Smartphone-enabled retinal arteriovenous imaging and correlation with coronary SYNTAX score.

OBJECTIVE: To assess the feasibility of measurement of retinal arteriovenous (AV) ratio using a smartphone, we performed a comparative evaluation with fundus camera imaging and coronary SYNTAX score. METHOD: Successive coronary artery disease (CAD) patients who underwent coronary angiography were recruited for smartphone retinal imaging. Following pupillary dilatation, fundus camera images and smartphone photography were performed. Video images were captured with a smartphone, edited and analysed. Retinal artery and vein size at 0.5 and 1 disc diameter (DD) were measured using DICOM software by two independent observers. Another observer calculated SYNTAX score. RESULTS: Analysable smartphone images were available in 91 (89.2%) of 102 patients. Tobacco use was found in 26%, hypertension in 54%, diabetes in 55%, and high LDL cholesterol in 50%. Median and 25-75 interquartile range (IQR) AV ratio at 0.5 and 1.0 DD, respectively, with smartphone were 0.48 (0.45-0.52) and 0.47 (0.45-0.52) and fundus camera were 0.48 (0.44-0.53) and 0.48 (0.45-0.53) (Spearman's correlation 0.80 and 0.79, p < 0.001). Coronary single vessel disease was in 21%, double vessel in 16%, triple vessel in 55%, normal angiogram in 8%, and median SYNTAX score was 18.0 (8.0-25.0). There was an inverse correlation of SYNTAX score with smartphone-derived AV ratio at 0.5 and 1.0 DD (rho -0.27,p = 0.007 and -0.26,p = 0.009) as well as with fundus camera (rho -0.37 and -0.38, p < 0.001). Trend-analysis showed an inverse association of smartphone AV ratio with increasing CAD (ptrend <0.001). CONCLUSIONS: Smartphone-based retinal AV imaging is feasible and comparable to fundus-camera imaging. There is a significant inverse correlation with coronary angiographic severity.

The Influence of Metformin on Serum Carbohydrate Antigen 19-9 (CA 19-9) Levels in Type 2 Diabetes Mellitus Patients.

Objective: Diabetes mellitus has been claimed to be a risk factor for the development of pancreatic carcinoma. CA 19-9 has a great sensitivity in detection of pancreatic adenocarcinoma. Metformin exhibits a strong and consistent antiproliferative action on several cancer cell lines including pancreatic cancer. We aim to determine the influence of metformin on CA 19-9 levels in type 2 diabetes mellitus patients. Methods: Total 193 patients with type 2 diabetes mellitus were registered for a single centre, cross-sectional study. On the basis of treatment modalities, patients were divided into metformin group (93 patients) and non-metformin group (100 patients). Detailed history, clinical examination, anthropometric measurements, serum CA 19-9 level, glucose and lipid metabolic profiles were determined. Results were presented as mean±SD. Association between CA 19-9 level and other variables were assessed with Pearson correlation and multiple stepwise regression analysis. Results: Mean CA 19-9 level was 18.99±4.30 U/ml in the metformin group as compared to 30.49±5.61 U/ml in non-metformin group (p<0.001). Mean value of CA 19-9 was found highest among all i.e. 37.05±4.94 U/ml in patients taking insulin. Patients having lifestyle modification for the management of diabetes had their mean CA 19-9 level of 21.39±5.62 U/ml. CA 19-9 level is positively correlated with age, duration of diabetes, BMI, 2-hour Plasma Glucose level, HbA1C, VLDL cholesterol, triglyceride, total cholesterol, LDL cholesterol (p<0.005) and negatively correlated with HDL cholesterol (p<0.001). Conclusion: Metformin is associated with lower level of CA 19-9 in type 2 diabetes mellitus patients. It may have a protective role in preventing pancreatic damage and pancreatic cancer in diabetic individuals. CA 19-9 level could be an effective indicator of glycemic control, disease progression and lipid metabolism in patients with type 2 diabetes mellitus.

Association of Serum Prolactin Level with Impaired Glucose Regulation and Diabetes.

BACKGROUND: Increase in prolactin during pregnancy has been identified as a major stimulus for ß cells. These effects have been demonstrated in both in-vitro and in-vivo non-pregnant animal models. Recently, bromocriptine has also been approved for the therapy of type 2 diabetes, regardless of the baseline prolactin level, with its mechanism of action poorly understood. Hence, this study was planned to assess whether prolactin levels within normal range associates with prediabetes and diabetes. METHODS: A total of 300 participants, 180 males and 120 females, with equal number of subjects in the prediabetes, diabetes and normal group were analyzed. The participants were categorized into sex-specific quartiles of serum prolactin, with the first quartile representing subjects with the lowest prolactin levels and the fourth quartile having the highest levels. In addition, multinomial logit analyses were performed to evaluate the odds ratio and 95% confidence interval of having prediabetes & diabetes for each quartile. RESULTS: Prolactin levels in the normal group were 10.99 ± 3.65 ng/ml for the males and 12.25 ± 3.67 ng/ml for the post-menopausal females. The prolactin levels for the males in prediabetes group were 9.46 ± 3.43 ng/ml and for diabetes group were 8.98 ± 3.43 ng/ml (p value = 0.005). In females, the prolactin levels were 10.20 ± 3.99 ng/ml for the prediabetes group and 9.60 ± 3.85 ng/ml for the diabetes group (p value = 0.007). The mean fasting plasma glucose for the four male quartiles in their numerical order were 135 mg/dl, 128 mg/dl, 120 mg/dl and 110 mg/dl (p value = 0.04) and the mean HbA1c in the same order for the quartiles were 7%, 6.4%, 6.1% and 5.9% (p value = 0.01). Similarly, the mean fasting plasma glucose for the four female quartiles in their numerical order were 138 mg/dl, 131 mg/dl, 124 mg/dl and 107 mg/dl (p value = 0.03) and the mean HbA1c in the same order for the quartiles were 7.2%, 6.7%, 6.3% and 5.8% (p value = 0.01). The age adjusted odds ratio for 2nd, 3rd and 4th quartiles as compared to the 1st quartile for prediabetes in men were 0.82, 0.72 and 0.61 and for diabetes were 0.84, 0.65 and 0.55, respectively. Risk for diabetes in females ranged from 0.04 to 0.72 for the 3rd quartile and 0.03 to 0.56 for the 4th quartile as compared to 1st quartile. The risk for prediabetes in females ranged from 0.06 to 0.95 for 3rd quartile and 0.04 to 0.74 for the 4th quartile as compared to 1st quartile. CONCLUSIONS: Mean prolactin levels in both males and females were lower in prediabetics and lowest in diabetics. Prolactin, on quartile based analysis, associated with better HbA1c and fasting plasma glucose. Decreasing relative risk trends for both prediabetes and diabetes were found with increasing serum prolactin concentrations. No association was found with obesity and dyslipidemia.

Effect of Carica papaya Leaf Extract Capsule on Platelet Count in Patients of Dengue Fever with Thrombocytopenia.

OBJECTIVE: Thrombocytopenia in dengue fever is a common and serious complication. However, no specific treatment is available for dengue fever induced thrombocytopenia. In few countries (Pakistan, Malaysia, Sri Lanka and other Asian countries) the leaf extract of Carica papaya has been effectively used for thrombocytopenia. So, the study is planned to access effect of Carica papaya leaf extract on platelet count in dengue fever patients. METHODS: All participants were randomised into two groups, study group and control group; the study group was given papaya leaf extract capsule of 500 mg once daily and routine supportive treatment for consecutive five days. The controls were given only routine supportive treatment. Daily complete blood counts, platelet counts and haematocrit level, liver function test, renal function test of both groups were observed. RESULTS: On the first day platelet count of study group and control group was (59.82±18.63, 61.06±20.03 thousands, p value 0.36). On the 2nd day platelet count of both study and control groups was not significantly different (61.67±19.46 and 59.93±19.52 thousands, p value 0.20) but on 3rd day platelet count of study group was significantly higher than control group (82.96±16.72, 66.45±17.36 thousands, p value < 0.01). On 4th and 5th day platelet count of study group (122.43±19.36 and 112.47±17.49 thousands respectively) was also significantly higher than the control group (88.75±21.65 and 102.59±19.35 thousands) (p value < 0.01). On 7th day platelet count of study group and control group were not significantly different (124.47±12.35 and 122.46±19.76 thousands respectively, p value 0.08). Average hospitalization period of study group v/s control group was 3.65±0.97 v/s 5.42±0.98 days (p value < 0.01). Average platelet transfusion requirement in study group was significantly less than control group (0.685 units per patient v/s 1.19 units per patient) (p value <0.01). CONCLUSIONS: It is concluded that Carica papaya leaf extract increases the platelet count in dengue fever without any side effect and prevents the complication of thrombocytopenia. So, it can be used in dengue fever with thrombocytopenia patients.