Academia Journal of Medicine 2021-08-12T07:57:39+00:00 Dr. Rohit Varshney Open Journal Systems <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> A Study of Microvascular Complications in Patients with Newly Diagnosed Type II Diabetes Mellitus in a Tertiary Care Hospital, Moradabad 2021-05-10T09:46:17+00:00 Abhishek Singh Vishvanayak Hare Krishna <p><strong>Background: </strong>Diabetes mellitus is a metabolic syndrome which has reached epidemic levels in both developed and developing parts of the modern world. With rising prevalence of obesity, physical inactivity and other related metabolic syndromes, the incidence and prevalence of type II DM is sharply increasing along with the related complications. Type II diabetes mellitus is related with macrovascular and microvascular complications, latter being usually overt. In fact, in many cases the type II diabetes often reaches clinical attention due to the microvascular complications. The common microvascular complications including diabetic retinopathy, diabetic nephropathy and sensory neurological deficits are a common cause of morbidity associated with type II diabetes. Aim: The frequency of microvascular complications in newly diagnosed cases of Type II diabetes mellitus. <strong>Subjects and Methods: </strong>More than 200 patients newly diagnosed cases of type II DM were included in the study conducted in Medicine Department of our Institution following approval from IEC and after obtaining written &amp; informed consent. The frequency of the microvascular complications including diabetic retinopathy, diabetic nephropathy and diabetic sensory neuropathy was calculated utilizing various tests and clinical examination along with presence of hypertension and smoking, latter are known factors in increasing the severity of the type II diabetes related morbidities. Appropriate statistical methods and tools were used to find out the statistical significance of various observations. <strong>Observations and Results: </strong>Significant number of patients in our study were in 41-60yrs age group with male predominance. Majority were obese and more than three-fourth had deranged HbA1c levels of &gt;6.5. Significant number of patients had hypertension and were smokers that showed statistical correlation with increased incidence of microvascular complications in the corresponding subgroup. Significant proportion of patients in our study group were detected with microvascular complications in form of diabetic retinopathy, diabetic nephropathy and sensory neuropathy. <strong>Conclusion: </strong>Since the incidence of microvascular complications including retinopathy, nephropathy and sensory neuropathy is quite high in newly diagnosed patients of Type II diabetes mellitus, hence clinical &amp; laboratory tests directed to their diagnosis should be included in the screening protocol of such patients. As these tests are inexpensive, hence their inclusion may go a long way in reducing the microvascular complication related morbidity in type II diabetes mellitus patients.</p> 2021-05-10T00:00:00+00:00 Copyright (c) 2021 Author Study of the Occurrence and Prognostic Significance of Hyponatremia in Myocardial Infarction 2021-05-10T09:58:25+00:00 Aarish Gujjar Vishvanayak Anil Kumar <p><strong>Background: </strong>Cardiovascular disease (CVD) is the commonest cause of natural death all over the world. Asians develop this disease nearly one to two decades earlier than the Western population. Though CVD does not always lead to immediate death yet may be associated with delayed mortality or morbidity leading to significant loss of productivity of an individual. Hence, it becomes imperative to assess clinical parameters that may not only prevent death but also helps in reducing morbidity. Hyponatremia is found to be one of the major causes of sudden as well as delayed deaths in patients experiencing acute myocardial infarction (AMI). As serum sodium estimation is an easy, inexpensive,&nbsp;&nbsp; and routine laboratory investigations performed in patients with AMI, we aimed to assess its prevalence and prognostic significance in such patients. <strong>Subjects &amp; Methods: </strong>One hundred patients of AMI admitted in the Department of Medicine of our institution were enrolled in our study according to inclusion &amp; exclusion criteria following approval from IEC. Serum sodium levels of all patients were recorded at the time of admission, at 48hours and at one month. All patients underwent ECG and echocardiography for assessment of their cardiac function as well as subgrouping into STEMI/NSTEMI. All patients were followed up for signs of congestive cardiac failure, arrhythmias &amp; cardiogenic shock or death. The above data was analyzed with appropriate statistical tests. <strong>Results: </strong>In our study, 38 patients developed hyponatremia, 13 at the time of admission, 15 at 48hours and 10 at one-month time. Out of 62 patients with normal sodium, 9 developed CCF, 9 arrhythmias and 4 died. On the other hand, nearly 25 patients with hyponatremia developed CCF and 11 patients died. This showed that AMI patients with hyponatremia have poor outcome. <strong>Conclusion: </strong>There is significant occurrence of hyponatremia, patients of acute MI. Occurrence of hyponatremia in patients of acute myocardial infarction is associated with adverse cardiovascular outcomes viz. arrhythmias, congestive cardiac failure and death. Also, the occurrence of these adverse efect is directly correlated the severity of hyponatremia. Hence, serum sodium can be used as simple and effective tool for risk assessment in patients of acute myocardial infarction.</p> 2021-05-10T00:00:00+00:00 Copyright (c) 2021 Author To Predict the Occurrence of Esophageal Varices in Chronic Liver Disease Patients Using Transient Elastography (Fibroscan) 2021-05-12T06:56:55+00:00 Deepankar Shivam Jigar M. Haria V.K. Singh Amit Kumar Mishra Alok Singhal Prashant Dubey Hare Krishna <p><strong>Background: </strong>Chronic liver disease (CLD) is a cause of significant morbidity all over the world including India. Progression of CLD to cirrhosis leads to multiple complications including development of esophageal varices (EV) with its risk of bleeding &amp; consequent morbidity &amp; mortality. Hepatic biopsy with its inherent limitations is still the gold-standard tool for diagnosis of cirrhosis while Upper gastrointestinal Endoscopy (UGIE) with its inherent limitations is still the gold-standard tool for diagnosis of EV in these patients. Transient elastography (TE-Fibroscan) is a recently developed tool for estimating hepatic fibrosis by liver stiffness measurements (LSM) to predict cirrhosis as well as EV in cirrhotic patients. <strong>Subjects and Methods: </strong>One hundred patients of CLD were enrolled and evaluated by Fibroscan for LSM and by UGIE for EV &amp; their grades following approval from Institutional Ethics Committee and after obtaining the informed consent. Various statistical methods and tools were then used to find out correlation of LSM with grade of EV and bleeder vs non-bleeder EV. <strong>Results: </strong>Majority of the patients were males with 41-50years being the dominant age-group. HCV followed by NAFLD were the commonest identifiable etiologies in our study group. Patients with small varices outnumbered those with large varices (52 vs 39). The mean LSM value increased significantly from no Varices (14.60 0.88) to&nbsp; Small esophageal varices (15.51&nbsp;&nbsp; 2.76) to Large esophageal varices (23.80 3.17) with positive correlation with variceal grade. Mean LSM value for identification of varices was 15.51 2.76kPa while it was 23.80 3.17 kPa for large varices. The bleeders had significantly higher LSM value compared to the non-bleeders (34.93 10.45kPa vs 18.46 5.59kPa). Significantly positive correlation was found between mean LSM; Total, Direct &amp; Indirect Bilirubin; Alkaline Phosphatase and serum Globulin while negative correlation was noted with serum Albumin. <strong>Conclusion: </strong>The noninvasive nature of TE (Fibroscan) makes it an attractive tool for screening of CLD patients needing UGIE not only for diagnosis of EV but those with large varices needing management. Thus, TE might play a crucial role in not only diagnosis but also in management of EV varices in patients with CLD obviating unnecessary UGIE.</p> 2021-05-10T00:00:00+00:00 Copyright (c) 2021 Author Estimation of Vitamin D Level in Patients of Chronic Liver Disease and its Association with Child Turcotte Pugh’s Score 2021-05-12T07:18:26+00:00 Kamal Mavi Ajay Kumar V.K. Singh Hare Krishna <p><strong>Background: </strong>Chronic liver disease (CLD) has a fairly high occurrence in the Indian subcontinent due to variety of etiological factors including alcohol abuse, viral hepatitis, etc. As liver plays a crucial role in digestive as well as metabolic functions, its significant dysfunction is related to severe imbalance of vitamin D. Though for long the role of vitamin D in bone mineral metabolism is known yet recent literature has suggested its significant role in immune modulation, inflammatory response and in fibrosis. Since insufficient data on vitamin D levels in CLD patients exists in Indian population, hence we planned this study. <strong>Subjects and Methods: </strong>Hundred patients of CLD were included in our study following approval from institutional ethics committee, obtaining informed written consent and excluding bone disease, chronic renal disease, known cardiac disease &amp; known malignancy. All patients underwent estimation of vitamin D levels and appropriate tests to diagnose CLD with further categorization into A, B, C as per Child-Turcot-Pugh (CP) Criteria. Appropriate statistical tests were then applied to find out the association between CLD and vitamin D levels. <strong>Results: </strong>Majority of the CLD patients were males and in 3<em><sup>rd</sup></em>-5<em><sup>th</sup> </em>decade with most of them i.e. 89% in our study, had insufficiency or deficiency of vitamin D in their serum with majority having moderate to severe grades of CLD as per CP score. This association was statistically significant with p value of less than &lt;0.01. Also, a negative Pearson correlation was observed meaning thereby that as the CP score increases, the vitamin D levels decrease. <strong>Conclusion: </strong>Since vitamin D plays a key role in immune based responses, its serum level is crucial in patients suffering with chronic liver diseases, where the serum vitamin D levels decrease as the Child-Turcot-Pugh score of liver disease increases. Early recognition of insufficient or deficient levels of serum vitamin D by their simple &amp; inexpensive serum estimation may go a long way in not only instituting early therapy but also in preventing related morbidities.</p> 2021-05-10T00:00:00+00:00 Copyright (c) 2021 Author Esophageal Candidiasis: Causative Species and their Antifungal Susceptibility Pattern in Hospital of Western U.P. 2021-06-04T10:18:27+00:00 Amit Mishra Shweta R Sharma Mohammad Zulfiqar Ali <p>Esophageal candidiasis is more commonly presented in persons with immunocompromised conditions but it can also be seen in immunocom- petent patients. There has been an epidemiological shift towards the predominance of candida spp. other than C.albicans such as C. glabrata parapsilosis, C. krusei, C. tropicalis, C. dubliensis etc. accounting for more than 50% of the Candida infections. The rampant misuse of antifungals has increased the antifungal resistance among C.albicans as well as non-albicans species and poses a challenge to clinicians for the management of such cases. The current study was aimed to understand the isolation of various Candida spp. in patients diagnosed with esophageal candidiasis attending a tertiary care center in western U.P. and to analyse its association with various predisposing factors. This study also extends to determine the susceptibility pattern of the isolated candida spp. against different antifungal agents. The study was conducted for 3 years in the hospital of western U.P. North India from July 2017 to June 2020. Candidial esophagitis was suspected when in endoscopy, whitish plaques are seen attached to the mucosa and these plaques were collected using biopsy forceps and sent to the microbiology laboratory for its fungal culture and speciation. In the current study, 60.1% were Candida albicans while 39.9% were other candida spp. Among NAC, the commonest species was C. parapsilosis (14.1%) followed by C. dubliensis (9.2%), C. glabrata (8.6%), C. tropicalis (4.9%) and C. krusei (3.1%). All isolates were found sensitive to AmphotericinB, however 3.1% of the isolates were resistant to Voriconazole and 7.4% to fluconazole. Fluconazole resistance is a serious issue as it is considered the drug of choice in cases with esophageal candidiasis. Such studies help clinicians to select appropriate antifungals for these patients and reduces patient’s morbidity and mortality.</p> 2021-06-02T00:00:00+00:00 Copyright (c) 2021 Author Causative Agents in Patients Presenting with Acute Viral Hepatitis along with their Clinical Profile at a Tertiary Care Hospital, Western U.P. 2021-06-04T10:23:28+00:00 Amit Mishra Shweta R Sharma <p>Acute viral hepatitis (AVH) is a common health-related problem throughout the world, but morbidity and mortality are prevalently seen in developing countries like India. In India, AVH is most commonly caused by HAV (hepatitis A virus) and HEV (hepatitis E virus) and in few cases, HBV (Hepatitis B virus) is the etiological agent. HEV mainly affects the middle-aged population, is mild in symptoms however it is lethal with 30% mortality in pregnant females compared to the mortality of 1% in the general population. This study was focussed to identify the etiological agents, various clinical - laboratory factors, disease severity and associated complications in patients presenting with AVH. In our study, HEV was the most common etiological agent accounting for 43.6% of cases followed by HAV (29.1%), HBV (26.1%) and HCV (1.2%). The most common age group involved with AVH was the adult group i.e. from 21-30 yrs (35.1%) followed by 11-20 yrs (27.9%), below 10 yrs (15.1%) and 31-40 yrs (14.5%). The commonest symptom was yellow-colored urine (86.1%) followed by yellow discolouration of sclera and loss of appetite. Bleeding derangement was observed in all patients with acute liver failure (ALF) while Hepatic encephalopathy was observed in 3 patients with ALF. To conclude, integration of diagnostic measures, early diagnosis, treatment protocols, prevention and mass vaccination will help in the overall reduction of AVH cases and related complications.</p> 2021-06-02T00:00:00+00:00 Copyright (c) 2021 Author Evaluation of Serum Creatine Phosphokinase as a Possible Marker for Severity in Organophosphorus Poisoning 2021-06-17T13:40:05+00:00 Yesha Chauhan Chandan Chudasama <p><strong>Background : </strong>Acute poisoning of organophosphorous compound has reached epidemic extent in largely element of the country mainly in developing countries like India. Case reports on clinical implication of total serum creatine phosphokinase in acute OP compound intake has been accounted occasionally, however there are no great extent studies with mention to total serum creatine phosphokinase level in OP compound. Hence this is an attempt to study the total serum creatine phosphokinase in assessing the severity of OP compound poison. <strong>Subjects &amp; Methods: </strong>Patients with history of OP compound consumption getting admitted in Department of Medicine, Gujarat Adani Institute of medical Science, Bhuj, Kutch, Gujarat during the period of two years were occupied up for study in view of inclusion and exclusion criteria. Information needed for this study collected through a proforma and pre-test proforma from every patient. <strong>Results: </strong>The levels of CPK were elevated significantly in patients with respiratory failure. In this study 7 out of 8 patients with raised initial CPK level has respiratory failure and eventually death. Only one patient with mildly elevated CPK level has no respiratory failure. <strong>Conclusion: </strong>In this study only 8 out of 100 case shows raised total serum CPK level. Seven out of 8 positive case who developed respiratory failure and death. All 7 patients has marked raise in total serum CPK level. So the initial raise in total serum CPK level correlated well with severity of OP compound poison and prognosis, suggesting its use as a prognostic indicator of OP compound poison.</p> 2021-06-17T00:00:00+00:00 Copyright (c) 2021 Author A study on the causes of Acute Kidney Injury in ICU in a Tertiary care centre and comparison of prognostic scoring systems (SOFA score and APACHE score) to predict mortality and renal outcome 2021-06-17T13:47:46+00:00 Jose Peumpillil Paul Nageswara Reddy Pamidi G. Suresh Kumar K. Sharath Kumar Reddy <p><strong>Introduction: </strong>Acute kidney injury (AKI) is a complex clinical disorder that is associated with severe morbidity and mortality, which in spite of technological advances in Renal replacement therapy (RRT), continues to be associated with poor outcomes. AKI is a syndrome of sudden loss of kidney’s excretory function, often associated with oliguria, occurring over hours to days seen commonly in hospitalised patients who are critically ill. <strong>Subjects and Methods: </strong>A prospective and observational study was conducted at Sapthagiri Institute of Medical Sciences &amp; Research Centre from January 2020 to December 2020. Patients with Acute Kidney Injury satisfying inclusion and exclusion criteria, admitted in the medical Intensive care unit (ICU), were selected after obtaining informed consent. <strong>Results: </strong>The mean age of the population was 64.51<em>±</em>14.29 years. 65% patients were males. Most common age group was older age group (65 to 75 years) for both males and females. In the younger age group (18-44 years) most of them were males. In the elderly age group (85- 100 years) females exceeded males. The mean duration of hospital stay was 10.78&nbsp; 8.39 days and the median duration of hospital stay was 9 days. The mean duration of ICU stay was 6.15&nbsp;&nbsp; 5.31days&nbsp; and the median duration of ICU stay was 4 days. In our study some patients had AKI on day 1 of ICU admission and the others developed AKI later during the course of ICU stay. The median day of ICU admission on which patients presented with AKI in our study was on the day 1. RRT was initiated in majority of the patients (53%) on the 1<em><sup>st</sup> </em>day of ICU admission itself. Remaining patients (25.6%) received RRT on day 2 of ICU admission. Only a few patients (21%) received RRT after 2 days. <strong>Conclusion: </strong>Elderly males are at higher risk for developing AKI. Sepsis with pneumonia is the leading cause of AKI in ICU. Pre-existing Chronic Kidney disease (CKD )has worse renal outcome. Kidney Disease Improving Global outcomes(KDIGO) staging is an independent predictor of ICU mortality, RRT requirement and ventilatory support. In the setting of acute kidney injury, Acute Physiology and Chronic Health Evaluation (APACHE) III is superior to Sequential Organ Failure Assessment (SOFA) and APACHE II for predicting in-hospital mortality. Patients with AKI have 2.33 times more risk of mortality compared to those without AKI. AKI is an independent predictor of mortality in ICU.</p> 2021-06-17T00:00:00+00:00 Copyright (c) 2021 Author A Study of Treatment Compliance in Newly Diagnosed Cases of Tuberculosis under District Tuberculosis Centre of Central Maharashtra 2021-06-17T13:53:56+00:00 Shivaji Sangappa Phulari Rahul Digambarrao Anerao Balaji Subhash Barure Eknath Dhondiba Male <p><strong>Background: </strong>Tuberculosis is an old disease and has deep social impact on the society. It is an re-emergent killer disease with rise in MDR and XDR strains. DOTS strategy has had a substantial impact over past few decades. Monitoring outcome of TB treatment is very much important in evaluating the effectiveness of tuberculosis control program. Keeping in view all of these facts, it was decided to study compliance and outcome of newly diagnosed cases of Tuberculosis, subjected to short course chemotherapy regimen under DOTS. <strong>Subjects and Methods: </strong>The study was a prospective cross sectional study conducted in newly diagnosed cases of Tuberculosis, subjected to short course chemotherapy regimen (DOTS). Medical records of all TB patients registered from April 2020 to 31 October 2020 were reviewed. Tuberculosis types, HIV and Diabetes status, as well as treatment outcomes were categorized according to RNTEP guidelines. <strong>Results : </strong>Out of total 663 patients, 408 (61.53%) were males and 225 (38.47%) were females. Male to female ratio was observed to be 1.60:1. The mean age of males was 40.02&nbsp; 14.04 and mean&nbsp;&nbsp; age of females was 36.15 14.82. 57.02% patients were having pulmonary Tuberculosis and 42.98% patients were having extra pulmonary tuberculosis. Treatment outcome among total 663 patients was as follows – 288 (43.43%) patients got cured, 251 (37.85%) completed treatment, 55 (8.29%) dies, 8.76 (5.88%) were lost to follow up (defaulter) and 30 (4.52%) failed treatment. <strong>Conclusion: </strong>The treatment success rate of tuberculosis patients was adequate (81.28%) in relation with national targets. Again easy accessibility of healthcare services are required to further improve the compliance of TB treatment.</p> 2021-06-17T00:00:00+00:00 Copyright (c) 2021 Author Role of Rigid Medical Thoracoscopy in Diagnosing Exudative Pleural Effusions with Low Adenosine Deaminase 2021-06-17T13:59:58+00:00 Javaid Ahmad Malik Elias Mir <p><strong>Background: </strong>Medical thoracoscopy (MT) performed in the evaluation of undiagnosed exudative pleural effusion (EPE) has a high diagnostic yield. In this study, we describe our experience of rigid MT in the evaluation of undiagnosed exudative pleural effusions (EPE) with low adenosine deaminase (ADA). <strong>Subjects and Methods:</strong>This is a retrospective analysis of RT pleural biopsies performed between July 2012 and June 2015 for diagnosing EPE. These patients had at least two pleural fluid samples negative for malignant cytology and ADA less than 65 IU/L. Here we report the yield and complications of pleural biopsies with RT. <strong>Results: </strong>Our yield of thoracoscopic pleural biopsies was 81% with malignancy as the commonest diagnosis in 46% patients. Malignant pleural effusion was caused commonly by adenocarcinoma (67%) followed by squamous cell carcinoma (17%), small cell lung cancer (8%) and lymphoma (8%). There was no case of mesothelioma. Biopsy revealed tuberculosis in 31%, vasculitis in 4%, nonspecific pleuritis (NSP) in 11% and normal pleural tissue in 8% subjects. The presence of nodules on CT scan and those on MT had no significant correlation (P &gt; 0.1). ADA did not significantly differ between various biopsy confirmed diagnostic groups (P &gt; 0.2). Minor complications that settled with conservative management developed in 3 patients (11.5%) and were significantly related to comorbidities (p &lt; 0.05) but not to the biopsy result (P = 0.894). <strong>Conclusion: </strong>Since majority of the EPE turn out to be either malignancy of tuberculosis, a rigid MT evaluation should be considered in all such patients if the facility is available at the center. Rigid MT has high diagnostic yield and acceptable safety.</p> 2021-06-17T00:00:00+00:00 Copyright (c) 2021 Author A Study on Effect of Laughter on Pulmonary Functions among Elderly People 2021-06-20T11:04:42+00:00 Mehek Bariana Archana Jadhav <p><strong>Background: </strong>Laughter Yoga has become a very popular form of exercise and is primarily practiced in groups. Laughter is initially forced&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; as a physical exercise by maintaining eye contact with other members in the group and promoting childlike playfulness. This soon leads to&nbsp; real, spontaneous laughter. Laughter Yoga is the one only technique that allows adults to achieve sustained hearty laughter without involving cognition. The objective is to study the effect of laughter on pulmonary functions in elderly people. <strong>Subjects and Methods</strong>: This study was done under ICMR STS research Programmed for Undergraduate students at Dr D Y Patil Medical College, Pune from June 2016 to October 2016. A total of 60 study subjects aged more than 60 years of age were selected for the purpose of the study. The Pulmonary functions were tested by using instrument ‘Spirotech before and after the laughter therapy for 4 weeks. <strong>Results: </strong>Immediately after a good bout of laughter FVC and PEFR were increased but not statically significant FEV1 was statically significant immediately after good laughter. All three pulmonary functions FVC, FEV1 and PEFR were statically highly significant after regular laughter therapy practice for 4 weeks. <strong>Conclusion: </strong>Laughter is beneficial for pulmonary functions when practiced regularly in our study laughter therapy for 4 weeks proved beneficial ruling out all age sex and ethnic differences.</p> 2021-06-17T00:00:00+00:00 Copyright (c) 2021 Author Experience in the Treatment of Injuries of the Parenchymatic Organs of the Abdominal Cavity in Combined Injury 2021-06-23T15:08:45+00:00 Ishnazar Boynazarovich Mustafakulov Zilola Aramovna Djuraeva Khamza Rashidovich Shomurodov Buron Numon ugli Khaidarov <p>Background: The main problem is the diagnosis and treatment of combined closed abdominal trauma, accompanied by shock on the background of massive intra-abdominal bleeding with liver and spleen injuries. The hospital mortality rate for this type of pathology ranges from 17.3 to 72.7%. Methods: The treatment and outcomes of 539 patients with closed injuries of the abdominal organs in 2011 - 2021 were analyzed. Multi-stage ”damage control” surgical tactics in isolated and combined severe liver injuries is an effective method in unstable patients with the risk of coagulopathy and multiple organ failure. Results: Out of 539 patients with closed abdominal injuries, 269 (49.9%) were operated on. Of these, 131 (48.7%) had liver and spleen injuries. According to the localization of damage according to the Mooge classification, there were: liver grade I in 9 people, grade II in 18, grade III in 25, grade IV in 17, and grade V in 3 victims. Spleen ruptures were diagnosed as grade I in 6 patients, grade II in 15, grade III in 26, grade IV in 10, and grade V in 2 patients. Conclusion: A necessary component at the final stage of surgical intervention is intestinal decompression in order to conduct enteral tube feeding to correct hypermatabolism and prevent secondary systemic complications associated with emerging enteric insufficiency.</p> 2021-06-21T00:00:00+00:00 Copyright (c) 2021 Author Analysis of the Incidence and Risk Factors in the Development of Acute Kidney Injury after Off Pump Coronary Artery Bypass Grafting 2021-07-02T12:13:33+00:00 Jose Perumpillil Paul Nageswara Reddy Pamidi G. Suresh Kumar K. Sharath Kumar Reddy <p><strong>Background: </strong>Acute kidney injury (AKI) is a serious complication after coronary artery bypass grafting and is associated with a high mortality. The aim of this study was to evaluate the incidence and the risk factors involved in the development of AKI after off pump coronary artery bypass grafting (OPCAB). <strong>Subjects and Methods: </strong>A retrospective analysis of 1378 adult patients who underwent OPCAB in Sapthagiri Institute of Medical Sciences and Research Centre during a one-and-a-half-year period was done. AKI was defined as an increase in creatinine more than 0.3 mg/dl or a decrease in urine output less than 0.5 for 6 hrs. The data relevant to the risk factors were collected and analysed using chi square test. <strong>Results: </strong>The overall incidence of AKI was 18.2%. The independent risk factors that were associated with AKI were increasing age, pre-operative chronic kidney disease, diabetes mellitus, left ventricular dysfunction, low mean arterial blood pressure and the need for intra-aortic balloon pump. <strong>Conclusion: </strong>AKI was common after OPCAB. Pre-existing renal dysfunction, diabetes mellitus, left ventricular dysfunction, advanced age, low mean arterial blood pressure during the intra operative period and the need for intra-aortic balloon pump were identified as the risk factors for the development of AKI after OPCAB.</p> 2021-06-25T00:00:00+00:00 Copyright (c) 2021 Author Analysis of Hypocalcemia in Dengue and Correlation of Serum Calcium Levels with Severity of Dengue Disease 2021-07-02T12:21:21+00:00 V S Sheshan Deepali Guruprasad C Shenoy Sudheendra S T Kavya <p><strong>Background: </strong>Hypocalcemia has been demonstrated in various tropical diseases, such as leptospirosis, malaria, including dengue. Calcium is believed to play a major role in the immune response in dengue. It has been proposed that the derangements of Calcium levels in the infected myocardial cells may play a major role in development of myocarditis. This study aims to correlate the serum calcium levels with severity of dengue and bradycardia. <strong>Subjects and Methods: </strong>This study was conducted on 100 dengue positive patients, above the age of 18 years, presenting to BMCRI, after obtaining informed consent. Dengue test kit was used for diagnosis which is based on rapid solid phase immunochromatographic test. Physical examination and routine investigations along with serum calcium levels were done and assessed. Radiological imaging was done wherever necessary. They were grouped into one of the three WHO categories based on severity and were correlated with serum calcium levels. <strong>Results: </strong>Out of 100 patients 65 patients had uncomplicated dengue fever while 30 had dengue fever with warning symptoms and 5 has severe dengue/ dengue shock syndrome. Chi-square test showed statistical significant association between severity of dengue and hypocalcemia. (<em>χ</em><sup>2</sup>= 94.08; p=0.00). Statistical analysis revealed significant association between serum calcium levels and pulse rate (<em>χ</em><sup>2</sup>= 16.01; p=0.00). <strong>Conclusion: </strong>Our study and several other studies showed that the presence of hypocalcemia correlates with the severity of Dengue illness and could be considered as one of the predictors of poor outcome. However, further studies are required in these lines that are aimed at understanding if the presence of hypocalcemia can be utilized as a prognostic indicator in dengue infection. The potential role of calcium as a treatment option, to modulate the immune system, in patients with dengue is to be explored.</p> 2021-06-25T00:00:00+00:00 Copyright (c) 2021 Author Clinicoradiological Profile in Severe Acute Respiratory Illness- Comparative Study in SARS COV-2 Positive and Negative Patients 2021-07-02T12:28:15+00:00 Sheshan VS P Arjun Chandrashekar Meer Zuhadulla Shashank J Nagaraja BS <p><strong>Background</strong>: COVID-19 is a global pandemic which has infected more than 171 million individuals and has taken an immense toll on the world in terms of morbidity and mortality. The disease may progress in some patients from an influenza-like illness to severe acute respiratory illness. Diagnosis of COVID 19 is by RTPCR supported by radiological evidence. <strong>Subjects and Methods: </strong>In this prospective observational study, 80 patients-40 positive for COVID- 19 and 40 negative respectively were enrolled for the study from March 2020 to July 2020 in Bowring and Lady Curzon Hospital, Bangalore after obtaining clearance and approval from institutional ethics committee. We analysed the clinical profile, routine investigations and radiological profile in the study subjects. <strong>Results: </strong>Majority of the patients in positive and negative groups were males – 55% and 57.5% respectively. Most of the patients in the positive group were between 61-80 (42.5%) and in the negative group between 41-60(37.5%). Fever was present in 65% of positive patients and 55% in negative patients, breathlessness was present in 90% of positive patients and 70% of negative patients, cough was present in 82.5% of positive patients and 70% of negative patients, loose stools were present in 2.5% of positive patients and 5% negative patients. X-ray showed bilateral involvement in 82.5% in the positive group and 37.5% in the negative group. Lower zone involvement is most commonly seen in positive patients (92.5%) and 67.5% in negative groups. Non homogenous opacities were the&nbsp; most common finding in chest x-ray. <strong>Conclusion: </strong>COVID -19 has multi-system manifestations with respiratory manifestations being the most common. COVID-19 positive patients showed increased severity radiologically compared to negative patients. Chest imaging via x-rays is a useful way to detect radiological changes in COVID 19 infection in resource limited settings for early prognostication of COVID-19 patients.</p> 2021-06-25T00:00:00+00:00 Copyright (c) 2021 Author RDW as a Marker of Treatment Response in Primary Adult Nephrotic Syndrome 2021-07-02T12:42:51+00:00 V S Sheshan Shashank J Ramrajesh K Ravi <p><strong>Background</strong>: Nephrotic syndrome has an incidence of three new cases per 100 000 each year in adults. Despite considerable advances in health care, glomerular disease constitutes one of the leading causes of renal failure resulting in considerable morbidity and mortality. In India, the histological type varies according to the demographic location, and treatment regime depends on the type of nephrotic syndrome. RDW is an inexpensive blood test and there are several studies that show a close relationship between RDW values and inflammatory activity. Our aim&nbsp;&nbsp;&nbsp; in this study is to test the predictive value of RDW in determining treatment response to therapy in adult nephrotic syndrome. <strong>Subjects and Methods: </strong>Newly diagnosed primary adult nephrotic syndrome patients admitted to Victoria hospital and hospitals attached to Bangalore Medical College and Research institute (BMCRI), between May 2018 to September 2020 were chosen for the study. The patients were recruited as per inclusion criteria and demographic profile, medical history, comorbidities, detailed physical examination and lab investigation such as serum creatinine, and 24 hour urine protein were recorded in the study performa . Patients who have nephrotic range proteinuria (&gt; 3.5 gm/24 hrs) with sonographically normal sized kidneys were subjected to renal biopsy to identify the etiopathology. Following this appropriate treatment was iniated and the patients were followed up for the duration of the study. <strong>Results: </strong>Our study included 39 patients with nephrotic syndrome were treated in hospitals attached to BMCRI. Of these patients, males constituted 61.5% and females 38.5%. 53.8% of cases occurred in third decade of life. The commonest presenting symptom among these patients was pedal edema. MGN was the most common histological variant followed by IgA nephropathy and MCGN. Mean RDW values among those who were resistant to treatment was 18.58+/- 0.62 and 13.23+/- 0.74 among those who responded to treatment. Difference in RDW between the two groups was found to be statistically significant showing that high RDW values may be associated with poor treatment response. <strong>Conclusion: </strong>In our study high RDW values were found to be associated with high rates of treatment resistance. These findings suggest that RDW may be used as a useful biomarker to predict treatment response in nephrotic syndrome patients.</p> 2021-06-25T00:00:00+00:00 Copyright (c) 2021 Author Ischemia Modified Albumin in Early Diagnosis of Acute Coronary Syndromes 2021-07-24T10:20:57+00:00 A Karthik Deepthi Rao C Sneha <p><strong>Background: </strong>Acute coronary syndromes (ACS) pose a diagnostic challenge in patients with unpredictable baseline ECGs or without evidence of myocardial necrosis. Its early diagnosis is of utmost importance as ACS has a high mortality. The present study was conducted to know the role of Ischemia Modified Albumin (IMA) as a Cardiac Marker in the early Diagnosis of ACS. <strong>Subjects and Methods: </strong>A cross-sectional study was conducted in 86 patients presenting with chest pain of less than 3hours. A 12-lead ECG was recorded, and a blood sample was taken for IMA and cardiac troponin T(cTnT). Results of all the parameters alone and in combination, were correlated with the final hospital diagnosis and analysed. <strong>Results: </strong>IMA was found to be abnormal among 72.1% of the patients. IMA had a sensitivity of 81.58% and a specificity of 83.33% which was found to be high when compared with other parameters. The combination of IMA, ECG, 2D ECHO, cTnT, and CKMB had a sensitivity of 100% and a specificity of 16.67%. <strong>Conclusion: </strong>The present study showed that IMA is a potential diagnostic biomarker for ACS. Further studies are required to support the present findings.</p> 2021-06-30T00:00:00+00:00 Copyright (c) 2021 Author A Prospective Study to Assess the Cases of COPD in Known Population 2021-08-12T07:57:39+00:00 P. N. Kiran Kumar <p><strong>Background: </strong>To assess cases of COPD in known population. <strong>Subjects and Methods: </strong>Sixty- eight patients with COPD of both genders were enrolled in present study. History of smoking, type of cooking fuel combustion, family history, education level etc. was recorded. A thorough physical and clinical examination was performed in all patients. <strong>Results: </strong>Out of 68 COPD patients, male comprised 40 and female 28. Education was primary in 44, secondary in 10 and graduation in 2. BMI was underweight in 38, overweight in 12 and normal in 18 cases. Family history was positive in 40 and fuel used was LPG in 10, kerosene in 20 and wood in 38. A significant difference was observed (P&lt; 0.05) [Table 2, Figure 1]. <strong>Conclusion: </strong>Chronic obstructive pulmonary disease is becoming common nowadays. Though underweight is one of the major cause but air pollution caused by combustion fuel cannot be overlooked.</p> 2021-06-30T00:00:00+00:00 Copyright (c) 2021 Author