BACKGROUND: Liver abscess is a common problem in lower socioeconomic group in India. Both types (Amoebic and pyogenic) of liver abscesses are important cause of morbidity and mortality in India. AIM: To observe the clinical features, biochemical and radiological abnormality, microbiological etiologies, and management outcomes in patients with liver abscess. MATERIALS AND METHODS: An open prospective study was conducted in the Department of Medicine, GR Medical College and JA Group of Hospitals, Gwalior from November 2009 to October 2011.The patients presenting with Liver abscess on ultrasonography (USG) were included. A detailed history, clinical examination, and laboratory profile of the patients were recorded. Radiological examination was also done to observe any pulmonary complication along with USG to observe size, site, number, echogenicity and other abnormalities. Effects of antibiotic and surgical intervention (USG guided aspiration or pigtail insertion) were also studied. RESULTS: A total of 104 patients were included in the study, out of which 52 were males. Most of them were from lower socioeconomic class (61.19%) and alcoholic (68.62%). Most patients presented with fever and abdominal pain. Most of the patients in amoebic liver abscess (ALA) group were of <40 years of age and in pyogenic liver abscess (PLA) >40 years of age. Liver abscess was mostly present in right lobe (65.67%) and single (59.70%). Etiology of abscess was 58.2% amoebic, 41.8% pyogenic. Diabetes mellitus and cholelithiasis were main inclining factors in case of liver abscess. Most common laboratory finding was abnormal alkaline phosphatase. All patients with ALA & 26 out of 29 patients with PLA improved with medical therapy. CONCLUSIONS: The most common presentation for liver abscess was male, alcoholic of low socioeconomic class having right lobe single abscess.
Xanthomas are often a manifestation of underlying lipid abnormalities. A 50-year-old male presented to our hospital with the lesions of multiple tuberous xanthomas all over the body. Routine investigations and systemic examination were normal. Lipid profile was within normal range and serum protein electrophoresis showed normal pattern. Histopathology from a nodular lesion showed collection of foamy macrophages in the dermis. We present a case of normolipemic tuberous xanthomas, which is an uncommon occurrence.
Background: High suicide rate is reported in India, and poisoning seems to be main cause in majority of these suicide cases. An enhanced rate is seen in poisoning by hair dye, and in few places, it comprises a huge part of the poisoning cases. Objective: To study the clinical profile, electrocardiographic (ECG) changes, and biochemical parameters of patients presenting with hair dye poisoning.
Introduction: Association between Chronic kidney disease (CKD) and increased risk of cardiovascular disease (CVD) is well established. Relationships of carotid intima-media thickness (CIMT) as a measure of subclinical atherosclerosis in CKD patients is a matter of debate. Current research aimed to study the role of CIMT in CKD patients and its association with the CKD staging. Material and Methods: Hundred CKD patients were studied and compared with 50 subjects without CKD in the Department of Medicine, G.R. Medical College & J.A. Group of Hospitals, Gwalior (M.P.) India. GFR was determined by MDRD (Modification of diet in renal study) equation. Study populations were subjected for high resolution B-mode Carotid ultrasonography. Results: In case group, majority were males (68%) having age between 30-60 years (62%). Majority had stage V CKD (67%), 21% had stage III and 14% had stage IV CKD. Majority of the cases had CIMT between 0.9-1.0 mm (42%) followed by 0.7-0.8 mm (17%) as compared to 0.5-0.6 mm (42%) in control. Mean CIMT was significantly higher in cases (0.87±0.24) as compared to control (0.61±0.34) group (p<0.001). No significant difference in mean CIMT was found between different stages of CKD (p=0.649). Conclusion: CKD patients have significantly more carotid arterial wall thickness in comparison to age matched controls. The CIMT does not differ in different stages of CKD.
Background: Stroke is one of the leading reasons for mortality throughout the world. Measurement of carotid intima media thickness (CIMT) is a reliable marker for the development of atherosclerosis and ischemic stroke (IS). The aim was to study and correlate lipid profile and CIMT in diabetic and non-diabetic IS patients. Methods: An observational study was done including 120 IS patients divided into two groups-diabetes (n=60, diabetic stroke patients) and non-diabetes (n=60, non-diabetic stroke patients) having age >18 years, admitted in Medicine and Neurology wards of G. R. Medical College, Gwalior, Madhya Pradesh, India between August 2015 to August 2016. Detailed history along with investigations such as fasting blood sugar (FBS), post prandial blood sugar (PPBS) and fasting lipid profile including triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) and total cholesterol (TC) was done. The common and the internal carotid arteries of both sides were evaluated ultrasonographically using a high frequency linear probe. All the data were analysed using IBM SPSS-ver.20 software. Data was expressed as percentage. Analysis was performed using two-way ANOVA and independent sample student t test. Pearson correlation was used to establish the relation between the data. P values <0.05 was considered to be significant. Results: Most common age group among diabetes and non-diabetes IS patients were 51-60 years (26.66%) and 61-70 years (28.33%) respectively with male predominance (75% and 66.67% respectively). Most of the diabetic IS patients had FBS >200 mg/dl (41.66%) and PPBS >250 mg/dl, (50%). Out of 120 IS patients, 55 (45.83%) had CIMT ≤0.8 mm and 65 (54.16%) patients had CIMT >0.8 mm. Lipid parameters including TC (p=0.034), TG (p=0.022), HDL (p=0.039), VLDL (p=0.043) and LDL (p=0.017) were significantly different between groups (p<0.05). Mean CIMT in patients with diabetes and non-diabetes was 1.03±0.255 mm and 0.83±0.54 mm respectively (p=0.006). A significant positive correlation was recorded between CIMT and TC (r=0.36, p=0.006), TG (r=0.48, p=0.0001) and VLDL (r=0.46, p=0.0001) among diabetes stroke patients. Among non-diabetes stroke patients, TC (r=-0.25, p=0.042), TG (r=-0.44, p=0.0003), HDL (r=-0.33, p=0.016) and LDL (r=-0.58, p=<0.001) were negatively correlated and VLDL (r=0.92, p=<0.0001) was positively correlated with CIMT. Conclusions: Lipid parameters including TC, TG, LDL and VLDL were significantly raised in diabetic stroke patients and had a positive correlation with the risk of stroke. CIMT was significantly high in diabetic stroke patients. Correlation of lipid parameters (TC, TG and VLDL) with CIMT in diabetic stroke patients were significantly positively correlated, in non-diabetic ischemic stroke patients' lipid parameters (TC, TG, HDL and LDL) were negatively correlated.
Background: Brachial artery flow mediated dilatation (BAFMD), assessed by high resolution ultrasonography, reflects endothelium dependent vasodilator function. BAFMD is diminished in patients with atherosclerosis and with coronary risk factors and improves with risk reduction therapy.Methods: Study was conducted on 50 patients of coronary artery disease from In-patients who were admitted in the Department of Medicine and 25 healthy control without cardiovascular disease risk factors. All patients having established CAD i.e. Acute coronary syndrome and past history of CABG/angioplasty were included in study. Those morbidly ill and patients with evidence of chronic inflammatory or malignant disease were excluded. Doppler ultrasound of brachial artery was performed in all of them to assess baseline lumen diameter and flow mediated dilatation (i.e. percent change in brachial artery diameter after occlusion cuff release). Patients were divided into two groups; first group was classified as those having BAFMD less than 7.5% and the second group consisted patients having BAFMD less than 10%.Results: Flow mediated dilatation in cases was 6.87±5.48% as compared to the control group in which it was 13.08±3.40% and was statistically significant (P value 0.000002). Brachial artery flow mediated dilatation was abnormal in 80% cases at a cut off value <10% significant abnormalities; i.e. BAFMD <7.5% was found in 66% patients.Conclusions: Endothelial function as assessed by FMD is significantly impaired in patient of coronary artery disease. Hence it may be used as an important screening tool in people having cardiovascular disease risk factors and may play as a crucial role in preventive cardiology.
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