Background & objectives:Type 2 diabetes mellitus (T2DM) is considered to be a protective factor against development of osteoporosis. But oral hypoglycaemic agents (OHA) are likely to increase the risk of osteoporosis. This study was carried out to evaluate the effect of various OHA on bone mineral density (BMD) in patients with T2DM.Methods:Forty one patients (study group) with T2DM (mean age 51.9±5.5 yr; 31 females) receiving treatment with oral hypoglycaemic agents (OHA) [thiazolidinediones alone (n=14) or in combination with other OHA (n=27)] for a period of at least three consecutive years and 41 age- and gender-matched healthy controls (mean age 51.4±5.1 yr) were included in the study. A detailed clinical history was taken and all were subjected to physical examination and recording of anthropometric data. BMD was assessed for both patients and controls.Results:The mean body mass index (kg/m2) (26.5±4.90 vs 27.3 ±5.33) and median [inter-quartile range (IQR)] duration of menopause (yr) among women [6(2-12) vs 6(1-13)] were comparable between both groups. The bone mineral density (BMD; g/cm2) at the level of neck of femur (NOF) (0.761±0.112 vs 0.762±0.110), lumbar spine antero-posterior view (LSAP) (0.849±0.127 vs 0.854±0.135); median Z-score NOF {0.100[(-0.850)-(0.550)] vs -0.200[(-0.800)-(0.600)]}, LSAP {-1.200[(-1.700)-(-0.200)] vs -1.300 [(-1.85)-(-0.400)]} were also similar in study and control groups. Presence of normal BMD (9/41 vs 8/41), osteopenia (16/41 vs 18/41) and osteoporosis (16/41 vs 15/41) were comparable between the study and control groups. No significant difference was observed in the BMD, T-scores and Z-scores at NOF and LSAP among T2DM patients treated with thiazolidinediones; those treated with other OHA and controls.Interpretation & conclusions:The present findings show that the use of OHA for a period of three years or more does not significantly affect the BMD in patients with T2DM.
Background: The clinical association between rheumatoid arthritis (RA) and hypothyroidism is important as both these conditions are associated with metabolic syndrome (MetS) which in turn makes the patients more prone for cardiovascular disease. Material and methods: In this cross-sectional study, the prevalence of thyroid disorders and MetS were studied in 54 consecutive adult patients with RA (mean age 46.0±10.4 years; 48 females) and 54 age-and gender-matched healthy control subjects. Results: The prevalence of thyroid disorders was higher in patients with RA than in control subjects; however, this difference was not statistically significant [19/54 (35.2%) Vs 12/54 (22.2%); p=0.201]. Nine patients with RA already known to have hypothyroidism were receiving levothyroxine treatment. Among the remaining RA patients (n=45), a significantly higher prevalence of autoimmune thyroid disease (AITD) (10/45 Vs 4/54; 2 =4.437, p=0.045) and subclinical hypothyroidism with anti-thyroid peroxidase (anti-TPO) antibody positivity (4/45 Vs 0/54; 2 =5.002, p=0.040) were observed compared with healthy control subjects. The prevalence of MetS was higher in patients with RA than in control subjects; however, this difference was not statistically significant [31/54 (57.4%) Vs 25/54 (46.3%); p=0.336]. Conclusions: A significantly higher prevalence of AITD and subclinical hypothyroidism with anti-TPO antibody positivity in patients with RA suggests that these patients would benefit from screening for AITD. The coexistence of hypothyroidism and RA reiterates the need for monitoring and early identification of cardiovascular risk factors in patients with RA.
We present a patient of who ingested large dose of of atenolol and amlodipine and was treated successfully with continuous venovenous hemodiafiltration. Early recognition of indications for renal support and early initiation of the same is the key to successful management.
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