Study of relationship between serum magnesium and carotid atherosclerosis in hemodialysis versus non-hemodialysis dependent CKD patients

Background: Cardiovascular diseases are the most important causes of morbidity and mortality in CKD mainly due to accelerated atherosclerosis. Mg2+ possesses an anti-atherosclerotic effect, because of its anti-inflammatory and antioxidant properties. Mg2+ deficiency promotes hydroxyapatite formation and calcification of VSMC thus leading to accelerated plaque formation. To evaluate relationship between serum Mg2+ level and atherosclerotic changes in CKD patients who are hemodialysis dependent versus who have not undergone hemodialysis. Methods: This hospital based observational cross-sectional study has been carried out in Department of K.P.S Institute of Medicine, GSVM Medical College, Kanpur.58 subjects (29 being dialysis dependent and other 29 who have not undergone dialysis sessions yet. All the subjects underwent routine tests and intima media thickness (IMT) of carotid artery was measured via Doppler study. Results: In our study the mean value of Mg was 2.25 mg/dl + 0.81 with 17 patients had hypomagnesemia. IMT of carotid artery with a mean value of 0.91mm + 0.24, was found to be increased in 16 patients, these were the patients who were on hemodialysis and had lower magnesium levels. Serum Mg2+ was negatively correlated (Pearson correlation coefficient was -0.677 and -0.704) with CIMT with statistical significance as (P<0.001) , only in patients who have underwent series of hemodialysis sessions. Conclusions: We concluded that serum Mg might be considered as a modifiable risk factor of atherosclerosis (and thus, cardiovascular mortality) in Hemodialysis dependent CKD patients

Effect on serum potassium level in patients of diabetic nephropathy on spironolactone and ramipril over follow up period

Background: The study was conducted to evaluate the change in serum potassium level over follow up period in patients of diabetic nephropathy on spironolactone (25 mg) and ramipril (5 mg) and compare the results with diabetic nephropathy patients on Spironolactone (25 mg) alone.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70 yr.) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Inclusion criteria followed in study were Age 30-70 years, diagnosed type 2 diabetes mellitus, serum potassium level <5 meq/l, estimated GFR >30 ml/min/1.73m2 and HbA1c <10%. Exclusion criteria were type 1 diabetes mellitus, impaired glucose tolerance secondary to endocrine disease, exocrine pancreatic disease, SBP >180 mmHg DBP >110 mmHg, UTI, hematuria, acute febrile illness, vigorous exercise, short-term pronounced hyperglycemia, obstructive uropathy, confirmed or suspected renal artery disease by USG doppler study, Serum potassium level >5.5 meq/l. Patients were divided in two groups, group A (n= 28, spironolactone 25 mg and ramipril 5 mg) and group B (n=27, spironolactone 25 mg). Subjects were followed over 12 weeks and baseline and 12-week serum potassium being compared. Other baseline base line laboratory investigation such as serum lipid profile, HbA1c, eGFR, fundus examination, ultrasonography (KUB), serum urea, serum creatinine, hemoglobin, were taken at the starting point.Results: Both the group after receiving respective drug were followed for 3-month duration and serum potassium level measured at end of 3 months. Mean values of baseline and follow up serum potassium for group A and group B were 4.24±0.59, 4.07±0.61 and 4.35±0.55, 4.16±0.61 respectively, p value found to be >0.05 at 95% CI.Conclusions: In the study it was concluded that p value found to be >0.05 at 95% C.I denoting that there is no significant difference between mean value of base line and follow up serum potassium value in both group. None of patients in either group had experienced hyperkalaemia over follow up period though serum potassium level were slightly higher in group A, but this difference was statistically not significant. Follow up period of study should be long enough to comment on safety profile of combining spironolactone and ACE inhibitors in diabetic nephropathy patients

Modified Rockall score: a predictor for outcome in patients presenting with upper gastrointestinal bleed

Background: Upper gastrointestinal bleeding (UGIB) is a life-threatening emergency with an overall mortality rate of around 10%. Complete Rockall score is designed to identify patients who are at greater risk of adverse outcome. The aim of this study was to assess the Rockall score as a predictor of adverse outcome in elderly population presenting with UGIB. Methods: Cross-sectional observational study to be carried out in indoor patients presenting with upper GI bleed and to study the correlation between Rockall score and outcome of patients at GSVM Medical College, Kanpur during 2020-2022. Results: Patients were grouped according to Rockall score with number of patients having score less than 3-13, 3-6-63, more than 6-18. Out of 120 cases, 56 (46.66%) had re-bleeding during hospital stay has an average score of 5.05 and rest 64 (53.33%) did not had re-bleeding and has a score of 4.11. Number of cases requiring having average score <3 has 8.1, score 3-6 has 8.38 and >6 has 9.67 has average hospital of stay (days). Number of cases requiring intensive care were 27 (22.5%) has 5.19 average Rockall score. Out of 120 studied cases, 101 (84.16%) were discharged has 4.29 and 19 (15.83%) were expired has 5.95 average Rockall score. Conclusions: Acute UGIB is a medical emergency and Rockall score is ideal to stratify elderly patients to anticipate outcome and prognosis

Comparison of diagnostic accuracy of APRI and Transient Elastography for prediction of esophageal variceal bleed in liver cirrhosis

Background: Liver Cirrhosis is the end-stage for chronic liver disease. Repeated course of endoscopy is recommended, as this intervention is expensive and often poorly accepted by patients, there is a need for non-invasive methods to predicts the progression of portal hypertension as well as the presence and size of esophageal varices. This study was aimed to assess the APRI and Transient Elastography for predicting esophageal variceal bleed in cirrhotic patients. Objectives of the study were to study Diagnostic accuracy of APRI for Prediction of esophageal variceal bleed in liver cirrhosis, diagnostic accuracy of Transient Elastography for Prediction of esophageal variceal bleed in liver cirrhosis, comparison of diagnostic accuracy of APRI and Transient Elastography for Prediction of esophageal variceal bleed in liver cirrhosis. Methods: It was a Single centre, observational study in 35 patients of chronic liver disease. Patients were included in the study after fulfilling inclusion and exclusion criteria. CBC, LFT, KFT, SE, viral marker, USG whole abdomen, UGIE, Transient Elastography was done. APRI was calculated for every patient. Results: The APRI and Transient Elastography showed moderate diagnostic accuracy in predicting the presence of esophageal variceal bleed. Transient Elastography performed better for prediction of esophageal variceal bleed. Conclusions: The APRI and Transient Elastography showed moderate diagnostic accuracy in predicting the presence of esophageal variceal bleed. They help in starting prophylactic therapy earlier to prevent the bleeding and other complications of varices. These non-invasive parameters can also play an effective role in conjunction with endoscopy in predicting the presence of esophageal varices

Prevalence of subclinical hypothyroidism in patients of chronic liver disease

Background: Chronic liver disease (CLD) is a continuous process of inflammation, destruction, and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism, as well as the synthesis of thyroid binding globulin. A complex relationship exists between thyroid and liver in health and disease. Methods: 103 patients of CLD were included in this study from December 2020 to September 2022. They were classified as per child Pugh scoring after clinical assessment and investigations. Thyroid function profile was measured for all the patients. Results: Among 103 patients, 8 (7.76%) patients were having overt hypothyroidism and 28 (27.18%) patients had subclinical hypothyroidism, while 67 (65.04%) patients had normal thyroid profile levels. There was significant correlation between CTP class and hypothyroidism status of patient (p value <0.001) with 25 (56.81%) patients of CTP class C having subclinical hypothyroidism, while 3 (7.5%) patients of CTP class B had subclinical hypothyroidism and none patient of CTP class A had subclinical hypothyroidism. Conclusions: Our study found that there was increased prevalence of subclinical hypothyroidism in CLD patients which increased with severity of CLD as assessed with CTP class

Correlation between vitamin D and lipid profile in patients with ischemic stroke

Background: This study aimed to investigate the relationship between serum vitamin D level and lipid profile in ischemic stroke patients.Methods: 217 patients with ischemic stroke were selected for analysis between ages 45 and 80 years admitted at our hospital from January 2014 to December 2015. Measurement of serum vitamin-D concentration was made by electrochemiluminescence immunoassay. Confounding variables like diabetes, hypertension, smoking, alcohol, tobacco, BMI, CRP, S. uric acid, duration of sunlight exposure, prior history of drug intake or fracture and S. calcium were considered. 200 age and sex matched controls were taken. The source of data was questionnaires and multiple linear regression analysis and correlation analysis were used.Results: A positive correlation was seen between vitamin D and serum cholesterol, VLDL, LDL, triglycerides, cholesterol/HDL ratio and LDL/HDL ratio but inverse correlation between vitamin D and HDL.Conclusions: In ischemic stroke patients increase in vitamin D is associated with increase in atherogenic lipids

To study the relation between spontaneous bacterial peritonitis and serum ascitis albumin gradient in chronic liver disease patients

Background: About half the patients with cirrhosis develop ascites during 10 years of observation. The present study was designed to study the relation between spontaneous bacterial peritonitis and serum ascites albumin gradient in chronic liver disease patients.Methods: This prospective observational study was done in 55 patients with chronic liver disease attending IPD of tertiary hospital. Based on investigation findings, patients were divided into two groups: Group A-Patients with sterile cirrhotic ascites, Group B- Patients with spontaneous bacterial peritonitis. Detailed history, examination and relevant investigation were done. Data was collected, recorded and statistical calculation was done using in Microsoft excel 2007.Results: Most common presenting symptoms of SBP patients were increasing ascites refractory to treatment (90%), followed by peripheral edema (80%). Jaundice and hepatic encephalopathy was found in 75% and 65% respectively. Serum and ascites albumin levels were lower in Group B (2.54±0.33 and 0.43±0.23 g/dl respectively) as compared to Group A (2.85±0.36 and 0.91±0.31 g/dl respectively) and it was statistically significant. The Mean±SD of SAAG for group A and group B was (1.94±0.36) and (2.09±0.47 g/dl) respectively. This difference was statistically not significant.Conclusions:Study conclude that the development of spontaneous bacterial peritonitis in chronic liver disease patients with sterile ascites is directly proportional to ascitic fluid albumin and serum albumin concentration whereas occurrence of SBP is not affected by variation in SAAG ratio if it is already higher than 1.1 g/dl.

A study to know the serum total testosterone levels in type II diabetes mellitus male patients from North India

Background: Diabetes mellitus is major public health issue facing the world in present century and the prevalence of type 2 diabetes is increasing explosively.  There are various diabetes related complications, one of which is low testosterone levels in men. This study was designed to estimate the serum testosterone level in male patients of type 2 diabetes mellitus.Methods: The patients of type -2 diabetes mellitus were picked up from out-patient and in-patients section of the hospital at random.Results: Seventy male  patients with type 2 diabetes mellitus were enrolled during the study period. The mean age of study population was 56.36±10.26 years (range 36-70), while that of control group patients was found to be 39.80±7.92years. Family history of diabetes was present in 14 (22.2%) patients. The mean HbA1c in study group was 8.83±1.95 %, which was significantly higher as compared to control group with HbA1c 4.82±0.40 %. Among study group, lower serum total testosterone level was observed in 85.7 % cases and normal level in 14.3 % cases. Among control group, lower serum total testosterone level was observed in 6.7 % cases and normal level in 93.3 % cases.Conclusions: The present study highlighted that significant difference in serum total testosterone level has been observed between cases and control groups (X2 =55.7, P=0.0001)

Prevalence of hypothyroidism in type 2 diabetic adult Indian females and its correlation with age, HbA1c, BMI and duration of diabetes

Background: Patients with type 2 diabetes mellitus are more prone to thyroid disorders. Hypothyroidism in them leads to an aggravation of microvascular complications. Screening for thyroid dysfunction in diabetic patients will allow early treatment of hypothyroidism. The aim of this study was to assess the prevalence of hypothyroidism in patients with type 2 diabetes mellitus and its correlation with age, HbA1c, BMI and duration of diabetes. Methods: This was a cross sectional study that was conducted at department of medicine GSVM medical college, Kanpur. 200 female patients with type 2 diabetes mellitus attending the outpatient department without any prior history of thyroid disease, chronic liver disease or acute illness were recruited for the study. Results: Our study describes 14% prevalence of hypothyroidism (subclinical hypothyroidism 13.5%) among 200 diabetic subjects. Hypothyroidism was more common in older age group maximum seen in age group 70-79 years (66.7%). Hypothyroidism was more common in subjects having diabetes for a longer duration; maximum seen in 25-30 years group (40%). No correlation was found between BMI and hypothyroidism. Conclusions: The prevalence of hypothyroidism was 14% among female patients with type 2 diabetes mellitus in this study. Overt hypothyroidism was 0.5 % and subclinical hypothyroidism was more common (13.5%) among the study subjects. Hypothyroidism was more common in older age group. and in subjects having diabetes for longer duration. No corelation was found between prevalence of hypothyroidism and body mass index (BMI)

Study of vitamin D level in patients with different etiologies of chronic liver disease and its correlation with Child Pugh class in a tertiary care centre in North India

Background: Skeletal manifestation in liver diseases represents the minimally scrutinized part of the disease spectrum. Vitamin D has a central role in developing hepatic deficiency of osteodystrophy in patients with chronic liver disease. This study aimed to investigate vitamin D levels and their and their relationship with disease advancement in these patients according to child Pugh-score. Aims and Objectives were study of vitamin D level in patients with different aetiology of chronic liver disease and its correlation with child Pugh score. Methods: This was a cross sectional study conducted over 200 patients after applying inclusion and exclusion criteria in patients with different etiology of chronic liver disease. Results: In our study total (N=200), 152 patients of alcoholic liver disease 41 patients having deficient vitamin D, 79 having insufficient vitamin D level and 32 patients having normal vitamin D level. Patients of chronic liver disease also have negative correlation on vitamin D level with Child Pugh score. In our study it was found that patients having higher Child Pugh score there is more chance of having vitamin D deficiency and insufficiency than the patient’s low Child Pugh score. Conclusions: The prevalence of vitamin d deficiency in patients with CLD was found to be having a significant correlation with increasing CTP score with p value <0.001