Academia Journal of Medicine http://aijournals.com/index.php/ajm <p style="text-align: justify;"><strong>Academia Journal of Medicine (AJM)</strong> is an open-access; freely accessible, online and print Bi-Annual peer-reviewed international journal publishes a wide spectrum of advanced research in different fields of clinical medicine, covering etiology, diagnosis, therapy and prognosis aspects.<br> <strong>Online ISSN: 2663-8290 | Print ISSN: 2663-8282</strong></p> Dr Sanket Hiware, College of Medicine and Health Science, DireDawa University, Ethiopia. en-US Academia Journal of Medicine 2663-8282 Clinical Profile of TB Patients on DOTS at a Tertiary Care Hospital http://aijournals.com/index.php/ajm/article/view/839 <p><strong>Background: </strong>Tuberculosis was considered to be among the top ten causes of global mortality and morbidity. The highest incidence of TB was found in developing countries. Estimates suggest that 32% of the world‟s population was infected with TB. In India, it was seen that TB kills more adults than any other infectious disease. 20% global burden of TB was in India.<strong> Subjects and Methods: </strong>Before initiating anti-tuberculosis treatment a detailed clinical assessment which included history and clinical examination was done. Hematological investigations like HIV test is done as per ICTC along with HBsAg. Hematological investigations included hemoglobin, WBC count, differential count, platelet count, prothrombin time and ESR. Biochemical investigations included total bilirubin, direct bilirubin, AST, ALT, alkaline phosphatase, random blood sugar, blood urea, s.creatinine and uric acid. <strong>Results: </strong>Out of the 50 patients studied, 70 % patients were sputum positive and 30 % were sputum negative. This is probably because majority of the patients studied were pulmonary tuberculosis. <strong>Conclusion: </strong>Adverse drug reaction was seen in 29 patients (58 %). One or more types of ADR was seen in these patients.</p> Arjun H Santosh VG Copyright (c) 2019 Academia Journal of Medicine 2019-07-24 2019-07-24 2 2 1 4 Clinical Profile of Snake Bite Envenomation in Patients Admitted at Tertiary Care Hospital http://aijournals.com/index.php/ajm/article/view/881 <p><strong>Background: </strong>Snakebite envenoming is a potentially life-threatening disease that typically results from the injection of venom following the bite of a venomous snake. Sometimes envenoming can also be caused by venom being sprayed into a person’s eyes by certain species of snakes that have the ability to spit venom as a defense measure. Not all snakebites are venomous. Some snakes are non-venomous and venomous snakes do not always inject venom during a bite. <strong>Subjects and Methods: </strong>Patients were examined for complications of snake bite. Haemotoxicity was assessed based on features like bleeding from the bite site, gums, epistaxis, haemoptysis, haematemesis, rectal bleeding or malaena, haematuria, vaginal bleeding, bleeding into the mucosae, skin (petechiae, purpura, discoid haemorrhages, ecchymoses. Neurotoxicity by drowsiness, paraesthesiae, abnormalities of taste and smell, ptosis, external ophthalmoplegia, paralysis of facial muscles and other muscles innervated by the cranial nerves, respiratory and generalized flaccid paralysis. <strong>Results: </strong>Majority of the patients were farmers with 44% followed by housewives (26%). Lower limbs were the most common site of bite in our study group comprising of74% of the patients. <strong>Conclusion: </strong>Most common manifestation of envenomation is local envenomation comprising of 66%.</p> N. Kotresh V. Sunitha Copyright (c) 2019 Academia Journal of Medicine 2019-08-13 2019-08-13 2 2 5 7 To Assess Correlation of Fasting Blood Glucose, Hb1Ac and Serum Lipid Level in Type II Diabetes Mellitus Patients http://aijournals.com/index.php/ajm/article/view/914 <p><strong>Background: </strong>Diabetes Mellitus (DM) refers to a group of common metabolic disorder that share the phenotype of hyperglycaemia caused due to either deficiency of insulin secretion or insulin resistance. The present study was conducted to assess correlation of fasting blood glucose, Hb1Ac and type II DM in given adults. <strong>Subjects and Methods: </strong>The present study was conducted on 134 patients with type II diabetes mellitus (DM) of both genders. Patients were subjected to estimation of fasting and random blood glucose level. Modified method of Fluckiger and Winterhalter was used for estimation of glycosylated haemoglobin (HbA1C). <strong>Results: </strong>Out of 134 patients, males were 84 and females were 50. Age group 20-30 years had 11, 30-40 years had 14, 40-50 years had 38, 50-60 years had 46 and &gt;60 years had 25 patients. The mean fasting blood glucose level in patients with good degree of control was 106.2, in fair was 164.4 and in poor was 208.2. Glycosylated hemoglobin level was good (6.74), fair (8.12) and poor (12.54). A positive correlation of fasting blood glucose and glycosylated hemoglobin level and serum cholesterol &amp; glycosylated hemoglobin level (P&lt; 0.05) was found. <strong>Conclusion: </strong>Authors found a positive correlation of fasting blood glucose and glycosylated hemoglobin level and serum cholesterol &amp; glycosylated hemoglobin level in type II diabetes mellitus patients</p> Nagendra Singh Chauhan Hemendra Kumar Agrawal Copyright (c) 2019 Academia Journal of Medicine 2019-08-15 2019-08-15 2 2 8 10 A Hospital Based Cross-sectional Study on Demographic Distribution of Both Symptomatic and Asymptomatic Patients an Art at Westren Region of Rajasthan. http://aijournals.com/index.php/ajm/article/view/1002 <p><strong>Background: </strong>Over the past two decades with the advent of highly active antiretroviral therapy (HAART), there is a substantial increase in the life span of HIV patients. Morbidity and mortality due to human immunodeficiency virus (HIV) continue to be major problems in developing countries like India. <strong>Subjects and Methods: </strong>The present study was a cross sectional hospital based study for a period of twelve months from 1st Nov. 2015 to 31st Oct. 2016 at ART center P.B.M. Hospital, Bikaner. 100 HIV+ patients on ART were included in the study by consecutive sampling technique. <strong>Results: </strong>We found that Maximum number of study participants in age group of 31-40 years in both study (50%) and control (42%) group. Males were higher in study (76%) as well as control (64%) group than females .Among the subjects mostly belonged to lower socioeconomic status followed by Medium and High socioeconomic status. Most of the subjects in study (92%) as well as control (94%) groups were married. <strong>Conclusion: </strong>We conclude that Males were higher in study (76%) as well as control (64%) group than females .Among the subjects mostly belonged to lower socioeconomic status followed by Medium and High socioeconomic status.</p> <p>&nbsp;</p> Alok Gahlot Pooja Gahlot Jitendra Acharya Copyright (c) 2019 Academia Journal of Medicine 2019-10-08 2019-10-08 2 2 11 13 A Cross Sectional Study on Correlation of Quantitative C - reactive protein With CD4 Count in Patients of HIV on Art http://aijournals.com/index.php/ajm/article/view/1003 <p><strong>Background: </strong>Over the past two decades with the advent of highly active antiretroviral therapy (HAART), there is a substantial increase in the life span of HIV patients. Hence, the focus has now shifted to managing long-term complications of HIV infection and improving the quality of life of HIV patients, especially in developed nations. On the other hand, in developing nations, the ever-growing incidence of HIV infection has placed a huge burden on their frail economy, so there is a growing need for simplifying HIV treatment protocols and for having cheaper alternatives for monitoring disease activity. <strong>Subjects and Methods: </strong>The present study was a cross sectional hospital based study for a period of twelve months from 1st Nov. 2015 to 31st Oct. 2016 at ART center P.B.M. Hospital, Bikaner. 100 HIV+ patients on ART were included in the study by consecutive sampling technique. Out of 100 patients, 50 were symptomatic and included in study group and remaining 50 were asymptomatic and taken as controls. <strong>Results: </strong>37 (74%) patients in study group had CRP levels &gt;6 mg/lit (normal level &lt;6 mg/lit). Out of 37, 19 subjects (38% of total) had CRP level &gt;20 mg/lit. While in control group, 44 subjects (88%) had CRP level &lt;6 mg/lit.&nbsp; Only 6 (12%) subjects of control group had CRP level &gt;6mg/lit. None of control subjects had CRP level &gt;20 mg/lit. The CRP levels and CD4 count were negatively correlated in study group and this was observed to be statistically significant (p=0.04) whereas in control group, the CRP levels and CD4 counts were found to be very weakly positively correlated and this correlation was observed to be statistically insignificant. <strong>Conclusion: </strong>There was statistical significant difference between CRP range and levels in both the groups. Also statistical significant difference between CD4 count range in both the groups.&nbsp; In our study, 38% of the study group patients had CRP &gt;20 mg/l whereas 88% of the control subjects had CRP of &lt;6 mg/l.</p> Alok Gahlot Pooja Gahlot Jitendra Acharya Copyright (c) 2019 Academia Journal of Medicine 2019-10-09 2019-10-09 2 2 14 17 A Study of Clinical and Laboratory Profile of Dengue Fever in a Tertiary Care Teaching Hospital http://aijournals.com/index.php/ajm/article/view/1056 <p><strong>Background: </strong>The incidence of dengue has grown dramatically around the world in recent decades. Year after year, the prevalence of the disease is on a rise. This study is designed to study the clinical and laboratory parameters of Dengue patients in a tertiary care teaching hospital. <strong>Subjects and Methods: </strong>Prospective observational study was undertaken in a tertiary care teaching hospital. This study was carried out for a period of two years between Jan 2017 to December 2018.Seventy-two patients were studied and analyzed. All patients with positive NS1 antigen and positive ELISA test were included in the study. Clinical, hematological and biochemical parameters were noted. <strong>Results: </strong>Of the 72 patients, majority were females (52.8 %). Fever was the most common symptom followed by other symptoms like head ache, myalgias etc. <strong>Conclusion: </strong>Dengue is an important cause of mortality and morbidity in our country. Early diagnosis and prompt management can have a positive effect on the outcome of the disease. Proper monitoring of the clinical and biochemical parameters and necessary intervention can bring down the mortality rates associated with this disease.</p> Kamal Rajesh Jampana Atchuta Chytanya Paka Copyright (c) 2019 Academia Journal of Medicine 2019-10-29 2019-10-29 2 2 18 20 A Study of Clinical and Laboratory profile of Scrub Typhus in a Tertiary care Teaching Hospital http://aijournals.com/index.php/ajm/article/view/1057 <p><strong>Background: </strong>Scrub typhus, also known as bush typhus, is a disease caused by bacteria called Orienta tsutsugamushi. This ricketssial infection is transmitted to humans through the bite of infected heptombidium mite larvae. <strong>Subjects and Methods: </strong>All patients were subjected to investigations to establish cause of febrile illness. after complete physical examination routine laboratory investigations like CBC, serology for enteric , malaria, scrub typhus and USG abdomen, chest x-ray ,urine analysis and renal function tests were done in all patients. In all cases diagnosis was based on detection of antibodies using a single step rapid immunochromatography method. <strong>Results: </strong>120 patients, who were admitted with undifferentiated acute febrile illness during the study period diagnosed to be suffering from scrub typhus with positive antibodies, the following results were noted. Fever was the most common symptom seen in all the 120 patients (100%). The duration of fever ranging from one to seven days present in 94(78.3%), fever for 7-12days present in 5 (4.2%) patients and more than 2 weeks present in 5 (4.12%) patients. Headache and vomiting symptoms were the commonly associated symptoms. Generalized muscle pain (myalgia) was present in 63(52.5%) patients. Headache was present in 64 (53.3%), diarrohea was complained by 2 patients(1.7%), vomiting in 47(39.2%) patients, shortness of breath was present in 16 (13.3%) patients, abdominal pain was present in 17(14.2%)patients and skin rash was seen in 1 patient(0.8%). <strong>Conclusion: </strong>Majority of the cases of Scrub typhus are seen in the cooler months of the year and in the rainy season. It has to be considered in the&nbsp; differential diagnosis of undifferentiated acute febrile illness.</p> Atchuta Chytanya Paka Kamal Rajesh Jampana Copyright (c) 2019 Academia Journal of Medicine 2019-10-29 2019-10-29 2 2 21 23 A Clinico-Hematological Study of Influenza Virus Infection http://aijournals.com/index.php/ajm/article/view/1058 <p><strong>Background: </strong>Influenza is a seasonal infectious viral disease which accounts for approximately 3-5 million cases of severe illness and 250,000 to 500,000 deaths in a yearly outbreak. The objectives of our study were to study the various clinical presentation of influenza infection and to correlate the demographic data and clinical symptoms with hematological parameters. <strong>Subjects and Methods: </strong>95 cases which were positive by One-step RT-PCR were included in the study. Elevation of serum transaminase levels, thrombocytopenia and raised creatinine levels are important parameters which mandates vigilant follow up in patients with influenza infection. <strong>Results: </strong>The most common symptoms were fever in 88.42% and cough in 88.42% of cases. 51.57% of patients presented with anemia on admission. 11.5% of patients had thrombocytopenia of which 36.36% had elevated liver enzymes. 35.78% of cases had leukocytosis of which 32.35% had elevated liver enzymes. 15.78% of patients had raised creatinine levels. <strong>Conclusion: </strong>Authors suggested that elevation of serum transaminase levels, thrombocytopenia and raised creatinine levels are important parameters which mandates vigilant follow up in patients with influenza infection.</p> Shivani Shenoy K Raj Shekhar Mary Mathew G Arun Kumar Copyright (c) 2019 Academia Journal of Medicine 2019-10-29 2019-10-29 2 2 24 27 Study of Serum Ferritin and Glycated Hemoglobin in Type 2 Diabetes Mellitus http://aijournals.com/index.php/ajm/article/view/1070 <p><strong>Background: </strong>Type 2 diabetes mellitus is a common metabolic disorder of multiple etiologies. Increased levels of serum ferritin have been indicated to be associated with the etiology of the diabetic process, as well as in pathogenesis of various diabetic complications. The study aims to understand the relationship between the serum ferritin and glycated hemoglobin in type 2 diabetes mellitus. <strong>Subjects and Methods: </strong>The study was conducted at Medical College Hospital and Research Centre. A total of hundred cases of type 2 diabetes mellitus of the age group 30 – 70 years were taken for the study after satisfying the inclusion and exclusion criteria. Hundred healthy volunteers in the age group 30 – 70 years, sex matched during the same period was included in the study under the control group. <strong>Results: </strong>Serum ferritin level was significantly high in cases compared to controls. There was moderate correlation between serum ferritin and glycated hemoglobin. There was significant increase in serum ferritin levels in type 2 diabetics compared to the controls. There was a moderate correlation between serum ferritin and glycated hemoglobin. <strong>Conclusion: </strong>This study explores the possibility of finding serum ferritin as a marker to explain the oxidative stress process in type 2 diabetes mellitus. This valuable information would be helpful in proper medical intervention.</p> Tanveer Ahmed Copyright (c) 2019 Academia Journal of Medicine 2019-11-07 2019-11-07 2 2 28 31 Clinical Profile of Patients with Type 2 Diabetes Mellitus at a Tertiary Care Hospital http://aijournals.com/index.php/ajm/article/view/1071 <p><strong>Background: </strong>Diabetes mellitus is described as a group of metabolic disorders of multiple etiology characterized by chronic hyperglycemia associated with disturbances of carbohydrate, fat and protein metabolism due to absolute or relative deficiency of insulin secretion and/or action. Diabetes mellitus is associated with significant long term sequels, particularly damage or dysfunction of various organs especially kidneys, eyes, nerves, heart and blood vessels. <strong>Subjects and Methods: </strong>A pre-structured and pre-tested proforma was used to collect the data. Informed consent was taken from all cases and control subjects. Base line data including age and sex, detailed medical history including conventional risk factors, clinical examinations and relevant investigations were included as part of the methodology. <strong>Results: </strong>The mean serum FBS level among cases was 146.94±54.99 mg % as compared to 86.71±9.71 mg % among controls. There was highly significant difference in serum FBS levels among cases and controls. <strong>Conclusion: </strong>The mean serum PPBS level among cases was 244.26±96.47 mg % as compared to 111.96±8.85 mg % among controls. There was highly significant difference in serum PPBS levels among cases and controls.</p> Tanveer Ahmed Copyright (c) 2019 Academia Journal of Medicine 2019-11-07 2019-11-07 2 2 32 35 Relationship between Smokeless Tobacco Dependence and Psychiatric Disorders http://aijournals.com/index.php/ajm/article/view/1072 <p><strong>Background: </strong>The epidemiology of nicotine dependence indicates how strongly addictive a drug it is that nearly half of those who ever smoked steadily for a month become highly nicotine dependent. It is a psychoactive substance that induces euphoria, reinforces its own use, and leads to nicotine withdrawal syndrome when it is absent. <strong>Subjects and Methods: </strong>Written informed consent was taken from all the cases and controls prior to the detailed assessment. The personal data was recorded in the socio demographic data. They were administrated Modified Fagerstrom test for nicotine dependence [FTND] and those who were nicotine dependent were then screened for psychiatric morbidity using GHQ – 12 [69] screening questionnaire. <strong>Results: </strong>Among those with psychiatric diagnosis majority had Major Depressive Disorder [24%], Generalized Anxiety disorder [18%], Mixed Anxiety Depressive disorder [10%] and Alcohol dependence syndrome[14%] as compared to non-nicotine dependents. <strong>Conclusion: </strong>Severity of Anxiety and depression increased with the severity of nicotine dependence among the cases.Coping skills were not significantly different between cases and controls.</p> Vijayraj N Copyright (c) 2019 Academia Journal of Medicine 2019-11-07 2019-11-07 2 2 36 41 Clinical Profile of Patients with Rickettsial Infection: Descriptive Study http://aijournals.com/index.php/ajm/article/view/1084 <p><strong>Background: </strong>Rickettsiae along with their public health implications. They have addressed the co-circulation of differentspecies and genotypes of rickettsiae within the same endemic areas and how these observations may influence, correctly or incorrectly, the trends and conclusions drawn from the surveillance of rickettsial diseases in humans. <strong>Subjects and Methods: </strong>A total of 60 subjects, satisfying the inclusion and exclusion criteria were included in the final analysis. The sample size was calculated assuming the expected proportion of rickettsial infection as 11% among fever cases as per previously published studies, with a precision of 8% and 95% confidence level. <strong>Results: </strong>Among people with a tick bite, 3 (12.5%) people had 80 overall Weil-Felix titre. The number of people with 160, 320 and 640 overall Weil Felix titre was 4 (16.66%), 10 (41.66%) and 7 (29.16%) respectively in people with a tick bite. Among people without tick bite higher proportion of people had 80 and 160 titre. None of them had 640 titre. Statistical significant could not be tested due to zero number of subjects in one of the cells. <strong>Conclusion: </strong>Among people with pain abdomen 11 (23.91%) people had 80 Overall Weil-Felix titre. The number of people with 160, 320 and 640 Overall Weil Felix titre was 15 (32.60%), 13 (28.26%) and 7 (15.21%) respectively in people with pain abdomen. Among people without pain abdomen higher proportion of people had 80 and 160 titres. None of them had 320 and 640 titres. Statistical significant could not be tested due to zero number of subjects in one of the cells.</p> Shivaprasad Krishna Kumar Naik Copyright (c) 2019 Academia Journal of Medicine 2019-11-19 2019-11-19 2 2 42 45 A Study on Biochemical Parametrs in Patients with Rickettsial Infection http://aijournals.com/index.php/ajm/article/view/1085 <p><strong>Background: </strong>The traditional views of tick-borne rickettsioses as endemic diseases with largely focal distributions and limited host and geographic ranges, predetermined seasonality and defined tick associations became obsolete or at least very incomplete. This expansion of awareness about the existence of other rickettsial agents with varied clinical and epidemiological attributes has been thoroughly reviewed but it has presented new challenges to the medical and public health communities. <strong>Subjects and Methods: </strong>The clinical presentation and multiple organ dysfunctions in these patients were evaluated with a special focus on the renal manifestation and hepatic manifestations. The study population included all the patients presenting fever, rash and were diagnosed with rickettsial disease by clinical examination. A total of 60 subjects, satisfying the inclusion and exclusion criteria were included in the final analysis. The sample size was calculated assuming the expected proportion of rickettsial infection as 11% among fever cases as per previously published studies, with a precision of 8% and 95% confidence level. <strong>Results: </strong>The mean AST in the 80 titre was 140.43 ± 79.92, it was 285.89 ± 184.95 in 160 titre, 364.92 ± 89.69 in 320 titre group and 579.29 ± 106.26 in 640 titre group. The mean difference of AST 145.47 in 160 titre group was statistically significant (p value&lt;0.001), 224.50 in 320 titre group was statistically significant (p value&lt;0.001), and in 640 titre group 438.86 was statistically significant. (P- Value &lt;0.001). <strong>Conclusion: </strong>The study has highlighted the need to have a high index of suspicion to enhance the diagnosis of ricketsial diseases and also the strong association between weilfelixtitre and liver and renal dysfunction.</p> Krishna Kumar Naik Shivaprasad Copyright (c) 2019 Academia Journal of Medicine 2019-11-19 2019-11-19 2 2 46 50 A Prospective Study of Lipid Profile and BMI as Risk Factors in MI in Young[<40 Yrs] In Rural Background http://aijournals.com/index.php/ajm/article/view/1092 <p><strong>Background: </strong>In recent years cardiovascular disease is the leading cause of mortality and morbidity worldwide in both male and female is accepted. The urbanisation has made its impact on the rising incidence of MI in India. One should not overlook however that MI in rural areas has doubled as well. This study is aimed at studying the Dyslipidaemia&nbsp;&nbsp; and Body mass index as risk factors in MI in young in rural background.<strong>Subjects and Methods:</strong>This prospective&nbsp;&nbsp; observational study was done in General Medicine Department at SVS hospital during July 2007 to July 2009.Out of 100 patients admitted with MI 20 selected and studied based on inclusion and exclusion criteria.<strong>Results:</strong>The study showed patients with high LDL&gt;100mg/dl and low HDL&lt;35mg/dl were prone for MI than other individuals. Furthur it was shown that patients with BMI&gt;30 had increased risk for MI than otherwise. It was also observed that female preponderance was more compared to males.<strong>Conclusion: </strong>The study shows that dyslipidaemia and abnormal BMI do contribute to MI in young in rural background.</p> Yadavendra C Reddy Copyright (c) 2019 Academia Journal of Medicine 2019-11-27 2019-11-27 2 2 51 53 Gastrointestinal Manifestations in Patients with Chronic Kidney Disease http://aijournals.com/index.php/ajm/article/view/1095 <p><strong>Background: </strong>Chronic kidney disease is a silent epidemic of the 21 century. Surveys have suggestedthat as many as 16% of the adult population have CKD1. The most common, non –renal, chronic disorders in patients with ESRD are gastro intestinal disorders2. Among upper gastrointestinal lesions caused by chronic kidney disease gastritis, an esophagus is,gastric ulcers are the most prevalent lesions. Here an attempt is being made to study the upper gastro intestinal changes in chronic kidney disease and evaluate theirrelationship with the stage of CKD or GFR. <strong>Objectives: </strong>1. To determine the prevalence of various upper gastro intestinal lesions withthe use of fibro optic endoscopy.2. To evaluate the relation between the gastro intestinal lesion with the stage ofCKD or GFR. <strong>Subjects and Methods: </strong>We conducted a cross sectional study on 50 patients ,who are diagnosed to haveChronic kidney disease and being presented to OPD and admission in NavodayaMedical College and Research Center, Raichur over a period of one year. All patientswith chronic kidney disease underwent upper gastrointestinal endoscopy wereincluded in the study. <strong>Results: </strong>Majority of the subjects belongs to age group of 31 to 40 years (26%) and least belongs to 70 to 80 years age group (6%).Out of the 50 subjects, males were 28 and females were 22.Majority of the cases in our study belonged to stage IV. 84% of the cases had upper gastrointestinal involvement on endoscopic examination in our study. Erosive gastritis (26%), either antral or fundal, was the predominant lesion found on endoscopy. Majority of the subjects having erosive gastritis, had stage IV CKD (53.8%).Out of 50 cases in our study 55% of subjects had lesions of the stomach, 26% of subjects had lesions in the duodenum, 19% of subjects had lesions in esophagus. Out of 50 subjects in our study 52% were undergoing haemodialysis and 48% of subjects were under conservative management. Majority of subjects undergoing haemodialysiswere belongs to stage V. <strong>Conclusion: </strong>Majority of the patients with chronic kidney disease have upper gastrointestinal involvement on endoscopic evaluation. Erosive gastritis is the most common upper gastrointestinal manifestation in our study. Upper gastrointestinal manifestations are predominant in stage V. Upper gastrointestinal findings are frequently observed in chronic kidney disease patients on dialysis. Early diagnosis and management can reduce mortality and morbidity and prevent fatal complication like massive upper gastrointestinal bleed.</p> Shivraj Venugopal.K Copyright (c) 2019 Academia Journal of Medicine 2019-11-27 2019-11-27 2 2 54 59 Prevalence of Mineral Bone Disorders in Chronic Kidney Disease Patients http://aijournals.com/index.php/ajm/article/view/1096 <p><strong>Background: </strong>Chronic kidney disease (CKD) is a progressive loss in renal function which involves in deterioration in mineral homeostasis with disruption of normal serum and tissue concentration of phosphorus and calcium. Also changes in circulating levels of hormones-parathyroid hormone (PTH), calcitriol (1,25(OH)2 D), and fibroblast growth factor-23 (FGF-23). Here our aim is to study the prevalence of markers associated with MBD in CKD stage 3-5 patients. Patients with CKD stage 3-5 were included in this observational study with all necessary parameter. X-RAY abdomen and echocardiography was done to look for evidence of vascular and valvular calcification respectively. Statistical analysis was done using SPSS software. A total of 170 patients (128 males, 42 females)(M:F = 3:1) were included in this study with a mean age of&nbsp; 50.54 years. Among CKD stages 3 to 5, the&nbsp; prevalence of hypocalcemia&nbsp; was 22.2%, 33.3% &amp; 48.9%,&nbsp; hyperphosphatemia&nbsp; was 11.1%, 25.5% &amp; 63%, hyperparathyroidism&nbsp; was 48.1%, 67.3% &amp; 89.1%, high total alkaline phosphatase was 0%, 5.9% &amp; 45.7% , low 25-OH-vit D was 59.2%, 70.6% &amp; 79.4%&nbsp;&nbsp; respectively. Low 25 (OH) D levels, hyperparathyroidism, and hyperphosphatemia were the noticeable markers of CKD-MBD in our patients. Mineral bone disorder are common in CKD patients which start in early CKD stages &amp; worsen with disease progression that causes morbidity and decreased quality of life.</p> Tapas Ranjan Behera Bishwaranjan Mohanty Alisha Sahu Sujata Naik Jatindra Nath Mohanty Copyright (c) 2019 Academia Journal of Medicine 2019-11-27 2019-11-27 2 2 60 63 Study of Clinical Profile of CAPD Patients in Eastern India – A Clinical Observation http://aijournals.com/index.php/ajm/article/view/1097 <p><strong>Background: </strong>The prevalence of end-stage renal disease (ESRD) requiring renal replacement therapy is rising steadily in developed and developing countries. Currently, continuous ambulatory peritoneal dialysis (CAPD) and in-center hemodialysis (HD) are the two major modes of dialysis used to treat ESRD . Only 8% of PD patients are initiated on PD directly, 92% are&nbsp; shifted from HD .There are several approaches to measuring peritoneal membrane function like&nbsp; peritoneal equilibration test (PET), the standard permeability analysis (SPA). Successful treatment&nbsp; with PD encompasses several important quality targets like Patient survival, Technique survival, Quality of life, Nutrition status. Complications includes Catheter malfunction, Exit site infection, Peritonitis, Fluid leaks. In this observational study of clinical profile of CAPD patients 40 patients were taken. Of the 40 patients included in study 72.5% were male and 27.5% were female. Various factors for preference of&nbsp;&nbsp; CAPD are&nbsp; remote places, expenditure(35%),&nbsp; cardiovascular morbidity(25%). The observations are out of&nbsp; 52 % had well maintained nutrition ,KT/V score ranges from 1.2 to 7 with mean (SD) 3.88 ± 1.59, only 22.5% have peritonitis and catheter exit site infections. None had catheter removal.&nbsp;&nbsp; All our&nbsp;&nbsp; outcome (such as correction of anemia, nutritional status, clinical well being, absence of edema) and biochemical parameters (for e.g. Peritoneal Equilibrium Test, weekly KT/V) will used to knowing the adequacy which is consistent to results of various national and international studies.</p> Bishwaranjan Mohanty Tapas Ranjan Behera Sujata Naik Chittaranjan Kar Smarak Ranjan Panda Alisha Sahu Deba Prasad Kar Jatindra Nath Mohanty Copyright (c) 2019 Academia Journal of Medicine 2019-11-27 2019-11-27 2 2 64 67 Evaluation of Urinary Cytokines in Idiopathic Glomerulonephritis in a Tertiary Care Teaching Hospital http://aijournals.com/index.php/ajm/article/view/1098 <p><strong>Background: </strong>Idiopathic primary glomerular diseases include a group of disorders characterized by pathologic alterations in normal glomerular structure and function, independent of systemic disease processes. Inflammatory cytokines, including MCP-1 and IL-6, plays an important role in glomerular inflammation. In this study we determined whether the measurement of urinary MCP-1 and IL-6 might be useful in assessing the role of these urinary marker in idiopathic primary glomerulonephritis and its relationship with histopathological finding. We found in result the minimum level of MCP-1 and IL-6 was 5.6pg/ml and 7.69pg/ml and the maximum level of MCP-1 and IL-6 was 23.6pg/ml and 60.04pg/ml respectively. The mean and standard deviation were higher in nephrotic range proteinuria than nonnephrotic proteinria. Correlation of urinary MCP-1 and IL-6 with 24 hour urinary protein &lt;3.5gm and ≥3.5gm were analysed. The correlation between urinary IL-6 and histopathological finding of idiopathic primary glomerular diseases were found statiscally significant (p value &lt;0.05). In conclusion, we found that level of urinary MCP-1 was raised in patients with increase degree of interstitial fibrosis and tubulointerstitial infiltrates and urinary IL-6 was noted in high level increase with increase degree of glomerlosclerosis, interstitial fibrosis and tublar atrophy.</p> Deba Prasad Kar Vijay Pratap Singh Anupam Agarwal Vivek C Ganiger Jatindra Nath Mohanty Copyright (c) 2019 Academia Journal of Medicine 2019-11-27 2019-11-27 2 2 68 72 Estimation of Plasma BNP Levels in Rheumatic Heart Disease Patients at a Tertiary Care Teaching Hospital in Eastern India http://aijournals.com/index.php/ajm/article/view/1099 <p><strong>Background: </strong>Brain natriuretic peptide (BNP) is a cardiac hormone secreted from the ventricular myocardium as a response to ventricular volume expansion and pressure overload. Rheumatic heart disease is a major health problem, mostly in developing country like India and particularly in this part of the country. In young age group rheumatic heart disease is the most common cause of cardiac morbidity and mortality. In this study our aim is to measure BNP levels in patients with RHD and to find out whether BNP concentrations correlate with clinical and echocardiographic findings. A total of 88 patients with rheumatic valve disease having different type of single or multivalvular lesions were included in this study.&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; BNP was measured using the chemiluminescence methods (Bayer Centure, Germany) by BNP kit. 2D Echocardiography with colour Doppler&nbsp; was performed in all patients to assess the severity of the valve disease and for the measurement of pulmonary artery pressure. The plasma concentrations of BNP were found significantly higher in patients with aortic stenosis than in control&nbsp; (355.92±204.31pg/ml vs.183.39±93.51pg/ml, p &lt; 0.001). The plasma BNP level was significantly higher in NYHA class&nbsp; IV than in class I (921.50±301.93 in class I&nbsp; and&nbsp; 125.85±52.88 pg/ml, p &lt; 0.001 in class III).&nbsp;&nbsp; The independent determinants of higher BNP levels were NYHA functional class and systolic pulmonary artery pressure in multivariate analysis. Along with these results we got all other relative output which suggested that&nbsp; increased plasma BNP levels in patients with rheumatic heart disease compared with healthy subjects.</p> Deba Prasad Kar Bandita Dash Anupam Agarwal Vijay Pratap Singh Jatindra Nath Mohanty Copyright (c) 2019 Academia Journal of Medicine 2019-11-27 2019-11-27 2 2 73 76 Renal Biopsy Findings in Lupus Nephritis and Their Correlation with Clinico-Biochemical Parameters http://aijournals.com/index.php/ajm/article/view/1100 <p><strong>Background: </strong>This is an observational analysis wherein we contemplated renal biopsy discoveries of 50 patients of lupus nephritis (LN) and these biopsy discoveries were associated with clinical and biochemical parameters of the LN patients. The study included 50 patients of SLE diagnosed to have renal involvement. Renal biopsy was done in every one of the 50 patients and the outcomes were ordered by the ISN/RPS arrangement of LN. Clinical and biochemical parameters were examined in all patients and they were corresponded with renal biopsy discoveries. The different biochemical parameters in our investigation were-proteinuria (100%) , raised serum creatinine (56%). Mean 24 hour protein discharge was 2386+/ - 1810 mg/day at presentation.11(22%) patients had nephrotic range proteinuria and 8 (16%) patients had proteinuria &lt;1gm/day. Nephrotic range proteinuria was seen in LN Class IV and Class V. Hematuria was available most ordinarily in LN Class IV (in 100%) while none of the Class II LN patients had hematuria. Hypertension was most ordinarily connected with Class III and Class IV LN. Mean serum creatinine was 2.53+/ - 1.92 mg/dl. Mean serum creatinine was relatively higher on Class IV LN than in different classes of LN. In our examination most regular kind of renal biopsy finding in lupus nephritis was LN Class IV. Most serious kind of LN is Class IV LN. LN patients may have mixed lesions of Class IV and Class V LN, which was found in 2 patients (4%) in our investigation. LN Class I and LN Class VI are exceptionally uncommon at introduction of LN which were not found in renal biopsy in our examination.</p> Vivek C Ganiger Deba Prasad Kar Bandita Dash Anupam Agarwal Jatindra Nath Mohanty Copyright (c) 2019 Academia Journal of Medicine 2019-11-27 2019-11-27 2 2 77 80 Urinary Interleukin 6: A Prognostic Bio Marker in Lupus Nephritis http://aijournals.com/index.php/ajm/article/view/1101 <p><strong>Background:</strong> Lupus nephritis is an frequent and potentially serious complication of SLE. It is an inflammatory disease of connective tissue and immune system, where we find organs and cells undergo damage initially mediated by&nbsp; tissue-restricting&nbsp; auto antibodies and immune complexes. Our aim was to evaluate the&nbsp; association of urinary interleukin 6 in lupus nephritis patients and validate its use as a prognostic marker. <strong>&nbsp;</strong>For this we took the complete demographic profiling of the participant patients along with all biochemical parameter were checked. For IL-6 analysis, we analyzed the whole immunological profile and correlated the level of urinary proteins, serum creatinine and urinary IL-6. The mean values of urinary IL-6 at presentation and after 6 months of treatment were calculated. Any change after 6 months was noted and correlation of Il-6 with disease activity scores was observed. Urinary IL-6 was found to be significantly high in patients of lupus nephritis than controls. Urinary IL-6 was higher in patients of severe form of lupus nephritis such as Class IV than other classes of lupus nephritis. Urinary IL-6 may be used as a prognostic marker of lupus nephritis. The patients who achieved complete remission had near normal levels of urinary IL-6 and patients with partial remission had decreased level of urinary IL-6 than at presentation&nbsp; after 6 months of induction phase treatment. But patients with no remission did not show any significant decrease in urinary IL-6 levels at 6 months. So, urinary Il-6 may be used to monitor the response to therapy.</p> Vijay Pratap Singh Deba Prasad Kar Bandita Dash Jatindra Nath Mohanty Copyright (c) 2019 Academia Journal of Medicine 2019-11-27 2019-11-27 2 2 81 85 Clinical Profile of Idiopathic Pulmonary Fibrosis http://aijournals.com/index.php/ajm/article/view/1102 <p><strong>Background: </strong>The incidence of IPF was estimated at 10.7 cases per 100,000 per year for men and 7.4 cases per 100,000 per year for women in a population-based study from the county of Bernalillo, New Mexico. A study from the United Kingdom reported an overall incidence rate of only 4.6 per 100,000 person-years, but estimated that the incidence of IPF increased by 11% annually between 1991 and 2003. This increase was not felt to be attributable to the aging of the population or increased ascertainment of milder cases. <strong>Subjects and Methods: </strong>This was an observational prospective study carried out in the Department of Pulmonary Medicine, Medical College. The study included 35 patients diagnosed with IPF during the two year study period. <strong>Results: </strong>Dyspnea was the most common symptom at presentation, being present in 35 (100 %) of the patients. Cough with or without expectoration was the next most common symptom, being present in 33 (94.2 %) of the patients. Other symptoms were chest pain, fever and weight loss, and joint pains. <strong>Conclusion: </strong>Clinical prediction models are used in many areas of medicine to provide accurate prognostic information and staging of disease; such a prediction model would be useful in IPF.</p> Mahesh NS Sadanand C D Durga Lawande Copyright (c) 2019 Academia Journal of Medicine 2019-11-29 2019-11-29 2 2 86 89 Management of Idiopathic Pulmonary Fibrosis Cases at a Tertiary Care Hospital http://aijournals.com/index.php/ajm/article/view/1103 <p><strong>Background: </strong>The clinical history of the disease is quite variable; there is usually a slow physiological deterioration, but in some patients there is a faster decline in lung function and death occurs within 6-12 months after diagnosis. Others experience an acute exacerbation during the course of the disease with a sudden worsening of respiratory symptoms, hypoxemia and the appearance of new radiological infiltrates without an identifiable cause. Despite different types of clinical course, IPF is inevitably associated with a poor prognosis, with a median survival of 2-3 years. <strong>Subjects and Methods: </strong>Age, sex, occupation, address (including phone number) was noted down. A detailed occupational history was sought, enquiring about the age at start of the occupation, exact nature of work, any history of exposure to fumes, gases, dust, etc, any other person in the work place suffering from similar complaints etc were obtained. <strong>Results: </strong>Majority of the patients were treated with steroids alone 22(62.8%). 10(28.5%) patients were treated with steroids with azathioprine.&nbsp; 3(8.5%) patients were treated with pirfenidone. <strong>Conclusion: </strong>Majority of the patients, 17(48.5%) out of 35 patients, expired during the study period. 5(14.2%) patients were lost to follow up and the outcome was not available. 10(28.5%) patients remained stable, while 3(8.5%) patients worsened. None of the patients improved during the study period.</p> Mahesh N Sadanand C D Durga Lawande Copyright (c) 2019 Academia Journal of Medicine 2019-11-29 2019-11-29 2 2 90 95 Evaluation of CT Finding in heat stroke patients http://aijournals.com/index.php/ajm/article/view/1113 <p><strong>Background: </strong>To describe the neurological manifestations and neuroimaging of heatstroke patients.<strong>Subjects and Methods: </strong>We extracted data&nbsp; retrospectively&nbsp; from&nbsp; patients’&nbsp; files&nbsp; and&nbsp; described their neurological manifestations and radiological features. An experienced brain-imaging&nbsp; radiologist&nbsp; reviewed&nbsp; and&nbsp; analyzed&nbsp; patients’&nbsp; radiographs&nbsp; to&nbsp; report&nbsp; on&nbsp; signs&nbsp; of&nbsp; abnormality.<strong>Results: </strong>This group included fifteen patients; eight males (53%) and seven females (47%), with an average age of (51.2 ± 10.1) years. Seven patients underwent brain imaging (CT scan), yet abnormal findings were detected in one patient images only. On the initial CT it showed bilateral thalamic and brainstem diffuse hypo-densities. The follow-up CT scans showed acute hemorrhage in the pons and 4th ventricle. There was third intra-ventricular extension of blood, with mild hydrocephalus.<strong>Conclusion: </strong>The study presented non-specific neurological findings that were associated with heatstroke patients. These findings may affect management and potential complications prognosis.</p> Sanjay Kumar Dharmendra Prasad Copyright (c) 2019 Academia Journal of Medicine 2019-12-04 2019-12-04 2 2 96 98 Evaluation of Incidence of Hepatitis C in Health Care Workers http://aijournals.com/index.php/ajm/article/view/1114 <p><strong>Background: </strong>Hepatitis C virus infection continues to be a major public health problem warranting high priority efforts for control and treatment. Aim: An observational, cross-sectional facility-based study was conducted to measure the prevalence of HCV infection and to identify risk factors associated with HCV infection among health care workers.<strong>Subjects and Methods: </strong>A total of 109 participants were selected. It conducted through stratified random sampling. For the analysis, Z-test and Fisher’s exact test were used. All participants in this study were tested for HCV marker (Anti-HC).<strong>Results: </strong>The positive for Anti-HC was found to be 1.8% (2/109), which was found among nurses and paramedics. The results showed association between Anti-HC positivity and blood transfusion, frequency of blood transfusion and exposure to sharp injuries, P values ( 0.003, 0.0001 and 0.029) respectively.<strong>Conclusion: </strong>Prevalence rate of Anti-HC was found to be low in HCWs (1.8%). The prevalence rate was found among nurses and medical engineers. Blood transfusion, frequency of blood transfusion and exposures to sharp injuries to be risk factors with Anti-HC positivity.</p> Sanjay Kumar Dharmendra Prasad Copyright (c) 2019 Academia Journal of Medicine 2019-12-04 2019-12-04 2 2 99 102