It has been suggested that diabetes mellitus is associated with an increased susceptibility to infections, the risk of using more aggressive therapeutic agents and increased mortality and morbidity; however, current evidence supporting these events in the field of pneumonia is scarce. Aim: The aim of the present study is to evaluate the clinical features and microbiological characteristics and outcome of bacterial pneumonia in patients with type-2 diabetes mellitus, and to compare them with non-diabetics. Materials and Methods: A prospective study conducted in Santhiram medical college and general hospital, Nandyal, which included 60 patients of pneumonia with diabetes and 60 patients of pneumonia in non-diabetics. The clinical and radiological characteristics, the spectrum of causative agents, microbiological data and the outcome of diabetic patients were analysed and compared with data obtained from nondiabetic patients. Results: Patients with diabetes were significantly associated with multilobar involvement (P = 0.039), prolonged duration of hospital stay (P = 0.018), more severe at presentation in form of increased PSI score (P = 0.038) and more ICU admissions. By contrast, there was no significant difference in age, sex, concomitant underlying illness, complications, mortality. In the sub group of patients with diabetes, mortality was associated with multilobar infiltrate, concomitant illness, high PSI score (P < 0.001) more complications (P < 0.001). Conclusions: In patients with pneumonia, diabetes is associated with poor prognosis, increased duration of hospital stay and poor outcome compared to non-diabetics. This study suggests that this outcome is more attributable to underlying circumstances of patients than to uncommon microbiological finding.
One-way Analysis of Variance was used to analyze the data on both whole blood glucose and plasma glucose values across the study duration. Variant means were separated using Duncans Multiple Range Test. Probability values equal or less than 0.05 (p ≤ 0.05) were considered significant. Independent sample t test was used to analyze the percentage change in blood glucose of diabetic and non-diabetic blood samples. Results were presented in tables and charts.
Figure 5 (A) Scatter graph plot of the bilateral Schirmer tear production of all adult donors versus age showing a general decline in tear production (left and right trend lines) with donor age. (B) Scatter graph plot with trend line (linear regression) of tear volume (mm) per Schirmer test strip versus GGT activity per Schirmer test strip for non-diabetic and diabetic tear donors. (C) Distribution of GGT (red) on DAPI-stained (blue nuclei) human conjunctival epithelial cells (×400). (D) GGT reaction substrate (yellow color) was concentrated on the Schirmer’s test strip in the conjunctival contact area (bracket) and decreased toward the tear meniscus (arrow).
Background: The aim of this study was to determine as well as to compare the salivary glucose levels in the diabetic and non-diabetic population and correlate the values with their fasting blood glucose and HbA1c (glycated Haemoglobin) levels. Many researchers have proposed the possibility of using salivary glucose estimation for screening and monitoring of effect in general population and in resource poor settings. But studies on this subject in Indian population are limited.
NonDiabetic with Generalized Chronic Periodontitis) and Group III (Generalized Aggressive periodontitis) subjects , the amount of local factors was less and periodontal destruction was more in Group I and Group III subjects as compared to Groups II. The mean plaque score for Group I was 2.273 ± 0.1533 and for Group III 1.353 ± 0.155 which was significantly less in Group I and in Group III than Group II which was 2.800 ± 0.218. This finding in our study was in agreement with studies done by Listgarten et al 42 who reported a significantly less plaque plaque score in diabetics and also with Van Dyke et al, Offenbacher et al 64 who reported a significantly less plaque score in GAgP subjects. The mean periodontal index score 6.126 ± 0.162 was significantly more in Group III than Group I which was 4.166 ± 0.134 and Group II which was 3.813 ± 0.130. This finding in our study was in agreement with Heikki Repo et al 27 ; Van Dyke et al; Offenbacher et al 64 who showed that mean periodontal index score was more in GAgP patient. Our findings were compatible with the expected clinical findings of patients with aggressive periodontitis.
Hair dyes, especially that containing p-phenylene diamine are toxic when consumed, administered or topically applied. p-phenylene diamine exerts oxidative stress as the chemical can penetrate the scalp and skin. This study aimed at investigating the oxidative stress and other biochemical alterations induced by the topical application of p-phenylene diamine in diabetic hair dye users when compared to non-diabetic controls. Alterations in the levels of enzymic and non- enzymic antioxidants, glucose, cholesterol and renal parameters were studied. A statistically (p<0.05) significant increase in the levels of all these parameters was found in the test subjects when compared to control. Lipid peroxidation was also increased (p<0.01) in the diabetic hair dye users. Zymogram analysis indicated increased activity of superoxide dismutase in the hair dye users when compared to non-user controls.
Pharmacological agents recommended as initial therapy for diabetic patients include diuretics, β-blockers, angiotensin converting enzyme (ACE) inhibitors, calcium channel block- ers, and angiotensin II blocker receptors (ARBs) (Guidelines Subcommittee 1999; Chobanian et al 2003). The choice of antihypertensive drug regimen in diabetic subjects is important for several reasons: they are susceptible to suffer metabolic decompensation, and the diabetic state may alter the pharmacokinetics of several cardiovascular drugs (Preston et al 2001). In this way, captopril was found superior to a diuretic/β-blocker antihypertensive treat- ment in diabetic patients, especially in those with metabolic decompensation (Niskanen et al 2001). Consequently, dosage requirements established for non-diabetic patients, when applied to the patient with diabetes, may potentially result in either therapeutic failure or undesirable adverse effects. Some epidemiological and clinical studies suggested a causal link between the use of thiazide diuretics and the subsequent development of type 2 diabetes (Bengtsson et al 1984; Padwal and Laupacis 2004), and β-blockers are not speciﬁcally indicated in diabetic patients (Scheen 2004). ACE inhibitors (Trost and Weidman 1987; Pollare et al 1989; Berne et al 1991; Oksa et al 1994; Padwal and Laupacis 2004; Scheen 2004) and calcium channel antago- nists (Trost and Weidmann 1987; Padwal and Laupacis 2004; Scheen 2004) have little or no signiﬁcant effects on plasma glucose and insulin levels in patients with and without diabetes.
Knowledge of Diabetes Mellitus Among Diabetic and Non Diabetic Patients in Klinik Kesihatan Seremban ORIGINAL ARTICLE Knowledge of Diabetes Mellitus Among Diabetic and Non Diabetic Patients in Klinik[.]
istance in these infants. This cross sectional study was conducted on 60 terms appropriate of gestational age (AGA) neonates (30 Infants of diabetic mothers and 30 infants of nondiabetic mothers) delivered in Obstetrics and Gynecology Departments, at El Menofiya University Hospital Elkom Teaching Hospital, from September 2014 to Marsh 2015. This study revealed that serum Insulin, Leptin & Insulin resistance were higher in average birth weight IDM compared with ≤ 0.001). Infants with bad maternal diabetic control showed higher serum Insulin and Leptin levels than infants with fair maternal diabetic control. Thus interventions during pregnancy, aimed at a close monitoring of maternal blood glucose concentrations, are likely to have an impact not only on maternal and neonatal health, but also on the epidemic of T2DM and childhood obesity. Breast feeding and postnatal follow up of IDM of diabetic mothers from these complications. We appropriate for gestational age (AGA) infants of diabetic mothers had higher cord
Abstract Background and objectives: Hypoglycemia in the body is controlled by counter regulatory hormones. Serum cortisol is one among them not subjected to extensive study, in Type 2 diabetes mellitus cases. Cortisol responses among non diabetics and type 1 diabetics have been studied to a certain extent. The primary objective of our study was to identify the serum cortisol levels in hypoglycemic patients with or without type 2 diabetes and to find out the correlation between the mean cortisol responses in the two groups. Methodology: A total population of 51 symptomatic hypoglycemic patients meeting Whipple’s criteria were studied in the ER of a medical college hospital at Kochi. Forty patients were diabetic and 11 nondiabetic. Previous history, present illness, comorbidities, medical history and reasons for hypoglycemia were considered. Laboratory investigations on RFT, 7 AM serum cortisol and RBS were made and the results analysed applying standard statistical methods and SPSS II software. Results and discussion: Male female ratio in the diabetic and nondiabetic groups was 3:1 and 10:1 respectively. Hypoglycemia was more among males, especially in the diabetic group due to decreased food intake(49%) or concurrent illness(51%), the mean age being 65.7 years in these cases. Hypoglycemia was more frequent in those on sulfonylurea (61.9%), and in habitual insulin users (42.5%). In nondiabetic patients, hypoglycemia was caused by renal failure(27.27%), insulinoma(27.27%) or sepsis(18.18%). The mean serum cortisol among the diabetic group was subnormal(17.47), and in the nondiabetic group it was 28.56. Age, sex, serum creatinine, GCS, period of stay and condition at discharge showed no correlation with serum cortisol levels. RBS, period of stay and condition at discharge showed no correlation with diabetic status. Conclusion: Diabetic patients with acute symptomatic hypoglycemia demonstrated a subnormal serum cortisol response as compared to nondiabetic hypoglycemic patients.
Study included 150 patients, half were diabetic while rest half were nondiabetic. Amongst diabet- ics42.7% (32) had GDM, 44% (33) had type-2 diabetes while 13.3% (10) had type-1 DM. Age in diabetics ranged from 17 to 45 yrs with a mean of 30.44 yrs. Non-diabetics age ranged from 17 to 41yrs with a mean of 27.19 yrs. Minimum weight was 53 kg while the maximum was 120 kg with the mean of 82.41kg in diabetics. Mean weight in nondiabetic group was 71.01kg. Glycated hemoglobin (HbA1c)in diabetic patients ranged from 5.1% to 10.7% with an average of 6.93%. About 28% patients in diabetic group had proteinuria ranging from 1+ to 3 + while it was 1.3% in non diabetics. Thirty (40%) patients amongst diabetics were also hypertensive while only 25.3% (19) amongst non-diabetics had hypertension. Caesarean section was performed in 62.6% of patients with diabetes while it was almost half in non diabetics (30.6%).
I hereby solemnly declare that the study “SERUM PHOSPHATE AS A MARKER OF CAROTID INTIMAL MEDIAL THICKNESS IN NON-DIABETIC CHRONIC KIDNEY DISEASE PATIENTS ” is done by me at Institute of Internal Medicine, Madras Medical College & Rajiv Gandhi Government General Hospital, Chennai during 2018 under the guidance and supervision of Prof.P.VASANTHI M.D., This dissertation is submitted to The Tamilnadu Dr. M.G.R Medical University, Chennai towards the partial fulfilment of requirement for the award of M.D. Degree in General Medicine (Branch I).
I herebydeclare that the dissertation entitled“EVALUATION OF CENTRAL CORNEAL THICKNESS AND ENDOTHELIAL CELL DENSITY IN VARIOUS STAGES OF DIABETIC RETINOPATHY AND COMPARING WITH NON-DIABETIC INDIVIDUALS USING SPECULAR MICROSCOPY " is a bonafide and genuine research work carried out by me under the guidance of Dr. Jeevamala Mercy Janaki, D.O, D.N.B, professor department of ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore in partial for the award of M.S. Degree in ophthalmology to be held inMay2018.This dissertation has not been submitted in part or fullto any other university or towards any other degree before this mentioned date.
The impact of acute hyperglycemia on clinical out- comes of diabetic and non-diabetic patients admitted with ST-elevation myocardial infarction (STEMI) has been extensively studied. High admission blood glucose among STEMI patients is associated with higher short- term incidences of failed reperfusion, acute kidney injury, stent thrombosis, myocardial damage and death among [1–12]. In addition, hyperglycemia during STEMI hospi- talizations in diabetics predicted left ventricular remod- eling and survival during long-term follow-up [13–18]. However, large-scale outcomes data of STEMI patients with acutely decompensated diabetes manifesting as dia- betic ketoacidosis (DKA) or hyperglycemic hyperosmo- lar state (HHS) are scarce . We utilized a nationwide representative sample to assess the contemporary trends in the incidence and in-hospital morbidity and mortality and cost of decompensated diabetes (defined as DKA or HSS) among diabetic patients admitted with STEMI.
DM is a risk factor for pneumonia because these patients have an increased risk of aspiration, hyperglycemia, impaired immunity, decreased lung function, pulmonary microangiopathy and coexisting illnesses such as renal failure and heart disease . Patients also have an increased risk of death from influenza and complicating pneumonia . In our study, influenza vaccination rate of 38.14% in diabetic patients, 31.8% in non-diabetic patients were determined. The pneumococcal vaccine rate was 13.4% in diabetic patients, 7.39% in non-diabetic patients. Although no statistically significant difference was determined between diabetic and non-diabetic groups in our study, a higher influenza and pneumococcal vaccination rate was found in the diabetic group.
In diabetic rats, significant loss in body weight had occurred at the end of six weeks of chronic hyperglycemia (Fig. 1). Weight loss is also a feature of diabetes mellitus in man, and it is owing to depletion of body adiposity as a result of marked reduction in plasma levels of insulin (28). In contrast, weight loss was not as marked in V. amygdalina-treated rats as it was in untreated diabetic animals. In V. amygdalina-treated rats, up to 27% increase in body weight was recorded, as opposed to 4% loss in weight obtained in untreated diabetic rats (Fig. 1). This relatively higher weight gain in V. amygdalina-treated rats (compared to untreated diabetic rats) may be due to increased levels of plasma insulin. Insulin, produced by islets of Langerhans, has a well established role in the regulation of energy metabolism in insulin- sensitive tissues such as skeletal muscle and fat. In the presence of insulin, substrates derived from ingestion of food metabolized by the body cells, and excess caloric intake is stored as increased adipose tissue, thereby leading to increased adiposity and body weight gain (28). However, although increases in body weight in V. Amygdalina-treated diabetic and non- diabetic rats were higher than what obtained in untreated diabetic animals, it was less than body weight gain in the control (Fig. 1). This may be due partly to reduction in feed intake in V. Amygdalina-treated animals, starting from the end of the first week of treatment (Fig. 2). Such potential anorexic effect of V. amygdalina may be due to increased production of leptin by adipocytes. This observation suggests that chronic administration of V. amygdalina may result in upregulation of leptin. Such mechanism had been reported for Exendin-4, a hypoglycemic agent from the saliva of the Gila monster lizard (29). The report of Bjorbaek et al, 1998 showed that intravenous administration of leptin to normal fasted rats inhibited food intake, while impaired leptin signaling and/or production results in hyperphagia and obesity (30).
Newer studies are in favour of lens implantation in diabetic eyes, as correction of aphakia with spectacle causes further image distortion and constriction of peripheral visual fields . The need for this study is to establish the influence of glycaemic control on visual control to better advice patients before surgery. The aim of this study was evaluation and comparison of visual outcomes after cataract surgery in diabetic and non-diabetic patients: patients with and without diabetic retinopathy; assessment of post-operative complications after cataract surgery in diabetics compared to non- diabetics; and analysis of increment in central foveal thickness using optical coherence tomography, after cataract surgery. Also, through this study, we wanted to determine whether uneventful SICS/phacoemulsification cataract surgery led to adverse visual outcomes in diabetics.
In terms of sleep quality, analysis of data on the quality of sleep in diabetic patients showed that the majority of them are at a low level. In a study by Hemmati et al. to assess the quality of sleep in diabetic and non-diabetic patients, the results represented an increase in sleep problems in diabetic patients (22).The results of a review study also revealed that the prevalence of sleep disorders increases with the onset of diabetes and poor blood glucose control (self-care) (14).According to the results of Tsai's research, in which the relationship between sleep quality and blood sugar levels was examined, a significant difference was shown between glucose levels and low sleep quality as well as inadequate sleep in patients and this is consistent with the outcomes of this study (23) as one of the self-care goals for diabetics is maintaining blood glucose at the normal level and subsequently
with increasing education. 16 This study revealed that mothers of higher socio-economic group had higher occurrence of macrosomic babies than lower socio- economic group. The study observed that prevalence of macrosomia was around seven times more common in mothers who belonged to higher socio-economic status as compared to mothers of lower socio-economic status (aOR: 6.86; CI: 1.18-39.88 p=0.032). A study conducted by Webb R also reported similar findings. 16 In addition to foetal over-nutrition as an explanation, it is also possible that there is a genetic or lifestyle pre-disposition to greater BMI, greater weight at birth and obesity throughout life in babies of mothers of higher socio- economic group. The present study reported that diabetic mothers had significantly higher incidence of macrosomia (10.3%) as compared to non-diabetic mothers (0.7%). The prevalence of overweight birth was shown to be about seventeen times more common in diabetic mothers (aOR: 17.46; CI: 5.23-32.27, p=0.000) than non-diabetic mothers. Xiong et al revealed that infants born to mothers with GDM had 1.12 higher odds [aOR: 1.12 (1.07–1.17)] of delivering a macrosomic baby. 17 A study conducted by Lawlor et al revealed an adjusted odds ratio for macrosomia of 5.50 (95% CI, 1.18-10.30) in mothers with GDM. 18 A prospective study conducted by Wahi et al revealed that the prevalence of macrosomia was significantly higher in mothers with GDM (16.2%) as compared to controls (5.7%) (p=0.03). 8 ACKNOWLEDGEMENTS
smooth muscle cell dysfunction, inflammation and hypercoagubility. 51 Tibial arterie’s occlussion susceptibly seen in diabetic patients along with development of impaired wound healing and microangiopathy. Diabetes is a stronger risk factor for PAD in women than in men. 52,53 Diabetes is a quantitative risk factor as each 1% increase in glycosylated hemoglobin is associated with a 25% increase in the risk for peripheral artery disease (PAD). The involvement of distal vessels in the extremities is typical and, together with microangiopathy and neuropathy, which imply a poor response to infection and a specific healing disorder, diabetes is associated with a risk of amputation 10 fold that of non-diabetic patients. Of importance is the fact that diabetic patients may have abnormally high pressure values in the ankle.  Being a key factor in the pathogenesis of diabetes, insulin resistance and its attendant metabolic abnormalities causes cardiovascular risk of diabetes. Diabetic patients with PAD are at higher risk of lower extremity amputation than those without diabetes due to critical limb ulceration of the foot. 55-58