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Assessment of Correlation of Vitamin D Level with Coronary Artery Disease
No full textBackground: Cardiovascular disease (CVD) is the leading cause of death in the developed world. The present study was conducted to assess correlation of plasma 25-Hydroxy-Vitamin D level with angiographic severity in coronary artery disease. Subjects and Methods: The present study was conducted on 120 patients of CAD. Group I were cases and group II were control. Hypertension, type II diabetes mellitus status, smoking etc. was recorded. 2 ml of blood sample was taken from all patients and measurement of 25(OH) vit D levels was performed. Results: The mean BMI in group I was 24.6 kg/m2and 24.8 kg/m2in group II, smoking habit was seen in 78 in group I and 34 in group II, hypertension was seen in 65 in group I and 26 in group II, diabetes was seen in 52 in group I and 30 in group II, alcoholism in 36 in group I and 10 in group II, dyslipidemia was seen in 48 in group I and 15 in group II. The mean 25 (OH) vitamin D in group I was 15.1 ng/ml and 19.6 ng/ml in group II. The difference was significant (P< 0.05). Maximum dyslipidemia (80.5%) patients had low vitamin D level followed by DM, smoking, BMI, alcoholism and alcoholism. There was no correlation between risk factors and vitamin D deficiency (P> 0.05). Conclusion: Authors found that in cases, vitamin D level was lowered as compared to control, however, there was no correlation between risk factors and CAD. 
Serum Procalcitonic (PCT) Versus Serum C - Reactive Protein (CRP) for Severity of Organ Dysfunction in Sepsis
No full textBackground: Intensive care units (ICUs), despite advances in critical care nursing, have frequent issues with early diagnosis and adequate treatment. Recently discovered world-class procalcitonin (PCT), a revolutionary laboratory marker, has been shown to be useful in this regard. The objective is to Comparison of concentrations of serum procalcitonin (PCT) and c-reactive protein (CRP) with a comparable level of organ malfunction during sepsis and evaluation of the interaction between serum PCT and CRP concentrations with different organ malfunction occurrence in sepsis. Design: It is a Hospital-Based Prospective study. Participants and Setting: Fifty people were admitted to the intensive care unit of Gandhi Medical College. Subjects and Methods: The extent of sepsis-related organ impairment was evaluated with the sequential organ failure assessment (SOFA) on day 1. Patients were identified by category 1(0-6), category 2(7-12), group 3(13-18), and group 4(19-24) in 4 separate classes with varying organ impairment seriousness of sepsis. Serum PCT and CRP concentrations have been measured. Results: The majority of the patients belonged to the age groups of 60-69 years (30%) and 50-59 years (22%) Majority of the patients belonged to the Sofa group 1 around 42% followed by sofa group 2 with 38%, sofa group 3 with 16% and the least belonged to the sofa group 4 with 4%. The mean PCT and CRP concentration in those who survived was 14.73 ng/ml and 149.916mg/L respectively and in those who died were 45.76 ng/ml (p-value <0.001) and 183.584 mg/L (p-value 0.172) respectively. The linear correlation between PCT plasma concentrations and the four groups was significantly stronger than with CRP. Conclusion: In SOFA and serum PCT, The level of organ dysfunction and complications in sepsis patients is closely related to serum CRP levels.
 
Evaluation of Lactate in Differentiating Pyogenic and Non-Pyogenic Meningitis
No full textBackground : Meningitis is serious and a life-threatening condition among any age group associated with serious mortality and morbidity. The objective of the present research was to assess the efficiency of CSF lactate in differentiating bacterial/ pyogenic from non-pyogenic meningitis. Subjects and Methods: A hospital-based one-year prospective study was conducted at a tertiary care hospital in Gujarat. The study was performed at the department of General medicine for a period of one year. All the cases suspected of meningitis above 18 years of age irrespective of sex were admitted and clinically evaluated. The Diagnosis of meningitis was made on account of various clinical symptoms and signs. Like headache, nausea, presence of kernig’s sign, altered sensorium, cranial nerves palsies, hemiparesis, seizures, etc, Results: The mean total cell count was highest in cases of pyogenic meningitis with a mean of 840.50 and SD of 112.30 than viral and tubercular meningitis. However, no statistical significance was associated with total count and types of meningitis. (P> 0.05) Lactate levels of the CSF were elevated than normal in both pyogenic and tubercular than viral, however, the mean CSF lactate was higher in pyogenic than tubercular. A clear statistical significance was observed in CSF sugar/blood glucose ratio and CSF lactate levels in this study (p≤0.05). Conclusion: CSF lactate level is a rapid, quite inexpensive and unpretentious process, important diagnostic indicator in the premature demarcation of pyogenic meningitis and tubercular meningitis from viral meningitis, serving in the premature organization of proper action and diminishing transience and impediments. Early detection may help in early decision on the type and institution of appropriate management could reduce the mortality and morbidity of meningitis. 
A Study on Uric Acid Levels in Non Diabetic Patients at a Tertiary Care Hospital
No full textBackground: The pathophysiology of diabetic nephropathy is complex and still not fully elucidated. Observational studies suggest a relationship of UA level with incident CKD, but studies evaluating the relationship with decline in kidney function in established CKD are conflictingSeveral prospective studies have suggested that hyperuricemia is associated with an increased risk of incident cardiovascular events and death in both nondiabetic and type 2 diabetic individuals Hyperuricemia also is largely prevalent in patients with chronic kidney disease(CKD). Subjects and Methods: The patients were randomly divided into two groups according group chosen by time of enrollment. By using simple random method, 64 study subjects will be taken, and the study subject is divided into 2 groups. 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 no statistical significant difference of mean serum uric acid among smokers and non-smokers in non-diabetes patients with CKD (P>0.05).Study reveals that, there was no statistical significant difference of mean serum uric acid among alcoholic and non-alcoholic cases in non-diabetes patients with CKD (P>0.05). Conclusion: non-diabetic patients with CKD cases (P<0.05). There was an increasing trend in the mean serum creatinine concentration with a corresponding decreasing trend in eGFR across increasing UA categories There is significantly sloping down of GFR with increase of SUA level as model. 
Clinicopathological Outcome in Infection Related Glomerulonephritis
No full textBackground: The term infection-related glomerulonephritis (IRGN) was proposed as the streptococcal, staphylococcal and gram-negative organisms were being isolated among elderly and immunocompromised patients treated for glomerulonephritis. Previously these were called as Post-infectious glomerulonephritis (PIGN). Most of the reported patients were Caucasians and Asians with male predominance. Among the adult IRGN patients a kidney biopsy is recommended to confirm the diagnosis and to rule out other glomerulonephritis. The aim of the study is to study the clinical characteristics and pathological patterns of infection-related glomerulonephritis (IRGN) in adults and to assess the clinical and pathological differences of C3 dominant and codominant IRGN patients. Subjects and Methods: A hospital-based, analytical retrospective clinical study was conducted among seventy-three patients. Cases were included irrespective of gender with biopsy proven IRGN and aged equal to or greater than 18 years of age. The study was conducted for a period of 6 months from 1st June 2019 to 30th Nov 2019 at Sapthagiri Institute of Medical Sciences and Research Center, Bangalore. A prior permission from the institutional ethics committee and written consent from the patients and their family members were obtained. Data obtained was entered in Microsoft Excel-2013 and analyzed in SPSS version-22 trial. Appropriate statistical tests were applied and p-value less than 0.05 was considered as significant. Results: In the present study 73 patients were included based on the selection criteria. The mean age of the study population was 41.8 ± 14.5 years. Majority 51 p.c (37) of study population were males and 49 p.c (36) were females. Hypertension was the most common risk factor which was reported among 56 p.c (32) of the patients. Diabetes was reported among 17 p.c (10) of the patients. About 15 p.c (9) of the patients were alcoholics and 10 p.c (6) of the patients were smokers. Conclusion: Renal biopsy plays an important role in the assessment of prognosis and underlying glomerular nephritis (GN). 
Correlation between Vitamin D and HbA1c in Type 2 Diabetic Patients
No full textBackground: Diabetes is a metabolic disorder that can affect nearly every organ system in the body. Recently, Vitamin D3 was given some importance worldwide in the pathogenesis of diabetes. The extraskeletal effects of Vitamin D3 have attracted considerable interest. The identification of 1,25-Dihydroxyvitamin D3 and 1-Alpha-Hydroylase expression in pancreatic Beta cells, in cells of the immune system,and in various other tissues besides the bone system , supports the role of Vitamin D3 in the pathogenesis of type 2 diabetes. Vitamin D3 deficiency appears to be related to development of diabetes mellitus type 2 and metabolic syndrome. The aim of the study is to find out whether this correlation between vitamin D and Diabetes is present or not. Mainly in this study we have tried to correlate Vitamin D with HbA1C levels in patients with Type 2 diabetes mellitus. Subjects and Methods: The present one and half years, cross sectional study was carried out in department of medicine, Darbhanga Medical College and Hospital, Darbhanga, Bihar from March – 2018 to September – 2019. A total of 125 patients with type 2 Diabetes Mellitus were studied. The estimation of vitamin D was done. Using Siemens, ADVIA centraurVit D assay a one pass 18 minute antibody competitive immunassay. Results: Maximum no. of cases was in the age group of 51 to 60 that is 40 patients (32%). The mean age of studied population was 60.22 +- 11.65 years. Out of 125 patients 77(61.6%) were males and 48 patients (38.4%) were females, with a ratio of male to female of 1.60:1. In 104 patients (83.2%), the level of vitamin D were below normal, in 11 patients (8.8%) the levels insufficient and in remaining 10 patients , the levels were either normal or more than normal. Conclusion: There was an inverse association between Vitamin D and HbA1C in patients with type -2 Diabetes Mellitus. Lower Vitamin D levels are associated with poor glycemic control. That means in case of low Vitamin D the study reveals high HbA1C. Vitamin D deficiency is prevalent in Diabetes mellitus Type 2 so by supplementation of vitamin D we can improve glycemic controls in patients of Diabetes mellitus Type 2. By improving glycemic control, we can reduce the complication of Diabetes. 
A Prospective Study on Effect of High Dose of Steroid on Platelet Count in Acute Stage of Dengue Fever with Thrombocytopenia
No full textBackground: Dengue was the second disease after “yellow fever” that was shown to be caused by virus. The present study was conducted to assess effect of steroid on platelet count in acute stage of dengue fever. Subjects and Methods: 112 patients of dengue fever were divided into 2 groups. Group I was prescribed intravenous dexamethasone 8 mg initially followed by 4 mg every 8 hours thereafter for 4 days and group II patients was given only IV fluids and antipyretics. Results: Group I had 30 males and 26 females and group II had 25 males and 27 females. The mean platelet count (thousands) in day 1 was 29846.8 and 32442.4 in group I and group II respectively, on day 2 was 56003.4 and 44284.6, on day 3 was 78012.6 and 74224.6 and on day 4 was 126124.8 and 114620.4. The difference between both groups was non- significant (P> 0.05). Conclusion: High dose dexamethasone regimen was not effective in achieving a higher rise in the platelet count in the acute stage of dengue fever. 
Laboratory Findings Associated with Pulmonary Tuberculosis in Diabetic Patients
No full textBackground: An epidemic of diabetes is currently, both in developed and developing nations. The seriousness of the association of pulmonary tuberculosis and diabetes mellitus was first noted by the great Arab Physician Avicenna nearly 1000 years ago. The global figure of people with diabetes is projected to rise from the current estimate of 220 million to 300 million in 2025. Subjects and Methods: All type 2 diabetic patients reporting to MVJMC and RH will form the subjects for study. 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: LDL: 18% of the patients had an LDL value below 100. 40% of the patients had LDL value between 100 – 120. Only 42% of the patients had LDL values between 120-140. HDL: 22.0% of the patients had an HDL value below 30. 24% of the patients had HDL values between 30 – 40. Only 36.0% of the patients had HDL value between 40-50 and 18% of the patients had an HDL value between 50-60. Triglycerides: 56.0% of the patients had Triglycerides value below 150. 42% of the patients had Triglycerides value between 150 – 199. Only 2.0% of the patients had Triglycerides value between 200-499. Conclusion: Male preponderance of the disease was noted and Peak incidence of the disease was noted in the age groups of 31 – 40 and 41 – 50. The majority of our patients had poorly controlled blood sugars, suggesting that severe hyperglycemia is associated with the development of pulmonary tuberculosis and sputum positivity was more in patients aged ≤ 50 yrs. Early diagnosis and properly monitored treatment regimen is the only time tested answer to this problem. 
Etiology and Outcomes in Elderly Patients Admitted For Acute Infections
No full textBackground: Infectious diseases are a major cause of mortality in elderly. The present study aimed to assess various acute infections in elderly population admitting in our department and factors which are associated with their clinical outcomes. Subjects and Methods: Hundred patients, aged more than 65 years of age, having fever of less than 7 days’ duration or having symptoms of any of the major system admitted in our department were included. Detailed history, clinical and laboratory work-up was done to diagnose the cause of infection. Mortality of the patients during hospital stay was noted and factors associated with it were ascertained from statistical analysis. Results: Mean age of the patients was 75.84 years, two-thirds being males. Hypertension and diabetes mellitus were the most common co morbidities. Pulmonary infections accounted for majority of the infections (43%), urinary tract infections were the second most common cause of acute infection. Gastrointestinal infections (10%), central nervous system infections (6%), skin infections (4%) were other less common causes. During hospitalization, the most common complication was respiratory failure. Overall, 15 patients died during hospital stay. We found higher APACHE-II score and presence of pulmonary infections to be significantly associated with in-hospital mortality. Conclusion: A multi disciplinary management of elderly patients with infections is required. 
Adenosine Deaminase Levels in Cerebrospinal Fluid in Different Etiology of Meningitis
No full textBackground: Meningitis is a medical emergency as it can be life threatening because of the inflammation proximity to brain and spinal cord. If not recognized earlier, it can lead to serious long term neurological sequelae like deafness, epilepsy, hydrocephalus and cognitive deficits. Subjects and Methods: The study included 75 patients of meningitis, on the basis of clinical findings, CSF findings and MRI brain who were admitted to the emergency and ICU of the hospital. Results: There were 63% male and 37% females in TBM 73.9% male and 26.1% females in PM and 72% male and 28% females in VM group. Conclusion: CSF ADA is markedly raised in tubercular meningitis, while lower ADA values are seen in pyogenic meningitis and viral meningitis.