BACKGROUNDThe aim of the study is to examine endothelial dysfunction in type 2 diabetes with inadequate glycaemic control and to study improvement in endothelial function after glycaemic control. MATERIALS AND METHODSAn observational study was performed in type 2 diabetic patients (35-60 years) with inadequate glycaemic control. Endothelial function was evaluated by non-invasive method. Flow associated dilation (%FAD) change in lumen diameter of brachial artery after glyceryl trinitrate spray (%GTN) were calculated. After achieving glycaemic control for >3 months, HbA1c and endothelial function test were compared with baseline. RESULTSOut of 73 patients (mean age 50.79±4.96 years) enrolled, 46.5% were male and 41.09% were overweight. The mean duration of diabetes was 4.84 ± 3.2 years. Significant difference was noted in HbA1c, fasting blood glucose and postprandial blood glucose after treatment (p<0.05 for all). Mean %FAD before glycaemic control was 7.34 ± 2.16 whereas mean % GTN was 14.60 ± 2.96; 89% patients had % FAD <10%. Significant improvement was observed in %FAD after glycaemic control (p<0.05) but not in %GTN (p=0.47). Percentage FAD significantly increased after glycaemic control in patients with HbA1c <7% (p<0.05). No significant difference was seen in % GTN in patients with HbA1c less than or more than 7% (p>0.05). %FAD did not improve in patients with baseline HbA1c >7% (p>0.05). After anti-diabetic therapy, reduction in HbA1c (p <0.05) and %improvement in FAD (p< 0.01) was better in patients with baseline HbA1c <7% compared to those with >7%. HbA1c and body mass index had significantly negative correlation with %FAD before as well as after glycaemic control. CONCLUSIONUncontrolled type 2 diabetes mellitus is associated with impaired endothelial function. Negative correlation is observed between endothelial dysfunction and glycaemic status of type 2 diabetes patients. Glycaemic control results in improvement of endothelial dysfunction.

Malaria can cause severe complications, sometimes affecting central nervous system. Cranial nerve palsies are rare after malaria. Plasmodium vivax malaria, often thought to be a benign disease can sometime lead to severe complications. We report a case of lower motor neuron palsy after plasmodium vivax malaria. KEYWORDSFacial Palsy, Vivax Malaria. HOW TO CITE THIS ARTICLE: INTRODUCTIONMalaria is a common health problem in tropical countries like India. Of the four plasmodium species causing malaria in humans, P. vivax is the most widespread. P. vivax malaria in India is more prevalent than plasmodium falciparum. 1 In India P. vivax and P. falciparum accounts for about 60-65% and 35% cases respectively. 2 P. vivax is often thought to be benign infection; however, it may sometime result in severe complications affecting different organs. 3 Commonly reported severe complications of P. vivax malaria include haematological problems, such as anaemia and thrombocytopenia, liver or kidney dysfunction, lung related complications, hypoglycaemia, shock and cerebral malaria. 2,3 We report here an unusual case of bilateral lower motor neuron palsy after P. vivax malaria.

Paraganglioma is an extra-adrenal tumour of the autonomic nervous system. Definitive diagnosis of paraganglioma is usually done with histologic examination. Surgical removal is the treatment of choice for symptomatic paraganglioma. We report a case of functional retroperitoneal paraganglioma in a 35-year-old patient who presented with symptoms of intermittent headache, palpitation and sweating.

BACKGROUND To study cardiac diseases in Human Immunodeficiency (HIV) infected patients and examine correlations of cardiovascular manifestations with CD4 counts and Anti-Retroviral Therapy (ART). MATERIALS AND METHODS In this cross-sectional study, HIV seropositive patients admitted in medicine ward were evaluated for presence of cardiac diseases by clinical examination and non-invasive cardiovascular investigation (chest x-ray, ECG and ECHO). RESULTS Fifty patients (mean age 37.36 years) were included. A total of 64% had Acquired Immune Deficiency Syndrome (AIDS), while 46% were on ART. Cardiac disorders were detected in 52% patients; however, only 6% patients were symptomatic. Systolic dysfunction, diastolic dysfunction, pericardial effusion, dilated cardiomyopathy, pulmonary hypertension and cardiac tumour were detected in 5 (10%), 16 (32%), 6 (12%), 3 (6%), 4 (8%) and 1 (2%) patients respectively. In 39 (78%) patients Electrocardiogram (ECG) was normal, whereas 11 (22%) patients showed abnormalities in the ECG. The abnormalities included sinus tachycardia 7 (14%), Ischaemic Heart Disease (IHD) 2 (4%), Left Ventricular Hypertrophy (LVH) 1 (2%) and low voltage complexes 1 (2%). Cardiomegaly was detected in 3 (6%) patients. Lower CD4 count was not associated with cardiac disorders (x 2 = 12; p = 0.213), but was associated with pericardial effusion (x 2 = 28 and p = 0.032). Lower CD4 count was significantly associated with cardiomyopathy (table 3; x 2 = 54; p = 0.000), but not with diastolic dysfunction (x 2 = 50; p = 0.394). ART status was not associated with cardiomyopathy (x 2 = 6; p = 0.199) or diastolic dysfunction (x 2 = 0.995; p = 0.318). CONCLUSION Cardiac disorders are common in HIV infected patients, but only few are symptomatic. Non-invasive investigations help in early diagnosis of asymptomatic cardiac disorders.