BACKGROUNDIn 1785, Withering discovered use of a cardiac glycoside from foxglove plant for the therapy of congestive heart failure. For centuries, digoxin use had been controversial for the risk benefit ratio. Digoxin affect the myocardium by affecting the autonomic nervous system. Antiadrenergic and parasympathetic stimuli suppressing SA node, but delayed after depolarisation of atrial muscles causes generation of multiple atrial pacemaker foci presenting in the form of MAT. The association of MAT with digoxin is poorly studied because of the rarity of both together. This case had multiple risk factor of advanced age, hypokalaemia, heart failure in presence of chronic digoxin exposure caused MAT. Withdrawal of digoxin along with correction of electrolyte imbalance and heart failure caused reversal of MAT to sinus rhythm. Early detection and correction prevents conversion of MAT to AF. KEYWORDSMultifocal Atrial Tachycardia (MAT), Digoxin Toxicity, Reversible, Rare. HOW TO CITE THIS ARTICLE: Tyagi P, Wahane M, Mohammad A. MAT (multifocal atrial tachycardia) in digoxin toxicity. J. Evid. Based Med.
BACKGROUND Type 2 diabetes and thyroid disorders are the two most common endocrinopathies. 1 Several studies have demonstrated relationship between DM type 2 and thyroid dysfunction, but there are only a few studies done to evaluate the association between subclinical hypothyroidism and glycaemic control of the diabetic patients. METHODS It was a cross sectional case control study in 100 diabetic patients out of which 50 cases had poor glycaemic control and 50 controls were patients with good glycaemic control. Subclinical hypothyroidism was defined as elevated TSH (>4 mIU/L) with normal free T4 and in absence of any clinical features. RESULTS 50 age and sex matched diabetics with HbA1c >6.5 were compared with diabetics with HbA1c <6.5 for thyroid abnormalities. 15% uncontrolled diabetic male and 30% of uncontrolled females had subclinical hypothyroidism compared to 0% male and 11% female with HbA1c <6.5. This when compared to hypothyroid frequency among case and control groups was found to be 5% males and 3.3% females compared to 0% and 3.7% in control group respectively. The frequency of hyperthyroidism was 5% and 6.7% in male and females of case group compared to 4.3% and 3.7% in male and female of control group. CONCLUSIONS The prevalence of subclinical hypothyroidism was more in the group with poor glycaemic control as compared to patients with HbA1c <6.5. Diabetics with poor control have an underlying subclinical hypothyroidism which may accentuate impaired glycaemic control and vice versa.
To study etiology, risk factors, various clinical and lab parameters and outcome of patients presenting with fever, jaundice and acute kidney injury. MATERIALS AND METHODS: An open prospective study was done on 100 patients presented with triad of fever, jaundice and acute kidney injury (AKI) in the Department of Medicine of G R Medical College and JA Group of Hospitals, Gwalior, MP from September 2011 to November 2012. Patients having temperature more than >100 0 F, serum creatinine ≥1.3 mg/dL or a 50 % increase from baseline or a reduction in urine output (documented oliguria of <0.5 ml/kg/hr for >6 hours), serum bilirubin >1.8 mg/dL were included in the study. A detailed history, clinical examination and investigations were done to find the cause of these derangements and all the patients were managed accordingly. RESULTS: A total 100 patients were included in study out of which 70% were males. Out of 100 patients, 50% were of septicemia, 34% were having malaria, 12% had acute pancreatitis and 4% patients were of dengue. Out of 50 septicemia patients, 35(70%) were male, out of which 11(31.42%) were of 56-65 years of age. Out of 17 deaths, 13(76%) were males. Among total death, 11(22%) were in septicemia followed by 5(14.70%) in malaria patients. CONCLUSION: Many infectious and non-infectious diseases like malaria, septicemia, acute pancreatitis, dengue fever etc. can present with fever, jaundice and deranged renal functions. This triad of presentation is associated with high morbidity and mortality and the advanced age, male gender presences of anemia were the risk factors for high mortality. AKI occurs most commonly in association with P. falciparum malaria. Early diagnosis and prompt management including dialysis can reduce mortality and expedite recovery of renal function.
OBJECTIVE:Increased uric acid level in case of Type II Diabetes Mellitus patient is associated with increased risk of Coronary Artery Disease (CAD) compared to those Type II Diabetes Mellitus who have normal uric acid level. METHOD: Total 100 patients of Type II Diabetes Mellitus (known case of Type II Diabetes Mellitus under treatment and also newly diagnosed cases.) were selected. 50 patients admitted or attending OPD selected as controls who were non-diabetic, diagnosed by screening with Fasting Blood Sugar, Random Blood Sugar and without any symptoms of Hyperglycaemia. RESULTS: In overall diabetics with CAD, serum uric acid level is >7.0mg/dL in 14/49 patients compared to without CAD having serum uric acid levels <7.0mg/dl in all 51 patients. The results were significant with p <0.001. Mean Serum Uric Acid Levels of all cases of Type II Diabetes Mellitus was higher than controls, with value of 5.14+1.25mg/dl, which was statistically significant with p<0.0001. CONCLUSION: Serum Uric Acid level in both group that is in those who were known case of Type II Diabetes Mellitus and also newly diagnosed cases of Type II Diabetes Mellitus is higher than control group. Also increased serum uric acid level is also responsible for the complication of Type II Diabetes Mellitus like Coronary Artery Disease.
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