Prevalence of Depression in Patients with Type II Diabetes Mellitus and its Impact on Quality of Life.

BACKGROUND: Diabetes mellitus (DM) is a frequently encountered chronic metabolic disease with various complications throughout its course, which causes severe restriction and disability in an individual's life. It has been well documented that the incidence of depression is higher in diabetic patients and co-morbid depression causes further deterioration in the quality of life in diabetic patients. AIMS: To study the prevalence of depression and its impact on quality of life in patients with type II DM. SETTINGS AND DESIGN: Single centre, cross-sectional, single interview. MATERIALS AND METHODS: Total 195 type II DM patients are included in this study. To diagnose Depressive Episode Structured Clinical Interview for DSM IV Axis-1 Disorders, Research Version patient edition was applied. All patients were evaluated with a semi-structured socio-demographic proforma to assess socio-demographic characteristics, Hamilton Rating Scale for Depression (HAM-D) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) SF (Short Form) to measure the quality of life. RESULTS: Among them, 46.15% (N=90; males: 41, females: 49) met the DSM-IV diagnostic criteria for major depressive episodes. Among the depressed group, majority were (36.7%) moderately depressed. QLESQ-SF total and each item scores were significantly lower in the depressed group than in the non-depressed group. Both the HAM-D scores and HbA1c level have significant negative correlations with QLESQ-SF total scores. CONCLUSION: Our study demonstrates that the presence of depression in type II DM further deteriorates the quality of life of the patients. Therefore, treating depression would have a beneficial effect on the quality of life.

Prediction of Clinical Outcome in Acute Hemorrhagic Stroke from a Single CT Scan on Admission.

BACKGROUND: From a single CT scan in primary intracerebral hemorrhage (ICH), clinical outcome can be assessed on admission by using the CT scan parameters. AIMS: The study aims to find out how hematoma volume, location of stroke, midline shift, intraventricular extension of bleed and ventricle compression influence the clinical outcome in patients with acute ICH. MATERIALS AND METHODS: Non-contrast CT scan was done on admission in hospital for every patient with acute hemorrhagic stroke and was analyzed accordingly. Clinical assessments were done in National Institute of Health Stroke Scale (NIHSS). Chi-square test and multiple logistic regression analysis were used for statistical analysis. RESULTS: Mean hematoma volume associated with death before 30 days is 33.16 cm(3) (P < 0.0001), with survived after 30 days is 15.45 cm(3) (P < 0.0001), with NIHSS score ≥16 is 29.03 cm(3) (P < 0.0001) and with NIHSS score <16 is 13.69 cm(3) (P < 0.0001). Independent poor prognostic factors were hematoma volume > 30 cm(3) (OR = 27.857), brain stem hemorrhage (OR = 6.000), intraventricular extension of bleed from other location (OR = 7.846), presence of ventricular compression alone (OR = 2.700) and in combination with midline shift of ≥ 5 mm (OR = 2.124). CONCLUSIONS: From a single CT scan during hospital admission, mortality and morbidity in next 30 days can be predicted. A hematoma volume >30 cm(3), brain stem hematoma, intraventricular extension of bleed and ventricular compression along and with midline shift are associated with early mortality in ICH.

Plasma osmolality in acute spontanious intra-cerebral hemorrhage: Does it influence hematoma volume and clinical outcome?

BACKGROUND: Neurological deterioration in acute spontaneous intra cerebral hemorrhage (ICH) may depend on hematoma volume, electrolyte imbalances, hydration status and other physiological parameters. Plasma osmolality is a marker of hydration. This study has examined the relationship of plasma osmolality with hematoma volume and clinical outcome. MATERIALS AND METHODS: This is a prospective observational study included 75 patients with non-traumatic acute spontaneous ICH. Plasma osmolality, hematoma volume and clinical outcome in National Institute Health stroke scale (NIHSS) were measured on admission and on day 7 after treatment. Mean plasma osmolality was compared between those who died before day 7 and those who died after day 7. Plasma osmolality was also compared between patients with NIHSS score >20 and patients with NIHSS score ≤20. Paired t test, Pearson correlation coefficient and independent sample t test were done using SPSS software (version 17 for Windows). RESULT: There is no significant correlation between hematoma volume and plasma osmolality. Higher admission plasma osmolality was associated with early death [312.0 (±16.0) mOsm/kg for those who died before day 7 versus 297.0 (±14.7) mOsm/kg for those who died after day 7, P value =0.031]. Higher admission plasma osmolality was associated with very severe stroke [311.5 (±14.1) mOsm/Kg for patients with NIHSS score >20 versus 293.6 (±11.3) mOsm/kg for patients with NIHSS score ≤20, P value =0.000). CONCLUSION: High plasma osmolality is a predictor of early mortality. Hematoma volume is not influenced by plasma osmolality.

Albuminuria and neuropathy in newly detected diabetics: profile and correlation.

Neuropathy and nephropathy are two most common chronic complications of diabetes mellitus. Albuminuria and neuropathy has been found to be associated in patients with long standing diabetes. In the present study, the profiles of proteinuria and neuropathy have been studied in newly diagnosed cases of type 2 diabetes mellitus and attempt has been made to determine any relationship between the two. We studied 100 newly diagnosed ceases of type 2 diabetes mellitus and presence and type of neuropathy was assessed clinically and electrophysiologically. Albuminuria was detected by morning spot sample for albumin to creatinine ratio estimation. Results were analysed using appropriate statistical methods. It was found that 21 patients (21%) had proteinuria and 31 (31%) had neuropathy. Both were present in 16% patients and absent in 64% cases. The overall prevalence of neuropathy and proteinuria among study subjects was 36%. Isolated peripheral neuropathy was found in 9% patients, isolated autonomic neuropathy was found in 7% patients, and both were present in 15% cases. Proteinuria was mostly micro-albuminuria (90.5%). Occurrence of albuminuria and neuropathy has been found to be significantly associated with increasing age. Concurrence of diabetic neuropathy and albuminuria has been found to be significantly associated. The present study reveals that presence of neuropathy as well as nephropathy is common in newly diagnosed cases of type 2 diabetes mellitus. Both these complications have been significantly associated with increasing age indicating the possibility of a longer duration of undetected diabetes among them. Concurrence of neuropathy and nephropathy found in this study suggests that microvascular complications go hand in hand.

A study of the association of micro-albuminuria and C-reactive protein (CRP) in normotensive diabetic and hypertensive diabetic patients.

Diabetes mellitus and hypentension are known to increase markers of inflammation, ie, C-reactive protein (CRP), especially when they develop micro-albuminuria. A total of 60 patients (23 males and 37 females), all having diabetes mellitus, according to ADA criteria and micro-albuminuria in morning spot urine sample were recruited in the study. They were randomised into 2 groups, each comprising 30 patients. Group A comprised hypertensive and Group B normotensive individuals. CRP level was assessed in all patients by routine assay. CRP value of >3 mg/l was observed in 56.66% patients of group A and 23.33% patients of group B (p=0.018). So diabetic patients with micro-albuminuria had more frequent association with increased marker of inflammation in the hypertensive group compared to those without hypertension.

Philadelphia chromosome positive essential thrombocythemia with dilated cardiomyopathy.

We report here an unusual case of a 30-year old male patient with essential thrombocythemia (ET) and dilated cardiomyopathy, who on further investigation was found to have Philadelphia chromosome positive (Ph+) cells in the bone marrow. The reverse transcriptase-polymerase chain reaction (RT-PCR) test on his peripheral blood leucocytes revealed b2a2 transcript of the bcr-abl fusion gene. Literature shows that the boundary line between Ph+ essential thrombocythemia and chronic myeloid leukemia (CML) is getting blurred day by day. Each one may be a part of the spectrum of a single clonal proliferative disease. Association of dilated cardiomyopathy with ET has not been reported.