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Background: Aluminium phosphide (AlP) is a common suicidal poison with a high mortality rate due to its cardiovascular impact and lack of antidote. The aim of the study wasto describe the electrocardiographic changes and other cardio-vascular manifestations in acute AlP poisoning and evaluate its impact on survival outcomes.Methods: A prospective cross-sectional study was conducted in a tertiary care hospital including patients who presented with acute AlP ingestion in any form. Patients’ vitals and ECG at the time of admission were taken and outcomes of survival were identified. A descriptive study of echocardiography was also done. The clinical parameters were correlated with the survival outcomes.Results: Fifty patients were included with 30 males and 20 females. The consumption of AlP in tablet form caused more hemodynamic compromise (hypotension and high anion gap metabolic acidosis) as compared to the powder form. ECG changes were seen in 42% of the cases, the most common finding was prolonged QTc interval (26%). The mortality was 30%.Hypotension, bradycardia, and QRS widening were found to be significant predictors of mortality (p<0.05). Echocardiography was performed for 10 patients, of which, one had right ventricular dysfunction and two had left ventricular dysfunction. Conclusions: AlP tablets are more lethal and hemodynamically compromising than AlP powder. Hypotension, bradycardia, and QRS widening are significant predictors of mortality. Direct cardiotoxicity leads to ECG changes, of which, QTc prolongation is the most common.
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Background:Type 2 diabetes mellitus (T2DM) is a multifactorial, complex disease associated with chronic hyperglycemia, resulting from the interplay of genetic, environmental, and epigenetic factors. T2DM can causes various disabling complications. Diabetic autonomicneuropathy (DAN) is one of the common complications in diabetes. The taste threshold affected by various factors such as age, ethnic backgrounds, drugs, local and systemic diseases, consumption of alcohol, smoking, and tobacco chewing.Method: The presentstudy is undertaken with the objectives to compare the taste dysfunction of four primary sensations in Type 2 DM with autonomic neuropathy and its relation with glycemic control. The 60 patients of T2DM with autonomic neuropathy and 60 healthy controls were taken for the study. Autonomic neuropathy was assessed clinically. Chemical taste test using four solutions of basic tastes (sweet, sour, salty, bitter) were done.Results: Taste dysfunction for sweet was significant in T2DM with uncontrolled hyperglycemia. The taste dysfunction in T2DM patients was not related to gender, disease duration, and type of treatment taken. The study found a significant correlation between taste dysfunction, HbA1C level and blood sugar fasting level in T2DM patients. Conclusions: The taste dysfunction was mainly for sweet. Sour and bitter did not show any difference in case groups compared to controls
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Background: Diabetes is a chronic metabolic disorder that is characterized by high level of blood glucose levels, which over a period of time can lead to micro-vascular or macro-vascular complications. Erectile dysfunction (ED) is common not much discussed and distressing complication of diabetes. ED in type 2 may be independent marker of coronary artery disease (CAD).Aim and objectives were to assess the ED in subject of type 2 diabetes mellitus (DM). Assessment of correlation of ED with CAD. Methods: The present cross-sectional study consisted total 180 diabetic patients. On basis of international index of erectile function (IIEF) questionnaire EDpatients were assessed.Result: Out of180 diabetic patients 36.11% had varying degree of ED. Out of 65 EDpatients, maximum frequency of moderate ED (47.69%) was found then severe ED (32.30%), mild to moderate ED (12.30%) and mild ED (7.69%). Most of the patients were in the age group of 40-50 years35 (53.84%), 50-60 years22(33.4%), <40 years(9.23%) and 60-70 years 2 (3.07%) showed ED. Fasting blood sugar and postprandial blood sugar showed significant (p<0.05) relation with ED. HbA1c show an insignificant correlation (p>0.05) with ED. In patient with ED was having more value of atherosclerotic cardiovascular disease (ASCVD) (9.11±4.84) than patient without ED (8.82±5.72). There was no significant (p>0.05) difference in term of ASCVD risk score in ED patient’s ED and without ED patients.Conclusions: Poor glycemiccontrol was a strongest risk factor for ED.
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Background: Assessment of efficacy and safety of daclatasvir+sofosbuvir+ribavirin (DCV+SOF+RBV) for 12 weeks as compare to daclatasvir and sofusbuvirfor 24 weeks in decompensated cirrhotic patients due to hepatitis C virus (HCV) genotype 3 infection. Methods: An observational, prospective, COHORTstudy over 1 year, in decompensated cirrhosis due to G3-HCV infected adult patients. Treatment was a combination of sofosbuvir 400 mg/day+daclatasvir 60 mg/day, with or without a weight-adjusted dosing of ribavirin for 12 or 24 weeks. The primary efficacyendpoint was sustained virologic response rates 12 weeks after therapy (SVR 12). The primary safety endpoint was treatment withdrawal rates secondary to severe adverse events. Results: The32 patients were screened and 2 were excluded, one patient due toassociated HBV+, one patient due to severe anemia. 30 patients were randomized. All 30 randomized patients were divided into two groups. Group 1 was given SOF+DCV+RBV for 12 weeks while group 2 patients were given SOF+DCV for 24 weeks. 81.8% of the participants in the group1 achieved SVR 12. The 90.9% of the participants in the group 2 achieved SVR12 (p=1). No other patient or treatment basal variables influenced the treatment effectiveness. No patient treatment withdrawal secondary to severe adverse events was observed. Conclusions: Both the regimen SOF+DCV with or without RBV are highly efficacious and safe. Addition of RBV can reduce the treatment duration to 12 weeks, and it will further improve compliance and more convenient for the patients.
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Background: A prospective study was carried out to find the variations in lipid profile in smokers when compared to non-smokers. The aim was to study the alterations in lipid profile in terms of severity of smoking.Methods: This study was carried out among 198 patients who attended medicine OPD of LLR hospital GSVM medical college Kanpur. The population was divided into 98 non-smokers and 100 smokers. The smokers were furtherdivided into 3 groups depending on the intensity of smoking. Results: Out of 100 patients inthe present study the number of subjects in mild, moderate and high smokers’ group were 33 (33%), 33 (33%), 34(34%) respectively. Smokershad higher total cholesterol, plasma triglycerides, serum low density lipoprotein (LDL), serum very low-densitylipoprotein (VLDL) and lower levels of serum high density lipoprotein (HDL) compared to non-smokers which wasstatistically significant. Conclusions: Increase in total cholesterol, triglycerides, LDL and VLDL were found in smokers of all age groups. Whereas HDL values showed inverse relationship. These changes were directly proportional to the severity of smoking. So, Tobacco smoking is associated with dyslipidemiawhich is atherogenic in nature.
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Background:Atherosclerotic disease is not only increased in incidence in type 2 diabetic patients, but its course is also accelerated. Stroke is one of the major causes of morbidity and mortality among the elderly population. The relationship between ischemic strokeand PAD (peripheral artery disease) has been poorly investigated in India. So, we studied the risk of stroke in PAD patients with type 2 diabetes. The aims and objectives of the study were to study the prevalence of PAD in patients with type 2 diabetes mellitus and to study the correlation of stroke in PAD patients with type 2 diabetes.Methods:Hospital based cross-sectional study was conducted among the 124 patients admitted with type 2 diabetes (age >25 years) from December2019 to October2021 in the various units of department of medicine/surgery, KPS institute, GSVM medical college,Kanpur. Color Doppler of limbs and carotid artery was done in study population. Clinical sign and symptoms, history of stroke or diagnostic investigation were used for evaluate cerebrovascular events.Results:In our study based on doppler ultrasound, the prevalence of PAD was found in 31 patients (25%) out of 124 with men having a higher prevalence (24 out of 74; 77.4%), as compared to women (7 out of 50; 22.6%) (p=0.020). The prevalence of stroke was 32.3% in PAD patients and 11.8% in non-PAD patients (p=0.009).Conclusions:By using Doppler, we found evidence of PAD in 25% of type 2 diabetics (M>F). The prevalence of stroke was 32.3% in PAD patients and 11.8% in non-PAD patients (p=0.009). PAD is associated with an increased risk of cerebrovascular disease morbidity and mortality. Clinician should identify a PAD patient with diabetes to elicit symptoms, complications like stroke to decrease mortality or morbidity.
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Background:Peripheral arterial disease (PAD) is one of the major macrovascular complications of diabetes mellitus (DM) which is largely neglected by clinicians. DM-associated atherosclerosis can lead to complications in all major of vascular beds, including the coronary arteries, carotid vessels, and lower extremity arteries. Aims and objective were tostudy the prevalence of PAD in patients with type 2 DMand to study the correlation with carotid artery intima-media thicknessMethods:Hospital based cross-sectional study was conducted among the 124 patients admitted with type 2 diabetes (age >25 year) from Dec 2019 to Oct 2021 in the various units of department of medicineor surgery, KPS institute, GSVM medical college Kanpur. Color doppler of limbs and carotid artery was done in study population.Results:In our study based on doppler ultrasound, the prevalence of PAD was found in 31 patients (25%) out of 124 with men having a higher prevalence (24 out of 74; 77.4%), as compared to women (7 out of 50; 22.6%) (p=0.020). The mean Carotid IMT (mm) (Average) was 0.82±0.16 in all diabetics. Patients with PAD have more increase in CIMT (0.95±0.12) as compare to non-PAD (0.77±0.15) p<0.001.Conclusions:By using doppler, we found evidence of PAD in 25% of type 2 diabetics (M>>F). Patients with PAD have more increase in CIMT as compare to non-PAD.
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Background:Parkinson disease(PD)is one of the most common age-related brain disorders, with cardinal symptoms rigidity, bradykinesia, resting tremor and postural instability. These aredopamine-related motor symptoms.PD is increasingly recognized as heterogeneous multisystem disorder involving other neurotransmitter associated with nonmotor symptoms. In whichcognitive decline is the most common and important NMS. cognitive decline in PD makes profound effect on patient quality of life and imposes significant burden on the caregiver.Methods:Hospital based cross sectional study conducted among 52 patients of idiopathic Parkinson disease, 61 to 80 years of age (fulfilling UKPDS brain bank criteria) at GSVM medical college, Kanpur during February 2020 to October2021 using SCOPA COG scale.Results:Using SCOPA COG score in 52 patients,17 (33%) patients foundwith declined cognition There was weak negative correlation betweentotal score and duration of illness(p=0.091), weak negative correlation between executive function (assessed by dice) and duration of illness (p=0.047)and a moderate negative correlationbetween visuospatial function (assessed by assembling pattern) and duration of illness (p=0.003).Conclusions:Significant cognitive decline found with increase in duration of illness in terms of visuospatial function.
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Background:NAFLD(non-alcoholic fatty liver disease) encompasses a variety of disorders of lipid metabolism ranging from NAFL, NASH to cirrhosis and rarely HCC. A great deal of evidence suggests that the metabolic syndrome predicts incident cardiovascular disease (CVD), so it is possible to hypothesize that NAFLD patients might portend a greater CVD risk and that NAFLD itself might confer a CVD risk above that associated with individual metabolic syndrome risk factors.Methods:55 T2DM patients were included in current study conducted fromAugust 2019 to September 2021 for assessment of NAFLD using USGabdomen, NAFLD fibrosis score and FIBROSCAN. ASCVD score was used for correlation between CVD risk and NAFLD.Results:Out of 55 patients 42 (76.4%) were having fatty liver based on USG abdomen while 13 (23.4%) patients were having no fatty liver. As far as steatosis is concerned mean CAP (dB/m) was 245±50.89 out of which 24 (43.6%) were having no or minimal steatosis (S0), while 31(56.4%) were having significant steatosis with 11 (20%), 9 (16.4%) and 11 (20%) having S1, S2 and S3 grade of steatosis respectively.15 patients out of 55 were of F0 grade while 19 (34.5%), 9 (16.4%), 7 (12.7%) and 5 (9.1%) were of grade F1, F2, F3 and F4 respectively. There was a positive statistically significant (p?0.001) association of ASCVD risk score with NAFLD fibrosis score and fibroscan: E (KPa). Conclusions:Our study found that the prevalence of NAFLD was quite higher in patients with T2DM based on both USG abdomen (76.4%) and transient elastography (steatosis-56.4% and fibrosis-65.5%) and a statistically significantassociation between fibrosis and ASCVD score with higher fibrosis associated with higher 10 years ASCVD score.
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Background:The objective of this study was to evaluate biochemical markers as predictors of dengue severity clinical outcome, bleeding severity, capillary leakage, supportive therapy requirement and duration of hospital stay.Methods:In this observational study Patients from age more than 15 years with history of acute febrile illness Total 263 confirmed cases (based on the WHO criteria) of DF were included in this study, who have been admitted in our hospital. We measured levels of CK, LDH, AST and ALT with modified liquid-UV tests; semi-quantitative levels of CRP with a colorimetric rapid test; levels of albumin with colorimetric tests; and lipid profiles [cholesterol, triglycerides, Low-density lipoprotein (LDL) and High-density lipo-protein (HDL)] with a liquid-color test. Positive control human samples were included in all tests.Results:We found that TG and LDL-C levels were significantly lower in dengue-positive patients compared to dengue-negative patients, and that LDL-C levels showed greater decreases and thus appeared to drive the reduction in total cholesterol. LDH, CPK, AST and ALT were significantly raised in DSS in compared to DF and other febrile illness. We found that lower total serum cholesterol and LDL-C levels at presentation were associated with subsequent development of DHF/DSS.Conclusions:Assessment of lymphocyte, platelet counts, levels of LDL, TG, CPK, LDH, levels of AST and ALT are very significant and easily available and low-cost biochemical markers for prediction of dengue infection severity.
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Background: The study was conducted to evaluate the change in serum potassium level over follow up period in patients of diabetic nephropathy on spironolactone (25 mg) and ramipril (5 mg) and compare the results with diabetic nephropathy patients on Spironolactone (25 mg) alone.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70 yr.) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Inclusion criteria followed in study were Age 30-70 years, diagnosed type 2 diabetes mellitus, serum potassium level <5 meq/l, estimated GFR >30 ml/min/1.73m2 and HbA1c <10%. Exclusion criteria were type 1 diabetes mellitus, impaired glucose tolerance secondary to endocrine disease, exocrine pancreatic disease, SBP >180 mmHg DBP >110 mmHg, UTI, hematuria, acute febrile illness, vigorous exercise, short-term pronounced hyperglycemia, obstructive uropathy, confirmed or suspected renal artery disease by USG doppler study, Serum potassium level >5.5 meq/l. Patients were divided in two groups, group A (n= 28, spironolactone 25 mg and ramipril 5 mg) and group B (n=27, spironolactone 25 mg). Subjects were followed over 12 weeks and baseline and 12-week serum potassium being compared. Other baseline base line laboratory investigation such as serum lipid profile, HbA1c, eGFR, fundus examination, ultrasonography (KUB), serum urea, serum creatinine, hemoglobin, were taken at the starting point.Results: Both the group after receiving respective drug were followed for 3-month duration and serum potassium level measured at end of 3 months. Mean values of baseline and follow up serum potassium for group A and group B were 4.24±0.59, 4.07±0.61 and 4.35±0.55, 4.16±0.61 respectively, p value found to be >0.05 at 95% CI.Conclusions: In the study it was concluded that p value found to be >0.05 at 95% C.I denoting that there is no significant difference between mean value of base line and follow up serum potassium value in both group. None of patients in either group had experienced hyperkalaemia over follow up period though serum potassium level were slightly higher in group A, but this difference was statistically not significant. Follow up period of study should be long enough to comment on safety profile of combining spironolactone and ACE inhibitors in diabetic nephropathy patients.
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Background: Cirrhosis is defined anatomically as a diffuse process with fibrosis and nodule formation. It is the result of the fibrogenesis that occurs with chronic liver injury. For reduced liver biosynthesis capacity, low level of serum cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) is usually observed in the chronic liver disease. Due to the high prevalence of chronic liver disease in our country we have conducted this study to determine role of lipid profile in a patient with cirrhosis and to assess its relationship to the severity of cirrhosis.Methods: In this cross-sectional study, patients classified in 3 groups as per CTP classification for severity of cirrhosis. Serum lipid profile was observed in these patients. The primary aim was to assess changes in various parameters of lipid profile and its relationship with severity of liver cirrhosis.Results: About 74 cirrhotic patients were enrolled, 20 in class A, 25 in class B and 29 in class C. serum lipid profile was observed in these patients. Serum cholesterol and HDL cholesterol were decreased with increasing severity of cirrhosis. Serum triglyceride level increases with progression of cirrhosis and very low density lipoprotein (VLDL) level has no correlation with severity of cirrhosis.Conclusions: Serum cholesterol and HDL level decreases with progression of cirrhosis. In future serum lipid profile can be used in classification criteria for assessing severity of liver cirrhosis.
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Background: Diabetes mellitus is major public health issue facing the world in present century and the prevalence of type 2 diabetes is increasing explosively. There are various diabetes related complications, one of which is low testosterone levels in men. This study was designed to estimate the serum testosterone level in male patients of type 2 diabetes mellitus.Methods: The patients of type -2 diabetes mellitus were picked up from out-patient and in-patients section of the hospital at random.Results: Seventy male patients with type 2 diabetes mellitus were enrolled during the study period. The mean age of study population was 56.36±10.26 years (range 36-70), while that of control group patients was found to be 39.80±7.92years. Family history of diabetes was present in 14 (22.2%) patients. The mean HbA1c in study group was 8.83±1.95 %, which was significantly higher as compared to control group with HbA1c 4.82±0.40 %. Among study group, lower serum total testosterone level was observed in 85.7 % cases and normal level in 14.3 % cases. Among control group, lower serum total testosterone level was observed in 6.7 % cases and normal level in 93.3 % cases.Conclusions: The present study highlighted that significant difference in serum total testosterone level has been observed between cases and control groups (X2 =55.7, P=0.0001).
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Background: Citicoline has emerged as a potential neuroprotectant in experimental models in stroke patients. Citicoline has shown some beneficial effects in human ischaemic stroke and with an excellent safety profile while in haemorrhagic stroke data is limited. Authors conducted this study to test role of citicoline in stroke patients in terms of cognition, memory and post stroke disability.Methods: In this prospective study, patients had to be previously independent, aged >18 years of age, presented within 24 hours of onset of symptoms of stroke diagnosed by neuroimaging (CT or MRI). Patients received either a placebo or 500 mg/12 h citicoline for 12 weeks (orally or intravenously). The primary aim was to evaluate improvement in cognition, memory and post stroke disability after 12 weeks. The efficacy endpoint was the percentage of subjects with MMSE and DRS at 12 weeks.Results: Total 75 stroke patients were enrolled, 40 in control group and 35 in citicoline group were allotted randomly. Patients in citicoline group were given intravenous citicoline 500 mg/12 hour during hospital stay and orally 500 mg/12 hour after discharge for up to 12 weeks. Control Group was given Placebo. cognition, memory and post stroke disability show positive improvement in citicoline group.Conclusions: Citicoline shows beneficial effects in stroke in terms of cognition, memory and post stroke disability.
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Background: The study was conducted to evaluate and compare the protective effects of spironolactone (alone) and its effects along with ACE inhibitor (ramipril) on diabetics (30-70year) in relation to proteinuria and state of diabetic nephropathy.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70year) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Patients were divided in two groups, group A (n=28, spironolactone 25mg and ramipril 5mg) and group B (n=27, spironolactone 25mg). Subjects were followed over 12weeks and baseline and 12-week urine ACR being compared.Results: Both the group after receiving respective drug were followed for 3month duration and response were assessed by measuring urine ACR value at end of 3months. Mean values of baseline and follow up urine ACR for group A and group B were 471.5±465.62, 244.66±237.54 and 474.88±438.94, 268.42±268.16 respectively, P value found to be >0.05 at 95%C.I. It was observed that percentage reduction of urine ACR were 48% and 43.47% in group A and group B respectively.Conclusions: In the study, it was concluded that spironolactone had significant effect over proteinuria reduction over follow up period in patient with diabetic nephropathy though there was no additional statistically significant advantage of addition of spironolactone and ACE inhibitor over proteinuria reduction. Significant reduction of proteinuria occurred in both group A and group B over 12weeks follow up period, 48 % reduction in group A and 43.47% in group B. This difference proved statistically not significant after applying independent t-test.