A study of clinico-demographic profile and ventilatory pulmonary function tests in type 2 diabetes mellitus.

Background: Type 2 Diabetes Mellitus (DM) is a non-communicable disease. DM produces damage in small blood vessels characterized by morphologic and biochemical alterations of the capillary basal lamina. These abnormalities have been observed in several organs including the lung. As the prevalence of diabetes is rapidly increasing, it would be important to study pulmonary functions in this sub group. Methods: The present observational study carried out at medicine department. It includes previously diagnosed type 2 DM patients between 31 to 50 years of age, non-smoker, non-pregnant with no major respiratory illness. Ventilatory Pulmonary Function Test (VPFT) which includes FVC, FEV1 and FEV1% were studied in all selected participants. VPFT categorized as per American Thoracic Society (ATS). All collected data analysed using Microsoft Excel 2010. Results: The total of 55 previously diagnosed Type 2 DM cases was recruited. 26 (47.2 %) & 29 (52.7 %) were male & female respectively. 21 (38.2 %) has duration of DM more than 5. 11 (20 %) & 5 (9 %) had neuropathy and retinopathy respectively. 29 (52.7 %) had abnormal pulmonary function test. The Mean FVC (84.11 ± 14.94), Mean FEV1 (84 ± 13.72) & Mean FEV1% was (100.05 ± 7.32) among the study participants. 29 (100.0 %) were restrictive type of abnormality. Conclusion: The reduced lung function is likely being a complication of diabetes mellitus. Lung functions needs to be checked periodically.

Molecular analysis of gut microbiota in obesity among Indian individuals.

Obesity is a consequence of a complex interplay between the host genome and the prevalent obesogenic factors among the modern communities. The role of gut microbiota in the pathogenesis of the disorder was recently discovered; however, 16S-rRNA-based surveys revealed compelling but community-specific data. Considering this, despite unique diets, dietary habits and an uprising trend in obesity, the Indian counterparts are poorly studied. Here, we report a comparative analysis and quantification of dominant gut microbiota of lean, normal, obese and surgically treated obese individuals of Indian origin. Representative gut microbial diversity was assessed by sequencing fecal 16S rRNA libraries for each group (n=5) with a total of over 3000 sequences. We detected no evident trend in the distribution of the predominant bacterial phyla, Bacteroidetes and Firmicutes. At the genus level, the bacteria of genus Bacteroides were prominent among the obese individuals, which was further confirmed by qPCR (P<0.05). In addition, a remarkably high archaeal density with elevated fecal SCFA levels was also noted in the obese group. On the contrary, the treated-obese individuals exhibited comparatively reduced Bacteroides and archaeal counts along with reduced fecal SCFAs. In conclusion, the study successfully identified a representative microbial diversity in the Indian subjects and demonstrated the prominence of certain bacterial groups in obese individuals; nevertheless, further studies are essential to understand their role in obesity.

Morphological abnormalities in baseline ECGs in healthy normal volunteers participating in phase I studies.

Background & objectives: Morphological abnormalities in 12-lead electrocardiograms (ECGs) are seen in subgroups of healthy individuals like athletes and air-force personnel. As these populations may not truly represent healthy individuals, we assessed morphological abnormalities in ECG in healthy volunteers participating in phase I studies, who are screened to exclude associated conditions. Methods: ECGs from 62 phase I studies analyzed in a central ECG laboratory were pooled. A single drug-free baseline ECG from each subject was reviewed by experienced cardiologists. ECG intervals were measured on five consecutive beats and morphological abnormalities identified using standard guidelines. Results: Morphological abnormalities were detected in 25.5 per cent of 3978 healthy volunteers (2495 males, 1483 females; aged 18-76 yr); the presence was higher in males (29.3% vs. 19.2% in females; P<0.001). Rhythm abnormalities were the commonest (11.5%) followed by conduction abnormalities (5.9%), axis deviation (4%), ST-T wave changes (3.1%) and chamber enlargement (1.4%). Incomplete right bundle branch block (RBBB), short PR interval and right ventricular hypertrophy were common in young subjects (<20 yr) while atrial fibrillation, first degree atrioventricular block, complete RBBB and left anterior fascicular block were more prevalent in elderly subjects (>65 yr). Prolonged PR interval, RBBB and intraventricular conduction defects were more common in males while sinus tachycardia, short PR interval and non-specific T wave changes were more frequent in females. Interpretation & Conclusions: Morphological abnormalities in ECG are commonly seen in healthy volunteers participating in phase I studies; and vary with age and gender. Further studies are required to determine whether these abnormalities persist or if some of these disappear on follow up.

Syndrome of tubulointerstitial nephritis and uveitis.

We report a case of acute tubulointerstitial nephritis and uveitis syndrome (TINU syndrome) in an elderly Indian woman. TINU is one of the rare causes of acute tubulo interstitial nephritis and is likely to be missed as there is often temporal gap between the appearance of the renal and ocular manifestations. ©

Tropical infections in the ICU.

Certain arthropod-borne infections are common in tropical regions because of favorable climatic conditions. Water-borne infections like leptospirosis are common due to contamination of water especially during the monsoon floods. Infections like malaria, leptospirosis, dengue fever and typhus sometimes cause life threatening organ dysfunction and have several overlapping features. Most patients present with classicial clinical syndromes: fever and thrombocytopenia are common in dengue, malaria and leptospirosis; coagulopathy is frequent in leptospirosis and viral hepatitis. Hepatorenal syndrome is seen in leptospirosis, falciparum malaria and scrub typhus. The pulmonary renal syndrome is caused by falciparium malaria, leptospirosis, Hantavirus infection and scrub typhus. Fever with altered mental status is produced by bacterial meningitis, Japanese B encephalitis, cerebral malarial, typhoid encephalopathy and fulminant hepatic failure due to viral hepatitis. Subtle differences in features of the organ failure exist among these infections. The diagnosis in some of these diseases is made by demonstration of antibodies in serum, and these may be negative in the first week of the illness. Hence empiric therapy for more than one disorder may be justified in a small proportion of cases. In addition to specific anti-infective therapy, management of organ dysfunction includes use of mechanical ventilation, vasopressor drugs, continuous renal replacement therapy and blood products. Timely transfer of these patients to well-equipped ICUs with experience in managing these cases can considerably decrease mortality and morbidity.

New onset fever in the intensive care unit.

Fever is defined as a core body temperature of >38.3 degrees C or 101 degrees F. About 50% of fevers in the ICU are due to infectious causes. Absence of fever in patients with infection heralds a poor prognosis. Temperatures between 102 degrees F-106 degrees F are more likely to be due to infection. The common infectious causes of fever are pneumonia, urosepsis, line infections and intraabdominal infections. Temperatures <102 degrees F or >106 degrees F are usually due to non-infectious causes like deep venous thrombosis, infusion reactions, aspiration, drug fever and the neuroleptic malignant syndrome. Fever should be distinguished from hyperthermia as antipyretics are ineffective in the latter. Inappropriate use of antibiotics selects resistant bacterial strains, but delay in treating infection could increase mortality. A structured approach is therefore required in order to correctly diagnose and treat fever in critically ill patients.

Complementary and alternative medicine in developmental disabilities.

Developmental disabilities (DD) are defined as a diverse group of severe chronic conditions due to mental and/or physical impairments. Individuals with developmental disabilities have difficulty with major life activities including language, mobility, and learning. Developmental disabilities can begin anytime during development--from prenatal up to 22 years of age, and the disability usually lasts throughout a person's lifetime. Autism spectrum disorders, cerebral palsy, mental retardation, and attention deficit hyperactivity disorder are common conditions falling within the definition of developmental disabilities. Complementary and alternative medicine (CAM) is becoming increasingly utilized in the general population for treatment of everything from the common cold to complex and chronic medical conditions. This article reviews the prevalence of different types of CAM used for various developmental disabilities.

Therapeutic interventions in cerebral palsy.

Various therapeutic interventions have been used in the management of children with cerebral palsy. Traditional physiotherapy and occupational therapy are widely used interventions and have been shown to be of benefit in the treatment of cerebral palsy. Evidence in support of the effectiveness of the neurodevelopmental treatment is equivocal at best. There is evidence to support the use and effectiveness of neuromuscular electrical stimulation in children with cerebral palsy. The effectiveness of many other interventions used in the treatment of cerebral palsy has not been clearly established based on well-controlled trials. These include: sensory integration, body-weight support treadmill training, conductive education, constraint-induced therapy, hyperbaric oxygen therapy, and the Vojta method. This article provides an overview of salient aspects of popular interventions used in the management of children with cerebral palsy.

Pharmacologic interventions for reducing spasticity in cerebral palsy.

Motor function abnormalities are a key feature of cerebral palsy. Spasticity is one of the main motor abnormalities seen in children with cerebral palsy. Spasticity is a velocity dependent increased resistance to movement. While in some children, spasticity may adversely impact the motor abilities, in others, it may help maintain posture and ability to ambulate. Thus, treatment to reduce spasticity requires careful consideration of various factors. Non-pharmacologic interventions used to reduce spasticity include physiotherapy, occupational therapy, use of adaptive equipment, various orthopedic surgical procedures and neurosurgical procedures. Pharmacologic interventions used for reducing spasticity in children with cerebral palsy reviewed in this article include oral administration of baclofen, diazepam, dantrolene and tizanidine, intrathecal baclofen, and local injections of botulinum toxin, phenol, and alcohol.

Management of pelvic inflammatory disease in adolescents.

Pelvic inflammatory disease (PID) is highly prevalent among sexually active adolescent females. The major organisms are N gonorrhoeae and C trachomatis. Diagnosis is based on historical information and clinical findings. Early diagnosis and treatment effectively reduce the incidence of complications associated with PID. Highly effective treatment regimens are available and main antimicrobials used include quinolones, cephalosporins, metronidazole, doxycycline, and azithromycin. Delay or inadequate treatment is associated with long term sequelae including tubal infertility and chronic pelvic pain. Prevention efforts should be directed towards routine screening and treatment for sexually transmissible infections, public education and provision of resources for treatment and follow-up.

Angioimmunoblastic lymphadenopathy with dysproteinemia: thoracic involvement.

Angioimmunoblastic lymphadenopathy (AILD) is a rare condition, which is difficult to diagnose as it mimics tuberculosis or lymphoma both clinically and radiologically. A case of AILD with pulmonary involvement that was initially mistaken for tuberculosis on fine needle aspiration cytology and put on antituberculous treatment for three months, is presented here. The case was subsequently diagnosed to lymph node biopsy as one of AILD.