Association of Sonographically Assessed Visceral and Subcutaneous Abdominal Fat with Insulin Resistance in Prediabetes.

INTRODUCTION: Visceral abdominal Fat, not Subcutaneous Abdominal Fat better correlates with insulin resistance. Hence the present study was undertaken to study the association of sonographically assessed visceral and subcutaneous abdominal fat with insulin resistance in patients with pre-diabetes. MATERIAL AND METHODS: It was a hospital based cross sectional study done in prediabetes subjects. All the subjects were called fasting overnight and were given a structured questionnaire designed by investigator. Fasting and postprandial blood sugar, lipid profile, HB1Ac and fasting insulin levels was done in every subject. Ultrasound assessment of subcutaneous and visceral abdominal fat, fatty liver and fatty pancreas was done. RESULTS: Seventy Five patients (males 35 and females 40) were studied. Twenty nine patients had fatty liver and 40 patients had fatty pancreas. Among all sonographic parameters visceral abdominal fat thickness (VAF) showed a significant positive correlation with insulin resistance (p< 0.05). Subcutaneous abdominal fat thickness (SAF) had a positive though statistically non significant correlation with insulin resistance. Visceral abdominal fat thickness correlated best with fatty pancreas and had a significant positive correlation with insulin resistance. CONCLUSION: Fatty pancreas and visceral abdominal fat prove to be two important indices which mark the risk of insulin resistance thus may be considered an important predictor for screening of metabolic syndrome.

Cardio-metabolic Risk Profile in Women with Previous History of Pre-Eclampsia.

INTRODUCTION: Preeclampsia is one of the leading causes of maternal and neonatal morbidity and mortality. However there is growing evidence that there are differences during the post partum period between subjects with prior preeclampsia and prior uncomplicated pregnancy and women with a history of preeclampsia are more likely to develop cardiovascular disease later in life. The aim of our study was to assess the cardio- metabolic risk profile in women with previous history of pre-eclampsia and to their counterparts who had normal pregnancy. METHODS & MATERIAL: In a hospital based case-control study, 50 women aged 20-45 years who had history of preeclampsia and equal numbers of age matched women who had normal pregnancy were included. Apart from routine anthropometric and biochemical parameters, they were assessed for insulin resistance, Hs CRP (High sensitive C reactive protein) and flow mediated vasodilatation (FMD). RESULTS: Significant difference was noted with regard to BMI and waist circumference, systolic and diastolic blood pressures, and HOMA-IR which were higher and HDL and FMD were lower in women the previous preeclampsia than women with normal pregnancy. The prevalence of various cardio-metabolic risk factors increased in with increase in duration from index pregnancy. CONCLUSION: Women with previous history of preeclampsia had adverse cardio-metabolic profile than those who had normal pregnancy. They had higher insulin resistance and endothelial dysfunction. They also have high prevalence of chronic metabolic disorders with increased duration since index pregnancy.

Endothelial Dysfunction by Flow-Mediated Vasodilatation in Chronic Kidney Disease.

INTRODUCTION: The last few years have seen a phenomenal increase in the prevalence of chronic kidney disease (CKD). Cardiovascular disease remains the most important cause of death in these patients.The present study was conducted to evaluate endothelial dysfunction in CKD patients as compared with controls. METHODS: Thirty-five patients of CKD and 32 age and sex-matched controls were included in the study. Flow-mediated vasodilatation was assessed in all individuals. Anthropometric measurements, haematological and biochemical assessment were also done. RESULTS: It was found that patients of CKD had significant endothelial dysfunction in comparison with controls as assessed by flow-mediated vasodilatation of brachial artery. It was also seen that late stages of CKD patients had significant endothelial dysfunction in comparison to early stages of CKD. CONCLUSIONS: The present study concludes that chronic kidney disease patients have significant endothelial dysfunction and this is more pronounced in the later stages of the disease.

A study of newly diagnosed type 2 diabetes mellitus patients from rural areas.

OBJECTIVE: To study the clinical and biochemical profile of newly diagnosed type 2 diabetes mellitus patients who belong to rural areas. METHODOLOGY: The study was conducted on 105 newly diagnosed type 2 diabetes mellitus patients. A detailed history and thorough clinical examination was done. Anthropometric measurements were recorded. Investigations were done to assess micro vascular, macro vascular complications and lipid profile. RESULTS: There were 54 males and 51 females. The mean age of patients was 49 years. The mean BMI of males was 23.3 kg/m2 while that of females was 25.9 kg/m2. Waist Hip ratio was 0.97 in males and 0.92 in females. 30% patients had hypertension. 30% patients had a serum triglyceride level more than 150 mg%, 20% patients had total serum cholesterol more than 200 mg%, 10% patients had LDL cholesterol more than 130 mg%. The prevalence of neuropathy, retinopathy and nephropathy was 23%, 15% and 19% respectively. CONCLUSION: The present study shows that newly diagnosed type 2 diabetic rural males have a near normal BMI even by the Indian criteria. The waist circumference of males was also within normal limits for Indians. Prevalence of metabolic syndrome was also very low in newly diagnosed male patients.

Hepatolenticular degeneration--is the term too narrow to explain Wilson's disease?

Wilson's disease is known for its protean manifestations due to abnormal copper metabolism. Although liver, brain and eyes are the well established sites for the latter but it can be speculated for other organs too. We report a case of Wilson's disease with tricuspid regurgitation possibly due to abnormal deposition of copper in heart.

A study of cardio-metabolic risk profile in patients with psoriasis.

INTRODUCTION/BACKGROUND: Psoriasis is a chronic immune mediated inflammatory disorder of the skin and joints. Recent studies have shown increased prevalence of traditional cardiovascular risk factors such as diabetes mellitus, hypertension and metabolic syndrome. Since atherosclerosis and psoriasis share a common link of inflammation, different workers have shown psoriasis to be a risk factor for atherosclerosis. The aim of our study was assessment of cardiovascular risk factors and evidence of subclinical atherosclerosis in patients of psoriasis. METHODS: In a hospital based, cross-sectional study, 96 patients with psoriasis and 100 age, sex and weight matched controls were enrolled. Prevalence of diabetes, hypertension, metabolic syndrome was studied. They were also assessed for endothelial dysfunction by brachial artery flow mediated dilatation(FMD) and carotid intima media thickness (CIMT). RESULTS: There was higher prevalence of hypertension, hypertriglyceridaemia, diabetes mellitus and metabolic syndrome in patients with psoriasis than in controls. FMD was lower in patients with psoriasis than in controls (5.6 +/- 2 vs7.5 +/- 2.8, P = 0.02). The mean CIMT was significantly increased (0.78 +/- 0.12 vs 0.62 +/- 0.08, P = 0.001) in patients with psoriasis compared with controls. In psoriasis patients, CIMT was associated with hypertension, hypertriglyceridaemia, diabetes, insulin resistance, increased severity and duration of psoriasis while in multivariate analysis insulin resistance (OR 2.8, 95% CI 1.92-6.34 P = 0.02) and increased duration of disease (OR 3.12, 95% CI 2.34-7.56) a were the independent risk factors associated with higher CIMT. CONCLUSION: Patients of psoriasis have higher prevalence of metabolic syndrome, cardiovascular risk factors and subclinical atherosclerosis than general population. As a routine, individuals with moderate to severe psoriasis of long duration should be recognised as being at increased cardio vascular risk and thus encouraged for therapeutic interventions to reduce the modifiable risk factors.

Attitudinal determinants of fasting in type 2 diabetes mellitus patients during Ramadan.

OBJECTIVE: Fasting during Ramadan has been dissuaded by the physicians for patients of Diabetes, yet fasting being a religious issue can not be made a contraindication for those who are determined. The aim of present study was to find out whether counseling prior to Ramadan can result in successful fasting with lesser adverse events. We have also studied clinical, social and demographic factors causing attitudinal difference in patients and its effect on fasting and diabetes control. RESEARCH DESIGN AND METHODS: We recruited 96 (males 54, Females 42) Muslim patients of Type 2 Diabetes, 2-3 weeks prior to Ramadan. Patients were educated about lifestyle, diet and medications. Awareness regarding diabetes management during fasting was assessed by a scored questionnaire prior to and after Ramadan. Last year Ramadan's experiences were recorded for comparison, on a recall basis. RESULT: There was increase in post Ramadan awareness score. Average increase in awareness score was more in rural patients (1.23 +/- 3.76; n = 52) than in urban (1.09 +/- 2.01; n = 44). Average number of fasts had positive correlation with duration of Diabetes. There was significant increase (p < 0.05) in the number of fasts kept this year. Maximum increase was in the age group 40-60 year (25.74%). Fifteen days fast was completed by all patients on diet control, 81.3% patients on OHA and 35.7% on insulin. Hypertensive patients had more hypoglycemic episodes. Lesser number of tobacco addicts could fast for > 15 days. No patient needed hospitalization or emergency care. CONCLUSION: Fasting in Type2 Diabetes patients during Ramadan can be facilitated with safer outcomes and lesser adverse events. Individual attitude is important as increases in awareness and education are not linked to specific improved end-points.

An unusual presentation of Kartagener's syndrome.

Kartagener's syndrome is a rare disorder which is seen in nearly half of the cases of primary ciliary dyskinesia. We report an unusual case of Kartagener's syndrome where the patient had associated ventricular septal defect, pectus excavatum and was fertile.

Levothyroxine replacement and Ramadan fasting.

Primary hypothyroidism is a common endocrine diseases and in recent times with increased awareness of thyroid diseases among internists, gynecologists and primary care physicians the number of patients with thyroid dysfunction seems increasing. During Ramadan, often patients find it difficult to administer levothyroxine on empty stomach since they may not wake up so early, so in this article suggestion has been given to take it at bed time. We conducted a prospective observational study during this year's holy month of Ramadan on patients enrolled from our thyroid clinic who had hypothyroidism and decided to undertake fasting. Our aim was to study the impact of bed time levothyroxine on TSH (thyroid stimulating hormone) levels.

Prevalence of hepatic steatosis in women with polycystic ovary syndrome.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS) both are known to be associated with insulin resistance and metabolic syndrome (MS). The aim of the study was to determine the presence of NAFLD and associated factors of hepatic steatosis in women with PCOS. MATERIALS AND METHODS: A cross-sectional hospital based study of 54 women with PCOS and 55 healthy controls who were age and weight matched were included. Anthropometric parameters, biochemical and hormonal investigations were done in all the patients. Insulin resistance was calculated by Homeostasis model assessment (HOMA). Abdominal ultrasonography and biochemical tests were used to determine the presence of hepatic steatosis after excluding other causes liver disease. RESULTS: Women with PCOS had a higher prevalence of hepatic steatosis (67% vs 25%, P = 0.001) MS (35% vs. 7%, P < 0.01) and elevated transaminases (31% vs. 7%, P = 0.03) than controls. All patients with PCOS and controls with MS had presence of hepatic steatosis. Age, BMI, waist-hip ratio, HOMA-IR, HDL and PCOS diagnosis were the factors associated with presence of hepatic steatosis. CONCLUSION: NAFLD is commonly present in women with PCOS in combination with other metabolic derangements. Evaluation for liver disease should be considered at an earlier age in women with PCOS, particularly those who have an evidence of MS.

Salmonella hepatitis: an uncommon complication of a common disease.

Typhoid fever is a very common infectious disease of tropics, associated with high morbidity and mortality. Typhoid fever is often associated with hepatomegaly and mildly deranged liver functions; a clinical picture of acute hepatitis is a rare complication. We report a young patient who presented with fever and jaundice and was found to have acute hepatitis secondary to typhoid fever. Recognition of Salmonella hepatitis is of clinical importance as it can mimic acute viral hepatitis. Early institution of specific therapy can improve the prognosis in these patients. Typhoid fever is a very common infectious disease of tropics, associated with high morbidity and mortality. Typhoid fever is often associated with hepatomegaly and mildly deranged liver functions; a clinical picture of acute hepatitis is a rare complication. We report a young patient who presented with fever and jaundice and was found to have acute hepatitis secondary to typhoid fever. Recognition of Salmonella hepatitis is of clinical importance as it can mimic acute viral hepatitis. Early institution of specific therapy can improve the prognosis in these patients.

Consultant assessment and appraisal: an outline in practice.

AIMS: To demonstrate a practical method to address new Department of Health requirements for assessment and appraisal. METHOD: This process was developed within the department to incorporate workload, clinical incidents and 360 degrees questionnaires to assess performance and working with departmental staff as preliminaries to an appraisal interview. CONCLUSION: Review of 2 years' process has resulted in minor amendments but there was general agreement that the parameters encompassed were practical and useful.