ABSTRACT
Background: Type 2 Diabetes Mellitus has emerged as a common endocrine disorder in india. Thyroid dysfunction may complicate glycaemic control of diabetic patients. For better management of diabetes, it is necessary to detect and treat thyroid dysfunction in these patients.Methods: This was an observational study conducted at SMS Hospital Jaipur, Rajasthan, India, between March 2016 to November 2017. Total 100 patients were included out of which 50 were Diabetic patients and 50 were age and sex matched nondiabetic controls reported in outpatient department of SMS Hospital, Jaipur. Patients of type 1 Diabetes, previously known case of thyroid disorder, patients having endocrine disorder or autoimmune disorder other than Diabetes, critically ill patients and pregnant females were excluded from study. Serum Fasting Blood Sugar, Free T3, Free T4, TSH were measured in all study subjects and results were analysed statistically to find out if there is any difference in prevalence of thyroid dysfunction in Diabetic patients and non-diabetic controls.Results: Thyroid dysfunction was present in 16 (32%) of 50 type 2 diabetics and 3 (6%) of 50 nondiabetic controls. The prevalence of thyroid dysfunction in type 2 diabetic females and males was 43.3% and 15% respectively. Mean fasting blood sugar was higher in diabetic patients having thyroid dysfunction (209.12 mg/dl) as compared to euthyroid diabetic subjects (173.58 mg/dl). Twelve (75%), out of 16 study subjects with thyroid dysfunction have secondary hypothyroidism. Three (18.75%) of them have mild (sub-clinical) hypothyroidism. One person (6.25%) has subclinical hyperthyroidism.Conclusions: Prevalence of thyroid dysfunction is higher in type 2 diabetic patients as compared to nondiabetic. Better glycaemic control is observed in euthyroid diabetic patients as compared to diabetic patients having thyroid dysfunction.
ABSTRACT
Background: Osteoporosis is commonly associated with chronic liver disease. Pathologic fracture in osteoporotic patients affects quality of life as well as decrease life expectancy. Around 40% of patients with chronic liver disease may experience osteoporotic fracture. The present study was undertaken to observe the relation of bone mineral density (BMD) with severity of liver cirrhosis along with effects of smoking and alcohol.Methods: A total of 187 liver cirrhosis patients who were admitted in SMS Hospital were taken for study and were classified into class A, B, C as per Child Turcot Pugh’s classification, after applying inclusion and exclusion criteria. All patients underwent standard laboratory testing and bone densitometric studies of the lumbar spine using dual X-ray absorptiometry (DEXA) scan. Statistical analysis done.Results: The bone mineral density was significantly low in Class C. Class C have 41 patients of osteoporosis out of 62 whereas only 16 patients have osteoporosis in Class B and only 1 case of osteoporosis in class A. Hypocalcemia and hypophosphatemia were more in class C as in comparison to class A and B. Also, chronic smoking and alcohol intake were strongly associated with the severity of cirrhosis.Conclusions: The prevalence of osteopenia and osteoporosis is higher in cirrhotic patients and significantly increases with severity. Hypocalcemia and hypophosphatemia are also associated with the cirrhosis. Thus, patients should undergo routine bone densitometry assessment and, if necessary, to be treated for osteoporosis
ABSTRACT
Background: The primary objective of the study was to assess serum free testosterone and high sensitivity c-reactive protein concentrations and their correlation with hematocrit in patients of diabetes mellitus type 2. Hypogonadotropic hypogonadism is a common defect in type 2 diabetes, irrespective of the glycemic control, duration of disease, and the presence of complications of diabetes or obesity. It has been demonstrated that about one third of male patients with diabetes mellitus type 2 have low serum free Testosterone level. Methods: We have included 50 patients of diabetes mellitus type 2 presenting to the department of medicine SMS Hospital Jaipur. Both indoor and out door patients were selected who were free of microalbuminuria and diabetic nephropathy. Primary or secondary hypogonadism, other than diabetes mellitus and anemia of other causes were ruled out. Results: Diabetes mellitus type 2 patients with low serum free testosterone levels have significantly low hematocrit values ( n= 29) (p-value <0.001) and mild anemia compared to eugonadal men ( n= 21). Their correlation was highly significant. Patients with DM type 2 who have low serum free testosterone, also have high hs-CRP concentration. Though hematocrit values were low in patients with high hs-CRP concentration but it was not statistically significant. Conclusion: At the end of the study we concluded that both a low serum free testosterone level and high hs-CRP concentration may play an important role in the pathogenesis of mild anemia and low hematocrit values in DM type 2 patients.
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For more than 50 years, warfarin has single-handedly ruled the world of anti-coagulation without any competition, whatsoever! The anticoagulant was made available in 1940 and since then no other anti-coagulant has ever been able to match it in the clinical arena. But it looks like that the advances in the field of anti-coagulation, for the first time, have seriously started to erode its base. This review takes a look at rivaroxaban, a direct factor Xa inhibitor and one of the most foremost competitors of warfarin.