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) Sun, 17 May 2020 14:11:52 +0000 OJS 60 Evaluation of Lipid Profile in the Smokers and Non-Smokers <p><strong>Background: </strong>Cigarette smoking leads to increased serum level of total cholesterol, LDL cholesterol, Triglyceride levels and decreased level of anti atherogenic HDL cholesterol. Many studies have shown a dose-dependent relationship between smoking and lipoprotein profile. Hence this study was-taken up to know the lipoprotein pattern in healthy young smokers. <strong>Subjects and Methods: </strong>Total of hundered healthy smokers and fifty healthy non smokers were included in the study. All the smokers’ subjects were divided in two groups as per the severity of the habit of smoking. Group 1: all those who smoke upto 10 cigarette per day, Group 2: all those who smokemore than 10 cigarette per day. <strong>Results: </strong>In our study, the mean serum cholesterol of smokers is 205.9 + 26.1 and that of non-smokers is 165.4 + 15.2 which is statistically significant Mean HDL-cholesterol is 34.20 + 4.0 in smokers and 38.40 + 6.4 in non-smokers, which is statistically significant. Mean LDL-cholesterol is 155.8 + 29.30 in smokers and 136.70 + 14.45 in nonsmokers which is statistically significant. Mean Triglyceride level in smokers is 163.28 + 38.7 and in non-smokers it is 116.72 + 23.3 which is statistically significant. <strong>Conclusion: </strong>The mean serum lipid values were significantly higher in smokers except HDL-C which were significantly decreased, as compared to non smokers. There is a linear increase in the levels of serum lipids except HDL-C which shows decrease in the levels with the duration and severity of smoking.</p> Vachan Mehta, Darshak Salat Copyright (c) Mon, 18 May 2020 00:00:00 +0000 Correlation between Vitamin D and HbA1c in Type 2 Diabetic Patients <p><strong>Background: </strong>Diabetes is a metabolic disorder that can affect nearly every organ system in the body. Recently, Vitamin D3 was given some importance worldwide in the pathogenesis of diabetes. The extraskeletal effects of Vitamin D3 have attracted considerable interest. The identification of 1,25(OH)2D3 and 1-Alpha-Hydroylase expression in pancreatic Beta cells, in cells of the immune system,and in various&nbsp; other tissues besides the&nbsp; bone&nbsp; system , supports the role of Vit D3 in the pathogenesis of type 2 diabetes. Vit D3 deficiency appears to be related to development of diabetes mellitus type 2 and metabolic syndrome. <strong>Aim of the Study:</strong>The goal of this study is to find out whether this correlation between vitamin D and Diabetes is present or not. Mainly in this study we have tried to correlate vit D with HbA1C levels in patients with type 2 diabetes mellitus. <strong>Subjects and Methods: </strong>The present one and half years, cross sectional study was carried out in department of medicine, Darbhanga Medical College and Hospital, Darbhanga, Bihar from March – 2018 to&nbsp; September – 2019. A total of 125 patients with type 2 Diabetes Mellitus were studied. The estimation of vitamin D was done. Using Siemens, ADVIA centraurVit D assay a one pass 18 minute antibody competitive immunassay. <strong>Results: </strong>Maximum no. of cases was in the age group of 51 to 60 that is 40 patients (32%).The mean age of studied population was 60.22 +- 11.65 years. Out of 125 patients 77(61.6%) were males and 48 patients (38.4%) were females, with a ratio of male to female of 1.60:1. In 104 patients (83.2%), the level of vitamin D were below normal, in 11 patients (8.8%) the levels insufficient&nbsp; and in remaining 10 patients , the levels were either normal or more than normal. <strong>Conclusion: </strong>There was an inverse association between vitamin D and HbA1C in patients with type -2 Diabetes Mellitus. Lower Vit D levels are associated with poor glycemic control. That means – Low vit D – high HbA1C. Vitamin D deficiency is prevalent in Diabetes mellitus type 2 so by supplementation of vitamin D we can improve glycemic controls in patients of Diabetes mellitus type 2. By improving glycemic control, we can reduce the complication of Diabetes.</p> Sudhir Chandra Jha, Himanshu Kumar, Syed Yousuf Faisal Copyright (c) Mon, 18 May 2020 00:00:00 +0000 Dengue Fever and its Dermatological Changes <p><strong>Background: </strong>Around the world dengue incidence has dramatically grown with a large number of asymptomatic cases. Worldwide about 390 million dengue infections were occurring per year, among them 96 million people were developing clinical manifestations with varied severity. About 3.9 billion people residing in 128 countries, were at-risk of dengue virus infection. Dengue fever (DF) is one of the common causes of acute febrile illness. In half the patients with dengue fever skin involvement occurs. <strong>Aim &amp; Objectives:</strong> To study the socio-demographic parameters, clinical features and laboratory parameters among the patients with and without skin rash in dengue infection. Also determine outcome among the patients with dengue fever and its association with skin rash. <strong>Subjects and Methods: </strong>A hospital-based, analytical prospective study was conducted in the Department of General Medicine, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore. Patients older than 16 years of age with clinical features and laboratory reports suggestive of dengue infection were included. The study was conducted for a period of 12 months from 1st December 2014 to 30th November 2015. These patients were further divided based on the skin rash presence and absence. The data obtained was entered in Microsoft Excel and analyzed in SPSS version-22 trial. Analysis was done using unpaired students t-test, ANOVA. <strong>Results: </strong>In total 97 patients with dengue fever were enrolled into the study. About 14.4 p.c (14) patients were with skin rash. The patients with skin rash were found to have lower platelet levels during the disease course. Patients with skin rash had higher percentage of platelet transfusion which was statistically significant. <strong>Conclusion: </strong>A cutaneous involvement may facilitate clinical diagnosis but it may not be present among all the patients.</p> Mohan Kumar R, Muddu Surendra Nehru Copyright (c) Mon, 18 May 2020 00:00:00 +0000 Mid Regional Natriuretic Peptide for Predicting Prognosis of Hypertrophic Cardiomyopathy <p><strong>Background: </strong>Hypertrophic cardiomyopathy (HCM) is a genetic disorder of cardiac myocytes that is characterized by cardiac hypertrophy, cellular disarray and interstitial fibrosis. Mutation of MYH7 and MYBPC3 encoding proteins β-myosin heavy chain and myosin binding protein C, respectively, are the two most common genes involved, together accounting for about 50% of cases. The present study was conducted to evaluate the prognostic value of MR-proANP in patients with HCM. <strong>Subjects and Methods: </strong>The present study was conducted at Narayana Medical College &amp; Hospital, Chintareddy Palem, Nellore, Andhra Pradesh from July 2016 to July 2017 on 46 patients of hypertrophic cardiomyopathy of both genders. Serum NT-proBNP was measured by a two-site electrochemiluminescence immunoassay on a Roche Diagnostics E170 analyser. <strong>Results: </strong>The mean systolic blood pressure was 124.8 mm Hg, diastolic blood pressure was 78 mm Hg, heart rate was 68 beats/minutes, NYHA 1(n=4), NYHA 2 (n=27), NYHA 3–4 (n=15) and atrial fibrillation was 12%. The mean MR-proANP was 106 pmol/L and NT-proBNP was 540 pg/mL at the start of the study. At the end of 12 months of follow up, 15 patients had a primary end point defined as heart failure hospitalisation (n=10), heart transplant (n=3) death(n=2). Both mean MR-proANP and NT-proBNP were strongly associated with the primary end points at the end of study period with values of 1010 pmol/L and 2545 pg/ml respectively. This showed a strong association with P &lt;0.05. <strong>Conclusion:</strong> Authors found that MR-proANP is a valuable biomarker for the prediction of heart failure related events in patients with HCM.</p> Niranjan Reddy R, Magesh B Copyright (c) Mon, 18 May 2020 00:00:00 +0000 Assessment of Glutathione Level in Non-Alcoholic Fatty Liver Disease Patients <p><strong>Background: </strong>Non-alcoholic fatty liver disease (NAFLD) is a range of hepatic disorders associated with fatty deposits in liver, which occur in the absence of alcohol consumption or alcohol abuse. NAFLD. The present study assessed glutathione level in non-alcoholic fatty liver disease patients. <strong>Subjects and Methods: </strong>The present study was conducted in Department of Internal Medicine, Narayana Medical College &amp; Hospital, Chintareddy Palem, Nellore, Andhra Pradesh. Duration of the study was from February 2018 to January 2019. 40 patients of NAFLD and 20 cases of fatty liver disease were recruited. Serum levels of 8-OHdG were measured using the highly sensitive 8-OHdG Check enzyme-linked immunosorbent assay (ELISA). Serum levels of GGT were measured using the Qualigent® GGT kit. Serum levels of glutathione (GSH) were measured using the GSH kit. <strong>Results: </strong>The mean total bilirubin in group I was 1.2 mg/dL and in group II was 0.7 mg/dL, aspartate transaminase was 58.2 U/l in group I and 62.6 U/l in group II, alanine transaminase in group I was 142.4 U/l in group I and 128.2 U/l in group II, alkaline phosphatase was 284.2 U/l in group I and 302.4 U/l in group II and γ-glutamyltranspeptidase in group I was 98.2 U/l and 118.4 U// in group II. The difference was non- significant (P&gt; 0.05). The mean glutathione level in group I was 0.6 and in group II was 0.4 and which increased to 1.4 in group I and 1.2 in group II after 3 months. The difference within the group found to be significant (P&lt; 0.05). <strong>Conclusion: </strong>Authors found that there was reduction in alanine transaminase, glutathione and gamma-glutamyltranspeptidase level. Antioxidant therapy with glutathione may reduce the pathological oxidative stress in the liver in NASH, preventing the progression from NAFLD to NASH cases.</p> Y. Pavan Kumar Reddy, Suraj Uppalapati Copyright (c) Mon, 18 May 2020 00:00:00 +0000 Assessment of Left Atrial Volume Index in the Patients with ACS in Adults <p><strong>Background: </strong>Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death universally. The present study was conducted to assess LA volume index (LAVI) in the patients with ACS in adults.<strong>Subjects and Methods: </strong>The present study was conducted on120 adult patients diagnosed with ACS of both genders in narayana medical college hospital from May 2016 toOctober 2016. Patients were divided into 2 groups of 60 each. Group I patients had LAVI &gt; 34 ml/m2 and group II patients had LAVI ≤ 34 ml/m2. The LV systolic function was analyzed by Simpson’s disc volumetric method. The LAV was assessed by the biplane area‑length method from apical 4‑chamber and 2‑chamber views.<strong>Results: </strong>The mean BMI in group I patients was 26.7 kg/m2 and in group II was 26.1 kg/m2, AW STEMI in group I was seen in 30 patients and in group II in 32, IW + PW STEMI in 6 and 4 patients in both groups respectively, IW STEMI in 5 and 4 patients respectively, NSTEMI in 4 and 3 patients respectively and UA in 15 and 17 patients respectively. Risk factors were diabetes mellitus in 32&nbsp;&nbsp;&nbsp; and 27 patients respectively, hypertension in 41 and 40 patients respectively, smoking in 43 and 38 patients respectively, alcohol in 30 and 35 patients respectively and positive family history in 12 and 16 patients respectively. The difference was non- significant (P&gt; 0.05). The mean LAVI at admission in group I was 38.1 and in group II was 27.2, after 1 month was 40.2 and 28.1 in both groups, after 6 months was 39.1 and 27.9 in both groups and after 12 months was 42.7 and 25.3 in both groups respectively. The difference was significant (P&lt; 0.05).<strong>Conclusion:</strong>Authors conclude that LAVI was found to be the independent predictor of mortality than left ventricular ejection fraction on multivariate regression analysis. Common risk factors in patients with ACS were diabetes mellitus, hypertension, smoking, alcoholism and positive family history. Patients with LAVI of value &gt;34 ml/m2 were associated with increased comorbidities.</p> Niranjan Reddy R, Shashanka Chunduri Copyright (c) Wed, 27 May 2020 00:00:00 +0000 Examination of Pervasiveness of Elevated Serum Uric Acid Level and Microalbuminuriain Prehypertension <p><strong>Background: </strong>The relationship between uric acid and microalbuminuriain healthy adults without other cardiovascular risk factors may help to clarify the role of uric acid in cardiovascular disease. In this study, we examined that elevated serum uric acid level was associated with microalbuminuria.<strong>Subjects and Methods: </strong>Study was done on both male and female prehypertensive patients of age more than 18 years and less than 60, admitted in wards and attending OPD. Controls were normotensive patients admitted in wards who were matched for age, sex and confounding factors.<strong>Results: </strong>Hyperuricemia was found in 53(15.14%) patients with prehypertension compared to 32 (9.14%) patients with normal BP. Thus hyperuricemia was seen in patients of prehypertension which was highly significant as P&lt;0.001.<strong>Conclusion:</strong>In conclusion we found that microalbuminuria and hyperuricemia are significantly more prevalent among prehypertensive subjects as compared to normotensive subjects.</p> Sunjay Pathak, Mahipal Singh Puri Copyright (c) Wed, 27 May 2020 00:00:00 +0000 A Study on Angiographic profile of Acute Coronary Syndrome in Smokers <p><strong>Background:</strong> Coronary artery disease is a devastating disease precisely because an otherwise healthy person in the prime of life may die or become disabled without warning. The objectives were to study the clinical profile, risk factors prevalence, angiographic distribution and severity of coronary artery stenosis in acute coronary syndrome (ACS) patients admitted in Cardiology Department of Cardiology Katuri Medical College &amp; Hospital, Guntur.<strong>Subjects and Methods:</strong>A total of 208 patients of ACS were analyzed for various risk factors, angiographic patterns and severity of coronary artery disease in smokers vs non-smokers at Katuri Medical College, Andhra Pradesh.<strong>Results:</strong>Study group consisted of 208 subjects, of which 108(51.9%) subjects were smokers including all forms of tobacco use and 100(48.1 Out of 108 study subjects in&nbsp; the&nbsp; smokers group, family history of CAD&nbsp; was present in 21(19.4%) subjects. Killip class is not applicable to 13 (12%) study groups as they presented with Unstable Angina with ECG changes. Killip class 1 was most common presentation (67.6%) in smokers. 28 patients (25.9%) had LV dysfunction with EF &lt; 50% by echocardiography. 80 patients (74.1%) had normal LV function. The mean EF was 55.56+/-10.16%. The median EF was 56.5%. LAD was type 3 in 100 (92.6%) patients and type 4 in 8 (7.4%) patients&nbsp;&nbsp; out of 108 study subjects.LAD type 3 was statistically significant with P value &lt; 0.05 when compared with LAD type 4. No statistically significant difference was seen with respect to the Normal coronary arteries as CAG diagnosis between smokers and non-smokers(6.7% versus 8%,p&gt;0.1,Not significant).<strong>Conclusion: </strong>Smokers were predominantly male and around 3 years younger than non-smokers. Diabetes mellitus and hypertension were less common among smokers and single-vessel disease was the more common angiographic finding for smokers as compared to 3-vessel disease for non-smokers. ST-segment elevation myocardial infarction in smokers despite younger age and the low atherosclerotic risk profile, in our region, emphasize the need for nicotine addiction management and smoking cessation campaigns at large and for pre-discharge counseling.</p> Hemasundar Korrapati, B.V. Narayana Reddy, Supraja Chegireddy Copyright (c) Wed, 27 May 2020 00:00:00 +0000 Lipid Profile Level among Healthy Subjects and Their Relation with Obesity- A Clinical Study <p><strong>Background: </strong>Obesity is a common metabolic disease world-wide and dyslipidemias among the most common metabolic disorders associated with obesity. The present study was undertaken to assess lipid profile level among healthy subjects and their relation with obesity.<strong>Subjects and Methods: </strong>This cross sectional study was conducted on 100 subjects. General information related to data such as name, age, gender etc. was recorded in case history proforma. BMI was evaluated based on formula of BMI = Weight (kg)/Height (m)<sup>2</sup>. Based on BMI, subjects were divided into two groups according to their BMI values as- group I- Obese and Group II- Non obese. Group I had 65 and group II had 35 subjects. Lipid profile was done.<strong>Results: </strong>There was significant difference in group I and group II regarding waist circumference (WC), BMI (kg/m2), body adiposity index (BAI), visceral adiposity index (VAI), total cholesterol (TC) (P&lt; 0.05). Waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), HDL- C, LDL- C, TG, TC/HDL- C, LDL-C/HDL-C and TG/HDL-C was non- significant (P&lt; 0.05). There was negative correlations between BMI and TC, LDL-C, HDL-C; WC, WHR, VAI and HDL-C and positive significant correlations were found between WC, WHR, and TG/HDL-C, as well as between VAI andTC, TG, TC/HDL-C, LDL/HDL-C, and TG/ HDL-C.<strong>Conclusion:</strong>Authors found that there was alteration of lipid profile in obese subjects. VAI is strongly related with lipid profile and may be considered as reliable obesity index in obese patients with dyslipidemias.</p> Radhika M, Vinu Thomas Copyright (c) Wed, 10 Jun 2020 00:00:00 +0000 Prevalence and Associated Risk Factors of Pulmonary Tuberculosis in Diabetic Patients <p><strong>Background: </strong>One-third of India’s population is infected with mycobacterium tuberculosis; there are 12 million active tuberculosis cases in India. One person dies of Tuberculosis every minute in India. No other disease has so much sociological, economic and health significance as Tuberculosis has. In 2005 there were an estimated 8.8 million new cases of Tuberculosis worldwide, with 1.9 million of those occurring in India. In India in 2000, there were an estimated 481,573,000 people over the age of 25 years. Among these, 4.3% i.e. around 20,707,639 had diabetes, 19 and 939,064 developed. <strong>Subjects and Methods: </strong>The study conducted over a period of 2 yrs. Adult patients with diabetes mellitus with pulmonary Tuberculosis were included, while Diabetic patients with extrapulmonary Tuberculosis were excluded from the study. <strong>Results: </strong>The maximum incidence of pulmonary Tuberculosis was noted above the age of 30yrs were 13(26.0%). The peak incidence was in the age group of 31 – 40 and 41 – 50 yrs. The mean age is 52.62. As Shown in [Figgure 1], the total numbers of males were 64% and females were 36%. The male to female ratio was 2.11:1 As Shown in [Table 3], the distribution of patient according to their occupation noted were Skilled (18%), Unskilled (38%), Business (16%), Service (2%), Housewife (22%), and Student (4%). As shown in [Table 4], the socio-economic status among 50 patients was distributed into: Upper (2%), Upper Middle (22%), Upper lower (32%), Lower (12%), Lower middle (32%), and Lower-middle (32%). <strong>Conclusion: </strong>Early diagnosis and properly monitored treatment regimen is the only time tested answer to this problem. All diabetics at the initial diagnosis and every year must have an x-ray chest done. All diabetics with abnormal weight loss,&nbsp; unexplained cough, or sudden increase of insulin requirement should have sputum examination and chest x-ray done.</p> P.V.R. Leelamohan, Mohan Kumar R Copyright (c) Thu, 25 Jun 2020 00:00:00 +0000 Laboratory Findings Associated with Pulmonary Tuberculosis in Diabetic Patients <p><strong>Background: </strong>An epidemic of diabetes is currently, both in developed and developing nations. The seriousness of the association of pulmonary tuberculosis and diabetes mellitus was first noted by the great Arab Physician Avicenna nearly 1000 years ago. The global figure of people with diabetes is projected to rise from the current estimate of 220 million to 300 million in 2025. <strong>Subjects and Methods: </strong>All type 2 diabetic patients reporting to MVJMC and RH will form the subjects for study. The study conducted over a period of 2 yrs. Adult patients with diabetes mellitus with pulmonary tuberculosis were included while Diabetic patients with extrapulmonary tuberculosis were excluded from the study. <strong>Results: </strong>LDL- 18% of the patients had an LDL value below 100. 40% of the patients had LDL value between 100 – 120. Only 42% of the patients had LDL values between 120-140. HDL: 22.0% of the patients had an HDL value below 30. 24% of the patients had HDL values between 30 – 40. Only 36.0% of the patients had HDL value between 40-50 and 18% of the patients had an HDL value between 50-60. Triglycerides: 56.0% of the patients had Triglycerides value below 150. 42% of the patients had Triglycerides value between 150 – 199. Only 2.0% of the patients had Triglycerides value between 200-499. <strong>Conclusion: </strong>Male preponderance of the disease was noted and Peak incidence of the disease was noted in the age groups of 31 – 40 and 41 – 50. The majority of our patients had poorly controlled blood sugars, suggesting that severe hyperglycemia is associated with the development of pulmonary tuberculosis and sputum positivity was more in patients aged ≤ 50 yrs. Early diagnosis and properly monitored treatment regimen is the only time tested answer to this problem.</p> P.V.R. Leelamohan, Kiran N Copyright (c) Thu, 25 Jun 2020 00:00:00 +0000 Clinicopathological Outcome in Infection Related Glomerulonephritis <p><strong>Background: </strong>The term infection-related glomerulonephritis (IRGN) was proposed as the streptococcal, staphylococcal and gram-negative organisms were being isolated among elderly and immunocompromised patients treated for glomerulonephritis. Previously these were called as Post-infectious glomerulonephritis (PIGN). Most of the reported patients were Caucasians and Asians with male predominance. Among the adult IRGN patients a kidney biopsy is recommended to confirm the diagnosis and to rule out other glomerulonephritis. Aims &amp; Objectives: To study the clinical characteristics and pathological patterns of infection-related glomerulonephritis (IRGN) in adults and to assess the clinical and pathological differences of C3 dominant and codominant IRGN patients. <strong>Subjects and Methods: </strong>A hospital-based, analytical retrospective clinical study was conducted among seventy-three patients. Cases were included irrespective of gender with biopsy proven IRGN and aged equal to or greater than 18 years of age. The study was conducted for a period of 6 months from 1st June 2019 to 30th Nov 2019 at Sapthagiri Institute of Medical Sciences and Research Center, Bangalore. A prior permission from the institutional ethics committee and written consent from the patients and their family members were obtained. Data obtained was entered in Microsoft Excel-2013 and analyzed in SPSS version-22 trial. Appropriate statistical tests were applied and p-value less than 0.05 was considered as significant. <strong>Results: </strong>In the present study 73 patients were included based on the selection criteria. The mean age of the study population was 41.8 ± 14.5 years. Majority 51 p.c (37) of study population were males and 49 p.c (36) were females. Hypertension was the most common risk factor which was reported among 56 p.c (32) of the patients. Diabetes was reported among 17 p.c (10) of the patients. About 15 p.c (9) of the patients were alcoholics and 10 p.c (6) of the patients were smokers. <strong>Conclusion: </strong>Renal biopsy plays an important role in the assessment of prognosis and underlying glomerular nephritis (GN).</p> Sanjay M, Gopalakrishna P Copyright (c) Thu, 25 Jun 2020 00:00:00 +0000