To Evaluate The Incidence Of Diabetic Retinopathy In Newly Diagnosed Diabetic Patients Presented At Tertiary Care Hospital

Background:Diabetes mellitus is defined as metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbances of carbohydrate, protein and fat metabolism resulting from defects in insulin secretion, insulin action, or both. It occurs in two forms: Insulin dependent diabetes mellitus and Non –insulin dependent diabetes mellitus1. This disease results in generalized macrovascular and microvascular complication directly affects kidneys, eyes, peripheral nerves and heart. The incidence of diabetes retinopathy in Indian population was 21.7%. Material And Methods:In this cross sectional study all the patients attending eye OPD and indoor patients at tertiary eye care were screen for eligibility. Total of 150 patients were included in the study for duration of 28 months. Detail history including hypertension and other systemic illness was asked. Best corrected visual acuity was taken after refraction. Anterior segment examination was done with slit lamp, specially looking for rubeosis iridis, pupillary reaction and type of lens opacity. Statistical analysis was done using Z test, unpaired T test and chi-square test with the help of software and methods. Result: Patients with type 2, diabetes have more incidence of developing diabetic retinopathy thanpatients with type 1. Hypertension was more commonly associated disease than other systemic illness. Diabetic retinopathy is more prevalent in patients with higher FBS and HB1Ac.Conclusion:The frequency of retinopathy is more common in patients with high blood sugar profile. Hypertension is more commonly associated with diabetes than other systemic illness.

Identification And Assessment Of Prediabetes-A Rural Indian Study (A Correlative Study Between Questionnaire And Biochemical Analysis)

Objective: To identify and prevent the vulnerable prediabetic population becoming diabetic patients in the future using the Indian Diabetic Risk Score (IDRS) and to evaluate the performance of the IDRS questionnaire for detecting prediabetes and predicting the risk of Type 2 Diabetes Mellitus in Chidambaram rural Indian population. Methods: A cross-sectional descriptive study was carried out among patients attending a master health check-up of RMMCH hospital located at Chidambaram. The IDRS was calculated by using four simple measures of age, family history of diabetes, physical activity, and waist measurement. The relevant blood test, like Fasting plasma glucose (FBS), Glycated hemoglobin (HbA1C) test, were observed for identifying prediabetes. Subjects were classified as Normoglycemic, prediabetics, and diabetics based on the questionnaire and diagnostic criteria of the Indian Council of Medical Research (ICMR) guidelines. Results: In the study, sensitivity and specificity of IDRS score were found to be 84.21% and 63.4% respectively for detecting prediabetes in community with the positive predictive value of 51.6% and negative predictive value of 89.6% and prevalence of prediabetes in the Chidambaram rural population is 31.6% among the 60 participants. Conclusion: The Indian diabetic risk score questionnaire designed by Ma­dras diabetic research federation is a useful screening tool to identify unknown type 2 diabetes mellitus. The question­naire is a reliable, valuable, and easy to use screening tool which can be used in a primary care setup.

Correlation of Apnea Hypopnea Index Severity with Fasting Blood Sugars and HbA1C Values in Patients with Metabolic Syndrome

Introduction: The relationship between OSA and glycemichealth is a topic of increasing clinical and research interest.Community-based studies have suggested that the presenceand severity of OSA are independent predictors of insulinresistance and T2DM prevalence the aim of the present studywas to examine the potential correlation of OSA and HbA1Cvalues in patients with Metabolic SyndromeMaterial and Methods: A cross-sectional study was conductedamong a total of 63 patients with a history of metabolicsyndrome and were divided into two groups diabetic and nondiabetic. The risk of OSA was assessed by three structuredand validated questionnaires namely STOP-BANG, ESS,Modified Berlin. Fasting blood sugars and HbA1C was done.All patients were evaluated with Polysomnography level III.Results were analyzed using statistical methods (Descriptiveanalysis and correlation). Using SSPS version 22 used.Results: Out of the total of 63 subjects, there was a malepreponderance (Male - 61%) with a mean age of 50.9 ± 12.98years. Increased AHI was seen in 91% of the subjects (morethan 5) with the mean AHI of 29.63 ± 22.14. The mean FBS &HbA1C was 151.62 ± 49.5mg/dl & 7.22 ± 1.71 respectively.In both diabetic & non-diabetic groups, the correlation of FBS& HbA1C values with AHI was statistically not significant.Conclusion: AHI severity did not correlate with FBS andHbA1c values in patients with metabolic syndrome. However,in the non-diabetic subgroup with severe AHI the fastingblood sugar levels were above a higher limit of normal.

A Study of Thyroid Dysfunction in Type 2 Diabetes Mellitus in Tertiary Care Center

Introduction: Type 2 diabetes mellitus and thyroid disordersare the most common endocrine disorders and growingproblem in our country. We have observed that many diabetesmellitus patients are associated with thyroid dysfunction.However, the prevalence of thyroid dysfunction in thesepatients has not been investigated. We conducted this study tostudy the proportion of Thyroid dysfunction in patients withtype 2 Diabetes.Materials and methods: The current study was a prospective,cross-sectional study. All the type-2 Diabetic patients andnormal subjects with no diabetes attended to the outpatientclinic and admitted in the General Medicine departmentat Kasturba hospital, Manipal was considered as the studypopulation. After obtaining informed written consent, astructured questionnaire was used to analyse the patient’s chiefcomplaints, General and local examination was performedby measuring BMI, waist circumference. Lab investigationswere recorded. Analysis based on patient’s lab values for FBS,PPBS, HbA1C AND TSH, LIPID PROFILE.Results: The mean age of subjects in cases was 55.98 ±11.19 years and it was 54.54 ± 10.08 years in controls. Thedifference in the proportion of gender between study groupswas statistically not significant, the difference in weight andBMI between the two groups was statistically significant.There was no statistically significant difference in cholesterol,triglyceride, LDL between two groups. The difference in theproportion of thyroid dysfunction between the two groups wasstatistically significant.Conclusion: The present study showed a high prevalence ofthyroid dysfunctions in patients of type 2 DM.

Reliability and validity of self-rated Family Burden Scale in families of the patients with anorexia nervosa / 上海交通大学学报（医学版）

Objective • To explore the reliability and validity of self-rated Family Burden Scale (FBS) evaluating caregiver burden in families of the patients with anorexia nervosa (AN). Methods • The study included female AN patients (n=103) treated in the Eating Disorder Center of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine from Jul. 2017 to Jul. 2019 and their caregivers (parents, n=148). General demographic information of the patients and their caregivers, the course of illness and body mass index (BMI) of patients, and the time each caregiver spent in caring for the patient per day were recorded. FBS, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and the MOS item short form health survey (SF-36) were self-rated by the caregivers. One-third of the caregivers were selected by random number method for FBS rating by specialists. The reliability of the scale was evaluated by calculating Cronbach's α coefficient, self-rating and other-rating consistency and the consistency between husband and wife (41 couples). The validity of the scale was evaluated by calculating the correlation of FBS score with the course of disease, patients' BMI, the time spent in caring per day, scores of BAI and BDI, and vitality, social function, role-emotion and mental health domain of SF-36. Results • The Cronbach's α coefficient of FBS was 0.921, the correlation coefficient between self-rating and other-rating by specialists was 0.705 (P=0.000), and the correlation coefficient of consistency score between couples was 0.547 (P=0.000). FBS score showed no correlation with the course of disease, %BMI and the time spent in caring per day. Scores of BAI and BDI, and vitality, social function, role-emotion and mental health domain of SF-36 showed low correlation with FBS score (all P<0.05). Conclusion • Self-rated FBS shows good reliability when used in families of AN patients. The validity is not as ideal, which suggests further revision of the scale.

A clinical investigational study on safety and effective management of type-2 diabetes mellitus patients by using sitagliptin

Background: To study the health and efficiency of the more up to date oral hypoglycemic specialist sitagliptin in the executives of sort 2 diabetes mellitus patients. In our examination authors have enlisted 250 patients who met our investigation criteria of which authors ordered dependent on age and lab information, most of patients in the age bunch between 45-55 years (n=97, 39.2%), the RBS was diminished to Comparatively estimations of RBS, FBS, PPBS, HbA1C were decreased in follow up than benchmark esteem.Methods: This simultaneous observational investigation was done when all is said in done department of General Medicine of Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha for a time of 6 months in which type 2 diabetes mellitus patients were enrolled dependent on incorporation and avoidance criteria and were pursued to assess the adequacy and security of sitagliptin. Information was dissected by utilizing chart cushion crystal understudy T-test.Results: Authors can presume that sitagliptin use was not related with any dangers and is compelling in the board of Type 2 diabetics, treatment with sitagliptin gave clinically significant decreases in HbA1C, RBS, FBS, PPBS by utilizing this investigation authors realize that gliptins are considerably more protected and powerful in the treatment of sort 2 diabetes mellitus.Conclusion: Treatment with sitagliptin provided clinically meaningful reductions in HbA1C, RBS, FBS, PPBS by using this study authors know that sitagliptins are much more safe and effective in the treatment of type 2 diabetes mellitus.

Correlation between Fasting Blood Sugar Level, HbA1C Level and Serum Lipid Levels in Type 2 Diabetes Mellitus Patients

Introduction: Diabetes Mellitus is one of the most commonendocrinal diseases in the world. Incidences of this disease areincreasing worldwide and this disease is called disease of thismillennium. This study was undertaken to correlate fastingblood sugar level, Glycosylated haemoglobin (HbA1C) leveland serum lipid levels in patients with diabetes mellitus.Material and Methods: This study was a cross sectionalstudy conducted on 100 patients of diabetes mellitus came toM.B Govt. Hospital, Udaipur. The fasting blood sugar (FBS)levels, HbA1C levels and serum lipid levels were performedand then correlated fasting blood sugar level with HbA1Clevels and FBS and HbA1C with serum lipid levels. There wasa significant positive correlation between FBS and HbA1C,and FBS and HbA1C with serum cholesterol and serumtriglycerides level and negative correlation with serum HDLcholesterol levels.Results: This study demonstrated that HbA1C level wasincreased in diabetics and it showed correlation with the statusof control of diabetes.Conclusion: Diabetics have got increased level of serumcholesterol, triglycerides and decreased levels of serumHDL-cholesterol. HbA1C showed stronger correlation withserum cholesterol and triglycerides as compared to FBS.HDL-cholesterol showed stronger correlation with FBS thanHbA1C.

Correlation Of Blood Sugar And Hba1c Levels In Different Stages Of Diabetic Retinopathy At Our Tertiary Care Center In Ajmer

Diabetic Retinopathy (DR) is most important cause of legal blindness between 20-70yr age group. The effect of prolonged hyperglycemia can be measured with the help of glycosylated haemoglobin (HbA1c). Intensive glycemic control had been proved to be effective in decreasing incidence rate of development and progression of DR in type 1 and type 2 DM. The present prospective study was conducted on 110 cases of DR which shows highly significant correlation (P<0.001) between HbA1c level and severity of diabetic retinopathy stages. However, among values of blood glucose level post prandial showed significant correlation (P-value<0.002) and whereas no significant correlation established in case of fasting values of blood glucose. (P>0.179). Thus our study revealed that PPBS has a closer association with HbA1c and better predictor for overall glycemic control.

Study of Plasma Glycemic Levels and Serum Magnesium Levels in Diabetes Mellitus (DM) and Non-Diabetic Healthy Controls: A Comparative Study

Introduction: Patients of DM are known to have low levelsof serum magnesium levels as compared to non-diabetics.There is a link between the low magnesium levels and poorglycemic controls and subsequently leading to complicationsin diabetic patients. The aim of this study was to assess theserum magnesium levels in relation to glycemic status indiabetic patients as compared to non-diabetics.Material and Methods: 172 cases of previously diagnosedDM were taken along with the age and sex matched controlswho were healthy and non-diabetic and their blood sampleswere analyzed for magnesium and blood sugar fasting andpost prandial.Results: In our study we have found that there is a significanthypomagnesemia in diabetic cases as compared to nondiabetic controls which is in accordance with other studies.There also exists a negative correlation between mean serummagnesium levels (2.08 ± 0.4 mg/dL) and mean fastingplasma sugar (FBS) (159.72 ± 71.60 mg/dL) and mean postprandial sugar (PPS) (222.76 ± 100.86 mg/dL) levels. Nosignificant variation as per age and sex in serum magnesiumlevels amongst diabetic subjects have been found in our study.Conclusion: Hypomagnesemia is common in diabetics ashas been found in our study also, and it helps in regulationof glycemic levels and in turn also affects magnesium levels.Considering estimation of magnesium as a routine laboratorywork up protocol in the management of diabetes may preventvarious complications due to hypomagnesemia with earlytherapeutic intervention.

Effect of ranolazine on HbA1c and blood glucose levels in diabetic patients with chronic angina

Background: Diabetes mellitus is the fifth leading cause of death worldwide and is one of the common co-morbid conditions associated with coronary artery disease (CAD). The overall prevalence of CAD is 7.4% but the prevalence of CAD in diabetics is 9%. Hence treatment of hyperglycemia is a key goal of secondary preventive therapy with a target of reducing HbA1c to <7%. The risk of CAD has been reported to occur 2 to3 decades prior in diabetics compared to non-diabetics. Hence discovery of drugs with potential role in both diabetes and CAD seems to be necessary. Ranolazine is a novel oral anti anginal drug known to reduce HbA1c and fasting blood glucose levels in angina patients with diabetes. The objective of this study is to show the effect of ranolazine (antianginal drug) on HbA1c and fasting blood glucose levels in diabetic patients with chronic angina.Methods: Patients were divided into: Group 1 continued with previous antidiabetic drugs and antianginal drugs. Group 2 were prescribed Tab ranolazine 1000mg b.d (orally) as add on therapy along with previous antidiabetic drugs and antianginal drugs.Results: There was a significant reduction in HbA1c and FBS levels in Group 2 patients who were on ranolazine. Reduction of HbA1c in group1 and Group 2 was 0.21�65% and 1.30�16% respectively. Reduction of FBS in group1 and group2 was 10.66�.80mg/dl and 29.97�.49mg/dl respectively.Conclusions: From the present study we can conclude that ranolazine, an antianginal drug when given at a dose of 1000mg bd in diabetic patients with chronic angina reduces HbA1c and FBS levels.

Drug Utilisation Pattern Of Antidiabetic Drugs Amongst Obese Diabetic Patients In A Tertiary Care Hoapital- An Observational Study

The principal aim of drug utilisation studies (DUS) is to facilitate the rational use of drug in a population.DUS is an essential part of pharmacoepidemiology and pharmacoeconomic as it describes the extent,nature and determinants of drug exposure. Diabetes at present appears as a common non communicable disease. It leads to high morbidity and mortality due to the disease itself and its diverse complications like coronary artery disease, hypertension, renal complication, retinal damage, neurological disorders, incidence of stroke at different sites, generalised infections etc. With such multifactorial background of high prevalence , progressive nature of the disease, availability of multiple therapeutic regimens prescribed on trial and error basis, the treatment is individualised and neither complete nor satisfactory. Objectives: This study was undertaken to analyse the current prescribing pattern in obese patients of type 2 diabetes mellitus with regard to drug/drugs precription ,dose, duration of treatment and frequency of change of drugs. Methods: This is a prospective, parallel group, comparitive observational study. The enrolled obese patients were divided as a)New diabetic b) Old diabetic(<3 years duration). Each category was further divided into four subgroups according to the treatment recieved a)Monotherapy-only Metformin b)Combination therapy- Metformin+another antidiabetic groups,preferably sulfonylureas, alphaglucosidase inhibitors or DPP 4 inhibitors c)Triple therapy( Metformin+SU+Voglibose or Gliptins or Glitazones) d)Insulin with other oral hypoglycemic drugs. Results: In the study of prescribing pattern, it was observed that most prescriptions in this tertiary care hospital were found to be in compliance with the ADA guidelines. Metformin monotherapy was prescribed as initial treatment. Sulphonylureas/ Gliptins / Alpha glucosidase inhibitors/ thiazolidinediones were used as second line therapy mostly anyone, in addition to metformin or as monotherapy according to patient requirement, tolerability and cost.Conclusions: The antidiabetic medications prescribed in this hospital,were found to be in compliance with ADA guidelines with metformin being the first line of treatment followed by sulfonylureas and alphaglucosidase inhibitors

Lipid Profile In Diabetes Mellitus.

Background: The prevalence of diabetes is rapidly rising all over the world. India is not an exception. Alteration of serum lipids & complications is significant in diabetics which lead to micro and macrovascular diseases. Aims & Objective: To know the lipid profile pattern in diabetic patients.To identify high risk group so that they can be treated early for preventing complications. Method: Total 200 OPD & indoor diabetic patients visiting at Sir Takhtsinhji General Hospital, Bhavnagar from June 2014 to May 2015 were selected using certain criteria. Results:Type I patients have onset of Diabetes at an early age with longer duration but they have normal lipid profile. Type 2 patients have onset of Diabetes at late age but they have elevated levels of Triglyceride, Cholesterol, LDL, VLDL with low HDL. Obesity is common in NIDDM.Females having higher lipid profile values than males. Uncontrolled Diabetic patients are more dyslipidemic. Interpretation & Conclusion: Type 1 diabetic patients have longer duration of disease. Type 2 diabetic patients having altered profile, having more risk for complications like atherosclerosis, Coronary Heart Disease etc. Control of Diabetes is necessary for controlling lipid profile & complications.

Correlation between elevated serum ferritin and HbA1c in type 2 diabetes mellitus.

Background: Serum Ferritin, an acute phase reactant is a marker of iron stores in the body. Recent studies indicate that increased body iron stores and subclinical hemochromatosis has been associated with the development of glucose intolerance, type 2 diabetes, metabolic syndrome and possibly the development of diabetic retinopathy, nephropathy and vascular dysfunction. This study was carried out to examine and establish a relationship between Serum Ferritin with Type 2 diabetes mellitus and metabolic syndrome and to examine whether a correlation between S. ferritin and FBS, HbA1c exists. Methods: 86 type 2 diabetes subjects (M:F - 57:29, mean age 54.3±9.2 years, mean BMI 24.28kg/m2) which included 24 patients with metabolic syndrome were studied and compared with controls. S. ferritin, Hb, ESR, FBS, PPBS, HbA1c and fasting lipid profile were measured. Results: Serum ferritin was significantly higher in diabetic patients when compared to controls and serum ferritin had a positive correlation with increasing duration of diabetes. Conclusions: There was a positive correlation between serum ferritin and FBS, HbA1c. There was no correlation between serum ferritin and age, sex, metabolic syndrome, coexistent hypertension, total cholesterol, LDL and serum triglycerides.

Reduction in lung functions in type-2 diabetes in Indian population : Correlation with glycemic status.

The purpose of this study was to evaluate pulmonary functions in patients with Type-2 diabetes mellitus and to determine their correlation with glycemic status of diabetes in Indian population. Forty Type-2 diabetic patients, aged 30-60 years, with diabetic duration of 1-20 years, were included in the study. FVC, FEV1, & FEV1% are recorded by Benedict’s Roth spirometer. PEFR and MEP were recorded by Wright’s Peak flow meter & Modified Black’s apparatus. Glycemic status of subjects was determined by FBS & PPBS by Glucose oxidase & peroxidase methods. And results were analyzed by calculating Mean±SD, using Student’s t test, and Pearson correlation. All the respiratory parameters are reduced in Type- 2 diabetic patients compared to control of which FEV1, FEV1%, & MEP show very highly significant reduction (P=0.000). Lung functions are negatively correlated with glycemic status & duration of diabetes. (r = – 0.390, & –0.342) Reduction in dynamic lung functions and its negative correlation to glycemic status might be due to respiratory muscle weakness as indicated by highly significant reduction in MEP. Hence strict glycemic control and breathing exercises to strengthen the respiratory muscles may improve lung function in diabetics.

Prenatal diagnosis of thalassemia and hemoglobinopathies: 20 years experience at Siriraj Hospital.

Objective: To show the experience of prenatal diagnosis of Thalassemia and hemoglobinopathies in Siriraj Hospital. Methods: Hb Bart’s hydrops fetalis can be detected by DNA study from polymerase chain reaction (PCR) product in the first trimester of pregnancy either by chorionic villus sampling (CVS) or aminocentesis but in late pregnancy it can be detected unambiguous by ultrasonography at 18-20 weeks gestation, the suspected cases are confirmed by fetal blood sampling and Hb electrophoresis. Prenatal diagnosis (PND) for β-thalassemia diseases can be done at early pregnancy by direct visualization of the PCR products on electrophoresis or by dot blot analysis of amplified DNA with a set of HRP-labeled oligonucleotide probes complementary to the mutations. If the mutation is unknown. The couples have to wait for Hb analysis by HPLC or in vitro globins chain analysis from fetal blood in the second trimester. Results: The results of PND at Siriraj Hospital are summarized as Hb Bart’s Hydrops fetalis 228 cases, Homozygous Beta-Thalassemia 126 cases, and Beta Thalassemia/Hb E disease 550 cases. There are various methods of sampling namely chorionic villous sampling, amniocentesis, fetal blood sampling, ultrasound, or even combined method. There are minimal incidences of fetal loss 9 out 904 cases which comparatively give us one of the best center for prenatal diagnosis in Asia. Conclusion: Of the 904 pregnancies, the diagnosis were obtained in 891 pregnancies in which had 5 fetal loss from dead fetus in utero after fetal blood sampling in the second trimester. The other complication occurred after sampling failure.

Effect of beta2-GP1 on the Binding of Anti-cardiolipin Antibodies to Cardiolipin

BACKGROUND: Anti-cardiolipin antibody (Anti-CL Ab) is one of the various anti-phospholipid antibodies (Anti-PL Abs) and found in the plasma of patients with systemic lupus erythematosus (SLE), atherosclerosis, and other infectious diseases. While anti-PL Abs found in the sera of patients with infectious diseases bind directly to CL, binding of anti-PL Abs to CL circulating in the sera of patients with autoimmune diseases is mediated by beta2-glycoprotein 1 (beta2-GP1). The purpose of this study is to investigate the effect of beta2-GP1 on the antigen binding assay of anti-CL Abs present in the sera of patients with atherosclerosis, which has been known as one of autoimmune diseases. METHODS: ELISA was performed with sera containing anti-CL Abs from three patients with atherosclerosis in the presence or absence of beta2-GP1 or FBS. RESULTS: Reactivity of anti-CL Abs to CL was increased in the presence of beta2-GP1 or FBS in a dose dependent manner. CONCLUSION: beta2-GP1 or FBS could be used as co-factor in CL ELISA with anti-CL Abs present in the sera of patients with atherosclerosis. It is suggested that anti-CL Abs found in atherosclerosis patients are similar in terms of antigen binding property to those circulating in the patients with autoimmune diseases, not to infectious diseases.

Prepae B-lymphoblastoid cell lines of HLA novel allele B ~*5610 in a family / 中国输血杂志

Objective To prepare B-lymphoblastoid cell lines of HLA novel allele B*5610 in a family for further study and identification . Method Isolate mononuclear cells under aseptic conditions from the peripheral blood. After infection with Epstein-Barr virus, the cells were cultured in 20% FBS, 2?g/ml CsA RPMI 1640. Results Immortalized B-lymphoblastoid cell lines of five B *5610 carriers in a family were achieved, and the new genes were inherited stably. Conclusion Our work is important for storing and breeding the precious material of biomedicine because the B *5610 genes in the immortalized B-lymphoblastoid cell lines were inherited stably.

Proliferative Effect of Serum on Bovine Retinal Pigment Epithelial Cell Culture

The retinal pigment epithelium(RPE) is one of the most important cell layers in the visual system and is vital to the integrity of the rod and cone outer segments. It has many complex functions, such as absorption of light, storage and conversion of vitamin A esters and formation of acid- mucopolysaccharide complex. As serum in the vitreous cavity stimulates the migration and proliferation of RPE cells, serum is necessary to grow RPE cells in culture. Bovine RPE cells were cultured with various concentrations of fetal bovine serum(FBS 0%, 5%, 10%, 20%, 40%) to evaluate their effects on RPE cell growth. FBS stimulated the proliferation of bovine RPE ells in a dose-dependent manner, with maximal proliferation at 20% FBS. This proliferative effect, however, was suppressed at the highest concentration(40% FBS).