Diabetes mellitus: A substantial factor of hearing loss in adults

Background: Diabetes mellitus is considered as most prevalent non-communicable disease throughout the world. It is associated with many complications. Hearing loss among diabetics is a recent concern, its magnitude and pathophysiology are not yet clearly defined. Aim and Objectives: The present study aimed to determine the relation between diabetes and hearing loss. Materials and Methods: The present study was conducted with 200 diabetes mellitus patients aged between 20 and 50 years, selected from endocrinology outpatient department, SCB Medical College and Hospital, Cuttack. Participants were subjected to pure tone audiometry at the department of ENT. Two hours PGBS (75 g) value was collected. Results: About 58% of the participants were detected with sensorineural hearing loss. There was a significant association of hearing loss with the duration of diabetes and glycemic status (with P < 0.05). Conclusion: The hearing loss found among diabetics showed strong association with the duration of the disease and the glycemic status. If detected earlier in its course, long-term complications of hearing can be avoided.

Association of nitrosative and oxidative stress in young type 2 diabetic patients.

Background: Nitric oxide levels play an important role in the pathogenesis of endothelial dysfunction in type 2 diabetes mellitus (DM). Aim of the study was to assess the association between serum nitric oxide levels (NOx), Oxidant load (FOX2) and total antioxidant status (FRAP) with fasting blood sugar (FBS) in type 2 diabetic patients. Methods: Serum concentration NOx was measured by Griess method in seventy six type 2 diabetic patients with age & sex matched (aged 45-65yrs) controls. Serum total oxidant load was estimated by Ferrous oxidation product in xylenol orange version 2 (FOX2), total antioxidant status by ferric reducing capacity of serum (FRAP) .FBS was estimated by commercial kits adapted to autoanalyser. Results: Significant difference was observed in serum NO level between patients and controls (78.6+ 8.6 vs. 37.59+ 4.19μmol/L: p<0.000). Significantly high FOX 2 levels (12.4+ 2.6μmol/L vs. 4.33+ 1.7 μmol/L) and lower FRAPS level was observed in patients as compared to controls (61.37+31.64 μmol/L vs. 226.46+ 15.23 μmol/L). Conclusions: Hyperglycemia leads to nitrosative stress (increase NO level) and oxidative stress by increasing total oxidant load (FOX2), decreasing antioxidant capacity (FRAP).

Impact of mode of delivery on maternal mortality in eclampsia.

Determinants of maternal mortality and causes of death pertaining to mode of delivery have been discussed. There were 23 deaths (case fatality rate of 7.2%) and maximum deaths occurred in intrapartum eclampsia (12 ie, 52.17%). Caesarean section was performed in 92 cases (28.7%) of which 4 women died (4.3%). Maternal mortality in cases who delivered vaginally was 7.1% (16 out of 225) and 3 cases died undelivered. Authors feel that at the referral centres early caesarean section in eclampsia may help in reducing maternal mortality.

Immunoglobulin G and complement C3 levels in pregnancy induced hypertension.

The immunoglobulin G (IgG) and complement C3 (C3) were measured in the maternal as well cord blood sera of 30 cases of pregnancy induced hypertension (PIH) as well as 9 controls with normotensive pregnancy. A depression of IgG as well as C3 level was observed in the maternal as well as cord sera of the mothers with PIH. These findings suggest decreased immunological status of both mother and her offspring in PIH, irrespective of the gestation and intrauterine growth status.

Audit in maternal and child health.

Audit in medicine is a well tried means of assessing the quality of practice by using acceptable measures of outcome. Audit in maternal and child health has been limited to fatal outcomes such as maternal and perinatal deaths. The outcome of audit is of interest to the providers, the health authorities and the consumers. The utility of audit lies in effective use of data to improve quality of service. Quality control of instruments and education of junior staff are some other benefits of audit. The limitations of manpower, money, means, fear of litigation and above all dislike of clinicians for handling data are hurdles in the way of effective audit. The concept of 'Standard Primipara' and 'Total Fetal Wastage' are likely to add new dimension to perinatal audit.

Congenital malformations at birth.

Three thousand nine hundred and thirty-two consecutive newborns were examined at birth for the presence of congenital malformations. The overall incidence of malformations was 1.2%. Congenital malformations accounted for 9.2% of perinatal and 12.8% of neonatal deaths. The central nervous system (39.5%) was most commonly involved followed by musculoskeletal system (14.5%). Involvement of more than one system was observed in 18.8% cases. Though there was higher incidence of malformations in babies born to mothers of more than 35 years the difference was not statistically significant. However, the babies born to mothers of gravidity 4 or more had significantly higher incidence of malformation when compared to mothers of lower gravidity (chi1(2) = 4.67, p < 0.05). The incidence of congenital malformations at birth was higher in stillborn and low birthweight babies.

Maternal hemoglobin and serum albumin and fetal growth.

Four hundred and eighty four pregnant women and their offsprings were studied to determine the relationship of maternal hemoglobin and serum protein levels on the birthweight of offspring. The correlation coefficient of maternal hemoglobin as well as serum albumin level (gamma = 0.1097 and 0.0936, respectively) with birthweight were not statistically significant. However, mean birthweight of neonates born to nonanemic mothers was significantly higher than of those born to anemic mothers. The prevalence of low birthweight babies was significantly higher among anemic mothers (p < 0.01); however, no such trend was observed in relation to maternal serum albumin (p > 0.05).

Maternal and perinatal mortality due to eclampsia.

Forty-four mothers with eclampsia and their newborns managed during the year 1988 at the University Hospital of Banaras Hindu University, Varanasi were analyzed. The incidence of eclampsia was 2.2% of all hospital deliveries. Eclampsia was more common in women (below 20 years) and at gestation of 36 weeks and below, and amongst the mothers deprived of antenatal care. The maternal mortality amongst cases of eclampsia was 31.8% and perinatal loss was 38.6%. A relatively high incidence of eclampsia and maternal and perinatal loss was considered to be related to lack of antenatal care and late referral to the hospital. Our findings suggest that more frequent use of properly timed cesarean section can improve the maternal outcome.

Birthweight: its relationship with maternal and newborn skinfold thickness.

Two hundred and forty seven pregnant women at term and their offsprings were studied. Maternal skinfold thickness was measured from ten different sites and newborn skinfold thickness was measured from four different sites in each set of cases. Maternal skinfold thickness was positively correlated with the birthweight and skinfold thickness of the offspring. The birthweight was also positively correlated with the skinfold thickness of offspring. The maternal axillary sites and offspring's subscapular site had higher inter correlation as well as with the birthweight of offspring.