Objective: Evaluation of patients' preferences (PP) impact on decision-making for solitary thyroid nodule management. Study Design: A retrospective review of prospectively collected data in patients with clinical solitary nodules admitted for thyroid surgery. PP survey in various management strategies included determinants of surgery, fine-needle aspiration cytology (FNAC), frozen section (FS), and PP for total thyroidectomy (TT) or total lobectomy (TL) compared to guidelines concordance. Results: Thyroid surgery was performed for 558 patients, 75.8% were females and 43.7% were international. FNAC was done in 79.8% and refused by 20.2% due to the misperception that it spreads cancer. The risk of malignancy was the reason for choosing surgery in 35.1%. FS was preferred by 87% of the patients for decision-making (TT vs TL) in our setting with available pathology resources and low FS cost. FS based decisions were more guideline-concordant (79%) with TT performed in 41% patients compared to 74.4% in PP based decisions alone (P < 0.001). 57.9% of the patients preferred surgeon authorization for decision-making when FS was unavailable. Papillary thyroid carcinoma (PTC) occurred in 85.3%. FS diagnosed PTC in 79% of the patients with malignant nodules in inconclusive FNACs (Bethesda I, III, IV, and V). Conclusion: Decisions (TT vs TL) based on PP and beliefs compared to FS based decisions were less guideline-concordant (21% vs 79%) with more TT performed (74.4% vs 41%) (P < 0.001). Advancing patients’ knowledge on their disease, guidelines, and equipoise awareness is needed for better-shared decision-making.

Aim and Objective: To find the association between polypharmacy and health consequences in type 2 diabetes mellitus (T2DM). Materials and Methods: 50 patients with multiple drugs (two or more) and morbidity, glycemic control, macrovascular complications, hospitalization, gastrointestinal disorders, cost of medicine were studied. History, physical examination, relevant investigation, and consequences of drugs were also studied. Results: Male to female: 32:18; average age: 44 years. Findings were: hyperglycemia is seen in 34 patients, hypoglycemia in 2, retinopathy in 10, coronary artery disease (CAD) by electrocardiogram (ECG) and 2D echo in 12, old myocardial infarction in 3, renal function test abnormality in 6, stroke in 2, hypertension in 15, dyslipidemia in 13, hypothyroidism in 3, and hospitalization due to any of the above in 5. Conclusion: Diabetes, a metabolic disorder, due to chronicity leads to macrovascular and microvascular complications which in turn are compelled to increase the number of medications due to uncontrolled hyperglycemia. More than two-third of patients in our study showed uncontrolled hyperglycemia. Diabetes has multiple sites and mechanisms of altered physiological and pathological processes. It is practical to have the requirement of more than two drugs when blood sugar in diabetes is not controlled. Also, it is obvious that the simultaneous use of more than one drug-having different mechanism of action appears to have an impact on treatments to control hyperglycemia. Sometimes, multiple drugs/therapy may give rise to undesirable side effects and it may be due to drug-drug or disease drug interaction. Furthermore, the activity of multiple targets by multiple drugs requires additional study. Multiple drugs in diabetes were seen more in males with geriatric age groups. Main reasons being comorbidities, which may be the main cause of morbidity and mortality, especially CAD, heart failure and diabetic cardiomyopathy. There is an indirect relationship between the glycemic control and the development and progression of clinical manifestations of comorbidities. Various comorbid diseases in diabetes require concomitant medications, that increases pill burden. Tailoring medical therapies to the patient’s biological characteristics may help to optimize disease treatment, thereby improving overall prognosis and decreasing comorbidities’ risk. Appropriate exercise and diet may reduce hyperglycemia with reduction in pill burden.

In the current COVID-19 pandemic, co-morbid metabolic syndromes are identified as important risk factors. The presence of metabolic syndrome not only increases mortality rate and probability of hospitalization but is also predicted to have a long-term impact on cognition. A decline in cognitive functioning and functional abilities can be seen in the COVID-19 survivors and it became accelerated by metabolic syndromes that include hypertension, diabetes mellitus, low HDL cholesterol, abdominal obesity, etc. In the present study, it was aimed to explore the cognitive status in COVID-19 survivors with and without metabolic syndrome. For this purpose, total 36 COVID-19 survivors participated who were divided into two groups, one with existing metabolic syndrome and the other without any significant co-morbidities. Mini-Mental State Examination (MMSE) and Brief Cognitive Rating Scale (BCRS) were administered to assess the cognitive status of the participants. Results suggest a significant difference between the groups in the domains of concentration and memory along with functioning and self-care.

Diabetes mellitus is a chronic and non-communicable disease which is also termed as “sugar” emerged as one of the leading causes of global health deterioration. It is associated with decreased physiological and psychological functioning. Age is a significant predictor to evolve diabetes mellitus. Cognitive changes due to diabetes and psychosocial distress are prominent among the population and the risk is high with increasing age range. The aim of the present study is to find out any association between age and cognitive and psychological functioning of patients with diabetes. In the present study, age range of the sample was selected as 40–60 years. A total of 60 individuals of both genders were selected; 30 individuals with diagnosis of diabetes mellitus and equal number of normal controls were included. The cognitive functioning was measured by neuropsychological tools and the psychological functioning was measured by Psychological General Well-being Index. The results indicate that in case of diabetes patients, age was found to be mostly significant and negatively correlated with cognitive and psychological functioning in comparison to normal controls. Findings from the present study suggest that age could be a predictor in changed cognitive and psychological functioning of patients with diabetes and increased age showed poorer cognitive and psychological functioning.

Background: With the advancement of diagnostic modalities, there is an increase in the number of individuals detected with thyroid nodules. There are multiple treatment options for the management of nontoxic benign nodular goiter. Radioactive iodine results in effective goiter size reduction which can be administered as out-patient basis and is an appropriate alternative for patients with higher risk for surgery. Our group have shown the effectiveness of 131Iodine therapy for nodular nontoxic goiters. We aim to determine the long-term effectiveness of radioactive iodine therapy among patients with nodular nontoxic goiter. Methods: This is a retrospective cohort study of patients with nontoxic benign nodular goiter, negative for malignancy on biopsy who underwent radioactive therapy with a follow-up of ≥36months using ultrasound studies. Thyroid size, number of nodules and size of nodules pre-treatment and ≥36months post-treatment were compared. Results: 63 patients were included with an average follow-up of 73.14 ± 34.87 months. Mean age during radioactive therapy and last follow-up was 41 ± 14 and 47 ± 14 respectively. Significant thyroid size reduction was noted in 92.06% of patients (right thyroid lobe: 47.54 ± 31.25%, left thyroid lobe 47.44 ± 31.82%) while significant reduction in number and size of nodules were noted in 96.82% and 98.41% of patients respectively. No increase in the number of nodules and no development of new nodules were noted among all patients. Conclusion: Radioactive iodine therapy for nontoxic benign nodular goiter produces a sustained reduction in thyroid size, number and size of nodules even after a long follow-up period. Hence, it is a viable alternative to surgical removal of the thyroid offering a lower risk for complication especially among patients who refuse surgery or has a contraindication to surgical management.

Diabetes is a group of diseases characterized by high levels of blood sugar for an extended period. Despite newer and effective therapy, current treatment is riddled with fundamental challenges. To overcome the adverse effects of existing drugs, regenerative medicine has emerged as an essential treatment, for which tissue engineering may serve as a foundation for the repair of pancreatic cells secreting insulin. Different polymeric scaffolds have been explored for pancreatic tissue engineering. In the current study, a continuation of our preceding work we attempt to test the role of previously synthesized agarose-chitosan coated silver nanocomposite scaffold (AG-CHNp) for the long-term growth of pancreatic cells. Pancreatic cells were isolated from BALB/c mice and were characterized by dithizone (DTZ) staining, real time polymerase chain reaction (RT-PCR), western blotting, and flow cytometry for characteristic pancreatic markers. The isolated population of cells was grown on scaffolds and its effectiveness towards insulin secretion was studied. The isolated population was found to be positive for glucagon, PDX-1 and Pax-4, while a 200-fold change transcript level of insulin was observed. The cells upon seeding on the scaffolds exhibited sustained growth and insulin secretion as confirmed by western blotting. Overall, the study demonstrates the suitability and application of AG-CHNp for pancreatic tissue engineering.

Background: This study aimed to determine long-term effect of intensive insulin therapy on prevention, progression, and development of chronic diabetes complications, both micro and macrovascular events. This study also aimed to evaluate long-term sustainability of glycemic control of patients on intensive insulin treatment. Methods: A retrospective review of adult type 2 diabetes mellitus (T2DM) patients on intensive insulin therapy for ≥7 years. Demographic data, co-morbidities, body mass index (BMI), hemoglobin A1c (HbA1c), hospitalization were collated. Majority received intensive insulin therapy with combination of premixed 70/30 given two times a day and fast short acting analogue given premeal three times a day, with the addition of glargine or degludec once a day in some. Results: Among 76 patients, 62% were males and 38% were females. Mean age at diagnosis and last visit were 53 and 65 years, respectively. At time of diagnosis, patient had the following co-morbidities: hypertension (32%), dyslipidemia (13%), non-dialyzable chronic kidney disease (CKD) (4%), thyroid disease (1%), pulmonary tuberculosis (1%). In terms of long-term complications, event rates during follow up period are as follows: 0.001 per person-year for acute coronary event; 0.002 per person-year for CKD needing dialysis, 0.009 per person-year for cerebrovascular accident. There were no blindness and amputation observed. There is a statistical difference between HbA1c levels at time of diagnosis (8.53 ± 1.86) and last follow up (7.83 ± 1.71) (P = 0.00). After a median follow up of 12 years (7–22 years), glycemic control was sustained with an HbA1c of ≤7% and ≤8% in 32% and 45% of patients, respectively. Conclusion: With intensive insulin therapy, micro and macrovascular complications can be prevented significantly. Long-term sustainability of glycemic control was also achieved.