CL Aravind, R. Ravikiran, Amith Kumar, GK Ranjith Kumar
Hyponatremia is a common electrolyte disorder in hospitalized patients and has been linked to increased morbidity and mortality in various clinical settings. Patients with ST-elevation myocardial infarction (STEMI) are at risk of developing hyponatremia due to complex interplay of pathophysiological mechanisms. This study aimed to investigate the prevalence, risk factors, and prognostic value of hyponatremia in patients with STEMI. This was a retrospective study of 192 patients with STEMI who were admitted to a tertiary care hospital between July 2021 and December 2021. Patients were divided into two groups based on their serum sodium levels during hospitalization: Hyponatremia group (serum sodium <135 mEq/L) and normonatremia group (serum sodium ≥135 mEq/L). The prevalence of hyponatremia, demographic variables, ejection fraction, Killip classification, type of STEMI, and in-hospital mortality were compared between the two groups. 20.8% of patients with STEMI had hyponatremia during their hospital stay. Patients with heart failure, lower ejection fraction, and higher Killip classification at admission were more likely to have hyponatremia ([odds ratio (OR): 2.71, 95% confidence interval (CI): 1.23–5.97, P = 0.014], [P = 0.023] and P = 0.002). Patients with lateral STEMI were more likely to have hyponatremia compared to those with other types of STEMI (OR: 2.68, 95% CI: 1.06–6.81, P = 0.037). Patients with hyponatremia had higher in-hospital mortality rate (8 [22.9%], [OR: 4.27, 95% CI: 1.54–11.85, P = 0.005]) and longer hospital stays (P = 0.019) compared to normonatremia group. Hyponatremic patients with STEMI are associated with increased morbidity and mortality. Patients with heart failure, lower ejection fraction, and higher Killip classification at admission should be closely monitored for dyselectrolytemia.
{"title":"Hyponatremia in Acute ST-elevation Myocardial Infarction – A Retrospective Observational Study","authors":"CL Aravind, R. Ravikiran, Amith Kumar, GK Ranjith Kumar","doi":"10.4103/ajim.ajim_52_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_52_23","url":null,"abstract":"Hyponatremia is a common electrolyte disorder in hospitalized patients and has been linked to increased morbidity and mortality in various clinical settings. Patients with ST-elevation myocardial infarction (STEMI) are at risk of developing hyponatremia due to complex interplay of pathophysiological mechanisms. This study aimed to investigate the prevalence, risk factors, and prognostic value of hyponatremia in patients with STEMI. This was a retrospective study of 192 patients with STEMI who were admitted to a tertiary care hospital between July 2021 and December 2021. Patients were divided into two groups based on their serum sodium levels during hospitalization: Hyponatremia group (serum sodium <135 mEq/L) and normonatremia group (serum sodium ≥135 mEq/L). The prevalence of hyponatremia, demographic variables, ejection fraction, Killip classification, type of STEMI, and in-hospital mortality were compared between the two groups. 20.8% of patients with STEMI had hyponatremia during their hospital stay. Patients with heart failure, lower ejection fraction, and higher Killip classification at admission were more likely to have hyponatremia ([odds ratio (OR): 2.71, 95% confidence interval (CI): 1.23–5.97, P = 0.014], [P = 0.023] and P = 0.002). Patients with lateral STEMI were more likely to have hyponatremia compared to those with other types of STEMI (OR: 2.68, 95% CI: 1.06–6.81, P = 0.037). Patients with hyponatremia had higher in-hospital mortality rate (8 [22.9%], [OR: 4.27, 95% CI: 1.54–11.85, P = 0.005]) and longer hospital stays (P = 0.019) compared to normonatremia group. Hyponatremic patients with STEMI are associated with increased morbidity and mortality. Patients with heart failure, lower ejection fraction, and higher Killip classification at admission should be closely monitored for dyselectrolytemia.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"422 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139247676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: Menstrual cycle is a natural physiological process of female during reproductive age group. Changes of estrogen and progesterone in different phases of menstrual cycle play a crucial role in respiratory functioning. Hence, this study was designed to estimate the change of peak expiratory flow rate (PEFR) in different phases of menstrual cycle. Materials and Methods: This study included 73 healthy young females of age group of 20–25 years. All participants were in the range of normal body mass index. Weighing machine VIRGO Model no 9811 B was used for the estimation of body weight. The machine was standardized by a known 20 kg weight material. The height of the subject was measured by stadiometer and expressed in meter. PEFR was recorded by Mini Wright’s peak flow meter. PEFR recording was done between 3 rd and 4 th days of cycle for menstrual phase, between 10 th and 12 th days of cycle for proliferative phase, and between 21 st and 25 th days of cycle for secretory phase. Results: The PEFR in menstrual, proliferative, and secretory phases of menstrual cycle was 310 ± 43, 347 ± 52, and 377 ± 47 L/min, and these variations were found to be significant with P < 0.0001. Post hoc analysis of PEFR between the groups showed P value between Group I-II, II-III, and III-I was 0.019, 0.048, and < 0.0001, respectively (I – menstrual phase, II – proliferative phase, and III – secretory phase). Conclusion: This study observed that the PEFR in secretory phase is highest, followed by proliferative phase then menstrual phase.
{"title":"Cyclical Changes of Peak Expiratory Flow Rate in Healthy Young Females","authors":"Sipra Dash, Sunil Kumar Jena, Satyanarayan Behera","doi":"10.4103/ajim.ajim_93_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_93_23","url":null,"abstract":"Abstract Background: Menstrual cycle is a natural physiological process of female during reproductive age group. Changes of estrogen and progesterone in different phases of menstrual cycle play a crucial role in respiratory functioning. Hence, this study was designed to estimate the change of peak expiratory flow rate (PEFR) in different phases of menstrual cycle. Materials and Methods: This study included 73 healthy young females of age group of 20–25 years. All participants were in the range of normal body mass index. Weighing machine VIRGO Model no 9811 B was used for the estimation of body weight. The machine was standardized by a known 20 kg weight material. The height of the subject was measured by stadiometer and expressed in meter. PEFR was recorded by Mini Wright’s peak flow meter. PEFR recording was done between 3 rd and 4 th days of cycle for menstrual phase, between 10 th and 12 th days of cycle for proliferative phase, and between 21 st and 25 th days of cycle for secretory phase. Results: The PEFR in menstrual, proliferative, and secretory phases of menstrual cycle was 310 ± 43, 347 ± 52, and 377 ± 47 L/min, and these variations were found to be significant with P < 0.0001. Post hoc analysis of PEFR between the groups showed P value between Group I-II, II-III, and III-I was 0.019, 0.048, and < 0.0001, respectively (I – menstrual phase, II – proliferative phase, and III – secretory phase). Conclusion: This study observed that the PEFR in secretory phase is highest, followed by proliferative phase then menstrual phase.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"140 32","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136352069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: Inflammation plays a major role in the pathophysiology of acute cerebrovascular accidents and nowadays, a newer and more sensitive method to test for lower circulating levels of C-reactive protein (CRP), highly sensitive CRP (hsCRP), is being used in apparently healthy individuals for risk assessment. Previous studies show that CRP strongly correlates with stroke severity and independently predicts mortality and recurrence in patients with acute ischemic stroke. The aim of this study was to evaluate the relationship between inflammatory marker-hsCRP and stroke severity by means of volumetric measurement of infarct size. Methods: In this cross-sectional study, 60 patients with acute ischemic stroke were included who were diagnosed using the National Institute of Health Stroke Scale (NIHSS) and magnetic resonance imaging (MRI) scans. Serum levels of hsCRP were measured. Lesion volumes (in ml) were calculated by multiplying slice thickness (4–5 mm) by the total lesion area and divided into quartiles. The relationship between hsCRP levels and diffusion-weighted imaging infarct volume quartiles was examined. Results: Ischemic stroke was predominantly seen in the male population ( n = 36, 60%) and the sixth decade of life. The mean NIHSS score of the study population was 10.68 ± 1.068. The mean (± standard deviation [SD]) level of serum hsCRP was 6.69 ± 7.072 mg/L. The mean (± SD) stroke volume was 8.64 ± 14.21 ml. The correlation between hsCRP and the size of infarct on three-dimensional MRI brain scan was statistically highly significant ( P < 0.001, r = 0.667). Conclusions: Higher hsCRP levels were associated with larger infarct volumes in acute ischemic stroke suggesting that elevated hsCRP levels, may serve as a helpful serologic marker in the evaluation of the severity of acute ischemic stroke.
{"title":"A Cross-sectional Study to Correlate the Levels of High Sensitivity C-Reactive Protein and Size of Infarct in Ischemic Stroke","authors":"Gurinder Mohan, Harsimran Kaur, Nisha Narang","doi":"10.4103/ajim.ajim_29_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_29_23","url":null,"abstract":"Abstract Background: Inflammation plays a major role in the pathophysiology of acute cerebrovascular accidents and nowadays, a newer and more sensitive method to test for lower circulating levels of C-reactive protein (CRP), highly sensitive CRP (hsCRP), is being used in apparently healthy individuals for risk assessment. Previous studies show that CRP strongly correlates with stroke severity and independently predicts mortality and recurrence in patients with acute ischemic stroke. The aim of this study was to evaluate the relationship between inflammatory marker-hsCRP and stroke severity by means of volumetric measurement of infarct size. Methods: In this cross-sectional study, 60 patients with acute ischemic stroke were included who were diagnosed using the National Institute of Health Stroke Scale (NIHSS) and magnetic resonance imaging (MRI) scans. Serum levels of hsCRP were measured. Lesion volumes (in ml) were calculated by multiplying slice thickness (4–5 mm) by the total lesion area and divided into quartiles. The relationship between hsCRP levels and diffusion-weighted imaging infarct volume quartiles was examined. Results: Ischemic stroke was predominantly seen in the male population ( n = 36, 60%) and the sixth decade of life. The mean NIHSS score of the study population was 10.68 ± 1.068. The mean (± standard deviation [SD]) level of serum hsCRP was 6.69 ± 7.072 mg/L. The mean (± SD) stroke volume was 8.64 ± 14.21 ml. The correlation between hsCRP and the size of infarct on three-dimensional MRI brain scan was statistically highly significant ( P < 0.001, r = 0.667). Conclusions: Higher hsCRP levels were associated with larger infarct volumes in acute ischemic stroke suggesting that elevated hsCRP levels, may serve as a helpful serologic marker in the evaluation of the severity of acute ischemic stroke.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"140 27","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136352070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mamta Gehlawat, L. Subitha, S. Kar, Goutham Thumati
Diabetes self-management education (DSME) improves patients’ clinical outcomes and quality of life by encouraging self-care behavior. This study aimed to find out the effectiveness of a DSME by comparing changes in stages of self-care behavior and to explore perceived barriers in diet, exercise, and foot care among patients with type 2 diabetes mellitus in an urban primary health center (PHC) of Puducherry. A mixed-method intervention study was conducted among 314 patients with type 2 diabetes mellitus in two urban PHCs randomly allocated to intervention and control arm. The stages of behavior change and barriers perceived in the domains of diet, physical activity, and foot care were captured using a pretested questionnaire. Intervention consisted of DSME along with information leaflets and self-care kits for the intervention group. At the end of 6 months, end-line assessment and in-depth interviews were conducted. Quantitative data were analyzed in STATA while manual coding and deductive thematic analysis were done for qualitative data. Footcare showed an improvement of 31%, while diet and exercise domains saw an improvement of 5% each from preaction to action stage when compared with control arm. The main barriers perceived in dietary modification and foot care were lack of awareness. For exercise, the main barriers were lack of perceived need and being physically unfit. Foot-care barriers witnessed maximum resolution (27%) following the intervention. DSME intervention helps in improving stages of behavior change while resolving self-care barriers. Culturally-oriented DSME and patient-tailored interventions are key to empower people living with diabetes by improving self-care.
{"title":"Improving Self-care Behavior and Removing Barriers by Structured Diabetes Education Program in Primary Health-care Settings of Puducherry: Evidence from a Mixed-method Intervention Study","authors":"Mamta Gehlawat, L. Subitha, S. Kar, Goutham Thumati","doi":"10.4103/ajim.ajim_58_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_58_23","url":null,"abstract":"Diabetes self-management education (DSME) improves patients’ clinical outcomes and quality of life by encouraging self-care behavior. This study aimed to find out the effectiveness of a DSME by comparing changes in stages of self-care behavior and to explore perceived barriers in diet, exercise, and foot care among patients with type 2 diabetes mellitus in an urban primary health center (PHC) of Puducherry. A mixed-method intervention study was conducted among 314 patients with type 2 diabetes mellitus in two urban PHCs randomly allocated to intervention and control arm. The stages of behavior change and barriers perceived in the domains of diet, physical activity, and foot care were captured using a pretested questionnaire. Intervention consisted of DSME along with information leaflets and self-care kits for the intervention group. At the end of 6 months, end-line assessment and in-depth interviews were conducted. Quantitative data were analyzed in STATA while manual coding and deductive thematic analysis were done for qualitative data. Footcare showed an improvement of 31%, while diet and exercise domains saw an improvement of 5% each from preaction to action stage when compared with control arm. The main barriers perceived in dietary modification and foot care were lack of awareness. For exercise, the main barriers were lack of perceived need and being physically unfit. Foot-care barriers witnessed maximum resolution (27%) following the intervention. DSME intervention helps in improving stages of behavior change while resolving self-care barriers. Culturally-oriented DSME and patient-tailored interventions are key to empower people living with diabetes by improving self-care.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"47 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139278061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in significant morbidity and mortality. As COPD progresses, patients develop more frequent and severe exacerbations. Several scores have been tested in AECOPD, but none of them is yet widely accepted or recommended to be used in practice due to a lack of data and evidence. (1) To compare neutrophil-to-lymphocyte ratio (NLR) between stable COPD patients and patients with acute exacerbation of COPD and (2) correlation of NLR with severity of acute exacerbation of disease as per clinical, spirometric, and arterial blood gas criteria. A total of 100 patients, 50 with acute exacerbation of COPD and 50 stable patients attending the casualty and Outpatient Department of Government Medical College and Associated Group of Hospitals, Kota, were included in the study The level of NLR was raised in patients with acute exacerbation of COPD (35.28 ± 34.66) as compared to stable COPD patients (2.23 ± 0.63) (P = 0.0001). Levels of this inflammatory marker (NLR) were also positively correlated with the duration of hospitalization (8.14 ± 5.99 days) (P = 0.0010). High NLR was found to be significantly associated with the need for mechanical ventilation (nine patients) and mortality (nine patients), and significantly associated with low forced expiratory volume 1/forced-vital capacity (0.49 ± 0.07) in cases with acute exacerbation of COPD. NLR can be used as a marker of acute exacerbation of COPD, as it was found to be significantly elevated in acute exacerbation patients and found within normal limits in stable patients.
{"title":"A Cross-sectional Study of Correlation of Neutrophil-to-lymphocyte Ratio in Acute Exacerbation of Chronic Obstructive Pulmonary Disease","authors":"Pankaj Kumar Jain, Manoj Seval, Rohit Labana, Sarla","doi":"10.4103/ajim.ajim_91_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_91_23","url":null,"abstract":"Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in significant morbidity and mortality. As COPD progresses, patients develop more frequent and severe exacerbations. Several scores have been tested in AECOPD, but none of them is yet widely accepted or recommended to be used in practice due to a lack of data and evidence. (1) To compare neutrophil-to-lymphocyte ratio (NLR) between stable COPD patients and patients with acute exacerbation of COPD and (2) correlation of NLR with severity of acute exacerbation of disease as per clinical, spirometric, and arterial blood gas criteria. A total of 100 patients, 50 with acute exacerbation of COPD and 50 stable patients attending the casualty and Outpatient Department of Government Medical College and Associated Group of Hospitals, Kota, were included in the study The level of NLR was raised in patients with acute exacerbation of COPD (35.28 ± 34.66) as compared to stable COPD patients (2.23 ± 0.63) (P = 0.0001). Levels of this inflammatory marker (NLR) were also positively correlated with the duration of hospitalization (8.14 ± 5.99 days) (P = 0.0010). High NLR was found to be significantly associated with the need for mechanical ventilation (nine patients) and mortality (nine patients), and significantly associated with low forced expiratory volume 1/forced-vital capacity (0.49 ± 0.07) in cases with acute exacerbation of COPD. NLR can be used as a marker of acute exacerbation of COPD, as it was found to be significantly elevated in acute exacerbation patients and found within normal limits in stable patients.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"2001 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139278228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia associated with autoantibodies that react mainly in the cold. CAD can interfere with immunohematology tests. We report two cases of CAD presented initially as blood grouping discrepancy leading us to further workup. Case I was a 61-year-old female with symptoms of weakness, bone pain, and difficulty breathing with laboratory findings of high cold agglutinin titers of 1:1024. Bone marrow aspirate revealed a mixture of >30% plasma cell and plasma blast. Bone marrow biopsy revealed an interstitial, focal, and nodular pattern of involvement by plasma cells, leading to the diagnosis of plasma cell dyscrasias. Case II analyzed was benign CAD with cold agglutinin titers of 1:64, with no other abnormality. Both patients were managed successfully. We report serological and clinical findings of two CAD cases with similar serological findings but different clinical outcomes.
{"title":"Cold Agglutinin Disease: Challenges in the Serological Workup and Management","authors":"Nimisha Sharma, Saroj Rajput, Charu Agarwal, Tathagata Chatterjee","doi":"10.4103/ajim.ajim_78_22","DOIUrl":"https://doi.org/10.4103/ajim.ajim_78_22","url":null,"abstract":"Abstract Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia associated with autoantibodies that react mainly in the cold. CAD can interfere with immunohematology tests. We report two cases of CAD presented initially as blood grouping discrepancy leading us to further workup. Case I was a 61-year-old female with symptoms of weakness, bone pain, and difficulty breathing with laboratory findings of high cold agglutinin titers of 1:1024. Bone marrow aspirate revealed a mixture of >30% plasma cell and plasma blast. Bone marrow biopsy revealed an interstitial, focal, and nodular pattern of involvement by plasma cells, leading to the diagnosis of plasma cell dyscrasias. Case II analyzed was benign CAD with cold agglutinin titers of 1:64, with no other abnormality. Both patients were managed successfully. We report serological and clinical findings of two CAD cases with similar serological findings but different clinical outcomes.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"121 41","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136351737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: The purpose of the present research was to study the correlation between serum triglyceride (TG) levels and the severity of stroke as limited data are available on the role of TGs. The severity of stroke was determined using the Scandinavian Stroke Scale (SSS). Methods: In this cross-sectional study, 60 patients with acute ischemic stroke were included, who were diagnosed on clinical examination and 3-dimensional magnetic resonance imaging scan of the brain. Serum TG levels were categorized according to the National Cholesterol Education Program and the Adult Treatment Panel. Stroke severity was assessed with the help of SSS. Results: The mean serum TG levels in the study were found to be 147.7 mg/dl ± 92 mg/dl. The mean SSS score in the study was 27.93 ± 3.86. There was a statistically significant association between the serum TG levels and SSS ( P = 0.001). The association was suggested by a positive Pearson correlation coefficient ( r = 0.481). Patients with low serum TG levels (≤150 mg/dl) had severe strokes as assessed by the SSS (≤25). Conclusion: This study confirms that low levels of TG are associated with poor outcome of acute ischemic stroke, which can be explained by the fact that low serum TG levels indicate malnutrition, which is a poor prognostic factor.
{"title":"Association between Serum Triglycerides and Severity of Stroke","authors":"Gurinder Mohan, Rajdeep Singh, Nisha Narang","doi":"10.4103/ajim.ajim_26_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_26_23","url":null,"abstract":"Abstract Background: The purpose of the present research was to study the correlation between serum triglyceride (TG) levels and the severity of stroke as limited data are available on the role of TGs. The severity of stroke was determined using the Scandinavian Stroke Scale (SSS). Methods: In this cross-sectional study, 60 patients with acute ischemic stroke were included, who were diagnosed on clinical examination and 3-dimensional magnetic resonance imaging scan of the brain. Serum TG levels were categorized according to the National Cholesterol Education Program and the Adult Treatment Panel. Stroke severity was assessed with the help of SSS. Results: The mean serum TG levels in the study were found to be 147.7 mg/dl ± 92 mg/dl. The mean SSS score in the study was 27.93 ± 3.86. There was a statistically significant association between the serum TG levels and SSS ( P = 0.001). The association was suggested by a positive Pearson correlation coefficient ( r = 0.481). Patients with low serum TG levels (≤150 mg/dl) had severe strokes as assessed by the SSS (≤25). Conclusion: This study confirms that low levels of TG are associated with poor outcome of acute ischemic stroke, which can be explained by the fact that low serum TG levels indicate malnutrition, which is a poor prognostic factor.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"140 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136352071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Debasish Mahapatra, Vijoy Kumar Jha, Sunita Patil, V. U. Jagadeeswaran
Abstract Invasive fungal infections are common in clinical settings of diabetes mellitus, immunosuppression, malignancy, and organ and tissue transplantation. Fungal infections were reported increasingly during the COVID-19 waves, with many cases ending in fatality. The reason for such increased incidence is deemed to be a mix of factors, with high steroid use being a major contributor. We present a patient with mixed mucormycosis and invasive aspergillus infection of paranasal sinuses, postrecovery from moderate COVID-19 disease. The patient developed acute kidney injury after starting liposomal amphotericin B, and it had to be stopped. The dilemma was “What next?” since the drug of choice could not be continued. The patient was managed with surgical debridement, intense surveillance, and alternate antifungals. The outcome was encouraging. We discuss the dynamics of polyene-induced renal function impairment, the possibility of the use of alternate antifungals and their basis, and the importance of a combination approach as a recipe for success.
{"title":"The Post-COVID Deadly Trio of Mucormycosis, Invasive Aspergillosis, and Acute Kidney Injury: Physician’s Nightmare and Management Dilemma in Resource Constraint Setting","authors":"Debasish Mahapatra, Vijoy Kumar Jha, Sunita Patil, V. U. Jagadeeswaran","doi":"10.4103/ajim.ajim_87_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_87_23","url":null,"abstract":"Abstract Invasive fungal infections are common in clinical settings of diabetes mellitus, immunosuppression, malignancy, and organ and tissue transplantation. Fungal infections were reported increasingly during the COVID-19 waves, with many cases ending in fatality. The reason for such increased incidence is deemed to be a mix of factors, with high steroid use being a major contributor. We present a patient with mixed mucormycosis and invasive aspergillus infection of paranasal sinuses, postrecovery from moderate COVID-19 disease. The patient developed acute kidney injury after starting liposomal amphotericin B, and it had to be stopped. The dilemma was “What next?” since the drug of choice could not be continued. The patient was managed with surgical debridement, intense surveillance, and alternate antifungals. The outcome was encouraging. We discuss the dynamics of polyene-induced renal function impairment, the possibility of the use of alternate antifungals and their basis, and the importance of a combination approach as a recipe for success.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"122 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136351883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Minal Hemant Shastri, Vishakha Vinod, Heti P. Mistry, V. Rathod, N. V. Gohil, R. Dobariya, Nilay Shetal Patel
Both atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) commonly coexist with overlapping symptoms, risk factors, and shared pathophysiology. Both conditions independently impact left atrial volume index (LAVI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, making it difficult to diagnose HFpEF in AF. The aim is to study the association of AF with NT-proBNP levels, LAVI, and left atrial (LA) size in HFpEF. An observational study of 40 patients was conducted at a Tertiary Care Center in Western India. Patients above 18 years of age with classical heart failure presentation were included and their clinical history and general and systemic examination were done along with NT-proBNP measurement and two-dimensional echocardiography for assessing heart structure and function. Twenty-one patients had sinus rhythm; 19 had AF. AF patients had higher NT-proBNP levels (2599 pg/mL) compared to patients with sinus rhythm (785 pg/mL). AF patients had a greater degree of left ventricular (LV) dysfunction (higher LV end-diastolic dimensions, LV posterior wall thickness, LV mass index, LA diameter, LA volume and LAVI), more prevalence of pulmonary artery hypertension (n = 19 vs. n = 17), higher degrees of diastolic dysfunction (e.g. higher e’ septum, e’ lateral and E/e’), and higher right ventricle systolic pressure as compared to patients with sinus rhythm. The present study shows that AF occurs in around half of HFpEF patients, with a higher incidence in women and younger people. Patients with AF have higher rates of right heart failure, severe atrial and ventricular remodeling, and higher levels of NT-proBNP, which indicate an advanced form of the disease.
{"title":"Impact of Atrial Fibrillation on Heart Failure with Preserved Ejection Fraction: An Observational Cross-sectional Study from Western India","authors":"Minal Hemant Shastri, Vishakha Vinod, Heti P. Mistry, V. Rathod, N. V. Gohil, R. Dobariya, Nilay Shetal Patel","doi":"10.4103/ajim.ajim_50_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_50_23","url":null,"abstract":"Both atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) commonly coexist with overlapping symptoms, risk factors, and shared pathophysiology. Both conditions independently impact left atrial volume index (LAVI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, making it difficult to diagnose HFpEF in AF. The aim is to study the association of AF with NT-proBNP levels, LAVI, and left atrial (LA) size in HFpEF. An observational study of 40 patients was conducted at a Tertiary Care Center in Western India. Patients above 18 years of age with classical heart failure presentation were included and their clinical history and general and systemic examination were done along with NT-proBNP measurement and two-dimensional echocardiography for assessing heart structure and function. Twenty-one patients had sinus rhythm; 19 had AF. AF patients had higher NT-proBNP levels (2599 pg/mL) compared to patients with sinus rhythm (785 pg/mL). AF patients had a greater degree of left ventricular (LV) dysfunction (higher LV end-diastolic dimensions, LV posterior wall thickness, LV mass index, LA diameter, LA volume and LAVI), more prevalence of pulmonary artery hypertension (n = 19 vs. n = 17), higher degrees of diastolic dysfunction (e.g. higher e’ septum, e’ lateral and E/e’), and higher right ventricle systolic pressure as compared to patients with sinus rhythm. The present study shows that AF occurs in around half of HFpEF patients, with a higher incidence in women and younger people. Patients with AF have higher rates of right heart failure, severe atrial and ventricular remodeling, and higher levels of NT-proBNP, which indicate an advanced form of the disease.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"1 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139278638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The spike-protein severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine has developed different adverse reactions. Still, delirium has not been reported in a low-risk patient, and it is important to consider it and recognize it as a possibility in all severity risk patients. We present a 76-year-old male patient who developed delirium after receiving the second dose of the BNT162b2 mRNA vaccine from Pfizer Inc. and BioNTech®. We theorize about the potential pathophysiology mechanisms involved.
{"title":"Delirium as an Adverse Reaction to BNT162b2 mRNA Vaccine from Pfizer Inc., and BioNTech","authors":"Lilia M. Sierra Galan, Raquel Cohen Shaooli","doi":"10.4103/ajim.ajim_66_21","DOIUrl":"https://doi.org/10.4103/ajim.ajim_66_21","url":null,"abstract":"Abstract The spike-protein severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine has developed different adverse reactions. Still, delirium has not been reported in a low-risk patient, and it is important to consider it and recognize it as a possibility in all severity risk patients. We present a 76-year-old male patient who developed delirium after receiving the second dose of the BNT162b2 mRNA vaccine from Pfizer Inc. and BioNTech®. We theorize about the potential pathophysiology mechanisms involved.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135885534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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