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Betel quid (paan) chewing is common in India, especially in Uttar Pradesh. Betel quid has multifaceted relationship with health, including metabolic and psychosocial health. The current recommendations have been released keeping in view the public health and clinical importance of this addictive behavior. The objective of this document is to offer clinical guidance for screening, diagnosis and management of co-occurring betel quid chewing among persons with Diabetes Mellitus (DM). The document aims to provide education and guidance to clinicians engaged in care and management of persons with DM, and improve access to treatment for co-occurring betel quid chewing among persons with DM. The current recommendation grades are based on published evidence, and categorized as strong, intermediate, weak and no evidence. The strength of these recommendations is based on the level of evidence., (© Journal of the Association of Physicians of India 2011.)

Tobacco use is one of the main preventable causes of mortality and morbidity worldwide. The global disease burden due to tobacco use is huge with projected mortality of eight million lives per year by 2030. Metabolic syndrome (MS) is defined as a constellation of cardiovascular and endocrine risk factors such as insulin resistance, obesity, raised blood pressure, and abnormal lipid profile. The relationship between tobacco use and MS has been well established. Also, the causal association between tobacco use and development of individual components of MS is well established. The Uttar Pradesh Association of Physicians of India (UP API) has drafted this position statement on managing tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). This position statement presents evidence-based recommendations as described below. Scope and purpose The objective of this position statement is to offer clinical recommendations for screening, diagnosis and management of tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). The purpose of this document is to aid in identification and treatment of maladaptive patterns of tobacco use i.e. tobacco use disorder (tobacco dependence, harmful use, abuse) in person with or at risk of developing MS. Intended Audience The position statement is targeted at the clinicians engaged in care and management of person with or at risk of developing Metabolic Syndrome (MS). This might also be of relevance to the policy makers considering the public health burden of both MS and tobacco use disorders., (© Journal of the Association of Physicians of India 2011.)

Introduction: Diabetes Mellitus (DM) is the most common chronic disease. DM is considered a Cardiovascular Disease (CVD) risk equivalent. Its macrovascular complications are associated with two-fold increased risk of premature atherosclerotic CVD. Most of the diabetics with cardiovascular involvement are asymptomatic. Electro Cardio Graph (ECG) abnormalities are found to be predictors of silent ischaemia in asymptomatic persons. An abnormal ECG response is associated with statistically significant high risk for cardiac mortality and morbidity., Aim: The aim of the study was to evaluate ECG changes in asymptomatic Type 2 DM patients., Materials and Methods: A cross-sectional comparative study was conducted in a tertiary care hospital in North India. One hundred diabetics presenting to Medicine OPD/IPD were included in the study who had no symptoms of heart disease and no diabetic complications. Fifty person with age and sex matched controls were included in the study. Relevant history and physical examination findings were recorded in a protocol. The variables studied were: gender, age, smoking, physical activity, and waist circumference, Body Mass Index (BMI) and blood pressure. Resting ECG was recorded., Results: Mean age of asymptomatic diabetic patients was 50.3±11.90 years (age range 25-75 years). In this study, none of the control group had ECG abnormality whereas, 26% asymptomatic diabetics had ECG abnormalities. Most of the asymptomatic cases with ECG changes had 5-10 year of duration of diabetes mellitus; 70% patients with ECG changes had poor glycaemic control, increased triglyceride and decreased High Density Lipoprotein (HDL) levels. Most common abnormality observed was ST-T changes, followed by Left Atrial Enlargement (LAE), Left Ventricular Hypertrophy (LVH), Left Bundle Branch Block (LBBB) and Right Bundle Branch Block (RBBB)., Conclusion: ECG changes are present in quarter of asymptomatic Type 2 DM patients. However, nonspecific ST-T changes, LVH and LAE are common.

Management of recurrent dislocation of total hip arthroplasty is often a challenging and daunting task. Re-revision of such a total hip prosthesis may not be easy as the removal of a well-fixed, fully coated stem is extremely difficult. We managed to salvage instability in three revision hip cases in which the fully coated stem had subsided by using a bioball universal neck adapter without changing the femoral stem or acetabular cup.

Objectives: The purpose of this study was to generate data regarding the drug utilization pattern in pediatric population of our tertiary care hospital so that we could generate an essential medicine list (EML)., Background: Drug therapy accounts for a major portion of expenditure toward health care. Reduction in health care cost for an individual can be achieved by lowering the cost of drug treatment., Methods: This was an observational study conducted in the Advanced Pediatric Centre of our hospital, during which prescriptions and case records were reviewed., Results: During the study a total of 891 prescriptions were reviewed. Antibiotics and nutritional supplements were the major drugs prescribed. A large percentage of drugs were prescribed as trade names. Eighty three per cent of the drugs were prescribed from the National List Of Essential Medicine 2003 (India). Antibiotics accounted for the major bulk of cost of drugs, most of which were purchased by the patients., Conclusions: Restricted use of newer antibiotics, branded drugs and prescribing from the EML could be considered as targets for reduction of cost of therapy.