QT interval abnormalities are the best predictors of cardiovascular deaths. Microalbuminuria is an independent marker for cardiovascular disease in diabetes mellitus. Hence QT interval abnormalities in diabetics with or without microalbuminuria were evaluated in this study. To study QT interval abnormalities in asymptomatic type 2 diabetic patients with or without microalbuminuria. : Open label controlled study with 214 subjects of either sex. Group A healthy subjects (n=100), group B asymptomatic, type 2 diabetics with no clinical evidence of cardiac disease. Group B subdivided into B with microalbuminuria (n=62), Bwithout microalbuminuria (n=52). Corrected QT interval (QTC), microalbuminuria, and blood pressure were measured for all subjects. QTC was calculated by using Bazzet's formula. QTC more than 440msec was considered prolonged. QTC was within normal range in diabetic patients(415+25msec). Highly significant (p<0.0001) prolongation was observed in diabetics, compared to healthy subjects. Both B(p<0.0001) and B(p<0.001) groups showed a significant increase in QTC than in healthy subjects. Among Band Bgroups QTC was not statistically significant. Prolongation of QTC is indicative of CAN. CAN is often under-recognised and undiagnosed cardiac complication.QTC was more in asymptomatic type 2 diabetics irrespective of microalbuminuria compared to healthy individuals, though values were within normal range. This denotes high risk for future cardiovascular complications in diabetic patients.
The incidence of cesarean scar pregnancy is increasing and its management has proven to be challenging for Gynecologists. Scar ectopic is a form of pregnancy due to abnormal implantation of the embryo at the previous scar site following surgeries of the uterus like cesarean section, hysterotomy, myomectomy and metroplasty. Complications of scar ectopic pregnancy are uterine rupture, profuse hemorrhage and maternal death. Here we present, five cases of cesarean scar pregnancy treated at our tertiary care center over a period of 2 years. Various clinical presentations have been analyzed. Common to the cases wasa history of previous one lower segment cesarean section and presentation with vaginal bleeding. The First and the second patient presented at 8 weeks period of gestation and had taken medication for termination of pregnancy in view of the initial scan showing nonviable pregnancy. On follow up, an ultrasounds can diagnosis of cesarean scar ectopic was made and they were given a trial of medical management with methotrexate. As the medical management failed, they underwent a laparotomy and a laparoscopic surgery for excision of scar ectopic with repair respectively. Third patient presented at 12weeks+4days period of gestation and was referred with the suspicion of gestational trophoblastic disease. Initial ultrasound scan showed nonviable fetus and was medically managed for termination of pregnancy. Follow up scan showed features of gestational trophoblastic disease. MRI was done to confirm the diagnosis of a scar ectopic. Laparotomy was done, to excise the scar ectopic with repair. Fourth patient presented at 13weeks+4days period of gestation with ultrasound scan suggestive of scar ectopic and was medically managed followed by laparotomy. Fifth patient presented at 9 weeks period of gestation with vaginal bleeding. Her ultrasound scan showed features suggestive of cesarean scar pregnancy. She underwent laparotomy for excision of scar ectopic with repair. All post laparotomy biopsies were sent for histopathology and confirmed with features consistent with products of conception at the scar site. They were followed up with serial serum Beta HCG values, which showed a decreasing trend initially until they reached negative levels. Conclusion:The diagnosis of a scar ectopic is challenging and a delay in the management could lead to maternal morbidity and mortality. Failure in medical termination of pregnancy should raise an alarm of a suspected ectopic pregnancy. The management of scar ectopic by excision could be carried out effectively through laparoscopy or laparotomy in experienced hands. Also, whenever patient comes with gestational trophoblastic disease and if the serum Beta HCG values are not falling, one should always suspect the possibility of cesarean scar pregnancy.
In a few examinations, low spirometric levels have been displayed to expand the achievement paces of smoking discontinuance, while different investigations have demonstrated that aspiratory work affects stopping smoking. Given the way that there are conflicting outcomes regarding this matter, we expected to research the impact of distinguishing aviation route obstacle by means of spirometry and its clarification to subjects on the achievement pace of smoking discontinuance temporarily. The current study was led in Gandhi Medical College, Hyderabad, India, Subjects who were conceded to the smoking discontinuance out-patient facility, went through pneumonic capacity tests (PFTs) and finished somewhere around 90 days of the suspension program following their induction were remembered for the investigation. The mean age of the 563 subjects was 41.9 ± 12.1 y 340 subjects (60.4%) were male. An aggregate of 162 subjects (28.8%) went to the subsequent visits following the primary meeting. The accomplishment of smoking suspension for 90 days was 11.3% for all subjects and 39.5% for subjects who came to follow-up visits. Of the subjects with impediment on PFT; 22.8% quit smoking, while 8.4% of the subjects without block did as such (P < .001). The level of subjects with impediment on PFT was altogether higher (P < .001) and the FEV1 % (P = .005), FEV1/FVC (P < .001), and constrained expiratory stream 25–75% (P = .008) levels were fundamentally lower in the weaklings contrasted and the non-slackers. Strategic relapse investigation showed that age (P = .001) and the presence of impediment on pft (p = .029) were autonomous factors. Old age and the presence of impediment on PFT increment the accomplishment of smoking end. Aspiratory work tests ought to be performed on all patients who apply to smoking end out-patient facilities, and patients ought to be educated with regards to their condition.
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