BACKGROUNDThe number of people infected with the Human Immunodeficiency Virus (HIV) worldwide was estimated to be 33.2 million at the end of 2007. The introduction of Anti-Retroviral Therapy (ART) has significantly reduced morbidity and mortality in HIVinfected patients in various developed and developing countries. However, the outcome of ART in India's National ART Programme has not been reported in detail. The aim of the study is to-1. Evaluate the immunological response of HIV infected adults starting Highly Active Antiretroviral Therapy (HAART).2. Evaluate the clinical response of highly active antiretroviral therapy in HIV infected adults.3. Assess the functional status improvement following highly active antiretroviral therapy. MATERIALS AND METHODSTo evaluate the effectiveness of the National ART Programme at Thanjavur Medical College Hospital, we undertook a prospective observational study involving ART naive patients who were started on ART between May 2015 and October 2016. ART was offered to these patients in accordance with NACO guidelines. The regimen consisted of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor. The available drugs included efavirenz, lamivudine, nevirapine and zidovudine. The CD4+ lymphocyte (CD4) count (cells/µL) was estimated at baseline and at six months intervals during follow-up. Prophylaxis and treatment of opportunistic infections were in accordance with NACO guidelines. Anti-tuberculosis treatment was administered according to the Revised National Tuberculosis Control Programme guidelines. RESULTSAmong 203 patients started on ART in this study, 3 died after completing 6 months of therapy and 17 died within 6 months of therapy. Out of the remaining 183 patients, 104 were males and 79 were females. The predominant route of HIV transmission is through unsafe sexual practice, which accounts for 84% of cases. Incidence of HIV is less common in literate population. Majority of patients were married in the category. Most of the patients tolerated CAT-I regimen (STV+LMV+NVP). Pulmonary TB is common in this group of patients. Improvement in the functional status was noted following ART in around 49-91% of patients. In this study, mean average CD4 count increased from baseline 141 cells/µL to 359 cells/µL after six months of initiation of ART. Immunological response seen in 64% of TB patients after ART.
BACKGROUNDZn is an essential trace mineral directly involved in the physiology and action of insulin. Insulin is stored as Zn crystals in the β cells of the pancreas. It has been suggested that abnormal Zn metabolism may play a role in the pathogenesis of diabetes and some of its complications. Zn depletion has several potential clinical implications. It is speculated that Zn repletion could improve insulin sensitivity in patients with DM and reduce the severity of certain complications of this disease. In order to understand the underlying pathobiochemical interrelationships of the late complications of diabetics in more detail, this study was undertaken.The aim of the study is to-1. Detect serum zinc level in patients with diabetes mellitus. 2. Compare the serum zinc level in newly-diagnosed diabetic patients and in those with complications. 3. Find out the relationship between zinc deficiency and complications of diabetes. MATERIALS AND METHODSStudy Centre-Thanjavur Medical College and Hospital. Study Duration-6 months. Study Design-Retrospective case control study. Sample Size-100 patients (cases) and 50 controls. RESULTSThere was no significant statistical variation in serum zinc levels between the various macrovascular complications. There was a significant negative correlation between HbA1c and serum zinc levels. It was also found in our study that compared to the newly-diagnosed patients with longstanding diabetes mellitus had lower levels of zinc. Also, patients with poor glycaemic control had lower zinc levels compared to the subjects with a better glycaemic control. CONCLUSIONDiabetic individuals have significantly lower levels of zinc when compared to normal healthy individuals. Patients with longstanding DM have lower zinc levels than those who are newly diagnosed. Patients with poor glycaemic control have lower zinc levels compared to the subjects with a better glycaemic control. Zinc supplementation may have a therapeutic role in control and prevention of complications in DM. Further studies are needed to clarify this aspect.
BACKGROUNDSystemic sclerosis (SSC) is a chronic multisystem disorder of unknown aetiology characterized clinically by thickening of the skin caused by accumulation of connective tissue and by involvement of visceral organs, including the gastrointestinal tract, lungs, heart and kidneys. The annual incidence of systemic sclerosis occurs at a rate of 2 per million population per year. The prevalence of systemic sclerosis is 50 per 1,00,000 population.The objectives of the study were-to detect pleuropulmonary involvement in systemic sclerosis patients by clinical examination and investigations including x-ray chest, high resolution computerized tomography, pulmonary function test, electrocardiograph, and echocardiogram with Doppler study of pulmonary arterial pressure and to analyse the incidence of various types of pulmonary manifestations.
BACKGROUNDNon-communicable diseases(NCD), also known as chronic diseases are not detected early since they remain asymptomatic in the initial stage. On communicable disease screening, OP services are started in government healthcare setup. Objective of this study is to find out the magnitude of NCDs in the outpatient screening programme. MATERIALS AND METHODSThe secondary data was collected from records available in NCD screening OP for a period of 4 years in Thanjavur Medical College Hospital. The data of nearly 55,207 patients screened in the NCD OP was analysed. The burden of the diseases to the healthcare setup and the risk these patients are likely to get in future were discussed in this study. RESULTSOut of 55,207 outpatients attending the NCD OP male patient's outnumbered female patients. 6,642 new patients with hypertension were detected in 4 years. 1608 new diabetics were detected and referred to medicine department for imitating treatment. 10,796 patients had both diabetes and hypertension. During this study period, 788 FNAC has been done for cancer breast detection, 82 patients were referred for biopsy. 14 cases of new cancer breast were detected during the study period. Doubtful cases were subjected to mammogram and ultrasound breast. 107 cases were referred for mammogram and ultrasound breast. Among them, four new cases of cancer breast has been detected. CONCLUSIONMost of the non-communicable diseases are not detected early, which leads to catastrophic complications like strokes, renal failure, cardiac failure, etc. Early detection by NCD screening programme can definitely pickup these cases and proper treatment can be started in time to avoid morbidity and mortality.
BACKGROUND Anaemia is a chronic nutritional health problem in India. Though there are plenty of causes for anaemia, iron deficiency anaemia is the most common cause of anaemia. As we all know, elevated serum lipids have a significant correlation with the risk of atherosclerosis, which in turn causes coronary artery disease, cerebrovascular disease and peripheral vascular disease, thus increasing morbidity and mortality worldwide. But, in the same way, low level of lipids in serum also cause some serious illness like depression, cancers, haemorrhagic stroke, aortic dissection and other metabolic abnormalities. Anaemia, irrespective of its cause produce decrease in serum lipid levels through various mechanisms. This study is conducted to assess the lipid profiles in various types of anaemia. The aim of the study is to study lipid profile of anaemic patients as compared with age and sex matched controls. To correlate, if type of anaemia has any effect on lipid profile and to study if severity of anaemia is associated with changes in various lipid subfractions. MATERIALS AND METHODS This is a case-control study, which has been carried out in the Department of Internal Medicine, TMCH, Thanjavur, from January 2017 to June 2017. RESULTS Cases younger than 50 years were found to be more likely to have severe anaemia. Fatigue and pallor were the most common clinical features. Clinical features were more common among cases with severe anaemia. The mean serum total cholesterol levels were significantly lower (P<0.01) in cases (130.2 mg/dL) as compared to controls (172.4 mg/dL). The effect of anaemia on the total cholesterol levels was very large. The mean serum HDL levels were significantly lower (P<0.01) in cases (30.0 mg/dL) as compared to controls (38.9 mg/dL). The effect of anaemia on the HDL levels was large. The mean serum LDL levels were significantly lower (P<0.01) in cases (78.7 mg/dL) as compared to controls (111.1 mg/dL). The effect of anaemia on the LDL levels was very large. The mean serum VLDL levels were significantly lower (P<0.01) in cases (20.6 mg/dL) as compared to controls (24.0 mg/dL). The effect of anaemia on the VLDL levels was mild. The mean serum triglyceride levels were significantly lower (P<0.01) in cases (109.1 mg/dL) as compared to controls (123.5 mg/dL). The effect of anaemia on the triglyceride levels was mild. The mean total cholesterol/HDL ratio was significantly lower (P<0.05) in cases (4.34) as compared to controls (4.43). The effect of anaemia on TC/HDL ratio was mild. The mean LDL/HDL ratio was significantly lower (P<0.01) in cases (2.6) as compared to controls (2.85). The effect of anaemia on LDL/HDL ratio was mild. There was a larger reduction in mean total cholesterol, HDL, LDL, VLDL and triglyceride levels alone with TC/HDL and LDL/HDL ratios with increased severity of anaemia (P<0.05). Type of anaemia did not have a significant effect on lipid levels (P>0.05). CONCLUSION Younger cases were more likely to have more severe anaemia. There was no relation between sex and severity of an...
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