Correlation of Anemia with Glycated Hemoglobin among Euglycemic Type 2 Diabetic Patients.

BACKGROUND: Diabetes mellitus (DM) and anemia are both prevalent in India. Glycated hemoglobin (HbA1c) is the gold standard test for the diagnosis of DM and monitoring of glycemic status. Hemoglobin (Hb) being the integral component of HbA1c, there is a possibility that anemia can also affect the level of HbA1c apart from the various other factorsObjectives: To study the prevalence, type of anemia, and correlation between HbA1c and anemia, including red blood cell (RBC) indices in euglycemic type 2 DM patients. The study was conducted with the objective of studying the correlation between HbA1c and anemia in euglycemic diabetic patients having controlled blood glucose over a period of 3 monthsMethodology: This cross-sectional study was conducted between May 2020 and May 2021 at the Department of General Medicine, Government Medical College, Kota, Rajasthan, India. All euglycemic diabetic patients with controlled blood glucose over a period of 3 months attending the outpatient department and fulfilling inclusion and exclusion criteria were enrolled in the studyInclusion criteria: All euglycemic type 2 DM patients with controlled blood glucose having three consecutive normal blood glucose levels [fasting blood sugar (FBS)-80-130 mg/dL and postprandial blood sugar (PP2BS) test-<180 mg/dL] over a period of 3 months from the outpatient departmentExclusion criteria: Type 1 DM and latent autoimmune diabetes of adults, patients with hemolytic anemia, pregnancy, chronic alcoholism, chronic kidney disease, chronic liver disease, combined deficiency anemia, patients with increased FBS and PP2BS, acute and chronic inflammatory state, malignancy, anemia of chronic disease, and vitamin B12 deficiency were excluded from our studyDetailed investigations of diabetes and anemia were conducted. The effect of anemia on HbA1c was assessed, and the correlation of anemia with mean HbA1c was analyzed statistically Results: The prevalence of anemia in diabetic patients is 56.8%. Normocytic normochromic anemia is the most common, which was observed among 48.86% of diabetic patients. The median HbA1c of anemic patients is higher than nonanemic patients (p < 0.01). There is a negative correlation between Hb and HbA1c (p < 0.01). The correlation of RBC indices, that is, mean corpuscular Hb (MCH), mean corpuscular volume (MCV), and MCH with HbA1c, is also negative (p < 0.01). There is a negative correlation between HbA1c and serum ferritin level, as indicated by the Pearson correlation test (p-value of <0.01)Conclusion: Anemia is prevalent in type 2 DM patients without renal involvement, and also normocytic normochromic type is the most common, followed by iron deficiency anemia (IDA). HbA1c levels are significantly affected by the presence of moderate anemia in spite of controlled glycemia.

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.

A Prospective Study on Utility of Exercise Treadmill Test in Type 2 Diabetes Mellitus Patients.

OBJECTIVE: Primary objective of this study was to access utility of exercise treadmill test in type-2 diabetes mellitus patients for detecting silent myocardial ischaemia and associated risk factors. METHODS: 75 DM-2 cases were enrolled in study of any age attending medical OPD. All cases were gone through detailed history and TMT procedure. RESULTS: There is higher prevalence of SMI in DM-2 patients. TMT positivity for inducible ischaemia in DM-2 patients were associated with increasing age, male sex, higher BMI, hypertension, smoking, alcoholism, microalbuminuria, macroalbuminuria and dyslipidemia. Duration of diabetes increases the development of CAD in diabetic patients. TMT is a safe procedure with no complication. CONCLUSIONS: For detection of silent myocardial ischaemia in diabetic patients TMT has a significant role. Prevalence of silent myocardial ischaemia in DM-2 patients is 37.3%. There is significant correlation between risk factors of CVD and evidence of ischaemia on TMT in diabetic patients. Duration of diabetic state has a strong correlation for inducible ischaemia on TMT. It may be a safer, cheaper, reliable and easily available non-invasive screening tool for earlier detection of CAD in diabetic patients.

Acute Scrotal Edema: An Atypical Manifestation of Dengue.

Acute scrotal edema associated with dengue fever is a rare and self limiting condition resolving in a few days without any complication or sequelae. We report two cases of dengue fever in father and son which presented simultaneously with acute scrotal edema.

Correlation and Comparison of Various Anthropometric Measurements of Body Fat Distribution and Sagittal Abdominal Diameter as a Screening Tool for Cardio Metabolic Risk Factors and Ischaemic Heart Disease in Elderly Population.

OBJECTIVE: Primary objective of this study was to assess utility of sagittal abdominal diameter (SAD) as a cardio vascular risk predictor and compare various anthropometric measurement of body fat distribution in elderly patients. METHOD: Four hundred patients were enrolled in study. Elderly patients more than 60 year of age attending medical OPD, geriatric OPD and suitable indoor patients who were willing to participate in the study were included. RESULT: SAD was significantly higher in patient with ischaemic heart disease (group 1) than patient without ischaemic heart disease (Group 2) (P < 0.001 for male and female). SAD was better than WC to ascertain individual cardio metabolic risk factors in male, especially FBS (Pearson correlation .33 vs. .29), total cholesterol (Pearson correlation .24 vs. .20) as well as LDL cholesterol (Pearson correlation .13 vs. .05), while in female WC and SAD showed equal correlation with individual cardio metabolic risk factors. CONCLUSION: In patient with metabolic syndrome IHD group showed considerably higher mean SAD values. SAD also showed very good correlation with individual cardio metabolic risk factors especially in elderly male, while in female both SAD and.WC were almost equivalent.

Neurological complications in Chikungunya fever.

OBJECTIVE: The present prospective study was undertaken to study the clinical manifestations and mainly neurological complication of an acute febrile illness termed chikungunya which has recently attacked india after 43 years. METHOD: This prospective study has been conducted in hospitalised patients admitted in government and private hospitals of Kota city from August 2006 to October 2006. Patients showing neurological involvement with typical clinical picture of chikungunya infection were studied in detail and followed up for improvement and any permanent damage or death. RESULTS: Apart from typical clinical triad of high grade fever, arthralgia and rash of chikungunya infection we have observed a spectrum of neurological abnormalities in terms of altered mental functions, seizures, focal neurological deficit with abnormal CT scan of head and altered CSF biochemistry. Permanent neurological sequelae and even death has occurred. CONCLUSION: Typical clinical history of chikungunya infection, neurological complications with associated CSF abnormalities, supportive laboratory evidences, positive chikungunya IgM card test, exclusion of other causes and known predilection of arboviruses for CNS infection allows us to conclude the diagnosis of study cases as Chikungunya Encephalitis.