Study of Impact of Glycemic Status (HbA1c) on Platelet Activity measured by Mean Platelet Volume & Vascular Complications in Diabetics.

INTRODUCTION: Diabetes mellitus is a global pandemic. The increased platelet activity may play a role in the development of vascular complications of this metabolic disorder. The mean platelet volume (MPV) is an indicator of the average size and activity of platelets. Larger platelets are younger and exhibit more activity. AIMS AND OBJECTIVES: To determine the MPV in diabetics with different glycemic control (HbA1C), to see if there is a difference in MPV between diabetics with and without vascular complications, and to determine the correlation of MPV with fasting blood glucose, glycosylated hemoglobin (HbA1c), body-mass index, and duration of diabetes in the diabetic patients. METHODOLOGY: Platelet counts and MPV were measured in 160 Type 2 diabetic patients using an automated blood cell counter. The blood glucose levels and HbA1c levels were also measured. All patients were divided in 2 groups, group A, which includes patients with HbA1C≤8 % and group B, which includes patients with HbA1C>8 %. Statistical evaluation was performed using Student's t test and Pearson correlation tests. RESULTS: The mean platelet counts and MPV were higher in diabetics with higher HbA1C (group B) compared to the diabetics with lower HbA1C (group A) [288.30 ± 103.96 X 109/l vs. 265.83 ± 66.97 X 109/l (P= 0.16)], 13.77 ± 0.08 fl versus 11.86 ± 0.66 fl (P= 0.0001), respectively. MPV showed a positive correlation with fasting blood glucose (regression (r) = 0.18) and HbA1C levels (P=0.0001). HbA1C and MPV increases with increase in duration of DM, which were 8.62±0.96 and 8.51±1.09 % (p=0.49) and 13.24±1.27 and 13.10±1.37 (p=0.50) respectively in both group with duration >5 years and ≤5 years. On the basis of vascular complications, HbA1C, MPV and Duration of DM were (in both group with and without complications respectively), 8.58±0.01 % and 8.56±0.09 % (p=0.03), 13.12±1.40 fl and 12.80±1.21fl (p=0.13), 9.11±3.22 years and 2.5±2.2 years (p<0.0001). CONCLUSION: Our results showed significantly higher MPV in diabetic patients with higher HbA1C (poor glycemic control). This indicates that elevated MPV could be either the cause for or due to the effect of the vascular complications. Hence, platelets may play a role and MPV can be used as a simple parameter to assess the vascular events in diabetes.

Association between Non- alcoholic Fatty Liver Disease and Left Ventricular Diastolic Dysfunction in Patients of Type 2 Diabetes.

OBJECTIVE: The purpose of the study was to assess if non-alcoholic fatty liver disease (NAFLD) in diabetic patients increases the risk and/or severity of diastolic dysfunction. RESEARCH DESIGN AND METHODS: We studied 70 type 2 diabetic individuals without a history of ischemic heart disease, hepatic diseases, or excessive alcohol consumption, in whom NAFLD was diagnosed by ultrasonography. All patients had normal left ventricular systolic function and blood pressure values under medication. Left ventricular diastolic dysfunction was assessed by pulsed wave Doppler and tissue Doppler imaging, studying mitral inflow patterns and E wave, E' wave velocities, E/A and E/E' ratios. RESULTS AND CONCLUSIONS: Fifty seven patients (81.43%) had NAFLD, and when compared with the other 13(18.57%) patients, age, sex, BMI, waist circumference, hypertension, smoking, diabetes duration, microvascular complication status, and medication use were not significantly different. In addition, the left ventricular (LV) mass and volumes, ejection fraction, systemic vascular resistance, arterial elasticity, and compliance were also not different. NAFLD patients had lower E' (8.42±0.89 vs.9.72±0.54, P <0.0001) tissue velocity, higher E-to-E' ratio (9.64±1.83 vs. 7.78±0.89, p<0.001), higher LV-end diastolic pressure (EDP) (15.52 ± 0.69 vs. 14.40±0.9 p <0.0001), higher LV EDP/end diastolic volume LV EDP/EDV (mmHg/ mL) (0.19 ±0.15 vs. 0.17±.02 p < 0.001) and higher glycosylated haemoglobin (HbA1C) (8.53±1.02 vs.7.65±0.66 p<0.01) than those without steatosis. All of these differences remained significant after adjustment for hypertension and other cardio metabolic risk factors. Our data show that in patients with type2 diabetes and NAFLD, even if the LV morphology and systolic function are preserved, early features of LV diastolic dysfunction detected. The frequency of diastolic dysfunction was significantly higher in diabetic patients with NAFLD versus controls.

Correlation and Comparison of Epicardial Adipose Tissue with Sagittal Abdominal Diameter and Other Anthropometric and Biochemical Variables of Metabolic syndrome.

OBJECTIVE: 1) To determine relation of epicardial adipose tissue (EAT) thickness with sagittal abdominal diameter (SAD) and other anthropometric measurements in metabolic syndrome (MetS). 2) To determine relation of epicardial adipose tissue with biochemical variables of metabolic syndrome. METHODS: Cases were recruited from the patients attending OPD in New Medical College Hospital, Govt. Medical College, Kota, Rajasthan, India between March 2015 to February 2016. Informed consent was obtained from all participants after taking permission from hospital ethical committee. Patients were categorized as cases and controls according to IDF criteria for MetS. We obtained receiver operating characteristic (ROC) curve of EAT for determination of cut-off values. RESULTS: Epicardial adipose tissue thickness had significant positive correlation with fasting blood sugar (r = 0.49), sagittal abdominal diameter(r = 0.48), body mass index (r = 0.47), LDL cholesterol(r = 0.34), waist circumference (r = 0.33), waist hip ratio (r = 0.32), triglycerides (r= 0.31) and total cholesterol (r = 0.29). Epicardial adipose tissue thickness had significant negative correlation to HDL cholesterol (r = -0.34). EAT thickness (cm) was greater in metabolic syndrome cases (0.515 ± 0.07 vs 0.338 ± 0.06; p < 0.0001). Optimal cut off of EAT in metabolic syndrome is 0.425 cm according to ROC curve at which test is 96% sensitive and 83 % specific. CONCLUSIONS: EAT has shown good correlation with SAD and other anthropometric measurements as well as biochemical parameters of metabolic syndrome. Optimal cut off value of EAT to predict metabolic syndrome is 0.425 cm. FBS and Triglycerides are more closely associated with EAT. HDL Cholesterol is better correlated to SAD while LDL cholesterol is best correlated to WC.

ECG Changes in Young Healthy Smokers: A Simple and Cost-Effective Method to Assess Cardiovascular Risk According to Pack-Years of Smoking.

OBJECTIVE: To document the prevalence of ECG abnormalities in young healthy smokers and compare ECG changes in smokers, young healthy non-smokers and amongst smokers with different pack years. METHODS: This was a prospective case-control study consisting of 200 young healthy male and female individuals, 150 smokers and 50 non-smokers between ages 25-40 years, further categorized and compared according to age, sex and pack years of smoking. The ECG recordings were analyzed for different ECG parameters like heart rate, P-wave duration, P-wave amplitude, PR interval, QRS duration, RR-interval, ST-segment duration, QT interval and QTc interval. The results were compared using statistical tools. RESULTS: In present study abnormalities in ECG parameters were significantly more prevalent in smokers as compared to non-smokers (56.66 % Vs 6.00 %) (p <.0001). Heart rate and QTc-interval increased with increase in the number of pack-years. This increase was reflected more in female with a similar number of pack years. P-wave amplitude tended to increase with increase in the number of pack years more so in males. P-wave duration, PR-interval, QRS-duration and RR-interval tended to decrease with increase in the number of pack years more so in females with similar number of pack years. QT-interval and ST-segment duration tended to decrease with increase in the number of pack years more so in males. CONCLUSIONS: ECG abnormalities in this study indicate cardiovascular risk in term of cardiac arrhythmia, pulmonary arterial hypertension, heart blocks etc in such subjects. As this procedure is non-invasive and cost effective it is potentially an effective and yet a simple method for cardiovascular risk evaluation in smokers. Furthermore, such ECG abnormalities may guide the clinician for risk evaluation in smokers and may be used to convince the smokers to quit smoking.

Acute venous sinus thrombosis after chickenpox infection.

BACKGROUND: Chickenpox is one of the classic childhood diseases. Recently chicken pox has been reported in adults with more severe systemic and neurological complications. Cerebral venous thrombosis (CVT) is a life threatening disorder if not treated in time. We report a patient with post varicella CVT as a rare complication of primary Varicella zoster virus. CASE REPORT: Vasculitic arterial infarction is known while venous stroke has rarely been reported with Varicella-zoster virus infection. Here, we report an immunocompetent 30 yr old male who developed chickenpox after contact with his daughter two month back. He presented with acute neurological deficit, one week after onset of skin lesion. MR venography revealed non-visualisation of left transverse sinus and left sigmoid sinus suggestive of venous sinus thrombosis. CONCLUSION: Varicella infection is rarely associated with venous sinus thrombosis. Possibly hypercoagulable state produced by the infection or direct invasion of virus in venous endothelial wall with subsequent damage to endothelium leading to thrombosis could be the cause.