Low Serum Testosterone Levels in Male Patients with Type 2 Diabetes Mellitus as a Risk Factor for Coronary Artery Disease.

BACKGROUND: Diabetes mellitus is a chronic debilitating illness associated with several complications of which hypogonadism in male patients with type 2 diabetes mellitus (T2DM) is often overlooked but carries a high prevalence and possibly associated with several co-morbidities. OBJECTIVES: To study the correlation of serum testosterone with clinical and biochemical factors in male patients with type 2 diabetes mellitus. METHOD: In our cross-sectional study, we selected a group of 100 patients with type 2 diabetes mellitus (50 each with hypogonadism and 50 with eugonadism) and obtained their biochemical parameters and looked for the prevalence of co-morbid conditions. We did a correlation of serum testosterone with each quantitative variable using Pearson's Coefficient of correlation and multivariable logistic regression analysis was applied. RESULT: Serum testosterone levels were found to be correlated with age, waist circumference, fasting blood sugar, serum triglycerides and eGFR (p<0.05).The prevalence of coronary artery disease was higher in T2DM male patients with hypogonadism as compared eugonadal patients. We found higher odds (1.33 times) for coronary artery disease in male patients with hypogonadism and T2DM as compared to males with T2DM and eugonadism. CONCLUSION: There is a higher risk of coronary artery disease in male patients with T2DM and hypogonadism as compared to males with T2DM and eugonadal status.

Exercise Prescription in Diabetes- S.M.A.R.T.: A Prospective Study.

BACKGROUND: Exercise prescription has always been a mandatory yet extremely under rated non-pharmacological approach in management of diabetes mellitus. SMART acronym for S - specific, M - measurable, A - attainable, R - realistic, T - time oriented, is a newly proposed idea for implementing the same with supposedly better results. We tried to analyse the results objectively by SMART prescription of individualized exercise regimes to patients along with medicines. METHODS: Single centred, prospective study conducted over a time span of 3 months, on 75 patients, with biweekly follow-up. At the end of three months, we evaluated the results (of 52 patients who remained) by comparing random blood sugar and glycosylated haemoglobin values of the patients at the beginning and end of the trial. RESULTS: A significant reduction in blood sugar (p-0.023) and A1C levels (p-0.105; ns) was noted after a period of three months; with an average reduction of 31mg/ dl and 0.37% noted in each respectively. Additional benefits of better follow up, reduced financial burden, increased compliance to the said regimen were observed. DISCUSSION: Recommending exercise and lifestyle changes is as important as pharmacological management in diabetes. A SMART approach, methodical prescription of the exercise routines and drugs- individualized for patients, will likely have better results and patient satisfaction. A practice of switching to precise written suggestions than verbal ideas and reviewing the progress on every follow up visit may improve the outcome.

COVID 19- Clinical Profile, Radiological Presentation, Prognostic Predictors, Complications and Outcome: A Perspective from the Indian Subcontinent.

BACKGROUND: Since December 2019, we have been facing one of the worst pandemics of human history. It originated from the Hubei province in China as a case of pneumonia, later named COVID-19.1 The causative pathogen, a new enveloped betacoronavirus2 is now known as Severe acute respiratory syndrome corona virus-2 (SARS-CoV 2). India reported its first case of COVID19, on 30th January 2020. We aim to identify the defining clinical and radiological characteristics, severity and prognosis, along with impact of age on outcome. METHODS: Cross sectional, observational study of patients diagnosed with COVID -19 [RT-PCR]. RESULTS: We observed male predominance, mean age of 36 years, with less or no symptoms, majority brought in after screening and contact tracing by the screening teams. Thrombocytopenia, lymphocytosis, raised LDH was common (>35%, p<0.05). Patients over the age of 60 were the ones having severe illness and more complications (p<0.05). Radiographic abnormality was frequently associated irrespective of clinical presentation and its severity. Poor prognosis was noted in elderly, especially those with co-morbidities. DISCUSSION: Though the disease has a relatively mild course in this part of the subcontinent, patients aged ≥60 are at significant risk for morbidity and mortality. Clinical and laboratory findings are similar to those found in viral diseases. Increased risk of cardiac involvement needs to be looked into. Chest X-ray proves sufficient for imaging, reducing the requirement of CT scans. Studies involving larger sample size and interventional trials are need of the hour.