24 research outputs found
Metabolic Profile of Young Onset Type 2 Diabetes Mellitus Patients and Their First Degree Relatives
Objective: There is a paucity of data on the metabolic profile of the first degree relatives of young onset type 2 diabetes mellitus especially from India. Therefore, this study was done to evaluate the metabolic profile of young- onset type 2 diabetic patients and their first degree relatives. Material and method: Thirty young- onset type 2 diabetic patients of age < 30 yrs and 89 first degree relatives (28 parents and 61 siblings) were assessed for anthropometric parameters such as BMI, waist circumference, waist hip ratio and body mass index. Various biochemical tests were done which included fasting and 2 hours post 75 gm glucose load, glycated haemoglobin (HbA1c), lipid profile and renal function test. Metabolic syndrome was diagnosed as per National Cholesterol Education Program- Third Adult Treatment Panel III (NCEP- ATP III) criteria and IDF criteria.Results: Mean age of the patients was 27.53 years whereas mean age of the first degree relatives was 36.53 years. Mean BMI of the patients and first degree relatives were 26.46 and 25.46 kg/m2 respectively. 60% of patients and their first degree relatives separately fulfilled the IDF criteria for central obesity. 51 (57.3%) first degree relatives fulfilled the WHO criteria for abdominal obesity. Family history of diabetes was seen in 60% of these young diabetics. Out of 89 first degree relatives, 32 relatives (35.9%) were found to have diabetes and additional 13(14.6%) relatives had either impaired fasting glucose or impaired glucose tolerance test results. 18 (60%) patients and 48 (54%) first degree relatives fulfilled the IDF criteria for metabolic syndrome. According to NCEP ATP III criteria, 73.3% of these young onset diabetic patients and 50% of their first degree relatives fulfilled the criteria for metabolic syndrome.Conclusion: More than 50% of the first degree relatives of the young onset type 2 DM patients fulfill the criteria of metabolic syndrome and 50% of these FDRs have diabetes or prediabetes. Hence, our study clearly reinforces the importance of screening the first degree relatives for metabolic parameters, as it will detect metabolic syndrome or diabetes early in this high risk group so that appropriate treatment can be started in time to prevent the complications
Clinical Correlates of Hepatitis B or Hepatitis C Coinfections in People Living with HIV/AIDS (PLHIV)
Introduction: Hepatitis B virus (HBV) coinfected HIV patients are likely to have chronic hepatitis B infection and associated severe liver disease, however effect of hepatitis B on HIV has not been proven to be off any effect. Similarly in HIV/HCV co-infection majority of the studies have shown no significant influenceof hepatitis C on the course of HIV infection, although some studies have demonstrated an association between HCV infection and faster HIV disease progression.14,15 Therefore, further studies are needed to study the impact of HBV/HCV co-infection on course of HIV, specially, in India.Aims and Objectives: To study the clinical, biochemical and immunological profile of PLHIV co-infected with either hepatitis B or hepatitis C virus, the severity of liver disease and hepatitis B and hepatitis C viral loads in these co-infected PLHIV and the association of WHO stage of HIV and immunosuppression withhepatitis B and hepatitis C viral loads as well as severity of liver disease.Method: It was an observational cross-sectional study, involving 30 PLHIV co-infected with either hepatitis B or C. A detailed history and physical examination was done. Complete Haemogram, Liver function tests, kidney function tests, Ultrasonography abdomen, CD4 cell counts, hepatitis B surface antigen (HBsAg),hepatitis B envelope antigen (HBeAg), hepatitis B Viral DNA (HBV DNA) and HCV RNA levels were done. Severity of liver disease was assessed by FIB 4 SCORE.Results: Among the 30 PLHIV subjects 30% were co-infected with HCV 70% were co-infected with HBV (HBsAg positive). All the subjects were asymptomatic for their liver disease. All the subjects were on Anti-Retroviral Therapy (ART) and 80% were in Early WHO stage (T1 and T2) and 20% were in Advanced WHO stage (T3 and T4). It was similar in both HBV and HCV co-infected group. The mean CD4 count of the subjects was 416.70±189.50 cells/mm3 with the range of 69 – 909 cells/mm3. Five subjects (16.67%) had a CD4 count 3.25). In HCV co-infected subjects 3 of 9 (33.33%) had severe liver fibrosis and only 1 of 21 (4.7%) among HBV co-infected had severe liver fibrosis.Among the 9 HCV co-infected subjects, 3 (33.33%) had undetectable HCV RNA. More number of subjects with detectable hepatitis C viral load had severe liver disease as compared to undetectable viral load.In HIV and HBV co-infected subjects the HBeAg positivity was seen in 42.86% subjects and 38.1% subjects had detectable HBV DNA load. Significant correlation was seen between HBeAg positivity and HBV DNA load. No correlation could be found between FIB 4 score and hepatitis B envelope antigen (HBeAg) positivity or HBV DNA load.No correlation between severity of liver disease (FIB 4) score and WHO staging or CD4 count could be seen. WHO staging and CD4 count also did not correlated with HCV RNA load, HBeAg positivity and HBV DNA load.Conclusions: There is no correlation of CD4 count and WHO stage with liver disease severity or hepatitis viral load in patients on HAART. In HIV and HBV co-infected patients high prevalence of HBeAg positivity is seen. Thus it becomes important to look for deranged liver enzymes and HBeAg positivity in PLHIV coinfected with hepatitis B so that ART can be initiated in these patients irrespective of CD4 count. Hepatitis C co-infected subjects are more likely to have severe liver disease inspite of good CD4 count, so specific treatment for hepatitis C virus should be considered
Infection of Human Papillomavirus Type 18 and p53 Codon 72 Polymorphism in Lung Cancer Patients From India
Study objectives: Infection with specific high-risk HPV types 16 and 18 and polymorphism of p53 codon 72 has been strongly associated with the genesis of various neoplasms in humans, but such study in lung cancer is limited and the results are controversial. In India, the role of these two factors has been strongly implicated in cervical and other cancers, but the occurrence of HPV or p53 codon 72 polymorphism has not been examined in lung cancer, which is the most common cause of cancer-related death in India. Design and patients: A total of 40 tumor biopsy specimens from advanced lung cancer patients and blood samples from 40 matching control subjects were obtained for the analysis of high-risk HPV types 16 and 18 infection and p53 codon 72 polymorphism by polymerase chain reaction. Results: Only HPV type 18 was detected in 5% (2 of 40 lung cancer patients), but no other HPV could be detected. A significantly increased frequency of Arg/Arg homozygotes was observed in patients with advanced lung cancer when compared to that of control subjects (p = 0.004; odds ratio, 5.13; 95% confidence interval, 1.59 to 17.26). However, no significant correlation could be made between p53 polymorphism and different clinical stages, except for advanced stage IV patients, who showed a higher proportion of Arg/Pro heterozygous genotype. Conclusions: HPV detected in a small proportion of lung cancer patients in India demonstrated an exclusive prevalence of HPV type 18, and there was a significantly higher frequency of p53 Arg/Arg genotype when compared to that of control subjects. Observation of a shorter duration of symptoms (≤ 4 months) in as many as 78% (seven of nine stage IV patients) with Arg/Pro genotype may be an indication that lung cancer patients with the heterozygous p53 genotype are more susceptible to early progression
Utility of Serum Neopterin and Serum IL-2 Receptor Levels to Predict Absolute CD4 T Lymphocyte Count in HIV Infected Cases
A prospective study was carried out to evaluate the efficacy of serum neopterin and soluble IL-2 receptor (sIL-2R) concentrations in comparison to CD4 count to study the progression of HIV disease and monitor response to ART in HIV cases. One hundred newly diagnosed HIV seropositive subjects were recruited. CD4 counts were determined by FACS system. Serum neopterin and sIL-2R levels were measured using enzyme immunoassay. In our study, levels of neopterin and sIL-2R were significantly higher in subjects with CD4 <200 cells/μL (with S. neopterin levels of >25.1 nmol/L and sIL-2R levels of >47.1 pM as cutoff values for CD4 <200 cells/μL) compared to those in subjects with CD4 >200 cells/μL at baseline which indicate that these markers can be utilized for initiation of ART in HIV cases. The levels of these markers decreased significantly after initiation of ART. In patients with CD4 >200 cells/μL, these markers are helpful in predicting disease progression
Genetic Risk Score for Essential Hypertension and Risk of Preeclampsia
Preeclampsia is a hypertensive complication of pregnancy characterized by novel onset of hypertension after 20 weeks gestation, accompanied by proteinuria. Epidemiological evidence suggests that genetic susceptibility exists for preeclampsia; however, whether preeclampsia is the result of underlying genetic risk for essential hypertension has yet to be investigated. Based on the hypertensive state that is characteristic of preeclampsia, we aimed to determine if established genetic risk scores (GRSs) for hypertension and blood pressure are associated with preeclampsia
Accelerated hypertension: Treatable yet underdiagnosed
Patients who present in young age with accelerated hypertension (HTN) should always be evaluated for secondary causes of hypertension. Renal parenchyma and vascular diseases constitute the majority of the etiology. Other causes include endocrine diseases such as pheochromocytoma, pregnancy-related HTN, and sleep apnea. We report a 23-year-old female who presented with palpitations and headache under treatment for anxiety from a tertiary care hospital. She was found to have accelerated HTN and was thoroughly worked up for etiology and treatment
Reasons for non-adherence to antiretroviral therapy among adult patients receiving free treatment at a tertiary care hospital in Delhi
Differential Expression Analysis for RNA-Seq Data
RNA-Seq is increasingly being used for gene expression profiling. In this approach, next-generation sequencing (NGS) platforms are used for sequencing. Due to highly parallel nature, millions of reads are generated in a short time and at low cost. Therefore analysis of the data is a major challenge and development of statistical and computational methods is essential for drawing meaningful conclusions from this huge data. In here, we assessed three different types of normalization (transcript parts per million, trimmed mean of M values, quantile normalization) and evaluated if normalized data reduces technical variability across replicates. In addition, we also proposed two novel methods for detecting differentially expressed genes between two biological conditions: (i) likelihood ratio method, and (ii) Bayesian method. Our proposed methods for finding differentially expressed genes were tested on three real datasets. Our methods performed at least as well as, and often better than, the existing methods for analysis of differential expression
Takayasu arteritis presenting as bowel gangrene: An unusual initial presentation
A 24-year-old lady presented to the emergency department with severe generalized abdominal pain and hematochezia of 2 days. Examination revealed absent bilateral radial, brachial, and carotid pulses. Rest of the peripheral pulses were normal. A bruit was heard over bilateral carotid, subclavian, and renal arteries. X-ray abdomen showed dilated bowel loops with multiple air fluid levels. Doppler study revealed intimal thickening in bilateral subclavian and common carotid arteries along with decreased flow. Computed tomography (CT) angiography was done urgently that showed critical narrowing of the bilateral subclavian, common carotid, coeliac trunk, superior mesenteric arteries, inferior mesenteric arteries, and bilateral renal arteries. We present a case of mesenteric ischemia in a patient of Takayasu arteritis (TA) leading to bowel gangrene involving entire small and large bowel and a fulminant outcome, which is an uncommon initial presentation of TA
Spectrum of Opportunistic Fungal Infections in HIV/AIDS Patients in Tertiary Care Hospital in India
HIV related opportunistic fungal infections (OFIs) continue to cause morbidity and mortality in HIV infected patients. The objective for this prospective study is to elucidate the prevalence and spectrum of common OFIs in HIV/AIDS patients in north India. Relevant clinical samples were collected from symptomatic HIV positive patients (n=280) of all age groups and both sexes and subjected to direct microscopy and fungal culture. Identification as well as speciation of the fungal isolates was done as per the standard recommended methods. CD4+T cell counts were determined by flow cytometry using Fluorescent Activated Cell Sorter Count system. 215 fungal isolates were isolated with the isolation rate of 41.1%. Candida species (86.5%) were the commonest followed by Aspergillus (6.5%), Cryptococcus (3.3%), Penicillium (1.9%), and Alternaria and Rhodotorula spp. (0.9% each). Among Candida species, Candida albicans (75.8%) was the most prevalent species followed by C. tropicalis (9.7%), C. krusei (6.4%), C. glabrata (4.3%), C. parapsilosis (2.7%), and C. kefyr (1.1%). Study demonstrates that the oropharyngeal candidiasis is the commonest among different OFIs and would help to increase the awareness of clinicians in diagnosis and early treatment of these infections helping in the proper management of the patients especially in resource limited countries like ours