Diabetes is a major public health problem. 285 million persons worldwide have diabetes, of these 51 million are in India. Diabetic peripheral neuropathy is a major microvascular complication of diabetes. Conventional methods used for the diagnosis of diabetic peripheral neuropathy in clinical practice have limited effectiveness. Since peripheral sensory neuropathy is a pivotal element in the causal pathway to both foot ulceration and amputation, screening and early identification of neuropathy offer a crucial opportunity for the patient with diabetes to actively modulate the course of suboptimal glycaemic control to currently recommended targets, and to implement improved foot care before the onset of significant morbidity. This study was carried out to evaluate the usefulness of simple bed side screening modalities for peripheral neuropathy like vibration perception threshold measurement with biothesiometer, 10g semmes-weinstein monofilament, diabetic neuropathy examination and symptom scores and ankle reflex testing in patients with diabetes mellitus and to seek an optimal screening method in diabetic clinic.

We report a rare case of a 50 year old Indian male patient with concomitant tophaceous gout and rheumatoid arthritis (RA) who presented with intradermal tophaceous deposits at some very rare sites. The presence of RA was confirmed by the presence of positive anti-CCP levels as compared to some other rare case reports where nonspecific rheumatoid factor substantiated the presence of RA. The presentation, diagnostic work up and management is discussed and the current literature pertaining to this interesting case is reviewed.

Background: COPD is proven to be a multisystem disorder among which cardiac manifestation are most common. Echocardiography provides a rapid, non-invasive, portable, and accurate method to evaluate the cardiac changes. The aim of this study was to assess the cardiac changes secondary to COPD by echocardiography and to find out the correlation between echocardiographic findings and different grades of severity of COPD.Methods: A total 50 of patients of COPD were selected and staged by spirometry and evaluated by echocardiography.Results: The numbers of patients with mild, moderate, severe and very severe COPD in our study were 4%, 28%, 58%, and 10%, respectively. On echocardiographic evaluation of COPD, 24% cases had normal echocardiographic parameters. Pulmonary hypertension was observed in 35/50 (70%) cases in which prevalence of mild, moderate, and severe PH were 0%, 50%, 79.3%, and 100%, respectively. Right ventricle was enlarged in ECHO in 46% of patients. Right atrium was enlarged in ECHO in 14% of patients. Measurable tricuspid regurgitation (TR) was observed in 72% cases. Conclusions: Prevalence of cardiac dysfunction increases as the severity of COPD increases. It is recommended that echocardiography should be done early in all cases of COPD to diagnose the cardiac complications of COPD, so that early interventions can be undertaken in order to improve quality of life and decrease mortality and morbidity in COPD patients.

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