Indira Gandhi Medical College (IGMC), formerly the Himachal Pradesh Medical College (HPMC), formerly known as Snowdown, located in Snowdown area of Lakkar Bazaar, is a state-owned medical college and hospital in Shimla in the state of Himachal Pradesh in India. It was established in 1966 as the Himachal Pradesh Medical College (HPMC), and assumed the present name in 1984.
One reliable sociodemographic predictor of sleep is marital status. Being lonely, separated, residing away from a spouse may have distinct consequences, particularly for middle-aged and older persons. The objective is to determine the association between sleep disorders and current marital status among Indian population aged 45 years and above, stratified into gender and age group. Longitudinal ageing study in India (LASI) is an ongoing cohort study to collect information on health aspects of ageing in India. Current study is conducted using 1st wave of LASI data set (April 2017 to December 2018). Sleep disorders including sleep disturbance was assessed using the Jenkin Sleep Scale (JSS-4). It covers four sleep related questions in last one month and participants were classified as presence or absence of sleep disorder. We have assessed the association of sleep disorder (outcome/ response variable) with current marital status (explanatory/ exposure variable) adjusted with covariate using multivariable logistic regression. P value < 0.05 was considered statistically significant. STATA version 17 was used for analysis. Sleep disorder was highest among participants in live-in relationship (15.88
Abstract Background Diabetic Peripheral Neuropathy (DPN) is a common and debilitating complication of diabetes, leading to significant morbidity. Conventional diagnostic methods such as nerve conduction studies (NCS) and clinical scores are often limited by invasiveness and inability to detect early neuropathic changes. Shear Wave Elastography (SWE), a novel ultrasonographic technique that quantifies tissue stiffness, offers potential for earlier and more accurate diagnosis. Aim To evaluate the role of Shear Wave Elastography in diagnosing Diabetic Peripheral Neuropathy and compare its diagnostic efficacy with conventional methods including NCS and ultrasonographic cross-sectional area (CSA) and echogenicity measurements. Materials and methods This prospective case–control study was conducted at Indira Gandhi Medical College, Shimla (January 2024–May 2025) and included 69 participants divided equally into three groups: (I) diabetics with DPN, (II) diabetics without DPN, and (III) healthy controls. All participants underwent Modified Toronto Clinical Neuropathy Scoring (mTCNS), laboratory evaluation, NCS, ultrasonography, and SWE of the tibial nerve 5 cm above the medial malleolus. Statistical analysis was performed using SPSS v28.0, with p < 0.05 considered significant. Results SWE values were significantly higher in patients with DPN (Right = 84.04 ± 37.37 kPa; Left = 93.17 ± 41.46 kPa) compared to diabetics without DPN and controls (p < 0.001). Echogenicity was markedly reduced in DPN (Right = 28.7 pixels) versus controls (66.5 pixels). ROC analysis yielded SWE cutoff values of 53.5 kPa (right) and 54 kPa (left), with sensitivity = 82.6% and specificity = 86.9% (AUC = 0.918 and 0.833 respectively). CSA differences were not statistically significant. Conclusion Shear Wave Elastography demonstrates high sensitivity and specificity in detecting DPN, offering a non-invasive, rapid, and reliable alternative to conventional methods. Incorporating SWE into clinical practice may facilitate earlier diagnosis and better management of diabetic neuropathy.
INTRODUCTION:Strict and life-long gluten-free diet (GFD) is the standard of care for patients with celiac disease (CeD). Maintenance of adherence to GFD is the key to the success of GFD; however, a proportion of patients are unable to maintain strict adherence to GFD. METHODS:We performed a systematic review and meta-analysis to estimate the pooled prevalence of adherence of GFD, as assessed by celiac dietary adherence test, BIAGI score, standardized dietitian evaluation or self-reported adherence to GFD, in patients with CeD after at least 1 year of initiating GFD. Electronic reference databases were searched from January 1, 1990 to April 30, 2025. Overall, 69 studies including 27,641 subjects were found eligible for pooling estimates by objective assessment methods. The pooled effect size (95% confidence interval [CI]) was calculated using a random effect model. RESULTS:Most of the studies had low risk of bias and there was no publication bias. The pooled prevalence of adherence to GFD as assessed by objective methods of assessment and self-reported adherence were 64% (95% CI 59%-69%) and 74% (95% CI 69%-79%), respectively. Specifically adherence rates were 65% (95% CI 57%-73%) with standardized dietitian evaluation, 57% (95% CI 50%-64%) with celiac dietary adherence test and 75% (95% CI 65%-83%) with BIAGI score. Highest adherence rates were reported from European and North American countries. There was no significant difference in the adherence rates with time or age of the participants. On univariate metaregression, method of assessment of adherence affected the rate of adherence to GFD. DISCUSSION:One in 3 patients with CeD is unable to maintain a good adherence to GFD. There is need to develop strategies to improve the adherence to GFD.
Importance:The optimal dual antiplatelet therapy after percutaneous coronary intervention (PCI) in patients with diabetes is not clearly defined. Although both ticagrelor and prasugrel are potent inhibitors of P2Y purinergic receptor 12 (P2Y12), evidence directly comparing their efficacy and safety in this high-risk group remains limited. Objective:To compare the clinical outcomes of ticagrelor vs prasugrel, each in combination with aspirin, in patients with diabetes and multivessel coronary artery disease who underwent percutaneous coronary intervention. Design, Setting, and Participants:The Ultrathin Strut vs Xience in a Diabetic Population With Multivessel Disease 2-India Study (TUXEDO-2) is an investigator-initiated, prospective, open-label, multicenter, 2 × 2 factorial design, 1:1 randomized clinical trial. Participants with diabetes and multivessel disease undergoing percutaneous coronary intervention were enrolled at 66 clinical sites from February 2020 to August 2024. Interventions:Patients undergoing percutaneous coronary intervention were randomized to receive either ticagrelor or prasugrel, each in combination with low-dose aspirin. Main Outcomes and Measures:The primary outcome was a composite of death, nonfatal myocardial infarction, stroke, or major bleeding as defined by the Bleeding Academic Research Consortium at 1 year. The trial was designed to test the noninferiority of ticagrelor compared with prasugrel with a noninferiority margin of 5%. Results:Among the 1800 participants randomized, mean (SD) age was 60 (10) years with 1296 (72.0%) male participants, 436 (24.2%) receiving insulin therapy, and 1530 (85.0%) with triple-vessel disease. At 1 year, the primary end point occurred in 129 participants (16.6%) taking ticagrelor and 107 participants (14.2%) taking prasugrel (P = .12). The risk difference of 2.33 percentage points (95% CI, -2.07 to 6.74 percentage points) failed to meet the prespecified threshold for noninferiority (P = .84). There was numerically higher (but not statistically significant) composite of death, myocardial infarction, stroke (10.43% vs 8.63%; P = .30), and major bleeding (8.41% vs 7.14%; P = .19) with ticagrelor when compared with prasugrel. Conclusions and Relevance:In patients with diabetes and multivessel disease undergoing PCI, ticagrelor was not noninferior to prasugrel for the reduction of primary outcome at 1 year of follow-up. Trial Registration:CTRI/2019/11/022088.
