A prospective study of complications in newly diagnosed type 2 diabetes mellitus patients of lower socioeconomic group with special reference to microvascular complication and metabolic syndrome

Background: All these metabolic derangements exist for many years in the asymptomatic phase of type 2 diabetes and they predispose to development of complications even before clinical diagnosis. Metabolic syndrome is considered to be a precursor of type 2 diabetes. Present study is primarily aimed to study the prevalence of micro vascular complications and metabolic syndrome in newly diagnosed type 2 diabetes mellitus patients of low socio-economic group.Methods: This is a cross sectional prospective study conducted in the dept. of general medicine Konaseema institute of medical science Amalapuram, Andhra Pradesh, India from November 2016 to October 2018. Based on exclusion and inclusion criteria 103 patients were enrolled for this study. Various parameters like age, sex, body mass index, waist circumference, lipid profile, systolic and diastolic blood pressure, neuropathy, nephropathy and retinopathy was measured.Results: The mean age of the patient was 48±10.0 years. Fasting and 2 hours OGTT was 174.6±46.8 mg/dl and 255.6±75.6 mg/dl. The mean of total cholesterol was 204.7±41.9 (mg/dl), Triglycerides was 218±83.4 (mg/dl) and HDL was 44±5.3 (mg/dl). Symptomatic neuropathy constituted 35.6% in 51-60 age group and 27.1% in 31-40 and 41-50 age groups. Objective neuropathy constituted highest (36.6%) in 51-60 age group. Retinopathy constituted highest (60%) in 51-60 age group and nephropathy constituted 26.3 % in 21-30 and 51-60 age groups.Conclusions: Prevalence of microvascular complications in newly diagnosed diabetics of low socioeconomic group were as follows: symptomatic neuropathy-57.3%, objective neuropathy-39.8%, retinopathy-4.9%, nephropathy-18.4%. These were similar to published studies from general population from the same geographical area

A prospective study of insulin resistance among infertile women with polycystic ovarian syndrome

Background: Insulin plays a key role in producing hyperandronism and suppression of insulin secretion in women with PCOS is associated with decreased cytochrome P450c17α. cytochrome P450c17α is a bifunctional enzyme present in ovary is a key enzyme for androgen synthesis. Various studies have been conducted regarding association of insulin resistance with PCOS in infertile patients but there is no study is available about this in our area. So we have designed this study to evaluate insulin resistance in infertile patients with PCOS in rural Andhra Pradesh.Methods: The study population include 180 untreated patients who attended the infertility clinic in outpatient department of obstetrics with infertility due to different cause that include polycystic ovarian disorder also. They have been selected for this study randomly based on inclusion and exclusion criteria.Results: The mean value of glucose insulin ratio was 5.146+2.611 in group A and 8.62 + 5.55 in group B the P value was 0.004909. The mean of LH/FSH ratio was 1.78+0.423 in group A and 1.02 +0.042 in group B. The P value was <0.00001. The mean of HOMA IR was 8.375+ 2.68 in group A and 3.03+ 1.09 in group B, with P value <0.00001. The mean value of QUICKI was 0.2815+ 0.0002875 in group A and 0.347+0.10 in group B with P value <0.00001. Mean serum DHEAS level was 275.59 + 53.48 in infertile patient with PCOS and 208.48 + 36.11 in infertile patients without PCOS. The p value was 0.00012.Conclusions: Based on present study we would like to conclude that the body mass index was high among infertile women with PCOS and a greater number of women presented with acanthosis. There was decrease insulin sensitivity and increase insulin resistance among infertile women with poly cystic ovarian disease, in rural area of Andhra Pradesh and that is not different from the study of other part of world

Comparative study of perinatal outcome between abdominal and vaginal route of delivery in case of breech presentation

Background: Breech presentation is also one of the most interesting subjects in obstetrics as no other malpresentation has so many manoeuvres during vaginal delivery and their impact on perinatal mortality. The mode of delivery also depends on so many variables like parity, type of breech presentation, associated obstetric complications, estimated birth weight etc and also from obstetrician point of view.Methods: Pregnant mother with breech presentation of gestational age 32 weeks or more were included in this study. Multiple pregnancy with first baby in breech presentation were excluded from this study. New born baby with gross congenital anomalies like anencephaly, omphalocele were excluded from this study. The cases for present study were collected from antenatal OPD, labour room, High-risk ward and Post-natal ward of KIMS & RF from June 2016 to December 2017.Results: Out of 61 cases of caesarean section there were 4 cases (6.55%) of neonatal death. PNM among the 100 cases was 4% in caesarean section. In 32 assisted breech delivery cases there were 8 cases (25%) of perinatal death. PNM among the 100 cases was 8% in assisted breech delivery. Out of 4 cases of breech extractions there were 3 cases (75%) of perinatal death. PNM among the 100 cases was 3% in breech extraction.Conclusions: Present study suggests that breech delivery should preferably be always managed in the hospital by skilled and experienced obstetrician with an assistant in collaboration with a pediatrician and an anesthetist. As good numbers of babies were premature a good premature care unit should be pre-managed under the supervision of a pediatrician

The ECG changes in various comorbidities with hypertension and without hypertension

Background: Hypertension is the commonest cardiovascular disorder posing a challenge to the societies in socioeconomic and epidemiologic transition. In India, Cardiovascular Diseases (CVDs) are estimated to be responsible for 1.5 million deaths annually. Indeed, it is estimated that by 2020, CVDs will be the largest cause of mortality and morbidity in India. To present study is designed to evaluate the variation of blood pressure and ECG wave forms among people hypertension with co morbidities (study group) and controls.Methods: The study included 50 people comorbidities with hypertension and 50 controls, each between ages 30-40 years from general population, and also from Medicine outpatient department, KIMS and RF Amalapuram. Detailed history from subjects, blood pressure (sitting position) and electrocardiogram was recorded during resting state in supine position. The ECG results were evaluated for various parameters like heart rate, P wave, PR interval, QRS complex etc.Results: There was significant increase in heart rate, systolic blood pressure as well as diastolic blood pressure in study group when compared to controls. Decrease in PR interval, decrease in QT interval, decrease in QTc interval, decrease in QRS axis in smokers when compared to controls.Conclusions: There was significant increase in heart rate in study group (smokers, diabetic) when compared to controls. There was significant increase in systolic blood pressure as well as diastolic blood pressure in study group (smokers, diabetics) when compared to controls. There was significant decrease in PR interval in smokers when compared to controls. There was significant decrease in QT and QTc interval in smokers when compared to controls

A study of dyslipidemias in newly diagnosed hypertensive patients

Background: Dyslipidemia and hypertension are a major, common and modifiable risk factor for diseases like a stroke; coronary artery disease etc. which are common causes for mortality in India. Dyslipidemia and hypertension are usually found co-exist, which accelerates the process of atherosclerosis.Methods: It is a cross-sectional study conducted on the patients who are newly diagnosed hypertensive visited Medical OPD in Konaseema institute of medical sciences between January 2018 to June 2019. All were investigated for various clinical parameters on lipid profile abnormalities. Results were compared among cases and controls.Results: A total number of patients included in the study were 167,107 are cases and 60 controls. Significant higher levels of total cholesterol, triglycerides, LDL-c and lower levels of HDL-c were observed in hypertensive patients with p-value significant <0.0001.Conclusions: Hypertensive patients have significantly elevated levels of all forms of cholesterol and a higher percentage of individuals in the dyslipidemic state when compared with normotensive patients. Pre-diabetic state significantly increases the total cholesterol in hypertensive patients

Clinical epidemiology and treatment outcome of Hexaconazole poisoning – A prospective six year study

Background: Hexaconazole is a category 3/4 of poison as per the W.H.O Expert Group on Pesticide Residues. Hexaconazole is used to control infection by fungi in paddy and other crops. Apart from destroying the target species, it can also cause damage to humans. There have been discrete reports of instances of human poisoning due to hexaconazole. Methodology: A patient record-based cross-sectional study was carried out in Konaseema Institute of Medical Science & Research Foundation, Amalapuram, Andhra Pradesh, India during a period from March 2014 to April 2020 on 26 confirmed cases of hexaconazole poisoning. The clinic-demographic data, hematological, and biochemical parameters at the time of admission and at 72 hrs as well as the outcome were recorded and analyzed using descriptive statistics and paired t test. Result: The prevalence of hexaconazole poisoning was 4.79% of all poisoning cases. The major clinical presentation was gastrointestinal symptoms with vomiting being commonest. There was no significant change in the biochemical and hematological parameters. The mean duration of hospitalization was 4.93+1.39 days. The recovery rate was 100% without any major sequel. Conclusion: Poisoning due to hexaconazole is uncommon in comparison to poisoning by other pesticides in the agricultural community. The clinical manifestations of hexaconazole poisoning indicated that it is  of non-serious nature and its recovery was without any sequel

Extended surfaces modulate and can catalyze hydrophobic effects

Interfaces are a most common motif in complex systems. To understand how the presence of interfaces affect hydrophobic phenomena, we use molecular simulations and theory to study hydration of solutes at interfaces. The solutes range in size from sub-nanometer to a few nanometers. The interfaces are self-assembled monolayers with a range of chemistries, from hydrophilic to hydrophobic. We show that the driving force for assembly in the vicinity of a hydrophobic surface is weaker than that in bulk water, and decreases with increasing temperature, in contrast to that in the bulk. We explain these distinct features in terms of an interplay between interfacial fluctuations and excluded volume effects---the physics encoded in Lum-Chandler-Weeks theory [J. Phys. Chem. B 103, 4570--4577 (1999)]. Our results suggest a catalytic role for hydrophobic interfaces in the unfolding of proteins, for example, in the interior of chaperonins and in amyloid formation.Comment: 22 pages, 5 figure

An open-label, multicenter, randomized, parallel, single-dose, comparative bioavailability study of two triamcinolone hexacetonide injectable suspensions in patients with knee osteoarthritis

Background: Triamcinolone hexacetonide (THA), a synthetic glucocorticoid with low solubility, can provide sustained pain relief and less systemic side effects in patients with knee osteoarthritis. This study aimed to characterize pharmacokinetic profile of THA-test product containing 20 mg/ml injectable suspension and compare its bioavailability with the standard reference in Indian patients with knee osteoarthritis. Methods: In this open-label, randomized, multicenter study, 44 adult patients were randomized (1:1; test n=23, reference n=21) to receive a single dose of test or reference products. The primary objective was to characterize the pharmacokinetic profile and compare bioavailability of both products via serum triamcinolone acetonide (TCA) concentration. Secondary objectives included safety and tolerability evaluation, impact on hypothalamic-pituitary-adrenal axis, and efficacy of test and reference products in reducing index knee pain. Results: Both products were absorbed with a median Tmax of 23.9 hours. Comparative bioavailability analysis demonstrated no statistically significant formulation effect for ln-transformed Cmax (1098.052 pg/ml for test, 1333.850 pg/ml for reference) and AUC0-t (159112.561 pg×h/ml for test, 211531.035 pg×h/ml for reference) for TCA. T/R ratio for Cmax was 82.3% and T/R ratio for AUC0-t was 75.2%, with &gt;100% inter-subject variability for both Cmax and AUC0-t. Additionally, recovery time of cortisol levels of test and reference arms was 96 hours and 456 hours, respectively. Both products significantly reduced knee pain (p&lt;0.0001). Conclusions: The test product provided lower systemic exposure and faster recovery of serum cortisol levels than the reference, while still providing similar beneficial effect in sustained index knee pain reduction

Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians

Aim: To evaluate the clinical and biochemical profile of patients with non alcoholic fatty liver disease (NAFLD) and to assess their histological severity at presentation. Methods: Consecutive patients presenting to the liver clinic of All India Institute of Medical Sciences (AIIMS) with raised transaminases to at least 1.5 times upper limit of normal, and histologically confi rmed non-alcoholic fatty liver disease were included. Patients who had significant alcohol intake or positive markers of other liver diseases or who were taking drugs known to produce fatty liver were excluded. The clinical, biochemical and histological profi le of this group was studied. Results: Fifty-one patients with NAFLD formed the study population. Their median age and BMI were 34(17-58) years and 26.7(21.3-32.5) kg/m2 respectively and 46 (90.1%) were males. The majority of the patients had mild inflammation, either grade 1 [32 (63%)] or grade 2 [16 (31%)] and only 3 (6%) patients had severe (grade 3) infl ammation. Twenty-three (45%), 19 (37%), 8(16%) and 1(2%) patient had stage 0, 1, 2 and 3 fi brosis respectively on index biopsy and none had cirrhosis. On univariate analysis, triglyceride levels more than 150 mg % (OR = 7.1; 95% CI: 1.6-31.5, P = 0.002) and AST/ALT ratio &gt; 1 (OR = 14.3; 95% CI: 1.4-678.5, P = 0.008) were associated with high grades of inflammation and none was associated with advanced fibrosis. On multivariate logistic regression analysis, hypertriglyceridemia &gt;150 mg% was the only factor independently associated with presence of high grade of infl ammation (OR = 1.6; 95% CI: 1.3-22.7, P = 0.02), while none was associated with advanced fi brosis. Triglyceride levels correlated positively with infl ammatory grade (r = 0.412; P = 0.003). Conclusion: NAFLD in North Indian patients is a disease of young over-weight males, most of whom are insulin resistant and they tend to have a mild histological disease at presentation