Avdhesh Gupta

Clinical audit of patients using DPP4 inhibitors in longstanding type 2 diabetes

AIMS Dipeptidyl peptidase-4 inhibitors (DPP 4i) are oral hypoglycemic agents and are supposed to be beneficial in the early stages of diabetes. In this study, we evaluated the role of DPP4i in long standing type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This retrospective data analysis was conducted from the patient records. All the patients (T2DM>5 years; Age>50 years; Gliptin use >12 months) were divided into 2 groups based on the duration of T2DM: Group A (<10 years) and Group B (>10 years). We excluded patients with type 1 diabetes and drug default of more than one month. Our primary objective was to study the change in HbA1c and secondary objectives were change in body weight and insulin requirement. Data are presented as mean ± S.D and comparison between the groups was done using Mann-Whitney and Fishers exact tests. RESULTS The study participants (n=501) had a mean age (64.2 ± 8.2 yr), diabetes duration (10.1 ± 4.9 yr), body weight (65.3 ± 9.5 kg), BMI (23.4 ± 3.9 kg/m(2)) and HbA1c of 9.7 ± 1.3%. The use of gliptins resulted in similar HbA1c reduction between the groups (p=0.8405) and greater reduction of insulin requirement in group B (p=0.0433) at the end of one year. Body weight and hypoglycemia episodes did not differ between the groups. CONCLUSION DPP4 inhibitors give similar benefit irrespective of the duration of diabetes and our data gives reassurance about their role in long standing diabetes.

Energy efficient clustering based 3-rank heterogeneous network model for wireless sensor network

Now-a-days many advanced technologies have been innovated in the field of Wireless Sensor Networks (WSN). The main problem regarding wireless sensor network is the improvement of its energy efficiency in the clustering protocol. Most of the direction-finding or path finding challenges are faced by WSN in terms of node deployment, energy consumption, communication range, fault tolerance, quality of service, etc. In this paper, the impact of heterogeneity of nodes are related to their nodes energy are considered. In wireless sensor networks nodes are divided into three types (type-1, 2, 3) based on their energy. We assume that nodes of type-1 energy are equipped with the additional energy resources than type-2 nodes and type-2 is having more energy than type-3 nodes. It is also assumed that the sensor nodes are arbitrarily disseminated. The dimension and sensor field and the coordinates of sink are known in advance. In homogeneous clustering protocol, all sensor nodes have same amount of energy. In this work we worked on energy efficient heterogeneous clustered scheme for WSN. Also we have simulated the results and find that the proposed approach in heterogeneous clustering is more effective in lifetime as compared to other protocols.

Clinical profile of patients using normal, high and very high insulin doses in type 2 diabetes.

AIMS Insulin requirement varies between patients with diabetes due to insulin resistance. The clinical profile of patients based on their insulin requirement has not been studied earlier. We stratified the patients based on total daily insulin requirement (TDIR) and studied their clinical profile and carbohydrate consumption. MATERIALS & METHODS Sixty patients with type 2 diabetes (aged 30-75 years, using stable insulin dose for last 6 months, HbA1c between 6-7.5%, negative screening tests for Acromegaly and Cushings disease) participated in this clinical observational study. All patients with major illness, surgery or diabetic ketoacidosis were excluded. The patients were divided into 3 groups: Group 1 (TDIR<1 U/kg, n=30), Group 2 (TDIR 1-2 U/kg, n=20) and Group 3 (TDIR>2U/kg, n=10). Data are presented as mean±S.D and comparison between three groups was done using one way ANOVA test. RESULTS The patients (27M: 33F) had mean age 54.3 ± 12.3 years, diabetes duration 10.1±4.7 years and an A1c of 7±0.38%. Patients in group 3 had lower body weight, BMI and highest carbohydrate consumption when compared with the other two groups (P<0.05). Hypoglycemic episodes and complications did not differ between the groups. CONCLUSION Our data showed that the low body weight and high carbohydrate intake are associated with increased insulin requirement. The clinical implications of our study are to check the carbohydrate intake in patients with high insulin requirement.

Traffic and congestion free routing for mobile robots

Small group of robots are being used at different places to gather information. The proclivity for the usage of a team of robots in order to gather information is likely to increase in the upcoming future. The efficient and lossless communication becomes vital for these robots. In our research paper we propose an algorithm that focuses on minimizing congestion and data losses amongst a team of robots. Our algorithm prevents congestion beforehand and can be divided into two parts. A detailed description of these parts has been given in the paper. The algorithm was also tested on various grounds. These results have been discussed in the paper. The algorithm focuses on labelling each node depending on its congestion status and discovering an alternate path having a lower congestion status as soon as the path becomes liable to come in the congested zone.

Anemia with jaundice: An unusual cause

Anemia and jaundice are two important clinical signs in medicine. Occurrence of these two signs together in a patient suggests hemolytic disorders. Hemochromatosis is a disease characterized by hyperpigmentation, arthralgia and diabetes. The disease usually presents in elderly individuals and is rare in menstruating females. We present a case of a young lady with anemia and unexplained jaundice with extensive work-up leading to the diagnosis of hereditary hemochromatosis with megaloblastic anemia. We present the case to highlight the unusual presentation of anemia and jaundice in a case of hemochromatosis.

Attitude of health care professionals about the diabetes from India

Background: Health care workers should have adequate knowledge and the correct attitude to deal with the diabetes. We conducted this study among nursing and medical students to assess their attitude regarding diabetes. Materials and Methods: This cross-sectional descriptive study was conducted on medical (Group 1, N = 50) and nursing (Group 2, N = 50) students. Data was collected using the Diabetes Attitude Scale questionnaire developed by the University of Michigan Diabetes Research and Training Centre. The scores identify the attitude regarding five key areas of diabetes, namely need for special training, seriousness of diabetes, value of tight control, psychosocial impact and patient autonomy. The data were analyzed with appropriate statistical tests using GraphPad Prism Software, version 6 (GraphPad Software, San Deigo, CA, USA). Results: The study participants consist of 100 students of which 27 were male and 73 were female with a mean age of 22.9 ± 3.3 year. The scores in any subscale did not differ between the medical and nursing students. The correlation analyzes revealed that seriousness of diabetes is increasing linearly with age (P = 0.0325) and all the five key areas of diabetes showed a significant correlation with the increasing duration of residency (P < 0.05). Conclusion: Increasing age and more exposure to formal education are the major determinants of an individual′s attitude toward diabetes. Our study attempts to highlights the need of education for all health care workers involved in the management of diabetes.

Acrocyanosis with intrahepatic carcinoid tumor

1. Burns DA. Necrobiotic disorders. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s Textbook of Dermatology. Oxford: Wiley‐Blackwell; 2010. p. 60.5‐60.7. 2. Prendiville JS. Granuloma annulare. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, editors. Fitzpatrick’s Dermatology in General Medicine. New York: McGraw Hill; 2008. p. 1959. 3. Mathai R. Necrobiotic disorders. In: Valia RG, Valia AR, editors. IADVL Textbook of Dermatology. Mumbai: Bhalani Publishing House; 2010. p. 1193‐5. 4. Wells RS, Smith MA. The natural history of granuloma annulare. Br J Dermatol 1963;75:199‐205. 5. Levin NA, Patterson JW, Yao LL, Wilson BB. Resolution of patch‐type granuloma annulare lesions after biopsy. J Am Acad Dermatol 2002;46:426‐9. 6. Huilgol SC, Liddell K, Black MM. Generalized granuloma annulare sparing vaccination sites. Clin Exp Dermatol 1995;20:51‐3. 7. Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med 1999;341:738‐46. 8. Malakar S, Dhar S. Spontaneous repigmentation of vitiligo patches distant from the autologous skin graft sites: A remote reverse Koebner›s phenomenon? Dermatology 1998;197:274.