Study to evaluate serum free testosterone and hsCRP concentration to predict low hematocrit in type 2 diabetes mellitus

Background: The primary objective of the study was to assess serum free testosterone and high sensitivity c-reactive protein concentrations and their correlation with hematocrit in patients of diabetes mellitus type 2.Hypogonadotropic hypogonadism is a common defect in type 2 diabetes, irrespective of the glycemic control, duration of disease, and the presence of complications of diabetes or obesity.It has been demonstrated that about one third of male patients with diabetes mellitus type 2 have low serum free Testosterone level.Methods: We have included 50 patients of diabetes mellitus type 2 presenting to the department of medicine SMS Hospital Jaipur. Both indoor and out door patients were selected who were free of microalbuminuria and diabetic nephropathy. Primary or secondary hypogonadism, other than diabetes mellitus and anemia of other causes were ruled out.Results: Diabetes mellitus type 2 patients with low serum free testosterone levels have significantly low hematocrit values ( n= 29) (p-value <0.001) and mild anemia compared to eugonadal men ( n= 21). Their correlation was highly significant. Patients with DM type 2 who have low serum free testosterone, also have high hs-CRP concentration. Though hematocrit values were low in patients with high hs-CRP concentration but it was not statistically significant.Conclusion: At the end of the study we concluded that both a low serum free testosterone level and high hs-CRP concentration may play an important role in the pathogenesis of mild anemia and low hematocrit values in DM type 2 patients.

Chronic neutrophilic leukaemia-a rare haematological malignancy

Chronic neutrophilic leukaemia is a rare myeloproliferative neoplasm. It requires exhaustive workup and puts a diagnostic challenge to the clinician as well as pathologist. It should be differentiated from chronic myelogenous leukemia and reactive neutrophilia. Prognosis of the disease is poor. Here we report a case presented to us with 4 months of fatigue and fever. Investigation shows leucocytosis with predominant neutrophilia, evaluated and diagnosed as Chronic Neutrophilic Leukaemia (CNL) according to revised WHO criteria

Echocardiographic evaluation of left ventricular diastolic dysfunction in recently diagnosed type 2 diabetes mellitus

Background: Diastolic dysfunction in patients suffering from diabetes mellitus represents an earlier stage in the natural history of cardiomyopathy. This study was done to assess the left ventricular diastolic dysfunction in recently diagnosed (<5yr) Type 2 Diabetes Mellitus by Echocardiography and also to determine association of glycemic status (by HBA1c levels) with left ventricular diastolic dysfunction (LVDD).Methods: An observational descriptive study involving 100 diabetic patients, taken on first come first serve basis after applying inclusion and exclusion criteria. In all the subjects, other than routine investigations, HbA1c was estimated and echocardiography was done to evaluate LVDD.Results: Mean value of HbA1c in the study was 8.31+ 1.408 %. 63 out of 100 subjects had LVDD. There was significant positive correlation between HbA1c and LVDD (p value <0.001). As HbA1c increased, severity of LVDD increased. In this study, as BMI increased, HbA1c and LVDD increased & both findings were statistically significant (p value =0.001).Conclusion: Our study indicates that myocardial damage in patients with diabetes affects diastolic function before systolic function &higher HbA1C level is strongly associated with presence of LVDD. Patients should be advised strict control of diabetes in order to reduce the risk for developing LVDD which is a precursor for more advanced disease.Keywords: Diabetes mellitus, Diastolic dysfunction, BMI, HbA1

The relation of serum GGT level in patients with non valvular atrial fibrillation and normal sinus rhythm

Background: The primary objective of the study was to assess and compare the relation of serum GGT level in patients with non valvular atrial fibrillation and normal sinus rhythm. The fundamental mechanisms underlying AF remains poorly understood. Oxidative stress is hypothesized to induce and maintain nonvalvular atrial fibrillation particularly in elderly patients. GGT levels are increased in patients with chronic inflammation. Increased serum levels of GGT are found in chronic nonvalvular atrial fibrillation (AF) patients as compared with patients in sinus rhythm.Methods: We included 75 patients of nonvalvular atrial fibrillation and 75 patients of sinus rhythm after applying exclusion criteria. Serum level of gamma glutamyl transrerase (GGT) of both the groups was compared.Results: Presence of coronary artery disease, hypertension, gender, hyperlipidemia, diabetes mellitus and smoking status were comparable between the 2 groups (P > 0.05 for all). Serum gamma glutamyl transferase activity in 75 cases was 71.45±26.21 with maximum being 147 IU/L more than the normal range for age, whereas in controls it was 19.68±5.53 i.e. much within the normal range for age.Conclusions: At the end of the study we concluded that serum GGT levels were significantly higher in patients with chronic nonvalvular atrial fibrillation (AF) patients as compared with patients in sinus rhythm

Echocardiographic evaluation of left ventricular diastolic dysfunction in recently diagnosed type 2 diabetes mellitus

Background: Diastolic dysfunction in patients suffering from diabetes mellitus represents an earlier stage in the natural history of cardiomyopathy. This study was done to assess the left ventricular diastolic dysfunction in recently diagnosed (&lt;5yr) Type 2 Diabetes Mellitus by Echocardiography and also to determine association of glycemic status (by HBA1c levels) with left ventricular diastolic dysfunction (LVDD).Methods: An observational descriptive study involving 100 diabetic patients, taken on first come first serve basis after applying inclusion and exclusion criteria. In all the subjects, other than routine investigations, HbA1c was estimated and echocardiography was done to evaluate LVDD.Results: Mean value of HbA1c in the study was 8.31+ 1.408 %. 63 out of 100 subjects had LVDD. There was significant positive correlation between HbA1c and LVDD (p value &lt;0.001). As HbA1c increased, severity of LVDD increased. In this study, as BMI increased, HbA1c and LVDD increased &amp; both findings were statistically significant (p value =0.001).Conclusion: Our study indicates that myocardial damage in patients with diabetes affects diastolic function before systolic function &amp;higher HbA1C level is strongly associated with presence of LVDD. Patients should be advised strict control of diabetes in order to reduce the risk for developing LVDD which is a precursor for more advanced disease.Keywords: Diabetes mellitus, Diastolic dysfunction, BMI, HbA1

Chronic neutrophilic leukaemia-a rare haematological malignancy

Chronic neutrophilic leukaemia is a rare myeloproliferative neoplasm. It requires exhaustive workup and puts a diagnostic challenge to the clinician as well as pathologist. It should be differentiated from chronic myelogenous leukemia and reactive neutrophilia. Prognosis of the disease is poor. Here we report a case presented to us with 4 months of fatigue and fever. Investigation shows leucocytosis with predominant neutrophilia, evaluated and diagnosed as Chronic Neutrophilic Leukaemia (CNL) according to revised WHO criteria