Endothelial dysfunction in a cohort of Indian patients with type-2 diabetes mellitus.

Introduction: Our aim was to study the endothelial functioning in type-2 diabetes mellitus and its correlation with factors commonly associated with type-2 diabetes mellitus like obesity and dyslipidaemia. Materials and methods: 40 patients of previously diagnosed type-2 diabetes mellitus were taken as cases and 40 matched healthy persons were taken as controls. Endothelial function was studied in both groups in accordance with the American College of Cardiology (ACC) guidelines for the ultrasound assessment of endothelial dependent flow-mediated dilation (FMD) of the brachial artery and endothelial independent flow using sublingual nitrate (GTN%). Comparisons were made and analysed statistically between the diabetics and non-diabetic matched controls. Sub-group analysis with respect to endothelial function, waist-hip ratio (WHR), body mass index (BMI), and lipid profile amongst the diabetic subjects was also made. Results: There was a statistically significant difference in the endothelial dependent dilation (4.57 ± 2.01 versus 10.38 ± 1.77 P value < 0.0001) as well as endothelial independent function (11.63 ± 2.01 versus 13.42 ± 1.92 P value 0.001) between the diabetics and non-diabetics. An inverse correlation with the endothelial function and BMI, WHR, and various parameters of the lipid profile amongst the diabetics was also demonstrated. Conclusion: Endothelial dysfunction by brachial ultrasound was found to be significantly higher in a cohort of Indian type-2 diabetics, with positive correlation with BMI and WHR as well as presence and degree of dyslipidaemia. The therapeutic and diagnostic implications of these findings need to be explored.

Gastric antral vascular ectasia with aortic stenosis: Heydes syndrome.

Gastric antral vascular ectasia (GAVE) is a well-recognized albeit rare cause of gastro-intestinal (GI) bleeding. It classically presents in an elderly female as iron-deficiency anemia due to chronic blood loss. The association of GI blood loss with aortic stenosis (AS) has been popularized as Heydes syndrome (HS). We report a case of an elderly woman presenting as iron-deficiency anemia subsequently diagnosed with HS.

Effect of intravenous infusion of verapamil in patients of severe hypertension.

Thirty patients with diastolic blood pressure of 120 mm Hg or more were administered a bolus dose of verapamil (0.15 mg/kg) followed immediately by an intravenous infusion at a rate of 0.005 mg/kg/min for one hour. The patients were monitored during this period and three hours following the discontinuation of the infusion. The systolic, diastolic and mean blood pressures before verapamil administration were 221.4 +/- 7.5, 134.3 +/- 2.7 and 163.4 +/- 4.1 mm Hg respectively, which decreased to 170.1 +/- 5.2, 99.1 +/- 3.7 and 122.8 +/- 3.6 mm Hg after intravenous bolus of verapamil. The fall in all the levels of blood pressure was significant (p less than 0.001) and was maintained at the lower levels throughout the infusion period and even three hours after discontinuation of the therapy. No untowards effects were observed and there was no significant change in heart rate and electrocardiogram. It, thus, proves to be an useful addition to the therapeutic armamentarium in the acute management of severe hypertension.