Dyslipidemia in Patients with Tuberculosis and Diabetes Mellitus

Aims : To calculate the prevalence of Dyslipidemia in patients with Mycobacterium Tuberculosis infection (Mtb) and Diabetes Mellitus (DM). Materials and Methods : A study done on 294 patients infected with Mtb were enrolled in the study. Patients infected with Tuberculosis (TB) were selected from Medicine and Pulmonary Medicine Departments in MLN Medical College Prayagraj. Patients were segregated into two groups on the basis of glucose tolerance; Abnormal Glucose Tolerance (AGT) and Normal Glucose Tolerance (NGT). Results: A total of 294 patients with TB were taken in the study, 143 patients in AGT group and 151 patients in NGT group. The average age of the patients in AGT group was 47.91 years. Among AGT and NGT, Dyslipidemia was found to be statistically significant among AGT group (p=0.01). Mean Serum Triglycerides (209.8, p<0.004) and LDL Cholesterol (144.3, p<0.0001) in AGT group. Conclusion : Patient with TB DM are more prone for Dyslipidemia and atherogenicity

Atherosclerosis and Associated Cardiovascular Risk Factors in Nonalcoholic Fatty Liver Disease and Metabolic Syndrome

Objectives: Nonalcoholic fatty liver disease (NAFLD) is a well-known contributor for the development of cardiovascular disease (CVD). Nonalcoholic fatty liver disease is considered as the liver component of metabolic syndrome (MetS). This study aimed to assess the influence of NAFLD and MetS on markers of subclinical atherosclerosis, including carotid intima-media thickness (CIMT), ankle-brachial pressure index (ABI), and to investigate the impact of NAFLD and MetS on left ventricular (LV) diastolic and systolic function. Study design: A case-control study. Materials and methods: In this case-control study, 120 cases and 90 healthy controls in the age group ranging from ?18 to ?65 years were included. Metabolic syndrome was assessed using International Diabetes Federation (IDF) criteria. Height, weight, waist circumference, body mass index (BMI), and blood pressure were measured. Liver ultrasonographic scanning was used for assessing fatty liver. To assess atherosclerosis, CIMT and ABI were used. Results: The prevalence of NAFLD was 66.7%. As compared with control subjects, patients with NAFLD had a significantly greater (p = 0.02) mean CIMT while in patients with MetS, it was not significant. Left ventricular diastolic and systolic function were significantly impaired (p = 0.03, p = 0.04, respectively) in NAFLD while only LV diastolic function was significantly (p = 0.04) impaired in MetS. There was a strong positive correlation between CIMT and triglyceride (TG) (r = 0.46, p = 0.0001), total cholesterol (TC) (r = 0.47, p = 0.0001), low density lipoprotein cholesterol (LDL-C) (r = 0.46, p = 0.0001), very low density lipoprotein cholesterol (VLDL-C) (r = 0.259, p = 0.001), BMI (r = 0.21, p = 0.003), and age (r = 0.22, p = 0.002). Conclusions: Carotid intima-media thickness, ABI, and LV diastolic function were affected in patients with NAFLD and MetS.

Can Platelet Large Cell Ratio and High-sensitivity Creactive Protein be used as Predictive Markers for Vascular Complications in Type 2 Diabetes Mellitus?

Background and Aims:A large proportion of patients with diabetes mellitus suffer from preventable vascular angiopathies. Alteredplatelet structure and functions have been linked with these vascular complications. Hence, this study was undertaken to correlateplatelet indices and high-sensitivity C-reactive protein (hs-CRP) levels with glycemic control and vascular complications to assesswhether they can be used as predictive factors.Materials and Methods: A total of 56 non-diabetics (control) and 145 diabetic patients were enrolled in this study. Criteria of fastingblood glucose ?126 mg/dL/postprandial plasma glucose (2 h) levels >200 mg/dL/HbA1c ?6.5 were considered. The diabetic groupwas further subdivided into diabetics without (82) and with complication (63) on the basis of clinical presentation, investigation, andexamination. Platelet indices (mean platelet volume [MPV], platelet distribution width [PDW], and platelet large cell ratio [P-LCR])were assessed on complete blood count analyzer. hs-CRP was done qualitatively and those samples which tested positive were assessedquantitatively.Observation: All the three platelet indices assessed - MPV, PDW, and P-LCR were significantly higher in diabetics compared to nondiabetic group and increased with increasing HbA1c level. However, only P-LCR showed a significant difference between diabetics withand without complications (P = 0.002) and MPV showed a significant difference among all the subgroups when correlated with HbA1c(P ? 0.04). For hs-CRP, the difference in the values was significant among the diabetics with and without complications (P = 0.01).Conclusion: A continuous increase in the value of MPV, PDW, and P-LCR with decreasing glycemic control proves that in diabeticsongoing inflammation causes persistent generation of larger platelets with enhanced activity. P-LCR should be the indice of choice forpredicting the possibility of future complication as in our study, it was the only parameter which showed significant difference betweendiabetics with and without complications

Regional differences in the reference blood pressure in young Indians.

This study compares the blood pressure (BP) in young population of North India and South India. Age, height and sex specific BP was estimated for 6320 North Indian subjects aged 7-18 years and compared with BP values of South Indian subjects. North Indian boys and girls had lower diastolic BP (DBP) with no difference in systolic BP (SBP) than South Indian boys and girls between 7-12 years. Between 13-18 years North Indian boys and girls had significantly higher SBP with no difference in DBP. The significant regional differences in BP distribution among young Indians suggest considering geographic location of the population in evaluating blood pressure.

Dissociation of clinical and laboratory diagnosis in hypothyroidism.

AIMS OF THE STUDY: To assess the significance of clinical versus biochemical diagnosis of hypothyroidism using a clinical scoring index and optimize the therapeutic dose of levothyroxine in Indian patients. METHODOLOGY: Three hundred and eighty eight cases of primary hypothyroidism (male:female ratio 1:5.8) were clinically classified as hypothyroid, euthyroid or inconclusive by Billewicz score. TSH estimation was repeated at 6-8 week intervals and appropriate adjustments in levothyroxine dosage made till the TSH was within the normal range. RESULTS: Of 388 biochemically confirmed hypothyroid subjects less than one fourth (21.6%) could be classified as hypothyroid, almost one half were euthyroid (48.4%) and the remaining (29.9%) fell in the inconclusive category according to Billewiz score. Of 227 patients who returned for complete follow up there was a positive correlation of replacement dose with age and initial weight in females, but not in males. Baseline TSH values were not found to have a significant correlation with the initial dose. The mean replacement dose of levothyroxine (T4) in our subjects was 109.4 +/- 24.05 microg/d (range 1.25-3.84 microg/kg). CONCLUSION: Clinical parameters alone fare poorly in establishing an unequivocal diagnosis of hypothyroidism. A biochemical confirmation is mandatory. The replacement done of T4 was found to be independent of the basal TSH level.

Use of complementary and alternative medicine by patients with diabetes mellitus.

BACKGROUND: A wide variety of alternative medicines have been traditionally used for the treatment of diabetes in India. We did a cross-sectional study to assess the use of complementary and alternative medicine by patients with diabetes attending our outpatient department. METHODS: Four hundred and ninety-three patients attending the outpatient endocrine clinic for allopathic treatment were included. They were interviewed to assess their knowledge, awareness and methods of practice of non-allopathic forms of therapy. Information on the patients' background characteristics, family history of disease, existing knowledge of their disease and therapy was obtained. RESULTS: The user rate of complementary and alternative medicine was 67.8% and this was not significantly associated with the educational or socioeconomic status of the patients. Desire for early and maximum benefit was the most common reason (86.8%) for using these remedies. The patients felt that acupressure followed by naturopathy were the most beneficial alternative therapies, while homeopathy was felt to have the least benefit in the control of diabetes. CONCLUSION: There was widespread use of complementary and alternative systems of medicine by our patients. It is therefore necessary to obtain objective data to assess the improvement in blood sugar level with, and side-effects of, these methods of treatment.