Cardiovascular dysfunction in patients of cirrhosis of liver

Background: Cirrhosis of liver refers to a progressive condition that disrupts the normal architecture of the liver. It is increasingly recognized that cirrhosis per se can cause cardiac dysfunction. The aim was to assess cardiovascular dysfunction electrocardiographically and echocardiographically in patients with cirrhosis of liver and to find the correlation between cardiovascular dysfunction and severity of liver cirrhosis as per child-PUGH score.Methods: Total 90 patients of cirrhosis of liver of both sexes were included in this cross-sectional study conducted from January 2018 to August 2019 in SGRDIMSR, Sri Amritsar. The severity of liver cirrhosis was assessed as per Child Pugh Score. QTc interval was calculated by Bazett抯 formula. Systolic and Diastolic dysfunction was seen on 2D-echocardiography.Results: QTc interval increased linearly with the severity of liver cirrhosis. Mean values of QTc in Child Pugh Class A=425.00(�.97), Class B=437.35(�.60), Class C=479.71(�.48) with p value of 0.04 which is significant. Diastolic dysfunction was also related with the severity of liver cirrhosis. In Child Pugh Class A= 2(33%) patients had grade 1 diastolic dysfunction, Class B=23(59%) patients had grade 1 diastolic dysfunction while in Child Pugh Class C=3(7%) had grade 1 diastolic dysfunction, 33(73%) patients had grade 2 diastolic dysfunction and 1(2%) patients had grade 3 diastolic dysfunction with p value of 0.04 which is significant. Systolic function was found normal in all the patients.Conclusions: Diastolic dysfunction and QTc interval prolongation are both related with the severity of liver cirrhosis and are major criteria of cirrhotic cardiomyopathy.

Left ventricular dysfunction in patients with type 2 diabetes mellitus

Background: Diabetes mellitus (DM) is on the increase globally. Cardiovascular complications, such as left ventricular dysfunction is a major cause of death in patients with type II DM. Prior to the development of symptomatic heart failure, subclinical left ventricular dysfunction (systolic and diastolic) may exist for some time. Aim of this study is to find out abnormalities in left ventricular function in patients of type 2 diabetes mellitus with help of 2D Colour Doppler Echocardiography. To find its correlation with glycemic control on the basis of glycosylated haemoglobin (Hba1c).Methods: Total 100 Patients of type 2 Diabetes Mellitus of duration more than 10 years of both sexes were included in the cross-sectional study conducted from Jan 2018 to Aug 2019.All the patients were assessed through clinical examination and 2-D echocardiography and control of diabetes determined on the basis of HbA1c.Results: Study consisted of 100 patients with type 2 DM, 55(55%) were females and 45(45%) males. Majority of patients were in the age group of 4th to 6th decade of life. Diastolic dysfunction was present in 81(81%) patients. systolic dysfunction was present in 14(14%) patients. There was a linear increase in prevalence of diastolic dysfunction with increasing age, increased FPG, increased BMI. There was also significant correlation between LV diastolic dysfunction (LVDD) and LA size. While no statistical correlation found between gender, duration of diabetes, HbA1c with diastolic and systolic dysfunction.Conclusions: LV diastolic dysfunction is an early manifestation of diabetic cardiomyopathy. LVDD contributes significantly to morbidity of congestive heart failure in diabetic patients. Echocardiography is a very useful non-invasive tool in detecting LVDD and systolic dysfunction in type 2 DM patients.

Prevalence and spectrum of iron deficiency anaemia in heart failure patients

Background: To study the prevalence and pattern of iron de?ciency (ID)in heart failure (HF) patients with or without anaemia.Methods: This is a single-centre observational study, conducted at a tertiary care hospital of Punjab. Patients were selected based on validated clinical criteria-Framingham criteria. The iron parameters were done during the study including serum iron, serum ferritin, total iron binding capacity, and transferrin saturation (TSAT), to diagnose iron deficiency anaemia. Anaemia was defined as haemoglobin (Hb) < 13g/dl in males and <12 g/dL in females, based on WHO definition. Absolute iron deficiency is defined as serum ferritin < 100 mg/L and functional ID was defined as normal serum ferritin (100�0 mg/L) with low TSAT (<20%).Results: A total of 120 patients of Heart Failure (54% males and 46% females) were studied. Most of the patients were of high-functional NYHA class (Class IV NYHA n=45). Iron Deficiency was present in 60% patients with 31.66% patients having absolute and 28.33% patients having functional ID. Nearly one-fifth of the patients were having ID but without anemia, signifying importance of workup of Iron deficiency other than haemoglobin levels.Conclusions: Study highlights the neglected burden of ID in HF patients in India. This study suggests further large-scale studies to better characterize this easily treatable condition and considering routine testing in future Indian guidelines.

Prevalance and clinical profile of metabolic syndrome in hypertensive patients and its correlation with insulin resistance

Background:Metabolic syndrome (MS) is a collection of cardiometabolic risk factors that includes obesity, insulin resistance, hypertension, and dyslipidaemia. Insulin resistance lies at the heart of the metabolic syndrome. The purpose of this study is to study the prevalence, clinical attributes of metabolic syndrome in hypertensive subjects and to find out the correlation between prevalence, clinical attributes of metabolic syndrome and insulin resistance.Methods: About 200 diagnosed cases of hypertension as per Joint national committee 8 guidelines were included in this cross sectional single centric study. All patients were examined, history enquired and laboratory tests like lipid profile, fasting plasma glucose were done and diagnosis of metabolic syndrome made as per the National Cholesterol Education Program- Adult Treatment Panel III criteria. Insulin resistance was calculated by Homeostatic model assessment method.Results: Amongst the 200 subjects enrolled, the prevalence of metabolic syndrome in hypertensive subjects was found to be 65%. 93.07% of patients with metabolic syndrome were having blood pressure >150/90 mm hg. The prevalence of metabolic syndrome among smoker males was 54.25%. The most common co-morbidity in these subjects was raised triglycerides (96.29% in males, 90.78% in females) followed by low HDL levels (87.03% in males, 90.78% in females). Insulin resistance was found in 75 out of 130 patients who fulfilled the criteria of metabolic syndrome (57.69%), implying increased correlation of metabolic syndrome in hypertensive patients with insulin resistance (p value <0.05).Conclusions: It was found that there is increased prevalence of metabolic syndrome in hypertensive patients and it correlates with insulin resistance.

To Study the Prevalence of QTc Interval Prolongation in Cirrhosis of Liver And Its Relationship with the Severity of Disease

Background: Cirrhosis of liver is considered as chronicdisease of liver characterised by the triad of parenchymalinflammation, necrosis and regeneration with diffuse increasein fibrosis and formation of nodules around regenerating liverparenchyma. A retrospective study of 90 patients of livercirrhosis visiting OPD/Indoor of SGRDIMSR, Vallah, SriAmritsar were included in the study conducted from Jan 2017to Aug 2018 to assess QTc interval in patients with cirrhosis ofliver due to any etiology and to find the correlation betweenQTc interval and severity of liver cirrhosis as per Child-PughScore.Methods: The severity of liver cirrhosis was assessed andaccording to the Child Pugh Score, divided into Class A, ClassB and Class C of 30 patients each. QT interval was noted in allthe patients. QTc was calculated by Bazett’s formula. Fromabove parameters we try to find out whether there is anycorrelation between QTc and severity of disease.Results: The mean value of calculated QTc interval in: ClassA=0.474; Class B=0.490 and Class C=0.583. The QTc intervalincreased linearly with the severity of the disease and the pvalue was less than 0.001 which is highly significant.Conclusion: In our study we concluded that the prolongationof QTc interval is co-related with liver function and itsprevalence increases with the severity of liver dysfunction.Prolongation of the QTc interval was statistically confirmed inChild-Pugh C and B. The prolonged Q-T interval predictssevere arrhythmias and sudden death, and they are the idealcandidates for liver transplantation.

Comparative study of detection of diabetic neuropathy by clinical and nerve conduction study in type 2 diabetes mellitus patients

Background: Diabetes mellitus is known for its complications such as retinopathy, neuropathy and nephropathy. Diabetic neuropathy is one of the devastating complication associated with diabetes mellitus. The objective of this study was to detect sensory motor neuropathy in type 2 Diabetes mellitus by clinical examination and nerve conduction study and to correlate clinical features of peripheral neuropathy with nerve conduction study in Type 2 Diabetes mellitus.Methods: This study was undertaken to study types of neuropathy in type 2 diabetes and to correlate clinical features of peripheral neuropathy with nerve conduction study in type 2 diabetes mellitus.100 patients with diabetes whose onset of diabetes mellitus after age of 30 years and duration of diabetes 5 years or more visiting SGRDIMSR, Vallah, Amritsar were subjected to nerve conduction study to find out peripheral neuropathy.Results: Eight four percentage patients were found to have neuropathy on NCS whereas only 61% of patients were found to have neuropathy on clinical examination and detection rate with NCS was statistically significant (p <0.001) as compared to clinical examination.Conclusions: NCS helps in early detection of neuropathy and most common form of diabetic neuropathy is distal symmetrical polyneuropathy.