Gall bladder ejection fraction as a marker of autonomic neuropathy in type 2 diabetes mellitus

Background: Diabetic neuropathy is one of the commonest complications of diabetes mellitus and associated with considerable morbidity and mortality. The influence of diabetes on gall bladder function was not demonstrated in many studies. In this study, the association of fasting gall bladder volume and gall bladder ejection fraction with degree of cardiac autonomic neuropathy was assessed and correlated with duration of diabetes and severity of diabetes..Methods: The study was conducted in Government Sivagangai Medical College Hospital, Sivagangai, Madurai during a period of January 2018 to September 2018 as a Prospective observational study conducted among 100 patients in study group and 50 healthy subjects in control group. The aim of the study was to find out the incidence of autonomic neuropathy in study group by simple bed side tests, to determine the fasting gall bladder ejection fraction in diabetics, comparison of gall bladder volume in both study and control group, correlation of gall bladder ejection fraction with autonomic neuropathy.Results: The incidence of CAN is found to be high with longer duration of the disease and the degree is also correlated with duration of the disease. The correlation coefficient of this association is 0.792 which indicates high correlation. The correlation of severity of DM   with incidence and degree of CAN was 0.81 which indicates high correlation and also the study showed an increase in the FGBV and a decrease in the GBEF with increase in the severity of cardiac autonomic neuropathy.Conclusions: In patients with type 2 diabetes mellitus, the gall bladder ejection fraction is  significantly  related  to  the  duration  of diabetes mellitus and degree of hyperglycemia in addition to cardiac autonomic neuropathy(CAN). Similarly,  fasting  gall  bladder  volume (FGBV)  is  significantly increased  in  type 2  diabetes  mellitus  patients  with  cardiac autonomic neuropathy.

Serum uric acid level in type 2 diabetes mellitus

Background: Diabetes mellitus is the most important risk factor associated with two to four fold increased incidence of coronary artery disease. The major risk factors for CAD are hypercholesterolemia, hypertension, diabetes mellitus, and cigarette smoking Objectives: To study the level of serum uric acid in type 2 diabetes mellitus and the correlation between elevated serum uric acid level and the component of metabolic syndrome like obesity, hypertension, dyslipidemia.Methods: The study was done as descriptive analytical study among the diabetic patients in a tertiary care setting during the period January 2018 to February 2019. The inclusion and exclusion criteria were clearly defined and the study participants were recruited for the study after getting the informed consent. The socio demographic profile, clinical and laboratory data were collected from the blood sample obtained from the patients with the standardized procedures. Data was entered in Microsoft excel spread sheet and analyzed statistically using SPSS statistical software. Student ‘t’ test and Chi-square test values were applied for significance.Results: Serum uric acid in the study population and control varied from 3.0 to 8.1 and 2.7 to 5.5 mg/dl respectively. The mean and standard deviation of uric acid among cases was 5.08±1.42 while in control it was 3.55±0.62 respectively. The serum uric acid level of diabetics was very much elevated compare with controls and it was highly significant. Significant correlation was noticed between serum uric acid and BMI as well as WHR. Elevated uric acid levels were significantly noticed among those with hypertension, dyslipidemia, coronary artery disease and chronicity of the diabetes.Conclusions: Uric acid was significantly elevated in diabetic population and the mean value of serum uric acid level was higher in longer duration of diabetes, hypertension, dyslipidemia, central obesity which are the components of metabolic syndrome.

A study on serum lipid and malondialdehyde levels among diabetic patients

Background: Elevated levels of lipid peroxide in diabetes mellitus may be due to the alteration of function of erythrocytes membrane. This inhibits the activity of superoxide dismutase enzyme leading to accumulation of superoxide radicals which cause the maximum lipid peroxidation and tissue damage in diabetes. The objectives was to study was done with the objectives of assessing the serum lipid and malondialdehyde levels among diabetic population and matched control group.Methods: This study was done among 50 NIDDM, 50 IDDM and 50 controls at Thanjavur Medical College, Tamil Nadu, India for a period of one year at the Department of Diabetology after getting the informed consent and IEC clearance. This study included all ambulatory NIDDM and IDDM patients without any complications. The following investigations like serum malondialdehyde, blood sugar, HBA1C, serum lipid profile, blood urea, serum creatinine, urine albumin and sugar were done by standardized procedures and reagents after getting the detailed history and examination.Results: Among NIDDM group 78% were between 6.4 to 8 categories whereas in IDDM group only 28% were in this 6.4 to 8 category (HBA1C). Comparison of serum MDA values among three groups were done by ANOVA with two groups separately and it was highly significant. Multiple comparison of mean difference of MDA and lipid values among all the three groups showed statistically significant results with p value at 0.05.Conclusions: Lipid profile is increased in poor glycemic controlled patients (both IDDM and NIDDM patients) and it is reflected in high serum malondialdehyde levels.

A study on the clinical spectrum and electrocardiographic changes in scorpion sting envenomation

Background: Scorpion stings, though not a big problem in many developed countries, it is a major public health problem in underdeveloped and in some developing countries all over the world. Objectives was to study on the clinical spectrum and electrocardiographic changes in scorpion sting envenomation.Methods: This study was conducted in a tertiary care institute after obtaining the IEC clearance and informed consent from the patients for a period of 6 months from January 2018 to June 2018. All the patients admitted to the toxicology ward and general ward with scorpion envenomation during the study period were included in the study. A total number of 53 cases of scorpion envenomation and 20 healthy patients from the outpatient department of General medicine, were taken as controls.Results: Fifty-nine percent of the patients presented with Grade 1 envenomation, seven percent with Grade 2 and thirty four percent with Grade 3 envenomation. Local pain (83%) and tachycardia (19%) were the commonest presenting symptom and sign respectively. Sinus tachycardia (6%) was the commonest ECG abnormality seen in the study. There was statistical significance in the relationship between ECG change and biochemical marker CK-MB.Conclusions: Scorpion envenomation in adults needs to be studied to identify the high-risk groups and to assess the morbidity caused it. There was no mortality due to scorpion sting in the study period and significant correlation between the time delay and severity of envenomation was found which indicates a need for immediate medical care following scorpion sting.

Selfie addiction: the prodigious self-portraits

Background: Selfie’s are self-portrait taken to admire the excessive pride in one’s own appearance. When these selfies are taken persistently in increased numbers with futile efforts to stop taking them is called as “SELFIE ADDICTION”. There is an uncontrollable craving for taking selfie’s which has a great impact on the life style modifications substantially in the adolescent age group. This problem has just commenced but it has disseminated rapidly to a greater magnitude.Methods: This study was done as a community based cross sectional study at Pondicherry, Chennai and Kadaloor district during November 2015 and February 2016 with the objectives of assessing the prevalence and its risk factors of the Selfie addiction among adolescents. Individuals of adolescent age group were randomly selected and the data were collected using direct questionnaire method with proper informed consent. The data was entered in MS excel sheet and analysis was done using SPSS software.Results: A total of 766 college students were interviewed of which 53% were males with the mean age of 19 years. The purposes of taking selfies were time pass (46%), to admire themselves (14.5%), to post in social network sites (23.7%). Among the study participants 87% of them had the habit of taking selfies regularly using mobile phones and the number of selfies per minute varied from 2 to 10 per minute. The prevalence of selfie addiction was present among 111 (14.5%) and it was significantly associated with gender, higher version mobile phone users, early morning selfie takers, chronic mobile users.Conclusions: The prevalence of selfie addiction among adolescent population in our study was moderately high and hence interventions should be made to create cognizance among the general population about the risk factors and its consequences.

Prevalence and commonest predictors of gestational diabetes mellitus: a cross-sectional study

Background: Babies born to mothers with GDM are at increased risk of complications, primarily growth abnormalities and chemical imbalances such as hypoglycemia, GDM is a reversible condition and women who have adequate control of glucose level scan effectively decrease the associated risks and give birth to healthy babies. The objective was to estimate the prevalence and the predictors of gestational diabetes mellitus.Methods: This study was conducted as a cross sectional study among the antenatal mothers at the outpatient department of the rural and urban health centers of the KG hospital and PG institute and its affiliated centers in Coimbatore. The study period was one year and during which 150 antenatal mothers participated in the study.Results: The prevalence of GDM was 76 (9%) and 74 (11%) in rural and urban health centers respectively. The maximum number of GDM Mothers to be 26-30years of age with a peak indicating 42% and 39% of GDM mothers were found to be in primigravida, 48% of GDM mothers were primipara. About 65% of GDM pre-pregnant mothers were overweight according to BMI, 53% of GDM mothers had positive family history of DM. Majority of the study population 100 (67%) had HBA1C less than 6% and the remaining 50 (33%) had more than 6% value. The variables like age, gravida, parity, family history of diabetes, pre-pregnant BMI, history of PCOS, history of hypertension, history of hypothyroidism was compared with the glycaemic status (HBA1C values) and it was found to be statistically significant at P<0.05.Conclusions: The commonest risk factors which increases the incidence of GDM were family history of diabetes mellitus, overweight pre-pregnant BMI, history of PCOS, hypothyroidism, increasing gravidity and parity respectively.

Diagnostic utility of heart type fatty acid binding protein (H-FABP) versus cardiac troponin I in myocardial infarction

Background: Acute myocardial infarction (AMI) management is one of the therapeutic challenges faced by the emergency physician. In the field of investigational cardiology advancements, the search of superior cardiac biomarkers has led to the discovery of sensitive biomarkers which help in the early confirmation of MI as timely intervention is the primary goal in acute coronary syndrome (ACS). Present study was aimed to evaluate the diagnostic performance of the novel biomarker H- FABP in patients with AMI especially in ST elevation MI (STEMI) and comparison of its diagnostic accuracy with the other biomarkers.Methods: We studied 66 patients with persistent STEMI presenting within 12 hours of symptom to the department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Puducherry. Quantitative and qualitative estimation and analysis of serum biomarkers of acute myocardial infarction such as CK-MB, cardiac Troponin I (cTnI) and H-FABP were done.Results: The sensitivity and specificity of H-FABP were 80.7 and 88.9% respectively. The positive percentage of the serum biomarkers among these patients were 64%, 65%, 86% for CK-MB, cardiac troponin I, and H-FABP respectively. The area under the curve was observed to be 0.695, with 95% confidence interval (0.514-0.876) at the optimum cut-off value of 7.0ng/ml for H-FABP.Conclusions: H-FABP the novel biomarker, because of its early appearance in the blood stream and due to its superior sensitivity and specificity compared to Troponin I and CK-MB can be used in the early diagnosis of acute ST elevation Myocardial Infarction

Cholesterol levels: the prognostic significance in ICU patients

Background: Snakebite envenomation is an important public health problem faced by the tropical countries with India, the worst affected in terms of mortality and morbidity. In spite of increasing reports of other snake species causing envenomation, the existing research and management strategies including antivenom are still focused on the “Big Four” species- Russel’s viper, saw scaled viper, common krait and spectacled cobra. Pit vipers as a group are being increasingly reported to cause human bites from different parts of the country. Hence, we decided to study the clinico-epidemiology of pit viper bites.Methods: 30 cases of proven pit viper bites who attended our Department during the study period of 18 months were analysed for the epidemiological factors, clinical features and abnormalities in laboratory parameters.Results: Hump nosed pit viper (Hypnale hypnale) was responsible for all the thirty cases. 57% of cases were females. Mean age of victims was 41.8 years. 17 patients had exclusively local envenomation. Ten cases had coagulopathy along with local envenomation. Three patients developed acute kidney injury of whom three underwent dialysis. No mortality was observed in the study. Low fibrinogen levels were observed in all cases with coagulopathy and some had low levels of factor V (70%) and factor VIII (40%).Conclusions: Hump nosed viper bites were observed to be common in this part of the country. Significant envenomation can occur. Further epidemiologic studies involving more centres will be helpful in quantifying the true incidence of bites. Since no specific antivenom is available, further researches in this direction are warranted.

Fibrodysplasia Ossificans Progressiva with Rare Familial Inheritance Pattern: A Case Series.

Fibrodysplasia ossificans progressive (FOP)also termed as “stone man syndrome” is an autosomal dominant disorder manifested in the form of congenital malformation of the great toes with progressive ossification of the skeletal muscle and soft tissues in a specific pattern. It is a rare disorder, usually as sporadic and isolated and very few cases have been reported. Often FOP is missed or diagnosed very late, both of which leads to rapid progression and reduced life expectancy. We report first of such a case series in India with the hereditary transmission in a family, affecting 3 persons. Our index case was the first daughter 17 years female who presented with stiff joints, worsening over time and her father 45 years male was also affected with his major joints fused in different positions, and her younger sister 13 years female was in the early stage of disease. Further investigations such as serum calcium, phosphorous, X-ray, computed tomography, and bone scan confirmed it as cases of FOP. We present our detailed study of the interventions, their effectiveness, the role of drugs given to reduce symptoms in FOP, and this would aid the physicians and healthcare workers to suspect/diagnose the disease.

Fast food addiction – The junk enslavement.

Research question: What extent do we crave for fast foods Background: Fast foods are consumed in larger quantities intended with persistent desire or futile efforts to minimise or to cease the intake of these items; hence it is called as “FAST FOOD ADDICTION”. Nowadays, there is an uncontrollable craving for excess of quick foods that has lead to significant life style modifications in the society regardless of the age group. In spite of quantum of this problem, there are very few studies from India investigating the addiction towards fast foods. Material and methods: This study was done as a community based cross sectional study at the outskirts of Chennai, India during November 2013 to January 2014 with the objectives of assessing the prevalence and its risk factors of the quick food addiction among adults. Individuals of adult age group were randomly selected and the data’s were collected using direct questionnaire method with proper informed consent. The data was entered in MS excel sheet and analysis was done using SPSS software. Results: Total 541 study participants were interviewed of which 58.8% were males with the mean age of 26 years. Among the study population 82.8% belonged to nuclear family and 65.1% were from class I socioeconomic status. The prevalence of quick food addiction was 30% (160). About 49.2% of people liked KFC as their favourite quick food place. Fast food addiction was significantly associated with male gender (p=0.02), professionals (p=0.000), unmarried (p=0.000), who enjoys quick food (p=0.014), KFC (p=0.003). Conclusion: The prevalence of fast food addiction among adult population in our study was moderately high and hence interventions should be made to create cognizance among the general population about the risk factors and consequences in consuming large amount of fast foods.