A Comprehensive Analysis of Clinical, Biochemical, and Polysomnographic Characteristics in Patients With Type 2 Diabetes Mellitus With and Without Obstructive Sleep Apnea.

BACKGROUND: Obstructive sleep apnea (OSA) has been a significant contributor to mortality all across the globe. The most attributing factors to pathogenesis are metabolic syndrome, obesity, diabetes, and so on, but the indicators of its early detection are still elusive. OBJECTIVE: The study aimed to compare the clinical, biochemical, and polysomnographic characteristics of type 2 diabetes patients with and without OSA. DESIGN AND METHODS: This cross-sectional study was conducted at the Department of Medicine and Endocrinology Unit of Dayanand Medical College and Hospital, Ludhiana. A total of 584 patients with type 2 diabetes were assessed using the Berlin questionnaire, with 302 fulfilling the criteria for a high risk of OSA. Out of 302 patients who met the criteria for the high-risk category, 110 patients underwent a sleep study. RESULTS:  Three hundred and two patients satisfying the inclusion and exclusion criteria were enrolled in the study. A total of 110 patients underwent a sleep study, of which 68 (61.8%) had evidence of OSA. The waist-to-hip ratio was considerably higher in the OSA patients than in the non-OSA group (1.09 vs 0.930, p = 0.001). HbA1c >7% was found in 58.8% of OSA patients contrary to 38.1% of non-OSA patients. Fasting plasma glucose levels (>126 mg/dl) were identified in a substantially larger proportion of OSA patients than the non-OSA patients (64.7% vs 45.2%, p = 0.04). Similarly, peripheral neuropathy was found more commonly in the OSA patients than in the non-OSA patients (47% vs. 26.1%, p = 0.02). Prevalence of retinopathy, nephropathy, coronary artery disease, stroke, heart failure, and peripheral vascular disease did not differ significantly between the two groups. CONCLUSIONS: OSA frequently occurs among individuals diagnosed with type 2 diabetes mellitus. The prompt identification of OSA within this demographic is imperative to pinpoint those at an elevated risk of succumbing to conditions such as peripheral neuropathy, the exacerbation of glycemic control, and the onset of unmanaged hypertension. Moreover, there exists a positive correlation between the waist-to-hip ratio and the prevalence of OSA in persons with type 2 diabetes mellitus, highlighting the critical role of waist-to-hip ratio assessments in this patient population.

Ansa Pancreatica: A Rare Culprit in Recurrent Acute Pancreatitis.

Ansa pancreatica is a rare anatomical variation of the pancreatic duct system, characterized by a reversed S-shaped loop that connects the main pancreatic duct to the minor papilla. Its clinical significance, particularly with recurrent acute pancreatitis, has been a subject of interest, but remains poorly understood due to the rarity of reported cases. We report the case of a 34-year-old female with a history of multiple episodes of acute pancreatitis, diagnosed with ansa pancreatica using magnetic resonance cholangiopancreatography (MRCP). The patient presented with severe epigastric pain radiating to the back, accompanied by vomiting and nausea. Laboratory findings revealed elevated serum amylase and lipase levels. MRCP imaging identified the ansa pancreatica, showing a distinct looping ductal variant terminating near the minor papilla. The patient underwent successful endoscopic treatment with significant improvement in symptoms and no recurrence of pancreatitis at follow-up. In this case, the presence of ansa pancreatica underscores the variant's potential role in predisposing individuals to recurrent episodes of acute pancreatitis. The literature review highlights the anatomical description of ansa pancreatica and its speculated pathophysiological mechanism leading to pancreatitis, primarily due to impaired pancreatic juice drainage. Despite its rarity, recognizing ansa pancreatica is crucial for the appropriate management of idiopathic recurrent pancreatitis, especially in cases where conventional causes are absent. This case report and literature review emphasize the importance of considering ansa pancreatica in the differential diagnosis of recurrent acute pancreatitis. Further research is needed to elucidate the exact mechanism by which this anatomical variant contributes to pancreatitis and to explore potential therapeutic interventions. Awareness and early detection of ansa pancreatica can lead to targeted treatments, reducing the morbidity associated with recurrent pancreatitis episodes.

Colonic Lipoma: A Rare Cause of Intussusception.

The most common and challenging chief complaint in the emergency department is abdominal pain. Intussusception, although rare in adults, is an important etiology to consider. The diagnosis is often delayed because of the nonspecific symptoms, especially in adults. This case highlights a rare case of intussusception in a middle-aged male with a colonic lipoma as a leading point. Endo-loop was applied to the colonic lipoma, leading to the resolution of intussusception. Therefore, this can be an effective alternative to surgery in select cases.

Clinical Profile and Outcomes of Patients With Hypercalcemia in an Indian Tertiary Care Center.

Hypercalcemia is a complex medical condition characterized by elevated levels of serum calcium (>10.5 mg/dL) in the bloodstream, often arising from various underlying etiologies. This condition presents a significant clinical challenge due to its diverse clinical manifestations and potential for serious complications. Profiling and understanding hypercalcemia is essential for accurate diagnosis, appropriate management, and improved patient outcomes. In this study, we delve into the comprehensive profiling of hypercalcemia, encompassing its epidemiology, pathophysiology, clinical presentation, and diagnostic approaches. We explore the multifaceted etiological factors contributing to hypercalcemia, including primary hyperparathyroidism, malignancies, granulomatous disorders, medications, and more. We highlight the intricate interplay between parathyroid hormone, vitamin D, and other regulatory mechanisms that influence calcium homeostasis, shedding light on the underlying molecular pathways. Furthermore, we discuss the diverse clinical manifestations of hypercalcemia, ranging from asymptomatic cases to severe, life-threatening complications involving the renal, gastrointestinal, cardiovascular, and neuromuscular systems. Accurate diagnosis is pivotal, and we evaluate the array of laboratory tests, imaging modalities, and specialized assays that aid in identifying the root cause of hypercalcemia. We emphasize the importance of a systematic approach to differential diagnosis and the significance of risk stratification to guide clinical decision-making. The evolving landscape of treatment options for hypercalcemia is also explored, encompassing both acute management and long-term strategies tailored to the underlying etiology. We assess the role of hydration, pharmacological agents, and surgical interventions, underscoring the need for individualized therapeutic plans based on the severity and underlying cause of hypercalcemia. In conclusion, the profiling of hypercalcemia is a multidimensional endeavor that necessitates a comprehensive understanding of its underlying mechanisms, diverse clinical presentations, and diagnostic intricacies. This study intends to serve as a valuable resource for healthcare professionals, offering insights into the complex terrain of hypercalcemia.

Hyponatremia and Outcome: Is Severity More Important Than Etiology?

BACKGROUND AND OBJECTIVE: Hyponatremia is the most common electrolyte abnormality encountered in a hospital setting, and the data regarding the contribution of hyponatremia to overall mortality are conflicting. The study objective was to determine patients' clinical profiles and outcomes with hyponatremia. METHODS:  This prospective cross-sectional study was conducted at Dayanand Medical College and Hospital, Ludhiana, and included 375 adult patients aged more than 18 years with a confirmed diagnosis of hyponatremia. Patients were subdivided into three groups based on the severity of hyponatremia: mild (130-135 mmol/L), moderate (125-129 mmol/L), and profound (<125 mmol/L). RESULTS: The most common symptom was confusion (57.3%) followed by deep somnolence (40%) and nausea (36.8%). The most common cause of hyponatremia was diuretics (30.7%), followed by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (17.8%) and chronic liver disease (CLD) (14.1%). The severity of hyponatremia did not significantly influence the outcome. Patients with CLD and chronic kidney disease (CKD) as the etiology of hyponatremia had significantly worse outcomes compared to other causes of hyponatremia. The most common type was hypovolemic hypotonic followed by euvolemic hypotonic and hypervolemia hypotonic hyponatremia. Nearly half of the total deaths were observed in the hypervolemic hyponatremia group and were significantly higher compared to the other two groups (p=0.001). Correction of hyponatremia (i.e., serum sodium >135 mmol/L) was significantly linked with good outcomes (p=0.003). CONCLUSION: Our study showed that the etiology of hyponatremia was a more important prognostic indicator rather than the severity of hyponatremia. Normalization of serum sodium was associated with improved survival.

Splenic infarct with scrub typhus: a rare presentation.

Scrub typhus has a variety of clinical presentations ranging from asymptomatic to fever with chills, myalgias, hepatitis, gastric ulcerations and pancreatitis, all being attributed to disseminated vasculitis, with splenic infarction being a rare presentation. A 26-year man, a resident of north India, presented with an acute febrile illness and abdominal pain, computed tomography scan of the abdomen was suggestive of a splenic infarct. After ruling out other aetiology, a positive IgM (ELISA) for scrub typhus led to treatment with oral doxycycline, following which the patient was discharged symptom-free. Rarely can splenic infarction be attributable to scrub typhus; so far, five such cases have been reported in the published literature.