Prediction of Depressed Left Ventricular Ejection Fraction Using Electrocardiogram.

Cardiac Failure is an organ system failure with a time sensitive treatment and is usually due to the failure of the left ventricle. Left ventricular function is most easily calculated by a 2D echocardiogram (ECHO). The 2D echo estimates accurately the ejection fraction(EF) of the heart thus, indicating the functioning of the left ventricle. But because of the restrains in availability of the 2D echo in rural set ups of India, it is essential to develop another method to calculate left ventricular function, which is cheap, rapid and accessible in peripheral settings. The objective of this study to calculate the sensitivity and specificity to predict low ejection fraction by Electrocardiogram (ECG). MATERIAL: This cross-sectional study was conducted in medicine department of B R Ambedkar medical college and hospital in Bangalore, from 1st November, 2019 to 31st August, 2021. The consenting participants underwent ECG and 2D ECHO. The ejection fraction values were obtained from the ECG using the formula (2.808 x QRS complex of aVR + 27.198) and by 2D Echo using the Simpson's method. Comparison of ECG and 2D ECHO derived ejection fraction was done, and the sensitivity and specificity was calculated for prediction of low ejection fraction by ECG, followed by stratification for age. OBSERVATION: A total of 340 subjects were included in this study. it was found that the EF value calculated using the ECG showed a sensitivity of 87.28% and a specificity of 40.12% to predict EF< 50%, with an accuracy of 64.12%. While the sensitivity and specificity to predict very low EF< 35% was 6.06% and 98.91% respectively, with an accuracy of 80.88%. The sensitivity and specificity of ECG to predict low EF was more for ages above 40 years. CONCLUSION: The ECG is found to be a good bedside screening tool of the left ventricle ejection fraction in age groups above 40 years of age. In primary care set ups in developing countries like India, the ECG can be used for decisions regarding emergency management and for referral to a cardiac centre/cardiologist, though it is always suggested to be followed up by a 2D- Echocardiogram whenever indicated. It can also be used to avoid unnecessary expensive testing like 2D ECHO, for patients belonging to poorer socio-economic status.

Clinicoradiological Presentation of Pulmonary Tuberculosis in Patients with Diabetes Mellitus at a Tertiary Care Hospital.

The relationship between TB and DM has been debated. Experts are concerned about the convergence of TB and diabetes epidemics, particularly in low- to middle-income countries like India and China, which have the world's highest TB burden and fastest rising diabetes prevalence. Diabetes mellitus may be related to the rise in TB cases in India. We discuss TB epidemiology, clinical features, microbiology, imaging, treatment, and prognosis. MATERIAL: The data was gathered from out-patients and medical ward patients at B.R. Ambedkar Medical College under NTEP and would be used in this research based on inclusion and exclusion criteria. The patient/attendant gave written informed consent. A comprehensive clinical history, physical examination, and appropriate investigations were performed. STUDY DESIGN: Prospective, observational study. SAMPLE SIZE: 50. Study place: Department Of General Medicine And Department Of Chest Medicine. INCLUSION CRITERIA: Age group >18 years. Sputum positive and sputum negative cases. Clinical diagnosed diabetes both naive and on treatment. EXCLUSION CRITERIA: Age group < 18 years. Pregnant women. Immunocompromised states (HIV positive, Long-term corticosteroid, chemotherapy, post transplant patients, associated oncological disorders). OBSERVATION: The research group had 60% men and 40% females, a 3:2 male to female ratio. 80% of patients were over 40, and 66% were from low socioeconomic backgrounds. Cough with expectoration (90%) was the most common symptom, followed by weight loss (32%), fever (30%), and hemoptysis (4%). Our study's participants comprised 46% smokers and 10% alcoholics. The group had diabetes for an average of 5.4 years and 58 percent had clubbing and 30% had Pallor. The research group's average fasting and postprandial blood sugars were 220.5 and 302.7 mg/dl. The study's HbA1c averaged 9.3. 50% of individuals had lower zone involvement and 36% had middle lung field TB. In 46% of patients, the right side was affected, 44% the left, and 10% had bilateral TB. Infiltrations (50%) and Cavitary lesions (30%) were the most frequent results, with multiple cavities (64.3%). Patients with greater HbA1c (>8%) had more cavities. CONCLUSION: All patients with pulmonary tuberculosis should be screened for diabetes mellitus and should be effectively treated for the same. Patients with coexisting pulmonary tuberculosis and diabetes mellitus have atypical presentations. Chest radiographs of such patients show multiple cavitations with predominant lower lobe involvement. Pulmonary Tuberculosis patients who have diabetes tend to have higher sputum positivity rates and delayed sputum conversion if glycemic levels are poorly controlled.

Prevalence of Dysnatremia in Pulmonary Tuberculosis.

Pulmonary tuberculosis is one of the common diseases with high prevalence of mortality and morbidity in developing countries. It is one of the rare pulmonary infections which can induce hyponatremia and it is important to recognise hyponatremia because of its potential hazards. OBJECTIVES: To assess the serum sodium levels in patients with pulmonary tuberculosis and to establish a relation between the serum sodium levels and its effect on illness in these patients. MATERIAL: This is a single-center prospective observational Study conducted on patients with Pulmonary Tuberculosis, irrespective of treatment, in the department of General Medicine, B. R. Ambedkar Medical College, Bangalore from August 2019 to June 2021after obtaining ethical clearance. A total of 100 patients were enrolled in the study who met the predefined inclusion criteria of age more than 18 years and having been diagnosed with active tuberculosis. The collected data was analysed using student's T test and Chi-Square Test and the analysis was done using SPSS software version 24.0. OBSERVATION: The mean age was 46.46+/- 15.69, with majority of participants in the age group 46-60 years. Gender wise there was male preponderance in our study with 60%. The average serum sodium concentration in our study was 134.20 +/- 5.59 mmol/l, with 44% prevalence of hyponatremia and 4% SIADH Conclusion: Although mild hyponatremia was seen in more than 50% of patients, we found out that hyponatremia in pulmonary tuberculosis is detected in 44% of our patients with male preponderance. The predominant mechanism of hyponatremia was syndrome of inappropriate anti- diuretic hormone secretion (SIADH), which was present in 65% of cases with hyponatremia. Early detection and treatment of underlying electrolyte abnormality can potentially reduce mortality and morbidity associated with tuberculosis and reduce duration of hospitalization. Further research into the prevalence of potassium, magnesium and chloride abnormalities can add to the lacunae of knowledge.