Cardiac autonomic neuropathy in diabetes mellitus

Background: The present study was conducted with an objective to study the prevalence of cardiac autonomic neuropathy (CAN) in patients with diabetes mellitus (DM) and its relation to duration, severity of DM, patient's age and BMI.Methods: This hospital based prospective study was conducted from August 2015 to September 2017, at M.K.C.G. Medical College Hospital, Berhampur, Odisha, India. Cross sectional study was design. A total number of 100 diagnosed patients of diabetes mellitus who were admitted in hospital or attended on OPD basis were taken for the study. Detailed history, clinical evaluation, laboratory investigations were carried out. The diagnosis of CAN was made by autonomic function tests. The CAN score of each patient was analysed. Database were generated based on age, duration of diabetes, severity of DM and BMI.Results: Out of 100 diabetic patients, 40 patients (23 males and 17 females) were selected for final analysis after excluding conditions causing cardiac autonomic neuropathy other than diabetes mellitus. All the patients were in the age group 21 to 70years. In the present study it was found that 57.5% of patients with DM had CAN and its incidence increased with severity of hyperglycemia, duration of DM, BMI and age of the patient.Conclusions: Cardiac autonomic neuropathy is a common and early complication of DM. Proper history taking to identify the symptoms related to CAN and performing simple autonomic tests in all patients of DM can identify cardiac autonomic neuropathy

Role of adenosine deaminase and lymphocyte/neutrophil ratio in the diagnosis of tuberculous pleural effusion in patients with exudative pleural effusion

Background: Present study was conducted with an objective to evaluate the role of ADA and lymphocyte/neutrophil ratio in the diagnosis of tuberculous pleural effusion in patients with exudative pleural effusion and to analyze the cause of non-tuberculous exudative pleural effusion.Methods: This hospital based observational study was conducted from August 2011 to September 2013 with a total number of 120 patients of exudative pleural effusion who were admitted in medical wards of MKCG Medical College Hospital, Berhampur, Odisha, India. Patients with transudative pleural effusion, age less than 12years and those who were haemodynamically unstable were excluded from the study. Statistical analysis was done using standard statistical techniques.Results: A total number of 120 patients with exudative pleural effusion were analyzed. 83 patients were males and 37 patients were females. Maximum no of patients were seen in the age group of 21-40 years. Total ADA was found to be >40 U/L in all cases of TB effusion. All cases of TB effusion were lymphocyte predominant with L/N ratio > 0.75. In case of exudative pleural effusion due to non-tuberculous etiology L/N ratio was 0.75 in 97 patients of tuberculous effusion and none of the non-tuberculous effusion. Combined use of ADA and L/N ratio is more efficient means for diagnosing tuberculous pleural effusion than the use of ADA alone

Superior vena cava syndrome: a case report of a rare form of presentation

Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with severe reduction in venous return from the head, neck and upper extremities. It is a medical emergency. Obstruction to the SVC may be caused by neoplastic invasion of the venous wall associated with intravascular thrombosis or, more simply, by extrinsic pressure of a tumour mass against the relatively thin-walled SVC. More than 80% cases of SVCS are caused by malignant mediastinal tumours. We present a 42-year-old female patient who was admitted with 15 days history of swelling of face, neck and upper limbs and dyspnea of 5 days duration at MKCG Medical College Hospital, Berhampur, Odisha, India. The patient was diagnosed as a case of Non-Hodgkin's Lymphoma (NHL) which is a rare form of presentation. In this case report we would like to highlight that although lung carcinoma being the most common cause of acute superior vena cava syndrome, other malignancies like NHL should also be kept in mind and the importance of a detailed history, clinical examination and thorough investigations cannot be over emphasised

Clinical and investigational study for the aetiological evaluation of patients in nontraumatic altered sensorium and its outcome

Background: Apart from head injury many patients present to the tertiary care hospital in unconscious state, the etiology of which is obscure in most of the cases. The present study was conducted with on objective to provide insight into the clinical features and diagnostic methods to know the aetiology of patients with non-traumatic cases of altered sensorium and to study the outcome of these patients.Methods: This is an observational study on 100 patients of altered sensorium of non-traumatic origin during the period from October 2012 to September 2014 conducted in the Department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. All patients were selected for the study based on the inclusion exclusion criteria. Detailed history, clinical evaluation, laboratory investigations like neuroimaging studies etc. were carried out. Statistical data analysis was done using Graph pad Prism 6 and Microsoft Excel. P value <0.0001 was considered statistically extremely significant.Results: Out of 100 patients of altered sensorium, 64 were males and 36 were females. All patients were in the age group of 19 to 89 years. Cerebrovascular accident was the most common aetiology of altered sensorium followed by metabolic encephalopathy and infection. Altered sensorium in patients with CVA carries a high mortality. Metabolic causes and younger age indicated a better prognosis, patients with low (Glasgow Coma Score) GCS score of 3 to 4 had poorer prognosis.Conclusions: The results suggest that clinical assessments yield accurate predictive information about the potential for recovery in cases of altered sensorium. So, this study concludes that empirically based estimates of prognosis in the neurologically severely ill provides great reassurance to those involved in a decision-making process, including patients’ families and physicians

Reactivity of schiff base, Part-4 : Reaction of 2-/4-hydroxybenzylidene-2- aminobenzothiazole with aniline in microemulsion

721-727Nucleophilic reaction at azomethine center of 2-/4-hydroxybenzylidene-2-aminobenzothiozole by aniline has been investigated in sodium Iauryl sulphate(NaLS)- isobutanol-chloroform-water microemulsion media. The role of hydroxy group at ortho and para positions in the benzene nucleus on the reaction mechanism has been analyzed. The entrapment of aniline by the reacting substrate gets support from the reaction kinetics

Challenges in Accessing and Delivering Maternal and Child Health Services during the COVID-19 Pandemic: A Cross-Sectional Rapid Survey from Six States of India

Background/Objectives: Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. Methods: A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. Results: More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being transportation-related difficulties (n = 99; 46%) unavailability of hospital-based services (n = 54; 23%) and interrupted outreach health services (n = 39; 18.4%). The supply-side challenges mainly included lack of infrastructural preparedness for outbreak situations, and a shortage of human resources. Conclusions/Recommendations: A holistic approach is required that focuses on both preparedness and response to the outbreak, as well reassignment and reinforcement of health care professionals to continue catering to and maintaining essential MCH services during the pandemic