Search

INTRODUCTION: Metabolic syndrome is a constellation of metabolic abnormalities that includes central obesity, hypertension, elevated fasting glucose, low high-density lipoprotein (HDL) cholesterol, high triglyceride (National Cholesterol Education Program Adult Treatment Panel III [NCEP ATP III]). It is associated with increased risk of coronary artery disease and stroke. Regardless of the existing controversies in diagnosis and definition, the metabolic syndrome is still considered to be a useful diagnostic tool in primary care prevention. A very few studies have been done in this topic in Gujarat, most of the data are from western population. So, no useful data is available regarding association of various parameters of metabolic syndrome particularly in our setup and area. AIMS AND OBJECTIVES: To study clinical profile of metabolic syndrome and its individual components in Type 2 diabetic and non-diabetic subjects. We also want to compare the distribution of metabolic syndrome by using the different criteria (ATP-III and IDF), compare the association of hypercholesterolemia and hypertension with type 2 diabetes mellitus and to compare the distribution of metabolic syndrome with hyperglycaemia and establishing its strong association with Type 2 DM by comparing them with non-diabetics. MATERIALS AND METHODS: we include the patients with T2DM with age >20 years and should be on treatment. We exclude the patient with T2DM age < 20 years, pregnant women, patient on long term steroid therapy, patient with severe complications, moribund patients and patient refusal. We took Waist Circumference Measurements, Blood Pressure Measurement and biochemical tests. DISCUSSION: Present study highlights the prevalence of metabolic syndrome in two different group, diabetic and non-diabetic. It is evident from the study that diabetic patients have higher prevalence of Mets than normal people. It is also concluded that hypertension, hyperlipidemia and central obesity are also closely related with metabolic syndrome. CONCLUSION: In this study, we have completed our data in our hospital with limited number of patients. When we are calculating the prevalence, larger sample size is recommended. So, we can apply the same for generalized population. Same like diabetic patients, we can also compare the prevalence of metabolic syndrome in hypertensive and non-hypertensive patients by dividing the study population into both groups. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice. Its prevalence is higher among older individuals, the most rapidly growing segment of population in Indian subcontinent. Also, different ethnic groups have different risk factors for the development of atrial fibrillation, with valvular heart disease being the most common cause in India and non valvular heart disease in Western countries. Atrial fibrillation may be associated with decreased functional capacity, increased medical expenditures and increased late mortality due to cerebrovascular accident or aggravation of heart failure. Totally new approaches to therapy in form of antiarrhythmics and anticoagulation are also emerging. Ablation or modification of atrioventricular conduction with adoptive rate pacing now permits effective rate control in virtually any patient. In context with recent advances in management and aggressive approach to patient with atrial fibrillation, all patients should be subjected to extensive investigations. MATERIAL & METHODS: Present study was performed in 50 patients who had clinical features, suggestive of atrial fibrillation like Difficulty in breathing, Palpitation, Irregularly irregular pulse - confirmed by ECG. Patients were evaluated and examined in detail. Routine investigations were carried out including haemogram, RFT, LFT, S.electrolytes, ECG, chest X rays, PT with INR and echocardiography. The special investigations like Thyroid function tests, lipid profile, CPK MB, digoxin level, coronary angiography, Holter monitoring and NCCT brain were also done. Treatment was given to the patients in the form of antiarrhythmic drugs, oral anticoagulant, cardioversion and supportive treatment. RESULTS: The incidence of atrial fibrillation increases after the age of 40 years and higher in females. Rheumatic heart disease was the commonest etiology for atrial fibrillation. The cases were due to mitral stenosis and Mitral stenosis + mitral regurgitation. The most common non-valvular causes of atrial fibrillation were Ischemic heart disease. The most common presenting complaint was found to be palpitation followed by chest pain. LVH in ECG was found in 36% of cases with rheumatic heart disease, while 92% in patients with HT + IHD. RVH was presents in 11% (n=3) of patients with rheumatic heart disease. LA clot was found in 29% of cases of rheumatic heart disease. LV clot was detected in 15% of HT+IHD. CONCLUSION: IN India rheumatic mitral valve disease is the commonest cause of atrial fibrillation, unlike in Western studies, where ischemic heart disease is the commonest cause. 2D echocardiography is very helpful to detect the cause of atrial fibrillation, LA size, LV function and LV or LA clot detection. In rheumatic heart disease, LA size co-relates well with incidence of atrial fibrillation, while in ischaemic heart disease low LV function is a better correlating factor. For management of AF diltiazem was used commonly. For antithrombotic therapy warfarin was preferred. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) is considered a common type of lung disease characterized by airflow restriction and serious long-term breathing problems. The maintainable decrease in the expiratory pressure flow is the main feature and inflammation plays a significant role in the pathogenesis of COPD. C-reactive protein (CRP) is an acute-phase protein mainly produced in the liver in response to tissue damage and inflammation. CRP reflects the overall burden of inflammation in the body of patients with COPD in exacerbation and stable conditions. CRP is also a predictor for hospitalization and mortality in chronic respiratory failure. It is assumed that high-sensitivity C-reactive protein (hs-CRP) is increased in patients with COPD and there is a relationship between plasma CRP level and the severity of COPD and quality of life. The aim of the present study was to evaluate the serum level of hs-CRP and assess its correlation with lung function parameters in patients with COPD. Materials and Methods: We included patients who had dyspnea, chronic cough, sputum production and risk factors, such as tobacco use and occupational exposures to dust and chemicals with all degree of airflow severity were consecutively included if they had a post bronchodilator FEV1/FVC of <0.7 after 400 micrograms of inhaled salbutamol and they were clinically stable (no exacerbation for 2 months) at the time of evaluation. Results: The maximum numbers of COPD patients in this study were in the age group of 50-59 years with mean age 52.54 ± 9.55 years. Majority of the patients (30/50) had a history of tobacco use of at least 11-29 pack-years, with a mean of 19.23 years. Almost all the patients had breathlessness and cough with sputum on presentation and had tachypnoea (70%) on presentation. Most of them had Barrel shaped chest (58%), parasternal heave (30%) and Loud P2 (34%). In the present study, 52% (26/50) of the patients had FEV1 50-79% of the predicted i.e., Moderate obstructive disease. In the present study, Correlation of hs-CRP levels was highly significant with mMRC scale, FEV1 and BODE index system, while no statistical co-relation was found with BMI and 6MWD. Conclusion: It was found that hsCRP combined with multidimensional BODE index appears to be an important, accurate biomarker for predicting disease severity in patients with stable COPD. In this setting, hsCRP is significantly correlated with the maximum components of BODE index as well as BODE index alone. Thus hsCRP can be considered as a significant prognostic marker in stable COPD patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Anemia is a frequent debilitating problem and complication of cancer, both at the time of diagnosis and during treatment. It negatively affects the quality of life of cancer patients. Despite being more common in hematologic malignancies, anemia is frequently seen in solid tumors. Most studies show the relationship of anemia in patients with solid tumors or leukemias after the start of chemotherapy. My study aims to find the prevalence and type of anemia in patients diagnosed with malignant solid tumors prior to the start of chemotherapy. MATERIALS AND METHODS: All the patients that came with treatment naive solid malignancies filling the study criteria were examined and detailed clinical history was taken and thorough physical examination was done. The anemia profile was evaluated by using the following tests: Complete Blood Count with peripheral blood smear, serum iron, TIBC, serum ferritin, reticulocyte count, vitamin B12, Serum LDH. RESULTS: The mean age of the cases of solid malignancies in our study was found to be 60 years and out of the 90 cases, 61 were females. The most commonly noted solid malignancies in our study were gynecological (36.6%) out of which the highest number of cases were of the uterus (25.6%), ovaries (9.9%) and cervix (1.1%). The prevalence of anemia increased from 35.4% in stage I - II to 45.2% in stage III and 53.6% in stage IV patients. Out of the 82 patients with anemia, 73 patients (89%) had microcytic hypochromic anemia. Rest of the patients had anemia of normocytic normochromic type (2.4%). In our study, majority of gynecological tumor patients with anemia had a history of bleeding (93.3%) which was a contributing factor for the higher anemia prevalence observed among these tumor types. CONCLUSION: The present study has shown that the main etiology of anemia in Indian cancer patients is iron deficiency. It is a widespread and serious problem especially among gynecological, colorectal, lung and breast cancer patients. Its early evaluation and management could reduce the incidence of treatment-related anemia in cancer patients. Measures directed towards characterization and treatment of anemia should be incorporated as an integral part of cancer management protocols. Patients with anemia should be closely monitored, and a vigilant management strategy should be implemented to reduce the risk of morbidity associated with anemia. [ABSTRACT FROM AUTHOR]

Introduction: Anemia is a very common disease worldwide with even more prevalence in developing countries like India. Prevalence of anemia among women of reproductive age (% of women ages 15-49) in India was 51.40% as of 2016, compared to 9% prevalence in developed countries. It is also the second most common cause of maternal mortality in India. Anemia leads to hyperdynamic state of heart at rest leading to impaired oxygen supply to myocardium. This ultimately leads to supply-demand myocardial mismatch causing myocardial ischemia or infarction. Long standing hyperdynamic state due to anemia may lead to cardiac dilatation and hypertrophy as well. These changes in heart cause cardiac disturbances. Electrocardiography is used to detect ischemic heart diseases, hypertensive heart diseases and asymptomatic arrhythmias. The abnormalities may be proportional to the severity of anemia or show no correlation to hemoglobin levels. The studies which show the effect of iron deficiency anaemia on ECG changes in females are few in India. Hence in the present study we decided to study the electrocardiographic changes in female anemic population. Materials and methods: It is the cross section observation study of 100 female patients of age group between 19-49 years those who were admitted with Hb less than 12 gm/dl. We excluded the patients with pregnancy, diabetes, hypertension, fever, renal disease, liver disease, COPD, cardiac disease and who not giving consent. Results: In the present Cross sectional observational study ECG changes in female anemic patents was studied. In the present study, anemia prevalence was higher in age group 20-40. Studies have shown reduced triglyceride levels in patients with anaemia. In the present study, 31 patients out of the 100 had shown cardiomegaly in chest X-ray. In the present study 45% of the patients presented with sinus tachycardia in ECG. Left axis deviation and left ventricular hypertrophy are seen 30% of the patients in the present study. Lower the hemoglobin values higher is the frequency of left axis deviation In the present study there were no changes in the P wave and QRS complexes. In the present study, 26% of the patients had ST segment depression and 18% of the patients had inverted T wave in the ECG. Conclusion: Anemia is more prevalent in India. Anemia has major effect on heart due to hyperdynamic state. ECG is the basic tool to identify various cardiac diseases. The studies which show the effect of iron deficiency anaemia on ECG changes in females are few in India. Hence in the present study we decided to study the ECG changes in female anemic population. [ABSTRACT FROM AUTHOR]

Introduction: Dengue fever is one of the most common arboviral mediated outbreaks reported with increased prevalence year after year with considerable morbidity and mortality. This study was designed to assess the clinical and biochemical parameters of dengue fever patients. Materials and methods: Prospective observational study was undertaken among adult patients in a Civil Hospital, Ahmedabad. Fifty patients were studied and analyzed. All patients who were NS1 antigen/IgM dengue positive were included in the study. Clinical features, hematological and biochemical parameters were noted. Results: Of the 50 patients studied, majority were males (64%). Fever was the major symptom (100%) followed by headache (96%), myalgia (94%), retro-orbital pain (64%), conjunctival injection (24%), rash (38%), abdominal pain (74%), pleural effusion (30%) and ascites (26%). Significant derangements in platelet (70%), leucocyte counts (78%) and serum transaminases (74%) were noted. Mortality rate was zero. Conclusion: Fever associated with headache, retro-orbital pain, erythematous morbilliform rash, conjunctival suffusion and itching in palms and soles along with thrombocytopenia, leucopenia, elevated liver transaminases should prompt a clinician on the possibility of dengue infection. Platelet transfusions have little role in management of dengue patients. [ABSTRACT FROM AUTHOR]

Background: Malaria a tropical disease has a wide clinical spectrum ranging from uncomplicated disease to a fatal one. The objectives were to study clinical profile of Malaria with special reference to its complications and outcome. Materials and methods: A study was carried out in a tertiary care hospital including total of 50 patients diagnosed with P. Vivax or P. Falciparum Malaria. Data on patients' clinical details with investigations, complications, and outcome was studied. Results: Out of 50 patients (37 male and 13 female), 41 had P. Vivax and 9 had P. Falciparum Malaria. Total 3 patients were complicated; two had cerebral malaria due to P.falciparum and one had multi organ failure due to P. vivax which eventually succumbed. Conclusions: Clinical profile of Malaria was studied which suggest, P.falciparum malaria was more complicated; which comprises cerebral complications, renal complication, hepato-biliary and respiratory complications leading to increased morbidity and mortality. It was observed that P. vivax had better outcome but it can also present with serious and life-threatening complication. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic ketoacidosis (DKA) is a metabolic derangement consisting of high blood glucose concentration, measurable ketone bodies in blood and/or urine and metabolic acidosis. DKA mainly occurs in patients with type 1 diabetes, but it is not uncommon in patients with type 2 diabetes. DKA is a Medical emergency, responsible for significant amount of admissions in Medical Emergency Ward. It is the most common serious and life threatening acute complication of diabetes. Materials and Methods: The present study was carried out on 60 patients who are k/c/o Diabetes Mellitus (Type 1/Type 2) or newly detected above the age of 12 years presented with DKA and have RBS >250 mg/dl, positive serum and urine ketone test, PH < 7.35, HCO3 level < 18 mmol/L, Respiratory rate < 30 per min, Systolic BP >90 mm of Hg and informed written consent given. Results: Infection and insulin therapy discontinuation being the most common causes of DKA. Incidence of DKA is more common in type 1 DM. DKA, most common presenting symptoms were Nausea/Vomiting. DKA is more common in female as compared to male. The mean blood glucose level at presentation higher in type 1 DM patients as compared to type 2 DM. Type 2 DM patients are less dehydrated than type 1 patients. Conclusion: Infection and insulin therapy discontinuation being the most common causes of DKA. Mortality in patients with DKA can be greatly reduced with early recognition of symptoms and precipitating factors and timely administration of insulin therapy. Proper insulin dosage and administration and prevention from infection can decrease incidence of admission in emergency medical ward. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid dysfunction is a disorder of the thyroid gland which manifests either as hyper - or hypothyroidism and is reflected in the levels of thyroid stimulating hormone (TSH). Type 2 Diabetes Mellitus is the commonest endocrine disorder and leading cause of morbidity worldwide. These two most common endocrine disorders encountered in clinical practice have been shown to mutually influence each other, and association between both the conditions has long been reported. The present study was conducted to find out the prevalence of thyroid disorders in patients of type 2 diabetes mellitus. Materials and methods: 100 cases of type 2 diabetes mellitus were examined for thyroid dysfunction. A detailed history was taken regarding presenting symptoms, duration of type 2 diabetes mellitus and clinical course of disease. A family history was taken with special reference to type 2 diabetes mellitus and other comorbidities. BMI was calculated to diagnose obesity. A thorough clinical examination was done. Ophthalmic examination was done to diagnose retinopathy and cataract. Detailed blood investigations were done including serum TSH, free T3 and free T4. Results: Males were more affected with diabetes than females and occurrence of thyroid dysfunction was found more common in females with Type 2 DM in our study. Hypothyroidism was most common type of thyroid dysfunction with affected age group was 51-60 years. DM and thyroid dysfunction were more common in overweight patients. Thyroid dysfunction in type 2 DM was seen more commonly with higher levels of HBA1C. Dyslipidemia was more in patients of diabetes with thyroid dysfunction. Patients taking insulin had more incidence of hypothyroidism than patients on OHA. Diabetes related microvascular complications increase the risk for thyroid dysfunction. Conclusion: Thyroid dysfunction prevalence is very high in patients with diabetes. Patients with diabetes having microvascular complications are more affected with thyroid diseases. Dyslipidemia is also common in DM with thyroid diseases. So thyroid function test must be done on regular basis in each and every patient of DM 2. [ABSTRACT FROM AUTHOR]

Background: Cerebrovascular accident (CVA) remains a major cause of morbidity and mortality worldwide. There is growing evidence that high homocysteine level contribute to the pathogenesis of ischemic stroke. High hohmocysteine levels are associated with increased risk of cardiovascular and cerebrovascular disease, although there are few studies that show no increase in risk, and there is still debate as to the strength and validity of the association. This study has been undertaken to correlate the serum homocysteine level in patients of cerebrovascular accident. Materials and methods: This study comprised of 100 patients of cerebrovascular accident admitted with acute onset of neurological deficit which are radiologically diagnosed. The diagnosis of cerebrovascular accident was made on the basis of history and clinical examination. We did CBC with ESR, renal function test, liver function test, serum homocysteine level, RBS, Fasting lipid profile, vitamin B12, urine routine analysis, HIV, CT scan Brain/MRI Brain, ECG, 2D ECHO, Carotid Doppler if required, ANA / RA factor and any specific investigation if indicated. Results: Highest no of patients were in 5th and 6th decades of life with highest mean serum homocysteine level. Males were more affected with CVA than females and the mean serum homocysteine level was also higher in males. Urban population has higher homocysteine level than rural. Most common presenting symptom of CVA in the present study was hemiplegia. Convulsion was more associated with hemorrhagic CVA rather than ischemic CVA. Hypertension is one of the major risk factors for CVA. The mean homocysteine was higher in vegetarian population. Out of 72 patients having raised S. homocysteine level, 38 patients had vitamin B12 deficiency. Conclusion: Hyperhomocysteinemia is an independent risk factor for CVA. Urban lifestyle is associated with higher incidence of CVA and higher homocysteine level. Homocysteine estimation should be included as a routine laboratory test for persons with cerebrovascular risk factors. Plasma vitamin B12 concentration is inversely associated with s. homocysteine concentration. Treatment of hyperhomocysteinemia with vitamin B12 supplements will reduce homocysteine level and ultimately reduce risk of CVA. [ABSTRACT FROM AUTHOR]

Background: In developing countries, the widespread use of organophosphorus compounds (OPCs) has been accompanied by increasing incidence of poisoning with these agents, both suicidal and accidental. This is attributed mainly to their easy availability, indiscriminate handling, storage and lack of knowledge about the serious consequences of poisoning. Of the various substance used for suicidal attempts in India, OPCs form a significant group. Since the clinical manifestation of OPC poisoning is diverse ranging from mild symptoms to fatal complications in the course of time, we need proper management of the situation. Materials and methods: We studied 50 patients of organophosphorus poisoning. We checked vital parameters, general examination and systemic examination. We also checked for various parameters on like cholinesterase level, complete blood counts, renal function test with electrolytes, liver function test. Results: In this study majority of patients fell in 20-30 years of age group with male predominance from lower and middle socio-economical class and most common reason was suicidal. Precipitating event were domestic problem, marital friction and financial problem. Most common clinical features were vomiting, miosis and giddiness. Majority of the patients belonged to mild grade. The average S.cholinesterase level was low as severity increases. More doses of PAM and atropine are required in severe poisoning. Most common complication was respiratory paralysis. Death was more in severe poisoning. Conclusion: OPC is one of the most common poisoning in India. Reason for poisoning is most commonly suicidal. It is common in male with low socio-economical class mainly due to domestic problems, financial issue and unhappy married life. In patients of OP poisoning presenting symptoms and S.ChE level directly correlated with severity. Therapeutic required dose of PAM and atropine are different in different grade of severity. Survival amongst patients is definitely better if atropine and PAM are being given with Mechanical ventilator support in cases of respiratory insufficiency. [ABSTRACT FROM AUTHOR]