Study of Risk Factors for ST Segment Elevation Myocardial Infarction and it’s Correlation With Thyroid Functions Profile

Background:To assess the occurrence of risk factors in patients with STEMI with special reference to Thyroid functions and Thyroid profile (Hypothyroidism/ Hyperthyroidism). Methods: A total of 140 patients diagnosed with ST segment elevation myocardial infarction (STEMI) admitted to ICU/CCU of NIMS Medical College & Hospital over the period of 18 months (june 2016 - november 2017) will be included in the study and subsequently evaluated for presence of risk factors and thyroid dysfunction. Majority of subjects belonged to rural areas located near to the hospital of either sex above the age of 18 years. On the basis of history, clinical examination, inclusion and exclusion criteria of the study, subjects were selected. It is an observational cross- sectional study. Statistical analysis were done using Fisher test, student ‘t’ test and Chi-Square test. ‘p’ value less than 0.05 is taken as significant. Results: Out of 140 patients with STEMI, 20 patients had thyroid dysfunction while 120 patients had euthyroid status. Subclinical hypothyroidism were reported in 12 (8.6%) patients while Hypothyroidism were noticed in 4 (2.9%) patients. Subclinical hyperthyroidism and Hyperthyroidism were observed in 3 (2.1%) and 1( 0.7%) patients, respectively. Out of 140 patients with STEMI, 2 patients with euthyroid status died while 8 patients with thyroid dysfunction died with p=0.001 which was statistically significant Conclusion: Thyroid dysfunction significantly increases relative risk of mortality as compared to euthyroid function in patients with STEMI.

Prevalence of Hyperuricemia and Microalbuminuria in Prehypertension.

Background: Many studies in the past have revealed the prevalence of hyperuricemia and microalbuminuria in hypertensive individuals and both are the well known markers of end organ damage. But there are very few studies which have demonstrated the prevalence of hyperuricemia and microalbuminuria in prehypertensive individuals in Indian clinical scenario so that we can identify the prehypertensive individuals at risk of subclinical organ damage by simply measuring these parameters. Objective: To study the prevalence of hyperuricemia and microalbuminuria in prehypertension. Methods: Study was done on both male and female prehypertensive patients of age more than 18 years and less than 60, admitted in wards and attending OPD under the Department of Medicine, NIMS Hospital, Jaipur. Controls were normotensive patients admitted in wards who were matched for age, sex and confounding factors. Results: Hyperuricemia was found in 47(15.67%) patients with prehypertension compared to 29(9.67%) patients with normal BP .Microalbuminuria (quantitative) was found in 51(17%) patients with Prehypertension compared to 31(10.33%) patients with normal BP. The study showed that subjects in prehypertensive group had serum uric acid values distributed more widely in the IIIrd and IVth quartiles than in the Ist and IInd quartiles, whereas subjects in control group had serum uric acid values with greater distribution, in the Ist and IInd quartiles than in the IIIrd and IVth quartiles. Conclusion: We found that microalbuminuria and hyperuricemia are significantly more prevalent among prehypertensive subjects as compared to normotensive subjects so that measurement of these parameters can serve as low cost, accurate & reliable clinical tool to identify prehypertensive patient at higher risk of subclinical target organ damage.

Diabetes Mellitus Type II: Correlation between HBA1C Level and Left Ventricular Diastolic Dysfunction.

Background: Diabetes is a metabolic disease which affects various organs of the body like heart, eye, kidney, skin and peripheral nerves. Diabetic cardiomyopathy is defined as the appearance of the symptoms of Congestive heart failure in diabetic patient in the absence of hypertension and any structural or congenital heart disease. The aim of the study is to find the relation between type 2 diabetes mellitus and cardiomyopathy, highlighting the variation in incidence according to age, sex and severity on basis of Doppler echocardiographic diagnosis. Methods: The prospective study was conducted for the duration of one year on 100 newly diagnosed Type 2 Diabetes patients aged between 30-60 years. Doppler echocardiography and HbA1c level of the patients was done. The study was conducted on the basis of grading of diastolic dysfunction on echocardiography. Quantitative data was analysed with the help of ‘t’ test and qualitative data with the Chi- Square and Fisher Exact Test. Statistical significance was taken as P < 0.05. Results: In this study, 39% of the newly diagnosed type 2 diabetes mellitus patients developed diabetic cardiomyopathy. In females, the disease was statistically absent in more patients (35) as compared to males (26) (<0.05). The commonest age group affected by grade 1 disease was 41-50 years. The incidence of grade 2 disease was more in age group 51-60 years. The grade 1 diabetic cardiomyopathy was statistically more common in males as compared to females (<0.05). The grade 2 diabetic cardiomyopathy was more common in females, but was statistically insignificant. Patients with HbA1c <8 have 16% chances to get LVDD with significant P value of 0.02. Patients with HbA1c between 8 to 10 have 30% chances to get LVDD with significant P value of 0.01. Conclusion: Diabetic cardiomyopathy is an important complication of type 2 diabetes mellitus patient. HbA1c level and Doppler echocardiography plays an important role in estimating the prevalence and severity of diabetic cardiomyopathy.

Incidence of Impaired Glucose Tolerance Test in Non- Diabetic Patients of Acute Coronary Syndrome and its Adverse Outcomes.

Background: Myocardial infarction, it still continues to be a major health problem worldwide. The aim of the study is to find out incidence of impaired glucose tolerance in non-diabetic patients with acute coronary syndrome. Methods: The study includes 50 patients. All the cases and controls were subjected to standard 75 gms. Oral Glucose Tolerance Test (OGTT) on admission, at the time of discharge and at three months follow-up and the observations were recorded. Results: Post prandial blood sugar at time 3 month follow up were 6 (12%) in cases and 9 (18%) in control but not significant statistically. There were 17 (34%) cases and 7 (14%) in control with IGT values which was statistically significant p= 0.034. Post prandial blood sugar at time of admission were 131.18 ± 21.52 in cases, 121.86 ± 21.47 in controls and at the time discharge in cases and controls were 139.10 ± 21.27 and 128.88 ± 9.44 respectively with p=0.003. Conclusion: Patients with acute coronary syndrome who have IGT on admission have longer hospital stay and more complications related to acute MI.

Hs-CRP and Serum Uric Acid as Risk Factors and Prognostic Markers in Acute Myocardial Infarction.

Background: To study the role of inflammatory markers like hs-CRP and S. Uric Acid as risk factors and prognostic markers in acute myocardial infarction. Methods: A total of 100 cases admitted in ICU/CCU under Department of Medicine/cardiology, NIMS Medical College & Hospital Jaipur and 100 controls who were the normal age/sex matched during study period of 15 months i.e. August 2014 to October 2015 were taken into study based on inclusion and exclusion criteria. Blood samples were taken to measure hs-CRP and Uric Acid and patients were followed for 7 days in hospital. Tests of statistical significance were done using Chi-square Test, unpaired ’t’ test, fisher test. Results: Out of 100 age and sex matched cases and controls, 63% were having positive hs-CRP compared to 2% in controls (p< 0.001). Hyperuricemia was found in 23% cases compared to 4% in controls(p=0.0002). 44 patients developed different complications during follow up, out of which 40 were having positive hs-CRP (P < 0.001) and 22 were having hyperuricemia (p< 0.001). Conclusion: We found that hs-CRP and Uric Acid are risk factors for myocardial infarction and are good predictors of outcome following MI.

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.

The study of TIMI Risk Score analysis and its correlation with ST segment Elevation Myocardial Infarction (STEMI).

Background: Analysis of TIMI risk score & correlation with ST elevation myocardial infarction (STEMI). Methods: This is a 12 months Observational Cross- sectional study conducted at NIMS Medical College and Hospital- a tertiary hospital in rural areas close to Jaipur. In this study we included 60 patients with acute myocardial infarction who were admitted to the coronary care unit of NIMS HOSPITAL JAIPUR during the year JAN 2015 –DEC 2015. The data obtained were analysed using Excel sheet/SPSS software. Tests of significance were done using the Chi - square test at 95% confidence interval. Results: According to our study myocardial infarction was more common in male compared to female (male:female ratio 4:1) Complications rate is significantly higher in male patients(p=0.0010) compared to female patients(p=0.0114). Mortality is increased with the increase in TIMI risk score. Conclusion: TIMI Risk score for ST segment Elevation Myocardial Infarction (STEMI) may be readily applied at the bedside at the time of hospital presentation and captures the majority of prognostic information offered by a full logistic regression model. The mortality increased proportionally with TIMI score. This risk assessment tool is likely to be clinically useful in the triage and management of patients eligible for fibrinolytic therapy and may also serve as a valuable aid in clinical research. Sufficiently simple to be practical at the bedside and effective for risk assessment across a heterogeneous spectrum of patients, the TIMI risk score may be clinically useful in the triage and treatment of patients with STEMI who undergo acute reperfusion therapy.

A study of platelet volume indices in a patients of ischaemic cerebrovascular disease.

Background: The objective of the study is to estimate platelet volume indices in patients of cerebral ischemic vascular disease. Methods: The present study was conducted on 170 subjects in Department of Medicine, NIMS Medical College and Hospital, Jaipur, Rajasthan over eighteen months. The study was conducted on 60 patients admitted in the wards and ICU under the Department of Medicine and 110 controls who were the normal and healthy during the study period. In this study the values of platelet indices – MPV, PDW and platelet count were observed in patients of cerebral ischemia. It was found that large platelets contribute to the prethrombotic state in ischemic syndromes and they may play a specific role in infarction. Because larger platelets are haemostatically more active and hence, their presence is probably a risk factor for developing thrombosis. Statistical analysis was done using Chi – square test, unpaired ‘t’ test and ANOVA test. A p value <0.05 was considered statistically significant. Results: In this study it was found that in cerebrovascular disease patients, MPV was 10.30±0.83 fL, PDW was 14.50±0.55 fL, platelet count was 260×109 ± 29×109 /L while in control, MPV was 8.14± 0.72 fL, PDW was 10.71±0.48 fL, platelet count was 285×109 ± 50 ×109 /L. MPV and PDW were higher and platelet count lower in cerebrovascular disease group and a highly significant difference (p<0.001) was found on comparing with controls. Conclusion: In this study, it was found that MPV and PDW were raised in cerebrovascular disease suggestive of statistically highly significant when compared to normal control group.

Study of Antepartum Haemorrhage and its Maternal and Perinatal Outcome.

Background: The Objectives of the present study are to assess the risk factors associated with antepartum haemorrhage (APH), maternal morbidity & mortality due to APH and its perinatal outcome in APH. Methods: This study was an analytical retrospective study conducted at NIMS University and Medical College, Jaipur over the duration of one year from July 2013-July 2014 over 100 cases of APH admitted in the hospital. Results: Among the 100 cases of APH the types observed were, placenta praevia: 39, abruptio placenta: 31, indeterminate causes: 25 and extra placental causes: 5. Maternal mortality out of 39 cases of placenta praevia was 1 and out of 31 cases of abruptio placentae was again 1. Perinatal mortality was 10% in placenta praevia and 19% in abruptio placentae. Conclusipn: APH is a major cause of maternal and perinatal mortality & morbidity, which can be prevented, by early registration, regular antenatal care, early detection of high-risk cases, early referral, better blood bank and OT facilities, improved intra-operative and postoperative care and better neonatal intensive care.

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

An Asymptomatic Double Outlet Right Ventricle (DORV).

We report a case of DORV in an 18-year-old female patient presented to NIMS Medical College and Hospital with unrelated symptoms of urinary tract infection. Diagnosis of this case is made by 2D-echocardiography with cardiologist consultation.