Basal-bolus insulin therapy during switching over from continuous intra venous regular insulin to sub cutaneous insulin therapy as compared to conventional regimens in type-2 diabetes patients admitted

Background: According to the World Health Organization (WHO), over 347 million people worldwide have diabetes. Latest estimates reveal that 25.4 million Americans have diabetes mellitus (DM), with up to 95% of those having type 2 DM. This study was done to know the effects of Glargine insulin plus human regular insulin on blood sugar control while switching over from continuous IV insulin infusion to SC route as compared to conventional SC insulin regimens in CCU setup.Methods: 65 patients of T2DM were included this study. Detailed history, physical examination and relevant systemic examination were performed and necessary lab investigations were done.Results: The mean age was 49.52±10.16. Mean FPG on 1st Day: The p value of B-B against PRE is significant. Mean FPG on Day of discharge: The p value of B-B against PRE is significant and B-B against NPH is also significant. Mean FPG 2Weeks after discharge: The p value of B-B against PRE is significant and B-B against NPH is also significant. Mean PPPG on 1st Day: The p value of B-B against NPH is significant. Mean PPPG on day of discharge: The p value of B-B against PRE is significant. Mean PPPG 2weeks after discharge: The p value of B-B against PRE is significant. Hypoglycemia was occurring in 25, 15, and 25 in BB, NPH, and PRE group respectively. The p value is significant when NPH compared to PRE.Conclusions: B-B regimen was better than other regimen for controlling FPG and PPPG. The insulin dose was high in NPH regimen compared to both B-B and PRE regimens. 

Etiological study of generalized lymphadenopathy in a tertiary care hospital

Background: This study was done to know about the clinical biochemical as well as radiological profile of patients presented as generalized lymphadenopathy in a tertiary care centre and to know the different causes of generalized lymphadenopathy.Methods: 116 patients of generalized lymphadenopathy were included this study based on the inclusion and exclusion criteria. Detailed history, physical examination and relevant systemic examination including detailed examination of lympho-reticular system were done as per a structured proforma and necessary lab investigations were done for confirming diagnosis.Results: Among 116 patients of generalized lymphadenopathy 59.5% were non-malignant causes where 40.5% diagnosed as malignant causes. Among them tuberculosis consist of 39 (33.6%), NHL 18 (15.5%), reactive lymphadenopathy 16 (13.8%), CLL and HD 8 (6.9%) each, ALL 7 (6%), SLE 5(4.3%), Kikuchi’s disease 4 (3.4%), AML and RA 3 (2.6%) each and castleman’s disease, phenytoin lymphadenopathy, metastatic lung and breast carcinoma 1 (0.9%) each. Cervical groups of lymph nodes were most commonly involved 86 patients (74.1%) followed by axillary groups 73 patients (62.9%). Lymph nodes size 1.5cm were due to malignant and non-malignant granulomatous cases. FNAC give definite diagnosis 80.9% malignant cases where 76.8% in non-malignant cases. HPE shown definite diagnosis in 100% cases both malignant and non-malignant diseases.Conclusions: Tuberculosis is most common cause of generalized lymphadenopathy followed by lymphoma. And reactive lymphadenitis is also an important consideration.

A study of stroke patients with respect to their clinical and demographic profile and outcome

Background: The incidence of cerebrovascular diseases increases with age and the number of strokes is projected to increase as the elderly population grows, with an effect of doubling in stroke deaths in the United States by 2030. This study was done to know the clinical demographic profiles and outcome of the patients presented with stroke in a tertiary care centre.Methods: 501 patients of stroke were included this study. Detailed history, physical examination and relevant systemic examination including detailed examination of neurological system were performed and necessary lab investigations were done.Results: Among 501 stroke patients 90 (18%) patients were of young and 236 (47.1%) of elderly (>60years). Among them 435 (86.8%) were hypertensive and 130 (25.9%) had H/O diabetes and 160(75.83%) had dyslipidemia. In CT scan or MRI of brain, 125 (25%) had lacunar infarction, 76 (15.1%) had non-lacunar infarction, 180 (35.9%) had parenchymal hemorrhage with no ventricular extension and 120 (24%) had parenchymal hemorrhage with ventricular extension. All patients who expired (n=95) presented with poor GCS (≤8) on admission regardless of the stroke subtypes. Among all lacunar infarctions, 92% occurred in hypertensive individuals and among all hemorrhagic strokes, 93.33% occurred in hypertensive patients. Non-lacunar infarction is the most common type of stroke among non-hypertensives (54.55%). And infarction is the most common type of stroke events in diabetics.Conclusions: Stroke can occur at any age, but the elderly persons are more commonly affected with a slight predilection to male. The hemorrhagic stroke outnumbers the ischemic stroke mainly because of uncontrolled hypertension. The GCS at presentation can predict the stroke outcome. Risk factors of stroke include Hypertension, smoking, high cholesterol and Diabetes, obesity, lack of exercise, and genetic factors

Left ventricular dysfunction in chronic obstructive pulmonary disease

Introduction: The prevalence of LV dysfunction is probably high in COPD patients because this condition shares common risk factors.The diagnosis of left heart failure is difficultin the early phases of COPD and also during exacerbation due to similarities in signs and symptoms. Bio-markers like hsCRP is found to be elevated in stable phase as well as in exacerbation of COPD. Objectives: To assess LV Dysfunction(Systolic and Diastolic) and to correlate Age, Symptoms, Duration and stage of illness, CRP with LV Dysfunction. Methods: Total 100 patients of which 50 were age and sex matched controls not having COPD complying with Inclusion and Exclusion Criteria. After taking history and clinical examination they were evaluated for COPD and Left ventricular Dysfunction using PFT and Echocardiogram. Results: Out of 50 patients, 37 patients (74%) had Diastolic dysfunction, of them 2 patients hadSystolic dysfunction also. 13 patients were normal.In the control group only 4 had Diastolic Dysfuncion.CRP was high in 35% (70%) of patients. In the higher age group of 50-60 years Diastolic dysfunction was significant. In patients of GOLD stage IV 5 out of 5 patients (100%) whereas in GOLD stage I and II it was in 1 case (16.66%) and21 case (80.76%) respectively. While comparing with the control group incidence of LV dysfunction parameters and CRP is more in case group. Conclusion: There is increased incidence ofLV Diastolic dysfunction and also with advanced GOLD stage.CRP also correlates well LVDD. Therefore it is pertinent to explore LVDD in all patients with acute exacerbation of COPD and advanced disease stage

A study of stroke patients with respect to their clinical and demographic profile and outcome

Background: The incidence of cerebrovascular diseases increases with age and the number of strokes is projected to increase as the elderly population grows, with an effect of doubling in stroke deaths in the United States by 2030. This study was done to know the clinical demographic profiles and outcome of the patients presented with stroke in a tertiary care centre.Methods: 501 patients of stroke were included this study. Detailed history, physical examination and relevant systemic examination including detailed examination of neurological system were performed and necessary lab investigations were done.Results: Among 501 stroke patients 90 (18%) patients were of young and 236 (47.1%) of elderly (>60years). Among them 435 (86.8%) were hypertensive and 130 (25.9%) had H/O diabetes and 160(75.83%) had dyslipidemia. In CT scan or MRI of brain, 125 (25%) had lacunar infarction, 76 (15.1%) had non-lacunar infarction, 180 (35.9%) had parenchymal hemorrhage with no ventricular extension and 120 (24%) had parenchymal hemorrhage with ventricular extension. All patients who expired (n=95) presented with poor GCS (≤8) on admission regardless of the stroke subtypes. Among all lacunar infarctions, 92% occurred in hypertensive individuals and among all hemorrhagic strokes, 93.33% occurred in hypertensive patients. Non-lacunar infarction is the most common type of stroke among non-hypertensives (54.55%). And infarction is the most common type of stroke events in diabetics.Conclusions: Stroke can occur at any age, but the elderly persons are more commonly affected with a slight predilection to male. The hemorrhagic stroke outnumbers the ischemic stroke mainly because of uncontrolled hypertension. The GCS at presentation can predict the stroke outcome. Risk factors of stroke include Hypertension, smoking, high cholesterol and Diabetes, obesity, lack of exercise, and genetic factors

Clinicopathological profile of mediastinal masses in a tertiary care hospital of Eastern India

Introduction:The Mediastinum is the central part of thorax where various organs are located which gives rise to various neoplastic and non- neoplastic lesions.Accurate diagnosis is important to formulate proper therapeutic strategy and predict prognosis. Studies are very few in this part of the country. Objective: To analyse presentation of patients with Meditastinal Mass and to classify according to the location of mass. Also, to document Malignant versus Non-malignant nature oflesions. Methods: Total 33 patients with mediastinal masses diagnosed by Imagingand Histopathological study were taken up consecutively in the study during one year of study. Results: of the 33 cases, 21 were male (63.6%) and 12 were female (36.4%), Male; female ratio being 1.8: 1. Age ranged from 14 years to 72 years maximum of 8 Patients (24.2%) in the 12-20 years of age group. 57% of the masses were malignant and 43% were benign. Most common lesion was Lymphoma in 10 cases (30.3%) followed by8 cases of Thymic tumours (24.2%). Metastatic Carcinoma was found in 6 patients (18.2%) followed by 3 patients of Germ cell tumours.One case each of Neurofibroma, Neurolipoma and 6 are of different less common category. Compartment wise, 9 cases (27.3%) were in Anterior Compartment, 1 (3%) case in Post Compartment, 3 case in superior mediastinum, 6 case in Middle mediastinum. Maximum cases, 14(42.5%) were occupying Multiple Compartments. Most common symptom was cough (72%). Pleural and Pericardial effusions were common complication of malignant lesions contributing 7 out of 19(36%) and 3 out of 19(17%) respectively. Conclusion: Mediastinal masses creates a diagnostic dilemma to the clinician. Uncommon cause of common symptoms like cough and common presentation of pleural or pericardial effusion may have Mediastinal mass behind the screen