Background: Organophosphorus poisoning is one of the most common poisonings often requiring ICU care and ventilatory support. The objective and aim of this study are to identify the factors which predict the need for ventilation in these patients. Methods: 50 patients who were diagnosed to have consumed organophosphorus compound poison admitted in Konaseema Institute of Medical Sciences and Research Foundation who presented within 24 hours of consumption are included in the study. Patients with double poisonings, concomitant illnesses, chronic lung diseases and those treated outside are excluded from the study. Results: A total number of 50 patients were studied. 18(36%) patients required ventilation. Generalized fasciculations was a discernible feature in 66% of cases in this study. 69.2% of patients with a fasciculation score of ≥4 required ventilation. Ventilation was needed by 55% of patients who had a Glasgow Coma Scale score of ≤10. Conclusions: Patients who presented with higher fasciculation scores and/or lower GCS scores were more likely to require ventilation. Using GCS scores as a predictor for the requirement of ventilatory support in organophosphate poisoning, a GCS score ten or less was significantly associated with an increased need for ventilatory support.
BACKGROUND Various oral hypoglycaemic agent has been used for the treatment of diabetes mellitus. Out of that, metformin is a biguanide, which is commonly used for the treatment of diabetes mellitus and sitagliptin is an orally effective inhibitor of dipeptidyl peptidase IV, which indirectly increase the secretion of insulin by preventing degradation of GLP-1. Present study is designed to evaluate the efficacy of addition of sitagliptin with metformin in comparison with metformin alone. MATERIALS AND METHODS Subjects included in this study were randomised into two groups. Group A were given metformin 500 mg once daily and group B was given metformin 500 mg plus sitagliptin 50 mg. Both the group consists of 30 patients each. Before start of the study, various parameter like fasting plasma glucose, postprandial plasma glucose, glycosylated haemoglobin, HDL-C, LDL-C, TG total cholesterol, fasting plasma insulin, glycosylated haemoglobin and HOMA-IR were measured. All the patients were followed regularly and advice regarding diet and regular exercise was given. Fasting plasma glucose was measured every 15 days. All the patients were informed about hypoglycaemia and its presentation. Patients were asked to inform about any adverse experience. All the parameters were measured after 16 weeks of treatment. RESULTS Fasting plasma glucose in group A was reduced to 104.6 mg/dL from its basal value 156.45 mg/dL. In group B, the fasting plasma glucose was reduced to 90.10 mg/dL from its basal value 154.7 mg/dL. Fasting plasma insulin in group A was 12.65 mIU/dL, which has been changed to 11.46 mIU/dL after 16 weeks of treatment with metformin 500 mg once daily. Fasting plasma insulin in group B has been decreased from basal value 13.24 mIU/dL to 12.46 mIU/dL at the end of 16 weeks. Glycosylated haemoglobin in group A was 7.64 at the start of study, which was decreased to 6.0 after 16 weeks treatment with metformin similarly in group B HbA1c was decreased from basal value 7.86 to 5.8 after 16 weeks of treatment. The HOMA-IR value also decreased in both group. In group A, initial value was 4.69, which was reduced to 2.94; and in group B, after 16 weeks, the basal value of 7.86 was reduced to 2.77. CONCLUSION Diabetes mellitus is a chronic progressive disease responsible for damage of major organ system. In present study, we have found that BMI and glycaemic index was improved when sitagliptin was added to metformin. Insulin resistance was better improved in sitagliptin combination group metformin alone. Sitagliptin addition is associated with increase in HDL-C.
BACKGROUND Metabolic syndrome is a group of disorders characterised by hyperglycaemia, central obesity and hypertension and dyslipidaemia. This is a condition which is advocated with increased risk of CVD and diabetes mellitus. It is a major modifiable condition that can be prevented and premature death can be decreased. MATERIALS AND METHODS Present study is designed to study the defect of telmisartan with diet and exercise versus telmisartan and metformin on various metabolic parameters in metabolic syndrome patients with hypertension. All the metabolic parameters fasting plasma glucose, insulin (fasting), total cholesterol, LDL-cholesterol, triglyceride, C-peptide Blood pressure, BMI and HOMA-IR were measured at the start of the study and was followed regularly. Final measurements of all these parameters were done after 6 months. Hexokinase method was used for estimation of plasma glucose. RESULTS Weight of the patient in group A was decreased from 89.52 yrs. to 79.6 yrs. after 6 months, in group B it was decreased from 86.52 kg to 84.56 kg, similarly body mass index (BMI) was reduced in group A from 30.4 kg/m 2 to 27.5 kg/m 2 and in group B it was reduced from 30.1 kg/m 2 to 29.4 kg/m 2. Fasting plasma glucose was 97.79 mg/dL in group A at the start of the study, after 6 months it reduced to 92.76 mg/dL. In group B the fasting plasma glucose was decreased from 96.86 mg/dL to 89.40 mg/dL. Fasting plasma insulin level has been reduced from 12.21 mIU/L to 10.21 mIU/L in group A and from 12.55 to 9.51 mIU/L in group B. HOMA-IR which was 2.96 in group A was reduced to 2.89 and in group B reduced from 3.03 to 2.82. CONCLUSION In our study, we have found that the decrease in weight and body mass index was more in group A than group B percentage change in mean of weight was 12.46% in group A and 4.57% in group B, similarly in BMI was 9.5% and 3.9% respectively. We have found that percentage change in mean of FPG, HbA1C and FPI was more in group B and also the change in HOMA-IR. Before start of the study, basal FPI was more but after six months it decreased, but plasma glucose concentration also decreased that indicates that sensitivity of insulin increased. Diet and exercise has good effect on serum triglyceride and LDL-C, but metformin has good effect on HDL-C and total cholesterol.
Background: Both metabolic syndrome and thyroid dysfunction are associated with increased risk of atherosclerotic heart disease. The present study was conducted to study the Association of thyroid dysfunction and Metabolic syndrome and to find out the type of thyroid dysfunction in metabolic syndrome patients.Methods: Sixty cases were defined according to the IDF Criteria. Detailed history and necessary investigations like fasting blood sample was analyzed for total triiodothyronine (T3), total thyroxine (T4), thyroid-stimulating hormone (TSH), lipid profile, and blood glucose were undertaken.Results: In this study population of metabolic syndrome cases, the thyroid dysfunction is present in 16.7% patients. Among the thyroid dysfunction, sub clinical hypothyroidism is highly prevalent - 11.7%, The hypothyroidism is 3.3% prevalent in metabolic syndrome patients (one patient had TSH levels of more than 150 mU/L) and sub clinical hyperthyroidism is 1.7% prevalent. There were no overt hyperthyroidism patients in the study.Conclusions: This study clearly shows that, one sixth of metabolic syndrome patients or every sixth metabolic syndrome had hypothyroidism either overt or subclinical. This finding indicates a need for investigating the presence of Thyroid dysfunction during managing metabolic syndrome patients
Background: Objective of the study was to determine the prevalence of Isolated B12deficient dementia in patients presenting to a tertiary care hospital. The MMSE was much lower in B12 deficiency compared to irreversible causes Thus, shorter duration, severe dementia, focal neurological signs, and a vegetarian diet were significantly associated with the development of B12 deficiency.Methods: Based on exclusion and inclusion criteria 100 patients were included in this study, a detailed history of the patient were taken with respect to duration of dementia and its symptoms, type and treatment. Study in terms of the correlation of the clinical features with investigations and diet. Estimation of the prevalence of dementia with reference to B12 deficiency. Mean MMSE analysis, assessment of the improvement in MMSE after treatment with B12 injections after a6-8 wks period.Results: In this study most of our patients were in the 60-69 age groups across all causes of dementia, 22out of 26, B12 deficient patients were vegetarians. This value was in keeping with the known fact that a vegetarian diet predisposes a person to develop B12 deficiency. The association between B12 deficiency, high MCV and megaloblastic blood picture in peripheral blood smear was significant. The MMSE scores were significantly lower 13.42 in patients with B12 deficiency as compared to those with Alzheimer's 14.3 means and those with multi-infarct state 17.3 means.Conclusions: The duration of the presentation in B12 deficiency was10-12months averagely. There was a significant improvement in MMSE after treatment in pureB12 deficient patients (by 9 points) if they presented within one year of symptoms. Except for myelopathy, there was an improvement in other neurological symptoms and signs. Early diagnosis and proper treatment can make improvements in a patient's memory and quality of life.
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