Volume 1 Issue 1

ADA
Volume 1 Issue 1

Clinical Diabetes in Primary Care 2024

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Diagnosis and Management Rajesh Jain1*, V Seshah2 2Distinguished Professor, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu; 2Jain Hospital & Research Centre, Kanpur, India Submitted: 20 June 2024; Accepted: 10 July 2024; Published: 15 July 2024 Corresponding Author: 1*Dr Rajesh Jain, 108 B Gandhi Gram, Jain Hospital & Research Centre, Kanpur-208007, India, Email: [email protected] Diagnostic Tests for Diabetes Diagnostic criteria Random glucose value with classic hyperglycemia symptoms/ hyperglycemic crisis What medications can be prescribed to adults to prevent type 2 diabetes? The U.S. Food and Drug Administration has not approved any drugs for diabetes prevention. Metformin has the strongest evidence base for diabetes prevention. Staging of type 1 diabetes2,3   Stage 1 Stage 2 Stage 3 Characteristics AutoimmunityNormoglycemiaPresymptomatic AutoimmunityDysglycemiaPresymptomatic AutoimmunityOvert hyperglycemiaSymptomatic Diagnostic criteria Autoantibodies may become absentDiabetes by standard criteria. Islet autoantibodies (usually multiple)Dysglycemia: IFG and/or IGTFPG 100–125 mg/dl (5.6–6.9 mmol/L)2-h PG 140–199 mg/dl (7.8–11.0 mmol/L)A1C 5.7–6.4% (39–47 mmol/mol) or ≥10% increase in A1C Autoantibodies may become absentDiabetes by standard criteria қ Does statin therapy increase the risk of developing type 2 diabetes? қ Does pioglitazone have a role in secondary cardiovascular prevention in people at risk for type 2 diabetes? Pioglitazone could reduce stroke and myocardial infarction risks in people with a history of stroke and evidence of insulin resistance or prediabetes. However, the benefit must be weighed against potential weight gain, edema, and increased fracture risk. Lower doses may lessen these adverse effects. Pharmacologic Approaches to Glycemic Treatment Ways to Address or Prevent Therapeutic Inertia for People with Type 1 or Type 2 Diabetes Reference 1. American Diabetes Association Primary Care Advisory Group. 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes—2024 abridged for primary care professionals. Clin Diabetes 2024; 42:183–185 (doi: 10.2337/cd24-a002). ©2024 by the American Diabetes Association. 2. Skyler JS, Bakris GL, Bonifacio E, et al. Differentiation of diabetes by pathophysiology, natural history, and prognosis. Diabetes 2017; 66:241–255 3. Type 1 Diabetes Trial Net Study Group. Teplizumab is an anti-CD3 antibody used in relatives at risk for type 1 diabetes. N Engl JMed 2019; 381:603–613. 4. American Diabetes Association Primary Care Advisory Group. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes—2024 abridged for primary care professionals. Clin Diabetes 2024; 42:206–208 (doi: 10.2337/cd24-a009). ©2024 by the American Diabetes Association. Not applicable Not applicable All the authors declared “No Conflict of Interest” with this publication. Not applicable This open-access article is distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Cite this article:  Rajesh Jain1*, Veeraswamy Seshiah2.Clinical Diabetes in Primary Care 2024. Diabetes Asia Journal. 2024; 1(1):76-80

GDM
Volume 1 Issue 1

Epidemiology of Gestational Diabetes Mellitus: Newer Evidence to curtail

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Rajesh Jain1*, Veeraswamy Seshiah2 N, Guneeta Mehta Jain3, Pikee Saxena4, 5Shaily Agarwal, 6Sadhana Tiwari 2MD, FRCP, Distinguished Professor, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India;3MD, Department of Obstetrics & Gynecology, Med Gynae clinic, Saharanpur, UP, India; 4MD, Department of Obstetrics and Gynecology, Lady Hardinge Medical college, New Delhi; 5MD, Department of Obstetrics & Gynecology, GSVM Medical College, Kanpur, India; 6MD Fellow,  Department of Obstetrics and Gynecology, GSVM Medical College, Kanpur, India Submitted: 28 June 2024; Accepted: 10 July 2024; Published: 20July 2024 1*Corresponding Author, Rajesh Jain MD, PG Diploma Diabetes (UK), Project Manager, Diabetes Prevention Control Project, NHM, Uttar Pradesh, India, 108 B Gandhi gram, Vinobha nagar, Kanpur-208007, India Email:[email protected] Abstract  Gestational diabetes mellitus (GDM) is a state metabolic disorder caused by carbohydrate intolerance during pregnancy for the first time. This disease is very important as it affects the mother and fetus. It is said that GDM disrupts the pregnancy process and causes many diseases, such as recurrent miscarriage, congenital anomalies, preeclampsia, stillbirth, macrosomia, preterm birth, and emergency delivery after pregnancy, pregnancy, and delivery. It also causes long-term complications by inducing type 2 diabetes mellitus in mothers and children. GDM is generally considered a lifestyle disorder, and therefore, its burden varies by race, geographic boundaries, genetics, and reproductive risk. Consequently, it is necessary to investigate the prevalence and risk of GDM to evaluate prevention strategies.  Ist Trimester early management of Dysglycemia with Medical Nutrition Treatment (MNT) and Metformin is promising. It might be advocated in the future for curtailing the epidemic of GDM and Type 2 Diabetes.  Recently, the TOBOGM study and our ongoing trial with early dysglycemia in 8-10 weeks of gestation resulted in better maternal-fetal outcomes and reduced GDM conversion during pregnancy. This publication is important as the final results of our trial will be published soon.  Prevalence  India is one of the countries with diabetes in the world and has one of the highest rates of GDM in women, affecting more than 5 million women in the country each year [1].  India currently has the second highest number of people with type 2 diabetes in the world at 77 million; Almost half of these patients are women. IDF 2019 estimates that 6 million newborns in India alone are affected by some form of hyperglycemia (HIP) during pregnancy, 90% of which are due to GDM [1].  Therefore, all women should be tested for gestational diabetes, even if they are asymptomatic. Unfortunately, the diagnostic criteria are not the same. (Table-1) Table – 1: Diagnostic Criteria used by International/National organizations for estimating gestational diabetes. Organization Fasting Plasma Glucose mmol/dl     or  mg/dl   Glucose Challenge 1 h Plasma Glucose mmol/dl or mg/dl 2 h Plasma Glucose 3 h Plasma Glucose      WHO1999 1   ≥7.0 or 125                75gm OGTT Not required ≥7.8 or 140 mg/dl Not required     WHO2 2013   ≥5.1 or 92   ≥10.0 or 180 ≥8.5 or 153 mg/dl   ADA3/American college     Obstetricians & Gynaecologist4 2018   ≥ 5.3 or 95 100gm OGTT ≥10.0 or 180 ≥8.6 or 155 mg/dl ≥7.8 or 140 mg/dl    ADIPS 5 2014   ≥5.1 or 92   ≥10.0 or 180 ≥8.5 or 153 mg/dl   EASD6, 1991   ≥7.0 or 125     ≥10.0 or 180   FIGO7, 2015   ≥5.1 or 92   ≥10.0 or 180 ≥8.5 or 153 mg/dl                  Diabetes Canada Clinical Practice Guidelines8, 2018   ≥5.3 or 95 75gm OGTT ≥10.6 ≥8.9 or 160 mg/dl Not required IADPSG9   ≥5.1 0r 92 75gm OGTT ≥10.0 0r 180 ≥8.5 or 153 mg/dl Not required DIPSI10 2014 – 75 gm OGTT, non-fasting – ≥7.8 or 140 mg/dl Not required NICE11   ≥5.6 or 100     ≥7.8 or 140 mg/dl Not required Note: 1WHO 1999 Guidelines: World health Organization; 2WHO 2013 Guidelines 3ADA: American Diabetes association; 4ACOG: American College of Obstetrician and Gynecologist; 5ADIPS: Australasian Diabetes in Pregnancy Society; 6EASD: European Association for the Study of Diabetes; 7FIGO: International Federation of Gynaecology and Obstetrics; 8Diabetes Canada clinical Practice Guidelines; 9IADPSG: International Federation of Gynaecology and Obstetrics; 10DIPSI: Diabetes in Pregnancy Study Group in india; 11NICE: National Institute of Clinical Excellence Diabetes in Pregnancy: Global, Regional, and Indian Scenario  The global diabetes epidemic is on the rise. According to IDF Head Professor Andrew Boulton, diabetes has become an epidemic. The global prevalence of diabetes is estimated to rise from 537 million in 2021 to 783 million in 2045, an increase of 46%. [1] Diabetes is common worldwide, and this is a concern; by 2021, there will be 74.1 million diabetics in India.  This increase may be due to the aging of the Population, physical inactivity, urbanization, and obesity. These conditions increase the risk of diabetes mellitus, but early life is a risk factor. As suggested in David Baker’s “Fetal origins of adult disease” hypothesis, pregnancy planning can significantly impact adult health and disease. Pregnancy can be defined as the process in which stress or stimulus during a sensitive or important period of fetal development permanently changes the structure, body, and metabolism and thus creates a predisposition to a disease in the elderly.  Lifestyle changes and medical interventions have been reported to slow or delay the development of Type-2 diabetes mellitus in people affected by impaired glucose tolerance (IGT), the first line of defense. Maintaining normoglycemia in GDM or other vulnerable individuals is the best option to prevent developing type 2 diabetes (T2DM). Diabetes can be reversed or stopped through primary prevention. For primary prevention of diabetes mellitus, women with gestational diabetes (GDM) are considered an ideal group because their children are more likely to have diabetes, and most of them acquired T2DM. Gestational diabetes may be an important factor in diabetes and obesity. By 2021, the Global prevalence of hyperglycemia in pregnancy (HIP) will be 21.1 million people, accounting for 16.7% of births to women aged 20-49. These individuals may experience some form of hyperglycemia during pregnancy; 80.3% of these were due to GDM [2]. Therefore, all women must be tested for GDM, even if they have

Diabetes
Volume 1 Issue 1

A study of the prevalence of Risk factors of Non-Communicable diseases amongst medical students in Rama Medical College, Kanpur

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Research Article Lakshmi Singh,1Anju Gahlot,2Atul Kumar Singh3 1Senior Resident, 2Professor, 3Professor 1,2,3 Department of Community Medicine, RMCHRC, Kanpur, U.P, India. Submitted: 29 June 2024; Accepted: 15 July 2024; Published: 20 July 2024 Corresponding Author: Dr Lakshmi Singh, Sen Resident, Rama Medical College Hospital & Research Centre, Mandhana, Kanpur, India. Email: [email protected] INTRODUCTION •Noncommunicable diseases (NCDs) are slowly progressive. They are of long duration and responsible for more than 50% of the global burden of disease, including heart disease, stroke, cancer, diabetes, and chronic lung disease. • few studies to date have examined the prevalence of tobacco and alcohol use among UGs and PGs. Out of the available studies, tobacco and alcohol use prevalence was 9.0% in UGs and 7.1% in PGs; however, they may be at a higher risk of substance use problems due to higher stress levels. • Few studies on NCDs and their risk factors have been conducted among medical students in Kanpur, so we have planned this study in this area. AIM: To study the prevalence of risk factors for noncommunicable diseases among medical students at Rama Medical College, Kanpur. MATERIAL AND METHODS • Cross-sectional analytical study was conducted on undergraduate medical students at Rama Medical College, Kanpur, from January 2021 to September 2022. • This study used simple random sampling, prepared using the total MBBS student list of four batches from their attendance register. •362 students were randomly selected in MS EXCEL by random number table. •First year to final year  MBBS were included while those who were unwilling excluded. •Data analysis was done by using the software SPSS version 20. The prevalence of NCD risk factors was presented in frequencies and percentages. Most of the variables in this study were categorical, so statistical significance was tested using the Chi-square test and p-value (p-value ≤0.05 is statistically significant, and > 0.05 is not important), and also, the strength of association was tested between risk factors using the independent t-test. CONCLUSION: The prevalence of physical activity in female students was 51.05%, and in male students, it was 48.94%. A large segment of students was nonsmokers (91.16%). Among students who were smoking i.e., 15.15% were smoking more than 3 packets per week. The prevalence of smoking was highest among male students (93.75%), with the most common age group being 21-26 years. Only 3.87% of students agreed to consume alcohol. Out of which 71.43%were taking < 2 pegs /week. The dietary assessment further revealed that 59.12 % were on a mixed diet, 69.34 % had a history of junk food consumption, and 73.48% took snacks between meals. RECOMMENDATION: Outdoor activities should be encouraged, and junk food should be restricted. Government policy: Increase taxes on cigarettes; decrease the advertisement of tobacco and alcohol.Vegetable and fruit intake. Avoid snacks in between meals. Avoid junk food. Avoid smoking and alcohol intake. Blood pressure screening should be done through regular health checkups among medical students. Screening for raised blood sugar should be done at admission and at regular intervals. REFERENCES: 2. Ramakrishna GS, Sankara Sarma P, Thankappan KR. Tobacco use among medical students in Orissa. Natl Med J India. 2005 Nov-Dec;18(6):285-9. PMID: 16483025 3. Seshadri S. Substance abuse among medical students and doctors: A call for action.NatlMedJIndia.2008;21(2):57–59 4. 4. British Medical Association.The Misuse of Alcohol and Other Drugs by Doctors. London: British Medical Association;1998 Not applicable Not applicable Not applicable All the authors declared “No Conflict of Interest” with this publication. Not applicable This open-access article is distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Cite this article: Lakshmi Singh,1Anju Gahlot,2Atul Kumar Singh3. A study of the prevalence of Risk factors of Non-Communicable diseases amongst medical students in Rama Medical College, Kanpur. Diabetes Asia Journal. 2024; 1(1):56-59

Biomedical waste
Volume 1 Issue 1

Knowledge, attitude, and practices regarding biomedical waste management(BMWM) among healthcare workers in Tertiary care facility

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Research Article Dr. Nilanjan Dam1, Dr. Poonam Kushwaha2, Dr. Saket Shekhar3, Dr. S.P. Singh4, Dr. Anju Gahlot5 1. MD Fellow, Department of Community Medicine, RMCHRC, Kanpur, U.P., India; 2 Assistant Prof, Department of Community Medicine, RMCHRC, Kanpur, U.P., India; 4Associate Prof, Department of Community Medicine, RMCHRC, Kanpur, U.P., India; 5 Professor and HOD, Department of Community Medicine, RMCHRC, Kanpur, U.P, India. Submitted: 20 June 2024; Accepted: 28 June 2024; Published: 29 July 5 2024 Corresponding Author: Dr. Nilanjan Dam, MD Fellow, Department of Community Medicine, RMCHRC, Kanpur, U.P., India. Email: [email protected] INTRODUCTION Biomedical waste management is critical to India’s public health and environmental protection. With the rapid growth of the healthcare sector, biomedical waste generation has increased significantly, posing challenges in its proper handling, treatment, and disposal. This comprehensive analysis provides an overview of the current status of biomedical waste management in India, including the regulatory framework, categorization of waste, segregation practices, collection and transportation methods, treatment and disposal technologies, record-keeping requirements, training and awareness programs, monitoring and enforcement mechanisms, and emerging trends. The analysis also explores the challenges healthcare facilities, regulatory authorities, and other stakeholders face in ensuring effective biomedical waste management and proposes strategies to address these challenges. Furthermore, it discusses innovative approaches and future directions to promote sustainable biomedical waste management practices and safeguard public health and the environment. Efforts to combat the Coronavirus disease (COVID-19) pandemic have significantly increased the quantity of bio-medical waste (BMW) generation. Emphasis should be given to awareness and training all HCWs regarding proper BMW management during this pandemic to prevent infection transmission.[1] Bio-medical waste (BMW) management is of utmost importance as its improper management seriously threatens healthcare workers, waste handlers, patients, caregivers, the community, and the environment. Simultaneously, the health care providers should know the quantity of waste generated in their facility and try to reduce the waste generation in day-to-day work because a lesser BMW amount means a lesser burden on waste disposal work and cost savings.[2] Evolution of Biomedical Waste Management Rules in India The management of biomedical waste in India has evolved over the years in response to growing concerns about its impact on public health and the environment. The journey of regulatory development in this area can be summarized as follows: Waste management has become critical, posing potential health risks and environmental damage. It has taken a central place in the national health policy and is attracting considerable international interest. India participated in the United Nations Conference on the Human Environment held in Stockholm in June 1972, where decisions were taken to take appropriate steps to protect and improve the human environment.[4] The safe & sustainable management of BMWs is a legal and social responsibility of everyone involved in providing or utilizing healthcare services (i.e., patients, families, HCWs, hospital administration, and health system). The BMW Rules, 2016 (further amended in 2018 & 2019) is a joint product of research made by agencies such as the Centre for Chronic Disease Control, Health Care Without Harm, and the Centre for Environmental Health under the Public Health Foundation of India. This guideline was introduced to create a stringent and elaborate set of rules and change how BMWs are managed in India. Monitoring the activities in health facilities and their compliance with the standard guidelines is important, as proper compliance with BMW practices ensures the safety of patients and HCWs.[5] Healthcare waste (HCW) includes all the waste medical facilities generate. It comprises waste produced during testing, treatment, or vaccination of humans or animals. The quantity of general (non-hazardous) waste is 70–80% of total waste generated by health care facilities (HCFs).[6] Pathology, microbiology, blood bank, and other diagnostic laboratories generate a sizable amount of biomedical waste (BMW). BMW’s audit is required to plan proper strategies. The audit in our laboratory revealed 8 kgs of anatomical waste, 600 kgs of microbiology waste, 220 kgs waste sharps, 15 kgs of soiled waste, 111 kgs of solid waste, 480 liters of liquid waste along with 33,000 liters per month of liquid waste generated from labware washing and laboratory cleaning and 162 liters of chemical waste per month.[7] Devoted healthcare workers and facilities are also significant. Further, the proper and continuous monitoring of BMW is a vital necessity. Therefore, developing environmentally friendly methods and the right plan and protocols for the disposal of BMW is very important to achieve the goal of a green and clean environment. This review article aims to provide systematic, evidence-based information and an organized, comprehensive study of BMW[8]. BACKGROUND In healthcare facilities, a significant amount of infectious material and biomedical waste (BMW) is produced during patient care, and healthcare professionals regularly handle these materials. Therefore, healthcare professionals must have the necessary knowledge, attitude, and practice regarding managing BMW. AIMS AND OBJECTIVES This study is, therefore, conducted to assess the knowledge, attitude, and practices of BMW management among healthcare workers in our institution.  MATERIAL AND METHOD The Institution, cross-sectional study will be conducted among all health care workers (paramedical staff, nursing staff, lab technicians, attendants, GNM and other trainees) of either sex, any age, involved in various procedures done during diagnostic, therapeutic, and vaccination etc. outpatient departments (OPD), indoor patient departments (IPD) and emergency/ causality of Rama Medical College Hospital and Research Centre, Mandhana, Kanpur, those who will give consent, with total enumerative sampling from August 2023 onwards. Subjects will be recruited after informed consent. Data collection and entry will be done using Google Forms. Collected data will be tabulated, analyzed, and interpreted by Jamovi 2.2.5.0. Continuous data will be presented as frequency, percentage, and Mean and SD. Categorical variables will be presented as frequency & percentages. Appropriate statistical tests will be applied accordingly. 95% confidence intervals (CI) and p-value (<0.05) will be considered significant. Confidentiality of the given information will be maintained. Ethical approval will be obtained from the Institutional Ethical and Research Advisory Committee, Rama Medical College Hospital and Research Centre, Mandhana, Kanpur. RESULTS Profile of study subjects- In the study, females 159 (78.3%) outnumbered males 44 (21.7%). The mean age of

Physical Activity
Volume 1 Issue 1

Level of Physical Activity and Relationship with Alcohol Use Among Youth: A Cross-sectional Study

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Research Article Manmohan Yadav,1 Vadlamudi Siddarth,2 Vishal Chauhan,3 Anju Gahlot4 1,2,3MBBS Student, Rama Medical College Hospital and Research Centre, 4Prof Department of Community Medicine, RMCHRC, Kanpur. Submitted: 18 June 2024; Accepted: 28 June 2024; Published: 29 June 2024 Corresponding Author: Vishal Chauhan, MBBS Student, Rama Medical College Hospital & Research Centre, Kanpur. Email: [email protected] ABSTRACT Background: Alcohol use and physical inactivity are major risk factors for noncommunicable diseases. Adequate physical activity keeps one healthy, but a sedentary lifestyle may contribute to other unhealthy practices like Alcohol use. They address them more strategically. Objectives: To assess the level of physical activity and identify its association with Alcohol use among college-going youth at Rama University, Kanpur. Material & Methods: Data on physical activity and Alcohol use were collected from students aged 18-24 studying medical and non-medical courses at Rama University through an online questionnaire. We used a self-modified questionnaire based on the Global Adult Alcohol Survey (GATS) to assess Alcohol use status and the GPAQ (Global Physical Activity Questionnaire) to assess physical activity. Results: The chance of consuming Alcohol is significantly lower among physically active respondents. Conclusions: Our findings indicate a significant relationship between physical activity and Alcohol use among youth. Promotion of physical activity may be a useful educational tool for reducing Alcohol use. Introduction Alcohol use is an important modifiable risk factor for major non-communicable diseases NCDs [1]. Globally, more than 1.1 billion people use Alcohol, which is significantly more common among males than females. This alarming number represents about one-third of the global population aged 15 years and above [2]. The problem is of particular concern in India, where tobacco-related mortality is highest. According to the Global Adult Alcohol Survey 2016-17, current Alcohol users in India among youth aged 15-24 years is 12.4% [3.4]. People who start using Alcohol at an early age are more likely to develop serious health complications [5]. According to the ICMR-INDIAB study, 54.4% of the Indian population surveyed were found to be physically inactive [6]. Recently, India’s performance was fairly poor in the concurrent preparation of Report Cards on the physical activity of children and youth in 38 world countries [7]. Growing evidence reveals a bidirectional relationship between Alcohol use and physical activity. Another systematic review shows that exercise seems to have a protective effect against smoking as well as a supportive impact on smoking cessation treatments[8]. Aims and Objective This study assesses the relationship between tobacco use and physical activity among college-going youth at Rama University, Kanpur. MATERIAL&METHODS Study Type: Cross-sectional study. Study Population: A college-based survey was conducted among the youth population. StudyArea: RamaUniversity, Kanpur. PeriodofStudy:01October,2023 to 28 October, 2023[4Weeks] SampleSize: 200 Sampling Method: Simple Random Method inclusion criteria: exclusion criteria: Strategy for collection: All students were divided into two strata – Medical & Non-Medical. The field investigator (FI)visited the students and explained the needs, objectives, and methodology for the study. Then a google form was shared among the students. The respondents were briefed up about the study objectives and were encouraged to clarify doubts before or during filling up the questionnaire. No names or emails were collected to maintain the anonymity of the respondents. We used a self-modified questionnaire based on the Global Adult Alcohol Survey (GATS) for assessing Alcohol use status and GPAQ (Global Physical Activity Questionnaire) for assessment of physical activity. RESULTS The study included 200 students aged 18-24 from medical and non-medical courses. The majority were males (72.5%). Current alcohol users were 13%, and least physical activity was observed in 27.5%. [Table1] The socio-demographic profile along with Alcohol use and level of physical activity of respondents is shown in [Table-1] The relationship between physical activity and Alcohol use among youth [Table] shows that non-alcohol users were physically more active (moderately active, 58.6% +veryactive,15.5%=74.1%) compared to Alcohol users (moderately active, 34.6% + very active, 26.9% = 61.5%). The inactivity level was higher among Alcohol users (38.4%) as compared to non-alcohol users (25.8%). The relationship between Gender and Alcohol use [Table 4] shows that there were more Alcohol users in males (69.4%) as compared to females (30.6%). Gender: Do You Want to Quit alcohol to enhance your physical activities? How much time has passed since you started consuming alcohol?     Have you noticed a reduction in your physique or stamina due to consuming alcohol? TABLE 1: SOCIO-DEMOGRAPHICPROFILEOFCOLLEGEGOINGYOUTHOFRAMAUNIVERSITY, KANPUR   Variable   Number(N=200)   %   Male 112 56.5% Gender     Female   88 43.5%   18-20   104   52.5%   Age Group(years)   21-22   54   27.%   23-24   42   21.5%   Non-Alcoholusers   170   85% Alcohol Use(Present)     Alcoholusers   30 15%   Alcohol Use(Past)   Non-Alcohol users   166   83% [Last consumption of             Alcohol>1year back] Alcohol users 34 17%   Not so Active   55   27.5%   Physical Activity Level   Moderately Active   109   54.5%     Very Active   36   18% TABLE 2: RELATIONSHIPOFPHYSICALACTIVITYANDALCOHOLUSEAMONGYOUTH   Physical ActivityLevel Non-Alcohol users(N=170) Alcohol users(N=30)   Numbers                                  %   Numbers   % NotsoActive 44                                   22% 12 6% Moderately Active   100                                  50%   10   5% VeryActive 26                                   13% 8 4% TABLE 3: RELATIONSHIP OF GENDER AND PHYSICAL ACTIVITY         Gender PhysicalActivityLevel Not so Active (N=55) Moderately Active (N=109)   Very Active(N=36) Numbers                  % Numbers % Numbers % Male 44                   80% 76 69.7% 25 69.4% Female 11                   20% 33 30.3% 11 30.6%   TABLE 4: RELATIONSHIPOFGENDERANDALCOHOLUSE       Gender         Male     Female   Non-Alcohol users (N=174)   Alcohol users(N=26)                                            Numbers                                 % Numbers %   98                                57.6%   22   83.4%   72                                 42.4%   8   26.6% DISCUSSION The present study was an attempt to assess the level of physical activity and its relationship with Alcohol use. We found that almost one-fourth of the participants were physically inactive, and almost one-fourth of the participants were exposed to tobacco. Both these variables showed significant inverse associations in the study. Another finding observed in

Teheran heart center
Volume 1 Issue 1

Comparative Analysis of Sternal Closure Methods Following CABG Surgery: A Study from the Tehran Heart Center

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Research Article Siyamak Jalal Hosseini1*, Soheil Mansourian2, Mohammadreza Shoghli3, Hermon Eyob Fesseha4 , Rajesh Jain5 Submitted: 14 June 2024;Accepted: 10 July 2024; Published: 27 June 2024 1. Assistant Professor, Tehran University of Medical Sciences, Tehran, Iran; 2. Professor Tehran University of Medical Sciences, Tehran, Iran; 3. Doctoral Researchers, Department of Population Health, University of Helsinki, Helsinki, Finland; 4. Hermon Eyob Fesseha: MD, cardiology resident, Peijas Hospital District of Helsinki and Uusimaa (HUS), University of Eastern Finland, University of Helsinki, Helsinki, Finland; 5. Consultant Diabetes, Jain hospital & research Centre, Kanpur, India. Corresponding Author:1* Assistant Professor, Tehran University of Medical Sciences, Tehran, Iran. email [email protected] Abstract: This study examined 204 patients undergoing CABG surgery at Tehran Heart Center between Ordibehesht 1402 and Ordibehesht 1403 for postoperative complications. Objective: Investigation and Comparison of Complications in Single-Wire and Double-Wire Sternal Closure Methods Following Open Heart Surgery in Patients Referred to Tehran Heart Center from May 2023 to May 2024 Methods: Patients were divided into two groups of 102 each, with Group 1 undergoing sternal closure using a single-wire method and Group 2 using a double-wire method. Results: All patients were discharged after surgery and followed up for one year. The age range was 44 to 75, with 21 patients aged 45-55 (10%), 133 patients aged 55-65 (65%), and 50 patients aged 65-75 (24%). Both groups had similar age distributions. Of the total patients, 78 were female (38.2%) and 126 were male (61.8%), indicating a higher prevalence of cardiovascular disease in males. In Group 1, 37% were women and 63% were men; in Group 2, 39% were women and 61% were men. We compared four parameters between the two groups: infection, pain, stability, and tissue reaction. In Group 1, 8 patients (7%) developed superficial skin infections, with a readmission rate of 1%. In Group 2, 6 patients (5%) developed superficial infections, with one readmission. Statistical analysis showed no significant difference in infection rates between the two methods. Regarding pain after surgery, 17 patients in Group 1 (10%) reported postoperative pain, which decreased to 2% after three months and disappeared completely after one year. In Group 2, 24 patients experienced pain, which also resolved within a year. However, statistical analysis revealed a significant difference in pain rates between the two groups, indicating more pain in patients with double-wire closure. Conclusion: The two groups had no significant differences in stability and tissue reaction. Our study suggests that the single-wire closure method may lead to less postoperative pain in stable patients without risk factors, contributing to earlier recovery and improved quality of life. Methodology and Procedure: We conducted a comparative study on sternal closure methods following CABG surgery among patients treated at the Tehran Heart Center between 2022 and 2024. We divided all patients into two groups, each consisting of 102 individuals. Gender distribution and age demographics were carefully balanced between the groups to prevent selection bias. Patients with poorly controlled metabolic diseases were excluded from the study. Group 1 underwent sternal closure using a single-wire method, while Group 2 underwent closure with double wires. After performing surgeries on all 204 patients, they were discharged from the hospital and followed up for one-year post-surgery. The age range of the patients was from 44 to 75, with 21 patients aged 45-55 (10%), 133 patients aged 55-65 (65%), and 50 patients aged 65-75 (24%). Both groups had similar age distributions. Of the total, 78 patients were women, and 126 were men, consistent with the documented higher prevalence of cardiovascular disease in men. Group 1 comprised 37% women and 63% men, while Group 2 had 39% women and 61% men. We analyzed four parameters across both groups: infection, pain, stability, and tissue reaction. In Group 1, 8 patients (7%) developed infections from sternotomy, with one patient requiring readmission. Similarly, in Group 2, 6 patients developed infections, with one readmission. Statistical analysis using SPSS showed no significant difference in infection rates between the two closure methods. Both groups showed similar stability and tissue reaction outcomes, with no dehiscence or adverse tissue reactions observed. A sternal dehiscence is a catastrophic event in cardiac surgery. Both sternal closure methods yielded comparable outcomes in stable patients without risk factors. However, the double-wire method required a longer operation than the single-wire method. In the assessment of post-CABG pain, remarkable findings emerged. In Group 1, 44 patients experienced pain, with 32 having mild pain, 10 moderate pain, and 2 severe pain. In contrast, Group 2 had 55 patients reporting pain, with 40 experiencing mild pain, 11 moderate pain, and 4 severe pain. After three months, only one patient in Group 1 continued to experience pain, which resolved by the sixth month. Conversely, all patients in Group 2 were pain-free after six months. Statistical analysis revealed that 43% of patients in Group 1 experienced pain compared to 53% in Group 2. Based on these findings, we concluded that avoiding double-wire sternal closure in stable patients (those without poorly controlled metabolic conditions, risk factors, sepsis, or osteopenia) could enhance the quality of life and rehabilitation outcomes following CABG surgery. Introduction Currently, most heart surgeries are performed via midline sternotomy. This type of incision was first proposed in 1857 and gained popularity in 1957. Generally, sternotomy complications are rare; however, they are usually serious when they occur. The most common complications include infection and mediastinitis [1]. Sternotomy is a surgical procedure in which surgeons make a vertical incision along the midline of the chest. This approach replaced the previous bilateral thoracotomy method. Sternotomy became popular mainly because it is less painful than previous models, and it quickly became apparent that it could lead to problems such as infection or wound dehiscence [1].  Sternotomy is a surgical procedure in which the surgeon creates an internal vertical incision along the midline of the chest. This allows access to the entire chest area, including the heart and lungs [2]. This approach has several advantages, including less pain, better access to pleural cavities, and greater protection of chest muscles [7]. Overall, sternotomy is a relatively

Volume 1 Issue 1

Herbal Cellular Concentrate for Type 2 Diabetes

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Taherah Mohammadabadi1*, Rajesh Jain2, Prashant Dehire3 and S.A. Anatolievitch4 1 Agricultural Sciences and Natural Resources University, Iran.  2 Jain Hospital & Research Centre Pvt Ltd, Medicine, Kanpur, India. 3SRTR Medical College, Community Medicine, Ambajogai, India 3 NPO Evolyutsiya, Research Department, Novosibirsk, Russia. Submitted: 19 May 2024; Accepted: 25 June 2024; Published: 29 June 2024 Corresponding Author: Department of Agriculture and Animal Sciences, Agricultural Sciences and Natural Resources University, Iran. Email: *[email protected] Abstract Diabetes is a group of metabolic disorders associated with chronic hyperglycemia in the blood due to defects in insulin secretion, insulin function, or both. Although the proper treatment of diabetes includes insulin injection continuously to maintain blood glucose levels, nowadays, there is an increasing interest in the use of alternative approaches for treating insulin resistance, and T2D Chicory significantly reduces blood sugar and glucose fluctuations, increases metabolism due to inulin in type 2 diabetes patients with excess weight. Equisetum arvense is one of the most effective plants for blood sugar, stabilizing metabolism, and hormone production. Tuberous roots are rich in inulin, enabling glucose utilization in the human body, and can potentially ameliorate insulin sensitivity in diabetic patients. Blueberry leaves improve insulin sensitivity and action. Galega officinalis lowers blood sugar levels for prediabetes and type-2 diabetes patients. Due to the side effects and temporary use of chemical drugs, herbal and natural medicines and chemical drugs are recommended for people with diabetes. However, more scientific studies are needed to confirm the effectiveness of herbal supplements in diabetes cases. Keywords: Type 2 diabetes, Herbal Cellular Concentrate, health Introduction Scientists studied the traditional herbalists’ recipes and unfolded their full potential by improving the formulas and preparing the herbs in a new way. Diabetes mellitus is the most widespread metabolic disease in the world. It is a group of metabolic disorders associated with glucose consumption failures and chronic hyperglycemia. Therefore, the development of either absolute or relative insulin insufficiency in the blood occurs due to a defect in the insulin secretion or insulin function, which leads to hyperglycemia development. Type 1 diabetes is an autoimmune disease that destroys pancreatic beta cells in producing insulin. Type 2 diabetes causes an increase in blood glucose due to decreased insulin secretion and function (Pallag et al., 2016). Diabetes is characterized by persistent hyperglycemia, insulin resistance, and complications such as neuropathy, arteriopathy, kidney dysfunctions, cardiomyopathy, cardiovascular diseases, and kidney and liver failures. Although the proper treatment of diabetes includes continuous insulin injections to maintain blood glucose levels, nowadays, researchers are following some natural herbs for diabetes (Pallag et al., 2016). This study aimed to use the herbal Concentrate as many people around the globe as possible and make their lives healthier. How is herbal cellular concentrate effective on diabetes? Diabetes is a group of metabolic disorders associated with chronic hyperglycemia in the blood due to defects in insulin secretion, insulin function, or both. Although proper diabetes treatment includes insulin injection continuously to maintain blood glucose levels, there is an increasing interest in using alternative approaches for treating insulin resistance and T2D. Chicory significantly reduces blood sugar and glucose fluctuations and increases metabolism due to inulin in type 2 diabetes patients with excess weight. Equisetum arvense is one of the most effective plants for blood sugar, stabilizing metabolism, and hormone production. Tuberous roots are rich in inulin, enabling glucose utilization in the human body, and can potentially ameliorate insulin sensitivity in diabetic patients. Blueberry leaves improve insulin sensitivity and action. Galega officinalis lowers blood sugar levels for prediabetes and type-2 diabetes patients. Due to the side effects and temporary use of chemical drugs, herbal and natural medicines and chemical drugs are recommended for people with diabetes. However, more scientific studies are needed to confirm the effectiveness of herbal and natural supplements in treating diabetes. Herbal concentrate of 11 herbs results in our research on 150 Patients in a pilot study showed a significant reduction in mild to moderate type 2 diabetes to prediabetes condition, and prediabetes seems to reverse in this study by Jain et al. Chicory and diabetes Chicory (Cichorium intybus L) is a main crop in northwestern Europe, and the chicory roots are rich in fiber inulin (Roberfroid, 2007). A bitter drink made from chicory roots is a substitute for coffee in France and Japan, where people of all ages can drink chicory root extract due to its noncaffeine components. Chicory inulin leads to decreasing energy calorie intake and is a powerful substitute for dietary fat (Nishimura et al., 2015). Inulin is a fructo-oligosaccharide, a fructose polymer with b (2/1) glycosidic linkages. Inulin in chicory significantly reduces blood sugar and glucose fluctuations (Nishimura et al., 2015).  Thus, chicory has an inulin content of 150 g kg-1 on a fresh weight basis and 750 g kg-1 on a dry weight basis (Letexier et al., 2003). Chicory increases metabolism and weight loss; therefore, it is highly recommended for type 2 diabetes patients with excess weight. Chicory provides high vitamins B and C and boosts energy levels. The presence of high vitamins and microelements enhances immune responses. The infusion and brew of Chicory increase appetite and regulate digestive activity (Nishimura et al., 2015). In one clinical trial on type 2 diabetic women, using 10 g/d inulin for 2 months improved the concentration of fasting blood glucose, insulin, and hemoglobin A1c (HbA1c) and reduced malondialdehyde levels compared with using maltodextrin (Pourghassem Gargari et al., 2013). Also, consuming 12 g/d inulin for 2 weeks was tolerated by adults. It caused a significant improvement in bowel movements and substantially increased Bifidobacterium and Lactobacillus in cases with average fecal Bifidobacterium (García-Peris et al., 2012). In another trial, cases who used the chicory root extract for 4 weeks showed a significant decrease in the changes of HbA1c compared with the control. No significant differences in the fasting blood glucose or insulin and total cholesterol, low-density lipoprotein-cholesterol (LDL), High-density lipoprotein-cholesterol (HDL), triglyceride, or serum adiponectin were observed before and after consumption of chicory root extract. Inulin fructans can modulate lipid metabolism in human cases and animal

Volume 1 Issue 1

Assessment of Noise-Induced Hearing Loss in Under Graduate Medical Students

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Research Article Anju Gahlot1, Lakshmi Singh,2 Rajesh Jain3 1Dr.Anju Gahlot, Professor, Department of Community Medicine, RMCHRC, Kanpur 2Dr.Lakshmi Singh, Senior Resident, Department of Community Medicine, RMCHRC, Kanpur 3Dr.Rajesh Jain, Professor, Department of Community Medicine, RMCH, RC, Kanpur Submitted: 17 May 2024; Accepted: 15 June Dec 2024; Published: 28 June 2024 Corresponding author: Dr Lakshmi Singh, Department of Community Medicine, RMCHRC, Mandhana, Kanpur, India Email address: [email protected] ABSTRACT: Assessing hearing loss in undergraduates is crucial to ensuring their academic success and overall well-being. Early detection and intervention can significantly improve educational outcomes and quality of life. Aims and objectives: To assess noise-induced hearing loss in undergraduate medical students And create awareness about the harms of earphones and stereo usage. Methodology: the data was collected using a pre-designed, pretested, semi-structured questionnaire, which included the frequency of earphone usage per day, duration of listening earphones, playing stereo at high volumes, and duration of stereo usage by simple random sampling. Key Words: Noise Induced Hearing Loss, NIHL, Students, Diabetes 2 Type INTRODUCTION: The World Health Organization estimates that around 360 million individuals have moderate to profound hearing loss for various reasons[1]. Occupational or firearm-related exposure, as well as recreational activities, have been traditionally linked to rates of hearing loss[2-3]. In 2015, the World Health Organization also highlighted that approximately 1.1 billion young people are at risk of hearing loss due to unsafe listening behaviors, especially related to recreational activities such as using personal audio devices with high-volume music for extended periods and exposure to loud environments like bars, entertainment venues, and sporting events[3]. The International Organization for Standardization (ISO) has played a significant role in hearing health by developing standards for estimating hearing thresholds and noise-induced hearing impairment[4]. These standards are based on data from various countries’ noise and hearing study databases. The emphasis on standardization and scientific rigor aims to strengthen the reliability of the data and the robustness of research in this field. In the United States, hearing is one of the health outcomes measured by the National Health and Nutrition Examination Survey (NHANES), a program conducted by the National Centre for Health Statistics to assess individuals’ health and nutritional status. Researchers use audiometric notches in a hearing test, which are dips in the ability to hear certain frequencies, as indicators of possible noise-induced hearing loss. According to 2011 data, about 24% of adults aged 20–69 in the United States exhibit an audiometric notch, with variations based on age, gender, race/ethnicity, and occupational noise exposure[5]. For example, a study of 6,557 automotive manufacturing workers in China reported that in 62% of the evaluated settings, noise levels exceeded the recommended level of 85 dBA. The prevalence of hearing loss varied across different job categories and was associated with both noise levels and cumulative noise exposure[6]. Occupational noise exposure is the primary risk factor for work-related hearing loss, highlighting the need for policy changes. A study analyzed hearing test results from 2000 to 2008 for workers aged 18–65 with higher occupational noise exposure than the average worker[7]. The study revealed concerning statistics: 18% of the surveyed workers had hearing loss, with the mining industry showing the highest prevalence and risk at around 27%. Other sectors with higher prevalence and risk included construction (23.48%), manufacturing (especially wood products and non-metallic mineral products at 19.89%), apparel (20.18%), and machinery (21.51%). Estimates for rates of hearing loss were reported for people in the agriculture, forestry, fishing, and hunting[8](AFFH) sector. The overall prevalence of hearing loss was 15%, but some subsectors of those industries exceeded that rate. The highest prevalence was found among forest nurseries and gathering of forest products workers at 36% and timber tract operations at 22%. The aquaculture sub-sector had the highest adjusted risk (adjusted probability ratio of 1.7) among all sub-sectors of the AFFH industries[9]. The same methodology was used to determine the prevalence of hearing loss among noise-exposed U.S. workers within the healthcare and social assistance sector. The prevalence of hearing loss in the medical laboratory’s subsector was 31%, and in the offices of all other miscellaneous health practitioner’s subsector was 24%. The child day-care services subsector had a 52% higher risk than the reference industry. While the overall sector prevalence for hearing loss was 19%, the prevalence in the medical laboratories and the offices of all other health practitioners’ sectors was 31% and 24%, respectively. The child day-care services subsector had a 52% higher risk than the reference industry of workers not exposed to noise at work (couriers and messengers). Audiometric records show that about 33% of working-age adults with occupational noise exposure have evidence of noise-induced hearing damage, and 16% of noise-exposed workers have material hearing impairment[10] The percentage of hearing loss in people with diabetes ranges from 5.3% to 28.1%, while in people without diabetes it ranges from 3.4% to 24.1%. The risk associated with hearing loss in people with diabetes ranges from 22.8% to 35.1%, compared to 17.2% to 20.1% in those without diabetes. This is quite eye-opening. The correlation between type 2 diabetes and hearing impairment was found to be independent of risk factors for hearing impairment, such as noise exposure, earwax build-up, ototoxic medication, smoking, and tobacco use[11]. Aim and Objectives:1. To assess noise-induced hearing loss in undergraduate medical students 2. To create awareness about the harms of earphones and stereo usage. Material and Methods: Study type: cross-sectional study Study population: undergraduate students of Rama Medical College, Kanpur Study area: Rama Medical College, Kanpur Study duration: March 2024 to May 2024 Inclusion criteria: students who gave consent Exclusion criteria: students who were not willing Sampling technique: simple random sampling. Sample Size: according to a previous study by Natarajan et al. in 2017, the proportion of noise-induced hearing loss varies from 16% to 21% across various geographic regions. (2)Applying a formula for one proportion, i.e., N= 4PQ/D2 P=21% Q=100 -P=100-21=79% D= 5% as Absolute precision N=4X21X79/52=265, adding 10% non-response, was 291, but we could select 300 students. Data collection: from available Four batches of undergraduate students, two

Volume 1 Issue 1

Early Gestational Glucose Intolerance (EGGI) Diagnosis and Prevention of Diabetes

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Veeraswamy Seshiah1, Anjalakshi C2, Bhavatharini N3, Geetha Lakshmi A4, Shanmugam A5, Pikee Saxena6, Dr Rajesh Jain7 1Distinguished Professor, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu; 2Department of Obstetrics Gynaecology, Madha Medical College and Research Institute, Chennai; 3SRC Diabetes Centre, Erode, Tamilnadu; 4Department of Obstetrics and Gynaecology, RSRM hospital, Stanley Medical College, Chennai; 5Dr Ambedkar Institute of Diabetes, Govt Kilpauk Medical College & Hospital, Chennai-10; 6 Department of Obstetrics and Gynaecology, Lady hardinge Medical college, New Delhi, 7Jain Hospital & Research Centre, Kanpur, India Submitted: 14 May 2024; Accepted: 05 June Dec 2024; Published: 27 June 2024 Correspondence Author: Dr V Seshiah, Email: [email protected] Key Words: Early Gestational Glucose Intolerance (EGGI), Early Gestational Diabetes Mellitus (eGDM), Diabetes in Pregnancy Study Group India (DIPSI), Metformin, Medical Nutrition Therapy (MNT). National institute of health (NIH). The NIH recommends screening at the 10th week of pregnancy because the fetal beta cell begins insulin secretion at the 11th week of gestation. Abnormal prandial glycaemic levels may stimulate beta cell secretion. According to the pattern of glycemia in normal pregnancy, if the postprandial blood sugar (PPBS) in the 10th week is greater than 110 mg/dl, it predicts gestational diabetes mellitus (GDM)[1]. Therefore, it is important to bring blood glucose levels to less than 110 mg/dl, as fetal beta cells start secreting insulin around 10-11 weeks, which leads to changes in maternal metabolism[2]. Given this background, there is a need to lower the cut-off to detect glucose intolerance, especially in the early weeks of pregnancy. With this in mind, a practical sub-categorization of glucose intolerance in pregnancy has been proposed (Table 1)[3]. The DIPSI Diabetes in Pregnancy Study Group in India, a pioneer in developing the DIPSI Test, has suggested conducting universal screening earlier in pregnancy, around the 8th to 10th weeks, to predict the risk of gestational diabetes (GD). This early prediction allows for the introduction of metformin and specialized medical nutritional treatment for women with glycemic abnormalities in the latter part of the first trimester[3]. Credit: V Seshiah Why are Indians more prone to Type 2 Diabetes mellitus (T2DM)? The typical South Asian Phenotype has the following features, which makes them more prone to Type 2 Diabetes mellitus. Guidelines currently recommend standard screening for gestational diabetes mellitus (GDM) at 24–28 weeks of pregnancy, with early screening offered to those deemed high-risk. The International Federation of Gynaecology and Obstetrics (FIGO) strongly recommends that all pregnant women undergo early screening for hyperglycemia during pregnancy using a Single Test procedure[5]. The Diabetes in Pregnancy Study Group of India (DIPSI) recommends universal screening for all pregnant women during the first trimester using a simple, cost-effective, and feasible Single Test procedure involving a 75-gm glucose challenge to diagnose GDM[6]. DIPSI’s guideline captures pregnant women with high insulin resistance as reflected in the Postprandial Blood Glucose ≥140 mg/dl. The IADPSG Guidelines recommend that GDM be diagnosed if any one value is abnormal in OGTT, but the diagnosis can only be made if OR=1.5 is implemented rather than 1.75 [7]. A study from Italy that used both DIPSI and IADPSG criteria in the same pregnant women found that both guidelines had almost the same prevalence but missed cases of GDM due to different criteria [8]. In a multi-centric study including India with a high incidence of hyperglycemia during pregnancy, the Towards a Better Outcomes in Gestational Diabetes Mellitus (TOBOGM) study emphasizes the critical importance of early screening at the beginning of pregnancy, followed by tailored interventions for identified GDM cases. The study found a 24.9% adverse neonatal outcome rate in the immediate treatment group and a 30.5% rate in the control group, although after adjustment, the risk difference was non-significant[9]. In Nigeria, Africa, a cross-sectional comparison of universal and selective risk factor-based screening for GDM found that selective risk factor-based screening missed 31.11% of patients with GDM compared to universal screening using a 75g oral glucose tolerance test OGTT[10]. There’s an interest in investigating if a similar scenario exists for GDM when screening is limited to high-risk patients[11]. The study by Seshiah and colleagues at Chennai Madras Medical College showed a significant reduction in adverse neonatal outcomes when using MNT (medical nutritional therapy) and metformin[12]. The intervention group, consisting of 69 pregnant women with blood glucose levels of ≥110 mg/dl, had an adverse neonatal outcome rate of 30.4%. In contrast, the non-intervention group, comprised of 82 pregnant women with blood glucose levels of ≤110 mg/dl (control group), had a lower rate of 12.2%. The difference was statistically significant, with a p-value of .006. Adverse neonatal outcomes included preterm delivery before 37 weeks, LGA (large for gestational age) newborns weighing more than 3.45 kg, newborns requiring phototherapy or experiencing neonatal respiratory distress, stillbirth, or neonatal death. Please note that these findings are currently being published. Picture 1: Primordial Prevention of Diabetes There is a pressing need to differentiate Early Gestational Glucose Intolerance (EGGI) from eGDM diagnosis (<24 weeks or average gestational age of 15.6 ± 2.5 weeks in the TOBOGM study). In contrast, the usual practice is to diagnose after 24 weeks. This differentiation is crucial and should be a priority in maternal and fetal health care. In summary, the evidence and experiences we have presented strongly advocate for the implementation of universal Early Gestational Glucose Intolerance (EGGI) By 10thWeek of gestation with ≥110 mg/dl value, timely identification and intervention with MNT & Metformin can significantly improve pregnancy outcomes. References 1. Hinkle SN, Tsai MY, Rawal S, Albert PS, Zhang C. HbA1c measured in the first trimester of pregnancy and the association with gestational diabetes. Sci Rep. 2018; 8:12249. https://doi.org/10.1038/s41598-018-30833-8. 2. Hernandez TL, Friedman JE, Van Pelt RE, Barbour LA. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Diabetes Care. 2011 Jul;34(7):1660–8 3. Seshiah V, Bronson SC, Balaji V, Jain R, Anjalakshi C. Prediction and prevention of gestational diabetes mellitus and its sequelae by administering metformin in the early weeks of pregnancy. Cureus. 2022; 14(11):e31532. 4. Kapoor N. Thin Fat Obesity: The Tropical Phenotype of Obesity. [Updated 2021 Mar 14]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com,

Volume 1 Issue 1

Early Gestational Diabetes Mellitus Screening and Treatment

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Submitted: 14 June 2024; Accepted: 25 June Dec 2024; Published: 27 June 2024 Editorial Rajesh Jain1 Corresponding Author, 1Rajesh Jain MD, PG Diploma Diabetes (UK), Consultant Jain Hospital & Research Centre, 108 B Gandhi gram, Kanpur-208007, India. Email:[email protected] Universal DIPSI Guidelines and Early Gestational Diabetes Screening: The Following Points need our attention to prevent Diabetes from in-utero to adults Reference: This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0.,which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited How do you cite this article,  Rajesh Jain. Early Gestational Diabetes Mellitus Screening and Treatment Diabetes Asia Journal.2024;1(1):1-2. https://doi.org/10.62996/daj.01072024

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