ABSTRACT
Background: There is a high prevalence of vitamin D deficiency (VDD) in exclusively breast-fed infants in the absence of appropriate vitamin D supplementation. Objective: To evaluate the efficacy of two doses of maternal vitamin D supplementation on vitamin D levels of mother-infant pairs and to assess its effect on growth parameters (weight, length and head circumference) and bone mass of infants. Study design: Randomized controlled trial. Participants: Lactating mother-infant pairs (n=220). Intervention: Maternal oral vitamin D supplementation in two doses (group 1: 1,20,000 IU/month and group 2: 12,000 IU/month) for 12 months. Main outcomes: Maternal and infant serum 25OHD levels, and infants’ growth and bone mass. Results: There was high prevalence of VDD at baseline in mothers (94%) as well as infants (98.5%), which was reduced to 43.1% in (mothers) and 46.5% in infants after 12 months. Significantly higher median (IQR) serum 25OHD levels (ng/mL) were observed among mothers in group 1 compared to group 2 [46 (17-159) vs 18 (6-64); P<0.01] and in infants [36.5 (15-160) vs 17 (7-32); P<0.01]. No significant association was observed between growth parameters or bone mass and serum 25OHD levels of mother or infant between the two groups. Four mothers (3.6%) and two infants (1.8%) in group I had serum 25OHD>100 ng/mL, but without hypercalciuria or hypercalcemia. Conclusion: Bolus vitamin D supplementation in the dose of 1,20,000 IU/month was more efficacious in improving maternal and infant vitamin D status at 12 months, as compared to 12,000 IU/month.
ABSTRACT
Background: To study and compare cytomorphological features of histologically proven cases of benign phyllodes and cellular fibroadenoma.Methods: Smears of histologically-proven cases of benign phyllodes and cellular fibroadenoma in one year, were reviewed. The cellular fibroadenoma had epithelial and/or stromal hypercellularity. The stromal and epithelial components as well as the background cells were qualitatively and quantitatively analyzed.Results: Number, cellularity and type of stromal fragments varied significantly in two groups. Higher number, intermediate to large-sized and hypercellular stromal fragments were commonly seen in phyllodes. Hypercellular (3+ cellularity) fragments were seen in 100% cases of phyllodes against 11.1% cases of fibroadenoma. Large-sized stromal fragments were found in 100% of phyllodes while in only 11.1% cases of fibroadenoma. The ratio of number of epithelial to stromal fragments was significantly high (58.5:1) in fibroadenoma against phyllodes (1.3:1). The epithelial architecture, atypia, apocrine metaplasia and presence of cystic macrophages did not very much in the two groups. The cellularity of the dispersed cells in background did not reveal significant difference though the type of cells varied; the proportion of long and short spindle cells was higher in PT group while proportion of oval cells was higher in FA group.Conclusion: The number, cellularity and nature of stromal fragments, ratio of epithelial to stromal fragments, cellularity and type of background cells are helpful in distinguishing benign phyllodes from cellular fibroadenoma. The identification of these features can improve the pickup rate of phyllodes tumor, thereby assisting proper management.
ABSTRACT
Diabetic Retinopathy is an important cause of blindness with diabetic macular edema(DME) affecting 15% of patients 15yrs after diagnosis. The prevalence of diabetes mellitus(DM) is expected to approximately double globally between 2000 and 2030. The burden of DME is likely to increase as prevalence of DM is expected to rise by 50% globally, from 2000 to 2030. Therefore, is a major cause of concern. To study diabetic macular edema prevalence and pattern in association with severity of diabetic retinopathy in patients of type 2 diabetes mellitus. 300 patients with type 2 diabetes mellitus were included in anobservational cross sectional study. Clinical assessment was done by recording Visual acuity by Snellen's drum test, slit lamp examination, direct and indirect ophthalmoscope, fundus examination with +90 D lens, Goldman applanation tonometry, gonioscopy, Cirrus SD-OCT macula and fundus photography. Among 600 eyes, prevalence of DME was 14.0% and 24.3% in NPDR and PDR eyes respectively. Statistically, this difference was not significant (p=0.226).Among the categories of diabetic retinopathy, a significant increase in prevalence of DME was observed with increasing severity of NPDR (p<0.001). Among 87 eyes with DME, the pattern of DME was 59.8% with diffuse retinal thickening, 21.8% with cystoids macular edema and 18.4% with serous retinal detachment. Prevalence of DME was more in NPDR group increasing with severity of NPDR. The prevalence of DME pattern of diffused retinal thickening was most followed by cystoid macular edema and serous retinal detachment among those with diabetic retinopathy.
ABSTRACT
Background: Silent ischaemia is a well known cause of mortality and morbidity in type-2 diabetic patients; however the role of high-sensitive C-Reactive Protein (hs-CRP) and exercise stress echocardiography in early detection of silent ischaemia is still less understood. Methods: Seventy three asymptomatic diabetic patients were enrolled from Dr Ram Manohar Lohia Hospital, Delhi in year 2013-15 and the baseline characteristics of the patients were studied. All the patients underwent exercise stress echocardiography for screening of coronary artery disease (CAD). All the patients with positive exercise stress echocardiography underwent angiography for confirmation of coronary artery disease. The patients were divided into two groups on basis of exercise stress echocardiography result as positive and negative and the baseline characteristics and risk factors including high-sensitivity C-reactive protein (hs-CRP) concentrations were compared between two groups in cross sectional study. Results: Silent ischaemia was found in 17.81% in asymptomatic diabetic patients. The positive predictive value of exercise stress echocardiography taking angiography as gold standard was found to be 84.6%. Sensitivity of hs-CRP >3 mg/L in predicting a positive exercise stress echocardiography is 53.8% and specificity is 90%. Negative predictive value of hs-CRP ≤3 mg/L in ruling out CAD is 90.0% and positive predictive value in detecting positive exercise stress echocardiography was 53.8%. Positive exercise stress echocardiography was found to be significantly associated with hypertension (HTN) (P=0.048), smoking (P=0.018), family history of CAD (P=0.002), total cholesterol (P=0.031), serum low-density lipoprotein (LDL) concentrations (P=0.041), serum hs-CRP (P=0.001), strict glycaemic control (glycated haemoglobin <7%) (P=0.028) and final ejection fraction after exercise stress (P=0.01). Conclusion: hs-CRP and exercise stress echocardiography can be used as simple screening tool for coronary artery disease in asymptomatic diabetic patients.