Showing papers in "International Journal of Advances in Medicine in 2020"
TL;DR: The route from the onset of the disease to its progress to death in patients is plotted, and the most likely causes that lead to such a poor prognosis are determined.
Abstract: COVID-19 is a viral infectious disease caused by the SARS CoV-2 virus, which is a respiratory pathogen It originated in the city of Wuhan in China from where it spread throughout the world This virus causes severe respiratory distress in a certain number of patients with specific risk factors In our article, authors plot the route from the onset of the disease to its progress to death in patients, and determine the most likely causes that lead to such a poor prognosis Authors also evaluate the severity and extent of organ damage that is involved and associated with fatality in cases with COVID-19 Authors also aim for clinicians to better understand and perceive the circumstances under which a patient may progress from severe infection towards death, and manage such cases in a more efficient manner
7 citations
TL;DR: This review examines some of the recent proposals for various routes of application of Insulin delivery system along with the particular attention to its latest intervention of novel drug delivery system.
Abstract: Diabetes mellitus is the chronic pathogenic condition which is primarily due to inadequate insulin secretion and is responsible for major healthcare problems worldwide cost billions of dollars annually. For more than 84 years of time, Insulin replacement therapy had been used to manage to overcome the complications and this present review is based on the various routes of insulin delivery based on its safety and efficacy. Depending upon the effective duration of action, insulin activity varies from 1.5 to 27 hours and to reduce insulin burden, now a days it can be delivered in sensor-augmented pump therapy, various types of insulin Pen as well as routes like inhalation, colonic insulin, buccal, intra- peritonea and ocular, rectal, vaginal delivery of insulin etc. had been added to it. This review examines some of the recent proposals for various routes of application of Insulin delivery system along with the particular attention to its latest intervention of novel drug delivery system.
6 citations
TL;DR: Plasmodium vivax is the species identified by conventional peripheral blood smear method, rapid immunochromatographic and molecular method in patients suspected for pyrexia of unknown origin (PUO) attending a tertiary care hospital.
Abstract: Background: Mosquito-borne diseases are the major concern in public health. Malaria is a protozoal disease caused by the parasites of the Genus Plasmodium - Plasmodium vivax , Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale, which are transmitted by the bite of female Anopheles mosquitoes. Prevalence of malaria worldwide is about 35%. Malarial infections can be diagnosed by peripheral smear, rapid immunochromatography and molecular technique. This study is focused on Plasmodium species detection by using species specific primers for diagnosis. Aim and objective of this study was to detect and compare the Plasmodium species by conventional, rapid immunochromatographic and molecular technique in patients suspected for pyrexia of unknown origin (PUO) attending a tertiary care hospital. Methods: The study was carried out at SRM MCH and RC, Tamil Nadu, India, from January 2018 to February 2019 after the institutional ethical committee approval. This was an observational study. Malarial parasites were identified in peripheral blood smear by conventional method (thick smear and thin smear), rapid immunochromatographic technique (serological technique using whole blood) and molecular technique. DNA extraction from whole blood done by spine column technique. Amplification and gel documentation done. Results: Total 83 blood samples were collected from patients with clinical diagnosis of PUO. Out of 83 samples 5 (6%) samples were positive for Plasmodium vivax species by conventional method, rapid immunochromatographic and molecular technique. Conclusions: In this study, Plasmodium vivax is the species identified by conventional peripheral blood smear method, rapid immunochromatographic and molecular method.
5 citations
TL;DR: Severe malaria usually caused by the falciparum more than vivax, early diagnosis and treatment decreases the mortality and morbidity, and all patients recovered without any mortality.
Abstract: Background: Malaria is a major health problem in many parts of India and some parts of Andhra Pradesh is one of the endemic areas for malaria. The objective was to study clinical profile and outcome of malaria in both species and mixed infection. Methods: Present study was carried out on 100 patients admitted during the period of November 2016 - October 2018 in Narayana medical college and hospital, Nellore. Malaria confirmed by Peripheral thick and thin smear or Antigen Assay underwent detailed clinical history and physical examination. This was followed by monitoring the outcome of the patients with respect to morbidity and mortality. Results: Out Of the 100 patients 58 patients were from rural background, males were predominant, most common age group was 20-30 (34%) followed by 31-40 (31%). Out of 100 patients, 54 patients were falciparum,44 patients had vivax and two had mixed infection. All of the patients had fever followed by chills and rigors (75%), nausea and vomiting (59%), easy fatiguability (28%), pain abdomen (17), cough (14%) in both infections, altered sensorium was seen in only falciparum (20.3%). On clinical examination,70% of the patients had pallor, splenomegaly in 46%, icterus (23%), hepatomegaly (14%) and pedal edema in12 patients were observed. All 0f the patients were treated with appropriate antimalarial drugs for appropriate duration, and all were recovered without any mortality. Conclusions: Malaria is very common disease in our country especially in South India, which is one of the endemic areas. Severe malaria usually caused by the falciparum more than vivax, early diagnosis and treatment decreases the mortality and morbidity.
5 citations
TL;DR: hs-CRP level is increased in stroke and shows significant association with severity of stroke and prognosis, and mean total cholesterol levels between cases and controls showed statistically significant difference.
Abstract: Background: Stroke is the second leading cause of death worldwide according to WHO. High sensitivity C-Reactive Protein (hs-CRP) is an acute phase reactant which is being studied extensively to delineate its role in development of stroke as well as in prognostication. This study was done to assess correlation of hs-CRP with risk factors of stroke and its association with types of stroke and prognosis. Methods: A prospective case control study of 100 patients with acute stroke along with 100 controls was conducted with informed consent. At baseline, hs-CRP levels were measured and Modified Rankin Scale (MRS) was assessed. On day 90 the Modified Rankin Scale was assessed again. Patients were divided into groups based on hs-CRP levels and MRS and the results were analysed. Results: Prevalence of stroke was more in men than women (p=0.0002). Statistically significant difference was found between mean hs-CRP levels in men (4.722±0.8982 mg/L) and women (4.133±0.9446 mg/L) (p=0.005) and between cases and controls (p=0.0003). There was no significant association with type of stroke (p=0.456). Mean total cholesterol levels between cases and controls showed statistically significant difference (p=0.0005). High MRS was significantly associated with high hs-CRP levels (p=0.003). Higher hs-CRP on day 1 correlated with higher MRS on day 90. Conclusions: hs-CRP level is increased in stroke and shows significant association with severity of stroke and prognosis.
5 citations
TL;DR: The crucial risk factors and biomarkers of the endometriosis as well as the possible pathogenesis towards the development of endometRIosis and its prevention strategies are considered.
Abstract: Endometriosis is an estrogen-dependent chronic inflammatory disease associated with substantial morbidity, including dyspareunia, dysmenorrhea, pelvic pain, multiple surgery, and infertility. This disease has a high impact on both woman’s physical and mental wellbeing. The etiology of endometriosis is complex and multifactorial. The risk factors associated with the development of endometriosis include family history, menstrual and reproductive cycle, low body mass index (BMI), diet, alcohol uses, smoking, environmental factors, immune system, genetic factors and intrinsic abnormalities in the endometrium. There exist many theories on the initiation and propagation of different types of endometriotic lesions and consequent biological disturbances, of which the most common is the Sampson’s theory according to which the retrograde flow of menstrual blood is linked to the development of endometriosis. Endometriosis affected women have a higher risk than the general female population, for ovarian cancer, coronary heart disease (CHD), and other long-term disease risks as well for autoimmune and atopic disorders. Therefore it becomes a necessity for the clinician not only to attain right diagnosis but also follow up for the other associated disorders. In this review, we have considered the crucial risk factors and biomarkers of the endometriosis as well as the possible pathogenesis towards the development of endometriosis and its prevention strategies. The currently available therapies for the control and treatment of endometriosis have also been elaborated.
5 citations
TL;DR: Serum albumin level is inversely correlated with severity of stroke at presentation and functional outcome in patients on follow up, and significant co-relation between mean serum albuminlevel and clinical outcome was observed.
Abstract: Background: Serum Albumin level is an important multifunctional protein in the blood for maintaining the normal permeability across vessel wall by osmotic gradient, in inhibiting platelet aggregation and in reducing blood viscosity. Serum albumin level as a novel parameter for predicting outcome and assessment of severity of coronary artery disease is established. Keeping in mind the scarcity of studies regarding albumin level in ischemic Cerebrovascular Accident (CVA), present study was undertaken to correlate serum albumin level with clinical outcome in acute ischemic stroke (AIS) patients. Methods: One hundred patients of diagnosed AIS were included in the study. Thorough clinical examination and risk factor profile assessment was done. Severity of stroke was assessed using National Institute of Health Stroke Scale (NIHSS) Score and then followed up to 1 week and 3 months post-admission with serum albumin level and assessment was done using modified Rankin Scale (mRS) score. Institutional ethics committee cleared the study. Results: In 100 patients with AIS, 58% were male and 42% were female. Mean age was 65±8.160. Motor weakness (85%) was the commonest presenting symptom. Around 75% of patients revealed infarction in middle cerebral artery (MCA) territory. Hypertension (HTN) (74%) was the most frequently associated comorbid condition. Patients with low serum albumin level at admission time were directly proportional to severity of stroke at presentation and poor clinical outcome. 1 week and 3 months follow up mean albumin level (g/dl) was 3.8±0.25 and 3.7±0.23 in patients with poor functional outcome respectively. Significant co-relation between mean serum albumin level and clinical outcome was observed. Conclusions: Serum albumin level is inversely correlated with severity of stroke at presentation and functional outcome in patients on follow up.
5 citations
TL;DR: This review has attempted to summate the potential drugs therapies with emphasis on convalescent plasma, and at last, the most awaited thing of this pandemic, COVID-19 vaccine.
Abstract: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China in December 2019. Despite the worsening trends of COVID-19, currently, no drugs are validated to have significant efficacy in the clinical treatment of COVID-19. The drugs currently being explored are hydroxychloroquine, antivirals like remdesivir, favipiravir alone or in combination, antibiotics like azithromycin and doxycycline. Low dose corticosteroids, either oral or intravenous, have also shown promising results in reducing mortality. On the other hand, Immunomodulators and biologics are found to be very effective in some cases. Autopsy finding of patients with COVID-19 shows the evidence of endothelial damage and formation of microthrombi with multiorgan involvement and, ultimately, multiorgan failure; hence anticoagulants also seem to have a definite role in preventing microvasculature clogging and multiorgan dysfunction. Pulmonary vasodilators acting via the cGMP/cAMP pathway may also prove to be beneficial in reducing airway hyper inflammation. In this review, authors have attempted to summate the potential drugs therapies with emphasis on convalescent plasma, and at last, the most awaited thing of this pandemic, COVID-19 vaccine.
4 citations
TL;DR: Fever associated with headache, retroorbital pain, erythematous morbilliform rash, conjunctival injection and itching over palms and soles along with thrombocytopenia, leukopenia, elevated liver transaminases should prompt a clinician on the possibility of dengue infection.
Abstract: Background: Dengue fever is one of the most common arboviral mediated outbreaks reported with increased prevalence over the last few years with considerable morbidity and mortality. This study was designed to study the clinical and biochemical parameters in dengue fever patients. Methods: Prospective observational study was undertaken among adult patients in a tertiary care hospital. fifty patients were studied and analysed. All patients who were NS1 (Non-Structural Protein 1) antigen or IgM dengue positive were included in the study. Clinical features, haematological and biochemical parameters were noted. Results: Of the 50 patients studied, majority were males (68%). Fever was the major symptom (100%) followed by Body ache (84%), Headache (64%), Retro-orbital pain (52%), Myalgia (48%), conjunctival injection (40%), Itching (40%), abdominal pain (36%), Bradycardia (34%), Rash (30%), pleural effusion and ascites both seen in (28%). Significant derangements in platelet (76%), leucocyte counts (84%) and serum transaminases (58%) were noted. Conclusions: Fever associated with headache, retroorbital pain, erythematous morbilliform rash, conjunctival injection and itching over palms and soles along with thrombocytopenia, leukopenia, elevated liver transaminases should prompt a clinician on the possibility of dengue infection. Platelet transfusions have little role in management of dengue patients unless patients having active bleeding secondary to thrombocytopenia due to dengue fever.
4 citations
TL;DR: Positive correlation between serum cholesterol level, LDL level and triglyceride level with plasma fibrinogen levels was found and there was inverse relation with HDL level.
Abstract: Background: Increasing evidence from epidemiological studies suggest that elevated plasma fibrinogen levels are associated with an increased risk of cardiovascular disorders especially in diabetic patients. Objective was to correlate fibrinogen levels in patients of type-2 diabetes mellitus with lipid profile. Methods: It is a descriptive observational study conducted among type-2 diabetes mellitus patients at Khaja Bandanawaz Institute of Medical Sciences, Gulbarga in year 2011. Newly detected type-2 diabetic patients with and without associated hypertension of more than 40 years of age belonging to both sexes were included. Results: Total 104 patients were involved in our study. Of which 75 were males and 29 females. There was a significant positive correlation between plasma cholesterol level and plasma fibrinogen level. The patients who had serum triglyceride level between 100-149 mg/dL had plasma fibrinogen level about 4.19±0.1 g/L and those with serum triglyceride level more than 400 mg/dL < had 9.01±0.83 g/L plasma fibrinogen level. Significant positive correlation between serum triglyceride level and plasma fibrinogen level found. 36 patients with HDL level 35-39 mg/dL had plasma fibrinogen level of 5.9±1.50 g/L. So, there was a significant negative correlation between serum HDL and plasma fibrinogen level. Conclusions: The present study showed positive correlation between serum cholesterol level, LDL level and triglyceride level with plasma fibrinogen levels. There was inverse relation with HDL level.
4 citations
TL;DR: Serum uric acid may be useful for prognostication among those with pre-existing AMI and is comparable between smoker and non-smokers and patients with and without diabetes.
Abstract: Background: Elevated levels of serum uric acid are associated with increased cardiovascular morbidity and mortality. However, this association with cardiovascular diseases is still unclear, and perhaps controversial. The objective of study was to assess the serum uric acid level in patients with Acute Myocardial Infarction (AMI). Methods: Sixty patients with AMI were studied in Department of Medicine/ Department of Cardiology, J.A. Group of Hospitals between 2016 -2018.Details of age, sex, smoking, alcohol consumption and history of ischemic heart disease (IHD) was obtained and recorded. Serum uric acid level was estimated and compared with control group (healthy subjects). Results: Serum uric acid level was significantly higher among AMI patients (6.43±2.60) as compared to control group (4.05±0.95) (p 7.1 followed by 20% patients who had uric acid level between 4.5-5.9 (p<0.001). Uric acid level was comparable between smoker and non-smokers (p=0.803), alcoholic and non-alcoholic (p=0.086), hypertensive and non-hypertensive (p=0.668), patients with and without diabetes (p=0.278) and patients with a history of IHD and without history of IHD (p=0.403). Conclusions: Serum uric acid may be useful for prognostication among those with pre-existing AMI.
TL;DR: It was found that as the glycaemic control became poorer the prevalence of TD increase in hypothyroid but not in hyperthyroidism, which suggests that female was more prone to thyroid dysfunction than males.
Abstract: Background: Aim was to study prevalence of thyroid dysfunction in type II diabetes mellitus (T2DM) patients. Methods: The present study was a cross sectional observational study, which focused on cases of diabetes mellitus. Study was conducted in Departments of Medicine, SBKS MI & RC, a tertiary care centre for a period of 6 months. All the patients of T2DM were included. Total of 263 patients were enrolled which involved indoor, outpatient and diabetic clinic attending patients. A detailed history taking, clinical examination and relevant investigations (Hb%, Total count, platelet count, serum creatinine, FBS, PP2BS, HbA1C, S.TSH, F.T3 and F.T4). Appropriate statistical analytics were used and important correlations and conclusions were drawn. Results: A study of thyroid dysfunction (TD) in T2DM patients which included 263 diabetic patients, out of them 67 had thyroid dysfunction. Out of these 67 patients 43 were female and 24 were male. This suggests that female was more prone to thyroid dysfunction than males. Out of 67 TD patients, 42 were above the age of 50 year. So, as the age increases the prevalence of TD also increases thyroid dysfunction also depends on the glycaemic control of the patients. Out of 67 patients 22 patients had>8.0 HbA1C level. In our study we found that as the glycaemic control became poorer the prevalence of TD increase in hypothyroid but not in hyperthyroidism. Conclusions: Following conclusions were drawn from this study TD is more common in female than male, more after the age of 50 year, in T2DM patients. Hypothyroidism is more common with poor glycaemic control and long duration of T2DM patients. But for hyperthyroidism data which we evaluated was not significant and further conclusion bigger study is needed.
TL;DR: Both DKD and non-diabetic CKD patients on haemodialysis revealed significant dyslipidaemia, a major cause of increased risk for cardiovascular diseases necessitating early treatment with statins.
Abstract: Background: Diabetes mellitus (DM) is a major cause of chronic kidney disease (CKD) leading to diabetic kidney disease (DKD). Several studies have observed lipid profile abnormalities in non-diabetic CKD patients with and without haemodialysis. Our study aims to reveal lipid profile abnormalities both in DKD and non-diabetic CKD patients on haemodialysis. Methods: A prospective comparative study included 50 DKD and 50 non-diabetic CKD patients on haemodialysis and 50 controls after fulfilling the inclusion and exclusion criteria. The demographic and biochemical, including lipid profile parameters data of all subjects was collected and statistically analysed. p<0.05 was considered as statically significant. Results: A total of 100 study patients, 50 DKD and 50 non-diabetic CKD patients, both on haemodialysis revealed significant dyslipidaemia when compared to controls. Total cholesterol in DKD patients on haemodialysis when compared to controls (177.5±80.5 versus 146.5±31.8 mg/dl) was significantly elevated (p=0.01). Low density lipoprotein (LDL) in DKD patients when compared to controls (94.1±43.3 versus 76.3±26.3 mg/dl) was also significantly elevated (p=0.01). Triglyceride levels in both DKD and non-diabetic CKD patients on haemodialysis in comparison to controls (213.8±182.1 and 169.2±132.3 versus 109.2±28.9 mg/dl respectively) were significantly elevated (p=0.0002 and p=0.003 respectively). Similarly, very low-density lipoprotein (VLDL) levels in both DKD and non-diabetic CKD patients were also significantly elevated when compared to controls (p=0.002 and p=0.003 respectively) whereas high density lipoprotein (HDL) was significantly reduced. Conclusion: Both DKD and non-diabetic CKD patients on haemodialysis revealed significant dyslipidaemia, a major cause of increased risk for cardiovascular diseases necessitating early treatment with statins.
TL;DR: E/E′ is a reliable estimate of LV filling pressure in subjects with systolic and diastolic heart failure and seems helpful to identify those with truly elevated LV filling pressures.
Abstract: Background: Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether the lateral mitral annular velocity as assessed by tissue Doppler imaging is associated with invasive measures of diastolic LV performance in patients with diastolic and systolic heart failure. Aim of the study was to compare the diagnostic accuracy of lateral mitral annular E/E′ as an estimate of LV filling pressure with invasive LVEDP measurement in subjects with systolic or purely diastolic heart failure. Methods: Total 100 patients were studied, 50 patients with diastolic heart failure and 50 patients with systolic heart failure in patients undergoing diagnostic coronary angiogram. Detailed 2D Echocardiography, Trans mitral Doppler and Tissue Doppler velocities of lateral mitral annulus was obtained. The ratio of peak mitral velocity (E) to lateral mitral annular velocity (E′) by TDI (E/E′) was calculated. Results: The ratio of E/E′ in diastolic group was 13.4±4.9 and in systolic group it was 13.7±5.2. The mean LVEDP in diastolic heart failure patients was 14.3±4.5 and 14.2±4.9 in systolic heart failure patients. The ratio of E/E′ showed a better correlation with LVEDP. E/E′ 15 identified increased LVEDP ≥15mmHg. Conclusions: E/E′ is a reliable estimate of LV filling pressures in subjects with systolic and diastolic heart failure. In subjects with diastolic heart failure, E/E′ seems helpful to identify those with truly elevated LV filling pressures. In patients with diastolic heart failure and normal E/E′, a search for other causes of symptoms (pulmonary disease, obesity and so forth) may be warranted.
TL;DR: Severity of retinal hard exudates in diabetic retinopathy patients is significantly associated with risk factors like systemic hypertension, dyslipidemia, raised HbA1C levels and urine microalbumin.
Abstract: Background: Diabetic macular edema (DME) characterized by deposition of hard exudates in central retina is now the leading cause of visual loss in persons with diabetes mellitus. Several studies have shown association between severity of retinal hard exudates and various components of serum lipid. The aim of this study is to estimate the proportion of severity of retinal hard exudates with risk factors like dyslipidemia, duration of diabetes, hypertension, HbA1c levels and microalbuminuria. Methods: A hospital based cross sectional study was done involving 242 diabetic retinopathy patients. After dilated fundus examination, severity of retinal hard exudates was graded by photographs with Topcon fundus camera using modified airlie house classification. These grades were divided into three groups. Group 1 (absent or minimal hard exudates) included patients with grade 0, 1 or 2 hard exudates; group 2 (hard exudates present), included patients with grade 3 or 4 hard exudates and group 3 (prominent hard exudates), patients with grade 5 hard exudates. Values of serum lipid profile, HbA1C and urine microalbumin were analysed in association with severity of retinal hard exudates. Results: Out of the 242 diabetic retinopathy patients, the male female ratio was 1:1 and the mean age was 59.8±7.4 years. There were 12% patients in group one, 52.5% in group two and 35.5% in group three. On univariate analysis, severity of hard exudates was significantly associated with serum cholesterol (p value<0.01), LDL (p value<0.01) triglycerides (p value<0.01), HbA1c (p value<0.01), systemic hypertension (p value<0.01) and urine microalbumin (p value=0.01). Conclusions: Severity of retinal hard exudates in diabetic retinopathy patients is significantly associated with risk factors like systemic hypertension, dyslipidemia, raised HbA1C levels and urine microalbumin.
TL;DR: There is an urgent need for developing strategies for efficient STEMI management, such as timely delivery of reperfusion therapy; reinforcement of health system and professionals, implementation of guideline-based interventions, streamlined insurance policy and greater emphasis on patient awareness for detection of symptoms.
Abstract: The prevalence of cardiovascular diseases continues to increase in India, with a rapid epidemiological transition. Timely management of ST-elevation myocardial infarction (STEMI)is the key to decrease mortality and morbidity rates. In India, patients most often do not receive optimal therapy owing to a number of factors such as socio-economic constraints, lack of knowledge, geographical restrictions etc, leading to suboptimal outcomes. The timely delivery of optimal reperfusion strategy for STEMI patients is immensely challenging for physicians, due to several reasons. Primary percutaneous coronary Intervention (PCI) is still a global gold standard for the treatment of STEMI. Delayed case presentation is a significant challenge, especially in Indian tier towns/cities, because of prolonged transportation time or traffic delays with regards to reaching a PCI facility. Keeping in mind the accessibility to PCI facility because of geographical locations as well as affordability concerns especially in smaller Indian towns, pharmaco-invasive approach is almost as effective and a practical approach for reduction of morbidity and mortality rates. Timely establishment of reperfusion therapy is critical for improving myocardial salvage in patients with STEMI. There is an urgent need for developing strategies for efficient STEMI management, such as timely delivery of reperfusion therapy; reinforcement of health system and professionals, implementation of guideline-based interventions, streamlined insurance policy and greater emphasis on patient awareness for detection of symptoms. In addition to the timely reperfusion therapy and other standard care drugs, statins and potassium channel activators have demonstrated clinically significant improvements in the outcome of STEMI management.
TL;DR: ClD patients have high prevalence of osteoporosis, and early screening of BMD is necessary in CLD patients, as Severity of liver disease, alcoholic Liver disease, serum calcium and vitamin D deficiency predisposes to osteoporeosis in these patients.
Abstract: Background: Hepatic osteodystrophy encompasses the spectrum of metabolic bone diseases in chronic liver disease (CLD) patients. CLD causing changes in BMD is well known. Although BMD evaluation in CLD cirrhosis are recommended by societies of British and American gastroenterology ,very less number of literature exist from India and none from the North-eastern region of India. Aim of the study to determine the association and severity of bone mineral density changes in patients with CLD and to correlate it with different aetiologies and severity of CLD. Methods: This cross-sectional study which included 79 patients with CLD was conducted in RIMS, Manipur from September 2017 to August 2019. All CLD patients of age 18-60 years were included. DEXA scan and other related blood investigations were performed. Results: Chronic alcohol intake (56.9%), viral infection (20.3%) and mixed (17.7%) were the main aetiology of CLD in our study. Seventy three (92.4%) of the total 79 patients had low BMD (Osteopenia in 29 (36.7%) and osteoporosis in 44 (55.7%) patients). Osteoporosis was detected in 53.4% of alcohol related Cirrhosis, 25%of viral liver disease. Majority of the severe CLD patients (Child class C) had osteoporosis (70.6%) as compared to less severe groups (23.5% and 36.4% in class B and A respectively). Conclusions: CLD patients have high prevalence of osteoporosis. Severity of liver disease, alcoholic liver disease, serum calcium and vitamin D deficiency predisposes to osteoporosis in these patients. Hence early screening of BMD is necessary in CLD patients.
TL;DR: Severe anemia is a poor prognostic factor and has adverse outcome and thrombocytopenia, increased PT, APTT does not have any correlation to mortality.
Abstract: Background: Malaria is a major health problem in many parts of India and some parts of Andhra Pradesh, which is also one of the endemic areas for malaria. Several factors have been attributed to increased morbidity and mortality in malaria especially with altered hematological and coagulation parameters playing an important role. The aim of present study was to study the hematological and coagulation abnormalities that correspond to severity and the final outcome. Methods: The present study was carried out on 100 patients admitted during the period of November 2016 to October 2018 at Narayana Medical College and hospital, Nellore. All of these patients were confirmed by Peripheral Smear or MPQBC or Antigen Assay followed by detailed clinical history, physical examination and investigated with hematological and coagulation parameters. Then subsequently required routine and special investigation which was followed by monitoring the outcome of the patients with respect to morbidity and mortality. Results: Out of 100 patients 20 patients had severe anemia (Hb% <7 gm%) and most of them patients were falciparum and mixed infection cases. Thrombocytopenia was observed in 63% of the patients and severe thrombocytopenia (<50,000 mm 3 ) was seen in 12% of the patients. PT and APTT were increased in 18% and 13% of the cases respectively. BT was increased in 5% of the cases. None of the patients expired in this study. Conclusions: severe anemia is a poor prognostic factor and has adverse outcome. Thrombocytopenia, increased PT, APTT does not have any correlation to mortality.
TL;DR: In this paper, a prospective study was conducted to determine the clinical and laboratory profile of anaemia among patients admitted to a hospital in India, where thirty nine patients of anemia admitted to Medicine ward in SNMC and HSK hospital were studied for their clinical and lab characteristics.
Abstract: Background: Anaemia is a major public health problem worldwide especially in developing countries like India. Nutritional cause of anaemia continues to predominate as the most common cause of anaemia. Objective of this study is to determine the clinical and laboratory profile of anaemia among patients admitted to our hospital. Methods: Our study was a prospective study in which thirty nine patients of anemia admitted to Medicine ward in SNMC and HSK hospital were studied for their clinical and laboratory characteristics. Duration of the study was 7 months from July 2019 to January 2020. Results: Anaemia was more common among females (65.1% of total patients). Patients aged less than 60 years contributed to 85% of patients. Pallor was the universal finding present in 100% of patients. On systemic examination haemic murmurs on auscultation was the most common finding present in 28.2% followed by hepatomegaly (17.94%). Microcytic and dimorphic anaemia constitute the bulk of anaemia. Conclusions: Nutritional anaemia particularly iron deficiency anaemia is the most common cause of anaemia. It tends to affect the working age group and females predominantly. Patients continue to present with severe anaemia to the hospital.
TL;DR: Curing HCV infection may lead to a better control of blood pressure in patients with compensated liver disease, however, an abrupt decrease in blood pressure may be a clinical sign of progressive liver disease and cirrhotic cardiomyopathy.
Abstract: Background: Chronic hepatitis C (HCV) infection has direct and indirect manifestations that promote vascular resistance. On the other hand, HCV infection leads to liver cirrhosis and complications such as cardiomyopathy, characterized by a hyperdynamic state with low peripheral vascular resistance. The aim of this paper is to study the evolution of arterial hypertension in patients with liver cirrhosis, after the cure of HCV infection. Methods: This is a prospective observational cohort study including 261 hypertensive patients with compensated HCV cirrhosis who underwent direct-acting antiviral treatment. Blood pressure was monitored at the initiation of antiviral therapy and at 3, 6 and 12 months follow-up. Screening for cirrhosis complications was performed and patients were also monitored by electrocardiography, liver and kidney function tests, serum lipids and N-terminal pro-B-type natriuretic peptide. Results: Virologic response after antiviral treatment led to a better control of arterial hypertension with a decrease of 24 hours mean blood pressure by 15% (p=0.04, CI 95%). In patients with stable liver disease serum levels of N-terminal pro-B-type natriuretic peptide slowly decreased at 6 and 12 months (p=0.02, p=0.03), while in patients with cirrhosis decompensation the levels increased. Also, patients with decompensated cirrhosis presented lower blood pressure values and required discontinuation of antihypertensive drugs. Conclusions: Curing HCV infection may lead to a better control of blood pressure in patients with compensated liver disease. However, an abrupt decrease in blood pressure may be a clinical sign of progressive liver disease and cirrhotic cardiomyopathy.
TL;DR: It can be concluded that Epicardial fat thickness has significant correlation with severity of coronary artery disease.
Abstract: People with diabetes are at high risk of coronary artery disease (CAD,) duration of diabetes is directly proportional to macro vascular complications. Epicardial fat through its various mechanism and anatomical closeness to the myocardium it has the direct impact on the severity of CAD. Aim of the study was to determine the correlation between epicardial fat thickness and severity of coronary artery disease in diabetic patients using syntax scoring system. The references used in this review were identified through PubMed and Google Schlor searches of articles published for the last 20 years. Search terms included CAD, correlation of EFT in CAD, syntax scoring system , Gensini scoring system, 2D-ECHO, diabetes in CAD. We reviewed 50 articles done on only humans. We reviewed relevant review articles also. It can be concluded that Epicardial fat thickness has significant correlation with severity of coronary artery disease.
TL;DR: Significant correlations between HbA1c levels and lipid levels point towards the usefulness of Hb a1c for screening high-risk diabetic patients.
Abstract: Background: Diabetes mellitus (DM) is a syndrome consisting of metabolic, vascular and neuropathic components that are interrelated. Diabetes mellitus is associated with a considerably increased risk of premature atherosclerosis, particularly coronary heart disease (CHD) and peripheral arterial disease. Dyslipidemia is a common feature of diabetes. There is an association between atherosclerotic cardiovascular disease and serum cholesterol and triglyceride levels in both type 1 and type 2 diabetes. Methods: The study was done on 50 adult diabetes mellitus (T2) patients from IPD of General Medicine wards at SMS Hospital, Ahmedabad, Gujarat. 50 healthy age and sex matched healthy volunteers were taken as control. They were evaluated for lipid profile i.e., Total Cholesterol (TC),Triglyceride (TG), Low-density lipoprotein (LDL), High density lipoprotein (HDL), Very low density lipoprotein (VLDL) and glycemic status i.e., Fasting blood glucose (FBS), Postprandial 2 hours blood glucose (PP2BS) & Glycosylated haemoglobin(HbA1C). Results: Diabetic cases had statistically highly significant (p<0.001) elevated levels of total Cholesterol, Triglycerides and VLDL as compared to controls. Serum TG, serum TC, LDL-C and VLDL-C had positive correlation with the postprandial plasma glucose, fasting plasma glucose and HbA1c. Conclusions: Significant correlations between HbA1c levels and lipid levels point towards the usefulness of HbA1c for screening high-risk diabetic patients. High TC, TG, LDL-C and HbA1c with normal or low HDL-C is seen in almost all diabetic patients either alone or in combinations.
TL;DR: Lifestyle modification should be expanded in PCOS patients including sleep hygiene alongside food and exercise positive outcome can be obtained, according to the view of Ayurveda.
Abstract: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder which affects the reproductive, metabolic and psychological health of women. Now a day’s incidence rate of PCOS is incising in reproductive age of woman due to sedentary lifestyle and faulty daily routine. Clinical studies indicate that sleep disturbance and disorders including obstructive sleep apnea and excessive daytime sleepiness are more common in the woman with symptoms of PCOS. Despite proof of the high prevalence of sleep disorders in these patients, modification of sleep is not considered as major point for treatment protocol in modern therapeutics. Ayurveda as a holistic medicine lays great emphasis on lifestyle modification under Aahaara (Diet)- Vihaara (Daily regimen)- Oushadha (Medicine) - triad for the prevention and treatment of all diseases. Among Vihaara, Nidra (Sleep) is considered as a very influencing factor in Ayurvedic classics. Balanced sleep at night maintains the health. Disturbance of sleep pattern can lead to Dosha vitiation which hampers regular metabolic activity of the body and leads to various disorders. Hormones affecting metabolism, appetite and blood glucose are regulated with circadian rhythms. When circadian rhythms are out of sync, the body’s metabolic health hampers. Irregular metabolic function disturbs the hormonal cycle including hypothelamo-pitutory-ovarian axis, hypothalamic–pituitary–adrenal function, and so on. These can ultimately lead to PCOS in reproductive age of women. It seems that if lifestyle modification should be expanded in PCOS patients including sleep hygiene alongside food and exercise positive outcome can be obtained. With this background this study is aimed to determine the importance of sleep hygiene in PCOS from the view of Ayurveda.
TL;DR: Thyroid function abnormality suggesting Non thyroid illness or euthyroid sick syndrome is common among critically ill patients is common, and the severity of illness correlates well with the reduction in total serum T3 level.
Abstract: Background: The nonthyroidal illness syndrome, also known as the low T3 syndrome or euthyroid sick syndrome. Any acute severe illness can cause abnormalities of circulating Thyroid Stimulating Hormone (TSH) or Thyroid Hormone (TH) levels in the absence of underlying thyroid disease. The laboratory parameters of this syndrome include low serum levels of T3 and high levels of reverse T3, with normal or low levels of thyroxine (T4) and normal or low levels of TSH. This condition may affect 60-70% of critically ill patients. The severity of illness correlates well with the reduction in total serum T3 level. Objectives of the study was to assess the thyroid status of critically ill patients admitted in intensive care unit of a tertiary care hospital. Methods: This is a retrospective observational study done at Department of General Medicine, MIMS, Mandya among patients admitted with critical illness to ICU. 100 patients admitted with critical illness to ICU are included in this study. Thyroid function reports obtained from case sheets, data entered into MS Excel sheet and analysed. Results: Out of 100 patients studied 34 patients had sepsis, 26 patients had respiratory failure, 20 patients had Congestive cardiac failure, 12 patients had acute renal failure and 8 patients had Diabetic ketoacidosis. Among 100 patients 63% had abnormal thyroid function test, 56% had low T3, 12% had low T4, 2% had high T4 and 3% had low TSH. Conclusions: Thyroid function abnormality suggesting Non thyroid illness or euthyroid sick syndrome is common among critically ill patients.
TL;DR: Pharmacists can prevent DRPs through providing drug information to doctors or other health professionals so that increased communication between health professionals is required.
Abstract: Background: DRP (Drug-Related Problems) affects the outcome of chemotherapy treatment to cancer patients. Matters related to DRP can be prevented by a pharmacist by providing drug information to doctors or other health professionals. The objective of this study was to determine the description of DRP, type of DRP, recommendations given by pharmacists on DRPs, acceptance of the results of recommendations and analysis of factors that affect DRPs. Methods: The research method was carried out through a cross sectional study in which observational data collection was conducted concurrently. The study population was all breast cancer patients from the Division of Surgical Oncology in the period January - April 2018 as many as 228 people. The collected data consisted of dosage suitability, suitability of carrier fluid volume, patient adherence to the schedule for breast cancer patients, recommendations given by pharmacists and the results of acceptance of pharmacist recommendations. Results: Based on research findings, the incidence of DRP was 76.3%. Most problems were regarding carrier fluid volume (64.5%) and dose mismatch (30%). There was also a DRP combination of carrier fluid volume and dose of 19%. The pharmacist’s recommendation was to change the dose by 15.52%, change the carrier fluid volume by 60.92%, and change the dose and volume of the carrier fluid by 23.56%. The recommended dosage received by doctors was 13 patients (7.47%), changing the volume of carrier fluid received by doctors by 106 patients (60.92%). Conclusions: Pharmacists can prevent DRPs through providing drug information to doctors or other health professionals so that increased communication between health professionals is required.
TL;DR: Iron deficiency anemia revealed as a most common type of anemia, vitamin B12 and folic acid deficiencies also contributed significantly to nutritional anemias.
Abstract: Background: Anemia is one of the most common health problems in India. Understanding the variations among the prevalence of anemia between population groups in this large and heterogeneous country is crucial to inform relevant health policy and health service interventions. The present study was conducted to assess prevalence of anemia in the population of Nanded district, Maharashtra. Methods : All subjects between 13-70 years of age were enrolled in the study for screening of prevalence of anemia. Under complete aseptic conditions, 10 ml of blood was withdrawn from antecubital vein and 2 ml was used for complete blood count estimation and for further blood investigations as necessary. Various hematological parameters were tested in correlation to history and clinical examination of the patients. All data thus obtained was arranged in tabulated form and analyzed using SPSS software. Results: There were a total of 2190 subjects evaluated, out of these 560 were anemic and 1630 were non-anemic. Out of 560 anemic subjects, 420 were of female gender and remaining 140 were male. The mean iron levels were 64 ± 34 μg/dl. The mean screen ferritin levels were 201±183 ng/dl. Conclusions: There were 26% of subjects in our study who were anemic, and majority of them were females Although, Iron deficiency anemia revealed as a most common type of anemia, vitamin B12 and folic acid deficiencies also contributed significantly to nutritional anemias. The disease widely occurs and affects mostly children of growing age, females in reproductive ages and elderly population.
TL;DR: Mainly gram-negative bacilli are found to be responsible for UTI and most frequent isolated bacteria was E-coli and the most sensitive antibiotics were nitrofurantoin, meropenem, and amikacin& gentamycin.
Abstract: Background: Urinary tract infection (UTI) is one of the most important causes of bacterial infections across the globe. Increasing antibiotic resistance among urinary pathogens to commonly prescribed drugs has become a therapeutic challenge. Periodic evaluation of antimicrobial activity of different antibiotics is essential as the pattern of antibiotic sensitivity may vary over periods. Methods: This cross-sectional study was undertaken in the Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet from January 2019 to June 2019 among 100 adult patients admitted Medicine indoor Department confirmed as UTI on the basis of symptoms, signs and compatible investigation, urine culture either positive or negative. Results: Out of the total 100 urine samples 60 samples were positive for pathogenic organisms. Escherichia coli was isolated in 41 (68.3%) of the positive samples, followed by Klebsiella sp 13 (21.6%), Pseudomonas sp 3 (5%) Proteus sp 2 (3.3%) staph. Aureus 1 (1.66%). E coli was found to be most sensitive to nitrofurantoin (92.5%), meropenem (92.5%), amikacin (84.6%) and gentamycin (71.8%) and resistant to most commonly used drugs like cefixime (78%), cefuroxime (77.5%), ciprofloxacin (62.5%), ceftriaxone (62.5%). Conclusions: Mainly gram-negative bacilli are found to be responsible for UTI and most frequent isolated bacteria was E-coli. The most sensitive antibiotics were nitrofurantoin, meropenem, and amikacin& gentamycin. Frequently usedantibiotic like cefixime, cefuroxime, cotrimoxazole, ciprofloxacin & ceftriaxone were mostly resistant to E-coli.
TL;DR: There was significant association of reciprocal changes in ECG with higher Hba1c, higher KILLIP class and higher incidence of unsuccessful thrombolysis in patients with and without reciprocalChanges in acute STEMI.
Abstract: Background: Recent studies indicate that STEMI with reciprocal changes is associated with more myocardial area at risk, larger infarct size and less ejection fraction as compared to STEMI without reciprocal changes. We undertook this study for correlating clinical outcome and complications in patients with and without reciprocal changes in ECG in acute STEMI. Methods: Eighty patients were divided into two groups of forty each. One having reciprocal changes in ECG and one without reciprocal changes. The KILLIP class of each patient at time of admission was noted. Patients were monitored for development of any complication, Left ventricular ejection fraction (LVEF) and mortality. BNP levels, Trop I levels, Hba1c levels were obtained at time of admission. Echocardiography was done on the second day of the admission. Results: The patients with reciprocal changes were found to be having a higher KILLIP class on admission. The LVEF of patients with reciprocal changes and who subsequently went on to develop complications was lower than those without reciprocal changes. The number of patients having unsuccessful thrombolysis was significantly higher in the group with reciprocal changes. Conclusions: There was significant association of reciprocal changes in ECG with higher Hba1c, higher KILLIP class and higher incidence of unsuccessful thrombolysis. Moreover, the sensitivity of other markers of poor clinical outcomes, such as BNP and LVEF increases in patients having reciprocal changes in their ECG. The monitoring in such patients should thus be more intensive.
TL;DR: Data from various studies point towards a paradigm shift from surgical to conservative management as the standard of care irrespective of the grade and mode of renal trauma.
Abstract: Introduction: The kidney is the most commonly injured genitourinary organ following trauma. It can be a result of both blunt and penetrating trauma to the abdomen. Both conservative and surgical managements are employed as per the clinical profile of the patient. Methods: This prospective observational study included all the patients with renal trauma who presented at the ER. Computed tomography (CT) was done for grading of renal trauma. Results: A total of 60 patients were included in the study. Eighty percent (n=48) patients were managed conservatively. Twenty percent (n=12) patients underwent some form of surgical management. The mean (SD) hospital stay as 11.38 (6.94) days. Twenty-eight patients (46.67%) had right renal injury. Thirty-two patients (53.33%) had left renal involvement. There were no patients with bilateral renal injury. According to American association for the surgery of trauma (AAST), 11.66% patients (n=7) were categorised in grade I, 20% patients (n=12) to grade II, 33.33% patients (n=20) to grade III, 25% patients (n=15) to grade IV and 10% patients (n=6) to grade V. The most common associated injuries were rib fracture and visceral injury. Conclusion: Much has changed since historical times with regards to renal trauma management. Data from various studies point towards a paradigm shift from surgical to conservative management as the standard of care irrespective of the grade and mode of renal trauma.
TL;DR: Platelet indices like Mean platelet volume and platelet distribution width was significantly higher in individuals with microvascular complications, predominantly Diabetic Nephropathy and Diabetic Retinopathy when compared to those without microv vascular complications.
Abstract: Diabetes is a common metabolic disorder affecting the world population which accounts for major amount of morbidity and mortality mainly due to its micro vascular and macro vascular complications. This is a comparative study which analyses the correlation between the Platelet indices like Mean platelet volume, platelet distribution width, plateletcrit and total platelet count in diabetic patients with micro vascular complications and without complications. This review of the literature was conducted through an Internet search on a public access website like PubMed Google scholar, Medline databases until 2019. Keywords utilized included Diabetes mellitus, Microvascular complications, platelet indices. The major exclusion criteria was studies which included the patients with macrovascular complications and patients taking drugs which alters the platelet indices. All these articles were analysed. Platelet indices like Mean platelet volume and platelet distribution width was significantly higher in individuals with microvascular complications, predominantly Diabetic Nephropathy and Diabetic Retinopathy when compared to those without microvascular complications. Change in platelet indices were found to be statistically associated with diabetic microvascular complications. Hence these parameters can be used to monitor and to predict the risk of microvascular complications.