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) Mon, 10 May 2021 07:23:50 +0000 OJS 60 A Study of Microvascular Complications in Patients with Newly Diagnosed Type II Diabetes Mellitus in a Tertiary Care Hospital, Moradabad <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> Abhishek Singh, Vishvanayak, Hare Krishna Copyright (c) 2021 Author Mon, 10 May 2021 00:00:00 +0000 Study of the Occurrence and Prognostic Significance of Hyponatremia in Myocardial Infarction <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> Aarish Gujjar, Vishvanayak, Anil Kumar Copyright (c) 2021 Author Mon, 10 May 2021 00:00:00 +0000 To Predict the Occurrence of Esophageal Varices in Chronic Liver Disease Patients Using Transient Elastography (Fibroscan) <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> Deepankar Shivam, Jigar M. Haria, V.K. Singh, Amit Kumar Mishra, Alok Singhal, Prashant Dubey, Hare Krishna Copyright (c) 2021 Author Mon, 10 May 2021 00:00:00 +0000 Estimation of Vitamin D Level in Patients of Chronic Liver Disease and its Association with Child Turcotte Pugh’s Score <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> Kamal Mavi, Ajay Kumar, V.K. Singh, Hare Krishna Copyright (c) 2021 Author Mon, 10 May 2021 00:00:00 +0000