ABSTRACT
Stroke is the leading cause of death worldwide and one of the main causes of long term disability. According to WHO, 15 million suffer from stroke each year. Studies have shown that levels of hsCRP measured shortly after stroke predicted complimentary aspects of prognosis. There is possibility that elevated hsCRP levels has direct relation to extent of cerebral tissue injury. We wanted to measure the levels of hsCRP in acute cerebrovascular accident. To correlate the level of hsCRP with severity of stroke and outcome.METHODSStudy was conducted in patients admitted in medical ward and medical ICU in tertiary care hospital (Grant Government Medical College and Sir JJ Group of Hospitals). It was a cross sectional study. A total of 150 patients who presented with stroke and fulfilled inclusion and exclusion criteria were enrolled in the study. In all patients hsCRP levels were measured within 48 hours of admission. Data was collected prospectively in a Microsoft Excel database. Statistical analysis was done using non-parametric ANOVA (Kruskal Wallis test) and Mann Whitney test.RESULTSMean age of patients was 59 ± 12 years. hsCRP levels were raised in stroke patients. Also values were found to be more in haemorrhagic stroke (value) than in ischemic stroke (value) and the difference was found to be significant. Significant correlation was also found between hsCRP levels and GCS with lower GCS scores associated with higher hsCRP levels in both types of stroke. Mean hsCRP level in survivors was 21.83 ± 23.17 mg/L and in non survivors was 82.07 ± 25.83 mg/L and the difference was statistically significant (p <0.0001)CONCLUSIONSWe concluded that hsCRP level is increased in cases of stroke (both ischemic and haemorrhagic) suggesting an inflammatory response in acute stroke. Increased levels of hsCRP correlated with severity of neurological deficit and worse outcome.
ABSTRACT
Diabetic nephropathy (DN) is a chronic microvascular complication of diabetes mellitus (DM). Microalbuminuria is an earliest marker of DN. Effective screening measures are required for early diagnosis and management to halt the progression of diabetic nephropathy. We wanted to evaluate urine Albumin Creatinine Ratio (ACR) as an earlier predictor of diabetic nephropathy in comparison to the gold standard test 24-hours urine protein.METHODSThis is a cross sectional study conducted among 210 patients of type-2 DM admitted in the medical ward of a tertiary care hospital, who fulfilled the inclusion and exclusion criteria. Relevant history including duration of DM, and other comorbidities was taken from the patients. Vital parameters such as heart rate, systolic and diastolic blood pressure were recorded. CBC, RFT, FBS, PPBS, HbA1c, Fundoscopy were done in all patients. Urine analysis for ACR from random urine sample and 24-hours urine protein from 24-hour urine sample were done.RESULTSProteinuria was present in 80.95% of patients and that with 24-hour urinary protein, in 59.04% patients. ACR showed sensitivity of 100%, specificity of 46.51% with PPV of 72.94% and NPV of 100%. ACR has strong positive correlation with 24-hours urinary protein. Positive correlation of urine ACR was seen with serum creatinine, blood urea, HbA1c, anaemia, duration of diabetes and the presence of diabetic retinopathy.CONCLUSIONSACR shows high sensitivity in the detection of proteinuria, especially microalbuminuria and hence can be considered as an alternative to 24-hour urine protein in an early screening for DN.