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1.
Article | IMSEAR | ID: sea-234150

RÉSUMÉ

Background: Adults having type 2 diabetes mellitus satisfying inclusion and exclusion criteria will be included. Consent of those who fit into inclusion criteria taken. 100 patients were analysed on the basis of history, clinical presentations, investigations. Patients presenting with signs and symptoms of neuropathy were accessed by nerve conduction studies (NCV), autonomic testing, heart rate variation with deep breathing, blood pressure response to standing. Arterial blood gas analysis, and CT /MRI also done. Methods: 100 patients of type 2 diabetes were taken and study of autonomic dysfunction was done for 3 months across tertiary health care centre. Results: Out of 100 diabetic patients under study 54 patients (54%) had diabetic neuropathy. Out of these 54, distal sensory motor neuropathy- most common (77%), sensory neuropathy- 24%. Axonal neuropathy was more prevalent than demyelinating neuropathy. Out of 100, 51 (51%) patients have autonomic neuropathy. Peripheral neuropathy was most common complication in which distal sensory motor polyneuropathy were common. Most common symptom of autonomic neuropathy was postural dizziness followed by erectile dysfunction. Conclusions: Most common complication of type 2 DM is neuropathy. Most common neuropathy was distal sensory motor polyneuropathy whereas most common symptom of diabetic neuropathy was postural dizziness. Other autonomic dysfunction was change in blood pressure and heart after standing.

2.
Article | IMSEAR | ID: sea-234222

RÉSUMÉ

Background: Central venous catheter-related bloodstream infections (CRBSIs) are associated with significant morbidity and mortality in hospitalized patients. Understanding the incidence and risk factors associated with CRBSIs is crucial for implementing effective preventive strategies. The study aimed to examine the incidence and risk factors associated with central venous CRBSIs in a tertiary care hospital setting. Methods: A prospective observational study was conducted at a tertiary care hospital to investigate the incidence and risk factors of CRBSIs. Patients aged >18 years with a central venous catheter inserted for >48 hours were included. Clinical and microbiological data were collected, and CRBSI rates were calculated. Statistical analysis was performed using SPSS V 23.0. Results: A total of 50 patients were recruited, with 11 diagnosed with CRBSIs. The incidence of CRBSIs was 8.1 per 1000 central line days and 5.7 per 1000 inpatient days, with a Device Utilization Ratio (DUR) of 0.7. Male gender and older age (>40 years) were significantly associated with CRBSIs (p<0.05). Gram-negative microorganisms were the most commonly isolated pathogens (63.63%), followed by Gram-positive organisms (27.27%) and Candida species (9.09%). Immune system status (p=0.0372) and duration of catheterization (P=0.0035) were found to have a significant association with CRBSI. Mortality was higher in patients with CRBSIs compared to those without (45.45% vs. 28.21%). Conclusions: CRBSIs remain a significant concern in tertiary care hospitals, with Gram-negative organisms being the predominant pathogens. Male gender and older age were identified as risk factors for CRBSIs. Effective infection control measures targeting high-risk populations are warranted to reduce the incidence of CRBSIs and improve patient outcomes.

3.
Article | IMSEAR | ID: sea-234118

RÉSUMÉ

Background: ARDS is a progressive inflammatory lung injury in patients with hypoxemic respiratory failure. Aspiration pneumonia and pneumonia are the most common cause of ARDS in direct lung injury whereas sepsis is the most common cause of ARDS in Indirect lung injury. Methods: This was observational study conducted in Intensive care unit, Department of Medicine, CPR Hospital, Kolhapur, Maharashtra for 6 months from 1 June to 30 November 2023 in 41 patients. Results: Most common cause of ARDS secondary to pneumonia, in this study population is bacterial pneumonia, followed by viral and parasitic infections. Average day of hospital stay for bacterial pneumonia is 13 days and 11 and 10 days for viral and parasitic infections respectively. For bacterial pneumonia mortality was 36%, for viral pneumonia was 37% and parasitic pneumonia was 33.33%. Out of 41 patients,16 patients were in mild ARDS with the SOFA score range of 2 to 5 and 12 patients were in moderate ARDS with SOFA score range of 6 to 9 and 12 patients were in severe ARDS with SOFA score range of 12 to 14. Conclusions: With our study we would like to conclude that sofa score is a good predictor of mortality in c/o ARDS patients in ICU setting. Patients who had sofa score of equal or more than 9 and who were in the category of moderate to severe ARDS, had poorer outcomes and high mortality rate.

4.
Article | IMSEAR | ID: sea-234007

RÉSUMÉ

Background: Mucormycosis, a rare but serious fungal infection, has shown a concerning rise in incidence among COVID and post-COVID patients, with males constituting majority of cases. This study aimed to investigate the impact of diabetes mellitus (DM) on outcomes in patients with COVID and post-COVID mucormycosis. Given the known association between DM and increased susceptibility to infections, particularly fungal ones, understanding the role of DM in exacerbating mucormycosis outcomes is crucial for clinical management. Methods: A cross-sectional analytical study was conducted, involving a cohort of 50 patients with mucormycosis, equally divided into diabetic and non-diabetic groups. Data on morbidity, complications, hospitalization rates, and mortality were collected and compared between the two groups. Additionally, glycemic control status was assessed among diabetic patients to evaluate its impact on outcomes. Results: Among the 50 patients analyzed, diabetic individuals displayed significantly poorer outcomes compared to their non-diabetic counterparts. This included increased morbidity, complications, hospitalization rates, and mortality. Moreover, patients with uncontrolled DM exhibited the worst outcomes, highlighting the critical importance of managing glycemic control during mucormycosis treatment. Conclusions: The study underscores the necessity of vigilant monitoring and targeted interventions, particularly in diabetic individuals, to mitigate the adverse effects of mucormycosis in the context of COVID-19. Effective management of diabetes, especially glycemic control, is crucial for improving overall patient outcomes and reducing the burden of mucormycosis-related complications and mortality in both COVID and post-COVID scenarios. Further research is warranted to refine treatment protocols and optimize outcomes for this vulnerable population.

5.
Article | IMSEAR | ID: sea-233995

RÉSUMÉ

Background: This study aimed to assess the impact of low dose factor prophylaxis on haemophilia patients with respect to annual bleeding rates and severity of bleeding events. Methods: This is an analytical study. All patients of HAEMOPHILIA A AND B who are registered with CPRH haemophilia treatment centre from January 2022 to December 2022 were included and were followed up every month from January 2022. The study population was divided into two groups: those receiving regular low dose factor prophylaxis and those receiving episodic factor treatment. Both the group participants were matched for severity of factor deficiency and age. The collected data was compared with respect to the annual bleeding rate as well as severity of bleeding episodes in the two defined groups. Results: There were 100 study patients, and 16 of them are receiving regular low dose factor prophylaxis. The average bleeding episodes were found to be more in patients receiving episodic factor doses (ABR in moderate haemophilia= 3.511+/-0.81, ABR in severe haemophilia=5.38+/-4, 53) as compared to those receiving prophylactic factor doses (ABR in moderate haemophilia = 0.16+/-0.32, ABR in severe haemophilia=0.3+/-0.29). The incidence of severe bleeds (those requiring hospitalisation) was higher in patients receiving episodic factor therapy (15) as compared to those receiving regular low dose factor prophylaxis (1). Conclusions: Haemophilia patients receiving episodic factor doses have higher Annual Bleeding Rate as compared to patients receiving regular low dose factor prophylaxis. Also, patients receiving prophylaxis face less severe forms of bleeding episodes as compared to other group of patients.

6.
Article | IMSEAR | ID: sea-233993

RÉSUMÉ

Background: Heart failure (HF) is becoming leading problem in world now a days. Thyroid hormone has been proven to influence physiologic functions of cardiovascular system in many ways. HF presents a clinical challenge, with thyroid dysfunction emerging as a significant comorbidity, affecting prognosis and management. Approximately 22% of patients with HF have been demonstrated to have thyroid dysfunction. Clinical studies were confirmed that the patients with sub-clinical hypothyroidism had high risk of cardiovascular disease due to increased low density lipoprotein, elevated homocystein, hypercoagulative blood. In this study, we aim to evaluate association between sub-clinical hypothyroidism and HF to know its clinical significance. Methods: An observational study conducted over three months on 70 diagnosed HF patients admitted in tertiary care hospital, evaluating history, clinical profile and demographics, HF types, comorbidity, and screened for thyroid function. Results: Thyroid dysfunction prevalence among HF patients was 27.14%, with subclinical hypothyroidism being most common. Treatment led to significant improvements in symptoms and cardiac function. Conclusions: There is significant correlation between thyroid dysfunction and HF with Subclinical hypothyroidism can be independent risk factor for HF. Timely and early recognition and management of thyroid dysfunction in HF patients are crucial for prognosis enhancement. Early intervention holds promise for improved outcomes in HF management.

7.
Article | IMSEAR | ID: sea-233991

RÉSUMÉ

Background: The global increase in type 2 DM is recognized re-emerging risk and challenge to TB control in India. TB-T2D association is again at the frontline of risk factors for TB, with an estimated worldwide population attributable fraction of 34.5%. T2D not only increases TB risk 3-fold, but also TB treatment failure including death. And prognosis of diabetic tuberculosis patients as compared to non diabetic ones is poorer. Methods: An comparative analytical study was done in microbiologically confirmed 50 diabetic and 50 non diabetic TB patients registered in RNTCP OPD of tertiary healthcare hospital who were followed up for 3 months. Results: In our study we found that elderly (above 65 age group) male diabetic patients were affected more with tuberculosis as compared to young patients and data was statistically significant. Extrapulmonary involvement was seen more in diabetic patients as compared to non diabetic patients. Radiologically diabetic tuberculosis patient showed predominantly lower lobe of lung involvement as oppose to non diabetic tuberculosis patients who showed upper lobe of lung involvement and data was statistically significant. Outcomes like Multidrug Resistance and prolonged sputum positivity after intensive phase treatment was seen more with diabetic tuberculosis patients but this was not statistically significant. Conclusions: Early screening of TB patients for DM and vice versa and early initiation of treatment will prevent unfavourable outcomes of these patients.

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