Ba Shastry

Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: A single blind, parallel group randomized controlled trial

OBJECTIVE To evaluate the effect of moderate intensity aerobic exercise (40%-60% of Heart Rate Reserve (HRR)) on diabetic peripheral neuropathy. METHODS A parallel-group, randomized controlled trial was carried out in a tertiary health care setting, India. The study comprised of experimental (moderate intensity aerobic exercise and standard care) and control groups (standard care). Population with type 2 diabetes with clinical neuropathy, defined as a minimum score of seven on the Michigan Diabetic Neuropathy Score (MDNS), was randomly assigned to experimental and control groups by computer generated random number tables. RANOVA was used for data analysis (p<0.05 was significant). RESULTS A total of 87 patients with DPN were evaluated in the study. After randomization there were 47 patients in the control group and 40 patients in the experimental group. A comparison of two groups using RANOVA for anthropometric measures showed an insignificant change at eight weeks. For distal peroneal nerves conduction velocity there was a significant difference in two groups at eight weeks (p<0.05), Degrees of freedom (Df)=1, 62, F=5.14, and p=0.03. Sural sensory nerve at eight weeks showed a significant difference in two groups for conduction velocity, Df =1, 60, F=10.16, and p=0.00. Significant differences in mean scores of MDNS were also observed in the two groups at eight weeks (p value significant<0.05). CONCLUSION Moderate intensity aerobic exercises can play a valuable role to disrupt the normal progression of DPN in type 2 diabetes.

Thrombocytopenia in vivax and falciparum malaria: an observational study of 131 patients in Karnataka, India

Abstract Background: Thrombocytopenia has been reported in the majority of malaria studies. Some but not all studies suggest the possible role of platelets in the pathology of severe malaria. We assess the association of admission platelet count with malaria complications and mortality in vivax and falciparum malaria. Methods: This is a prospective, observational study of patients aged 18 years and above admitted in a tertiary care teaching hospital from August 2004 to July 2006 in Manipal, India. Malaria was diagnosed based on clinical features along with positive Quantitative Buffy Coat method (QBC MP) or thin blood smear examination (Giemsa stain). Platelet counts were measured using Coulter LH 756 Analyser. Thrombocytopenia was defined as a platelet count <150×109/l. Results: A total of 131 consecutive patients were included. Sixty patients (46%) were infected with Plasmodium vivax and the rest with Plasmodium falciparum. Forty-six (35%) patients had non-severe and 24 (18%) had severe falciparum infection. The prevalence of thrombocytopenia was similar in vivax and falciparum malaria. Patients with severe falciparum malaria had a statistically significant lower platelet count (P = 0·01) compared to non-severe falciparum malaria. Severe malaria patients with renal failure (P = 0·02) or hyperparasitaemia (P = 0·03) had a statistically significant lower mean platelet count compared to non-severe falciparum malaria. Patients with involvement of more than one organ system had a lower mean platelet count compared to those with single organ involvement. Conclusions: The incidence of thrombocytopenia was similar in vivax and falciparum malaria. The admission platelet count is significantly lower in patients who have hyperparasitaemia and acute renal failure compared to patients without complications.

Amlodipine poisoning revisited: Acidosis, acute kidney injury and acute respiratory distress syndrome

We report the case of an 18-year-old girl presenting with shock following ingestion of 85 mg of amlodipine and 850 mg of atenolol with suicidal intent. Subsequently, the patient developed severe metabolic acidosis, acute kidney injury, and acute respiratory distress syndrome, which were managed conservatively. The patient ultimately made a full recovery. Given the popularity of amlodipine and atenolol as antihypertensive drugs in this part of the world, it is likely that more such cases will be encountered in the future. Physicians should be aware of the severe complications that can develop with amlodipine overdose.

Colonization or spontaneous resolution: Expanding the role for Burkholderia pseudomallei

A 19-year-old Asian Indian female presented with productive cough since the past one month and low grade fever since the past two weeks. She was diagnosed with pulmonary tuberculosis and treated with antitubercular drugs. Subsequently, delayed cultures of bronchoalveolar lavage fluid grew Burkholderia pseudomallei (B. pseudomallei). On follow up the patient reported significant subjective improvement and ESR progressively returned to normal. In summary, this case report raises two distinct and equally intriguing roles for B. pseudomallei, i.e. respiratory colonization and spontaneously resolving pulmonary infection. The pathogenic potential of B. pseudomallei, the etiologic agent of melioidosis, is well known. Confirmation of either colonization or spontaneous resolution, would potentially spare many patients unnecessary and expensive therapy with broad-spectrum antibiotics, and contribute to more rational usage of antibiotics, especially in co-infection with Mycobacterium tuberculosis and B. pseudomallei-two bacterial diseases with closely similar clinical, radiologic and histopathologic features.

Distal sensory polyneuropathy in human immunodeficiency virus patients and nucleoside analogue antiretroviral agents

Distal sensory polyneuropathy, which occur commonly in human immunodeficiency virus (HIV) patients can occur as a consequence of the disease itself or the antiretroviral treatment the patient is receiving. Among the antiretroviral agents, nucleoside analogues are commonly associated with neuropathy and the main underlying mechanism is thought to be the mitochondrial toxicity exhibited by these agents. Clinical presentation of antiretroviral induced neuropathy is similar to that associated with the HIV infection and in many patients they may overlap. Treatment is primarily symptomatic and certain pathogenesis-based approaches have shown promising results.

Effect of moderate-intensity aerobic exercise on glycosylated haemoglobin among elderly patients with type 2 diabetes & peripheral neuropathy

Aerobic exercise has been known to improve glycosylated haemoglobin (HbA1c) levels and insulin sensitivity in patients with type 2 diabetes mellitus (T2DM). The present study was undertaken to evaluate the effect of eight week moderate-intensity aerobic (heart rate reserve 40-60%) exercise on glycaemic control in elderly patients with T2DM and diabetic peripheral neuropathy (DPN). The participants (n=87) were randomly assigned to an eight-week programme by a computer-generated random number table to the study or control group, respectively. There were 47 participants in the control group and 40 participants in the study group after randomization. There was a significant difference in the mean values of glycated haemoglobin (HbA1c) at baseline and 8th week between the two groups. Moderate-intensity aerobic exercise of eight weeks duration helped in achieving enhanced glycaemic control in the T2DM patients with DPN.