Diabetes mellitus: A substantial factor of hearing loss in adults

Background: Diabetes mellitus is considered as most prevalent non-communicable disease throughout the world. It is associated with many complications. Hearing loss among diabetics is a recent concern, its magnitude and pathophysiology are not yet clearly defined. Aim and Objectives: The present study aimed to determine the relation between diabetes and hearing loss. Materials and Methods: The present study was conducted with 200 diabetes mellitus patients aged between 20 and 50 years, selected from endocrinology outpatient department, SCB Medical College and Hospital, Cuttack. Participants were subjected to pure tone audiometry at the department of ENT. Two hours PGBS (75 g) value was collected. Results: About 58% of the participants were detected with sensorineural hearing loss. There was a significant association of hearing loss with the duration of diabetes and glycemic status (with P < 0.05). Conclusion: The hearing loss found among diabetics showed strong association with the duration of the disease and the glycemic status. If detected earlier in its course, long-term complications of hearing can be avoided.

Study on electrophysiological changes of peripheral nerves in type 2 diabetes mellitus

Background: Peripheral neuropathy is a common and disabling complication due to diabetes mellitus. In such neuropathy, the function of sensory neurons, motor neurons, and autonomic functions are affected. The involvement of sensory function predominates in majority of cases. The neuropathy when develops is not reversible and also can not be stopped with any modality of treatment. Aim and Objectives: The objective is to evaluate diabetic neuropathy using the electrodiagnostic studies which are considered as a valuable tool. These studies are sensitive, specific, reproducible, and easily standardized. Material and Methods: Forty patients were subjected to electrodiagnostic study to evaluate the status of peripheral nerves in type- 2 diabetic patients. The different conduction velocities (motor nerve conduction velocity [MNCV], sensory nerve conduction velocity [SNCV]), distal latency (DL), nerve action potential (sensory nerve action potential [SNAP], and combined muscle action potential [CMAP]) are studied. All the cases were divided into two groups based on normal and abnormal diabetic neuropathy score. Sex, body mass index matched thirty numbers of healthy adults of both sexes were included in the control group. Nerve conduction study (NCS) of all the three groups were compared. Result: Neuropathy mostly peripheral was observed in 15 (37.5%) cases. The age of majority of cases was from 50–60 (45%) with mean age of 52.42 ± 7.39, having predominance of male (66.67%) in cases with symptoms of neuropathy. Fourteen (93.33%) cases out of the above cases had abnormal NCS. Abnormal NCS was also found in cases without clinical neuropathy, i.e. 14 (56%). The mean values of CMAP, SNAP, MNCV, and SNCV with prolonged DL are observed which was statistically significant. The conduction defect was observed more in lower limbs than in upper limbs. In the category of the motor nerve (common peroneal) is the most affected whereas the most affected sensory nerve was Sural nerve. Conclusion: Affection of nerves with neuropathies due to diabetes was in Sensory nerve than motor nerve. Early screening for neuropathy in clinical practice with NCSs can help in early diagnosis and their management.

Susceptibility characterisation of Candida spp. to four essential oils.

In the present investigation, anti-Candida activity of four essential oils i.e. Black cumin (Nigella sativa), Curry leaf (Murraya koienigii), Ajwain (Trachiyspirum ammi), and Betel leaf (Piper betel) were screened against four human pathogenic species of Candida viz. Candida albicans, Candida tropicalis, Candida glabrata, and Candida parapsilosis. The minimum inhibitory concentration (MIC) values of the oils ranged between 15.62 and 250 l/ml while studied through tube dilution method. The oils retained their anti-Candida activities even after heat treatment (at 45ºC, 60ºC, 100ºC for 1 hour) and also on autoclaving. Both Ajwain and Black Cumin leaf oils showed better anti-Candida activity against Candida albicans, resulting in an irreversible damage to the cells. The anti-Candida activity of these essential oils could be attributable to the membrane inhibition mechanism. The activity of the oils is reported to be microbicidal (Candida-cidal).

Association of mycobacterium tuberculosis in the causation of Eales' disease: An institutional experience.

Background: Eales’ disease is an idiopathic retinal vasculitis characterized by retinal infl ammation, ischemia, and neo-vascularisation. It frequently causes massive vitreous haemorrhage and retinal detachment leading to blindness. Although the exact etiology is unknown, this condition is considered to be a consequence of hypersensitivity reaction to tubercular protein due to previous Mycobacterium tuberculosis (M. tuberculosis) infection. This study is aimed at the detection of association of M. tuberculosis in patients with Eales’ disease. Materials and Methods: A prospective case-control study was undertaken in 65 clinically diagnosed cases of Eales’ disease. Patients with proliferative diabetic retinopathy, neo-vascular proliferation, macular oedema, premacular fi brosis and tractional retinal detachment were taken as controls. M. tuberculosis DNA was detected (MPT64 gene by polymerase chain reaction, PCR) in patients with Eales’ disease. Clinical symptoms along with tuberculin skin test (TST) and erythrocyte sedimentation rate (ESR) were used as gold standard for comparing results of PCR. Result: PCR positivity was found in 12 (38.7%) patients with Eales’ disease. The PCR positivity was signifi cantly associated with the patients with high TST reading and high ESR values. Conclusion: Patients with a high TST reading and ESR value and a positive PCR in vitreous samples have a high likelihood of having M. tuberculosis as an etiology.

Corynebacterium striatum: An emerging nosocomial pathogen in a case of laryngeal carcinoma.

Corynebacterium striatum is an emerging nosocomial pathogen associated with wound infections, pneumonia and meningitis. It is also a multidrug-resistant pathogen causing high morbidity. This is a report of an unusual case of wound infection in a patient with laryngeal carcinoma. Accurate diagnosis of the infection and prompt management helped in a favourable outcome for the patient. This case highlights the role of C. striatum as an important nosocomial pathogen in immunocompromised patients.

Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient.

Primary cutaneous aspergillosis is a rare entity, usually caused by A. fumigatus and A. flavus . Here, we present such a case, manifested by ulceration due to A. niger, which remained undiagnosed for a prolonged period. The immunological status was intact, although the patient had associated severe fungal infection. Recurrence of the lesion occurred despite repeated anti-fungal therapies. Anti fungal testing was done based on the broth dilution (M-38A, NCCLS, USA) method. The culture isolate was found to be sensitive to fluconazole and amphotericin B. Continuation of antifungal therapy improved the symptoms, reducing the size of the lesion.

Platelet estimation: its prognostic value in pregnancy induced hypertension.

Thrombocytopenia is an associated phenomenon of Pregnancy induced hypertension (PIH). But the accurate count of platelets either by manual, (direct or indirect methods) or by automated cell counters is not feasible for all patients at all hospitals. Therefore we have adopted the method of platelet estimation, not platelet count as an alternate procedure to estimate the degree of thrombocytopenia in patients with PIH cases. We included 30 normal pregnant women and 90 pregnant women with varying degree of PIH. Blood platelets were estimated by an accepted manual method. Platelet numbers were found to be 2.38 lacs/mm3 +/- 0.33 in control group, 2.23 lacs/mm3 +/- 0.19 in mild PIH, 1.82 lakhs/mm3 +/- 0.45 in pre eclampsia and 1.21 lacs/mm3 +/- 0.49 in eclampsia. This indicated that there is an inverse relationship between the severity of PIH and platelet numbers. So this method of platelet estimation is useful as a rapid method of assessment in PIH. This method is not only rapid and cheap but can be done even in rural hospital settings.

Sjogren's syndrome presenting with interstitial lung disease.

We report a patient of primary Sjogren's syndrome presenting with interstitial lung disease. The clinical picture was dominated by respiratory symptoms leading to a delay in diagnosis.

A review of association of dietary factors in gallbladder cancer.

Gallbladder cancer (GBC) is the prominent malignancy of hepato-biliary tract, being the fifth most common carcinoma for gastrointestinal tract in United States. Epidemiological studies world wide have implicated dietary factors in the development of gallbladder cancer. The ecological evidences indicate considerable geographic variation in the incidence of gallbladder cancer. However the variations in GBC incidence of different populations might be partly determined by their dietary variations. Higher intake of energy and carbohydrate possibly increase the risk of gallbladder cancer. Obesity plays an important role in the causation of GBC. Adequate intake of fruits and vegetables probably reduce the risk of GBC. This nutritional preventive effect against GBC could be attributed to high content of vitamins, carotenes and fibers. They can not be too emphatically stated as the sole determinants of GBC. It is apparently clear that a variety of essential nutrients can significantly modify the carcinogenic process. Furthermore, an attempt has been made to establish an association between dietary factors and the occurrence of gallbladder cancer.

Prevalence of HIV among low and high risk population of eastern part of northern India.

A total of 7,904 persons visiting University Hospital of Banaras Hindu University (BHU), Varanasi, were screened for HIV antibody by ELISA and/or rapid test. The overall seroprevalence of HIV (3.17%) in this area was higher than that of Uttar Pradesh and India as a whole. The seroprevalence of HIV/AIDS among the high risk group (HRG) (6.42%) being significantly higher than low risk group (LRG) (0.37%). In the LRG, the prevalence among medical and surgical patients; and ANC (antenatal cases) was 1.17% and 0.14%, respectively. However, HIV infection was not detected in HCWs (healthcare workers), BHU students and foreigners. Among HRG, CSWs (commercial sex workers) had the highest prevalence (14.0%) and STD (sexually transmitted diseases) patients, the lowest prevalence (1.99%). The STD patients had significantly lower prevalence rate as compared to others in HRG. Majority of the HIV positive were found to be within the age group 15-44 years, with heterosexual mode as the main route of transmission. Seven HIV positive children were of 2-5 yr old age group. Majority of seropositive women (62.52%) were working in a low income jobs and were mainly infected by their spouses who was mostly migrating labourers of lower socioeconomic group and with less than primary level of education. Married females, being mainly the spouses of HIV positive males had the highest seropositivity (60.25%). These population people were directly transmitting the infection from the metropolitan cities to the rural areas of this region. Prevalence of HIV-2 was negligible as compared to HIV-1, the actual reason is yet to be explored.

Prevalence of human immunodeficiency virus infection in and around Varanasi, Uttar Pradesh, India.

Human Immunodeficiency Virus (HIV) infection is rising rapidly in the eastern Uttar Pradesh; however no data is available regarding its positivity rate. We have screened 1239 cases of various groups. HIV seropositivity rate of 0.28% was noted. These results suggest that HIV infection is spreading rapidly in this part of the country. M. tuberculosis was the commonest co-infection amongst them (29.5%). We recommend routine HIV screening of all patients of tuberculosis, especially if the persons frequent the cities, visit foreign countries where sex tourism is encouraged or stay away from their spouses for long periods as true history of sexual contact with commercial sex workers was difficult to obtain from them.

Artificial neural network and medicine.

The introduction of human brain functions such as perception and cognition into the computer has been made possible by the use of Artificial Neural Network (ANN). ANN are computer models inspired by the structure and behavior of neurons. Like the brain, ANN can recognize patterns, manage data and most significantly, learn. This learning ability, not seen in other computer models simulating human intelligence, constantly improves its functional accuracy as it keeps on performing. Experience is as important for an ANN as it is for man. It is being increasingly used to supplement and even (may be) replace experts, in medicine. However, there is still scope for improvement in some areas. Its ability to classify and interpret various forms of medical data comes as a helping hand to clinical decision making in both diagnosis and treatment. Treatment planning in medicine, radiotherapy, rehabilitation, etc. is being done using ANN. Morbidity and mortality prediction by ANN in different medical situations can be very helpful for hospital management. ANN has a promising future in fundamental research, medical education and surgical robotics.