Echocardiographic assessment of the impact of cardiovascular risk factors on left ventricular systolic function in patients with acute myocardial infarction

Background: Objectives of current study were to determine the magnitude of left ventricular systolic dysfunction in patients with acute myocardial infarction in the rural sub-population of Uttar Pradesh in India and to evaluate the impact of cardiovascular risk factors on the risk of impairment of left ventricular systolic function. Methods: One hundred and fifty seven consecutive patients with first acute myocardial infarction were enrolled into the study. Most patients were male (73.2%) and the mean age of presentation was 52.7 years. Two dimensional echocardiography was utilized to assess conventional parameters such as Left Ventricular End-Diastolic Diameter (LVEDD), Left Ventricular End-Systolic Diameter (LVESD), LV End-Diastolic Volume (LVEDV), LV End-Systolic Volume (LVESV) and Left Ventricular Ejection Fraction (LVEF). The LV volumes (end-systolic and end-diastolic) and LVEF were calculated from the conventional apical two-and four-chamber images using the biplane Simpson’s technique. LV systolic function was considered depressed when LVEF was less than 45%. The chi-square test was used in the statistical analysis to compare proportions and a logistic regression model was used to assess the independent effect of the each variable.Results:The study projects a high proportion (42.7% of the patient population) of left ventricular systolic dysfunction in patients with Acute Myocardial Infarction (AMI). No association was found between gender or age and LV systolic dysfunction. The proportion of patients with diabetes mellitus was higher in the sub-group of patients with impaired LV systolic function (45.2% vs. 30.2%, P = 0.01); the proportion of patients with history of current or past smoking was also higher in the sub-group of patients with impaired LV systolic function (48.9% vs. 34.2%, P = 0.03). On the other hand, hypertension and dyslipidemia were not associated with impaired LVEF. After adjustment of other variables, diabetes and smoking were associated with a significantly higher risk of LV systolic dysfunction (diabetes: OR = 3.73; 95% CI = 1.25-11.16; smoking: OR = 3.8; 95% CI = 1.37-11.05).Conclusion:Since the proportion of patients with LV systolic dysfunction in patients with AMI remains relatively high, LV systolic function variables such as LVEF and LVESV should be echocardiographically evaluated in all patients with AMI. Since the post-infarction LV systolic function remains the single most important determinant of survival, treatment of AMI patients should be aimed at limitation of infarct size and prevention of ventricular dilation. Moreover, cardiovascular risk factors such as diabetes mellitus and smoking have a significant impact on the likelihood of impairment of LV systolic function in patients with AMI and hence could influence long-term prognosis.

Study of hair dye poisoning and its outcome in tertiary care rural institute

Background: Hair dye poisoning is not rare but is an emerging poisoning in India. The main component of hair dye causing toxicity is para phenylene diamine (PPD). Due to its easy availability and low cost, it is becoming a common mode of self-poisoning in rural area. A prospective study was planned to assess the clinical profile and outcome in patients with hair dye poisoning.Methods: This prospective observational study was conducted on 260 patients of para-phenylene-diamine (hair dye) poisoning, hospitalized in the medical unit of UP Rural Institute of Medical Science and Research, Saifai from January  2011-2014 over a period of  4 years. The diagnosis of PPD poisoning was based on history of ingestion and clinical manifestations. All cases were thoroughly evaluated for different complications and were treated accordingly.Results: Out of 260 cases enrolled, majority were females and were in the age group of 21-30 years. The intent of poisoning was suicidal in 100% cases. Cervico-facial edema was the most common presentation followed by respiratory distress, hypotension and generalised bodyache. Nephro-toxicity was observed in 58.46% cases. Myocarditis was observed in 11.53% cases. Mortality in PPD poisoning was high (21.53%) due to cardiotoxicity and renal failureConclusions: Hair dye (PPD) poisoning is hepato-nephro as well as myo and cardiotoxic.

Chronic complications in newly diagnosed patients with type 2 diabetes mellitus in rural area of western Uttar Pradesh, India

Background: Diabetes is a serious public health problem that threatens the quality of life. Studies have shown that its prevalence is rapidly increasing. In India many studies have been done on diabetes and its complications but most of the studies have been done in urban area. There is limited data on diabetes from rural area. Our study is an attempt to provide data on diabetes in rural area that will guide health care professionals in managing the disease appropriately. The aim of the study was to determine the prevalence of chronic complications in newly diagnosed type 2 diabetes mellitus (T2DM) patients from rural area of western Uttar Pradesh, India.Methods: The study was conducted on 306 newly diagnosed type 2 diabetes mellitus patients. Each patient was screened for diabetic complications, hypertension, dyslipidemia, and body mass index. Standard protocols were used to make the diagnosis of retinopathy, neuropathy and nephropathy.Results: There were 174 males and 132 females. Majority were less than 60 years of age. 20.26% of patients had neuropathy 15.36%, retinopathy and 5.56%, nephropathy. Risk factors of macro-vascular complication such as hypertension, obesity, and dyslipidemia were observed in 38.9, 55.9%, and 54.6% of patients respectively. Coronary artery disease was noticed in 9.15%.Conclusions: Present study shows that high prevalence of micro vascular complications was present at diagnosis along with cardiovascular risk factors among T2DM patient from rural area of western Uttar Pradesh, India.

Relation between non-alcoholic fatty liver disease and ischemic heart disease studied at rural tertiary care centre in Uttar Pradesh, India

Background: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States and other industrialized countries, many study has identified NAFLD as a risk factor not only for premature coronary artery disease and cardiovascular events, but also for early subclinical abnormalities in myocardial structure and function. Aim of this study was to the presence of NAFLD in patients with Ischemic Heart Disease (IHD) and Relation of NAFLD with other risk factors of IHD.Methods: The study group consisted of 150 patients that comply with inclusion criteria and selected of 100 consecutive patients who underwent coronary angiographies. Coronary artery disease was defined as a stenosis at least 50% in at least one major coronary artery. Fatty liver was diagnosed by abdominal ultrasonography (4 stages: Grades 0, 1, 2 and 3). Statistical evaluations were performed using T test, Chi- square test.Results: The present study was done in 100 patients of coronary artery disease divided into two groups i.e. Non NAFLD group n= 62 (62%) and NAFLD group n= 38 (38%). The present study shows that the prevalence of NAFLD was highest (86.8%) in more than 40 years of age group. The present study shows that the prevalence of NAFLD was more in males (84.2%) as compare to females (15.8%). The present study also shows significantly high incidence of metabolic syndrome in patients with NAFLD (23.7%) as compared to Non-NAFLD (3.2%) patients with Coronary Artery (CAD).Conclusions: The presence of fatty liver and its severity should be carefully considered as independent risk factors for IHD. The study results suggest the synergistic effect in between fatty liver and deranged lipid profile for developing IHD. Abdominal ultrasonography may provide valuable information about IHD risk assessment

A study of association of vitamin D deficiency and coronary artery disease

Background: Recently vitamin D has received great interests for its multiple effects on inflammatory system and potential role in atherothrombosis. Coronary artery disease (CAD) is one of the common causes of death and disability in developed countries. Experimental evidence points to the involvement of multiple factors in coronary plaque formation, including vitamin D. The study aimed to examine the association of coronary artery disease with vitamin D level.Methods: 140 patients of CAD (coronary artery disease) and 101 age and sex matched control were enrolled in the study and 25-hyroxyvitamin D (25(OH)D) concentration was measured. All participants were evaluated for presence of conventional risk factors for coronary artery disease. Association of vitamin D level was established after adjusting other risk factors using logistic regression analysis.Results: In our study vitamin D level is significantly lower in patient group (CAD patients) compared with control group (18.2±10.9 vs 28.8±21ng/mL). Vitamin D deficiency was present in 81.4% patient in CAD patients whereas 57.7% in control group. Vitamin D deficiency was found to be an independent predictor of CAD after adjusting effect of other risk factors like hypertension, diabetes, smoking, obesity, high blood cholesterol and level of physical activity with adjusted odds ratio (95% confidence interval) 2.695 (1.148-6.330).Conclusions: In present study patients of coronary artery disease had significantly low level of vitamin D as compared to individual without coronary artery disease. Vitamin D deficiency was found to be an independent predictor of CAD after adjusting other risk factors emphasizing that vitamin D can be a potential risk factor for development of coronary artery disease. 

Correlational study of interleukin-6 with albuminuria in type 2 diabetes mellitus

Background: Individuals with type 2 diabetes display features of low-grade inflammation. Mediators of inflammation such as IL-6 have been proposed to be involved in the events causing as well as progression of diabetes. Diabetic nephropathy is one of the commonest causes of chronic kidney failure throughout the world. Although diabetic nephropathy is traditionally considered a non-immune disease, accumulating evidence now indicates that immunologic and inflammatory mechanisms play a significant role in its development and progression.Methods: This cross sectional study was conducted in the department of medicine, UPUMS, Saifai. The study was conducted from June 2018 to February 2019. A total of 80 type 2 diabetes patients were included in the study. After informed consent, patients were recruited. FBS, PPBS, HbA1C, 24 Hrs Urinary protein and interleukin-6 levels were measured. The data was analysed using SPSS 23. Pearson co relation co efficient was determined between IL -6, HbA1c and Urinary protein.Result: A total of 80 type 2 diabetes patients were studied. The study subjects were divided into 3 groups based on the urinary protein level into normo-albuminuria, Micro- albuminuria and macro- albuminuria. FBS, PPBS, HBA1c, 24 Hrs Urinary protein and Interleukin – 6 were significantly associated with proteinuria (p<0.001). Urinary protein was positively correlated with IL-6 (R2=0.57, p<0.01). The blood glucose was positively correlated with IL-6 (R2=0.413, p-0.01).Conclusion: Raised IL-6 levels in diabetics revealed the presence of inflammation. Our study showed positive correlation between IL-6, HBA1c and Urinary protein

Association of subclinical hypothyroidism and HbA1c levels in non-diabetic subjects attending rural tertiary care centre in central India

Background: Subclinical hypothyroidism is defined as an elevated serum TSH level and normal concentrations of free T3 (FT3), free T4 (FT4), T3 and T4. A positive association between thyroid and diabetes mellitus is well recognized but to study the effect of thyroid disorders on glucose metabolism in non-diabetic patients is an area for extensive research. Present study was planned to assess correlation between subclinical hypothyroidism and glycosylated haemoglobin levels in non-diabetic patients.Methods: A case-control study was conducted on total 209 subjects. 109 patients were allotted in case group and 100 in control group. Controls were relatives and friends of patients who were matched for age and sex. Comparison between the case and the control groups were made using Student’s t-test (unpaired) and Box and Whisker Plot and regression graph were presented for correlation between serum TSH and HbA1c.Results: It was found that there was a positive correlation between the levels of serum TSH (µU/L) and HbA1c (%) in all the participants of the study by Pearson’s correlation coefficient (r=0.35, p < 0.0001).Conclusions: HbA1c levels are increased in subclinical hypothyroid patients. The effects of the elevated levels of Serum TSH on the HbA1c must be considered when interpreting the HbA1c for the diagnosis of diabetes or pre-diabetes in the subclinical hypothyroid patients

A case of resolution of inferior wall myocardial infarction and varying degrees of atrioventricular block: a case report

Inferior wall myocardial infarction (IWMI) complicating with high degree atrioventricular (AV) block had been a subject of discussion for a long time. Also the transient nature of these AV blocks in the presence of IWMI is well known to us. However our case presented with IWMI with right ventricular MI (RVMI) and in complete heart block and subsequently post thrombolysis developed varying degrees of AV block and reverted back to sinus rhythm. We found it as an incidence not much reported and thus reporting the case herewith

Association of lipid abnormalities with thyroid dysunction in patients of subclinical hypothyroidism

Background: Dyslipidemia is thought to associated with the risk of cardiovascular disease development. Overt hypothyroidism is associated with lipid abnormalities. However, the relationship between subclinical hypothyroidism (SCH) and pattern of lipid abnormalities is not well eastablished. The aim of this study was to find the lipid abnormalities in patients of subclinical hypothyroidism (SCH) and determine relationship between lipid level and TSH. Methods: Serum lipid levels of 92 patients with subclinical hypothyroidism (SCH) and 110 age and sex matched healthy controls were evaluated in this cross sectional case control study. Results: In this study total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were significantly higher (p value&lt;0.05) in patients with subclinical hypothyroidism (SCH) as compared to control group. Triglycerides (TG) and very low density lipoprotein cholesterol (VLDL-C) were also increased in these patients as compared to control but the difference was not statistically significant. High density lipoprotein cholesterol (HDL-C) was found to be marginally lower in these patients than control. Conclusions: Total cholesterol (TC) and low density lipoprotein (LDL-C) are higher in patients with subclinical hypothyroidism (SCH) as compared to healthy controls

A study of Helicobacter pylori infection in patients of ischemic cerebro vascular stroke

Background: The objective of the study was to study the prevalence and association of Helicobacter Pylori infection in patients of ischemic cerebrovascular stroke. Observational analytic cross sectional study.Methods: Seroprevalence of infection by H. pylori was assessed by History, examination, CT scan Brain, Rapid Urease Test and Elisa in 39 patients with acute cerebral ischemia and 30 age and sex matched control subjects selected randomly from general population with similar socio economic status. The presence of carotid plaques instability was evaluated by color doppler ultrasound.Results: Hypertension (61.54%) and previous history of cerebral ischemia are clinically significant leading cause of cerebral ischemia among the patients (p 0.05).Conclusions: Our results support the hypothesis of an association between infection with H. pylori and acute cerebral ischemia and there is no significant association found between H. pylori seropositivity and carotid plaque instability.