Study of Prognostic Association of C-Reactive Protein (A Biomarker) with Clinically Important Predictors of Outcome in Stable and Unstable COPD Patients.

Background: COPD is characterized by persistent airflow limitation that is progressive and is associated with enhanced chronic inflammatory response in the airways to noxious particles or gases. It has both systemic and pulmonary effects. Since COPD deaths estimated to increase by 30% in next 10 years, cost of treatment will be a heavy burden on global economy. The costs are proportional to pulmonary and extra pulmonary components of the disease. Methods: In this study, we examined 100 patients of COPD, out of which 80 were stable and 20 were unstable. Results: CRP levels were found to be increased in cases more than in controls (13.55+10.83 vs. 2.07+0.82 mg/lit, p<0.001), the levels being higher in unstable patients than in stable patients (33.78+7.74 vs. 8.50+1.81 mg/lit, p<0.001). We also submitted the patients to MMRC dyspnoea scale and found that CRP is positively correlated with MMRC dyspnoea scale (r=0.638, p<0.001) and was inversely correlated with 6- minute walk distance (r= -0.364, p<0.001). There was a significant positive correlation of CRP with BODE index (r=0.780, p<0.001). Conclusion: The study is valuable in detecting the severity of COPD cases both in stable and unstable conditions and to forecast the future morbidity and mortality outcome of such cases.

Prevalence of Factors of Metabolic Syndrome in Adolescents and Adults in Urban and Rural Population around Jaipur.

Background: Metabolic syndrome (MetS) is a multiplex of metabolic risk factors including abdominal obesity, hypertension, atherogenic dyslipidemia and insulin resistance.The study is aimed to find causes and aetiological factors responsible for metabolic syndrome prevailing in and around Jaipur, both in rural and urban areas.Methods: It involves measurement of height, weight, blood pressure, fasting blood glucose, triglycerides and HDL levels. Results: In our study, overall prevalent rates of MetS in adolescents is 6.8% and in adults, it is 50.4%. According to present study, TGs, high blood pressure and low HDL were found to be major contributing factors for MetS in adolescents whereas in adults abdominal obesity contributed the most. Conclusion: These findings prove to be important tools to screen out MetS positive subjects because it is one of the leading risk factors of CVD, DM and stroke posing an emerging health problem to old and the new stressed out younger generation.

Prevalence of Thyroid Disorders in Type 2 Diabetes Mellitus.

Background: Diabetes mellitus and thyroid diseases are the two common endocrine diseases. Thyroid disorder is found commonly in most forms of diabetes and is associated with advanced age particularly in type 2 diabetes. The aim of the study is to know the prevalence and profile of thyroid disorders as assessed by thyroid hormone assay in hospital based cross section study in patients of type 2 diabetes mellitus and to know the prevalence of sub clinical hypothyroidism in type 2 diabetes mellitus and its effect on dyslipidemia in a rural setting. Methods: This is an observational, cross-sectional study done during the period from February 2013 to December 2014. Study population consists of 100 diabetic patients. Blood samples from all patients were collected in a standardized manner and were subjected for routine and special investigations including FBS, PP2BS, TSH, T3, T4. Fisher exact test was used for analysis of nominal variables presented in two (2×2) tables and chi-square test was used for distributions are presented in two by two tables. P-value<0.05 was taken as significant. Results: The prevalence of hypothyroidism was high in individuals with type 2 diabetes mellitus. It was 13% in this study and it was statistically significant. It was also concluded that subclinical hypothyroidism was more common in diabetics. Conclusion: Diabetes and thyroid disorders are co-related with each other. In patients of diabetes, subclinical hypothyroidism is commonly found.

A Clinical Study of Cardiovascular Dysfunction in Patients of Cirrhosis of Liver.

Background: Cirrhosis is a very common ailment in India mostly caused by alcoholism, viral hepatitis and malnutrition. The clinical picture of patients with cirrhosis is dominated by the classical complications such as ascites, bleeding from esophageal varices, portal hypertension and encephalopathy. Cardiovascular abnormalities have been reported by several investigators. Methods: It is a cross sectional study done on 60 patients admitted to NIMS Medical College, Jaipur between Jan. 2013 to Dec. 2014. USG of liver was done by GE Voluson promachine with probe frequency of 3.5 MHz and high frequency of 7-10 MHz for detection of cirrhosis and ascites with special reference to caudate lobe, portal vein and spleen. ANOVA with post hocTukey HSD was used for analysis of continuous variables whereas Chi-square test was used for nominal/ categorical variables. p value < 0.05 was taken as significant. Results: Diastolic dysfunction is measured by E/A ratio was prevalent LVED diameter, IV septal thickness, left ventricular posterior wall thickness were proportional to severity of liver cirrhosis. Electro physiologically, 38.33% patients of cirrhotic liver patients had prolonged QTc interval. Here, as far as cardiac abnormality were considered, we found QTc prolongation more in severe degree of cirrhosis MELD score III (7 out of 10) 70%, than moderate (40%) MELD score II and mild (20%) MELD score I of cardiac QTc prolongation. Conclusion: Diastolic dysfunction is a major criteria of cirrhotic cardiomyopathy which can be diagnosed by electro and echo cardiography

Effective High Dose Multi-Drug Treatment Regimen Favours Event Free Survival Rate in DCMP Patients.

Background: To study the effect of multidrug treatment regimen in the patient of DCMP (Dilated cardiomyopathy) compared to single drug/ low dose multi drug regimen. Methods: A total of 40 patients diagnosed with DCMP (both ischemic and non-ischemic) in the last 5 years attending to Cardiology OPD/ Inpatients in National Institute of Medical sciences, Jaipur were enrolled in the study. Out of 40 patients, 20 were kept on routine treatment regimens like diuretics, beta-blockers, angiotensinogen converting enzyme inhibitor/ Angiotensin receptor blockers (ACEI/ARB), either of them or all three of them in low dose. The other 20 patients were started on mineralocorticoid receptor antagonists (MRA’s), beta-blockers, ACEI all together with gradual increments of doses to a higher level. Both these groups were followed for 2 years and we found that patient groups with effective high dose multi drug regimen has good event free survival rate compared to traditional single drug /low dose multiple regimen. Tests of statistical significance were done using Chi-square Test. Results: Out of 20 patients in normal (routine treatment regimen) 12 patients presented with congestive cardiac failure (CCF) ,15 with dyselectrolemia ,10 with hypotensive episodes and 6 deaths were seen compared to 5 patients with CCF, 5 with dyselectrolemia, 8 with hypotension and 2 deaths were seen in high dose multi drug regimen. Out of this episodes of CCF (p=0.002), dyselectrolemia (p=0.001) are statistically significant. Conclusion: High dose MDR is preferable for event free survival rate in patients of DCMP.

A preliminary evaluation of comparative effectiveness of riluzole in therapeutic regimen for irritable bowel syndrome

Objective: To develop agents that are specifically effective in controlling the key disturbance of visceral hyperalgesia besides abating of associated multiple symptoms, and evaluate comparative effectiveness for IBS symptom relief for standard regimen (antispasmodic and probiotic) and add-on amitriptyine or riluzole regimens following two weeks administration.Methods:groups were studied. First group received standard treatment (mebeverine 200 mg twice daily and probiotic 200 mg twice daily). Second group received add-on amitriptyline 25 mg before bedtime, while the third group got add-on riluzole 50 mg twice daily. Overall gastrointestinal symptom rating scale improving symptoms and hospital anxiety depression scale improving associated psychological morbidity were employed as measures at induction and at two-week follow-up period. Individual symptom scores were also examined to define the outcome profiles.Results:108 patients with visceral hypersensitivity accompanying IBS, divided into three rating scale score, not the other two regimens. Pain relief was seen with both riluzole and amitriptyline regimens significantly superior to standard treatment regimen, but riluzole effect appeared specific and independent anxiolytic effect. Amitriptyline caused relief in diarrhea and did not benefit in constipation point to non-specific remedial role in IBS. Riluzole regimen resulted in significant reduction of overall gastrointestinal symptom Conclusions: Riluzole specifically relieves visceral hypersensitivity and is proved to be superior to current treatments in IBS patients. It appears a lead remedy based on glutamate transporter mechanisms in visceral hypersensititvity.