International Journal of Medical Research and Review

The Severity of diabetic retinopathy and its relationship with duration of diabetes and hypertension

Preethi K S — 2024-08-13

Objective: This study aims to evaluate the risk factors affecting diabetic retinopathy and its severity in type 2 diabetic patients about the duration of diabetes and hypertension.

Methods: A retrospective chart analysis was done of patient data collected from the patients visiting our tertiary institute (Karnataka Institute of Endocrinology and Research) from November 1st, 2022 to October 31st, 2023. In these diabetic patients, the prevalence of diabetic retinopathy and its severity concerning the duration of diabetes and hypertension was evaluated. Diabetic retinopathy and diabetic macular edema (DME) were classified based on the International Clinical Disease Severity Scale for Diabetic Retinopathy (DR).

Result: 5363 was the total number of diabetic patients included in this study. The prevalence of Diabetic retinopathy(DR) was 13.95% with diabetes for less than 5 years, 37% with diabetes for 5 to 10 years and 58.74% for more than 10 years. In diabetic patients with associated hypertension, the prevalence of diabetic retinopathy (DR) was 36 % as compared to 28.4% without associated hypertension. In multivariate analysis for factors associated with diabetic retinopathy, the odds ratio (OR) was 3.61% (95% CI, 3.08 – 4.23, P – Value < 0.001) in patients with diabetes between 5 – 10 years and in patients with diabetes above 10 years the odds ratio (OR) was 8.69 (95% CI, 7.36 – 10.26, P – Value < 0.001) as compared to patients with diabetes < 5 years. The odds ratio (OR) for developing DR was 1.19 (95% CI, 1.03 – 1.37, P – Value 0.015) in patients with diabetes and hypertension as compared to diabetic patients without hypertension.

Conclusion: The prevalence of diabetic retinopathy is higher in diabetic patients with longer duration of diabetes and diabetic patients with associated hypertension. It is important to evaluate all diabetic patients for diabetic retinopathy and maintain good glycemic and hypertensive control. Managing comorbidities along with diabetes reduces the prevalence and complications of diabetic retinopathy.

Influence of Family History on the Age of Onset and Complication Spectrum in patients with Type 2 Diabetes Mellitus

Vidhya Innanje — 2024-08-20

Background:

Type 2 Diabetes Mellitus (T2DM) is a prevalent chronic health condition globally, with its onset and complications significantly influenced by genetic and environmental factors. This study aimed to assess the influence of family history on the age of onset and complication spectrum among T2DM patients.

Methods: This descriptive cross-sectional study recruited 500 participants diagnosed with T2DM. Data were collected through structured interviews and clinical assessments, focusing on demographics, medical and family history, age of onset, and diabetes-related complications.

Chi-Square and logistic regression analyses were employed to examine the association between family history and diabetes complications, adjusting for confounders.

Results: Among the participants, 73.8% reported a positive family history. The mean age of onset for those with a family history was significantly lower (43.8 ± 9.86 years) compared to those without (48.24 ± 9.87 years; p < 0.001). Patients with higher HbA1c levels were younger, had an earlier onset of diabetes, and a higher prevalence of hypertension. The age of onset was earlier, if more family members had a history of diabetes. Complications were present in 80.8% of the cohort, with the most common being diabetic peripheral neuropathy (70.6%). Logistic regression analysis indicated that having siblings with diabetes was a significant predictor for general diabetic complications (OR=2.589, CI: 1.481 to 4.53, p<.001), diabetic retinopathy (OR=1.981, CI: 1.20 to 3.26, p=0.007), and diabetic peripheral neuropathy (DPN) (OR=1.709, CI: 1.042 to 2.8, p=0.034).

Conclusion: The study highlights the significant influence of family history on the age of onset and the spectrum of complications in T2DM. These findings suggest the necessity for comprehensive family history assessments in clinical settings to identify at-risk individuals for early intervention and personalized management strategies.

Prevalence of Anti Thyroid Peroxidase Antibody Positivity in Subclinical and Clinical Hypothyroidism subjects attending a tertiary centre in South India.

Anilkumar R — 2024-08-24

Objective:

To estimate the prevalence of anti-TPO antibodies in subjects with subclinical and clinical hypothyroidism in subjects attending a tertiary centre in South India.

Materials and Methods:

50 subjects with subclinical hypothyroidism and 120 subjects with clinical hypothyroidism attending the out-patient department of Karnataka Institute of Endocrinology and Research, Bangalore were included over a period of one year from June 2023 to June 2024. Measurements of weight, height, and waist circumference were obtained using standardized techniques. Fasting plasma glucose, post prandial plasma glucose, HBA1c, lipid profile, of these subjects were determined. TSH, FT4 and anti TPO antibodies were estimated by chemiluminescent immunoassay.

Results:

170 subjects with hypothyroidism were studied. Amongst these subjects, 50 had subclinical hypothyroidism and 120 had clinical hypothyroidism.

Out of 50 subjects with subclinical hypothyroidism, 64% were females. 70% of patients had BMI more than 25. Waist circumference was greater than 80 cms in 96% of patients. Family history of hypothyroidism was present in 16%. Anti TPO antibody was positive in 42% of the subjects. Total cholesterol, LDL and triglyceride levels were higher in anti TPO positive subjects.

Out of 120 subjects with clinical hypothyroidism, 76.7% were females. 74.9% of patients had BMI more than 25. Waist circumference was more than 80 cms in 92% of patients. Family history of hypothyroidism was present in 24.2% of the subjects. Anti TPO antibody was positive in 69.2% of the subjects. Total cholesterol, LDL and triglyceride levels were higher in anti TPO positive patients.

Conclusions:

Prevalence of anti TPO antibody was present in 42% of subclinical hypothyroidism patients. As anti TPO positive patients progress to clinical hypothyroidism at a higher rate than negative patients, estimation of anti TPO antibodies should be an integral part of investigation of subclinical hypothyroidism. Prevalence of anti TPO antibody was present in 69.2% of clinical hypothyroidism patients. Anti TPO antibody positivity indicates autoimmune etiology of hypothyroidism and helps in follow up management of hypothyroidism. Anti TPO antibody titres does not determine the severity of clinical hypothyroidism.

Differences Between Premenopausal And Postmenopausal Coronary Artery Disease (CAD) Risk Factors and Clinical Profile

Md Shahadat Hossain — 2024-08-24

Introduction: Coronary artery disease is the leading cause of mortality and morbidity of both men and women accounting for over one third of total deaths [1]. It has reached epidemic proportion among Indians. It accounts for 1 out of 3 women death regardless of the race or ethnicity [2]. In women, the annual mortality rate from CAD is high. Objective: To assess the differences between premenopausal and postmenopausal coronary artery disease (CAD) risk factors, clinical manifestation, clinical profile and angiographic characteristics. Methods: A prospective observation study was conducted at cardiology department, NICVD, Dhaka, Bangladesh from January to December 2019. Total 200 female CAD patients were drawn from the cardiology department. The subjects were enrolled in accordance with the criterion of diameter stenosis ≥50% in left mean and ≥70% in LAD, LCX and ECA in at least one invasive coronary angiogram. Patients with pulmonary embolism, aortic aneurysm, congenital heart disease, rheumatic heart disease, myocarditis, or cardiomyopathy were excluded. A total of 50 premenopausal cases and 150 postmenopausal cases were enrolled according to their status at the time of diagnosis. All patients underwent percutaneous coronary intervention and were given conventional drug therapy for coronary artery disease during follow-up. Results: Differences were compared between the 2 groups. Fewer premenopausal women suffered from hypertension (46% versus 82%, P< 0.001), type 2 diabetes (10% versus 36%, P = 0.001), and hyperlipidemia (4% versus 36%, P<0.001), but more had a positive family history of premature CAD (42% versus 26%, P = 0.03). Acute coronary syndrome (ACS) was more frequently seen in premenopausal women (80% versus 48%, P < 0.001), and their left anterior descending branch was the vessel most often involved (68%). The cumulative recurrence rate was 1.76 times higher in postmenopausal patients than premenopausal patients. Clinical diagnosis (HR = 2.54, 95%CI: 1.21-4.85, P = 0.02) and type 2 diabetes (HR = 4.10, 95%CI: 2.37-8.83, P = 0.004) were two factors that influenced recurrence in premenopausal subjects, while the clinical diagnosis (HR = 1.93, 95%CI: 1.59-3.46, P = 0.03) and Gensini score (HR =1.20, 95% CI: 1.11-1.45, P = 0.02) were influencing factors in the postmenopausal patients. Symptoms among younger women were atypical, but the onset of disease was faster and more urgent. Conclusion: Our study clarified the differences between postmenopausal and premenopausal women with respect to risk factors, clinical symptoms, cardiovascular features, and recurrence rate, and provided a reference for further study on the mechanism and prognosis in postmenopausal or premenopausal CAD patients.

A SUSPECTED CASE OF ACUTE APPENDICITIS REVELAED TO BE ISOLATED SUBMUCOSAL LIPOMATOSIS OF APPENDIX ON COMPUTED TOMOGRAPHY: A CASE REPORT

PINTU BISWAS — 2024-09-10

Symptomatic isolated submucosal intestinal lipomatosis is a rare entity [^1,2]. Also, few cases have been reported in literature. Here, we are presenting computed tomography findings of a rare case of isolated submucosal lipomatosis of appendix presumptively diagnosed as acute appendicitis in a 72-year-oldfemale. This case highlights the importance of considering isolated submucosal lipomatosis as a differential diagnosis in instances of suspected acute appendicitis, especially when clinical findings are inconclusive.