A Comparative Study of Alanine Aminotransferase & Alkaline Phosphatase in Type-2 DiabeticPatients and Non-Diabetics.

Background: The aim of this study was to find out the liver function test abnormalities in a group of diabetic type-2 patients in Jamnagar, Gujarat and to determine the factors associated with these biochemical changes. Method: In this cross sectional study conducted at the diabetic clinic in GGH General Hospital, Jamnagar between May 2012 and April 2013, a total of 100 patients were included. Parameters like serum alanine aminotransferase (ALT), alkaline phosphatase (ALP) used. Result: Raised ALT was noted in 30 % of diabetes type -2 patients while in control group 6% had elevated value. Elevations in serum alkaline phosphatase (ALP) were found in 38 %. Mean value of ALT & ALP had no correlation with gender of the diabetes patients. In conclusion, abnormal liver function results are more common among diabetes patients. Elevated ALT and ALP are the markers for associated non alcoholic fatty liver disease in diabetes patients.

Retrograde Venous Perfusion in Chronic Ulcers of Lower Limb.

Chronic foot ulcers are difficult to treat. These patients need prolong treatment which is costly and often associated with non-compliance. These patients are vulnerable to develop gangrene leading to amputation. Retrograde venous perfusion (RVP) is a new therapeutic approach which was recently introduced to the treatment of diabetic foot as an adjunctive line to systemic therapy and local therapy. It is based on principle of regional anesthesia. Recently, Latin American investigators, applied this approach to local therapy of pedal ischemia. Since then this approach was mainly employed for therapy of diabetic neuropathic pedal ulcers. In this work, the efficacy of this approach was explored in 5 group of chronic foot disorder – 1) Diabetic foot presenting as foot infection, 2) Dibetic neuropathic pedal ulcers, 3) Diabetic pedal ischemia and infection, 4) Nondiabetic post traumatic foot ulcers, 5) Non-diabetic ischemic ulcer and pre-gangrene or gangrene. The present study was conducted on 56 patients having non healing ulcer of lower limb. Regular dressing and debridment and retrograde venous perfusion therapy was done in all patients. Results were assessed after completion of therapy. The following conclusions are drawn from the present study. Out of all diabetic patients, 23.7% of cases presented as diabetic foot. The incidence of diabetic foot patients was 64.29% out of all studied patients with ulcer foot. Maximum number of patients, 28.57% were in 31-40 years age group. The mean age of the patients was 44.4 years. There was male predominance with male and female ratio being 1.55:1. Mean reduction of ulcer size after RVP therapy was 63.89%. Maximum improvement was found in patients with diabetic pedal ischemia and infection i.e. 70% where as patients with non diabetic post traumatic foot ulcers had minimum improvement i.e. 52.22%. Whole foot or more than 4 toe amputation was not required in any patient in therapy group. After RVP therapy gangrene or pre-gangrene was prevented in 72.73% of patients. Minimum days of stay was 11-15 days in 32.14% of patients. Average duration of hospital stay was 18 days. Patients with foot ulcer in whom RVP therapy was not done, average duration of hospital stay was 31 days. This denotes that RVP reduces the time of therapy an avoids prolonged treatment. The ratio of diabetic and non-diabetic patients with neuropathy was 2.5:1. In Doppler ultrasound study, patients with sign of ischemia, ankle-brachial pressure index was less than 0.6 in 22 patients, out of them 16 patients were diabetic. After RVP therapy 93.33% of diabetic foot patients and 80% of non-diabetic foot ulcer patients ankle-brachial ratio became more then 0.8 denoting that after RVP therapy the blood flow in lower limb was increased. The present study confirms the good result in respect to decrease in ulcer size, overcome critical complications which are threatening the foot, early healing of ulcer, increase blood flow in ischemic foot, check progression of gangrene and pre-gangrene and to conserve the foot to avoid amputation. This study entailed expansion of the application of RVP to intractable post-traumatic ulcers of the foot and lower leg, as well as, to critical pedal ischemia in diabetic and non-diabetic patients.

Early diagnosis diabetic retinopathy / Монголын Анагаах Ухаан

IntroductionThere are an estimated 246 million people with diabetes mellitus globally and this figure is predictedto rise to 380 million by 2025, with the most rapid growth in developing countries, among the workingage group of the population.Now in Mongolia, the more than half of population live in cities and settlements, following thisurbanization the population`s diet and lifestyle has been changed to more western style and morepeople affected by diabetes mellitus.Diabetic retinopathy is the most common chronic and devastating complication of diabetes whichleads to visual impairment and blindness. Diabetic retinopathy develops in nearly all persons withtype 1 diabetes and in more than 77% those with type 2 who survive over 20 years with disease. Thecurrent estimates of the prevalence of diabetic retinopathy vary in different countries. The WHO hasestimated that diabetic retinopathy is responsible for 4.8% of 37 million cases of blindness throughoutthe world.Significant independent predictors of proliferative diabetic retinopathy determined by multivariableanalysis were fasting plasma glucose level, duration diabetes, plasma cholesterol, systolic bloodpressure and therapeutic regimen.In recent years a number of randomized clinical trials have shown that interventions to improvemetabolic control, careful monitoring and treatment reduce late diabetic complications.GoalTo establish the prevalence, severity and risk factors of diabetic retinopathy type 2 diabetic patientsin Ulaanbaatar.Materials and MethodsThe study conducted by cross sectional study. Randomly selected 235 patients type 2 diabetic patientsfrom Bayanzurh districts of city Ulaanbaatar. Participants provided a detailed medical and personalhistory, underwent an ocular examination including funduscopy. Fasting blood glucose-FBG, totalcholesterols, triglyceride, HDL were determined by methods of laboratory in venous plasma.ResultsThe prevalence of diabetic retinopathy among people with type 2 diabetes was 37.4%. The prevalencenon-proliferative diabetic retinopathy was 17% (40), pre-proliferative diabetic retinopathy was 8.1%(19), and of proliferative diabetic retinopathy was 12.3 %( 29).The mean age of participants with diabetic retinopathy was 57.4 years (range 26-79). The meanage of participants with non-diabetic retinopathy was 53.6 years (range 26-76). The prevalence of diabetic retinopathy did not vary significantly with age. Retinopathy was positively associated with alonger reported duration of diabetes and with higher fractions of blood glucose (p<0.05).Progression of diabetic retinopathy positively associated with high level fasting blood glucose (6.2mmol/l), total cholesterol (4.5 mmol/l), systolic pressure (130 mm Hg) diastolic pressure (90 mm Hg),triglyceride (2.2 mmol.l) and low level HDL (1.1 mmol/l).ConclusionRisk factors for diabetic retinopathy were found to be high level of blood glucose, longer duration ofdiabetes. Diabetes poor control was significantly associated with progression of diabetic retinopathy.