Background: Diabetes mellitus is the most common metabolic disorder characterized by metabolic abnormalities and long term complications. The chronic complications of diabetes mellitus affect many organ systems and are responsible for the majority of morbidity and mortality associated with the disease. The aim of the study is to estimate the serum fibrinogen level in patients of Type 2 diabetes and correlate it with parameters like glycemic control (HbA1C), duration of diabetes mellitus, complications and pharmacotherapy. Methods: The study was conducted at the medicine department of J. A. Group of Hospital & G. R. Medical College, Gwalior, included patients of type-2 diabetes mellitus with or without microvascular complications between the ages of 25-85 years of either sex. Total 60 patients were selected randomly divided in two groups: Group A (n=34) was type-2 diabetes mellitus with microvascular complication, Group B (n=26) was type-2 diabetes mellitus without microvascular complication and Group C (n=28) was non diabetic healthy control. Patient's history, clinical examination, routine blood tests, serum fibrinogen level and fundus examination were carried out. Serum fibrinogen was measured by Clauss method. Results: Maximum number of patients in study was between 40-60 years' age group. Microvascular complication in Group A were nephropathy (n=17), retinopathy (n=13) and neuropathy (n=4). Serum fibrinogen level in patient with microvascular complications, without microvascular complications and in non-diabetic controls were 515±138.7, 437±137 and 308±52.65 respectively. Serum fibrinogen level was higher in overweight patients as compared to normal weight patient in all groups. Serum fibrinogen level in different albuminuria groups (<30mg/l, 30-300mg/l, >300mg/l) were 439.7±135.15, 525.7±145.4, 545.7±112.2 respectively. Mean fibrinogen level was 541.1±121.7 in diabetics with total cholesterol >200. Serum fibrinogen level in patients with HbA1C >12% among both group A & B was 567.5±173.4 and 538.6±184.6 respectively. Most of type-2 diabetes mellitus patient have high fasting blood sugar >126 and high PPBS >200 in both group A & B. Mean fibrinogen level in patients taking insulin, oral hypoglycemic agents and in patients who were not taking any treatment was 640.8±126.4, 449.9±145.7, 419±72 respectively. Conclusions: Further larger studies are required studying the serum fibrinogen level in diabetic patients with microvascular complications and effect of interventions done to reduce the fibrinogen levels.
Background: Influenza is known to cause annual seasonal epidemics in Asian subcontinent. Our study assessed the clinical profile, factors influencing the response, prognosis and outcome in H1N1 positive patients during FebruaryMarch 2015. We aimed to understand the epidemiology and patterns of the disease so that the high risks groups could be identified. Methods: Medical records of the patients who were admitted during Feb-March 2015, as a suspected case to the swine flu ward of J A Hospital and G R Medical College, Gwalior, India were manually retrieved and retrospectively studied. H1N1 positive patients, who were diagnosed clinically and confirmed by RT-PCR method, were included for analysis. Results: Out of 208 patients were admitted for suspicion of swine flu influenza and underwent testing out of which 88 (42.30%) were found to be positive for H1N1. Most common (37.40%) affected age group was 20-30 years. Females were more involved (62.5%), out of which 20% were antenatal. The common presenting symptoms were cough, fever, breathlessness. Overall case fatality ratio was 4.45%. Conclusions:Patients with influenza like illness should not panic as many of them become negative for H1N1. In our area prevalence of H1N1 was high in young and females. Most of the patients recovered with symptomatic treatment and oseltamivir therapy. Proper prevention steps, personal hygiene and admission to designated swine flu ward can be helpful in preventing the spread in the community.
BACKGROUND Tuberculous meningitis (TBM) still remains an important cause of morbidity and mortality in India. Due to lack of early and timely diagnosis of TBM, the fatality rate remains high. OBJECTIVES To evaluate the role of Adenosine Deaminase (ADA) activity in the Cerebrospinal Fluid (CSF) in diagnosis of Tubercular meningitis in adults. MATERIAL AND METHODS The study included 100 patients who presented with sign and symptoms suggestive of meningitis. All the patients were admitted; detailed history and examination including neurological examination was done. CSF samples were taken along with other routine investigations. CSF analysis was done for sugar, protein, cells, and ADA. X-Ray Chest was done in all patients to find out the lung involvement. RESULTS Out of a total of 100 patients, 49 were diagnosed as TBM based on the clinical features and CSF analysis. The CSF showed pleocytosis of 10 to 500 cells/mm3 predominantly lymphocytes, protein >45mg/dl, sugar<40mg/dl or <40% of blood glucose concentration. The mean ADA activity was 12.54±3.91 U/L in patients with TBM. The sensitivity and specificity was 75.51% and 100% respectively when a cutoff value of ADA of 10U/l was used, with an accuracy of 88%. CONCLUSIONS ADA activity in the CSF is very important and rapid screening test that can help in the diagnosis of TBM. ADA activity is markedly higher in TBM.
BACKGROUND AND OBJECTIVE: Malaria, a disease with protean manifestations is endemic in India with an estimated 70-100 million cases each year. Of these 45-50% are plasmodium falciparum. The present study is aimed at to study clinical features, complications, response to treatment and outcome in a tertiary care hospital. METHODOLOGY: This hospital based prospective study was done on 100 confirmed cases of falciparum malaria (either by peripheral smear or rapid diagnostic test) admitted in Department of Medicine, G.R. Medical College, Gwalior (M.P) from July 2013 to November 2014.A case sheet proforma was prepared and data (demographic profile, clinical feature, investigation, treatment, and complication) from all indoor patients was collected and analyzed. RESULT: Out of 100 patients, 65(65%) were males and 35 (35%) were females. Most of the patients were between the age group 21-40 years. The numbers of admissions due to malaria increased from July onward with maximum number of cases were found in the month of August. Fever was the most common symptom followed by headache, nausea and vomiting. Anemia was present in 50(50%) patients followed by hepatomegaly (32%) and spleenomegaly (30%). Jaundice was seen in 47% cases in this study while significant jaundice was seen in 19% case out of which 4% cases was predominantly unconjugated jaundice and 15% cases was predominantly conjugated jaundice. In this study 9% cases found to have malarial hepatopathy. Prothombin time is usually normal and significant prolongation seen in 15% cases. Severe hypoalbuminemia (<2 gm%) was seen in 5% cases out of which 1% case was presented with very high level of bilirubin. Incidence of renal dysfunction was 18% out of which 14% patients associated with significant rise in serum bilirubin. In patients of significant jaundice duration of hospital stay was prolonged. Mortality was seen in 2% cases, 1% presented with significant hepatocellular jaundice and another 1% presented with significant cholestatic jaundice. These 2% cases had also associated with renal dysfunction. CONCLUSION: Liver is commonly involved in falciparum malaria and ranges from mild elevation in serum bilirubin and liver enzymes to elevation above significant level. Jaundice is a serious complication in falciparum malaria. Prognosis of these patients is poor.
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