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.

Study of clinical and nerve conduction study correlation in patients of diabetic neuropathy in diabetes mellitus type 2

Background: Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia with disturbance of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action or both with an increased risk of neuropathy. Early diagnosis and management of diabetic polyneuropathy (DPN) are crucial as failure to diagnose can lead to serious consequences, including disability and amputation. Present study aimed at investigating the demographic profile and correlation of clinical features with nerve conduction studies in patients with diabetic neuropathy in type 2 diabetes mellitus.Methods: The cross-sectional study design with total 66 patients of type 2 DM were selected in 30 to 60-year age groups, from Pt. Jawaharlal Nehru Memorial Medical College, Department of Medicine, Raipur (C.G.) (Pt. JNMMC) and associated hospital. Descriptive statistics and χ2 test were used for analysing the data.Results: Total 66 patients were selected, Most of the patients are presenting with tingling sensation (n=64, 97.0%) and burning feet (n=52, 78.8%), NCV is mostly absent in the tibial nerve (n=52, 78%), sural nerve (n=63, 95.5%) and planter nerve (n=41, 62.1%) while it is largely normal in median nerve (n=54, 81.8%) and ulner nerve (n=61, 92.4%). Tingling sensation, burning feet, diminished vibration sensation and diminished light touch are significantly associated (p=0.00) with NCV in different nerves.Conclusions: Limitations of study includes small sample size, lack of general population, and a control group. Diabetes mellitus is a chronic illness with an increased risk of neuropathy. NCS having high sensitivity and specificity for detection of DPN. Understanding the NCS and its correlates in patients with DPN is crucial for early detection and development of effective management and strategies to prevent its complications.

Prevalence of dental erosion among asthmatic patients in India / Prevalência de erosão dentária em pacientes asmáticos na India

OBJETIVOS: O presente estudo foi realizado para investigar a associacao entre erosao dentaria e asma e estabelecer relacao com a historia medica, dieta e nivel de erosao dentaria. MATERIAL E METODO: O estudo transversal foi realizado entre 102 asmaticos e nao asmaticos, com idades entre 18 e 65 anos, em Udaipur, Rajasthan, India, em janeiro de 2009. A erosao dentaria foi determinada pelo uso de index de erosao utilizado em trabalho no Reino Unido em 1993. Os dados foram coletados por meio de questionarios. Os individuos foram examinados utilizando um procedimento do tipo III, por um unico examinador. A variacao intra examinadores foi testada estatisticamente, com acuracia de 90,3%. O teste qui-quadrado foi aplicado com utilizacao do programa SPSS, versao 11.0. RESULTADOS: Erosao dentaria estava presente em 76.5% de adultos com asma e em 66,7% de pacientes sem asma. 86% das drogas prescritas para asma tinham um pH abaixo de 5,5 %. Ocorreu tambem associacao entre erosao dentaria e consumo de refrigerantes, bebidas carbonatadas e frutas frescas. CONCLUSOES: Ha diferenca significativa na prevalencia de erosao, sendo que adultos com asma tem maior prevalencia do que nos grupos controle. Embora ocorra uma relacao entre niveis de erosao, ha tambem relacao dos niveis de erosao relacionadas com a historia medica e componentes acidos da dieta.

OBJECTIVE: This study was done to investigate association between tooth erosion and asthma and to find out the relationship between medical history, dietary practices and the level of dental erosion. MATERIAL AND METHOD: A cross sectional survey was conducted among 102 asthmatic and non asthmatic patient aged from 18 to 65 years old in Udaipur, Rajasthan, in January 2009. Tooth erosion was assessed using tooth erosion index employed in the childrenfs dental health in UK survey 1993. Data was collected by using self-prepared questionnaire. The subjects were examined using a type III examination procedure by single examiner. Intra examiner variability was tested by weighted kappa statistic which was 90.3%. Chi-square test was applied by using SPSS software (version 11.0). RESULTS: Tooth erosion was present in 76.5% of adults with asthma and in 66.7% asthma free subjects. 86% drugs which were prescribed for asthma had a pH below 5.5. There were also association between dental erosion and consumption of soft drinks, carbonated beverages and fresh fruits. CONCLUSION: There was significant difference in prevalence of erosion, adults with asthma having a higher prevalence than controlled group, although there is relationship between levels of erosion, medical history and acidic dietary components.

Mycobacterium tuberculosis and dendritic cells: recognition, activation and functional implications.

The highly complex nature of interactions of Mycobacterium tuberculosis with cells of the immune system has puzzled researchers the world-over in understanding the pathogenesis and immunology associated with tuberculosis (TB). This has contributed to the delay in development of effective vaccine(s) for TB. Several excellent studies have provided only a glimpse of the kind and degree of immune responses elicited following infection by mycobacteria. Preferred entry via respiratory route results in the capture of mycobacteria by alveolar macrophages that eventually become their long-term hosts. Since the pathogen is rarely cleared this has resulted in the human population serving as a large reservoir for mycobacteria. Owing to their unique ability to prime naïve and memory T cells, dendritic cells (DCs) play important and indispensable roles in the initiation and maintenance of protective immune responses following infection. The kind of immune response initiated by DCs with respect to mycobacteria determines the character of immune responses mounted by the host against the pathogen. The profile of cytokines and chemokines secreted as a result of infection of DCs by mycobacteria further plays an important role in defining the course of infection. This minireview attempts to highlight key interactions of mycobacteria with dendritic cells. We discus the uptake of mycobacteria by DCs followed by DC activation and the spectrum of immune responses initiated by infected/activated DCs, followed by numerous ways the pathogen has devised to subvert protective responses.