Systemic inflammatory response syndrome as a predictor of poorer outcomes in diabetic foot infection: a prospective analytical study

Background: This study was done to diagnose the severity of infection in a group of hospitalized diabetic foot infection (DFI) patients based on the presence or absence of systemic inflammatory response syndrome (SIRS) and compare the outcomes.Methods: This was a single-center cohort study, in which 50 consecutive DFI patients having SIRS and 50 consecutive patients not having SIRS were included. Patients were followed for the duration of the hospital stay; parameters for glycaemic control, minor and major amputation, microbial culture, duration of hospital and ICU stay and mortality was recorded.Results: The relative risk of major amputation among the patients of DFI who presented with SIRS was 2.66 times higher compared to who was not having SIRS at presentation (95% CI, 1.56-4.55). The presence of polymicrobial infection also had a statistically significant association with the incidence of major amputation. The duration of hospital stay was ~9.5 days longer in the DFI patients who presented with SIRS compared to who was not having SIRS at the time of presentation [8.00 (4.00-20.50) days versus 17.50 (10.75-38.25) days]. DFI patients with SIRS required a significantly prolonged ICU.Conclusions: SIRS can be used as objective criteria to predict poorer outcomes in the diabetic foot infection patient and also to classify it.

Thyroid dysfunction in major psychiatric disorders in a hospital based sample.

Background & objectives: Abnormalities in thyroid hormonal status is common in major psychiatric disorders. Although the relevance of thyroid dysfunction to bipolar disorder is well-recognized, yet the association between thyroid dysfunction and schizophrenia-spectrum disorders is under-emphasized. The aim of this study was to examine and compare the rates of abnormal thyroid hormonal status in patients with schizophrenia-spectrum disorders and mood disorders in an inpatient tertiary care general hospital psychiatry unit. Methods: This was a retrospective hospital-based study on 468 inpatient samples. Data on serum thyroid stimulating hormone (TSH), T3 (triiodothyroxine), T4 (L-thyroxine), free unbound fractions of T3 and T4 (FT3 and FT4) were obtained from records of 343 patients, 18 patients were anti-TPO (anti thyroid peroxidase antibody) positive. The rates of abnormal thyroid hormonal status were compared using the chi square test. Results: Abnormal thyroid hormonal status in general, and presence of hypothyroidism and hyperthyroidism, in particular were seen in 29.3, 25.17 and 4.08 per cent patients with schizophrenia spectrum disorders, respectively. These were comparable to the rates in patients with mood disorders (23.24, 21.62 and 1.62%, respectively). Eleven of the 18 patients with antiTPO positivity had a schizophrenia-spectrum disorder. There were no gender differences. Interpretation & conclusions: Thyroid dysfunction was present in patients with schizophrenia-spectrum disorder as well as mood disorders. Autoimmune thyroid disease was more commonly seen in patients with schizophrenia-spectrum disorders compared to mood disorders. The findings reiterate the relevance of screening patients with schizophrenia-spectrum disorders for abnormal thyroid hormonal status.

Heart rate variability responses to standing are attenuated in drug naive depressed patients.

Depression has been linked to altered cardiac autonomic regulation. Previous studies have been inconsistent in terms of measurement of heart rate variability (HRV), selection of depressed patients with cardiac disorders and not controlling for co-morbid conditions such as substance use and anxiety disorders. The objective of this study is to compare the effect of posture on spectral measures of HRV in drug naive healthy patients with major depression with age and gender matched healthy controls. Spectral measures of HRV in supine position and with active standing were obtained (using Task force recommendations). Repeated measure ANOVA revealed an attenuated response in HRV parameters (HF normalized units & LH/HF ratio) to active standing in depressed subjects compared to healthy controls. We conclude that there is an impaired parasympathetic modulation in response to physiological maneuver (orthostatic challenge) in drug naive subjects with major depression (co-morbid medical or psychiatric conditions) compared to healthy controls.

Vitamin B12 deficiency & levels of metabolites in an apparently normal urban south Indian elderly population.

Background & objectives: There is no published literature on the extent of vitamin B12 deficiency in elderly Indians as determined by plasma vitamin B12 levels and methylmalonic acid (MMA) levels. Vitamin B12 deficiency is expected to be higher in elderly Indians due to vegetarianism, varied socio-economic strata and high prevalence of Helicobacter pylori infection. We therefore, studied the dietary habits of south Indian urban elderly population and measured vitamin B12, MMA red cell folate and homocysteine (Hcy) levels. Methods: Healthy elderly urban subjects (175, >60 yr) were recruited. Detailed history, physical examination and neurological assessment were carried out. Food Frequency Questionnaire (FFQ) for dietary analysis for daily intake of calories, vitamin B12, folate and detailed psychological assessment for cognitive functions was carried out. Blood samples were analyzed for routine haematology and biochemistry, vitamin B12, red cell folate, MMA and Hcy. Results: The mean age of the study population was 66.3 yr. Median values for daily dietary intake of vitamin B12 and folate were 2.4 and 349.2 μg/day respectively. Sixty two (35%) participants consumed multivitamin supplements. Plasma vitamin B12 level and the dietary intake of vitamin B12 was significantly correlated (P=0.157). Plasma vitamin B12 and Hcy were inversely correlated (P= -0.509). Red cell folate was inversely correlated with Hcy (P= -0.550). Significant negative correlation was observed between plasma vitamin B12 and MMA in the entire study population (P= -0.220). Subjects consuming vitamin supplements (n=62) had significantly higher plasma vitamin B12 levels, lower MMA levels and lower Hcy levels. There was no significant correlation between plasma vitamin B12, MMA, Hcy and red cell folate and any of the 10 cognitive tests including Hindi Mental Status Examination (HMSE). Interpretation & conclusions: Our study is indicative of higher vitamin B12 (2.4 μg/day) intakes in urban south Indian population. Thirty five per cent of the study population consumed multivitamin supplements and therefore, low plasma vitamin B12 levels were seen only in 16 per cent of the study subjects. However, MMA was elevated in 55 per cent and Hcy in 13 per cent of the subjects.

Prevalence of health related disability among community dwelling urban elderly from middle socioeconomic strata in Bangaluru, India.

Background & objectives: Research has shown that health related conditions and socio-economic factors influence disability in the elderly. We examined the prevalence of health related disability in community dwelling elderly (≥65 yr) residents in a suburb of Bangaluru, Karnataka, India, and assessed the association of disability with various socio-economic variables and current health status. Methods: Using the International Classification of Functioning, Disability and Health (ICF) disability was measured in 356 elderly in the Koramangala suburb of Bangaluru city. Various socio-economic and health related factors associated with disability were documented. Results: A total of 85 per cent of the respondents reported current medical problems. Based on a total disability score computed from the participation section of the ICF, 27 per cent of the respondents had mild disability while 37 per cent had higher level of disability. Disablement was significantly associated with age > 75 yr and impairment in cognitive and sensory functions especially hearing. Interpretation & conclusion: In this urban elderly population while majority had current medical conditions, a significant proportion did not experience any difficulties in activities of daily living. Restriction in participation in activities of daily living was more influenced by increasing age and impairment in cognitive functions and not current health status. A multidimensional measure of disability as captured by the ICF needs to be applied to other populations such as urban poor and rural elderly to get a more comprehensive picture of disability among the elderly in India.

High risk behaviours following alcohol use in alcohol dependent men.

Background & objectives: Heavy alcohol drinking and propensity to risk taking behaviour may both be associated with the occurrence of high risk behaviour. The present study was carried out to examine the association between high risk behaviours and alcohol abuse among patients admitted to an inpatient facility for treatment of alcohol dependence syndrome. Methods: Using event analysis technique, the prevalence and type of high risk behaviour as a consequence of a heavy drinking episode was identified among heavy drinkers. Four types of high risk behaviour namely road traffic accidents, violence, self-injurious and risky sexual behaviour were studied. Patients with and without high risk behaviour were compared on measures of severity of drinking, sensation seeking and impulsivity using addiction severity index, sensation seeking scale and Baratt’s impulsivity scale respectively. Results: In 300 subjects with alcohol dependence syndrome, the most common high risk behaviour was road traffic accident following alcohol use. In 193 (64.3%) subjects heavy drinking episode was associated with high risk behaviours. Compared to those without high risk behaviours, the subjects with high risk behaviours had higher scores on sensation seeking scale and addiction severity index. Interpretation & conclusions: Our findings indicated that there was a high prevalence of high risk behaviour following an episode of heavy drinking in male patients with alcohol dependence syndrome. Both, severity of drinking and personality factors were associated with the occurrence of high risk behaviour as a consequence of heavy drinking.