Sri Devaraj Urs Medical College

Carbohydrate counting is a vital meal-planning approach to manage patients with Type 1 Diabetes Mellitus (T1DM) treated with a basal-bolus insulin regimen. This method involves identifying the amount of carbohydrates in meals and its impact on blood sugar levels in T1DM patients. Objective To assess the impact of carbohydrate counting and a standard diabetic diet on the glycemic control of children and adolescents with T1DM.Please provide objective separately after the background. To assess the impact of carbohydrate counting and a standard diabetic diet on the glycemic control of children and adolescents with T1DM. A Randomized Controlled Trial was conducted with 100 subjects (CG n = 50, IG n = 50) aged 6 to 18 years. The control group followed a standard diet pattern, while the intervention group adopted the carbohydrate-counting method for six months. Anthropometric measurements, biochemical profiles (FBS and PPBS, HbA1c), and daily insulin requirements were recorded at baseline and after the intervention for both groups. Descriptive statistics and parametric tests were utilized for data analysis and interpretation. The demographic variables of both groups exhibited similar distributions. The intervention group demonstrated a significant reduction in mean HbA1c levels [Baseline-(10.6 ± 3.0), end of 6 months- (8.4 ± 1.5), P < 0.00001] compared to the control group. Mean values of bolus insulin were lower in the intervention group, whereas in the control group, it remained the same. While both groups exhibited decreasing trends in mean FBS and PPBS levels, the intervention group showed a more pronounced reduction; however, statistical significance was not achieved. The intervention group showed a significant improvement in HbA1c levels, indicating improved glycemic control. These findings highlight the importance of individualised nutrition therapy in managing Type 1 diabetes in paediatric populations.

Introduction Enteric fever remains a significant public health issue in developing countries, where timely and accurate diagnosis is crucial for appropriate therapy and infection control. This study aimed to evaluate the diagnostic performance of the Widal test and two rapid IgM-based assays (Advantage Typhi and Typhiwell IgM enzyme-linked immunosorbent assays (ELISA)) compared with blood culture, the gold standard. Methods A prospective study involving 410 clinical samples from patients with suspected enteric fever based on clinical findings was conducted between December 2015 and June 2017. Blood culture, the Widal test, and two rapid Salmonella IgM assays (Advantage Typhi and Typhiwell IgM ELISA) were performed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated. Results The Widal test demonstrated a sensitivity of 70.18%, a specificity of 74.22%, a PPV of 30.53%, an NPV of 93.91%, and an overall diagnostic accuracy of 73.66%. Advantage Typhi exhibited low sensitivity (12.28%) with moderate specificity (81.02%). The Typhiwell IgM ELISA showed the greatest sensitivity (88.46%) and the highest NPV (97.50%), but had reduced specificity (47.37%), leading to the highest overall diagnostic accuracy (95.89%). Conclusions The Typhiwell IgM ELISA provides improved diagnostic accuracy and may function as a rapid and effective diagnostic method in endemic regions. However, it should be used as a complementary test rather than a substitute for blood cultures. Additional studies, including molecular methods, are recommended to further enhance overall diagnostic accuracy.

Introduction The upper lumbar spine is anatomically predisposed to neural compression due to a relatively narrow spinal canal, the presence of the conus medullaris and proximal cauda equina, and reduced segmental mobility. This distinct anatomy can lead to a wide range of clinical presentations, from nonspecific polyradiculopathy to cauda equina syndrome. The variability in symptoms and the unique anatomical features often complicate surgical decision-making. The primary objective of this study was to evaluate the association between upper lumbar disc level (L1-L2, L2-L3, L3-L4) and neurological as well as functional presentation. Secondary objectives included correlation with radiological characteristics and demographic variables. Material and methods A prospective observational study was conducted at Stavya Spine Hospital and Research Institute over a period of one year. Patients meeting the inclusion criteria underwent a comprehensive clinical evaluation, including a history-taking session, physical examination, and assessment using functional scoring systems, such as the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Patients were asked to map their patterns of back and leg pain, and radiological findings were meticulously documented. Results Fifty patients were enrolled consecutively, with an overall mean age of 51.26 ± 14.68 years. Patients with L1-L2 disc herniation were younger (mean age 42.13 ± 11.14 years) compared with those with L3-L4 herniation (54.45 ± 12.24 years). Although patients with L1-L2 disc herniation were younger on average compared with those with L3-L4 herniation, the difference in age across disc levels was not statistically significant. Most L1-L2 disc herniations were classified as Michigan State University (MSU) Type 1B, while L2-L3 and L3-L4 herniations were predominantly MSU Type 2B and Type 3B, respectively. Gait imbalance, extensor plantar response, motor weakness, sensory deficits, reflex changes, and bowel or bladder involvement were more commonly observed in patients with L2-L3 and L3-L4 disc herniations. Conclusion Upper lumbar disc herniation demonstrates level-specific demographic and clinico-radiological patterns. L1-L2 herniations occur in relatively younger patients and are predominantly MSU Type 1B, whereas L2-L3 and L3-L4 herniations are more common in older individuals and are typically larger, classified as MSU Type 2B and 3B. Disc herniations at L2-L3 and L3-L4 levels more frequently present with upper motor neuron-like (epiconus-related) neurological features, including gait imbalance, extensor plantar response, motor weakness, sensory deficits, reflex changes, and bowel or bladder involvement. Recognition of these level-dependent clinical patterns is essential for accurate diagnosis and timely surgical decision-making in upper lumbar disc herniation.

This cross-sectional study was conducted at a district headquarters in southern India. The investigators have interviewed both the common people and health care providers about the snakes and snake bite management practices. It is observed that the majority of the participants could not identify the snakes properly. Russell’s vipers (27.33%) and saw scaled vipers (8%) are the least identified by them and have many misconceptions about the snake bite management protocols to be followed, both as first aid and as institutional care. 90% believe in the use of tourniquets above the bite site, only 52% have knowledge about the use of crepe bandage, 20% believe in incising the wound to bleed out venom, and only 20% know to immobilize the limb to halt the flow of venom systemically.

Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a multisystem disorder associated with cardiometabolic complications. Emerging evidence suggests a potential link between hepatic steatosis and diabetic kidney disease, particularly microalbuminuria. This study aimed to evaluate the association between hepatic steatosis burden and urinary albumin-creatinine ratio (UACR) in patients with type 2 diabetes mellitus. Methods In this cross-sectional study, 95 patients with type 2 diabetes mellitus were evaluated. Hepatic steatosis was assessed using computed tomography-derived liver attenuation index (LAI) and steatosis grading. UACR was used as a marker of microalbuminuria. Correlation analysis and multivariate linear regression were performed to determine the relationship between hepatic steatosis parameters and albuminuria. Results The mean age of participants was 53.16 ± 9.94 years, with a mean BMI of 24.97 ± 2.03 kg/m². UACR increased progressively with higher grades of hepatic steatosis (Kruskal-Wallis H = 49.53, p < 0.001). LAI showed a significant negative correlation with UACR (r = -0.66, p < 0.001). In multivariate regression analysis, LAI (β = -1.69, p < 0.001) and BMI (β = 2.13, p = 0.004) were independently associated with UACR. Conclusion Hepatic steatosis burden is significantly associated with microalbuminuria in patients with type 2 diabetes mellitus, suggesting its potential role as an early marker of renal endothelial dysfunction.