A Study of Association of Plasma Procalcitonin with Various Components of Metabolic Syndrome and Insulin Resistance.

The metabolic syndrome is a cluster of risk factors that are associated with increased risk of cardiovascular diseases and Type 2 diabetes mellitus. The aim was to study the association of plasma procalcitonin with various components of metabolic syndrome (abdominal obsesity, dyslipidemia, hypertension and hyperglycemia) and insulin resistance and compare with healthy controls. In addition, we tried to gauge the association of plasma procalcitonin with complications of metabolic syndrome at presentation. MATERIAL: This was a hospital based observational comparative study on 30 cases of metabolic syndrome in hospital wards and OPD of SMS Medical College, Jaipur and 30 accompanying healthy controls. INCLUSION CRITERIA: Age more than 18 years, and newly diagnosed or old cases of metabolic syndrome using the definition given by International Diabetes Federation (2006). EXCLUSION CRITERIA: Individuals with active infection, trauma, surgery, neoplasms, cirrhosis, pancreatitis and autoimmune diseases or taking medications which can alter the biochemical profile. Detailed history was taken, subjects clinically examined and anthropometric measurements were taken. Required investigations were obtained and statistical analysis done. OBSERVATION: Plasma procalcitonin was significantly higher in cases (mean 0.11 ng/ml) compared to controls (mean 0.002 ng/ml). Waist and neck circumference (102.87±5.19 and 42.03±3.08) values were higher in case group compared to control group (79.67 ±7.98 and 37.10±1.35). Plasma procalcitonin significantly (p<0.05) correlated with level of insulin resistance (HOMA IR), waist circumference, neck circumference, S. Triglycerides, S. VLDL, fasting blood glucose and fasting insulin level in the case group when analyzed by linear regression analysis. We also found that out of 30 subjects in cases, 16.7% had history of MI, whereas in control group no subject was reported with MI. In case of history of CVA, 16.7% had CVA in case group, whereas in control group, no patient was reported with CVA., Conclusion: Our findings based on community-based data showed that higher plasma procalcitonin levels in the normal range are associated with increased measures of obesity, components of the metabolic syndrome, and greater risk of having metabolic syndrome and insulin resistance. Because associations only partly depend on BMI, plasma procalcitonin may serve as a new marker for adipocyte dysfunction, chronic low-grade inflammation, or both.

A Comparative Study between Mean Platelet Volume and Hba1c Levels in Patients of Type 2 Diabetes Mellitus.

Diabetes mellitus is a major global health problem, increasingly affecting the population across the world. Diabetic patients have an increased risk of developing micro and macro vascular diseases, and platelets may be involved as a causative agent with respect to altered platelet morphology and function. There are studies evaluating the association between Mean Platelet Volume (MPV) and HbA1c and its role in predicting glycaemic control with conflicting results. Thus the present study was conducted to assess the relationship between HbA1c levels and platelet activity (MPV), determine the association among MPV, glycemic control, and diabetic vascular complications and to evaluate the influence of improved glycemic control on MPV in type 2 diabetic patients. MATERIAL: This was a hospital based observational comparative study on 100 cases of diabetes mellitus divided in 2 groups i.e Group A (HbA1c <7) and Group B (HbA1c >7) and 50 healthy controls in Group C in hospital wards and OPD of SMS Medical College, Jaipur. INCLUSION CRITERIA: Age more than 18 years, and newly diagnosed or old cases of diabetes mellitus using the definition given by American Diabetes Association. EXCLUSION CRITERIA: Abnormal platelet count (<100 and >450×103/µL), Acute febrile illness, Use of drugs affecting platelet function, Male patients with Hb<12.5mg/dl and females with Hb<11.5 mg/dl and Pregnant females. OBSERVATION: It was observed that mean MPV(fl) was maximum in Group B (13.35±1.27), followed by Group A (10.77±.77) and Group C (9.09±.85) and a significant (p-value<0.05) relation was found statistically. We also observed that mean HbA1c (%) was maximum in Group B (8.82±1.41), followed by Group A (6.66±.004) and Group C (5.67±.45) and a significant (p-value<0.05) relation was found statistically in these 3 groups. In group B, at baseline MPV(fl) levels were more (13.35±1.26) than at follow up after glycemic control of 3mths (12.13±1.20) and this was found to be statistically significant. CONCLUSION: We found that Mean platelet volume in diabetic mellitus type 2 patients was significantly higher than non-diabetic group. We also found that the mean platelet volume in uncontrolled diabetic group (HbA1c more than 7 percent) was significantly higher than controlled diabetic group (HbA1c less than 7 percent). Our study showed that in diabetes mellitus, platelets become more reactive and aggregable and their mean volume (MPV) is increased. We also found that increase in HbA1c concentration was directly proportional to increased MPV.

Association of Stress Hyperglycemia and Adverse Cardiac Events in Acute Myocardial Infarction - A Cohort Study.

BACKGROUND: Stress hyperglycemia is a common phenomenon in patients presenting with acute myocardial infarction (MI). We aim to evaluate the association of stress hyperglycemia at the time of hospital presentation and adverse cardiac events in myocardial infarction during the course of hospital stay. METHODS: Subjects with age ≥18 years with acute MI were recruited on hospital admission and categorized based on admission blood glucose (<180 and ≥180 mg/dl, 50 patients in each group). Both groups were compared for clinical outcomes, adverse cardiac events and mortality. We also compared the adverse cardiac outcomes based on HbA1c levels (<6% and ≥6%). RESULTS: Patients with high blood glucose on admission (stress hyperglycemia) had significant increased incidences of severe heart failure (Killip class 3 and 4), arrythmias, cardiogenic shock and mortality (p value = 0.001, 0.004, 0.044, and 0.008 respectively). There was no significant association between adverse cardiac events and HbA1c levels (heart failure 18.8% vs. 25%, p value = 0.609 and mortality 16.7% vs. 17.3%, p value = 0.856). CONCLUSIONS: Stress hyperglycemia is significantly associated with adverse clinical outcomes in patients with MI irrespective of previous diabetic history or glycemic control. Clinicians should be vigilant for admission blood glucose while treating MI patients.

Overview of Early Cases of Coronavirus Disease 2019 (COVID-19) at a Tertiary Care Centre in North India.

INTRODUCTION: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread on an unprecedented scale from around the world, we described our experience in treating early COVID-19 cases in India. MATERIALS AND METHODS: An observational study of COVID-19 patients admitted to a tertiary care centre in North India between 2 March-4 April 2020 was performed. The clinical, epidemiological, laboratory, treatment and outcome data of patients were evaluated. RESULTS: A total of 75 patients were treated and 56 (74.66%) were men. The clinical spectrum of COVID-19 ranged from asymptomatic to acute respiratory distress syndrome (ARDS). Fever (85.36%) was the most common symptom followed by cough (56.09%) and dyspnoea (19.51%). Findings from hemogram analysis showed that 32%, 21.33% and 18.67% of patients had lymphopaenia, eosinopenia and thrombocytopaenia, respectively. Inflammatory markers such as C-reactive protein, D-dimer, ferritin, fibrin degradation product and interleukin-6 were significantly elevated (P <0.05) in patients who required oxygen therapy than those who did not require it, suggesting the potential role such markers could play in predicting prognosis in patients. Mean hospital stay was 9.2 days and 72 (96%) patients made a complete recovery, but 3 (4%) patients demised after progressing to ARDS. CONCLUSION: The clinical and epidemiological spectrum of COVID-19 has jeopardised the health system in India. Without a proven therapy to combat this pandemic and with no sight of vaccines in the near future, a preventive strategy should be adopted to contain the spread of this infectious disease.

Study of the Association of Epicardial Adiposity with Albuminuria in Patients with Essential Hypertension.

BACKGROUND: Epicardial adipose tissue (EAT), a type of visceral adipose tissue, has been found to be a cardiometabolic risk factor contributing to cardiovascular disease. Albuminuria, a marker of endothelial dysfunction is also associated with an increased risk for cardiovascular disease. The aim of this study was to investigate the relationship of echocardiographic epicardial adipose tissue (EAT) thickness and albuminuria in hypertensive patients. AIMS AND OBJECTIVES: To compare EAT between essential hypertensive patients with normal UACR (<30) and albuminuria (UACR>30). METHODS: 100 essential hypertensive patients were included into the study. Age, body mass index (BMI), blood pressure, hemoglobin, random blood sugar, creatinine, albumin was evaluated. Spot urine sample was collected for the assessment urine albumin creatinine ratio (UACR). Patients were divided into two groups according to UACR; Group A included UACR <30 mg/g; and Group B included UACR > 30mg/g. Thereafter, all subjects underwent transthoracic echocardiography to measure EAT thickness, left ventricular mass (LVM), left ventricular mass index (LVMI) and ejection fraction (EF). MAIN OUTCOMES AND MEASURES: Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. The primary composite end-point was admission to an intensive care unit (ICU), the use of mechanical ventilation or death. Patients were categorized as severe pneumonia and non-severe pneumonia at time of admission and outcome data was compared. RESULTS: The mean EAT was found to be significantly higher in patients with significant albumin excretion (UACR>30 mg/g) as compared to group A (6.65 ± 1.944 mm vs. 3.64 ± 1.13 mm, respectively, p<0.001). Upon correlation analysis, EAT was found to be positively correlated with age (r = 0.749, p < 0.001), serum creatinine (r = 0.244, p = 0.014), LVM (r = 0.691, p = 0.001) and LVMI (r = 0.677, p = 0.001) and negatively correlated with EF (r = -0.599, p = 0.001). CONCLUSIONS: Epicardial adipose tissue thickness can serve as a high-risk marker to stratify essential hypertensive patients.

Characteristics, Treatment Outcomes and Role of Hydroxychloroquine among 522 COVID-19 hospitalized patients in Jaipur City: An Epidemio-Clinical Study.

PURPOSE: The present study was undertaken to investigate epidemiological distribution, clinical manifestation, co morbid status, treatment strategy and case fatality index of emerging COVID-19 infection at SMS Medical College Hospital, Jaipur, Rajasthan. It also evaluated efficacy of hydroxychloroquine (HCQ) in treatment of patients and risk of serious adverse outcomes in patients with COVID-19 in relation to their co morbid status. MATERIALS AND METHODS: In an attempt to provide extensive information pertaining to epidemiological and clinical characteristics of COVID-19, the present study was undertaken on 522 patients. The patients were COVID-19 confirmed positive by genomic analysis through Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) at SMS Medical College and Attached Hospitals, Jaipur. The indoor admitted patient's information inclusive of demographic profile (age, sex, nationality, residence), date of confirmation for positive COVID-19 case, travel/ exposure history, date of recovery/ death, clinical features, co morbidities and treatment plan was recorded. A serial follow-up of recovered patients to evaluate infective period of the disease was also part of the study. RESULTS: A total of 522 patients of laboratory confirmed COVID-19 test by RT-PCR at SMS Hospitals, Jaipur were assessed. Among the confirmed cases, most of patients were young adult in the age group with mean age of 35.42 years. 22.41% patients were below 20 years of age, majority of patients (58.80%) were in the age range of 21 to 50 years and only 18.79% patient population was in the age range of above 50 years. Females (39.08%) were affected less than males (60.91%) with an average sex ratio of female: male being 0.64. Out of the total analyzed patients, only 24.32% patients were symptomatic, among them fever (55.90%), cough (52.75%), sore throat (49.60%) and shortness of breath (46.45%) were the most common presenting clinical manifestations while a few patients also had symptoms of headache (26.77%), chest pain (6.29%) and other symptoms (7.87%) like pain abdomen, fatigue, joints pain, altered sensorium etc. Most of symptomatic patients belonging to older age group. An average of 40.40% patient population of above 50 years of age, were symptomatic while none of the patients below 10 years of age were symptomatic. 13.98% patients had some or the other underlying co morbid disease. The most prevalent co morbidity was hypertension (42.46%) followed by Diabetes mellitus (39.72%), Old k-chest (20.54%), COPD/ Bronchial Asthma (16.43%), Coronary artery disease (13.69%), Chronic kidney disease (13.69%) and Valvular heart disease (6.84%) distributed in co morbid patients of COVID-19. 60.27% of patient population with underlying co morbid conditions were more prone to develop symptomatology complex as compared to that observed in patients with no co morbidity (18.42%). 116 patients had recovered with effective treatment till the date of data analysis. Time of recovery was counted from the date of positive report to 1st negative report of oropharyngeal sample by RT-PCR for COVID-19 with an average recovery time of 8.15 days. 23.27% patients recovered within 5 days, while 52.58% patients took about 6-10 days, 23.27% patients took 11-15 days and remaining 0.86% took more than 16 days to recover. In the present study 15 patients had died till analysis of data, among the deceased, 73.33% were above 50 year of age with a male preponderance (66.6%). Interestingly, all deceased (100%) had presented with clinical manifestations of COVID-19 and all had underlying multiple co morbid conditions. Majority of patients had early mortality after admission to hospital with two third death account in initial three days. Asymptomatic patients (cases) treated with HCQ recovered early (average recovery time =5.4 days) compared to asymptomatic patients who did not receive any treatment (control group) and had longer recovery time (average recovery time =7.6 days). CONCLUSION: The varied spectra of COVID-19 mostly affects young adult age group (third to fifth decades of life). Interestingly, early age group was also affected in significant proportion when compared with similar data from other countries. It was observed that male population seemed to be was more prone to getting infected. Majority of COVID-19 positive patients (nearly three-fourth) were asymptomatic (mostly in young age range) at the time of diagnosis, which poses a major challenge for health care workers. Fever, cough, sore throat and shortness of breath were major symptoms that could be detected in such COVID-19 patients. Symptomatic clinical manifestations were more common in old age population. Infectivity was higher in patients that had underlying co morbid disease, especially in patients with multiple co morbid conditions. Symptomatic presentation of COVID-19 was observed to be higher in patients with co morbid disease. Average recovery time from COVID-19 was 8 days with effective treatment. Mortality in COVID-19 was higher in old age population, male gender, symptomatic and co morbid patients as compared to other similarly matched group. Most of mortality was noted within first few days of admission, suggestive of early mortality due to the primary disease process. Treatment with HCQ had early recovery without effectively influencing the overall mortality.

A Crossover Study Evaluating Effect of Timing of Levothyroxine on Thyroid Hormone Status in Patients of Hypothyroidism.

OBJECTIVE: Current literature shows a definite benefit of fasting state Levothyroxine administration. However, superiority of any specific timing is not yet established. Our study was designed to compare the effect of timing of levothyroxine administration, morning versus evening dose, on thyroid profile control in patients of hypothyroidism. METHODOLOGY: :A randomized double-blind crossover study was performed on 60 patients with primary hypothyroidism, euthyroid on stable levothyroxine regime of 100 µg daily, randomized into two sequence groups, morning dose first (AB sequence) versus evening dose first (BA sequence) with switch over after 6 weeks. Primary endpoints were change in thyroid function tests. RESULTS: There was an insignificant rise in TSH in morning dose first group (AB) at 6 weeks which reduced significantly in evening dose, [2.36(1.11) to 2.45(1.19) mIU/L (p=0.56)], [2.07(0.99) (p=0.006)] respectively. Levothyroxine evening dose first group (BA) showed significant reduction of TSH levels at 6 weeks followed by non significant increase [2.63(0.96) to 1.85(1.35) mIU/L, (p=0.002)], [2.14(1.16), (p=0.15)]. Group AB showed mild followed by significant rise in FT4 at 6 and 12 weeks respectively, [1.06(0.30) to 1.14(0.33) ng/dl (p=0.18)], [1.24(0.36) (p=0.008)]. FT4 of BA sequence significantly increased at 6 weeks followed by mild increase, [1.10(0.29) to 1.20(0.28) ng/dl (p=0.01)] [1.23(0.31) ng/dl (p=0.58)]. FT3 of AB revealed initial reduction (p=0.87), followed by significant rise (p=0.02). Group BA showed a significant rise (p=0.04) in FT3 followed by fall (p=0.63). CONCLUSION: Bedtime dosing of Levothyroxine showed improved thyroid hormone status control and could be a viable option in treatment of patients with hypothyroidism.