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Background: Prevalence of hypomagnesaemia is significantly higher in diabetic patients with microvascular complications compared to diabetics with no microvascular complications. The aim of this study is to measure levels of serum magnesium in patients with newly diagnosed type 2 diabetes mellitus and study its association with the presenting microvascular complications.Methods: This was hospital based, one year cross-sectional study carried out in Department of Medicine, IGMC Shimla in patients with newly diagnosed type 2 diabetes mellitus. Total 53 patients were enrolled in this study who presented in medicine OPD or admitted in medicine ward.Results: Serum Magnesium value of the patients ranged from 1.20-3.0 mg/dl with mean value of 1.9±0.3 mg/dl. Fourteen patients (26.4%) had hypomagnesaemia. A total of 34 (64.2%) patients presented with complications of diabetes in which proteinuria was present in 34 (64.2%), retinopathy in 4 (7.5%) and neuropathy in 1 (1.9%). Fourteen (41.2%) patients with hypomagnesaemia presented with complications of diabetes (p value=0.003). 34 (64.2%) patients presented with proteinuria out of which 14 (41.2%) patients had hypomagnesaemia while 20 (58.8%) had normomagnesaemia (p=0.03). One (1.9%) patient had neuropathy and hypomagnesaemia was also present in this patient (p=0.6). Four patients (7.5%) presented with retinopathy out of which 3 (5.7%) had hypomagnesaemia while 1 (1.9%) had normomagnesaemia.Conclusions: Hypomagnesaemia is associated with microvascular complications of diabetes. Also there is statistically significant relationship between proteinuria and hypomagnesaemia in patients with newly diagnosed type 2 diabetes mellitus.
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Background: Himachal Pradesh is an endemic area for scrub typhus. If not treated early, it can lead to life threatening complications, affecting various systems of the body. Hence, this study was done with an objective to study the cardiovascular abnormalities in patients of severe scrub typhus.Methods: Authors conducted a hospital-based study in Departments of Medicine and Cardiology, of a tertiary care hospital in Sub-himalayan region in patients of severe scrub typhus from June 2016 to May 2017.Results: Thirty-two (55%) patients were aged <60 years with female preponderance (72%). Electrocardiographic changes included sinus tachycardia in 56 (97%), axis deviation in 5(9%), ST-T changes in 3(5%) and atrial fibrillation in 1(2%). Echocardiographic changes included tricuspid regurgitation in 14(24%), pericardial effusion in 4(7%), myocarditis in 1(2%) and Regional wall motion abnormality in 1(2%). Left ventricular ejection fraction >45% in 47 (81%) and <45% in 11(19%). Fifty-one patients had hypotension at presentation and 49 (90%) of them improved. Interestingly, 10 of 11 patients with reduced EF (<45%) survived whereas 6 of total 7 patients, who died, had preserved EF (>45 %).Conclusions: Severe scrub typhus manifested with ST/T changes, myocarditis, pericardial effusion, arrhythmias, shock and patients with reduced EF on Echocardiography had better outcome.
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Right ventricular myocardial infarction (RVMI) predominantly a complication of inferior wall myocardial infarction is a distinct clinical entity in which major hemodynamic disturbance may occur. Bedside hemodynamic measurement, electrocardiography, gated blood pool radionuclide angiography and echocardiography are used to identify right ventricular involvement in setting of inferior wall infarction. RVMI as assessed by various diagnostic methods accompanies 30 to 50% of inferior wall infarction. We studied 37 consecutive patients of acute inferior wall infarction (by non invasive method) to determine echocardiographic evidence of RVMI and compared its sensitivity to electrocardiography and clinical criteria. On echocardiography 12 out of 37 patients (32%) had right ventricular involvement. Kussmaul’s signs was present in 27% of the patients and it had sensitivity of 50%, specificity of 88% and predictive accuracy of 70%. Right sided precordial leads (V3R – V4R) on electrocardiography showed evidence of RVMI in 30% of patients with sensitivity, specificity and predictive accuracy of 67%, 88% and 73% respectively. Echocardiographic features included enlargement of right ventricle and hypokinesia or akinesia of right ventricular wall. Right ventricular dilatation and dysfunction is gained from relative right and left ventricular dimension on echocardiography. It is more sensitive and specific than clinical signs and ECG.