Insulin resistance, diabetes mellitus, and metabolic syndrome in patients with human immunodeficiency virus (HIV) infection are increasingly being reported in the global medical literature. This ...cross-sectional study was done to describe the occurrence of metabolic syndrome, diabetes mellitus, and insulin resistance in HIV-positive patients in a tertiary referral center in South India. A total of 60 patients who had HIV infection for 12 months or more were enrolled in the study. Of these, 30 patients were antiretroviral therapy (ART)-naïve, and 30 were treated with ART. Biochemical estimations (fasting blood glucose, 75 g oral glucose tolerance test, lipid profile, and fasting insulin) and anthropometric measurements (height, weight, and waist circumference) were performed for each patient. Metabolic syndrome was diagnosed using National Cholesterol Education Program-Adult Treatment Plan III criteria, and insulin resistance was calculated applying the homeostasis model assessment method. Diabetes mellitus, impaired fasting glycemia, and impaired glucose tolerance were diagnosed based on American Diabetes Association criteria. A high prevalence of metabolic syndrome was observed in patients with HIV (16/60), and was more prevalent in the ART-treated group (13/30; P = 0.028). Similarly, insulin resistance was also noted to be high (24/60), and of these patients, 15 were on ART. Seventy-five percent of patients with metabolic syndrome had insulin resistance. Diabetes was diagnosed in one patient who was ART-naïve and in six patients who were on ART. Our observations suggest an increased prevalence of metabolic syndrome, insulin resistance, and diabetes mellitus in ART-treated patients. These warrant attention and substantiation with larger studies. While ART improves survival, it may lead on to cardiovascular morbidity and mortality, especially in the Indian subcontinent where there is a genetic predisposition to cardiovascular risk.
Thyroid dysfunction has been reported following COVID-19 infection in the recent past. A 50 year old hypertensive female with no previous thyroid illness, developed features of thyrotoxicosis two ...weeks after a COVID-19 infection. There was no thyromegaly, neck pain or fever and her ESR was 15 mm/hour. She was initiated on propranolol and methimazole in an outside hospital. Ten days later, she presented to our hospital with fever, sore throat, cough and breathing difficulty. On evaluation she was found to be in neutropenic sepsis (WBC -820 cells/mm3, ANC-6 cells/mm3). Evaluation of thyroid functions showed: TSH- <0.00025 IU/ml, free T3 - 4.17 pg/ml, free T4- 3.59 ng/ml and Thyroid Receptor Antibody Levels (TRAb)- 2.53 IU/L. Following treatment with colony stimulating factors and antibiotics she recovered. The patient was commenced on lithium bicarbonate and cholestyramine, along with propranolol. On follow up in the OPD she is euthyroid with free T4 1.43 ng/ml (normal) levels. Post COVID-19 thyrotoxicosis in this case is likely due to Graves’ disease. Thyrotoxicosis following COVID-19 is now being recognised and is possibly due to infection induced molecular mimicry with activation of immune pathways causing autoimmune disorders.
Background: Anemia is increasingly recognized as a risk factor for DR. Nutritional anemia is a major cause of anemia in India. This study was undertaken to explore anemia as a risk factor for DR. ...Methodology: Patients with type 2 diabetes admitted to the medical wards of a tertiary care hospital were enrolled into the study, in the absence of renal failure, pregnancy and ocular disorders unrelated to diabetes. Retinopathy was classified as per ETDRS classification. Anemia was defined and graded based on WHO guidelines. In patients with anemia, serum B12, serum iron, total iron binding capacity (TIBC) and percent saturation were assayed. Results: A total of 170 patients were enrolled into the study (males 93, females 77). The mean age of the study group was 59 ± 12.30 (SD) years. Patients with DR (n=85) were classified as Group 1 and those without DR (n=85) as Group 2. The mean age of patients in Group 1 was 60.74 ± 13.00 (SD) years and that in Group 2 was 57.26 ± 11.39 (SD) years. The mean duration of diabetes was 12.40 ± 7.60 (SD) years for Group 1 and 6.64 ± 4.48 (SD) years for Group 2. The mean Hb of patients in Group 1 was 10.40 ± 0.25 (SD) gm% and in Group 2 was 12.70 ± 0.18 (SD) gm% (p=0.001). Within these groupings, 67 patients had anemia (56 in Group 1, 11 in Group 2). There was a significant association between anemia and DR (p=0.001) and a trend towards association between increasing grades of anemia and severity of DR (p=0.06). In Group 1, among patients with anemia, 28 (50%) patients had nutritional anemia (iron: 24, B12: 3 and dual: 1). On logistic regression analysis, anemia and duration of diabetes emerged as predictors of DR. Discussion: Anemia in patients with diabetes may be multifactorial in etiology. While metformin therapy, albuminuria and reduced renal function are implicated, vegetarian diet is a major contributor for nutritional anemia. Regular monitoring of Hb and treatment with supplements or dietary modifications may reduce occurrence and arrest progression of DR.
Objectives: The objective of this study was to estimate the occurrence of Vitamin B12 deficiency in patients with type 2 diabetes mellitus treated with metformin, and the clinical and biochemical ...profile of vitamin B12 deficiency in them. Materials and Methods: This was a cross sectional study. Type 2 Diabetics over the age of 18 years were recruited for the study. Patients were divided into two groups - one groupof 62 patients who were on metformin for more than 6 months and the other group of 62 patients who were on other oral hypoglycemic agents or insulin. Patients were interviewed using a questionnaire. Relevant blood investigations were done. Results: The mean (+SD) age of study population was 57 (±9.8) years with an age range of 35 to 79 years. There was high prevalence of vitamin B12 deficiency in patients with type 2 diabetic mellitus treated with metformin (22.6%)(p-value<0.001). This study showed a statistically significant inverse relationship between duration of metformin use and vitamin B12 levels (p-value 0.01). There was a statistically significant correlation between the dose of metformin and vitamin B12 deficiency – the higher the dose, the lower the average vitamin B12 level (p-value 0.02). The study revealed significantly increased neuropathic symptoms in Type 2 Diabetic patients on metformin with B12 deficiency than with normal B12 levels (p-value<0.001). Conclusions: This study demonstrated a high prevalence of vitamin B12 deficiency in patients with type 2 diabetic patients treated with metformin (22.6%). Hencethe measurement of vitamin B12 should become an essential part of the annual review in all patients with type 2 diabetic patients on metformin therapy. The study revealed significantly increased neuropathic symptoms in Type 2 Diabetic patients on metformin with B12 deficiency than with normal B12 levels.
Actinomycosis is a chronic inflammatory condition caused by Actinomyces israeli, a gram positive anaerobic bacterium. It can have a variety of clinical manifestations and can mimic a malignancy. We ...present one such case of urachal actinomycosis that mimicked a tumor. A 28-year-old man presented with abdominal pain of 20 days duration. Per abdominal palpation revealed a firm mass with ill-defined borders in the suprapubic region. Computed tomography and magnetic resonance imaging scans of the pelvis showed an irregular lesion in the urinary bladder extending to the umbilicus, giving the impression of urachal remnants with inflammation. Peroperatively, an irregular, hard mass measuring 6 × 5 cm, involving the anterior and posterior bladder walls, the appendix, the terminal ileum and sigmoid colon, was seen, which was suspicious for a malignancy. Frozen sections from the mass showed extensive inflammation and a florid fibroblastic proliferation, giving the impression of an inflammatory pseudotumor. The tissue was extensively sampled for paraffin sections and only one of them revealed a colony of Gram, PAS and GMS- positive organisms, conclusive for Actinomycosis. It is important to be aware of this uncommon, yet significant, presentation of a common infectious disease in order to avoid misdiagnosis and over-treatment as a malignancy.
There are currently approximately 40.9 million patients with diabetes mellitus in India and this number is expected to rise to about 69.9 million by the year 2025. This high burden of diabetes is ...likely to be associated with an increase in associated complications.
A total of 23 (15 male and 8 female) patients with type 2 diabetes of 10-15 years duration and their age and gender matched controls (n=23) were recruited. All subjects underwent detailed clinical proforma, questionnaire related to autonomic symptoms, anthropometry, peripheral neural examination and tests of autonomic nervous system including both conventional and newer methods (heart rate and blood pressure variability).
Conventional tests of cardiac parasympathetic and sympathetic activity were significantly lower in patients with diabetes compared to the controls (P<0.05). The diabetic patients group had significantly lower high frequency and low-frequency HRV when expressed in absolute units (P<0.05) and total power (P<0.01) compared to the controls.
Data from the current study demonstrated that diabetics had both cardiac sympathetic and cardiac parasympathetic nervous system involvement. The presence of symptoms and involvement of both components of the autonomic nervous system suggest that dysfunction has been present for a while in these diabetics. There is a strong need for earlier and regular evaluation of autonomic nervous system in type 2 diabetics to prevent further complications.
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