Jitendra Kodilkar ¹, Mrunal Patil ², Neelima Chafekar ³, Ashwinkumar More ¹

Affiliations
1 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN
2 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN
3 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN

Abstract

Introduction: Echocardiography is noninvasive, most frequently used usually the initial imaging test to evaluate all cardiovascular disease related to structural, functional, or hemodynamic abnormality of the heart or great vessels. The major advantage of echocardiography is the ability to obtain instantaneous real time image even in emergency units. The present study was undertaken to evaluate left ventricular function, extent of myocardium involved and complications of acute myocardial infarction by 2D ECHO, to correlate these findings with ECG and clinical presentation, and to assess the role of 2D ECHO in management and prognosis of patients with acute myocardial infarction.

Materials and Methods: The present study was conducted on patients visiting our tertiary health centre, Nasik over a period of 2 years. 55 patients were included in the study. Patients with prior history of acute myocardial infarction, valvular heart disease, cardiomyopathy, cardiac surgery, congenital heart disease and non ST elevation MI were not included in the study. Patients were classified as per Killip classification and 2D ECHO was performed on the patients within 24 hours of admission. The findings of which were correlated with clinical and ECG findings.

Results: Of 55 patients studied it was found that MI had male preponderance with hypertension as major risk factor. Also, the severity of the infarction increased with the increase in the Killip class. Mean ejection fraction was also observed to be decreasing in patients with increase in severity of the infarction.

Conclusion: 2D ECHO performed within 24 hours of admission helps the clinician to predict and diagnose complications in patients with acute MI and take proper steps in the management of the patient.

Keywords

Echocardiography, Killip Classification, Myocardial Infarction

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Jitendra Kodilkar ¹, Manish Kolge ¹, Neelima Chafekar ¹, Mrunal Patil ²

Affiliations
1 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
2 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN

Abstract

Aim: To study the clinical profile of diabetic patients who present with Acute Coronary Syndrome (ACS) for the first time, to correlate the Blood Sugar Level (BSL) and Glycosylated hemoglobin (HbA_1C) at the time of admission and the severity of acute coronary syndrome; and to assess the correlation between tight glycemic control of diabetics based on HbA_1C estimation and presence of end organ damage in diabetics. Materials and Methods: The study was undertaken at our medical college in the medicine department. 64 adult patients who are known diabetics or detected for the first time presenting in outpatient department or emergency department as acute coronary syndrome were studied. Study period was 2 years from January 2011 to December 2012. Results: The study showed a definite male preponderance, with 56.23% males as compared to 43.73% females. Atypical presentations of acute coronary syndrome were more common as compared to typical chest pain (34.37%). Chest pain commonly is prevalent in younger age group. 95.30% of the patient had some or other associated risk factors like hypertension (59.37%), smoking (26.56%), obesity (15.62%) or dyslipidemia (65.62%). ST elevation MI was the commonest presentation (73.40%) and involvement of anterior wall was common (36.20%). On admission BSL (Blood Sugar Level) was not found to have a definite prognostic value in predicting outcome in diabetic patients with acute coronary syndrome. Impaired glycosylated haemoglobin was found to be an independent risk factor and had a definite prognostic value in predicting outcome. Diabetic patient with acute coronary syndrome had LV dysfunction, cardiac rhythm abnormalities, cardiogenic shock and are likely to be readmitted, thus having worst morbidity as well as mortality. Conclusion: The primary aim of this study was to study correlation of blood sugar level and glycosylated haemoglobin at the time of admission with severity of acute coronary syndrome and to study clinical profile of diabetic patients with due consideration to complications which are related to diabetes.

Keywords

Acute Coronary Syndrome, Blood Sugar Level, Dyslipidemia, Glycosylated Hemoglobin.

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Umang Patil ¹, Jitendra Kodilkar ¹, Neelima Chafekar ¹, Deodatta Chafekar ¹, Gauri Anand Diwan ²

Affiliations
1 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra, IN
2 Department of Anaesthesia, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra, IN

Abstract

Aim: To study clinical profile, laboratory features and importance of rehydration in patients admitted with acute kidney injury due to gastroenteritis. Materials and Methods: The study was carried out as a prospective observational study of 70 patients at medicine department of a medical college and tertiary health care center, over a period of two years that included cases of acute kidney injury due to gastroenteritis in the age group of 18-40 years. Results: Study showed male predominance (72.86%) in elderly age group. Prerenal type was more common (75.71%) as compared to acute tubular necrosis. Duration and frequency of diarrhea was associated with severity of the disease. Mortality was high (100%) in those who required more time (>12 hours) to achieve normal mean arterial pressure. Maximum deaths (93.33%) were observed in anuric patients. Most common complication observed was septicemia in 20% of patients. Overall mortality observed in our study was 21.43%, while 78.57% patients survived. Mortality was high in those having severe dehydration, high baseline creatinine, who received dialysis. Conclusion: Acute kidney injury due to gastroenteritis is preventable if presented early and adequate hydration can decrease mortality.

Keywords

Acute Kidney Injuries, Acute Tubular Necrosis Gastroenteritis, Mean Arterial Pressure.

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Neelima Chafekar ¹, Jitendra Kodilkar ¹, Parth Deogaonkar ¹, Maansi Gujarathi ¹

Affiliations
1 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon, Nashik – 422003, Maharashtra, IN

Abstract

Background: Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycemia caused by relative or absolute deficiency of insulin¹. Cardiac autonomic neuropathy is a complication of diabetes. Our study intends to study Cardiac Autonomic Neuropathy in diabetics attending our hospital. Aims and Objectives: To study the clinical profile of Cardiac Autonomic Neuropathy in type 2 DM. Materials and Method: The study was carried out in a tertiary care hospital. The data was collected from August 2013 to December 2015 in 54 patients. The history, examination and bedside tests were done and conclusions drawn. Tests performed included heart rate response to deep breathing, standing, valsalva maneuver; BP response to sustained handgrip and standing. Results: Of 54 patients studied, 25 (46.29%) had CAN. Of the 25 patients affected with CAN 3 were between age 41-50, 10 between 51-60, 10 in 61-70 and 2 in 71-80. Out of 25 patients having CAN in the study 14 (56%) are male and 11 (44%) are female. Mean age of patients having CAN was 10.36 as compared to 6.55 in those not having CAN. Our study gave the following. Conclusions: Cardiac Autonomic Neuropathy is one of the most common but under diagnosed complications of diabetes mellitus. Cardiac Autonomic Neuropathy is associated with both type 1 and type 2 Diabetes Mellitus. It correlates with the duration and age. Resting tachycardia is a signs of autonomic dysfunction. Heart rate response to deep breathing and B.P. response to sustained hand grip are the most sensitive and specific tests for diagnosis of autonomic dysfunction. Cardiac Autonomic Neuropathy is significantly associated with other microvascular complications of DM like Diabetic retinopathy and nephropathy.

Keywords

Cardiac Autonomic Neuropathy, Diabetes Mellitus, Diabetic Neuropathy, Diabetic Nephropathy, Diabetic Retinopathy.

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Mohammad Sultan ¹, Chetan Patil ², Neelima Chafekar ³, Jitendra Kodilkar ²

Affiliations
1 Former PG Resident, Department of Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India ., IN
2 Associate Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India ., IN
3 Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India ., IN

Abstract

Incidence of diabetes is increasing substantially worldwide. Cardiovascular disease is most prevalent cause of mortality and morbidity in diabetic populations. Cardiovascular risk factor including obesity, hypertension, dyslipidemia are common in patients with diabetes mellitus particularly with those of type 2 diabetes. Atherosclerosis has been described as an inflammatory disease. Aim: Study to evaluate correlation of C-Reactive Protein and Glycosylated Haemoglobin in Patients of Diabetes Suffering from Acute Coronary Syndrome. Material and Methods: A descriptive study after satisfying criteria was conducted in 115 patients in medicine department of a medical college and tertiary care hospital over a period of two years that included patients of diabetes suffering from acute coronary syndrome in the age group of 30 to 70 years. Evaluation and correlation was done by clinical profile. Results: Majority of patients were elderly age group of male of 51 to 60 yrs having mean BMI of 24 kg/m2 . CRP level of >3 mg/dl was found in 77.39% and majority of patients had HbA1C >7%. CRP and HbA1C were significantly correlated (p<0.05). Majority of patients with elevated CRP were found in with killip class I. But CRP and killip classification were not significantly correlated in our study. Conclusion: Elevated C Reactive Protein and Glycosylated Haemoglobin are better correlated as poor prognostic marker for cardiovascular event in patients of diabetes suffering from acute coronary syndrome.

Keywords

CAD, Cholesterol, CRP, Diabetes, HbA1c

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