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Introduction: Hypertension (HTN) is a major cause of cardiovascular morbidity and mortality, particularly in diabetic people. Because HTN and Type 2 Diabetes Mellitus (T2DM) frequently co-exist, HTN is a significant risk factor for chronic problems masked HTN affects around a one third of T2DM patients who have normal Blood Pressure (BP) readings in the clinic. T2DM patients frequently have normal office BP (BP) and no nocturnal BP falling. The non dipping BP pattern raises the risk of cardiovascular events and damage to target organs. Multiple BP recordings can be obtained with Ambulatory BP Monitoring (ABPM). By providing variability of BP, and diurnal variation in BP, it assists the treating physician in the diagnosis and management of HTN. Aim: To elucidate the prevalence of non dipping pattern in T2DM and the characteristics of diabetics who have non dipping pattern using ambulatory monitoring. Materials and Methods: This was an observational study carried out in the Department of Medicine at JIPMER, Pondicherry, India. Between January 2016 and December 2017, 110 patients with T2DM were visited to Medicine Outpatient Department and the Diabetic Clinic. Out of 110, a total of 62 patients, with an average age of 46.67 years, were included in the study. Sun Tech Oscar 2' 24 hourR ABPM system was used for the study of ambulatory BP of patients, at specified times. Results: Sixty-two normotensive T2DM patients, mean age of 46.67 years were analysed in the 24 months. A total of 62 patients, the non dipping pattern was seen in 47 (76%) of the 62 individuals evaluated for ABPM, while the dipping pattern was seen in 15 (24%) of the normotensive T2DM patients. A non dipping pattern was associated with a higher Body Mass Index (BMI) (p-value=0.03). A non dipping habit was also substantially associated with high PPBS values (p-value=0.02). Conclusion: Patients with a history of HTN and smoking had a higher chance of non dipping patterns, which may lead to endorgan damage and future cardiovascular events. ABPM can be used as a screening tool to predict cardiovascular events in T2DM. [ABSTRACT FROM AUTHOR]

Hypogonadism secondary to genetic disorders like Klinefelter syndrome has been described as a cause of male osteoporosis, but the diagnosis is frequently missed or delayed because the clinical features are often subtle or at times normal. We report the case of a 25 year old male mosaicism Klinefelter syndrome lacking typical clinical features such as tall stature, gynaecomastia or low intelligence, whose sole presentation was low back ache due to diffuse osteoporosis involving the vertebra and pelvic bones. Bone loss is a minor characteristic of KS, while it is a distinctive feature of idiopathic hypogonadotrophic hypogonadism. There are only a few reported cases of Klinefelter mosaicism in which the sole presenting symptom complex was osteoporosis. The diagnosis is often missed or delayed because of the low index of suspicion that many health care professionals have toward genetic diagnoses in adults.

Background: Glycosylated hemoglobin (HbA1c) has not been evaluated extensively for diabetes and prediabetes diagnosis and short-term variability of fasting plasma glucose (FPG), 2-h PG post-75 g glucose load (2 hPG) and HbA1c has not been studied among Indians. Objectives: The study aimed to compare the sensitivity of HbA1c, FPG and 2 hPG for diabetes and prediabetes diagnosis as per the American Diabetes Association criteria, assess short-term variability of three tests and determine optimal HbA1c cutoffs for diabetes and prediabetes diagnosis among high-risk south Indians. Methods: This diagnostic accuracy study, conducted at a tertiary care teaching hospital located in South India, enrolled 332 adults at high risk for diabetes and subjected them to testing (FPG, 2 hPG, and HbA1c) twice at 2-3 weeks interval. Sensitivity of three tests for diagnosing diabetes and prediabetes was determined based on the final diagnosis of normoglycemia/prediabetes/diabetes made with six test results for each participant. Optimal HbA1c cutoffs for diabetes and prediabetes were determined based on the final diagnosis of glycemic status made with four test results of FPG and 2 hPG. Results: FPG, 2 hPG, and HbA1c, at American Diabetes Association recommended values, had sensitivity of 84.4%, 97%, and 93.8% respectively for diabetes diagnosis. HbA1c had lowest short-term variability (CVw = 1.6%). Receiver operating characteristic curve plotted with mean (of two values) HbA1c for each participant showed optimal HbA1c cutoffs of 6.5% for diabetes (area under curve [AUC] =0.990, sensitivity = 95.8%, specificity = 96.2%, accuracy = 95.2%) and 5.9% for prediabetes (AUC = 0.893, sensitivity = 84.3%, specificity = 80%, accuracy = 75.6%) diagnosis respectively. HbA1c <5.6% had 100% negative predictive value to exclude prediabetes/diabetes. Conclusions: HbA1c =6.5% is a convenient and reliable alternative to plasma glucose tests to diagnose diabetes among high-risk South Indians. HbA1c =5.9% is optimal for prediabetes diagnosis and value <5.6% excludes prediabetes/diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Health Care associated Infections (HAI) are the most common complications affecting the hospitalized patients. HAI are more common in developing and under developed countries. However, there are no systematic surveillance programs in these countries. Aim: To find out the burden, predisposing factors and multidrug resistant organisms causing HAI in a resource limited setting. Materials and Methods: This prospective observational study was done at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Patients aged 13 years or more with stay of more than 48 hours in a 16 bedded Medical Intensive Care Unit (MICU) between November 2011 and April 2013 were included in the study. Patients were prospectively followed up till discharge or death for the development of HAI. Device associated HAI like Ventilator Associated Pneumonia (VAP), Catheter Related-Blood Stream Infection (CR-BSI) and Catheter Associated-Urinary Tract Infections (CA-UTI) were studied. Standard laboratory methods were used for identification of microorganisms causing HAI and to test their antibiotic sensitivity. Results: A total of 346 patients were included in the study with median age of 38 years. Common indications for admission to Medical Intensive Care Unit (MICU) were poisoning (31.5%); neurological illness (23.4%) like Guillian-Barre syndrome, tetanus, meningitis, encephalitis; respiratory illness (14.5%) like pneumonia, acute respiratory distress syndrome and tropical infections (7.2%) like malaria, scrub typhus, leptospirosis. Fifty percent (174/346) patients developed one or more HAI with VAP being the most common. The rates of HAI per 1000 device days for VAP, CR-BSI, CA-UTI were 72.56, 3.98 and 12.4, respectively. Acinetobacter baumannii was the most common organism associated with HAI. Multidrug resistance was seen in 74% of the isolates. Conclusion: The burden of HAI, especially with MDR organisms, in resource constrained setting like ours is alarming. There is urgent need for infection control and monitoring system to reduce HAI. [ABSTRACT FROM AUTHOR]

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright of Clinical Kidney Journal is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. [Extracted from the article]

The present study was carried out to investigate the effects of curcumin on oxidative stress and redox-sensitive kinases in high fructose- and high-fat-fed rats. Sixty rats were randomly divided into six groups with ten animals each. Rats were fed with a standard rodent diet, high fructose diet (60%), and high-fat diet (30%). Curcumin was administered to control, high fructose and high fat diet groups for ten weeks. At the end of the study, body weight and blood glucose levels were measured. The antioxidant enzymes GSH (reduced glutathione), GPx (glutathione peroxidase), and catalase activities were estimated in the blood. MDA, TAS, and TOS were estimated in the plasma, liver, and kidney. Curcumin treatment decreased body weight and blood glucose levels in the rats fed with fructose and high-fat diet. Antioxidant enzymes and plasma TAS were significantly improved by curcumin treatment in high fructose-fed rats, whereas in high-fat-fed rats, there was an increase only in the GPx activity. Curcumin significantly attenuated the elevation of plasma MDA and TOS in both diet groups. Hepatic MDA and TOS were found to be decreased upon curcumin supplementation in both diet groups, whereas a decrease in the renal MDA levels was observed only in fructose-treated rats, not in fat-fed rats. Curcumin treatment elevated liver TAS in rats fed only with the fructose-rich diet. Curcumin showed a significant decrease in the oxidative stress index (OSI) in plasma, liver, and kidney tissues in both diet groups. ERK phosphorylation was significantly decreased in both diet groups by curcumin treatment. Similarly, curcumin reduced the phosphorylation of p38 MAPK only in the high fructose-fed rats, not in the high-fat-fed rats. No significant changes were found in JNK phosphorylation in both diet groups. Thus, curcumin may be effective in the management of diet-induced oxidative stress and could be explored as a therapeutic adjuvant against complications associated with obesity and diabetes. [ABSTRACT FROM AUTHOR]

Background: Blastocystis was identified almost a century ago, yet its biology and pathogenicity status in humans is obscure. Studies on Blastocystis in India are scanty and are mostly microscopy based. This study compared three detection modalities to determine their efficiency in the identification of Blastocystis in human feces., Materials and Methods: A total of 279 stool samples were screened using microscopy, culture (Jones' medium), and polymerase chain reaction (PCR)-based methods. Among the three, PCR is considered the gold standard test for detection of Blastocystis , as it helps to authenticate the sensitivity, specificity, and kappa agreement obtained by the other two tests. The morphological features of Blastocystis were recorded at 24, 48, and 72 h. After positive morphological identification, ten samples were cultured on Löwenstein-Jensen (LJ) medium and Locke's egg slant medium., Results: The sensitivity and specificity determined on the basis of microscopy were 36.2% and 99.4%, respectively. On the other hand, Jones' medium showed 67.6% sensitivity and 100% specificity. Further, we documented various morphological and reproductive features of Blastocystis using various staining techniques on cultures positive in Jones' medium. In addition, we also found that LJ medium was not equally efficacious as Jones' medium in assisting the growth of Blastocystis ., Conclusions: Although molecular diagnosis is a necessary tool for understanding the true epidemiology of Blastocystis , in laboratories devoid of molecular detection facilities, stool microscopy in conjunction with stool culture on Jones' medium could serve as the best alternative tool for the detection of Blastocystis ., Competing Interests: There are no conflicts of interest.

Primary Intestinal Lymphangiectasia (PIL) is a rare disease of unknown aetiology which presents in the paediatric age group with anasarca, diarrhoea, hypoproteinaemia, lymphoedema and chylous effusions. Tuberculosis, filariasis, chest trauma, malignancies and haematological disorders usually contribute to most cases of secondary lymphangiectasia and chylous effusions. We hereby describe a case of PIL presenting with chylous effusions which remained undiagnosed for eight years.

We present the case of a 35-year-old woman presenting with the rare combination of scleroderma and ischemic heart disease. Her ECG suggested old inferior wall myocardial infarction. Coronary angiography revealed significant coronary artery disease.