Serum Uric Acid Level in Type 2 Diabetes Mellitus

Diabetes Mellitus is strongly associated with hyperuricemia. The role of uric acid is a independent risk factor for cardiovascular disease is a matter of controversy. The present study was proposed to asses the uric acid status in patients with diabetes mellitus and to find out its association with age, gender, BMI, WHR, smoking and CAD. With rigid criteria, patients were selected carefully and evaluated on social, clinical, and laboratory aspects after getting institutional, ethical clearance and informed consent. 30 healthy age, sex matched individuals were kept as control. There were 46 males and 24 Females in the study group and 18 males and 12 females in the control group. The mean and standard deviation of age among the patient group was 60.01± 8.82 and 56.27 ± 7.84 in control group. There was no significant difference among cases and controls in relation to age. In study group, BMI below 25 seen in 32 cases (45.7%) BMI above 25 seen in 38 cases (54.3%) which was significantly more than controls. BMI had significantly correlated with hyperuricemia. Similarly WHR was greater among women than men in diabetics, which also correlated with elevated serum uric acid significantly. Elevated serum uric acid level was noticed more among those who had hypertension (21.4%), dyslipidemia (28.6%), Coronary artery disease (21.4%) and they were significant. Patients with longer duration of diabetes also had elevated uric acid level. The factors contribute to hyperuricemia in diabetes are 1. Hyperinsulinemia acutely reduces urinary uric acid and sodium excretion. 2. Hyperinsulinemia imposes a chronic antinatriuretic and antiuricosuric pressure on the kidney. 3. Microvascular disease in diabetes mellitus causes local tissue ischemia, and decreased renal blood flow. Ischemia with associated lactate production that blocks urate secretion in proximal tubules. Increased uric acid synthesis due to increased purine metabolism, ischemia induced increased xanthine oxidase production, insulin resistance, and diuretic use. Meticulous control of blood sugar, hypertension, dyslipidemia, body weight and abdominal girth, form an essential component of diabetes which will bring down uric acid level, a less discussed issue among diabetic population. In view that it is worth to explore uric acid levels atleast in patients with family history of diabetes and in obese diabetic patients to detect early cardiovascular complications

Study on etiopathogenesis clinical presentation and outcome in 100 young stroke patients.

OBJECTIVES: To study 100 cases of completed stroke patients in the age group < 45 years with regard to 1. Etiopathogenic risk factors analysis, 2. Clinical presentation of young stroke 3. Their outcome in further follow up. DESIGN: Single Observational study. This study was conducted among 100 Young stroke patients who were admitted in our hospital with various etiologies since March 2013 to February 2014. RESULTS & CONCLUSION Stroke under 45 yrs is common in the age group between 35-45 years. Males are affected more than females in young stroke. Ischemic stroke more common than hemorrhagic stroke. Thrombotic stroke more common than embolic stroke in ischemic strokes Anterior circulation strokes more common than posterior circulation strokes. MCA more commonly involved than ACA and PCA. Motor weakness is the common presentation of young stroke followed by unsteadiness, unconsciousness and speech disturbances. Right sided weakness more common than left sided weakness. Hemiparesis more common than hemiplegia. Motor aphasia most common type of aphasia in our study. Smoking and Alcohol are the most common risk factor for ischemic stroke followed by Dyslipidemia, Diabetes mellitus and Hypertension. Atrial fibrillation is the most common risk factor for embolic stroke. Rheumatic heart disease is the most common cardiac disease causing embolic stroke. Hypertension is the single most important factor for hemorrhagic stroke. Vasculitis,Hypercoagulable states, Homocystinemia, APLA are rare risk factors for young stroke. Weakness and speech disturbances were improved significantly. Unsteadiness not improved significantly. Death were seen in 12 cases