To Study the Association of Depression with Complications of Type 2 Diabetes and to Find Out any Correlation Between Type of Complication and Depression.

Background: Depression is common among people with diabetes and it is associated with poor outcomes. This study was carried out to investigate the association of depression with various complications of type 2 diabetes and to find out any correlation between type of complications and depression. Methods: 200 patients with established T2DM attending the Outpatient department and indoor wards of Medicine Department of Rajindra Hospital, Patiala were evaluated for depression by a previously validated depression questionnaire [PHQ-12 item]. Results: Patients with T2DM (n=200) were evaluated [94 (47%) male and 106 (53%) female]. Maximum number of patients i.e. 68(34%) were in 51-60 years age group. 57(28.5%) patients out of 200 had depression. Depression was commonly associated with retinopathy (68.57%), followed by neuropathy (61.2%), nephropathy (59.57%) & CAD (25.45%). It was most commonly associated with PDR (100 %) and least commonly with CAD. Conclusion: This study showed high prevalence of depression in patients with T2DM. The prevalence of depression is higher in T2DM subjects with retinopathy, neuropathy and nephropathy compared to those without the respective complications. The Chances of becoming depressed increased with increase in number of complications.

Demographic Profile and Clinical Features of Admitted HIV Positive Patients and their Correlation with CD4 Counts in a North India Tertiary Care Hospital.

Background: HIV Infections continues to be a burden globally and presents serious public health problems in the developing countries, especially in India. Aims and objectives: To study the demographic profile and clinical features of HIV positive admitted patients and to evaluate the correlation of clinical features with their CD4 counts. Methods: The present study was conducted to assess the socio-demographic profile and clinical features of 150 HIV+ve /AIDS patients admitted in various wards of Department of Medicine, Rajindra Hospital, Patiala from September 2013 to October 2015. For these patients a preformed questionnaire was prepared to enquire about socio-demographic characteristics such as age, sex, literacy status, marital status, occupation and socio-economic status. Thorough clinical examination was performed and correlation of clinical features with CD4 counts was evaluated using Pearson Coefficient of correlation. Results: The results of study showed that the most common age group affected was 26-45 years (56%). Male patients were 69.3% and females constituted 30.7%. Most common mode of transmission was heterosexual (73.3%), followed by intravenous drug abuse (6.7%), unsafe injections/needle stick injury (4.6%), blood transfusion (2.7%), 8% were both HS and IDU and transmission was unknown in 2.7%. The common presenting symptoms in admitted HIV patients were fever (71.3%), weight loss (50%), night sweats (39.3%), dry cough (36%), anaemia (32%), cough with expectoration (26%), lymphadenopathy (24%), shortness of breath (22%), chest pain (20.7%),diarrhoea (15.3%) and mouth ulcers (8.7%). Others were, headache (10.7%), haemoptysis (10%), icterus (6.7%), change of voice (4%), altered sensorium (14%) and neurological deficit (7.3%). 16 patients had pulmonary and 13 had extra pulmonary tuberculosis. It was also found that most patients (52%) had CD4 count in range of 200-500, with mean CD4 count of 282.61 + 14.31 cells/cmm at time of presentation. The frequency of these symptoms increased with fall in CD4 count indicating negative correlation. Conclusion: A thorough knowledge of the demographical & clinical profile of admitted patients will go a long way in managing resources and planning management of these patients. This will serve as a great step in achieving zero deaths as envisaged by NACO.

To Study the Prevalence of Thyroid Dysfunction in Newly Diagnosed HIV +ve Patients and Correlation between CD4 Count and Thyroid Dysfunction.

Background: Thyroid dysfunction is one of the common endocrine dysfunction in HIV Positive patients. Newly Diagnosed HIV Positive patients are rarely monitored for this problem. Objective:- To study the prevalence of thyroid dysfunction in newly diagnosed HIV positive patients & to Correlate it with CD4 Count. Methods: A prevalence study was carried out on 150 newly diagnosed HIV Positive patients with different CD4 Counts divided in three groups (Group A; CD4<350, Group B; CD4 350-550 and Group C; CD4>550) who were evaluated for thyroid dysfunction. Blood samples were collected for CD4 T Lymphocytes. Counts were determined by flow cytometry and Thyroid function was evaluated by chemiluminescence immunoassay. Results: Out of 150 cases studied, 47 Patients (31.33%) had thyroid dysfunction. Group A, B and C had Thyroid dysfunction in 40 %( 20), 32 %( 16) and 22 %( 11) patients respectively. All except one had hypothyroid state (TSH above normal range).When the results were analyzed for 150 patients with Pearson correlation coefficient. There was an inverse correlation of CD4 count and TSH. There was progressive decline in T3, T4 levels as CD4 count decreased. Conclusion: Thyroid dysfunction is frequent in newly diagnosed HIV positive patients and prevalence of thyroid dysfunction increased with decrease in CD4 count. TSH levels increased as CD4 count declined.

Tubercular Arthritis of Sternoclavicular Joint: A Case Report.

Sternoclavicular joint (SCJ) is a rare site for occurrence of tubercular arthritis. Diagnosis often gets delayed due to rarity, leading to annoyance to patient. Here we report a case of 66 years old female who presented to us with painful swelling of Right>Left sternoclavicular joint. Diagnosis was clinched by clinical evaluation, appropriate imaging and strongly positive Interferon gamma release assay and fine needle aspiration cytology. Patient was put on ATT with significant improvement after 2 months.

Profound Hyponatremia: Prevalence, Underlying Disorders and Outcome in Tertiary Care Hospital.

Background: Profound hyponatremia (<125 mmol/l) is a serious electrolyte disturbance often encountered in tertiary care setting and is associated with increased morbidity and mortality. Does hyponatremia per se or the underlying disorder contribute to increased mortality remains a controversial point. Clinical records of profound hyponatremia patients were explored with the aim of finding its cause and contribution of hyponatremia in final outcome. Materials and Methods: All the inpatients with serum sodium ≤125 mmol/L were identified from laboratory data over a period of four months in a tertiary care hospital. Outpatients and cardiac patients were not included in the study. They were classified into three groups according to serum sodium levels in mmol/l (group I: 121-125, group II: 116-120, group III: ≤115). Clinical data was obtained from medical record office. Clinical diagnosis, extent of hyponatremia correction and mortality rates were studied. Observations: One thousand and fifty patients were identified as having profound hyponatremia (sodium ≤125 mmol/l). Prevalence of profound hyponatremia was recorded as 6.35%. Majority of profound hyponatremic patients (70.54%) had sodium levels in range of 121-125 mmol/l. Very profound hyponatremia (≤115 mmol/l) was noted in 17.6% patients. Mortality rate was significantly higher than the general mortality rate of hospital during that period (8.83% vs 4.6%, p < 0.001). Mortality in group III was highest (12%) followed by patients in group-I (8.42%). Most common cause of hyponatremia was chronic liver disease (20.9%), followed by infectious disease (17.04%), chronic and acute renal disease (15.4%). Diabetes mellitus along with its complications and endocrinological cause were present in 12.1% patients. Other causes include malignancy (11%), neurological (7.04%), pulmonary and trauma (6.4% and 5.17% respectively). Some miscellaneous causes like burns, psychological, skin disease were also noted. It was observed that patients died mainly because of underlying disease as in majority of subjects (75.72%) hyponatremia was corrected either fully or partially (Na≥ 130 mmol/l and Na ≥ 125 respectively) before demise. Conclusion: High prevalence of hyponatremia was recorded in inpatients making it a common electrolyte disturbance. Underlying disease and severity of hyponatremia have a bearing on final outcome of patients.

Pregnancy Following Laparotomy for Ruptured Interstitial Pregnancy.

An interstitial pregnancy is an uncommon type of ectopic pregnancy, accounting for 2-4% of all ectopic pregnancies. We present a patient with history of ruptured interstitial pregnancy who had been managed successfully at our hospital. The patient had refused tubectomy and conceived against medical advice within six months after laparotomy. She was counseled for risk of rupture of uterus and admitted to the hospital at the beginning of 9th month. She underwent an elective cesarean section and a male baby was delivered. Palpation of the uterine scar revealed that it was papery thin. Had there been any delay, the uterus would have ruptured with resultant maternal and fetal morbidity and mortality.

Homocysteine – Risk factor for ischemic stroke.

The present study was undertaken to compare the homocysteine levels in patients of ischemic stroke with controls. Our study included 117 patients of ischemic stroke and 101 controls. The mean homocysteine levels in patients with ischemic stroke were 16.80±6.71 umol/L while in controls it was 12.30±4.68 umol/L, the difference being statistically significant (P<0.01). The increased homocysteine levels in patients with ischemic stroke are independent of diabetes mellitus, age and sex. The homocysteine levels were higher in hypertensive subjects than non-hypertensive (P<0.05).