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Introduction: Chronic renal failure, regardless of the cause, is the presence of kidney damage or a reduced level of kidney function for three months or longer. It is a group of signs and symptoms brought on by slow and long-term renal damage. The most frequent cardiovascular finding in people on dialysis is LVH. Objective: The study was conducted to estimate the prevalence of left ventricular hypertrophy and left ventricular diastolic dysfunction by echocardiography in patients with chronic renal failure. Method: This was an observational cross-sectional study at the Department of General Medicine among IPD patients, Tertiary Care Hospital, Surat. Result: Left ventricular hypertrophy out of 34 cases 22 (64.71%) cases were show left ventricular hypertrophy with an odd ratio of 3.208 (1.049, 9.81) and a p-value 0.0378 which was statically significant. prevalence of diastolic dysfunction was 79%. comparison of renal function test and echocardiographic change of chronic renal failure. In the renal function test serum, creatinine and EGFR were show a p-value < 0.001 which was statistically significant. Conclusion: Cardiac dysfunction and LVH are frequently noted in individuals with chronic renal failure at the time of commencement of dialysis. cardiovascular abnormalities in the form of LVH and diastolic dysfunction which antedate severe systolic dysfunction are frequently observed in milder degrees of chronic renal failure
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Background:Left ventricular diastolic filling patterns are altered in patients with sickle cell anaemia andthese diastolic abnormalities may be present in the absence of heart failure. These abnormal patterns suggest an intrinsic myocardial abnormality in patients with sickle cell anaemia andmay prove to be early markers of cardiac disease. The ventricles do not properly relax and become stiff meaning they cannot fill with blood properly.Methods:This study was carried out in tertiary health care hospital in western India, where homozygous sickle cell disease patients and age and haemoglobin matched controls were taken into cross sectional observational study design.Results:The mean values of E, A, E/A, IVRT, DT, AT, were in normal range in controls. In cases although the mean values of E, A, E/A, IVRT, DT, AT were in normal range, there were 19 cases of sickle cell anaemia who had significant alteration in indices of diastolic LV function from normal range. Out of these 20 cases with diastolic dysfunction, 11 cases had significant increase in (E) velocity from normal range with E/A ratio more than 2 suggestive of restrictive filling pattern of diastolic dysfunction while in 8 cases E value was less than normal with increase in (A) velocity and E/A ratio was less than 1 suggestive of impaired relaxation pattern of diastolic dysfunction. When indices of diastolic LV function were compared in cases and controls, mean early peak filling velocity (E) was significantly higher in cases. Conclusions:In present study, out of 37 cases 19 (51%) cases had LV diastolic dysfunction.Of these 19 cases with diastolic dysfunction, 11 cases had restrictive filling pattern and 8 cases had impaired relaxation pattern of diastolic dysfunction.
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A 42-year-old male patient who is a known case of DM and mucormycosison treatment presented with sudden onset difficulty in moving all 4 limbs followed by decreased depth of respiration for 4 hours. The patient was known case of DM for 10 years and was on OHA for the same, he had history of biopsy diagnosed rhino mucormycosis 4 months ago and was on treatment for the same. On initial examination the tone was hypotonic in all4 limbs along with power of 3+, respiration was shallow and patient was bedridden unable to stand on his own, he was ambulatory 6 days before presentingto hospital. Potassium-1.7 mEq/l, ABGA pH-7.18, HCO3-10 Meq/l, urine osmolality 220 mOsm/l, urine pH-7.0, potassium-to-creatinine rstio (K/Cr)-3.9 mEq/ml, urine K-22 mEq/ml. Distal RTA (dRTA) is the classical form of RTA, being the first described. DistalRTA is characterized by a failure of H+ secretion into lumen of nephron by the alpha intercalatedcellsof themedullary collecting ductof thedistalnephron.This failure of acid secretion may be due to a number of causes, and it leads to an inability to acidify the urine to apHof less than 5.3.This case study enumerates the potentially dangerous side effects of amphotericin B in patients which canprecipitate RTA type 1 leading to severe hypokalaemia and acidosis, thus all patients receiving amphotericin B should be cautiously warned regarding side effect of hypokalaemia and prophylactic potassium syrup supplementation may be given in predisposed patients.
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Background:In India, the national prevalence of diabetes mellitus (DM) is estimated at 18.2%. More than half of all diabetic deaths are accounted for by atherosclerotic disease leading to cardiovascular or cerebral complications. Intima media thickness (IMT), a measure of atherosclerotic vascular disease. It can easily be measured especially at the carotids by B mode ultrasonography, a relatively simple way representing a safe, precise, and reproducible measure. It has therefore been proposed as a non-invasive measure of predicting chances of cerebrovascular disease burden in adults. Methods:A total of 60 subjects in the age group of 30-75 years (M:F=37:23) were selected and divided into three groups, group C: Patients of either sex in the age group of 30-75 years with type 2 DM (T2DM) with or without hypertension with ischemic stroke demonstrated on CT scan. Group B: Age-matched T2DM patients of either sex without any prior history of transient ischemic attack or stroke. Group A: Age-matched normal individuals of either sex. The following groups of diabetic patients with stroke were excluded from our study: cardioembolic stroke, patients with hemorrhagic stroke, and patients with stroke due to secondary causes like trauma, impaired coagulation or tumor.Results: Average mean common carotid artery IMT (CCA-IMT) ranged from 0.72 to 0.97 mm across cohorts in people with diabetes.Patients with T2DM with ischemic stroke were found to have significantly higher prevalence of increased CIMT and a value greater than 0.8 mm was found to be associated with the occurrence of stroke. The mean CIMT was significantly higher in diabetic subjects compared to healthy subjects.Conclusions: A high CIMT is a surrogate and reliable marker of higher risk of cerebrovascular accidents amongst type 2 diabetic patients. Our study demonstrates the utility of carotid IMT as a simple non-invasive screening test for the assessment of atherosclerosis risk/prognosis in T2DM.
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Background: After acute myocardial infarction (MI), a patient's prognosis is closely related to the extent of irreversibly damaged myocardium. The evaluation of infarctsize after acute MI (AMD) is important for predicting the subsequent clinical course. Cardiac troponin I (cTnl) is accepted as a highly reliable biochemical marker for detecting myocardial damage, and its use in the diagnosis of acute MI (AMI) is increasing. Its concentration is unaffected by thrombolysis after the first12 hours, following which it shows a stable plateau for about 48 hours.Methods: This study investigated the value of a single cTnl concentration, estimated 12-48 hours after admission, to provide an integrated measurement of the degree of cardiac damage following first acute MI, and its correlation with left ventricular ejection fraction (LVEF). This study of troponin I measurement after acute MI and its correlation with LVEF was conducted during the period between October 2019 and October 2021 at SMIMER hospital, Surat. Results: This study shows a strong negative correlation between cTnI concentration measured between 12-48 hours post MI and echocardiographic LVEF. It was also found that cTnl concentration more than 3.8 ng/ml is a sensitive (100%) and specific (78.12%) indicator of LVEF <40% after a first acute MI. It can be considered as a significant prognostic marker.Conclusions:In conclusion, cTnl shows excellent promise as a marker of infarct size, and for the assessment of LVEF; and may potentially replace the CPK-MB as the cardiac specific marker for AMI detection.