RESUMO
Background: Abnormal liver enzymes and liver function in congestive cardiac failure has long been recognized and occurs quite frequently in acute and chronic failure. Heart failure (HF) is characterized by the inability of systemic perfusion to meet the body's metabolic demands and is usually caused by cardiac pump dysfunction and may occasionally present with symptoms of a non-cardiac disorder such as hepatic dysfunction. The primary pathophysiology involved in hepatic dysfunction from HF is either passive congestion from increased filling pressures or low cardiac output and the consequences of impaired perfusion. Aim of the study: The present study was undertaken to identify alterations in the liver biochemical profiles in relation to congestive heart failure and also to show their significance with respect to the duration of heart failure. Materials and methods: Totally Sixty cases with heart failure of various etiologies and twenty healthy controls who got admitted at medicine ward of Sri Rajah Mutaiah Medical College and Hospital in the year 2019 March-August were included in the study. The higher number of cases was found within the age group of 40 to 50 years followed by the age group of 50 to 60 years. Laboratory tests measured only a limited number of these functions. No one test enabled the clinician to accurately assess the liver's total functional capacity. To increase both the sensitivity and specificity of laboratory tests in the detection of liver disease, it is best to use them as a battery. Results: Present study has found a strong relationship between liver function derangements and heart failure cases. The study observed 20% of cases with jaundice. Among sixty cases liver enlargement was seen in 63% of cases. Increased liver size is strongly correlated with hyperbilirubinemia. Though the conjugated fraction of bilirubin was also elevated, the levels of unconjugated fraction were higher. Mathew Jeraud. Clinical evaluation of liver function in congestive heart failure in Cuddalore District . IAIM, 2019; 6(9): 43- 48. Page 44 Serum aminotransferases were elevated in 78% of cases, unlike serum alkaline phosphatase which was increased only in 25% of cases. There found to be a significant correlation between rise in unconjugated bilirubin and elevation of serum aminotransferases. Conclusion: Study revealed marked alterations in liver function with acute heart failure and during hypotension when compared to chronic heart failure. Low serum proteins and serum albumin levels are seen in many of the cases. Various factors play in causing these changes which have already been discussed. Serum prothrombin time, though prolonged in 88% of cases, the changes were only mild.
RESUMO
Introduction: Chronic hyperglycemia is associated with continuing damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart, lungs, and blood vessels. The pathogenesis is thought to involve both a micro-angiopathic process and non-enzymatic glycosylation of tissue proteins. It has been demonstrated that pulmonary complications in diabetes are due to thickening of walls of alveoli, alveolar capillaries, and pulmonary arterioles and these changes cause pulmonary dysfunction. Aim of the study: To correlate the lung function in type II diabetes with duration of diabetes and to find out whether it is obstructive or restrictive pattern. Materials and methods: Totally 100 subjects participated in the study. Out of 100 participants, 50 were type II diabetes forming the study group and the remaining 50 were normal subjects forming the control group. A detailed history and thorough clinical examination were carried out. Inclusion criteria were Apparently healthy individuals with type II diabetic patients on oral hypoglycemic drugs and having diabetes for more than 2 years duration of age group 35 – 55 years. Thorough clinical examination and history were obtained from the subjects in order to determine the health status of the individual. Anthropometric measurements like height, weight were measured and BMI was calculated. Glycemic status for the participants was measured by doing fasting & postprandial blood sugar. HbA1c was determined. Results: The Mean (±SD) of HbA1c of controls was 3.16 ± 0.482 and for the study group was 5.38 ± 1.174, showed that the controls and study group with good glycemic control were selected for the study. The mean (±SD) of FEV1 for the control group were 91.40±11.236 and for diabetic group were 81.15±16.523. It was found to be significantly reduced (P= 0.002). The mean (±SD) of FVC for the control group was 81.85±9.211and for diabetic group was 73.75±13.933. The mean (±SD) of PEFR for the control group was 98.85±21.996 and for diabetic group was 85.95±24.045. The mean values of Mathew Jeraud. Clinical evaluation pulmonary function test in type II Diabetes Mellitus. IAIM, 2019; 6(9): 37-42. Page 38 FVC and PEFR were found to be reduced in diabetic group when compared to controls and were statistically significant. The mean (±SD) of FEV1/FVC% for the control group was 117.05±7.250 and for diabetic group was 116.58±7.071. The mean (±SD) of FEF25-75% for the control group was 136.73±26.056 and for diabetic group was 125.63±41.009. The mean (±SD) of MVV for the control group was 65.20±15.010 and for diabetic group was 58.80±16.530. The mean values of FEV1/FVC%, FEF25-75%, and MVV were reduced in diabetic group when compared with the control group but not statistically significant. Conclusion: The pulmonary dysfunction may be one of the earliest and easily measurable nonmetabolic alterations in diabetes. Therefore the patients with diabetes are suggested to undergo pulmonary function testing periodically. As spirometry is much more reliable, valid and simple test, it is time to include the spirometer as a tool for monitoring diabetes. Strict glycemic control and regular breathing exercises to strengthen respiratory muscles are necessary to improve the pulmonary function in type II diabetics.