Farooq Ahmad Dar

Copper, zinc, and magnesium levels in non-insulin dependent diabetes mellitus.

A relationship has been reported between trace elements and diabetes mellitus. This study evaluated the role of such a relationship in 83 patients with non-insulin dependent diabetes mellitus (40 men and 43 women), with a mean duration of diabetes of 3.9 +/- 3.6 years. Patients with nephropathy were excluded. Thirty healthy non-diabetic subjects were studied for comparative analysis. Subjects were subdivided into obese and non-obese. Diabetic subjects were also subdivided into controlled and uncontrolled groups; control was based on fasting blood glucose and serum fructosamine levels. Plasma copper, zinc and magnesium levels were analysed using a GBC 902 double beam atomic absorption spectrophotometer. Plasma zinc and magnesium levels were comparable between diabetic and non-diabetic subjects, while copper levels were significantly elevated (p < 0.01) in diabetic patients. Age, sex, duration and control of diabetes did not influence copper, zinc, or magnesium concentrations. We conclude that zinc and magnesium levels are not altered in diabetes mellitus, but the increased copper levels found in diabetics in our study may merit further investigation of the relationship between copper and non-insulin dependent diabetes mellitus.

Prevalence of Type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent

This cross-sectional population survey was undertaken to determine the prevalence of type 2 diabetes and impaired glucose tolerance in subjects aged 40 years or more in Kashmir Valley, India. The study was carried out in two phases. In phase one, 6091 randomly selected subjects, 40 years or older, from all six districts of the valley were surveyed for prevalence of known diabetes mellitus. In phase two, 5083 subjects, 40 years or older, were screened with oral glucose tolerance test for prevalence of undiagnosed (asymptomatic) diabetes mellitus and impaired glucose tolerance. Abnormalities of carbohydrate intolerance were determined as recommended by WHO. Of 6091 subjects interviewed, 115 were known cases of diabetes mellitus with an overall prevalence of 1.89% (1.98% in males and 1.77% in females). Results of glucose tolerance test revealed that mean fasting as well as mean 2 h blood glucose was significantly more in females as compared to males (4.68+/-0.91 and 6.40+/-2.12 vs. 4.49+/-0.96 and 5.94+/-2.03 mmol/l, respectively, P < 0.0001). Of 5083 subjects who were subjected to glucose tolerance test (GTT), 627 (12.34%) had an abnormal test; with 411 (8.09%) having impaired glucose tolerance (IGT) and 216 (4.25%) having diabetes mellitus. The prevalence of IGT as well as of diabetes was significantly more in females as compared to males (P < 0.001). Subjects who had family history of diabetes had a significantly higher prevalence of abnormal GTT. Prevalence of known diabetes as well as that of abnormal GTT steadily increased with age, with a highest prevalence in the age group of > or = 70 years (P < 0.001). Obese subjects had a significantly higher basal as well as 2 h blood glucose in males as well as in females. Subjects with diabetes on GTT had a higher waist/hip ratio. Overall the prevalence of diabetes as well as IGT was significantly higher in the urban population. We conclude that 1.89% of the general population have known diabetes, 4.25% have undiagnosed diabetes and 8.09% have impaired glucose tolerance test; making the total load of abnormal glucose tolerance 14.23% in Kashmir Valley. In subjects greater than 40 years of age having a family history of diabetes, obesity, higher age (50 years or above), female sex, and urban origin have more chance (odds ratio: 4.65, 2.30, 1.87, 1.49 and 1.16, respectively) of developing abnormal glucose tolerance.

Prevalence of diabetes mellitus and other abnormalities of glucose tolerance in young adults aged 20-40 years in North India (Kashmir Valley).

AIMS To assess the burden of type 2 diabetes mellitus (T2DM) and other abnormalities of glucose tolerance in young-adult (20-40 years) men and non-pregnant women. METHODS Prevalence of diagnosed T2DM, undiagnosed T2DM and other abnormalities of glucose tolerance studied in 3032 subjects from Kashmir Valley of India. The study included a questionnaire, anthropological measurements, blood sampling, and a standard OGTT. RESULTS Eight (0.3%) of surveyed subjects were previously diagnosed to have diabetes. Of 3024 subjects screened, prevalence of diabetes, impaired glucose tolerance (IGT), and impaired fasting glycemia [IFG, World Health Organization, Definition, Diagnosis, and Classification of Diabetes Mellitus and its Complications. Part 1. Diagnosis and Classification of Diabetes Mellitus, World Health Organization, Geneva, 1999], IFG [American Diabetes Association, Diagnosis and classification of diabetes mellitus, Diabetes Care 27 (Suppl. 1) (2004) S5-S10] was 2.5%, 2.0%, 11.9% and 26.7%, respectively. Overall, age-adjusted prevalence of T2DM (known plus unknown), IGT, IFG (WHO) and IFG (ADA) was 2.4% (95% CI: 1.9-3.0), 1.6% (95% CI: 1.3-2.2), 11.1% (95% CI: 10.0-12.3), and 25.2% (95% CI: 23.7-26.8), respectively. The difference in diabetes prevalence was significant by age, habitat, family history of diabetes and BMI. The ratio of known-to-unknown diabetes was 1:10. CONCLUSIONS This is the first large scale study from North India on prevalence of type 2 diabetes in the younger age group of 20-40 years. Abnormal glucose tolerance including undiagnosed T2DM is common in young adults.

Impaired fasting glucose and impaired glucose tolerance - lack of agreement between the two categories in a North Indian population.

This study was carried out to determine the relationship between impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in a North Indian population. The data in 5083 subjects studied earlier was reanalyzed by applying new WHO diagnostic criteria. Reanalysis revealed that 305 (6.0%) subjects had diabetes mellitus (198 on the basis of fasting plasma glucose of > or =7.0 mmol/l (> or =126 mg/dl) and an additional 107 based on a 2-h glucose tolerance test), 381 (7.5%) had IFG and 361 (7.1%) had IGT. Of these 361 subjects with IGT, only 99 (27.4%) had impaired fasting glucose whereas 262 (72.6%) had normal fasting glucose of <6.1 mmol/l (<110 mg/dl). Of 381 subjects with IFG, 99 (26%) had IGT where as 282 (74%) had normal 2-hr glucose. We conclude that there is a poor correlation between IGT and IFG.

Profile of neurological problems in diabetes mellitus retrospective analysis of data from 1294 patients.

Data from 1294 patients with diabetes mellitus admitted to the Endocrinology Department of the Institute of Medical Sciences, Srinagar, Kashmir, from 1986 to 1994, were analyzed for frequency of various neurological problems. Of 1294 patients, 46.29% had clinical evidence of one or more neurological problems. The frequency of neurological problems was significantly more in patients with type II diabetes mellitus (P<0.001). Predominant neurological problems included peripheral neuropathy (96.66%), stroke (5.51%), Parkinsonism (1.50%), seizure disorder (1.17%) and dementia (1%). Mean (+/- SD) age of patients with neurological problems was significantly more (P<0.001) than those without neurological problems (52.07+/- 9.52 versus 47.45+/- 12.87 years for type II diabetes mellitus; 26.73+/- 8.40 versus 18.0+/- 3.62 for type I diabetes mellitus). Mean duration of diabetes in patients with neurological problems was significantly more than those without neurological problems (6.70+/- 6.04 versus 3.95+/- 4.22 years for type II diabetes mellitus; 5.63+/- 3.67 versus 1.89+/- 2.57 for type I diabetes mellitus). At the time of admission, fasting blood glucose was lower in patients without neurological problems as compared to patients with problems (9.08+/- 2.22 versus 11.05+/- 4.91 mmol/L for type II diabetes mellitus; 9.44+/- 2.80 versus 13.01+/- 5.01 mmol/L for type I diabetes mellitus; P7lt;0.001).

Minimally invasive thoracotomy approach for double valve replacement for valvular heart diseases

Background: Double valve replacement (DVR) is usually done through median sternotomy. However, right anterolateral thoracotomy is an alternative approach. Aim: The aim of this study was to analyze the results of right anterolateral thoracotomy for DVR. Patients and Methods: This was a prospective study conducted on during the period from January 2009 to January 2012. This study consists of 56 patients who had a concomitant mitral and aortic valve disease and were subjected to DVR. Patients were studied according to their age and sex, New York Heart Association (NYHA) class, valve pathology, concomitant procedures, urgent/elective, length of incision, surgical exposure, mean bypass time, operating time, hospital stay, and cosmesis. Results: Majority of the patients were in 3 rd and 4 th decade (61%). Postoperative length of stay was 7-12 days, 70% of patients were discharged by the 7 th day. The average size of incision in males was 7.5 cm and in females the size of incision was 7.25 cm with a mean of 7.3 cm in both genders. Rheumatic heart disease was responsible for 89.28% of cardiac valvular lesions, degenerative disease in 7.14% and endocarditis in 3.5%. Postoperatively at 2 months, there was a statistically significant improvement in the NYHA class with 94% of the survivors in class I-II. There was a statistically significant difference in the outcome in patients having higher ejection fraction as compared to those who had low ejection fraction preoperatively. Thirty days mortality was 1.78%. Over the first 24 postoperative hours, only about 30% of patients were pain free, and this proportion increased to about 50% by day 2, 60% by day 3, 70% by day 4, 75% by day 5 and stabilized. Postoperative length of stay was 7-12 days, 70% of patients were discharged by the 7 th day. Conclusion: DVR via thoracotomy appears to be associated with faster recover, early discharge and reduced use of rehabilitation facilities that translate into a shorter hospital stay and cost. In addition to early benefits of thoracotomy approach, late cosmetic results are also better than conventional sternotomy.