Insulin resistance in psoriasis: prevalence and prospects from a tertiary care centre

Background: Psoriasis is a chronic autoimmune inflammatory disorder of skin. Though the exact etio-pathogenesis is not well-understood, several studies hypothesised it as a complex interaction between genetics, immunology, and environment. Hence, we aimed toassess the insulin resistance among psoriasis patients and to correlate the insulin resistance with the disease severity, and inflammation.Methods:A tertiary hospital-based observational study was conducted for a year (2016-2017) at dermatology and endocrinology OPD, IPGMER andSSKM Hospital, Kolkata. The eligible participants were selected after applying the inclusion and exclusion criteria. After obtaining the written informed consent, basic demographic details were collected and examined for certain physical and biochemical parameters. Data was entered in Microsoft excel and analysed using SPSS software. Appropriate statistical analysis was carried out.Results: A total of 48 cases and 40 controls participated in the study. The median fasting insulin (p<0.001), HOMA-IR (p<0.001), and hs CRP (p=0.047) in cases were significantly higher than controls. There were significant differences of HOMA-IR within three groups of psoriasis. There was a positive correlation and statistically significant between PASI and HOMA-IR (rho=0.469, p value=0.001) and between PASI and fasting insulin (rho-0.528, p value<0.001).Conclusions: Chronic psoriasis patients were more insulin resistant and significantly correlated with the disease severity index.

Clinical profile of patients with inter vertebral disc disorders / clínica de pacientes con trastornos de los discos intervertebrales

Introduction: Intervertebral disc disorders (IDDs) are being commonly observed nowadays among the young and middle aged population. Objectives: This hospital record based study was done to study the risk factors, clinical presentation, imaging findings and management practices among patients with all types of IDDs. Methods: A validated proforma was used to obtain information of patients confirmed with IDDs over the past three years. Results: Mean age at onset of disc disorders among the 219 patients was 44.7±14.2 years. History of poor exercising habits were present among 72(32.9 percent) patients. The most common site of disc involvement was L4-L5 [151(68.9 percent)]. 143(65.3 percent) patients had single site disc involvement. The most common clinical symptom was lower back pain [180(82.2 percent)]. Nerve root compression was present among 154(70.3 percent) patients. Disc bulge, protrusion, extrusion and sequestration were present among 116(53 percent), 90(41.1 percent), 52(23.7 percent) and 4(1.8 percent) patients respectively. Age at onset >65 years (p=0.035), age at onset ≤55 years (p=0.004) and history of direct impact to the neck region (p=0.017) were associated with disc prolapse at L2-L3 level, L4-L5 level and C5-C6 level respectively, among patients with single site disc involvement. Risk of multiple level disc involvement was found to increase after 35 years (p<0.001). It was seen more involving cervical vertebrae (p=0.0068). Lumbar (p<0.0001) and lumbosacral vertebrae (p<0.0001) involvement were seenmore among patients with single site disc involvement. NSAIDs [155(70.8 percent)] were the most the commonly used medication. Microdiscectomy was done among 35(76.1 percent) out of the 46 patients who underwent surgical management. Conclusions: Exercising habits need to be encouraged among people for the prevention of IDDs. The various high risk groups identified in this study need to be periodically screened for IDDs(AU)

Introducción: Actualmente, los trastornos de los discos intervertebrales (TDI) son frecuentes en la población joven y de mediana edad. Objetivos: Este estudio hospitalario de las historias clínicas se realizó para examinar los factores de riesgo, la presentación clínica, los hallazgos imagenológicos y las prácticas de tratamiento entre los pacientes con todos los tipos de trastornos de los discos intervertebrales. Métodos: Se utilizó una proforma validada para obtener información de los pacientes confirmados con trastornos de los discos intervertebrales en los últimos tres años. Resultados: La edad media de aparición de los trastornos discales entre los 219 pacientes fue de 44,7 ± 14,2 años. El historial de malos hábitos de ejercicio estuvo presente en 72 (32,9 por ciento) pacientes. El sitio más común de afectación del disco fue L4-L5 [151 (68,9 por ciento)]. 143 (65,3 por ciento) pacientes tenían compromiso de disco en un solo sitio. El síntoma clínico más frecuente fue el dolor lumbar [180(82,2 por ciento)]. La compresión de la raíz nerviosa estuvo presente en 154 (70,3 por ciento) pacientes. Se mostró presencia de protuberancia, protrusión, extrusión y secuestro discal en 116 (53 por ciento), 90 (41,1 por ciento), 52 (23,7 por ciento) y 4 (1,8 por ciento) pacientes, respectivamente. La edad de inicio >65 años (p=0,035), la edad de inicio ≤55 años (p=0,004) y el antecedente de impacto directo en la región del cuello (p=0,017) se asociaron con prolapso discal a nivel L2-L3, L4- Nivel L5 y nivel C5-C6 respectivamente, entre pacientes con compromiso discal en un solo sitio. Se encontró que el riesgo de afectación del disco en múltiples niveles aumenta después de 35 años (p<0,001). Se vio más involucradas las vértebras cervicales (p=0,0068). La afectación de las vértebras lumbares (p<0,0001) y lumbosacras (p<0,0001) se observó más entre los pacientes con afectación del disco en un solo sitio. Los fármacos anti-inflamatorios no esteroideos (AINE) [155 (70,8 por ciento)] fueron los medicamentos más utilizados. La microdiscectomía se realizó en 35 (76,1 por ciento) de los 46 pacientes que se sometieron a manejo quirúrgico. Conclusiones: Es necesario fomentar hábitos de ejercicio entre las personas para la prevención de los TDI. Los diversos grupos de alto riesgo identificados en este estudio deben someterse a pruebas periódicas de IDD(AU)

Exploration of the risk factors of essential hypertension with hyperhomocysteinemia: A hospital-based study and nomogram analysis

OBJECTIVES: To explore the risk factors of essential hypertension with hyperhomocysteinemia (H-type hypertension) and design a nomogram to predict this risk. METHODS: A hospital-based study was conducted on 1,712 individuals, including 282 patients with H-type hypertension, 105 patients with simple hypertension, 645 individuals with hyperhomocysteinemia, and 680 healthy controls. Logistic regression and nomogram models were applied to evaluate the risk factors. RESULTS: Logistic regression showed that advanced age, male sex, high body mass index (BMI), high total cholesterol levels, high glucose levels, and high creatinine levels were risk factors of H-type hypertension in the healthy population and were integrated into the nomogram model. Advanced age, male sex, high BMI, high total cholesterol levels, and high glucose levels were shown to be risk factors of H-type hypertension in the hyperhomocysteinemia population. Male sex and high creatinine levels were shown to be risk factors of H-type hypertension in the hypertension population. Nomogram analysis showed that the total factor score ranged from 106 to 206, and the corresponding risk rate ranged from 0.05 to 0.95. CONCLUSIONS: Men are more likely to have H-type hypertension, and advanced age, high BMI, high total cholesterol levels, and high glucose levels are risk factors of H-type hypertension in healthy and hyperhomocysteinemia populations. Furthermore, high creatinine level is a risk factor of H-type hypertension in healthy and hypertension populations. Nomogram models may be used to intuitively evaluate H-type hypertension risk and provide a basis for personalized interventions.

A prospective hospital based study of relation between carotid artery intimal medial thickness in patients with type 1 diabetes

Background: The aim of this study was to found association between Type 1 Diabetes Mellitus and Carotid Arterial Intimal Thickness (CIMT).Methods: Study design: It was a prospective case control hospital-based study. One hundred type 1 diabetes patient between the age group 3-36 years were taken. The association between type 1 diabetes with CIMT was studied. All the measurements were standardized. 50 age and sex matched controls were taken for comparison.Results: There is positive correlation between type 1 diabetes and CIMT (p<0.0001). The correlation further extends between duration of diabetes, glycemic control, age of onset, frequency and severity of diabetic related complication with CIMT.Conclusions: Carotid atherosclerosis as measured by CIMT has definite association with type 1 diabetes.

Assessment of hemoglobin status among cancer patients: a hospital based study

Background: Cancer related anemia (CRA) is a major healthcare issue among patients suffering with cancer. In the Indian context, these figures are likely to be higher due to the prevailing malnutrition and low socio-economic status in the general population. This observational hospital-based study has been conducted among cancer patients with following objectives to assess the socio demographic profile of different cancer patients admitted at hospital. To measure hemoglobin level among different cancer patients admitted at hospital on the basis of socio demographic profile and type of cancer.Methods: The registers maintained in the department of Radiotherapy were checked and those belonging to the year 2011-12 were used to process and analyse the cancer patient抯 data in respect to age, type of cancer, hemoglobin level admitted in health care facility.Results: By far distribution of Hb level is concerned among all cancer patients, 87.56% patients were having Hb level more than 9 gm% and around 12.43 % patients were having Hb level less than 9 gm%. Majority of patients whose Hb level was less than 9gm% were belonging to age group more than 45 years.Conclusions: It is very much evident that anemia among cancer patients is a major healthcare problem and surely adds into morbidity and mortality of cancer patients. It may further aggravate the health condition of cancer patients if not corrected timely. Therefore, anemia among cancer patients should be taken and treated very seriously.

Types And Risk Factors Of First Time Stroke: A Saudi Hospital- Based Study

Background: The purpose of this study was to explore the stroke types and the risk factors of the first-time stroke in the holy city of Madinah Munawarah. Methods: A prospective hospital-based research study was carried out over the year of 2014. The patients with the diagnosis of the cerebrovascular accident were enrolled in the study. The details of patients’ history, demographic data, stroke type, and risk factors were collected. Results: First-time stroke were determined in 164 patients (91 male and 73 female) during the entire periods of this study with a mean age of 67.52 ± 2.31 years. The prevalence of types of stroke was ischaemic strokes in 133 patients (% 81.1), intercerebral hemorrhage in 24 patients (14.63%), and subarachnoid hemorrhage in one patient (0.6%). The most common risk factors recorded were hypertension (86.6%), diabetes mellitus (63.4%), and ischaemic heart disease (41.5%). There was no significant relationship between the frequency of ischaemic stroke and intercerebral hemorrhage stroke ( p> 0.05). Conclusion: The study indicates that hypertension, diabetes, and ischaemic heart disease are critical risk factors for developing stroke and fairly commensurate with the global reported risk factors. Further research is needed to investigate stroke patterns and other possible risk factors concurrently with Saudi national prevention programs.

Clinical Characteristics of a Nationwide Hospital-based Registry of Mild-to-Moderate Alzheimer's Disease Patients in Korea: A CREDOS (Clinical Research Center for Dementia of South Korea) Study

With rapid population aging, the socioeconomic burden caused by dementia care is snowballing. Although a few community-based studies of Alzheimer's disease (AD) have been performed in Korea, there has never been a nationwide hospital-based study thereof. We aimed to identify the demographics and clinical characteristics of mild-to-moderate AD patients from the Clinical Research Center for Dementia of Korea (CREDOS) registry. A total of 1,786 patients were consecutively included from September 2005 to June 2010. Each patient underwent comprehensive neurological examination, interview for caregivers, laboratory investigations, neuropsychological tests, and brain MRI. The mean age was 74.0 yr and the female percentage 67.0%. The mean period of education was 7.1 yr and the frequency of early-onset AD (< 65 yr old) was 18.8%. Among the vascular risk factors, hypertension (48.9%) and diabetes mellitus (22.3%) were the most frequent. The mean score of the Korean version of Mini-Mental State Examination (K-MMSE) was 19.2 and the mean sum of box scores of Clinical Dementia Rating (CDR-SB) 5.1. Based on the well-structured, nationwide, and hospital-based registry, this study provides the unique clinical characteristics of AD and emphasizes the importance of vascular factors in AD in Korea.

A study on demographic and clinical profile of burn patients in an Apex Institute of West Bengal.

Burn injuries constitute a major public health problem. A hospital-based descriptive observational study was conducted among 83 burn patients admitted in the Institute of Post Graduate Medical Education and Research, Kolkata in 2008 to assess the demographic and clinical profile of burn patients and to study the medicolegal and social causes. Majority of patients were females (61.5%), literates (78.4%), hindus (79.5%) and in the age group of 20-39 years (56.6%). Occupation-wise housewives were 36.1% followed by students (16.8%).Majority of the cases (61.4%) were accidental whereas suicidal and homicidal cases were 18.1% and 20.5% respectively. According to the size 25.3% patients had 20% -39% of body surface burns and 21.7% had 80% or more burns. 53% of the cases were given blood transfusion and 23.5% died in the study period.

A hospital based prospective study of acute childhood poisoning.

Objective To study acute poisoning in Sri Lankan children. Design A prospective hospital based study. Setting Lady Ridgeway Hospital for Children, Colombo. Patients Children with suspected acute poisoning admitted to hospital from January 1985 to January 2000. Results There were 2100 children with acute poisoning. 1256 (60%) were males. 1643 (78%) were below 4 years of age. Route of poisoning was ingestion in 2094 (99.7%) cases. Household products were involved in 1050 (50%) cases, drugs in 622 (30%), poisonous plants in 212 (10%), agrochemicals in 134 (6%) and miscellaneous substances in 82 (4%). Outcome There were 14 (0.7%) deaths.

Clinical Features of Ocular Trauma in Emergency Department

This study analyzed a hospital-based study to investigate the incidence and clinical features of ocular traumatic emergencies in Korea. Over a 6-year period, 1809 patients with ocular traumatic emergency each individually underwent clinical study including subject characteristics, type of ocular emergency, disease severity, etiology of ocular trauma, injury location, cause of decreased visual acuity, management of ocular injury, and final visual acuity. The homogeneity of each finding of the clinical features of ocular traumatic emergency was tested by an X2 test at a 95% level of certainty. During follow-up periods ranging from 3 days to 23 months (mean 2.0 months), the 1809 patients with ocular traumatic emergency, 1183 males (65.4%) and 626 females (34.6%), were studied. The incidence of ocular emergencies peaked in the third decade of life, irrespective of gender (P< 0.05). Corneal abrasion was the most common etiology among 1, 552 (85.8%) closed injuries, and corneal laceration among 257 (14.2%) open injuries (P< 0.05). There were 542 cases (30%) of severe ocular injury, such as penetrating ocular injury, blow out fracture, and intraocular foreign body (IOF), and 1267 (70%) of less severe ocular injury, such as superficial ocular injury or contusion. The most common etiology of severe ocular injury was penetrating ocular injury, and that of less severe injury was corneal injury (P< 0.05). The main causative activity of ocular injuries was work in 631 cases (34.9%), assault in 398 (22.0%), play in 278 (15.4%), traffic accidents in 145 (8.0%) and sports in 128 (7.1%). Five hundred and fifty-four cases (32.5%) underwent surgical intervention. There was an improvement of visual acuity in 502 cases (70.1%), no change in 122 (17.0%), and worsening in 92 (12.9%). We suggest that preventive educational measures be instigated at workplaces to reduce the incidence of ocular traumatic emergency, especially severe ocular injury.