Potential Association of Triglyceride Glucose Index with Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus Patients

Cardiac autonomic neuropathy (CAN) is a common and most neglected complication of diabetes, estimated to be roughly 8% in recently diagnosed patients and greater than 50% in patients with chronic disease history. The insulin resistance (IR) itself is bidirectionally associated with increased risk of type 2 diabetes mellitus (T2DM) and CAN is a predisposing factor. The primary objective of the present study was aimed to find a correlation of triglyceride glucose index (TyG index) in CAN patients along with the prevalence of CAN in T2DM patients as a secondary objective. This prevalence study was conducted on 202 patients visiting the diabetic clinic of Hamdard Institute of Medical Sciences and Research, Jamia Hamdard (HIMSR) teaching hospital in New Delhi, India who fulfilled the inclusion criteria. The Ewings autonomic function test was used for diagnosis of CAN. TyG index was calculated for patients based on fasting levels of glucose and triglyceride. The CAN was diagnosed in 62 participants out of 202 T2DM patients (overall prevalence 30.7%). The mean ± standard deviation (SD) for TyG index was 10.3 ± 0.2 and 9.5 ± 0.2 in CAN positive, T2DM patients, respectively. The difference of TyG index, in CAN positive and T2DM patients, was highly significant (P < 0.001). Further correlation analysis was performed to find an association of TyG index, duration, and age with patient groups. TyG index showed a positive correlation with heart rate during deep breathing (HRD), heart rate variation during standing (HRS), blood pressure (BP) response to handgrip and BP response to standing. Our finding highlights the TyG index, low-cost IR index, might be useful as an alternative tool for the early screening of patients at a high risk of diabetic neuropathy.

Ototoxicity by aminoglycosides a clinical study in an Apex Hospital

To study the drugs causing ototoxicity, their likely mechanism and developing rational approach for prevention and management of this therapeutic problem. Patients attending OPO and IPD with any evidence of drug-induced ototoxicity were included in the study and they were further evaluated by detailed history of drug exposure to find out drug responsible for ototoxicity and then local and audiometric examination of ear was done to find out the type and extent of hearing impairment the relevant drugs produced. 100 patients of ototoxicity caused by various aminoglycosides were studied and observed that Streptomycin is the commonest aminoglycoside and tinnitus is the commonest manifestation of aminoglycoside-induced ototoxicity. Aminogtycoside causes initial high frequency hearing loss which in severe cases also involves normal speech frequencies, a significant hearing loss had already been established in most of the patients before the hearing impairment became apparent to patients or even to prescribing physician, so these drugs should be avoided where possible or preventive measures must be applied at least in high risk individuals

Post polio syndrome: Case report and review of literature

Post-polio syndrome is a constellation of symptoms, such as generalized fatigue, muscle pain and respiratory insufficiency, which occur many years after the acute episode of poliomyelitis. This syndrome is believed to occur primarily because of overburdened motor units which lead to metabolic stress. Diagnosis is essentially clinical. In managing patients with post-polio syndrome, a multi-disciplinary approach needs to be adopted. The role of non-fatiguing exercises in improving the strength of the muscles and alleviating pain without damaging motor units has been supported by a number of studies. Other salient features of management include weight loss, use of supportive devices at joints and using positive pressure ventilation for those with respiratory insufficiency

Drug induced hearing impairmenta - pilotstudy

The aim of the study is to observe the drugs causing hearing impairment, their likely mechanism and developing rational approach for prevention and management of this therapeutic problem. Patients attending OPD and IPD with any evidence of drug induced ototoxicity were included in the study and they were further evaluated by detailed history of drug exposure and local and audiometric examination of ear to find out the type and extent of hearing impairment and drugs responsible for ototoxicity. 120 patients of ototoxicity caused by various drugs and of varying degrees were included in the study and we observed that aminoglycosides are the most common cause and tinnitus is the most common manifestation of ototoxicity. Hearing impairment is initially of high frequency which in severe cases also included abnormal speech frequencies.A significant hearing loss had already established in most of the patients before the hearing impairment became apparent to patients or even prescribing physician, so these drugs should be avoided where possible or preventive measures must be applied at least in high risk individuals