Background: Diabetes is commonly associated with dyslipidemia, which is one of the major risk factors of coronary heart disease (CHD), the leading cause of mortality in patients with type 2 diabetic. It is thus desirable that an anti-diabetic drug must provide good glycaemic control and in addition cause correction of dyslipidaemia, at the same time being safe. Fenugreek, a traditional drug has been found to have beneficial effect on glycaemic control as well as lipid profile and may be thus useful in such patients. The study was thus planned to further explore the effect of fenugreek seed on glycaemic control and lipid profile by comparing it with a standard anti-diabetic drug glipizide. Methods: This 12 week, prospective, randomized, open-label, parallel group comparative study was conducted on 60 patients with type 2 diabetes. The patients were randomized to receive either glipizide 5 mg once daily (group A, n=20), fenugreek seed extract 500 mg twice a day (group B, n=20), or a combination of glipizide 2.5 mg and fenugreek seed extract 500 mg once daily (group C, n=20). The primary endpoint were the change in fasting blood glucose (FBG), glycated haemoglobin (HbA1c), and lipid profile from baseline after 12 weeks of treatment. Results: A statistically significant decline in mean FBG levels (group A -33.97%, p<0.001; versus group B -24.62%, p<0.001; versus group C -29.96%, p<0.001), and in HbA1c levels (group A -12.98 %, p<0.0001; group B -9.38%, p<0.0001; and group C -10.62%, p<0.0001) was seen in all three treatment groups. Total cholesterol (TC) reduced non-significantly in group A (-0.98%, p=0.1982), whereas in group B (-5.66%, p<0.001) and group C (-3.87%, p<0.001) it decreased significantly. Non-significant reduction in plasma triglycerides (TG) were seen in group A (-0.74%, p=0.0669), and significant reductions were seen in both group B (-17.23%, p<0.001) and group C (-11.34%, p<0.001). Low density lipoproteins cholesterol (LDL-C) showed nonsignificant reductions in group A (-0.74%, p=0.5482), and significant reductions in both group B (-4.15%, p<0.001) and group C (-2.68%, p=0.0463). Highdensity lipoproteins cholesterol (HDL-C) showed non-significant changes in all three groups (group A -0.60%, p =0.1529; group B 0.65%, p=0.2072; and group C 0.76%, p = 0.0543). The adverse drug reactions seen were mild in nature and none of the patients was withdrawn from the study because of serious adverse drug reactions. Conclusions: Monotherapy with fenugreek produced significant improvement in glycaemic control and dyslipidaemia. Glipizide monotherapy was more efficacious in controlling FBG and HbA1c levels than fenugreek monotherapy or in combination with fenugreek; glipizide monotherapy had no effect on lipid profile whereas fenugreek monotherapy was more efficacious in controlling dyslipidaemia than in combination with glipizide. Both drugs as monotherapy or in combination were well-tolerated by the patients.
Background: Diabetes is estimated to complicate 2-5% of all pregnancies of which 90% of those are detected during pregnancy i.e. gestational diabetes mellitus (GDM) and the rest are overt or pregestational i.e. either Type 1 or Type 2. According to ADA, approximately 7% of all pregnancies are complicated by GDM resulting in more than 2,00,000 cases annually. The aim was to study the incidence of GDM among pregnant women between 24 to 28 weeks of gestation, to evaluate and compare the occurrence of risk factors e.g.; family history of diabetes, prematurity, history of foetal loss and congenital anomaly associated with diabetes in pregnancy.Methods: 50gm of glucose, glucose challenge test (GCT) was given to women coming for antenatal check-up between 24 to 28 weeks of gestation irrespective of presence or absence of risk factors for GDM.1 hour glucose levels were checked. Patients with glucose levels more than 130mg/dl were subjected to 100gm of oral glucose tolerance test (OGTT) according to Carpenter and Coustan modification of the National Diabetes Data. Data was compiled and statistically analysed.Results: In this study it was observed that 20 (women had raised GCT, 11 (5.3%) women developed GDM out of 206 women. All GDM patients have one or more risk factors. Age >25 years (63.6%) fetal loss (36.3%), BMI (33.3%) are common risk factors followed by family history of diabetes (27.3%).Conclusions: Family history of diabetes and past history of congenital anomalies are statistically significant in GDM group as compared to non GDM.
Diabetes is a major public health problem. 285 million persons worldwide have diabetes, of these 51 million are in India. Diabetic peripheral neuropathy is a major microvascular complication of diabetes. Conventional methods used for the diagnosis of diabetic peripheral neuropathy in clinical practice have limited effectiveness. Since peripheral sensory neuropathy is a pivotal element in the causal pathway to both foot ulceration and amputation, screening and early identification of neuropathy offer a crucial opportunity for the patient with diabetes to actively modulate the course of suboptimal glycaemic control to currently recommended targets, and to implement improved foot care before the onset of significant morbidity. This study was carried out to evaluate the usefulness of simple bed side screening modalities for peripheral neuropathy like vibration perception threshold measurement with biothesiometer, 10g semmes-weinstein monofilament, diabetic neuropathy examination and symptom scores and ankle reflex testing in patients with diabetes mellitus and to seek an optimal screening method in diabetic clinic.
Posterior reversible encephalopathy syndrome(PRES) is a proposed reversible cliniconeuroradiological entity characterized by headache, altered mental status, cortical blindness, seizures, focal neurological signs and a diagnostic magnetic resonance image showing multiple hyperintense signal in cortical and subcortical white matter. We report a case of 25 year female who presented 2 days postdelivery with posterior reversible encephalopathy syndrome. Early diagnosis with MRI showing bilateral parietal and occipital hyperintensities and treatment with manitol, antiepileptics and supportive measure, the syndrome was fully reversible. Clinicians as well as radiologists should be familiar with this clinically frightening, underdiagnosed condition to assure timely diagnosis and treatment to prevent persistent neurological deficits.
ABSTRACT:We are presenting a case which reveals unmasking of Brugada pattern with aluminum phosphide (celphos) ingestion that could most probably be due to hypomagnesaemia caused by the chemical, though its direct toxic effect on cardiac tissue cannot be ruled out. Earlier low levels of magnesium has been shown to precipitate arrhythmias in susceptible individuals and low magnesium levels have been recorded in survivors of sudden death with underlying Brugada syndrome, this is the first case in which celphos induced hypomagnesaemia has unmasked the Brugada pattern in ECG that can increase susceptibility to life threatening arrhythmias. This case opens scope for further research on role of magnesium in celphos poisoning. KEY WORDS: Brugada Pattern, celphos, hypomagesaemia, cardiac tissue, arrhythmias. A CASE REPORT:A 20 years old male presented in the emergency department one hour after ingestion of two tablets of Celphos. He vomited 5 times before admission and was brought in a state of shock and altered sensorium. He did not complain of chest pain, palpitation or breathlessness. His pulse was 145/min, irregularly irregular with pulse deficit of 15 and poor volume. Systolic blood pressure was 80 mmHg and respiratory rate was18/min. His systemic examination did not reveal any positive finding except drowsiness. His routine blood investigations were within normal limits except serum magnesium level of 1.0 mmol/lt and serum potassium of 2.2 mEq/lt. ECG showed typical (type-I phenotype) of Brugada Syndrome with atrial fibrillation (AF) with heart rate of ~145/min. (Fig-1). Gastric lavage was done and patient was given I/V fluids with ionotropic support, I/V magnesium & potassium supplements and hydrocortisone. Patient's condition stabilized with treatment and next day serum electrolytes normalized except serum magnesium which still measured 1.2 mmol/lt & ECG showed persistence of the same pattern. ECHO showed normal cardiac functions. On day 4, serum magnesium level was 2.0 mmol/lt and ECG showed type III Brugada pattern (decreased ST elevation) with regular heart rate of 107/min (Fig--2). ECGs of his mother and brother were normal, however, the provocative tests and genetic testing were declined. Patient had to be discharged on persistent requests.
BACKGROUND: Serum ferritin, which measures stored iron, is an inflammatory marker and a potential novel risk factor for CAD. Its role in coronary artery disease like acute myocardial infarction has generated considerable interest in recent times. There is a plethora of articles reporting the relationship between serum ferritin and acute myocardial infarction but with conflicting and contradictory results. AIMS AND OBJECTIVES: 1) To compare serum ferritin levels in cases of coronary artery disease with those of controls, in order to assess the relationship of serum ferritin with coronary artery disease. 2)
Background: Liver plays a central role in glucose homeostasis. Chronic liver disease is associated with an increased incidence of insulin resistance (IR) and Diabetes Mellitus. Diabetes that develops as a complication of cirrhosis of liver is known as 'Hepatogenous diabetes (HD)'. This study was conducted to study the prevalence of insulin resistance in liver cirrhosis. Methods: One Hundered (100) non-diabetic patients of liver cirrhosis considering the inclusion and exclusion criteria and visiting both indoor and outpatient department of medicine, SGRDIMSAR were included in the study. All cirrhotic patients irrespective of etiology were subjected to fasting plasma glucose level and fasting plasma insulin levels and insulin resistance was calculated by HOMA-IR method. Study was statistically analyzed. Results: 79 out of 100 patients were found to have insulin resistance and increase in prevalence with grades of child pugh score were noted. Conclusions: Keeping in view the results of the study, we conclude that FPG and HbA1c are not sufficient in detecting glucose metabolism disorders in cirrhosis. As insulin resistance can be used as an important prognostic marker in patients with cirrhosis of liver, serum insulin levels can be recommended as routine investigation in these patients. Diabetes mellitus increases the risk of HCC in cirrhosis patients. So, by early detection of diabetes mellitus by calculating insulin resistance with HOMA-IR method we can prevent progression of disease to development into HCC.
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