Orthostatic Hypotension and its Relationship with HbA1c Levels in Patients with Diabetes Mellitus

Introduction: For the diagnosis of diabetes mellitus, various tests are available such as FBS (Fasting blood sugar), PPBS ( Post Prandial Blood Sugar), Oral Glucose Tolerance Test, Random Plasma Glucose Test, HBA1c, etc, of which HBA1c is considered to be the most standard test.1,2 As diabetes mellitus can be asymptomatic initially, it can lead to important complications such as neuropathy, nephropathy, retinopathy, cardiovascular diseases, etc if not detected early.3 Postural blood pressure measurement which diagnoses orthostatic hypotension is a cheap, easy and useful tool to predict HBA1c level even in asymptomatic diabetic patients. Methods: This is a randomized cross-sectional study of 100 diabetic patients attending Medicine OPD or admitted in our tertiary care hospital of South Gujarat. Pretested proforma was used to collect data after taking informed consent. Investigations including blood pressure measured with a standard Sphygmomanometer at the end of 3 min after standing and HBA1c as mentioned in the proforma was carried out. Final analysis has been done with Open EPI and SPSS software. Results: 33% of patients of our study population were found with abnormal orthostatic hypotension. Our data shows orthostatic hypotension is directly associated with high HbA1c, longer duration of DM, and higher value of BMI. No correlation was found between age and gender. Conclusion: Among diabetic patients, high HbA1c, prolong duration of DM and high BMI were associated with abnormal orthostatic hypotension, which can be alarming sign of complications of diabetes mellitus.

A Study of Pattern of Vehicular Injuries over Pedestrians: A Retrospective Study.

Objectives: Present study makes a little effort to understand patterns of injuries over pedestrians during road traffic accidents, to set on record a statistical statement of the severity and survival period in pedestrians accidents and to define, delineate and compare present study with other available studies. Materials and Methods: Present study is based on an analysis of 156 autopsies on victims of pedestrian accidents at Sheth V.S. General Hospital, Ahmedabad during two consecutive years from May 2008 to April 2010. Result: This study shows the males (80.8%) are outnumbered the females (19.2%). Evaluation of patterns of injuries shows head injury is overall most common in pedestrians. In primary impact injury head injury (41%) and lower limb injuries (36.5%) are most common followed by pelvic injuries (12.1%). Head injury (33.9%) is again most common in secondary impact injuries. Chest injuries (16.6%) and abdomen injury (12.8%) are most common secondary injuries to pedestrians followed by head (8.3%) and neck (5.1%). Road traffic accidents are the major contributors of unnatural deaths worldwide. Pedestrians are the most commonly involved victims in such cases.

Interleukin-2 treatment induces an acquired behavioral response pattern (repetitive stereotyped movements) mediated by dopamine D1 and D2 receptors.

Interleukin (IL)-2 is implicated in the etiology of psychiatric disorders (e.g., schizophrenia, psychosis) involving an increased expression of repetitive stereotyped movements. However, little is known about the underlying pharmacological mechanisms or behavioral processes. Of further importance, we sought to identify underlying pharmacological mechanisms. We found that dopamine D1 receptors underlie the development of IL-2- induced stereotypic movements while D1 and D2 receptors are required for the expression of IL-2-induced stereotypies. These findings raised the intriguing possibility that IL-2 treatment induced an acquired behavioral response pattern requiring concurrent stimulation of D1 and D2 receptors. Thus, we determined whether stimulation of D1 and D2 receptors following termination of IL-2 treatment would re-instate the expression of repetitive stereotyped movements (i.e., an acquired response pattern). Based on these findings, we suggest that sub-chronic or chronic elevations in peripheral IL-2 levels may produce behavioral disturbances that persist beyond the presence of IL-2 by altering dopamine receptor activity resulting in the acquisition of an abnormal response pattern, and thus increase vulnerability to psychopathological outcomes associated with repetitive stereotyped movements. To our knowledge, these are the first data to identify a process by which a cytokine produces an abnormal response pattern.

Soluble cytokine receptor subunits modulate catecholaminergic cell activity.

Soluble cytokine receptors (SCR) modulate cytokine signaling and are increased in states of abnormal immune activation. SCR’s are also increased in psychiatric and neurological disorders associated with altered brain catecholaminergic activity; although, there is no evidence that any soluble cytokine receptor alone modulates such activity. One such soluble cytokine, soluble IL-2 receptor (sIL-2R) modulates lymphocyte activity. Here, we discovered that soluble IL-2 receptors (sIL-2Rα, sIL-2Rβ) dose-dependently increase cAMP levels in differentiated PC12 cells. sIL-2Rγ and sIL-6Rα have produced no effect. Co-treatment of sIL-2Rs with IL-2 alters cAMP levels in a concentrationdependent manner. This is the first evidence that soluble receptors modulate catecholaminergic cell activity. Thus, soluble cytokine receptors, including the α and β subunits, may represent new therapeutic targets for relevant psychiatric and neurological disorders.

Manifestation of tuberculosis in HIV/AIDS patients and its relationship with CD4 count.

Background: Tuberculosis (TB) is said to be one of the commonest opportunistic infection among human immunodeficiency virus (HIV) seropositive. Varied clinical manifestations have been observed according to immune status of HIV positives. Aims & Objective: The present study aims to relate the clinical, radiological and laboratory profiles of patient with HIV/TB co-infection and its correlation with CD 4 count. Material and Methods: Seventy adult TB patients having confirmed HIV seropositivity were included. A detailed history, physical examination, laboratory and radiological investigations were carried out. Results: Maximum numbers of patients were from age group of 21–40 years. Commonest mode of HIV was heterosexual route (80 %). Male: Female ratio was 4:1. Most of the patients (45.71%) were labour workers, followed by housewife (20%), sales man (18%), textile worker (8.8%), and transport driver (8.8%). Fever (75.71%), weight loss (68.57%) and decrease appetite (65.57%) were predominant symptoms. Pulmonary TB (PTB) was found in 24.28% patients, while extra-pulmonary TB (EPTB) in 75.72% patients. Most of Pulmonary TB had CD 4 count > 180, while in extra-pulmonary TB most of patients had CD 4 count < 180. Commonest form of EPTB was disseminated TB (30%) followed by abdominal TB (21.42%), tuberculous lymphadenopathy (12.85%) and CNS tuberculosis (4.28%). Positive smear for acid-fast bacilli (AFB) was found in 17.14% patients of PTB. The mean CD4 count at presentation were 214 cells/μl, 182.47 cells/μl, 175.22 cells/μl and 54.66 cells/μl in tubercular meningitis, abdominal TB, tuberculosis lymph node TB and disseminated TB respectively. Conclusion: HIV/TB co-infection is more common in sexually active age group and commonest mode of HIV infection is heterosexual transmission. Sputum smear AFB test positivity is low in TB patients having HIV. Disseminated TB is common in advanced HIV cases as CD 4 count decreases.

Study of demographic profile & presentation of lung cancer at Jamnagar.

Introduction: As the Smoking, Industries, and Pollution is increasing day by day, the lung cancers have taken place as one of the common malignant disease among people and recognized as a serious problem because of its high morbidity, mortality1. This study was conducted to know incidence of lung tumor as per age, gender, habits, and type. Material & Methods: The present study comprises of 100 patients suspected of lung tumors. The study was carried out in the department of pathology, Shree M.P. Shah Medical College, Jamnagar. The samples of bronchoscopic material were received from tuberculosis and chest Diseases Department, G. G. G. Hospital, Jamnagar. Total 100 patients clinically suspected to have lung cancer were selected for cytological and histological study during the period from Aug. 2010 to sep. 2012. Of all patient clinical history and other details were recorded in the specially formed proforma. Results: Out of 100 cases, 20 were benign (09 of inflammatory lesions, 06 of squamous metaplasia, 5 were dysplasia) and 80 were malignant cases, the commonest tumor was squamous cell carcinoma (50 cases, 62.5%) followed by adenocarcinoma (12 cases,15%), small cell carcinoma (8 cases, 10%)and large cell carcinoma (2 cases 2.5%). In most of the lung tumors high age incidence was found in 6th and 7th decade. Out of 100 cases, males were predominantly affected (82 were males and 18 were female). Out of 100 cases, 82 were smokers and 18were non- smoker, and out of 80 cases positive for malignancy, 74 (92.8%) had positive history of smoking.

Retrospective study of ABO & Rh blood groups in blood donors at Dharpur.

Background and Objectives: In these days of fast life nobody knows when he or she will be in urgent need of human blood for surgical or accidental causes. That is why to keep a record of blood donors with their blood groups may be of lots of help. This study was conducted to record the ABO & rhesus blood group pattern in blood donors at Blood Bank of GMERS Medical College, Dharpur - Patan. Methods: This is a retrospective study. After the permission of Departmental head and Medical Superintendant we used the data available at blood bank. Results: From the month May 2012 to June 2013 total 652 donors donated their blood. Out of which 640 were males and 12 were females. The commonest blood group found was B blood group in 42.63%, followed by O blood group in 26.38% , A blood group in 19.94% and AB blood group in 11.04%. While 96.01% donors were Rh positive and 3.99% donors were Rh negative. The maximum numbers of donors were between in age group 21-30 years. Conclusion: Blood group B is the commonest blood group followed by blood group O, A and AB. Most common age group is 21-30 years amongst the all donors.

Profile of fatal two wheeler accidental cases in Ahmedabad.

Background and objective: In these days of fast life every person wants to save his/her time. But unfortunately some becomes victim of accidents. Objective of this study is to analyze age, sex and time distribution, area of accidents, type of rider and protection used in deceased in two wheeler road traffic accidents. Methodology: The present study was conducted in the department of Forensic Medicine, B.J. Medical College, Ahmedabad. The study included 100 cases of fatal two wheeler accidents occurred during the time between January 2011 to June 2011. Results: in the two wheeler accidental deaths most commonly involved age group is 31-40, males are predominant, more in urban area, drivers are more affected, occur more in evening time and non protected are more affected. Conclusion: it can be concluded that careful driving should be done at the evening time, and Helmet/protection must be used and everyone must follow the traffic rules.

Hemoglobinopathies in South Gujarat population and incidence of anemia in them.

Objective: To Screen of South Gujarat population for determination of prevalence of different hemoglobinopathies particularly beta thalassemia trait (BTT) and sickle cell trait (SCT) and find out the incidence of anemia in them. Material and Methods: The present study screened 32,857 samples of students from different school and colleges in South Gujarat. Blood samples were initially tested for solubility test and complete hemogram on hematology analyzer. Samples having MCV (≤78), MCH (≤28) and/or positive solubility test were investigated for Hb electrophoresis on cellulose acetate membrane (pH 8.6). Hb A 2 level ≥3.5% was considered as diagnostic for BTT. High performance liquid chromatography on Biorad Hb variant system was done on samples having doubtful results. Result: Overall prevalence of BTT and SCT in South Gujarat was 4.4% and 1.3% respectively. Gamit, Vasava, Chaudhary, and Mahyavanshi castes had high prevalence of BTT (15.9%, 13.6%, 12.6%, and 6.9%) as well as SCT (22.2%, 15.2, 22.3, and 4.2%) respectively. Other communities like Lohana (10.8%), Sindhi (10.2%), Prajapati (6.3%), and Ghanchi (6.2%) also showed higher prevalence of BTT. Incidence of mild to moderate anemia was higher in BTT and SCT compared to non-BTT or non-SCT subjects. Conclusion : Study suggests that BTT is the most prevalent hemoglobinopathy in South Gujarat. β-thalassemia and Sickle cell anemia are highly prevalent in Mahyavanshi, Chaudhary, Gamit, Vasava and Rohit. Prajapati, Lohana, Leva Patel, and Ghanchi have β- thalassemia risk. SCT is more frequently detected in Dhodia Patel and Kukanas.

Association of ABO groups in malaria infection of variable severity.

Background & objectives: Literature reports several studies on ABO groups and malaria but a study with an adequate sample size and controls is not available. ABO groups are genetically controlled, hence, large sample size and comparison with population frequency is essential. To determine whether malaria infection with variable severity has correlation with ABO groups. Study design & Methods: Blood samples of non-transfused malaria cases were obtained from pathology laboratories and transfused malaria patients’ from Blood Bank. The malaria parasites were identified by examination of thick and thin smears. Control (normal population) included 11,303 students. Results: The ABO group frequency of normal population was ‘O’ 32.3%, ‘A’ 22.2%, ‘B’ 36.7% and ‘AB’ 8.8%. The overall ABO group distribution in 8028 malaria cases was ‘O’ 30%, ‘A’ 24.6%, ‘B’ 35.5% and ‘AB’ 8.9%. ‘A’ group incidence was significantly higher than normal (‘A’ vs non-‘A’ 2 = 15, df=1, p <0.001). ABO group frequencies were comparable within Plasmodium falciparum and P. vivax malaria. There was no significant difference in ABO group distribution in malaria patients having severe anemia or among transfused and nontransfused malaria cases. About 32% of P. falciparum cerebral malaria cases and 36% DIC cases were of ‘A’ group. Compared to 22.2% ‘A’ group in the population, malaria cases showed preponderance of ‘A’ group. Because of the small numbers statistical evaluation was not done. Conclusion: ‘A’ blood group is more susceptible to have malaria infection and risk of cerebral malaria and DIC in malaria is also more in ‘A’ group individuals.

Prevalence and hematological profile of β-thalassemia and sickle cell anemia in four communities of Surat city.

Background: From the data of transfusion-dependent thalassemia major cases, the 4 communities (Muslim, Dhodia Patel, Kachhiya Patel, and Modh Bania) with high prevalence but not studied methodically were selected. Aim: The aim of this study is to find prevalence of β-thalassemia and sickle cell anemia in 4 selected communities and also to evaluate hematological profile in them. Materials and Methods: For screening of β-thalassemia trait (BTT) and sickle cell trait (SCT), all samples were tested for red cell indices, solubility, HbA 2 level and doubtful cases confirmed on HPLC. Statistical Analysis: Mean ± SD, χ2 and 't' tests were used to evaluate the significance. Results and Conclusion: Among 4 selected communities, the highest prevalence of BTT was observed in Modh Bania (6.2%) and Kachhiya Patel (6.05%) and that of SCT in Dhodia Patel (14.0%). Significantly higher prevalence of BTT was observed in Memon ( P < 0.0001) and of SCT in Khalifa 6.6% ( P < 0.0001) compared to other Muslim sub castes. Anemia was more prevalent in BTT compared to non-BTT and non-SCT subjects. 80% of Dhodia Patel non-BTT and non-SCT subjects showed microcytic red cell morphology. Their Mean ± SD Hb concentration was 12.1 ± 1.73, hence iron deficiency cannot be a sole reason. This community needs α-thalassemia and iron studies.

The relationship between overactive bladder and sexual activity in women

PURPOSE: We assessed the relationships between bladder symptoms, demographic, and medical history variables and sexual dysfunction in women with overactive bladder (OAB) disorder. MATERIALS AND METHODS: Seventy-eight women diagnosed with OAB completed self-administered questionnaires related to overall heath status, bladder function, and sexual function. Data were compiled for questionnaire responses, and multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. RESULTS: Bothersome bladder symptoms were reported by ³ 60 percent of the sample. Sixty-percent of the sample was sexually active in the past month. Difficulty with sexual arousal, orgasm, and sexual enjoyment were reported by about 25 percent of the women. Sexual partner status was the best predictor of sexual arousal, orgasm, and sexual enjoyment. Menopausal status emerged as an important predictor of arousal and sexual enjoyment. CONCLUSION: The majority of women with symptoms of OAB viewed these symptoms as bothersome. However, the extent of symptom bother did not predict aspects of female sexual dysfunction (FSD). Instead, menopausal and partner status emerged as the best predictors of FSD in our sample.