International Journal of Health and Clinical Research
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Effects of Hyponatremia in Patient with Acute Coronary Syndrome
Full text linkIntroduction - Hyponatremia mostly occur very common in acute coronary syndrome and it is a bad prognostic indicator in patients with acute coronary syndrome. Also hyponatremia is a single independent predictor of adverse clinical outcomes on mortality in hospitalized patients due to severe heart failure1. In these patients with acute coronary syndrome hyponatremia has been related to the non-osmotic release of ADH, activation of RAS and then leading to catecholamine production. Coronary artery disease is the world’s most important cause of death. Electrolyte imbalance is common in hospitalized patients, especially in patients with heart failure. Hyponatremia is also common after myocardial infarction which increases the mortality and but there is very much clinical improvement followed by a rise in plasma Sodium at concentration. Hyponatremia is defined as plasma concentration of <135 mEq/L. Aim & Objective - To study the effects of hyponatremia in patients with acute coronary syndrome, To analyse prognostic significance of hyponatremia in patients with acute coronary syndrome. To access usefulness of hyponatremia in predicting short term mortality. To find association between hyponatremia and other risk factor like Ejection fraction, Hypertension, diabetes mellitus, type of infarction. Methodology - Prospective study, Study population: 105 patients admitted as acute coronary syndrome. Inclusion criteria: 100 clinically diagnosed cases of acute coronary syndrome. Patients with chest pain > 20 min and ST segment elevation in ECG. Exclusion Criteria: Patients with renal failure, Diabetic patients, Acute and chronic liver failure, COPD patients on beta agonists. Results - Acute coronary syndrome is an important cause of mortality and morbidity in the world. 105 cases of acute coronary syndrome was selected in our study conducted in Gajraraja Medical College, Gwalior, from 2020 to 2022 and was found that hyponatremia was a major prognostic factor in acute myocardial infarction. In my study middle aged population >40 years age are at more risk to developing coronary artery disease. It is relatively a small proportion of all MI. Studies show that 900 people under the age of 30 die every day from heart disease in India. Many risk factors like psychological stress, cocaine use, alcohol, APLA, family history, OCP, hypercoagulable states, etc have been attributed to the cause. In my study, the incidence of male and female were 81 and 24 respectively among the 105 patients. Hyponatremia is well known that it is a serum Sodium at level <135 mEq/L. The severity of hyponatremia was defined as mild(130-135mEq/L) and moderate to severe (<130mEq/L). Serum Sodium at levels were documented as follows: baseline measurement at the day of admission, the lowest Sodium at level during hospitalization i.e after 48 hrs of admission and during discharge. Conclusion - On concluding hyponatremia has significant prognostic value in short term and long term adverse events in patients diagnosed with ACS. It is a single predictive factor for prognosis of Acute Coronary syndrome. Prognosis worsen with increasing severity of hyponatremia. As seen in the study, mortality rate was higher with hyponatremia patients, both at admission and discharge. Among the patients in my study hyponatremia was more common in the 6th decade without any previous illness like diabetes mellitis, chronic kidney disease heart failure. The common cause of hyponatremia was ruled out of which acute myocardial infarction was the only cause for hyponatremia in the study population
Formulation and Evaluation of Rapid Dispersible Tablets of NSAIDS using Co-Micronisation Method
Full text linkThe objective of the present study was to develop a pharmaceutically active, stable, safe, cost effective and quality improved formulation of NSAIDS. Rapid Dispersible Tablets are an alternative to swallowing tablets, since they are made with a unique composition that dissolves rapidly in water to create a drinkable solution. As soon as a pill makes contact with the fluid, it begins to disintegrate. Next, the granules begin to de-aggregate, or break down into smaller, fundamental particles than they were originally. Less than three minutes is ideal for the RDT's rate of dispersal or disintegration. Superdisintegrants such as carboxymethyl cellulose, polyvinyl pyrrolidine, and sodium starch glycolate are crucial to the RDT development process. Solubility of drug is the basic factor which controls the release profile of the finished product. Particle size reduction or Co-Micronization (e.g. by high pressure homogenization) might also increase the saturation solubility of a drug, further enhancing the dissolution rate. The purpose of this study was to create a fixed-dose combination formulation for the efficient management of migraines. Co-micronization was used to enhance the release profile of tolfenamic acid
Prevalence of Depression in Diabetes Mellitus: A hospital based Cross sectional study
Full text linkIntroduction: Diabetes is a metabolic disorder that has life-changing consequences for individuals affected by it. Diabetes may be diagnosed and treated, but the depression in these patients often goes unnoticed. Most of the time depression is not considered as an important factor and often ignored and left untreated. Depression is associated with poor health behaviors (i.e., smoking, physical inactivity, caloric intake) that increase risk of type 2 diabetes .Depression is also associated to central obesity and potentially to impaired glucose tolerance and may worsen diabetes.Objectives of the study: The primary aim is to study the prevalence of depression in type 2 diabetes mellitus patients.Materials & Methods: A hospital based observational study was carried out on diabetic patients attending the general medicine OPD in a tertiary care hospital during the period June-October2018. Results: The prevalence of depression in diabetic patients is 56% in the current study which is in par with earlier studies. In the present study, among depressed patients 38.39% had mild depression, 34.82% has moderate symptoms, 19.64% had moderately severe depression, 7.14% had very severe symptoms. On evaluation of various parameters of diabetes, the parameters that are significantly associated with depression are glycated hemoglobin ( p=0.028),Fasting blood sugar(p=0.019),Body mass index(p=0.004),Duration of diabetes(p-0.002).Depression is mostly observed in patients with diabetes duration of 7-9 years. Among the parameters evaluated in the present study, number of complications and treatment regimen (p=0.000) have showed the most significant association with severity of depression.Conclusion: Higher glycated hemoglobin value, fasting blood sugar levels and duration of diabetes, higher BMI all are significantly associated with severity of depression. The number of complications and treatment regimen in diabetes are also significantly associated with depression. As the disease burden of depression increases in terms of duration of illness or poor control or complications, the severity of depression also seems to increase. Therefore adequate screening and intervention of depression is necessary for better outcome on both diabetes and depression especially in diabetic patients with higher morbidity and longstanding illness
Evaluation of hearing loss in HIV infected patients in a tertiary care centre
Full text linkBackground: Hearing loss manifestations are common among HIV/AIDS patients. Understanding the effects and treatment of HIV/AIDS on the auditory system has become crucial for improving the quality of life of the patients.Objectives: To estimate the prevalence of hearing loss and to determine the risk factors for hearing loss in HIV positive patients.Materials and Methods: A cross-sectional observational study conducted in the Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Imphal, Manipur, India for a period of 2 years from October 2019 to September 2021. 91 HIV positive patients were enrolled for the study. Prevalence of hearing loss and association of various risk factors for hearing loss were studied.Results: The prevalence of hearing loss was 34.06%. The age ranged from 16 to 62 years, with mean age of 39.00±9.82 years. The study showed a pre-ponderance to male with M:F of 1.4:1. The median duration of treatment was 4 years with a minimum of one year and a maximum of nine years. Majority had CD4 count > 200 (89% patients), followed by 50 to 200 in 8.8% of the patients. With every unit increase in age the hearing loss increases and was found to be statistically significant (p = 0.04). But in adjusted analysis, it was not significant. With every unit increase in the duration of treatment for HIV, the hearing loss increases and was found to be statistically significant (p= 0.001). Even after adjusted analysis, it was found to be significant (p =0.006). Also, CD4 count < 200 is significantly associated with hearing loss than those with CD4 count ≥200 (p=0.03). But in adjusted analysis, it was not significant. Gender of the patients was not significant with the prevalence of hearing loss in unadjusted and adjusted analysis.Conclusion: HIV patients with hearing loss manifestations should be recognized early and managed promptly to prevent disease morbidity and mortality, and to assure the patients a better quality of life
Factor Affecting Recovery of Cauda Equina Syndrome in Patients With Prolapsed Lumbar Intervertebral Disc
Full text linkIntroduction: Cauda equina syndrome is a neurological condition characterized by severe low back-pain, saddle anaesthesia, bowel and bladder dysfunction, sexual dysfunction and neurological deficit in lower limb. Aims and objective: To study the clinico-pathogenesis, Factors affecting the outcome and To assess the impact of early and delayed decompression of prolapsed lumbar intervertebral disc on the recovery of caudaequina syndrome. Materials and method: A prospective study was carried out on patients presenting with clinical features of caudaequina syndrome. Patients presenting with clinical feature of caudaequina syndrome and giving consent for surgery will be admitted in Department of Neurosurgery, J.A. group of hospitals, G.R. Medical College, Gwalior (M.P.), over a period of 24 month (from December 2017 to November 2019). Results & Conclusion:. Cauda Equina Syndrome is a serious surgical condition, Early diagnosis and surgical decompression within 48 hours of onset of bladder dysfunction in CES-I can prevent further neurological damage to bladder dysfunction and also prevent deterioration to complete CES
An Epidemiological Study of Oral Cancer Patients Attending Tertiary Health Care Centre
Full text linkBackground: oral cancer is the most common cancer in India; amongst men (16.1%) while in women it is the fourth most common cancer (4.6%). Oral squamous cell carcinoma (OSCC) has been defined by WHO as a carcinoma with a squamous differentiation arising from the mucosal epithelium. Tobacco is addictive and is harmful to health in many ways. Smokeless tobacco includes betel quid with tobacco, pan masala, mainpuri tobacco, mawa, gul, tobacco with slaked lime(khaini) etc. Gutka chewing is the most and popular form of smokeless tobacco used in India. Material and methods: This prospective analytical study conducted at Department of Community medicine, Shree Narayan Medical College & Hospital, Saharsa, Bihar after approval from Thesis & Ethical Committee from Dec 2021 to Nov 2022 on 63 oral cancer patients. These 63 patients were collected from our medical college and hospital and multiple clinics of Surgery and ENT from Saharsa district and Purnea district. Permission from Surgery and ENT clinics was taken for the present study of diagnosed cases of oral cancer. Results: Most number of patients belongs to > 60 years’ group i.e., 24 (38.09%). Based on gender most common were male i.e., 46 (73.02%), According to distribution of patients with respect to occupation, most of them belong to Clerical and skilled category i.e., 15 (23.81%). Most number of studied patients were having cancer site- Tongue i.e., 16 (25.40%). Most common presenting symptom in studied patients was painful oral ulcer i.e., 50 (79.37%). Out of 63 cases, 10 (15.87%) cases were diagnosed as well differentiated SCC, 48 (76.19%) cases were diagnosed as moderately differentiated SCC and 05 (07.94%) cases were diagnosed as poorly differentiated SCC. Conclusion: Early Oral SCC discovery not only improves survival rates but also lessens the necessity for deforming procedures. Unfortunately, because up to 50% of patients already have local or distant metastases at the time of diagnosis, early detection of oral malignant lesions has proven challenging. Only a small number of cells or discrete regions of tissue are affected by the malignant change at the start of carcinogenesis
Coronary Angiographic Pattern in Patients Aged >45 Years: A Prospective Study
Full text linkBackground: Cardiovascular Diseases (CVD’s) remain the biggest cause of death worldwide. Recent trends suggest that disease incidence has escalated and has started affecting younger age group also. Aims and objectives: This study was conducted to study the coronary angiographic pattern in patients aged >45 years.Materials and Methods: All patients >45 years who underwent coronary angiography and angioplasty were included in the study. Subjects meeting the inclusion criteria were selected. Detailed history, clinical examination, electrocardiography findings, echocardiography findings were studied. Angiographic findings were then correlated with the risk factors, demography and electrocardiographic findings.Results: A total of 100 patients were included in the study. Majority were in the age group 55-64 years (n=50) with a mean age of 60.59±7.16 (mean±SD). There was a male preponderance (83, 83%). Most common angiographic finding was double vessel disease in 25% followed by triple vessel disease in 23%, followed by single vessel disease in 22%. Most common angiographic pattern among the males was Triple vessel disease & Double vessel disease (26.5%) while in females, it was non-critical CAD(47.1%). The most common abnormal ECG finding was ST elevation MI in 35% participants.Conclusion: DVD was the most common angiographic abnormality which was followed by TVD and SVD.RCA was the most common culprit vessel in the majority of patients, followed by LAD and LCX
Adverse Drug Reactions (Adrs) Associated With Hospital Admissions – Male Patients Are At Highest Risk
Full text linkAdverse Drug Reaction (ADR) may occur following a single dose or prolonged administration of a drug or may result from the combination of two or more drugs. The meaning of this term differs from the term "side effect" because side effects can be beneficial as well as detrimental. The study of ADRs is also known as pharmacovigilance. During this study ADRs assessed according to World Health Organization (WHO)–Uppsala Monitoring Centre (UMC) causality assessment criteria, Naranjo scale, Karch and lasagna scale, the result indicate symptoms of ADRs in male patient of adults and geriatrics common and it may be due to combination drug therapy. When ADRs assessed by using WHO Possible scale & Naranjo’s probability scale it was found that only 05.13% have certain ADRs which required treatment while possible ADRs are between 39.84 to 55.68% also required strict monitoring. The main aim of this study was to find out the cause of ADRs and their assessment during hospital stay and developing a monitoring system and actively electronic submission of identified ADRs as per WHO ADRs monitoring system to prevent risk of ADRs
Acute Encephalitis Syndrome Due to Scrub Typhus: A Missed Diagnosis
Full text linkIntroduction- Clinically, a case of Acute Encephalitis Syndrome (AES) is defined as a person of any age, at any time of year with the Acute onset of fever and a change in mental status (including symptoms such as confusion, disorientation, come, or inability to talk) and/or new onset of seizures (excluding simple febrile seizures). Acute encephalitis syndrome (AES) is a major public health problem worldwide because of its high morbidity and mortality. Although incidence of AES varies according to different studies, it is generally between 3·5 and 7·4/1,00,000 patient-years, and is higher in children aged <1 year and adults aged > 65 years.(3). Material and methods- This study was Open Labeled, Prospective study and was performed over a period of 1 year and 6 months from January 2018 to June 2019 at Department of Microbiology, TNMC and BYL Nair Ch. Hospital, Mumbai and Molecular Diagnostic Reference Laboratory, Kasturba Hospital, Mumbai only after taking Approval from Institutional Ethics Committee and Informed consent of every patient enrolled in the study. Results- This study was done on adult population and the mean age was 42.5 years. The minimum age was 14 years and the maximum age was 78 years. Almost half of the patients were between 15 and 45 years of age, which suggest the disease has a higher incidence in the younger adults. A maximum number of patients came during the month of July -October, suggesting the seasonal occurrence of the disease. The most common clinical features of AES patients were fever and altered sensorium followed by behavioral changes, headache, and seizures. The most common finding of general examination of AES patients was pallor followed by tachycardia and tachypnea. Most of the patients had low GCS (<=7), hypotonia and abnormal movements during their CNS examination. In this study, 17(28.3%) the CSF R/M finding were suggestive of bacterial infection (white cell counts high with neutrophilic predominance, accompanied by elevated proteins and hypoglycorrachia) and in 5(8.4%) the CSF R/M findings were suggestive of viral infection (mild pleocytosis and lymphocytic predominance, slightly elevated protein, and normal glucose), however in 38(63.33%) patients CSF R/M findings were normal. Conclusion- To conclude, the etiology panorama of acute encephalitis syndrome including Scrub Typhus and viral agents (excluding JE) is not well documented especially in western India. The lack of published data from western India leads to lack of understanding of disease. Conventional methods like culture and routine CSF studies lead to identification of only few etiologic agents causing AES, Diagnosis of AES should be done by new molecular diagnostic technologies including PCR, nucleic acid sequence-based amplification, and branched-DNA assay. Multiplex PCR is a boon for CNS infections where “TIME IS PRECIOUS” and help in early diagnosis of infectious agents and thereby providing specific treatment. A surveillance system for undiagnosed infections should be developed which helps to monitor the trends of emerging infection and aid in their early diagnosis
"Primary Etiological Profile of Hospitalized Patients with Documented Episode of Hypoglycemia"
Full text linkBackground: Glucose is a major fuel source for body tissues. Plasma glucose concentrations are maintained between 70 to 110 mg/dl in the fasting state. Homeostasis is maintained by stimulating counter hormone response and suppressing insulin secretion during hypoglycemic episodes. Any derangement in homeostasis can cause hypoglycemia. Objectives: To investigate, identify, determine and analyze the incidence of primary etiological profile of hospitalized patients. Material and Methods: Patients admitted in the General Medicine wards who had at least one episode of documented hypoglycemia i.e less than 70mg/dl and age >=18 years were included and observed over a period of 24 months i.e November 2019 to November 2021. The data obtained was analyzed statistically by using chi square test. Results: In present study of 119 patients 90 were male and 29 were females. Diabetes with Chronic Kidney Disease was found to be the most common primary diagnosis. As we analyze the presence of risk factors in hospitalized hypoglycemic patents, it was found that as the number of risk factors in a patient increases, chance of succumbing to them also increases. In the category of patients having 3 or more risk factors, the death rate was 15 out of 42 which is 35.71%. Conclusion: Hypoglycemia needs to be investigated thoroughly to know the causative factor and should be treated appropriately. Hypoglycemia is an important predicting factor of mortality in cases of heart failure and sepsis