Influence of Serum Levels of Vitamin D on Insulin Resistance in Patients with Type II Diabetes Mellitus

Background: Vitamin D plays an important role in bone and modulates mineral metabolism and immune function with probable link to several chronic and infectious conditions. In vivo studies have revealed that vitamin D deficiency reduces insulin secretion capacity of the islet beta cells in pancreas. Several studies have shown a correlation between vitamin D levels and insulin resistance, nonetheless, extensive studies showing the relationship between the two are lacking especially among southern Indian population. So the present study was aimed at evaluating the relationship between vitamin D and insulin resistance by using homeostatic model assessment-insulin resistance (HOMA-IR). Materials and methods: In a cross-sectional study, 184 people among which 92 were diabetic and 92 were nondiabetic were recruited at RL Jalappa Hospital, Kolar in the Department of Medicine between May 2018 and April 2019. Fasting serum insulin (I 0), fasting plasma glucose (G0), hemoglobin A1c (HbA1C), renal function test, liver function test (LFT), lipid profile, and vitamin D levels were estimated. IBM SPSS version 22 was used for statistical analysis. Results: The prevalence of vitamin D deficiency in our study was (72) 78.2% among diabetic cases and (59) 64.1% among the nondiabetic controls, with the diabetic cases showing lower levels of vitamin D than the controls, however, it was not statistically significant. There was no significant difference in homeostatic model assessment-beta-cell function (HOMA-B) and HOMA-IR between vitamin D deficient and nondeficient groups among cases and controls. Conclusion: Vitamin D deficiency is prevalent in both type II diabetes mellitus (T2DM) as well as nondiabetic. Furthermore, there is no association between vitamin D deficiency and insulin resistance or beta-cell function.

The paradox of thrombotic thrombocytopenic purpura and the TACO challenge!

Thrombotic thrombocytopenic purpura (TTP) is a rare medical emergency characterized by the pentad of microangiopathic hemolytic anemia, thrombocytopenia, fever, renal failure, and neurological dysfunction. TTP is an infrequent condition and is a thrombotic microangiopathy. TTP is essentially a clinical diagnosis. As untreated TTP has a high mortality, diagnosis is usually presumptive and prompt treatment with plasma exchange is highly beneficial and reduces mortality significantly. Therapeutic plasma exchange with fresh frozen plasma is the standard treatment of choice for TTP. Transfusion-associated reactions may occur in some patients further complicating the disease picture and prolonging hospital stay and recovery. Transfusion-associated circulatory overload and transfusion-associated acute lung injury are the leading cause of transfusion-related mortality. We present here the diagnostic and therapeutic challenges that we faced with a young male patient who presented with fever, jaundice, and seizures.

A cross sectional study on out born neonate referral pattern and factors influencing the neonatal outcomes among the out born neonates admitted to sick newborn care units of a government teaching hospital

Background: Neonatal mortality rate (NMR) is one of the major contributors to infant mortality rate. The neonatal mortality depends on many factors birth weight, gestational age, post-natal care; it also depends on maternal social and environmental conditions which contribute to the social determinants of maternal health. This study was taken up to identify maternal social determinants contributing to outcome among outborn neonates in order to reduce neonatal deaths. The present was conducted to assess the outcome among the outborn neonates and assess the maternal social determinants of health affecting the outcome.Methods: A cross sectional study conducted in sick newborn care units (SNCU), Hassan Institute of Medical Sciences, Hassan among all out born neonates. After taking prior written consent, all mothers/bystanders of outborn neonates were interviewed using predesigned, pretested semi-structured proforma. Social factors, environmental conditions and antenatal care affecting the maternal health were collected. Neonatal outcome data was collected from SNCU register. The mothers/bystanders of outborn neonates not willing to give consent and re-admitted neonates were excluded from the study. Data analysis was done using SPSS V20.0.Results: Of 353 outborn neonates admitted, 16.1% was mortality rate. Number of antenatal care visits, consumption of iron tablets, gestational age, high risk mother, staff attending delivery, birth weight, referral time (at p≤0.5) and distance from hospital, passive smoking exposure, maternal services utilization (at p-value <0.1) were significantly associated with poor outcome among outborn neonates.Conclusions: There is need for establishment of SNCUs at sub-divisional levels.

Study Of Pulmonary Function Test In Patients Of Type 2 Diabetes Mellitus And Its Correlation With Duration Of Diabetes

Aim-Pulmonary complications of diabetesmellitus (DM) have been poorly characterized. The study was undertaken to analyze the pulmonary function parameters in type 2 diabetic patients. We correlated forced vital capacity (FVC) and FEV1/FVC in diabetic patients with duration of the disease and Glycosylated hemoglobin (HbA1c) and fundoscopic changes.Subjects and methods-Pulmonary function tests (PFTs) were recorded in 70 type 2 diabetic patients, who were divided into two groups, depending upon duration of diabetes. Group I 5 to 10 years and group II11 to 15 years .Using easy one flow pirometer, PFT parameters were recorded. The PFTs recorded were – FVC, FEV1, FEV1/FVC, and peak expiratory flow rate (PEFR). In addition HbA1c,FBS and PPBS and fundoscopic changes of all the patients was estimated.Results -In our study Restrictive lung function defect was more commonly found among patients of type 2 diabetes mellitus. Poor lung functions are in correlation with longer duration of T2DM.Conclusion -DM being a systemic disease, which also affects lungs causing restrictive type of ventilator changes probably because of glycosylation of connective tissues, reduced pulmonary elastic recoil and inflammatory changes in lungs. Lung function parameters are negatively correlated to glycemic status and duration of diabetes. Hence strict glycemic control may improve pulmonary functions.

Prevalence of genetic variants associated with cardiovascular disease risk and drug response in the Southern Indian population of Kerala.

BACKGROUND AND AIM: This study reports the prevalence of five clinically significant variants associated with increased risk of cardiovascular disorders, and variable responses of individuals to commonly prescribed cardiovascular drugs in a South Indian population from the state of Kerala. MATERIALS AND METHODS: Genomic DNA isolated from 100 out‑patient samples from Kerala were sequenced to examine the frequency of clinically relevant polymorphisms in the genes MYBPC3 (cardiomyopathy), SLCO1B1 (statin‑induced myopathy), CYP2C9, VKORC1 (response to warfarin) and CYP2C19 (response to clopidogrel). RESULTS: Our analyses revealed the frequency of a 25 bp deletion variant of MYBPC3 associated with risk of cardiomyopathy was 7%, and the SLCO1B1 “C” allele associated with risk for statin‑induced myopathy was 15% in this sample group. Among the other variants associated with dose‑induced toxicity of warfarin, VKORC1 (c.1639G>A), was detected at 22%, while CYP2C9*3 and CYP2C9*2 alleles were present at a frequency of 15% and 3% respectively. Significantly, the tested sample population showed high prevalence (66%) of CYP2C19*2 variant, which determines response to clopidogrel therapy. CONCLUSIONS: We have identified that certain variants associated with cardiovascular disease and related drug response in the five genes, especially those in VKORC1, CYP2C19 and MYBPC3, are highly prevalent in the Kerala population, with almost 2 times higher prevalence of CYP2C19*2 variant compared with other regions in the country. Since the variants chosen in this study have relevance in disease phenotype and/or drug response, and are detected at a higher frequency, this study is likely to encourage clinicians to perform genetic testing before prescribing therapy.

Preputial adhesions – A misunderstood entity.

Objective. To assess the trends and outcomes in referrals of ‘phimosis for circumcision’ to a tertiary care pediatric surgical department. Methods. This is a prospective study of 100 consecutive children of presumed phimosis referred for circumcision. They were assessed and classified by the senior author as having either preputial adhesions or phimosis. The patients in the former group underwent outpatient preputial adhesiolysis while those in the latter group were offered circumcision primarily. All were followed up till resolution. Results. All 100 were referred with a non-retractile prepuce and an additional reason – preputial ballooning at voiding, dysuria or suspect UTI. Eight (mean age -58 months, referred for preputial ballooning at voiding -6/8 and dysuria -2/8) had phimosis and were primarily offered circumcision. The remaining 92 (mean age – 22 months, referred for preputial ballooning at voiding -52/92, dysuria -28/92 and suspect UTI -12/92) had preputial adhesions. In the latter group, none has a documented urinary infection on specific investigations. These 92 underwent outpatient preputial adhesiolysis. Seventy three (79 %) required a single sitting, 11 (12%) required 2 -4 sittings and 4(4.5%) required 5-8 sittings over a follow up period of 1 -24 months (median -3 weeks). 4/92(4.5%) were deemed non-responders to adhesiolysis and were circumcised later. Conclusion. The majority of children referred with ‘phimosis for circumcision’ to this tertiary pediatric surgical centre were actually physiologic preputial adhesions that were managed with outpatient preputial adhesiolysis. This study underscores a lack of awareness amongst referring primary care physicians regarding preputial adhesions and the potential for an erroneous diagnosis of phimosis translating into unnecessary circumcisions in many young boys.

Incidence of type 1 diabetes mellitus and associated complications among children and young adults: results from Karnataka Diabetes Registry 1995-2008.

The purpose of this study was to estimate incidence of type 1 diabetes mellitus (T1DM) among children and young adults aged 0-25 years and to assess growth, glycaemic control, complications, risk factors and mortality associated diabetes mellitus,based on prospective registration of patients in Karnataka Diabetes Registry during the period 1995-2008. Complications were determined in subgroups serving as cohorts by screening tests and based on physicians' report. There were 1040 patients (514 boys and 526 girls) registered during the period 1995-2008. The overall incidence/prevalence of T1 DM (per 100,000 persons) was 3.8(0.32/10(5)/year) [males 3.7(0.3110(5)/year) and females 4(0.33/10(5)/year)]. On cross-sectional analysis of different cohorts, 88% (90/102) were below 50th percentile height, 95% (114/120) were <50th percentile of weight. Thirty-nine patients (10.7%) had poor glycaemic control (A1c>9%), The prevalence of different complications were as follows: Neuropathy 5.2% (12/230), retinopathy 8.4% (14/166), nephropathy 8.6% (20/230), hypertension 2.6% (6/230). Hypercholesterolaemia and hypertriglyceridaemia were found in 20.2% (24/119) and 41.7% (48/115) cases respectively and 18.1% (19/105) had low HDL. The percentage of patient with micro-albuminuria, high sensitive C-reactive protein were 29.6% (n=233) and 44.4% (20/45) respectively. Poor glycaemic control, hypertension and duration were strong consistent predictors of all complications. Twenty patients died during the period of which 10 deaths were related to diabetes. Though the incidence of diabetes in the young is low in our population compared to the western population, the burden of diabetes is high due to large population in our country. In spite of our best efforts there are still a huge gap between the standard of care and practice. Majority of type 1 diabetics are not reaching the ideal glycaemic targets.