International Journal of Medical Research & Review (IJMRR)
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Prevalence of vitamin B12 deficiency in Indian type 2 diabetes subjects on metformin therapy
Get PDFBackground: To find out the prevalence of vitamin B12 deficiency in Indian type 2 diabetes subjects on metformin therapy.
Material Methods: 161 type 2 diabetes subjects were studied over a period of 6 months at Karnataka institute of endocrinology Bangalore. All subjects gave written informed consent. BMI, Waist circumference, FPG, PPPG and HBA1c were estimated. Vitamin B12 levels were estimated by electrochemiluiminescence. We have excluded patients taking alcohol, vitamin B12 supplements, pregnant woman, and type 1 diabetics. Subjects whose vitamin B12 less than 200 picogram/ml were considered to be deficient in vitamin B12. Subjects who were on metformin treatment for more than 6 months were included in the study.
Results: 118 diabetes subjects were males. They were in the age group of 30 to 80 years. Duration of diabetes was 1 to <5 years in 20.5%, 5 to <10 years in 28.5% and 10 years and morein 51% of diabetes subjects studied respectively. 55.9% of subjects had positive family history of type 2 diabetes. 112 subjects were on 1000 mg metformin for one year or more and 49 were on 2000 mg metformin for one year or more. Prevalence of vitamin B12 deficiency was 27.33%.
Conclusions: The prevalence of vitamin B12 deficiency is 27.33% in type 2 diabetes subjects on metformin therapy. The percentage of deficiency increased with increase in dosage of metformin but there was no correlation to duration of metformin therapy
Insulin resistance and significance of postprandial lipid profile in normoglycemic coronary artery disease
Get PDFBackground: Coronary artery disease is a continuum of a pathological process, in which the coronary arteries gradually thicken, harden and atherosclerotic plaques develop which further occludes the blood flow. The prevalence of coronary artery disease is rapidly rising in India. There are various risk factors of CAD which have been extensively studied, out of which Type-2 diabetes is an important etiopathogenic factor of accelerated CAD. Insulin resistance plays an important role in the pathogenesis of the development of type- 2 diabetes. Despite the clear relationship between type-2 diabetes and CAD, the association of insulin resistance and CAD is more obscure in people without diabetes.
Aims & Objectives: To find the association between insulin resistance and Coronary artery disease, to evaluate the role of postprandial lipid profile and its relationship with development of CHD and the evaluation of apolipoproteins (a and b) on the same group.
Subjects and Methods: Fifty patients of coronary artery disease admitted to ICCU/CCU of psg institute of medical sciences and research were studied. The cases of this present study were 50 non diabetic CAD patients and controls were selected based on age and sex matched non diabetic ‘and non CAD patients who has to undergo similar set of investigations as cases to find out association of insulin resistance by using HOMA score and to find out the significance in abnormalities of postprandial lipid profile in these patients.
Results: 92% of the cases had insulin resistance, 52% of the controls had normal HOMA score when compared to cases. Apolipoprotein b was significantly elevated in cases (84%) than controls. All patients were normoglycemic. Serum triglycerides were significantly high in cases than controls in both fasting and postprandial states.
Conclusion: Improving insulin sensitivity would offer substantial benefits by decreasing the morbidity, mortality, and economic burden associated with CAD especially in the country like Indi
The relationship between blood sugar levels (glycosylated haemoglobin) and the risk of development of diabetic retinopathy
Get PDFIntroduction: Diabetic retinopathy is a major cause of visual impairment and blindness in India and with its early detection and timely treatment, the risk of visual loss can be reduced significantly. Onset and progression of retinopathy is determined by fasting and postprandial blood sugar levels and other risk factors such as duration of diabetes, hypertension, nephropathy, hypercholesterolemia and obesity. This study was done to evaluate the role of glycosylated hemoglobin and its association with the severity of retinopathy.
Materials and Methods: A total of 100 patients were included. This was a prospective study conducted over 1 year in Sri Ramachandra University, Chennai, India. Fundus examination was done using slit lamp biomicroscopy and indirect ophthalmoscopy on all patients. Ancillary investigations such as fundus fluorescein angiography and optical coherence tomography were performed. HbA1c was measured along with fasting, postprandial, lipid profile and urine sugars.
Results: High and uncontrolled levels of HbA1c were associated with maculopathy. A statistically significant difference (p < 0.01) was found in them. The retinopathy however was not related to HbA1C alone. The most frequent type of maculopathy noted was cystoid macular oedema and the level above which it occurred was 7% of HbA1C. Besides HbA1C, the other important factor that was associated with maculopathy was duration of diabetes mellitus.
Conclusion: HbA1c value >7.0% was significantly related with maculopathy. The severity of retinopathy is dependent on the level of blood sugar and duration of diabetes. Control of sugar levels is crucial to prevent diabetic retinopathy and its complications which can lead to irreversible complications in the eye
Can diabetes with controlled glycemic status cause placental changes and affect foetal outcome? A histomorphology study from a tertiary care centre from Eastern India
Get PDFBackground: Normal foetal development and postnatal survival depends on healthy placenta. The adverse effects of diabetes on pregnancy and related foetal outcomes are well established and through this study we have attempted to study the intensity of damage caused, by examining the gross and microscopic features of placenta along with histochemical changes.
Material and Methods: This was a prospective study undertaken in a tertiary teaching hospital in which a total of 80 cases of term pregnancy were studied, out of which 40 were from diabetic mothers and 40 were from non diabetic mothers. Biochemical parameters of all the cases were studied. All placenta were examined on the basis of gross features, histological & histochemical changes.
Results: In the present study, it was noted that gross morphology of placenta was not much altered between diabetic and normal mothers but showed marked variation in the histological findings. On microscopic examination, marked basement membrane thickening, vascular proliferation, chorangiosis, syncytial knots, villous fibrosis and edema were noted among diabetic mothers and most common postnatal complication of newborns among diabetic mothers was macrosomia.
Conclusion: This study highlights the impact of gestational and pregestational diabetes mellitus on placenta as observed by the magnitude of histological changes inspite of having controlled glycemic status either by diet or insulin and associated postnatal morbidities of newborns
Pulmonary hypertension before and after balloon mitral Valvuloplasty
Get PDFObjective: To testify effectiveness of BMV in mitral stenosis to resolve pulmonary hypertension.
Material and Method: The study was conducted at N.R.S Medical College and Hospital over 18 months with 39 patients of severe mitral stenosis with pulmonary hypertension. They were followed up at 48hours, 1 month and 6 month after BMV.
Result: 20.51% patients had mild, 41.02% patients had moderate and 38.46% patients had severe pulmonary hypertension before BMV. Mean mitral valve area before and after BMV were 0.89±0.11cm and 1.89±0.21cm respectively. Mean transmitral gradient was 15.43±2.3mm 0f Hg before and 7. 86±2.25 mm of Hg after BMV. On 3rd day, before discharge PASP became normal in 1 patient in mild group although improvement was not statistically significant (p=0.234) but statistically significant improvement of PSBP was seen in both moderate and severe groups (p=0.001). At 1m follow up PASP came down to normal in 3 patients of mild group (p=0.106). 5 of moderate and 1 patient of severe groups also improved to have PSBP ˂25 mm of Hg, the finding was statistically significant in both groups (p=0.001). The improvement in all three groups at final check up at 6m was statistically significant (p=0.001). 5 patients in each mild and moderate and 2 in severe group were found to have normal PASP.
Conclusion: In spite of significant risk, BMV is worth doing in patients with pulmonary hypertension due to mitral stenosis as there is not only dramatic relief of PH of cardiac causes but also improvement of PH due to pulmonary pathology to some extent
Prevalence of obesity among school children aged 6-18 years with special reference to differences in government and private schools
Get PDFIntroduction: In the society which is switching towards Non communicable diseases, lack of physical activity and luxurious lifestyle and long sitting area in schools have contributing a lot to emerging obesity in school age group students. Overweight and obesity in childhood continues in adulthood and increases the burden of cardiovascular disease.
Aims: is to study the prevalence of obesity among school children aged 6-18 years in government and private schools in Raipur City of Chhattisgarh with Objectives being to evaluate association of some modifiable risk factors.
Material and Methods: A cross sectional study conducted in urban schools of Raipur from March15 to April-16. Equal number of government (15) and private schools (15) were selected by cluster sampling method and all children of 6 to 18 years age group were studied. Sample size was calculated using formula 4pq/l2 which was 1640. Materials like were weighing machine, measuring tape, portable stadiometer and BMI percentile curves were used. The prevalence of obesity was calculated and associations between modifiable factors were established using Spearman\u27s chi square test. (p<0.05). Data was analyzed using SSPS (version 16.0).
Results: Prevalence of obesity is 13.46% among 6-18 in Raipur city and Prevalence of overweight is 10.54% and factors that are significantly associated with obesity are less duration of physical activity, studying in private school, Increased intake of chocolates/drinks and fast food, going school in vehicles, female gender and small playground area in school.
Conclusion: overweight and obesity are continuously expanding in our city, proper physical activity routine and dietary habits should be set intricately as best as possible
Expression of estrogen receptor, progesterone receptor and KI 67 in epithelial ovarian tumors and their histopathological correlation
Get PDFIntroduction: Expression of ER, PR and Ki 67 in epithelial ovarian tumors and their histopathological correlation analyzed by immunohistochemistry.
Methods: This study was conducted on 60 ovarian specimens received in Department of Pathology, Gandhi Medical College, Bhopal for ovarian tumors from 1st January 2012 -31st august 2016.
Results: The expression of ER was more in malignant tumor 21/26 than borderline 5/9 and benign tumors 5/25. The PR expression was more in benign tumors 14/25 than malignant 13/26 and borderline 2/9 tumors. The Ki67 expression was more in malignant tumors 22/26 than borderline 7/9 and benign 1/25 tumors.
Conclusion: In our study ER and Ki-67 positivity was maximally seen in malignant cases. This shows that ER was enhanced in ovarian carcinoma and Ki67 was proliferative marker. PR expression was maximally seen in benign tumors. This showed protective role of PR marker in ovarian carcinoma
Association between smoking and hearing status: a comparative study between smokers and non – smokers
Get PDFBackground: Smoking, age, gender, socioeconomic class and education may contribute to the hearing loss. In this study hearing loss between smokers (current and ex) and non smokers was compared.
Materials and Methods: 145 smokers [79 current (68 males, 11 females) and 66 ex smokers (60 males, 6 females)] and 145 non smokers (69 males, 76 females) were studied. Modified Kuppuswamy scale and smoking index were used. Hearing loss was assessed by Audiometry. P value of<0.05(unpaired t test and chi square test) was taken as statistically significant.
Result: Statistically significant and non significant differences were found between the mean age and educational status of current -ex smokers and smokers-non smokers respectively. Statistically significant and non significant differences were found between the socioeconomic status of smokers-non smokers and current -ex smokers respectively. Difference was significant between smoking index of current and ex smokers (p=0.003). 70.05% males had hearing loss as compared to females (49.46%). About 59.24% and 26.09% hearing loss cases belonged to low education and upper and upper middle social class respectively. 68% and 24.24% of moderate and severe smoking index were of professional to graduate educational status. 36.17% and 30.30% of moderate to severe smoking index belonged to upper and upper middle socioeconomic class. 73.91% were from low social classes. 47.59% non smokers and 25.51% smokers had no hearing loss. The severity of hearing loss was more in heavy smokers.
Conclusion: Hearing loss associated with smoking was found to be more in male gender, advancing age, low socioeconomic and educational classes
Role of lipids and free radicals in diabetic with hypertension and smokers for causation of coronary heart disease
Get PDFIntroduction: The major independent risk factors for the development of atherosclerosis are the plasma cholesterol concentration, triglyceride, cigarette smoking, hypertension and diabetes, which are by them self’s risk factor for coronary heart disease. Cardiovascular disease (CVD) threatens to cripple India’s workforce and stunt India’s growth if timely and appropriate public health measures are not instituted. Hyperglycemia, hypertension and cigarette smoking depletes natural antioxidants and facilitates the production of reactive oxygen species (ROS) which has the ability to react with all biological molecules and exert cytotoxic effects on cellular components that promotes and accelerate atherosclerosis. Hence the present study was aimed to find out collective effect of NIDDM, hypertension and cigarette smoking on lipid profile and oxidative stress in progression of CHD events.
Materials and methods: We studied 50 healthy and 50 diabetes with hypertension and or smokers patients (i. e. had two or more CHD risk factors) patients with matched for age and body mass index. Blood samples were drawn after an overnight fast. W e estimated serum triglycerides,total cholesterol, HDL-c and LDL-c and VLDL- c values were calculated by Friedwald’s equation. We also estimated the total serum lipid peroxides by reaction with thiobarbituric acid.
Results: In the control group I mean values of total cholesterol were 180.21 ± 18.13 mg %, LDL-c 106.60 ±18.2 mg%, serum triglycerides were 99.90 ± 16.14 mg %, HDL-c were 53.83 ± 16.42mg% and in the group II serum triglycerides 217.9 ± 19.1 mg% and were significantly increased as compared to group I. The serum HDL-c group II 29.6 ± 8.07mg % were significantly decreased as compared to group I (P is<0.05). The serum lipid peroxides in the group 2nd (296.9.±60.10) were significantly increased as compared to group 1st (180.96±35.16).
Conclusion: It can be concluded that patients of NIDDM with hypertension, smoking have higher total serum cholesterol, serum triglycerides, serum lipid peroxides (MDA), LDL- c and VLDL-c with lower HDL- c. These can be corrected, treated by dietary and life style modification before the development of end organ damage. For realization of exact role of lipid profile and oxidative stress further higher level studies should be done
Imaging evaluation of renal masses
Get PDFIntroduction: This article demonstrate the imaging characteristics of cystic and solid renal masses, along with a summary of identified imaging criteria that may be of use to differentiate masses that are more likely to be benign from those that are more likely to be malignant.
Aim and Objectives: To evaluate the patients with renal cancer by ultrasonography (USG) and computed tomography (CT) and to compare the findings of USG and CT.
Material and Methods: Present study was conducted on 60 patients presented with renal masses, initially evaluated with ultrasonography (USG) and later on characterization of the mass was done by using computed tomography (CT).
Results: CT has higher sensitivity, specificity, accuracy, positive predictive value and negative predictive value for renal cell carcinoma (RCC) on correlation with USG.
Conclusion: CT is capable of detecting tumor invasion of perinephric fat and adjacent muscles, which cannot usually seen by ultrasound. While both CT and ultrasound demonstrate venous and retroperitoneal tumor extension, CT is more reliable