Complications of treadmill testing.

Complications occurring in 2,400 treadmill tests are reported, out of which 2107 (87.8%) were on males and 292 (12.2%) on females. The total number of patients with complications was 29 (1.2%) and the types were: acute MI in 2, ventricular tachycardia (sustained) in 3, nonsustained in 7 with ventricular couplets in 3 patients, atrial tachyarrhythmias in four of AVNRT in 2, EAT in 2, SVT with abberancy in 1, SVT (undifferentiated) in 3, bradyarrhythmias in form of sinus bradycardia in 4, hypotension in 4 and AV block in 2. There were no deaths. Only 8 (0.33%) patients required treatment-2 each of acute MI, sustained VT, AVNRT and hypotension, though only 4 of them were hospitalised (2 each of acute MI and VT) and subsequently discharged. Highest incidence of complications was seen in post MI patients (2.01%) followed by those with typical anginal pain (1.9%) and they had more serious problems in form of MI and sustained VT. 55.17% patients with complications were positive for provocative ischaemia as compared to 22.75% positivity in the total. Although 14 (38.2%) patients developed complications at workload of 4-6 METS but 2 achieved load of 10 METS also. Complications were seen mostly during exercise and also during recovery only.

Clinical profile of stroke in relation to glycaemic status of patients.

Present study was undertaken in fifty consecutive patients of acute stroke to assess the role of glycemic status on clinical profile of stroke. Majority of patients (76%) were in age group of 41-70 years. The patients were classified into four groups: euglycemics (33), known diabetics (8), newly diagnosed diabetics (6) and stress hyperglycemics (3). Diabetics as well as stress hyperglycemics had higher prevalence of larger sized severe haemorrhagic stroke with poor outcome and there was positive correlation between them.

Observation of lipid profile and lipoproteins in viral hepatitis and hepatic coma.

Lipid profile and lipoprotein levels were estimated in 35 patients of viral hepatitis, 15 patients of viral hepatitis with coma and in age and sex match 35 healthy controls. The values were compared in different groups. Levels of triglycerides were significantly raised (145.00 +/- 30.70 mg/dl) in viral hepatitis as compared to viral hepatitis with coma (111.40 +/- 16.80 mg/dl) which were similar to controls (110.8 +/- 20.6 mg/dl). Patients who recovered had higher levels of triglycerides (136.0 +/- 30.8 mg/dl) as compared to those who expired (110 +/- 15.72 mg/dl). Total serum cholesterol remained statistically unaltered in both groups. HDLc was significantly decreased in both groups, viral hepatitis (2.23 +/- 6.7 mg/dl) and viral hepatitis with coma (16.52 +/- 2.27 mg/dl) in comparison to controls (62.21 +/- 18.04 mg/dl). The levels were much lower in patients with coma than without coma. Furthermore the values were still lower in patients who expired (15.82 +/- 2.27 mg/dl) than in patients who recovered (24.13 +/- 7 mg/dl). The levels of LDLc were significantly raised in both groups, as compared with each other and in relation to mortality. VLDLc levels were significantly decreased in patients of viral hepatitis (22.13 +/- 5.8 mg/dl) as well as on viral hepatitis with coma (21.89 +/- 4.3 mg/dl). However, no significant difference was observed when compared with each other and in relation to mortality. Thus it may be concluded that isolated low value of HDLc in viral hepatitis may be used as a prognostic indicator.

Plasma lipoproteins in cortical and lacunar infarction.

Plasma lipoproteins in 30 patients of cortical infarction and 20 patients of lacunar infarction were estimated to study the relation of plasma lipids to the risk for ischaemic stroke by comparing clinical and biochemical characteristics of survivors. No significant differences were observed in the concentrations of total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins in both the groups. However patients with lacunar infarction had higher concentrations of high density lipoproteins as compared to patients with cortical infarction. These data suggest that previously demonstrated differences in HDL concentration between patients with ischaemic stroke and control subjects without stroke may be true for patients with cortical infarction but not for patients of lacunar infarction.

A study of nerve conduction velocity in patients on diphenylhydantoin therapy.

Peripheral nerve conduction studies were performed in 30 epileptics, treated with DPH and results were compared with age and sex matched controls. There was significant reduction in the amplitude of sensory nerve action potential of median (26.65 +/- 14.71 mu v) and superficial radial nerve (25.65 +/- 10.08 mu v) (p < 0.001) in DPH treated group as compared to controls, (median nerve 42.64 +/- 15.93 uv and superficial radial nerve 40.72 +/- 24.74 mu v). The results suggest that DPH causes a subclinical distal axonal neuropathy in therapeutic dosage.

A study of aluminium phosphide poisoning with special reference to its spot diagnosis by silver nitrate test.

A total of 45 cases of Aluminium phosphide poisoning were studied from December 1989 to November 1990. Silver nitrate (AgNO3) test was positive in gastric aspirate in all cases (100%) who took fresh tablets and negative in those who took exposed tablets. The test was also positive in breath but had a lower sensitivity. Majority of patients revealed ECG abnormalities.

Comparison of sodium valproate and phenytoin as single drug treatment in generalised and partial epilepsy.

Ninety four patients of generalised and partial epilepsy were randomly assigned to treatment with sodium valproate (49 cases) or phenytoin (45 cases). Serum levels were monitored. Cases were evaluated after 4, 12, 24 weeks of treatment. Both drugs were found to be equally effective in controlling generalised seizures. However, valproate is better in partial seizures. No correlation could be established. Side effects were minor with both the drugs.

Pyogenic meningitis.

Fifty cases with pyogenic meningitis, aged 15 to 72 years, with a male:female ratio of 5:1, were studied. The majority of cases (70%) were in the 15 to 25 years age group. The organisms detected in the 29 culture-positive cases included S aureus (12), pneumococci (9) and meningococci (8). Thirteen patients died; the poor prognostic factors included old age, the presence of coma or shock, CSF sugar below 10 mg/dl or protein above 750 mg/dl and the presence of gram negative organisms in the CSF.

Valproate sodium in epilepsy. A clinical trial including monitoring of drug levels.

Sodium valproate was used as monotherapy in 90 cases with epilepsy who had at least one fit per week, irrespective of the type of seizures. The effect of the drug was evaluated on the basis of change in seizure frequency. Serum valproic acid levels were estimated by homogenous enzyme immunoassay. All the patients with absence (5/5) and myoclonic (3/3) seizures and 80% (42/53) of cases with generalized tonic-clonic seizures, became seizure free. Six of ten patients with only tonic seizures became seizure free. An average daily dose of 19.6 mg/kg provided a mean valproic acid level of 81.4 micrograms/ml in all seizure free patients. No correlation could be established between valproate dose and serum levels. Mild transient side effects were noted. No haematologic abnormality or hepatotoxicity was observed. Valproate sodium effectively controlled seizures in a majority of patients with partial seizures. Serum level monitoring helps to establish an optimal dose to keep the patient seizure free. No correlation could be established between side effects and serum levels.

Lipid profile in smokers.

In this study we observed that all the lipids except HDL cholesterol were higher in heavy smokers and those making for longer duration. HDL cholesterol was lower in smokers than nonsmokers. The changes in lipid profile were similar in cigarette and bidi smokers.

Effect of treatment on systolic time intervals in systemic arterial hypertension.

Twenty six hypertensive patients and 25 control subjects were studied and their systolic time intervals (STI) were measured. It was found that an alteration in STI, signifying left ventricular dysfunction sets in most of the hypertensives earlier than any evidence of left ventricular hypertrophy (LVH) by clinical, radiological or electrocardiographic criteria. The parameters affected are the PEP interval which shows prolongation and PEP/LVET ratio which is increased. After treatment the left ventricular performance was found to improve in those who did not reveal evidence of LVH. Thus STI may be a sensitive indicator of early left ventricular dysfunction in hypertensives and a useful guide to assess improvement after treatment at a stage when other non-invasive methods are not so useful.

Effect of treatment on systolic time intervals in systemic arterial hypertension.

Twenty-six hypertensive patients and 25 control subjects were studied, and their systolic time intervals (STI) were measured. It was found that an alteration in STI, signifying left ventricular dysfunction, sets in most of the hypertensives earlier than any evidence of left ventricular hypertrophy (LVH) by clinical, radiological or electrocardiographic criteria. The parameters affected are the PEP interval which shows prolongation and PEP/LVET ratio which is increased. After treatment, the left ventricular performance was found to improve in those who did not reveal evidence of LVH. Thus, STI may be a sensitive indicator of early left ventricular dysfunction in hypertensives and a useful guide to assess improvement after treatment at a stage when other non-invasive methods are not so useful.