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Background The clustering of risk factors of cardiovascular disease (CVD) in individuals has been defined as Metabolic Syndrome (MetS). The major forerunner of all the components of MetS is Insulin Resistance (IR) which is measured by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and requires the measurement of fasting plasma insulin levels. We attempted to study the performance of lipid-based biochemical markers of IR for the diagnosis of MetS and postulate a population-specific cutoff for these indices in the South Indian population. In this study, we analyzed three lipid-based indices, Triglyceride Glucose index (TyG index), triglyceride: high-Density Lipoprotein (TG:HDL) ratio, and lipid accumulation product (LAP). Methods This was a cross-sectional study and included apparently healthy individuals presenting to our hospital for routine Master Health Checkup assessment and apparently healthy population residing in Kallindhiri, a village near Madurai. Based on the anthropometric measurements and blood investigations, Body Mass Index (BMI), Waist hip ratio, Waist height ratio, HOMA-IR, TyG index, TG:HDL ratio, and LAP were calculated. The diagnostic efficacy of these indices was compared against the presence of MetS based on the NCEP ATP III criteria. The receiver operating characteristic (ROC) Curve was performed to discriminate decision levels (cutoffs) of serum markers in early diagnosis of metabolic syndrome. The results were considered significant with a p-value less than 0.05. Results We included a total of 192 patients in our study, consisting of 36% (n=70) males and 63% (n=122) females. All the baseline characteristics except height, weight, and HDL cholesterol were comparable between the male and female groups. The values of HOMA-IR, TyG index, TG:HDL ratio, and LAP showed an increasing trend with the BMI. The mean values of HOMA-IR, TyG index, TG:HDL ratio and LAP was significantly higher in patients with MetS than in patients without MetS. Based on the ROC curve plotted for the data, a population-specific cutoff for these indices was computed. Our proposed cutoff for the South Indian population for HOMA-IR is 1.23, for TyG index is 4.65, for TG:HDL ratio is 3.44 in males and 2.6 in females and for LAP is 43.81 Conclusion The cutoffs for the novel indices of insulin resistance which have been previously studied in Caucasian populations cannot be applied to Indian populations due to distinct ethnic characteristics. The diagnostic accuracy of these novel lipid-based biomarkers of Insulin Resistance is better than the biochemical gold standard of HOMA-IR based on the ROC curve. We propose the usage of these population-specific cutoffs in routine clinical practice for early diagnosis of metabolic syndrome.
RESUMO
Aim of Study: To study the clinico-epidemiological profile and identify risk factors for the development of COVID-19-associated mucormycosis (CAM) among the patients treated at our regional mucormycosis center. Materials and Methods: This was a cross-sectional single-centre observational study. All CAM patients admitted to Government Rajaji Hospital, Madurai from April 2021- August 2021 were included in the study. Information regarding clinical features, potential risk factors, diagnostic workup, and comorbid illness was collected. Results: A total of 164 patients of CAM were admitted to our hospital with a mean age of 51.7 years. Out of 164 patients, 12 patients were not covid positive, based on imaging and RT-PCR, however subclinical infection could not be ruled out. Out of the 164 patients studied, 160 patients had diabetes, out of which 66% (n = 105) patients had a previous history of diabetes, and 34% (n = 55) had newly detected diabetes. Most of the patients admitted with mucormycosis had uncontrolled diabetes (94%) and were not on insulin therapy, but were on oral antidiabetic drugs alone. The majority of the patients (68%) have received steroids (IV/oral) during the COVID-19 illness. 74% of these patients were under hospitalization for COVID-19 disease. Only 30% (n = 50) of CAM patients had a history of oxygen therapy and 7% of these patients were treated in ICU during active COVID-19 illness. 59% of patients used cloth masks without adequate hygiene, rest 41% (n = 67) patients reused disposable masks. We also found that 87% of the patients developing mucormycosis had exposure to organic material in the convalescence period of COVID-19 illness. Conclusions: From our study, we found steroid use, poorly controlled diabetes mellitus, reuse of masks, daily steam inhalation, and exposure to organic matter to be more associated with CAM, but oxygen therapy was less associated with CAM. Hence, we could suggest screening for hyperglycemia and daily use of disposable surgical masks to be continued for at least 4 weeks post-COVID-19. It is preferable to continue insulin in titrated doses along with OHA for at least 4 weeks following steroid cessation in the post-COVID-19 period as there is are considerably increased inflammatory cytokine levels in the convalescence phase. Clean environmental hygiene would also help prevent CAM.
