A Study of Association of Plasma Procalcitonin with Various Components of Metabolic Syndrome and Insulin Resistance.

The metabolic syndrome is a cluster of risk factors that are associated with increased risk of cardiovascular diseases and Type 2 diabetes mellitus. The aim was to study the association of plasma procalcitonin with various components of metabolic syndrome (abdominal obsesity, dyslipidemia, hypertension and hyperglycemia) and insulin resistance and compare with healthy controls. In addition, we tried to gauge the association of plasma procalcitonin with complications of metabolic syndrome at presentation. MATERIAL: This was a hospital based observational comparative study on 30 cases of metabolic syndrome in hospital wards and OPD of SMS Medical College, Jaipur and 30 accompanying healthy controls. INCLUSION CRITERIA: Age more than 18 years, and newly diagnosed or old cases of metabolic syndrome using the definition given by International Diabetes Federation (2006). EXCLUSION CRITERIA: Individuals with active infection, trauma, surgery, neoplasms, cirrhosis, pancreatitis and autoimmune diseases or taking medications which can alter the biochemical profile. Detailed history was taken, subjects clinically examined and anthropometric measurements were taken. Required investigations were obtained and statistical analysis done. OBSERVATION: Plasma procalcitonin was significantly higher in cases (mean 0.11 ng/ml) compared to controls (mean 0.002 ng/ml). Waist and neck circumference (102.87±5.19 and 42.03±3.08) values were higher in case group compared to control group (79.67 ±7.98 and 37.10±1.35). Plasma procalcitonin significantly (p<0.05) correlated with level of insulin resistance (HOMA IR), waist circumference, neck circumference, S. Triglycerides, S. VLDL, fasting blood glucose and fasting insulin level in the case group when analyzed by linear regression analysis. We also found that out of 30 subjects in cases, 16.7% had history of MI, whereas in control group no subject was reported with MI. In case of history of CVA, 16.7% had CVA in case group, whereas in control group, no patient was reported with CVA., Conclusion: Our findings based on community-based data showed that higher plasma procalcitonin levels in the normal range are associated with increased measures of obesity, components of the metabolic syndrome, and greater risk of having metabolic syndrome and insulin resistance. Because associations only partly depend on BMI, plasma procalcitonin may serve as a new marker for adipocyte dysfunction, chronic low-grade inflammation, or both.

A Comparative Study between Mean Platelet Volume and Hba1c Levels in Patients of Type 2 Diabetes Mellitus.

Diabetes mellitus is a major global health problem, increasingly affecting the population across the world. Diabetic patients have an increased risk of developing micro and macro vascular diseases, and platelets may be involved as a causative agent with respect to altered platelet morphology and function. There are studies evaluating the association between Mean Platelet Volume (MPV) and HbA1c and its role in predicting glycaemic control with conflicting results. Thus the present study was conducted to assess the relationship between HbA1c levels and platelet activity (MPV), determine the association among MPV, glycemic control, and diabetic vascular complications and to evaluate the influence of improved glycemic control on MPV in type 2 diabetic patients. MATERIAL: This was a hospital based observational comparative study on 100 cases of diabetes mellitus divided in 2 groups i.e Group A (HbA1c <7) and Group B (HbA1c >7) and 50 healthy controls in Group C in hospital wards and OPD of SMS Medical College, Jaipur. INCLUSION CRITERIA: Age more than 18 years, and newly diagnosed or old cases of diabetes mellitus using the definition given by American Diabetes Association. EXCLUSION CRITERIA: Abnormal platelet count (<100 and >450×103/µL), Acute febrile illness, Use of drugs affecting platelet function, Male patients with Hb<12.5mg/dl and females with Hb<11.5 mg/dl and Pregnant females. OBSERVATION: It was observed that mean MPV(fl) was maximum in Group B (13.35±1.27), followed by Group A (10.77±.77) and Group C (9.09±.85) and a significant (p-value<0.05) relation was found statistically. We also observed that mean HbA1c (%) was maximum in Group B (8.82±1.41), followed by Group A (6.66±.004) and Group C (5.67±.45) and a significant (p-value<0.05) relation was found statistically in these 3 groups. In group B, at baseline MPV(fl) levels were more (13.35±1.26) than at follow up after glycemic control of 3mths (12.13±1.20) and this was found to be statistically significant. CONCLUSION: We found that Mean platelet volume in diabetic mellitus type 2 patients was significantly higher than non-diabetic group. We also found that the mean platelet volume in uncontrolled diabetic group (HbA1c more than 7 percent) was significantly higher than controlled diabetic group (HbA1c less than 7 percent). Our study showed that in diabetes mellitus, platelets become more reactive and aggregable and their mean volume (MPV) is increased. We also found that increase in HbA1c concentration was directly proportional to increased MPV.

Overview of Early Cases of Coronavirus Disease 2019 (COVID-19) at a Tertiary Care Centre in North India.

INTRODUCTION: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread on an unprecedented scale from around the world, we described our experience in treating early COVID-19 cases in India. MATERIALS AND METHODS: An observational study of COVID-19 patients admitted to a tertiary care centre in North India between 2 March-4 April 2020 was performed. The clinical, epidemiological, laboratory, treatment and outcome data of patients were evaluated. RESULTS: A total of 75 patients were treated and 56 (74.66%) were men. The clinical spectrum of COVID-19 ranged from asymptomatic to acute respiratory distress syndrome (ARDS). Fever (85.36%) was the most common symptom followed by cough (56.09%) and dyspnoea (19.51%). Findings from hemogram analysis showed that 32%, 21.33% and 18.67% of patients had lymphopaenia, eosinopenia and thrombocytopaenia, respectively. Inflammatory markers such as C-reactive protein, D-dimer, ferritin, fibrin degradation product and interleukin-6 were significantly elevated (P <0.05) in patients who required oxygen therapy than those who did not require it, suggesting the potential role such markers could play in predicting prognosis in patients. Mean hospital stay was 9.2 days and 72 (96%) patients made a complete recovery, but 3 (4%) patients demised after progressing to ARDS. CONCLUSION: The clinical and epidemiological spectrum of COVID-19 has jeopardised the health system in India. Without a proven therapy to combat this pandemic and with no sight of vaccines in the near future, a preventive strategy should be adopted to contain the spread of this infectious disease.

Study of the Association of Epicardial Adiposity with Albuminuria in Patients with Essential Hypertension.

BACKGROUND: Epicardial adipose tissue (EAT), a type of visceral adipose tissue, has been found to be a cardiometabolic risk factor contributing to cardiovascular disease. Albuminuria, a marker of endothelial dysfunction is also associated with an increased risk for cardiovascular disease. The aim of this study was to investigate the relationship of echocardiographic epicardial adipose tissue (EAT) thickness and albuminuria in hypertensive patients. AIMS AND OBJECTIVES: To compare EAT between essential hypertensive patients with normal UACR (<30) and albuminuria (UACR>30). METHODS: 100 essential hypertensive patients were included into the study. Age, body mass index (BMI), blood pressure, hemoglobin, random blood sugar, creatinine, albumin was evaluated. Spot urine sample was collected for the assessment urine albumin creatinine ratio (UACR). Patients were divided into two groups according to UACR; Group A included UACR <30 mg/g; and Group B included UACR > 30mg/g. Thereafter, all subjects underwent transthoracic echocardiography to measure EAT thickness, left ventricular mass (LVM), left ventricular mass index (LVMI) and ejection fraction (EF). MAIN OUTCOMES AND MEASURES: Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. The primary composite end-point was admission to an intensive care unit (ICU), the use of mechanical ventilation or death. Patients were categorized as severe pneumonia and non-severe pneumonia at time of admission and outcome data was compared. RESULTS: The mean EAT was found to be significantly higher in patients with significant albumin excretion (UACR>30 mg/g) as compared to group A (6.65 ± 1.944 mm vs. 3.64 ± 1.13 mm, respectively, p<0.001). Upon correlation analysis, EAT was found to be positively correlated with age (r = 0.749, p < 0.001), serum creatinine (r = 0.244, p = 0.014), LVM (r = 0.691, p = 0.001) and LVMI (r = 0.677, p = 0.001) and negatively correlated with EF (r = -0.599, p = 0.001). CONCLUSIONS: Epicardial adipose tissue thickness can serve as a high-risk marker to stratify essential hypertensive patients.