RESUMO
Objectives: The aim of our study is to determine the relation of the type of stroke and site of lesion and medical comorbidities such as diabetes and hypertension with the severity of depression, HAM-D scores as well as age and gender of these patients. Materials and Methods: The present study was a hospital-based cross-sectional study conducted over 2 months that included 61 patients from neurology OPD of IMS and SUM Hospital, Bhubaneswar. Purposive sampling was done. The patients fulfilling the inclusion and exclusion criteria were first assessed using a semi-structured questionnaire to obtain the sociodemographic data. Clinical psychiatric evaluation and detailed mental state examination were done. Based on the clinical findings and using ICD 10-DCR criteria, the 61 patients with CVA were segregated as depressive and non-depressive categories. HAM-A and HAM-D scales were applied on both the groups. MRI findings done at the time of the attack were obtained. Further research is needed to identify the mechanisms of depression and why antidepressants lead to improved physical and cognitive recovery and decreased mortality. Results: Age of onset, gender, type of stroke and hemispherical involvement do not show any correlation with PSD. However, we found that the HAM-D scores were much higher in PSD patients with lacunar lesions as compared to non-depressive post stroke patients. Conclusion: Lacunar lesions may be involved in the psychopathology of depressive illness among stroke survivors. This could help us predict the occurrence of depressive illness among stroke patients with lacunar lesions. HAM-D and HAM-A may be used to detect anxiety and depressive symptoms among these patients.
RESUMO
Background & objectives: In contrast to Caucasians of European origin, the aetiology of diabetes mellitus (DM) in young adults in other ethnic groups, including Indians is likely to be heterogeneous and difficult to determine. This study was undertaken to determine the aetiology of diabetes in young Indian adults using a protocol-based set of simple clinical and investigation tools. Methods: In this prospective study, 105 Indian young adults with diabetes (age at onset 18-35 yr; duration <2 yr) were studied for a period of 1-3 years. Pancreatic imaging, fasting C-peptide, islet antibodies (against glutamic acid decarboxylase, tyrosine phosphatase and zinc transporter-8) and mitochondrial A3243G mutational analysis were performed in all patients. Four patients were screened for maturity-onset diabetes of the young (MODY) using next-generation sequencing. Results: Type 1 and type 2 diabetes mellitus (T1DM and T2DM) were equally frequent (40% each), followed by fibrocalculous pancreatic diabetes (FCPD, 15%). Less common aetiologies included MODY (2%), mitochondrial diabetes (1%) and Flatbush diabetes (2%). There was considerable phenotypic overlap between the main aetiological subtypes. Elevated islet antibodies were noted in 62 per cent of T1DM patients [positive predictive value (PPV) 84%; negative predictive value (NPV) 78%] while low plasma C-peptide (<250 pmol/l) was present in 56 per cent of T1DM patients [PPV 96% (after excluding FCPD), NPV 72%]. Using these tests and observing the clinical course over one year, a final diagnosis was made in 103 (99%) patients, while the diagnosis at recruitment changed in 23 per cent of patients. Interpretation & conclusions: The aetiology of diabetes in young adults was heterogeneous, with T1DM and T2DM being equally common. FCPD was also frequent, warranting its screening in Indian patients. Testing for islet antibodies and C-peptide in this age group had good PPV for diagnosis of T1DM.