Status of carotid intima-media thickness and associated risk factors in diabetic, prediabetic and non-diabetic acute stroke.

OBJECTIVE: Measure carotid intima-medial thickness (CIMT), its variability, risk factors, their correlation, in type 2 diabetic (DM), pre-diabetic (PDM) and non-diabetic (NDM) acute strokes. METHODS: Twenty four DM and a matched population of 14 patients each of PDM and NDM strokes were studied. Each group was compared as whole and by gender and stroke segregation. Study parameters were right and left CIMTs (CIMTR, CIMTL), insulin resistance (IR), age, BMI and lipids, correlations between CIMTs and CIMTs with risk markers. RESULTS: CIMTR was higher in DM and PDM compared to NDM, but CIMTLs did not differ. CIMTs were similar in genders and stroke types of each group. The IR was significantly high only in DM. Age and BMI correlations were predominantly positive and lipids variable except in PDM. Age and IR had better impacts on CIMTs in DM while BMI was poor. Females and infarcts had a more congruous CIMT increment in DM and PDM but male and haemorrhage in NDM. CONCLUSION: With similar levels of risk markers, their impacts on the CIMTs are highly variable at various levels of glycaemia. CIMTs were similar in the genders and stroke types of each group, irrespective of the glycemic status. The pre-diabetes group had distinct features.

Utilization of therapeutic intervention to prevent mother to child transmission of HIV in a teaching hospital in Kolkata, India.

AIM: To assess the uptake of an HIV screening program and therapeutic intervention to minimize the risk of mother to child transmission. METHODS: This was a cross-sectional, observational study with retrospective data obtained from patient medical records. Pregnant women presenting to a tertiary care center in Kolkata, India, from 1 January 2004 - 31 December 2007 underwent HIV serology by rapid test after receiving group counseling. Care was administered using a standard national protocol by a multi-disciplinary team of health-care personnel. Main outcome measures were: acceptance of pretest counseling and HIV testing by pregnant women attending antenatal clinic services, post-test counseling rate, coverage rate of nevirapine to mother-child pairs, and averted HIV infection in children. RESULTS: Of the 52 127 new antenatal booking visits, 49 580 (95.11%) women attended pretest counseling and 47 506 (91.13%) women accepted HIV testing. Eighty-six women were found to be seropositive. The seroprevalence rate of HIV infection was 0.17%. Thirty-seven mothers (88%) and all newborn infants (100%) had received nevirapine prophylaxis. Overall nevirapine coverage rate was 48%. Twenty-four of the mother-infant pairs that we assessed had infants who were aged over 18 months by June 2008. Eleven (45.83%) of these women turned up with their babies for a blood test at 18 months. Three (27.27%) babies tested reactive. CONCLUSION: As uptake of testing is high and detection of HIV-infected women in pregnancy remains very low, a radical rethinking of policies on therapeutic intervention and their implementation now needs to be undertaken.

Comparative evaluation of ophthalmoscopy and angiography for the assessment of retinopathy in type 2 diabetes mellitus.

Diabetic retinopathy (DR) is emerging as a common cause of visual loss. This study was aimed at comparing the relative utility of fundus fluorescein angiography (FFA) with ophthalmoscopy (OPT) in its diagnosis with a cross-sectional cohort. A total of 100 patients of type 2 diabetes mellitus was divided into 3 groups depending on the duration from initial diagnosis and matched by important risk factors. Group A was < 5 years duration and had 31 patients; group B ranged between 5 and 15 years and had 40 patients; and group C were > 15 years with 29 patients. Parameters compared were: Normal retina (NR), background diabetic retinopathy (BDR), preproliferative diabetic retinopathy (PPR), proliferative diabetic retinopathy (PDR); and clinically significant maculopathy (MAC). Dye leakage (DL) and micro-aneurysms (MA) were assessed separately as they are recognised early markers of DR. Result analysis revealed that FFA is well correlated with OPT (0.99) for all groups except group A, where DL (35.5%) played a significant role in altering the correlation (0.85 versus 0.98--OPT versus FFA); 8% of total patients revealed a worse grade with FFA compared to OPT, so appropriate grading of retinopathy is better with FFA at any duration. Less severe varieties of DR predominate in all the groups (BDR-77.4%, 80%, 24.1% respectively), more severe varieties dominate in group C (17.2% and 58.6% of PPR and PDR respectively). MAC is present significantly in group C. FFA is strongly advised, at least in the high-risk groups, at initial diagnosis for detection of DL and also appropriate grading. OPT is a simple and adequate option beyond 5 years of duration. OPT is as good as FFA for the diagnosis of MAC.

Foetomaternal complications in pregnancies with diabetes mellitus: association with the amount of insulin requirement, mean terminal blood glucose and HbA1C levels.

Pregnancy hyperglycaemia can lead to foetomaternal complications. Normoglycaemia with exercise, diet and/or insulin can alter outcomes. The insulin requirement itself may alter outcomes independently. Two hundred and forty patients of pregnancy with diabetes mellitus were selected of which 176 belonged to gestational diabetes mellitus and 64 pregestational diabetes mellitus groups. Insulin requirement of pregestational diabetes mellitus group was 1.8 times higher than the gestational diabetes mellitus group. There were no insulin related increased complications in either group. The foetal complications were higher in pregestational diabetes mellitus group (62.5%) than in the gestational diabetes mellitus group (27.3 and 40% in < 15 units or > or = 15 units insulin requirement respectively). The terminal glycaemic parameters (fasting plasma glucose, 2 hours postprandial plasma glucose, HbA1C%) were not different in case of gestational diabetes mellitus between those with and without foetal complications, except for fasting plasma glucose where 'with complications' fasting plasma glucose was lower than without (79.4 +/- 13.14 versus 75.28 +/- 3.68 mg/dl). For pregestational diabetes mellitus patients those without complications had a significantly lower level of all the parameters (fasting plasma glucose 69.75 +/- 0.5 versus 122 +/- 14.14 mg/dl, postprandial plasma glucose 95 +/- 7.4 versus 131.5 +/- 12.02 mg/dl; HbA1C 6.8 +/- 0.28 versus 7.3 +/- 3.6%) compared with those having complications. Maternal complications could not be segregated as all the subgroups had a very incidence of caesarean section (60%-100%). However, when lower segment caesarean section was excluded and maternal complications segregated, for gestational diabetes mellitus patients, only fasting plasma glucose was significantly lower in cases without complications while in pregestational diabetes mellitus patients the fasting plasma glucose as well as HbA1C were significantly lower in cases without complications.

Diabetic microvasculopathy: the renal-retinal link.

Manifestations of diabetic microvasculopathy are protean. Graded increases in the severity are recognised in both nephropathy and retinopathy. This study was undertaken with 100 patients of type 2 diabetes mellitus to evaluate how far these graded increments could be linked at each stage and in each patient. The renal parameters studied were the various accepted levels of albuminuria; the retinopathy parameters ranged from normal retina to severe proliferative stages. Corresponding grades were proposed and altered, if required, to reach the best possible correlation. The correlation was attempted though the common link of mean glomerular filtation rates at each level and the concordance of either parameter grade in an individual patient. The correlations of the mean glomerular filtration rate for all propositions of severity were significant. However, there was significant variability of the parameters in an individual patient. This was more with less severe grades but diminished with increased duration. The predictive value of one lesion for the other was low in cases with shorter duration and less severe grades. Probably, shorter duration patients have an interplay of both genetic factors and the assault of the risk factors while in longer duration patients the cumulative risk exposure play the dominant role.