Prevalence of thyroid dysfunction in type 2 diabetics

Background: Type 2 Diabetes Mellitus has emerged as a common endocrine disorder in india. Thyroid dysfunction may complicate glycaemic control of diabetic patients. For better management of diabetes, it is necessary to detect and treat thyroid dysfunction in these patients.Methods: This was an observational study conducted at SMS Hospital Jaipur, Rajasthan, India, between March 2016 to November 2017. Total 100 patients were included out of which 50 were Diabetic patients and 50 were age and sex matched nondiabetic controls reported in outpatient department of SMS Hospital, Jaipur. Patients of type 1 Diabetes, previously known case of thyroid disorder, patients having endocrine disorder or autoimmune disorder other than Diabetes, critically ill patients and pregnant females were excluded from study. Serum Fasting Blood Sugar, Free T3, Free T4, TSH were measured in all study subjects and results were analysed statistically to find out if there is any difference in prevalence of thyroid dysfunction in Diabetic patients and non-diabetic controls.Results: Thyroid dysfunction was present in 16 (32%) of 50 type 2 diabetics and 3 (6%) of 50 nondiabetic controls.  The prevalence of thyroid dysfunction in type 2 diabetic females and males was 43.3% and 15% respectively. Mean fasting blood sugar was higher in diabetic patients having thyroid dysfunction (209.12 mg/dl) as compared to euthyroid diabetic subjects (173.58 mg/dl). Twelve (75%), out of 16 study subjects with thyroid dysfunction have secondary hypothyroidism. Three (18.75%) of them have mild (sub-clinical) hypothyroidism. One person (6.25%) has subclinical hyperthyroidism.Conclusions: Prevalence of thyroid dysfunction is higher in type 2 diabetic patients as compared to nondiabetic. Better glycaemic control is observed in euthyroid diabetic patients as compared to diabetic patients having thyroid dysfunction

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

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

Neuropathic pruritus: an early indicator of neuromyelitis optica spectrum disorders

Neuromyelitis optica is a relapsing, inflammatory astrocytopathic disorder, affecting predominantly the optic nerves and spinal cord. It is associated with antiaquaporin-4 immunoglobulin G (AQP4-IgG) in up to 70% of patients. Spinal cord involvement typically presents as a longitudinally-extensive transverse myelitis, with associated sensorimotor and sphincter dysfunction. Sensory symptoms such as numbness, dysaesthesia, pain and tonic spasms are common. Here, we present a case of a 25years old female who came to the medicine OPD, with the chief complaints of intense itching over face and forehead, which was later on progressed to quadriparesis after 3 weeks. This case highlights neuropathic pruritus as an under-recognised early feature of neuromyelitis optica

Psychosis as the sole presenting feature of hyperthyroidism: a case report

Thyroid disease is a very common entity with a wide range of presentation, We report a case of twenty six year old female presented to emergency room with frank psychosis over the course of her stay in hospital we investigated thoroughly and finally she turned out to be a case of hyperthyroidism with psychosis as the only presenting symptom and after starting her on carbimazole patient responded to the treatment remarkably

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

Post-stroke reorganization of transient brain activity characterizes deficits and recovery of cognitive functions

Functional magnetic resonance imaging (fMRI) has been widely employed to study stroke pathophysiology. In particular, analyses of fMRI signals at rest were directed at quantifying the impact of stroke on spatial features of brain networks. However, brain networks have intrinsic time features that were, so far, disregarded in these analyses. In consequence, standard fMRI analysis failed to capture temporal imbalance resulting from stroke lesions, hence restricting their ability to reveal the interdependent pathological changes in structural and temporal network features following stroke. Here, we longitudinally analyzed hemodynamic-informed transient activity in a large cohort of stroke patients (n = 103) to assess spatial and temporal changes of brain networks after stroke. Metrics extracted from the hemodynamic-informed transient activity were replicable within- and between-individuals in healthy participants, hence supporting their robustness and their clinical applicability. While large-scale spatial patterns of brain networks were preserved after stroke, their durations were altered, with stroke subjects exhibiting a varied pattern of longer and shorter network activations compared to healthy individuals. Specifically, patients showed a longer duration in the lateral precentral gyrus and anterior cingulum, and a shorter duration in the occipital lobe and in the cerebellum. These temporal alterations were associated with white matter damage in projection and association pathways. Furthermore, they were tied to deficits in specific behavioral domains as restoration of healthy brain dynamics paralleled recovery of cognitive functions (attention, language and spatial memory), but was not significantly correlated to motor recovery. These findings underscore the critical importance of network temporal properties in dissecting the pathophysiology of brain changes after stroke, thus shedding new light on the clinical potential of time-resolved methods for fMRI analysis

Improvements in forecasting intense rainfall: results from the FRANC (forecasting rainfall exploiting new data assimilation techniques and novel observations of convection) project

The FRANC project (Forecasting Rainfall exploiting new data Assimilation techniques and Novel observations of Convection) has researched improvements in numerical weather prediction of convective rainfall via the reduction of initial condition uncertainty. This article provides an overview of the project’s achievements. We highlight new radar techniques: correcting for attenuation of the radar return; correction for beams that are over 90% blocked by trees or towers close to the radar; and direct assimilation of radar reflectivity and refractivity. We discuss the treatment of uncertainty in data assimilation: new methods for estimation of observation uncertainties with novel applications to Doppler radar winds, Atmospheric Motion Vectors, and satellite radiances; a new algorithm for implementation of spatially-correlated observation error statistics in operational data assimilation; and innovative treatment of moist processes in the background error covariance model. We present results indicating a link between the spatial predictability of convection and convective regimes, with potential to allow improved forecast interpretation. The research was carried out as a partnership between University researchers and the Met Office (UK). We discuss the benefits of this approach and the impact of our research, which has helped to improve operational forecasts for convective rainfall event

The State-Moro Armed Conflict in the Philippines: Unresolved national question or question of governance?

The continuing struggle of the Moro secessionist movement in the Philippines is one of Southeast Asia’s longest armed conflicts. The tenacity of the conflict lies in two competing concerns: the assertion of self-determination rights of the Moro separatist movement; and the affirmation of the Philippines’ sovereign right to territorial integrity. However, beneath these rights are crucial issues that remain unanswered both by the contending forces—problems where internecine violence and conflict emanate from. This article argues that self-determination rights can be adequately exercised by people who have clearly defined their national identity and concept of a nation. Unfortunately, the Moro multi-ethnic national identity has yet to be crystallised while the idea of a Bangsamoro (Bangsa Nation) remains weak. On the other hand, the state has yet to address the Moros’ legitimate demands of political autonomy, socio-economic development, and social justice and discrimination. Without underestimating the ethnic component of secessionism, the article concludes that poor governance has prolonged, complicated, and further justified the Moros’ quest to secede from the Republic

Cyclin A2 Mutagenesis Analysis: A New Insight into CDK Activation and Cellular Localization Requirements

Cyclin A2 is essential at two critical points in the somatic cell cycle: during S phase, when it activates CDK2, and during the G2 to M transition when it activates CDK1. Based on the crystal structure of Cyclin A2 in association with CDKs, we generated a panel of mutants to characterize the specific amino acids required for partner binding, CDK activation and subcellular localization. We find that CDK1, CDK2, p21, p27 and p107 have overlapping but distinct requirements for association with this protein. Our data highlight the crucial importance of the N-terminal α helix, in conjunction with the α3 helix within the cyclin box, in activating CDK. Several Cyclin A2 mutants selectively bind to either CDK1 or CDK2. We demonstrate that association of Cyclin A2 to proteins such as CDK2 that was previously suggested as crucial is not a prerequisite for its nuclear localization, and we propose that the whole protein structure is involved