Study of cardiac manifestations in patients with chronic liver disease

Background: Chronic liver disease is a common cause of mortality and morbidity worldwide. This has pathological effects on various systems in the body including cardiovascular system which usually is unnoticed. In majority of cases of chronic liver disease, cardiovascular complications develop as a subclinical condition which manifests only during stressful situations. Hence early detection of cirrhotic cardiomyopathy by echocardiography and 2D-ECHO studies in all patients of chronic liver disease helps in reducing the morbidity and mortality.Methods: 100 cases of chronic liver disease were included in the study. Data was collected through a prepared proforma. All patients were subjected to cardiac evaluation by ECG and Echocardiography. Serum pro-BNP levels were done for selected patients. Severity of the liver disease was assessed by using Child-Pugh score. Cardiac abnormalities were noted and correlated with the severity of the liver disease.Results: Out of 100 patients studied, 83% were males. 80% of the patients had history of alcoholism. 59% of the patients had abnormal ECG finding. 40% of them had QT prolongation and was related to the severity of liver disease. 60% of the total patients studied had positive pro-BNP values in patients with significant cardiac dysfunction. 46% of the patients had normal echocardiographic finding; most common abnormal finding was diastolic dysfunction (43%) and positively correlated with severity of liver disease.Conclusions: In chronic liver disease patient’s QT prolongation is the most common ECG abnormality. Most common Echocardiographic finding was diastolic dysfunction which had strong correlation with the severity of the liver disease.

Rare cause of pathological fracture in adults as hypophosphatemic rickets

Hypophosphatemic rickets is a disorder of defective bone minerlization due to defect in renal phosphate handling process. It is characterised by increased phosphate excretion accompanied by increased phosphatonins like fibroblast growth factor 23. It can be hereditary form of X linked, autosomal dominant, autosomal recessive type of hypophosphatemic rickets. It is associated with low serum phosphorus, normal serum calcium, inappropriately low to normal vitamin D level. Correct identification of these disorders is important for determining therapy. Early diagnosis and management prevent subsequent complication of the disease.

Depressive symptoms in type II diabetics of a tertiary care hospital in southern India

Background: International diabetes federation has highlighted that 搕he diabetic epidemic is here and threatens to overwhelm health systems if unchecked拻. The global prevalence of diabetes among adults has risen from 4.7% in 1980 to 8.5% in 2014. India unfortunately tops the list of countries with the largest number of people living with diabetes. Diabetes and depression are independent risk factors for one another and both are associated with increased risk of cognitive decline. Prevalence of depression is doubled in Diabetes mellitus, and also appears to vary by type of Diabetes mellitus, race/ethnicity, and duration of diabetes and associated debilitating complications and co-morbidities. Various studies using different methodology have revealed varying prevalence of depression. Data on this association of Diabetes and depression is limited in Indian context.Methods: This is a cross sectional study conducted on type 2 Diabetics attending outpatient department of Victoria and Bowring and Lady Curzon Hospital. Data regarding duration and treatment of diabetes, HbA1c levels and associated comorbidities were collected along with basic particulars of the patient. Becks depression questionnaire were used for analyzing the depressive symptoms.Results: A total of 302 diabetic patients were included in the study, out of which Males were 156 and Females were 146. Severe depressive symptoms were found in 18.21% of diabetics, and moderate depressive symptoms were found in 39.74% of study population. It is also found that the significant predictors of these depressive symptoms are increasing age, longer duration of diabetes, treatment intensity.Conclusions: In conclusion depressive symptoms are more common in diabetic subjects compared to non-diabetic population. Especially this increases with duration of diabetes and uncontrolled sugars. Hence there is a need to screen all diabetes subjects for depression.