Academia Journal of Medicine <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> en-US (Dr. Rohit Varshney) (Mr Shadan Pasha) Sat, 26 Dec 2020 09:08:59 +0000 OJS 60 Clinical Profile and Outcome of Dengue Fever in Tertiary Care Hospital at Kerala <p><strong>Background</strong>: Among all flaviviruses, Dengue is the most common fever. Every year 2-5 lakh cases of Dengue hemorrhagic fever occur. The objective of the study was to evaluate the clinical profile of patients with Dengue fever at a hospital in Kerala. <strong>Subjects and Methods: </strong>Patients with more than 12 years of age and those admitted with fever, headache, and myalgia were assessed with other clinical characteristics (warning signs of dengue fever, signs of hemorrhage, signs of plasma leakage and signs of shock). Laboratory examinations such as Hb, total count, differential count, platelet count, packed cell volume, peripheral smear for the malarial parasite, and liver function test (including S. protein) and renal function test were carried out. Blood coagulation profiles such as Bleeding Time, Clotting Time, Prothrombin Time and aPTT were performed. Radiological findings like X-ray chest and USG abdomen were also performed. <strong>Results: </strong>Consequently dengue fever is ordinary in young adults. In the current study, males were more pretentious than females. Males were affected by 63.7% while females are affected by 36.3%. The most usual indication was fever (94.8%) experienced in all patients followed by headache (41.3%), Generalized weakness (77.5%), myalgia (51.7%), vomiting (57.7%). Predominant organ involvement was hepatic (transaminases, jaundice) followed by gastrointestinal (abdominal pain, distension, loose stools, vomiting, ascites) systems. The total survivors are 86(74.1%) whereas 30(25.8%) were non-survivors. <strong>Conclusion: </strong>Dengue fever usually affects male and young populace. Headache, fever, myalgia are ordinary at hand grumble however in the recent few years, the world has observed the diverse experimental appearance of the dengue fever in dissimilar epidemics, even in the same regions and even with the period of times.</p> P. Leela Kumari Copyright (c) 2020 Author Sat, 26 Dec 2020 00:00:00 +0000 Estimation of Lipid Profiles of Patients with Type-2 Diabetes Mellitus at Adoor, Kerala <p><strong>Background: </strong>Lipid abnormalities in patients with diabetes are often phrased as “diabetic dyslipidemia”. The aim of the study was to evaluate the lipid profiles of patients with type-2 diabetes mellitus. <strong>Subjects and Methods: </strong>the subjects who were enrolled in this study were diabetic patients. For the study, a total of 150 diabetic patients with a history of diabetes for 10 years were arbitrarily chosen and scrutinized for dyslipidemia. Patients with other diseases and metabolic disarray were barred from the study. The patients were selected on an indiscriminate base and detailed case history was measured with all appropriate clinical checks. <strong>Results: </strong>Total 140 diabetic patients with a mean age of 49.98 13.3 years were included in the study. The mean FBS of study participants was 189.78&nbsp;&nbsp; 55.65 mg/dl. Mean triglycerides level was 203.59&nbsp;&nbsp; 84.48mg/dl. Out&nbsp;&nbsp; of the total 150 patients, borderline high cholesterol (200-239 mg/dl) and high cholesterol ( 240 mg/dl) level were 29 (19.3%) and 22 (14.6%) respectively. Out of 150 subjects, 37(24.6%) had borderline high triglyceride (150-199 mg/dl) while 61 (40.6%) had high triglyceride (200-249 mg/dl) level. <strong>Conclusion: </strong>Hyperlipidemia is the most frequent snag of diabetes mellitus and it can prompt patients to precipitate atherosclerosis and microvascular difficulty. Good glycemic control can avert the advances and succession of usual lipid irregularity in diabetes like heightened triglycerides, LDL, serum cholesterol and low HDL.</p> P. Leela Kumari Copyright (c) 2020 Author Sat, 26 Dec 2020 00:00:00 +0000 A Clinical Study of Hypothyroidism Associated With Type – 2 Diabetes Mellitus <p><strong>Background: </strong>Thyroid disorders are common in the general population and the incidence of type 2 diabetes mellitus is also rapidly increasing day by day. The objective is to determine the age and sex prevalence, pattern of presentation and management of patients suffering from hypothyroidism associated with type-2 diabetes mellitus. <strong>Subjects and Methods: </strong>Design: The study was an observational study of 20 types&nbsp;&nbsp;&nbsp; 2 diabetics attending the Department of Medicine (outpatient/inpatient). Duration: 1 year i.e. from December 2004 – December 2005. Setting: Out-patient department. Participants:20 patients with both Diabetes Mellitus type 2 and Hypothyroidism. Patients with known diabetes attending OPD were considered. Data were collected using a standardized case report form. <strong>Results: </strong>The majority of the patients had got diagnosed with hypothyroidism and diabetes within a span of 0 to 5 years, followed by 6 to 9 years span with 4 patients and 3 patients within the span of 10 to 14 years and 2 patients in the span of 15 to 19 years. Only 1 patient was diagnosed with both in a span of 20- to 24 years and one patient in 25 to 29 years. <strong>Conclusion: </strong>Annual Screening is mandatory in all hypothyroid patients for the early detection and treatment of diabetes mellitus, thereby to prevent and/or postpone the complications of diabetes, and all diabetes mellitus patients to undergo thyroid function screening (TFT) yearly for the early detection of thyroid dysfunction and thereby reducing the morbidity and mortality.</p> Prakash Ajmera, P Sailaja, P Raghu Ramulu Copyright (c) 2020 Author Sat, 26 Dec 2020 00:00:00 +0000 Microvascular and Macrovascular Complications In Type 2 Diabetes Milletus <p><strong>Background: </strong>Long-term damage and malfunction of various organ systems can be linked to diabetes and its related complications. The objective is to evaluate the microvascular and macrovascular complications of Type 2 Diabetes Mellitus. <strong>Subjects and Methods: </strong>Patients with confirmed diabetes attending OPD were included. A detailed history is recorded for each individual case with diabetes mellitus, obesity, symptoms and family history with individuals suffering from diabetes mellitus. The physical examination was done for sensory and motor signs. Prevalence rates were typically calculated and standardized for age and sex for microvascular and macrovascular complications at baseline. <strong>Results: </strong>The overall number of patients examined was 100, of which 54% were male and 46% were female. The mean age of the patients in the sample was 53 years. The prevalence of diabetes increased with age. The prevalence of diabetes in elderly patients was maximum for 61 to 70 years of age. 29 percent of patients have a positive history of diabetes in the family. 13% of patients were smokers and all of them were males. The risk factor – Hypertension –19%, Obesity – 25% and hypercholesterolemia – 43% were present at the time of diagnosis. <strong>Conclusion: </strong>The general risk of microvascular and macrovascular problems is severe in patients with type 2 diabetes that are relatively early in the disease phase. Such findings indicate that the early risk factor may be actively changed, especially in regions with a high prevalence of complications. There are important correlations between predominant diabetes and the rising circumference and body mass index. Coronary artery disease, nephropathy and retinopathy have become particularly prevalent.</p> Prakash Ajmera, P Sailaja, P Raghu Ramulu Copyright (c) 2020 Author Sat, 26 Dec 2020 00:00:00 +0000 Study of Correlation of Hypertension and Anthropometric Measurements in Obese Vs Non – Obese Individuals <p><strong>Background: </strong>Obesity exists worldwide at a large incidence rate. All systolic and diastolic blood pressure show a strong association with the height and weight of both sexes. This research was intended to establish the incidence of hypertension in obese patients relative to findings reported in non-obese persons. The objective is to research Hypertension in accordance with the Body Mass Index and to equate it between the two classes of Obese and Non-Obese persons. <strong>Subjects and Methods: </strong>The following anthropometric tests were carried out of both such patients Height 2. Weight 3. Circumference of dimension 4. The hip circumference. The Body Mass Index and the Waist Hip Ratio is determined from these measures. Blood pressure monitoring of BP was taken three times to validate systemic hypertension. Careful history was first taken of these cases involving pre-existing chronic hypertension and disease diagnosis. <strong>Results: </strong>The pre-hypertension level saw more people from both Obese and non-obese classes. Prevalence of stages 1 and 2 of hypertension was mostly seen in obese people. The mean systolic and diastolic blood pressure was higher in obese males than females but barely any noticeable variation in the waist circumference of &gt; 100 and in the waist circumference of 90-100 cm, males were greater than females. <strong>Conclusion: </strong>The incidence of elevated blood pressure and mean systolic and diastolic blood pressure in increased BMI classes, i.e. obese people, was far higher. High BMI demonstrated a strong hypertension association.</p> Sirikonda Aishwarya, Karankoti Raj Kumar, Rallabhandi Sai Sri Harsha, Patnala Chakradhar Copyright (c) 2020 Author Sat, 26 Dec 2020 00:00:00 +0000 Serum Procalcitonic (PCT) Versus Serum C - Reactive Protein (CRP) for Severity of Organ Dysfunction in Sepsis <p><strong>Background: </strong>Intensive care units (ICUs), despite advances in critical care nursing, have frequent issues with early diagnosis and adequate treatment. Recently discovered world-class procalcitonin (PCT), a revolutionary laboratory marker, has been shown to be useful in this regard. The objective is to Comparison of concentrations of serum procalcitonin (PCT) and c-reactive protein (CRP) with a comparable level of organ malfunction during sepsis and evaluation of the interaction between serum PCT and CRP concentrations with different organ malfunction occurrence in sepsis. Design: It is a Hospital-Based Prospective study. Participants and Setting: Fifty people were admitted to the intensive care unit of Gandhi Medical College. <strong>Subjects and Methods: </strong>The extent of sepsis-related organ impairment was evaluated with the sequential organ failure assessment (SOFA) on day 1. Patients were identified by category 1(0-6), category 2(7-12), group 3(13-18), and group 4(19-24) in 4 separate classes with varying organ impairment seriousness of sepsis. Serum PCT and CRP concentrations have been measured. <strong>Results: </strong>The majority of the patients belonged to the age groups of 60-69 years (30%) and 50-59 years (22%) Majority of the patients belonged to the Sofa group 1 around 42% followed by sofa group 2 with 38%, sofa group 3 with 16% and the least belonged to the sofa group 4 with 4%. The mean PCT and CRP concentration in those who survived was 14.73 ng/ml and 149.916mg/L respectively and in those who died were 45.76 ng/ml (p-value &lt;0.001) and 183.584 mg/L (p-value 0.172) respectively. The linear correlation between PCT plasma concentrations and the four groups was significantly stronger than with CRP. <strong>Conclusion: </strong>In SOFA and serum PCT, The level of organ dysfunction and complications in sepsis patients is closely related to serum CRP levels.</p> Sirikonda Aishwarya, Karankoti Raj Kumar, Rallabhandi Sai Sri Harsha, Patnala Chakradhar Copyright (c) 2020 Author Sat, 26 Dec 2020 00:00:00 +0000 An Analytical Study on Anemia in Rural Population <p><strong>Background: </strong>Anemia is one of the common Hematological disorders in India and worldwide. It affects all the age groups both in Males and Females. Moderate to Severe Anemia causes increased morbidity and mortality in elderly patients (AWHO expert group) - According to Worlds Health Organization, Anemia is a define when adults males are having Hemoglobin less than 13.5gr% when adults females non-pregnant less than 12 gr% and when pregnant females are having less than 11 ger%. The incidence of Anemia is very high in old age people who are more than 75 years of age. It ranges from 9% to 41%. In India Anemia is commonly due to nutrition, pregnancy, Hookworm infestation, DUB in the case of females, and Malignancy. The prevalence of anemia in the elderly has been found to range from 9% to 42% with the highest prevalence in 80 years and above. The common causes of anemia in India are Nutritional, Pregnancy, Hookworm infestation, and DUB in the case of Females and Malignancy. The common symptom is General weakness, Fatigue, Lack of concentration, Shortness of Breath, and Palpitations. A WHO expert group proposed that anemia should be considered when hemoglobin level below 13.5gr&amp; in adult males; 12gr% in adults females non-pregnant; 11 gr% in adult female pregnant; 12gr% in children over 14yrs(1). The aim is to evaluate the etiology and clinical features of anemia in adults in rural medical colleges. <strong>Subjects &amp; Methods</strong>: This study is conducted at GEMS Medical College, Srikakulam, A.P for the period of 1 year from April 2018 to March 2019. This study includes 120 patients with Anemia. The age group is between 20 years and 70 years. Males were 56 and females were 64. <strong>Results: </strong>We have conducted this study at GEMS Medical College, Srikakulam for 1 year, from April 2019 to March 2019 total no. of patients included in this study are 120 males 56 and females 64. The age group is between 20 years and 70 years. The maximum patients are in between 30 years and 70 years in both sexes. <strong>Conclusion: </strong>Anemia is a common medical problem in developing countries. In a rural part of India, the disorders will complicate the pregnancy also. So periodical examination and education of the people can decrease morbidity and mortality. In our area still, the common cause is nutritional.</p> Shirish Ardhapuskar, Raghu Rammulu Copyright (c) 2020 Author Sat, 26 Dec 2020 00:00:00 +0000 Assessment of Inflammatory Markers IL- 6 and TNF- Alpha in Newly Diagnosed Type II Diabetics without Hypertension in Comparison with Non-Diabetic Normotensive Subjects <p><strong>Background: </strong>The present study was conducted to assess inflammatory markers IL- 6 and TNF- alpha in newly diagnosed type II diabetics without hypertension. <strong>Subjects and Methods: </strong>68 types of II diabetes mellitus patients and equal numbers of normotensive non-diabetic subjects were also recruited. Glycated hemoglobin (HbA1c) levels, TNF- alpha and IL- 6 were determined.&nbsp; <strong>Results: </strong>The mean IL- 6 level in group&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; I was 17.4 pg/ml and in group II was 4.2 pg/ml. TNF- alpha level in group I was 35.8 pg/ml and in group II was 12.5 pg/ml. The difference&nbsp; was significant (P&lt; 0.05). <strong>Conclusion: </strong>TNF- alpha and IL- 6 level was higher among diabetic patients as compared to healthy normotensive non-diabetic subjects.</p> Manoj Kumar Jain, Gunjan Jain Copyright (c) 2020 Author Sat, 26 Dec 2020 00:00:00 +0000 Evaluation of Lactate in Differentiating Pyogenic and Non-Pyogenic Meningitis <p><strong>Background : </strong>Meningitis is serious and a life-threatening condition among any age group associated with serious mortality and morbidity.&nbsp; The objective of the present research was to assess the efficiency of CSF lactate in differentiating bacterial/ pyogenic from non-pyogenic meningitis. <strong>Subjects and Methods: </strong>A hospital-based one-year prospective study was conducted at a tertiary care hospital in Gujarat. The study was performed at the department of General medicine for a period of one year. All the cases suspected of meningitis above 18 years of age irrespective of sex were admitted and clinically evaluated. The Diagnosis of meningitis was made on account of various clinical symptoms&nbsp;&nbsp; and signs. Like headache, nausea, presence of kernig’s sign, altered sensorium, cranial nerves palsies, hemiparesis, seizures, etc, <strong>Results: </strong>The mean total cell count was highest in cases of pyogenic meningitis with a mean of 840.50 and SD of 112.30 than viral and tubercular meningitis. However, no statistical significance was associated with total count and types of meningitis. (P&gt; 0.05) Lactate levels of the CSF were elevated than normal in both pyogenic and tubercular than viral, however, the mean CSF lactate was higher in pyogenic than tubercular. A clear statistical significance was observed in CSF sugar/blood glucose ratio and CSF lactate levels in this study (p 0.05). <strong>Conclusion: </strong>CSF lactate level is a rapid, quite inexpensive and unpretentious process, important diagnostic indicator in the premature demarcation of pyogenic meningitis and tubercular meningitis from viral meningitis, serving in the premature organization of proper action and diminishing transience and impediments. Early detection may help in early decision on the type and institution of appropriate management could reduce the mortality and morbidity of meningitis.</p> Mehul K. Patel, Hitesh J. Patel Copyright (c) 2020 Author Wed, 30 Dec 2020 00:00:00 +0000 Analysis of Lipid Profile in Subclinical Hypothyroidism at Tertiary Care Hospital-An Observational Study <p><strong>Background : </strong>Subclinical hypothyroidism could damage vascular function by suggesting enhance in SVR and arterial rigidity and by changing endothelial purpose and so increasing the danger of atherosclerosis and coronary artery disease<strong>. </strong>The objective of this study is to analyze the relation amid SCH and serum lipid parameters in this subgroup. <strong>Subjects and Methods: </strong>Current research was performed for the duration of one year at the Department of Medicine, tertiary care institute of India, in patients diagnosed with Sub Clinical Hypothyroidism. Eighty patients were incorporated in the present study and 80 age- and sex-matched and regularly menstruating healthy controls, which were evaluated for the Thyroid Function test, were randomly recruited from staff and volunteers. T3, T4, and TSH were anticipated by utilizing quantitative hard stage ELISA, whereas TC was estimated with photometric determination according to the CHOD PAP method; TG and HDL were estimated by using the enzymatic colorimetric method. <strong>Results: </strong>There is a momentous augment in the serum TC stage in group II individuals 161.14 48.23 mg/dl when compared to group I 124.35 9.57 mg/dl, it is also a significant amplify in serum LDL-Cholesterol in group II individuals 97.99 32.42 mg/dl when compared to group I individuals 63.35 7.55. <strong>Conclusion: </strong>Subclinical hypothyroidism (SCH) is linked with increased serum TC and LDL-C levels. As a result, a prospective association amid subclinical hypothyroidism and atherosclerosis occurs. Larger studies are needed to prove this association in Indian patients.</p> Mehul Marwadi, Kanugir Gosai Copyright (c) 2020 Author Wed, 30 Dec 2020 00:00:00 +0000 Assessment of Serum Uric Acid Levels in Patients with Acute Myocardial Infarction <p><strong>Background : </strong>Aim of the study was to discover if there is the efficacy of serum uric acid in the prognostication of myocardial infarction subjects. <strong>Subjects and Methods: </strong>A total of 200 subjects were incorporated into the research. Of them, 74 patients had ST- elevated myocardial infarction, as in 26 subjects they were diagnosed with non-ST elevation myocardial infarction. Of the total of 100 subjects in the study group, there were 70 males and 30 females. A total of 100 healthy individuals as a control group were also incorporated in the study. Serum uric acid was measured on day 0, 3, 7 as well on day 30 of MI. <strong>Results: </strong>Serum uric acid was calculated on day 0, day 3, and day 7 and on day 30 of the myocardial infarction in the case study group. The mean uric acid levels on day 0 were found to be 6.32 1.45 mg/dl, mean uric acid level on day 3 was found to be 5.98 0.98 mg/dl, mean uric acid level on day 7 was found to be 5.14 2.18 mg/dl and mean uric acid level on day 30 was found to be 4.98 0.44 mg/dl. <strong>Conclusion: </strong>Serum uric acid stages are elevated in subjects of acute MI in contrast to standard well individuals. Subjects with higher Serum uric acid levels have an elevated probability of transience and it can be measured as a marker of appalling prediction.</p> Manjiri Ravindra Kulkarni Copyright (c) 2020 Author Wed, 30 Dec 2020 00:00:00 +0000 Efficacy of Gensini Score in Assessing the Severity of Coronary Artery Disease <p><strong>Background: </strong>The present study was conducted to assess the efficacy of the Gensini score in the severity of CAD. <strong>Subjects &amp; Methods: </strong>100 hospitalized patients presenting as myocardial infarction (MI) (STEMI and NSTEMI), CAD without MI (CSA and UA) were recruited for&nbsp;&nbsp; &nbsp;the study. Plasma 25-OH Vit D level was measured by using the electrochemiluminesent immunoassay (ECLIA) method. Gensini score was recorded which was based on the percentage of luminal narrowing (25%: 1 point; 50%: 2 points; 75%: 4 points; 90%: 8 points; 99%: 16 points, and total occlusion: 32 points). <strong>Results: </strong>Severe vitamin D deficiency &lt; 20ng/ml is seen in a total of 17 patients, out of which 9 patients were having SVD, 8 patients were having DVD, none of the patients having TVD and Normal Coronaries. Gensini score is calculated in all patients undergoing CAG. Mean Gensini score for DVD 34.75, for SVD 16. The mean vitamin D levels are correlated with the severity of coronary disease using the Gensini score. There is a trend towards increasing severity of coronary artery disease with decreasing levels of vitamin D levels with an odd ratio of 2.233. <strong>Conclusion: </strong>Authors found that Gensini score is useful in assessing severity of Coronary artery disease.</p> Reddi Basha Saheb Shaik, B.V. Narayana Reddy Copyright (c) 2020 Author Wed, 30 Dec 2020 00:00:00 +0000 A Comparative Study to Assess the Determinants and Outcomes of Sepsis Treated in Medical Wards and ICU in an Indian Teaching Hospital <p><strong>Background: </strong>Sepsis is a systemic, deleterious host response to infection. Severe sepsis is defined as acute organ dysfunction secondary to documented or suspected infection and septic shock is severe sepsis with hypotension not reversed by fluid resuscitation. The present study was conducted to assess the determinants and outcomes of sepsis treated in medical wards and ICU. <strong>Subjects and Methods: </strong>The study was done at Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka. 320 patients with sepsis of both genders were divided into 2 groups. Group I patients were admitted to the medical ward and group II to ICU. Clinical examination and laboratory tests were done. <strong>Results: </strong>Source of infection was a urinary tract in 12% in group I and 11% in group II, a respiratory tract in 40% in group IU and 32% in group II, GIT in 25% and 22% in group I and II respectively, blood infection in 15% and 20% in group I and II respectively and soft tissue infection in 8% and 15% in group I and II respectively. The difference was significant (P&lt; 0.05). Appropriate specimen culture was present in 75 in group I and 64 in group II and blood culture in 42 in group I and 23 in group II. The difference was non-significant (P&gt; 0.05). <strong>Conclusion: </strong>Clinical features and co-morbidities were higher in ICU patients as compared to the medical ward.</p> S Nagendra, Dayananda AS Copyright (c) 2020 Author Wed, 30 Dec 2020 00:00:00 +0000