Low Serum Testosterone Levels in Male Patients with Type 2 Diabetes Mellitus as a Risk Factor for Coronary Artery Disease.

BACKGROUND: Diabetes mellitus is a chronic debilitating illness associated with several complications of which hypogonadism in male patients with type 2 diabetes mellitus (T2DM) is often overlooked but carries a high prevalence and possibly associated with several co-morbidities. OBJECTIVES: To study the correlation of serum testosterone with clinical and biochemical factors in male patients with type 2 diabetes mellitus. METHOD: In our cross-sectional study, we selected a group of 100 patients with type 2 diabetes mellitus (50 each with hypogonadism and 50 with eugonadism) and obtained their biochemical parameters and looked for the prevalence of co-morbid conditions. We did a correlation of serum testosterone with each quantitative variable using Pearson's Coefficient of correlation and multivariable logistic regression analysis was applied. RESULT: Serum testosterone levels were found to be correlated with age, waist circumference, fasting blood sugar, serum triglycerides and eGFR (p<0.05).The prevalence of coronary artery disease was higher in T2DM male patients with hypogonadism as compared eugonadal patients. We found higher odds (1.33 times) for coronary artery disease in male patients with hypogonadism and T2DM as compared to males with T2DM and eugonadism. CONCLUSION: There is a higher risk of coronary artery disease in male patients with T2DM and hypogonadism as compared to males with T2DM and eugonadal status.

Dengue Encephalopathy in Hadoti Region: Clinical Presentation, Diagnostic Evaluation, Management and Outcome.

BACKGROUND: Dengue viral infection is common worldwide. Recent studies have shown dengue viral infection causing encephalopathy, with high morbidity and mortality. Dengue encephalopathy patients usually present with altered sensorium, elevated lab parameters and high antibody titres at the time of admission. Dengue infection was very common and virulent in Hadoti region during August to November 2017 and many patients presented with encephalopathy. AIMS: To study the clinical presentation, lab parameters and other diagnostic features, management and outcome of patients of dengue fever with encephalopathy in Hadoti region in August to November 2017. SETTINGS AND DESIGN: The study was done in Govt Medical college Hospital Kota and other multi-speciality hospitals of Kota. Study population comprised of 60 patients presenting with febrile illness and thrombocytopenia, serologically proved to be having Dengue fever. Among these 60 patients, 30 patients had encephalopathy who presented with altered sensorium, seizures or any other neurological symptoms and remaining 30 had no signs and symptoms of encephalopathy. RESULTS: Among 30 patients with encephalopathy and positive serology (NS1/IgM/ IgG), fever and altered sensorium was most common symptom, while amongst patients without encephalopathy fever with chills and generalised bodyache was more common clinical feature. Convulsions and respiratory distress were very common among encephalopathy patients. Out of 30 encephalopathy patients 16 patients (53%) had convulsions, 14 (46%) had respiratory distress, 17(56%) had shock and 3 patients (10%) had hemiplegia. 2 patients also had visual blurring and dysarthria. Mean duration between appearance of fever and altered sensorium was 4.6 (±2.1) days. Most of patients with encephalopathy had deranged hepatic (bilirubin, SGOT, SGPT), renal (urea, creatinine, decreased urine output) and coagulation parameters (PT/INR, bleeding manifestations). 9 (30%) patients died and 21(70%) patients improved with complete recovery (except 3 hemiplegic patients). CONCLUSION: Increased incidence of dengue fever with encephalopathy in the recent years, in the absence of single sensitive test for detecting dengue encephalopathy, variable CSF and MRI Brain features, and associated high morbidity and mortality poses a big problem for clinician. This study may be helpful in focussing on early diagnosis and aggressive initial management which can influence final outcome.

ECG Changes in Young Healthy Smokers: A Simple and Cost-Effective Method to Assess Cardiovascular Risk According to Pack-Years of Smoking.

OBJECTIVE: To document the prevalence of ECG abnormalities in young healthy smokers and compare ECG changes in smokers, young healthy non-smokers and amongst smokers with different pack years. METHODS: This was a prospective case-control study consisting of 200 young healthy male and female individuals, 150 smokers and 50 non-smokers between ages 25-40 years, further categorized and compared according to age, sex and pack years of smoking. The ECG recordings were analyzed for different ECG parameters like heart rate, P-wave duration, P-wave amplitude, PR interval, QRS duration, RR-interval, ST-segment duration, QT interval and QTc interval. The results were compared using statistical tools. RESULTS: In present study abnormalities in ECG parameters were significantly more prevalent in smokers as compared to non-smokers (56.66 % Vs 6.00 %) (p <.0001). Heart rate and QTc-interval increased with increase in the number of pack-years. This increase was reflected more in female with a similar number of pack years. P-wave amplitude tended to increase with increase in the number of pack years more so in males. P-wave duration, PR-interval, QRS-duration and RR-interval tended to decrease with increase in the number of pack years more so in females with similar number of pack years. QT-interval and ST-segment duration tended to decrease with increase in the number of pack years more so in males. CONCLUSIONS: ECG abnormalities in this study indicate cardiovascular risk in term of cardiac arrhythmia, pulmonary arterial hypertension, heart blocks etc in such subjects. As this procedure is non-invasive and cost effective it is potentially an effective and yet a simple method for cardiovascular risk evaluation in smokers. Furthermore, such ECG abnormalities may guide the clinician for risk evaluation in smokers and may be used to convince the smokers to quit smoking.

Study of Effectiveness of Convalescent Plasma-therapy in Moderate to Severely ill COVID-19 Patients

Background : Convalescent Plasma-therapy, a classic adaptive immunotherapy used in the treatment of SARS, MERS and 2009 H1N1 pandemic with acceptable efficacy and safety in the past. Convalescent Plasma-therapy was taken into consideration in management of COVID-19 disease during the initial days of pandemic but was withdrawn later due to its doubtful beneficial role. This study aims to explore the beneficial role of Convalescent plasma and to determine whether Convalescent Plasma-therapy holds a second chance in treating SARS-CoV-2. Methods : This cross-sectional observational study includes 82 cases of moderate to severely ill COVID-19 patients who received Convalescent Plasma-therapy and 41 controls who didn抰. regular monitoring of Total Leukocyte Count (TLC), PaO2/FiO2 (PaO2 is partial pressure of Oxygen in arterial blood, fractional inspired oxygen (P/F ratio), Neutrophil to Lymphocyte Ratio (N/L ratio) inflammatory markers, respiratory rate, oxygen saturation, ABG and Radiological Imaging was done for comparative analysis. Results : In case group 39 patients (47.56%) were on oxygen mask, 17 patients (20.73%) on Non-invasive Ventilation (NIV), 9 Patients on Non-rebrether Mask (NRM) (10.97%), 16 patients (19.51%) on room air, 1(1.21%) on High Flow Nasal Cannula (HFNC) initially. After 7th day of Convalescent Plasma-therapy 49 patients (59.75%) were on room air which suggests significant improvement in mode of ventilation in case group as compared to Control Group. Mean respiratory rate in case group was 30.46 Cycles Per Minute (CPM) initially and 24.7 CPM on day 7th of Plasma-therapy which is statically significant. Conclusion : Plasma-therapy is effective if given in early stage of disease and Convalescent Plasma donors having adequate antibody titre.

A comparative study of serum uric acid level in various acute coronary syndromes and its short term prognostic significance using KILLIP classification

Background: Serum uric acid is increased in ischemic conditions and is significantly higher in patients with acute myocardial infarction. The aim of study was to correlate serum uric acid level with KILLIP class in respect of mortality and morbidity profile of patients with acute coronary syndromes..Methods: 100 patients fulfilling the standard diagnostic criteria for acute coronary syndromes on the basis of classical history, clinical signs, ECG changes and biomarkers were included in the study. Age and sex matched 50 normal healthy subjects were also included as control group after obtaining informed consent. Serum uric acid level was measured on day 0, 3 and 7 of various ACS.Results: There was statistically significant higher level of serum uric acid concentration in patients of AMI on day of admission as compared to controls and unstable angina patients. On all three days of serum uric acid estimation, the serum uric acid levels were higher in AMI patients who were in higher KILLIP class as compared to lower KILLIP class group. Smokers had significantly higher baseline serum uric acid but age, sex, dyslipidemia, hypertension and diabetes mellitus did not significantly affect serum uric acid level at any stage in various ACS patients. Five patients who died during hospital stay, had serum uric acid level more than 7.0 mg/dL and all of them were in KILLIP class III and IV.Conclusions: serum uric acid level is a strong and independent risk factor in predicting mortality and morbidity profile of patients of acute myocardial infarction. Also, serum uric acid level correlates well with KILLIP class.