Diabetes mellitus is one of the most common diseases in the world and is acquiring epidemic proportions. Its prevalence is growing in both developed and developing countries. India is the Diabetic Capital Of the world. Indians are genetically more susceptible to diabetes compared to other races. Cardiovascular complications are known to be the main cause of morbidity and death in diabetic patients. In diabetic patients there is an increased rate of ischemic heart disease and cardiomyopathy which may lead to heart failure (Diastolic heart failure). Despite similar left ventricular systolic function, patients with diabetes have more pronounced heart failure symptoms, use more diuretics, and have an adverse prognosis compared with those without diabetes; one putative explanation for these discrepancies is diastolic dysfunction of the left ventricle in diabetes mellitus. Left ventricular diastolic dysfunction represents an early stage of heart failure, without any clinical manifestations. In the view of these above facts the present study was conducted to assess the diastolic dysfunction in diabetic patients. MATERIAL AND METHODS: This cross sectional study comprising 50 cases was conducted in the Department of Medicine, Pt. Jawaharlal Nehru Memorial Medical College and Dr. B.R.A.M. Hospital, Raipur (C.G.) from July 2013 to July 2014 in diabetic patients without evidence of cardiovascular involvement and blood pressure less than 140/90mmHg were studied. Permission of ethical committee was taken. 26 patients were female and 24 were male. LVDD was evaluated by Doppler echocardiography, which included E/A ratio; left atrial size was assessed in relation with age/sex, duration of diabetes and HbA1c level. RESULTS: Results showed that diastolic dysfunction was present in 35 (70 %) of the patients. Among males diastolic dysfunction was present in 17 cases (70.83%). Among females diastolic dysfunction was present in 18 cases (69.23%). Diastolic dysfunction was associated with uncontrolled diabetes as assessed by HbA1c levels. Diastolic dysfunction was more common in patients who were on treatment with both oral hypoglycemic agents and insulin. The prevalence of diastolic dysfunction increased with longer duration of diabetes. There was a linear progression of diastolic dysfunction with the increase in age and those with more Left Atrial size. CONCLUSION: The findings in our study indicate that myocardial damage in patients with diabetes affects left ventricular diastolic function before systolic function. E/A ratio and Left atrial size are significantly altered in diabetic patients with diastolic dysfunction. Diastolic dysfunction is significantly associated with duration of diabetes, glycemic levels and the type of treatments. Onset of diastolic dysfunction occurs earlier in females as compared to males. Doppler Echocardiography is a simple, noninvasive, cheap, easily available and a valuable tool in diagnosing diastolic dysfunction. In diabetics before they develop cardiac symptoms, Echocardiography should be d...
Community Acquired Pneumonia imposes a considerable burden on health care facilities in developing countries like ours where resources are already scarce, therefore the need for simple and easy methods of stratification of the cases with regard to severity is undeniable. Recent studies have shown that cortisol level is a reliable predictor of outcome and risk stratification in patients with Community Acquired Pneumonia, therefore cortisol level estimation is advisable which will help guide the management, and reduce the burden on the individual and health care facilities. The most established scoring systems are the PSI-score and the CURB or CRB-65 scores, which perform comparably for mortality prediction and identification of low risk patients suitable for an outpatient management strategy. 1 additionally, biomarkers have been found to improve risk stratification and management decisions in CAP. 2 The aim of our study is to determine the serum cortisol level as a predictor of severity and outcome in Community Acquired Pneumonia. MATERIAL AND METHODS:The study was conducted in the Department of Medicine, Pt. Jawaharlal Nehru Memorial Medical College and Dr. B.R.A.M. Hospital, Raipur (C. G.) among 50 patients admitted in medicine ward who were diagnosed as a case of pneumonia on admission. The study was conducted between April 2013-September 2014. RESULTS: Out of the 17 patients with a CURB-65 score of 0-1, the mortality is 0, 2 out of the 17 patients with CURB-65 score of 2 died within 30 days of admission and 6 out of the 16 patients with a CURB-65 score of 3-5 died within 30 days of admission which was statistically significant (p<0.01, OR= 9.75). Out of the 37 patients with a Cortisol level <27.23, there was negative outcome on 5.4% of the patients. Out of the 13 patients with Cortisol level >27.23, 46.15% had a negative outcome and this findings was statistically significant with p value of <0.01 and OR=8.53. CONCLUSION: The findings in our study indicates that severity of pneumonia is related to serum cortisol level which has a strong prediction as to the course of the disease and outcome of the patients. Strong association between elevated cortisol levels and severity of illness and the risk of death have been demonstrated. There is a positive correlation between CURB-65 score and serum cortisol level.
BACKGROUND Diastolic dysfunction is associated with adverse outcome. There are no direct means to determine diastolic function by echocardiography, however, a multitude of echocardiography parameters assist in determining the diastolic dysfunction. The application of these parameters is not well validated in chronic kidney disease subjects. MATERIALS AND METHODS This study used echocardiography parameters to determine diastolic function in chronic kidney disease and in normal subjects. RESULTS Left atrial volume index appears to be a strong parameter for determining diastolic dysfunction in this subset. CONCLUSION Echocardiographic parameters as a standalone tool for determining diastolic dysfunction in the presence of chronic kidney disease are inadequate. Therefore, a combination of these parameters becomes mandatory to gauge the diastolic dysfunction in chronic kidney disease patients. Left atrial volume index may be proposed as a significant tool for diastolic dysfunction and it should be an essential part of echocardiographic interrogation in chronic kidney disease patients.
Background: The study aimed to assess the magnitude of asthma chronic obstructive pulmonary disease asthma chronic obstructive (ACO) in patients with chronic airway disease.Methods: The study was conducted as cross-sectional study on patients with chronic airway disease presenting at our institute during the study period of 1 year. Global initiative for asthma management and prevention (GINA) syndromic approach table was used to diagnose patients with chronic airways disease. Syndromic and confirmatory diagnosis of ACO was made based upon clinical features and spirometry respectively.Results: About 73.6% were diagnosed as chronic obstructive pulmonary disease (COPD) and 26.4% cases were diagnosed as asthma. Overall ACO was present in 20% cases. ACO was significantly associated with advancing age, male gender, and longer duration of smoking (p<0.05) in asthma patients whereas in COPD patients ACO was associated with advancing age (p<0.05).Conclusions: Overall one fifth of the patients with chronic airway disease have asthma COPD overlap. The ACO is observed in almost equal proportions in asthma and COPD. ACO prevalence was found to increase with age in patients with asthma and COPD.
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