201 research outputs found
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Thyroid Function Abnormalities in Critically Ill Patients
Get PDFBackground: To study the alterations in thyroid hormone levels in critically ill patients. Subjects and Methods: Fasting venous blood samples were collected on admission to ICU from all critically ill patients and were subjected for thyroid hormone analysis by VIDAS-ELISA. They were also be evaluated for body temperature, blood pressure, pulse rate, respiratory rate, and impairment of consciousness on the Glasgow coma scale. Arterial blood gas analysis, complete blood count, liver function test, renal function test was interpreted, and the APACHE II score was calculated. Course and the outcome of these patients were followed in the hospital. Result: Maximum patient belong to 41-50 years age group (n=34, 34%) Maximum patients were male (n=69, 69%) and rest were females (n=31, 31%). 42 (42%) patients required Ventilator assistance. The mean APACHE-II score was significantly higher among non-survivors compared with survivors (25.52 ± 6.84 vs. 14.06 ± 5.71, P < 0.01). The mean value of TSH was 3.27±6.91. The mean value of FT3 was 3.42±0.36. The mean value of FT4 was 14.79±1.17. A total of 22 patients (22%) succumbed to their illness during ICU admission. The mean level of both FT3 and FT4 were lower in non-survivors (2.98, 13.39) as compared to survivors (3.82,15.71). The mean level of TSH was lower in non-survivors (2.63) as compared to survivors (4.07). Conclusion: FT3 and FT4 was lesser in non-survivors as compared to survivors with significant difference. Although TSH level was lower in non-survivors as compared to survivors, but there was not statistically significant difference.FT3 and FT4 were the best independent predictors of ICU mortality. 
Causative Agents in Patients Presenting with Acute Viral Hepatitis along with their Clinical Profile at a Tertiary Care Hospital, Western U.P.
No full textAcute viral hepatitis (AVH) is a common health-related problem throughout the world, but morbidity and mortality are prevalently seen in developing countries like India. In India, AVH is most commonly caused by HAV (hepatitis A virus) and HEV (hepatitis E virus) and in few cases, HBV (Hepatitis B virus) is the etiological agent. HEV mainly affects the middle-aged population, is mild in symptoms however it is lethal with 30% mortality in pregnant females compared to the mortality of ≤1% in the general population. This study was focussed to identify the etiological agents, various clinical - laboratory factors, disease severity and associated complications in patients presenting with AVH. In our study, HEV was the most common etiological agent accounting for 43.6% of cases followed by HAV (29.1%), HBV (26.1%) and HCV (1.2%). The most common age group involved with AVH was the adult group i.e. from 21-30 yrs (35.1%) followed by 11-20 yrs (27.9%), below 10 yrs (15.1%) and 31-40 yrs (14.5%). The commonest symptom was yellow-colored urine (86.1%) followed by yellow discolouration of sclera and loss of appetite. Bleeding derangement was observed in all patients with acute liver failure (ALF) while Hepatic encephalopathy was observed in 3 patients with ALF. To conclude, integration of diagnostic measures, early diagnosis, treatment protocols, prevention and mass vaccination will help in the overall reduction of AVH cases and related complications. 
Association between Non Alcoholic Fatty Liver Disease and Coronary Artery Disease.
Get PDFBackground: To study the association of Non Alcoholic Fatty Liver Disease in patients of Coronary Artery Disease. Subjects and Methods: 100 patients of established CAD admitted were included in the study. Patients were screened for NAFLD with USG. 2 groups were made: CAD with NAFLD & CAD without NAFLD and comorbidities were identified and evaluated for Risk Factors and Correlation was identified. Result: Majority of study subjects (79%) were males and 21% were females. Highest proportion of subjects (29%) were in 51-60 years of age and lowest (9%) in above 70 years of age. Chest pain was the commonest presenting symptom preceding breathlessness and sweating. In the fatty liver group, a high proportion of subjects had history of Type-II DM (31% vs 4%) and Hypertension (18% vs 11%) in comparison to normal liver group. The mean BMI of study participants in the present study was 29.5 kg/m2. In fatty liver group, higher proportion of subjects had fasting blood glucose levels > 126 (66.7%) than the non-fatty liver subjects (3.8%). higher proportion of subjects had total cholesterol levels higher than 200 (14.6%) than the non-fatty liver subjects (1.9%). In group with non-fatty liver, greater proportion of subjects had LDL levels higher than 100 (40.4%) than the fatty liver group (33.3%). it was found that 37.5% subjects had mild grade of NAFLD whereas 43.8% had moderate grade and 18.7% had severe grade of NAFLD. Conclusion: There is a significant relationship between NAFLD and an elevated CVD risk in those with or without Metabolic Syndrome. 
To Compare Effectiveness and Safety of Teneligliptin vs Glimepiride in Patients with Type 2 Diabetes Mellitus
Get PDFBackground: To determine the efficacy of Teneligliptin [DPP-4 inhibitor] vs Glimepiride [sulfonylurea] in patients with type 2 diabetes mellitus. Materials and Methods: Patients with inadequate glycemic control with maximum tolerable dose of metformin were randomly divided into 2 groups (Group A & Group B). Group A was started on Teneligliptin and Group B on Glimepiride. The patients were assessed for weight, fasting plasma glucose (FPG), post parandial glucose (PPG), HbA1c and Lipid Profile. The patients were followed up in OPD for 3 months. The difference in all the mentioned parameters were used to determine the efficacy of Teneligliptin V/S Glimepiride. Result: There were more males as compared to females. Most of the subjects in both the groups were having age >50 years. Mean age in group A and B was 58.72±12.78 and 59.31±13.06 years individually. Family history of diabetes was discovered in 38.69% and 45.61% of the subjects in group A and B individually. The duration of diabetes was 42.11% and 47.37% of the subjects in group A and B since 5-10 years. Hypertension and cardiovascular disease were found in 14.04%, 5.26% and 19.30%, 3.51% of the subjects in group A and B. Lipid profile viz. Cholesterol, HDL, LDL and VLDL was similar among both the groups as p>0.05. Conclusion: In the current research, Glimepiride as well as Teneligliptin were very much endured when added to Metformin. Patients on Metformin+Teneligliptin displayed better command in control of glycemic profile as well as lipid profile. Thus, Teneligliptin is the better choice as an add-on medication to Metformin in type 2 diabetes patients. 
Study of the Occurrence and Prognostic Significance of Hyponatremia in Myocardial Infarction
No full textBackground: Cardiovascular disease (CVD) is the commonest cause of natural death all over the world. Asians develop this disease nearly one to two decades earlier than the Western population. Though CVD does not always lead to immediate death yet may be associated with delayed mortality or morbidity leading to significant loss of productivity of an individual. Hence, it becomes imperative to assess clinical parameters that may not only prevent death but also helps in reducing morbidity. Hyponatremia is found to be one of the major causes of sudden as well as delayed deaths in patients experiencing acute myocardial infarction (AMI). As serum sodium estimation is an easy, inexpensive, and routine laboratory investigations performed in patients with AMI, we aimed to assess its prevalence and prognostic significance in such patients. Subjects & Methods: One hundred patients of AMI admitted in the Department of Medicine of our institution were enrolled in our study according to inclusion & exclusion criteria following approval from IEC. Serum sodium levels of all patients were recorded at the time of admission, at 48hours and at one month. All patients underwent ECG and echocardiography for assessment of their cardiac function as well as subgrouping into STEMI/NSTEMI. All patients were followed up for signs of congestive cardiac failure, arrhythmias & cardiogenic shock or death. The above data was analyzed with appropriate statistical tests. Results: In our study, 38 patients developed hyponatremia, 13 at the time of admission, 15 at 48hours and 10 at one-month time. Out of 62 patients with normal sodium, 9 developed CCF, 9 arrhythmias and 4 died. On the other hand, nearly 25 patients with hyponatremia developed CCF and 11 patients died. This showed that AMI patients with hyponatremia have poor outcome. Conclusion: There is significant occurrence of hyponatremia, patients of acute MI. Occurrence of hyponatremia in patients of acute myocardial infarction is associated with adverse cardiovascular outcomes viz. arrhythmias, congestive cardiac failure and death. Also, the occurrence of these adverse efect is directly correlated the severity of hyponatremia. Hence, serum sodium can be used as simple and effective tool for risk assessment in patients of acute myocardial infarction. 
Association between High Density Lipoprotein (HDL) and Glycosylated Haemoglobin (HbA1c) in Type 2 Diabetes Mellitus Patients Undergoing Angiography for Acute Coronary Syndrome
Get PDFBackground: To evaluate association between high density lipoprotein (HDL) and glycosylated hemoglobin (HbA1c) in type 2 diabetes mellitus patients undergoing angiography for Acute Coronary Syndrome (ACS). Subjects and Methods : Type 2 Diabetic patients who presented with Acute Coronary Syndrome were subjected to Angiography and Comparison of HDL & HbA1c level in view of single vessel or multi vessel Coronary Artery Disease was done to Evaluate association/correlation between HDL & HbA1c level with single/multi vessel Coronary Artery Disease. Result: In present study out of 90 subjects who have undergone C.A.G, 29 (32.22%) had S.V.D and 61 (67.78%) had M.V.D. In present study no. of male patients with S.V.D was 22 (75.86%) and females were 7 (24.14%). Whereas, no. of male patients with M.V.D were 45 (73.77%) and females were 16 (26.23%). Maximum no. of patients with S.V.D belong to age group <40 years (n=11, 37.93%). Maximum no. of patients with M.V.D belong to age group 51-60 years (n=26, 42.62%), Maximum patients had S.T.E.M.I i.e., n=73 (81.11%), whereas N.S.T.E.M.I was present in only 17 patients (18.89%). Among those with S.V.D, 72.41% (n=21) had HbA1c 6.5 to 8.4 and among 27.59% (n=8) had HbA1c >8.5. Among those with Multi vessel disease, 68.85% (n=42) had HbA1c >8.5 and 31.15% (n=19) had HbA1c of 6.5 to 8.4. There was significant inverse correlation present between level of H.D.L and number of vessel involved. Most of the patients with L.D.L ≥100 had Multi vessel disease (n=53, 86.99%). Conclusion: The severity of A.C.S, as measured by a single or multi-vessel disease on coronary angiography, is directly linked to poor glycemic management, as measured by a higher HbA1c. The severity of A.C.S is also linked to an abnormal lipid profile, such as elevated L.D.L and low-H.D.L. 
To evaluate the Efficacy of Teneligliptin as an add-on Therapy in type 2 Diabetes Mellitus (T2DM) Patients with Inadequate Glycemic Control with a Stable dose of Metformin 1 to 2g and Glimipride 1 to 6mg Per Day
Get PDFBackground: To evaluate the effectiveness of Teneligliptin as an add-on therapy in type 2 diabetes mellitus (T2DM) patients inadequately controlled with a stable dose of Metformin and Glimipride. Subjects and Methods: Pateints with type II DM on Metformin 1-2gm per day and Glimipride 1-4mg per day were prescribed with TENELIGLIPTIN 20mg tablet once daily. The patients Were followed up in OPD every month till 3 months. At the end of 3 months, Blood Pressure, Body weight CBC,KFT,LFT, Lipid Profile, Fasting Blood sugar, 2 hours Post parandial Blood sugar and HbA1c was assessed. The difference in all the mentioned parameters was used to determine the effectiveness of TENELIGLIPTIN. Result: There were more males as compared to females. Mean age among the study subjects was 59.08±12.17 years Family history of diabetes was revealed in 34.17% of the subjects.48.33% of the subjects had diabetes since 5-10 years. Hypertension and cardiovascular disease was revealed in 14.17% and 6.67% of the subjects respectively. After intervention, mean weight among study subjects reduced to 71.97 from 72.61. After intervention; HbA1c, FBS and PPBS reduced to 7.02±0.44, 131.70±6.17 and 204.95±9.39 Mean Triglyceride, HDL, LDL and VLDL among the study subjects was 151.76±6.19, 38.28±2.87, 108.11±6.43 and 39.32±3.12 among the study subjects. Conclusion: The present assessment shows patients with T2DM who were treated with teneligliptin had measurably large and clinical important reductions in HbA1c levels
A Study of Treatment Compliance in Newly Diagnosed Cases of Tuberculosis under District Tuberculosis Centre of Central Maharashtra
No full textBackground: Tuberculosis is an old disease and has deep social impact on the society. It is an re-emergent killer disease with rise in MDR and XDR strains. DOTS strategy has had a substantial impact over past few decades. Monitoring outcome of TB treatment is very much important in evaluating the effectiveness of tuberculosis control program. Keeping in view all of these facts, it was decided to study compliance and outcome of newly diagnosed cases of Tuberculosis, subjected to short course chemotherapy regimen under DOTS. Subjects and Methods: The study was a prospective cross sectional study conducted in newly diagnosed cases of Tuberculosis, subjected to short course chemotherapy regimen (DOTS). Medical records of all TB patients registered from April 2020 to 31 October 2020 were reviewed. Tuberculosis types, HIV and Diabetes status, as well as treatment outcomes were categorized according to RNTEP guidelines. Results : Out of total 663 patients, 408 (61.53%) were males and 225 (38.47%) were females. Male to female ratio was observed to be 1.60:1. The mean age of males was 40.02 ± 14.04 and mean age of females was 36.15 ± 14.82. 57.02% patients were having pulmonary Tuberculosis and 42.98% patients were having extra pulmonary tuberculosis. Treatment outcome among total 663 patients was as follows – 288 (43.43%) patients got cured, 251 (37.85%) completed treatment, 55 (8.29%) dies, 8.76 (5.88%) were lost to follow up (defaulter) and 30 (4.52%) failed treatment. Conclusion: The treatment success rate of tuberculosis patients was adequate (81.28%) in relation with national targets. Again easy accessibility of healthcare services are required to further improve the compliance of TB treatment. 
A Clinical Study of Hypothyroidism Associated With Type – 2 Diabetes Mellitus
No full textBackground: Thyroid disorders are common in the general population and the incidence of type 2 diabetes mellitus is also rapidly increasing day by day. The objective is to determine the age and sex prevalence, pattern of presentation and management of patients suffering from hypothyroidism associated with type-2 diabetes mellitus. Subjects and Methods: Design: The study was an observational study of 20 types 2 diabetics attending the Department of Medicine (outpatient/inpatient). Duration: 1 year i.e. from December 2004 – December 2005. Setting: Out-patient department. Participants:20 patients with both Diabetes Mellitus type 2 and Hypothyroidism. Patients with known diabetes attending OPD were considered. Data were collected using a standardized case report form. Results: The majority of the patients had got diagnosed with hypothyroidism and diabetes within a span of 0 to 5 years, followed by 6 to 9 years span with 4 patients and 3 patients within the span of 10 to 14 years and 2 patients in the span of 15 to 19 years. Only 1 patient was diagnosed with both in a span of 20- to 24 years and one patient in 25 to 29 years. Conclusion: Annual Screening is mandatory in all hypothyroid patients for the early detection and treatment of diabetes mellitus, thereby to prevent and/or postpone the complications of diabetes, and all diabetes mellitus patients to undergo thyroid function screening (TFT) yearly for the early detection of thyroid dysfunction and thereby reducing the morbidity and mortality. 
Study of Correlation of Hypertension and Anthropometric Measurements in Obese Vs Non – Obese Individuals
No full textBackground: Obesity exists worldwide at a large incidence rate. All systolic and diastolic blood pressure show a strong association with the height and weight of both sexes. This research was intended to establish the incidence of hypertension in obese patients relative to findings reported in non-obese persons. The objective is to research Hypertension in accordance with the Body Mass Index and to equate it between the two classes of Obese and Non-Obese persons. Subjects and Methods: The following anthropometric tests were carried out of both such patients 1. Height 2. Weight 3. Circumference of dimension 4. The hip circumference. The Body Mass Index and the Waist Hip Ratio is determined from these measures. Blood pressure monitoring of BP was taken three times to validate systemic hypertension. Careful history was first taken of these cases involving pre-existing chronic hypertension and disease diagnosis. Results: The pre-hypertension level saw more people from both Obese and non-obese classes. Prevalence of stages 1 and 2 of hypertension was mostly seen in obese people. The mean systolic and diastolic blood pressure was higher in obese males than females but barely any noticeable variation in the waist circumference of > 100 and in the waist circumference of 90-100 cm, males were greater than females. Conclusion: The incidence of elevated blood pressure and mean systolic and diastolic blood pressure in increased BMI classes, i.e. obese people, was far higher. High BMI demonstrated a strong hypertension association.