ABSTRACT
Background: Currently about 35 million Indians are reported to suffer from diabetes mellitus, a significant proportion of whom are either undiagnosed or diagnosed but undertreated leading to poor glycemic control. This leads to accelerated development of macrovascular complications like Peripheral Vascular Disease (PVD). As most of the patients are asymptomatic, hence, early detection and treatment of PVD in patients with diabetes mellitus carries utmost importance.Methods: The present study was undertaken in SGRDIMSAR, Amritsar on 100 patients of type 2 Diabetes Mellitus with asymptomatic PVD. The diagnostic accuracy of Ankle-Brachial Index (ABI) and pulse oximetry as a screening tool was compared against Color Doppler ultrasonography as the reference standard.Results: The sensitivity, specificity, positive predictive value and negative predicted value of pulse oximetry to diagnose asymptomatic PVD in diabetics was found to be 98.31% (95% CI: 90.91-99.96), 41.46% (95% CI: 26.32- 57.89), 70.73% (95% CI: 65.08-75.81) and 94.44% (95%CI: 70.19-99.19) respectively. The sensitivity, specificity, positive predictive value and negative predicted value of ABI to diagnose asymptomatic PVD in diabetics was found to be 77.97% (95% CI: 65.27-87.71), 97.56% (95% CI: 87.14-99.94), 97.87% (95% CI: 86.85-99.69) and 75.47% (95% CI: 65.51-83.29) respectively.Conclusions: Pulse oximetry is better than ABI for the screening for asymptomatic PVD among diabetics. However, ABI is more accurate as compared to pulse oximetry in diagnosing asymptomatic PVD in diabetics.
ABSTRACT
Background: Obesity and Diabetes mellitus are well knownrisk factors for cardiovascular diseases (CVD). Though bodyfat appears to play important role in insulin resistance, the waybody fat is distributed is also significant. Waist circumference(WC), calf circumference (CC), and wait to calf ratio (WCR)can be used as predictors of risk of CVD. This study aims toevaluate the utility of WCR as a simple non-invasive, cheaper,easy to use and non-instrumental modality which can be usedas screening tool and as an indicator of coronaryatherosclerosis and resulting cardiovascular risk in patients(OPD as well as Inpatients) with Diabetes mellitus bycorrelating WCR with Carotid Intima Media Thickness (CIMT)which itself is an established indicator for risk of CVD.Methods: 100 adult patients with Type-2 diabetes werediagnosed on the basis of latest ADA criteria. Detailed history,clinical examination, anthropometric measurements,biochemical indices were assessed for all the selectedpatients. Carotid atherosclerosis was measured by scanningthe bilateral common carotid arteries using a high resolutionUSG system with 10 MHz linear transducer. The carotid intimamedia thickness (CIMT) was measured at three points on farwall of mid and distal CCA and 1 cm proximal to dilation ofcarotid bulb. Mean value of six measurements from right andleft CCA were used.Results: There is an expected negative correlationbetween calf circumference and prevalence of abnormal CIMT(p<0.011). WCR correlated with CIMT more strongly than theindependent measures with (p<0.001) and is a good predictorof CIMT abnormality as AUC (area under the curve) is 97.7%Conclusion: Waist to calf circumference ratio is a simple noninvasive, cheaper, easy to use and non-instrumental modalitywhich can be used as screening tool in assessment ofatherosclerotic burden of the vasculature at an early stage intype 2 diabetic OPD as well as in patients. WCR will serve assurrogate marker of coronary artery disease.
ABSTRACT
The liver and skin are the organs most commonly involved in serious adverse drug reactions. Rarely a drug reaction can affect both organs concurrently. The association of drug induced liver injury (DILI) and toxic epidermal necrolysis (TEN) is even rarer and may be rarely reported. This is a case report on development of both TEN and DILI following use of piperacillin / tazobactam. We describe our experience of DILI occurring in association with TEN including the etiological agent responsible, its clinical/ biochemical characteristics and ultimate outcome.