ABSTRACT
Background: There is paucity of data regarding the relationship between the severity of left ventricular dysfunction and renal function impairment in diabetic patients. Aims and objectives was to study the relation between eGFR and ejection fraction in type 2 diabetes mellitus of more than 5 years duration.Methods: This cross sectional was carried out from May 2017 to May 2018 at Yenepoya Medical college a tertiary care center in the southern Indian state of Karnataka. The data on 220 diabetic patients were studied. A detailed clinical history physical examination was carried out on the study population as per the approved proforma. Apart from base line investigations, eGFR was calculated using serum creatinine levels. 2D echocardiography was done for the assessment of ventricular function.Results: Out of 220 patients, 138 were men (63%) and 82 were women (37%) and the mean age of the patients was 59.60±11.145 years. The mean duration of diabetes was 10.08±5.28 years. We found a progressive reduction in ejection fraction from 57.74±9.97% to 50.64±14.7 as the eGFR declined from <90 mL/min/1.73m2 to 30 mL/min/1.73m2. There was significant correlation between eGFR and RWMA (p value 0.001) and LVDD (p value 0.029) in this study cohort. Micro/macroalbuminuria was found to be in 55% of patients. Proteinuria had significant correlation with longer duration of diabetes, blood urea, serum creatinine and eGFR.Conclusions: This study found positive clinical correlation between LVEF and eGFR. However, it did not reach significant levels statistically. Further studies may be carried out to confirm the association.
ABSTRACT
Objectives: To identify the factors associated with intestinal parasitosis in rural and urban school children of Kashmir. Methods: Single fresh stool samples from rural and urban school children in three age groups: a)5 to < 8 years ,b) 8 to <11 years and c)11-14 years were taken .Various demographic characteristics considered were source of drinking water, type of toilet used and social classes as per the Kuppuswamy social scale. Personal hygiene was assessed by the visiting physician based on length of nails, hair and frequency of bathing. Stool samples were analyzed for detection of motile forms of E. histolytica and microscopic examination under low power detected eggs of intestinal helminths. Concentration methods were used if egg count was low. Results: 274 stool samples from rural school children and 240 samples were taken from urban school children respectively. 214 (46.7%) students had stool tests positive for parasitosis. Ascariasis was the most prevalent parasitosis ( 28%) followed by Giardiasis ( 7%) , Trichuriasis( 5%) and Taeniasis( 4%). There was higher prevalence of parasitosis among rural orphanage children compared to urban orphanage students (76% vs. 48% p <0.05). Highest prevalence of 70% was seen in the age group 8-11years. Students using river/stream water had higher rates of parasitosis compared to those who were using tap water. 202 students were found to have poor personal hygiene and parasitosis was higher in them compared to students with good personal hygiene (p<0.05). Conclusion: Poor environmental sanitation, personal hygiene, type of toilet and water used were associated with recurrent intestinal infestation besides socio economic status. Regular deworming programmes need to be adopted at school level especially in 8-11 years old children to check the surge of intestinal parasites and their subsequent morbidities.
ABSTRACT
Upper gastrointestinal (UGI) endoscopy is an important diagnostic modality in evaluation of patients with upper gastrointestinal (GI) disorders. However, lesions located in the cricopharyngeal area and upper esophagus can be missed, as this area may not be well visualized during endoscopy. This study was conducted to study the utility of a new technique of endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire in diagnosing esophageal disorders. Patients with suspected upper esophageal disorders on history and radiological investigations were assessed using guide wire assisted endoscopic examination during withdrawal of the endoscope. In this technique, endoscope is inserted into the esophagus under vision and thereafter the whole of esophagus, stomach and proximal duodenum is examined. The endoscope is then withdrawn into the mid-esophagus, a guide wire is fed into the biopsy channel, and thereafter inserted into the esophagus. Once guide wire has been advanced into the esophagus, the endoscope is withdrawn gently over the guide wire into esophagus carefully examining for lesions in upper esophagus and cricopharyngeal area. Twenty cases of various abnormalities localized to the upper esophagus were studied. The final diagnosis in these patients was cervical esophageal web (10), post transhiatal esophagectomy leak (4), heterotopic gastric mucosa (3), posttraumatic esophageal perforation (2), and Zenker's diverticulum (1). Intact web was detected in 2 patients and in 8 patients fractured web was seen. Guide wire assisted examination of upper esophagus improved the ability to visualize and characterize these lesions and no complications were encountered as a result of this procedure. Endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire is safe and effective in diagnosing anatomical abnormalities of the upper esophagus that may be missed or poorly characterized during standard endoscopy.