Imran Pinjari ¹, Chetan Patil ², Neelima Chafekar ³, Madhuri Kirloskar ²

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

Abstract

Background: Diabetes Mellitus is a clinically and genetically heterogeneous group of metabolic disorders that manifest in an abnormally high level of glucose in the blood. Diabetic Ketoacidosis (DKA) represent extremes in the spectrum of decompensated diabetes. The mortality in patients with Diabetic Ketoacidosis is rarely caused by a metabolic complication of hyperglycemia or metabolic acidosis and it is usually related to the underlying medical illness that precipitates metabolic compensation. The second most important contributor to the development of DKA is inadequate insulin treatment, commonly seen as a result of noncompliance, especially in the young population. Methods: The present study was conducted for period of 2 years. It is a hospital based prospective observational study of 60 Diabetic Ketoacidosis patients. The biochemical prognostic markers were studied. Results: The study was done for 60 patients diagnosed with Diabetic Ketoacidosis presented to the medicine department. The mean age was 55.44 years. So from the current study it was proved that, serum phosphorus and APACHE II score can be used for predicting the prognosis in the the DKA patients. The mean serum phosphate among the deceased patients (n = 8) was more as compared to the discharged patients (n = 52). Out of 60 patients, highest patients (n = 38) had infection (AFI, LRTI, pneumonia. UTI, sepsis pancreatitis, enterocolitis, AKI, viral fever) as their precipitating factors. Conclusion: APACHE II score and serum phosphorus is an important biochemical marker in the prognosis of DKA. APACHE II score is directly proportional to mortality index in DKA.

Keywords

APACHE II, Diabetic Ketoacidosis, Glasgow Coma Scale, Serum Phosphate

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Neelima Chafekar ¹, Mayur Babras ², Madhuri Kirloskar ³

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

Abstract

Background: Thyroid hormone has a major role in the cardiovascular function and cardiac hemodynamics as well as to maintain the cardiovascular homeostasis. The present study was planned to assess risk factors for coronary artery disease and their correlation with thyroid hormone profile amongst women with ST segment elevation in acute myocardial infraction. Material and Methods: A total number of 78 females having ST elevation myocardial infarction diagnosed through detailed clinical history and ECG evaluations were included after they satisfy the eligibility criteria. Patients were subsequently evaluated for presence of risk factors of ischemic heart disease such age, marital status, parity, and menopause, use of oral contraceptives, family history, obesity, diabetes mellitus, hypertension, hypercholesterolemia and hypertriglyceridemia. Their thyroid hormone profiles (T3, T4, TSH) were done and were correlated with risk factors for ischemic heart disease. Results: A total 78 patient included in the study most of the study population belongs to the age group of 40 to 50 years (43.6 %). Hypertension was the most common clinical features amongst study population (59%) followed by Diabetes (50%). Most of the study population had Normal Thyroid status (57.69%) followed by Hypothyroidism (25.64%) and Hyperthyroidism (16.67%) and SERUM TSH is the most sensitive test for evaluation. Diabetes Mellitus was statistically significant risk factor (p valueConclusion: Patients with coronary artery disease especially in the presence of other risk factors should be screened for thyroid dysfunction specially diabetes. We recommend tests for thyroid disorders in acute coronary syndrome can give predictor for risk of morbidity and mortality in those subjects.

Keywords

MI-Myocardial Infarction, Hyperthyroidism, Hypothyroidism, STEMI-ST- Segment Elevation Myocardial Infarction, TSH- Thyroid Stimulating Hormone

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Karishma Anil Nigoo ¹, Neelima Chafekar ², Madhuri Kirloskar ³

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

Abstract

Introduction: Diabetes mellitus commonly leads to peripheral neuropathy in patients with chronically high blood sugar levels. Diabetic peripheral neuropathy leads to numbness, loss of sensation or may have extremely painful symptoms. In some patients there might be marked neuropathic deficit which may be unnoticed. Objectives: Hence to evaluate patients with diabetes mellitus helps in early screening of peripheral neuropathy. Methodology: This involves using the bedside screening techniques like monofilament test, biothesiometer, tuning fork test and diabetic symptom and examination questioner. Results: Diabetic neuropathy was most commonly present in poor control of diabetes (67%) followed by fair control (24%) and good control (9%). It was observed that severity of peripheral neuropathy was related with blood sugar. With high frequency of patients leading to diabetic peripheral neuropathy the observation is that morbidity remains high in such patients. Conclusion: Diabetic peripheral neuropathy is a major complication of diabetes mellitus. Rapid diagnosis and management are important, since recent modalities include like tricyclic antidepressants or anticonvulsants and optimal glycemic control can improve outcome of these patients. Early diagnosis of diabetic peripheral neuropathy is considered at risk of foot ulcerations and must receive preventive education and care.

Keywords

Bedside Screening, Biothesiometer, Monofilament, Peripheral Neuropathy, Tuning Fork Test, Type 2 Diabetes Mellitus

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Madhuri Kirloskar ¹, Gaurav Balasaheb Kulkarni ², Sandeep Chaudhari ¹, Manohar Ketkar ³

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

Abstract

Background: Coronary heart disease constitutes an immense public health problem. Myocardial Infarction is one of kind components of cardio vascular disease burden all around the world. Aim: Many epidemiologic studies have shown raised uric acid levels to predict increased risk of cardiovascular events. Studies have addressed the value of this biomarker across the whole range of patients with ACS (Acute Coronary Syndrome) especially in Indian scenarios. Thus, the aim of this study was to investigate whether there is an association between serum uric acid level with CAD (Coronary Artery Disease) risk factors and its severity in ACS patients. Also to know the prognostic value of serum uric acid levels in those patients undergoing coronary angiography for underlying coronary artery diseases. Material and Methods: This prospective observational study included 200 random patients admitted with Acute Coronary Syndrome in the ICU and medicine department of the institution. The presence and severity of CAD was determined by the following clinical vessel score; Absent: No coronary lesions, 1 vessel, 2 vessels and 3 vessels - disease based on the number of coronary arteries involved. The correlation of serum uric acid levels with CAD risk factors and the severity of CAD in the ACS patients was analysed statistically. Results: There was a significant association between uric acid and the coronary angiographic findings (P<0.001). The patients in the hyperuricemia group had more number of coronary vessels involved than the other group. Conclusion: The serum uric acid level is correlated with the presence and severity of CAD by coronary angiographic findings (P<0.001) in the Acute Coronary Syndrome patients. Uric acid being an inexpensive and easily available biochemical marker, it will be of much use in settings with restricted resources. Serum uric acid levels can be used to predict the severity of CAD.

Keywords

ACS (Acute Coronary Syndrome), CAD (Coronary Artery Disease), Hyperurecemia

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