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Fibroscan of Liver in Type 2 Diabetes Mellitus and Its Correlation with Risk Factors

Journal of Diabetes Mellitus 2019年第2期9卷 62-68页

作者： Nikhil A. Kumar sidhartha das Department of Medicine SCB Medical College and Hospital Cuttack India Department of Medicine and Dean and Principal SCB Medical College and Hospital Cuttack India

Introduction: Non-alcoholic fatty liver disease (NAFLD) is regarded as the hepatic manifestation of metabolic syndrome. Insulin resistance is regarded as central to the development of NAFLD. Type 2 Diabetes Mellitus (DM) is an important cause of NAFLD. The pathology in NAFLD ranges from hepatic steatosis, non-alcoholic steatohepatitis (NASH), cirrhosis and primary liver cancer. Diagnosis of NAFLD requires demonstration of increased liver fat in the absence of hazardous levels of alcohol consumption. Liver biopsy is the gold standard for diagnosis of NAFLD but it is fraught with various difficulties and is a risky procedure. Fibroscan (?Abbott) or transient elastography is a non-invasive tool which measures the hepatic stiffness. Objective: To estimate the degree of hepatic stiffness due to NAFLD and to identify the factors affecting it. Patients: 50 patients of newly diagnosed Type 2 diabetes mellitus without a history of chronic hepatitis or alcohol intake were included in the study. Results: In our study, 40% of the patients were obese with 46% of the total patients having an elevated AST, 66% having an elevated ALT and 18% having an elevated alkaline phosphatase. Dyslipidemia was very common with 14% of total patients having a high cholesterol, 36% having elevated triglycerides, 64% having a low HDL with none with an elevated LDL. 50% of patients had steatosis on ultrasound. On comparing liver stiffness, a significantly high hepatic stiffness (>7.9 kPa) was found in 34% of patients with severe fibrosis (≥12 kPa) in 10% of patients. Multivariate analysis showed significant positive correlation of fibroscan value with total cholesterol and ALT levels and there was a significant negative correlation with AST levels and serum HDL levels. Conclusion: Fibroscan may be helpful in diagnosing and guiding treatment of NAFLD. Larger studies to evaluate its efficacy in determining prognosis of NAFLD are warranted.

关键词： Diabetes Mellitus NAFLD Fibroscan Transient Elastography NASH

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Study of Cardiac Manifestations in Patients with HIV Infection and Their Correlation with CD4 Count in Indian Population

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International Journal of Clinical Medicine 2012年第3期3卷 178-183页

作者： Ayaskanta Singh sidhartha das Rabindra Kumar Dalai Postgraduate Department of Medicine and Nodal Officer Anti Retroviral Therapy (ART) Centre SCB Medical College and Hospital Cuttack India Postgraduate Department of Medicine SCB Medical College and Hospital Cuttack India

Introduction: With advances in the management of patients living with HIV and AIDS (PLHA), not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovascular complications. Aims and Objectives: To determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection and to evaluate their correlation with CD4 count. Materials and Method: 70 consecutive patients with HIV infection admitted to Post Graduate Department of Medicine from the period of July 2010 to August 2011 were studied. All cases of PLHA diagnosed after positive ELISA test for HIV infection were included, whereas those with congenital heart disease, rheumatic heart disease, hypertension, Ischemic heart disease were excluded from the study. CD4 count and 2D echocardiography along with routine investigations were done for all patients. Result: Male to female ratio was 2:1. Echocardiographic abnormalities were seen in 58% of patients. Reduced ejection fraction (below 50%) and fractional shortening below 30% were the most common cardiac abnormality (48.7%) followed by pericardial effusion (17.4%), pulmonary artery hypertension (11.4%), dilated cardiomyopathy (8.5%), diastolic dysfunction (8.5%) and regional wall motion abnormality (1.4%) respectively. Significant statistical positive correlation was observed between low CD4 count and echocardiographic abnormalities (p < 0.0001). Pericardial effusion was seen more in patients with CD4 count below 200 (p < 0.001). Maximum number of echocardiographic abnormalities was seen in WHO clinical stage IV. Conclusions: Cardiac manifestations are frequent PLHA in our population but do not have detectable clinical manifestation. Echocardiographic abnormalities have a strong correlation with low CD4 count and occur more in advanced stage of the disease.

关键词： HIV AIDS PLHA CD4 Count Echocardiographic Findings

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Study of hsCRP, adiponectin, NF-κB in low bodyweight, standard bodyweight and obese subjects with type 2 diabetes mellitus in India

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Journal of Diabetes Mellitus 2012年第4期2卷 386-392页

作者： sidhartha das Durga Prasanna Misra Pratima Kumari Sahu Department of Biochemistry Sriram Chandra Bhanj Medical College Cuttack India Department of Medicine Sriram Chandra Bhanj Medical College Cuttack India

Introduction: Low bodyweight type 2 DM is a distinct clinical entity having many inherent peculiarities seen in India and developing countries, constituting 11% to 25% of type 2 diabetic subjects. Our study aimed at assessing the prevalence of inflammatory markers like hsCRP, adiponectin and NF-κB expression in peripheral blood mononuclear cells in subjects with type 2 DM in relation to BMI. Materials and Methods: 57 consecutive type 2 diabetics were recruited for study, classified as Low Bodyweight (A = BMI < 18.5), Standard weight (B = BMI 18.5 - 24.99) and Obese (C = BMI ≥ 25). Group D comprised 14 healthy controls. They were evaluated for clinical parameters, FBG, 2hrPPBG, HbA1c, lipid profile and above mentioned inflammatory markers. Results: Serum hsCRP was significantly higher in all group of diabetics as compared to Group D but was lowest in Group A. Adiponectin levels were highest in Group D, similar in Groups B and C but lowest in Group A. NF-κB expression, though higher in diabetic subjects than controls (OD = 0.041 ± 0.006), was least in Group A (OD = 0.045 ± 0.005). Discussion and Conclusion: Our study revealed that Indians with type 2DM are in a pro-inflamematory state. Low bodyweight type 2 diabetics had the least pro-inflammatory load. This further supported the earlier observation of lesser macrovascular disease load and testifying that Low Bodyweight type2DM constitutes a distinct entity.

关键词： Low Bodyweight Type 2 DM hsCRP NF-κB Adiponectin

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Role of C-Peptide in Relation to Levels of Anti-GAD and Islet Cell Antibodies in Characterizing Types of Diabetes in the Young, in Eastern India

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Journal of Diabetes Mellitus 2022年第1期12卷 1-11页

作者： sidhartha das Dipanweeta Routray Manoranjan Behera Saroj Kumar Tripathy Formerly HOD P. G. Department of Medicine and Dean and Principal SCBMCH Cuttack India Department of Community Medicine SCBMCH Cuttack India SCBMCH Cuttack India Department of Department of Medicine. S. L. M. Medical College Koraput Odisha India

Background: Measuring fasting C-peptide (FCP) and antibodies against Glutamic acid decarboxylase (GADA) and Islet cell antibodies (ICA) are not so commonly explored in children and young adults. Objectives: To assess the levels of FCP, GADA and ICA in subjects below the age of 25 years with DM and compare their levels to differentiate between Autoimmune and Non-Autoimmune Type 1 DM. Methodology: Blood samples of 93 subjects diagnosed with DM, reporting to the tertiary care hospital, were analysed for ICA, GADA and FCP. Receiver operating characteristics (ROC) curves were analysed to check the ability of autoimmune markers, BMI and C-peptide to differentiate between Autoimmune (Ai) and Non-Autoimmune (NonAi) diabetes. Results: 30/93 (32.2%) were positive for anti-GAD ab and/or ICA and categorised as Autoimmune (Ai), the most common antibody being, anti-GAD ab (80%) in them. The level of FCP among Ai compared to NonAi, was significantly low (p 20.75 nmol/l) as a very dependable test for diagnosing Ai, Type 1 DM, in children and young adults. Its sensitivity and specificity are in the range of 86.2% and 96.8% respectively. Low level of C-peptide (Conclusion: This study revealed predominant positivity for anti-GAD ab (80%) among Ai+ patients. ROC analysis shows GADA above 20.75 nmol/l and Fasting C-peptide < 0.36 nmol/l as a good indicator for diagnosing Ai in children and young adults.

关键词： C-Peptide Anti-Glutamic Acid Decarboxylase Antibodies (GADA) Islet Cell Antibodies (ICA) ROC Analysis Type 1 DM Type 2 DM

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Association of NFkB1 Gene Polymorphism with Inflammatory Markers in Patients of Type 2 Diabetes Mellitus with or without Renal Involvement in Eastern India

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Journal of Diabetes Mellitus 2020年第3期10卷 169-181页

作者： Sonalika Behera Andrew Abel Lamare Roma Rattan Bijan Patnaik sidhartha das Department of Medicine Sriram Chandra Bhanja Medical College Cuttack Odisha India Department of Biochemistry Laboratory of Molecular Science Sriram Chandra Bhanja Medical College Cuttack Odisha India

Aims: To evaluate the association of Nuclear factor kappa B1(NFkB1) gene polymorphism with inflammatory markers Urinary Monocyte Chemoattractant Protein 1 (UMCP1) and Tumor Necrosis Factor alfa (TNF alfa) in Patients of diabetes mellitus with or without renal involvement in Eastern India. Material and Methods: Consecutive Patients of Type 2 Diabetes Mellitus (DM) with or without microalbuminuria attending SCB MEDICAL COLLEGE and HOSPITAL Medical OPDs in between September 2018 to September 2019 were recruited in this study. Patients were subjected to blood and urine investigations. DNA extraction and Restriction fragment Length Polymorphism (RFLP) was done in Department of Biochemistry. Controls were unrelated healthy attendants with no history of Diabetes Mellitus, HTN, Chronic Kidney Disease (CKD). Results: Mean Systolic BP, Fasting Blood Glucose, Post Prandial Blood Glucose, HBA1c, Total Cholesterol were significantly higher in diabetes mellitus and diabetic nephropathy groups than control group. Estimated Glomerular Filtration Rate was significantly lower in diabetic nephropathy (p value Conclusion: insertion/insertion NFkB1 gene polymorphism increases the risk of nephropathy by 2.52 times (OR = 2.52, 95% CI: 0.04 - 0.63, p value = 0.019) in diabetes patients in eastern India.

关键词： DN: Diabetic Nephropathy UACR: Urinary Albumin Creatinine Ratio UMCP1: Urinary Monocyte Chemoattractant Protein 1 TNF Alfa: Tumor Necrosis Factor Alfa NFkB1: Nuclear Factor Kappa B Ins/Ins Polymorphism: Insertion/Insertion Polymorphism Del/Del Polymorphism: Deletion/Deletion Polymorphism Ins/Del Polymorphism: Insertion/Deletion Polymorphism

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Study of Lipid Abnormalities in Type 2 Diabetes Mellitus Patients with Nephropathy in Eastern India

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Journal of Diabetes Mellitus 2020年第1期10卷 16-25页

作者： Sonalika Behera Andrew Abel Lamare Bijan Patnaik Roma Rattan sidhartha das Department of Medicine Sriram Chandra Bhanja Medical College Cuttack.odisha India Department of Biochemistry Sriram Chandra Bhanja Medical College Cuttack.odisha India

Background: Diabetic nephropathy is one of the major complications of diabetes. Nephropathy patients must be evaluated for dyslipidemia as it is an established risk factor for cardiovascular events. We compared the degree of dyslipidemia among type 2 diabetes mellitus (T2DM) subjects with or without nephropathy and analyzed the factors associated with nephropathy among them. Methods: In this retrospective study, T2DM patients with overt nephropathy were enrolled in the study group (n = 50);without nephropathy were enrolled in the control group (n = 50). Both groups were matched for age duration of diabetes. After taking informed consent anthropometrical clinical examinations were done. Biochemical investigations (Total cholesterol, TG, HDL, LDL, VLDL, sdLDL-C, S. urea, S. creatinine were done in SCB MCH, Biochemistry department. Urine microalbumin per gm of creatinine was done. TG/HDL-C ratio, a surrogate marker for small, dense, LDL particles (sdLDL), and estimated glomerular filtration rate (eGFR) were calculated using equations. Results were analyzed statistically using SPSS version 20. Results: Mean Total cholesterol, TG, LDL, sdLDL are significantly high in nephropathy patients with p values 0.026, 0.012, 0.014, 0.04 respectively. Estimated GFR has a significant positive correlation with TCHOL (r = −0.850, p = 0.01), TG (r = −0.14, p = 0.008), LDL (r = −0.62 p = 0.037). Estimated GFR has a significant negative correlation with S. urea (r = −0.587, p ≤ 0.01), S. creatinine (r = −0.59, p ≤ 0.01), UACR (r = −0.47, p ≤ 0.01). Dyslipidema sdLDL is significantly more in nephropathy group in comparison to diabetic group with p values 0.033, 0.045 respectively. Conclusion: Our study shows that dyslipidemia was highly prevalent among subjects with nephropathy. So cardiovascular risks can be averted by regular screening for dyslipidemia in diabetic nephropathy patients.

关键词： Dyslipidemia Diabetic Nephropathy Insulin Resistance sdLDL Atherogenic Dyslipidemia

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The Relationship of Carotid Plaque, Intima Media Thickness (IMT), Resistivity Index (RI) and Pulsatility Index(PI) in Asian-Indian Patients with Acute Ischemic Stroke with and without Type2 DM

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International Journal of Clinical Medicine 2011年第5期2卷 561-567页

作者： sidhartha das Kamalesh Chakrabarty Madhusmita Patnaik Laxmidhar Roul Jayashree Mohanty Sarat Chandra Singh 不详

Aim: To determine the relationship of carotid plaque, intima media thickness (IMT), resistivity index (RI) and pulsatility index (PI) and prevalence of different risk factors with acute ischemic stroke and stroke subtypes in both diabetic and non-diabetic subjects. Materials and methods: 80 cases of acute ischemic strokes and 40 healthy controls were included in the study. The plaque, IMT, RI and PI were measured by carotid duplex ultrasound. Results: 31 subjects were Type 2 diabetic, 54 hypertensive while 25 were both diabetic and hypertensive. 23 cases (28.75%) had lacunar stroke (LACI), 32 (40%) stroke involving partial anterior circulation(PACI), 10(12.5%) stroke in posterior circulation (PACI) and 15(18.75%) stroke involving total anterior circulation(TACI) respectively. The mean IMT (0.88 ± 0.19mm), RI(0.76 ± 0.05) and PI(1.71 ± 0.19) of patients and mean IMT (0.6±0.09mm), RI (0.61 ± 0.06) and PI (1.53 ± 0.11) of controls were statistically significant (p-0.000). The mean values of IMT, PI and RI were significantly higher in diabetics (IMT-0.90 ± 0.16 VS 0.64 ± 0.11, p-0.013;PI-1.76 ± 0.20 VS 1.49 ± 0.09, P-0.000 and RI-0.76 ± 0.04 VS 0.59 ± 0.06, P-0.000) and similarly the mean values for IMT, PI and RI in hypertensives as compared to controls (IMT-0.88 ± 0.16 vs 0.65 ± 0.10, P-0.006;PI1.69 ± 0.18 vs 1.49 ± 0.09, P-0.000 and RI 0.76 ± 0.04 vs 0.59 ± 0.06, P-0.000). The mean IMT, PI and RI were increased significantly in smokers compared to controls (IMT-0.93 ± 0.20 vs 0.63 ± 0.06, P-0.000;PI-1.82 ± 0.22 vs 1.49 ± 0.09, P-0.000 and RI-0.77 ± 0.04 vs 0.59 ± 0.06, P-0.000). Type 3 plaque accounted for 27 (56.2%) cases and Type 2 plaque 12 (25%) cases. The total number of plaques in patients as compared to controls were significantly more (P-0.0034) and the mean plaque area was 46 mm2 for cases and 20 mm2 for control (P-0.0001). TACI was the most common type of ischemic stroke seen in DM (60%), HTN (66.6%) and smokers (66.7%). Plaques (73.3%), IMT (0.90 ± 0.12),

关键词： Intima Medial Thickness Pulsatility Index Resistivity Index Carotid Plaque Type 2 Diabetes Mellitus Ischemic Stroke and Asian Indian Subjects

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Effect of Lifestyle Modification and Oral Anti-Diabetic Drugs on Metabolic Parameters in Recently Diagnosed Patientswith Uncomplicated Type 2 Diabetes Mellitus in Eastern India

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Journal of Diabetes Mellitus 2018年第2期8卷 9-19页

作者： Nikhilesh Pradhan sidhartha das Anoj Kumar Baliarsinha Ashirbad Parhi Bijan Patnaik Pramod Kumar Rout Department of Medicine S.C.B Medical College Cuttack India Department of Endocrinology S.C.B Medical College Cuttack India

BACKGROUND: Oral anti-diabetic drugs (OADs) are often advised for initial treatment for patients with Type 2 Diabetes Mellitus (T2DM). Their effects on glycemic control, lipid profile, insulin resistance and beta cell function has not been systematically studied in India. The objective of this study was to evaluate the effect of lifestyle modification and OADs on metabolic parameters in recently diagnosed uncomplicated T2DM patients. MATERIAL METHODS: A total of consecutive sixty four (64) cases of recently diagnosed uncomplicated T2DM in the age group of 30 - 60 years were studied. They were evaluated for weight, body mass index (BMI), fasting plasma glucose (FPG), 2hr post glucose plasma glucose (2hrPGPG), HbA1c, lipid profile, serum fasting insulin, c-peptide, HOMA-IR and HOMA-β. They were divided into four groups according to increasing order of HbA1c values (6.5% - 6.9%, 7% - 7.5%, 7.6% - 8.5%, 8.6% - 8.9%). These four groups were subjected to lifestyle modification (LSM), monotherapy with metformin (1 g) and LSM, dual drug therapy i.e. metformin (1 g), glimepiride (1 mg) and LSM, triple drug therapy i.e. metformin (1 g), glimepiride 1 mg, sitagliptin 100 mg) and LSM respectively. These patients were followed up after three months of therapy. They were evaluated for the same metabolic parameters and compared with their baseline value. Fourteen (14) patients were lost to follow up. RESULTS: We found 91%, 92.8%, 53.3% and 60% of our patients from above four different groups achieved target glycemic control (HbA1c ≤ 6.5%). In all the four groups, significant improvement in glycemic status, lipid profile, HOMA-IR and HOMA-β were observed (p value CONCLUSION: In our study, early Initiation of LSM along with OADs either as monotherapy or in combination therapy according to HbA1c value showed significant improvement in glycemic control, insulin resistance and beta cell function.

关键词： Type 2 Diabetes Mellitus Metformin Glimepiride Sitagliptin HOMA-IR HOMA-β

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The Level and Role of Interleukin-17 in Patients of Type 2 Diabetes Mellitus with and without Complications

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Journal of Diabetes Mellitus 2019年第4期9卷 176-185页

作者： Ashirbad Parhi sidhartha das Srikrushna Mahapatra Nikhilesh Pradhan Manoranjan Behera Bijan Patnaik Roma Rattan Department of Cardiology SCBMCH Cuttack India Department of Medicine SCBMCH Cuttack India Department of Biochemistry SCBMCH Cuttack India

Background: Type 2 Diabetes Mellitus (T2DM) is the most prevalent metabolic disorder in the world. Recent evidence however suggests that T2DM is not only a disease of metabolism, but also an inflammatory disorder and that inflammation also plays an important role in the pathogenesis of Diabetic complications. Our aim was to study the level of interleukin-17 (IL 17) in Indian populations with T2DM as an inflammatory marker and analyze its role in different diabetic complications. Methods: A total of consecutive 67 patients of T2DM were evaluated for clinical parameters fasting blood glucose (FBG), 2hr-post-prandial blood glucose (PPBG), lipid profile, HbA1c and plasma IL 17. They were divided into three groups—Patients of T2DM without any complications (group A;n = 24), T2DM with acute complications (group B;n = 20), T2DM with chronic complications (group C;n = 23) and compared with 23 healthy controls (group D). Results: Diabetic patients had a higher level of IL 17 as compared to the healthy controls. The level of IL 17 in complicated diabetics was higher than the patients with T2DM without complications. Multiple logistic regression analysis showed positive correlation of IL 17 with Diabetic Retinopathy and Diabetic Neuropathy. IL 17 also showed a positive Pearsons correlation with systolic blood pressure (SBP), diastolic blood pressure (DBP), serum triglycerides (TG), serum total cholesterol (TC), very low density lipoproteins (VLDL), low density lipoproteins (LDL), HbA1c and a negative correlation with HDL. Conclusion: Indian subjects with T2DM with or without complications had higher values of IL 17 as compared to healthy controls. Also diabetic neuropathy and diabetic retinopathy were positively correlated to levels of IL 17. Further levels of IL 17 were positively correlated to hypertension and dyslipidemia indicating a prevalent inflammatory state in our population of T2DM with and without complications.

关键词： IL-17 Inflammation Interleukins

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Morbidity Profile and Causes of Mortality in Type 2 Diabetes Patients: Data from a Tertiary Teaching Hospital from Eastern India

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Journal of Diabetes Mellitus 2017年第3期7卷 195-211页

作者： Soumya Ranjan Behera Manoranjan Behera sidhartha das Bhabani Prasad Panda Saroj Kumar Tripathy Purna Chandra dash Department of Medicine VSS Institute of Medical Sciences and Research Burla Sambalpur Odisha India PG Department of Medicine Faculty of Medicine Sriram Chandra Bhanja Medical College Cuttack Odisha India PG Department of Medicine Sriram Chandra Bhanja Medical College Cuttack Odisha India

Background: Data regarding the prevalence of morbidity and mortality in patients of Type 2 Diabetes Mellitus (T2DM) is scanty in India. Objectives: To determine the prevalence of micro and macro vascular complications, acute metabolic complications, infections, Non Alcoholic Fatty Liver Disease (NAFLD) and cause of mortality in T2DM patients admitted to a tertiary care teaching hospital in Eastern India. Material and Methods: This was a hospital-based prospective study evaluating 150 T2DM patients admitted to a tertiary care institution in Eastern India. Diagnosis of micro and macro vascular complications, infections and NAFLD was made using standard protocols. In case of death, the most probable cause was noted. Results: Out of 150 patients, 14.7% of patients were newly diagnosed T2DM and out of them 41% of patients had vascular complications and 54.5% had infections. Of the total patients, 56% had nephropathy, 20% neuropathy, 17.3% retinopathy, 31.3% CVD, 11.3% CAD, 4.6% acute metabolic complications, 44% infections and 16.6% had NAFLD respectively. Macrovascular events occured earlier than microvascular complications. Multiple logistic regression analysis showed strong association of age, duration of diabetes, serum cholesterol, triglyceride, LDL-C with retinopathy (Regression coefficient β: -0.1086807, 0.4127152, -0.0513393, 0.0146429, 0.0587475;p < 0.05, < 0.001, < 0.05, < 0.05, < 0.05 respectively), while only duration of diabetes was strongly associated with nephropathy and neuropathy (Regression coefficient β: 0.2538751, 0.2261636;p < 0.001 for each). Increasing age was associated with CAD (Regression coefficient β: 0.055392;p β: 0.0055014;p 18.6% patients died due to diabetes related complications. Cardiovascular (CV)-related deaths (CVD+CAD) were most common cause (51.5%: CVD 36.4%, CAD 15.1%) to be followed by infections (27.3%) and then chronic kidney disease (12.1%). Conclusions: This study highlights the high prevalence of vascular complications and in

关键词： Type 2 Diabetes Mellitus Vascular Complications Infections NAFLD Mortality

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