Journal of Cardio-diabetes and metabolic disorders

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Immune-mediated musculoskeletal (MSK) manifestation is one of the most prevalent phenotypes of rheumatic disorders. Diabetes Mellitus (DM), the modern epidemic, acts as a great mimicker of rheumatic diseases in terms of MSK involvement. Numerous attempts have been made in various strands of scientific research to identify the level of association of these disorders with DM but unfortunately, the results are not uniform. In daily clinical practice, it is sometimes difficult to differentiate diabetes-related joint and muscle problems from pure rheumatic disorders without proper background knowledge. Rheumatic manifestations often amplify the magnitude of diabetes-related morbidities. In the modern era, treating the primary disease is often not sufficient; we need to go further ahead to tackle its long-term complications also to mitigate the suffering of patients. The identification and management of diabetes-related rheumatic problems in the ocean of rheumatology needs sufficient evidence-based knowledge, expertise, as well as clinical experience. In our article, we intend to discuss various MSK problems related to diabetes, their pathogenesis, clinical features, important clues for diagnosis, and overall management strategies.

Background: Diabetes mellitus (DM) is a major health problem globally. It is estimated that approximately 50% of people with diabetes suffer from diabetes peripheral neuropathy (DPN). All patients with diabetes should be screened for peripheral neuropathy. Therefore, this study was undertaken to explore and determine the factors associated with peripheral neuropathy. Materials and Methods: A cross-sectional study was conducted on patients with type 2 DM and with peripheral neuropathy at a patient visiting diabetes clinic of a tertiary care center. Neuropathy analysis was done by a peripheral neuropathy analyzer (Vibrotherm: EN ISO 13485:2012). The test consisted of four different steps: The first step was vibration perception for a six-point assessment of each foot; then, cold perception; hot perception; and finally, a 10g Semmes-Weinstein monofilament test. Descriptive and inferential statistics were used for data analysis. Result: Out of 50 patients, the maximum were male (70%); mean age was 55.80 ± 11.48 years; 50% were living in urban areas, 40% in rural areas, and 10% in semi-urban areas; 34% were farmers, 26% were doing jobs, 24% were housewives, and 16% were businessmen. The mean duration of type 2 DM was 8.34 ± 7.89 years, and HbA1c (glycated hemoglobin) was 9.47 ± 3.17. Overall, 44 patients had neuropathy; among them, 29 had only large fiber neuropathy, 42 had small fiber neuropathy, and 27 had both small and large fiber neuropathy. Large fiber neuropathy was found to be significantly associated with HbA1c level and the duration of DM, and mixed fiber neuropathy was found to be significantly associated with the age of the participants (P < 0.05). Conclusion: Peripheral neuropathy is very common in patients with type 2 DM; it is associated with age, level of HbA1c, and the duration of DM, so early action should be taken to mitigate its occurrence.

Background: Text messaging health service is used to improve quality of life of people living with diabetes in Eastern Nepal. It has been projected that the number of diabetic patients has increased to 170% from 1995 to 2025 in developing countries and to 41% in developed world. The objectives of the study were to assess the quality of life of people living with diabetes, to prepare and provide health education, and to evaluate the effectiveness of health education program and mobile/telephone health services provided to the diabetes patients. Materials and Methods: The study was conducted among consecutive stable ambulatory patients, >18 years old, and 396 patients diagnosed with diabetes for at least 3 months were included in the study. The education intervention was continued for 6 months by the principal investigator and a trained nurse. Results: Most of the respondents (53.3%) were of the age group 40–60 years; female (59.34%); Hindus (97%); and of the Janjati ethnic group (52.5%). The majority (96.5%) were married and self-employed (70.7%). About 30% of the respondents belonged to the poor economic status group. Most of the respondents had type II diabetes mellitus; about 34% of the respondents had a family history of (sibling) diabetes. Most of them were non-vegetarians (88.9%). About 16% of the respondents were obese. Regarding habits, 14% had tobacco chewing, 5% had gutka chewing, 8% had smoking, and around 8% had alcohol consumption habits. Regarding treatment, about 84% were on oral hypoglycemic agent, 22% on insulin therapy, 68% on diet control therapy, 58% on weight control, and 4.5% on herbal therapy. It was found that the mean knowledge score before education intervention was 22.53 and after education intervention was 35.32. It was found that the difference in the mean score calculated using t-test between knowledge before and after education intervention program was significant (P < 0.01). Conclusion: It can be concluded that the education intervention program and SMS mobile service provided to diabetes patients were found to be very effective.

Aim: The primary objective was to study the electrocardiogram (ECG) findings of normal pregnant women in their third trimester. The secondary objective was to compare the ECG findings of pregnant women in their third trimester with the ECG findings during the postpartum period. Materials and Methods: An Electrocardiography recording was done for 60 pregnant women during their third trimester and on postpartum day 7. Results: The common ECG findings during pregnancy found in our study were sinus tachycardia, and conspicuous Q wave (LV dilation) and an inverted P wave (nonspecific) in lead II. We also found left axis deviation of a mean of 15° (QRS axis) when compared with the QRS axis of the same patient postpartum (P < 0.05). Conclusion: There are physiological changes in an ECG during pregnancy. A routine antenatal ECG is safe, feasible, economic, and possibly advantageous to lower maternal mortality and morbidity. The ECG findings must be interpreted carefully during pregnancy.

The difference addressed earlier may not be a very hype intervention, unlike what science has been giving us, but this can do a lot in setting us free from this very pandemic, COVID-19. The fight against COVID-19 is a biological warfare that cannot be won at the cost of ammunitions but with proper knowledge, information, and communication, through various advertisements, banners, and posters. This is an hour-saving time where COVID-19 is rapidly evolving. The entire focus is placed on caring for the patient and on abandoning community spread of the disease in order to decrease disease burden; nevertheless, the rapidity of COVID-19 has proven to be grave for medical education and severely disrupted the medical curriculum.

Online since 8^th September 2020