Article Type: Editorial
Title: Challenges Met by Healthcare Professionals (Nurses) at the time of Covid-19 Pandemic
Year: 2021; Volume: 1; Issue: 2; Page No: 3 – 4
Author: Sumathi Senthilvel
DOI: 10.55349/ijmsnr.20211234
Affiliation: Associate Editor, IJMSNR, Formerly Assistant Professor in Nursing, Department of Fundamental Nursing, Amrita College of Nursing. Ponekkara, Kochi, Kerala. Email ID: AssociateEditor@ijmsnr.com
Article Summary: Submitted : 26-October-2021
Revised : 10-November-2021
Accepted : 02-December-2021
Published : 31-December-2021
Diabetic is a well known public health problem of today. There are many risk factors of it, which can be identified in pre-diabetic state. So the present study was conducted with the aim to know the status of anthropometric and haematological parameters in pre-diabetic states. For this hospital based study pre-diabetic subjects were identified from first degree relatives of type 2 DM Patients, enrolled in diabetic research centre P.B.M. hospital Bikaner. Relevant investigations were done. Data thus collected on semi-structured questionnaire and analysed using content analysis. Data analysis revealed that although mean Body Mass Index (BMI) was within normal range but Waist circumference (WC), West Hip (W/H) Ratio, Systolic blood pressure were higher than the normal range accepted for that parameter. But mean value of all the studied haematological parameter were within the normal range accepted for that parameter. So it can be conclude that anthropology of an individual may be associated with the pre-diabetic state. Hypertension was found in 25.35% of pre-diabetics. Further researches are necessary to find out this possible association of anthropologic parameter and pre-diabetic state.
Background: This study aimed to determine the prevalence of Diabetic Retinopathy and to find the associated risk factors of DR among known Type II DM patients.
Materials and Methods: A hospital-based cross-sectional and single center study was conducted among Type II DM patients with and without DR in the department of Endocrinology with a sample size of 150 with DM patients in 2018. Data were expressed as mean, standard deviation, proportions, Chi-Square, t-test test and Binary Logistic Regression analysis.
Results: Diabetic patients 150 were identified as Type II DM as per inclusion criteria with aged 30 years and above. Among 150 Diabetic patients, 39 (26%) patients had Diabetic Retinopathy and 111 (74%) patients were not having Diabetic Retinopathy. The association between groups (with and no DR) and duration of DM were very highly significant with p-value < 0.01. DR prevalence was higher in female when compared with male population.
Conclusion: From our study, we have concluded that the prevalence of DR was very high. DR was strongly associated with HbA1C, FBS, duration of DM, medication, duration of hypertension and smoking. Hence, there is a need for regular screening check-up with ophthalmologist to prevent diabetic retinopathy or to prolong or to escape from the vision loss.
Keywords: type II diabetic mellitus, diabetic retinopathy, prevalence, risk factors
Prevalence of Chronic Kidney disease in Patients with Metabolic Syndrome in S...asclepiuspdfs
Background and Objective: Chronic kidney disease (CKD) which is an increasingly important clinical and public health issue is associated with cardiovascular disease. Epidemiologic studies have also linked metabolic syndrome (MetS) with an increased risk of incident CKD. Therefore, the present study was designed retrospectively to find the prevalence and potential risk factors of CKD in patients with MetS in Saudi Arabia.
Impact of Malnutrition on Lipid Profile in Chronic Kidney Disease Patients in...Neeleshkumar Maurya
The present study was carried out to identify the role of malnutrition and its relationship for the development of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients taking hemodialysis. We conducted an analytical study with 100 patients. It was carried out over one-year period, from February 25, 2017 to March 30, 2018. The inclusion criteria were the patients who have been on hemodialysis for at least past three months period and at least more than 18-year-old. All the patients were divided into two groups: first group of patients have both CVD and CKD and other group of patients have only CKD. Patients were subjected to biochemical and anthropometric parameters. Out of hundred patients, about 60 followed the inclusion and exclusion criteria. Eight women and 52 men with the age range from 18 to 80 years with 49±10.2years as mean age. We found that higher level of cholesterol, triglyceride, low protein intake and low energy conception in CKD alone patients is directly associated with malnutrition. The association between cholesterol levels and CKD would be altered by the presence of malnutrition. Low level of protein and total energy intake also confirms the presence of malnutrition in CKD patient developed the CVD.
Keywords: Malnutrition, hemodialysis patients, chronic kidney disease (CKD), cardiovascular disease (CVD)
THE PREVALENCE AND IMPACT OF DIABETIC RETINOPATHY AMONG TYPE 2 DIABETES POPUL...indexPub
Objective: This study aimed to evaluate the prevalence and visual impact of Diabetic Retinopathy (DR) among individuals with Type 2 Diabetes (T2D) in Hazara, Pakistan. Methods: A cross-sectional study was conducted from May to August 2023. The sample consisted of 1332 patients who attended the Outpatient Department for eye examination, with 133 (10%) identified as diabetics. Parameters such as glycemic control, HbA1C levels, comorbidities, family history, medication, lifestyle factors, and ocular manifestations were analyzed. Results: The study indicated that 73.01% of diabetic patients had uncontrolled glycemic levels. The prevalence of refractive errors was high (84.12%), and the incidence of DR was significant, with 6.34% having proliferative DR. The findings also emphasized lifestyle factors, including screen usage and spectacle usage patterns. In addition, weight-height proportions and a family history of diabetes were associated with the incidence of DR. Conclusion: The high prevalence of uncontrolled diabetes and significant incidence of DR underscores the urgent need for improved diabetes management and regular screenings for early detection of DR. The results advocate for prioritizing regular health checkups, enhancing public health strategies, and improving accessibility to healthcare facilities, particularly in rural regions.
Diabetic is a well known public health problem of today. There are many risk factors of it, which can be identified in pre-diabetic state. So the present study was conducted with the aim to know the status of anthropometric and haematological parameters in pre-diabetic states. For this hospital based study pre-diabetic subjects were identified from first degree relatives of type 2 DM Patients, enrolled in diabetic research centre P.B.M. hospital Bikaner. Relevant investigations were done. Data thus collected on semi-structured questionnaire and analysed using content analysis. Data analysis revealed that although mean Body Mass Index (BMI) was within normal range but Waist circumference (WC), West Hip (W/H) Ratio, Systolic blood pressure were higher than the normal range accepted for that parameter. But mean value of all the studied haematological parameter were within the normal range accepted for that parameter. So it can be conclude that anthropology of an individual may be associated with the pre-diabetic state. Hypertension was found in 25.35% of pre-diabetics. Further researches are necessary to find out this possible association of anthropologic parameter and pre-diabetic state.
Background: This study aimed to determine the prevalence of Diabetic Retinopathy and to find the associated risk factors of DR among known Type II DM patients.
Materials and Methods: A hospital-based cross-sectional and single center study was conducted among Type II DM patients with and without DR in the department of Endocrinology with a sample size of 150 with DM patients in 2018. Data were expressed as mean, standard deviation, proportions, Chi-Square, t-test test and Binary Logistic Regression analysis.
Results: Diabetic patients 150 were identified as Type II DM as per inclusion criteria with aged 30 years and above. Among 150 Diabetic patients, 39 (26%) patients had Diabetic Retinopathy and 111 (74%) patients were not having Diabetic Retinopathy. The association between groups (with and no DR) and duration of DM were very highly significant with p-value < 0.01. DR prevalence was higher in female when compared with male population.
Conclusion: From our study, we have concluded that the prevalence of DR was very high. DR was strongly associated with HbA1C, FBS, duration of DM, medication, duration of hypertension and smoking. Hence, there is a need for regular screening check-up with ophthalmologist to prevent diabetic retinopathy or to prolong or to escape from the vision loss.
Keywords: type II diabetic mellitus, diabetic retinopathy, prevalence, risk factors
Prevalence of Chronic Kidney disease in Patients with Metabolic Syndrome in S...asclepiuspdfs
Background and Objective: Chronic kidney disease (CKD) which is an increasingly important clinical and public health issue is associated with cardiovascular disease. Epidemiologic studies have also linked metabolic syndrome (MetS) with an increased risk of incident CKD. Therefore, the present study was designed retrospectively to find the prevalence and potential risk factors of CKD in patients with MetS in Saudi Arabia.
Impact of Malnutrition on Lipid Profile in Chronic Kidney Disease Patients in...Neeleshkumar Maurya
The present study was carried out to identify the role of malnutrition and its relationship for the development of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients taking hemodialysis. We conducted an analytical study with 100 patients. It was carried out over one-year period, from February 25, 2017 to March 30, 2018. The inclusion criteria were the patients who have been on hemodialysis for at least past three months period and at least more than 18-year-old. All the patients were divided into two groups: first group of patients have both CVD and CKD and other group of patients have only CKD. Patients were subjected to biochemical and anthropometric parameters. Out of hundred patients, about 60 followed the inclusion and exclusion criteria. Eight women and 52 men with the age range from 18 to 80 years with 49±10.2years as mean age. We found that higher level of cholesterol, triglyceride, low protein intake and low energy conception in CKD alone patients is directly associated with malnutrition. The association between cholesterol levels and CKD would be altered by the presence of malnutrition. Low level of protein and total energy intake also confirms the presence of malnutrition in CKD patient developed the CVD.
Keywords: Malnutrition, hemodialysis patients, chronic kidney disease (CKD), cardiovascular disease (CVD)
THE PREVALENCE AND IMPACT OF DIABETIC RETINOPATHY AMONG TYPE 2 DIABETES POPUL...indexPub
Objective: This study aimed to evaluate the prevalence and visual impact of Diabetic Retinopathy (DR) among individuals with Type 2 Diabetes (T2D) in Hazara, Pakistan. Methods: A cross-sectional study was conducted from May to August 2023. The sample consisted of 1332 patients who attended the Outpatient Department for eye examination, with 133 (10%) identified as diabetics. Parameters such as glycemic control, HbA1C levels, comorbidities, family history, medication, lifestyle factors, and ocular manifestations were analyzed. Results: The study indicated that 73.01% of diabetic patients had uncontrolled glycemic levels. The prevalence of refractive errors was high (84.12%), and the incidence of DR was significant, with 6.34% having proliferative DR. The findings also emphasized lifestyle factors, including screen usage and spectacle usage patterns. In addition, weight-height proportions and a family history of diabetes were associated with the incidence of DR. Conclusion: The high prevalence of uncontrolled diabetes and significant incidence of DR underscores the urgent need for improved diabetes management and regular screenings for early detection of DR. The results advocate for prioritizing regular health checkups, enhancing public health strategies, and improving accessibility to healthcare facilities, particularly in rural regions.
My STSH Scholary Article about TREATMENT of PRE-DIABETES with SSDDDr. Sutanu Patra
I had done research on "Scope of Individualistic treatment with Serially Succussed and Diluted Drugs in treating Pre-diabetic condition: an Open-label Exploratory trial – in search of Prevention of Diabetes" and this was got awarded in Short Term Studentship in Homeopathy (STSH) 2014 by Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, Govt. of India.
Study Of Prevalence Of Malnutrition In HIV Positive Children And Its Correlat...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Novel Approach Of Diabetes Disease Classification By Support Vector Machine W...IJARIIT
Early diagnosis of any disease with less cost is always preferable. Diabetes is one such disease. It has become the fourth leading cause of death in developed countries and is also reaching epidemic proportions in many developing and newly industrialized nations. Diabetes leads to increase in the risks of developing kidney disease, blindness, nerve damage, blood vessel damage and heart disease also. In this study, we investigate an automatic approach to diagnose Diabetes disease based on Bacterial Foraging Optimization and Artificial Neural Network .firstly, we applied Bacterial Foraging Optimization for features selection and then we implement artificial neural network for finding out the classification accuracy. The proposed SVM method obtains 87.23% accuracy on UCI diabetes dataset which is better than other models.
Secondly, we applied again Bacterial foraging optimization for features selection and then we applied support vector machine for finding out the classification accuracy .The proposed Correlation with SVM method obtains on UCI dataset.
Background: One of the commonest complications of poorly controlled Type 2 diabetes mellitus (T2DM) is Diabetic nephropathy (DN), which occurs in 30-40% of DM cases. It is important to identify the high-risk group who are likely to develop DN with the modifiable and non-modifiable risk factors. This study had the objectives to estimate and correlate the levels of the urine albumin creatinine ratio (UACR) with age, anthropometric measures, glycaemic control markers, lipids, and renal function. To estimate each variable as independent and multivariate risk factors.
Materials and Methods: It was an observational and cross-sectional study conducted in a tertiary care center in Eastern India. Totally, 221 consecutive ambulatory T2DM subjects were recruited after obtaining their written consent.
Results: The diabetics were classified as having diabetic nephropathy by the urine albumin creatinine ratio (ACR) of >30 mg/gm. 53.4% of our study group had DN. There was a significant risk associated with PPBS with p=0.043 (<0.05), serum creatinine with p=0.032 (<0.05), and urine albumin with p=0.0001 (<0.001). In the multivariate regression analysis of all these variables, there was a highly significant likelihood ratio for predicting DN with p=0.0001 (<0.001) with a predictive value of 74.5% in females and 75% in males.
Conclusion: The additive factors contributed by the risk factors in the prediction of DN will benefit the DM in the prevention of DN.
Keywords: diabetic nephropathy, risk factors, diabetic kidney disease, Asian Indian
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Assessment of cardiovascular disease risk among qatari patients with type 2 p...Dr. Anees Alyafei
Original Research Paper on the Assessment of Cardiovascular Disease Risk on Qatari Diabetics. The behavior of two risk prediction tools categorized patients differently.
https://www.researchgate.net/publication/340895704_Assessment_of_Cardiovascular_Disease_Risk_among_Qatari_Patients_with_Type_2_Diabetes_Mellitus_Attending_Primary_Health_Care_Centers_2014
Glycation plays a role as risk factor in Alzheimer’s Disease (AD) and D-ribose is one of the important contributors to protein glycation.
Here, we recruited 93 participants (49 AD patients, 44 cognitively normal participants) and measured their cognitive abilities with
Mini-Mental State Examination (MMSE), D-ribose and formaldehyde levels in the morning urine. Urine D-ribose levels of AD patients
(especially women) were signifi cantly higher than those of cognitively normal participants. Like formaldehyde, D-ribose levels were
negatively correlated with MMSE scores in all participants. Unlike formaldehyde, D-ribose levels still showed the negative correlation in
cognitively normal participants. These data may provide a novel clue to study AD.
Background: Covid-19 an illness caused by SARS- COV-2 virus, it has killed millions of people all over the world and has wreaked havoc in India too. Even today there is no confirmed drug that can successfully tackle the illness. According to WHO, efficient vaccines and equitable access to them is vital to curbing the Covid-19 pandemic.
Materials and Methods: With the help of a semi-structured question guide, six focus group discussions were conducted in several villages in East Khasi hills Meghalaya, each focus group had 6-12 participants, thematic analysis was used to analyze the data.
Results: Most of the villagers are affected by covid-19 and the lockdown measures to curb it, but their perceptions on vaccinations were negative. Certain thematic areas that seemed to repeat were, religious beliefs, lack of awareness, individual freedom to choose, not feeling like they require it as they are just agricultural laborers, fear of side effects, and the prevalence of negative propaganda on social media. Most believe if it’s mandatory to take the vaccine everyone would take it. Few village heads suggested better awareness might be able to convince a few.
Conclusion: The majority said they were not ready to get vaccinated, and cited religion and individual freedom to choose as the reasons for their reluctance. Health awareness programs and more pro vaccine governmental policies may help improve coverage.
Keywords: covid-19, covid vaccination, tribal health, vaccine hesitancy, Meghalaya
Article Type: Editorial
Title: Changing and Challenging Scenario of Burden of Disease
Year: 2022; Volume: 2; Issue: 1; Page No: 3 – 4
Author: Dr. P.K. Govindarajan
10.55349/ijmsnr.20222134
Affiliation: Professor, Department of Community Medicine, Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry (UT), India.
Email ID: drpkgr@gmail.com
Article Summary:
Submitted : 15-February-2022
Revised : 27-February-2022
Accepted : 15-March-2022
Published : 31-March-2022
More Related Content
Similar to Challenges Met by Healthcare Professionals (Nurses) at the time of Covid-19 Pandemic
My STSH Scholary Article about TREATMENT of PRE-DIABETES with SSDDDr. Sutanu Patra
I had done research on "Scope of Individualistic treatment with Serially Succussed and Diluted Drugs in treating Pre-diabetic condition: an Open-label Exploratory trial – in search of Prevention of Diabetes" and this was got awarded in Short Term Studentship in Homeopathy (STSH) 2014 by Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, Govt. of India.
Study Of Prevalence Of Malnutrition In HIV Positive Children And Its Correlat...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Novel Approach Of Diabetes Disease Classification By Support Vector Machine W...IJARIIT
Early diagnosis of any disease with less cost is always preferable. Diabetes is one such disease. It has become the fourth leading cause of death in developed countries and is also reaching epidemic proportions in many developing and newly industrialized nations. Diabetes leads to increase in the risks of developing kidney disease, blindness, nerve damage, blood vessel damage and heart disease also. In this study, we investigate an automatic approach to diagnose Diabetes disease based on Bacterial Foraging Optimization and Artificial Neural Network .firstly, we applied Bacterial Foraging Optimization for features selection and then we implement artificial neural network for finding out the classification accuracy. The proposed SVM method obtains 87.23% accuracy on UCI diabetes dataset which is better than other models.
Secondly, we applied again Bacterial foraging optimization for features selection and then we applied support vector machine for finding out the classification accuracy .The proposed Correlation with SVM method obtains on UCI dataset.
Background: One of the commonest complications of poorly controlled Type 2 diabetes mellitus (T2DM) is Diabetic nephropathy (DN), which occurs in 30-40% of DM cases. It is important to identify the high-risk group who are likely to develop DN with the modifiable and non-modifiable risk factors. This study had the objectives to estimate and correlate the levels of the urine albumin creatinine ratio (UACR) with age, anthropometric measures, glycaemic control markers, lipids, and renal function. To estimate each variable as independent and multivariate risk factors.
Materials and Methods: It was an observational and cross-sectional study conducted in a tertiary care center in Eastern India. Totally, 221 consecutive ambulatory T2DM subjects were recruited after obtaining their written consent.
Results: The diabetics were classified as having diabetic nephropathy by the urine albumin creatinine ratio (ACR) of >30 mg/gm. 53.4% of our study group had DN. There was a significant risk associated with PPBS with p=0.043 (<0.05), serum creatinine with p=0.032 (<0.05), and urine albumin with p=0.0001 (<0.001). In the multivariate regression analysis of all these variables, there was a highly significant likelihood ratio for predicting DN with p=0.0001 (<0.001) with a predictive value of 74.5% in females and 75% in males.
Conclusion: The additive factors contributed by the risk factors in the prediction of DN will benefit the DM in the prevention of DN.
Keywords: diabetic nephropathy, risk factors, diabetic kidney disease, Asian Indian
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Assessment of cardiovascular disease risk among qatari patients with type 2 p...Dr. Anees Alyafei
Original Research Paper on the Assessment of Cardiovascular Disease Risk on Qatari Diabetics. The behavior of two risk prediction tools categorized patients differently.
https://www.researchgate.net/publication/340895704_Assessment_of_Cardiovascular_Disease_Risk_among_Qatari_Patients_with_Type_2_Diabetes_Mellitus_Attending_Primary_Health_Care_Centers_2014
Glycation plays a role as risk factor in Alzheimer’s Disease (AD) and D-ribose is one of the important contributors to protein glycation.
Here, we recruited 93 participants (49 AD patients, 44 cognitively normal participants) and measured their cognitive abilities with
Mini-Mental State Examination (MMSE), D-ribose and formaldehyde levels in the morning urine. Urine D-ribose levels of AD patients
(especially women) were signifi cantly higher than those of cognitively normal participants. Like formaldehyde, D-ribose levels were
negatively correlated with MMSE scores in all participants. Unlike formaldehyde, D-ribose levels still showed the negative correlation in
cognitively normal participants. These data may provide a novel clue to study AD.
Background: Covid-19 an illness caused by SARS- COV-2 virus, it has killed millions of people all over the world and has wreaked havoc in India too. Even today there is no confirmed drug that can successfully tackle the illness. According to WHO, efficient vaccines and equitable access to them is vital to curbing the Covid-19 pandemic.
Materials and Methods: With the help of a semi-structured question guide, six focus group discussions were conducted in several villages in East Khasi hills Meghalaya, each focus group had 6-12 participants, thematic analysis was used to analyze the data.
Results: Most of the villagers are affected by covid-19 and the lockdown measures to curb it, but their perceptions on vaccinations were negative. Certain thematic areas that seemed to repeat were, religious beliefs, lack of awareness, individual freedom to choose, not feeling like they require it as they are just agricultural laborers, fear of side effects, and the prevalence of negative propaganda on social media. Most believe if it’s mandatory to take the vaccine everyone would take it. Few village heads suggested better awareness might be able to convince a few.
Conclusion: The majority said they were not ready to get vaccinated, and cited religion and individual freedom to choose as the reasons for their reluctance. Health awareness programs and more pro vaccine governmental policies may help improve coverage.
Keywords: covid-19, covid vaccination, tribal health, vaccine hesitancy, Meghalaya
Article Type: Editorial
Title: Changing and Challenging Scenario of Burden of Disease
Year: 2022; Volume: 2; Issue: 1; Page No: 3 – 4
Author: Dr. P.K. Govindarajan
10.55349/ijmsnr.20222134
Affiliation: Professor, Department of Community Medicine, Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry (UT), India.
Email ID: drpkgr@gmail.com
Article Summary:
Submitted : 15-February-2022
Revised : 27-February-2022
Accepted : 15-March-2022
Published : 31-March-2022
Article Type: Editorial
Title: Patient Safety: Paradigm shift of modern healthcare delivery and research
Year: 2022; Volume: 2; Issue: 1; Page No: 1 – 2
Author: Dr. Mohammed Imran
10.55349/ijmsnr.20222112
Affiliation: Associate Professor, Medical Pharmacology, College of Medicine and Health Sciences, Sohar, National University of Science and Technology, Sultanate of Oman.
Email ID: imran@nu.edu.om
Article Summary:
Submitted : 10-February-2022
Revised : 26-February-2022
Accepted : 12-March-2022
Published : 31-March-2022
Background: Iodine deficiency disorder is common public health problem in developed and developing countries. In Worldwide, nearly 70% of the households only using adequate iodized salt in their regular food. To estimate the household salt utilization, prevalence of goiter, status of iodine deficiency disorder, and to find the iodine level at household level in the study areas.
Materials and Methods: We have done a community-based observational study on IDD in the coastal areas of Villupuram District, Tamil Nadu with examined households salt in 1233 households in selected eight villages. All data were analyzed using Chi-Square test. p–value<0.05 was considered as statistically significant.
Results: Totally 1233 households were recruited and incorporated in this study. Among 1233 households, male 385 (31.2%) and female 848 (68.8%). The male and female age-group was showed statistically highly significant association with p<0.01. Out of 1233 individuals, 141 (11.4%) were found as total goiter. The prevalence of goiter was 105 (12.4%) in female than male was 36 (9.4%) and no statistical association between gender among goiter prevalence (p>0.05).
Conclusion: From our present study findings, we have concluded that majority of the study population was used iodized salt in their regular food. But, very less adequately iodized salts were available nearby study areas. Nevertheless, majority of the households didn’t know about the benefits about the usage of iodized salt. Health education is needed in to the shopkeepers and local vendors. This will be conducted by non-Governmental organization, Government organization and other nearby medical colleges.
Keywords: household salt, utilization, iodine, iodine deficiency disorder, coastal areas
Background: The developed Semi-Markov model with Kumaraswamy Exponentiated Inverse Rayleigh distribution examined patients with hypertension, heart diseases, smoking habits and Stroke, is measured from one state to another.
Materials and Methods: Patients with Non-Communicable disease described through Kumaraswamy Exponentiated Inverse Rayleigh distribution.
Results: The estimated parameters of Semi-Markov model with this distribution predicted by the maximum likelihood estimation for each successive state observed significant abnormality. The data noted predicts established model is a good fit for many attributes that prevailed in studied data. The developed Semi-Markov model is a best fit for non-Communicable disease in the long run of patient’s data. Through different Exponential family distribution, one can look at for further perfect fit of patient data, which is to be estimated.
Conclusion: This model can be an alternative method to estimate the effect of patient in survival analysis, where it will be effective in time consumption in medical field.
Keywords: heart diseases, hypertension, Semi-Markov processes, smoking, stroke
Background: The HIV virus carries projection of significant global population with specific estimations of the mathematical results of evolutionary methods which was presented in Tree Hidden Markov model (HMM).
Materials and Methods: Hidden Markov models used to model the progression of the disease among HIV infected people. The author predicts a Baum Welch Algorithm method through HMM that can assess an unknown state of transition.
Results: The Tree HMM model predicts the break down point starts once patient is infected with the HIV virus as it affects the immune system. The immune system drops more quickly in the initial inter arrival time when compared with the later time interval. The HIV virus length in the nth state within regrouping is uncertain to occur in each state of the given model. A simulation study was done to assess the goodness of fit for the model.
Conclusion: The HIV virus length in the nth state within regrouping is uncertain to occur in each state of the given model. The inter arrival censoring between each state is essential in each infected HIV patients. The outcome of this works states that health care expert can use this model for effective patient cares.
Keywords: expectation, hidden markov model, human immunodeficiency virus, immune system, transition
Background: Incidence of diabetes mellitus continues to rise, common focus areas for diabetes control are blood glucose levels, diet, and exercise. Controlling these factors are essential for a better quality of life in diabetes patients. Patients with diabetes have an increased risk of asymptomatic bacteriuria and pyuria, cystitis, and, more important, serious upper urinary tract infection.
Materials and Methods: This was a hospital based descriptive and cross-sectional study which included 250 Study subjects who were admitted in CSI Kalyani General hospital during the period from July 2017 to July 2018 and who has Diabetic as a comorbidity were interviewed using structured protocol based proforma. Patient underwent routine clinical, pathological and biochemical investigations.
Results: In this study, 250 in-patients were included and analyzed. The prevalence of Infection in Diabetes mellitus was 65.6%. There is no significant association between Age, Education, Occupation, HbA1C, Duration and type of treatment and biochemical values. The commonest organism in Urine sample among the study group was E.coli followed by Klebsiella. UTI is more common in females, Respiratory infection is more common in males and it is statistically significant (p<0.009) and it is statistically significant (p<0.007).
Conclusion: From this study, we have concluded that patient with diabetes mellitus is at increased risk for common infections due to poor glycemic control and Obesity. Poor glycemic control suppresses the immunity and more prone for infection. Therefore, the challenges will be to attain good glycemic control, change in lifestyle to maintain normal BMI. This will prevent the morbimortality, reduce the long-term complication and maintenance to prolong the life without any sequele. More prospective case control studies on the management of infections in DM patients are needed.
Keywords: type 2 diabetes mellitus, infections, clinical profile, hba1c, glycemic control
Background: Diabetic Retinopathy is a non-communicable disease and metabolic disorder. It is a public health problem in Worldwide. In this paper, finding influencing factors and how much probability to development of DR among known T2DM patients.
Materials and Methods: This was a hospital-based cross-sectional and observational study among T2DM patients, with and without DR in the diabetes clinic with sample of 150 patients. Statistical analysis used chi-square and binary logistic regression analysis was used to identify correlates of DR after controlling of confounders.
Results: In this present study, among 150 patients, 39 (26%) patients had DR. Smoking habit was strongly associated with development of DR (AOR=15.39, p=0.002), patients had history of hypertension was associated with DR (AOR=1.10, p=0.016), medication, in that insulin users were strongly associated with DR (AOR=5.72, p=0.002), duration of diabetes mellitus with >10 years was associated with DR (AOR=1.18, p=0.001), total cholesterol with abnormal was 5-fold more increase in risk with the development of DR (AOR=5.86, p=0.065) but not significant, high hba1c with >6.5% was associated with the progression of DR (AOR=1.34, p=0.035), and fasting blood sugar with abnormal was associated with the progression of DR (AOR=1.01, p=0.027) except age but, showed positive association with DR. Probability of developing DR in a T2DM patient was 98%.
Conclusion: From this study, we revealed that influencing variables were hba1c, smoking habit, intake of tablet/insulin, duration of DM, history of hypertension and fasting blood sugar. The chance/probability of developing retinopathy was very high among known diabetes patients those who had longer duration of DM. Hence, we have recommended a periodic eye screening is mandatory in T2DM patients.
Keywords: diabetes mellitus, diabetic retinopathy, influencing factors, probability, multivariate analysis
Article Type: Editorial
Title: One Health Approach: The key to addressing pandemics and other complex challenges of the 21st Century
Year: 2021; Volume: 1; Issue: 2; Page No: 1 – 2
Author: Priyanka Raj CK
DOI: 10.55349/ijmsnr.202111212
Affiliation: Deputy Editor-In-Chief, IJMSNR, Associate Professor, Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Sohar, National University of Science and Technology, Sultanate of Oman. Email ID: priyankaraj@nu.edu.om and DeputyEditor-in-chief@ijmsnr.com
Article Summary: Submitted : 22-October-2021
Revised : 06-November-2021
Accepted : 03-December-2021
Published : 31-December-2021
Background: The COVID-19 pandemic has created a wide range of crises affecting many nations, resulting in adverse health consequences. The implementation of the lock down upended the lifestyle of mostly all people and was associated with disturbed sleep. Our study is to estimate the variation of the sleep-wake cycle during lockdown and after lock down among people of age 15-60 and its impact on Psychological wellbeing.
Materials and Methods: We have done a cross-sectional and descriptive study with a sample of 152 participants was formed using convenience sampling method by online google form. They were administered with The Munich Chronotype Questionnaire (MCTQ) and The Flourishing scale. The responses were collected during and after lock down. The data obtained is subjected to descriptive analysis.
Results: In this study we have included 304 participants. Out of 304 participants, 151 (49.7%) were male and 153 (50.3%) were female. Flourishing scale scores mean during lockdown was 28.83 ± 4.75 and after lockdown was 41.50 ± 4.42 and the mean value was more in after lockdown period and a paired-t test showed statistically highly significant difference at p-value <0.01.
Conclusion: The variation in the sleep-wake cycle was more in adolescents than in other age groups and the Psychological wellbeing of women was affected more than men in all age groups during lockdown.
Key Words: lockdown, sleep-wake cycle, psychological wellbeing, age difference, gender difference
Background: Cardiac catheterization (CC) is the inserting of a thin, hollow catheter into a chamber or vessel; it is done for diagnostic and intervention purposes. Death charges from coronary heart disease have decreased in recent decennium, however, coronary heart disease is still a major cause of morbidity and mortality worldwide especially in developed countries. Coronary heart disease refers to different conditions of failing circulation of the heart and includes myocardial infarction (MI). In this study, we assessed the patients’ knowledge regarding CC.
Materials and Methods: A descriptive study was conducted with a purposive sample of 250 patients were selected and included from Cardiac Specialty Hospital in Slemani City, Iraq. This study was carried out between November 2017 and October 2018. A self-conductive questionnaire was used for data collection.
Results: Totally 250 patients were included in this study. Among 250 patients, 176 (70.4%) were males and 74 (29.6%) females. The validity of the questionnaire was estimated through a panel of experts related to the field of the study, and its reliability was determined through a pilot study which was carried out on 105 patients who were selected purposively from the patient were admitted those who have undergone the procedure at Cardiac Specialty Hospital in Slemani city. Most 70.4% of the participants were male and the majority 212 (84.8%) were Kurdish and more than a quarter of the patient’s age was in group 60 years and above. Among 250 patients, 202 (80.8%) were married and 117 (46.8 %) of study participants were illiterate, 171 (68.4%) of them were unemployed, and 148 (59.2%) were lived in an urban area.
Conclusion: Our present study showed that the majority of participants had a low level of knowledge regarding CC as well as the level of knowledge from post-CC was higher than pre-CC procedure.
Key Words: patients’ Knowledge, cardiac catheterization, pre and post-cardiac catheterization, Slemani City, Iraq
Article Type: Editorial
Title: Fairer world for a healthier and safer world
Year: 2021; Volume: 1; Issue: 1; Page No: 1 – 2
Author: Priyanka Raj CK
DOI: 10.55349/ijmsnr.2021.1112
Affiliation: Deputy Editor-In-Chief, IJMSNR, Associate Professor, Department of Public Health and Epidemiology, National University of Science & Technology, College of Medicine and Health Sciences, Sohar, Al Batinah North, Sultanate of Oman. Email ID: priyankaraj@nu.edu.om
Article Summary: Submitted: 02-August-2021
Revised : 30-August-2021
Accepted : 03-September-2021
Published: 30-September-2021
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FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
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Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
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400 genes for odorant receptors.
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Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
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Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
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Characteristics of Smell:
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Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
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Structure and Function of Taste Buds:
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Location of Taste Buds:
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Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
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Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
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Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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A multivariate analysis approach on identifying of influencing factors
and the chance of development of diabetic eye disease among diabetes in
a diabetic Centre of Southwestern Malabar region of India
Amitha Prasad1
, Senthilvel Vasudevan2
1
Biostatistician Technician, IQVIA, World Trade Center Kochi (Brigarde), 7th
floor, Tower A, Info Park SEZ, Info Park Phase-1 Campus,
Kakkanad, Kochi, Kerala, India. 2
Assistant Professor of Statistics (Biostatistics and Epidemiology), Department of Pharmacy Practice, College
of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Background: Diabetic Retinopathy is a non-communicable disease and metabolic disorder. It is a public health problem in Worldwide. In
this paper, finding influencing factors and how much probability to development of DR among known T2DM patients.
Materials and Methods: This was a hospital-based cross-sectional and observational study among T2DM patients, with and without DR
in the diabetes clinic with sample of one hundred and fifty patients. Statistical analysis used chi-square and binary logistic regression analysis
was used to identify correlates of DR after controlling of confounders.
Results: In this present study, one hundred and fifty DM patients were included and in that, 39 (26%) patients had DR. Smoking habit was
strongly associated with development of DR (AOR=15.39, p=0.002), patients had history of hypertension was associated with DR
(AOR=1.10, p=0.016), medication, in that insulin users were strongly associated with DR (AOR=5.72, p=0.002), duration of diabetes mellitus
with >10 years was associated with DR (AOR=1.18, p=0.001), total cholesterol with abnormal was 5-fold more increase in risk with the
development of DR (AOR=5.86, p=0.065) but not significant, high hba1c with >6.5% was associated with the progression of DR (AOR=1.34,
p=0.035), and fasting blood sugar with abnormal was associated with the progression of DR (AOR=1.01, p=0.027) except age but, showed
positive association in bivariate with DR. The probability of developing DR in a known T2DM patient was 98%.
Conclusion: From this study, we revealed that influencing variables were hba1c, smoking habit, intake of tablet/insulin, duration of DM,
history of hypertension and fasting blood sugar. The chance/probability of developing retinopathy was very high among known diabetes
patients those who had longer duration of DM. Hence, we have recommended a periodic eye screening is mandatory in T2DM patients.
Keywords: diabetes mellitus, diabetic retinopathy, influencing factors, probability, multivariate analysis
Keywords:
Introduction
Diabetes Mellitus (DM) is called otherwise by the word “Diabetes”. DM is a non-communicable disease [1]. DM is the public health problem
in Worldwide. It is classified into two major types namely Type I DM, Type II DM [2]. Diabetic Retinopathy (DR) is a non-communicable
and metabolic disorder. It is the complication of DM. DR is also called as “eye threatening disease”. DR affects the minor blood vessels in
the retina. It is a public health problem in both developing and developing countries. Overall, in India there are 65 million people with DM,
and it would be projected to increase to 134 million in coming year 2045. [3] If the body glucose level is not maintaining correctly for a long
period, then it leads to last stage vision loss [4]. The prevalence of DR was 27% in between 2015 – 2019 based on Worldwide and in that
Proliferative DR (PDR) was 1.4% [5].
The prevalence of DR is more in male gender, urban area had more prevalence and 22.18% patients had DR. [6] Even though the literacy
rate is high in Kerala, but the prevalence of DM is 16.3% also very high and vision threatening was seen in 39.5% population. So many
studies were done with small sample size, and some studies were done with larger sample size. [7] DR progression was associated with older
age, male sex, hyperglycaemia (higher HbA1C) and with not smoking. [8] There was no separate paper related to find probability of
developing or progressing DR in DM patients. That’s why, we did this study with a reasonable sample size. The main aims of this study
was to identify the influencing factors of DR among T2DM patients and to estimate the probability of developing of DR among known
T2DM patients.
How to cite this article: Prasad A, Vasudevan S. A multivariate analysis approach on identifying of influencing factors and the
chance of development of diabetic eye disease among diabetes in a diabetic Centre of Southwestern Malabar region of India.
Int J Med Sci and Nurs Res 2021;1(2):5-9.
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-Non-Commercial-ShareAlike 4.0 International
License, which allows others to remix, tweak, and build upon the work
non-commercially, as long as appropriate credit is given and the new creations
are licensed under the identical terms.
Corresponding Author: Dr. Senthilvel Vasudevan,
Assistant Professor of Statistics, Department of Pharmacy Practice,
College of Pharmacy, King Saud Bin Abdulaziz University for Health
Sciences, Riyadh, Saudi Arabia. Email ID: vasudevans@ksau-hs.edu.sa
International Journal of Medical Sciences and Nursing Research 2021;1(2):5-9 Page No: 5
Abstract
Article Summary: Submitted:02-October-2021 Revised:02-November-2021 Accepted:08-December-2021 Published:31-December-2021
2. Materials and Methods:
A hospital-based cross-sectional and observational study was conducted
with one hundred and fifty known DM patients by simple random
sampling method were recruited and included in this study. Data were
collected from the Diabetic Centre patients in Amrita Institute of
Medical Sciences, Kochi, Kerala. This study was done in between
February and March 2018.
Selection of variables and allocation for the data analysis: In our
present study, we have considered the variables as binary variables for
the purpose of data analysis.
Gender (X1): Male = 0, Female = 1,
Age (X2): ≤50 years = 0, >50 years = 1,
Educational status(X3): School = 0, College = 1,
Family history of Diabetes Mellitus (X4): No = 0, Yes = 1,
Alcohol consumption (X5): No = 0, Yes = 1.
Smoking habit (X6): No = 0, Yes = 1,
History of hypertension (X7): No = 0, Yes = 1,
Medication (X8): Tablet Users = 0, Insulin Users = 1,
Duration of Diabetes Mellitus (X9): <10 years = 0, ≥ 10 years = 1,
Body Mass Index classification (X10): Normal = 0, Over Weight = 1,
Total cholesterol (X11): Normal = 0, Abnormal = 1,
HbA1C (X12): ≤ 6.5% = 0, > 6.5% = 1, and
Fasting blood sugar (X13): Normal = 0, Abnormal = 1 as shown in Table
– 1.
For the analysis, I have taken the variables were converted as binary
variables. We have found the association between dichotomous variables
(gender, educational status, family history of DM, smoking habit, history
of hypertension, medication, BMI classification, total cholesterol, and
fasting blood sugar) and found mean comparison between continuous
variables (age, duration of diabetes mellitus, and hba1c), with and
without variables by using Chi-Square test.
To find out the odds ratio (Probability of developing DR in a DM patient)
as follows:
Y = β0 + β1X1 + β2X2 + β3X3 + … + βiXi + … + βnXn … … … (1)
Find the value of Y and substitute in eY
, and then
P
------------ = eY
… … … (2)
1 – P
and find the value of P.
This P – value is the probability of developing DR in a DM patient.
Inclusion Criteria: T2DM patients with aged ≥30 years those who have
been lived permanently in area in and around Kochi area.
Exclusion Criteria: Patients those who had other chronic diseases and
other communicable and non-communicable diseases.
Statistical analysis: All data were entered and managed by using
Microsoft Excel 2010 [Microsoft Office 360, Microsoft Ltd., USA]
and data were analyzed by using SPSS 20.0 version for windows
[IBM SPSS Ltd., Chicago IL, USA].
Descriptive Statistics: Quantitative variables were expressed as
mean and standard deviation, and qualitative variables were
expressed as frequency, and proportions. Bivariate analysis: Chi-
Square test was used to compare dichotomous variables.
Multivariate Logistic Regression (MLR) Analysis: Binary Logistic
Regression equation (Y = β0 + β1X1 + β2X2 + β3X3 + … … … + βnXn)
with backward conditional analysis was used to find the influencing
factors in the development of DR among known T2DM patients. [9]
The statistically significant (p<0.05) variables were identified from
bivariate analysis and variables had p-value <0.20 were identified and
included in the final Binary Logistic Regression analysis. [10] The
level of significant was fixed as p<0.05.
Ethical Consideration: This study was done with prior permissions
were obtained from both the institutions before conducted. Patients’
data were obtained from the medical records and some information
from the patients directly. Patients’ data were confidential and
preserved by the AIMS institutions, Kochi, Kerala. Ethical approval
from the Institutional Review Board/Ethics Committee had been
obtained and informed all the details about the study and had got the
oral consents were taken from all participants at the time of study
period.
Results:
In our present study, two hundred T2DM patients as per inclusion and
exclusion criteria with aged thirty years and above were recruited and
included. In that, 39 (26%) patients had DR and 111 (74%) patients
were not having DR. The average age of the participants was 58.2 ±
10.5 (31–87) years. The other variables were presented in Table – 1.
In bivariate analysis, the variables duration of diabetes mellitus,
medication, duration of hypertension, smoking habit, HbA1C, and
FBS were showed statistically significant with and without DR with
p<0.05. So, these variables were influencing with the development
of DR among known T2DM patients.
In this study, we have used Binary Logistic Regression (BLR)
Analysis with backward conditional analysis to predict the
influencing factor to develop the diabetic retinopathy among known
T2DM patients. From the multivariate logistic regression analysis,
the results were obtained and in that, Hosmer-Lemeshow test was
showed a goodness of fit with Chi-Square value of 2.891 and p-value
was 0.941 (p>0.05). Hence, we have concluded that the selection of
prediction variables was very much suitable to the final model binary
logistic regression model was a good fit and the substitute variables.
The history of hypertension wasn’t significant in the bivariate
analysis but included in the final BLR analysis. The history of
hypertension wasn’t significant in the bivariate analysis but included
in the final BLR analysis.
Prasad A et al. A multivariate analysis approach on influencing factors and the chance of development of diabetic eye disease
International Journal of Medical Sciences and Nursing Research 2021;1(2):5-9 Page No: 6
3. Prasad A et al. A multivariate analysis approach on influencing factors and the chance of development of diabetic eye disease
International Journal of Medical Sciences and Nursing Research 2021;1(2):5-9 Page No: 7
Table: 1 Distribution of basic and clinical characteristics of
with and without Diabetic Retinopathy among Type 2 Diabetes
Mellitus patients
Variables
No. of Patients
n (%)
Diabetic Retinopathy
With DR Without DR
Gender (X1) Male 85 (56.7) 20 (23.5) 65 (76.5)
Female 65 (43.3) 19 (29.2) 46 (70.8)
Age groups
(in years) (X2)
≤ 50 34 (22.7) 60.38 9.06
> 50 116 (77.3) 57.37 10.84
Educational Status
(X3)
School 91 (60.7) 23 (25.3) 68 (74.7)
College 59 (39.3) 16 (27.1) 43 (72.9)
Family History of
DM (X4)
Yes 47 (31.3) 9 (19.1) 38 (80.9)
No 103 (68.7) 30 (29.1) 73 (70.9)
Alcohol
Consumption (X5)
Yes 127 (84.7) 32 (25.2) 95 (74.8)
No 23 (15.3) 7 (30.4) 16 (69.6)
Smoking Habit
(X6)
Yes 136 (90.7) 33 (24.3) 103 (75.7)
No 14 (9.3) 6 (42.9) 8 (57.1)
History of
hypertension (X7)
Yes 55 (36.7) 8 (14.5) 47 (85.5)
No 95 (63.3) 31 (32.6) 64 (67.4)
Medication (X8) Tablet Users 93 (62.0) 11 (11.8) 82 (88.2)
Insulin Users 57 (16.0) 28 (49.1) 29 (50.9)
Duration of DM
Mean (SD) (X9)
< 10 years 64 (42.7) 16.62 7.57
≥ 10 years 86 (57.3) 10.21 6.65
BMI
Classifications
(X10)
18.5 – 24.9
(Normal)
68 (45.3) 17 (24.6) 52 (75.4)
25.0 – 29.9
(Over Weight)
82 (54.7) 22 (27.2) 59 (72.8)
Total Cholesterol
(X11)
Normal 123 (82.0) 36 (29.3) 87 (70.7)
Abnormal 27 (18.0) 3 (11.1) 24 (88.9)
HbA1C (in %)
Mean (SD) (X12)
≤ 6.5 30 (20.0) 8.94 2.12
> 6.5 120 (80.0) 7.97 1.83
Fasting Blood
Sugar~
(X13)
Normal 14 (10.4) 2 (14.3) 12 (85.7)
Abnormal 121 (89.6) 33 (27.3) 88 (72.7)
In the third step of backward elimination only, the variables smoking
habit, β-regression value=0.002, Adjusted Odds Ratio, [AOR:15.39;
95%CI:(2.66–89.18); p=0.002], (p<0.05), was 15-times more risk than
non-smokers. History of hypertension, β-regression value=0.013,
[AOR:1.10; 95%CI:(1.02–1.18); p=0.016], (p<0.05) with hypertension
10% increase in risk in the development of DR. Medication, β-regression
value=0.009, [AOR = 5.72; 95%CI:(1.93–16.91); p=0.002], (p<0.05). The
risk was five times more in insulin users than tablet users.
Duration of diabetes mellitus, β-regression value=0.085, [AOR:1.18;
95%CI:(1.07–1.31); p=0.001], The risk was 18% more those who had DM
≥10 years (p<0.05). Total cholesterol, β-regression value=0.001,
[AOR:5.86; 95%CI: (0.89–38.41); p=0.065], (p>0.05). The risk was 5-
times more in abnormal than normal but not significant. According to
HbA1C, β-regression value = 0.218, [AOR:1.34; 95%CI: (1.02–
1.75); p=0.035], (p<0.05). 34% risk increase as shown in Table–2.
Table – 2 List of predictor variables in the multivariate
logistic regression equation, β-Values, its significance,
odds ratios and 95% Confidence Interval
Variables in the
Multivariate Logistic
Regression Equation
β
Value
OR Significance
95% CI
Lower
Limit
Upper
Limit
Age (X2) 0.458 0.97 >0.05, NS 0.92 1.03
Smoking habit (X6) 0.002 15.39 <0.01, HS 2.66 89.18
History of HTN (X7) 0.013 1.10 <0.05, S 1.02 1.18
Medication (X8) 0.009 5.72 <0.01, HS 1.93 16.91
Duration of DM (X9) 0.085 1.18 <0.01, HS 1.07 1.31
Total Cholesterol (X11) 0.001 5.86 >0.05, NS 0.90 38.41
HbA1C (X12) 0.218 1.34 <0.05, S 1.02 1.75
FBS (X13) 0.002 1.01 <0.05, S 1.00 1.02
Constant 1.486 0.72 <0.05, S
HTN - Hypertension; DM - Diabetes Mellitus; β - Regression Values; OR -
Odds Ratio; CI - Confidence Interval, HS- Highly Significant; S -
Significant; NS - Not Significant
In bivariate analysis, the association between groups (with and
without DR) and duration of DM was showed a highly statistically
significant with p-value<0.01 as shown in Figure–1.
Figure:1 Relationship between with and without diabetes
and classifications of duration of diabetes mellitus
The other variables like medication, duration of hypertension,
smoking habit, HbA1C, and FBS were also showed statistically
significant with and without DR with p<0.05. HbA1C in the
progression of DR. Next, to find the probability of the development
of DR in a DM patient. Here, we have taken clinical data of a DM
patient with DR and in high and substitute in the equations (1) and
(2), the variables were as follows: smoking habit (X6) = yes = 1;
history of hypertension (X7) = yes = 1; medication (X8) = yes = 1;
duration of diabetes mellitus (X9) = 20 years; hba1c (X12) = 7.2%;
34.90%
14.30%
65.10%
85.90%
0% 20% 40% 60% 80% 100% 120%
≥ 10 years
<10 years
With DR Without DR
4. International Journal of Medical Sciences and Nursing Research 2021;1(2):5-9 Page No: 8
Prasad A et al. A multivariate analysis approach on influencing factors and the chance of development of diabetic eye disease
fasting blood sugar (X13) = 190 mg/dL. Substitute in equation – 1,
Hence, the binary logistic regression equation (1) became,
Y = β0 + β1X1 + β2X2 + β3X3 + … … … + β13X13 ---------- (1)
According to final multivariate logistic regression analysis, the above
equation was rewritten as follows, ie., modified (1) equation was,
Y = β0 + β6X6 + β7X7 + β8X8 + β9X9 + β12X12 + β13X13
Y = 1.486 + (0.002) (1) + (0.013) (1) + (0.009) (1) + (0.085) (20)
+ (0.218) (7.2) + (0.002) (190)
Y = 4.160
Therefore, eY
= 64.072 and Substitute, the value of eY
= 64.072 in
the equation (2), We have got following,
P
------------ = eY
------------------ (2)
1 – P
P
------------ = 64.072
1 – P
P = 0.984 ~ 98%
Hence, the probability of developing DR was P = 0.984 (Odds Ratio).
So, the probability of developing DR in a known T2DM patient was
estimated as 98%.
Discussion:
This is the study in Kerala related to find the influencing factors and
probability to the progression of DR in diabetic patients. DR is one of
the public health problems in Worldwide. [3] DM patients have not
controlled their blood glucose level over a period of time then, they
will have to effect by retinopathy. If not screened in time and not
properly controlled the risk factors then, it will affect the retina and it
will cause to vision loss. In bi-variate analysis, duration of DM,
medication, total cholesterol, HbA1C, fasting blood sugar were showed
a significant with development of DR. But body mass index wasn’t
showed any significance with the progression of DR.
In the final statistical model in the BLR analysis the variables HbA1C,
FBS, smoking habit, intake of tablet/insulin, duration of DM and
history of hypertension were only showed a significant with the
development of DR. In our present study, the newly diagnosed with
Type 2 DM patients, 26% had DR. After the multivariate analysis the
related factors, smoking was a prominent risk factor in the development
of DR. ie, smoking habit was very highly significantly associated with
DR (AOR = 15.39, p=0.002). Similar type of result was mentioned by
Kumari et al. [11] In some other studies that the history of smoking
was found as a factor of DR development. [12, 13] Medication ie.,
insulin use [AOR = 5.72, 95%CI:(1.93–16.91)]; p<0.05. Similar
results were found by Kumari et al. [11, 14] History of hypertension
was a risk factor in the progression of DR. Similar type results were
determined by Hong et al., Pradeepa et. al. [15, 16] But, in our study
also the history of hypertension was showed a significant association
in the progression of DR.
Duration of diabetes mellitus 10 years or longer was showed a
significant factor in the development of DR in diabetes. Similar type
result was found by Roberts et. al., Kawasaki et. al. [17, 18] HbA1C was
a risk factor and association with the development/progression of DR.
The same type of results was found by Song et al. [19] In this study, we
have got total cholesterol was a prominent risk factor with 5-fold with
DR and it was an influencing with the development/progression of DR
but not showed any significant with DR in the multivariate analysis.
In a study by Abougalambou and Abougalambou. [20] have obtained
fasting blood sugar was a risk factor in the progression of retinopathy.
Brambilla et al. has also arrived similar result in the study. [21] There
was a positive correlation between DR and age with 60 years and above
but, not showed any significant with DR development. But in a study
by Stratton et al. has determined the older age was associated with the
progression of DR. [22]
Conclusion: From this study revealed that the influencing
variables were HbA1C, smoking habit, intake of tablet/insulin, duration
of DM (longer years), history of hypertension and fasting blood sugar
in a known T2DM patient. The chance/probability of developing
retinopathy was very high among diabetes patients those who have had
longer duration of diabetes mellitus. Hence, we have to recommend to
the diabetic/retinopathy patients to get health education and eye care
from their family physician/endocrinologist/authorized diabetic/retina
Centre public health professionals. Moreover, the diabetic patients have
to go for a periodic eye screening once in six months to prevent from
the development of DR, or to avoid, or to retain in the same severity
stage or to rescue themselves from loss of eye sight.
Acknowledgement: The authors are thankful to the Medical-Director,
Medical Superintend, Head of Retina Centre, and Head of the
Department of Biostatistics of Amrita Institute of Medical Sciences,
Kochi, Kerala for their support and guidance to proceed the study.
Authors’ contributions: AP, SV: Conception and Study design; AP:
Acquisition of Data; AP, SV: Data processing, Analysis and
Interpretation of Data; Both the authors – AP and SV were drafting the
article, revising it for intellectual content; Both authors were checked
and approved of the final version of the manuscript.
Here, AP – Amitha Prasad; SV – Senthilvel Vasudevan
Source of funding: None
Conflict of interest: None
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