Treadmill test as a screening tool for detecting silent myocardial ischemia in type 2 diabetes patients: a case control study from Raipur, Chhattisgarh, India

Background: The incidence of diabetes mellitus (DM) is increasing substantially worldwide. CAD silently progresses over years in the diabetics. Diabetic individual appears to be less able to perceive some of the symptoms and signs of ischemia or may have asymptomatic ‘classic silent ischemia’. Thus, screening for early detection of asymptomatic CAD in type 2 diabetes may be helpful to prevent these catastrophic cardiac events and consequent deaths. Objectives of the study was to assess utility of TMT in Type 2 diabetic mellitus subjects to detect silent myocardial infarction.Methods: Hospital based observational analytical case control study was conducted in Department of Medicine in Dr BRAM Hospital Raipur during August 2016 to September 2018. Cases were 45 subjects of Type 2 Diabetes mellitus with normal ECG and controls were 45 subjects of Type 2 Diabetes Mellitus with abnormal resting ECG. Data analyzed using SPSS 17 version.Results: Majority i.e. 40% were found to be in fifth decade of their life. 71 (78.9%) male subjects and 19 (21.1%) female subjects. TMT was found positive in 8(17.8%) subjects with positive ECG changes whereas in 12(26.7%) subjects with no ECG changes. No significant difference was noted between distribution of any parameters except for hypertension which was found to be significantly higher in TMT positive subjects compared to TMT negative subjects.Conclusions: No significant difference was observed regarding TMT findings between T2DM subjects with and without ECG changes. Type 2 diabetes mellitus subjects with dyslipidemia, and hypertension are at higher risk of Positive TMT.

Confusion, blood urea, respiration and blood pressure 65, pneumonia severity index and shock index and hypoxemia scores in community acquired pneumonia and outcome prediction: a descriptive study from Dr B R Ambedkar Memorial Hospital Raipur, India

Background: According to WHO, pneumonia is the third important cause of death worldwide despite various advances in medical science. Incidence of Community acquired pneumonia is about 20% to 30% in developing countries compared to 3% to 4 % in developed countries. Incidence of CAP is much higher in the very young and the elderly individuals. Objectives of the study was to compare CURB 65, PSI (Pneumonia severity index) and SIPF (shock index and hypoxemia) scores with respect to outcome prediction in community acquired pneumonia (CAP).Methods: The present hospital based descriptive observational study was conducted in the Dept of medicine, Pt. J.N.M. Medical College and Dr B. R. A. M. Hospital, Raipur, during 2016-2018 involving a total of 98 patients of community acquired pneumonia.Results: Majority of them i.e. 22 (22.4%) subjects belonged to age group 41-50 years. 34 (34.7%) subjects were found to have CURB65 score 1. 28(28.6%) subjects PSI score was noted to be class I. 89 (90.8%) subjects were discharged while, there was death of 9 (9.2%) subjects. The difference in the mean score was statistically significant (p<0.001). PSI score was found to have diagnostic sensitivity of 94.4% and specificity of 100% while CURB 65 score having 83.1% sensitivity and 100 % specificity. SIPF score had least AUC 0.88.Conclusions: Maximum diagnostic ability was noted with PSI score followed by CURB 65 and SIPF score.

Study of serum cobalamin level in vegetarian v/s nonvegetarian geriatric individuals.

Background: Vegetarianism is found in all geographic areas, they may have lower B-12 levels than nonvegetarian; problem could be graver in elderly. This study intended to recognise geriatric individuals with B-12 deficiency so as to save them from anaemia, dementia & neuropsychiatric disturbances by timely recommendations for supplementation. Methods: Current study was conducted on 200 healthy attendants divided in to two groups- A comprised of 100 vegetarian and B of 100 nonvegetarian geriatric individuals (> 60yrs.), they had no previous chronic disease and an attempt was made to exclude diabetes mellitus, hypertension, chronic gastritis, hypoplastic & aplastic anaemia. Those with history of alcohol intake, PPI therapy & regular vitamin supplementation were excluded. Complete clinical examination and routine blood tests were done. Serum cobalamin level was determined by ACCU-BIND ELISA Microwells method. Results: Total of 58 vegetarians were found to be B-12 deficient compared to 42 normal (>350pg/ml) this was statistically significant. Out of 100 nonvegetarian 48 were deficient while 52 had normal levels this too was statistically significant. On comparing the vegetarians and non vegetarian groups significant result was obtained (p <0.01). When different age groups were statistically compared insignificant result was obtained, same was true for gender distribution. Statistically significant result was obtained on comparing vegetarian Vs nonvegetarian group. Conclusions: Irrespective of the dietary habit B-12 deficiency is prevalent in elderly, as 58% of vegetarian & 48% of nonvegetarian were found B-12 deficient, detailed dietary analysis revealed that majority of them consumed nonvegetarian food only occasionally. No significant effect of increasing age & gender was found on B-12 levels in either group. Every elderly vegetarian or non vegetarian irrespective of gender should get their B-12 levels checked & if found low should receive B-12 supplemennt.

Evaluations of soil Fertility Status of Available Major Nutrients (N,P & K) and Micro Nutrients (Fe, Mn, Cu & Zn) in Vertisol of Kabeerdham District of Chhattisgarh, India.

Grid based (GPS) surface (0-15 cm) soil samples by systematic survey were collected from 4 blocks, 84 selected villages in Kabeerdham district were 297samples identified from Vertisol. These soil samples were analyzed for N,P and K and Fe, Mn, Cu and Zn andcategorized as low medium and high as per criteria fallowed in the soil testing laboratory. Based upon the coefficient of correlation between macronutrients& micronutrient and soil properties, a significant and positive correlations observed was between soil pH and available N, P and K. Electrical conductivity exhibited significant and positive relationship with available N, P, K and organic C showed significant and positive correlation with available N and K.

Pitfalls in diagnosis of epilepsy of Janz and its implications.

84 patients of juvenile myoclonic epilepsy (JME) of Janz were studied. Diagnosis was confirmed using clinical and electro-encephalographic (EEG) criterias. 58 (78%) patients of JME were referred as 'refractory or uncontrolled seizures'. Ignoring myoclonic episodes and non-use of activation procedures in EEG were important reasons for diagnostic delay. Sodium valproate (VPA) or clonazepam are the drugs of choice while phenobarbitone (PB), carbamazepine (CZ), and phenytoin (PHT) are ineffective. Clinical spectrum of JME is slightly different in India. Family history of epilepsy or JME is not forthcoming and there is gross delay in the diagnosis. Other differences include age of presentation and mild cognitive impairment. All juvenile patients of generalized epilepsy, not responding to more commonly used CZ, PB and PHT should be strongly suspected for JME by carefully searching for myoclonus.

Effect of common anti-epileptic drugs on cognition in schoolchildren with epilepsy.

This study was conducted to observe the effect of some commonly used anti-epileptic drugs (AEDs), on cognition, in 118 school going children with epilepsy, in an age range of 9-12 yrs., (Mean 10.4 +/- 1.7 yrs.). For comparison, 28 healthy, age and sex matched schoolchildren served as controls. After a clinical, electrophysiological and radiological evaluation, the cognitive functions were assessed in both groups, using a modified Wechsler's Intelligence Scale. It was observed that cognition was impaired in only 2.5% of children with epilepsy, there being no relationship between cognitive performance and the type of AED used. It is concluded that cognitive functions are impaired in only a limited number of children with epilepsy and effect of phenobarbitone and phenytoin on cognitive functions is comparable to carbamazepine and sodium valproate, particularly when demand of task is not very high.

Neonatal mortality in Meerut district.

A study of neonatal mortality in Meerut district revealed an infant mortality rate of 50.1 per 1000 live births. Neonatal mortality accounted for 37.8% of infant mortality with a neonatal mortality rate of 19.0 per 1000 live births. 90.5% of these neonates were delivered at home largely by untrained personnel (57.2%). Only 28.6% of these neonates were treated by qualified doctors and only 30.9% of their mothers were fully immunized against tetanus. At least 2/3rd of neonatal mortality was due to exogenous factors with tetanus neonatorum and septicaemia being the principal causes of mortality each accounting for a mortality rate of 4.7 per 1000 live births.

Socioeconomic factors and prevalence of endemic goitre.

The present study was conducted on 2611 school children of a rural area of Meerut, with the objectives to find out the prevalence and distribution of endemic goitre and the socioeconomic variables associated with the distribution of the endemic goitre. Grading of goitre was done as per the criteria laid down by the WHO-1979 (1). The overall prevalence rate of endemic goitre was 50.1%, the prevalence was more among females (55.1%) as compared to males (47.2%). Maximum number of goitre cases were having grade Ia enlargement (46.9%) followed by grade Ib (34.1%), grade 2(15.0%) and grade 3 (4.0%). Prevalence increased with increase in age. Statistically significant differences were found in the prevalence of endemic goitre in relation to different religions and caste groups, different occupations of the parents/guardians of children and types of houses used for the purpose of living.

Respiratory disorders in females of Delhi.

A retrospective study was carried out on 1532 female patients attending chest clinic, over a period of 13 years. The incidence of smoking was found to be 6.6%, maximum incidence (17%) being in those above 60 years of age. High incidence (66%) of exposure to kitchen smoke was observed in women above 40 years of age. Chronic bronchitis was found to be the commonest illness followed by bronchial asthma, pulmonary tuberculosis and bronchiectasis. Bronchial asthma and pulmonary tuberculosis were common in younger age groups, while above the age of 40 years 42% patients had chronic bronchitis and 27% had bronchiectasis. Incidence of smoking and exposure to kitchen smoke was also high in this subset. This shows that they may be important contributory factors for chronic obstructive pulmonary disease in females. Evidence of chronic cor pulmonale was found in 130 (8.5%) patients. Maximum incidence (28%) was seen in the age group of above 60 years. Chronic bronchitis with or without emphysema turned out to be the commonest cause of cor pulmonale, followed by bronchiectasis, pulmonary tuberculosis and bronchial asthma.

Diabetes mellitus in geriatric females.

A study was carried out on 36 geriatric diabetic females (above 60 years). Marked exhaustion and significant loss of weight were common presenting complaints (60%) besides usual symptomatology. Only 25% patients were asymptomatic for diabetes. Generalised itching (20%) and pruritus vulvae (33.3%) were other common presenting complaints. Neuropathy was found to be the commonest complication being present in 77.7% patients, followed by retinopathy (50%) and nephropathy (27.7%). Hypertension was found to be associated in 44% patients and evidence of ischaemic heart disease was found in 42%. Development of nephropathy, retinopathy, neuropathy, and hypertension showed direct correlation with duration of illness ie, longer the history of diabetes higher was the incidence of complications.