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Showing papers in "International Journal of Advances in Medicine in 2017"


Journal ArticleDOI
TL;DR: Echocardiographic examination is reliable in following COPD patients with PAH instead of repeated cardiac catheterization and correlated with the severity of the disease (p<0.05).
Abstract: Background: COPD is a powerful and independent risk factor for cardiovascular morbidity and mortality which includes right ventricular (RV) dysfunction and cor pulmonale secondary to pulmonary arterial hypertension (PAH), left ventricular dysfunction. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate cardiac functions. Early diagnoses and intervention for cardiac comorbidities would reduce mortalities in COPD patients. The aim of this study is to find echocardiographic changes in COPD patients and to assess RV dysfunction by echocardiography and correlate with the disease severity. Methods: 100 patients of COPD fulfilling the inclusion criteria coming to OPD/wards of NMCH, Kota were recruited. They were staged by pulmonary function test (PFT) and evaluated by echocardiography. Statistical analysis of correlation was done with chi square test and statistical significance was taken p<0.05. Results: Most common echocardiographic finding was cor pulmonale, which was present in 62% of cases, other echocardiographic findings were PAH in 44% cases, RA/RV dilatation (43%), RVH (42%), LVDD (46%), RVSD (14%) and LVH in 11% of cases. Echocardiographic signs of RV dysfunction observed are PAH, cor pulmonale and RVSD which are correlated with the severity of the disease (p<0.05). Conclusions: Echocardiographic examination is reliable in following COPD patients with PAH instead of repeated cardiac catheterization. The incidence of RV dysfunction is more common as the severity of COPD increases and there is a significant correlation between the degree of air flow limitation (FEV1) and RV dysfunction.

18 citations


Journal ArticleDOI
TL;DR: Azithromycin (10mg/kg) given once daily for seven days has proven effective in the treatment of typhoid fever in some adults and children, and a dose of 1g per day for days was also found to be more effective in most adults.
Abstract: Typhoid fever is still a deadly disease in developing countries, particularly in India. Although, the paediatric population is mostly affected by this disease, yet the disease is an important cause of morbidity and mortality in adult populations also. In India, most of the cases of typhoid fever are diagnosed clinically, or at the most by the Widal test which is not fool proof. The disease typhoid fever is an orally transmitted communicable infectious disease caused by the bacteria Salmonella typhi . It is usually caused by consuming impure water and contaminated food. Salmonella typhi is serologically positive for lipopolysaccharide antigens O9 and O12, protein flagellar antigen Hd, and polysaccharide capsular antigen Vi. S. typhi Vi-positive strains are more infectious and virulent than Vi-negative strains. Following the incubation period of 7 to 14 days, there is onset of fever and malaise. The fever is then accompanied by chills, headache, malaise, anorexia, nausea, vague abdominal discomfort, dry cough and myalgia. These are followed by coated tongue, tender abdomen, hepatomegaly, and splenomegaly. Azithromycin (10mg/kg) given once daily for seven days has proven effective in the treatment of typhoid fever in some adults and children. A dose of 1g per day for five days was also found to be more effective in most adults. Of the third generation cephalosporins, oral Cefixime (15-20mg per kg per day, for adults, 100-200mg twice daily) has been widely used. Intravenous third generation cephalosporins (ceftriaxone, cefotaxime) are effective. Aztreonam and imipenem are potential third line drugs.

15 citations


Journal ArticleDOI
TL;DR: Haematological profile in diabetes patients in deranged and diabetics are more prone for anemia, leucocytosis and lymphocytotosis, which shows that routine and regular screening for haem atological profile is recommended in diabetic patients to initiate early prevention strategies and to reduce the morbidity related to it.
Abstract: Background: Anemia is a common haematological finding in diabetic patients. Many research studies have reported that anemia mostly occurs in patients with diabetes who also have renal insufficiency. A few other studies have also reported an incidence of anemia in diabetics prior to evidence of renal impairment. Anemia occurs earlier and at a greater degree in patients presenting with diabetic nephropathy than those presenting with other causes of renal failure. The objective of this study is to determine the haematological profile among type 2 Diabetes mellitus in comparison with non-diabetic controls. Methods: Hospital based case control study was conducted in a rural tertiary care centre for a period of 1 year (May 2016 to April 2017) among type 2 diabetic patients and equal proportion of controls without diabetes. 70 diabetics and non-diabetics as controlled were enrolled for the study. Pretested and structured questionnaire was used to collect the data from subjects. For laboratory investigation 5 ml of blood was drawn from the patient and analysed in the automated cell counter for haematological parameters. Data was analysed using SPSS 22 version, Chi-square test and independent t test was the test of significance for qualitative and quantitative data respectively. P value of <0.05 was considered to be statistically significant. Results: Mean age of diabetics was 55.7±3.6 years and non-diabetics was 56.2±3.5 years. Majority of subjects in both the groups were females. In diabetics mean haemoglobin, RBCs, PCV, and MCV was significantly lower than in non-diabetics. Whereas mean MCHC, WBCs and lymphocytes was significantly higher in diabetics compared to non-diabetics. No difference was observed for MCH, neutrophils and platelets between two groups. This shows that diabetics are prone for anemia, leucocytosis and lymphocytosis. Conclusions: Haematological profile in diabetes patients in deranged and diabetics are more prone for anemia, leucocytosis and lymphocytosis. Hence routine and regular screening for haematological profile is recommended in diabetic patients to initiate early prevention strategies and to reduce the morbidity related to it.

14 citations


Journal ArticleDOI
TL;DR: GDM continues to be an important obstetrical condition with significant feto-maternal morbidity in diabetic mothers with suboptimal glycaemic control during pregnancy and is found to increase with increasing age, with increasing parity, low socioeconomic strata and in urban population.
Abstract: Background: Prevalence of the diabetes among pregnant women is increasing, attributable to advance maternal age, multi foetal gestation, increased body mass index, strong family history, sedentary life style, change in the diet, continued immigration. Gestational diabetes has few symptoms, commonly diagnosed by screening during pregnancy. Methods: The present study was conducted at Department of Medicine and Department of Obstetrics and Gynaecology, Dr. S.N. Medical College, Jodhpur. Rajasthan, India. Results: Out of 476 patients attending the antenatal outdoor at the Umaid Hospital, Jodhpur, Rajasthan, India. The prevalence of gestational diabetes in present study was 7.98%, Incidence of GDM found to increase with increasing age with maximum prevalence (10.71%) in more than 30 years age group, with increasing parity, low socioeconomic strata and in urban population. With maximum prevalence amongst higher parities (12.5%) in >G5 and higher). The incidence was higher with history of PIH (36.36%), family H/O DM (33.3%), GDM (12.12%), perinatal losses (15.15%), anomalous baby (9.09%), high BMI (67%). GDM complicate the normal course of pregnancy with increased incidence of PIH (36.4), Polyhydramnios (27.2%), infections like vaginal candidiasis (24.2%) and UTI (39.3%). The infant of diabetic mother had 12 (32.29%), 9 (26.47%), 11 (32.35%), 8 (23.53%) 5 (14.70%) and 3 (8.82%) of hypoglycemia, respiratory distress, macrosomia, congenital anomalies, birth injuries, polycythaemia, and hypocalcaemia respectively in diabetic mothers with suboptimal glycaemic control during pregnancy. Conclusions: GDM continues to be an important obstetrical condition with significant feto-maternal morbidity. Complications in infant of diabetic mother are more common with those mothers who had poor glycaemic control.

12 citations


Journal ArticleDOI
TL;DR: The most common cardiac manifestations noted were transient rhythm abnormalities, of which sinus bradycardia was the commonest, and there was no evidence of myocarditis in any of the patients.
Abstract: Background: This study was done to observe the presence of Electrocardiographic (ECG) changes in patients presenting with dengue infection and to evaluate whether there were any related clinical cardiac manifestations and to find out the correlation of cardiac manifestations to warning signs of dengue. Methods: The study was conducted at MLN Medical College, Allahabad in the Department of Medicine between July 2016 to December 2016. One hundred consecutive patients aged 18 years or more with positive dengue serology were interviewed and examined. ECG was done for all patients. The data was analyzed using statistical significance tests. Results: Thirty-six patients had no warning signs, 64 patients had warning signs, out of which 43 patients had two or more warning signs while 21 patients had single warning sign. Most common warning sign in this study was abdominal pain (50%) and Vomiting (45 %) while hepatomegaly was the least common warning sign. The most common cardiac abnormalities noted were rhythm abnormalities of which the commonest was sinus bradycardia, found in 60 percent. There was statistically significant correlation between cardiac manifestations and all the warning signs except lethargy/restlessness and hepatomegaly. Conclusions: The most common cardiac manifestations noted were transient rhythm abnormalities, of which sinus bradycardia was the commonest. There was no evidence of myocarditis in any of the patients. There was statistically significant correlation between cardiac manifestations and all the warning signs except lethargy/restlessness and hepatomegaly.

11 citations


Journal ArticleDOI
TL;DR: Epidermal cyst and nevus were the commonest benign lesions and sebaceous carcinoma was the most common malignant tumor and Eyelid lesions were commoner in females and in 5th and 6th decades.
Abstract: Background: Eyelid lesions are commonly encountered in histopathology practice and encompass a wide variety of non-neoplastic and neoplastic lesions. Here we report the histopathological features of eyelid lesions in patients presenting to a tertiary care center in Kerala, South India. Methods: In this retrospective study, a total of 414 eyelid lesions were identified over a period of 10 years (January 2006 - December 2015). In each case, details including age, gender and final histopathological diagnosis were recorded from histopathology registers. Results: Non-neoplastic lesions (52.4%) were more common than neoplastic lesions (47.6%). In the neoplastic lesions, benign tumors outnumbered (37.7%) malignant tumors (9.9%). Age of patients ranged from 1 to 90 years with a mean age of 43.4 years. M: F ratio was 1:1.3. The most common non-neoplastic lesion was epidermal cyst (14.3%) followed by parasitic granuloma (9.2%), chalazion and dermoid cyst (5.6% each). Nevus was the commonest benign eyelid tumor (13.7%) followed by squamous papilloma (9.2%), seborrhoeic keratosis and capillary hemangioma (3.9% each). Sebaceous carcinoma was the most frequent malignant tumor (2.4%) followed by squamous cell carcinoma (2.2%) and basal cell carcinoma (1.5%). Uncommon lesions encountered were actinomycosis, tuberculous granuloma, amyloid deposit, calcinosis cutis, molluscum, angiolymphoid hyperplasia with eosinophilia, xanthelasma, granular cell tumor, benign fibrous histiocytoma, mucinous eccrine adenocarcinoma etc. Conclusions: Eyelid lesions were commoner in females and in 5th and 6th decades. Epidermal cyst and nevus were the commonest benign lesions and sebaceous carcinoma was the most common malignant tumor. The results are comparable with available data from South India.

11 citations


Journal ArticleDOI
TL;DR: Family history of diabetes and past history of congenital anomalies are statistically significant in GDM group as compared to non GDM.
Abstract: Background: Diabetes is estimated to complicate 2-5% of all pregnancies of which 90% of those are detected during pregnancy i.e. gestational diabetes mellitus (GDM) and the rest are overt or pregestational i.e. either Type 1 or Type 2. According to ADA, approximately 7% of all pregnancies are complicated by GDM resulting in more than 2,00,000 cases annually. The aim was to study the incidence of GDM among pregnant women between 24 to 28 weeks of gestation, to evaluate and compare the occurrence of risk factors e.g.; family history of diabetes, prematurity, history of foetal loss and congenital anomaly associated with diabetes in pregnancy. Methods: 50gm of glucose, glucose challenge test (GCT) was given to women coming for antenatal check-up between 24 to 28 weeks of gestation irrespective of presence or absence of risk factors for GDM.1 hour glucose levels were checked. Patients with glucose levels more than 130mg/dl were subjected to 100gm of oral glucose tolerance test (OGTT) according to Carpenter and Coustan modification of the National Diabetes Data. Data was compiled and statistically analysed . Results: In this study it was observed that 20 (women had raised GCT, 11 (5.3%) women developed GDM out of 206 women. All GDM patients have one or more risk factors. Age >25 years (63.6%) fetal loss (36.3%), BMI (33.3%) are common risk factors followed by family history of diabetes (27.3%). Conclusions: Family history of diabetes and past history of congenital anomalies are statistically significant in GDM group as compared to non GDM.

10 citations


Journal ArticleDOI
TL;DR: Fine Needle Aspiration evaluation is a quick, easy, relatively non - traumatic, and, in expert hands, a reliable method of diagnosing the pathology underlying enlarged superficial lymph nodes.
Abstract: Background: The aim of the study was to study the pattern of pathologies identified on FNA of superficial lymph nodes in a tertiary hospital in Hyderabad during the period January 2014 to August 2016, as well as to identify the profile of patients undergoing the procedure at our Hospital. Methods: The data pertaining to the details of the patients who underwent FNA evaluation of superficial lymph nodes from the period January 2014 to 31 August 2016 at a tertiary hospital located in Hyderabad, Telangana, was analysed to determine the age and sex distribution of the patients and the distribution of pathologies diagnosed on FNA evaluation of the lymph nodes. Results: The female gender was predominant (61%; 156 out of 253 patients) among the patients who underwent FNA evaluation of lymph nodes. A majority of the patients were in the age group of 20 to 50 years. Reactive lymph node hyperplasia was the predominant diagnosis in our series (49.8 %; 126 cases out of 253 FNA evaluations). Granulomatous lymphadenitis was the second most common diagnosis (37.15%; 94 out of 253 FNA evaluations). Conclusions: Fine Needle Aspiration evaluation is a quick, easy, relatively non - traumatic, and, in expert hands, a reliable method of diagnosing the pathology underlying enlarged superficial lymph nodes. Reactive lymph node hyperplasia and granulomatous lymphadenitis were the two most common causes of lymph node enlargement in our series.

10 citations


Journal ArticleDOI
TL;DR: The majority of ovarian lesions received for evaluation were benign and unilateral, and most patients were in the third to sixth decades of life.
Abstract: Background: The aim of the study was to identify the pattern of pathologies involving ovarian mass lesions which were received for histopathological evaluation at a tertiary hospital in Hyderabad, Telangana, India during the period January 2012 to December 2016 Methods: The data pertaining to samples of ovarian lesions received for histopathological evaluation at the laboratory of a tertiary care hospital in Hyderabad from January 2012 to December 2016, were analyzed to determine the pattern of pathologies diagnosed during such evaluation and the age distribution of all lesions Results: Non-neoplastic lesions of the ovary constituted 440% of all cases received; follicular cysts constituted 455% of these lesions Malignant lesions constituted only 20% of all pathologies Serous cystadenoma of the ovary constituted the predominant neoplastic lesion diagnosed (625% of all neoplastic lesions) 532% of patients whose samples were received belonged to the age group of 20-39 years 908% of the lesions were unilateral Conclusions: The majority of ovarian lesions received for evaluation were benign and unilateral Most patients were in the third to sixth decades of life

10 citations


Journal ArticleDOI
TL;DR: MRI CSF flowmetry using phase contrast method is an advanced imaging parameter which can non-invasively and reliably detect NPH and can act as a prognostic marker.
Abstract: Background: Normal pressure hydrocephalus is a very gloomy entity. The objective of this study is to analyse aqueductal velocity parameters by phase contrast MRI CSF flowmetry in Idiopathic Normal pressure hydrocephalus patients (NPH). Methods: This study consists of 72 participants which included 36 patients and 36 matched healthy controls. The study stretched over three years in multicentre tertiary research hospitals using 3T MRI scanner. Both normal MRI sequences and phase contrast CSF flowmetry was done for both group of patients and result analysed using SPSS 17 software. Results: Mean age of patients in our study is 61.07 years. The most common clinical symptom was gait unsteadiness in our study. Most common conventional MRI finding was ventriculomegaly with transependymal seepage of CSF. Amongst CSF flowmetry parameters Aqueductal stroke volume, peak systolic velocity, mean systolic velocity, forward flow volume and backward flow volume were statistically significant in differentiating cases from controls. Conclusions: MRI CSF flowmetry using phase contrast method is an advanced imaging parameter which can non-invasively and reliably detect NPH. Also, it can be used to follow the response to treatment following shunting and can act as a prognostic marker.

9 citations


Journal ArticleDOI
TL;DR: The magnitude of dyslipidaemia in type 2 DM patients is highlighted and that there is a significant association of DN with lipid parameters to achieve target lipid values along with adequate glycemic control to prevent or delay the appearance and progression of DN.
Abstract: Background: Dyslipidaemia is highly prevalent in type 2 Diabetes mellitus patients. The role of dyslipidaemia in macrovascular complications of Diabetes have been extensively studied but its role in microvascular complications namely nephropathy is still unclear. The present study was undertaken to study the prevalence and pattern of dyslipidaemia and its association with Diabetic nephropathy (DN) in patients with type 2 DM. Methods: 100 patients with type 2 DM attending OPD or admitted, over a period of 1 year were studied. Detailed history was taken and clinical examination was done. Serum lipid profile was studied in all patients and its association with DN was assessed. Results: The prevalence of dyslipidaemia in DM patients in our study was 90% and there was no statistically significant difference in the prevalence among males and females. Poorly controlled diabetics had high prevalence of dyslipidaemia as compared to well controlled diabetics. The prevalence of Diabetic nephropathy in our study was 41%. There was significant association of DN with high Total Cholesterol, high Low-density lipoprotein (LDL-C) and high Triglycerides. There was no significant association of DN with High density lipoprotein (HDL-C). Conclusions: Present study highlights the magnitude of dyslipidaemia in type2 DM patients and that there is a significant association of DN with lipid parameters. Hence patients should be managed with life style modifications with or without lipid lowering agents to achieve target lipid values along with adequate glycemic control to prevent or delay the appearance and progression of DN.

Journal ArticleDOI
TL;DR: It is illustrated that as the magnesium level decreases in type 2 diabetes mellitus patients, prevalence of retinopathy increases, and the present study illustrates that hypomagnesaemia in type 1 diabetes was 30% in the presentStudy.
Abstract: Background: Diabetes mellitus is a heterogeneous group of metabolic disorders characterized by chronic hyperglycemia with disturbance of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. The aim of this study was to estimate serum magnesium levels in patients with type 2 diabetes mellitus and correlate it with complications of type 2 diabetes mellitus - glycemic control and retinopathy. Methods: A cross-sectional study of 100 patients with type 2 diabetes, attending Government Medical College and associated Hospital, Jammu over a period of one year from 1 st November, 2014 to 30 th October, 2015. Detailed history including duration of diabetes, treatment mode, symptoms suggestive of retinopathy and associated diseases such as hypertension and ischemic heart disease were obtained, as per the proforma, followed by physical examination. Results: Majority of patients (38%) of type-2 diabetes mellitus were in the age group of 51-60 years. Males constituting 71% with male to female ratio of 2.45:1. Complications were observed in 48 cases, which mainly included retinopathy 60.42% (all non-proliferative). Maximum patients (79%) had abnormal (>6.5%) glycosylated hemoglobin levels ranging from 6.5 to 12%. Patients with diabetic retinopathy had significantly higher prevalence of hypomagnesaemia compared to patients without retinopathy (58.62 % vs 18.31%). Conclusions: Prevalence of hypomagnesaemia in type 2 diabetes was 30% in the present study. The present study illustrates that as the magnesium level decreases in type 2 diabetes mellitus patients, prevalence of retinopathy increases.

Journal ArticleDOI
TL;DR: Dermoscopic characteristics, such as black dots, yellow dots, broken hair, tapering hair and clustered short vellus hair are primary indicators of alopecia areata.
Abstract: Background: Alopecia areata is a common auto-immune condition, characterized by circumscribed, patches of hair loss usually of the scalp. There are various treatment modalities available but no treatment is fully curative or preventive. Also, alopecia areata can have devastating effects on the patient’s quality of life and self-esteem. The aim of this study was to determine dermoscopy findings of alopecia areata that could be used as a clinical indicator of disease and also to evaluate the efficacy of intralesional injection Triamcinolone acetonide in the treatment of alopecia areata. Methods: Seventy patients with alopecia areata, aged between 11 and 56 years were injected with intralesional triamcinolone acetonide at a 4 weeks interval. Treatment response was evaluated using re-growth scale approach. Dermlite DL3 dermoscope was used to assess disease activity, response to treatment and side effects. Using Wilcoxon signed rank test, changes were assessed in the severity of the disease during follow-ups. Results: Baseline mean percentage area of scalp involved was 23.21±10.70. All the patients had black dots, 98.6% had yellow dots, 27.1% had broken hair, 74.3% had tapering hair and only 71.4% had vellus hair. At baseline, 15 (21.4%) patients had Alopecia Grading Score (AGS) 1, 29 (41.4%) had score 2 and 26 (37.1%) had a score of 3. Injection Triamcinolone acetonide (5 mg/ml) was injected at 1 cm intervals with 0.1 ml on each site and the procedure was repeated every 4 weeks for a maximum period of 24 weeks. From baseline level to the last follow up, proportion of patients with black dots reduced from 100% to 4.3%, yellow dots from 98.6% to 0%, broken hair from 17% to 0% and tapering hair from 74.3% to 0%. Vellus hair increased from 71.4% to 100%. Overall success rate in terms of achievement of re-growth Ssore 4 at last follow up was 60%. Conclusions: Dermoscopic characteristics, such as black dots, yellow dots, broken hair, tapering hair and clustered short vellus hair are primary indicators of alopecia areata.

Journal ArticleDOI
TL;DR: In this article, the mean Cystatin C values in Group A were 1.73 and mean CYstatin c values in group B were 2.07 in the patients in which clinical albuminuria had not yet started.
Abstract: Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycaemia. The metabolic dysregulations associated with DM causes secondary pathophysiological changes in multiple organ systems which result in various complications, responsible for the morbidity and mortality associated with the disease. Methods: The present study was undertaken in the Department of Medicine in collaboration with the Department of Biochemistry, of SGRDIMSR, Vallah, Sri Amritsar, Punjab, India. The present hospital based study was undertaken with a total number of 100 patients. Results: The mean Cystatin C values in Group A were 1.73 and mean Cystatin C values in group B were 2.07. The results show that the Cystatin C values were raised even in the patients in whom clinical albuminuria had not yet started. Conclusions: serum Cystatin C may be considered as an early marker, than microalbuminuria and serum creatinine, the commonly used marker for nephropathy, for declining renal function, in diabetic subjects. Further studies in larger population are needed to confirm this result.

Journal ArticleDOI
TL;DR: Pleura is most common site of extra-pulmonary tuberculosis in the authors' study and co-infection with HIV seems to have a poor outcome on patients with extra-Pulmonary TB and needs to be studied in large number of samples.
Abstract: Background: Pulmonary tuberculosis being the predominant manifestation of the disease extra-pulmonary sites can also involve as a result of dissemination from a chief focus. Extra- pulmonary tuberculosis is more common in HIV cases. The present study aims to determine the presentation and outcome of patients with extra-pulmonary tuberculosis treated with DOTS and to assess any difference in outcome of treatment in HIV positive extra-pulmonary tuberculosis. Methods: Data was collected from cases of tuberculosis patients diagnosed and treated under DOTS at Sri Siddhartha Medical College for the period of one year (during 2015). We evaluated extra-pulmonary cases and recorded sites of involvement in order of frequency. We also studied treatment outcome by recording as per definitions given by the WHO and also evaluated any difference in outcome of extra-pulmonary tuberculosis disease with HIV co-infection. Results: Extra-pulmonary cases accounted for 30.5% of total TB cases. Among 224 cases of extra-pulmonary TB studied, 136 (60.7%) were males and 88 (39.3%) were females. Most common site of extra-pulmonary tuberculosis was pleura (29.9%) followed by meninges (22.5%), abdomen (19.6%) and lymph node (10.7%) tuberculosis. Among these patients 82.2% completed treatment, 7.5% were defaulted, 9.9% died and 0.4% treatment failure. The most common reason for default was irregular treatment (29.5%) followed by alcohol abuse (23.5%). Among 8 HIV reactive patients, 5 patients completed treatment and the remaining 3 patients died during the course of treatment. Conclusions: Extra-pulmonary Tuberculosis accounts for 30.5% of the total cases studied. Pleura is most common site of extra-pulmonary TB in our study. Treatment irregularities and alcohol abuse are the two most common reasons for default. Co-infection with HIV seems to have a poor outcome on patients with extra-pulmonary TB and needs to be studied in large number of samples.

Journal ArticleDOI
TL;DR: Prevalence of hypomagnesemia in Type 2 diabetics was 34% and serum magnesium levels were significantly higher, and hypomgnesemia was significantly associated with diabetic retinopathy.
Abstract: Background: Hypomagnesemia has been proposed as a novel factor implicated in the pathogenesis of poor glycemic control and diabetic complications. Aim of the present study is to study serum magnesium level in patients with type 2 DM and to find the correlation between serum magnesium levels, HbA1c and diabetic complications. Methods: 100 patients with Type 2 DM (50 males and 50 females) who were diagnosed on the basis of ADA criteria or taking treatment for Diabetes were included in the study. All patients underwent tests for serum magnesium level, fasting blood sugar, postprandial blood sugar, HbA1c and also target organ evaluation for Diabetes. A detailed history and examination was also done. Results: There was significant difference in the prevalence of hypomagnesemia (34% vs 6%) and serum magnesium levels (1.59±0.187 versus 1.78±0.126, p <0.0001) between diabetics and control group. FBS (172.17±30.55 versus 137.06±37.76, p<0.0001), PPBS (243±61.21 versus 195.84±59.1, p = 0.0003) and HbA1C (8.42±1.292 versus 7.04±0.956, p<0.0001) were significantly higher in hypomagnesemic diabetics as compared to normomagnesemic diabetics. Significant proportion of hypomagnesemic diabetics were suffering from retinopathy as compared to normomagnesemic diabetics (47.06% versus 19.70%, p = 0.0042). Diabetic nephropathy, neuropathy, hypertension and IHD were also higher in hypomagnesemic diabetics as compared to normomagnesemic diabetics, but insignificant. Conclusions: Prevalence of hypomagnesemia in Type 2 diabetics was 34%. Diabetics with hypomagnesemia had poor glycemic control. Hypomagnesemia was significantly associated with diabetic retinopathy.

Journal ArticleDOI
TL;DR: PSI was most sensitive in both predicting ICU admission and death whereas CURB-65 is most specific in predicting ICu admission andDeath, and even though IDSA/ATS criteria did not have highest sensitivity and specificity as single criteria it had modest sensitivity and Specificity in predictingICU admitted and death.
Abstract: Background: Few comparative studies regarding prognostic scoring systems for community acquired pneumonia (CAP) are available from Indian context. Methods: Hospital-based prospective study to test the comparison between confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65), Pneumonia severity index (PSI) and infectious diseases society of America/American thoracic society criteria (IDSA/ATS) scoring systems in patients with community acquired pneumonia. Results: CURB-65 class ≥III, PSI class ≥IV and patients who needed admission to intensive care unit (ICU) based on IDSA/ATS criteria were having sensitivity of 41.7%, 91.7% and 87.5% in predicting ICU admission with a specificity of 89.5%, 59.2% and 73.7% respectively. Their sensitivity in predicting death were 44.4%, 88.9% and 83.3% with a specificity of 87.8%, 54.9% and 68.3% respectively. In both PSI score and IDSA/ATS criteria risk scoring systems, mortality rate, need for ICU admission increased progressively with increasing scores but CURB-65 score did not show this correlation. The PSI class ≥IV was more sensitive in predicting ICU admission than CURB-65 and IDSA/ATS criteria. Conclusions: PSI was most sensitive in both predicting ICU admission and death whereas CURB-65 is most specific in predicting ICU admission and death. But CURB-65 is least sensitive in both predicting ICU admission and death. Even though IDSA/ATS criteria did not have highest sensitivity and specificity as single criteria it had modest sensitivity and specificity in predicting ICU admission and death.

Journal ArticleDOI
TL;DR: There is a strong association between the clinical trial of anemia, CKD and CVD and prompt identification and management of common risk factors and adequate correction of anemic patients is necessary to slow progression of CKd and prevent cardiovascular events.
Abstract: Background: Chronic kidney disease (CKD) is recognized as a global health issue having high mortality and morbidity rates putting a substantial burden on global resources. CKD has become a recognised independent risk factor for several adverse health outcomes including cardiovascular disease (CVD). Anaemia is an anticipated consequence as renal function declines, and can develop at any stage of CKD. There is a strong association between anemia and cardiovascular complications in CKD patients and many studies have proven that anemia plays a key role in worsening CVD in CKD patients. The objective of this study was to study the prevalence of anemia and cardiovascular diseases in CKD patients and establish an association between them. Methods: This study was conducted between January 2008 and June 2008 for a period of six months at a Government tertiary referral institution in south India. During this period, all newly diagnosed cases of chronic kidney disease based on the National Kidney foundation definition were included in this study. All the patients were evaluated based on detailed history taking, clinical examination and laboratory investigations after an informed consent was obtained from them. Staging of CKD was done based on the national kidney foundation (NKF/KDIGO) staging system. GFR was estimated using the abbreviated MDRD (Modification of Diet in Renal Disease) formula. Results: Of the 333 newly diagnosed CKD patients, a large majority (264, 79.28%) of the patients in the study presented in stage 5 CKD. The mean Hb in the study was 8.42±2.20 g/dl. Anemia was present in 90.39% while 25.53% had an Hb of <7g/dl. The prevalence of anemia increased from stage 3 (66.6%) to stage 5 (94.7%) and this correlation was statistically significant (p<0.0005). 167 (50.15% ) were found to have some form of cardiovascular disease, of which 120 (71.86%) were males and 47 (28.14%) were females. 83.93% had left ventricular hypertrophy, 16.17% had ischemic heart disease and 7.78% had congestive heart failure. 56.3% of patients in the age group 41-60 years had cardiovascular disease. The correlation between cardiovascular disease and age was statistically significant (p = 0.04139). And it was found that cardiovascular disease was more common when the cause of CKD was Diabetic nephropathy (65.8%) and hypertensive nephrosclerosis (84.6%). The correlation between the cardiovascular disease and etiological diagnosis of CKD was statistically significant. (p<0.0005).Cardiovascular disease was present in 61.2 % of the study population with diabetes mellitus and in 56.4% of the study population with hypertension. The correlations between CVD and diabetes and hypertension were statistically significant. Cardiovascular disease was present in 61.2% of the study population with Hemoglobin <7 gm/dl, 41.7% with Hb between 7-11 gm/dl and the correlation between cardiovascular disease and the level of Hb was highly significant in CKD patients. Conclusions: Thus there is a strong association between the clinical trial of anemia, CKD and CVD and prompt identification and management of common risk factors and adequate correction of anemia is necessary to slow progression of CKD and prevent cardiovascular events.

Journal ArticleDOI
TL;DR: It was found that higher education, multiparity, early pregnancy registration, were statistically significantly associated with adequate knowledge and can be utilized as a tool of health education for counseling during ANC visit at village level in the Anganwadis.
Abstract: Background: MCP card has been developed as a tool for families to learn, understand and follow positive practices for achieving good health of antenatal mothers and children. It serves as informative tool with pictorial contents for enrichment of mother’s knowledge, which may be a determinant of their practice. The objectives of this study were to evaluate the perception among mothers about antenatal care from MCP card and to associate selected variables of interest with their knowledge. Method: A cross-sectional study was conducted among 200 mothers attending immunization OPD of MKCG Medical College during June to August 2016. Data was obtained from them by pre-designed and pre-structured questionnaire. Results: 86% have read the MCP card and understood it. Among them 10% have understood it pictorially, 62% have understood it both pictorially and literally. It was found that higher education, multiparity, early pregnancy registration, were statistically significantly associated with adequate knowledge (p<0.05). About various aspects of antenatal care, 90% correctly stated that 2 injections of TT are given in pregnancy but only 12% could say that deworming is done after 3 rd month of pregnancy. 86% correctly said bleeding as a danger sign but only 2% knew about pallor as a danger sign. 81% said contacting health worker as an arrangement for emergency labour but only 35% said that they would identify a hospital in advance. Conclusion: This can be utilized as a tool of health education for counseling during ANC visit at village level in the Anganwadis.

Journal ArticleDOI
TL;DR: There was parasympathetic preponderance over sympathetic nervous system in the involvement of diabetic autonomic neuropathy as compared to retinopathy and nephropathy and statistically significant association with other diabetic angiopathies.
Abstract: Background: Neuropathy is a common complication of diabetes mellitus and it may affect both the peripheral nerves and autonomic nervous system. It’s prevalence ranges from 1% to 90%. The present study is therefore designed to investigate autonomic nervous system involvement in diabetes mellitus by using simple bedside tests and to study its association with other diabetic angiopathies. Methods: 100 patients of diabetes mellitus were selected in the study. In Autonomic function tests for evaluating parasympathetic damage E: I ratio, 30:75 ratio and Valsalva ratio test was performed. Sympathetic damage was diagnosed by Blood pressure response to standing test and Blood pressure response to sustained handgrip test. Results: Abnormal E:I ratio was noticed in only 24 patients. The 30:15 ratio was found to be abnormal in 38 patients while the Valsalva Ratio was abnormal in 34 patients. Postural hypotension was observed in only 8% patients. The sustained hand grip test was abnormal in 10 patients. The prevalence of cardiac autonomic neuropathy was 58%. The association between the presence of autonomic neuropathy and peripheral neuropathy was statistically significant. However, the association between autonomic neuropathy and retinopathy and nephropathy was not statistically significant. Conclusions: The overall prevalence of autonomic neuropathy in diabetes mellitus was 58%. There was parasympathetic preponderance over sympathetic nervous system in the involvement of diabetic autonomic neuropathy. There was statistically significant association of diabetic autonomic neuropathy with peripheral neuropathy as compared to retinopathy and nephropathy.

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TL;DR: Bleeding manifestations have no significant association with severity of platelet count, and there is no need for platelet-transfusion in all patients with thrombocytopenia with minor bleeds.
Abstract: Background: Dengue is a common vector-borne disease in India with significant morbidity & mortality. Thrombocytopenia is a common complication in dengue. Bleeding manifestations in dengue put an immense pressure on both patients and treating physicians. There are no clear guidelines for transfusion of platelets in bleeding patients and role of Platelet transfusion in this condition is a bit controversial. Methods: It was an observational study done at Sree Rajarajeswari medical college and hospital between 1 st May and 31 st July 2016. Total of 100 dengue-positive cases were studied with respect to clinical features, laboratory parameters and requirement of platelet transfusion. Results: Majority of patients were males and in the age group 21-30 years. Fever was present in all cases, with a mean of 3-6 days duration. Epistaxis was the most common bleeding manifestation (43%), Malena being the least (3%). Leucopenia was observed in 52% patients. Thrombocytopenia was seen in 89% of admitted patients and 38% among them had raised aPTT. 53%of patients in our study received platelet transfusion. Conclusions: Bleeding manifestations have no significant association with severity of platelet count. Severe leucopenia is associated with thrombocytopenia. There is no need of platelet-transfusion in all patients with thrombocytopenia with minor bleeds.

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TL;DR: Obesity in humans is an independent risk factor for lipid peroxidation and depletion of cytoprotective enzymes even in the absence of other confounding factors such as diabetes and hyperlipidaemia.
Abstract: Background: Obesity is increasing in prevalence and presents a serious risk for the development of various disorders like diabetes mellitus, hypertension, heart disease, gall bladder disease and certain forms of cancer Animal studies have shown that obesity is associated with increased myocardial oxidative stress and increased lipid peroxidation The objective of this study was to test the hypothesis that obesity per se causes increased plasma lipid peroxidation and decreased erythrocyte cytoprotection Methods: A prospective randomized study including 300 obese subjects, was conducted in the Department of Medicine and Department of Biochemistry, G R Medical College, Gwalior Age and sex matched 100 subjects having BMI between 19 to 25 kg/m 2 were also enrolled Patients were grouped as Case (n=300) and Control (n=100) Detailed physical examination and laboratory investigations including lipid profile were performed Venous blood was obtained and used for the estimation of Superoxide dismutase (SOD) and plasma malondialdehyde (MDA) Unpaired t test and analysis of variance (ANOVA) with post-hoc Bonferroni and Tukey test along with Pearson correlation was used to analyze the data using IMB SPSS ver 20 software Significance is assessed at 5 % level Results: Mean age of subjects among Case and Control group was 462±24 years and 445±22 years respectively with male predominance in each group Mean weight, height, BMI, waist, hip, waist to hip ratio, mean blood glucose, total cholesterol, triglyceride, LDL-C, HDL-C and VLDL-C among Cases were9157±98 kg, 1616±93 cm, 3617± 34 kgm 2 , 1147±62 cm, 11423±1712 cm, 098±022, 873±26 mg/dl, 1960±126 mg/dl, 2536±273 mg/dl, 135±4703 mg/dl, 471±12 mg/dl and 458±1403 mg/dl and among Control group were61±52 kg, 1631±87 cm, 2124±188 cm, 2124±188 kg m 2 , 852±14 cm, 9732±912 cm, 086±014, 944 ± 32 mg/dl, 1866 ± 69 mg/dl, 1434±154 mg/dl, 9573±2748 mg/dl, 516±17 mg/dl and 224±1045mg/dl respectively Mean MDA level in Case and Control group was 468 ± 172 and 206±076 μmol/ml respectively (p< 0001) Mean SOD level among Case and Control groups was 765±113 and 1242±218 units/ml respectively (p<0001) Female obese patients had lower level of SOD A significant negative correlation of SOD was observed with BMI (n=300, r= -0045, P<0001), whereas, MDA was positively correlated with BMI (n=300, r= 0342, P<0001) Conclusions: Obesity in humans is an independent risk factor for lipid peroxidation and depletion of cytoprotective enzymes even in the absence of other confounding factors such as diabetes and hyperlipidaemia

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TL;DR: The main etiological cause of bleeding in the study was dengue hemorrhagic fever followed by megaloblastic anaemia and malaria, which was common in younger population.
Abstract: Background: In tropical countries like India thrombocytopenia is commonly encountered by clinicians in any speciality. Thrombocytopenia present as asymptomatic condition to sometimes becomes a life-threatening condition requiring blood transfusion in various etiological conditions. Infections like malaria and dengue are invariably associated to thrombocytopenia with changing trends in clinical features. Infection is the commonest cause of thrombocytopenia. The objective of study was to evaluate the different causes of thrombocytopenia along with study of clinical profile and laboratory parameters in patients with thrombocytopenia. Methods: A cross-sectional hospital based study was conducted in Department of Medicine at Indian Institute of Medical Science and Research Medical College, Badnapur, Dist. Jalna, Maharashtra, India from November 2015 to August 2017. This study comprises cases of thrombocytopenia of age more than 12 years admitted with platelet count <1 lack/mm 3 was included in study, whereas patients with malignancy and chemotherapy induced thrombocytopenia, idiopathic thrombocytopenic purpura, cirrhosis of liver were excluded. Results: Study shows almost 55.83 % of total patients were below age of 30 years and 44.17% patients were above 30 years of age. The highest incidence of thrombocytopenia was seen in the age group of 21-30 years (32.50%) followed by 31-40 (25.83%) and 12-20 years (23.33%). The most common diseases that causes thrombocytopenia were infections (63.33%) [i.e. Dengue (30%), Malaria (20.83%), Enteric fever (5%), HIV (4.166%), Leptospirosis (1.66%) and DIC (1.66%)] and Megaloblastic anemia (21.66%) were common in younger population. Conclusions: Study concluded that most common causes of thrombocytopenia were infections (63.33%) and megaloblastic anemia (21.66%). Bleeding manifestations were present in 37.50% of patients and the most common site of bleeding was skin and mucous membrane. The main etiological cause of bleeding in our study was dengue hemorrhagic fever followed by megaloblastic anaemia and malaria.

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TL;DR: ADRs are major factor limiting completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.
Abstract: Background: Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis, is the major health care burden responsible for morbidity and mortality. The objective was to study the profile of adverse drug reactions (ADRs) and its outcome. Methods: It was a prospective observational study conducted in one of the RNTCP centre of Ahmedabad district. All TB patients visiting and taking short course of directly observed treatment (DOTS) were enrolled and monitored for ADRs. All the ADRs spontaneously reported or identified by the researcher were recorded and analyzed. Results: Total 974 patients screened during the study period 72 (7.79%) developed ADRs. Significantly higher occurrence of ADRs were in age group of 31- 40 years (p 0.05). Occurrence of ADRs was significantly more (p<0.05) in patients of category I TB (31, 43%). Out of the 49 (68%) pulmonary tuberculosis patients who developed ADR, 32 patients (44%) were sputum positive showing significant association (p<0.05). Gastro-intestinal side effects were most common ADRs followed by giddiness and headache. Nine patients required complete stoppage of offending agent, while 2 patients require treatment interruption and most of the patients (61) were managed with supportive medication without removing anti tubercular drug from their treatment regimen. Out of these 72 patients, majority (56) declared cured at the end of treatment. Conclusions: ADRs are major factor limiting completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.

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TL;DR: The prevalence of anemia was 75% which was higher than that seen in the euthyroid controls andHypothyroid patients were more symptomatic for anemia than the controls, and there was a statistically significant negative correlation between TSH and hemoglobin.
Abstract: Background: The association between anemia and hypothyroidism has been recognized, although the prevalence of anemia in hypothyroid patients varies widely between studies. The main objectives were to study the prevalence, type, etiology of anemia in primary hypothyroidism and to correlate severity of anemia with severity of hypothyroidism. Methods: A case control study was carried out in a tertiary care hospital. Newly diagnosed 60 overt primary hypothyroid patients and 180 euthyroid controls were evaluated for anemia. Morphological types of anemia, their etiology were studied. Severity of anemia was correlated with that of hypothyroidism. Results: Anemia was observed in 45 patients with hypothyroidism. Symptoms due to anemia were significantly higher in cases than in the anemic controls. RBC morphology showed normocytic normochromic in 39, microcytic hypochromic in 14 and macrocytic in 7 cases. Serum iron was significantly lower in the cases than in the controls. Serum anti-TPO positivity was 63.33% in cases as compared to 10% in controls. Anemia was severe in cases with high TSH. Conclusions: The prevalence of anemia was 75% which was higher than that seen in the euthyroid controls. Hypothyroid patients were more symptomatic for anemia than the controls. Normocytic normochromic type of anemia was the most common type in our study. Autoimmunity in the form of anti-TPO positivity was detected in 69% of anemic cases. Iron deficiency was observed in the cases more than in the controls. There was a statistically significant negative correlation between TSH and hemoglobin.

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TL;DR: 2D:4D ratio is a measure of Hand Grip Strength in men, but is not a robust measure of HGS in women.
Abstract: Background: The ratio of the lengths of the index and the ring finger (2D:4D ratio) is generally different between men and women. This has often been used as an indicator of the levels of prenatal androgen exposure. It has hence been suggested to have a role in many gender differences including performance in sports. Men generally outperform women in most physical abilities. However, reports in various studies have been inconclusive, depending upon the physical ability tested. Hand Grip Strength (HGS) is a good measure of overall strength of an individual. Hence, we decided to determine the relationship between 2D:4D and HGS of both hands in men and women. Methods: Scanned images of both hands of young volunteers were analysed and the 2D:4D ratio calculated. HGS was measured and results correlated with 2D:4D. Results: 2D:4D ratio of men was significantly less than of women for the right (p<0.001) and the left hand (p<0.001). HGS of men was significantly greater than that of women for the right (p<0.0001) and for the left hand (p<0.0001). 2D:4D ratio in men showed a weak but significant positive correlation with HGS of right(p<0.05) and left hand(p<0.05). A weak but significant positive correlation was also seen for the left hand in females. However, 2D:4D ratios did not show any significant correlation with HGS for the right hand in women. Conclusions: We conclude that 2D:4D ratio is a measure of Hand Grip Strength in men, but is not a robust measure of HGS in women.

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TL;DR: Role of ultrasonography has a supporting role in dengue fever for prognostic and diagnostic significance and acute acalculous cholecystitis is not uncommon and is usually self-limiting and resolves with conservative management only.
Abstract: Background: Dengue fever is an acute febrile illness characterized by frontal headache, retro ocular pain, muscle and joint pain, nausea, vomiting and rash. Frequent sonographic findings in a case of dengue include thickened gall bladder with pericholecystitic fluid, ascites, spleenomegaly and pleural effusion which is commonly right sided. Methods: 540 patients of confirmed dengue fever were subjected to ultrasonography abdomen to find the incidence of acalculous cholecystitis for diagnostic and prognostic significance. Results: Acalculous cholecystitis was detected in 210 patients (38.88%) of confirmed dengue fever. Patients developing acalculous cholecystitis recovered with conservative treatment only though the hospital stay was prolonged in these patients. Conclusions: In dengue fever patients, acute acalculous cholecystitis is not uncommon and is usually self-limiting and resolves with conservative management only. Role of ultrasonography has a supporting role in dengue fever for prognostic and diagnostic significance.

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TL;DR: Dyslipidemia is indicating the strong association with silent CAD in type 2 diabetes mellitus, and it is also advisable to have a screening ECG for silent CAD at the time of diagnosis or during the follow-up period in type 1 diabetes.
Abstract: Background: The patients with type 2 diabetes have an increased prevalence of lipid abnormalities (Dyslipidemia). Early diagnosis of diabetic patients with silent CAD and dyslipidemia can reduce the morbidity and mortality for cardiovascular death. The objective of the present study is to assess the prevalence of silent coronary disease among south Indian type-2 diabetic patients without cardiovascular symptoms and association between lipid profile and silent coronary disease among them. Methods: 100 Type 2 diabetes mellitus patients (65 males and 35 females) of age 40-80 years attending the OPD of Sri Siddhartha Medical College, Tumakuru, Karnataka, India were enrolled in this study. The Serum samples were analysed for fasting blood glucose (FBS), post prandial blood glucose (PPBS), HbA1c, and lipid profile. The patients were classified into CAD and Non CAD groups based on ECG changes and stress test. Results were analysed SPSS 16.0 software. Results: The study revealed that 46% of our study population had silent CAD. The prevalence of dyslipidemia was found higher in males than females in both study groups. CAD group patients had significantly higher levels of serum total cholesterol, triglycerides, LDL- cholesterol and low HDL - cholesterol compared to Non CAD group. Conclusions: Dyslipidemia is indicating the strong association with silent CAD in type 2 diabetes mellitus. It is also advisable to have a screening ECG for silent CAD at the time of diagnosis or during the follow-up period in type 2 diabetes.

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TL;DR: RDW levels measured on admission can be used as a prognostic marker in patients in severe sepsis and septic shock, and was higher and statistically significant among non-survivors with respect to duration of stay and requirement of inotropes.
Abstract: Background: The incidence of severe sepsis and septic shock has increased over the past 30 years, and the annual number of cases is now >700,000 (~3 per 1000 population). There are many markers of sepsis which are being evaluated for its diagnosis among which RDW is emerging as a promising marker. Hence this study is being done to see the correlation between RDW and sepsis. Methods: A total of 162 patients-81 survivors and 81 non-survivors of severe sepsis and septic shock fulfilling inclusion and exclusion criteria who were admitted to intensive care unit between October 2013 and September 2015 were included in the study. Baseline variables, laboratory parameters, complications, and RDW were compared between the two groups. Results: Majority of patients - 73(45.06%) were in the age group of 61 - 80 years. Mean RDW was 15.20±2.29 in non-survivors and 13.86±2.20 in survivors, which was statistically significant (p<0.001). Mean RDW was higher and statistically significant among non-survivors with respect to duration of stay and requirement of inotropes. Conclusions: RDW levels measured on admission can be used as a prognostic marker in patients in severe sepsis and septic shock.

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TL;DR: Of all registered herbicides, Paraquat is the most serious and life threatening, and despite of early haemodialysis, steroids and cyclophosphamide therapy, it was ineffective in reducing the mortality rates.
Abstract: Background: Paraquat poisoning is a weedicide used rarely for suicide. It is now being increasingly as this type of suicidal poisoning is almost always fatal as there is no specific antidote for paraquat poison. ARDS, acute kidney injury with metabolic acidosis or multi-organ failure are the frequent causes of mortality. Methods: The study aimed to study the morbidity and mortality rates of Paraquat poisoning in tertiary care teaching hospital. Patients admitted with Paraquat poisoning were included, and the data were collected and analysed. Results: The total number of cases admitted with paraquat poisoning in intensive care unit in three years duration were 10. All the cases were suicidal in nature. 80% of the cases had acute kidney injury with severe metabolic acidosis and 20% had mediastinitis. 70% of cases died within 48 hours of ingestion. The overall mortality rate was 100% in spite of active management. Conclusions: Of all registered herbicides, Paraquat is the most serious and life threatening. Inspite of early haemodialysis, steroids and cyclophosphamide therapy, it was ineffective in reducing the mortality rates. Newer treatment like early hemoperfusion may help to reduce the mortality in future.