Can glycated haemoglobin (HbA1c) be used as a predictor of left ventricular diastolic dysfunction in non-hypertensive patients with newly diagnosed type 2 diabetes mellitus: a cross-sectional study at a tertiary care centre in Eastern India

OBJECTIVES

This study was conducted to establish the association between glycated haemoglobin (HbA1c) and left ventricular diastolic dysfunction (LVDD) in non-hypertensive patients with newly diagnosed type 2 diabetes mellitus (DM) and determine the cut-off value of HbA1c for detecting LVDD.

DESIGN

Cross-sectional study.

SETTING

This study was conducted in General Medicine Department in collaboration with the Cardiology Department at All India Institute of Medical Sciences, Patna.

PARTICIPANTS

The study population comprised patients with newly diagnosed type 2 DM within the past 3 months, aged between 18 years and 80 years, who were not hypertensive and without any systemic diseases and who presented to the General Medicine Department.

PRIMARY AND SECONDARY OUTCOME MEASURES

The presence of LVDD was the primary outcome measure.

RESULTS

Among the total of 60 participants, it was observed that age (adjusted odds ratio (AOR): 1.169, 95% CI: 1.066 to 1.283) and HbA1c (AOR: 2.625, 95% CI: 1.264 to 5.450) were found to be independent predictors for the presence of LVDD. Receiver operating characteristic analysis identified a cut-off value of HbA1c at 9.5% (80 mmol/mol) for detecting LVDD, with a specificity of 96.43%, a sensitivity of 37.5% and a positive predictive value (PPV) of 91.62%.

CONCLUSIONS

This study demonstrated that age and HbA1c levels are independent predictors of LVDD in patients with newly diagnosed type 2 DM without hypertension. A cut-off value of 9.5% for HbA1c was identified with a high specificity and PPV for predicting LVDD in patients with newly diagnosed type 2 diabetes. This underscores the importance of conducting echocardiography in patients with newly diagnosed asymptomatic type 2 diabetes with HbA1c 9.5% or more to assess LVDD, allowing for prompt interventions if necessary and to decelerate the progression towards heart failure.

Classic paroxysmal nocturnal haemoglobinuria presenting with intestinal malabsorption syndrome, acute abdomen and acute kidney injury

A male patient in his 30s presented with complaints of acute abdominal pain, black stools and red-coloured urine. CT revealed thrombi in the splenic and left renal veins, leading to infarctions. An endoscopy displayed scalloping of the duodenal folds, indicative of intestinal malabsorption syndrome (IMS). Histopathological examination confirmed IMS. Due to the presence of intravascular haemolysis, haemoglobinuria and thrombotic complications, paroxysmal nocturnal haemoglobinuria (PNH) was suspected and subsequently confirmed by flow cytometry. Thus, a diagnosis of classic PNH with IMS and thrombotic complications was established. This unique case highlights the coexistence of PNH and IMS, resembling the complement hyperactivation, angiopathic thrombosis and protein-losing enteropathy disease, suggesting potential shared pathophysiology.

Secondary Hemophagocytic Lymphohistiocytosis: A Series of Three Cases

Hemophagocytic lymphohistiocytosis (HLH) is a disease of abnormal activation of the immune system, either due to a familial cause or a sporadic cause, in relation to various triggering agents. Secondary HLH is a complication of various diseases, such as infections, malignancies, and autoimmune disorders. In our case series, we present three cases of secondary HLH with varied etiologies. Case 1 involved an 18-year-old male with a history of pulmonary tuberculosis, presenting with fever, hepatosplenomegaly, and elevated inflammatory markers. HLH was treated with steroids alongside antitubercular therapy (ATT). In case 2, a 17-year-old male presented with dengue fever, fever, hepatosplenomegaly, and elevated inflammatory markers. HLH was managed with steroids and etoposide. In case 3, a 29-year-old female with systemic lupus erythematosus (SLE) presented with fever, hepatosplenomegaly, and a positive antinuclear antibody (ANA) test. Steroid therapy was initiated for HLH. The prognosis depends on various factors. The management of such cases necessitates expeditious treatment of the underlying disease in conjunction with amelioration of the cytokine storm with the immunosuppressive agents precipitated by the secondary conditions. Once the underlying cause of the cytokine storm is treated, the lethal progression of the disease may come to a halt.

Association between ivermectin treatment and mortality in COVID-19: A hospital-based case-control study

Purpose

This study was designed to test the hypothesis that exposure to ivermectin in early disease prevents mortality due to COVID-19. A secondary objective was to see if the drug has any impact on the length of hospital stay among the survivors.

Methods

It was a hospital-based retrospective case-control study conducted at a tertiary teaching hospital in India. All patients with a diagnosis of COVID-19 who were admitted between 1^st April and 15^th May 2021 and received inpatient care were included. Important variables like demographic details, dates of admission and discharge or death, symptoms at the time of admission, comorbidities, severity of illness at the time of admission, whether ivermectin was administered or not during the course of the illness and other treatments received as part of the standard of care were retrieved from the medical records.

Results

Of the 965 patients who received inpatient care, 307 died during their hospital stay while 658 were successfully discharged. The proportion of cases treated with ivermectin was 17.26% among the non-survivors (53/307) and 17.93% among the survivors (118/658). The effect was statistically insignificant (crude OR = 0.954; 95% CI: 0.668-1.364, P = 0.80). Among the survivors, the median length of stay was 11 days for patients who received ivermectin (IQR: 7-15) as well as for those who did not (IQR: 7-16).

Conclusion

This study did not show any effect of ivermectin on in-patient mortality in patients with COVID-19 and there was no effect of the drug on the length of hospital stay among the survivors.