Cognition in type 2 diabetes: Association with vascular risk factors, complications of diabetes and depression.

BACKGROUND: The role of variables like duration of diabetes, diabetic control and microvascular complications in the causation of cognitive decline in patients with type 2 diabetes is not well studied. The contribution of hypertension to the cognitive decline in nondemented diabetic patients is unclear. AIMS: We wanted to see if cognition in patients with type 2 diabetes is associated with the duration of diabetes, control of diabetes, complications of diabetes, vascular risk factors, or depression. We also looked at association of noncompliance with cognition, and depression. SETTINGS AND DESIGN: We recruited ambulant patients with type 2 diabetes who are 55 years or more in age from the weekly diabetic clinic. We excluded patients with past history of stroke. METHODS AND MATERIAL: We selected the time taken for the Trial A test, delayed recall on ten-word list from Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Rowland Universal Dementia Assessment Scale (RUDAS) and Centre for Epidemiologic Studies Depression scale (CES-D) screening instrument to assess these patients. STATISTICAL ANALYSIS USED: We utilized mean, standard deviation, Chi-square test and Pearson's correlation for statistical analysis. We considered P < 0.05 to be significant. RESULTS: RUDAS scores inversely correlated (r = -0.360) with CES-D scores (P = 0.002). Scores of the screening instrument for depression, the CES-D was associated with the duration of diabetes mellitus (P = 0.018), fasting blood glucose (P = 0.029) as well as with 2-hour post prandial blood glucose (P = 0.017). CONCLUSIONS: There is correlation between depression and global cognitive score. Depression seems to be associated with duration of diabetes and control of diabetes.

Impact of antiretroviral therapy on vocational rehabilitation.

This study evaluates the impact of a free antiretroviral therapy (ART) programme on the employment status of people living with HIV/AIDS. Patients on ART were interviewed regarding the employment status before and after ten months of enrollment into therapy. We included patients who were started on the free ART program of Kerala state at the Medical College, Thrissur. We documented the demographic details, indication for starting ART, disease status, WHO staging and CD4 count (whenever available) and the job status at the time of enrollment into the study. We collected data about the patient's job status at the end of ten months of ART. We excluded patients below 20 years of age, those who died during the study period and those lost for follow-up before the end of ten months from the analysis. We looked at factors associated with having employment at the end of ten months of ART using logistic regression. At the end of ten months of therapy the employment status improved significantly (p<0.01) to 74% (77 patients). We found that 96.4% of those previously employed are at present employed, while 65.8% of those previously unemployed are employed at present. A history of previous employment (p=0.014) was associated with acquisition of employment; sex, duration on ART, stage of disease or age does not significantly influence the present employment status. This study suggests that the provision of free ART by the state can significantly improve the employment status of PLWHA.

Sexual and physical growth in Kerala boys.

One hundred and fifty males in the age group 10-17 years were studied longitudinally for 2 years to determine their physical and pubertal development. The velocity of linear growth, weight gain and pubertal growth velocities were determined. The relation between peak height velocity and genital stages and between genital stages and pubic hair was determined. It is concluded from this study that 86 percent of normal males reach peak height velocity while in G4 and only 5% will not have achieved peak height velocity by the time G5 is reached.