Daliparthy D. Pratyush

Prevalence and severity of vitamin D deficiency in patients with diabetic foot infection

The aim of the present research was to study the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection. Patients were enrolled in two groups: diabetic patients with foot infection (n 125) as cases and diabetic patients without the infection as controls (n 164). Serum 25-hydroxyvitamin D (25(OH)D) was measured by RIA. Data were presented as means and standard deviations unless otherwise indicated and were analysed by SPSS. Results revealed that 25(OH)D (nmol/l) was significantly lower (40·25 (sd 38·35) v. 50·75 (sd 33·00); P < 0·001) in cases than in controls. Vitamin D inadequacy (25(OH)D < 75 nmol/l) was equally common in cases and controls (OR 1·45, 95 % CI 0·8, 3·0; P = 0·32), but cases had a greater risk of vitamin D deficiency (25(OH)D < 50 nmol/l) than controls (OR 1·8, 95 % CI 1·1, 3·0; P = 0·02). Risk of severe vitamin D deficiency (25(OH)D < 25 nmol/l) was significantly higher in cases than in controls (OR 4·0, 95 % CI 2·4, 6·9; P < 0·0001). Age, duration of diabetes and HbA1c were significantly higher in cases than in controls and therefore adjusted to nullify the effect of these variables, if any, on study outcome. The study concluded that vitamin D deficiency was more prevalent and severe in patients with diabetic foot infection. This study opens up the issue of recognising severe vitamin D deficiency (< 25 nmol/l) as a possible risk factor for diabetic foot infections and the need for vitamin D supplementation in such patients for a better clinical outcome. This could be substantiated by similar data from future studies.

Obesity augmented breast cancer risk: A potential risk factor for Indian women†

Obesity is caused by disturbances of energy balance, which is homeostasized by the physiological processes. The study aims to determine the possible impact of rising prevalence of obesity and its effect in the development of breast carcinoma (BC) in Indian population.

A new approach to touch down method using betaine as co-solvent for increased specificity and intensity of GC rich gene amplification.

Tissue specific genes that contain high GC segments are difficult to amplify by standard PCR. We report an improved method for successful amplification of gene segment that has >70% GC base pairs. This new method of touch down PCR differed by having an initial annealing temperature (Ta) 1.5°C below the primers melting temperature that descended 0.2°C per cycle for 20 cycles and continued thereafter at fixed Ta for next 15 cycles. Different co-solvents were tested with this method to improve the result and betaine proved better than the other co-solvents. This new method is economical, fast and specific in amplifying GC rich region of other genes also.

Waist circumference cutoff and its importance for diagnosis of metabolic syndrome in Asian Indians: A preliminary study

Background: There is inconsistency in accepting waist circumference (WC) as mandatory and also regarding its significance for diagnosis of metabolic syndrome (MetS) for different populations. Aim: To study the association of individual parameters of MetS with WC cutoffs suitable for South Asian Indians. Materials and Methods: From an ongoing hospital-based study on MetS as per the criteria of diagnosis of modified NCEP ATP III, 713 subjects having a minimum three of the four parameters, i.e., dyslipidemia [low high density lipoprotein (HDL), high triglycerides], dysglycemia and hypertension, without regard to cutoffs of WC, were included in the present study. Results: Receiver operator characteristic curve analysis of WC cut-off points for males was 90 cm with a sensitivity and specificity of 71% and 96%, respectively, and for females was 85 cm with a sensitivity and specificity of 86% and 93%, respectively, associated with the risk factors of MetS. Multiple logistic regression analysis for low density lipoprotein (LDL) cholesterol concentration of ≥3.38 mmol/l showed an odds ratio of 5.03 (95% CI = 1.29–19.5) in males and 3.17 (95% CI = 1.14–8.76) in females which was statistically significant (P < 0.02); in addition to higher WC, higher level of triglyceride (P ≤ 0.0001) and lower level of high density lipoprotein cholesterol (P ≤ 0.02) were observed. Conclusion: This study suggests that WC of 90 cm in males and 85 cm in females should be a mandatory criterion of MetS in our subset of population. LDL may be considered one of the components of MetS along with the currently defined WC cutoffs.

Risk factors of diabetes in North Indians with metabolic syndrome

AIM Metabolic syndrome progresses to diabetes and determinants of this progression like hyperinsulinemia, hypertriglyceridemia and genetic factors have been speculative. The present study was aimed at quantifying the insulin resistance and influence of family history of diabetes in subjects with metabolic syndrome developing prediabetes and diabetes. METHODS Consecutive subjects attending the endocrine clinic were evaluated for metabolic syndrome as per definition of International Diabetes Federation, 2005. The family history of diabetes in their first degree relatives was ascertained and Homeostasis model assessment of Insulin resistance (HOMA-IR), Homeostasis model assessment for beta cell function (HOMA-B) and Quantitative insulin sensitivity check index (QUICKI) were calculated in 163 subjects enrolled. RESULTS HOMA-IR was higher (p<0.05) but HOMA-B and QUICKI were lower (p<0.0001) in subjects with metabolic syndrome+prediabetes or diabetes compared to metabolic syndrome with normal glucose tolerance. HOMA-B was lower and prevalence of prediabetes and diabetes was higher in metabolic syndrome subjects with family history of diabetes than in those without such family history (p<0.05). CONCLUSIONS subjects with metabolic syndrome having prediabetes and diabetes had more severe insulin resistance than those with metabolic syndrome only. Beta cell dysfunction was remarkable and prevalence of prediabetes was high in metabolic syndrome subjects with family history of diabetes. Both the severity of the insulin resistance and family history of diabetes are therefore proposed to be determinants of diminished Beta cell function leading to diabetes in metabolic syndrome.

Vitamin D status of patients with type 2 diabetes and sputum positive pulmonary tuberculosis

Introduction: Vitamin D deficiency is expected to be higher in patients with diabetes and pulmonary tuberculosis (TB). Studies estimating prevalence in the subset of patients with both diabetes and pulmonary TB are scarce. Materials and Methods: A total of 155 subjects were recruited; 46 patients with type 2 diabetes, 39 non-diabetic healthy controls, 30 patients of pulmonary TB and 40 patients with both pulmonary TB and type 2 diabetes. Vitamin D level (25 OH vitamin D) levels were done for all the 4 groups. Results: Mean vitamin D levels were not different between groups with TB, diabetes mellitus or combination of both, but the prevalence of severe vitamin D deficiency was higher in the group with both diabetes and TB (45%) as compared with the group with only TB (26.66%) and diabetes (17.39%) and healthy controls (7.69%). Conclusion: The prevalence of patients with severe vitamin D deficiency is higher in patients with dual affection of TB and diabetes mellitus as compared with either disorder alone implying that patients with type 2 diabetes with the most severe vitamin D deficiency are the one of the most predisposed to pulmonary TB.

Parenteral vitamin D supplementation is superior to oral in vitamin D insufficient patients with type 2 diabetes mellitus

BACKGROUND/OBJECTIVES Oral vitamin D supplementation is better than parenteral in improving vitamin D deficiency in individuals with no systemic illness. Our aim was to compare the efficacy of oral and parenteral routes of vitamin D supplementation on circulating serum 25(OH) vitamin D level in patients with type 2 diabetes mellitus. METHODS Total 85 cases of with type 2 diabetes mellitus were screened for vitamin D status of which 71 patients were vitamin D insufficient/deficient. They were randomized into two intent to treat groups with different vitamin D supplementation protocols (a) Oral-60000 IU per day for 5days (group I; n=40) and (b) injectable-300000 IU intramuscularly once (group II; n=31). Baseline and one month post supplementation 25(OH) vitamin D levels were measured in both the groups. RESULTS Baseline clinical characteristics and 25(OH) vitamin D levels were comparable in both the groups. Post treatment 25(OH) vitamin D level in group I was 26.06±9.06ng/ml and in group II was 49.69±18.92ng/ml. After one month of vitamin D supplementation, increment in 25(OH) vitamin D level from baseline was significantly higher in group II than group I (p<0.001). INTERPRETATION & CONCLUSIONS Injectable method of supplementation was better than oral route in improving serum 25 (OH) vitamin D status in patients with type 2 diabetes. The study suggested impaired absorption of vitamin D from the gastrointestinal tract in patients with type 2 diabetes mellitus and a need for parenteral route of vitamin D supplementation in deficient patients with type 2 diabetes mellitus.

Design, implementation and results of a mobile clinic-based diabetes screening program from India

Highlights 1. This study describes the implementation of a mobile‐clinic based hub and spoke model to bring diabetes screening and awareness to remote regions. 2. Government‐accredited field workers were trained to conduct high risk screening via house to house visits. 3. The results suggest that this program is effective in bringing diabetes screening and awareness to remote and rural communities.

Significance of Surgical Intervention in the Management of Diabetic Foot Infections

The incidence of diabetes is increasing at an alarming rate. Diabetic foot is a major cause of frequent hospital visits and extended stays. Both micro and macro-vascular abnormality play a role in its pathogenesis; i.e., it can be neuropathic or ischemic. Other factors such as impaired immunity, poor tissue reparative process and altered foot anatomy further deteriorate wound condition. Infection complicates the wound, delays healing and is a major cause of amputations. Infection control is the primary target for effective wound healing. This can be achieved by appropriate antibiotic selection and surgical intervention. Incision, drainage, debridement, revascularization and wound closure are the key surgical procedures for the management of diabetic foot infection. Careful evaluation of clinical and laboratory findings helps to determine the associated risk of organ involvement, complexity of the wound and severity of infection, as well as the timing of surgical interventions. This chapter provides an overview of diabetic foot infection and its management, with emphasis on surgical intervention.

Vascular calcification in diabetic foot and its association with calcium homeostasis.

Introduction: Vascular calcification (VC), long thought to result from passive degeneration, involves a complex process of biomineralization resembling osteogenesis, frequently observed in diabetes and is an indicator of diabetic peripheral vascular disease with variable implications. Aim and Objective: To study the association between vascular calcification and calcium homeostasis in diabetic patients with foot ulcers without stage 4, 5 chronic kidney disease. Materials and Methods: A total of 74 patients with diabetic foot ulcer were enrolled, and VC was detected by X-ray and Doppler methods. Serum calcium, phosphate, alkaline phosphatase (ALKP), fasting and post-prandial glucose levels, and glycosylated hemoglobin (HbA1C) were recorded. Serum iPTH and 25 (OH) vitamin D were estimated by immune radiometric assay and radioimmunoassay, respectively. Data was analyzed by SPSS 16.0. Results: Vascular calcification was present in 42% of patients. Significant difference in the mean (±SD) of vitamin D, HbA1C, and eGFR was observed in VC +ve compared to VC –ve. There was no significant association of age, duration, BMI, PTH, Ca, PO4, ALKP with that of VC incidence. Severe vitamin D deficiency was more common in VC +ve (51.6%) compared to in VC –ve (18.6%). Sub-group analysis showed that the risk of VC was significantly higher (RR = 2.4, P < 0.05, 95% C.I. = 0.058-2.88) in patients with vitamin D < 10 ng/ml compared to others. Conclusion: Vitamin D deficiency could be a risk for vascular calcification, which possibly act through receptors on vascular smooth muscle cells or modulates osteoprotegerin/RANKL system like other factors responsible for VC in diabetic foot patients.