Diabetes among Patients with Overt Primary Hypothyroidism Visiting the Outpatient Department of General Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Thyroid diseases are one of the commonest endocrine disorders and hypothyroidism is the commonest among them. There are many publications about hypothyroidism prevalence in diabetes, however, reports of diabetes in hypothyroidism are scarce. This study aimed to find out the prevalence of diabetes among patients with overt primary hypothyroidism visiting the Outpatient Department of General Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among adults with overt primary hypothyroidism who attended the Department of General Medicine of a tertiary care centre. Data from 1 November 2020 to 30 September 2021 were collected between 1 December 2021 and 30 December 2021 from the hospital records. Ethical approval was obtained from Institutional Review Committee (Reference number: MDC/DOME/258). Convenience sampling method was used. Out of all patients with different thyroid disorders, consecutive patients with overt primary hypothyroidism were included. The patients with incomplete information were excluded. Point estimate and 95% Confidence Interval were calculated. Results: Among total 520 patients with overt primary hypothyroidism, the prevalence of diabetes was 203 (39.04%) (34.83-43.25, 95% Confidence Interval), with 144 (70.94%) in female and 59 (29.06%) in male. Among 203 hypothyroid patients with diabetes, the proportion of female was more than that of male. Conclusions: The prevalence of diabetes among patients with overt primary hypothyroidism was higher than the other studies done in similar settings. Keywords: diabetes mellitus; hypertension; hypothyroidism; thyroid disorder.

Waning of Antibody Response Among Vaccinees who Received Two Doses of Covishield Vaccine.

Introduction: There are limited data available on the long-term presence of SARS-CoV-2-specific binding antibodies and neutralizing antibodies in circulation among the elderly population. This study aims to examine levels of anti-SARS-CoV-2 antibodies in vaccines who have completed at least 6 months since the second vaccine dose. A cross-sectional study was conducted from November 2021 to January 2022 among 199 vaccines aged 60 years and above residing in Belagavi city, who received two doses of the Covishield vaccine. Methods: Antibody response to SARS-COV-2 virus whole cell antigen was measured by a kit COVID KAWACH IgG Micro LISA (J Mitra and Company, India) in 199 participants who had completed at least 6 months after receiving the second dose of Covishield vaccine. The antibody response was measured as a ratio of optical density (OD) in the participant's sample to the mean OD in negative control test by normal (T/N). Independent Kruskal-Wallis test was applied to test the difference between the T/N ratio by months of vaccination since the second dose and by the age group strata. Results: The median T/N values among participants who completed 6, 7, 8, and 9 months since the second vaccine dose were 14.17, 10.46, 7.93, and 5.11, respectively, and this decline in T/N values was statistically significant. Antibody response values showed a decline with increasing age for participants in the age strata 60-69, 70-79, and 80 and above, respectively. Conclusions: A significant decline was observed in antibody response over 9 months supporting the administration of booster dose of vaccine.

Hyperuricemia as an Early Marker in Predicting Mortality and Morbidity in Patients with Sepsis.

Sepsis continues to be a medical and financial burden for both developed and developing countries, and affects all age groups. The normal value of uric acid varies with age, gender, ethnicity and physiologic status of the population. Uric acid levels in septicemic patients and their correlation with increased global prevalence along with septic shock depends on its severity. The use of uric acid levels for grading the severity and its outcome in these patients is widely advocated despite caveats to its use with septicemia and conditions like shock being cited as a major confounding factor. The value of serum uric acid may be erroneous in those with septicemia and its sequelae, thus mandating its evaluation. The objective of this study was to identify a correlation between severity of sepsis & outcome of patients and the derangement of uric acid levels in an adult population. MATERIAL: The present study was conducted on patients with a diagnosis of sepsis admitted in the Department of General Medicine of KLES Prabhakar Kore Hospital and Medical Research Centre from January 2019 to December 2020. Relevant data was collected by a detailed interview with the patient, clinical examination and blood investigations. The patients were categorized into tcategories of severity of sepsis, as per the patient's procalcitonin values. Serum uric acid levels were measured and recorded and a correlation of severity of different types of sepsis with the outcome was studied. Statistical tests such as Chi Square test and ANOVA were used for analysis. OBSERVATION: In the 79 septicemic patients, age ranged from 18-88 years. The number of male patients was slightly more than females. The commonest symptom of patient presentation was generalized weakness, and the most common sign was pallor. Majority of our patients were found to have severe septicemia with shock. We observed higher levels of serum uric acid levels in patients with severe sepsis. There was higher mortality observed in patients with severe sepsis. There was an observed correlation between consumption of alcohol and the outcome of patient, mostly leading to mortrality. CONCLUSION: Uric acid levels in patients with septicemia may be affected by variables such as age, sex, chronic illnesses or drugs. We feel it is worthwhile to study these confounding factors with large sample sizes for ascertaining a correlation of uric acid levels with sepsis and the outcome of patients considering these variables.

Association of Telomere Length and Serum Vitamin D Levels with Type 2 Diabetes Mellitus and its Related Complications: A Possible Future Perspective.

Evidence show that shortened telomere length (TL) and low Vitamin D levels can increase the risk of type 2 diabetes mellitus (T2DM) and its associated complications. T2DM has been considered as an age-related disease, it may be associated with TL. The study aimed to evaluate the association of TL and Vitamin D levels with complications of T2DM and the impact of Vitamin D on TL in patients with T2DM. This 1-year cross-sectional study was conducted at a tertiary care hospital on 90 patients. Height, weight, body mass index, waist-hip ratio was calculated. Fasting blood sugars, postprandial blood sugar, and glycated hemoglobin (HbA1c) were analyzed. Absolute TL was obtained from quantitative real-time polymerase chain reaction (qPCR). Vitamin D estimation was done by chemiluminescent immunoassay. Descriptive analysis of the data was done using R i386 3.6.3. The study found a positive correlation between TL and Vitamin D levels (r = 0.64; P < 0.0001). The interaction with high HbA1c levels and lower levels of Vitamin D led to the shortening of TL (P = 0.0001). The median of TL and mean of Vitamin D levels were significantly less in the diabetic group (P < 0.0001). Vitamin D levels positively affected the TL and its levels had an inverse relation with the HbA1c levels. This association had a significant effect on the shortening of TL. Vitamin D also had a significant association with other diabetic complications that instigated the shortening of TL. Therefore, assessing the role of Vitamin D levels on the shortening of TL can prove to be crucial biomarkers in managing optimal glycemic levels in T2DM patients.

Association Between Estimated Glomerular Filtration Rate and Microvascular Complications in Type II Diabetes Mellitus Patients: A 1-Year Cross-Sectional Study.

BACKGROUND: Previous studies have indicated that reduced estimated glomerular filtration rate (eGFR) is not only the predictor of renal function impairment in patients with diabetic nephropathy, but also in patients with diabetic neuropathy, diabetic retinopathy, and other diabetic-related complications. Therefore, evaluation of eGFR is critical in diabetic patients. However, there is a paucity of data regarding the association of various stages of kidney disease with microvascular complications. OBJECTIVE: The objective of the study was to evaluate the association between eGFR and microvascular complications in type II diabetes mellitus (DM) patients. METHODS: The present 1-year cross-sectional study involved a total of 50 type II DM patients with duration of >5 years. Descriptive data, detailed history regarding the duration of DM, and clinical investigations were performed according to a predesigned and pretested proforma. Specific investigations such as urine microalbumin excretion test and serum creatinine test were also performed. Serum creatinine test was done to calculate the eGFR by modification of diet in renal disease (MDRD) formula. All the type II DM patients were divided into various stages of kidney disease by calculating the eGFR by MDRD. Chi-square test was used to find the association of eGFR with microvascular complications. P < 0.05 was considered statistically significant. RESULTS: The mean age of the study patients was 57.76 ± 10.35 years with a male predominance. Most of the patients were identified with diabetic nephropathy (33) and diabetic neuropathy (32). Many (21) patients were in stage I kidney disease. Reduced eGFR was associated significantly with diabetic neuropathy (P = 0.007) and diabetic nephropathy (P = 0.0092); whereas, no significant association was observed with diabetic retinopathy (P = 0.285). Furthermore, reduced eGFR led to reduction in glycated hemoglobin levels, and increased the risk of hypertension (P = 0.0401) in patients with type II DM. CONCLUSION: Overall, eGFR can be considered as a rational noninvasive mode of assessing the renal status in patients with type II DM. Reduction in eGFR is significantly associated with microvascular complications, such as diabetic neuropathy and diabetic nephropathy.