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Assessment of Left Atrial Volume Index in the Patients with ACS in Adults
No full textBackground: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death universally. The present study was conducted to assess LA volume index (LAVI) in the patients with ACS in adults. Subjects and Methods: The present study was conducted on120 adult patients diagnosed with ACS of both genders in narayana medical college hospital from May 2016 toOctober 2016. Patients were divided into 2 groups of 60 each. Group I patients had LAVI > 34 ml/m2and group II patients had LAVI ≤ 34 ml/m2. The LV systolic function was analyzed by Simpson’s disc volumetric method. The LAV was assessed by the biplane area-length method from apical 4-chamber and 2-chamber views. Results: The mean BMI in group I patients was 26.7 kg/m2and in group II was 26.1 kg/m2, AW STEMI in group I was seen in 30 patients and in group II in 32, IW + PW STEMI in 6 and 4 patients in both groups respectively, IW STEMI in 5 and 4 patients respectively, NSTEMI in 4 and 3 patients respectively and UA in 15 and 17 patients respectively. Risk factors were diabetes mellitus in 32 and 27 patients respectively, hypertension in 41 and 40 patients respectively, smoking in 43 and 38 patients respectively, alcohol in 30 and 35 patients respectively and positive family history in 12 and 16 patients respectively. The difference was non- significant (P> 0.05). The mean LAVI at admission in group I was 38.1 and in group II was 27.2, after 1 month was 40.2 and 28.1 in both groups, after 6 months was 39.1 and 27.9 in both groups and after 12 months was 42.7 and 25.3 in both groups respectively. The difference was significant (P<0.05). Conclusion: Authors conclude that LAVI was found to be the independent predictor of mortality than left ventricular ejection fraction on multivariate regression analysis. Common risk factors in patients with ACS were diabetes mellitus, hypertension, smoking, alcoholism and positive family history. Patients with LAVI of value >34 ml/m2 were associated with increased comorbidities. 
Prevalence and Associated Risk Factors of Pulmonary Tuberculosis in Diabetic Patients
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Background: One-third of India’s population is infected with mycobacterium tuberculosis; there are 12 million active tuberculosis cases in India. One person dies of Tuberculosis every minute in India. No other disease has so much sociological, economic and health significance as Tuberculosis has. In 2005 there were an estimated 8.8 million new cases of Tuberculosis worldwide, with 1.9 million of those occurring in India. In India in 2000, there were an estimated 481,573,000 people over the age of 25 years. Among these, 4.3% i.e. around 20,707,639 had diabetes, 19 and 939,064 developed. Subjects and Methods: The study conducted over a period of 2 yrs. Adult patients with diabetes mellitus with pulmonary Tuberculosis were included, while Diabetic patients with extrapulmonary Tuberculosis were excluded from the study. Results: The maximum incidence of pulmonary Tuberculosis was noted above the age of 30yrs were 13(26.0%). The peak incidence was in the age group of 31 – 40 and 41 – 50 yrs. The mean age is 52.62. As Shown in [Figgure 1], the total numbers of males were 64% and females were 36%. The male to female ratio was 2.11:1 As Shown in [Table 3], the distribution of patient according to their occupation noted were Skilled (18%), Unskilled (38%), Business (16%), Service (2%), Housewife (22%), and Student (4%). As shown in [Table 4], the socio-economic status among 50 patients was distributed into: Upper (2%), Upper Middle (22%), Upper lower (32%), Lower (12%), Lower middle (32%), and Lower-middle (32%). Conclusion: Early diagnosis and properly monitored treatment regimen is the only time tested answer to this problem. All diabetics at the initial diagnosis and every year must have an x-ray chest done. All diabetics with abnormal weight loss, unexplained cough, or sudden increase of insulin requirement should have sputum examination and chest x-ray done. 
Correlation of Lipid Profile & Acute Inflammatory Markers in Rheumatoid Arthritis
No full textBackground: Rheumatoid arthritis (RA) primarily affect the synovium and is a chronic inflammation disease, which leads to joint damage and bone destruction. Causes of significant morbidity are due to result of synovial inflammation, joint destruction and associated disability. Many pieces of evidence suggest that proatherogenic disease associated with increased cardiovascular (CV) mortality is rheumatoid arthritis (RA). Addition to genetic and conventional CV risk factors, chronic inflammation has emerged as a key component of this process. Cardiovascular concerned demises shown a preferment in CRP among RA cases who have ongoing active inflammation that\u27s why CRP can be self-sufficient pointer for cardiovascular disease. Subjects and Methods: Current study has been conducted in Teerthanker Mahaveer hospital, Teerthanker Mahaveer medical college. Data has been collected in duration of 12 months. After obtaining consent, data has been collected from 60 consecutive established case of rheumatoid arthritis. Almost equal number of participants were belonging to 30-39 years (16, 26.7%), 40-49 years (15, 25.0%), and 50-59 years (16, 26.7%) age groups. Very few participants were belonging to 20-29 years (4, 6.7%) and 60-69 years (9, 15.0%). Range of age was from 25 years to 69 years. Results: Pearson correlation coefficient of CPR with Total cholesterol, HDL-C, Triglyceride, LDL-C and VLDL-C were -0.326, -0.269, -0.307, -0.310 and -0.307 respectively. All the correlation coefficients were statistically significant (<0.05). Correlation coefficient of ESR with Total cholesterol, HDL-C, Triglyceride, LDL-C and VLDLC were -0.294, -0.311, -0.226, -0.253 and -0.226 respectively. Among them correlation coefficient of ESR with total cholesterol (p-value=0.023) and HDL-C (p-value=0.016) were statistically significant (<0.05). Conclusion: General population danger of atherosclerosis surmount with increment in LDL and wane of HDL but in RA population there is wear off in HDL LDL and total cholesterol, when present in its inflammatory condition. There is a difference in the lipid trend in RA patient then the general population. Rheumatoid arthritis is a disease with lipid paradox. A high inflammatory burden determined by the mean values of ESR and CRP in active disease is associated with low lipid levels but more risk of CV events. 
Clinical Profile and Outcome of Dengue Fever in Tertiary Care Hospital at Kerala
No full textBackground: Among all flaviviruses, Dengue is the most common fever. Every year 2-5 lakh cases of Dengue hemorrhagic fever occur. The objective of the study was to evaluate the clinical profile of patients with Dengue fever at a hospital in Kerala. Subjects and Methods: Patients with more than 12 years of age and those admitted with fever, headache, and myalgia were assessed with other clinical characteristics (warning signs of dengue fever, signs of hemorrhage, signs of plasma leakage and signs of shock). Laboratory examinations such as Hb, total count, differential count, platelet count, packed cell volume, peripheral smear for the malarial parasite, and liver function test (including S. protein) and renal function test were carried out. Blood coagulation profiles such as Bleeding Time, Clotting Time, Prothrombin Time and aPTT were performed. Radiological findings like X-ray chest and USG abdomen were also performed. Results: Consequently dengue fever is ordinary in young adults. In the current study, males were more pretentious than females. Males were affected by 63.7% while females are affected by 36.3%. The most usual indication was fever (94.8%) experienced in all patients followed by headache (41.3%), Generalized weakness (77.5%), myalgia (51.7%), vomiting (57.7%). Predominant organ involvement was hepatic (transaminases, jaundice) followed by gastrointestinal (abdominal pain, distension, loose stools, vomiting, ascites) systems. The total survivors are 86(74.1%) whereas 30(25.8%) were non-survivors. Conclusion: Dengue fever usually affects male and young populace. Headache, fever, myalgia are ordinary at hand grumble however in the recent few years, the world has observed the diverse experimental appearance of the dengue fever in dissimilar epidemics, even in the same regions and even with the period of times. 
A Comparative Study of Formative Assessment in Medicine Using Conventional Long Case Examination and Objective Structured Long Examination Record (OSLER) Among Final Year MBBS Students
No full textBackground: Most medical colleges in India traditionally use the Long Case Examination (LCE) in both formative and summative patterns of assessment in clinic. This age-old issue has been addressed over the years by the introduction of several modifications of the LCE such as OSCE and OSLER. OSCE, though attractive in its brevity and specificity of focus, falls short in terms of being comprehensive. This study was taken up to compare conventional LCE to OSCE and OSLER. Subjects and Methods: Final year MBBS students, posted to Department of General Medicine, HIMS, Hassan were studied for 5 months. Type of study: Prospective observational study Four examiners were selected for the formative assessment: Examiners 1 and 2 were asked to assess the students assigned to Group 1; Examiners 3 and 4 were asked to assess Group 2. The OSLER method concentrates on the following ten items: (1) pace and clarity of presentation, (2) communication process, (3) systematic approach, (4) Establishment of case facts, (5) systematic examination, (6) Examination technique, (7) Establishment of correct physical findings. Results: The mean time taken for the assessment in Group 1 was 28.22 minutes and the SD was 7.588. The mean time taken for the assessment in Group 2 was 17.09 minutes and the SD was 4.546. Conclusion: In our study, the students seem to prefer the time-tested long case examination and did score better marks with the conventional method than with OSLER.  
Clinical Profile of Patients with Chronic Kidney Disease
No full textBackground: DM is the leading cause of end-stage renal disease (ESRD), non-traumatic lower extremity amputations, and adult blindness. It also predisposes to cardiovascular diseases. With an increasing incidence worldwide, DM will be likely a leading cause of morbidity and mortality in the future29. Chronic kidney disease (CKD) encompasses a spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate. Subjects and Methods: A written informed consent was obtained from all patients. History regarding the duration of hypertension, the medications being taken, coexisting medical problems, and symptomatology suggestive of ischemic heart disease, transient ischemic attacks and that of renal involvement were documented. A detailed history, anthropometry, vital signs, clinical examination and laboratory parameters were recorded for both the study group. Results: The Study reveals that, there was statistically very highly significant difference of age among Type 2 diabetes mellitus with CKD and Non-diabetic patients with CKD (P<0.001).Type 2 diabetes mellitus with CKD cases had significantly higher mean age as compare to Non-diabetic patients with CKD cases. Conclusion: There was statistical significant difference of mean serum uric acid among vegetarians and non-vegetarians with CKD patients (P>0.05).It’s found that vegetarians have less SUA level when compare to mixed diet patients. 
Association of Birth-Weight, Obesity and Family History in the Development of Latent Autoimmune Diabetes in Adults (LADA) and Type 2 Diabetes Mellitus
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Background: A proportion of subjects with adult-onset autoimmune diabetes does not require insulin-therapy at the time of diagnosis and are clinically similar to patients with type 2 Diabetes Mellitus (T2DM). Objectives: The present study was undertaken association of birth-weight, obesity and family history in the development of latent autoimmune diabetes in adults (LADA) and type 2 Diabetes Mellitus. Subjects and Methods: A total of 50 healthy controls, 50 type 2 diabetic and 50 patients with LADA were enrolled. Complete demographic details of all the patients were obtained. Clinical examination of all the patients was carried out and medical history of all the patients was obtained. Detailed medical history and family history of all the patients was recorded separately. A Performa was made and complete anthropometric parameters were recorded. Body mass index (BMI) was calculated. All the results were recorded in Microsoft excel sheet and was analysed by SPSS software. Results: While assessing association of birth-weight in the development of latent autoimmune diabetes in adults (LADA) and type 2 Diabetes Mellitus; it was observed that significantly higher proportion of patients of the diabetic group and the LADA group had low birth weight in comparison to the patients of the control group. While assessing association of family history of diabetes in the development of latent autoimmune diabetes in adults (LADA) and type 2 Diabetes Mellitus; it was observed that significantly higher proportion of patients of the diabetic group and the LADA group had positive family history of diabetes in comparison to the patients of the control group. While assessing association of obesity in the development of latent autoimmune diabetes in adults (LADA) and type 2 Diabetes Mellitus; it was observed that mean BMI of the patients of the diabetic group and the LADA group was significantly higher in comparison to the patients of the control group. Conclusion: Low birth weight, obesity and positive family history of diabetes are important risk factors in the development of latent autoimmune diabetes in adults (LADA) and type II diabetes. 
Study of Clinical Correlates of Tubercular Meningitis in a Tertiary Care Centre in Moradabad
No full textBackground: Tuberculosis continues to remain a leading cause of mortality worldwide with tubercular meningitis being the most common type of central nervous system tuberculosis that is associated with significant morbidity and mortality if not identified and treated promptly. Due to meager amount of published data and lack of evaluation of the western UP population, this study was conducted in order to observe a detailed clinical course of the disease as well as to analyze predictors of morbidity and mortality in patients of TBM admitted at a tertiary care hospital in Moradabad.Subjects and Methods: A total of 120 patients with diagnosis of TBM as per the diagnostic criteria of the study were included and all their information and features recorded and treatment done as per guidelines and a follow-up done at 3 months using Barthel Index.Results: Multivariate logistic regression analysis of various factors revealed age of the patient (p=0.04), duration of symptoms (p=0.002), stage of TBM on presentation (p=0.001), TLC>9000 (p=0.006), low CSF glucose (p=0.01), hyponatremia (p=0.04), hypoalbuminemia (p=0.007) and hydrocephalus (p=0.04) on neuroimaging were significant risk factors of mortality and morbidity in adult patients of TBM.Conclusion: The current study may provide components for the composition of a score to predict outcome using the significant poor prognostic factors that were recognized in this study. This can be utilised for prompt employment of rigorous management remedies in order to reduce patients’ morbidity and mortality. 
Dengue Fever and its Dermatological Changes
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Background: Around the world dengue incidence has dramatically grown with a large number of asymptomatic cases. Worldwide about 390 million dengue infections were occurring per year, among them 96 million people were developing clinical manifestations with varied severity. About 3.9 billion people residing in 128 countries, were at-risk of dengue virus infection. Dengue fever (DF) is one of the common causes of acute febrile illness. In half the patients with dengue fever skin involvement occurs. The aim of the study is to study the socio-demographic parameters, clinical features and laboratory parameters among the patients with and without skin rash in dengue infection. Also determine outcome among the patients with dengue fever and its association with skin rash. Subjects and Methods: A hospital-based, analytical prospective study was conducted in the Department of General Medicine, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore. Patients older than 16 years of age with clinical features and laboratory reports suggestive of dengue infection were included. The study was conducted for a period of 12 months from 1st December 2014 to 30th November 2015. These patients were further divided based on the skin rash presence and absence. The data obtained was entered in Microsoft Excel and analyzed in SPSS version-22 trial. Analysis was done using unpaired students t-test, ANOVA. Results: In total 97 patients with dengue fever were enrolled into the study. About 14.4 p.c (14) patients were with skin rash. The patients with skin rash were found to have lower platelet levels during the disease course. Patients with skin rash had higher percentage of platelet transfusion which was statistically significant. Conclusion: A cutaneous involvement may facilitate clinical diagnosis but it may not be present among all the patients. 
Examination of Pervasiveness of Elevated Serum Uric Acid Level and Microalbuminuria in Prehypertension
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Background: The relationship between uric acid and microalbuminuria in healthy adults without other cardiovascular risk factors may help to clarify the role of uric acid in cardiovascular disease. In this study, we examined that elevated serum uric acid level was associated with microalbuminuria. Subjects and Methods: Study was done on both male and female prehypertensive patients of age more than 18 years and less than 60, admitted in wards and attending OPD. Controls were normotensive patients admitted in wards who were matched for age, sex and confounding factors. Results: Hyperuricemia was found in 53 (15.14%) patients with prehypertension compared to 32 (9.14%) patients with normal BP. Thus hyperuricemia was seen in patients of prehypertension which was highly significant as P<0.001. Conclusion: In conclusion we found that microalbuminuria and hyperuricemia are significantly more prevalent among prehypertensive subjects as compared to normotensive subjects.