Glycaemic control and C- reactive protein levels in type 2 diabetes mellitus -how well they co-relate?: a prospective study

Background: Poorly controlled diabetes mellitus as indicated by elevated glycated haemoglobin (HbA1c) levels is associated with increased cardiovascular risk. C–reactive protein (CRP), an important cardiovascular risk factor, is elevated in diabetics with poor glycaemic control than those with good control. The present study assessed the correlation between HbA1c and CRP levels.Methods: A prospective study was conducted in thirty type 2 diabetic patients irrespective of the disease duration and treatment; those with established target organ damage were excluded. HbA1c and hsCRP levels were measured at baseline; sugars were monitored monthly and medications optimised; at the end of six months HbA1c and hsCRP levels were measured.Results: Mean age of the study subjects was 58.7±8.6 years; At the baseline, all had poor glycaemic control (HbA1c >7%); 15 had hsCRP >3 mg/L. At the end of 6 months, 5 achieved good glycaemic control (HbA1c 3 mg/L. Baseline median hsCRP was 3.33 mg/L (0.68, 15.9) and at the end of 6 months it was 2.08 mg/L (0.48, 9.12). Mean HbA1c at baseline and end line was 10.6±1.55% and 8.43±1.84% respectively. There was significant reduction in both the mean HbA1c and median hsCRP at the end of 6 months (p <0.001). Positive correlation was observed between HbA1c and CRP at baseline (r=0.32, p=0.10). However, this was not observed at the end of 6 months.Conclusions: There is positive correlation between the level of glycaemic control (HbA1c) and CRP levels; Better glycaemic control results in significant reduction in the hsCRP levels

Prevalence of metabolic syndrome in patients with premature coronary artery disease proven by coronary angiogram

Background: Metabolic syndrome (MS) is associated with premature coronary artery disease (CAD). The aim of this study was to evaluate the prevalence of MS and its association with severity of CAD proven by coronary angiogram (CAG) in young patients.Methods: We included patients, aged 45 years or less, admitted with acute coronary syndrome (ACS), who had CAD confirmed by coronary angiography. They were divided into two groups according to the presence or absence of MS based on International Diabetes Federation (IDF) criteria. CAD was classified into single, double and triple vessel disease (TVD). The prevalence of MS and its individual parameters was calculated.Results: Among 90 young patients who presented with ACS, MS was present in 67 patients (74.44%). Among those with MS, the prevalence of each individual criterion was statistically significant in MS group (P <0.05). Prevalence of pre-existing hypertension and diabetes was significantly higher in MS group (p <0.01). Smoking, alcohol consumption and family history of CAD were not statistically significant in patients with and without MS. Fifteen out of 90 patients (14 in MS group) who presented with ACS had TVD in CAG, but this was not statistically significant (p 0.06).Conclusions: This study confirms a very high prevalence of MS in young Indian patients with premature CAD. MS was more prevalent than the conventional risk factor smoking in young CAD patients. We could not find significant difference in severity of CAD based on CAG between MS and non-MS group

Reliability of dipstick assay in predicting urinary tract infection

Aims: Urine dipstick analysis is a quick, cheap and a useful test in predicting Urinary Tract Infection (UTI) in hospitalized patients. Our aim is to evaluate the reliability (sensitivity) of urine dipstick analysis against urine culture in the diagnosis of UTI. Materials and Methods: Patients admitted to our hospital suspected of having UTI, with positive urine cultures were included in this study from a 2-year period (January 2011 to December 2012). Dipstick urinalysis was done using multistix 10 SG (Siemens) and clinitek advantus analyzer. The sensitivity of dipstick nitrites, leukocyte esterase and blood in these culture-positive UTI patients was calculated retrospectively. Results: Urine dipstick analysis of 635 urine culture-positive patients was studied. The sensitivity of nitrite alone and leukocyte esterase alone were 23.31% and 48.5%, respectively. The sensitivity of blood alone in positive urine culture was 63.94%, which was the highest sensitivity for a single screening test. The presence of leukocyte esterase and/or blood increased the sensitivity to 72.28%. The sensitivity was found to be the highest when nitrite, leukocyte and blood were considered together. Conclusions: Nitrite test and leukocyte esterase test when used individually is not reliable to rule out UTI. Hence, symptomatic UTI patients with negative dipstick assay should be subjected to urine culture for a proper management