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Background: Systemic inflammation and various drugs used for treating coronavirus disease 2019 (COVID-19) including high-dose corticosteroids play a role in the development of new-onset diabetes (NOD). Patients of all ages and genders recovering from COVID-19 reportedly have an increased incidence and relative risk of developing diabetes. The present study thus tried to compare NOD in post moderate-to-severe COVID-19 patients with newly diagnosed diabetes patients with mild or without prior COVID-19 infection. Methods: This cross-sectional study included 100 newly diagnosed diabetes patients with a previous history of moderate-to-severe COVID-19 and those with no or mild history of previous COVID-19 infection (50 each in both groups). A detailed history was taken, and a clinical examination was done. Data on symptomatology, family history of diabetes, behavioral habits, anthropometry, and glycemic parameters was captured. Stress levels were assessed using the 5-point Perceived Stress Scale-10. The data obtained were statistically analyzed. Results: Assessing for the glycemic indices – fasting blood glucose, postprandial blood glucose, and glycosylated hemoglobin – was significantly higher in the moderate/severe COVID-19 arm as in comparison to the no/mild COVID-19 arm (P < 0.0001). C-peptide was significantly higher in the moderate/severe COVID-19 arm (P < 0.0001). The stress score was as high as 23.54 for the moderate/severe COVID-19 arm in comparison to 15.00 for the no/mild COVID-19 arm. Conclusion: NOD following COVID-19 pneumonia differs to some extent from NOD without COVID-19 in terms of having increased insulin resistance and worsened glycemic parameters. Clinicians should be aware of this entity as more aggressive control of dysglycemia is warranted to avoid complications arising out of it.

Waiting time at transit stops is found to be an influential policy variable for a passenger's decision on whether to undertake a given transit service. With regard to policy framework for improvement of operational service headway of a transit service and thereby its waiting time, the necessity to have knowledge on its critical value becomes inevitable. The critical value of waiting time for passengers waiting at transit stops is that duration beyond which passengers are found to be no more interested to wait for a that transit service. The paper demonstrates an approach for estimating the critical value of waiting time at urban transit stops with reference to public transport services such as city bus and shared-auto operational in Bhubaneswar, India. The critical value of waiting time is estimated from the point on cumulative distribution curve of waiting time frequency distribution, at which the maximum rate of change of the slope of curve occurs. The work assumes two positively skewed distributions such as gamma and log-normal for observed distributional pattern of waiting time. The work identifies that gamma distribution is comparatively fitting the observed data better than log-normal distribution. The study reveals that the critical value of waiting time for city bus passengers is about twice than that of shared auto passengers. Though, the study presents new information on critical values of waiting time with reference to an urban area of a developing country, it also demonstrates an experience on application of probability distribution functions for understanding distributional pattern of waiting time.

Introduction: Globally, about 425 million people are living with diabetes mellitus. Diabetic Foot Ulcers (DFU) are one of the severe complications of poorly controlled diabetes and over the time, about 50% of DFUs become infected which may require hospitalisation. Aim: To find out the DFU infection severity pattern and its predictors among Type 2 Diabetes Mellitus (T2DM) patients. Materials and Methods: This cross-sectional study was conducted at Integrated Diabetes and Gestational Diabetes Clinic (IDGDC), IQ City Medical College and Multispeciality Hospital, Durgapur, West Bengal, India, among T2DM patients from June 2018 to November 2018. Total 1534 T2DM patients attended IDGDC during data collection period of four months and 132 of them had diabetic foot ulcer. After taking written informed consent, detailed data were collected from 132 of study participants using predesigned, semi structured and pretested schedule developed with the help of Infectious Disease Society of America (IDSA) and International Working Group on the Diabetic Foot (IWGDF/IDSA) classification system. Socio-demographic characteristic like age, sex, education, residence were recorded along with clinical data like glycated haemoglobin (HbA1c), duration of diabetes, treatment modalities. Anthropometric measurements were taken as per World Health Organisation (WHO) guidelines. T2DM was defined and classified as per American Diabetes Association (ADA) Guidelines. DFU infection severity was classified into uninfected, mild infection, moderate infection and severe infection as per IWGDF/IDSA guidelines. Chi-square test was used to show association between categorical variable. One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test was used to show association between mean HbA1c level and DFU infection severity. The p-value ≤0.5 was considered significant. Results: Proportion of DFU was found to be 8.6%. As per the IWGDF/IDSA classification of DFU infection severity was found to be moderate in 59 (44.7%) of the study participants and mild in 32 (24.2%) of the study participants. 22 (16.7%) of study subjects had severe infection and required hospitalisation for optimal care. Only 14.4% of study subjects did not have DFU infection. Increasing age (p-value=0.023), rural residence (p-value=0.015), poor education (p-value=0.001), obesity (p-value=0.001), central obesity (p-value=0.001), longer duration of diabetes (p-value=0.028), and poor glycaemic control (p-value=0.001) was found to be significant risk factors for severe infection in DFU. Conclusion: Routine clinical assessment of DFU infection may help in making clinical decision of treatment modalities and help in saving lower limb as well as life of people with T2DM.

This post-authorization study was conducted to evaluate the safety of insulin degludec/insulin aspart (IDegAsp) in adult patients with diabetes mellitus (DM) during routine clinical care under a real-world setting in India. Eligible patients received IDegAsp for a minimum of 12 months during routine clinical management. Data were collected at 0, 3, 6, and 12 months. In total, 1029 adult patients with DM were included; 65.2% (n = 671) were men; mean age was 55.0 ± 12.2 years, and the mean duration of diabetes mellitus was 10.8 ± 7.4 years. Thirty adverse events were reported in 23 patients (2.2%) during the follow-up: two adverse events in two patients were serious with fatal outcomes, which were unrelated to IDegAsp use. At baseline, there were 176 confirmed hypoglycemic events in 67 (6.7%) patients while they were on their previous treatment options. At 12 months of treatment with IDegAsp, 11 confirmed hypoglycemic events were reported in 11 (1.1%) patients since the previous visit; there were no reported episodes of severe hypoglycemia. Mean glycosylated hemoglobin value reduced from 9.5% ± 1.8% at baseline to 7.7% ± 1.1% at 12 months. This study showed the safety of IDegAsp in patients with diabetes mellitus over a period of 1 year during routine clinical care.

Background: Parkinson's disease (PD) is one of the most common neurodegenerative movement disorders and its incidence is increasing worldwide along with population aging. Previous clinical and histologic studies suggest that the neurodegenerative process, which affects the brain, may also affect the retina of PD patients. Objective: The objective of this study was to determine the thickness changes of retina nerve fibers and macular volume with optical coherence tomography (OCT) in PD patients. Materials and Methods: The spectral domain OCT was used to assess the thickness of retinal nerve fiber layer (RNFL) and macular volume from 34 PD patients and 50 healthy age-matched controls. Results: Compared with healthy age-matched controls, the RNFL thickness of PD patients was much thinner (P < 0.05) in all retinal quadrants, with temporal thinning being more than nasal thinning. Macular volumes were diminished in both perifoveal and outer macular regions in all sectors (P < 0.05) with preserved foveal volume. The degree of tissue loss corroborated with the severity of disease as objectively assessed by standardized rating scales (UPDRS). Conclusion: There is generalized retinal nerve degeneration in patients of PD and the degree of loss correlated with the severity and duration of disease.

Background: The A 1 chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from North East, India. Results: A total of 730 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 518), insulin detemir (n = 88), insulin aspart (n = 74), basal insulin plus insulin aspart (n = 19) and other insulin combinations (n = 30). At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 9.5%) and insulin users (mean HbA 1 c: 9.2%) groups. After 24 weeks of treatment, both groups showed improvement in HbA 1 c (insulin naïve: −1.6%, insulin users: −1.5%). SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

Diabetes has emerged as a disease of major public health importance in India affecting the rich and the poor alike. Conventionally, comprehensive diabetes management is aimed at preventing micro and macro vascular complications. However, morbidity and mortality due to infections are also significant. In developing countries like India, the concept of adult immunization is far from reality. Recently the H1N1 pandemic has triggered the necessity for considering immunization in all age groups for the prevention of vaccine-preventable fatal infectious diseases. Considering the economics of immunization in a developing country, providing free vaccines to all adults may not be a practical solution, although the free universal immunization program for children is in existence for several decades. There is no consensus on the use of vaccines in diabetes subjects in India. However, there are some clinics offering routine pneumococcal, influenza and other vaccinations. Patients with diabetes have a deranged immune system making them more prone for infections. Hospitalization and death due to pneumococcal disease and influenza are higher in diabetes patients. They, like other healthy individuals, have a normal humoral response to vaccination with clinically significant benefits. The American Diabetes Association, Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, World Health Organization, United Kingdom Guidelines and a number of other scientific organizations have well defined guidelines for vaccination in diabetes. In this article we make some suggestions for clinicians in India, regarding use of vaccines in subjects with diabetes.

Most of the traffic information considers a single item like travel time or delay. In the present work, enhanced traffic information displaying instantaneous travel time and its variation from the previous interval to the present, is considered. An initial investigation is made on the effectiveness of such traffic information on route choice behavior of trip makers by valuation of attributes of the traffic information. Taking a case study of two urban corridors in the Kolkata metro city, India, the valuation is done separately for private car and taxi trip makers. The stated preference (choice based) data collected from trip makers are analyzed using both multinomial logit (MNL) and mixed logit (ML) modeling techniques. Assuming sparsely used constrained triangular distribution of random parameters, two different types of ML model are developed: one with independent choice sets and the other one by accounting heterogeneity around the mean of random parameter(s). Both family income and trip purpose are found to decompose heterogeneity around the mean estimate(s). The values of travel time and their variation presented in the paper encourage further investigation on such type of traffic information for management of congestion on alternative urban corridors both spatially and temporally. First Published Online: 27 Oct 2010

In order to model traffic stream speed resulting from complex interactions among different vehicle types in a heterogeneous/mixed traffic volume, an Artificial Neural Networks (ANN) approach is exploited. Two different categories of ANN model are attempted based on input vectors used. The performance of both categories of ANN model is evaluated using traditional evaluation framework. In addition, relevant logical test is carried out with both categories of ANN model. It is shown that selection of suitable input vectors and carrying out of relevant logical test are the two essential components for ANN model development process. First Published Online: 27 Oct 2010

Younger women exhibit more aggressive pathologic features of breast cancer (BC) compared to their older counterparts. Young age has been shown to be an independent predictor of adverse prognosis. These findings have raised the question of whether these differences are also present at the genetic level. Twenty-five early onset (age ≤ 40 years) tumors including 4 bilateral tumors, and 26 late onset (> 40 years) breast tumors, including 2 bilateral tumors, were xamined for loss of heterozygosity (LOH) at chromosome 1 using 11 polymorphic microsatellite markers. A comparative study revealed high frequencies of LOH in chr.1p36 (61%), 1p31.3 (40%), 1p21.3 (50%) and 1q22-23.2 (56%) in a younger group, and chr. 1p36 (46%), 1p34.2 (48%), and 1q22-23.2 (52%) in an older group. These differences in LOH frequency in these two age groups were significant for chr. 1p21.3 (p = 0.025) only. These data suggest that the deletion pattern in early onset breast tumors is not fully identical to late onset breast tumors. Similar differential deletion patterns of LOH in the 5 highly deleted regions were seen in premenopausal and postmenopausal groups. An association was seen between LOH at chr.1p34.2 and chr. 1q22-23.2 and higher grade of the tumors in older women. Among the highly deleted regions, the deletion at chr.1p36 was found to occur early in both groups because of common allelic loss in the bilateral tumors. [ABSTRACT FROM AUTHOR]

Erectile dysfunction (ED) is defined as the inability to achieve or maintain penile erection sufficient to permit satisfactory sexual activity. The prevalence increases with age. Basic and clinical research is identifying the neurovascular and humoral control of the mechanisms. The initial evaluation should differentiate erectile dysfunction from premature ejaculation and loss of libido. Myocardial insufficiency, hypogonadism and peripheral neuropathy should be looked for. Initial laboratory investigations should be restricted to identifying previously undetected medical illness that may directly contribute to erectile dysfunction. Discussing the available options with the couple is an important aspect. If erectile dysfunction is secondary to other treatable disorders these should be treated simultaneously. When other diseases that require intervention are ruled out and if there are no contraindications, therapy may be initiated with a phosphodiesterase inhibitor. In selected cases, psychosexual therapy may be beneficial. If phosphodiesterase inhibitors are contraindicated, vacuum constriction devices may be tried. Further options include intracavernosal injection, intraurethral instillation, penile revascularization and prosthesis. The availability of effective and well-tolerated oral medications has dramatically changed the clinical approach to erectile dysfunction. Pharmacotherapy is the preferred cost-effective first-line therapy in the vast majority of patients. A stepped-care approach is followed in the primary care and family practice settings. Appropriate urological, endocrine and psychiatric referrals, and shared decision-making with the couple will enable effective treatment of men with erectile dysfunction., (© Journal of the Association of Physicians of India 2011.)