Study of erectile dysfunction in patients of type 2 diabetes mellitus and its association with cardiovascular risk

Background: Diabetes is a chronic metabolic disorder that is characterized by high level of blood glucose levels, which over a period of time can lead to micro-vascular or macro-vascular complications. Erectile dysfunction (ED) is common not much discussed and distressing complication of diabetes. ED in type 2 may be independent marker of coronary artery disease (CAD).Aim and objectives were to assess the ED in subject of type 2 diabetes mellitus (DM). Assessment of correlation of ED with CAD. Methods: The present cross-sectional study consisted total 180 diabetic patients. On basis of international index of erectile function (IIEF) questionnaire EDpatients were assessed.Result: Out of180 diabetic patients 36.11% had varying degree of ED. Out of 65 EDpatients, maximum frequency of moderate ED (47.69%) was found then severe ED (32.30%), mild to moderate ED (12.30%) and mild ED (7.69%). Most of the patients were in the age group of 40-50 years35 (53.84%), 50-60 years22(33.4%), <40 years(9.23%) and 60-70 years 2 (3.07%) showed ED. Fasting blood sugar and postprandial blood sugar showed significant (p<0.05) relation with ED. HbA1c show an insignificant correlation (p>0.05) with ED. In patient with ED was having more value of atherosclerotic cardiovascular disease (ASCVD) (9.11±4.84) than patient without ED (8.82±5.72). There was no significant (p>0.05) difference in term of ASCVD risk score in ED patient’s ED and without ED patients.Conclusions: Poor glycemiccontrol was a strongest risk factor for ED.

A study of non-alcoholic fatty liver diseasein patients with type 2 diabetes mellitusand itscorrelation with cardiovascular risk

Background:NAFLD(non-alcoholic fatty liver disease) encompasses a variety of disorders of lipid metabolism ranging from NAFL, NASH to cirrhosis and rarely HCC. A great deal of evidence suggests that the metabolic syndrome predicts incident cardiovascular disease (CVD), so it is possible to hypothesize that NAFLD patients might portend a greater CVD risk and that NAFLD itself might confer a CVD risk above that associated with individual metabolic syndrome risk factors.Methods:55 T2DM patients were included in current study conducted fromAugust 2019 to September 2021 for assessment of NAFLD using USGabdomen, NAFLD fibrosis score and FIBROSCAN. ASCVD score was used for correlation between CVD risk and NAFLD.Results:Out of 55 patients 42 (76.4%) were having fatty liver based on USG abdomen while 13 (23.4%) patients were having no fatty liver. As far as steatosis is concerned mean CAP (dB/m) was 245±50.89 out of which 24 (43.6%) were having no or minimal steatosis (S0), while 31(56.4%) were having significant steatosis with 11 (20%), 9 (16.4%) and 11 (20%) having S1, S2 and S3 grade of steatosis respectively.15 patients out of 55 were of F0 grade while 19 (34.5%), 9 (16.4%), 7 (12.7%) and 5 (9.1%) were of grade F1, F2, F3 and F4 respectively. There was a positive statistically significant (p?0.001) association of ASCVD risk score with NAFLD fibrosis score and fibroscan: E (KPa). Conclusions:Our study found that the prevalence of NAFLD was quite higher in patients with T2DM based on both USG abdomen (76.4%) and transient elastography (steatosis-56.4% and fibrosis-65.5%) and a statistically significantassociation between fibrosis and ASCVD score with higher fibrosis associated with higher 10 years ASCVD score.

A study to know the serum total testosterone levels in type II diabetes mellitus male patients from North India

Background: Diabetes mellitus is major public health issue facing the world in present century and the prevalence of type 2 diabetes is increasing explosively.  There are various diabetes related complications, one of which is low testosterone levels in men. This study was designed to estimate the serum testosterone level in male patients of type 2 diabetes mellitus.Methods: The patients of type -2 diabetes mellitus were picked up from out-patient and in-patients section of the hospital at random.Results: Seventy male  patients with type 2 diabetes mellitus were enrolled during the study period. The mean age of study population was 56.36±10.26 years (range 36-70), while that of control group patients was found to be 39.80±7.92years. Family history of diabetes was present in 14 (22.2%) patients. The mean HbA1c in study group was 8.83±1.95 %, which was significantly higher as compared to control group with HbA1c 4.82±0.40 %. Among study group, lower serum total testosterone level was observed in 85.7 % cases and normal level in 14.3 % cases. Among control group, lower serum total testosterone level was observed in 6.7 % cases and normal level in 93.3 % cases.Conclusions: The present study highlighted that significant difference in serum total testosterone level has been observed between cases and control groups (X2 =55.7, P=0.0001).

Assessment of health-related quality of life (HRQoL) in patients with spasmodic dysphonia

Background: There is paucity of literature regarding health related quality of life in Spasmodic Dysphonia (SD) especially from India. This study assessed HRQoL in it’s global and disease specific aspect by previously validated instruments in patients with SD.Methods: The study was performed in AIIMS, New Delhi. Subjects with SD as well as age and gender matched healthy controls were enrolled from Movement Disorder and botulinum toxin clinic, Department of Neurology, AIIMS, New Delhi. Uneducated patient, those could not read questionnaires & cases who had received botulinum toxin within 6 months were excluded from the study. Each patient filled SF-36, BDI, VoiSS-30 and VPQ questionnaire.Results: 14 pts of Spasmodic Dysphonia (SD) were enrolled. Compared with controls SD patients suffered from statistically significant impaired global health related quality of life (SF36) in areas of role physical (p = 0.007), general health (p = 0.004), social functioning (p = 0.024), role emotion (p = 0.008) and mental health (p=0.039). Patients with SD scored much worse in BDI scale than their control group (12.57±8.0 vs. 4.71±5.0, p=0.005). 65% pt of SD had depression out of whom 14% had moderate depression. SD patient group showed statistically significant impaired scores in disease-specific QOL (VoISS) in 2 out of 3 subscales, impairment (p= <0.001) and emotional (p=<.001) but not in physical (p=0.44). Voice quality of patients with SD was severely affected compared to controls (mean 37± 8.0 vs. 12.9± 1.5).Conclusions: This study clearly demonstrated that patients with SD suffered from significant impairment in HRQoL as compared to controls. Higher proportion of patients with SD suffered from mild to moderate depression compared to their control.

The Study of Arrhythmias in the First Week of Myocardial Infarction.

Background: Cardiac arrhythmias are quite common in the setting of acute myocardial infarction. Ninety percent of patients with acute myocardial infarction (AMI) have some cardiac rhythm abnormality, and 25% have cardiac conduction disturbance within 24 hours of infarct onset. These are tachyarrhythmias, ventricular arrhythmias, and atrioventricular block. A good correlation exists between the site of infarct and type of arrhythmias. Sinus bradycardia, sinoatrial escape rhythms, Wenkebach type and complete heart block are usually associated with inferior wall myocardial infarction (IWMI). Atrial premature contraction (APC) and ventricular premature contraction (VPC) are usually seen in anterior wall myocardial infarction (AWMI). Methods: The present cross-sectional study was conducted on 100 consecutive cases of acute myocardial infarction with arrhythmias attending as indoor emergency patients of Guru Nanak Dev Hospital attached to Government Medical College, Amritsar were included. History, clinical examination and required investigations including lipid profile, blood sugars, electrolytes, CPK-MB, ECG, and 2D-Echo were done. Results: Out of the hundred patients in the study, males (57%) outnumbered females (43%). Most of the patients were found in the age group of 51-60 years (34%). Smoking was the most significant risk factor (38%), followed by diabetes mellitus (35%), hypertension (30%) and prior ischemic heart disease (28%). The majority (56%) of the patients had anterior wall myocardial infarction (AWMI), followed by IWMI (24%), IWMI + RVMI (13%) and AWMI + IWMI (7%). Most of the arrhythmias (62%) developed during initial 24 hours of admission, while 27% in next 24 hours and 11% after 48 hours of admission to hospital. The most common arrhythmia observed was VPC (50%), followed by sinus tachycardia (48%), sinus bradycardia (16%), accelerated idioventricular rhythm (9%), 3rd degree heart block (7%), ventricular tachycardia (6%), 1st degree Heart Block (5%), 2nd degree Heart block (5%), ventricular fibrillation (4%), APC (4%) and AF (1%). Maximum incidence of VPC, sinus tachycardia, ventricular tachycardia (VT) and ventricular fibrillation (VF) were recorded in AWMI, while the maximum incidence of sinus bradycardia and AV block were observed in IWMI. Mortality was more common in patients developing arrhythmias specifically VT, VF and heart blocks especially 2nd-degree heart block and 3rd-degree heart block. Conclusion: Most of the patients with acute myocardial infarction develop some kind of arrhythmias which is an important cause of morbidity in these patients, develop during the initial 24 hours of admission to the hospital. Most common arrhythmias observed were VPC, followed by sinus tachycardia, AV block, bundle branch block, sinus bradycardia, VT, and VF. VPC, sinus tachycardia, VT, and VF were more common in AWMI, while sinus bradycardia and AV block were more common in IWMI. Diligent monitoring for arrhythmias and appropriate treatment can be life saving.

A Study of Arterial Blood Gas (ABG) Values in Liver Cirrhosis and Ascites.

Background: In cirrhotic patients, in addition to hepatocyte and Kuppfer cells dysfunction, portopulmonary shunt, intrapulmonary arteriovenous shunt and VA/Q inequality can induce a decrease in PaO2 and SaO2 as well as acid base disturbances. The present study was done to analyse arterial blood gas changes, prevalence of hypoxemia and acid base disturbances as well as to correlate grading of hypoxemia with different aetiologies and Child-Pugh score in patients with liver cirrhosis and ascites. Methods: The present correlative cross sectional study was conducted on 100 patients with cirrhosis and ascites for a period of 24 months. Arterial blood gas samples obtained by percutaneous radial puncture were analysed for various acid base abnormalities and arterial blood gas oxygenation. Results: Acid base disturbances observed were: respiratory alkalosis in 39 cases (39%), metabolic alkalosis in 20 cases (20%), metabolic acidosis in 11 cases (11%), metabolic acidosis with respiratory alkalosis in 10 cases (10%) and no acid base disturbance in 20 cases (20%). Mean values of PaO2 was 75.85±7.8 mmHg, PaCO2 was 35.27±5.13 mmHg, pH was 7.44±.115 and HCO3- was 23.65±3.85 mmol/l. Alcoholic cirrhotics had hypoxemia in 42% cases in contrast to hypoxemia in other aetiologies ( Hepatitis C 18%, Hepatitis B 5%).Conclusion: Metabolic abnormalities, hypoxemia and hypocapnia are commonly found in cirrhotics. Hypoxemia is more common in alcoholic cirrhotics but has no correlation with Child-Pugh score.

Management of type C intercondylar fractures of lower end humerus in adults: A clinical study.

Thirty-six patients of type C intercondylar fractures of lower end of humerus who visited JN Medical College, Aligarh between January, 2001 and January, 2003 were included in the study. All patients were treated surgically by open reduction and internal fixation with 4mm cancellous screws, reconstruction plates, one-third tubular plates. Early physiotherapy was started and the results graded using Krishnamoorthy criteria.