Vitamin D levels and microvascular complications in type 2 diabetes.

BACKGROUND: Vitamin D has important actions on glucose metabolism. These include improved insulin exocytosis, direct stimulation of insulin receptor, improved uptake of glucose by peripheral tissues, improving insulin resistance. It has got various pleiotropic effects like suppression of cell mediated immunity, regulation of cell proliferation, stimulation of neurotropic factors such as nerve growth factor, Glial cell line-derived neurotrophic factor, neurotropin, suppression of RAAS, reduction of albuminuria, immunomodulatory effects, and anti-inflammatory effects. Thus, vitamin D is implicated in many ways in the pathogenesis of retinopathy, neuropathy and nephropathy. OBJECTIVES: To study the correlation of vitamin D levels with microvascular complications in type 2 diabetes. MATERIALS AND METHODS: Cross-sectional case-control study of 18 patients (18-70 years), who met the American Diabetes Association 2011 criteria for type 2 diabetes, was conducted. Age and sex matched healthy controls were taken. Subjects were evaluated for the presence of microvascular complications by clinical evaluation, urine examination, fundus examination, nerve conduction studies, and various biochemical tests. 25-OH cholecalciferol levels were done for each. Cut off level for vitamin D deficiency was 20 ng/ml. RESULTS: Mean vitamin D was lower in type 2 diabetics than healthy subjects (19.046 vs. 27.186 ng/ml). Prevalence of vitamin D deficiency and insufficiency was found to significantly higher in diabetics when compared to healthy subjects (P = 0.0001). Vitamin D deficiency was found to be significantly associated with neuropathy (χ(2) = 5.39, df = 1, P = 0.020), retinopathy, (χ(2) = 6.6, df = 1, P = 0.010) and nephropathy (χ(2) = 10. 52, df = 1, P = 0.001). Lower levels of vitamin D were found to be associated with increasing prevalence of combinations of microvascular complications namely neuropathy with retinopathy (P = 0.036), neuropathy with nephropathy (P = 0.029), retinopathy with nephropathy (P = 0.022) and neuropathy with retinopathy with nephropathy (P = 0.0001).

Accidental isoniazid poisoning--a report.

Eight patients who had taken accidental overdose of Isoniazid were followed in relation to its clinical manifestations, EEG changes and management. All cases survived without any residual effect.

Myocarditis and hemiplegia from scorpion bite--a case report.

A 16 year old boy presenting with features of myocarditis and pulmonary oedema following scorpion sting developed hemiplegia with patchy vasculitic lesions on CT scan. The possible pathogenic mechanism is discussed.

Visual evoked responses in ethambutol induced optic neuritis.

Pattern evoked responses were recorded in 46 patients of tuberculosis on ethambutol and 16 healthy subjects. Deterioration in visual acuity was documented in two patients (4.3%). P100 latency was delayed in 16 cases (34.8%), while in 12 patients (26.1%) both latency and amplitude were affected. A cut off latency value of > or = 140 ms was associated with ophthalmological findings. The incidence of subclinical toxicity as detected by visual evoked response (VER) was higher in older subjects, patients on higher doses of ethambutol (> or = 20 mg/kg/day) and longer duration of treatment. Of two cases with objective ocular signs, one who reported for follow up after two months had recovered completely after stopping ethambutol. Recording of VER is an extremely useful objective test for subclinical optic nerve damage.

Isoniazid induced neuropathy in slow versus rapid acetylators: an electrophysiological study.

Clinical, biochemical and nerve conduction studies were performed in 100 cases of tuberculosis taking isonicotinic acid hydrozide (isoniazid) for more than 12 weeks. Electro-physiological studies were carried out in a similar number of normal age and sex matched controls. In 16 percent of cases an abnormality was documented in the motor nerve conduction velocity, amplitude and terminal latency of the common peroneal, ulnar and median nerves; of these, only two patients had objective evidence of neuritis. The occurrence of isoniazid neuropathy was found to be more in the fourth decade of life (10 of 16), in those who had taken the drug for over six months (13 of 16), and in 'slow' inactivators (10 of 16).

Contrast computed tomography in epilepsy with special reference to intracranial ring or disc enhancing lesions.

We report the results of computed tomography (CT) in 170 patients who developed seizures. Localized signs could be demonstrated by neurologic examination in 23.5%. CT findings were normal in 64 patients (37.6%). The commonest abnormality was a focal ring or disc enhancing lesion in 66 patients (62.3%) followed by calcification (18 patients; 16.9%), cerebral atrophy (9; 8.5%), vascular lesions (7; 6.6%), tumours (4; 3.8%) and congenital hydrocephalus (2; 1.9%). The occurrence of abnormal CT was higher (74.3%) in patients with partial seizures.