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Objective:The objective of this paper was (1) to study the prevalence of latent autoimmune diabetes in adult (LADA) in the region of north-eastern Uttar Pradesh, India, based on the positivity for glutamic acid decarboxylase 65 (GAD65) antibodies and (2) to compare the glycemic profile between GAD65-positive and GAD65-negative subjects. Materials and Methods?The subjects were of more than 30 years of age, with either recently diagnosed pre-diabetes/diabetes presenting with the hemoglobin A1c (HbA1c) level of ?5.7% or already diagnosed cases of type 2 diabetes mellitus (T2DM) who had no requirement of insulin therapy for at least 6 months from the time of their diagnosis. All the patients were natives of north-eastern Uttar Pradesh. The GAD65 test was done by the enzyme-linked immunosorbent assay. Further, the glycemic status of GAD-positive and GAD-negative subjects were compared on the basis of fasting blood sugar (FBS), fasting insulin (FI), and homeostatic model assessment for insulin resistance (HOMA-IR). The “unpaired t-test” was used to compare and assess the significance of differences between the glycemic profile of GAD65-positive and GAD65-negative subjects using the GraphPad Prism Scientific Software, San Diego, CA, United States. The p-value of <0.05 was considered to be significant. Results?A total of 77 patients were included in the study, with the age group ranging from 30 to 75 years (47.81?±?12.9 years) with the male–female ratio of 1:2.6. The prevalence of LADA was found to be 51.95%. On comparing GAD65-positive and GAD65-negative groups, a higher value of HbA1c levels and FBS were found in the former, whereas FI and HOMA-IR were found to be higher in the latter. On testing for significance of difference, only FI and HbA1c values were significant (p-value <0.0001). Conclusion?LADA can no longer be considered a rare type of diabetes mellitus, with the present study showing a high prevalence of LADA in this north eastern region of Uttar Pradesh. Identification of adult-onset diabetics accurately as LADA or true T2DM is very crucial for the appropriate treatment, as LADA patients require insulin inevitably and much earlier than true T2DM patients, who can be managed mostly on oral hypoglycemic agents with seldom requirement of insulin
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Background: There is paucity of information regarding the effects of cholecystectomy on serum lipid profile parameters and blood glucose levels in the patients of cholelithiasis. Therefore, this study was undertaken to compare some serum lipid parameters and blood glucose levels in patients of cholelithiasis and effect of cholecystectomy on the same.Methods: The study was conducted on 50 patients of cholelithiasis who were admitted in Surgery department, MLN Medical College over a period of one year and were planned for cholecystectomy. Complete lipid profile (which included total cholesterol, triglycerides, high density lipoproteins (HDL) cholesterol, low density lipoproteins (LDL), very low density lipoproteins (VLDL) and atherogenic index) and fasting blood glucose was evaluated pre-operatively and post-operatively on the 3rd, 7th and further after 1 month of cholecystectomy. Results: Out of 50 patients, maximum of 38% were in their 4th decade with females constituting 82% of total. There was significant elevation in fasting blood glucose and HDL cholesterol on 3rd, 7th and 30th day post-cholecystectomy as compared to pre-operative values (p value<0.0001). Triglyceride and VLDL cholesterol elevated on 3rd and 7th day but it significantly decreased one-month post-cholecystectomy as compared to pre-operative levels (p value<0.0001). However, LDL, total cholesterol and atherogenic index significantly decreased on 3rd ,7th and 30th day post-cholecystectomy.Conclusions: Cholelithiasis is an important cause associated with significant pathological changes in many lipid profile parameters, which will return towards normal after cholecystectomy. This normalization will be a time dependent phenomenon with long term beneficial effects.
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Incidence of new cases of a severe form of unchecked primary hyperparathyroidism is decreasing day by day. Here, we report the case of a 40-year-old female patient of primary hyperparathyroidism with a maiden visit to the hospital with multiple osteolytic lesions and multiple pathological fractures. The diagnosis was installed and managed accordingly
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Choristomas are tumor like mass that are aggregates of microscopically normal tissue in an abnormal location. Commonly reported choristomas are of Osseous, Cartilaginous, Glandular and Glial types. The oral cavity is an unusual site of presentation where the most common site is dorsum of the tongue. Ventral aspect is an extremely rare site with only four cases reported till date. We report here a case of a 24-year-old male who presented with a small swelling on the ventral surface of the tongue. The histopathological examination revealed features of a well-circumscribed mass composed of exclusively mature cartilage encased within a dense fibrous connective tissue. The case is presented for its double rarity of site which is a ventral surface of the tongue and the histopathology which revealed a pure form of cartilaginous choristoma
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Objectives: To document the dose received by brachial plexus (BP) in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck squamous cell carcinoma (HNSCC) and report the incidence of brachial plexopathy. Methods: Newly diagnosed patients of HNSCC treated with radical or adjuvant IMRT were included in this retrospective study. No dosimetric constraints were applied for BP maximum dose equivalent dose (EQD2 α/β = 3). Patients with minimum 6-month follow-up were included and patients with suspicion of plexopathy were evaluated further. Results: Sixty-seven patients were eligible and 127 BP were analyzed. The mean BP maximum dose (BPmax) was 62.4 Gy (+6.9), while mean BP volume was 28.1 cc (+4.1). Proportion of patients receiving BPmax >66 and >70 Gy were 34.7% and 14.2%. The mean BPmax for T4 tumors was significantly higher than T1 tumors (65 vs. 57.5 Gy, P = 0.005) but when adjusted for N-category, T-category was not independently significant in accounting for BPmax >66 or >70 Gy. Mean BPmax for N0 versus N2+ was 59.8 versus 65.6 Gy (P = 0.0001) and N1 versus N2+ was 61.6 versus 65.6 Gy (P = 0.018). After adjusting for T-category, patients with N2+ had a mean 4.2 Gy higher BPmax than N0-N1 (P = 0.0001). Stage III–IV patients had a mean six Gy higher BPmax doses than Stage I–II disease (P = 0.0001). With a median follow-up of 28 months (interquartile range 16–42), no patient had brachial plexopathy. Conclusion: Clinically significant plexopathy was not seen in spite of majority having over 2-years follow-up and a third of patients having dose above the recommended tolerance. Only nodal category independently influenced dose to the brachial plexii
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Background and Aims:A large proportion of patients with diabetes mellitus suffer from preventable vascular angiopathies. Alteredplatelet structure and functions have been linked with these vascular complications. Hence, this study was undertaken to correlateplatelet indices and high-sensitivity C-reactive protein (hs-CRP) levels with glycemic control and vascular complications to assesswhether they can be used as predictive factors.Materials and Methods: A total of 56 non-diabetics (control) and 145 diabetic patients were enrolled in this study. Criteria of fastingblood glucose ?126 mg/dL/postprandial plasma glucose (2 h) levels >200 mg/dL/HbA1c ?6.5 were considered. The diabetic groupwas further subdivided into diabetics without (82) and with complication (63) on the basis of clinical presentation, investigation, andexamination. Platelet indices (mean platelet volume [MPV], platelet distribution width [PDW], and platelet large cell ratio [P-LCR])were assessed on complete blood count analyzer. hs-CRP was done qualitatively and those samples which tested positive were assessedquantitatively.Observation: All the three platelet indices assessed - MPV, PDW, and P-LCR were significantly higher in diabetics compared to nondiabetic group and increased with increasing HbA1c level. However, only P-LCR showed a significant difference between diabetics withand without complications (P = 0.002) and MPV showed a significant difference among all the subgroups when correlated with HbA1c(P ? 0.04). For hs-CRP, the difference in the values was significant among the diabetics with and without complications (P = 0.01).Conclusion: A continuous increase in the value of MPV, PDW, and P-LCR with decreasing glycemic control proves that in diabeticsongoing inflammation causes persistent generation of larger platelets with enhanced activity. P-LCR should be the indice of choice forpredicting the possibility of future complication as in our study, it was the only parameter which showed significant difference betweendiabetics with and without complications