BACKGROUND: The involvement of liver in dengue fever is not uncommon as reported in literature since 1970. Liver and nervous system involvement simultaneously predicts poor outcome in dengue fever. Atypical manifestations include liver involvement with elevation of enzymes, central nervous involvement (encephalopathy) and cardiac alterations (myocarditis). Liver involvement in dengue fever is manifested by the elevation of transaminases representing reactive hepatitis, due to direct attack of virus itself or the use of hepatotoxic drugs. OBJECTIVE OF THE STUDY: Study of serum aminotransferase levels in dengue fever. METHODOLOGY: In this descriptive, cross sectional study, all patients who presented to the Department of medicine with dengue IgM positive were included. Study period of 24 months from July 2010-June 2012, patients attending to M.S. Ramaiah medical college were included (n=166). RESULTS: 166 patients reactive for dengue virus specific IgM antibody were studied. As per WHO classification, 137 (82.5%) patients were classified as dengue fever, 20 (12%) as dengue hemorrhagic fever, and 9 (5.4%) as dengue shock syndrome. Mean age of dengue infection patients was 35.71 ±12.9 (SD) years, with male to female ratio nearly equal. Hepatic dysfunction is very common in all forms of dengue infection, with AST rising significantly more than ALT. Serum aminotransferase levels appear to have a directly proportional correlation with grading of dengue infection. Hyperbilirubinemia, elevated transaminases, hypoproteinemia, hypoalbuminemia and deranged coagulation profile were seen in higher frequency in DHF and DSS group as compared to classical DF group. AST and ALT were significantly higher in patients with secondary infection (IgM & IgG positive) as compared to primary infection (IgM positive). CONCLUSION: Serum aminotransferase levels are significantly raised in all forms of dengue infection and it directly correlates with severity of infection. Serum aspartate aminotransferase was significantly raised compared to alanine aminotransferase levels in all forms of dengue infection. The degree of affection of serum albumin and prothrombin time which are absolute indicators of liver cell function correlated with severity of dengue infection.
BACKGROUND & OBJECTIVES:Left ventricular diastolic dysfunction is known to occur in early stages of diabetic cardiomyopathy but its exact prevalence is not known. The present study was conducted to assess the prevalence of diastolic dysfunction in diabetic patients in the absence of hypertension or CAD. The role of valsalva maneuver in diagnosis of diastolic dysfunction was also studied. AIMS: To study left ventricular diastolic dysfunction in asymptomatic normotensive patients with Type 2 Diabetes. To study the role of valsalva maneuver in diagnosing diastolic dysfunction. METHODOLOGY: 100 consecutive asymptomatic normotensive patients (mean age 52.34 ±8.6 yrs.) with Type 2 diabetes free of any major clinical diabetic complications and having no evidence of CAD on non-invasive testing were studied for LV diastolic functions, using pulsed Doppler at the tip of mitral valve. The peak velocities of LV filling during the early rapid (E wave) and atrial contraction (A wave) phases, the ratio of the 2 filling velocities (E/A ratio) were recorded at end expiration at baseline and again during phase II of valsalva maneuver. RESULTS: LVDD was found in 54% of subjects of whom 11% had pseudo normal pattern of ventricular filling and 43% had impaired relaxation. LVDD was well correlated with age and duration of diabetes. CONCLUSION: LVDD is much more common in Type 2 diabetes who are free of clinically detectable heart disease. Pseudonormal pattern may account for a significant number of patients with diastolic dysfunction and failure to recognize it may lead to significant underestimation of the true prevalence of LVDD in these patients.
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