An Observational Study Of Cardiac Involvement In Copd Patients And It’s Correlation With Severity Of The Disease

Introduction: The association of type 2 diabetes mellitus and thyroid dysfunction is well known. Thyroid dysfunction especially subclinical hypothyroidism has been reported to be a risk factor for sight threateningdiabetic retinopathy. Therefore, it is of importance to investigate the determinants of clinical and subclinicalhypothyroidism in patients with diabetic retinopathy. This study was aimed to investigate the effect of hypothyroidism on diabetic retinopathy and the determinants of hypothyroidism.Aims: To study the association of hypothyroidism and diabetic retinopathy and its effect on severity of retinopathy in type 2 diabetes and investigate the determinants of hypothyroidism in patients with diabetic retinopathy.Subjects and methods: A cross sectional study conducted on one hundred patients of type 2 diabetes withdiabetic retinopathy. They were evaluated for status of diabetes control, thyroid function, lipid profile andretinopathy grade. Those found to have clinical and subclinical hypothyroidism were analyzed for variousclinical and biochemical parameters for possible determinants of thyroid dysfunction.Results: There were seventy-four euthyroid patients and eighteen with subclinical hypothyroidism and five withclinical hypothyroidism. Patients with subclinical hypothyroidism had severe form of retinopathy (61.11%versus 32.43%). The odds of having a subclinical hypothyroidism in patients with severe form of diabeticretinopathy was found to be significant (OR 3.23; p=.048 CI=1.10-9.88). High HBA1c was an independent determinant of abnormal thyroid function.Conclusions: About one fourth of type II diabetes patients with retinopathy have thyroid dysfunction. Thesepatients are also likely to have severe form of the retinopathy especially those having subclinical hypothyroidism. Thus, we recommend thyroid function test should be done in all patients with type II diabetes mellitus withretinopathy. Those identified as having subclinical hypothyroidism should be closely followed so as, to detectand prevent vision threatening complications

An analysis of 2800 CT Head scans in patients with chronic headache

Introduction: Chronic headache is a common health problem in general medical practice and there is increasing demand of CT scan from specialist as well as non-specialist doctors to refer patients for CT head scan. Patients and methods: The present study was done on 2800 CT head scans of patients with problem of chronic headache. While patients in Group 1 (n=1900) had only chronic headache without any neurological findings, Group B comprised of cases (n=900) referred by specialist doctors after neurological examination. CT scan was done by trained technicians and contrast was injected where necessary. Results: Present study showed majority of patients in both group 1 and group 2 (90% and 87.7% respectively) had normal CT findings or insignificant findings. However, difference was not significant in both groups when significant findings (10.0% Gr. A and 12.2% Group B) were compared. Discussion: Our findings are consistent with other studies concluding that routine CT scan may not provide clinically useful information in chronic headache.

A comparative study on efficacy and safety of glycopyrronium bromide + salmeterol/fluticasone and tiotropium bromide + salmeterol/fluticasone in hronic obstructive pulmonary disease

Objective: To compare the effect of tiotropium bromide and glycopyrronium bromide in the treatment of chronic obstructive pulmonary disease. Methods: This was an open labeled Randomized controlled trial study. Patients diagnosed with COPD according to the Global Initiative for chronic Obstructive Lung Disease (GOLD) strategy were included in the study. The patients were divided in two groups and each group had 100 patients. Group A- COPD patients on Tiotropium bromide + Salmeterol/Fluticasone; Group B – COPD patient on Glycopyrronium bromide + Salmeterol/Fluticasone. Tiotropium bromide: 18 mcg OD, Glycopyrronium bromide: 50 mcg OD along with Salmeterol 50 mcg/Fluticasone 100mcg was given. Results: The mean age of patients of Group A and Group B was 56.28±7.78 and 57.64±8.06 years respectively. Baseline variables were comparable between the groups. There was significant (p<0.05) difference in PFT parameters between the groups at 12 and 24 weeks except for FEV1/FVC. The mean change was higher in Group B compared to Group A from 0 week to 24 weeks. There was clinical improvement among all the patients in both the groups. Conclusion: Once-daily GLY demonstrated similar effects to TIO when combined with SAL/FP in patients with moderate and severe COPD.

Retrospective analysis of chest x-ray of patients from eastern Uttar Pradeshpresenting in Radiology department ofHind Institute Medical Sciences, Barabanki Uttar Pradesh

Introduction: Chest Xray is one of the most frequently asked radiological examination in patients with heart or lung problems in general medical practice. There are many studies on correlation of CXR findings and other tools of investigations like CT scan, MRI and laboratory investigations like spirometry and sputum examinations etc. The present study aims at establishing a possible correlation in rural population of Eastern Uttar Pradesh. Methods: We have done a cross sectional study in a period of six months including 2500 patients coming for CXR. Patients were followed up to a point where radiological diagnosis was confirmed or otherwise after other investigations and clinical response. Results: There was fairly good correlation in patients with COPD (73.15%), tuberculosis (85.8%), interstitial lung disease (63.9%) and congestive heart failure (68.6%). Conclusion: We conclude that CXR is tool of reasonable sensitivity however there is sizeable possibility of false positive and negative cases.

Open label case control prospective study to evaluate the impact of aceclofenac on antihypertensive action of amlodipine and ramipril in hypertensive patients with osteoarthritis

Objective: To study the impact of aceclofenac on antihypertensive action of amlodipine and ramiprilin hypertensive patients with osteoarthritis in an open label case control prospective study. Methods: This was an open label case control prospective study. Hypertensive patients on either amlodipine or Ramipril were included in control groups. A total of 120 patients were included in the study and divided into 4 groups: Group A- Hypertensivepatients on Ramipril; Group B – Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Ramipril; Group C– Hypertensive patients on Amlodipine and Group D- Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Amlodipine. Results: At the end of the first month (phase I), the ramipril subgroup in the control group had a mean systolic blood pressure of 136.73±3.80 which was an 8.19% decrease from the baseline and it was found significant (p<0.05). The systolic blood pressure measurements at the end of the second month (phase II) in the control groups revealed further fall in mean systolic blood pressure. The cases of osteoarthritis on aceclofenacand ramiprilshowedan increase in BP. The mean Systolic BP was 159.2 ± 5.816.An increase of 9.74%from the base line and 16.09% was noted at the end of phase-I (P<0.5). Patients on aceclofenac and amlodipine in contrast showed a fall in BP from base line in phase 0 and their mean systolic blood pressure at positive in of second month of phase-II was 142.07± 2.43 about 1.88% fall baseline and 2.94% increase in BP compared to Phase-I. Almost similar observations were recorded for diastolic blood pressure. Conclusion: The interaction of NSAIDs on the antihypertensive action of the ACE inhibitors is significantly greater than their blunting action on the calcium channel blockers.

A study of relationship of hyperuricemia in hypothyroid patients

Introduction: Hypothyroidism is a common metabolic disorder in general population. The prevalence of primary hypothyroidism is 1:100, but it may be 5:100 if patients with subclinical hypothyroidism (normal T4, raised TSH) are included.The degree of severity ranges from mild and unrecognized hypothyroid states to striking myxedema. The thyroid dysfunction increases with age, especially in women.Uric acid has been found to be significantly elevated in primary hypothyroidism in many studies. In comparison to the prevalence reported in the general population, a significant increase of both Hyperuricemia and gout was found in the hypothyroid patients. In hypothyroidism, the hyperuricemia is secondary to a decreased renal plasma flow and impaired glomerular filtrationThis study was designed for evaluation of uric acid levels in hypothyroid patients which might be helpful for clinical management of hypothyroid patients with hyperuricemia. Objective of Study: To find out any relationship between hyperuricemia in hypothyroidism patients. Methods:In our study, out of 100 patients, only 15 were found to have increased serum uric acid levels and only 3 had increased urinary uric acid levels. Out of these 15, 9 were females and 6 males, or can be said out of 70 females in study; only 9 were having increased serum uric acid levels. Results: In our study, the association between hypothyroid function and hyperuricemia seems to be week.No significant correlation was found betweenT3, T4 &TSH and serum uric acid. Conclusion: The correlation between hypothyroidism and gout still remains a matter of debate and more extensive studies need to be done to come to a definitive conclusion.

Bullous Erythema Nodosum Leprosum: A Rare Entity

Erythema Nodosum Leprosum (ENL) usually presents in patients with Lepromatous Leprosy. It commonly presents as tender erythematous nodules but other rare forms like pustular, vesicular, bullous or necrotic have also been reported. We report a case of a 30 year old male who initially presented with erythematous tender nodules and plaques over both lower limbs with a past history of being treated for Lepromatous Leprosy. He further developed bullous lesions over the same sites. Biopsy specimen of a bulla was sent for histopathology which was suggestive of ENL. This presentation of ENL makes it an interesting case to be reported.

Multidrug Resistant Pseudomonas aeruginosa from Wound & Pyogenic Infections.

Abstracts: Background: Wound infections are one of the most common hospital acquired infections and are an important cause of morbidity and account for 70-80% mortality. Pseudomonas aeruginosa is an epitome of opportunistic nosocomial pathogen & responsible for serious infection such as septicemia ,pneumonia ,various pyogenic & wound infections. Pseudomonas aeruginosa is inherently resistant to many antibiotics and can mutate to even more resistant strains during therapy. So the present study aimed to find out the strains of Pseudomonas aeruginosa from various pyogenic & wound infections, their antibiotic sensitivity profile & to find out multidrug resistant strains. Methodology: Pseudomonas aeruginosa isolates obtained from pyogenic & wound infection samples were identified by conventional microbiological techniques. All these isolates were tested for antimicrobial susceptibility on Muller-Hinton’s agar by Kirby-Bauer disk diffusion method as per CLSI guidelines. Results: Out of 90 Pseudomonas aeruginosa strains,49 (54.44 %) were MDR strains & highest sensitivity was found to levofloxacin (74.44 %) ,amikacin, (67.77%),cefepime(65.55 %), pipercillin (64.4%) & ceftazidime (63.33 %). Conclusion: The prevalence of MDR strains in our study is 54.4 % which calls for the judicious selection of antibiotics in clinical practice. In addition, regular antimicrobial susceptibility surveillance is essential for area-wise monitoring of the resistance patterns. An effective national and state level antibiotic policy and draft guidelines should be introduced to preserve the effectiveness of antibiotics and for better patient management.

Morphological Spectrum of Endometrium in Patients Presenting with Dysfunctional Uterine Bleeding.

Dysfunctional uterine bleeding (DUB) is a clinical term used to describe bleeding not attributable to any underlying organic pathological condition. A total of 187 patients were included in the present study which were categorized in reproductive (<40 yrs), perimenopausal (40-50yrs) and postmenopausal (>50yrs) age groups. One hundred sixteen cases (62%) were in reproductive age group, 47 cases (25.1%) in perimenopausal age group and 24 cases (12.8%) in postmenopausal age group. Histopathological examination of dilatation and curettage (D&C) samples was done to elucidate the cause of DUB. In reproductive age group, proliferative endometrium was the most common finding (26.8%) followed by irregular maturation (25%).Complex hyperplasia was seen in 6 cases, out of which 1 case showed atypia. Nineteen cases (16.4%) showed associated endometritis. No case of malignancy was observed in this group. In perimenopausal age group, simple hyperplasia was the most frequent finding (29.8%).Complex hyperplasia was seen in 3 cases, out of which 1 revealed atypia. Three cases of malignancy (6.4%) were reported. In postmenopausal age group, most frequent finding in DUB was complex hyperplasia seen in 8 cases (33.3%), out of which 2 cases showed atypia. Six cases (25%) of simple hyperplasia and 4 cases (16.7%) of malignancy were reported. Atrophic endometrium was observed in D&C samples from 6 patients (25%).

Newborn with tail - a genetic throwback.

The birth of a child with a caudal appendage resembling a tail generates an unusual interest and anxiety. True human tail is a rare event; less than 40 cases have been reported in the literature so far. It is defined as a caudal, vestigial, midline protrusion of muscle and adipose tissue with skin covering. We are reporting a case of true tail in a baby, a rare event in human.

Histopathological manifestations in kidney of Clarias batrachus induced by experimental Procamallanus infection.

Kidney of Clarias batrachus infected with Procamallanus showed varying degrees of histopathological alterations on 15, 30, 45 and 60 days post-infection. The infected kidney showed variable sized glomeruli, cloudy swelling in tubules, vacuolar/atrophic degeneration, fibrosis, mild degenerative changes in distal convoluted tubules, enlarged Bowmen's capsule, necrotic changes as well as increased granulation and hyperplasia in proximal convoluted tubules after 15 days. After 30 days of infection, the changes were rupture of Bowmen's capsule wall, degenerative changes, edema, necrosis, pyknosis, karyorrhexis and karyolysis in proximal and distal convoluted tubules, fibrosis, cloudy swelling and inflammatory lymphocytes, proliferation and shrinkage in glomeruli, and vacuolization in proximal convoluted tubules as well as cloudy swelling. After 45 days, the infected kidney showed cloudy swelling in glomeruli as well as variation in their size, infiltration of RBCs in intralobular vein and necrosis in proximal convoluted tubules, cloudy swelling in interstitium, vacuolization in the epithelial lining cells, necrosis in haemopoietic tissue and inflammatory edema. After 60 days post-infection, the changes were rupture of intralobular vein, cloudy swelling, necrosis in few proximal convoluted tubules, atrophy and shrinkage in glomeruli, distinct inflammatory edema, pyknosis, karyorrhexis and karyolysis, aggregation of lymphocytes and dilation in blood vessels.

Flowcytometric evidence of platelet activation in patients on aspirin following myocardial infarction.

BACKGROUND: Following a myocardial infarction, patients are usually started on long term antiplatelet therapy with aspirin in a dose of 80-150 mg/day. However, there are no quick and easy methods to assess the efficacy of the antiplatelet activity of aspirin. METHODS: We studied 60 consecutive patients (men, < 40 years of age) 8-10 weeks after they had had acute myocardial infarction. These patients were receiving 100 mg aspirin daily orally with or without b-blockers. We measured P-selectin expression and fibrinogen binding by flowcytometry at least 3 times over a period of 2 years in all the patients. We also studied 100 age- and sex-matched controls. RESULTS: Of the 60 patients, 30 (50%) showed both increased P-selectin and fibrinogen binding by platelets, suggesting platelet activation. Fourteen other patients had increased fibrinogen binding but normal P-selectin expression. Sixteen patients and all the controls had normal results of both tests. CONCLUSION: Our data show evidence of platelet activation in at least 50% of patients receiving 100 mg of aspirin daily. Flowcytometry for P-selectin expression and fibrinogen binding to platelets can be used to monitor antiplatelet therapy with aspirin following acute myocardial infarction.

Thrombophilia in coronary artery disease: a double jeopardy.

Thrombophilia can be defined as an increased risk of thrombosis. The central event to the pathogenesis of any thrombotic episode is the perturbation of haemostasis, the cause of which may be genetic or environmental. The clinical manifestations of the chronic development of coronary artery atheroma are angina and acute myocardial infarction. In recent years literature is emerging on the role of different factors of blood coagulation in arterial thrombosis. Different coagulation factors, natural anticoagulants, platelet antigens and other factors such as homocysteine, lipoprotein (a), have been studied as risk factors for coronary artery disease (CAD). The results of many of these studies are contradictory. In India, there is an alarming rise in the number of young patients with myocardial infarction (MI) and an interesting feature is that a large majority of these patients lack the conventional risk factors. There have been scattered studies on the thrombophilia status among Indians. The management of thrombophilia can be done by a regimen of different drugs which has been evaluated in different clinical trials. Since the cost of thrombophilia investigations is quite phenomenal for a developing country like India, the selection of these investigations assumes an utmost importance.

Hepatic involvement and hepatitis B surface antigen (Hbs Ag) in leprosy.

Hepatic involvement and hepatitis B surface antigenemia was studied in 80 leprosy patients and results were compared with 50 normal healthy controls. HbsAg was detected in 7.54% of lepromatous leprosy patients as compared to 2% of the normal healthy controls. There was a decrease in albumin and increase in globulin levels with significant decrease in A: G ratio. SGPT levels were significantly raised in lepromatous leprosy patients. Histopathological changes were present in 57.1% of lepromatous leprosy and 23.8% of tuberculoid leprosy patients.

Monitoring of presterile disposable syringes and needles marketed in Pune.

Out of hundred syringes and hundred needles (both presterile, disposable) tested, 41 syringes (41%) and 6 needles (6%) showed aerobic growth. Forty of the above syringes were tested simultaneously for fungi and anaerobes. Fungi isolated were 5.7% and no anaerobe was grown. Fifty glass syringes and fifty needles autoclaved in the departmental laboratory served as controls and did not show any growth. As a preventive measure, proper disposal of used disposable material should be made mandatory so that it does not find its way into the market. Or has the time come to switch back to the former conventional practice of using in house autoclaved articles?

QSAR study on 1-benzyl-4[w(substituted phthalimido)alkyl]piperidines:acetyl cholinesterase inhibitors.

QSAR studies on a series of 18 piperidine derivatives, which act as acetyl cholinesterase (AchE) inhibitors, have been performed using van der Waals volume (V omega) and topochemical index (tau). Significant correlations have been obtained, which make it clear that AchE inhibition activity is controlled dominantly by topo chemical index.

Total hepatic vascular exclusion for major hepatic resection.

Use of vascular occlusion techniques during hepatic resection has besides decreasing blood loss improved the feasibility of surgical extirpation of large hepatic tumors. We report successful use of this technique to resect a large hepatoma in the right lobe of the liver. The hemodynamic and biochemical changes in the perioperative period are documented.

Toxicities, LD50 prediction and in vivo neutralisation of some elapid and viperid venoms.

Toxicity levels of elapid (Naja naja and Naja oxiana) viperid (Vipera lebetina and Vipera russelli) venoms for mice and rat for intraperitoneal intravenous and intramuscular routes have been determined. The data have been analysed using a mathematical expression to calculate lethal venom concentrations in human snake bite cases. Further, in vivo neutralisation of snake venom potency (after experimental injection) using high voltage-low current electric shock treatment has been attempted. This treatment postponed the death further by 60-90 min in mice in case of elapid envenomation. In case of viperid envenomation such a postponement of death time was not noticed. The death postponement induced by the shock treatment probably refers to structural impairments that occur at molecular level in venom components and their consequent altered interactions with the target tissue or system.