ECHOCARDIOGRAPHIC ASSESSMENT OF HYPERTENSIVE CHANGES IN ELDERLY PATIENTS OF ISOLATED SYSTOLIC HYPERTENSION WITH SPECIAL REFERENCE TO CARDIOVASCULAR COMPLICATIONS

Objective: The objective of the study was to assess the echocardiographic changes and cardiovascular complications in patients with isolated systolic hypertension (ISH). Methods: This was an observational cross-sectional study done in the Departments of General Medicine, Cardiology, and Radiodiagnosis of MKCG Medical College and Hospital, Berhampur, Odisha, India. Seventy patients above the age of 65 years with systolic blood pressure (BP) ≥140 mm Hg and diastolic BP <90 mm Hg, without any secondary causes of hypertension and antihypertensive drug therapy were selected for this study. Echocardiography and electrocardiography studies were implemented for demonstrating the development of cardiovascular complications. Results: Of 70 cases (41 males and 29 females), 64.3% were asymptomatic and 35.7% were symptomatic, with palpitation being the major symptom, 40% (28 cases) developed retinopathy, 45.71% developed increased left ventricular mass index (p=0.04), 18.57% had increased in LV volume (>90 ml/m2), 30% cases had regional wall motion abnormalities, 27.1% had reduced ejection fraction (<56%), and 52.66% showed LA enlargement in this study (p=0.048). Doppler measurements of diastolic filling were significant in patients with ISH with higher peak atrial velocity (A wave) of 79.71±11.79 cm/s and a lower ratio of peak early to atrial velocity of 0.82±0.29. Conclusion: This study demonstrates that elderly patients with ISH had a prevalence of concentric left ventricular hypertrophy (LVH) which was found to be more in female patients than in male patients followed by left atrial enlargement

CLINICAL PROFILE AND ETIOLOGICAL EVALUATION OF NON-TRAUMATIC MYELOPATHIES USING MAGNETIC RESONANCE IMAGING

Objective: The present study was conducted with an objective to identify the etiology of non-traumatic myelopathies of both compressive and non-compressive types with the aid of magnetic resonance imaging (MRI). Methods: This retrospective observational cross-sectional study was conducted on 100 patients with a clinical diagnosis of non-traumatic myelopathy belonging to the age group of 15–75 years from August 2018 to July 2020 in the Departments of General Medicine and Radiodiagnosis of MKCG Medical College and Hospital, Berhampur, Odisha. Detailed history, clinical evaluation, laboratory investigations, and findings of MRI spine and brain were compiled. Results were analyzed using descriptive statistics. Results: Among 100 patients of non-traumatic myelopathy, 65 patients presented with compressive myelopathy and 35 patients with non-compressive myelopathy where 56 patients presented with paraparesis and 44 with quadriparesis. Pott’s spine (n=25, 38.46%) and acute transverse myelitis (ATM) (n=24, 68.57%) were the most common etiologies found in compressive and non-compressive groups, respectively. Conclusion: Pott’s Spine, spondylotic myelopathy, and ATM were the most common etiologies of non-traumatic myelopathy. MRI has proven to be the ultimate imaging modality for their etiological evaluation

Serum uric acid level in acute ischemic stroke in eastern India

Background: Present study was done to estimate the level of serum uric acid in acute ischemic stroke and to find out whether it is protective against or increases the risk for ischemic stroke and its effect on stroke outcome.Methods: A total of 100 patients and 100 controls were taken randomly. Risk factors of stroke were considered such as hypertension, diabetes, adverse lipid profile, smoking and obesity. Serum uric acid level was measured in both cases and controls. Modified National Institute of Health (NIH) stroke scale score was calculated at the time of admission and discharge. Statistical analysis was done using SPSS 21.0 software.Results: Out of 100 patients studied 65 were males and 35 were females. The mean serum uric acid level in stroke cases was 6.11±1.47 where as it was 4.85±1.12 in controls. SUA levels was higher among males than females. The mean SUA in hypertensive subjects (6.58±1.33) was significantly higher than in normotensive subjects (5.23±1.42). There was statistically significant difference between SUA levels in diabetic (6.66±1.26) and non-diabetic patients (5.63±1.49). Mean SUA among overweight patients was (7.0±1.16) where as it was (5.22±1.23) in patients with normal weight. The mean SUA in smokers (6.33±1.38) was higher than that in non-smokers (6.02±1.51). There was significant positive correlation between SUA an NIH stroke scale score(P<0.05). SUA levels were significantly higher in patients who succumbed as compared to those who were discharged from hospital.Conclusions: SUA can be used as a marker for increased of stroke. Higher SUA is associated with a bad prognosis

EVALUATION OF RENAL CHANGES IN SICKLE CELL DISEASE IN A REFERRAL GOVERNMENT INSTITUTE OF SOUTHERN ODISHA

Objective: The objective of the study was to study various renal manifestations in sickle cell disease (SCD) and to establish a cause and effect relationship with the evaluation of risk factors. Methods: This prospective observational cross-sectional study was conducted on 82 SCD patients belonging to the age group of 15–50 years of both the genders over a period of 2 years from January 2019 to December 2020 in MKCG Medical College and Hospital, Berhampur, Odisha, India. Eighty-two patients, 32 (39.02%) having sickle cell anemia (SCA) and 50 (60.98%) having sickle cell trait (SCT), admitted to medicine and nephrology wards of the hospital were included in this study. SCD patients with other hemolytic anemia and with renal congenital/structural abnormality and patients with systemic diseases such as diabetes mellitus, systemic hypertension, and systemic lupus erythematosus were excluded from the study. Various laboratory investigations such as complete blood count, hemoglobin (Hb), serum sodium, serum potassium, serum urea, serum creatinine, fasting blood sugar, erythrocyte sedimentation rate, liver function test, urine routine, and microscopic test were carried out. Diagnosis of SCD patients was based on sickling test and high-performance liquid chromatography testing. Radiologic imaging (Sonography for renal changes) was done at radiodiagnosis department of the hospital. Results: Glomerular and tubular dysfunction was more in SCA (Hb SS) patients than SCT (Hb AS) patients and the abnormality was more in patients in crisis. Albuminuria in 78.12%, hematuria in 46.87%, cast and crystal in 28.12%, epithelial cell in 31.25%, and hyposthenuria in 56.25% were found in SCA patients. In SCT patients, albuminuria in 38%, hematuria in 16%, cast and crystal in 22%, epithelial cell in 12%, and hyposthenuria in 24% were found. All the above findings were more in percentages in crisis patients of both the groups. In SCA, 37.5% and in SCT, 2% were found to have chronic kidney disease. Conclusion: Renal involvement in the form of glomerular and tubular dysfunction occur in SCD and more in crisis patients, leading to renal complications, and end-stage renal disease

PREVALENCE OF ACUTE KIDNEY INJURY IN TROPICAL ACUTE FEBRILE ILLNESS AND ITS OUTCOME IN A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL STUDY.

Background Tropical acute febrile illness (TAFI) accounts for the majority of hospitalizations in our country. It is one of the most frequent causes of acute kidney injury (AKI) leading to very high morbidity and mortality in the Indian sub-continent. This study was conducted to evaluate the prevalence and outcome of AKI associated with TAFI.   Methods  This observational study was carried out on 100 patients of TAFI belonging to the age group of 15-89 years of both genders, admitted in the medicine ward fulfilling the inclusion and exclusion criteria in a tertiary care government teaching hospital in Eastern Odisha, India from June 2021to October 2022. After obtaining informed consent, they were thoroughly evaluated for clinical signs and symptoms along with routine laboratory investigations. Kidney Disease Improving Global Outcomes (KDIGO) criteria were followed for AKI diagnosis and classification. Outcomes in terms of duration of hospital stay, treatment with dialysis, the requirement for intensive care unit (ICU) support, survival, and mortality were analyzed and recorded.  Results Out of 100 patients of TAFI, 58% of patients developed AKI among whom 20 (34.4%) patients required hemodialysis. The majority (77.6%) of AKI patients improved, around 15.5% of patients progressed to chronic kidney disease (CKD) and mortality was seen in about 6.8% of patients Conclusion  The spectrum of TAFI in this present study shows malaria (38%) followed by dengue (27%), scrub typhus (16%), and leptospirosis (12%). The most common etiology of AKI in TAFI is leptospirosis (75%).   Recommendations Recommendations include early diagnosis and management of tropical acute febrile illness (TAFI) and acute kidney injury (AKI), preventive measures targeting common causes, and a multi-disciplinary approach to patient care to reduce morbidity and mortality in tropical regions.  

Cardiovascular changes in newly detected hypothyroid patients in Eastern India

Background: Present study was carried out with an objective to study all the cardiovascular changes associated with newly detected hypothyroidism, and to know the cardiovascular involvement in sub-clinical hypothyroidism.Methods: A total number of 60 newly detected hypothyroid patients, diagnosed by clinical evaluation and confirmed by thyroid hormone assay by chemiluminescence immunoassay (CLIA) method, were subjected to cardiovascular examination, electrocardiograph, echocardiography and Tread mill test. It was cross sectional study design based on random sampling method which was conducted for 2 years in the department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. The work was carried out after approval from the Institutional Ethics Committee of MKCG Medical College Hospital, Berhampur, Odisha. Patients were investigated before thyroid hormone replacement therapy. Statistical data analysis was made on basis of deviation, standard error, t-test and the proportion test. P value of < 0.05 was considered statistically significant.Results: Out of 60 patients studied 14 were males and 46 were females. Hypothyroidism was newly diagnosed more in females and maximum in age group of 17-47 years (69.9%). Out of 60 patients, 63.3% had symptoms less than 3 months duration. Cardiovascular symptoms were present in 12 (20%) patients. Bradycardia was observed in 7% patients. Stage 1 hypertension was noticed in 13.3% (diastolic high blood pressure). Low voltage complexes in electrocardiogram was present in 40% study group. Pericardial effusion was present in 26.7% patients. Tread mill test was positive for inducible ischaemia in 2 patients. Diastolic dysfunction was noticed in 26.6% study group. Altered lipid profile was present in 16.7% (S. cholesterol) and 53.4% (S. Triglycerides).Conclusions: Hypothyroidism is common in female, maximum between 17-47 years age group. Majority of the patients did not have any cardiovascular changes. Observed cardiovascular changes were ECG abnormalities, pericardial effusion, diastolic hypertension and diastolic dysfunction. Systematic study was done to know the early effects of hypothyroidism on cardiovascular system. The identification of patients with hypothyroidism is an important individual as well as public health issue. Hence, early detection and initiation of hormone replacement therapy can minimize associated cardiovascular changes

CLINICAL AND ETIOLOGICAL PROFILE OF PATIENTS PRESENTING WITH ASCITES IN A TERTIARY CARE HOSPITAL

Objectives: Ascites is one of the common clinical problems confronting a physician, with a myriad of causes behind. Early detection and evaluation of the causes of ascites helps in effective management and lessens complications. But there is lack of data regarding the prevalence of causes of ascites in our set-up. So, this study was conducted in our tertiary care hospital to study the clinical profiles and etiological factors of patients with ascites. Methods: This prospective observational study was carried out in the Department of General Medicine of S.C.B. Medical College and hospital, Cuttack, Odisha, India from September 2019 to November 2021. Hundred patients of ascites of either sex &gt;18 yrs of age, admitted in the medicine ward fulfilling the inclusion and exclusion criteria were included in this study and were thoroughly evaluated after obtaining informed consent. All the patients were subjected to detailed history taking, thorough physical examination and routine laboratory evaluation such as complete blood count, random blood sugar, liver function test, renal function test, serum protein and albumin, serum electrolytes, prothrombin time, international standardised ratio, hepatitis B surface antigen and antibody to hepatitis C. Hepatic encephalopathy, when present, was classified into 4 grades according to West Haven criteria. Ultrasonography of abdomen and pelvis, Digital chest X-ray PA view, ECG were done in all the patients. Results: In the present study of 100 patients, major cause of ascites was found to be cirrhosis of liver (64%) followed by tuberculosis (10%), malignancy (9%), heart disease (7%) and nephrotic syndrome (3%). The major cause of the cirrhosis of liver were alcoholism (64%) followed by hepatitis B (15.6%), NASH (Nonalcoholic steatohepatitis) (14.1%), Hepatitis C (4.7%) and cryptogenic (3.1%). Complications like hepatic encephalopathy and spontaneous bacterial peritonitis were observed in 17% and 7.8% cases of ascites, respectively. Conclusion: Cirrhosis of liver was found to be the most common cause of ascites in our study followed by tuberculosis and malignancy. Alcoholism was the most common cause of cirrhosis followed by chronic hepatitis B. &nbsp

ROLE OF RETICULOCYTE HEMOGLOBIN CONTENT IN DIAGNOSIS OF IRON DEFICIENCY ANEMIA

Objectives: Anaemia is a global problem of immense health significance affecting persons of all ages and economic groups. Iron deficiency anaemia (IDA) is the most common type of anaemia met with in clinical practice. For IDA diagnosis, estimation and treatment, many indices like serum iron (SI), total iron binding capacity (TIBC), serum ferritin (SF), soluble transferrin receptor assay are used. But reticulocyte haemoglobin content (CHr) is called as the gold standard for diagnosing IDA as it is the most valuable screening tool for identifying IDA with a sensitivity of 94% and specificity 80% and differentiates IDA from anaemia of systemic disease (ASD). The present study was undertaken to evaluate CHr as a most efficient marker in diagnosing IDA. Methods: This prospective observational study was carried out in the Department of General Medicine of M.K.C.G. Medical College and hospital, Berhampur, Odisha, India from October 2017 to October 2019. Sixty microcytic hypochromic patients of either sex &gt;18 yrs of age admitted in the medicine ward fulfilling the inclusion and exclusion criteria were included in this study. After taking detailed history and clinical examination, laboratory investigations including complete blood count (CBC), serum iron, serum, ferritin, serum transferrin saturation, TIBC, CHr and bone marrow aspiration with iron stain were done in all patients. Results: In the study group of 60 patients, 10(16.66%) patients had mild anaemia, 17(28.33%) had moderate anaemia and 33(55%) had severe anaemia. Mean haemoglobin of the patients was 6.86g/dL and SD was 1.95g/dL. Nineteen (31.66% patients) had TIBC in the range of 351-400 µg/dl. Mean ± SD of serum TIBC was 333.91 ± 67.26 µg/dL. Thirty-nine patients (65%) had transferrin saturation in the range of 0.1-10%. The Mean ± SD of the study group was 13.68 ± 3.22%. Fifty (83.33%) patients had serum ferritin in the range of 0-100 µg/dL. Twenty-three patients (38.33%) had CHr concentration between 15.1-20pg followed by 19(31.66%) between 20.1-25pg and 18(30%) between 25.1-30pg. The Mean ± SD of this study was 22.14pg ± 3.92. Conclusion: Reticulocyte haemoglobin content is a potential biomarker that can be used to differentiate iron deficiency anaemia from other causes of anaemia

A STUDY OF CLINICAL AND ECHOCARDIOGRAPHIC PROFILE IN PATIENTS OF DILATED CARDIOMYOPATHY

Objective: Dilated cardiomyopathy (DCM) is the third most common cause of heart failure (HF) and is the most common cardiomyopathy. The present study was undertaken with the aim to study the different clinical presentations of dilated cardiomyopathy, to correlate echocardiography findings with different clinical presentations and to find out the variables which determine the poor outcomes. &nbsp; Methods: This prospective observational study was conducted in the Department of General Medicine of MKCG Medical College and Hospital, Berhampur, Odisha, India from November 2019 to November 2021. Fifty cases of dilated cardiomyopathy (28 males &amp; 22 females), diagnosed on clinical and echocardiography criteria in the Department of General Medicine and Cardiology were selected for the study. &nbsp; Results: Out of 50 cases, there were 28(56%) males and 22(44%) females giving male to female ratio 1.27:1. Forty (80%) were idiopathic. Dyspnea was most common presenting clinical feature in 43(86%) cases. In echo study, maximum number of cases (n=21, 42%) were having ejection fraction (EF) in the range of 36-40% and maximum number of cases (n=26, 52%) had severe fractional shortening (FS). &nbsp; Conclusion: DCM is one of the commonest causes of heart failure and is most common type of cardiomyopathy found in middle aged and elderly male population. Biventricular failure followed by left ventricular failure was the most frequent clinical presentation. Early identification and treatment are very essential to improve cardiac function and alleviate patient symptomology

DELIBERATE SELF-POISONING IN SOUTH ODISHA: STUDY OF ITS CLINICAL PROFILE AND OUTCOME

Objective: Deliberate self-poisoning is a serious global issue that contributes to significant morbidity and mortality all over the world. The present study was conducted with an objective to identify the common agents used for self-poisoning prevalent in South Odisha and to determine the common clinical features and outcome of such cases. Methods: This cross-sectional observational study was conducted on 200 patients with deliberate self-poisoning belonging to the age group of 15–70 years over a period of 2 years from August 2017 to September 2019 in Maharaja Krishna Chandra Gajapati Medical College and Hospital, Berhampur, Odisha, India. All the above-mentioned patients admitted to the hospital, were treated with specific antidotes according to the poison ingested. Results were analyzed using appropriate standard statistical methods such as mean, standard deviation, and percentage. Results: Out of 200 patients, majority were female (65%, n=130) and 35% (n=70) were male; mean age was 38.9 (±16.8) years. Organophosphates, aluminum phosphide, glyphosate, organochlorines, and carbamates were the most common pesticides used as poisoning agents (74.5%, n=149) followed by plant poisons (7%, n=14) which included yellow oleander seed. Overall mortality in our study was 12.5%. Conclusion: Pesticides and plant poisons were the common agents used in our study for deliberate self-poisoning. Young persons, illiterates, and housewives were commonly involved in suicide attempts. Organophosphate caused majority of deaths