ABSTRACT Objective: This study describes the incidence and clinical profile of hypoglycemia (including mild, moderate, severe, and recurrent) and its correlation with the time of the day, duration of diabetes mellitus (DM), administration of insulin/oral hypoglycemic agents (OHAs) and diagnosis at admission in hospitalized adult patients. Materials and Methods: This retrospective, observational study analyzed the data of hospitalized patients with episode(s) of hypoglycemia. For each patient, clinical profiles such as age, gender, antidiabetic therapy, timing of hypoglycemic event, duration of diabetes, working diagnosis, place of hypoglycemia, dietary changes, and mode of corrective action were studied. Results: Of 100 patients with a mean ± standard deviation age of 62.72 ± 3.54 years, hypoglycemia was the most common among those aged 61–90 years. There were 134 hypoglycemic events and mild hypoglycemia was the most common (72.39% vs. moderate 21.64% and severe 5.97%). There were 59 (44%) events of recurrent hypoglycemia. Hypoglycemic events were maximum during 4:00 am–7:59 am (34%). Longer duration of DM (>15 years, 42%) and insulin therapy were the high-risk factors. There was a statistically significant association between hypoglycemia and duration of diabetes (P < 0.0133), insulin therapy (P < 0.0001), OHA (P < 0.0192), and a combination of insulin and OHA (P < 0.0059) within 24 h before the event but not with the incidence and dietary changes. Conclusion: Patients above 60 years were the most vulnerable population for hypoglycemia, especially during the early hours of the day. Patients who had diabetes for >15 years, on insulin therapy, and those with pulmonary and renal diseases were the most vulnerable to overall and recurrent hypoglycemic events, respectively.

ABSTRACT In many areas of diagnosis and treatment, psychiatry and ophthalmology overlap significantly. A patient who has had a great deal of psychological stress may exhibit vision loss. The results of neuro-ophthalmological testing might influence the psychiatric diagnosis and course of therapy. There is a wide range of psychiatric signs and symptoms noted in various ophthalmological disorders which an ophthalmologist witnesses every day. As a result, there is a great deal of overlap between the two disciplines methods to treatment. It goes without saying that the connection between psychiatry and ophthalmology has not gotten the attention it merits.

ABSTRACT Background: Diabetes is one of the top 10 contributors to death globally. It is affecting more and more younger populations due to lifestyle changes in India. Tools like the Indian Diabetic Risk Score (IDRS) help in screening high-risk individuals for diabetes. Early diagnosis and prompt treatment help in avoiding complications and disabilities due to diabetes. Hence, this study was conducted to calculate the risk of diabetes using IDRS and to determine the knowledge and risk perception of diabetes among the nondiabetics residing in the rural field practice area of a medical college. Methodology: A descriptive cross-sectional study was conducted in the rural field practice area of a medical college. A total of 885 people participated in our study. All nondiabetics above 18 years of age were involved. The data were collected using a questionnaire and the IDRS questionnaire was used to determine the risk of diabetes. Data were analyzed using IBM SPSS 20th version. Results: Majority of the participants were between the age of 18 and 50 years. About 65.8% of the study population had medium risk according to IDRS. There was a significant relationship between gender, body mass index, and IDRS. A majority had good knowledge about diabetes. Only 31.5% knew that diabetes can cause complications in other organs of the body. Conclusion: Compared to prior research on rural Indians, this study’s population knew more about diabetes. To encourage people to adhere to their medication and treatment, further health education sessions should concentrate on minimizing the risk factors and complications of diabetes.

ABSTRACT Obscure gastrointestinal bleed (OGIB) is defined as bleeding of unknown origin that persists or recurs after a negative initial or primary endoscopy (colonoscopy and upper gastrointestinal [GI] endoscopy) and imaging. Approximately 5% of all GI bleeding is obscure GI bleed. Abnormal blood vessels arteriovenous malformations (AVMs) cause 30%–40% of small intestinal bleeds. AVMs are the main source of bleeding in patients over the age of 50 years. Tumors (benign and malignant), polyps, Crohn’s disease, and ulcers are some of the other causes of bleeding. Various diagnostic modalities available to detect small intestinal bleed are upper GI endoscopy, colonoscopy, contrast-enhanced computed tomography scan of the abdomen with angiogram, small bowel enteroscopy, video capsule endoscopy, and scintigraphy studies. Advanced imaging/diagnostic modalities may not be available in all centers, posing a great challenge in the localization of the source of GI bleed. This series highlights the role of diagnostic laparoscopy with intraoperative enteroscope (IOE) in the management of OGIB.

ABSTRACT Impaired performance of the respiratory muscle pump or lung dysfunction can lead to a severe condition of respiratory failure. Therefore, mechanical ventilation is used to sustain the life of individuals with this syndrome. Furthermore, this condition is harmful to the body and can cause complications. This study aimed to describe nursing care provided to patients with respiratory failure. The design was a case study with narrative analysis. The data were collected in October 2022 at a Government Teaching Hospital in Bandung. The nursing assessment shows that the patient (Mr. S) was unconscious and unresponsive to pain stimuli under sedation. The patient was in moderate acute respiratory distress syndrome, receiving mechanical ventilation with synchronized intermitten mandatory ventilation pressure control and pressure support (SIMV PCPS) mode, and was breathing spontaneously. Furthermore, there were rhonchi breath sounds, temporary gurgling sounds, pitting edema in the upper and lower extremities, and anuria. Impaired spontaneous breathing is the key nursing concern for this patient, along with poor airway clearance as well as fluid and electrolyte imbalance. In conclusion, ventilation is the primary management of the patient with respiratory failure. This intervention should be given appropriately to reduce the disease’s symptoms and the risk of complications. Therefore, maintaining a low tidal volume, prone position, continuous respiratory assessment, minimizing sedation, suctioning, and chest physiotherapy are essential to achieve a good outcome.

ABSTRACT Introduction: Moderate and late preterm and early-term infants constitute a significant proportion of hospitalizations in neonatal intensive care units (NICU), yet have been perceived as low-risk groups. Their gestational age-specific data have been poorly studied, including respiratory morbidity and outcome. Objectives: The objectives of this study were to determine the respiratory morbidity among moderate and late preterm and early-term infants and to study their short-term outcomes. Materials and Methods: A longitudinal descriptive hospital-based study was conducted at a tertiary care hospital in Southern India, from January 2018 to June 2019. Newborns between 32 and <39 completed weeks, after gestational age assessment, were observed until discharge and later followed up to 40 weeks of gestation. The outcome was recorded in terms of respiratory issues, length of hospital stay, and readmissions within a month. Results: Two hundred and fifty babies were included in the study. NICU care was required in 78%, 72%, and 9.2% of moderate preterm, late preterm, and early-term infants, respectively. Respiratory distress was noted in 78%, 66%, and 6% of moderate preterm, late preterm, and early-term infants, respectively. The association of respiratory distress with gestational age was highly significant (P < 0.0001). Surfactant requirement was 12%, 6%, and 1.7% among the three groups. The average length of NICU stay was 7.8 days, 6.5 days, and 0.3 days among moderate and late preterms and early-term infants, respectively. Conclusion: Moderate and late preterms and early-term infants have significant morbidities. Gestational age has a substantial correlation with respiratory distress and neonatal outcomes. Knowledge about these issues can ensure improved outcome in these infants.

ABSTRACT Diabetes mellitus (DM) is a common endocrine disorder. It has an impact on various organs and systems in the body. Both hypo- and hyper-glycemia can lead to cognitive impairment through several metabolic pathways. Previously, the battery of studies has reported the decline in cognitive functions through preclinical studies using in vivo and in vitro methods as well as clinical studies in elderly populations. Previous reports of the clinical studies had limited to one domain of cognitive function, the elderly population, and inflammatory cytokines/chemokines and tau protein levels. The present review article attempts to find the various mechanisms and their inter correlation leading to cognitive impairment among patients with DM.

ABSTRACT Background: Self-directed learning (SDL) is an internationally accepted principle of adult education. CBME curriculum implemented by the Government of India has allotted 280 hours of SDL in all subjects for undergraduate medical students. SDL is yet to root into the student community as norms and a definitive program evaluation is still not in shape. Aim and Objective: To identify students’ readiness and perceived barriers towards SDL. Materials and Methods: This questionnaire-based study was conducted between January 2023 to May 2023 among faculties and students. The 12 items of self-directed learning readiness instrument were adopted from Shen et al. Results: A total of 480 MBBS students participated. 97.7% of students were aware of SDL in their first year. The highest score was in the “self-monitoring” domain (Mean ± SD = 3.89 ± 0.64) and the lowest score was in “Planning and Implementation” (3.56 ± 0.80). Students perceived that SDL would enhance their communication (50.41%), critical thinking (49.2%), problem solving (40.4%), research (39.8%) and cognitive skills (37.1%). Among barriers the most significant was lack of guidance and resource deficiency (30.4%, 29%). In this study 52 CISP completed faculty participated and 82.69% agreed students were ready for SDL. The suggested resource materials were reference books and online materials (90.38% & 26.92%). Conclusion: Medical students’ readiness for SDL is quite encouraging which was also attested by 83% of faculty. Given the fertile nidus of growing young minds if deficiencies are addressed, the medical curriculum would be fortified with SDL ensuring long term benefits.