ePrints@TNMGRM (Tamil Nadu Dr. M.G.R. Medical University)
ePrints@TNMGRM (Tamil Nadu Dr. M.G.R. Medical University)Not a member yet
20811 research outputs found
Sort by
A Study on Predictors of Poor Outcome in Snake Bite Induced Acute Kidney Injury at Chengalpattu Medical College Hospital
No full textBACKGROUND: Snake bite is a significant cause of death and morbidity in tropical and subtropical countries such as the Indian subcontinent. Acute renal failure can result from the bite of a venomous snake, more common in Viper species of snakes. Globally published statistics on the incidence of acute kidney injury (AKI) after venomous snakebites in developing countries such as India are less, and the proportion of victims who rely on conventional treatments is often fatal.
AIM OF THE STUDY: To determine the incidence of acute renal injury and to examine the clinical, hemodynamic, and investigational profiles of those who were admitted with snakebite and analyzing its outcomes. To identify and categorise patients with AKI using the AKIN staging and to understand the root causes of AKI development.
MATERIALS AND METHODS: After getting approval of institutional ethical committee, 150 patients who fulfilled the inclusion and exclusion criteria were recruited for the study. Details regarding initial treatment, renal parameters have been collected. Acute kidney injury was defined according to AKIN criteria. Patients were classified into 4 groups- NO AKI, AKIN 1, AKIN 2, AKIN 3 by monitoring urine output and Serum Creatinine. CBC- Hb, PCV, and Platelet count was monitored daily. Renal parameters were monitored daily. The study design was a cross sectional study. All data collected were noted using a structured proforma, including the investigations. Data was analysed using statistical package and SPSS structured software to find out the proportion of acute kidney Injury among 150 patients, and their clinical profile and outcome of them.
RESULTS: In our study, 99 patients developed AKI. 92% of patients recovered completely.64 patients with AKIN 1, 13 patients with AKIN2, 1 patients with AKIN 3 recovered with conservative management. 7 patients become Dialysis dependent for more than a month and progressed to chronic kidney Disease and advised to monitor renal parameters regularly and 5 patient died in hospital, 4 of them in stage 3 AKIN and one person in stage 1 AKIN.
CONCLUSION: Our study concluded that a severe acute renal damage is highly linked with a delay in bringing the patient to the hospital. Poor prognosis is seen in patients with rapidly progressing cellulitis and those who have coagulopathy, moderate to severe thrombocytopenia also in elderly patients with co morbidities
A Randomised Control study on Split Skin Graft Success Rate between Tumescent Infiltrated and Uninfiltrated Donor Sites
No full textA Prospective Comparative study to Estimate Efficacy of Saline Dressing Versus Collagen Dressing in Management of Diabetic Foot Ulcer Patients
No full textEfficacy of Low Molecular Weight Heparin in Treatment of Sever Acute Pancreatitis: A Prospective Clinical study
No full textSubclinical Hypothyroidism in Newly Diagnosed Hypertensive Patients
No full textINTRODUCTION: Hypertension is one of the leading causes of morbidity and mortality worldwide. It is a major risk factor for several diseases like Coronary artery disease, Stroke, Peripheral arterial diseases and Chronic Kidney Disease. Primary hypertension is the main cause of hypertension worldwide. Subclinical hypothyroidism which is defined as the normal Free T4 and T3 levels with elevated Serum TSH levels has been shown to be associated with adverse cardiovascular outcomes. Some studies have shown that even the subclinical hypothyroidism increases the risk of hypertension but it is still under debate. AIMS AND OBJECTIVES: The Aim of the study is to find the prevalence of subclinical hypothyroidism in newly diagnosed hypertensive patients. MATERIALS AND METHODS: Patients who are found to have newly diagnosed hypertension according to ISH (International Society of Hypertension) 2020 guidelines will be taken as subjects. Informed consent will be obtained from them regarding the study. A full clinical history including the demographic characteristics, comorbidities, and addictions will be obtained and a full clinical examination will be done. Patients will be advised to follow up the next day for a fasting blood sample and the thyroid functions – Serum TSH, Free T4, and Free T3 will be measured with standardized assays in the biochemistry laboratory. The data obtained will be analysed for the association of thyroid dysfunction in newly diagnosed hypertensive individuals.
RESULTS: The majority of patients, 94 (29.3%) were observed in the age group of 51-60 years, followed by the age group of 31 to 40 years 93 (29%). Of all patients who participated in the present study majority were male 177 (55.1%) whereas 144 (44.9%) were reported as female. The observation of BMI was also carried out in the present study and it was found that 160 (49.8%) patients were obese and 148 (46.1%) patients were reported overweight. 89 (27.7%) patients were reported with DM whereas 232 (72.3%) patients were observed without DM. The SCH in all patients was also recorded and it was found that only 29 (9%) patients reported SCH whereas the majority of patients 292 (91%0 were found without SCH. The maximum patient 10 (23.8%) with SCH was reported in the age group of more than 60 years, followed age group of 31 to 40 years with 8 (8.6%) patients. The observation of SCH was carried out for the gender of patients. It was found that more female patients 17 (11.8%) with SCH whereas male patients reported 12 (6.8%) SCH cases. When the BMI of patients was recorded with the observation of SCH in patients, it was observed that overweight patients were found with a maximum of 17 (11.5%) cases of SCH followed by obese patients with 1 (7.7%) patient with SCH. The DM of patients was correlated for observation of SCH in patients. It was found that patients with DM showed more incidences of SCH 10 (11.2%) in comparison to patients without DM 19 (8.2%). CONCLUSION: Subclinical hypothyroidism is prevalent in general population and the awareness of the implications of it is not well appreciated. The management of the condition whether it requires or not is still controversial and not completely understood. It has been shown that subclinical hypothyroidism increases the risk of cardiovascular morbidities. The association between hypertension and subclinical hypothyroidism has not been well studies especially in Indian population. Our study shows that the prevalence of subclinical hypothyroidism is 9 percent in newly diagnosed hypertensive patients. The relative risk of getting diagnosed with hypertension has to be studied further and the causal association between the hypertension and subclinical hypothyroidism has to be investigated further
Left Ventricular Dysfunction by Echocardiography in Type 2 Diabetes Mellitus Patients With and Without Albuminuria
No full textINTRODUCTION:
Diabetes mellitus (DM) is a category of metabolic illnesses characterised by hyperglycemia. A complicated interplay between heredity and the environment generates multiple forms of DM. In addition, the secondary pathophysiologic alterations in numerous organ systems that result from the metabolic dysregulation associated with DM place a great burden on the person with diabetes and the health care system.
Numerous cardiovascular issues, such as an increased incidence of atherosclerotic coronary artery disease, myocardial infarction, congestive heart failure, coronary microangiopathy, systemic arterial hypertension, and cardiomyopathy, are brought on by DM.
Diabetic cardiomyopathy is a disease process that damages the myocardium in diabetic individuals, ultimately leading to LVH [left ventricular (LV) hypertrophy] and diastolic and systolic dysfunction, or a combination of these conditions. Depending on symptoms and indications, diabetic cardiomyopathy may be asymptomatic or manifest. In most cases, there seems to be a lengthy subclinical course before the onset of symptoms. It is believed that diabetic cardiomyopathy results from microangiopathy, collagen deposition, and impaired myofilament Ca2+ sensitivity.
Worldwide, Type 2 DM is the leading cause of chronic kidney disease (CKD), such as albuminuria. In India, it accounts for around 45% of instances of end-stage renal disease among dialysis patients. Moreover, type 2 diabetes has been linked to an increased risk of heart failure (HF), morbidity, and death. However, the explanation for this elevated risk is not entirely understood and cannot be fully explained by established cardiovascular disease risk factors (CVD). Patients with renal insufficiency commonly exhibit structural and functional cardiac abnormalities owing to pressure and fluid overload. In addition, individuals with chronic kidney disease have a significant incidence of decreased left ventricular (LV) systolic and diastolic function and LV hypertrophy (LVH).
In individuals with DM, coronary artery disease (CAD) and diabetic cardiomyopathy, as defined by LVH and LV systolic and diastolic dysfunction, are the most frequent structural and functional cardiac diseases. Therefore, to minimise or postpone consequences, it is crucial to diagnose pre-clinical cardiovascular disease in this group as soon as possible. Few investigations, however, have examined echocardiographic abnormalities in individuals with intermediate to severe CKD and DM.
AIM OF THE STUDY:
To compare LV dysfunction by ECHO in Type 2 Diabetes mellitus patients with and without albuminuria.
OBJECTIVES OF THE STUDY:
To find a statistically significant association between albuminuria and severity of cardiac dysfunction by ECHO, independent of possible confounding factors.
MATERIALS AND METHODS:
STUDY DESIGN: COMPARATIVE CROSS-SECTIONAL STUDY
STUDY POPULATION:
Patients with type 2 diabetes mellitus who attend the outpatient department of internal medicine.
SUMMARY:
● The maximum number of patients observed in the age group of less than 51 to 60 years and 61 to 70 years in both groups with (WIA) 41 (39%) and without albuminuria (WOA) 42 (40%). There is no significant difference in age between groups.
● The majority were female in WIA 55 (52.4%) and male in WOA 62 (59%) group. There is no significant difference in gender between groups.
● The maximum number of patients were reported overweight, 44 (41.9%), followed by obese, 32 (30.5%).
● The maximum number of patients with more than 15 years of DM duration in both groups was WIA: 31 (29.5%); WIA: 31 (29.5%) in the WOA group. There is no significant difference in DM duration between groups.
● 49 (46.7%) patients were in the WIA group with LVD. Only 20 (19%) patients were reported with LVD in the WOA group. There is no significant difference in LVD between groups.
● Overweight and obese patients were observed with more LVD 17 (34.7%) in the WIA group. More overweight patients were found with LVD 8 (40%) in the WOA group. There is no significant difference in BMI patients with LVD between groups.
● 18 (36.7%) patients were observed with LVD in the WIA group. Out of 29 patients with hypertension, 6 (30%) patients were reported with LVD in the WOA group. There is a significant difference in hypertension patients with LVD between the WOA group.
● Four hundred thirteen patients with dyslipidemia, 19 (38.8%) patients were observed with LVD in the WIA group. Out of 44 patients with dyslipidemia, 8 (40%) patients were reported with LVD in the WOA group.
● There is no significant difference in dyslipidemia patients with LVD between groups.
● Of eleven patients with smoking, 3 (12%) were observed with LVD in the WIA group. Of seven patients with a smoking habit, 1 (10%) patient was reported with LVD in the WOA group. There is no significant difference in smoking patients with LVD between groups.
● Six patients with alcoholism, 3 (12%), were observed with LVD in the WIA group. There is no significant difference in alcohol patients with LVD between groups.
● Thirty-one patients with maximum DM duration (more than 15 years) and 20 (40.8%) patients were observed with LVD in the WIA group. Thirty-one patients with maximum DM duration (more than 15 years) and 9 (45%) patients were reported with LVD in the WOA group. There is a significant difference in DM patients with LVD between groups.
CONCLUSION:
This study unequivocally establishes the link between albuminuria and LVD and the direct and independent link between ageing and LVD in patients with normotensive diabetes. Therefore, to get a more thorough risk assessment for the emergence of cardiovascular problems, frequent screening for albuminuria should be performed in diabetes patients, along with other risk markers, including lipid profile and BP.
Further, Patients with type 2 diabetes who have albuminuria should have yearly echocardiography screenings to look for LVDD early on. In addition, echocardiography-based evaluation of heart function in T2DM patients should be required for early preventative measures
Correlation Between Mean Platelet Volume and Microvascular Complications in Type II Diabetes Mellitus
No full textINTRODUCTION: Diabetes mellitus is a chronic metabolic disorder characterized by endothelial dysfunction and is associated with long term macrovascular and microvascular complications involving the blood vessels, eyes, kidneys, and nerves. Type 2 diabetes accounts for over 80% of cases of diabetes mellitus and is a slow onset, heterogeneous disorder resulting from complex interactions between environmental factors and polygenetic inheritance. Diabetes is characterised by changes in morphology of platelets and their function, causing hyperactivity resulting in a pro-thrombotic condition. Morbidity and mortality in people with type 2 diabetes is related to micro and macrovascular complications.
Novel newer biomarkers are required to identify and treat the people with greater risk. Larger platelets which contain denser granules are both metabolically and enzymatically active than the smaller ones and have higher thrombotic capabilities. Hence, platelet parameters such as mean platelet volume and platelet count are indicators of thrombotic potential. These parameters have been found to be increased in diabetic patients, leading to increased risk of vascular complications. Among platelet indices, mean platelet volume (MPV) reflects changes in either stimulation of platelets or production rate of platelets. In view of this, we aim to study mean platelet volume in type 2 diabetes mellitus and its predictive role in microvascular complications.
AIM OF THE STUDY:
To assess the correlation between the mean platelet volume with nephropathy, retinopathy, and neuropathy in type II diabetes mellitus.
OBJECTIVES:
1.To find out whether a significant association exists between the occurrence of nephropathy, retinopathy, and neuropathy in type II diabetes mellitus with increased mean platelet volume.
2. To find out the association between the severity of these complications and duration of diabetes with the mean platelet volume.
STUDY METHODOLOGY:
All diabetic patients attending medicine OPD and those admitted to Kilpauk Medical College during the time period described above were assessed. Patients fulfilling the inclusion criteria were enrolled into the study, after obtaining an informed consent. Data was collected and recorded as per the proforma. Blood samples were analyzed using Sysmex automated analyzer and mean platelet volume measured. The samples were taken to the institutional laboratory within 2 hours of collection. Peripheral smear study was also done for each sample taken to rule out the presence of platelet aggregates.
Nephropathy was quantitated by collecting an early morning urine sample and it was sent to laboratory for measuring the urine spot protein-creatinine ratio. Retinopathy was assessed by direct ophthalmoscopy. Neuropathy was assessed by 10gram monofilament testing. After baseline evaluation patients were divided based on the presence or absence of microvascular complications. The mean platelet volume between these subgroups was compared and correlation analysis done.
CONCLUSION:
Mean platelet volume can thus be used as a cost effective and reliable indicator for emergence of nephropathy, retinopathy, and neuropathy in diabetes as evidenced by increased mean platelet volume in the complications group. From the study results it is also evident that there is a direct correlation between the severity of these microvascular complications and mean platelet volume. Duration of diabetes and Mean platelet volume were not dependent on each other possibly alluding to the fact that the glycemic control would play a role in the occurrence of the microvascular complications. This is also supported in the study wherein statistical significance was observed in the treatment undertaken between the groups
A Study on Serum Magnesium as a Prognostic Marker in Predicting Outcomes in Sepsis
No full textINTRODUCTION:
Magnesium is the fourth most abundant electrolyte in the body. Magnesium has been associated with many conditions such as chronic obstructive pulmonary disease, sepsis, critically ill patients, cardiac illness etc. Magnesium has many roles including membrane stability, protection against sepsis, regulation of blood pressure, electrolyte stability, lactic acid metabolism. We conducted a study to find if serum magnesium could be used as a biomarker in predicting outcomes in sepsis.
AIMS AND OBJECTIVES:
The aim of the study is to evaluate the use of serum magnesium levels as a prognostic indicator to predict outcomes in sepsis patients.
Primary objective :
To assess the value of serum magnesium levels as a prognostic indicator in predicting outcomes in sepsis
Secondary objectives:
1. To assess outcomes in terms of recovery and mortality
2. To assess the proportion requiring ventilation, duration of ventilation, duration of imcu stay.
3. To assess clinical and biochemical parameters after 15 days of admission.
MATERIALS AND METHODS:
This study involved 100 patients admitted in intensive medical care unit with sepsis and measured serum magnesium on days one and three of their admission and statistical analysis was done to find out correlation between
hypomagnesemia and parameters such as ionotropic support, need for mechanical ventilation, duration of mechanical ventilation, duration of imcu stay and mortality. This study intended to find whether serum magnesium can be used
as a biomarker in predicting outcomes in sepsis.
OBSERVATIONS AND RESULTS:
This study involved 64 male patients and 36 female patients. Hypomagnesemia on day one was around 64 percent and 56 percent on day three. 40 percent of patients were found to have ionotropic support, 59 percent of patients required
mechanical ventilation. SOFA score was calculated. Analysis done showed there was significant positive correlation between hypomagnesemia on day one and three with the need for ionotropic support, the need for mechanical ventilation,
the duration of mechanical ventilation. There was no significant correlation between duration of stay in imcu and hypomagnesemia didn't correlate with mortality.
CONCLUSION:
This study found out that hypomagnesemia could be associated with worse outcomes in sepsis patients. Hence routine screening of hypomagnesemia in intensive care set up could help in treating the patients and if needed replacement of magnesium could help I'm better outcomes in patients with sepsis.
Since this study involve small number of population large multicentric trials are needed to confirm the use of serum magnesium as a biomarker in helping to predict outcomes in sepsis
Serum Lipid Profile and Its Correlation with Iron Deficiency Anemia
No full textINTRODUCTION:
In an era where there is an increasing prevalence of atherosclerotic vascular disease, the factors that contribute to atherosclerosis need to be evaluated. Hyperlipidemia is one of the chief contributors to the atherosclerotic process. Yet another significant issue in the spotlight in India is the prevalence of anemia. Anemia, as per the World Health Organisation (WHO), is defined as Hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men. Maram et al. in their study showed that iron deficiency anemia was a significant risk factor for dyslipidemia in the Egyptian population and its treatment led to significant reduction in lipids levels. Studies also have demonstrated that iron deficiency affected lipid metabolism by down regulating apolipoprotein H expression and thus is likely to cause increased cholesterol, triglycerides and LDL in plasma. Thus, with an increase in the prevalence of both Atherosclerotic Cardiovascular disease (ASCVD) and iron deficiency anemia, in India, a correlation, if established, can help in treatment of anemia which will have a beneficial effect on the lipid levels, which in turn can serve as a protective mechanism against ASCVD.
AIM OF THE STUDY: 1. To look for a correlation between the lipid profile and iron deficiency anemia.
2. To look for the alterations in lipid profile of the patients after correction of iron deficiency.
MATERIAL AND METHODS:
STUDY DESIGN: Prospective observational study
STUDY PERIOD: 6 months
STUDY CENTRE: Dept of General Medicine, Government Kilpauk Medical
College, Chennai.
TOTAL SAMPLE SIZE: On basis of my reference article, with a confidence
interval of 95%, using the method of sample size for difference between the
means, my sample size is 66 for each group. Adding 10% for loss to follow up,
my final sample size is 73+73 – 146 subjects.
INCLUSION CRITERIA: Informed consent. Age >18 years
CASES: Patients with iron deficiency anemia without the co-morbidities
mentioned in the exclusion criteria.
CONTROLS: Non-anemic patients matched for age, sex and BMI., without the
conditions mentioned in the exclusion criteria.
EXCLUSION CRITERIA:
1. Individuals with chronic diseases like systemic
hypertension, diabetes mellitus, prior myocardial infarction, prior cerebrovascular accidents, hypothyroidism, nephrotic syndrome.
2. Patients with liver diseases.
3. Patients on lipid lowering medications, glucocorticoids, diuretics, beta blockers were excluded from the study.
4. Patients with retroviral diseases.
5. Patients with a BMI 25.
6. Age <18 years and pregnancy.
SUMMARY: A female predominance was reported in the current study with 82 females (56.2%) and males were 64 (43.8%). In the case group, 42 females were seen and 40 males were included, followed by 31 females and 33 males in the control group. Out of 73 patients in the case group, 41 patients presented with moderate anemia (56.2%), followed by severe anemia in 29 patients (39.7%). All participants in the current study were observed with normal levels of HDL in both groups. The study reports a significant difference in the LDL levels in patients in the case and control groups (p-value = 0.001). Elevated levels of LDL were reported in 7 patients in the case group and 23patientss in the control group. The current study reports that severe anemia patients were seen with increased triglyceride levels (24.1%), followed by increased VLDL levels in 24.1% of the patients. Patients with moderate anemic conditions were seen with elevated levels of triglycerides (14.6%). An increased level of LDL was seen in patients with moderate anemia (14.6%). The study finds that the control group significantly had elevated levels of cholesterol levels when compared with the case group and reports a statistical difference in HDL and LDL levels for the case and control group respectively (p-value <0.0001). The study reports a significant difference concerning the total cholesterol levels among patients with mild, moderate, and severe anemia (p-value <0.0001). In addition, the study also reports a significant difference in the HDL and LDL levels in the case group with a p-value of 0.001. A 3-month follow-up revealed mild anemia in 32.9% of the patients, and 50.7% of patients were not anemia anymore. However, a loss to follow-up was reported in 12 patients (16.4%). 50.7% of patients after a 3-month follow-up were reported with no amenia, however, the prevalence of mild anemia was seen with a mean of 120.54 (SD = 14.44) in 32.9% of patients. The study reports a significant difference in total cholesterol levels with the severity of anemia after 3 months.
CONCLUSION: Anemia and lipid profile pose a direct relationship that adversely affects the clinical condition of patients. The current study was conducted among case and control groups with a mean age of 39.52 (SD = 17.08) and 37.26 (SD = 15.75) respectively with a female predominance of 56.2%. The severity of anemic condition differed in the participants out of which 56.2% were moderately anemic and 39.7% were severely anemic. The comparison of LDL levels in the case and control group revealed a significant difference which revealed that patients with anemia are more prone to a decreased level of lipid profile. A significant difference was reported in the comparison of case and control groups concerning the differences in HDL and LDL levels among patients (p-value <0.0001). In addition, the severity of anemia and the decreased levels of total cholesterol in the case group with a significant difference (p-value <0.0001) which demonstrates the correlation of anemic condition with lipid profile. To assess further, the study also conducted a 3-month follow-up for which reported 50.7% of normalized patients and 32.9% with the mild anemic condition. The study finds a significant correlation between total cholesterol levels and a 3-month severity assessment of anemia (p-value <0.0001). To conclude, the current study reports a direct relationship between anemia and the prevalence of altered lipid profiles among patients affected majorly with decreased levels of total cholesterol, HDL, and LDL levels. Hence, patients with anemic conditions can be tested for a lipid profile to prevent further at-risk complications. Similarly, low lipid levels in patients with unknown etiology can be correlated with the incidence of anemia