Cardiovascular Changes in Hypothyroidism, a Tertiary Centre Study

Background:Among the commonly existing endocrine disorders found in India, Thyroid disease contributes fairly to the clinical scenario affecting around 9-15 % of the female population as well as the male population to a milder degree. Among the principal targets of the thyroid hormones is the cardiovascular system. The effects noted on the CVS are changes in the cardiac contractility, myocardial oxygen consumption, alterations in the systemic vascular resistance (SVR), decreased cardiac contractility leading to decreased cardiac output, increased rate of atherosclerosis and hence greater potential of CAD. Hypothyroidism also causes QT interval prolongation. Only few studies have been done in our country to assess these cardiovascular parameters in hypothyroid patients. Principally the thyroid hormone-T3, affects the heart with variations in cardiac gene expression principally mediated by T3. On 2D-ECHO mild Left Ventricular Diastolic Dysfunction (LVDD), mild concentric Left Ventricular Hypertrophy (LVH) with or without Left Ventricular Diastolic Dysfunction, mild mitral insufficiency or minimal pericardial effusion can be found. Since there does exist some evidence of a causal relationship, it is advisable to perform a basic cardiac work-up which should also include an echocardiogram to assess systolic and diastolic dysfunction as part of initial evaluation of the hypothyroid patients. Also to make note is the fact that persistent subclinical thyroid dysfunction may notably increase the cardiovascular disease risk ratio.

To Analyse the Pattern of Lipid Profile in Patients of Chronic Kidney Disease

Background:Chronic kidney disease (CKD), is a progressive and irreversible deterioration in the function of kidney over months to years,2 which is defined as“glomerular filtration rate (GFR) lesser than 60 ml/min with protenuria for 3 months”.3 It leads to various biochemical disturbances and numerous clinical symptoms and signs.4Some of the associated changes are abnormalities in haematology parameters, heart related issues, disturbances of gastrointestinal tract, neurologic disorder, osteodystrophy, skin related problems and sexual dysfunction. Dyslipidemias are a common among CRF patients. The disturbances of lipoprotein metabolism are seen in early stages of CRF and can follow decrement pattern that follows the renal function deterioration. Aim and Objectives This study was aimed to analyse the pattern of lipid profile among the dif. Methods: The study was cross-sectional observational study conducted on 100 patients either attending or being admitted in the department of Internal Medicine, TMMC & RC, TMU , Moradabad, U.P., INDIA, which were in line with the inclusion criteria. Result &Conclusion: Our results indicated that patients undergoing CRF show important abnormalities of lipid metabolism which could contribute to atherosclerosis and cardiovascular disease and may increase the morbidity and mortality in these patients.

An Observational Study to Identify the Role of ECG in Locating the Occluded Vessel in Patients of Myocardial Infarction with Angiographic Correlation.

Background: The electrocardiography (ECG) is considered as a fundamental tool in identifying the location and managing the symptoms of acute myocardial infarction. The aim of the present study is to study different ECG patterns according to the vessel involved and then it is correlated with the angiographic findings. Methods: It is a prospective and observational study conducted on 50 patients suffering from myocardial infarction with elevated ST segment in ECG who subsequently underwent coronary angiography. Based on the various ECG criteria the vessel involved was recognized and then correlated with angiographic findings. The sensitivity and specificity of individual parameters were calculated. Results: The present study demonstrated that ST depression in inferior leads >1mm had maximum sensitivity and specificity in localizing the position of occlusion proximal to S1. Presence of Q wave in aVL had maximum sensitivity and ST depression in the inferior leads showed extreme specificity in patients with occlusion proximal to D1. Presence of Q wave in V4-V6 had 95% specificity and Absence of inferior ST depression presented 89% sensitivity in patients with occlusion in distal S1. Presence of ST depression in aVL showed 98% specificity in patients with distal D1 occlusion. In patients with right coronary artery, ST elevation in LIII>ST elevation in LII and in case of left circumflex occlusion, ST ↑elevation in LII > LIII is the parameter with highest sensitivity and specificity. Conclusion: The ECG in patients with ST elevation myocardial infarction is important not only for defining which patient should receive early reperfusion treatment, but also for deciding the site and degree of acute myocardial injury.

The Influence of Telmisartan on Metabolic Parameters in Hypertensive Patients of Metabolic Syndrome- A Prospective Study.

Background: Telmisartan, an angiotensin II receptor blocker, has a higher affinity for AT1 receptors. It has also been recognized as partial agonist of the nuclear hormone receptor PPAR-gamma. The present study is conducted to study the effect of telmisartan on various metabolic parameters in hypertensive patients who have satisfied the standards of metabolic syndrome. Methods: This is a prospective and randomised study done on twenty hypertensive patients suffering from metabolic syndrome. All the patients underwent following investigations like Fasting plasma glucose, post prandial plasma glucose, HbA1c levels, lipid profile including total triglyceride, LDL, total cholesterol and HDL, C-peptide level, blood pressure, body mass index and weight were also measured. All the patients were recommended 40 mg of telmisartan orally every day. The above mentioned investigations were repeated after 4 months. Data was tabulated and compared with the previous readings by using paired t- test and P value < 0.05 was considered significant. Results: The change in both weight and body mass index is statistically insignificant. All the three haemodynamic parameters (SBP, DBP, MAP) showed significant decrease after intake of 40 mg telmisartan for four months. All the parameters (Total cholesterol, LDL, Triglycerides) of lipid profile of the patients except HDL demonstrated decrease in value. Regarding glucose metabolism, fasting c- peptide level, glycosylated haemoglobin concentration showed no difference in the value, whereas both fasting and post prandial blood glucose decreased significantly. Conclusion: The present study proves that telmisartan has agonistic and modulating action on PPAR Gamma receptor and is thus associated with lipid and glucose metabolism.

Synthesis and microbial screening of 6-pyridin-4-yl-2, 3-dihydro-1Hpyridazin-pyridazin-4-one derivatves.

6-pyridin-4-yl-2, 3-dihydro-1H-pyridazin-4-one derivatives were synthesized by a simple method. The isonicotinic acid hydrazide was made to react with acetaldehyde and acetone. This results into the formation of the respective hydrazones. These hydrazones formed were cyclized to the pyridazine derivatives. All synthesized compounds were subjected to antimicrobial activity.

Stimuli-sensitive hydrogels: A novel ophthalmic drug delivery system.

Background: Stimuli-sensitive hydrogels are three-dimensional, hydrophilic, polymeric networks capable of imbibing large amounts of water or biological fluids on stimulation, such as pH, temperature and ionic change. Aim: To develop hydrogels that are sensitive to stimuli, i.e. pH, in the cul-de-sac of the eye for providing a prolonged effect and increased bioavailability with reduction in frequency of administration. Materials and Methods: Hydrogels were formulated by using timolol maleate as the model drug, polyacrylic acid as the gelling agents, hydroxyl ethyl cellulose as the viscolizer and sodium chloride as the isotonic agent. Stirring of ingredients in pH 4 phosphate buffer at high speed was carried out. The dynamic dialysis technique was used for drug release studies. In vivo study for reduction in intraocular pressure was carried out by using albino rabbits. Statistical Analysis: Drug release studies data were used for statistical analysis in first-order plots, Higuchi plots and Peppas exponential plots. Student t-test was performed for in vivo study. Results: Viscosity of the hydrogel increases from 3.84 cps to 9.54 cps due to change in pH 4 to pH 7.4. The slope value of the Peppas equation was found to be 0.3081, 0.3743 and 0.2964. Up to 80% of drug was released in an 8 h drug release study. Sterile hydrogels with no ocular irritation were obtained. Conclusions: Hydrogels show increase in viscosity due to change in pH. Hydrogels were therapeutically effacious, stable, non-irritant and showed Fickian diffusion. In vivo results clearly show a prolonged reduction in intraocular pressure, which was helpful for reduction in the frequency of administration.

Hypolipidemic activity of Hibiscus rosa sinensis root in rats.

The hypolipidemic activity of Hibiscus rosa sinensis (family Malvaceae) root extract was studied on triton and cholesterol-rich high fat diet (HFD) induced models of hyperlipidemia in rats. In triton WR-1339-induced hyperlipidemia, feeding with root extract (500 mg/kg body wt/day p.o.) exerted lipid-lowering effect, as assessed by reversal of plasma levels of total cholesterol (TC), phospholipids (PL) and triglycerides (TG) and reactivation of post-heparin lipolytic activity (PHLA) of plasma. The other model was fed with cholesterol-rich HFD and root extract (500 mg/kg body wt/ day p.o.) simultaneously for 30 days. This also caused lowering of lipid levels in plasma and liver homogenate and reactivation of plasma PHLA and hepatic total lipoprotein lipase activity. The hypolipidemic activity of Hibiscus rosa sinensis root was compared with a standard drug guggulipid (200 mg/kg body wt/day p.o.), a known lipid- lowering agent in both models. Histopathological findings in rat liver supported the protective role of H. rosa sinensis root extract in preventing cholesterol-rich HFD-induced hepatic steatosis.

Perforated Meckels diverticulum causing giant pseudocyst and secondary appendicitis.

Meckels diverticula are known to present with a myriad of complications. However its perforation followed by development of a giant pseudocyst and secondary appendicitis is not reported in literature thus far. We report this complication in a five and half month old infant.