Prevalence of Left Ventricular Diastolic Dysfunction in Patients with Normal Systolic Function and its Relation with Other Risk Factors from Eastern India.

Impaired diastolic filling of left ventricle may be the important cause of symptoms ranging from mild to severe form of dyspnea with overt features of pulmonary edema which may be wrongly imparted to systolic failure. To study prevalence and severity of diastolic dysfunction and its relation with various risk factors. Methods: Patients from in and out patients department were subjected to detail history, estimation of BMI, blood sugar levels, BP measurement, echocardiographic assessment of cardiac function. Patients of isolated diastolic dysfunction were identified and the degree of diastolic dysfunction was correlated with functional class (NYHA grade) of the patients as well as various risk factors. Results: Out of 400 patients 16 (12.5%) asymptomatic patients had diastolic dysfunction (DD). Severity of diastolic dysfunction increased as the presenting NYHA grade was higher. In NYHA grades III and IV, 59% and 57% of the patients respectively had diastolic dysfunction .DD was significantly associated with diabetes (p<.0001), BMI (p =0.0002), dyslipidemia (p =0.0491), hypertension (p=0.0489). Conclusion: DD is a significant cardiac morbidity. Hypertension, diabetes, dyslipidemia and obesity have significant association with diastolic dysfunction. There is no randomized control trials for treatment for DD. Whether asymptomatic DD needs treatment is not known.

Systemic lupus erythematosus and chronic myeloid leukemia: mere coexistence or association.

Systemic Lupus Erythematosus (SLE) is a multisystem connective tissue disorder associated with increased predisposition to haematological malignancies. Myeloid series malignancies are rarely associated with SLE. We here report a case of Philadelphia chromosome positive chronic myeloid leukemia (CML) associated with SLE in a 36 year old Indian housewife. This is probably the first such case to be reported from India and only a handful of such cases have been reported in World literature till now. The patient presented initially with leukopenia. She was treated with imatinib with good results.

Study of Retinal Nerve Fibre Layer Thickness in Type 2 Diabetes Mellitus by 3-Dimensional Optical Coherence Tomography from Eastern India.

Three dimensional optical coherence tomography (OCT) is a novel technique to diagnose retinal disorders. In diabetes, loss of retinal neurons is said to be an early event. We did a small pilot study from Eastern India to find the usefulness of OCT in detecting changes in retinal nerve fibre layer (RNFL) in diabetics. We selected adult type 2 diabetics without overt retinopathy. Patients aged more than 60 or with pre-existing problems like glaucoma or vasculitis were excluded. RNFL thickness was measured using HRA-OCT Spectralis analyser. A 12º area around optic nerve head was analysed and depth of each quadrant was separately measured. The patient values were compared with normative Indian data to detect aberrations. Also, the venous blood sugar levels were measured and correlation studies were done with the retinal thickness values. Standard statistical methods were used. We had 10 diabetic cases (20 eyes) and 11 controls (22 eyes). There was significant thinning of RNFL in 6 (60%) diabetic cases and none of the controls. Two of the diabetics had severe thinning around optic nerve head. 83% of the patients had thinning on temporal side and 50% on nasal side. Mean blood glucose levels were higher in those with RNFL thinning. Both FBS and PPBS showed significant negative correlation with retinal thickness measurements. This is probably the first study of its kind from India. 3-D OCT can be a valuable tool in screening diabetics for complications. However, more studies are needed to better elucidate the role of this novel technology.

Study of C Reactive Protein in Type 2 Diabetes and its Relation with Various Complications from Eastern India.

Diabetes is associated with a pro-inflammatory state and endothelial dysfunction. Various markers of inflammation like C Reactive Protein (CRP) are elevated significantly in diabetic population. The levels of these markers also correlate with the severity of diabetes and presence of various complications. We therefore undertook this study to find the CRP levels in type 2 diabetes and its relation with other parameters. We selected only newly diagnosed drug naïve type 2 diabetes patients. Besides clinical examination, various blood tests including lipid profile and HbA1C were done. CRP levels were done by immunoturbidimetric method and the levels were compared among different subsets of patients. We had total of 80 patients (M: F: 47:33). Dyslipidemia was the commonest complication (n=66) followed by nephropathy. Patients with cardiac and retinal complications had significantly higher levels of CRP. The presence of any 1 diabetic complication was associated with significantly higher CRP levels (1.8± 1.32 mg/dl vs. 0.49± 0.22; p <0.05 by t test). CRP levels showed significant positive correlation with serum triglyceride and HbA1C. CRP was associated with various diabetic complications. It was also related with the severity of glycemic status, as evidenced by HbA1C. Although our study was cross sectional, still, it showed correlation of CRP with many complications of diabetes and thus this can be an effective marker of clinical status in diabetes.