A study of correlation of pulmonary function test in patients with metabolic syndrome with different components of metabolic syndrome

Background:The increasing incidence of metabolic syndrome has been on the rise especially in urban population and leading to increased risk of cardiovascular disease (CVD) and diabetes mellitus. It has been associated with impairment of pulmonary functions. However, there is limited data regarding the association with individual components of metabolic syndrome and overall effect on components of pulmonary functions.Methods:This is a cross sectional study consisting of 50 subjects with metabolic syndrome. All the subjects underwent pulmonary function tests and the association between different components of metabolic syndrome and pulmonary function were examined using unpairedt-test and Pearson抯 partial correlation coefficient. This data was analysed by using statistical package for the social sciences (SPSS) version12.0.Results:In females, moderate negative significant correlation was seen between forced vital capacity (FVC)and systolic blood pressure (SBP), diastolic blood pressure (DBP),fasting blood sugar(FBS), triglyceride (TG), waist circumference (WC)and body mass index(BMI)whereas positive weak non-significant correlation was seen between FVC and high density lipoprotein cholesterol (HDLC), while no such relation was found with forced expiratory volumein one second (FEV1). In males, negative, moderate significant correlation was seen between FVC and FBS whereas strong, positive, significant correlation was seen between FVC and WC; between FVC and BMI. Negative, moderate, significant correlation was seen between FEV1 and WC; between FEV1 and BMI.Conclusions:Our study concluded that there was a significant impact of FBS and WCon decreasing FVC on both genders with minimally significant impact of other components of metabolic syndrome on FVC with no effect on FEV1 hence indicatinga restrictive pattern of pulmonary function derangement. Hence, further studies with larger sample size isneeded to confirm whether there are direct or indirect mechanisms through which insulin resistance could affect pulmonary function.

Gender disparity in COVID-19: Role of sex steroid hormones

The emerging pandemic of COVID-19 caused by the novel pathogenic human coronavirus SARS-CoV-2 has caused significant morbidity and mortality across the globe, prompting the scientific world to search for preventive measures to interrupt the disease process. Demographic data indicates gender-based differences in COVID-19 morbidity with better outcome amongst females. Disparity in sex-dependent morbidity and mortality in COVID-19 patients may be attributed to difference in levels of sex steroid hormones -androgens and estrogens. Evidence suggests that apart from the regulation of viral host factors, immunomodulatory and cardioprotective roles exerted by estrogen and progesterone may provide protection to females against COVID-19. Exploring the underlying mechanisms and beneficial effects of these hormones as an adjuvant to existing therapy may be a step towards improving the outcomes. This article aims to review studies demonstrating the role of sex steroidal hormones in modulating SARS-CoV-2 host factors and summarize plausible biological reasons for sex-based differences seen in COVID-19 mortality.

Islets of hypoglycaemia: a rare case of adult onset nesidioblastosis

A case of diffuse nesidioblastosis in an adult patient is reported in this study. A 24-year-old female with no known comorbidities presented with multiple episodes of documented recurrent hypoglycaemia and Hypoglycaemia induced seizures both in fasting and postprandial state. Her blood investigations revealed low plasma glucose levels, high insulin and C-peptide levels with positive 72-hour fast test. Her transabdominal USG and CECT abdomen did not reveal any abnormality, 68Ga DOTANOC PET CT done showed ill-defined diffuse somatostatin receptor expression in the pancreatic head and tail suggestive of nesidioblastosis. As patient was not willing for surgical treatment, hence started on medical treatment with oral nifedipine. Nesidioblastosis is very rare in adults. It is an important differential diagnosis in adults with hyperinsulinemic hypoglycemia although the incidence is very rare in adults. PET SCAN was used to non-invasively diagnose nesidioblastosis in this case. Surgery being the preferred choice of treatment in nesidioblastosis, there is limited data on medical line of management in nesidioblastosis.

A comparative study of anaemia with the degree of glycaemic control in type 2 diabetes mellitus

Background: Anaemia is one of the world’s most common preventable condition yet it is often overlooked especially in people with Diabetes Mellitus. Anaemia is a common finding in patients with diabetes. Anaemia in patients with diabetes mellitus might contribute to the pathogenesis and progression of cardiovascular disease and aggravate diabetic nephropathy and retinopathy. This aims to study the correlation between HbA1c and blood glucose levels in anaemic diabetics in order to assess the influence of anaemia on HbA1c and the effect of severity and type of anaemia on HbA1c.Methods: It’s a case control study, 200 Diabetic subjects were divided into two groups of 100 each based on their HbA1c levels group A, with good glycaemic control (HbA1c<7) and group B with poor glycaemic control (HbA1c>7), incidence of anaemia was measured and compared among them and also with 100 age and sex matched healthy non Diabetic controls. Results: In this study, it was found that high incidence of anaemia was found significantly higher in diabetics group with poor glycaemic control. Anemia was detected in 55% of patients among diabetic patients. Anaemia was seen in 71% of patients in group B with poor glycaemic control as compared to group A with good glycaemic control, in which only 39% of patients had anaemia. Mean haemoglobin was significantly lower that is, 10.81±3.0 in group with poor glycaemic control as compared to group with good glycaemic control i.e. 13.04±2.02. There was a statistically significant negative correllation between Haemoglobin percentage and HbA1c.Conclusion: Anaemia is a common finding in patients with diabetes. Diabetes related chronic hyperglycaemia can lead to a hypoxic environment in the renal interstitium which results in impaired production of erythropoietin by the peritubular fibroblasts and subsequently anaemia occurs. Anaemia in patients with diabetes mellitus might contribute to pathogenesis and progression of cardiovascular disease and aggravate diabetic nephropathy and retinopathy. However, an emphasis on regular screening for anaemia, alongside that for other diabetes related complications, might help to delay the progression of vascular complication in these patients.

Anesthetic considerations for a patient with myasthenia gravis undergoing deep sedation in an outpatient oral surgery setting

Myasthenia gravis (MG) is a neuromuscular autoimmune disorder which clinically presents as muscular weakness and fatigue due to autoantibody formation against acetylcholine receptors (AChR), leading to their subsequent destruction. Due to the neuromuscular implications of MG, certain considerations must be taken into account when providing anesthesia to MG patients. In the following case report, we have outlined procedural considerations for the anesthetic management of a patient with MG undergoing deep sedation for an elective oral surgery in an outpatient setting, as well as a discussion of relevant literature.

Rosuvastatin plus fenofibrate in diabetic dyslipidemia: a hospital record based study

Background: Cardiovascular diseases (CVD) are the leading cause of death throughout world population each and every year. Focus on dyslipidemia management is urgently required in India to halt the rising tide of CVD. The purpose of diabetic dyslipidemia study is a record based one, to find out the effect of Rosuvastatin plus Fenofibrate, in adult Type 2 diabetes with dyslipidemia, with high TGL/HDL ratio in Lipid profiles, in a tertiary care hospital in the Union territory of Puducherry.Methods: There were 101 patients hospital records were analysed in which male were 45 and females were 56. The various biochemical parameters like serum Total Cholesterol, HDL, LDL, TGL, Non-HDL, TCL/HDL Ratio and TGL/HDL ratio reports were collected before and after 12-weeks of Rosuvastatin 10 mg with Fenofibrate 145 mg combination, for the treatment period once daily for their lipid-lowering therapy.Results: The combination therapies of Rosuvastatin plus Fenofibrate were safe and feasible to achieve more TG goal and proved that has predominately decreased the elevated lipid profiles from the medical resources of our record based study. The use of combination medications of rosuvastatin (10mg) plus Fenofibrate (145mg) is often needed to effectively treat the lipid triad, by the potency of rosuvastatin to lower LDL-C and Fenofibrates effectiveness in lowering TG in treating mixed diabetic dyslipidemia.Conclusions: After Rosuvastatin (10mg) plus Fenofibrate (145mg), the lipid profile data proved that the importance of TGL/HDL ratio apart from the TCL/HDL ratio, for good lipid control in diabetic dyslipidemic patients.

Manifestations of malaria: a clinical experience

Background: Malaria is fast emerging as a number one infectious disease with high morbidity and mortality across the globe. It’s being transmitted across 108 countries containing 3 billion populations (40% of world’s populations) with more than 3 million deaths per year. India is an endemic country for malaria with an estimated 70-100 million1 cases per year. 45-50% of them are due to Plasmodium falciparum (Pf). Pf is responsible for majority of severe and fatal malaria though death due to Plasmodium vivax mono infection have also been reported. Symptoms and sign are highly non-specific in malaria making it more of a clinical diagnosis more than a laboratory diagnosis. Presentation may vary at times and can be quite confusing as malaria is a multisystem disease. Authors’ idea was to study the variable manifestations in confirmed cases of malaria patients at our hospitalMethods: A hospital based cross sectional study was conducted for a period of one year-from 01-08-2015 to 31-07-2016 based on authors’ hospitals records (case sheets with demography profile, clinical features, investigations and treatment outcome).Results: A total of 369 patients positive for malaria parasite were included in the study. 369 were smear positive-219 positive for Plasmodium vivax, 127 were P. falciparum type and 23 were for both. Majority were males (64.50%) and belonged to the age group of 21-50 years (58.84%). They were admitted in post monsoon months (60.43%). Of them 46.44% had classical symptoms of malaria. All the patients had received mainly artemisinin combination therapy (ACT) and 91.87% patients recovered in 7-28 days. The mortality rate was nearly 5.69%.Conclusions: The present study was useful to know the varied manifestations of malaria and hence will be useful in making a clinical diagnosis of malaria.

Comparative evaluation of natural curcumin and synthetic chlorhexidine in the management of chronic periodontitis as a local drug delivery: A clinical and microbiological study.

Background of the Study: The aim of this study is to evaluate the efficacy of natural curcumin in the management of chronic periodontitis as local drug delivery in comparison to synthetic chlorhexidine, which is the gold standard. Materials and Methods: Thirty chronic periodontitis patients with an age range of 20–50 years with probing pocket depth (PPD) of 4–6 mm were included. Curcumin and chlorhexidine gel was applied in the contralateral disease sites at baseline and day 15. The clinical parameters like PPD, clinical attachment level (CAL), gingival index (Loe and Silness) and plaque index (Turesky Gillmore modification of Quigley Hein) were recorded and colony forming units (CFU) were assessed microbiologically at baseline, 15 and 30 days. Results: There was a significant reduction of the clinical parameters (PPD, CAL) and microbiological parameters CFU at 15 and 30 days for both the groups. Curcumin group showed a greater reduction in the clinical parameters when compared with chlorhexidine group. Both groups had a significant reduction in parameters when compared with baseline. Conclusion: Although curcumin has equivalent benefit to chlorhexidine, curcumin being an ayurvedic herb is an excellent alternative to chlorhexidine due to minimal side‑effects.

Occurrence of Three Headed Sternocleidomastoid Muscle and a Common Thyro-Linguo-Facial Vein – A Case Report

Variant anatomy of muscles and veins of the neck is of importance to plastic surgeons, radiologists and general surgeons. We report the variations of sternocleidomastoid muscle and veins of the neck in the present article. Right sternocleidomastoid muscle had three heads of origin. The third head took its origin from the clavicle just lateral to the usual clavicular head. All the three heads were about 4 inches long and united with each other at the level of thyroid cartilage. There was no external jugular vein on the right side. The retromandibular vein united with facial vein to form common facial vein. Common facial vein joined with superior thyroid and lingual veins to form a thyrolinguo-facial trunk one inch below the angle of mandible. This trunk was about 2 inches long and terminated into the internal jugular vein. Knowledge of this case could be useful while raising a sternocleidomastoid flap, administering anesthesia to brachial plexus, neck surgeries and carotid endarterectomy.

Dermatological adverse drug reactions due to systemic medications a review of literature

Cutaneous adverse drug reactions [ADRs] affect 2-3% of hospitalized patients. These reactions can arise as a result of immunologic or non-immunologic mechanisms. Extremes of age, female sex, previous history of ADRs and environmental factors are the major risk factors. The severity of the cutaneous ADRs may vary from a mild itching to a life threatening Stevens-Johnson syndrome [SJS]. In general, most are usually mild and respond to topical treatment. Different skin diseases and cutaneous manifestation of systemic diseases should be ruled out before diagnosing a cutaneous ADR. In order to establish the causal relationship between the offending drug and the reaction, causality assessment should be carried out. The Naranjo algorithm is widely used to determine the causality of an ADR. The cessation of the offending agent, along with the use of systemic and topical steroids, antipruritic agents and oral antihistamines may be helpful in the management. Patients with extensive skin involvement should be cared for as burns patients. High risk patients should be counseled regarding the possibility of developing a cutaneous ADR during the course of treatment and the strategies to be followed upon occurrence of a cutaneous ADR. This is a review article

Pre-operative diagnosis of Meckel's diverticulum: report of a case and review of literature.

Meckel's diverticulum represents a patent omphalomesenteric duct at its junction with the ileum. Although it is a common anomaly, it is often a surgical surprise as the preoperative diagnosis is seldom established. We present an unusual case where the constellation of imaging findings was so typical that we could suggest this diagnosis prospectively and it was subsequently confirmed surgically.

Cutaneous adverse drug reactions to modern medicines and initial experiences from a spontaneous adverse drug reaction reporting program in a tertiary care teaching hospital of Western Nepal

Cutaneous adverse drug reactions [ADRs] affect 2-3% of hospitalized patients; most are usually mild and respond to topical drugs. These reactions can arise as a result of immunologic or non-immunologic mechanisms. Extremes of age, female sex, previous history of ADRs and environmental factors are the major risk factors. The Naranjo algorithm is widely used to determine the causality of an ADR. To share the authors' experience of spontaneous adverse drug reaction reporting program Nepal. During a period from September, 2004 to March, 2005, any patient who experienced a dermatological ADR were asked to report the Pharmacovigilance Cell of the Manipal Teaching Hospital, Pokhara, Nepal. Morphology of the eruption was recorded. A total of 45 cutaneous ADRs were reported during the study period. Maculopapular rash [15 reports] was the most common, followed by contact dermatitis [7 reports], fixed drug eruptions [6 reports] and erythema [4 reports]. Considering its effectiveness, the pharmacovigilance program in Manipal Teaching Hospital should be strengthened and transformed to a full-fledged active reporting program. The nationwide extension of this program would be beneficial