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Assessment of Left Ventricular Hypertrophy and Dysfunction in Patients of Chronic Kidney Disease
No full textBackground: India experiencing an alarming increasing the burden of non-communicable diseases, like the prevalence of obesity and diabetes mellitus. Prevalence of CKD is also rising parallel but about this disease studied done infrequently, so the data on incidence of CKD is sparse. Cardiovascular disease can causing 50% fatality in these patients irrespective of biological age. According to international registries death in dialysis population that are occurring due to cardiac disease occurring up to 40%. Cardiovascular related morbidity and mortality that are associated with LVH is highly analytical for future progression that occurring in CKD patients.Subjects and Methods: This study was done in the Department of Medicine of TMMC & RC, TMU, MORADABAD, U.P. it was a Cross-sectional Observational Study.100 cases will be taken from OPD and IPD setting in TMMC & RC, TMU, Moradabad, U.P.Diagnosed cases of CKD patients aged >18 years of both sexes
admitted in IPD or visiting to OPD in Teerthanker Mahaveer medical College & Hospital, Moradabad. Those who were give valid consent.Cases below 18years of age, pregnant women. All cases of acute renal failure. All known primary case of IHD, CHF, RHD, Cardiomyopathies and any other cardiac disorders.Results:Majority (54.0%) of sample were in the age group of 54 and above years, most (64.0%) of them were males.It revealed that, the mean body weight of the sample was 55.0±8.42 Kg, the mean Systolic Blood Pressure (mmHg) of the sample was 144.56±19.88 mmHg. Mean Diastolic Blood Pressure (mmHg) of the sample was 91.02±9.23 mmHg.ECG revealed that, around 65% of the sample had LVH.2-D ECHO-LVH/LV Function reveled that, around 36% AND 33% of the sample have Mild concentric LVH and Moderate LV systolic dysfunction and LVH respectively.Majority (71.0%) of the sample have reduced ejection fraction.Conclusion:Left ventricular hypertrophy and dysfunction is a veryimportant preventive feature of CKD associated cardiomyopathy.There is increased chance of left ventricular hypertrophy in CKD patients.With respect to category of chronic kidney disease, the LVH prevalence is progressively increases with increasing severity of CKD (chronic kidney disease).Blood pressure control is very important step to forestall the development of CKD and other related damage of end organs. 
Analysis of Lipid Profile in Subclinical Hypothyroidism at Tertiary Care Hospital-An Observational Study
No full textBackground : Subclinical hypothyroidism could damage vascular function by suggesting enhance in SVR and arterial rigidity and by changing endothelial purpose and so increasing the danger of atherosclerosis and coronary artery disease. The objective of this study is to analyze the relation amid SCH and serum lipid parameters in this subgroup. Subjects and Methods: Current research was performed for the duration of one year at the Department of Medicine, tertiary care institute of India, in patients diagnosed with Sub Clinical Hypothyroidism. Eighty patients were incorporated in the present study and 80 age- and sex-matched and regularly menstruating healthy controls, which were evaluated for the Thyroid Function test, were randomly recruited from staff and volunteers. T3, T4, and TSH were anticipated by utilizing quantitative hard stage ELISA, whereas TC was estimated with photometric determination according to the CHOD PAP method; TG and HDL were estimated by using the enzymatic colorimetric method. Results: There is a momentous augment in the serum TC stage in group II individuals 161.14±48.23 mg/dl when compared to group I 124.35±9.57 mg/dl, it is also a significant amplify in serum LDL-Cholesterol in group II individuals 97.99±32.42 mg/dl when compared to group I individuals 63.35±7.55. Conclusion: Subclinical hypothyroidism (SCH) is linked with increased serum TC and LDL-C levels. As a result, a prospective association amid subclinical hypothyroidism and atherosclerosis occurs. Larger studies are needed to prove this association in Indian patients. 
Assessment of Awareness and Approach Towards Hypertension Management Among General Practitioners
No full textBackground: Hypertension and its complications are a global concern, due to its high prevalence especially as it often remains undiagnosed. The present study was conducted to assess awareness and approach towards hypertension management among general practitioners. Subjects & Methods: 150 general practitioners were questioned regarding the technique of measurement of blood pressure, diagnosis of prehypertension and hypertension, evaluations of newly diagnosed hypertensive patients, level of blood pressure to start pharmacological treatment and selection of antihypertensive agents in different clinical conditions. Results: Out of 150 subjects, males were 80 and females were 70. Cuff placement covering 2/3 of the arm at heart level was recommended by 84%, preferred position of patient was sitting replied by 52%, supine by 32% and standing and supine by 16%. The number of readings of blood pressure was 1 by 2%, 2 by 40% and 3 by 58%. Investigation preferred by GP was ECG by 91%, urine examination by 68%, serum creatinine by 82%, lipid profile by 80%, ultrasound of abdomen by 35%, serum potassium level by 72% and RBS by 98%. Common symptoms reported were morning headache by 70%, dizziness by 45%, palpitation by 52%, easy fatigability by 57% and impotence by 48%. The difference was significant (P< 0.05). Conclusion: Most of the GPs are well aware and updated about the initial lab investigations, symptoms and techniques. 
Evaluation of Lipid Profile in the Smokers and Non-Smokers
No full textBackground: Cigarette smoking leads to increased serum level of total cholesterol, LDL cholesterol, Triglyceride levels and decreased level of anti atherogenic HDL cholesterol. Many studies have shown a dose-dependent relationship between smoking and lipoprotein profile. Hence this study was-taken up to know the lipoprotein pattern in healthy young smokers. Subjects and Methods: Total of hundered healthy smokers and fifty healthy non smokers were included in the study. All the smokers’ subjects were divided in two groups as per the severity of the habit of smoking. Group 1: all those who smoke upto 10 cigarette per day, Group 2: all those who smokemore than 10 cigarette per day. Results: In our study, the mean serum cholesterol of smokers is 205.9 ± 26.1 and that of non-smokers is 165.4 ± 15.2 which is statistically significant Mean HDL-cholesterol is 34.20 ± 4.0 in smokers and 38.40 ± 6.4 in non-smokers, which is statistically significant. Mean LDL-cholesterol is 155.8 ± 29.30 in smokers and 136.70 ± 14.45 in nonsmokers which is statistically significant. Mean Triglyceride level in smokers is 163.28 ± 38.7 and in non-smokers it is 116.72 ± 23.3 which is statistically significant. Conclusion: The mean serum lipid values were significantly higher in smokers except HDL-C which were significantly decreased, as compared to non smokers. There is a linear increase in the levels of serum lipids except HDL-C which shows decrease in the levels with the duration and severity of smoking. 
Clinico-Etiological Profile of New Onset Seizures in Gaeriatric Patients at a Tertiary Care Hospital
No full textBackground: Seizure is defined as “a paroxysmal event due to abnormal excessive or synchronous neuronal activity in the brain.” Based on discharge characteristics and its distribution, this unusual activity can manifest either as focal or generalized tonic clonic to absence seizures which are not easily noticeable by observer. For 2010, as indicated by the Global Burden of Disease (GBD) investigation, epilepsy accounted for 0.7% of burden globally i.e, more than 17 million DALYs. Studies conducted in India have reported variable incidence rates which varies from 0.2 to 0.6 per 1,000 population. The incidence rates reported from India are similar to most of the developed countries and less than most of the developing nations which ranged from 1.0 to 1.9 per 1,000 per year. AIM: The aim of the study is to assess & identify the various clinico-etiological factors causing first onset of seizures in gaeriatric patients. Rationale: Several studies are available on seizure in elderly in western population but very few studies are done in this part of the world. Etiological profile of seizures varies from place to place because of difference in socio-economic and cultural attributes, prevalence of various diseases in a particular area and several other factors. This study aims to observe the clinico-etiological profile of new onset seizures in elderly in Moradabad region of western Uttar Pradesh. Subjects and Methods: This study was carried out at Teerthanker Mahaveer Medical College and Research Centre, Moradabad (UP) as an observational hospital based study. 51 patients of new onset seizures above 60 years of age. Inclusion Criteria: All patients with new onset seizures and were more than 60 years of age. Exclusion Criteria: All patients with age less than 60 years. All known cases of Seizure disorder/Epilepsy were excluded. All those who did not give consent. Results: Out of 51 elderly patients, males accounted for 55%, females accounted for 45% and a gender ratio of 1.2:1 for male to female. Among 51 patients with new-onset seizures, hypertension was seen in 29.4% patients as co-morbidity and 13.7% patients had both hypertension and diabetes as co-morbidities. The study also showed that generalized tonic-clonic seizures (GTCS) were found among 76.5% cases whereas among 23.5% patients were of focal seizures. However, acute and remote symptomatic were almost found in an equal proportion 47.1% and 45.2% respectively and only 7.8% were idiopathic. It was noted that the maximum number of patients had CVA as the cause of new onset seizures in this age group, of which 90.9% patients had an ischaemic stroke. 14 patients had metabolic insult of which, 35.71% patients had uremic encephalopathy as the cause of new onset seizures. 60% of seizures in CNS infections are secondary to tuberculosis probably because of high burden of tuberculosis in the study area. Conclusion: In our study CVA was the frequently observed etiology of seizures among study population and the second most common was metabolic insults. Among stroke, seizures occured more commonly in ischemic stroke than in hemorrhagic stroke. In our study GTCS was the most common type of seizure in 76.5% of study population. And acute symptomatic and remote symptomatic were almost seen in equal numbers 47.1% and 45.2% respectively. CVA accounted for most of the remote symptomatic seizures of which ischemic stroke is most common and metabolic causes accounted for most of the acute symptomatic seizures. The high burden of tuberculosis in the study area may have accounted for this higher percentage (60%) of seizures secondary to tuberculosis in the study patients under CNS infections sub group. 
Prognostic Importance of Hyponatremia in Acute STEMI
No full textBackground: Hyponatremia develops in early phases of acute myocardial infarction, recently, several studies showing its importance as important early prognostic tool. Many studies shown that significant increase in plasma AVP level was in patients who had associated with complication as heart failure and fatal outcome after acute MI, and clinical improvement was noted following the rise in serum plasma level of sodium. hence Early developed hyponatremia is a unique indicator of neuro hormonal activity in the early phases of recent MI, so it can help predict the complication as long-term development of HF and death. OBJECTIVE: To observe the prognostic importance of hyponatremia in settings of acute STEMI event and helpfulness in prediction of short term and long term survival. Subjects and Methods: Randomized double blinded study, in 100 of patients with acute S TEMI presented to outpatient department and indoor emergency patients. Results: Patients who developed hyponatremia at admission had higher mortality rate than the patients who developed hyponatremia at 72 hrs and normonatremic patients. Mortality in patients correlates with the severity of hyponatremia 5(100%) patient died with sodium levels <130mmol/l whereas 5(16%) death occurred in the patient having sodium level between 131-134. (Odds ratio 6.0, p value 0.02). Conclusion: We concluded that hyponatremia developed in early as well as late phases of acute STEMI serve as is an ‘independent determinant of both short term (in hospital mortality, development of arrhythmias and heart failure) as well as long term survival (cardiac death, post discharge heart failure). Plasma sodium levels may help identify patient at risk. 
To Study the Occurrence of Non-Alcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes Mellitus.
No full textBackground: Macrovascular and Microvascular complications are well evaluated in DM but NAFLD is the most neglected and unevaluated complication among DM.Fibroscan is the non-invasive method for assessing liver fibrosis which has high reproducibility and accuracySubjects and Methods: It was a Case Control study. Fibrosis was assessed by fibroscan and was then quantified. Results: In our study there was a significant difference seen among the different grades of fibrosis among controls and cases (p=0.004). The mean fibrosis score too was high among cases (13.498) as compared to controls (6.052). The overall prevalence of NAFLD (F2-F4) was found to be 50% among cases as compared to 14% in controls.Conclusion: Diabetes has a significant etiological role in occurrence of NAFLD in population. Fibroscan has a substantial role in screening and diagnosing diabetics for NAFLD and fibrosis, thus advocating its use is recommended to prevent understudied and unrecognized complication of DM preventing mortality and morbidity. 
Estimation of Lipid Profiles of Patients with Type-2 Diabetes Mellitus at Adoor, Kerala
No full text
Background: Lipid abnormalities in patients with diabetes are often phrased as “diabetic dyslipidemia”. The aim of the study was to evaluate the lipid profiles of patients with type-2 diabetes mellitus. Subjects and Methods: the subjects who were enrolled in this study were diabetic patients. For the study, a total of 150 diabetic patients with a history of diabetes for 10 years were arbitrarily chosen and scrutinized for dyslipidemia. Patients with other diseases and metabolic disarray were barred from the study. The patients were selected on an indiscriminate base and detailed case history was measured with all appropriate clinical checks. Results: Total 140 diabetic patients with a mean age of 49.98 ± 13.3 years were included in the study. The mean FBS of study participants was 189.78± 55.65 mg/dl. Mean triglycerides level was 203.59 ± 84.48mg/dl. Out of the total 150 patients, borderline high cholesterol (200-239 mg/dl) and high cholesterol (≥240 mg/dl) level were 29 (19.3%) and 22 (14.6%) respectively. Out of 150 subjects, 37(24.6%) had borderline high triglyceride (150-199 mg/dl) while 61 (40.6%) had high triglyceride (200-249 mg/dl) level. Conclusion: Hyperlipidemia is the most frequent snag of diabetes mellitus and it can prompt patients to precipitate atherosclerosis and microvascular difficulty. Good glycemic control can avert the advances and succession of usual lipid irregularity in diabetes like heightened triglycerides, LDL, serum cholesterol and low HDL. 
An Analytical Study on Anemia in Rural Population
No full textBackground: Anemia is one of the common Hematological disorders in India and worldwide. It affects all the age groups both in Males and Females. Moderate to Severe Anemia causes increased morbidity and mortality in elderly patients (AWHO expert group) - According to Worlds Health Organization, Anemia is a define when adults males are having Hemoglobin less than 13.5gr% when adults females non-pregnant less than 12 gr% and when pregnant females are having less than 11 ger%. The incidence of Anemia is very high in old age people who are more than 75 years of age. It ranges from 9% to 41%. In India Anemia is commonly due to nutrition, pregnancy, Hookworm infestation, DUB in the case of females, and Malignancy. The prevalence of anemia in the elderly has been found to range from 9% to 42% with the highest prevalence in 80 years and above. The common causes of anemia in India are Nutritional, Pregnancy, Hookworm infestation, and DUB in the case of Females and Malignancy. The common symptom is General weakness, Fatigue, Lack of concentration, Shortness of Breath, and Palpitations. A WHO expert group proposed that anemia should be considered when hemoglobin level below 13.5gr& in adult males; 12gr% in adults females non-pregnant; 11 gr% in adult female pregnant; 12gr% in children over 14yrs(1). The aim is to evaluate the etiology and clinical features of anemia in adults in rural medical colleges. Subjects & Methods: This study is conducted at GEMS Medical College, Srikakulam, A.P for the period of 1 year from April 2018 to March 2019. This study includes 120 patients with Anemia. The age group is between 20 years and 70 years. Males were 56 and females were 64. Results: We have conducted this study at GEMS Medical College, Srikakulam for 1 year, from April 2019 to March 2019 total no. of patients included in this study are 120 males 56 and females 64. The age group is between 20 years and 70 years. The maximum patients are in between 30 years and 70 years in both sexes. Conclusion: Anemia is a common medical problem in developing countries. In a rural part of India, the disorders will complicate the pregnancy also. So periodical examination and education of the people can decrease morbidity and mortality. In our area still, the common cause is nutritional. 
A Comparative Study to Assess the Determinants and Outcomes of Sepsis Treated in Medical Wards and ICU in an Indian Teaching Hospital
No full textBackground: Sepsis is a systemic, deleterious host response to infection. Severe sepsis is defined as acute organ dysfunction secondary to documented or suspected infection and septic shock is severe sepsis with hypotension not reversed by fluid resuscitation. The present study was conducted to assess the determinants and outcomes of sepsis treated in medical wards and ICU. Subjects and Methods: The study was done at Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka. 320 patients with sepsis of both genders were divided into 2 groups. Group I patients were admitted to the medical ward and group II to ICU. Clinical examination and laboratory tests were done. Results: Source of infection was a urinary tract in 12% in group I and 11% in group II, a respiratory tract in 40% in group IU and 32% in group II, GIT in 25% and 22% in group I and II respectively, blood infection in 15% and 20% in group I and II respectively and soft tissue infection in 8% and 15% in group I and II respectively. The difference was significant (P< 0.05). Appropriate specimen culture was present in 75 in group I and 64 in group II and blood culture in 42 in group I and 23 in group II. The difference was non-significant (P> 0.05). Conclusion: Clinical features and co-morbidities were higher in ICU patients as compared to the medical ward.