Indian Journal Of Clinical Practice
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Systematic Review of the Role of Albuminuria on Kidney Function in Type 2 Diabetes
Get PDFObjective: This systematic review explores the impact of albuminuria on renal function in patients with type 2 diabetes(T2D), assessing its role in diagnosing diabetic kidney disease (DKD) and its correlation with reduced glomerular filtrationrate (GFR). Materials and methods: A systematic review was conducted following PRISMA guidelines. Searches in PubMed,Embase, Cochrane Library, and Medline included studies from 2019 to 2023. Inclusion criteria were adults (≥18 years) withT2D, studies assessing impact of albuminuria on kidney function, including randomized controlled trials, observationalstudies, or meta-analyses. Primary outcomes included albuminuria progression, renal function decline (estimated GFR [eGFR]or creatinine clearance), and DKD progression. Secondary outcomes evaluated the safety and tolerability of interventionsmanaging albuminuria in T2D patients. Two reviewers independently extracted data and assessed risk of bias. Results: From1,748 records, nine studies involving 9,91,285 patients were included. Studies consistently showed higher albuminuria levelsto be significantly associated with reduced eGFR and increased DKD progression risk. Conclusions: Our findings underscorealbuminuria as a crucial indicator of kidney damage and eGFR as a key marker for DKD severity in T2D patients. This reviewhighlights the need for patient-centered care in managing T2D to reduce renal complications and calls for further researchto comprehensively understand DKD outcome
Consensus on Stroke Prevention in Atrial Fibrillation and Utilization of NOACs in the Real-World Setting in India
Get PDFAtrial fibrillation (AF) is the most frequent cardiac arrhythmia. Prevention of stroke and systemic thromboembolism remainsthe cornerstone of the management of AF. Even today, there are unresolved knowledge gaps in AF pathophysiology, screeningand therapeutic strategies and stroke prevention. The modified DELPHI method was used to develop the best practicerecommendations for the management of AF in a real-world setting with the participation of 500 cardiologists across India.The experts concurred that the decision to initiate antithrombotic treatment in patients with transient AF could be based onthe duration of transient AF, the co-existence of the risk factor for stroke and echocardiographic abnormalities impact thedecision. The decision to initiate anticoagulant therapy in device-detected atrial high-rate episodes (AHRE) can be decidedbased on the duration of AHRE, the burden of AHRE and the individual’s risk of stroke and thromboembolism. The benefitof early anticoagulation should be balanced with the risk of intracerebral hemorrhage (ICH), especially in elderly patientsand in severe strokes. Apixaban is the preferred drug in patients with concomitant ischemic heart disease (IHD), patientswith a history of gastrointestinal (GI) bleeding, patients with underlying malignancy, elderly patients with AF, patients withcomorbid diseases and patients with hepatic disease or renal disease. Apixaban was considered to be an affordable noveloral anticoagulant (NOAC) for Indian patients for primary and secondary stroke prophylaxis in AF patient
Scrub Typhus with Acute Bilateral Cerebellar Ataxia: A Rare Presentation
Get PDFScrub typhus, also known as Bush typhus, is a zoonotic infectious disease predominantly affecting rural and semi urbanareas. It is caused by the bacterium Orientia tsutsugamushi. Scrub typhus is predominantly seen in monsoon and post-monsoonseasons. It a vector-borne disease and has a varying clinical presentation ranging from mild acute febrile illness to lifethreatening multiorgan dysfunction. Neurological manifestations can occur in the form of meningitis, meningoencephalitis,polyneuritis cranialis, intracerebral hemorrhage; rarely, it can cause cerebellar dysfunction. Herein, we report a case of acutebilateral cerebellar ataxia, one of the rare neurological complications of scrub typhus