International Journal of Medical Research & Review (IJMRR)
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Differences Between Premenopausal And Postmenopausal Coronary Artery Disease (CAD) Risk Factors and Clinical Profile
Full text linkIntroduction: Coronary artery disease is the leading cause of mortality and morbidity of both men and women accounting for over one third of total deaths [1]. It has reached epidemic proportion among Indians. It accounts for 1 out of 3 women death regardless of the race or ethnicity [2]. In women, the annual mortality rate from CAD is high. Objective: To assess the differences between premenopausal and postmenopausal coronary artery disease (CAD) risk factors, clinical manifestation, clinical profile and angiographic characteristics. Methods: A prospective observation study was conducted at cardiology department, NICVD, Dhaka, Bangladesh from January to December 2019. Total 200 female CAD patients were drawn from the cardiology department. The subjects were enrolled in accordance with the criterion of diameter stenosis ≥50% in left mean and ≥70% in LAD, LCX and ECA in at least one invasive coronary angiogram. Patients with pulmonary embolism, aortic aneurysm, congenital heart disease, rheumatic heart disease, myocarditis, or cardiomyopathy were excluded. A total of 50 premenopausal cases and 150 postmenopausal cases were enrolled according to their status at the time of diagnosis. All patients underwent percutaneous coronary intervention and were given conventional drug therapy for coronary artery disease during follow-up. Results: Differences were compared between the 2 groups. Fewer premenopausal women suffered from hypertension (46% versus 82%, P< 0.001), type 2 diabetes (10% versus 36%, P = 0.001), and hyperlipidemia (4% versus 36%, P<0.001), but more had a positive family history of premature CAD (42% versus 26%, P = 0.03). Acute coronary syndrome (ACS) was more frequently seen in premenopausal women (80% versus 48%, P < 0.001), and their left anterior descending branch was the vessel most often involved (68%). The cumulative recurrence rate was 1.76 times higher in postmenopausal patients than premenopausal patients. Clinical diagnosis (HR = 2.54, 95%CI: 1.21-4.85, P = 0.02) and type 2 diabetes (HR = 4.10, 95%CI: 2.37-8.83, P = 0.004) were two factors that influenced recurrence in premenopausal subjects, while the clinical diagnosis (HR = 1.93, 95%CI: 1.59-3.46, P = 0.03) and Gensini score (HR =1.20, 95% CI: 1.11-1.45, P = 0.02) were influencing factors in the postmenopausal patients. Symptoms among younger women were atypical, but the onset of disease was faster and more urgent. Conclusion: Our study clarified the differences between postmenopausal and premenopausal women with respect to risk factors, clinical symptoms, cardiovascular features, and recurrence rate, and provided a reference for further study on the mechanism and prognosis in postmenopausal or premenopausal CAD patients
Expert opinion on the clinical approach of using sodium glucose cotransporter-2 inhibitors for managing diabetic patients with cardiovascular and renal complications in Indian settings: Expert view on sodium glucose cotransporter-2 inhibitors
Full text linkObjective: To evaluate the prescription practice of sodium-glucose co-transporter-2 (SGLT2) inhibitors with a special focus on dapagliflozin to treat cardiac and renal disorders in obese Indian diabetic patients.
Methods: A cross-sectional, questionnaire based study was conducted to collect the perspectives among physicians with expertise in treating diabetic obese patients with cardiac and renal disorders in endocrinology across India between June 2022 and December 2022. Descriptive statistics were used to summarize the characteristics of the study by employing frequencies and percentages.
Results: Among the 1,446 survey participants, 80% of them indicated that young diabetic patients with obesity, and obese patients with cardio-renal complications may require SGLT2 inhibitors. Furthermore, patients aged between 41-50 and 51-60 years also required SGLT2 inhibitors for diabetes management according to 57% and 27% of the respondents. The majority of the respondents (91.29% and 90.53%) recommended dapagliflozin as the best SGLT2 inhibitor for treating patients with chronic kidney disease and heart failure. Additionally, about 59% and 66% of the experts indicated that patients would experience an average weight loss of 2-3 kilograms and an average blood pressure reduction of 3-6 mm Hg after 12 weeks of treatment with dapagliflozin, respectively.
Conclusion: Experts recommend the use of SGLT2 inhibitors for the treatment of young diabetic patients with obesity and obese subjects with cardiorenal complications. Dapagliflozin monotherapy was preferred for patients with chronic kidney disease and heart failure. Furthermore, experts highly recommend the combinations of dapagliflozin + metformin and DPP4 inhibitors + metformin + dapagliflozin for effective diabetes managemen
The Intersection of LGBTQ+ Mental Health and the Rise of Same-Sex Marriage: Understanding Current Trends and Implications for LGBTQ+ Rights and Society: Understanding Current Trends and Implications for LGBTQ+ Rights and Society
Full text linkThe LGBTQ+ community has long faced discrimination, prejudice, and marginalization, which have had significant impacts on their mental health and well-being. Studies have shown that LGBTQ+ individuals are at a higher risk of experiencing mental health disparities compared to their heterosexual and cisgender counterparts (Indian Journal of Psychiatry, 2017; India HIV/AIDS Alliance, 2019). However, in recent years, there have been significant advancements in LGBTQ+ rights and recognition, including the increasing acceptance and legal recognition of same-sex marriage in many countries around the world, including India. These developments have important implications for the mental health and well-being of LGBTQ+ individuals, as marriage is a significant institution that can impact various aspects of an individual\u27s life, including their mental health and relationships
Prevalence and associated factors of nomophobia among undergraduate students of AIIMS Patna
Full text linkIntroduction: In recent years, the popularity of smartphones has grown to the point that it is unimaginable for individuals to do anything without using one. Nomophobia is the fear of being cut off from one\u27s mobile phone, and it relates to the discomfort, anxiety, tension, uneasiness, and anguish that comes with it. Since the first decade of the twenty-first century, when this social phobia was coined, a growing number of research have investigated and reported the prevalence of this technology-related condition. This study aims to assess the prevalence and associated factors of nomophobia and to determine association of prevalence and associated factors of nomophobia with selected socio demographic variables among undergraduate students of AIIMS Patna. Material and Methods: The research approach here is quantitative approach and the design used here is descriptive. Undergraduate students of AIIMS, Patna are taken as target population in which minimum required sample size was 210 but it was increased to 230 for this study. Data was collected by sending questionnaire via social media. Data analysis was done by using descriptive and inferential statistics. Results: It shows that out of the taken 230 samples, total 229(99.56%) are having nomophobia in which 55(23.913%) are having mild nomophobia, 128(55.652) are having moderate nomophobia, 46(20%) are having severe nomophobia i.e. most of the students are moderately nomophobia. The findings also reveal that there is association of prevalence and associated factors of nomophobia with selected socio demographic variables (Duration of using smartphone per day) with p value 0.000 and the Fisher exact value is 22.169 by using SPSS, the p value for this study is 0.05. Conclusion: The study shows that 99.56% of students are having nomophobia and it is an alarming wake up
Anatomical Variations in Palmar Creases and Their Correlation to The Intelligence Capacity of Libyan Medical and Dental Students of Omar Al-Mukhtar University.
Full text linkBackground: For centuries, clinicians, anthropologists, and palmists have found the creases in the palm interesting. However, only in the last fifty years that research\u27s started to examine the variations in these creases. Based on the three main palmar creases, thenar, proximal, and distal transverse creases, four patterns of palmar creases are identified; nonvariant, Sydney, Suwon, and simian. Previous studies of palmar creases revealed that familial components, race, sex, and age are factors that influence the expression of palmar crease patterns. Simian patterns of palmar creases are linked to various congenital diseases, some characterized by low level of intelligence.
Aim: This paper aims to investigate the variations in palmar crease patterns among medical and dental students of Omar Al-Mukhtar University and to study the range of intelligence capacity associated with each pattern.
Materials and methods: The study was conducted on 183 students. A paper-based IQ test was performed and photos were taken from both palms of all participants.
Results: Out of 183 participants, the nonvariant pattern of palmar creases was found in 92%, in which, 100 students have bilateral 2 points of origin palmar creases and 48 students have bilateral 3 points of origin palmar creases, whereas 18 participants have one palm of 2 points and the other palm of 3 points of origin. Unilateral simian was the dominant type in the aberrant palmar creases, followed by bilateral Sydney, then unilateral Sydney, and Suwon.
Conclusion: The students with unilateral simian have the highest average score of 47.166 followed by bilateral nonvariant and unilateral nonvariant. Students with unilateral Sydney have the lowest average score of 41
obstructive sleep apnea : a clinical review
Full text linkThe aim of this article is to provide a detailed description for obstructive sleep apnea regarding its signs and symptoms, the way it is diagnosed, the risk factors, management, the role of dentists and oral appliances in treatment. Obstructive sleep apnea (OSA) is a potentially life-threatening disorder characterized by repeated collapse of the upper airway during sleep, with periodic cessation of breathing for more than ten seconds.
Dental professionals have a unique doctor patient relationship that can help them in recognizing the sleep disorder and co-managing the patients along with a physician or a sleep specialist. Oral appliance therapy is an important treatment modality for sleep apnea patient
A Cross-Sectional Study of Socio-Demographic and Clinical Features of Indian Subjects with Type 2 Diabetes Mellitus in a Tertiary Diabetes Hospital
Full text linkIntroduction: Diabetes mellitus is a group of heterogeneous diseases with varied clinical presentation and disease progression. Understanding the socio-demographic factors in subjects with diabetes is an important step for planning diabetes care. Objectives: The objective of the study was to assess the socio-demographic and clinical features of subjects with diabetes and impact of these factors on their glycemic control. Materials and Methods: A cross-sectional observational study was conducted in the outpatient department of Karnataka Institute of Endocrinology and research, Bangalore. 200 subjects with diabetes were recruited for the study, between January to August 2019. Results: In the study, mean age at diagnosis was 43.73 ± 8.705 years. Majority of subjects were in the age group >56 years (53%). 59.5% of the subjects were males and 83.5% of the subjects were from urban area. Majority of them were diagnosed during routine check-up (52.5%). Most common symptom was polyuria (21%). 12.5% of the subjects were incidentally detected during hospital admission. 46.5% had family history of Diabetes. 77.5% of the subjects were overweight and obese. Only 18.5% of the subjects had HbA1c <7. 39% of the subjects had dyslipidemia, 54.5% had hypertension and 19% had hypothyroidism. 29% of the subjects had retinopathy, 20% had neuropathy, 7% had nephropathy and 3.5% had PAD. 79% of the subjects were on OHA, 6% were on insulin and 12.5% were on both OHA and insulin. Amongst the subjects on oral drugs, only 6.3% were on monotherapy and the rest were on multiple drugs. Amongst subjects on insulin, 96.5% were on premixed insulin. Age, gender, education, OHA and combination of insulin and OHA for treatment were the factors associated significantly with glycemic control. Good control was highest in young age group (66.7%) and lowest in old age group (16%). Females had highest level of poor control compared to males. Graduates had higher percentage of good control compared to lower educational status. Subjects on OHA had higher percentage of good control. Conclusions: The study revealed that poor glycemic control, comorbidities like HTN, obesity and dyslipidemia and chronic complications were commonly prevalent in subjects with T2DM. Emphasis should be given to periodic evaluation of glycemic status, comorbidities, and diabetes complications
In Hospital Outcome of Acute Anterior Myocardial Infarction in Diabetic and Non-Diabetic Patients
Full text linkBackground: Patients with acute anterior myocardial infarction and diabetes have a poor prognosis. Objectives: To see the in-hospital outcome of acute anterior myocardial infarction in diabetic and non-diabetic patients. Methodology: This cross-sectional observational study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Sylhet over a period of two years from July 2015 to June 2017. A total of 100 acute anterior MI patients (50 diabetic and 50 non diabetic) were included in this study. Acute anterior MI patients admitted after 6 hours of symptom onset or who did not receive streptokinase were excluded. Results: Male predominance was obvious in both groups [40 (80%) versus 42 (84%); p>0.05] in diabetic and non-diabetic group respectively. Mean age was 53.34 ± 11.32 and 54.84 ± 14.12 years in diabetic and non-diabetic groups respectively. Dyslipidemia [6 (12%) versus 6 (12%); p >0.05], Smoking [32 (64%) versus 34 (68%); p >0.05] and Family history of cardiovascular disease [6 (12%) versus 4 (8%); p >0.05] were similar among diabetic and non-diabetic respectively. Hypertension was found more among non-diabetic [27 (54%) versus 19 (38%); p>0.05] but difference was not statistically significant. Diabetic group had more Apical Anterior MI [22 (44%) versus 19 (38%); p<0.05] and Extensive Anterior MI [20 (40%) versus 11 (22%); p<0.05] while non-diabetic group had more Septal MI [10 (20%) versus 3 (6%); p<0.05] and Mid Anterior MI [10 (20%) versus 4 (8%); p<0.05]. LV ejection fraction was found significantly low in diabetic patients [43.96 ± 5.95 versus 53.68 ± 6.36; p<0.01]. Killip Class III was more in diabetic [24 (48%) versus 9 (18%); p<0.01] and Killip Class I was more in non-diabetic group [18 (36%) versus 3 (6%); p<0.01] according to Killip classification of HF which was statistically significant between the two groups. Atrial Fibrillation was more in diabetics [6 (12%) versus 1 (2%); p<0.05] while sinus tachycardia was more among non-diabetics [20 (40%) versus 5 (10%); p<0.05] which are statistically significant. Diabetic group had more acute MR [2 (4%) versus 0 (0%); p>0.05] but was not significant. Death was more in diabetic group than that of non-diabetic group [7 (14%) versus 3 (6%); p>0.05] but it was statistically not significant. Conclusion: It is concluded from the present study that in hospital outcomes of acute anterior myocardial infarction are worse in diabetic patients than in non-diabetic patients
LYMPH NODE METASTASIS AFTER NEOADJUVANT CHEMOTHERAPY : DEFAULTER- TRIPLE NEGATIVE CARCINOMA WITH AXILLARY INVOLVEMENT RIGHT BREAST
Full text linkNeoadjuvant therapy refers to the systemic treatment of breast cancer prior to definitive surgical therapy (ie,
preoperative therapy). Neoadjuvant chemotherapy is offered to patients with locally advanced breast cancer and also
those breast cancer patients who may benefit from size reduction before conservation therapy. Response to neoadjuvant
chemotherapy is evaluated by the change in tumor size from pretreatment clinical and/or radiologic measurement to
post-treatment status. The spectrum of response to neoadjuvant chemotherapy varies from complete response, partial
response, to non-response. This concept is the same in breast tumors as well as axillary lymph nodes. The presented
case is a known case of Triple Negative Invasive Ductal carcinoma with Axillary involvement Right Breast since
November, 2020 and had undergone Neoadjuvant Chemotherapy till February 2021, followed by surgical intervention
in October 2022
A CASE OF REFRACTORY SUPRAVENTRICULAR TACHYCARDIA IN A NEWBORN.
Full text linkSupraventricular Tachycardia (SVT) is the most common neonatal dysrhythmia with incidence being 1 in 100 for children of all ages and 1 in 250 for neonates. Origin of Supraventricular tachycardia is either above the bifurcation of the bundle of His or it has mechanisms dependent on the bundle of His. Newborns may present with irritability, poor feeding and tachypnea. The most important clinical signs of SVT is tachycardia sometimes associated with hypotension, heart failure, pallor, or decreased level of consciousness. Diagnosis is done with heart rate continuously remaining ≥ 220 beats per minute with a QRS < 0.08 seconds. Adenosine is the first-line abortive therapy of choice. Intractable SVTs are treated with amiodarone, esmolol, and procainamide. SVT with Circulatory collapse needs a synchronized DC cardioversion. Prognosis of SVT is generally excellent in the absence of structural heart disease