Rheumatoid Arthritis is Associated with Higher Prevalence of Thyroid Abnormalities- A Cross-Sectional Study

Background: The relationship between thyroid abnormalities and rheumatoid arthritis is a debatable subject. Studies show a higher prevalence of thyroid abnormalities in patients with RA. It is widely observed that disorders with an autoimmune pathogenesis occur with increased frequency in patients with a history of another disease. RA is a systemic disorder that can affect any organ in the body, it could be speculated that abnormal thyroid functions are due to thyroid activity of the autoantibodies produced in this disease. Objectives:-Present study was doneto study the prevalence and correlation between Rheumatoid Arthritis and thyroid dysfunction; hypo as well as hyperthyroidism and to find whether thyroid disorders are found with increased frequency in Rheumatoid Arthritis patients as compared to general population. Methods: A cross sectional observational study was conducted on 50 patients of RA (diagnosed according to 2010 ACR/EULAR criteria) attending outdoor or admitted in wards at Rajindra hospital Patiala. Age and sex matched 50 persons from general population were taken as control group. These patients were evaluated for thyroid abnormalities using thyroid function test T3, T4, TSH. Results: Thyroid abnormalities were found among 28% cases of RA as compared to 8% among controls. Percentage of clinical hypothyroidism, subclinical hypothyroidism, and clinical hyperthyroidism in cases was 10%, 16%, 2% respectively. In controls percentage of clinical and subclinical hypothyroidism observed was 2% and 6% respectively. Females with RA had two fold enhances prevalence of thyroid abnormalities as compared to males with RA (31.6% females and 16.7% males with RA had thyroid abnormalities). Conclusion: The asymptomatic or mildly symptomatic clinical course of thyroid diseases in RA patients may be masked by underlying disease, posing hazards of late diagnosis and treatment. So higher prevalence of thyroid abnormalities in RA patients in comparison to controls indicate the need for screening by thyroid function tests.

The Study of Prevalence of Cardiovascular (CV) Risk Factors in Diagnosed Patients of Acute Coronary Syndrome (ACS)

Background: Coronary Artery Disease (CAD) as a life style disease is a significant public health problem that can no longer be disregarded. The risk factors of ACS, if identified at an early stage can be extremely useful in planning primary and secondary preventive strategies for ACS and its complications. Method: We conducted a study to find out the prevalence of various risk factors associated with increase in incidence of Coronary Heart Disease (CHD) in north India particularly in Punjab. The present study was carried out in 100 clinically diagnosed more than 40 yrs of either sex ACS patients admitted to Intensive Coronary Care Unit/ Medical wards of Rajindra Hospital Patiala,to calculate the prevalence of various modifiable and non-modifiable CV risk factors and gender differences associated with ACS. Result: In our study family history of CAD was present in 13% of the patients, smoking in 33% and 44% were Hypertensive, female patients showed greater preponderance towards HT , DM and Obesity. There was a significant gender difference in prevalence of decreased HDL ,33% in females and 13% in males. 50% men were non-vegetarian and only 9% females were non-vegetarian. In present study 10% of the ACS patients did not manifest any Coronary risk factor, included in the study. Conclusion: A high prevalence of risk factors for ACS was verified, indicating a necessity of Health Education Program to reduce morbidity and mortality.Most of the risk factors are modifiable and therefore its early identification is vital to set the strategy for preventive measures.

Prevalence Of Abnormal Liver Function Tests In Type 2 Diabetes Mellitus And Their Correlation With Glycemic Control And Duration Of Disease

Background: Diabetes mellitus (DM) is a syndrome of disordered metabolism with abnormally high blood glucose levels (hyperglycemia). The study was conducted to see the prevalence of abnormal liver function tests in patients with Type 2 diabetes mellitus and correlate them with glycemic control and duration of Type 2 DM so that we can detect them at early stage and prevent the long term morbidity and mortatlity. Methods: 100 patients of Type 2 diabetes mellitus attendingRajindra hospital outpatient and inpatient department were taken randomly to find out prevalence of abnormal liver abnormal liver tests. They were thoroughly investigated for liver function abnormalities. Results: The mean age of the patients was 55.15 ± 7.65 years with maximum patients in the age group of 56-60 years. Females outnumbered males in this study. The mean duration of diabetes in study group was 8.67 ± 4.07 years. Mean BMI in the study group was 28.37 ± 3.73 (kg/m2). Out of 100 patients, 50% had good glycemic control (HbA1c <7) and 50% had poor glycemic control (HbA1c ≥7). About 53% of the patients had minimum 1 abnormality of the liver function tests. Conclusion: Liver function test abnormalities showed a direct relationship with increasing duration of diabetes (p value 0.001) and increasing BMI (p value 0.031). USG abdomen showed fatty infiltration of liver in 19 patients out of which 11 had poor glycemic control as compared to rest of 8 with good glycemic control which was not statistically significant (p=0.444). These results show that poor the glycemic control, the frequency of abnormal liver function increases.

The Study of Relationship of Glycated Haemoglobin with Carotid Artery Intimal Thickness in Patients with Ischaemic Stroke

Background:Long term uncontrolled hyperglycemia, which is indicated by HbA1c levels, is strongly suspected of promoting atheogensis.An accurate marker for assessing the risk of stroke is the carotid artery intima-media thickening (IMT), assessed by Doppler ultrasound. Increased common carotid artery IMT is correlated with silent cerebral infarcts.This study aimed to show the association between marker of uncontrolled long term hyperglycemia (HbA1C) and marker of atherosclerosis (Carotid intima media thickness [CIMT]) in ischemic stroke patients. Methods: This study was conducted In Deptt. of Medicine, Rajindra hospital Patiala in collabroration with Deptt. Of Radiology and Deptt. of Biochemistry. Results: This study included a total number of 75 patients admitted in various ward of Medicine Deptt. Rajindra Hospital Patiala.CIMT was found to be significantly increased in the patients having diabetics mellitus than non diabetic patients.Conclusion:There is seen a positive correlation of HbA1C with CIMT in our study which included only the ischemic stroke patients.

Disseminated Cysticercosis - A Case Report.

Cysticercosis is a common public health problem in the Tropics. One of the uncommon manifestations and a rare complication is its disseminated form (DCC). Here, we report a case of disseminated cysticercosis with history of generalized tonic clonic seizures for 2 years with characteristic MRI findings and biopsy evidence from para vertebral muscles.

Demographic Profile and Clinical Features of Admitted HIV Positive Patients and their Correlation with CD4 Counts in a North India Tertiary Care Hospital.

Background: HIV Infections continues to be a burden globally and presents serious public health problems in the developing countries, especially in India. Aims and objectives: To study the demographic profile and clinical features of HIV positive admitted patients and to evaluate the correlation of clinical features with their CD4 counts. Methods: The present study was conducted to assess the socio-demographic profile and clinical features of 150 HIV+ve /AIDS patients admitted in various wards of Department of Medicine, Rajindra Hospital, Patiala from September 2013 to October 2015. For these patients a preformed questionnaire was prepared to enquire about socio-demographic characteristics such as age, sex, literacy status, marital status, occupation and socio-economic status. Thorough clinical examination was performed and correlation of clinical features with CD4 counts was evaluated using Pearson Coefficient of correlation. Results: The results of study showed that the most common age group affected was 26-45 years (56%). Male patients were 69.3% and females constituted 30.7%. Most common mode of transmission was heterosexual (73.3%), followed by intravenous drug abuse (6.7%), unsafe injections/needle stick injury (4.6%), blood transfusion (2.7%), 8% were both HS and IDU and transmission was unknown in 2.7%. The common presenting symptoms in admitted HIV patients were fever (71.3%), weight loss (50%), night sweats (39.3%), dry cough (36%), anaemia (32%), cough with expectoration (26%), lymphadenopathy (24%), shortness of breath (22%), chest pain (20.7%),diarrhoea (15.3%) and mouth ulcers (8.7%). Others were, headache (10.7%), haemoptysis (10%), icterus (6.7%), change of voice (4%), altered sensorium (14%) and neurological deficit (7.3%). 16 patients had pulmonary and 13 had extra pulmonary tuberculosis. It was also found that most patients (52%) had CD4 count in range of 200-500, with mean CD4 count of 282.61 + 14.31 cells/cmm at time of presentation. The frequency of these symptoms increased with fall in CD4 count indicating negative correlation. Conclusion: A thorough knowledge of the demographical & clinical profile of admitted patients will go a long way in managing resources and planning management of these patients. This will serve as a great step in achieving zero deaths as envisaged by NACO.

To Study the Prevalence of Thyroid Dysfunction in Newly Diagnosed HIV +ve Patients and Correlation between CD4 Count and Thyroid Dysfunction.

Background: Thyroid dysfunction is one of the common endocrine dysfunction in HIV Positive patients. Newly Diagnosed HIV Positive patients are rarely monitored for this problem. Objective:- To study the prevalence of thyroid dysfunction in newly diagnosed HIV positive patients & to Correlate it with CD4 Count. Methods: A prevalence study was carried out on 150 newly diagnosed HIV Positive patients with different CD4 Counts divided in three groups (Group A; CD4<350, Group B; CD4 350-550 and Group C; CD4>550) who were evaluated for thyroid dysfunction. Blood samples were collected for CD4 T Lymphocytes. Counts were determined by flow cytometry and Thyroid function was evaluated by chemiluminescence immunoassay. Results: Out of 150 cases studied, 47 Patients (31.33%) had thyroid dysfunction. Group A, B and C had Thyroid dysfunction in 40 %( 20), 32 %( 16) and 22 %( 11) patients respectively. All except one had hypothyroid state (TSH above normal range).When the results were analyzed for 150 patients with Pearson correlation coefficient. There was an inverse correlation of CD4 count and TSH. There was progressive decline in T3, T4 levels as CD4 count decreased. Conclusion: Thyroid dysfunction is frequent in newly diagnosed HIV positive patients and prevalence of thyroid dysfunction increased with decrease in CD4 count. TSH levels increased as CD4 count declined.

Tubercular Arthritis of Sternoclavicular Joint: A Case Report.

Sternoclavicular joint (SCJ) is a rare site for occurrence of tubercular arthritis. Diagnosis often gets delayed due to rarity, leading to annoyance to patient. Here we report a case of 66 years old female who presented to us with painful swelling of Right>Left sternoclavicular joint. Diagnosis was clinched by clinical evaluation, appropriate imaging and strongly positive Interferon gamma release assay and fine needle aspiration cytology. Patient was put on ATT with significant improvement after 2 months.

Double Chamber Right Ventricle (DCRV) With Ventricular Septal Defect in Adulthood.

Double-chambered right ventricle (DCRV) is a form of right ventricular outflow tract obstruction. It typically presents in childhood or adolescence. Only a handful of previous cases have been described in which DCRV occurred in adulthood. We report here a case of DCRV with ventricular septal (VSD) presenting in adulthood.

Tubercular Spinal Paravertebral Abscesses Presenting as Multiple Dermal Sinuses in HIV Reactive Patients.

Extra Pulmonary tuberculosis (EPTB) accounts for more than 50% of the cases of Tuberculosis in HIV-reactive patients and the clinically presentation is often atypical. EPTB sometimes poses diagnostic dilemmas as conventional diagnostic methods have a poor diagnostic yield and definite diagnosis may be delayed. Here we report a case of Spinal TB who uncommonly presented with multiple non healing sinuses in the Thoracolumbar region. Diagnosis was clinched by clinical presentation, +ve Interferon Gamma Release Assay (IGRA) accompanied by suggestive Magnetic resonance imaging findings.

Clinical Profile of Neurological Manifestations in HIV-Reactive Patients and Their Relation with CD4 Count.

Background: Neurologic abnormalities have been noted in one-third of patients with AIDS, but at autopsy the nervous system is affected in all of them. Aim: To study the clinical profile of neurological manifestations in HIV reactive patients and their correlation with CD4 counts. Methods: A randomized case study was conducted at Department of Medicine, Government Medical College, Patiala over a period of 2 years. 200 HIV-infected adult and adolescent patients (>15 years of age) were studied. The diagnosis of HIV was confirmed by 3 HIV ELISA& RAPID positive reports in symptomatic patients. Results: In the present study, 37% of the patients were in the age group of 26-35 years. Males are affected more frequently than females, with a male to female sex ratio of 2.56: 1. Meningitis, HIV associated dementia, Progressive multifocal leukoencephalopathy& peripheral neuropathy are the commonest neurological disorders observed in HIV-infected patients. Tuberculosis is the commonest opportunistic infection in retroviral positive patients. Conclusion: Central nervous system infections, intracranial mass lesions, stroke, and HIV-associated dementia are more common in patients with a CD4+ count less than 200.