Thrombo-embolism in patients with myocarditis

Myocarditis and dilated Cardiomyopathy continues to be an important cause of hospital admission in our part of the world. Systemic embolism due to thrombi in left ventricle is a rare but important complication of these patients. Study objectives: To determine the incidence, course and outcome of thrombo-embolism in children with dilated dysfunctioning heart due to acute myocarditis or dilated Cardiomyopathy. Design: A 5 year analysis [December 1999- Nov 04] of all children under 16 years of age admitted and diagnosed as having myocarditis or dilated Cardiomyopathy in a single tertiary care center. Patients and The charts and echocardiography records of all patients with dilated dysfunctioning heart and systemic thrombo-embolism were reviewed. Data was reviewed for mode of presentation, age, hospital course and outcome. Echocardiography data was reviewed with special reference to the size, function and presence of thrombus in LV. Of all admissions to the paediatric cardiology unit over the study period, myocarditis and dilated Cardiomyopathy was the underlying lesion in 405 patients. The mean age of patients was 2.1 +/- 4 years. Systemic embolism was the presenting feature in 28 [6.9%] patients [Group A]; while another 17 [4.2%] developed it during the hospital stay [Group B]. Another 5 patients had thrombus in the LV but did not develop embolism. All 50 patients showed seriously impaired LV function with mean ejection fraction [EF] for those with vs. those without thrombo-embolism was 17.5 +/- 5.5 vs. 20.0 +/- 6.9 [p = 0.08]. The groups were similar with respect to other baseline characteristics, co morbid illnesses, and drug therapies other than anticoagulants. In group A 26/28 patients presented with a stroke. Only 6 had a thrombus in LV at the time of admission. All 28 patients with or without LV thrombus were treated with heparin and then oral anticoagulant warfarin. There were two deaths. In group B, 3/17 patients had thrombus in the LV on echocardiography at presentation. They were started anticoagulation but still went on to develop a stroke. There were 2 deaths in this group as well. Conclusions: Myocarditis and dilated Cardiomyopathy is an important cause of hospital admission in our set up accounting for 15% of all admissions to a paediatric cardiology unit. These patients are at risk of developing thromboembolism, which may well be the presenting feature. The risk is higher in patients with lower ejection fraction of the LV. All patients with EF below 17% should be treated with prophylactic anticoagulation. A peripheral embolic event adds to morbidity and is related to poor long-term survival in this patient group

Acanthosis nigricans in non insulin dependent Diabetes mellitus

Three hundred non-insulin dependent diabetics were divided into two groups, one hundred and fifty each, depending upon the duration of their diabetes mellitus. Group I [G 1] had been given the diagnosis of NIDDM less than six months previously while group II [G 2] had NIDDM for five to ten years. These groups were comparable for height, weight, BMI, and fasting blood glucose. Group I showed a significantly greater prevalence of Acanthosis nigricans on a graded scale G I [1.931 +/- 0.932] v. G2 [0.586 +/- 0.66] two tailed significance t test >.0001. The prevalence of acanthosis nigricans is significantly greater in newly diagnosed NIDDM patients as compared to patients with more than five years' history of the disease

Insulin sparing effect of glibenclamide in poorly controlled type-diabetics and its effect on the body mass index [BMI]

Forty-seven poorly controlled Type-II diabetics were randomly divided into two treatment groups. The patients in Group-A [n=22] continued on their maximum dose of glibenclamide. Twice a day [Plain + NPH] insulin was added, and adjusted to achieve the best glycaemic profile. In the group B patients, glibenclamide therapy was replaced with insulin therapy, carried out on the similar lines to that of group A. The glycaemic profile of both groups improved significantly. This improvement was comparable in The two groups. the insulin requirement in group A was 58.4+ - 14.3 units/day as compared to 70.2+ - 18.6 units/day for group B. This difference is statistically non-significant. During the study period there was no significant change in the Body Mass Index [BMI]

Comparison of metabolic control, achieved with twice a day beef versus human insulins in Pakistani population

This study was planned to compare the metabolic control in diabetics taking twice daily insulin injections when transferred from beef tohuman insulins. Out of fifty, forty-three patients completed the trial. Half of the initially recruited patients were started on human insulin while the other half continued on beef insulin. After three months treatment was reversed. Metabolic control was assessed by seven-point glucose profile and haemoglobin A1c measurement during each treatment protocol. During this period there was no significant improvement in over all metabolic control with human insulin, as assessed by blood glucose profile, area under the BG curve, or haemoglobin A1c. There appears to be no improvement in metabolic control when patients taking twice daily beef/insulins are transferred to human insulins

Assessment of metabolic profile and body mass index [BMI] in type II diabetes treated with metformin and insulin

Obese type -