Prevalence of micro and macrovascular complications and their risk factors in type-2 diabetes mellitus.

OBJECTIVES: To determine the prevalence of micro and macrovascular complications in type-2 diabetes in Northwest India and its correlation with various risk factors. METHODS: In this study, total 11,157 subjects (M:F 6661:4496), attending the diabetic clinic, were analysed. The study sample resembles the population sample in anthropometric, age and socioeconomic factors. All patients had undergone the test for retinopathy by fundus examination, nephropathy by microalbuminuria, serum creatinine and blood urea, neuropathy by monofilament and biothesiometer, peripheral vascular disease (PVD) by colour doppler and cardiovascular disease by ECG. RESULTS: Among 11,157 subjects, retinopathy was diagnosed in 32.5%, nephropathy was present in 30.2%, peripheral neuropathy was present in 26.8%, coronary heart disease (CHD) was present in 25.8% and peripheral vascular disease (PVD) was present in 28% of the subjects. Multiple logistic regression analyses showed that age had a significant association with retinopathy, neuropathy, coronary heart disease (CHD) and peripheral vascular diseases (PVD). Duration of diabetes had significant association with the neuropathy, nephropathy and PVD. Higher HbA1C increases the risk of retinopathy, neuropathy and nephropathy. Hypertension was associated with nephropathy and coronary heart disease. CONCLUSION: The study highlights the high prevalence of vascular complications in type-2 diabetes in Northwest India. Retinopathy and nephropathy were the commonest complications of diabetes in our study.

Hepatocyte growth factor, adiponectin and hepatic histopathology in non-alcoholic steatohepatitis.

OBJECTIVES: Hepatocyte growth factor (HGF) and Adiponectin are adipokines. Serum HGF and adiponectin levels are strongly associated with liver disease, obesity, insulin resistance and metabolic syndrome (MS). Non alcoholic steatohepatitis (NASH) is the hepatic component of metabolic syndrome. Our aim was to elucidate the status of HGF, adiponectin levels and histopathology of liver in NASH. METHODS: This study was conducted among 50 subjects (25 patients and 25 controls) age and sex matched attending OPD. Patients were randomly selected for the study and after explaining in detail design of the study, written consent was taken. Institutional ethical approval was also taken.The only diagnostic method for NASH is liver biopsy (after exclusion of other causes based upon clinical examination and laboratory investigations) and pathological grading and staging was done according to Brunt classification. Diagnosis of patients was done on the basis of liver biopsy and fasting HGF and adiponectin were performed with commercially available ELISA kits (quantikine HGF and adiponectin ELISA kits). RESULTS: Mean serum HGF in patient and control groups were 2.33 +/- 0.66 pg/ml and 0.56 +/- 0.21 pg/ml respectively (p < 0.001). Mean serum adiponectin in patient and control groups were 6.93 +/- 1.50 ng/ml and 14.54 +/- 3.58 ng/ml respectively (p < 0.001). Multiple regression analysis revealed that statistically significant difference was found (p < .001) when comparing mean brunt grade and brunt stage (hepatic histopathology) with fasting serum adiponectin and HGF CONCLUSION: Fasting serum HGF was significantly high and fasting serum adiponectin was significantly low in patients of various grades of hepatic histopathology in NASH.Various parameters of MS were significantly correlated with various stages of hepatic histopathology, as well as decreased serum adiponectin and increased fasting serum HGF.

Annual Cost of Care of Parkinson's Disease and Its Determinants in North India - A Cost of Illness Study with Patient Perspective.

Background: Parkinson's disease (PD) is a slowly progressive and disabling disorder, so the cost of illness may change with time. We aimed this study to know the annual cost of care of PD in India. Methods: After ethics approval, a prospective cohort study was conducted at the movement disorder clinic of tertiary care hospital for 2 years (2014-2016). The outcomes were a description of the total annual direct cost of Parkinson's disease including health care as well as non-health care cost. We also did correlation analysis to know the determinants of the total cost. Results: A total of 200 consecutive patients of PD with 141 (70.50%) males and 59 (29.50%) females with a mean age of 56.84 ± 10.51 years were enrolled. The annual Median Direct cost of care was INR 27,315.0 (IQR 13636.6-44908.4), whereas the Indirect cost was INR 21,400 (IQR 9800 - 96800). Cost on drugs (Direct health care) formed 68.50% (Median) of the total Direct cost. Total direct cost formed 11.38% of the Median total yearly income of our patients. Of the direct cost, the Median expenditure on drugs was INR 18,712.8 (8064.0 -30696.0). Only 5% of patients had health care insurance. The total direct cost was determined by the stage of Parkinson's disease and duration of disease (P = < 0.01) but not predicted by age, gender, age at onset, and the yearly income of patients. Conclusion: Annual cost of care of Parkinson's disease is high and increases with the duration of the disease as well as the progression of the disease.