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Introduction: Pulmonary Embolism is a major health problemwhich is associated with significant mortality and morbidity. Itis a common and lethal condition. This study was undertakento find the association between NT-Pro-BNP levels and thelocalisation of thrombus in acute Pulmonary Embolism and toprognosticate the patients.Material and methods: Prospective study conducted ata tertiary care hospital.Thirty patients with PulmonaryEmbolism of various etiologies, confirmed with clinicalfeatures, laboratory investigations and imaging and fulfillingthe inclusion and exclusion criteria were included. Aftergetting informed consent, Blood samples for assessmentof NT-Pro-BNP levels were collected within 24 hours ofadmission.Results: In 19 patients, the thrombus was located centrally(in main pulmonary artery) whereas in 11 patients, thethrombus was located in the peripherally (in segmental andsubsegmental pulmonary arteries). 22 participants of thestudy had normal clinical outcome. 5 patients were morbid(oxygen dependant/ heart failure) whereas 3 patients died.Patients with central pulmonary embolus had higher NT-ProBNP levels whereas patients with pulmonary embolus in thesegmental or subsegmental pulmonary arteries had relativelyless NTPro-BNP levels. Patients with high NT-Pro-BNPlevels had complicated in-hospital course/ mortality whereas,patients with relatively lower NT-Pro-BNP had uncomplicatedin-hospital course.Conclusion: This study shows that higher NT-Pro-BNPlevels indicate higher probability of a more central locationof thrombus in pulmonary embolism and also right ventricularoverload. Also patients with higher NT-Pro-BNP levels had acomplicated in hospital course.
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Introduction: Diabetes is the leading cause of adult blindnessdue to retinopathy, end stage renal disease due to nephropathyand foot ulcers and lower limb amputation due to neuropathy.Serum uric acid levels independently predict the developmentof micro vascular complications. In this study, we analysethe association of serum uric acid with the micro vascularcomplications of diabetes.Material and methods: In this hospital based observationalstudy, hundred diabetic patients were included; of which fiftyhad micro vascular complications, the remaining fifty had nocomplications. Blood investigations including fasting(FBS)and post prandial blood sugars(PPBS), glycosylatedhaemoglobin (HbA1C), and serum creatinine and serumuric acid were done in all patients. All the parameters werecompared between the two groups.Results: Females presented with significantly highercomplications as compared to males. The mean age of thepatients presented with and without complications was 56.4± 9.3 and 59.9 ± 10.3 respectively. HbA1C had a positivecorrelation with the serum uric acid (SUA) (r=0.327, P =0.001). Mean uric acid levels were higher among patientswith complications (5.96 ± 2.16) compared to patients withoutcomplications (4.95 ± 2.04) which was statistically significant(P value =0.021). Patients with nephropathy and neuropathyhad significant elevation in serum uric acid levels than thosewithout; however this significance was not noted in those withretinopathy.Conclusion: Patients with micro vascular complications hadhigher levels of serum uric acid compared to those withoutcomplications. Also there was positive correlation betweenHbA1C and serum uric acid levels
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Introduction: Stroke is a global health problem. In this study we evaluated the risk factors, clinical features and their correlation with Magnetic Resonance Imaging (MRI) brain including Magnetic Resonance Angiogram (MRA) and Carotid Verteberal (CV) Doppler findings in patients presenting with acute ischemic stroke. Material and methods: Seventy five patients of the age group 20 to 80 years admitted with acute ischemic stroke were enrolled for the study. A detailed history, clinical examination and blood investigations were done. MRI, MRA and CV Doppler were done in all patients. Serum Homocysteine levels and Anti-nuclear antibody assay (ANA) by Immunofluorescence (IF) were done in selected patients. Statistical analysis was done using SSPS version 16.0 for microsoft windows. Results: In this study, there were more males than females. The mean age was 59 years. Young stroke population (<40 years) was 5%. Anterior circulation was predominantly involved than posterior circulation. Right Middle Cerebral Artery was the most common artery involved. There was positive correlation for clinical presentation and area of infarct and for areas of infarct and the vessels involved. Most common clinical presentations were weakness and slurring of speech. There were 3% intracranial anomalies. 56% had significantly elevated levels of homocysteine. 24% had ANA- IF positivity. Recurrence of stroke was seen in 17%; National Institute of Health Stroke Scale (NIHSS) score was higher in patients with recurrent stroke and right hemisphere infarcts. Conclusion: There was positive correlation for clinical presentation and area of infarct and for areas of infarct and the vessels involved.
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Background: Poorly controlled diabetes mellitus as indicated by elevated glycated haemoglobin (HbA1c) levels is associated with increased cardiovascular risk. C–reactive protein (CRP), an important cardiovascular risk factor, is elevated in diabetics with poor glycaemic control than those with good control. The present study assessed the correlation between HbA1c and CRP levels.Methods: A prospective study was conducted in thirty type 2 diabetic patients irrespective of the disease duration and treatment; those with established target organ damage were excluded. HbA1c and hsCRP levels were measured at baseline; sugars were monitored monthly and medications optimised; at the end of six months HbA1c and hsCRP levels were measured.Results: Mean age of the study subjects was 58.7±8.6 years; At the baseline, all had poor glycaemic control (HbA1c >7%); 15 had hsCRP >3 mg/L. At the end of 6 months, 5 achieved good glycaemic control (HbA1c <7%); 10 had hsCRP >3 mg/L. Baseline median hsCRP was 3.33 mg/L (0.68, 15.9) and at the end of 6 months it was 2.08 mg/L (0.48, 9.12). Mean HbA1c at baseline and end line was 10.6±1.55% and 8.43±1.84% respectively. There was significant reduction in both the mean HbA1c and median hsCRP at the end of 6 months (p <0.001). Positive correlation was observed between HbA1c and CRP at baseline (r=0.32, p=0.10). However, this was not observed at the end of 6 months.Conclusions: There is positive correlation between the level of glycaemic control (HbA1c) and CRP levels; Better glycaemic control results in significant reduction in the hsCRP levels.
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Background: Gastro esophageal reflux disease is the commonest pathologies encountered by gastroenterologist in day to day practice. Longstanding and untreated gastro esophageal reflux disease can lead to many complications including adenocarcinoma. This study was conducted to evaluate the various symptoms and to analyze the lifestyle and dietary factors influencing gastro esophageal reflux disease which can be modified.Methods: Hundred patients with gastro-esophageal reflux disease of age more than 18 years were enrolled in the study. Various patient details including demographic details, lifestyle information and symptomatology data were analyzed and compared with complications.Results: Mean age of gastro esophageal reflux disease patients was 56.09±15.93 years. Gastro esophageal reflux disease is more prevalent in males than females. Gastro esophageal reflux disease is more frequent in BMI <25, greater number of co morbidities and in non-vegetarians. Mean age of gastro esophageal reflux disease with complications was 67±11.53 years and without complications was 52.64±15.57 years. No strong association of smoking, alcohol, spicy foods, fried foods, citrus fruits, heavy meals, tea/coffee, aerated drinks, sleep disturbance and effect on work was identified in gastro esophageal reflux disease.Conclusions: Classical symptoms of gastro esophageal reflux disease were not present in all the patients. Higher age of the patient infers higher risk of complications. Daily episodes of heartburn, regurgitation and retrosternal chest pain implies higher risk of complications. Presence of Helicobacter pylori in gastro esophageal reflux disease patients signify higher risk of complications.
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Introduction:: Stroke is a global health problem. Studies haveshown that serum albumin level is an independent predictor ofischemic stroke outcome. In the present study we comparedthe serum albumin and the volume of infarct with the clinicaloutcome.Material and methods: Fifty patients of age more than18 years with clinical and radiological evidence of acuteischemic stroke were included in the study. The severity ofstroke at admission was assessed by National Institute ofHealth stroke scale (NIHSS). Serum albumin levels weremeasured at admission within 36 hours after stroke onset.Functional outcome was measured 1 week post admissionand after 3 months during follow up using modified Rankinscale (mRs). A score of mRs >3 or death was taken as pooroutcome. Statistical analysis and interpretation of the data wasdone. P value of <0.05 was taken as statistically significant.Results: The mean age group of the study population was53 years, male patients had more severe stroke comparedto female patients. Most common risk factors were diabetesmellitus and systemic hypertension. Patients with a goodoutcome had lower NIHSS score, low mRS score, highalbumin and low volume of infarct. Those with worst outcomehad higher NIHSS, high mRS and high volume of infarct.Conclusion: Relatively high serum albumin level in acutestroke patients decreases the risk of poor outcome. It is notonly serum albumin but volume of infarct also does play a rolein the final outcome of the patient