AIM: To study level of serum concentration of C-reactive protein (CRP) and lipids in patients of acute ischemic stroke and to ascertain the role of CRP levels and its correlation with lipids.

MATERIALS AND METHODS: The study was done during the period of November 2003 to November 2005. Thirty cases (M-18; F-12) were studied taking into consideration exclusion criteria. Detailed clinical histories including family history, personal history, risk factors, treatment history were taken which included detailed general and systemic examination. Routine investigation like Hb, DC, TLC, ESR, S. Urea, S. Creatinine, FBS, Urine: Routine and Microscopic were done. CT scan of brain was done in all cases. Quantitative estimation of CRP by latex fixation technique was estimated. Lipid profile of all cases was done which included estimation of total serum cholesterol (Enzymatic method), HDL cholesterol (Phosphotungstate method), Serum triglycerides (Colorimetric method), LDL-C & VLDL-C (Indirect method by Friedrich’s equation).

OBSERVATION: Raised CRP and levels of lipids were observed as follows:
Age (in Years) Male Female Total (n=30)
No. of Cases Mean No. of Cases Mean
40-50 5 8.42 2 8.3 8.38
51-60 7 8.3 6 8.4
61-70 4 8.45 3 8.67
71-80 2 8.1 1 8.8
Mean 8.3 Mean 8.5
Raised CRP levels were seen in all cases. In all cases lipids showed normal level except LDL which was slightly raised as suggested by Mean Cholesterol-185mg%, Mean TG –171.31mg%, Mean HDL 47.34mg%,Mean LDL 107.32mg%, Mean VLDL 34.26mg%.

DISCUSSION: Out of 30 patients of CT proven ischemic stroke patients all were with raised CRP (Mean 8.38) but lipid profile was not significantly altered except LDL.

CONCLUSION: CRP level was increased in acute ischemic stroke due to inflammatory process. Lipid levels did not increase as studied by others. So it was concluded that there is no correlation of increased levels of CRP in acute ischemic stroke along with lipids in our study. But raised CRP has got a definite prognostic significance.

AIM & OBJECTIVES:
To study the clinical profile and prognosis of AMI in diabetics in contrast to AMI in non-diabetics in present era of aggressive management of AMI from Janurary2003 to March 2004.

MATERIAL AND METHODS:
In present study 35 patients of AMI with diabetes mellitus and 35 patients of AMI without Diabetes mellitus in Department of General Medicine and Department of Cardiology were included. These patients were assessed & followed up in following manner.

All the patients were subjected for detail clinical examination and history at time of presentation to the hospital with special emphasis on particular complication. Serial ECG was done at Zero hour, 12 hour, 24 hour and daily till date of discharge. Routine X-ray was done in all cases to see evidences of pulmonary hypertension and other pathology. Routine biochemical investigations including liquid profile, blood urea, creatinine, glycosylated Hb, cardiac enzymes was done. Detailed Echo examination was done in all cases. All cases were critically evaluated at the time of discharge and were followed up to 30 days.

OBSERVATION:
The clinical course of acute myocardial infraction (AMI) was compared between 35 known diabetics (Ds) and 35 non-diabetics (NDs). AMI patients matched for age, sex and hospital ward. In both groups similar number of cases with shock pulmonary edema and clinical observed arrhythymias were found. In contrast, diabetic patients had significantly more frequent. A-V and intra-ventricular conduction disorder then non-diabetics (P<0.02). Diabetics also died twice more often from AMI (30%) than matched controls (15%) Diabetics with arrhythymias and/or conduction disorders had a particularly poor prognosis for surviving, the relative risk exceeding 3.

CONCLUSION:

The higher mortality and complication of AMI Diabetics calls for aggressive correction of metabolic and modifiable risk factors, treatment of acute events and secondary prevention,

AIM OF THE STUDY:
Validity of C.S.F. and Serum CRP in the diagnosis of meningitis in adults.

MATERIALS AND METHODS:
Fifty cases of meningitis were taken for study in the Department of Medicine form June 2004 to May 2006. Detailed clinical history, physical examinations and routine laboratory investigations were done including mandatory serum and CSF CRP estimation by semi-quantitative method. Clinical diagnosis of pyogenic (bacterial) and TB meningitis (TBM) was determined by history, physical examination, Routine CBC, CSF cytological and biochemical studies.

OBSERVATION AND DISCUSSION:
Out of 50 cases of meningitis 58% were males, 42% were females. Among the bacterial meningitis group maximum number of cases 8 (53.3%) were adults (26-40 years) and in TBM maximum number of cases 12 (37.5%) are in the age group 26-40 years. Fever and headache were the commonest symptoms in all type of meningitis (100%). Meningeal signs were more marked in bacterial (100%) than in TBM (62.5%) and viral cases. Majority of bacterial meningitis were conscious well oriented (66.6%) or at best confused (20%). Altered level of consciousness was more common among TBM cases (87.5%). CSF cell count in pyogenic meningitis varied from 2000/cmm to 63/cmm and 11(73.3%) cases were predominantly polymorphic whereas 4(26.6%) were dimorphic. Among 32 TBM cases the cell count varied from 150/cmm to 20/cmm . 6(18.7%) were dimorphic and rest 26 (81.25%) were predominantly mononuclear. CSF sugar level was reduced more in bacterial meningitis (<20mg/dl) than in TBM cases whereas it was nearly normal in cases of viral meningitis. The CSF protein levels both in bacterial and TBM are high (> 100 mg/dl) whereas it was nearly normal in viral meningitis. The CSF CRP test was positive in 14 (93.3%) out of 15 bacterial meningitis and 2(6.25%) out of 32 cases of TBM. Serum CRP test was positive in all cases of bacterial and tubercular meningitis (100%).

Type of Meningitis No. of Cases Positive serum CRP Positive CSF - CRP
Bacterial meningitis 15(30%) 15(100%) 14(93.3%)
TB meningitis 32(64%) 32(100%) 2(6.25%)
Viral Meningitis 3(6%) - -
Total 50 47 16

CONCLUSION:

Clinical features, cytological and biochemical study of CSF did not differentiate accurately pyogenic from TBM. It was observed that CSFCRP test was positive in almost all cases of bacterial and partially treated bacterial meningitis. The serum CRP test did not discriminate different meningitis whereas CSF CRP positive indicates pyogenic meningitis with greater validity and CSF CRP negatitivity validates tubercular meningitis