Prevalence of pseudoexfoliation in diabetic patients with senile cataract: A hospital-based study in Kashmir, India

Purpose: To study the prevalence of pseudoexfoliation syndrome (PEX) in diabetics with senile cataracts and compare it to the prevalence in nondiabetic control group. Methods: Two hundred and fifty diabetics and 250 nondiabetics (age and sex matched) were evaluated for PEX deposition. Results: Chi?squared test was employed, and a P value < 0.05 was considered significant. In the PEX group, most patients belonged to the age group of 60–70 years (55.17%). Out of 18 patients with PEX, 11 (61.1%) showed bilaterality. There was a higher frequency of raised intraocular pressure (IOP; >20 mmHg) in PEX eyes (10.3%) than in the non?PEX eyes (5.9%). The PEX group had a higher number of eyes with cup?to?disc ratio (CDR) >0.6 (11.12%) than the non?PEX group (4.32%). Nuclear cataracts were more frequent in PEX eyes than non?PEX eyes, whereas PSC and mature cataracts were more prevalent in the non?PEX group. Most eyes had PEX deposition on the anterior lens capsule and pupillary margin. Of the 500 study eyes corresponding to the diabetic group, 418 had cataracts (rest pseudophakic), of which 28 had pseudoexfoliation, accounting for 6.7% of the total. In the nondiabetic control group comprising 500 eyes, 430 had senile cataracts (rest pseudophakic), of which 105 had PEX deposition, accounting for 24.4% of the total. Conclusion: According to our findings, diabetics have a lower prevalence of PEX than nondiabetics. Few such studies have been conducted so far, and none have been conducted in the Indian population.

Psycho-Social Drivers of COVID-19 Vaccine Uptake Among University Students

Background: Students play a significant role in delivering effective messages for better uptake of health pro-moting behaviour. Understanding factors that are associated with COVID-19 vaccine uptake among students will help develop promising strategies in vaccine promotion of the pandemic. The present investigation was undertaken to look into psycho-social drivers of COVID-19 uptake among Indian students.Method: 587 students, aged 18-35 years participated in an online survey. Standardized measures targeting socio-demographic details, health anxiety, preventive health behaviour and constructs of health belief model were used for the present study. Results: The results showed that overall vaccine uptake among students was quite high with nearly 74% of the students reported being vaccinated against COVID-19. Factors like COVID-19 contact, level of education, belief in safety and efficacy of vaccine, social distancing, age, health worry and preoccupation were emerged as the significant drivers of COVID-19 vaccination behaviour increase the probability of vaccine uptake among students. Moreover, factors like Interference with life, Reassurance Seeking, irrational belief about preventive health measures and perceived barriers about vaccination had significant negative link with vaccination de-creasing the likelihood of vaccine uptake. Conclusion: Psychological and socio-demographic factors play vital role in the success of public health strate-gies of COVID-19 vaccine promotion in managing the pandemic.

CAUSES OF OCCUPATIONAL STRESS AMONG JUNIOR COLLEGE LECTURERS

Occupational stress is a noticeable and widespread aspect of contemporary businesses. The right amount of stress may motivate someone and boost performance, while too much stress results in poor performance. One of the jobs with the highest stress is teaching. Psychiatric disorders can result from excessive stress. The study's goal is to identify the main factors contributing to junior college lecturers' stress. The present study involves 79 lecturers from private junior colleges (43 male and 36 female). Two sections (Part A & B) make up the questionnaire. Part-A contains demographic data on junior college lecturers, and Part-B has nine stress-related factors against which lecturers have to give ranking from most stress factor 1 to least stress factor 9. Statistical analysis employs the Garrett ranking approach. The ?ndings show that lecturers experience the highest stress from students' misbehavior, followed by work pressure and no job security.

Covid-19 presenting as isolated severe thrombocytopenia in an HIV-lymphoma survivor

Coronavirus disease has myriad manifestations and can present with predominantly extrapulmonary manifestations. We describe a 50-year-old man, a person living with HIV (PLHA), a non-Hodgkin lymphoma survivor, who presented with isolated severe thrombocytopenia. He was found to have immune-mediated thrombocytopenia, and showed excellent response to intravenous immunoglobulins.

COVID-19 Pandemic: Trend Analysis with Respect to District Anantnag, Jammu and Kashmir, Northern India

With 1st case being reported in Wuhan city of China in December 2019, COVID?19 infection cases made their way to every corner of the world. Then, on January 07, 2020, laboratory results led to pneumonia being named as COVID?19. Scant data is available from Northern India, thus to reveal the trend of COVID?19 infection since last year of COVID?19 pandemic onset, this study took shape. The unit of analysis of our study was District Anantnag, Jammu and Kashmir. Till February 05, 2021, a total of 4625 cases of COVID?19 virus were reported in District Anantnag, Jammu and Kashmir. Negative history of close contact with COVID?19 patient (66.1%) constituted the most common exposure, majority (84.4%) were asymptomatic and comorbidities were present in 68 (1.5%). COVID?19 infection was more prevalent among younger age group, with higher male predominance, with comorbid being at higher risk, hence most stringent measures must be adopted.

Evaluation of the larvicidal potential of root and leaf extracts of Saussurea costus (Falc. ) Lipsch. against three mosquito vectors: Anopheles stephensi, Aedes aegypti, and Culex quinquefasciatus

Abstract INTRODUCTION: The larvicidal potential of Saussurea costus (Falc.) Lipsch. was studied against the early 4th instar larvae of Anopheles stephensi Liston., Aedes aegypti Linn.,and Culex quinquefasciatus Say. because of the emergence of mosquito resistance to conventional synthetic insecticides. METHODS: At concentrations of 12.5-200 ppm, larvicidal activities were studied under laboratory conditions. RESULTS: After 24 h of exposure, the methanol extract of the roots recorded the highest larvicidal activity against An. stephensi, with LC50 and LC90values of 7.96 and 34.39 ppm, respectively. CONCLUSIONS: We are developing potent larvicidal compound(s) from S. costus for controlling the mosquito larval population.

A comparative study of supraclavicular versus infraclavicular approach for central venous catheterization in neurosurgical patients

Background: Central venous cannulation is a commonly performed procedure in neurosurgical patients to maintain the hemodynamic stability in the intraoperative period. It is used for infusion of intravenous fluids, vasopressors central venous pressure monitoring and detection of air embolism. Subclavian vein is commonly performed as there are minimal effects of positioning on it. Supraclavicular approach to subclavian vein cannulation is not as frequently employed as the infraclavicular approach. The purpose of this study was to compare the supraclavicular approach versus the infraclavicular approach in terms of number of attempts, success rate of catheterization and complications associated with the procedure.Methods: About 150 patients undergoing various neurosurgical procedures were enrolled in the study. They were divided into two groups. 75 patients underwent right supraclavicular catheterization of subclavian vein while as 75 patients underwent right infraclavicular catheterisation of the subclavian vein. The number of attempts for cannulation, success or failure of catheterization and any complications associated with the procedure or in the postoperative period were noted in each group. The data was compared between the two groups by using Chi-square test and Student’s Independent Samples T-test.Results: The right supraclavicular vein was successfully cannulated in 90.66% while as the right infraclaviclar vein was successfully cannulated in 96% of the patients (p >0.05). Malpositioning of catheter (threaded in contralateral subclavian) was noted in 4 patients in Group S and ipsilateral internal jugular vein in 2 patients. Pneumothorax was encountered in 1 patient in the group S undergoing supraclavicular subclavian vein cannulations while as subclavian arterial puncture was seen in 4 patients who underwent infraclavicular arterial puncture.Conclusions: There was no difference in successive cannulations between right the supraclavicular and right infraclaviclar veins. The rate of complications between the two approaches was comparable.

Small Incision Cataract Surgery with Trabeculectomy versus Phacotrabeculectomy in Eyes with Pseudoexfoliation - A Retrospective Study

Pseudoexfoliation (PXF) syndrome is very common in Kashmir Valley. Eyes with pseudoexfoliation have a higher incidence of both cataract and glaucoma. Eyes with pseudoexfoliation respond poorly to medical treatment hence the need for early surgical intervention. AIM: To evaluate the effectiveness of small incision cataract surgery (SICS) with trabeculectomy versus phacotrabeculectomy in patients with psuedoexfoliative glaucoma with coexistent cataract. Methods: Present retrospective study was done in the post graduate department of ophthalmology Sher-i-Kashmir institute of medical sciences (SKIMS) and hospital Bemina. A total of 50 eyes with pseudoexfoliative glaucoma were divided in to two groups, 25 underwent small incision cataract surgery with trabeculectomy and 25 had phacotrabeculectomy done by the same surgeon. Intra and postoperative complications were compared between the two groups, moreover best corrected visual acuity (BCVA) and intra ocular pressures (IOP) were compared at 8 weeks and 6 months. Results: In our study we found that there was a significant improvement in best corrected visual acuity as well as getting the desired IOP levels in both groups of patients. However the difference between the two groups in terms of intra and post-operative complications, BCVA and IOP was found to be statistically insignificant. Conclusion: Our study concludes that both SICS with trabeculectomy and phacotrabeculectomy are equally effective in management of patients with PXF associated with cataract and glaucoma.

Short Term Outcome of Extracorporeal and Intracorporeal Anastomosis in Laparoscopic Colorectal Surgeries – A Prospective Observational Study

Aim of Study:Laparoscopiccolorectal surgery has gained popularity around the Globe. Laparoscopiccolectomy significantly improves the short term and long term outcomes of patients. The bowel anastomosis after laparoscopic resection of the tumour can be done in two ways -extracorporeal anastomosis and Intracorporeal anastomosis. Our study observed and evaluated the data of the patients who underwent these two techniques.Materials and Methods:A prospective observational study was conducted in the department of General Surgery, SMHS hospital of Government Medical College, Srinagar. A total of 32 patients were studied out of which 20 patients had undergone intracorporeal anastomosis and 12 patients had undergone extracorporeal anastomosis. The aims of the study were to assess the operative time, post-operative ileus, length of hospital stay, anastomoticleak and other anastomotic complications,wound infections and extraction site hernias.Results:The patients in our study were in the range of 30-85 years with a mean age of 59.18 ± 14.92. and 59.4% of patients were males and the rest 40.6% were females, with male/female ratio of 1.46:1. There was no significant difference in mean operative time between the intracorporeal group and extracorporeal group (188±9.78 minutes’ vs.180.3±13.8 minutes). The patients in the intracorporeal group had earlier return of bowel function than extracorporeal group as reflected by earlier appreciation of flatus and tolerance to orals. This had led to the shorter hospital stay of the intracorporeal group than the extracorporeal group of patients (median of 5 days vs. 6.5 days) The wound infection rate was 6.3 percent in our study, 5.0% in the intracorporeal group and 8.3% in the extracorporeal group. Only 1 out of the total 32 patients developed mesenteric twist to the extracorporeal group (1 out of 12 patients). We observedno leak or incisional hernia in either groups.Conclusion:Intracorporeal anastomosis in laparoscopic colorectal surgeries leads to earlier return of bowel function, earlier resumption of orals and shorter hospital stay than the extracorporeal anastomosis. There does not exist a significant difference between the two modes of anastomosis in terms of anastomotic and wound related complications

Laparoscopic Fundoplication for Gastro-esophageal Reflux Disease and Hiatus Hernia: A Short Term Outcome of First 8 Cases

Background:Acute gastro-esophageal reflux disease is a common ailment in kashmiripopulation. Most of these patients are managed by gastroenterologist, physicians and surgeons in daily outpatient basis. Majority of them settle by medical management with the help of proton pump inhibiters, prokinetics and antacids., laparoscopic Nissen’s fundoplication (LNF) is currently the procedure of choice for the surgical management of GERD.Aims and Objectives:The aim of this study was to know the feasibility of laparoscopic fundoplication for hiatus hernia and acute gastro-esophagealrefluxdisease in termsof operative time, post operative pain, length of hospital stay, conversion rate and recurrence of symptoms.Materialsand Methods:The present prospective observational study was conducted in the Post-Graduate Department of General Surgery and minimal access surgery Government Medical College Srinagar from June 2013 to June 20117. The patients that were included in the studyhad symptomatic gastro-esophageal reflux(documented by endoscopy) with either persistent symptomsdespite adequate and prolonged medical treatment, CT documented hiatus hernia and patients, who wanted to avoid long-term medical treatment. The duration of reflux symptoms ranged from 9 months to 30 years (median 6 years). Patients who were excluded from the study were those unfit for anesthesia. Informedconsent was taken before surgery in the language, the patients understood.Results:This study includes 8 patients, with median age of 40 years (range 20-70 years). In the study group, 5 were males and 3 were females. The mean operative time was 90 minutes (range 60 t0 120 minutes). There were no major intra operative and postoperative complications. The postoperative pain was minimal as compared to open surgery. The median hospital stay was 3.5 days (range 3 -6 days). Two patients developed symptoms of bloating, early satiety, nausea and diarrhea. However these symptoms improved within weeks with a good response to appropriate medication. The median time until normal physical activity resumed was 2 weeks (range 3 days to 4 weeks). Median follow-up was 6 months (range1-12 months).The overall short-term results in appropriately selected patients were excellent. The recurrence of symptoms was not observed in any patient within follow up of 6 months. Conclusion:We conclude from our early series of 8 cases, that patients having long standing GERD not responding to medical management who areat a threat to develop barrettes esophagus should be given the benefit of laparoscopic fundoplication. However proper evaluation, patient selection is mandatory. The choice of fundoplication should be dictated by thesurgeon’s preference and experience. Currently, the main indication for laparoscopic fundoplication is represented by PPI-refractory GERD, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained by impedance-pH monitoring

Demographic Profile of Cervical Cancer: A Retrospective Study Conducted in Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India

Introduction: Worldwide, cervical cancer remains the most common gynecological cancer and the fourth most commonmalignancy in women, with over 526,000 women globally developing this tumor as reported in 2015 and 239,000 women dyingof the disease every year. To date, there are limited data of cervical cancer in Kashmir, India.Objectives: The aim of the present study was to analyze the demographic spectrum of cervical cancer in Kashmir.Materials and Methods: This was a retrospective study. All the patients who had histopathologically confirmed cervical cancer,registered at Regional Cancer Center of Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, were included, between2008 and 2015. All the patient characteristics including age, presentation, type of cancer, stage of cancer, parity, and treatmentreceived in each case were studied in detail.Results: The present study included 120 patients of cervical cancer. The median age of patients was 51 years. Majority of ourpatients were multiparous (88.3%) and from a rural background (74%). The most common presenting complaint was abnormal vaginalbleeding (70%) followed by abdominal pain (19%). Squamous cell carcinoma was the most common type of cervical carcinomaseen in 95% of patients followed by adenocarcinoma (5%). Most of the patients (66.67%) presented at late Stages (II, III, and IV).Conclusion: Early detection will reduce the number of deaths of cervical cancer patients. Asignificant number of cervical cancer patientsin Kashmir present with an advanced stage of disease. Cervical cancers are observed at a middle age group that is >40 years of age.People should be educated for an early consultation for symptoms, and high-risk individuals should be encouraged for screening. Thehealth programs about cervical cancer should be carried out in open places to give more information about cervical cancer to the public.

Management of displaced transverse fractures of the patella using tension band wiring with or without circumferential cerclage wiring: A comparative study

Background: Transverse fractures of body of the patella are by far the most common fractures of this bone. Surgical fixation is the recommended treatment in displaced fractures with extensor lag. Although, tension band wiring (TBW) technique is the gold standard for these fractures, few surgeons recommend augmentation with circumferential cerclage wiring to improve the strength of the fixation. We compared the results of the internal fixation of displaced transverse fractures of the patella using TBW and circumferential cerclage wiring with those treated with TBW alone. Methods: We treated 54 displaced transverse fractures of the patella at our institution. We segregated the patients into two groups: Group 1 (n=23) included fractures treated with tension band wiring (TBW) along with augmented circumferential cerclage wiring while as Group 2 (n=31) included fractures treated by TBW alone. Outcome was studied, graded and compared on the basis of knee pain, knee stiffness, quadriceps wasting, loss of flexion and loss of extension. Results: 73.90% patients among group 1 and 70.96% among group 2 showed excellent to good results (P value < 0.1). Fixation failure and need for revision surgery among group 1 and group 2 was found to be 8.69% and 9.67%, respectively (P value < 0.6). Infections and non union occurred among 4.34% patients in group 1 whereas in group 2 it was 6.45% of the patients who encountered the same (P value < 0.6). Conclusions: The use of circumferential cerclage wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over fixation with tension band wiring alone. Keywords: Patella fracture, Tension band wiring, cerclage wiring

Genetic study in congenital heart defects

Background: Congenital heart diseases (CHD) are relatively common with a prevalence ranging from 3.7 to 17.5 per 1000 live births. Little is known about genetic link with respect to congenital heart disease. Iroquoise (Irx) homeobox genes have been widely studied and their expression in both developing and adult heart. Author tried to study the role of irx4 and irx5 genes in structural congenital heart disease, keeping the focus on study reported by Cheng Z et al.Methods: Author studied reported mutation site sequences in 25 various congenital heart disease patients and control healthy relatives of patients. It is a unique study and there has not been such a study reported in literature till date. Besides comparison with healthy related controls, author took cardiac tissue biopsy in patients while doing corrective cardiac surgery. However, blood samples were taken from controls due to ease of feasibility.Results: Although, there were no sequence variations in the studied exon regions, but author got a base pair sequence change at 6 bp intron region, which is near the exon splice site in irx4 gene. Besides two ASD patient’s male children (one child each) had ASD prompting us to believe some role of sex linkage. However later needs pedigree analysis and sex chromosome studies for further analysis.Conclusions: Gene sequence in the Kashmiri population is unique. There is possibility of role of irx genes in CHD. ASD might have sex linkage in some.

The Spectrum of Histopathological Patterns Observed in Prostate Specimens in a Tertiary Care Hospital in Kashmir

Introduction: Prostate gland involved by a no. of benignand malignant diseases is a common cause of morbidity andmortality in the elderly men. The present study was an attemptto understand the histopathological spectrum of prostaticlesions in the specimens received by a tertiary care hospital.Material and Methods: 433 cases of prostatic specimensincluding TURP chips, TRUS guided biopsies and Prostaticspecimens received in the Department of Pathology,Government Medical College Srinagar were included in thepresent study. There were 344 needle biopsies and 82 TURPchips. All the specimens were fixed in 10% neutral bufferedformalin and thin sections were stained with Hematoxylinand Eosin stain (H&E stain). Relevant clinical data includingage, the presenting complaints and S.PSA values in suspectedcases of carcinoma prostate were recorded.Results: A total of 433 prostate specimens were receivedduring the period of three years. The specimens included 344TURP chips and 82 TRUS guided biopsies. 7 prostectomyspecimens were also included. The age of the patients variedfrom 42 years to 89 years. There were 380 benign cases and53 malignant cases. The most common presenting featurewas increased frequency of micturition followed by difficultyin starting and stopping the stream of urine. Among benignlesions the most frequent histopathological entity observedwas benign nodular hyperplasia. The most common age ofpresentation was the sixth to seventh decade of life. Almostall neoplasms of the prostate were prostatic adenocarcinomaswith most of the cases seen in the sixth to seventh decade oflife with another peak in the seventh to eight decade of life.Conclusion: A variety of benign and malignant lesions areseen in prostatic specimens. These need to be differentiatedand classified. Benign nodular hyperplasia is the mostcommon benign lesion and prostatic adenocarcinoma isthe most common malignant lesion of Prostate. Perineuralinvasion is a significant finding and guide. Serum PSA is auseful adjunct in cases where the values are higher.

​Clinico-demographic Profile and Treatment Patterns of Ovarian Cancer in Kashmir

Introduction: Ovarian cancer is the fourth most common cause of cancer deaths world wide and also the commonest causeof death among all gynecological cancers.Aims and Objectives: To study the clinico demographic profile and treatment patterns of Ovarian Ca in our population.Material and Methods: We conducted an analytical, non-randomized, cross-sectional study on the Clinico-Demographic profileof 731` patients with Ovarian Carcinoma who reported to our OPD between 2008 to 2015.Results: The mean age of patients was 45±1. 49 years. Most common age group of our patients at presentation was 46-60 years.Majority of patients 70% in our study were from rural area. The major clinical presentation of ovarian in our study was pelvic pain(36%) followed by abdominal distention (34%) and ascites (22%). Most common type of ovarian cancer was of surface epithelialtype (94%) followed by sex cord stromal tumor (3%) and germ cell tumour (1. 6%). Most of the cases 61% in the present studyhad presentation at advanced stages (stage III & IV) while as only 39% cases had presented at early stages (stage I & II).Majority of the patients having ovarian tumors underwent surgical staging with surgery in 88% cases. Chemotherapy was themost common adjuvant therapy in 38% patients who had malignant ovarian pathology and had advanced stage of diseases.while as 7 patients (1%) received radiotherapy for brain and bone mets.Conclusion: Majority of patients were from rural background with pelvic pain as most common presenting symptom Most ofour cases presented in late stages of disease. Greater awareness among our community is needed to reduce the morbidityand mortality associated with Ovarian Ca

Pilomatrixoma: A Clinico - Pathological Study

Introduction: Pilomatrixoma (calcifying epithelioma ofMalherbe) is a benign skin tumor with differentiation towardshair follicles. Pilomatrixoma may be mistaken for many otherconditions like epidermoid cyst, dermoid cyst, calcified lymphnode or a hemiangioma. The aim of this study was to describethe clinical and histopathological characteristics of patientspresenting with pilomatrixoma.Material and Methods: The present study was conductedin the Post Graduate department of pathology, govt. medicalcollege Srinagar. 51 cases of pilomatrixoma were included inthe study. The final diagnosis was arrived by histopathologicalexamination of the specimens. The clinical features andphysical examination including age, sex, site of lesion andsize were noted and analyzed.Results: 51 cases of pilomatrixoma, comprising about 37%cases of all skin adnexal tumors were considered. The mostcommon age group involved was 11-20 years comprising of33.34% of all cases. 23 (45.10%) were males and 28 (54.90%)were females. There was a slight female predominance. Themost common anatomical location for the tumor was foundto be head and neck followed by trunk, upper limbs and lowerlimbs. The histopathological findings observed were: a benignwell demarcated lesion surrounded by a capsule in almost allof the cases. The lesions were found to be composed of islandsof epithelial cells embedded in a stroma. Two types of cellswere identified in these epithelial islands basaloid cells andshadow cells.Conclusions: Pilomatrixoma should be considered in thedifferential diagnosis of nodules, especially those on the headand neck. Careful clinical examination and familiarity withthe condition may lead to accurate diagnosis and appropriatetreatment.

Effect of New Onset Diabetes after Transplantation (NODAT) On Graft Survival in Renal Transplant Recipients

Background:Newonset diabetes after transplantation (NODAT) refers to diabetes that occurs in previously nondiabetic persons after solid-organ transplantation, bone marrow and hematopoietic stem cells. New Onset Diabetes After Transplantation (NODAT) is one of the metabolic complications after kidney transplantation which affects adversely the allograft kidney and patient outcomes. Methods: This study was conducted in Department of Nephrology at Sher I Kashmir Institute Of Medical Sciences (SKIMS ) , a tertiary care center in Srinagar , Jammu and Kashmir , India, between July 2013 to June 2016.All the patients who underwent renal transplantation during this period in our institute were enrolled in this study.In the post renal transplant period , patients were classified as those who developed NODAT and as normal patients. Effect of NODAT on the graft survival was studied by comparing the serum urea, creatinine and urinary protein between the NODAT and the normal patients. Results: A total of 100 patients of End Stage Renal Disease (ESRD) who underwent renal transplantation in department of nephrology were enrolled in our study.Out of 100patients, 79 were males and 21 were females. A total of 17 patients developed NODAT in our study. It was observed that the patients developing NODAT in post renal transplantation period were having a higher values of serum creatinine and urea as compared to normal patients. Moreover proteinuria was more commonly present in NODAT patients than normal patients. Conclusion: The development of NODATis associated with a poor graft function in the post transplant period.

Obstructive Sleep Apnea (OSA) in Patients with Type 2 Diabetes: A Prospective Study

Background:The incidence of obstructive sleep apnea (OSA) is more in type II diabetis patients as compared to healthy individuals. One of the links between OSA and type 2 diabetes is obesity and increased Body mass index is found to be associated with increased risk of metabolic syndrome, diabetes and OSA. OSA is found to have an adverse effect on overall glycemic control in type 2 diabetes and diabetics who have OSA have found to have relatively higher levels of HbA1c indicating poor long-term glycemic controls. As the diagnosis of OSA is usually delayed due to non-specific symptomatology any patient having disturbed sleep and daytime somnolence must be investigated for OSA. It is important from the perspective of treating physician to diagnose OSA in diabetics so as to optimally manage long term glycemic control. We conducted this study to find out the incidence of OSA in type 2 diabetics and its effect on long term glycemic control. Methods: This was a prospective observational study conducted in a tertiary care hospital in which 50 diagnosed cases of type 2 diabetes and suspected to be having Obstructive sleep apnea and came for evaluation were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and thorough clinical examination was done. OSA was diagnosed on the basis of polysomnography. The diagnosis of OSA was done on the basis ofpolysomnography OSA was defined as apnea-hypopnea index (AHI) > 5 per hour sleep. The incidence of OSA in diabetics and its effect on long term glycemic control was studied. Data was analyzed using SSPE 17.0 software. P value less than 0.05 was taken as significant for statistical purposes. Results: Out of 50 studied cases there were 32 (64%) were males and 18 (36%) were females with a M:F ratio of 1:0.56. Mean age of the studied cases was found to be 46.16+/- 8.53 years. 32 patients were obese (BMI =/> 30) and 10 patients were overweight (BMI=\> 25 but < 30). Common co-morbidities seen were hypertension (36%), hypertriglyceridemia (68%) and low HDL levels (44%). 24 (48%) patients were found to be having obstructive sleep apnea on the basis of polysomnography and history of associated symptoms. Raised BMI and Fasting blood sugar levels were found to be higher in patients with OSD (P<0.0001). There was a statistically significant difference in glycosylated Hemoglobin levels in patients with and without OSA. Patients with OSA were found to have higher HbA1c levels indicating poor glycemic control. Conclusion: Patients with Type 2 Diabetes are more at risk of developing OSA which is usually diagnosed late due to non-specific symptomatology. OSA is associated with poor long-term glycemic control in these patients. It is important from the perspective of treating physician to diagnose and treat OSA in diabetics for optimum management.

Clinical profile in arrhythmogenic cardiomyopathy and a recessive plakophilin-2 gene mutation

Objective Arrhythmogenic cardiomyopathy (ACM) is not an uncommon cause of cardiac morbidity in Kashmir valley. This study was designed to document various clinical features and to sequence exons 11 and 12 of plakophilin 2 (PKP2) gene in these patients. Methods ACM patients who attended cardiology outpatient department of our institute from January 2014 to April 2015 were included in the study. Their records were reviewed. Controls were randomly selected, who had no history or family history of cardiac illness and had a normal cardiac examination. A blood sample was also taken from both the groups for sequencing of exon 11 and 12 of PKP2 gene. ACM patients were followed up until July 2016. Results Eleven ACM patients and seven controls were included in the study. Most common mode of presentation was ventricular tachycardia (VT). Two patients had left ventricular (LV) systolic dysfunction. One patient had a splice site mutation in exon 12 of PKP2 gene and one patient died during follow-up. One of the controls had an intronic variation that has no pathogenic significance vis-à-vis ACM. Conclusion Our study describes various clinical parameters in ACM patients and a recessive plakophilin 2 mutation after a limited PKP2 gene sequencing.

Profile of Chronic Kidney Disease (CKD) patients presenting in a tertiary care center in north India

Background: Chronic Kidney Disease (CKD) is one of the most common causes of morbidity and mortality due to renal causes. There are multiple causes of CKD with diabetes, hypertension and chronic glomerulonephritis among the most common causes. All of these causes gradually lead to the final common pathway of End stage renal disease (ESRD). Chronic Kidney Disease (CKD) is defined as Kidney damage for ≥3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR or GFR <60 mL/min/1.73m2 for ≥3 months, with or without kidney damage. Aim: To study the profile of Chronic Kidney disease (CKD) patients presenting in a tertiary care center. Rahul Sudan, Mehroz Ahmed, Imtiyaz Ahmed Wani, Muzaffar Maqsood Wani, Khurshid Ahmed Banday, Gunjan Gupta. Profile of Chronic Kidney Disease (CKD) patients presenting in a tertiary care center in north India. IAIM, 2018; 5(8): 72- 80. Page 73 Materials and methods: This study was conducted at Sher I Kashmir Institute of Medical Sciences (SKIMS), a tertiary care center in Srinagar, Jammu and Kashmir, India, from July 2013 to January 2016. All the patients of CKD visiting our institute were enrolled in this study. This included patients on follow up at the Out Patient Department (OPD), patients presenting to emergency with complications of CKD, patients referred from other departments who were detected in initial stages of CKD during the routine investigations. A total of 300 patients were enrolled in this study. Results: In our study, a total of 300 patients were enrolled. CKD was more common in males. The most common aetiology of CKD was diabetic nephropathy which was seen in 102 patients (34%) followed by chronic glomerulonephritis seen in 80 patients (27%). Volume overload was the most common cause of morbidity in these patients. Patients in the initial stages of CKD were managed with symptomatic treatment and 230 patients (76.66%) received peritoneal dialysis at some stage of their management. It was in the stage of ESRD that patients were offered some definitive form of renal replacement therapy in the form of renal transplantation or hemodialysis. Out of 160 patients of ESRD, only 12 patients (7.5%) received renal transplantation and the remaining 148 patients (92.5%) were managed with hemodialysis. Conclusion: CKD is one of the leading causes of morbidity and mortality due to renal causes. The early stages of CKD which are managed by conservative methods gradually lead to the development of ESRD. It is therefore necessary to diagnose the patients of CKD in the early asymptomatic stages. At these stages it is feasible to slow down the loss of nephrons by controlling the underlying factors like diabetes and hypertension but once the stage of ESRD sets in, renal transplantation is the preferred modality of renal replacement therapy