, respectively. However, "It does not disrupt the workflow" (35.1%) and "EMRS is comfortable while entering the data instead of writing" (34.8%) were appreciated negatively. Consultants (53.9%), male (53.4%), expatriates (56.7%), physicians of King Abdul Aziz Hospital, Ta'if (56.9%), and age group of 46-55 years (53.8%) appreciated EMRS positively. Overall perception of EMRS was found positive by 52.8%. Conclusion: Majority appreciated the EMRS, but specific concerns about its usage easiness and workflow disturbance were opposed by them also.
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Ventricular septal defect and bivalvular endocarditis
Kate E Birkenkamp, Jay J Jin, Raina Shivashankar, Hayan Jouni, Larry M Baddour, Lori A Blauwet
January-March 2015, 5(1):21-23
DOI:10.4103/2231-0770.148507  PMID:25625086
A 63-year-old man presented with generalized fatigue, chills, malaise, dyspnea, intermittent fevers, and 50-pound weight loss of 4 months' duration. Blood cultures were positive for pan-sensitive Streptococcus anginosus. Transesophageal echocardiography showed an 11 mm × 3 mm mobile mass attached to the mitral valve, a 16 mm × 16 mm mobile mass attached to the pulmonary valve, and a small membranous ventricular septal defect. The patient received 12 weeks of intravenous (IV) antibiotics with eventual resolution of the masses. Multi-valve endocarditis involving both the left and right chambers is rarely reported without prior history of IV drug use or infective endocarditis. Our case emphasizes the importance of careful assessment for ventricular septal defects or extra-cardiac shunts in individuals who present with simultaneous right and left-sided endocarditis.
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A longitudinal study to assess the impact of exercise on clinical, biochemical, and anthropometric parameters among the type 2 diabetes patients of South India
Pradeep Sukla, Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
January-March 2015, 5(1):16-20
DOI:10.4103/2231-0770.148504  PMID:25625085
Aim: Aim of the study isto assess the scope of physical activity among type 2 diabetes mellitus (T2DM) patients residing in an urban area of SouthIndia. Materials and Methods: A longitudinal interventional study was conducted for a period of 8months (January 2014-August 2014) among patients of T2DM accessing the healthcare services at an Urban Health and Training Center (UHTC) of a Medical College located in Kancheepuram district, Tamil Nadu. Universal sampling method was employed and all diagnosed T2DM patients attending UHTC during the month of January were enrolled in the study provided they satisfied the inclusion and exclusion criteria. Overall 151 participants were considered for final analysis and all of them were subjected to indulge in moderate type of aerobic exercise in the form of brisk walking for 2.5 h spread over a period of 1 week, for the next 6months. Before and after the exercise regimen, cases were subjected to clinical evaluation, measurement of weight and waist circumference, and estimation of fasting and postprandial blood sugar; and the results were compared with the baseline estimates.The associations were tested using paired t-test for continuous (mean ΁ standard deviation ( SD)) variables. Results: Majority (86, 57%) of the diabetics were from the age group of 40-60 years with a definite female preponderance (82/151) in contrast to males (69/151). A significant reduction in both fasting and postprandial sugar was observed before and after the exercise. However, from the perspective of the weight and waist circumference, although a reduction was observed, the association was not statistically significant. Conclusion: The findings of the present longitudinal study suggest that compliance with moderate type of physical activity can significantly improve the fasting and postprandial blood sugar, apart from reduction in weight of T2DM patients.
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Association of microalbuminuria with ischemic heart disease in non-diabetic Asian-Indians: A case control study
Sowjanya Naha, Kushal Naha, Vinay R Pandit, R Balasubramanian
January-March 2015, 5(1):6-10
DOI:10.4103/2231-0770.148501  PMID:25625083
Context: Microalbuminuria is a known indicator of atherosclerosis and its association with ischemic heart disease (IHD) has been extensively studied in the diabetic population. The significance of urine microalbumin in non-diabetics, however, is yet to be elucidated. Aim: To determine whether an independent association exists between microalbuminuria and IHD in non-diabetic Asian-Indians, and the level of microalbuminuria predictive of concomitant IHD. Materials and Methods: A cross-sectional case-control study was conducted between July 2009 and June 2011. Non-diabetic patients undergoing evaluation for IHD were divided into cases and controls, based on the presence or absence of IHD, respectively. Fifty cases and 50 controls were included, and matched by age, sex, smoking habit, hypertension and body-mass index (BMI). Fasting blood glucose (FBG), fasting lipid profile, and urine microalbumin were recorded for all patients. Results: Mean fasting glucose, mean low density lipoprotein (LDL)-cholesterol and mean urine microalbumin were all significantly higher in cases compared to controls. Urine microalbumin was independently associated with IHD, and microalbumin greater than 12.6 mg/g was predictive of IHD (OR: 13.5; 95% CI, 4.6-39.9; P < 0.001). Conclusion: Urine microalbumin is independently associated with IHD in non-diabetics and levels greater than 12.6 mg/g are predictive of IHD.
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