STUDY OF DYSLIPIDEMIA IN CORONARY ARTERY DISEASE PATIENTS WITH TYPE - 2 DIABETES MELLITUS
Posted by on Thursday, 22nd July 2010
Aims and Objective:
Dyslipidemia is associated with 50% of all diabetic people and contributes to substantial increased risk (3-4 fold) of premature, extensive and accelerated atherosclerosis leading to CAD, PVD and MI etc. It remains silent in majority of patients with diabetes. This peculiarity makes CAD in diabetes the single most important cause of premature mortality accounting for 60-65% of all deaths. The aims of the present study was to determine the pattern of dyslipidemia in patients of CAD with type 2 DM so as to initiate anti-lipidemic therapy for secondary prevention.
MATERIALS AND METHODS:
We studied 100 cases of type 2 DM with CAD and without CAS admitted to V.S.S. Medical College and Hospital, Burla, Orissa. The mean age group of the study was 30-69 years from both the sexes. The FBS and 2 hour PPBG was done by glucose oxidase method and serum lipid profile was estimated by enzymatic methods and compared to study the pattern of dyslipidemia.
Results:
In the present study dyslipidemia was found in 92% of diabetic patients with LDL hyperlipoproteinemia in 76% (LDL > 100mg%)HDL dydlipidemia in 64% (HDL < 40 mg%), hypertriglyceridemia in 925 (TG > 150 mg%) and hypercholesterolemia (56%) (> 200,g%). The lipid profile was significantly altered in patients with coronary artery disease compared to patients without coronary artery diseases.
Conclusion:
The major concern in the present study highlights the high percentage of LDL and TG dydlipidemia. However TC and HDL levels were of less significance. In the present study more than 90% of patients were smokers and alcoholics, LDL dyslipidemia is more significant from prognostic and therapeutic point of view, hence pharmacotherapy in the form of statins and TG dyslipidemia can be brought down by blood glucose control itself. Glycemic control should be the first priority followed by fibric acid derivatives or high dose statins.
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MICROALBUMINURIA IN DIABETES MELLITUS AND ITS PROGNOSTIC SIGNIFICANCE
Posted by on Thursday, 22nd July 2010
AIM OF THE STUDY:
Microalbuminuria is well established as the earliest detectable marker of nephropathy in Diabetes. Persistent microalbuminuria leads to nephropathy, cardiovascular changes and other complications. The present study was undertaken to correlate microalbuminuria in both type of Diabetes with complications.
METHODOLOGY:
One hundred cases of DM were studied during the period of January 2003 to December 2003. Urine samples of all cases were subjected to boiling test for detection of albumin (Microalbuminuria). Negative samples were subjected to micral test for microalbuminuria. Cases having definite previous history of Renal, Thyroid and Hepatic disease and Nephrotoxic drugs exposure were excluded from the study. All cases were subjected to detailed history, clinical and laboratory examination.
OBSERVATION:
In the present study out of 36 cases of Type 1 DM , 5 had microalbuminuria(13.8%) and out of 64 cases of type 2 DM, 11 cases had microalbuminuria(17.1%). In both groups there was male preponderance (Type I, 17.3:7.6%; Type 2 21.5:12.5%). The 24 hour protein excretion was 14956.5 mg% in microalbuminuria cases. The mean systolic blood pressure was 145 19.95mm of HG in micral positive cases compared to 12622.83 mm of Hg in negative cases. The mean Blood pressure was 105.213.5mm of Hg in micral positive groups as compared to 91.312.63 mm of Hg in control group. The FBS and 2 hours PGBS was higher in micral positive groups. The creatinine clearance was 14712.9ml/min in micral group as compared to 12613.10 ml/min in negative groups indicating a significant increase in GFR in microalbuminuria cases. The serum cholesterol was high i.e 202.334.45 mg% in microalbuminuria cases indicating association of dyslipidemia specially in Type 2 DM. Peripheral neuropathy, retinopathy and cardiovascular diseases were larger in patient with microalbuminuria <100 mg/24 hours suggesting renal hypertrophy is an early feature of diabetic renal disease and GFR was more in these patients. Renal biopsy showed basement membrane thickening in 11 cases and mesangial cell proliferation in 9 cases.
CONCLUSION:
In the present study microalbuminuria was correlated with different complications irrespective of the type of DM the systolic, diastolic and mean blood pressure was high. Neuropathy, retinopathy and cardiovascular complications were more in microalbuminuria cases and directly correlated with the duration of diseases. Renal hypertrophy was an early feature if nephropathy. Renal hisopathology was found to have a direct correlation with duration of disease and severity of microalbuminuria.
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CORRELATION OF ECG CHANGES IN HYPOKALEMIC PERIODIC PALSY WITH SERUM POTASSIUM LEVEL
Posted by on Wednesday, 21st July 2010
Aims and Objective:
To study the correlation of ECG changes in hypokalemic periodic palsy with serum potassium level.
Material and Method:
Thirty five cases of clinically diagnosed hypokalemic periodic palsy were included in this study admitted to medicine wards of VSS Medical College Hospital, Burla during the period of February 2004 to June 2004. Correlation between electrocardiographic changes i.e PR interval , QRS duration, QTc interval, ST- Segment depression, flattening of T-wave and presence of U-wave and AV block with corresponding serum potassium level was studied.
Secondary causes of hypokalemia were excluded in this study.
Observation:
ECG Changes of 35 cases are tabulated below with serum potassium level
Se. K+ level in mEq/L Total Cases Prolonged PR interval Presence of U-wave
Mild (3.1 3.5) 1 0 1
Moderate (2.6-3) 14 1 14
Severe (<2.5) 20 05 20
There were one (2.9%) cases of mild, 14(40%) cases of moderate and 20(57.1%) cases of severe hypokalemia. At the time of admission all 35 (100%) cases showed flattering of T-wave with presence of U-wave in ECG and prolonged QTc interval in 32(91.4%) cases. ST depression was found only 20 (57.1%) cases. Out of 10 cases of AV block, 6(17.1%) cases had first degree AV-block with prolonged PR interval and 4(11.4%) cases had second degree AV block.
Out of 10 cases of AV- block 9 (90%) cases had AV-block with serum potassium level 2.5 mEq/L and 1(10%) case had AV block with serum potassium 2.8 mEq/L.
Conclusion:
Various types of ECG changes occur in moderate to sever hypokalemia and do not specify level of hypokalemia. However AV block was present in majority cases of severe hypokalemia and presence of AV block with other features of hypokalemic ECG changes preclude immediate potassium supplementation before the availability of serum potassium level reports.
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HEMATOLOGICAL CHANGES IN CHRONIC ALCOHOLIC LIVER DISEASES
Posted by on Wednesday, 21st July 2010
AIM:
To study the hematological changes in chronic alcoholic liver diseases.
MATERIALS AND METHODS:
Thirty chronic alcoholic patients were investigated after excluding the patients having pathological diseases of other organs those altering the haematological status. All selected cases had history of alcohol abuse for more than 5 years, all the haematological parameters were compared with the duration and amount of alcohol consumption and the observations were complied and discussed. The significance of mean in comparison to control was done by using student unpaired t test. Association of parameters with amount and duration of alcohol consumption was made by calculating correlation coefficient.
RESULTS:
Chronic alcoholism was commonly observed in 4th and 5th decades with median age of 44 years.
The mean Hb% was 9.21.3 gm% , macrocytosis (MCV > 96fl) in 56.7% of cases and all cases were normochromic (MCH >27 pg and MCHC>30%). Raised ESR (86.6%), leucopenia (33.33%), thrombocytopenia (30%) were other observations.
CONCLUSION:
Correlation of duration of alcohol consumption with haematological changes revealed a significant decrease in Hb% and increase in ESR and increase in MCV with the duration of alcohol consumption 5 to 10 years and when it is more than 10 years of duration.
CRP IN AMI A UNIQUE PROGNOSTIC INDICATOR
S. Bhakta, Sk Lath, SR Pattnaik, BK Barik, B Pradhan , S Tripathy, RC Sethy
Aim and Objective:
Plaque rupture, the commonest cause of acute myocardial infarction(AMI) is associated with raised level of acute phase reactants like C-reactive protein. CP is a marker of atherosclerotic inflammation and insult of myocardial necrosis. In this study serum CRP level in AMI pateitns at the time of hospital admission was correlated with their subsequent in hospital prognosis.
Materials and Methods:
In the present study, 61 AMI patients with varied types of presentation and risk factors were taken. Fifty healthy age and sex matched volunteers were taken as control. Non-cardiac causes, which can raise the CRP level, were excluded from both groups. Blood samples of AMI patients for CRP were sent at the time of their hospital admission. Other cardiac markers like CK-MB and troponin I also estimated for diagnostic purpose as well as to correlate with CRP as a prognostic indicator. Patients were followed up fro complications like LVF, repeat cardiac discomfort, arrhythmia, cardiogenic shock and death.
Observation:
Raised level of CRP (8.203.86 ms/1 SD) was noted in AMI patients compared with controls (31.195 mg/1 SD). Patients with >6 mg/1 of CRP developed more (82.85%) complications like arrythmia, CCF, pericarditis and repeat chest complications (P<0.001). 11 patients (18%) expired out of them 10 had > 6 mg/1 CRP (91%). More complications observed when CRP levels were raised within 6 hr duration of symptoms (70.83%). In contrast to it other cardiac markers (CK-MB and TROP I) failed to predict the prognosis within 6 hr duration of symptoms. After 6 hours , prognostic value of CRP and other cardiac markers correlated well.
Conclusion:
The serum CRP level on hospital admission is an indicator short term of prognosis of AMI irrespective of the duration of symptoms.
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PENTOXYFYLLINE AS AN ADJUVANT THERAPY IN TREATMENT OF SEVERE FALCIPARUM MALARIA IN PATIENTS OF SICKLE CELL ANAEMIA
Posted by on Wednesday, 21st July 2010
AIM:
To study the pentoxyfylline as an adjuvant therapy in treatment of severe falciparum malaria in patients of sickle cell anaemia.
MATERIALS AND METHODS:
Patients having clinical features suggestive of severe falciparum malaria (according to WHO guidelines) excluding pregnant woman were investigated for sickling test and hemoglobin electrophoresis. Biochemical and haematological investigations e.g hemoglobin concentration, total leucocyte count, differential count, urine for sugar , albumin, red cell , pus cell, hemoglobin, serum for direct and indirect bilirubin, AST, ALT, alkalaine phosphatase, urea, creatinine, sodium and potassium were done on the day of asmission and on 3rd and 8th day. Detailed daily clinical examination was done. Forty cases of severe falciparum malaria with sickle cell disease were studied. Twenty cases treated with quinine and pentoxyfylline and other twenty cases were treated with quinine only.
RESULT:
Patients who received pentoxyfylline and quinine had less duration of unconsciousness, had significant fall of bilirubin concentration as compared to those received quinine only. There was no significant difference in BUN and overall mortality between the two groups.
CONCLUSION:
This study shows that simultaneous administration of pentoxyfylline and quinine leads to early recovery from coma and reduction of serum bilirubin concentration . So pentoxyfylline may be useful in severe falciparum malaria in sickle cell disease.
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