Staphylococcus aureus septicemia presenting as disseminated intravascular coagulation - thrombotic thrombocytopenic purpura overlap and thrombus in inferior vena cava, right atrium and right ventricle: a case report

Staphylococcal sepsis following furunculosis and complicated by suspected deep vein thrombosis and septic inferior vena caval, right atrium, right ventricle emboli accompanied by disseminated intravascular coagulation (DIC) - thrombotic thrombocytopenic overlap in a 65 years old lady is presented. She was managed successfully with antibiotics and anticoagulation. The case is reported for its rarity and brings to light the vivid manifestations of septicemia specially staphylococcal

Miller Fisher syndrome/acute motor axonal neuronopathy overlap an atypical manifestation of malaria: a case report

Various types of neurological manifestations are described in P. falciparum/vivax malaria of which Guillian Barre syndrome and its variant like Miller Fisher Syndrome (MFS) and Acute Motor Axonal Neuronopathy (AMAN). We are reporting such an unusual case who presented with five days history of fever and weakness of three days duration. On investigations it turned out to be acute MFS/AMAN overlap with peripheral blood showing mixed infection having heavy parasitaemia of P. falciparum and P. vivax combine. All other causes of acute polyneuropathy were ruled out by history and relevant examination. Patient improved with Artemisinin based Combination Therapy (ACT) and other supportive measures

Correlation of non alcoholic fatty liver disease in patients of coronary artery disease

Background: In NAFLD, increase in factor VIII and a reduction of protein C leads to the progression from steatosis to cirrhosi. The aim was to study the correlation of NAFLD with other associated risk factors of CAD.Methods: A total number of 100 patients of coronary artery disease were assessed for presence of NAFLD, dyslipidemia, metabolic syndrome & diabetes by various laboratory tests.Results: 46% of the CAD patients were found to have NAFLD. 69.6% patients of NAFLD were in the age group of 40-60 years. 21.7% were above 60 years. 91.1% of NAFLD patients were males. Half of the NAFLD patients were diabetic. 21.7% of NAFLD patients were found to have a total cholesterol level >200. Triglyceride level was also high among these patients (58.7%). All the NAFLD patients had LDL <100. 52.2% of them had metabolic syndrome.Conclusions: The study showed a direct correlation between NAFLD & CAD. Metabolic syndrome, diabetes, increased total cholesterol & triglyceride level were also associated with increased risk for CAD. However LDL level was not found to be associated with NAFLD risk

Atrial fibrillation associated with high voltage electric shock in a young healthy female: a case report

Atrial fibrillation is amongst the various arrhythmias resulting after electrical injury but its incidence has been reported to be extremely rare. Here we are reporting a case of 35 years old lady presenting to our Emergency department with atrial fibrillation with fast ventricular rate after accidentally being injured by high voltage electrical current. She was managed successfully with pharmacological cardioversion followed by a period of observation. The rhythm reverted back to normal sinus rhythm on 3rd day. This approach of management is amongst one of the few published cases where patient was managed conservatively

Endothelial dysfunction in patients with metabolic syndrome: a prospective study in a rural institute in India

Background: The objective was to evaluate endothelial dysfunction in patients with metabolic syndrome.Methods: This prospective, cross-sectional, hospital based observational study included 45 patients with metabolic syndrome and 20 age and sex matched controls who attended hypertension clinic, diabetes clinic, general medicine OPD and patients admitted in wards department of medicine, UPRIMS&R, Saifai, Etawah, UP, India. All patients who fulfilled inclusion criteria were subjected to the color Doppler of the brachial artery in the department of radio-diagnosis of the same institute.Results: Of the 45 patients with metabolic syndrome included in the study, 22 patients (48.9%) were males and 23 patients (51.1%) were females. Ten males (45.5%) had a waist circumference of >90 cm whereas 20 females (87%) had waist circumference of >80 cm. 9 males (40.9%) had abnormal waist hip ratio whereas 22 females (95.7%) had abnormal waist hip ratio. 43 patients (95.6%) had a SBP >130 mm of Hg whereas 39 patients (86.7%) had a DBP >85 mm of Hg. 24 patients (53.3%) had impaired fasting blood sugar i.e. >100 mg/dl ,25 patients (55.6%) had a TGL level >150 mg/dl, and 9 males (40.0%) had HDL < 40 mg/dl whereas 18 females (78.3%) had HDL value < 50 mg/dl respectively. The mean brachial artery baseline diameter were 3.50 ± 0.39 mm in males and 3.25 ± 0.29 mm in females respectively, FMD percentage was 14.91 ± 3.56 in females and 14.53 ± 4.02 in males, and GTN mediated dilatation were 27.67 ± 9.83% in females and 27.62 ± 6.85% in males respectively.Conclusion: Estimation of Endothelial Dysfunction in patients at risk of developing full blown Metabolic Syndrome may predict the cardiovascular morbidity and mortality in these individuals even before fulfilling the 3/5 criteria of NCEP/ATP III Guidelines for the diagnosis of metabolic syndrome.

Pattern of dyslipidaemia in human immunodeficiency virus infected patients- a study from rural tertiary care hospital in central India

Background: HIV/AIDS is a major health problem affecting the whole globe. With introduction of highly active antiretroviral therapy longevity of HIV patient have increased and they are subjected to high cardiovascular risk as age increases due to various risk factors. Of these dyslipidaemia is one of important risk factor and HIV patients have different degree of deranged lipid profile. Various studies have shown different lipid derangement in these patients but most of them were conducted in urban areas, so this study was conducted to look for lipid profile in HIV patients who are resident of rural areas. Methods: This study was conducted on 66 HIV infected or AIDS cases. Each case was subjected to history taking, through clinical examination and fasting lipid levels. Dyslipidaemia was a classified using NCEP/ATP III guideline.Results: Of total 66 cases, there were 39 male and 27 female with average age of 37 years. Hypercholesterolemia was present in 50% of patients, hypertriglyceridemia in 36.4%. LDL and VLDL were raised in 37.9% and 36.4% respectably while HDL was found below 40 mg/dl in 37.9% of the patients. S. total cholesterol, HDL and LDL was found to have positive correlation while S. TG and VLDL have no significant correlation with CD4 count.Conclusions: Present studies have shown high prevalence of dyslipidaemia in different WHO clinical stage with variable correlation with CD4 count

Prevalence of metabolic syndrome in a rural population- a cross sectional study from Western Uttar Pradesh, India

Background: Prevalence of non-communicable diseases like hypertension, diabetes mellitus and coronary artery disease is on the rise due to the change in lifestyle, unfavourable dietary habits and obesity. Metabolic syndrome is a simple tool by which we can predict the future risk of diabetes mellitus and cardiovascular disease. Studies showed that prevalence of metabolic syndrome is rising in Indian population, but majority of them were done in urban population. This study was conducted to look into the current status of the metabolic syndrome in rural population.Methods: The study was conducted among a population of 2982. Each participant was subjected to clinical examination, anthropometric measurements and necessary laboratory investigations. Metabolic syndrome was diagnosed based on modified NCEP: ATP III criteria.Results: The prevalence of metabolic syndrome was found to be 11.7% and was higher among female population (13.8%) as compared to males (9.6%). The prevalence of metabolic syndrome increased with increasing age. 28.3% of the participants over the age of 50 years had metabolic syndrome whereas it was only 0.4% below the age of 20 years. Nearly half (47.1%) of the obese individuals were suffering from metabolic syndrome implicating obesity as one of the most important risk factors in the etiopathogenesis of metabolic syndrome. The prevalence was only 1.1% among the underweight group.Conclusions: Present study has shown moderate prevalence of metabolic syndrome among the rural population of Western Uttar Pradesh, India with a more female predisposition

Prevalence of type 2 diabetes mellitus in rural population of India- a study from Western Uttar Pradesh

Background: Diabetes is a major challenge for a resource-limited country like India. Majority of the patients are diagnosed late in the course of illness with presence of complications. There is limited data on diabetes from rural India. Present study is an attempt to provide data on diabetes in rural India. The overall objective of present study was to estimate the prevalence of Type 2 diabetes mellitus in rural population above 25 years age in district Etawah and neighbouring areas of Uttar Pradesh, India.Methods: The study was planned to determine the prevalence of diabetes mellitus in rural community by health camp and door to door approach. Fasting capillary blood glucose was first determined using a glucose meter (SD check code free, SD biosensor Inc. Korea). All the adults were given 75gm of glucose dissolved in 200ml water which was drunk over a period of up to 5 minutes and the 2-hour post load capillary blood glucose was estimated. Diabetic status was confirmed by taking blood samples for fasting and postprandial blood sugar levels in a fluoride vacutainer. Fasting plasma glucose ≥126mg/dl and or 2-hour postprandial glucose ≥200mg/dl were taken as the diagnostic criteria for diagnosis.Results: Prevalence of type 2 diabetes in the rural population was found to be 8.03%. Prevalence was higher in female population (9.91%) as compared to males (6.79%). 19.74 % of participants over 70 yrs of age were diabetics while diabetes was present only in 2.95% of participants in the age group of 25-39 year. The maximum number of diabetes were in the age group of 50-59 years. 10.04 % of participants were diagnosed to be Prediabetics. 35.77% of the diabetics were newly diagnosed.Conclusions:Present study shows there is high prevalence of type 2 diabetes in rural area of western Uttar Pradesh, India.

Prevalence of hypertension in rural population of Central India

Background: Hypertension is an important public health problem in both rural and urban areas of economically developed as well as developing nations. It is a chronic medical condition and is one of the most common life threatening non-communicable disease. It is an asymptomatic condition, symptoms do not arise unless the complications develop which result in delayed diagnosis and treatment especially among the uneducated and unexplained social groups such as rural population. Present study was an attempt to provide data on hypertension in rural area of central India. The objective of present study was to estimate the prevalence of hypertension in rural population above 18 years of age in Etawah and neighbouring districts of Uttar Pradesh, India.Methods: The study was planned to determine the prevalence of hypertension in rural community by health camp and door to door approach. BP measurements were made after the subject had rested for at least 5 minutes in a seated position using mercury sphygmomanometer. The first blood pressure measurement was taken after obtaining socio-demographic information from the study subject, while the second was recorded after 5 minutes.Results: The prevalence of hypertension was found to be 17%, which was observed to be higher among female i.e. 170 (18.3%) individuals than males 153 (15.8%) individuals. The prevalence of hypertension was observed to be higher among the older individuals. It was found to be 5.26 times higher in older (>50 years) than the younger (<30 years) age group. We found prehypertension in 65.74%, Stage I hypertension in 11.33% and stage II hypertension in 5.69% individuals.Conclusions: Present study showed that high prevalence of hypertension in rural area of Western Uttar Pradesh, Central India

Correlation of non alcoholic fatty liver disease in patients of coronary artery disease

Background: In NAFLD, increase in factor VIII and a reduction of protein C leads to the progression from steatosis to cirrhosi. The aim was to study the correlation of NAFLD with other associated risk factors of CAD.Methods: A total number of 100 patients of coronary artery disease were assessed for presence of NAFLD, dyslipidemia, metabolic syndrome &amp; diabetes by various laboratory tests.Results: 46% of the CAD patients were found to have NAFLD. 69.6% patients of NAFLD were in the age group of 40-60 years. 21.7% were above 60 years. 91.1% of NAFLD patients were males. Half of the NAFLD patients were diabetic. 21.7% of NAFLD patients were found to have a total cholesterol level &gt;200. Triglyceride level was also high among these patients (58.7%). All the NAFLD patients had LDL &lt;100. 52.2% of them had metabolic syndrome.Conclusions: The study showed a direct correlation between NAFLD &amp; CAD. Metabolic syndrome, diabetes, increased total cholesterol &amp; triglyceride level were also associated with increased risk for CAD. However LDL level was not found to be associated with NAFLD risk