Journal of Diabetes and Endocrinology Association of Nepal

Improving Management of Diabetes Mellitus in Primary Care

P.P. Gupta — 2023-08-10

No abstract available.

Knowledge, Attitude and Practice regarding Polycystic Ovarian Syndrome(PCOS) among final year medical students and interns in a Medical College in Kathmandu Nepal

P. Adhikari — 2023-08-10

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrinal conditions in young women. It affects women in their reproductive years. This study was undertaken to find out understanding of PCOS in young doctors who will be shortly delivering health services in the community.

Methods: This will be a Descriptive, Cross-sectional study carried out in Nepal Medical College Teaching Hospital on the final year medical students of MBBS and interns. Survey was done online using Google docs questionnaire. A set of questionnaire adopted from similar study was used. The questionnaire had 3 sections, testing knowledge, attitude and practice. A total of 117 study participants were enrolled in the study. Data was tabulated and analyzed. Descriptive statistics was used to calculate frequency and percentage of variables.

Results: There were 61 (52.13%) female, and 56 (47.86.%) were male who participated in the study. The median age of the population was 23 years. The population's age range was 10 years, with the youngest person being 20 and the oldest person being 30. Majority (98%) had heard about the ovarian cyst before, and 74.4% had received knowledge through friends. All participants (100%) chose to comfort and counsel their friend regarding treatment modalities; in response to if she reveals her diagnosis to them.76.92% thought that PCOS patient will hide their diagnosis. 92.30 % of the study participants responded positively for weight reduction as an option for management with 72.72 % identified it to help in countering insulin resistance. 96.58% of them responded to lack of authentic material for PCOS awareness and 85.47% of them thought that awareness can be raised through social media. When asked about best person to treat PCOS, 85.47% responded to Gynecologist.

Conclusion: The final year medical students and interns demonstrated a satisfactory level of polycystic ovary syndrome knowledge and had a good attitude towards disease with good practice knowledge for disease.

Uncontrolled Diabetes Mellitus during Lockdown period of Covid 19 pandemic

D. Mall — 2023-08-10

Background: Nepal Government had declared a lockdown from 24th March till 21st July 2020 for prevention and control of spread of Covid 19 pandemic. This has made patients with diabetes mellitus unable to do their physical activity outside home, not able to visit physicians or healthcare workers on time, buy medicines on time, check blood sugar as scheduled. In this study we aimed to study the effect of lockdown on glycemic control of Diabetes patients.

Methods: This study was done at National Academy of Medical sciences, Bir Hospital-Endocrine Unit outpatients department. After the ease of lockdown certain patients visited us with past and new reports of Blood glucose and HbA1c. We kept a record of variation of glycemic control, lack of physical activities, continuation of medications and daily food habits.

Results: Total of 91 Diabetes Mellitus patients visited our OPD in 3 weeks period after lockdown was eased. 58% were Female and 42 % were Male. Only 7% of patients had good control of Diabetes, 32% had fairly controlled Diabetes and 61% had poorly controlled Diabetes in males. In females 3% had good control of Diabetes, 27% had fairly controlled and 70% had poorly controlled Diabetes. 46-65 age group in both male and female had uncontrolled blood sugar. Among males 49% had increased food habits, 32% had decreased physical activity and 10% of them left or decreased medicine. In similar among females 23% had increased food habits, 39% decreased physical activity, 38% had left or decreased medicines.

Conclusion: Lockdown during Covid 19 pandemic had adverse effect on glycemic control of patients. This will lead to further complications of diabetes mellitus. Patients must do normal physical activities. They can do normal exercise inside their house and increase activities with family members in a small area, where possible. We must advice our patients to learn how to perform self glucose monitoring and self adjustment of Insulin and diet. Learning how to access to physicians, healthcare workers and pharmacist through telemedicine is very important during lockdown period.

The Comparison of Coronary Angiographic Profile between Diabetic and Non-Diabetic Patients with Coronary Artery Disease in a Nepalese Population

P. Katuwal — 2023-08-10

Background: Diabetes mellitus is associated with an increase in cardiovascular morbidity and mortality. As the prevalence of diabetes mellitus is increasing globally the burden of death related to cardiovascular disease including myocardial infarction will be a great burden to countries like Nepal. The aim is to compare the extent and severity of coronary artery disease between diabetic and non-diabetic patients referred for coronary angiography.

Materials and methods: It was a Hospital-based, cross-sectional study conducted in the Department of Internal medicine, BPKIHS Dharan, Nepal. All consecutive patients undergoing coronary angiography with a clinical indication for the procedure during the study period of one year were included in the study. 61 subjects with diabetes were compared with 147 subjects without diabetes for assessing the severity and extent of coronary artery disease. The coronary atherosclerosis score was used to grade the severity of lesions visualized by coronary angiography.

Results: The mean coronary atherosclerosis score was 6.64±4.18 among diabetes and 4.97±4.07 among the non-diabetic group with p-value of 0.008 which was statistically significant. The left anterior descending coronary artery was significantly more frequently involved in diabetics than nondiabetic patients 88.52% vs. 66.67% (p<0.002).

Conclusion: Diabetic patients had more severe and extensive atherosclerotic lesions in coronary arteries than the non-diabetic patients on coronary angiography suggesting atherosclerotic burden in the diabetes population is higher in our population.

Isochromosome Mosaic Turner Syndrome with Delayed Growth and Puberty: A Case Report

R. Tamrakar — 2023-08-10

Isochromosome Mosaic Turner Syndrome, a variant of Turner syndrome which has a milder presentation, can present without the typical features of Turner syndrome. Evaluation of Turner syndrome with karyotyping has to be performed in females presenting with short stature. We present a case of 15 years girl who presented with delayed growth and puberty with primary amenorrhea and hyperthyroidism. Cytogenetic study of peripheral blood revealed 45,X [31]; 46, X,i(X)(q10) [19] suggestive of Isochromosome Mosaic Turner Syndrome.

Topical Corticosteroid-Induced Iatrogenic Cushing Syndrome in an Adolescent: A Case Report

A. Rai — 2023-08-10

Cushing syndrome (CS) is an endocrinological disorder characterized by increased blood cortisol level. It is either due to an excessive endogenous release of steroids (e.g., pituitary adenoma or adrenal hyperplasia) or exogenous administration of steroids. Iatrogenic Cushing syndrome is the most common form of Cushing syndrome. The vast majority of cases are due to oral or parenteral steroid preparations, which are commonly prescribed for pulmonary, renal, hematological or autoimmune diseases. Prolonged use of topical corticosteroids, particularly in children, may cause Cushing syndrome and suppression of the hypothalamo-pituitory-adrenal (HPA) axis, which is less common than that of oral or parenteral route. Iatrogenic CS due to the overuse of topical corticosteroids is rarely reported. There are only few cases that reported young children having Cushing syndrome secondary to misuse of topical corticosteroids.