Glycemic status in diabetic and nondiabetic ESRD Patients with or without hemodialysis in rural hospital of Central Maharashtra.

Background: Diabetes is a potent cardiovascular risk factor in the general population as well as in people with end-stage renal disease (ESRD) undergoing maintenance dialysis treatment. Previous observational studies have yielded inconsistent results regarding the association between glycemic controls in patients receiving maintenance hemodialysis (MHD). Studies provide evidence that very poor glycemic control is associated with higher mortality in dialysis patients. The significance of the levels of glycosylated haemoglobin in non-diabetic patients with renal disease receiving maintenance hemodialysis remains unclear at the present time. The knowledge of HbA1c in patients with renal diseases could be important in assessing the overall prognosis in such patients and it also has implications in the assessment of their glycaemic status and in preventing post-dialysis morbidity and mortality. Aims & Objective: (1) To study the role of HbA1c as a marker of glycemic status in patients of kidney disease with or without MHD. (2) To compare the utility of fasting glucose level and HbA1c in accessing glycemic status and their relationship. Material and Methods: Study was conducted in the AVBRH, Jawaharlal Nehru medical college, Sawangi (M) Wardha by department of Biochemistry in collaboration with Department of Medicine. 30 patients undergoing maintenance hemodialysis and 30 patients of kidney diseases who are not undergoing MHD, has been taken from ABVRH Sawngi (Meghe). 30 age and sex matched healthy controls were also included in the study. 5.0 ml of blood has been collected from each subject after informed consent .Different parameters such as HbA1c, Fasting and random blood glucose, Urea creatinine, sodium potassium were evaluated in all the groups. Results: Study concluded that the HbA1c values in CKD patients undergoing hemodialysis is found above the normal range (6.71 ± 0.99) as compared to the control group (4.38 ± 0.52) while the results of HbA1c in CKD patients not going through hemodialysis found to be within the normal range (4.93 ± 0.52) and less than the patients going through the hemodialysis (6.71 ± 0.99) but more than the control group (4.38 ± 0.52). Conclusion: In non-diabetic patients with ESRD undergoing hemodialysis HbA1c may be used as a marker of impaired glucose metabolism and glycemic control is necessary to prevent future complications in these patients. Secondly in CKD patients not undergoing hemodialysis HbA1c value are more than control though they are under normal limit but it should be strictly monitored.

Extra Adrenal Pheochromocytoma Presenting as Hypertensive Crisis in a Young Male.

Pheochromocytoma is a tumor of aderenal medulla which secrets catecholamines and usually presents as hypertension. Extra-adrenal pheochromocytomas are extremely rare. They occur in the organ of zukerkundle, bladder, retroperitonium, posterior mediastinum and sympathetic chain. We present a case of a young male who presented with hypertension and eventually was found to have extra adrenal pheochromocytoma of the bladder.

Progressive Supranuclear Palsy (PSP).

We present 2 cases of Progressive supranuclear palsy (PSP), both of the cases presented to us with typical signs of Parkinson’s disease (PD), but they also had history of falls and difficulty in looking downwards. PSP is one of the variants of Parkinson Plus Syndromes.

Multiple visceral abscesses due to tuberculosis.

Tuberculosis is a global epidemic, especially in India. In immuno-competent host, abdominal tuberculosis most commonly presents as ileo-caecal tuberculosis and ascitis. Presented is a rare case of immuno-competent host with abdominal tuberculosis in the form of multiple visceral abscess.

Blood pressure response to treadmill testing among medical graduates: the right time to intervene.

BACKGROUND: Longitudinal studies have revealed significant correlation between exaggerated blood pressure response to exercise and higher incidence of developing resting hypertension in future. Normotensive persons at high risk of developing systemic hypertension have greater cardiovascular reactivity to exercise. METHODS AND RESULTS: Our study compared the blood pressure response to treadmill exercise in normotensive offspring of the hypertensive parents (age 22 +/- 1.7 years, n = 50; study group) with those of the normotensive parents (age 22 +/- 1.4 years, n = 50; control group). The morphometric characteristics, resting, exercise (treadmill exercise with Bruce protocol) and recovery blood pressure values of all the subjects were recorded. The analysis showed that the difference in mean peak systolic blood pressure during exercise was the only statistically significant parameter in the study and control groups (188.52 +/- 25.16 mmHg and 178.56 +/- 14.96 mmHg, respectively, p < 0.05). The number of hyperreactors (defined as peak systolic blood pressure > 200 mmHg during exercise) was significantly more in study group compared to control group (10 and 3 respectively). The mean resting systolic blood pressure of hyperreactors (126.46 + 8.49 mmHg) falls in the pre-hypertension category as designated by JNC VII. Also, their resting diastolic blood pressure, recovery blood pressure and body mass index were significantly higher as compared to normoreactors. Conclusions: Our study showed that this response pattern could represent impairment in cardiovascular adjustment to exercise indicating a greater risk for development of resting hypertension in the future. Therefore there is a need for early lifestyle modifications to postpone/prevent development of hypertension.