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Introduction: Cardiac autonomic neuropathy (CAN) is a key complication of type 2 diabetes mellitus (Ty2DM). Vascular endothelial-derived growth factor (VEGF-A) plays a key role in diabetic macrovascular and microvascular complications. It is shown to be elevated in diabetic neuropathy and has the potential to serve as a biomarker in Ty2DM. We evaluated VEGF-A levels and cardiac autonomic function in newly diagnosed Ty2DM patients. Materials and Methods: Forty-four newly diagnosed patients (with symptoms within 1 year from the date of recruitment) were included in the study. Cardiac autonomic function was assessed using heart rate variability (HRV) and Ewing's battery tests. Ewing's scores were computed and tabulated. VEGF-A levels were estimated using enzyme-linked immunosorbent assay (ELISA). Results: The patients demonstrated normal responses to the reactivity tests. Ewing's scores were 0 (0-0) and 0 (0-0) for sympathetic and parasympathetic parameters, respectively. The autonomic tone was impaired as assessed by HRV parameters. VEGF-A levels were elevated (308.3 ± 167.2 pg/mL) when compared with the previous literature. Discussion: Impaired tone with normal reactivity was suggestive of early stage of autonomic neuropathy. Elevated VEGF-A levels may be attributed to a protective action of the factor seen in early stages of neuropathy in Ty2DM. Serial VEGF-A estimation in large cohorts of newly diagnosed diabetics may validate it as a biomarker in CAN seen in Ty2DM. [ABSTRACT FROM AUTHOR]

Lead ranks as one of the most serious environmental poisons all over the world amongst toxic heavy metals with no known biological function useful for the human body. A case of lead toxicity due to consumption of herbal medicine is being discussed. The case presented with gastrointestinal complaints and history of intake of herbal medicines for diabetes control for past 8 months. The analysis of the powdered herbal medicine procured from ayurveda practitioner was found to have high content of lead responsible for the lead toxicity. The patient is under regular followup. He has improved symptomatically on chelating therapy and blood lead levels have gradually improved. Regular awareness programs should be conducted in the population regarding possible exposure through home made herbal remedies so that general public can be made aware of the dangerous side effects of lead and other heavy metals on health. [ABSTRACT FROM AUTHOR]

Five lakh patients of tuberculosis die every year in India. Meningeal tuberculosis is an endemic disease with 7-12% incidence. Delay in diagnosis and in initiating treatment results in poor prognosis and sequelae in upto 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective and non-invasive test for diagnosing this disease. Forty patients between 6-24 months of age having symptoms and signs of meningitis were selected and divided into two groups tuberculous and non-tuberculous, depending upon the accepted criteria. Cerebrospinal fluid (CSF) was drawn and adenosine deaminase (ADA) estimated. Out of 19 tuberculous patients, 18 patients had CSF ADA at or above the cut-off value while 1 had below the cut-off value. Out of 21 non-tuberculous patients, 2 patients had at or above the cut-off value while 19 were below this value. Results of this study indicate that ADA level estimation in CSF is not only of considerable value in the diagnosis of tuberculous meningitis, CSF ADA level of 10 U/L as a cut-off value exhibited 94.73% sensitivity and 90.47% specificity in differentiating tuberculous from non-tuberculous meningitis; it also has 90.00% positive predictive value and 95.00% negative predictive value. ADA estimation in CSF is simple, inexpensive, rapid and fairly specific method for making a diagnosis of tuberculous aetiology in TBM; especially when there is a dilemma of differentiating the tuberculous aetiology from non-tuberculous and for this reason ADA estimation in TBM may find a place as a routine investigation.