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.

Assessment of Depression in Patients of Type-2 Diabetes Mellitus Attending a Tertiary Care Centre

Introduction: Type-2 diabetes mellitus is a common, chronic metabolic disorder with multiple complications if not well controlled. Depression is a very common psychiatric comorbidity in these patients. Multiple environmental and patient related factors are linked with this co-morbidity. It is important to address depression and related factors in these patients for a better outcome. This study aimed to assess depression and distribution of various socio-demographic and clinical details in patients of type-2 diabetes mellitus. Material and Methods: Using a purposive sampling technique, a total of 118 patients of type-2 diabetes mellitus who fulfilled the inclusion and exclusion criteria of this study were enrolled. They were administered Hamilton Depression Rating Scale to assess depression. Overall 66.1% of the patients had co-morbidity of depression. Results: Significantly more number of patients of type-2 diabetes mellitus with co-morbid depression were unmarried (41% vs 15%, χ2=9.029, df=2, p<.05), unemployed/unskilled workers (21.8% vs 5% / 73.1% vs 55%, χ2=24.893, df=2, p<.01), from lower socio-economic status (71.8% vs 52.5%, χ2=4.342, df=1, p<.05), joint family (33.3% vs 7.5%, χ2=9.519, df=1, p<.05) and rural background (82.1% vs 62.5%, χ2=5.453, df=1, p<.05), and had poor control of the level of HbA1c (55.1% vs 2.5%, χ2=41.022, df=2, p<.01) than those without co-morbid depression. There was a significant negative correlation of years in education with HAM-D total score (r=-.471, p<0.01). Conclusion: A co-morbidity of depression is very common in patients of type-2 diabetes mellitus and various sociodemographic and clinical factors are linked to this comorbidity. It is important to address these issues for the sake of overall better outcome in type-2 diabetes mellitus.

Assessment of muscular fitness in school children using kraus-weber tests.

Objective of the study: The present study was carried out to assess muscular fitness in healthy Indian school children between 9 to 12 years of age (older pediatric age-group) using Kraus-Weber Tests. The aim was to compare the results of this study with similar studies that have been carried out in India, Europe and America previously. Methods: Kraus-Weber Tests don’t require sophisticated equipment and are much easier to administer than traditional tools for analyzing muscular fitness like Electromyogram (EMG). Earlier studies have proven these tests to be excellent screening devices not only for physical but also psychosocial incompetence. They can actually be used as indicators of overall health in this older pediatric age-group. Results: The present study found more number of fitness and flexibility failures as compared to the last such study in India. In stark contradistinction to previous studies, girls have fared poorly than boys on the fitness front.Conclusion: These findings could be attributed to increased stress in school children especially in female students. A sharp dip has been observed in muscular fitness just prior to puberty (most probably due to hormonal causes).

Academic performance of school children with their intelligence quotient.

Present study was carried out to correlate academic performance of Indian school children with their intelligence quotient (as measured by Porteus Maze Tests). These tests have been tried and tested successfully in previous studies, don’t require sophisticated equipment and are easier to administer than traditional tests like Wechsler Tests. Contrary to popular belief, no statistically significant correlation was found in this study between intelligence and academic grades. Thus intelligence is not a prerequisite to succeed in examinations and therefore in life.

Academic performance of school children with their intelligence quotient.

Present study was carried out to correlate academic performance of Indian school children with their intelligence quotient (as measured by Porteus Maze Tests). These tests have been tried and tested successfully in previous studies, don’t require sophisticated equipment and are easier to administer than traditional tests like Wechsler Tests. Contrary to popular belief, no statistically significant correlation was found in this study between intelligence and academic grades. Thus intelligence is not a prerequisite to succeed in examinations and therefore in life.

Plumbism--a mimicker of common childhood symptoms.

Lead poisoning is a preventable entity that can affect almost every system of the body. Its toxic effects range from subtle common childhood symptoms to even death. In a prospective study forty six children with at least one symptom compatible with plumbism were enrolled after screening patients attending medical services at AIIMS. The work-up included a detailed clinical history and examination including intelligence quotient (IQ) and behaviour. Blood lead levels were estimated in all with due precautions. Their ages ranged from 2.5 to 18 years and M:F ratio was 2:1. The common symptoms included unexplained recurrent colic (39), anorexia (21), sporadic vomiting and constipation (13), pigmented gum lines (11), growth failure (11), history of pica (9) etc. None of the children had acceptable blood lead levels (< 10 micrograms/dl). Ninety three per cent children had levels > 20 micrograms/dl and 47.8% had > 45 micrograms/dl. Statistically significant correlation with blood lead levels was seen with most symptoms. Plumbism can mimic common childhood illnesses and should be investigated in children with a clinically compatible profile. Community awareness with regard to pica reduction may be an important preventive measure. This silent epidemic needs to be aggressively tackled by a multipronged approach.

Abdominal tuberculosis in children: experience over a decade.

This presentation deals with 110 surgically proven cases of abdominal tuberculosis in the pediatric age group. The protean clinical profiles and complications of the disease entity made the clinical diagnosis difficult; the investigations were also found non-pathognomonic. The most common type of pathology seen was adhesive variety followed by nodal type. Strictures of the small bowel were uncommon and hyperplastic variety was rarely seen in the present series. The pathogenesis relating to various varieties has been suggested based on the vast experience from a single institution.

Teratomas in pediatric age group: experience with 75 cases.

The clinicopathological features of 75 children under the age of 12 years with teratomas are reviewed. Tumors arose in the following anatomic sites: sacrococcygeum (n = 49), ovary (n = 10), Testis (n = 5), oral cavity (n = 3), retroperitoneum (n = 2) and others (n = 6). Fifty five (74%) presented within the first year of life. Excluding the gonadal tumors, male-female ratio was 2:5. Majority of the tumors had only mature tissues. Such patients and those 9 patients in whom the histology was not specified, underwent excision alone and had 95% early survival rates. Five patients had admixture of mature and immature tumors. Nine patients had malignant tissues. Germ cell tumors containing only malignant component, but no mature or immature teratomatous tissues were excluded from the series. The patients with immature and malignant tissues underwent multimodal therapy including surgical excision, multiagent chemotherapy (VAC regimen) and at times radiotherapy. Mortality in patients with immature and malignant teratomas was 20 and 66.7%, respectively. Besides histology, the only factor which affected prognosis, especially in case of sacrococcygeal teratomas was the age at the time of presentation. Our experience highlights the importance of early recognition and complete surgical excision of teratomas in the pediatric age group.

Congenital granular-cell myoblastoma.

Congenital granular-cell myoblastoma is a rare jaw tumor presenting in the neonatal period. The differentiation between congenital epulis and granular cell myoblastoma is a controversial issue amongst pathologists. It is a benign swelling in which simple excision is the treatment of choice. Here we report two cases with a brief review of literature.

Spontaneous gastrointestinal perforation in the neonate.

Twenty seven cases of spontaneous gastro-intestinal perforation were treated from 1981 to 1990. Four perforations were in the stomach, 17 in the small bowel and seven in the large bowel. One of them had dual perforation, one in the stomach and another in the duodenum. The exact etiology remained obscure. Various factors observed were maternal obstetric complications, prematurity and perinatal asphyxia. Stress should be laid on early diagnosis by following up 'at risk neonates' thus, giving a better overall survival rate.

Abdominal tuberculosis in children.

Problems in the management of abdominal tuberculosis in children are discussed with reference to 80 surgically proven cases. The protean clinical manifestation depends on the site and the extent of the disease and its complications. The clinical diagnosis is difficult because of the vague symptoms, non-specific signs, and non-availablity of specific diagnostic tests. The most common type of pathology seen in abdominal tuberculosis in the paediatrics age were adhesive variety followed by nodal type. Strictures of the small bowel are uncommon and hyperplastic variety is rarely seen in this age group. Response to the antitubercular drugs is excellent however, the post operative complications and mortality remain high.