Association of Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus- An Analytical Cross-Sectional Study

Nonalcoholic fatty liver disease (NAFLD) is a common liver disorder but is often ignored especially in diabetes mellitus and thus carries serious complications in the long run. We aim to study the association of NAFLD with type 2 diabetes mellitus.METHODSA prospective observational case control study of diabetic patients was done in a tertiary care teaching hospital. A total of 50 diabetic patients fulfilling the inclusion criteria were selected as cases while 50 age sex matched non-diabetic patients were included as controls. Complete clinical, laboratory and radiological data was collected from each patient and analyzed. Data was analyzed using statistical software SPSS ver. 21.RESULTSMean value of age in cases was 52.42 ± 10.24 years and in control was 54.04 ± 10.16 years (p>0.05). There were 56% males and 44% females in both the groups. Among the cases, majority (84%) of the patients were on Oral Hypoglycemic Agents (OHA). As compared to controls, cases had significantly higher SGOT and SGPT but significantly lower total bilirubin levels (p<0.05). In the lipid profile, cases had significantly higher TG, LDL and VLDL levels (p<0.05). Significant difference was seen in the USG findings between cases and controls. Majority (66%) of the patients in cases had abnormal USG findings showing liver thickness, as compared to 30% in controls.CONCLUSIONSType 2 diabetes was strongly found to be associated with development of NAFLD, and since most patients of NAFLD remain asymptomatic, all diabetic patients must be screened for development NAFLD.

Genome sequencing of four strains of Phylotype I, II and IV of Ralstonia solanacearum that cause potato bacterial wilt in India

Abstract Ralstonia solanacearum is a heterogeneous species complex causing bacterial wilts in more than 450 plant species distributed in 54 families. The complexity of the genome and the wide diversity existing within the species has led to the concept of R. solanacearum species complex (RsSC). Here we report the genome sequence of the four strains (RS2, RS25, RS48 and RS75) belonging to three of the four phylotypes of R. solanacearum that cause potato bacterial wilt in India. The genome sequence data would be a valuable resource for the evolutionary, epidemiological studies and quarantine of this phytopathogen.

Central pontine myelinolysis: a rare presentation secondary to hyperglycaemia

Central pontine myelinolysis (CPM) is classically described as a demyelinating condition that results from the rapid correction of hyponatraemia. CPM has also been reported to arise from hyperglycaemia in association with concomitant acidosis, hypernatraemia and hyperosmolar syndrome. Herein, we report a rare presentation of CPM, which was purely secondary to hyperosmolar hyperglycaemia. The patient presented with ataxia and pseudobulbar affect, which evolved subacutely over a duration of two weeks. It is important to note that, in addition to acute changes in osmolality, a subacute shift secondary to hyperglycaemia may also lead to CPM.

Toxic leucoencephalopathy after 'chasing the dragon'

Toxic leucoencephalopathy (TLE) is a rare neurological complication of heroin abuse. 'Chasing the dragon' is an inhalational mode of heroin abuse that originated in Southeast Asia. Intriguingly, no cases of TLE have been reported from this region, although the inhalational mode of heroin abuse is common. We herein report the case of a middle-aged man with a history of polysubstance abuse who presented with progressive neurological symptoms and progressed to an uncommunicative state. While the initial impression was that of iatrogenic parkinsonism, diffuse leucoencephalopathy with sparing of the cerebellum was noted on magnetic resonance imaging. In view of his history of inhalational heroin abuse close to the onset of the neurological symptoms, a diagnosis of TLE was made. No clinical improvement was noted with administration of a dopaminergic agent. This is the first known case of delayed TLE following heroin inhalation from Southeast Asia with the unusual feature of cerebellar sparing.

Asymptomatic type B right atrial thrombus in a case with protein S deficiency.

Thirty seven year old asymptomatic male underwent routine medical examination which revealed an abnormal mass in the right atrium. Family history was not suggestive of any cardiac or malignant disease. Detailed investigation detected defi ciency of protein S, which is a vitamin K dependent protein and a cofactor for activated protein C mediated cleavage of factor Va and VIIIa. The defi ciency of protein S predisposes to venous thrombosis. Further investigation revealed that it was an organized calcifi ed thrombus in right atrium occupying almost whole of the cavity. Various approaches including surgical excision, thrombolysis and anticoagulation has been used to manage such thrombosis. However therapeutic approach is still a question of debate. Atriotomy and excision of mass was done using cardiopulmonary bypass.

Coronary artery bypass surgery in the presence of cerebrospinal fluid rhinorrhea.

A seventy eight year old male patient was admitted in our hospital with headache, vomiting, irritability and confusion. Initially he was diagnosed as a case of pyogenic encephalitis. Further investigations revealed that patient had cerebrospinal fluid rhinorrhea and coronary artery disease. He successfully underwent coronary artery bypass grafting and cerebrospinal fluid leak repair.