S. Aparna Reddy

Bio: S. Aparna Reddy is an academic researcher from Sri Venkateswara Institute of Medical Sciences. The author has contributed to research in topics: Tuberculosis & Rheumatoid arthritis. The author has an hindex of 1, co-authored 6 publications receiving 5 citations.

Derivation & validation of glycosylated haemoglobin (HbA 1c ) cut-off value as a diagnostic test for type 2 diabetes in south Indian population.

Abstract: Background & Objectives: Glycosylated haemoglobin (HbA 1c ) has been in use for more than a decade, as a diagnostic test for type 2 diabetes. Validity of HbA 1c needs to be established in the ethnic population in which it is intended to be used. The objective of this study was to derive and validate a HbA 1c cut-off value for the diagnosis of type 2 diabetes in the ethnic population of Rayalaseema area of south India. Methods: In this cross-sectional study, consecutive patients suspected to have type 2 diabetes underwent fasting plasma glucose (FPG) and 2 h post-load plasma glucose (2 h-PG) measurements after a 75 g glucose load and HbA 1c estimation. They were classified as having diabetes as per the American Diabetes Association criteria [(FPG ≥7 mmol/l (≥126 mg/dl) and/or 2 h-PG ≥11.1 mmol/l (≥200 mg/dl)]. In the training data set (n = 342), optimum cut-off value of HbA 1c for defining type 2 diabetes was derived by receiver-operator characteristic (ROC) curve method using oral glucose tolerance test results as gold standard. This cut-off was validated in a validation data set (n = 341). Results: On applying HbA 1c cut-off value of >6.3 per cent (45 mmol/mol) to the training data set,sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for diagnosing type 2 diabetes were calculated to be 90.6, 85.2, 80.8 and 93.0 per cent, respectively. When the same cut-off value was applied to the validation data set, sensitivity, specificity, PPV and NPV were 88.8 , 81.9, 74.0 and 92.7 per cent, respectively, although the latter were consistently smaller than the proportions for the training data set, the differences being not significant. Interpretation & conclusions: HbA 1c >6.3 per cent (45 mmol/mol) appears to be the optimal cut-off value for the diagnosis of type 2 diabetes applicable to the ethnic population of Rayalaseema area of Andhra Pradesh state in south India.

Disseminated tuberculosis in a patient with systemic lupus erythematosus

Abstract: Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder. Intercurrent infections and nephritis are important causes of mortality in SLE. Among infections, tuberculosis (TB) is of particular importance as SLE patients are more susceptible to develop active TB, prior TB can precipitate SLE in genetically susceptible individuals and similar clinical presentations of SLE flare and TB may lead to delayed diagnosis. We report a patient with SLE, who developed disseminated TB. The present case highlights the importance of a high index of suspicion and focussed evaluation in the diagnosis of intercurrent infections, particularly TB in patients with SLE

Case Report: Disseminated tuberculosis in a patient with systemic lupus erythematosus

Abstract: Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder. Intercurrent infections and nephritis are important causes of mortality in SLE. Among infections, tuberculosis (TB) is of particular importance as SLE patients are more susceptible to develop active TB, prior TB can precipitate SLE in genetically susceptible individuals and similar clinical presentations of SLE flare and TB may lead to delayed diagnosis. We report a patient with SLE, who developed disseminated TB. The present case highlights the importance of a high index of suspicion and focussed evaluation in the diagnosis of intercurrent infections, particularly TB in patients with SLE

Hyperphysiological F-18 Fludeoxyglucose Uptake of Masticator Muscles in a Case of Awake Bruxism.

Abstract: F-18 FDG is a tracer of glucose metabolism, which is commonly used in PET/CT for oncological diagnosis and staging. F-18 FDG uptake represents the glycolytic activity in the cell. Physiological FDG concentration may be noted often in the muscles of head and neck, tongue, muscles on mastication, extra ocular muscles due to eye movements, cricopharyngeus and posterior cricoarytenoid muscles on phonation, etc. Here we report a case of Awake Bruxism, who came for F-18 FDG PET/CT for evaluation of Pyrexia of unknown origin (PUO), showing intense F-18 FDG uptake symmetrically in masticator muscles. Bruxism is a habit of involuntary spasmodic grinding or clenching of teeth. Many factors like psychosocial, genetic, certain medications and sleep disorders are known to be associated with bruxism. Therefore knowledge of physiological F-18 FDG uptake as well as artifactual uptake is essential for nuclear medicine physicians, to avoid ambiguity in diagnosis.

Comparison of Hemoglobin A1c with Fasting and 2-h Plasma Glucose Tests for Diagnosis of Diabetes and Prediabetes among High-risk South Indians.

Abstract: 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

Choice of criterion used in the receiver operating characteristic analysis.

Abstract: We read with interest the article of Mohan et al1 on determination of glycosylated haemoglobin (HbA1c) cut-off value for the diagnosis of type 2 diabetes in Rayalaseema area in Andhra Pradesh, Southern India1. They mention that various studies have reported different HbA1c cut-off values from ≥5.6 per cent (38 mmol/mol) to ≥7.0 per cent (53 mmol/mol) and that ‘age, ethnicity, genetic makeup, erythrocyte lifespan and erythrocyte environment’ are the most likely causes of the observed variance. We believe that in selecting the criterion used to derive the most appropriate test cut-off value in the receiver operating characteristic (ROC) curve analysis, we should also consider other important contributing factors2.

Intermediate hyperglycaemia and 10-year mortality in resource-constrained settings: the PERU MIGRANT Study.

Abstract: AIM To determine whether intermediate hyperglycaemia, defined by fasting plasma glucose and HbA1c criteria, is associated with mortality in a 10-year cohort of people in a Latin American country. METHODS Analysis of the PERU MIGRANT Study was conducted in three different population groups (rural, rural-to-urban migrant, and urban). The baseline assessment was conducted in 2007/2008, with follow-up assessment in 2018. The outcome was all-cause mortality, and the exposure was intermediate hyperglycaemia, using three definitions: (1) impaired fasting glucose, defined according to American Diabetes Association criteria [fasting plasma glucose 5.6-6.9 mmol/l (100-125 mg/dl)]; (2) intermediate hyperglycaemia defined according to American Diabetes Association criteria [HbA1c levels 39-46 mmol/mol (5.7-6.4%)]; and (3) intermediate hyperglycaemia defined according to the International Expert Committee criteria [HbA1c levels 42-46 mmol/mol (6.0-6.4%)]. Crude and adjusted hazard ratios and 95% CIs were estimated using Cox proportional hazard models. RESULTS At baseline, the mean (sd) age of the study population was 47.8 (11.9) years and 52.5% of the cohort were women. The study cohort was divided into population groups as follows: 207 people (20.0%) in the rural population group, 583 (59.7%) in the rural-to-urban migrant group and 198 (20.3%) in the urban population group. The prevalence of intermediate hyperglycaemia was: 6%, 12.9% and 38.5% according to the American Diabetes Association impaired fasting glucose definition, the International Expert Committee HbA1c -based definition and the American Diabetes Association HbA1c -based definition, respectively, and the mortality rate after 10 years was 63/976 (7%). Intermediate hyperglycaemia was associated with all-cause mortality using the HbA1c -based definitions in the crude models [hazard ratios 2.82 (95% CI 1.59-4.99) according to the American Diabetes Association and 2.92 (95% CI 1.62-5.28) according to the International Expert Committee], whereas American Diabetes Association-defined impaired fasting glucose was not [hazard ratio 0.84 (95% CI 0.26-2.68)]. In the adjusted model, however, only the American Diabetes Association HbA1c -based definition was associated with all-cause mortality [hazard ratio 1.91 (95% CI 1.03-3.53)], whereas the International Expert Committee HbA1c -based and American Diabetes Association impaired fasting glucose-based definitions were not [hazard ratios 1.42 (95% CI 0.75-2.68) and 1.09 (95% CI 0.33-3.63), respectively]. CONCLUSIONS Intermediate hyperglycaemia defined using the American Diabetes Association HbA1c criteria was associated with an elevated mortality rate after 10 years in a cohort from Peru. HbA1c appears to be a factor associated with mortality in this Peruvian population.

Thyroid Profile in Rheumatoid Arthritis

Abstract: Rheumatoid Arthritis (RA) and thyroid disorders have autoimmunity as one of the aetiological factors. This study aims to find the thyroid profile in RA patients. This is a descriptive cross-sectional study of 164 RA patients who attended Rheumatology OP department of Government Medical College Thiruvananthapuram over a period of one year in 2016, diagnosed according to ACR/EULAR 2010 criteria for RA. Activity index is calculated using DAS 28 scoring based on ESR. All the patients were tested for TSH, FT4, FT3, and Anti-TPO by chemiluminescent Immunoassay method. Thyroid status is defined based on the Dutch National Healthcare Consensus Committee. The mean age at diagnosis of RA was 43.3years ±11.7 years and mean duration of symptoms of RA were 4.7± 2.3 years. 90.2% were females and 9.8% were males. Thyroid abnormalities are found in 29.3% and relatively more among those between 41-50 years. 24.4% were hypothyroid, 3.7% had subclinical hypothyroidism, and 2% had subclinical hyperthyroidism. 14.6%) had Thyroid swelling, 6.1% had multi nodular goitre, and 8.5% had diffuse goitre. Among the patients with thyroid dysfunction, all had constitutional symptoms and 24.4% had morning stiffness for more than an hour. Mean duration of symptoms of thyroid dysfunction were5.1±3.0 years compared to 4.5±1.8 years in normal. There was significant correlation of patients with thyroid dysfunction to positive anti TPO antibodies. 27 patients with thyroid abnormalities were on treatment with NSAIDS or DMARDs. There was a significant correlation between RA and thyroid dysfunction and the commonest abnormality was hypothyroidism.

Mediastinal Pseudo-Tumor Tuberculosis Associated with Systemic Lupus Erythematosus

Abstract: We report the singular association of mediastinal pseudo-tumoral tuberculosis [TB] with systemic lupus erythematosus [SLE]. D. I, 22 years old woman, is followed for a SLE since 2006 controlled by hydrochloroquine ‘HCQ’200mg twice/day and a thyroiditis of Hashimoto under levothyrox 125 mg/d. It does not relate to tuberculosis. She is hospitalized in pneumology for progressive dyspnea and chest pain. Objective clinical examination shows a conserved general condition, apyrexia T° to 37, BMI to 21.1 (without notion of loss of weight), heart beat 94 / min, respiratory rate at 24 cycle/min and blood pressure at 110/60 mmHg. The pleuropulmonary and cardiovascular examination were without abnormality and thus the remainder of the clinical examination. The image of the thoracic face fails with a right para-cardiac opacity erasing the right edge of the cortex and the CT concludes to a mediastinal tumoral process, filling the gutter vertebral and extending from T6 to T10, with tissue density presenting areas of necrosis within it. Bronchial fibroscopy finds a thickening of inter-lobar spurs and bronchial biopsies identifies a bronchial mucosa site of chronic inflammatory remodeling with presence of multi-nucleated giant cells suggesting a tuberculoid process. The parameters of the hemogram were normal and the inflammatory syndrome was attested by both the increase ERS at 54 mm and the level of CRP at 12 mg/l. The smears, negative on direct examination, will prove positive for culture on Lowenstein medium. Antituberculosis treatment has been prescribed with good clinical, bacteriological and radiological progress. Long-term asymptomatic mediastinal pseudo-tumoral tuberculosis can be revealed at the compressive stage by dyspnea and chest pain. The fear of lymphoma requires biopsies with pathological examinations which sometimes reveal benign affections (tuberculosis, sarcoidosis in their tumor forms) which can enamel the autoimmune disorders characterizing a SLE.