Madhur Bhattarai

By Madhur Dev Bhattarai

Part of the book: Evidence Based Medicine

By Madhur Dev Bhattarai

Axis deviation indicates possible presence of various conditions. It also affects the QRS and T morphologies. The limits of axis deviations are as such arbitrary and the approximate degree of axis itself can be easily determined. Various conditions often shift the QRS axis without fulfilling the defined limits of deviations in the initial stage. The associations with various conditions may be missed if such partial shift of the axis is disregarded. Isolated left axis deviation is relatively common in the general population and left anterior fascicular conduction delay is the most common cause of such isolated leftward shift of axis. Vulnerability of left anterior fascicle to interruption makes it likely to be affected by both atherosclerosis and fibrodegeneration. Glucose intolerance may increase the risk of both atherosclerosis and fibrodegeneration. The association of glucose intolerance with leftward shift of axis has been increasingly noticed. Research studies to get further evidences are required; however, utilizing the already available evidences to protect the susceptible population is equally essential. Documenting the approximate degree itself of the axis is the bottom line to study the association with the levels of various possible risk factors like glycated hemoglobin.

Part of the book: Interpreting Cardiac Electrograms

By Madhur Dev Bhattarai

Apart from stopping smoking, controlling hypertension and using statin, losing possible excess bodyweight and regular physical activity and exercise are the cornerstones in diabetes management. There is often need of controlling blood glucose immediately. Approach of ‘dynamic dose management of medications likely to cause hypoglycemia’ helps to control high blood glucose immediately as and when required with sulfonylurea or insulin and to taper off their dose later. Anti-hyperglycemic medications which are unlikely to cause hypoglycemia are continued to control hyperglycemia. The diagnosis of gestational diabetes usually made at 24-28 weeks is applicable for clinical management of mother and child and for possible prevention of diabetes later in the mother. From the public health perspectives, however, protection of the susceptible in utero population from maternal malnutrition or clinical or subclinical hyperglycemia right from the time of conception itself also needs to be considered to control the diabetes epidemic at the population level. Campaigns and programmes for maintenance of optimal pre-pregnancy body weight as per the recommended body mass index of the respective populations along with regular physical activity and exercise during pregnancy are the essential measures available at hand to prevent the possibility of maternal hyperglycemia right from the early pregnancy.

Part of the book: Diabetes and Its Complications