ABSTRACT
BACKGROUND: Obstructive sleep apnea (OSA) has been a significant contributor to mortality all across the globe. The most attributing factors to pathogenesis are metabolic syndrome, obesity, diabetes, and so on, but the indicators of its early detection are still elusive. OBJECTIVE: The study aimed to compare the clinical, biochemical, and polysomnographic characteristics of type 2 diabetes patients with and without OSA. DESIGN AND METHODS: This cross-sectional study was conducted at the Department of Medicine and Endocrinology Unit of Dayanand Medical College and Hospital, Ludhiana. A total of 584 patients with type 2 diabetes were assessed using the Berlin questionnaire, with 302 fulfilling the criteria for a high risk of OSA. Out of 302 patients who met the criteria for the high-risk category, 110 patients underwent a sleep study. RESULTS: Three hundred and two patients satisfying the inclusion and exclusion criteria were enrolled in the study. A total of 110 patients underwent a sleep study, of which 68 (61.8%) had evidence of OSA. The waist-to-hip ratio was considerably higher in the OSA patients than in the non-OSA group (1.09 vs 0.930, p = 0.001). HbA1c >7% was found in 58.8% of OSA patients contrary to 38.1% of non-OSA patients. Fasting plasma glucose levels (>126 mg/dl) were identified in a substantially larger proportion of OSA patients than the non-OSA patients (64.7% vs 45.2%, p = 0.04). Similarly, peripheral neuropathy was found more commonly in the OSA patients than in the non-OSA patients (47% vs. 26.1%, p = 0.02). Prevalence of retinopathy, nephropathy, coronary artery disease, stroke, heart failure, and peripheral vascular disease did not differ significantly between the two groups. CONCLUSIONS: OSA frequently occurs among individuals diagnosed with type 2 diabetes mellitus. The prompt identification of OSA within this demographic is imperative to pinpoint those at an elevated risk of succumbing to conditions such as peripheral neuropathy, the exacerbation of glycemic control, and the onset of unmanaged hypertension. Moreover, there exists a positive correlation between the waist-to-hip ratio and the prevalence of OSA in persons with type 2 diabetes mellitus, highlighting the critical role of waist-to-hip ratio assessments in this patient population.
ABSTRACT
Ansa pancreatica is a rare anatomical variation of the pancreatic duct system, characterized by a reversed S-shaped loop that connects the main pancreatic duct to the minor papilla. Its clinical significance, particularly with recurrent acute pancreatitis, has been a subject of interest, but remains poorly understood due to the rarity of reported cases. We report the case of a 34-year-old female with a history of multiple episodes of acute pancreatitis, diagnosed with ansa pancreatica using magnetic resonance cholangiopancreatography (MRCP). The patient presented with severe epigastric pain radiating to the back, accompanied by vomiting and nausea. Laboratory findings revealed elevated serum amylase and lipase levels. MRCP imaging identified the ansa pancreatica, showing a distinct looping ductal variant terminating near the minor papilla. The patient underwent successful endoscopic treatment with significant improvement in symptoms and no recurrence of pancreatitis at follow-up. In this case, the presence of ansa pancreatica underscores the variant's potential role in predisposing individuals to recurrent episodes of acute pancreatitis. The literature review highlights the anatomical description of ansa pancreatica and its speculated pathophysiological mechanism leading to pancreatitis, primarily due to impaired pancreatic juice drainage. Despite its rarity, recognizing ansa pancreatica is crucial for the appropriate management of idiopathic recurrent pancreatitis, especially in cases where conventional causes are absent. This case report and literature review emphasize the importance of considering ansa pancreatica in the differential diagnosis of recurrent acute pancreatitis. Further research is needed to elucidate the exact mechanism by which this anatomical variant contributes to pancreatitis and to explore potential therapeutic interventions. Awareness and early detection of ansa pancreatica can lead to targeted treatments, reducing the morbidity associated with recurrent pancreatitis episodes.
