Tertiary Health Care Unit Research Articles

Tumor Board Practice and Current Approach of Oncologists in Türkiye

Objective: Interdisciplinary cooperation is essential in treating and following up cancer disease. The primary objective of multidisciplinary tumor councils (MDTCs) is to identify the most suitable and effective treatment strategies for cancer patients through the collective decision-making of experts in oncology. MDTC plays a key role in breaking traditional taboos, providing the most up-to-date approach to the patient, sharing responsibility and accountability, and encouraging interdisciplinary communication and collaboration. Material and Methods: In this study, the perspectives, expectations, and experiences of medical oncologists regarding tumor boards were evaluated. The survey consisted of 10 questions and was conducted as an online survey at the '7th National Immunotherapy and Oncology Congress'. This study was cross-sectional and online. While those who were actively working as medical oncologists and those who wanted to voluntarily participate in the survey were included in the study, those who were not medical oncologists, those who were not actively working, and those who worked in private clinics were not included in the study. Participants were asked various questions about multidisciplinary tumor boards. They were asked about the specialties they most needed on the boards, the other clinics participating in the boards, and the clinics they felt were essential. The necessity of genetic clinics and molecular boards in shaping the future of oncology through molecular assessments was also assessed. The impact of board decisions on patient treatment and management was investigated. Results: A total of 624 oncologists participated in the survey. The majority of the participants were young oncologists. Most participants worked in tertiary healthcare units, including university hospitals and training and research hospitals. Almost all of the participants stated that they did MDTC. The most frequent and regular councils are; thoracic cancers and gastrointestinal cancers. The most needed and hard to reach branch was the medical genetics department. Conclusion: Cancer treatment is a complex process that cannot be confined to a single expertise. Multidisciplinary tumor boards (MDTB) are one of the cornerstones of a comprehensive approach to cancer treatment. In multidisciplinary tumor boards, various topics such as medical treatment planning for patients, diagnosis, surgical and radiotherapy planning, side effect management, and palliative care can be examined. MDTB not only provides effective treatment for cancer patients from a broad perspective but also ensures rapid and comprehensive solutions in case of potential complications.

Preterm Retinopathy of Prematurity and risk factors from a tertiary health care unit: A descriptive study

Abstract Introduction: Retinopathy Of Prematurity (ROP), is the major preventable blindness in infants. A study was conducted to find the risk factors of ROP in premature infants with gestational age (GA) < 36 weeks. Methods: It was a descriptive study conducted in Kakatiya Medical College, Hanumakonda. Babies with major congenital, chromosomal anomalies were excluded. One hour before screening, a drop of Tropicamide was instilled for every 10 – 15 minutes for 4 times followed by a drop of Phenylephrine just before examination. ROP screening was carried out by a senior ophthalmologist in NICU. First, the anterior segment was examined. This was followed by sequential examination of all clock hours of the peripheral retina and findings were recorded. Association between variables was analysed by using Chi-Square test. P < 0.05 was considered to be statistically significant. Results: ROP was detected in 31.4%; statistically there was no significant difference between gender. Apnoea, hyperbilirubinemia, anaemia, respiratory distress were found to be the risk factors for ROP; statistically there was significant difference, respectively. Conclusion: Preventing prematurity is the best way to reduce ROP. Proper coordination between obstetrician, neonatologist and ophthalmologist can help to reduce the incidence.

Assessing Adherence to Royal College of Surgeons Guidelines: A Closed-Loop Audit of Operation Notes in a Tertiary Healthcare Unit.

Introduction Accurate, comprehensive, and legible operation notes are essential for maintaining patient records, supporting healthcare professionals, and facilitating research. The study focused on adherence toRoyal College of Surgeons (RCS) guidelines established in 2008. Despite the guidelines, poor documentation practices have been reported globally. This audit seeks to address this issue and enhance documentation quality. Methodology The audit evaluated 19 parameters as defined in the 2014 RCS operative note guidelines. Data collection occurred during the initial cycle, spanning from March to April 2023, encompassing all surgical procedures at Hayatabad Medical Complex (HMC). Subsequently, a re-audit took place in July 2023 to gauge enhancements following a survey and educational intervention that took place in June 2023. The process included the formation of an audit team, securing ethical approval, and implementing a comprehensive methodology for data collection and analysis. The study spanned two data collection cycles to comprehensively assess improvements. Results Comparing initial and re-audit cycles (n = 390 and n = 108, respectively), improvements were observed in several documentation aspects. Parameters such as surgery date, elective/emergency classification, and names of key personnel showed significant enhancement. Notable improvements were also seen in the recording of operative details, complications, extra procedures, and post-operative care instructions. In our department, an educational survey was conducted to gain insights into compliance rates. This survey underscored the significance of adhering to RCS guidelines, identified the factors influencing adherence, and proposed strategies for improvement. Conclusion The audit affirmed the significance of adhering to RCS guidelines for operation note documentation. The study demonstrated improvements in documentation practices, emphasising the importance of accurate records for patient care, research, and ethical standards. The findings validate RCS guidelinesas a tool for the identification of defects in documentation and thus as a guide that highlights where improvements are necessary. Addressing challenges identified in this audit can drive the department towards becoming a model for RCS guideline adherence and showcasing high-quality surgical documentation and patient-centred care.

Assessing knowledge, attitude, and readiness to use e-health among doctors in a tertiary health care unit in Bhubaneswar city, Odisha - A cross-sectional survey.

The term ""e-health"" refers to all technological applications in the delivery of a more affordable, high-speed, and widely accessible mode of health care. It is a definite solution to managing the public's health and well-being during the coronavirus disease (COVID-19) pandemic, and doctors from all fields of expertise are required to be at par with it in terms of knowledge, attitude, and readiness to use it to their advantage under the current circumstances. A cross-sectional survey was conducted among the faculty, postgraduates, and interns of the medical and dental schools of a university, which used an expert-validated self-administered questionnaire assessing knowledge, attitude, and readiness to use e-health. Among the 400 participants, it was observed that the categories of age (P < 0.0001), gender (P = 0.018), designation (P = 0.031), and years of service (P < 0.0001) have significant differences across the groups. It was seen that the mean e-health knowledge (3.55 ± 0.52) and mean attitude (2.42 ± 0.59) to use e-health were more in dentists while participants from the medical field showed higher mean readiness (1.97 ± 0.58) to use e-health in daily practice. It was observed that male professionals had more mean knowledge (3.54 ± 0.60) than female professionals (3.43 ± 0.52) while female participants had more mean e-health readiness (1.96 ± 0.57). In a broad sense, the majority of participants responded positively to using e-health in their everyday practice. While medical doctors have a stronger outlook and preparedness, dentists showed more literacy and a supportive attitude to adopting e-health and telemedicine. Thus, it is necessary to step up comprehensive e-health workshops and training sessions for health care experts.

Molecular Epidemiology of Cystic Echinococcosis in Rural Baluchistan, Pakistan: A Cross-Sectional Study.

Cystic echinococcosis (CE), or hydatid cyst disease (HCD), is a zoonosis of significant importance caused by the cestode of Echinococcus granulosus sensu lato (s. l.) that affects mainly nomadic populations and has substantial economic consequences. Due to the 76% rural and nomadic population, Baluchistan is a highly endemic region in Pakistan for CE; however, it has not yet been investigated for CE. For this purpose, this study was carried out to investigate the molecular epidemiology of CE in this region. In total, 23 human hydatid cyst samples were collected from tertiary health care units in Baluchistan and processed for DNA extraction, which was then followed by sequencing of the cox1 mitochondrial gene of all 23 collected samples, genotyping, and phylogenetic and haplotype analysis. Most subjects were livestock owners (39.13%) in rural settings (73.91%). Most patients (73.19%) were pet owners (dogs) and used water from open sources for drinking. The liver was the most affected organ (52.17%), followed by the lungs (17.39%). Sequence analysis based on the cox1 gene revealed that EG genotype 1 (G1) was the most prevalent (56.52%), followed by G3 (34.78%), while some samples (8.7%) were identified as the Echinococcus canadensis (G6/7) genotype. A total of five haplotypes were detected with high haplotype diversity (0.80) and low nucleotide diversity (0.033). Phylogenetic analysis revealed two diverse sub-clades, each of G1 and G3 isolates from Baluchistan, that were evolutionarily related to previously reported G1 and G3 isolates from Pakistan and China. On the other hand, the G6/7 isolates of this study were evolutionarily identical to the already reported G6/7 isolates from Pakistan, Turkey, and Kazakhstan. This study concludes that diverse G1 and G3 EG isolates are present in this part of Pakistan, while the G6/G7 genotype was reported for the first time from Baluchistan.

Twenty years of real-world data to estimate chronic kidney disease prevalence and staging in an unselected population.

Chronic kidney disease (CKD) represents a global public health burden, but its true prevalence is not fully characterized in the majority of countries. We studied the CKD prevalence in adult users of the primary, secondary and tertiary healthcare units of an integrated health region in northern Portugal (n=136993; representing ∼90% of the region's adult population). Of these, 45983 (33.6%) had at least two estimated glomerular filtration rate (eGFR) assessments and 30534 (22.2%) had at least two urinary albumin:creatinine ratio (UACR) assessments separated by at least 3months. CKD was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines as a persistent decrease in eGFR (<60ml/min/1.73m2) and/or an increase in UACR (≥30mg/g). The estimated overall prevalence of CKD was 9.8% and was higher in females (5.5%) than males (4.2%). From these, it was possible to stratify 4.7% according to KDIGO guidelines. The prevalence of CKD was higher in older patients (especially in patients >70years old) and in patients with comorbidities. This is the first real-world-based study to characterize CKD prevalence in a large, unselected Portuguese population. It probably provides the nearest estimate of the true CKD prevalence and may help healthcare providers to guide CKD-related policies and strategies focused on prevention and on the improvement of cardiovascular disease and other outcomes.

Prevalence of White Coat Hypertension amongst Patients in the Kurdistan Region of Iraq-Erbil

Background: White coat hypertension (WCH) is a condition in which people exhibit an elevation in blood pressure (BP) in a clinical setting, although they do not show such elevation in other settings. This study aims to provide new insight into determining the prevalence of WCH amongst patients with or without any cardiovascular risk. Method: This is a cross-sectional study of convenience sampling study design where 300 patients were involved based on their consultation to a Tertiary Healthcare Unit between November 2021 to March 2022 in Erbil city. Patients were classified according to the ESC into different categories of BP patterns by comparing the first BP reading that was taken at clinic with their average AMBP readings which were taken at home. Results: A total of 300 patients were included in the study where 58% of the population was male and 42% of the population was female. Of the population, 16% had WCH, 12.3% had sustained HTN, 59.3% were considered to be normotensive (NT), and 12.3% among them were categorized as masked hypertension. From the total of 47 patients that were diagnosed with WCH, 55.3% were male and 44.7% were female patients. The overall average Systolic Blood Pressure in WCH was 125.79±15.30 mmHg, and in Hypertensives it was 147.70±17.15 mm Hg with a P-value of &lt;0.001. The Mean Arterial Pressure in WCH was 94.63±8.87 mmHg and in Hypertensives it was 112.16±13.62 mmHg with a P-value of &lt;0.001. The average Pulse Pressure in WCH was 75.27±9.42 mmHg, and in Hypertensives it was 76.35±9.11 mmHg with a P-value of 0.001. Conclusion: WHC is significantly prevalent in Erbil city; therefore AMBP monitoring should be performed for those with certain indications to limit the prescription of unnecessary long-term medications with possibly significant side effects to patients with WHC.

COmparisoN of TastES of Available NutriTional integrated or non-integrated formulas for infants older than 1 year of age with cow's milk allergy: A multicenter, prospective, single blind, cross-sectional observational clinical study (CONTEST Study).

Palatability of the infant formulas lacking cow milk protein formulas is reported by parents to be an important drawback. The purpose of this study is to examine decisions made by mothers of infants having cow milk protein allergy, and physicians concerning the palatability of unflavored extensively hydrolyzed formulas and amino acid-based formulas. We conducted a multi-center, randomized, single-blinded, observational taste study involving 149 pediatricians from gastroenterology and allergy subspecialties at 14 tertiary healthcare units from different regions of Turkey and involving 94 mothers of infants with cow milk protein allergy. Blinding was performed for seven formulas available in the market, which were the most commonly prescribed for feeding: four AAFs (Neocate-Numil®, Aptamil Pregomin AS-Numil®, Alfamino-Nestle®, Comidagen-Mamma®), one AAF specifically designed to address the growing nutritional and lifestyle needs of children >1 year (Neocate Junior-Numil®), 2 eHFs (Bebelac Pepti Junior-Numil®, Similac Alimentum-Abott®). Considering all three formula characteristics, Neocate junior-Numil® ranked as the number 1 product among seven products by mothers (63.8%) and physicians (69.8%). The ratings of mothers were significantly higher than the physicians (8.1 points and 6.1 points, respectively; p < 0.001). No difference was found in terms of taste, smell, and appearance for Neocate junior-Numil® between the mothers' and physicians' ratings. Since caregivers have responsibility for careful selection of replacement products for infants with cow milk protein allergy, it is noteworthy that increased awareness and confidence in the palatability characteristics of these products should motivate mothers and physicians to comply with replacement treatment in the long term.

The association between body image, self-esteem, and body mass index in patients with schizophrenia at a tertiary care unit: A case–control study

Abstract Background: When compared to the general population, patients with schizophrenia are more likely to have a higher body mass index (BMI). As a result, they are more likely to have low self-esteem, poor quality of life, and poor drug adherence. Aims and Objectives: The aims and objectives of the study are to compare the body image and self-esteem in patients on treatment for schizophrenia with healthy controls and study the association of BMI with body image and self-esteem in them. Setting and Design: This was a case–control study, comprising 50 patients with schizophrenia who attended the outpatient clinic of our tertiary health-care unit’s department of psychiatry and 50 healthy controls. Materials and Methods: Sociodemographic data were obtained, and BMI was computed. Body image was assessed using the Body Weight, Image, and Self-Esteem Evaluation Questionnaire (B-WISE), and global self-worth was measured using the Rosenberg Self-Esteem Scale for all participants. Statistical Analysis: Chi-square test/Fisher’s exact test was used to assess independent variables and their distribution across the study groups. Mann–Whitney U-test was used to compare the means of continuous variables across the study groups. Pearson and Spearman correlation tests were done to study the association between clinical variables. It was done using IBM SPSS 22 Program on the windows operating system. Results: The schizophrenia group differed from the control group in marital status (P = 0.012) and educational level (P = 0.001) calculated using the Chi-square test. They also differed significantly in terms of BMI (P &lt; 0.001) and self-esteem (P &lt; 0 .001) assessed using the Mann–Whitney U-test. There was no significant difference in B-WISE scores between the groups (P = 0.0451). Spearman correlation revealed a positive correlation between B-WISE scores and self-esteem scores, a negative correlation between BMI and self-esteem scores, and between BMI and B-WISE scores among the cases. Conclusion: Patients with schizophrenia had lower self-esteem and increased BMI compared to controls. Patients with a better body image had more self-esteem. Patients with greater BMI had poorer body image and lower self-esteem.

A Model; Road Map to Achieve Sustainable Development Goals 2030 Realizing Your Potential a Proposed Guidelines for National Health Policy for Integrated Health Care Delivery

The goals that are set for 2030 regarding sustainable Development are a wakeup call to action that reforms should be made to end poverty, protect the planet and ensure health for all and everywhere. The needs to review and reprioritize the use of existing resources in the health sector along with significant addition and allocation of resources for health should be focusing more on primary health care. Pakistan must also adopt a holistic integrated approach that views health, education, and other social sector development as intrinsically interrelated and interwoven.Most of the patients in Pakistan visit two to three general practitioner / family physicians to rule out and to know the exact diagnosis of their ailment. This increases the frequency of visits to the other physicians and decreases follow up and compliance concerning to the treatment provided. Another Important concern is record maintenance as most of the time patient loss their important notes/ reports.&#x0D; So to streamline these all patient record as well as provision of safe treatment and referral if any needed in the region he is residing are the main purpose; this will decrease patient load to Private as well as public sector health units and will decrease the unnecessary movement of patients. The Unique Model by Using the latest Technology has evolved by putting the Communication, Coordination in a synchronization pattern and by keeping the health care provider and client in a centralized position. This will integrate all levels of family Physicians; centralize the patient registration Mechanism in Pakistan. This will regulate Screenings &amp; Surveillance of Communicable and Non communicable Diseases thus support the District Health Administration to keep an eagle eye to monitor disease prevalence and incidence.This will work in coordination with Primary secondary and specialized healthcare; Tertiary health care units Public Sector.The efficient and effective Decrease the Chronicity, Resistance and Poor Compliance&#x0D; OBJECTIVES: To strengthen the feedback and Reporting System in Pakistan. To Improve Tracking System, Patient’s Health Care, Surveillance, Coordination, Team Facilitation &amp; Integration hence help in policy development&#x0D; METHODOLOGY: This will be a unique Web Portal System with customized features The integrated model will be configured and synchronized; based on integrated, self-regulated concept. It’s all sections shall be interconnected and reports will be auto generated after a concrete analysis and Produce comparative results instantly.&#x0D; RESULTS: Rapid communication and Instant strategies policies to improve patient’s health care, by improving the surveillance &amp; tracking system in Pakistan&#x0D; CONCLUSIONS: The “Integration Model For Pre &amp; Post Epidemic Communication, Strategies will help to Improve Tracking System, Patient’s Health Care, Surveillance, Coordination, Team Facilitation as well as strengthening the feedback and Reporting System In Pakistan”. This will also help the District Health Authority &amp; District Administration for proper and appropriate measures to initiate.

Role of Rawalpindi Medical University Students in Perspective of Public Health

Role of Rawalpindi Medical University Students in Perspective of Public Health

Study on Clinical Spectrum of Neurological Manifestations in HIV Positive Patients from a Tertiary Health Care Unit

Study on Clinical Spectrum of Neurological Manifestations in HIV Positive Patients from a Tertiary Health Care Unit

Perianal condylomata acuminata in pregnancy.

A 23-year-old woman of low socioeconomic status presented to our obstetric department reporting pain in the perineal area, occasional bleeding during defecation and discomfort at the sitting position. The woman was nulliparous, at the 34th week of gestation and had an unattended pregnancy, since she had never visited a healthcare provider the last three years. Physical examination revealed multiple, irregular vegetative lesions covering the perianal region. These cauliflower-like masses where hard and painless with maximum diameter 10cm, while vagina and vulva were free of warts. The patient was scheduled for elective caesarean section at the 38th week of pregnancy, because large warts were blocking the natural birth canal. She was referred to a tertiary health care unit for further counselling and treatment after postpartum period.

Transferência de Cuidados de um ambulatório de referência para a atenção básica: caminhos com vistas à integralidade

Trata-se de resultados da pesquisa de Transferência de Cuidados, realizada em ambulatório de crianças de uma unidade de saúde de média e alta complexidade, que abrange o estado do Rio de Janeiro, para a atenção básica. A transferência de cuidados constitui-se num conjunto de estratégias que visa garantir o acesso à atenção básica, objetivando a integralidade entre os níveis de atenção, através da intersetorialidade em parceria com a rede e com as Unidades Básicas de Saúde (UBSs) do território dos usuários. Desta forma, analisar o processo da transferência de cuidados das crianças em condições de atendimento nas (UBSs) torna-se o objetivo geral deste artigo. Os resultados apontam sucesso na maioria das transferências; e as dificuldades relatadas por alguns responsáveis relacionam-se ao subfinanciamento das UBSs. As transferências resultaram em menor custo de deslocamento para os usuários e na maior oferta de vagas do ambulatório, ampliando o acesso ao nível de atenção conforme necessidade de saúde, respeitando os princípios do SUS.

Hope and General Self-efficacy in Adults with and Without Advanced Illness: A Comparative Study

Background: To compare level of Hope and General Self-Efficacy (GSE)in adults with and without advanced illness. Methods: This cross-sectional comparative study was conducted during November 2017 to March 2018. Convenient sampling technique was used to collect data from tertiary health care units of Faisalabad. Sample was consisting of adults without diagnosis of advanced illness and diagnosed with advance illness i.e., the experimental group of this study. The Herth Hope Index (HHI) and Generalized Self-Efficacy (GSE) scale were used to assess hope and GSE level in adults with and without advanced illness. Descriptive statistics and independent sample t-test was run in SPSS 21 for windows. Results: The sample was consisting of (N=180) with mean age 53.38(11.43) including 90(50%) with and 90(50%) without advanced illness, amongst them men were 120(66.7%) and women 60(33.3%). Independent sample ttest indicated that adults without advanced illness had significantly high level of Hope as compared to adults with advanced illness. Further on GSE adults with advanced illness had significantly lower level in contrast to adults without advanced illness. No significant gender difference was observed among patients and general population. Conclusion: Adults without advanced illness are more hopeful about their lives and have higher GSE as compared to adults with advanced illness.

An Immunological Stairway to Severe Tissue Complication Assembly in Bothrops atrox Snakebites.

Snakebites are a serious public health problem and, in the Amazon, the Bothrops atrox snake is the most frequent cause of envenomation. B. atrox venom (BaV) causes pathophysiological changes with intense, local inflammatory processes, such as severe tissue complication (STC). However, mechanisms associated with the inflammatory process in humans are still poorly understood. Thus, in this study, we sought to describe the profile of local and systemic immunological soluble molecules in Bothrops envenomation patients treated at a specialist tertiary healthcare unit in the Brazilian Amazon. An analytical and prospective study was performed with patients who had snakebites with different clinical outcomes (STC and Mild Tissue Complication—MTC) using venous blood and blister exudate in order to measure immunological soluble molecules present in the response process. Twenty STC patients and 20 MTC patients were eligible for the study. In addition, 20 healthy donors (HD) who had never been bitten by a snake were used as controls. The biomarkers CXCL-8, CCL-5, CXCL-9, CCL-2 and CXCL-10; C3a, C4a, and C5a; IL-1, IL-2, IL-4, IL-5, IL-6, IL-10, TNF, IFN-γ and IL-17A were quantified using flow cytometry and ELISA. The circulating response profile differs between the studied groups, with MTC patients presenting a mixed profile and STC patients presenting a more polarized profile for Th1 response. In addition, individuals who develop STC have a more intense local immune response, because the tissue response differs from the circulating immunological soluble molecules and presents Th1/Th2/Th17 response polarization. Furthermore, these results suggest that CCL-2 and CXCL-10 are biomarkers for STC and the response profile they assume against Bothrops snakebite should reflect in the clinical practice for the patient.

SOCIO-DEMOGRAPHIC PROFILE OF THE PATIENTS WITH OCULAR TRAUMA

Background: Ocular trauma is an important cause of preventable visual morbidity, particularly among younger age groups as shown by different studies worldwide. The impact of trauma on the human eyes may range from minute corneal abrasions/innocuous subconjunctival haemorrhage to a badly lacerated globe.Aim: To study the Socio-demographical profile of the patients with ocular traumaMethods: An observational study was carried out at the Department Of Ophthalmology, Burdwan Medical College and Hospital, a tertiary health care unit of West Bengal. The entire study was conducted after proper consultation and recommendations from the ethical committee. The research was carried out during a period of one year (01/03/2010 to 28/02/2011). A total of 120 patients were taken into consideration for the scope of the study.Results: The patients were aged between 0-50 years were mostly suffered most ocular injuries. The research also showed that the majority of the affected patients were males, i.e. 75%. Furthermore, in the course of the study, the majority of the patients belonged to the rural population, i.e. 71.5%.Conclusion: This study indicates that ocular trauma is a significant cause of monocular and sometimes binocular visual loss in all age groups. Many injuries and their visual outcome may be prevented through education and prompt, appropriate medical care.

Quality indicators in type 2 diabetes patient care: analysis per care-complexity level

BackgroundThis study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System’s primary and tertiary health care centers within a local population.MethodsThis was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%).ResultsIn the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered.ConclusionsOur results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients.

“Sex hormone independent associations between insulin resistance and thyroid status –a gender based biochemical study on clinically euthyroid non-obese, overweight and obese type 2 diabetics'’

AimStudies indicate that type 2 diabetes mellitus (T2DM) might contribute to the development of thyroid disorders (TD). However, few gender based reports are available describing therelationship between T2DM and TD in clinically euthyroid, anthropometry specified groups of type 2 diabetics. The aim of this study was to relategender based biochemical changes in anthropometry specified, clinically euthyroid type 2 diabetics. MethodologyThe study was carried out on clinically euthyroid type 2 diabetics (male n = 269; female n = 301) at a tertiary health care unit in Pondicherry, South India. Three groups were segregatedbased on Body mass Index: 153 non-obese type 2 diabetics (BMI = 18.5–24.99), 291 overweight type 2 diabetics (BMI = 25–29.99) and 126 obese type 2 diabetics (BMI ≥ 30). Biochemical parameters included glycated hemoglobin, insulin resistance, Cortisol and Thyroid profile. ResultsThe study had included clinically euthyroid type 2 diabetics (52.8% females and 47.2% males). Statistically significant associationsweredifferently observed between insulin resistance (dependent variable) andother independent variables, irrespective of sex hormone status. Total protein was negatively related in non -obese male type 2 diabetics (R = 0.780); Triiodothyronine was inversely associated in overweight males, whereas cortisol and the divalent cations (Zinc and Magnesium) depicted positive association (R = 0.555) in the same group (overweight), butcortisol in non -obese female type 2 diabeticswas negative (R = 0.742); Glycated hemoglobin and calcium exhibited positive relationshipin obese type 2 female diabetics (R = 0.771).. ConclusionOur study has revealed distinctive relationship between T2DM and TD in the anthropometry specified, clinically euthyroid and gender based type 2 diabetics, independent of the sex hormones.

Quality of life of people with diabetes mellitus.

To analyze the quality of life of people with type 2 diabetes mellitus in the three levels of the healthcare system. A quantitative, cross-sectional and descriptive study carried out in primary, secondary and tertiary healthcare units with individuals in outpatient care. The validated Diabetes-39 instrument was used to evaluate quality of life. The sample consisted of 53 people. There was a decreasing tendency in the quality of life impairment from the primary to the tertiary care levels. In the total sample, there were differences between domains of quality of life with the variables gender, insulin use and occupation, greater perception of quality of life impairment and disease severity in people with higher rates of glycated hemoglobin. Quality of life tends to worse as the disease worsens. The results suggest that quality of life is related to sociodemographic and clinical variables, therefore, these should be considered in the care.