Academia Journal of Medicine (AJM) is an open-access; freely accessible, online and print Bi-Annual peer-reviewed international journal publishes a wide spectrum of advanced research in different fields of clinical medicine, covering etiology, diagnosis, therapy and prognosis aspects. Online ISSN: 2663-8290 | Print ISSN: 2663-8282
Comparison of Dental Defects in Oval Root Canals Prepared with Two Distinct End odontic Rotary Files: An In Vitro Analysis
Aim: This study aims to investigate and compare the occurrence of dentinal fractures during root canal preparation using a scanning electron microscope (SEM). Materials and Methods: Thirty extracted human mandibular premolars were divided into three groups of ten: two experimental groups and one control group. In the experimental groups, root canals were shaped using Group I: the Waldent Walflex file and Group II: the Trunatomy (TRN) file. Group III served as the control group with no canal preparation. After sectioning the roots at 3, 6, and 9 mm from the apex, the surfaces were analyzed using SEM. Results: Data were analyzed using the Chi-square test. The untreated control group (Group III) showed no signs of cracks. Dentinal cracks were primarily observed in the Waldent Walflex group, particularly between the 3 mm and 6 mm intervals. Conclusion: The study highlights that dentinal cracks are more pronounced with the Waldent Walflex file. These findings underscore the need for careful selection of endodontic instruments to minimize the risk of dentinal defects during root canal procedures. Further research is warranted to explore the long-term implications of these findings on treatment outcomes.
Comparative Evaluation of Pain During Local Anaesthetic Administration with Conventional and Custom Modified Syringe in Pediatric Dental Patient: A Clinical Trail
Aim: This clinical trial aimed to evaluate and compare the pain experienced during local anaesthetic administration using a conventional syringe versus a custom modified syringe designed with attractive emojis. The hypothesis was that the custom syringe would decrease anxiety and perceived pain.Materials and Methods: Thirty pediatric dental patients of age 6-8 years were randomly assigned to receive local anaesthesia with either a conventional disposable syringe or a custom modified syringe, decorated with vibrant, engaging emoji stickers. Pain levels were assessed immediately after the injection using the Wong-Baker FACES Pain Rating Scale, allowing patients to express their pain intensity through visual representation. Data were collected and analyzed to compare pain scores between the two groups.Results: The findings indicated that patients using the custom modified syringe reported significantly lower pain scores than those using the conventional syringe. The visual appeal of the custom syringe appeared to reduce anxiety, contributing to a more positive experience during the procedure.Conclusion: The incorporation of attractive emojis on syringes may serve as an effective strategy to reduce pain and anxiety associated with local anaesthetic administration. These findings suggest potential benefits for enhancing patient comfort and compliance in clinical settings. Further research is warranted to explore the long-term impact of such modifications on patient experiences in various medical procedures.
Molecular Biology of Streptococcus Mutans: A Review
Streptococcus mutans is a gram-positive bacterium and a primary etiological agent of dental caries. Its ability to adhere to tooth surfaces and form biofilms is largely attributed to its production of extracellular polysaccharides, primarily through glucosyltransferases. The genome of S. mutans, approximately 2.0 million base pairs long, contains genes that facilitate carbohydrate metabolism, acid production, and stress response mechanisms, enabling the organism to thrive in acidic environments. This bacterium ferments sugars, particularly sucrose, to produce lactic acid, leading to the demineralization of enamel and consequent tooth decay. The regulation of virulence factors is influenced by environmental factors, including pH and nutrient availability, and is mediated through complex regulatory networks and quorum-sensing mechanisms. Advanced molecular techniques, such as gene knockout and proteomics, have been employed to unravel the pathogenicity of S. mutans and identify potential targets for therapeutic intervention. Understanding the molecular biology of S. mutans is crucial for devising effective strategies for the prevention and treatment of dental caries, highlighting its significance in oral microbiology and public health.
Pilates Exercise and Resisted Muscle Training To Hip And Knee Muscle Impairment In Improving Pain And Quality Of Life In Patients With Tibio Femoral Osteoarthritis
Aim: The aim of the study is to compare the effect of pilates exercise and resisted muscle training of hip and knee joint muscles to improve pain and quality of life in tibio femoral osteoarthritis. Method: 50 patients diagnosed with tibiofemoral osteoarthritis were included in the study. The patients were randomly assigned into 2 groups. Group A received pilates exercise on mat for hip and knee joint muscle for 4 weeks and Group B received resisted muscle training using theratube for hip and knee joint muscle for 4 weeks. Pre and post intervention measures for KOOS (Knee Osteoarthritis Outcome Score) scale were observed and documented. Result & Conclusion: The results indicate that both group A and group B shows improvement in all components of KOOS. But when compared between both groups, group A shows more significant improvement in pain and symptom than group B.
Formal Faculty Mentorship at Aga Khan University Medical College and AKU-SONAM: A Comprehensive Triangulation Approach for Improved Outcomes
Objective: To obtain a comprehensive understanding of the mentorship programs in Aga Khan University Medical College (AKU-MC) and Aga Khan University School of Nursing and Midwifery (AKU-SONAM) by the framework of Program Inputs, activities, followed by triangulation of results. Design: Exploratory study Setting: AKU-MC and AKU SONAMParticipants: mentors, mentees, administrators, and leadership from both entities of the university.Data collection comprised of in-depth interviews (IDIs) focus group discussions (FGDs with administrators and leadership Primary outcome: Comprehensive understanding of the mentorship programs in AKU-MC and AKU-SONAM by the framework of Program Inputs, activities, followed by triangulation of results. Data collection comprised of in-depth interviews (IDIs) focus group discussions (FGDs). Triangulation was applied at the level of entities in i) data collection methods; FGD, and document review, ii) participants; mentors, mentees, administrators and leadership, iii) response from investigators; researcher and supervisory team to enhance the rigor of the study. Results: All the participants from both entities agreed that mentorship programs transferred knowledge and skills, enhanced relationships and facilitated networking. A work-driven and Dyad mentorship model was accredited by mentors, mentees, at AKU-MC and AKU-SONAM respectively. Mentorship committees from both entities oversaw mentor and mentee enrolments, matching, and monitoring of activities The constancy of mentor-mentee meeting frequency, and lack of a structured feedback mechanism were identified as challenges. The significance of recognition, rewards, opportunities for higher qualifications and institutional recognition was suggested by all participants. All Mentors and mentees recommended departmental collaborations and networking for meaningful outcomes.Conclusion: The exploration of context of both mentorship programs revealed that financial and logistic resources of both programs need to be amplified. Mentees were given a choice for selection of mentors for pairing however monitoring of activities may be overcome by selecting appropriate mentors and mentees, practical matching for work relationships, and monitoring successful outcome.
Tailoring: The Healthiest Profession –An observational Retrospective study
Background: - It is a proven fact that the job involving sitting for long hours leads to increase in mortality1 and morbidity2 and is one of the major causes of life style diseases. However recently, it is proven that calf muscle pushup3 while sitting causes improved blood sugar level and even fidgeting4,5of legs while sitting has many health benefits and potential to prevent life style diseases. While the tailoring job involves sitting for long hours, but at the same time, action of their feet to make sewing machine work, is synonymous to calf muscle pushups. To work on the sewing machine, they have to continuously move their feet on foot pedal of the machine while sitting. The purpose of this retrospective observational study is to find out if the adverse effect due to long hours of sitting can be mitigated by calf muscle pushups and leg fidgeting. Aim.: To find the status of health condition of tailors (working on sewing machine with foot pedal) Material and Methods Sample Size: A total sample size of 250 tailors from and nearby Kurti Nagar, Meerut UP India, which is the major hub of tailoring business was considered for this study. Tailors of every age group were included (with no age criteria). There were no exclusion criteria. Questionnaire-The following questions were asked from the tailors and the response was recorded through videography. Results: The study revealed that none of the 250 tailors reported any health issues or use of medication. The consistent movement of the feet during tailoring work appeared to have a protective effect against the adverse outcomes of prolonged sitting. Discussion & Conclusion: This study highlights tailoring as a potentially healthier profession among sedentary jobs, owing to the inherent physical activity of operating a sewing machine’s foot pedal. The findings suggest that integrating similar movements into other sedentary occupations could mitigate health risks associated with prolonged sitting.
A Case Report on the Integrative Management of Chronic Kidney Disease: An Ayurvedic Approach
Chronic Kidney Disease (CKD) is a progressively debilitating condition, primarily affecting individuals with diabetes mellitus and hypertension, contributing significantly to global morbidity and mortality rates. As of 2021, CKD has emerged as the 9th leading cause of death worldwide. In patients with CKD, renal function declines gradually over time, often resulting in severe complications. Conventional treatments like dialysis and renal replacement therapy remain financially inaccessible to many, leading to a growing interest in alternative medical systems such as Ayurveda. Ayurveda provides a unique perspective on CKD, categorizing it under Madhyama rogamarga vyadhi, associated with accumulated kleda (excessive bodily fluids) throughout the body. Though the kidney is not explicitly mentioned in classical Ayurvedic texts, it can be correlated with vrikka. The embryological origin of vrikka is linked to medas (adipose tissue) and rakta (blood), which, when disturbed by improper diet and lifestyle, contribute to the pathogenesis of CKD. Ayurvedic management focuses on restoring balance in these dhatus, offering a holistic treatment approach that may complement conventional therapies. A case report of a 57-year-old male diagnosed with CKD stage V in 2010 illustrates the effectiveness of Ayurvedic interventions. The patient, presenting with recurrent vomiting, loss of appetite, decreased urine output, disturbed sleep, constipation, and right lower limb cellulitis, underwent Panchakarma therapy at Jeena Sikho Lifecare Limited Hospital, Derabassi, Chandigarh, in April 2024. He followed an Ayurvedic diet, practiced yoga and made lifestyle modifications, along with Ayurvedic medication, leading to positive clinical outcomes. This case underscores the potential of an integrative Ayurvedic approach to managing CKD effectively.
Impact of Sesame Oil vs Chlorhexidine Mouthwash on Gingivitis: A Randomized Controlled Study
Aim: To evaluate the effectiveness of 0.2% chlorhexidine and sesame oil (SO) in Oil Pulling Therapy (OPT) for patients with gingivitis. Materials and methods: 75 participants were divided at random into group A- Scaling only, B- Scaling with prescribed SO and C- Scaling with Chlorhexidine respectively. Participants were instructed regarding the use of OPT with SO and Chlorhexidine in addition to their regular dental hygiene regimen for 30 days. Results: The mean plaque and gingival index in group B and C was reduced after 1 month compared to baseline scores. Statistically significant variance showed between group A and B and group A and C respectively. OPT decreased gingivitis and plaque after a month but group B and C did not show significant variance. Conclusion: Because oil pulling is a domestic remedy that assists in avoiding gum infections in nations with restricted resources, we need to spread knowledge of it.
Platelet Rich Fibrin (PRF) and Its Applications in Dentistry: A Review
Platelet-rich fibrin has emerged as an innovative biomaterial in dentistry, known for its regenerative properties that facilitate healing in various oral procedures. This review examines PRF’s clinical applications, efficacy, and mechanisms of action in dental treatments, including oral surgery, periodontics, and implantology. PRF is derived from the patient’s own blood, enhancing biocompatibility and reducing the risk of adverse reactions. Current research indicates that PRF contributes to improved soft and hard tissue healing, reduces postoperative complications, and enhances implant stability. Despite its promising potential, challenges such as variability in preparation protocols and the need for standardized clinical guidelines persist. This review advocates for continued research to optimize PRF application and to establish best practices in dental medicine.
In recent years, robotics has emerged as a transformative force in the field of dentistry, revolutionizing many aspects of clinical practice and advancing patient care. This review provides an overview of the current state and future prospects of robotics in dentistry, focusing on applications such as robotic assisted surgery, automated orthodontic procedures, and precision diagnostics. Highlighting technological advancements, we examine how robotics enhances precision, reduces procedural time, and increases safety in dental procedures. Additionally, the review addresses challenges such as high costs, the need for specialized training, and ethical considerations surrounding robotic integration into dental practices. By analyzing current research, this article aims to present a comprehensive understanding of the benefits, limitations, and impact of robotics in dental care. Future prospects and innovations are also discussed, paving the way for an increasingly automated and efficient dental industry.
CBCT in Modern Dentistry: Transforming Diagnosis and Treatment Planning
Cone-Beam Computed Tomography (CBCT) has revolutionized modern den tistry, offering high-resolution, three-dimensional imaging that enhances diag nostic accuracy and treatment planning. This advanced technology provides invaluable insights into dental structures, root canals, bone anatomy, and pathol ogies, resulting in better patient outcomes. By minimizing exposure to radiation compared to traditional CT scans and offering detailed visualization beyond con ventional 2D radiography, CBCT stands as a transformative tool in various dental specialties. This paper explores CBCT’s impact on contemporary dental practices, its advantages, limitations, and future potential in improving dental care. intervention in implantology, endodontics, orthodontics, and maxillofacial surgery.1
Moskowitz syndrome manifesting as recurrent large vessel strokes in a young male-An original research paper
Background: Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening condition characterized by microthrombus formation due to a deficiency of ADAMTS13, which cleaves von Willebrand factor multimers. This deficiency leads to widespread microangiopathic hemolytic anemia and multiple organ involvement, particularly affecting the brain, heart, and kidneys. TTP can present atypically and poses a diagnostic challenge, especially in young patients with neurological symptoms and thrombocytopenia. Early diagnosis and prompt initiation of plasma exchange therapy (PEX) and steroids are critical to reduce mortality. Case Report: A 17-year-old male presented in an altered state with weakness in the right upper arm and bilateral lower limbs for 4 days. He had a history of fever and convulsions 4 days prior, with two previous convulsive episodes in the last two years, both of which had resolved without neurological deficits. On examination, the patient was febrile, tachycardic, and drowsy, with left gaze palsy and significant weakness in the right upper limb and both lower limbs. The patient had lost bowel and bladder sensation, and plantar reflexes were bilaterally upgoing.An MRI of the brain with angiogram revealed acute large vessel occlusion in the bilateral anterior cerebral artery (ACA) territory and gliosis in the right middle cerebral artery (MCA) region. Laboratory investigations showed severe thrombocytope nia (platelet count 23k/cumm), anemia (Hb 6.2 g/dL), elevated LDH (1597 U/L), and increased cardiac troponin (35 pg/mL). The patient was diagnosed with TTP and was promptly started on plasma exchange therapy and high-dose steroids. His sensorium improved within 2 days, though weakness persisted. Plasma exchange therapy was continued daily for 11 days, resulting in gradual improvement.
TTP - Thrombotic Thrombocytopenic Purpura
ADAMTS13 - A Disintegrin and Metalloprotease with Thrombospondin type 1 motif member 13 HUS - Hemolytic Uremic Syndrome
absent kidney injury absence of active cancer presence of mycoplasma
and no other cause of thrombocytopenia score
ISTH - International Society on Thrombosis and Haemostasis
Evaluation of Patients with Dengue Infection for Their Clinical and Hematological Profile, Management and Outcomes at Mount Zion Medical College Hospital in Kerala
Background: Dengue Fever which is also known as break bone fever is a benign syndrome begin by many arthropod– borne viruses, which is specify by myalgia, high grade fever, or arthralgia, rash, leukopenia and lymphadenopathy. Our study was carried out with an aim to describe the different clinical spectrums of dengue with its hematological profile. Subjects and Methods: A total of 130 cases were anticipated with age of all groups, and those who were serologically positive for Dengue tested by ELISA/Card (NS1, IgG, IgM) method were included in this study. Patients found to be serologically dengue negative and positive patients who were also found to be positive for other coexisting infections, viz. malaria, typhoid, etc and not done the clinical test were excluded, so this study included all patients diagnosed with dengue. The examination based on WHO criteria and the case definition was based on compatible clinical history and, confirmed by positive serology for dengue applying the ELISA IgM method. All patients with bleeding manifestations, thrombocytopenia with platelet count < 30,000 cu/mm were admitted and pregnant patients and infants with decrees platelet counts were admitted. Results: Out of a total of 130 cases enrolled in the study a total of 75 (58%) did not have bleeding manifestations and comprised the Group I of study where as remaining 55(42%)patients presented with bleeding manifestations and were placed in Group II of study. Among these 130 patients with confirmed diagnosis, 75were Group I while the rest were Group II giving a Group I to Group II. Their ages ranged from 4 years to 80 years. Conclusion: In the current study the clinical profile of patients having bleeding manifestations which is the extreme form of dengue fever was marked by raised portion of hepatomegaly and decreased platelet count. The clinical course of disease is marked by a rationalization of platelet count by day 5 of illness. Dengue fever does not have specific medical therapy hence clinical recovery monitoring is largely dependent on haematological parameters. This study concludes that parameter like platelet count, haematocrit, leukocyte count and coagulation studies aid greatly in clinical monitoring of patient.
Assessment of Prevalence of Iron Deficiency Anemia among Known Population
Background: The most significant and common cause of anemia is iron deficiency. Hence, we planned the present study to assess the prevalence of iron deficiency anemia among known population. Subjects and Methods: A total of 350 subjects who reported to the department of internal medicine for routine checkup were included in the present study.Blood samples were obtained from all the subjects and were sent to central laboratory for the assessment of blood hemoglobin levels. Criteria described in the past literature were used for categorizing patients with iron deficiency anemia. Females with mean hemoglobin concentration less than 11.5 g/dL, and males with mean hemoglobin concentrations less than14 g/dL were categorized as anemic.6 All the results were analyzed by SPSS software. Results: Overall prevalence of iron deficiency anemia in the present study was 15.28 percent. The overall prevalence of iron deficiency anemia was found to be higher among subjects with more than 60 years of age. Also, significantly higher prevalence of iron deficiency anemia was found among females. Conclusion: Prevalence of iron deficiency anemia was found to be higher among females and illiterates. Therefore health education programs are recommended in future for increasing the awareness of adverse events associated with iron deficiency anemia among general population.
Complications in Pregnancy and Foetal Outcomes in Gestational Diabetes – An Observational Study in a Tertiary Hospital in Nigeria
Background: A retrospective cohort study to compare the pregnancy complications and foetal outcomes in pregnancies complicated by diabetes mellitus. Subjects and Methods: One hundred and eighty five diabetic pregnant patients who delivered at the Department of Obstetric & Gynecology, University of Nigeria, Nsukka. during the 3-year-period formed the subjects of this study. There were 27(14.6%) (type 1) - insulin dependent diabetics, group 1, 19 (10.2%)(type 2), non insulin dependent diabetic patients who constituted group 2 and 139(75.2 %) gestational diabetic patients who made up group 3. Data extracted from the case files included maternal age, gravidity, parity , number of abortions, gestational age at booking, time of diagnosis of diabetes mellitus, complications during pregnancy, birth weight, placental weight. Results: There were no statistically significant differences in the three groups regarding the mean gravidity, parity, birth weight and placental weight (p>0.05). However, statistically significant differences were found with respect to the mean maternal age, gestation at booking, fasting blood sugar, and gestation at delivery (p<0.05). Out of 139 gestational diabetics, 23(16.5 %) were diagnosed by the 14" week of pregnancy while 24(17.2 %) were diagnosed between the 15- 27 weeks of gestation. The control of blood sugar was adjudged to be poor in 32% of gestational diabetics, 50% of type 2 diabetics and 69 % of type I diabetics, with statistically significant difference between the groups, (p<0.05). Although there was statistically significant difference between the groups regarding one of the pregnancy compli- cations( polyhydramnios) (p<0.05), none were found in other complications (p>0.05). The overall caesarean section rate was 48%. The overall perinatal mortality was 5.7%, all the deaths occurred in babies born to patients with gestational diabetes. Conclusion: Gestational diabetes accounted for all the fetal losses in this study, while polyhydramnios was the most common antenatal complication which was significantly higher in type 1 diabetics.
Evaluation of Cardiac Markers in Patients with Myocardial Infarction
Background: One of the major causes of morbidity and mortality worldwide is acute myocardial infarction (AMI). Various cardiac markers have been used from time to time for assessing the diagnosis and prognosis of the disease. Hence; we planned the present study to evaluation of cardiac markers in patients with myocardial infarction. Subjects and Methods: The present study included assessment of different cardiac markers in patients with myocardial infarction. For the present study, ethical approval was obtained from the ethical committee of the institution, and written consent was obtained after explaining in detail the entire research protocol. A total of 20 AMI patient and 20 healthy controls were included in the present study. Fresh blood samples were taken and mean serum creatine kinase (CK), and cardiac troponin (CT) values were assessed and compared. All the results were analysed by SPSS software. Chi- square test was used for assessment of level of significance. Results: Mean value of CK-MB among the patients of the AMI group and the control group was 28 IU/L and 18 IU/L respectively. Mean value of CT among the patients of the AMI group and the control group was 4.8 ng/L and 0.5ng/L respectively. The cardiac biomarkers were found to be significantly raised among the AMI patients in comparison to the healthy controls. Conclusion: These biomarkers are assessable biological variables which function as indices for health analysis.
A Comparative Study of Lipid Profile in Chronic Renal Failure Patients on Dialysis
Background: Chronic renal failure (CRF) is characterized by irreversible destruction of nephrons along with decrease glomerular filtration and suppressed urine. Disturbance of lipid profile in CRF has been found associated with increased triglycerides (TG) and low high density lipids while normal level of total cholesterol (TC) and low density lipids (LDL). Dislipidemia in CRF patients induces cardiovascular diseases (CVD); in addition, CVD in turn leads to more rapid destruction of kidney. Therefore the present study was designed to evaluate the lipid profile in CRF patients with and without dialysis. Subjects and Methods: This was a prospective type of study conducted in the department of medicine of a tertiary care centre. Total 100 patients of CRF patients and 40 normal control subjects were recruited for the study. CRF patients were divided into two groups. Group I consisted CRF patients with dialysis and group II included CRF patients without dialysis. Normal subjects were kept under group III control group. Results: Results of the present study revealed that there was a significant difference between TG, HDL and VLDL of group I (p>0.01) and group II (p>0.01) in comparison of group III. Nevertheless, there was no significant difference between the TC and LDL of all groups. Conclusion: CRF patients either with dialysis or without dialysis have a great possibility of developing dyslipidemia as well as CVD. Dialysis has been found effective in reducing nitrogenous waste products in blood; however, it is not able to decrease lipid profile in CRF patients.
Analysis of Cardiac Profile in Patients with Liver Cirrhosis: An Observational Study
Background: Cirrhosis is defined as the histological development of regenerative nodules surrounded by fibrous bands in response to chronic liver injury that leads to portal hypertension and end stage liver disease.Studies suggested that underlying cardiac dysfunction precedes the development of Hepato-renal syndrome. hence; under the light of above mentioned data, we planned the present study to assess the cardiac profile in patients with liver cirrhosis. Subjects and Methods: A total of 30 liver cirrhosis patients were included in the present study. Routine haematological profile of all the patients was carried was assessed. Transthoracic 2 D echo with Doppler was done in all patients and parameters (Left atrial enlargement, Left ventricular diastolic dysfunction) were assessed. Liver disease was staged according to Child-Pugh’s score. All the results were compiled and analyzed by SPSS software. Results: Significant results were obtained while correlating the patients with left atrial enlargement and severity of liver cirrhosis. Also, significant results were obtained while correlating the patients with diastolic dysfunction and severity of liver cirrhosis. Conclusion: Cardiac parameters are directly correlated with the severity of the disease in liver cirrhosis patients.
Developing a Vaccine for Rheumatic Fever and Rheumatic Heart Disease: Current Research Strategies and Challenges
Rheumatic heart disease (RHD) is the most serious manifestations of rheumatic fever, which is caused by group A Streptococcus (GAS or Streptococcus pyogenes) infection. RHD is an auto immune sequelae of GAS pharyngitis, rather than the direct bacterial infection of the heart, which leads to chronic heart valve damage. Although antibiotics like penicillin are effective against GAS infection, improper medical care such as poor patient compliance, overcrowding, poverty, and repeated exposure to GAS, leads to acute rheumatic fever and RHD. Thus, effort to design a vaccine based on emm gene identification of GAS, M-protein going on for more than 40 years, is unlikely to succeed. M-protein is strain specific. Infection with one strain does not provide immunity from infection with another strain. Based on the emm gene identification, of 250 or more identified strains of GAS, the distribution is heterogenous and keeps changing. The M-protein gene sequence of the organism tends to mutate. A vaccine prepared from available strains may not be effective against a strain following mutation.
Relationship between Glycemic Control in Type II Diabetes Mellitus and Anaemia
Background: Chronic hyperglycemia in uncontrolled diabetes is related to higher incidence of anaemia which goes unrecognized prior to the development of chronic renal failure.This study was conducted to know the prevalence of Anaemia in persons with with Type II Diabetes Mellitus,in relation to glycemic control using HbA1c as a tool to it. Subjects and Methods: 60 Diabetic subjects were divided into two groups of 30 each based on their glycemic control(group A,with poor glycemic control and group B with good glycemic control taking 7% Hba1c as cut off value),incidence of anaemia was measured and compared among them and also with 30 age and sex matched healthy non Diabetic controls. Results: Incidence of anaemia was found to be significantly higher in diabetics group as compared to non diabetics and among diabetics it was significantly higher in uncontrolled group as compared to group with controlled diabetes. Conclusion: Good glycemic control in diabetes is associated with a better haemoglobin levels,hence it is desirable to evaluate the haemoglobin level often to monitor the micro and macrovascular complications of diabetes even when the renal parameters are normal.
Assessment of Cases of Stroke in Emergency Department
Background: One of the leading causes of death and adult disability among general population is stroke. The efficacy of acute stroke treatment is very time dependant. This includes both pharmacological and mechanical thrombolysis. Hence; we planned the present study to assess the cases of stroke which reported to the emergency department of the institution. Subjects and Methods: The present study included assessment of cases of stroke which reported to the emergency department of the medical institution. A total of 50 cases of stroke were included in the present study. Complete demographic details of all the patients were obtained. All the results were compiled in Microsoft excel sheet and were analysed by SPSS software. Results: Dyslipidaemia was found to be present in 80 percent of the patients. Disturbances in speck and visual disturbances were found to be present in 78 percent and 80 percent of the patients. Motor and sensory symptoms were found to be present in 72 percent and 64 percent of the patients. Headache and dizziness was present in 84 percent and 78 percent of the patients. Conclusion: Stoke represent a significant health problem with high mortality and morbidity. It is more common in elderly subjects with positive history of smoking and dyslipidaemia.
Comparative Study of Adenosine Deaminase Levels in Pleural Effusion of Tuberculous and Non Tuberculous Etiology; A Cross Sectional Study
Background: Tuberculous pleural effusion (TPE) is very common in developing countries in comparison of developed countries; further TPE is one of the common characteristic of extra pulmonary tuberculosis. Adenosine deaminase (ADA) is an important enzyme which is found highly active in the diseases which induce cellular immunity. Therefore, the present study was designed to evaluate the accuracy of ADA level in the diagnosis of pleural effusion caused by tubercular etiology. Subjects and Methods: This was a cross-sectional type of study conducted at tertiary care institute. Total one hundred thirty five patients of pleural effusion were recruited for the study among them eighty nine pleural effusion patients were suffering with tuberculosis and forty six pleural effusion patients were without tuberculosis. A p-value < 0.05 was considered statistically significant. IBM SPSS Statistics 21 manufactured by IBM USA was used for entire calculations. Results: Findings of the present study have shown there was significant difference between ADA level of tubercular effusion patients (69.3±27.22) in comparison of non-tubercular pleural effusion patients (20.46±7.34). Further there was a significance difference between Lactate dehydrogenase (LDH) levels of the tubercular effusion patients (172.72±25.7) in comparison of non-tubercular pleural effusion patients (81.91±6356). However there was no significance difference between total protein (p>0.05), glucose level (p>0.05) and total cells (p>0.05) level of both groups. Conclusion: Finding of the present study showed that The ADA level was significantly high in pleural effusion patients with tubercular etiology in comparison of non-tubercular pleural effusion.
Effects of Yoga on Blood Pressure and MDA in Mild Hypertensive Patients.
Background: Cardiovascular diseases (CVD) have emerges as the leading cause of mortality throughout the world. Essential hypertension is one of the important risk factor for CVD in modern society despite advanced and effective management. Malondialdehyde (MDA) is a well known marker of oxidative stress, which is produced by oxidation of poly unsaturated fatty acid. Nadishodhan pranayam leads to decrease stress as well as blood pressure. Subjects and Methods: It was an interventional type of study. Ninety seven mild hypertensive patients (53 males and 44 females) of group I completed the yoga program. While, fifty normotensive subjects were include as control in group II. Blood pressure and MDA was measured of every participants before and after three months of yoga program. Results: Total ninety seven mild hypertensive patients of age 33.6± 8.66 years of group I completed three months yoga program. However, fifty subjects (34.7± 7.73 years)of group II had not done any yogic exercise during three months. Results of the present study showed that there was a significant difference in SBP (p<0.001), DBP (p<0.001), HR (p<0.001), PP (p<0.001) and MAP (p<0.001) group I mild hypertensive patients after following three months yoga program. There was a significant difference between before and after yoga program MDA level of group I mild hypertensive patients. However, there was an insignificant difference between before and after three months level of MDA in group II control subjects. Conclusion: In this study, it has been observed that daily practice of yoga improves the blood pressure of mild hypertensive patients. Moreover, it substantially decreases the oxidative stress. Yoga can be an effective alternative to reduce the blood pressure in mild hypertensive patients either with medication or without medication.
The Association between Serum Lipid Profile and Retinopathy in Type 2 Diabetes Mellitus Patients
Background: Blood such as VLDL, intermediate density lipoprotein (IDL), chylomicrons, chylomicron remnants and lipoprotein and therefore provides a more accurate estimate of CV risk than LDL-C alone, as shown in numerous epidemiological and clinical studies. This is particularly true for patients who are already on statin therapy or those with elevated levels of VLDL-C such a patients with obesity, metabolic syndrome and diabetes. Subjects and Methods: A pre-structural proforma was used to collect baseline date detailed clinical history with clinical examination and relevant investigation was done on participating individuals. Results: Significant correlation between HbA1c and various circulating lipid parameters and significant difference of lipid parameters in two groups (</.0% and >7.0%) of glycated haemoglobin indicates that HbA1c can be used as a potential biomarker for predicting dyslipidemia in type 2 diabetic patients. Conclusion: As good control of diabetes is shown to keep the lipid levels in near normal range, it appears important to aim at critical control of DM to prevent or at least postpone the onset of various complications.
The Association between Serum Lipid Profile and Nephropathy in Type 2 Diabetes Mellitus Patients
Background: The prevalence of hypercholesterolemia (TC>200md/dl) alone, as reported tin numerous studies across India, has varied from about 20% to 35%. However, what is more important is the pattern of dyslipidemia. When compared with the western populations, Indians and migrant Asian Indians tend to have higher triglycriede levels and lower HDL-C levels. Subjects and Methods: This was a comparative study conducted among 100 cases. A pre-structural proforma will be used to collect baseline date detailed clinical history with clinical examination and relevant investigation will be done on participating individuals. Results: There was correlation between lipid levels and duration of diabetes for all lipid fractions which were significant. Conclusion: Correlation coefficient between nephropathy and lipid profile was found to be significant.
Study of Serum Lipid Profile in Type-2 Diabetes Mellitus Patients
Background: Dyslipidemia may cause or exacerbate diabetic retinopathy and nephropathy and alterations in the coagulation-fibrnolytic system, changes in membrane permeability, damage to endothelial cells and increased atherosclerosis.Serum triglycerides and all types of lipoproteins are affected and this leads to increase morbidity and mortality in type 2 diabetic patients. Subjects and Methods: A total of 100 with type-2 diabetes mellitus irrespective of duration of diabetes in the age group of 35-80 years formed the study subjects. A pre-structural proforma will be used to collect baseline date detailed clinical history with clinical examination and relevant investigation will be done on participating individuals. Results: During our study we randomly selected 100 Diabetes mellitus-type-2 patients visiting OPD or admitted in the department of Medicine at our institution. Out of 100 DM patients, 61 were Males and 39 were Females. The Mean age of patients in our study was 57.29 +56.55 mg/dl and mean PPBS was 252 +73.76 mg/dl. Conclusion: This study shows significant increasing levels of TG, TC, LDl-C, and Vdl-C and significant decrease in level of HDL-C has the severity of diabetes.
To Evaluate Serum Uric Acid as a Risk Factor For Micro- Vascular Complications of Diabetes Mellitus
Background: Diabetes Mellitus (DM) as a metabolic disorder of multiple etiology, characterized by chronic hyperglycaemia with disturbances of carbohydrate, protein and fat metabolism. The present study was conducted to evaluate serum uric acid as a risk factor for micro- vascular complications of diabetes mellitus. Subjects and Methods: The present study was conducted on 84 patients with type II diabetes mellitus of both genders. 10 ml of blood was obtained for assessment of blood glucose and uric acid level. Results: Age group 40-60 years had 46, 60-80 years had 25 and >80 years had 13 patients. Hyperuricemia was positive in 56 and negative in 28. The difference was significant (P< 0.05). Out of 56 patients with hypertension, 42 had high and 14 had low serum uric acid level. Out of 28 patients who had not hypertension, 18 had high serum uric acid and 10 had low. The difference was significant (P< 0.05). Among 48 patients who had stroke, 28 had high serum uric acid and 20 had low uric acid. The difference was significant (P< 0.05). Conclusion: Elevated serum uric acid levels in type 2 diabetes mellitus cause more micro vascular and macro vascular complications.
A Study of MODS in Dengue Fever with Emphasis on Comparison between Survivors & Non-Survivors
Background: Dengue is the most common mosquito-borne viral disease throughout the world. Dengue could be asymptomatic or it may manifest as non-severe, severe and fatal types. Severe dengue manifests itself in myriad ways. Excessive hospitalization of dengue patients occurs due to the absence of definite early prognostic markers or early predictors of severity/mortality. There are few Indian studies on mortality in severe dengue. The objective of this study was to explore Multi-organ dysfunction syndrome (MODS) in Dengue fever with an emphasis on comparison between survivors & non-survivors. Subjects and Methods: This study was done at JSS Hospital, a tertiary referral teaching hospital of JSSMC, JSSAHER with 80 adult ICU beds. It was a retrospective observational study. Patients with laboratory-confirmed severe dengue infections satisfying inclusion and exclusion criteria and admitted to the ICU between September 2016 and September 2017, including the large outbreak period were considered. The data were collected from inpatient case-records and the analysis was done, retrospectively. Results: A total of 29 patients met all inclusion and exclusion criteria. In our study, out of 29 cases, total number of males were 17 (58.6%), whereas females were 12 (41.4%). Mean age of patients was 43.37 years (SD:14.36). The mortality of severe dengue with MODS admitted to the ICU remains high (55.2%) in this study. In this study, mean age was more in survivors when compared to non survivors; At admission, Creatinine, Lactate & PCV were higher among non survivors; All patients with Hypotension, Both the patients with ARDS, myocarditis & All the 6 patients who had bleeding manifestations expired & prolonged a PTT and PT-INR were found among many non survivors; Other parameters like LFT, Se.Albumin and Comorbidities did not have any impact on mortality. In this study, though both the groups had hypoalbuminemia, Serum Albumin was not statistically significant between survivors & non-survivors while arterial Lactate, creatinine and PCV were significant. Conclusion: The mortality of severe dengue with MODS admitted to the ICU remains high. In this study, surprisingly, mean age was more in survivors when compared to non-survivors; Creatinine, Lactate & PCV were higher among non-survivors. Other parameters like LFT, Se.Albumin and Comorbidities did not have any impact on mortality. Definite early prognostic markers or early predictors of severity/mortality is the need of the day.
Assessment of Vitamin D Status in Pregnant Women, a Prospective Observational Study from Northern District of Kashmir Valley
Background: An increased prevalence of vitamin D deficiency has been reported from across the globe including India. Various studies have shown an intrinsic relation between various parameters of maternal and fetal wellbeing with maternal vitamin D status during pregnancy. Aims: To prospectively assess the vitamin D nutritive status in pregnant women in North district of Kashmir Valley and to study the prevalence of suboptimal vitamin D status in apparently healthy pregnant North Kashmiri women.Study Design: Sixty three consenting pregnant women attending the antenatal clinic of the DH Baramulla and Endocrine OPD over the study period of 12 months were enrolled. Subjects and Methods: The subjects underwent a detailed history and physical examination as per a pre-formed Performa. History was focused on occupation, dietary history including diet taken in last 24 hours, exposure to sunlight, drug intake, menstrual history and history of any systemic illness. A particular record was made of the women’s dressing habits. Of the 63 subjects recruited, only 60 subjects (in whom Vitamin D levels could be estimated) were further analyzed for the study. Serum levels of [25 (OH) D] were estimated by 25-OH-D assay, an RIA based procedure. Results: In the present study, vitamin D insufficiency (defined as serum 25[OH] D levels <30 ng/ml) was observed in about 98.2 % of pregnant North Kashmiri women while as vitamin D deficiency (serum 25[OH] D <20 ng/ml)2 was observed in 71.6 %. In only about 3.2 % subjects vitamin D sufficiency (serum 25[OH] D >30 ng/ml) was observed. Conclusion: From our study we conclude that vitamin D deficiency is quite prevalent in normal pregnant women in North Kashmir valley. Taking a cut off value of 25 (OH) D of less than 20 ng/ml as vitamin D deficiency, overall 98 % of pregnant women were found to be vitamin D deficient.
To Study the Pattern and Prevalence of Lipid Profile Abnormality in Newly Diagnosed Type 2 Diabetes Mellitus
Background: Diabetes is one of the commonest chronic non communicable disease affecting the society at large both in developing and developed countries. Present study aimed to study the Pattern and Prevalence of lipid profile abnormality in newly diagnosed type 2 diabetes mellitus. Subjects and Methods: In this study, 100 newly diagnosed cases of type 2 diabetes mellitus patients were evaluated. A cross section of both male and female diabetes patients diagnosed within the last 3 months (new onset) was taken into study. A detailed history, clinical examination and relevant investigations were performed. Collected data were analysed by using appropriate software. Results: In our study 60% were male and 40% were female. Majority of cases were in the age group of 46-55 years, followed by in age group 56-65 years. Dyslipidemia was present in 36.66% of male and 35 % of female. Highest prevalence of dyslipidemia was present in 56 -65 age group. Hypertriglyceridemia was present in 33.33% of cases, Hypertriglyceridemia with low HDL-C was present in 33.33 % of cases, Hypertriglyceridemia with low HDL-C and low LDL –C was present in 13.88% of cases while 19.44 % were having other mixed pattern of dyslipidemia. Conclusion: Endeavour should be made to control hyperglycemia and hyperlipidia tightly by appropriate therapeutic measures so that the occurrence and worsening of complications could be mitigated.