Echocardiographic Changes in Controlled Type 2 Diabetes Mellitus with Reference to Body Mass Index and Waist Hip Ratio

Type2 diabetes mellitus is associated with central obesity. Studies showsthat central obesity, leads to insulin resistance is an important determinant for insulin resistance and cardiovascular morbidity. In the present study clinical profile of type2 diabetics with special reference to cardiac changes were studied and their relationship were established. This is a prospective cross-sectional study conducted in Sree Balaji Medical College and Hospital. 50 obese patients with controlled diabetes less than 5 years of duration were compared with obese non diabetics. There is significant statistical correlation with obese diabetic subjects particularly females, alterations in LV geometry. Obese female subjects had predominantly higher left ventricular mass. From the data of the present study high BMI, WHR have increased incidence of cardiovascular disease

A Unusal Presentation Of Bartter Syndrome

Bartter Syndrome is a rare congenital disease that manifests as hypokalemia, hyponatremia and hypotension. The disease occurs due to defective genes that are responsible for the reabsorption of certain electrolytes in the renal tubules. Hence it results in salt-wasting dyselectrolytemia. By its inheritable nature, the usual presentation of the disease is in the infants and children. But this case report presents an adult with symptoms of Bartter Syndrome which was discovered by chance while the patient was being treated for Acute gastroenteritis. Adult onset of Bartter Syndrome is incredibly rare and has been reported only in few other cases.

Characteristics of rheumatoid arthritis patients at first presentation to a specialized rheumatology department.

Background: Rheumatoid arthritis (RA) is a chronic, progressive, debilitating, systemic, autoimmune disease that mainly affects the diarthrodial joints. It is the most common form of inflammatory arthritis that occurs in approximately 1% of adults. The main objective is to study the characteristics of patients with Rheumatoid Arthritis (RA) at first presentation to a specialized rheumatology department. Methods: The study included 122 consecutive patients with RA, fulfilling 1987 American College of Rheumatology (ACR) criteria for RA at ‘Joint Disease Clinic’ of rheumatology department, at ISIC, New Delhi. Results: The mean age was 45.3 ± 12.4 years, F:M ratio, 8.4:1; maximum patients (31.1%) belonging to age group 30-40 years. Mean age at onset of symptoms was 38.1 ± 12.9 years and disease duration mode 5 years. 88% patients were literate and 59% referred by other patients. 14.8% patients had family history of RA, 7.38% (all males) were smokers. 16.4% female patients developed symptoms of arthritis within one year after delivery. 44.3% patients had severe, 50.8% moderate, 3.3% mild and 1.6% inactive disease (DAS 28[ESR] scoring system). 28.7% patients were taking treatment from alternative systems, 25.4% from orthopaedicians, 15.6% from internists and 8.2% from rheumatologists. Methotrexate and glucocorticoids were the most prescribed drugs (50.8% each) but in inappropriate doses. 23.8% patients had co-morbidities, hypothyroidism (9%) being the commonest. Conclusions: RA affects middle aged women. Hypothyroidism is the mostly associated autoimmune disease. The majority receive suboptimal / inappropriate treatment before visiting a rheumatologist. Most patients consult a rheumatologist at late stage in the disease often with deformities. Hence, increased awareness is needed about this disease among patients and doctors so that patients get timely referral to a rheumatologist for the proper management of this disease.

patient with musculoskeletal [MSK] pains-clinical approach

Joint complaints make an important component of musculoskeletal system [IMSK] diseases. In this write-up the importance of a clinical approach for categorizing joint diseases based upon the number of involved joints [monoarthritis or polyarthritis], duration of disease [<6 weeks - acute; >6 weeks - chronic] and whether the problem is inflammatory or non-inflammatory in nature, has been highlighted. Classifying patients on these clinical grounds helps in streamlining their management [e.g. primarily a problem of physician-rheumatologist, a physiatrist - rehabilitation expert or a joint surgeon]. It provides the appropriate management strategy for such patients

Evaluation of two intradermal vaccination regimens using purified chick embryo cell vaccine for post-exposure prophylaxis of rabies.

BACKGROUND: Post-exposure prophylaxis for rabies with cell culture vaccines by the conventional intramuscular regimen is very expensive. The World Health Organization has advocated two cost-effective intradermal regimens with cell culture vaccines for use in developing countries. We evaluated these two regimens--the 2-site and the 8-site regimens--in terms of immunogenicity, safety and tolerance in people with category I exposure to rabies. METHOD: Eighty-two subjects who had mild category I exposure to rabies were immunized using a purified chick embryo cell vaccine. The first regimen given to 43 subjects, consisted of intradermal administration of 0.2 ml of vaccine at 2 sites on days 0, 3 and 7 and at one site on days 28 and 90. The second regimen, given to 39 subjects, consisted of intradermal administration of 0.1 ml of vaccine at 8 sites on day 0, at 4 sites on day 7 and at one site on days 28 and 90. The mouse neutralization test was used to estimate titres of rabies neutralizing antibody in these subjects on different days after vaccination. The subjects were followed up for 1 year. RESULTS: Both regimens produced adequate neutralizing antibody titres from day 14 onwards, though the second regimen produced a more rapid antibody response and significantly higher titres (p < 0.001) on all days tested. There were minimal side-effects and both regimens were well tolerated. CONCLUSION: Both the 2-site and 8-site intradermal regimens with purified chick embryo cell vaccine produce adequate levels of neutralizing antibodies but the 8-site regimen appears to be more immunogenic. The feasibility of using these cost-effective regimens in routine practice needs to be further evaluated under the field conditions prevalent in India.

Study Of Malformations And Down Syndrome In India (SOMDI) : Delhi Region.

A total of 23,367 children born at Safdarjung hospital, New Delhi were examined for the incidence of congenital malformations as a part of multicentric project (SOMDI) funded by DAE. The study revealed 3.1% of still births, 1.46% of malformations. The frequency of malformations was more in babies born to rural mothers cum parents who were blood relatives. Amongst the malformations recorded central nervous system (Neural tube defect) malformations were more frequent (7.87/1000 births) followed by muscutoskeletal cum gastrointestinal type (3.08/1000 births) and multiple malformations (1.67/1000 births).

Response to purified chick embryo cell rabies vaccine administered intradermally for post-exposure prophylaxis.

BACKGROUND: Post-exposure immunization of rabies with presently available cell culture vaccines in the regular five-dose intramuscular schedule is expensive for developing countries. In view of the latest World Health Organization recommendation on the use of the abbreviated intradermal regimen (now routinely followed in Thailand), we evaluated this regimen for the purified chick embryo cell vaccine. METHODS: Twenty-five subjects who had nursed or casually handled a rabies patient were administered purified chick embryo cell vaccine. RESULTS: There was 100% seroconversion and all the subjects developed neutralizing antibody levels higher than the adequate level of 0.5 i.u./ml. Only minor side-effects were observed in some subjects. CONCLUSION: The feasibility of using this regimen in routine practice needs to be evaluated further.

Hemostatic profile in nephrotic syndrome.

OBJECTIVE: To evaluate the coagulation profile and its relation to steroid therapy, and the frequency of thromboembolic complications and its correlation with coagulation parameters in nephrotic syndrome (NS). SETTING: Hospital based. SUBJECTS AND METHODS: Forty children with NS were subdivided into four groups, namely, fresh cases, steroid dependent, remission after therapy and steroid resistant. An equal number of age and sex matched children served as controls. In all the study and control subjects, detailed clinical examination, liver function tests, renal function tests and detailed coagulation profile were done. Evaluation of renal veins and inferior vena cava for the presence of thrombosis was also done by abdominal ultrasonography. RESULTS: Thrombocytosis was detected in 57.5% and the degree of thrombocytosis was directly related to the amount of proteinuria. The mean prothrombin and thrombin times were within normal range in the study children. The activated partial thromboplastine time (APTT) was prolonged in six cases (15%) and three out of these six children had thromboembolic complications. Antithrombin-III level was significantly lower (p < 0.001) whereas protein C and S were significantly elevated (p < 0.001) as compared to controls. The levels became normal with remission of the disease. Steroid therapy significantly increased the levels of proteins C, protein S. AT-III and fibrinogen as compared to controls. Thromboembolic complications were seen in 3 cases (7.6%) and were associated with very low levels of AT-III and protein C and all three had serum albumin below 2 g/dl. CONCLUSIONS: The importance of coagulation profile in nephrotic syndrome is highlighted and a high index of suspicion for thromboembolic complications is warranted in patients with thrombocytosis, hyper fibrinogenemia, prolonged APTT and in children with low levels of AT-III, protein C and protein S.

Prevalence of hypertension in schoolgoing children.

OBJECTIVE: To establish norms of blood pressure in children of different age groups, prevalence of hypertension and probable precipitating or aggravating factors. DESIGN: Cross sectional study. SETTING: Five thousand school children of Amritsar city. METHODS: Three readings of blood pressure were recorded. Norms for each year age group from 5-17 years of age were established. Persistently hypertensive children were investigated. Influencing factors like family history of hypertension and obesity were taken into account. RESULTS: The blood pressure increased with increase in age with a spurt in systolic blood pressure at the age of 12 years in both the sexes. There was no significant differences in the blood pressure of two sexes at various age groups except for systolic blood pressure at 5,6 and 16 years and for diastolic blood pressure at 9 and 13 years. Only 0.46% children were hypertensive. Children with obesity (n = 342) and family history of hypertension (n = 271) had hypertension in 3.5% (n = 12) and 5.9% (n = 16) cases, respectively as compared to other children in which the prevalence was only 0.23% and 0.14%, respectively. CONCLUSIONS: The norms for determining hypertension in this population were established and it's prevalence was 0.46%. Significant risk factors were obesity and family history of hypertension.

Meningococcaemia with arthritis

A patient is described with acute meningococcaemia and arthritis, but without meningitis. Although he had a positive blood culture, repeated synovial fluid cultures were sterile. Over the course of his illness and as his septicemia recovered with antibiotic treatment, the pattern of his arthritis changed from that of a polyarthritis to oligoarthritis and then a monoarthritis of the left knee. The knee deteriorated in fact while all the other features showed complete recovery. Repeated aspirations of the knee involved did not help. However, a local injection of a depot preparation of methylprednisolone into the involved knee led to a quick and complete recovery. This paper reviews different patterns of arthritis due to meningococcal infection and discusses its management

Acute arthritis with subcutaneous nodules on the shin-acute sarcoidosis [lofgren's syndrome]

This case report describes a young Lebanese man with acute polyarthritis, fever and tender erythematous nodules on both shins. The nodules had the appearance of typical erythema nodosum [EN]. An algorithmic approach to acute arthritis with erythema nodosum led to a diagnosis of Lofgren's syndrome that is a variety of acute sarcoidosis. Differential diagnosis of acute arthritis with EN in males is discussed

Assessment of thyroid functions and its role in body growth in thalassemia major.

The present study was done to establish the role of thyroid gland in causing growth retardation in regularly transfused thalassemic children. Growth, skeletal maturation and thyroid functions were assessed in 25 patients of thalassemia major in the age range of 5-17 years (mean age 10.3 +/ 3.6 years). Thirteen patients were migrants from Pakistan and 12 were of Indian origin. Twenty-five age and sex matched children who were not anemic served as controls. Thalassemic children received multiple blood transfusions ranging from 36-350 units with a mean of 168.4 +/ 98.9 (+/ 1 SD). The mean pretransfusion hemoglobin was 8.7 +/ 1.6 g/dl. Twenty eight per cent patients were below the 5th percentile for height and another 24% between 5th and 10th percentiles. The height age retardation was more pronounced than bone age retardation. The mean serum total T3 and T4 levels were significantly lower (p < 0.001) and the mean serum TSH levels were significantly higher (p < 0.005) in patients with thalassemia major as compared to the controls. Eight patients had high TSH levels; of these 5 had compensated primary subclinical hypothyroidism (elevated TSH with normal T3 and T4) and 3 had uncompensated primary sub-clinical hypothyroidism (elevated TSH, low T4 and normal T3). Two patients had low T4 with normal T3 and TSH levels. Thyroid dysfunction was not related to age, sex, hemoglobin levels and country of origin but transfused iron load (units/kg, units/year) was significantly higher in patients with hypothyroid function compared to those with euthyroid function (p < 0.005). Height age, weight age and bone age retardations were more pronounced in patients with hypothyroid function; however, the difference was not statistically significant. It is concluded that hypothyroidism is unlikely to be the sole cause of growth retardation; however, it may have a potentiating or permissive role. The strong association of high transfused iron load and decreased thyroid function stresses the need for intensive chelation therapy.

Evaluation of thyroid functions in critically ill infants.

The degree to which thyroid functions are affected by non-thyroid illness and an assessment of its correlation with mortality was evaluated. Thirty infants (20 M, 10 F) with a mean age of 433 +/- 3.28 months (+/- 1 SD), with severe acute systemic illness and 30 healthy controls, age and sex matched, were studied for total serum T3, T4 and TSH levels at admission and recovery or before death. Serum thyroid hormones were measured using standard techniques. There was no significant change in thyroid indices with age, sex, nutritional status, serum protein and C-reactive protein. Serum T3 levels in infants were significantly lower (0.62 +/- 0.63 ng/ml) than the controls (1.90 +/- 0.62) (p < 0.001), with normal T4 and TSH levels at admission. Both serum T3 and T4 levels increased with recovery. Out of 30 infants studied, 14 died whereas 16 were discharged. It was noticed that T3 and T4 values were significantly reduced at or near death when compared with the admission levels (p < 0.001). Prognosis could not be determined at the time of admission, as thyroid indices at admission of patients who died, when compared to infants who were discharged, showed no significant difference in T3, T4 or TSH levels. The above mentioned changes in thyroid indices probably occur as a temporary adaptive mechanism to limit catabolism in states of stress such as infection. Hence, it is suggested that thyroid function tests be interpreted with caution in patients with non-thyroid illness.

p-Aminobenzene sulphonyl morpholine, compound 82/208 a new anticonvulsant agent.

p-Aminobenzene sulphonyl morpholine, compound 82/208, was evaluated for acute toxicity and anticonvulsant action in mice against tonic seizures induced by supramaximal electroshock and pentylene tetrazole and strychnine induced seizures and for its effect on blood pressure and respiration in cat. Diphenyl hydantoin (DPH) was used as reference standard. Compound 82/208 exhibited anticonvulsant activity against electroshock induced seizures and PTZ induced tonic seizures in mice. The compound had several distinct advantages over DPH in experimental evaluation in mice.

Neurosonographic abnormalities in neonates with hypoxic ischemic encephalopathy.

Pattern of neurosonographic (NSG) abnormalities in 150 term newborn infants with hypoxic ischemic encephalopathy (HIE) was studied. Sonographic abnormalities, presumably indicating cerebral edema and or ischemia, were observed in 86% (n = 129) cases. Obliteration of the ventricles occurred as the sole abnormality in 30 (20%) cases. Eighty (53%) patients had diffusely increased echogenicity of the brain parenchyma (DPE) in addition to the compression of the ventricles, sulci and the interhemispheric fissure. Focal parenchymal echodense (FPE) lesions occurred in nine (6%) neonates with HIE. Ten (6.6%) patients, however, had increased periventricular echogenicity (PVE). Two patients, one with focal parenchymal lesions and the other with PVE had obliterated ventricles in addition. Regarding temporal sequence earliest NSG abnormalities were DPE or slit like ventricles that were observed on day-1 itself. Focal or periventricular echogenic lesions, however, made their first appearance on day-3 of life. Twenty one patients had normal scans. Fifty patients with abnormal scans died. None of the infants with normal scans, however, died (p < 0.001). At 4 weeks of age, scans performed in 100 survivors revealed no abnormality in 51 cases. Others showed development of cerebral atrophy (n = 21), multicystic encephalomalacia (n = 2), porencephalic cyst (n = 1), or persistence of PVE without cystic changes (n = 4). The results of this study highlight the diagnostic efficacy of neurosonography in cases of HIE. We suggest that it should be incorporated in the routine evaluation of patients with hypoxic brain injury.