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Priya G, Kalra S, Dardi IK, Saini S, Aggarwal S, Singh R, Kaur H, Singh G, Talwar V, Singh P, Saini BJS, Julka S, Chawla R, Bajaj S, Singh D. Diabetes Care: Inspiration from Sikhism. Indian J Endocrinol Metab 2017; 21:453-459. [PMID: 28553604 PMCID: PMC5434732 DOI: 10.4103/ijem.ijem_52_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Religion has been proposed as a means of enhancing patient and community acceptance of diabetes and cultural specific motivational strategies to improve diabetes care. Sikhism is a young and vibrant religion, spread across the world and the Holy Scripture Sri Guru Granth Sahib (SGGS) is regarded as the living Guru by all Sikhs. The three key pillars of Sikhism are Kirat Karni (honest living), Vand Chakna (sharing with others) and Naam Japna (focus on God). They can help encourage the diabetes care provider, patient and community to engage in lifestyle modification, shared responsibility, positive thinking and stress management. The verses (Sabads) from the SGGS, with their timeless relevance, span the entire spectrum of diabetes care, from primordial and primary, to secondary and tertiary prevention. They can provide us with guidance towards a holistic approach towards health and lifestyle related diseases as diabetes. The SGGS suggests that good actions are based on one's body and highlights the relevance of mind-body interactions and entraining the mind to cultivate healthy living habits. The ethics of sharing, community and inclusiveness all lay emphasis on the need for global and unified efforts to manage and reduce the burden of the diabetes pandemic.
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Affiliation(s)
- Gagan Priya
- Department of Endocrinology, Fortis Hospital, Mohali, Punjab, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | | | - Simarjeet Saini
- Department of Electrical and Computer Engineering, University of Waterloo, Ontario, Canada
| | | | - Ramanbir Singh
- Department of Endocrinology, Apollo Hospital, Ludhiana, Punjab, India
| | - Harpreet Kaur
- Department of Anaesthesiology, ESI Hospital, Amritsar, Punjab, India
| | - Gurinder Singh
- Department of Plastic Surgery, Hargun Hospital, Amritsar, Punjab, India
| | - Vipin Talwar
- Department of Endocrinology, Golden Hospital, Jalandhar, Punjab, India
| | - Parminder Singh
- Department of Endocrinology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Brig J. S. Saini
- Department of Endocrinology, Oxford Hospital, Jalandhar, Punjab, India
| | - Sandeep Julka
- Department of Endocrinology, CHL Hospital, Indore, Madhya Pradesh, India
| | - Rajeev Chawla
- Department of Diabetology, North Delhi Diabetic Centre, New Delhi, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Devinder Singh
- Additional District Sessions Judge, Faridabad, Haryana, India
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Kakusa M, Kamanga B, Ngalamika O, Nyirenda S. Comatose and noncomatose adult diabetic ketoacidosis patients at the University Teaching Hospital, Zambia: Clinical profiles, risk factors, and mortality outcomes. Indian J Endocrinol Metab 2016; 20:199-205. [PMID: 27042416 PMCID: PMC4792021 DOI: 10.4103/2230-8210.176358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is one of the commonly encountered diabetes mellitus emergencies. AIM This study aimed at describing the clinical profiles and hospitalization outcomes of DKA patients at the University Teaching Hospital (UTH) in Lusaka, Zambia and to investigate the role of coma on mortality outcome. MATERIALS AND METHODS This was a cross-sectional analytical study of hospitalized DKA patients at UTH. The data collected included clinical presentation, precipitating factors, laboratory profiles, complications, and hospitalization outcomes. Primary outcome measured was all-cause in-hospital mortality. RESULTS The median age was 40 years. Treatment noncompliance was the single highest identified risk factor for development of DKA, followed by new detection of diabetes, then infections. Comatose patients were significantly younger, had lower baseline blood pressure readings, and higher baseline respiratory rates compared to noncomatose patients. In addition, comatose patients had higher baseline admission random blood glucose readings. Their baseline sodium and chloride levels were also higher. The prevalences of hypokalemia, hypernatremia, and hyperchloremia were also higher among comatose patients compared to noncomatose patients. Development of aspiration during admission with DKA, pneumonia at baseline, development of renal failure, and altered mental status were associated with an increased risk of mortality. Development of renal failure was independently predictive of mortality. CONCLUSION The mortality rate from DKA hospitalizations is high at UTH. Treatment noncompliance is the single highest identifiable precipitant of DKA. Aspiration, development of renal failure, altered sensorium, and pneumonia at baseline are associated with an increased risk of mortality. Development of renal failure during admission is predictive of mortality.
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Affiliation(s)
- Mwanja Kakusa
- Department of Medicine, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
| | - Brown Kamanga
- Department of Medicine, Endocrine Unit, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
| | - Owen Ngalamika
- Dermatology and Venereology Division, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
| | - Soka Nyirenda
- Department of Medicine, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
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Abstract
Religious pilgrims have been going to high altitude pilgrimages long before trekkers and climbers sojourned in high altitude regions, but the medical literature about high altitude pilgrimage is sparse. Gosainkunda Lake (4300 m) near Kathmandu, Nepal, and Shri Amarnath Yatra (3800 m) in Sri Nagar, Kashmir, India, are the two sites in the Himalayas from where the majority of published reports of high altitude pilgrimage have originated. Almost all travels to high altitude pilgrimages are characterized by very rapid ascents by large congregations, leading to high rates of acute mountain sickness (AMS). In addition, epidemiological studies of pilgrims from Gosainkunda Lake show that some of the important risk factors for AMS in pilgrims are female sex and older age group. Studies based on the Shri Amarnath Yatra pilgrims show that coronary artery disease, complications of diabetes, and peptic ulcer disease are some of the common, important reasons for admission to hospital during the trip. In this review, the studies that have reported these and other relevant findings will be discussed and appropriate suggestions made to improve pilgrims' safety at high altitude.
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Affiliation(s)
- Buddha Basnyat
- Oxford University Clinical Research Unit-Nepal and Nepal International Clinic , Himalayan Rescue Association, Kathmandu, Nepal
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Alourfi Z, Homsi H. Precipitating factors, outcomes, and recurrence of diabetic ketoacidosis at a university hospital in Damascus. Avicenna J Med 2015; 5:11-5. [PMID: 25625084 PMCID: PMC4296391 DOI: 10.4103/2231-0770.148503] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
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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Affiliation(s)
- Zaynab Alourfi
- Department of Internal Medicine, Damascus University, Damascus, Syria
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Hakam Homsi
- Faculty of Medicine, Damascus University, Damascus, Syria
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Abstract
Diabetes mellitus is becoming a global health issue with more than 80% diabetics living in developing countries. India accounts for 62.4 million diabetics (2011). Indian Council of Medical Research India Diabetes Study (ICMR-INDIAB) study showed highest weighted prevalence rate in the north India among all studied regions. Diabetes in north India has many peculiarities in all aspects from risk factors to control programmers. North Indians are becoming more prone for diabetes and dyslipidemia because rapid westernization of living style and diet due rapid migration to metropolitan cities for employment. North Indian diabetes is plagued with gender bias against females, poor quality of health services, myths, and lack of disease awareness compounded with small number of prevention and awareness programmers that too are immature to counteract the growing pandemic.
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Affiliation(s)
- Manish Gutch
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
| | - Syed Mohd Razi
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
| | - Sukriti Kumar
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - Keshav Kumar Gupta
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
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Koul PA, Khan UH, Hussain T, Koul AN, Malik S, Shah S, Bazaz SR, Rashid W, Jan RA. High altitude pulmonary edema among "Amarnath Yatris". Lung India 2013; 30:193-8. [PMID: 24049253 PMCID: PMC3775198 DOI: 10.4103/0970-2113.116254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Annual pilgrimage (Yatra) to the cave shrine of Shri Amarnath Ji' is a holy ritual among the Hindu devotees of Lord Shiva. Located in the Himalayan Mountain Range (altitude 13,000 ft) in south Kashmir, the shrine is visited by thousands of devotees and altitude sickness is reportedly common. MATERIALS AND METHODS More than 600,000 pilgrims visited the cave shrine in 2011 and 2012 with 239 recorded deaths. Thirty one patients with suspected altitude sickness were referred from medical centers en-route the cave to Sher-i-Kashmir Institute of Medical Sciences, a tertiary-care center in capital Srinagar (5,000 ft). The clinical features and the response to treatment were recorded. RESULTS Thirty-one patients (all lowlanders, 19 male; age 18-60 years, median 41) had presented with acute onset breathlessness of 1-4 days (median 1.9 d) starting within 12-24 h of a rapid ascent; accompanied by cough (68%), headache (8%), dizziness and nausea (65%). Sixteen patients had associated encephalopathy. Clinical features on admission included tachypnea (n = 31), tachycardia (n = 23), bilateral chest rales (n = 29), cyanosis (n = 22) and grade 2-4 encephalopathy. Hypoxemia was demonstrable in 24 cases and bilateral infiltrates on radiologic imaging in 29. Ten patients had evidence of high-altitude cerebral edema. All patients were managed with oxygen, steroids, nifedipine, sildenafil and other supportive measures including invasive ventilation (n = 3). Three patients died due to multiorgan dysfunction. CONCLUSIONS Altitude sickness is common among Amaranath Yatris from the plains and appropriate educational strategies should be invoked for prevention and prompt treatment.
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Affiliation(s)
- Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Kalra S, Sridhar GR, Balhara YPS, Sahay RK, Bantwal G, Baruah MP, John M, Unnikrishnan AG, Madhu K, Verma K, Sreedevi A, Shukla R, Prasanna Kumar KM. National recommendations: Psychosocial management of diabetes in India. Indian J Endocrinol Metab 2013; 17:376-95. [PMID: 23869293 PMCID: PMC3712367 DOI: 10.4103/2230-8210.111608] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - G. R. Sridhar
- Department of Endocrine and Diabetes Centre, Visakhapatnam, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), AIIMS, New Delhi, India
| | | | - Ganapathy Bantwal
- Department of Endocrinology, St. John's Medical College, Bengaluru, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Centre Hospitals, Guwahati, India
| | - Mathew John
- Department of Endocrinology, Providence Endocrine and Diabetes Specialty Centre, Trivandrum, India
| | | | - K. Madhu
- Department of Psychology, Andhra University, Vishakhapatnam, India
| | - Komal Verma
- Department of Psychology, Consultant Psychologist, Noida, India
| | - Aswathy Sreedevi
- Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Rishi Shukla
- Department of Endocrinology, Center For Diabetes, Kanpur, Uttar Pradesh, India
| | - K. M. Prasanna Kumar
- Department of Endocrinology, CDEC and Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
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