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.

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.

The Study of Correlation between Serum Magnesium Level and Diabetic Retinopathy in Rural Population.

Background: Diabetic retinopathy is one of the leading causes of blindness in the world. Hypomagnesaemia has been reported to occur at an increased frequency among patients with type 2 diabetes mellitus (DM) with retinopathy compared with their counterparts without diabetic retinopathy. The study was done with aimed whether there is any correlation between serum magnesium concentration and diabetic retinopathy in a rural population. Aim: This study was carried out to find the correlation between serum magnesium levels in diabetic patients with retinopathy. Methods: 100 type 2 DM patients admitted in NIMS Medical Collage Hospital, Jaipur over the period of 8 months between 1st December 2014 to 31th July 2015, were selected for this study. Detailed history, general physical examination, systemic examination, and various investigations like fasting blood sugar (FBS), post prandial blood sugar after 2 hrs (PP2BS), glycosylated hemoglobin (HbA1C), Blood urea, serum creatinine and urine examination were carried out. Serum magnesium was estimated by Calmagite dye method. Retinopathy was assessed by direct opthalmoscopy. Results: Prevalence of hypomagnesaemia in type 2 diabetic was 30% hypomagnesaemia was significantly higher in diabetic with retinopathy compared to diabetic without retinopathy. Serum magnesium level is in uncontrolled DM when compare with control DM. No significant associations existed between serum magnesium concentrations and other factors like age, sex, durations of diabetes, mode of treatment. Conclusion: Prevalence of hypomagnesaemia in type 2 diabetics is 30%, And especially more significant in diabetes with retinopathy when comparison to diabetes without retinopathy.

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.

Prediction of airway responsiveness to allergen from skin sensitivity to allergen, airway responsiveness to histamine and serum IgE levels.

Immediate allergic reaction of the skin, non allergic airway responsiveness of the bronchi, and serum IgE levels were estimated in 25 atopic non asthmatic subjects and 15 controls. A good correlation was observed between these three parameters i.e. patients with positive skin response to allergen had increased airway responsiveness and significantly increased levels of serum IgE. However, the serum levels of IgE provided a significantly better indication of the likely presence of bronchial allergic reactivity than did the skin reactivity. The results indicate that knowledge of the airway responsiveness to histamine, skin sensitivity to allergen and serum IgE levels can predict the presence of airways responsiveness to an allergen. In all atopic non asthmatic individuals with a significant correlation between these parameters, the relevant allergen could stand identified as having the potential to provoke attacks of clinical asthma.

Histamine bronchoprovocation tests in subjects with gastro-oesophageal reflux disease.

The relationship of gastro oesophageal reflux (GER) with bronchial asthma has already been well documented in asthmatic subjects and it has been postulated that their asthma might have been caused by GER disease. Thus, it was planned to establish an association, if any, between GER and increased bronchial reactivity by histamine broncho provocation. The study was done in 25 GER disease patients and 15 controls. The difference in bronchial reactivity between the two groups was found to be significant (p less than 0.01). It was concluded that GER subjects expressed greater bronchial reactivity and it has been discussed that at a later stage of life they may be more prone to develop asthma.

Comparative study of capillary and arterial, blood gas values in plastic and glass syringes at various intervals in normal and asthmatic subjects.

Fifty-six normal healthy subjects and forty-four patients with bronchial asthma were subjected to capillary and arterial blood gas analysis. Arterial blood values were measured immediately and at two and four hours interval after storing the samples between 0-4 degrees C using glass and plastic syringes. It was observed that PO2 of arterial blood was significantly higher (P less than 0.001) than capillary PO2 values, while material of syringe and time interval of analysis did not make any significant alteration. PCO2 and pH values in arterial samples at various intervals and in different syringes were comparable in normal as well as in asthmatic subjects.