European Journal of Cardiovascular Medicine

A 82-year-old man with hypercholesterolemia, hypertension and glucidic intolerance, presented with angina pectoris upon exertion. The vital signs were normal. Echocardiography showed normal left ventricular (LV) ejection fraction, non-critical aortic valvular stenosis and LV diastolic dysfunction. Rest and stress myocardial echocardiography showed a reversible abnormal septal-wall motion. Therefore, an initial diagnosis of possible coronary artery disease was made. Coronary arteriography showed no atherosclerotic lesions in the 3 major coronary arteries; however, in the anterior descending artery a communication with the right ventricle (RV) cavity through five small, diffuse fistulae was detected (Figure 1 and 2), resulting in complete RV contrast opacification. The patient was stabilised on medical therapy because he refused any further invasive therapy.

Clopidogrel and Aspirin are widely used antiplatelet agents in the prevention and treatment of isch- emic heart disease (IHD). Many patients have been noticed with recurrence of major ischemic events, due to resistance of these drugs. Different platelet function tests can be used to evaluate the de- gree of achieved platelet inhibition in patients treated with clopidogrel. The objective of this study was to determine frequency of clopidogrel resistance in patients of ischemic heart disease. Seventy one patients of IHD were selected from out-patient department of Punjab Institute of Cardiology Lahore. Platelet aggregation studies were performed on Diamed Impact R. Clopidogrel response as- say was performed with DiaAdin(ADP 110µmol/L). Chi-square test was applied to measure statistical significance. Resistance to Clopidogrel was observed in 17% (12 out of 71). Clopidogrel resistance was significantly associated with female gender (p=0.046). In our study no statistically significant as- sociation was observed between clopidogrel resistance and risk factors like diabetes mellitus, family history ischemic heart disease, hypertension and smoking. We concluded that resistance to Clopido- grel therapy is seen in significant number of patients and female patients are at high risk of develop- ing the resistance to clopidogrel therapy. These patients can be identified by performing platelet aggregation studies on Impact R.

Background: Left atrial enlargement (LAE) has been proven to be significantly related to stroke and cardiovascular diseases. Previous studies have shown a link between Left atrial enlargement (LAE) with the increase in the risk of stroke and cardiovascular diseases (CVD). Bangladeshi data is lacking on the exact prevalence of LAE. Aims and Objectives: To study the prevalence of LAE and its associated risk factors. Materials and Methods: Hundred patients having were studied in the Department of Vascular Surgery, Bangabandu Sheikh Mujib Medical University (BSMMU), and Dhaka, Bangladesh from January 2020 to December 2020. After a complete physical examination, echocardiogram was performed in all the patients. In present study LAE is defined if the LA diameter is more than 4.0 cm in men and 3.8 cm in women. We performed multivariable logistic regression analysis to identify risk factors for LAE. Results: Prevalence of LAE was 8%. The prevalence of LAE was higher in men (9.37%). On multivariable logistic regression analysis advancing age (OD;1.034), increased systolic blood pressure (SBP) (OR: 2.862), increased diastolic blood pressure (DBP) (OR: 1.32), abnormally high BMI (OR: 3.721), increased prevalence of diabetes (OR: 1.245), increased left ventricular myocardial index (LVMI) (OR: 1.023), and decreased left ventricular ejection fraction (LVEF), decreased heart rate (HR), and decreased estimated glomerular filtration rate (eGFR) were found to be the major risk factors of LAE. Conclusion: A significant number of patients had LAE. Among the risk factors advancing age, increased SBP, increased BMI, presence of diabetes mellitus, increased LVMI, decreased eGFR, decreased LVEF, and decreased HR were more common.

Background: Legionella pneumophila is a common cause of Community Acquired Pneumonia (CAP) which is often associated with a severe clinical course and a mortality rate of 5% to 25% among immunocompetent patients. Complications of Legionella infection include acute renal and respiratory failures, disseminated intravascular coagulation and septic shock which often require intensive level of medical care. Reported cases of myocardial dysfunction and acute systolic heart failure from legionella disease are rare. This case describes an atypical presentation of legionella pneumonia in a previously healthy patient complicated by multi-organ failure. Case Presentation: A 63 year old female with medical history of hypertension was admitted to the intensive care unit for acute onset of altered mental status, decreased oral intake, subjective fevers, dizziness and diarrhea. Physical exam was remarkable for temperature of 101.2 F, pulse rate 112 beats/minute, respiratory rate 22 cycles/minute and blood pressure 88/60 mmHg. Laboratory studies showed leukocytosis, markedly elevated serum Creatinine Kinase (CPK), and creatinine and lactic acid levels. Troponin was elevated; however no evidence of cardiac ischemia on electrocardiogram. Chest X-ray revealed right mid-lung opacities consistent with pneumonia. A Transthoracic Echo (TTE) showed reduced ejection fraction of 35% and urine legionella antigen test was positive for Legionella pneumophilia group 1 antigen. She was admitted to the medical Intensive Care Unit (ICU) and initiated on Intravenous (IV) fluids and empiric antibiotics for CAP (IV Ceftriaxone 2 g daily and Azithromycin 500 mg daily) and by day 5 of hospitalization, her fever had completely resolved and neurological status returned to normal. Her serum CPK and creatinine levels significantly improved and troponin levels normalized. She was discharged home to follow up with infectious disease and cardiology team outpatient. A repeat TTE six weeks later showed normal ejection fraction of 60% to 65% and a normal cardiac stress test.

Background: Hypertension, the leading global risk factor for mortality and the third leading risk factor for disease burden, is an increasing public health problem in sub-Saharan Africa. This study aims to evaluate the prevalence & associated risk factors of hypertension among Assosa town. Objective: To assess the prevalence of hypertension and its associated factor and to increase awareness of controlling hypertension among study subjects. Methods and Materials: Institutional based cross sectional study design with quota non-probability sampling technique was conducted among patients visited OPD units of AGH and AHC from March to June 2018. All outpatients were included. Data was collected by face to face interviews using pre-tested structured questionnaire. SPSS version -20 software was used to enter and analyze data. Descriptive statistics like frequency table, chi-square test of independence and logistic regression was used to characterize disease and associated factors.

Introduction: Eclampsia has been recognized as a clinical entity since the time of Hippocrates; and has been a nightmare to healthcare providers ever since. It is defined as the occurrence of generalised convulsions associated with preeclampsia during pregnancy, labour or within 7 days of delivery and not caused by epilepsy or other convulsive disorders. The incidence of eclampsia has often been viewed as an index of civilization in a country. There is low utilization of both antenatal and intrapartum care services and the patients may present to the hospital only as a last resort. Materials And Methods: This is a Prospective Study was carried out at the Department of Obstetrics and Gynecology at Tertiary Care Teaching Hospital over a period 2 years. All patients presenting with eclampsia during the said period were recruited into the study. All patients presenting with eclampsia during the said period were recruited into the study. Eclamptics are usually admitted directly into the labour ward. Patients who were diagnosed with other causes of convulsions in pregnancy like cerebral malaria and epilepsy were excluded from the study. A total of 821 pregnant mothers with eclampsia admitted in the inpatient department of the tertiary care teaching hospital were recruited for the study, irrespective of their previous antenatal check up history. Results: Majority (66%) of the patients had between 2 to 5 episodes of convulsion. The MINIMUM number was 1 episode of convulsion , seen in 13 % of the patients. The MAXIMUM number of convulsions was 40. Of the 66 patients who had had more than 10 no. of convulsions , 30 had not received any treatment prior to referral, while there were no patients who had had more than 10 no. of convulsions after receiving the Loading Dose of MgSO4. For patients having less than 5 no. of convulsions , the number of patients having received only the IM Dose of MgSO4 was 1.5 times those having received the Loading Dose.(228/154 =1.48) In 29% of the patients, Hypertension was controlled by delivery alone. Those who failed to achieve a control of BP by Delivery alone were administered Calcigard (Nifedipine). Conclusion: Eclampsia was noted to be commoner among the young primigravida patients. The importance of this finding is that this group of patients deserve extra surveillance during antenatal care in terms of monitoring their blood pressure and screening their urine for proteinuria to detect pre-eclampsia. It is hoped that such interventions will have positive impact on maternal and child care. However, all this will go in vain unless health care providers at the grassroot levels are sensitised regarding the early diagnosis of Pre eclampsia and prompt and appropriate initiation of treatment

Background: H. pylori is the most common human bacterial pathogen that colonizes the gastric epithelium especially in those habitual Qat chewers; it influence can absorption of glucose which is also abnormal in DM patients, its common infection in diabetic patients who have inadequate metabolic control, this study was conducted to reveal the prevalence of H. pylori among T2DM and non-DM patients and potential risk factors. Methods: A cross-sectional study was conducted in the department of medicine, a tertiary care hospital in India, and there were 250 patients who included in this study. Data were collected through structural intervals questionnaire and sampling information. Results: The overall prevalence of H. pylori among diabetics was 29.2%. There was no significant association between H. pylori infections and diabetes (P> 0.05), most of the patients were 46-60 year age group, with male predominance (76.7%) H. pylori infections were not significantly associated with the smoking, hypertension, dyslipidemia and obesity. H. pylori infection increased in longer duration of diabetes and the increase in HbA1c level. Conclusion: Positive H. pylori DM patients should update their sugar level values and control the disease. Further research is highly recommended on relationship between H. pylori infections and diabetes

Introduction: Yoga is an art in all its aspects, from the most practical to the highest. It is a spiritual art, in the sense that it transforms the seer and brings him into contact with his inner soul. It is a fine art, since it is aesthetic, expressive, visual art, since the body is made to form geometrical designs, lines architectural shapes and the like which are beautiful to behold. It is essentially a useful art for the doer and is presented as a performing art for viewer. Objective: To assess the effect of 45 minute yogic kriya (Surya Namaskar and Kapalbhati) for for 30 days on various physiological and biochemical parameters. Materials and Methods: This is a prospective and observational study conducted in the Department of Physiology and Biochemistry at Tertiary Care Teaching Hospital over a period of 6 months. All subjects volunteering for participation in the study had given their written informed consent. The study protocol was approved by our college ethical committee. Only healthy volunteers with daily regular lifestyle and are not involved in any sport regularly, were chosen to be part of the study between the age group 17-21 were taken into study. Subjects having any pathological condition and those who are on any pharmacological treatment from 3 months prior to the study were excluded from the study. Results: In the present study it was found that the pulse rate was decreased significantly (p<0.05) at 30 days in Group I and II. RR decreased significantly at 30 days in group I, and II with p<0.05. This significant decrease continued at 30 days with group I and II. In our study it was found that significant decrease in SBP at 30 days. At 30 days two groups had highly significant decrease in SBP (p<0.05). In addition, it was also found that significant decrease in DBP at 30 days. At 30 days two groups had highly significant decrease in DBP (p<0.05). After yoga, at 30 days, the reduction in the Serum Total cholesterol, serum triglycerides levels were found in two groups in the present study. The decrease was significant (p<0.05) in Group I and II (p<0.01). In addition, after 30 days of yogic practices significant (p<0.05) increase in the HDL level was found in Group I and II. Conclusion: It was concluded that in hypertensive subjects whether newly diagnosed subjects were restoration of the altered parameters towards normal

Introduction: Preeclampsia is a pregnancy-specific multi-systemic disorder characterized by proteinuria and the onset of hypertension during pregnancy (1, 2) Among the hypertensive disorders that complicate pregnancy, pre-eclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity3. Calcium has an important role in the pathogenesis of pre- eclampsia. The present study was aimed to compare the level of serum calcium in normal pregnant women and in preeclampsia and determine the association of serum calcium with severity of the disease

Periodontitis is a multifactorial disease causing inflammatory destruction of supporting structures of the dentition and eventually leading to its loss. This study was designed to evaluate common risk factors for periodontitis and acute coronary syndrome in the study population and demonstrate the systemic impact of periodontitis on the occurrence of acute coronary syndrome. A total of 160 patients (35 female and 125 male) were enrolled in the study. Considering the age range, the largest group of patients (118 patients) was between 55 and 65 years, which accounted for 73.8% of the total study population. There were 35 patients (21.9%) in the age group of 45 to 54 years, while the youngest age group of 35 to 44 years had as many as seven patients. Medical history and physical examination, including periodontal status, were performed. API, PD, CAL, and CPITN were evaluated. Common risk factors for periodontitis and acute coronary syndrome were assessed. The study assessed risk factors such as hypertension, diabetes, dyslipidemia, general health, smoking, height, weight, and hip circumference. In light of the above-described etiopathogenesis of atherosclerotic disease and its association with periodontal disease, it is important to emphasize preventing and treating periodontitis, especially in patients in the so-called high-risk group for cardiovascular disease. Dentists’ introduction of an appropriate prophylactic and therapeutic plan may constitute both primary and secondary prevention of cardiovascular diseases

Background: Chronic kidney disease (CKD) is a long-term condition characterized by a gradual loss of kidney functions, usually accompanied by other comorbidities including cardiovascular diseases (hypertension, heart failure and stroke) and diabetes mellitus. Epidemiological and clinical observations have shown that polypharmacy may increase the probability of adverse drug reactions (ADRs), possibly through a higher risk of drug-drug interactions (DDIs). Renal impairment may further worsen this scenario by affecting the physiological and biochemical pathways underlying pharmacokinetics and ultimately modifying the pharmacodynamic responses

Introduction: In India, diabetes is turning into an epidemic as currently, more than 62 million individuals suffer from the disease. To our knowledge, very few studies have evaluated the correlation between lipid profiles and glycated hemoglobin (HbA1c) in newly diagnosed type II diabetes patients with hypertension. The early detection of lipid abnormalities in these patients will help prevent the cardiovascular outcomes

Aim and Objectives: This study was done to investigate the relationship between essential hypertension and blood uric acid levels. Materials and Method: This cross-sectional observational study was done after getting the permission from Board of Studies Department of General Medicine, Rajshree Medical Research Institute, Bareilly

This study is a Prospective cross sectional observational study. The study was conducted from December 1st, 2020, to June 1st, 2022 in which 100 patients who had presented to the Surgery OPD and Emergency Department of Katuri medical college &hospital, Chinakondrupadu, Guntur with history suggestive of urolithiasis were enrolled for the purpose of studying the incidence of urolithiasis at different levels of the urinary tract and to assess different modalities of treatment and compare outcome of those results with that of the world literature. Our Study had found that the incidence of urolithiasis at our center was 3.74%. The age group of people between 21-30 years were the most commonly affected. However, the mean age for developing urolithiasis was 40.4 years. Males appear to be predisposed to the formation of calculi with M: F ratio being 1.77:1. Pain was the most common symptom which was seen in 91 % of the patients followed by nausea/vomiting seen in 58% followed by burning micturition (43.84%), fever (16.44%) and haematuria (15.08 %) of the study group. Right kidneys were affected more commonly than the left. Diabetes mellitus   was   the   most   commonly   associated   comorbidity   followed   by hypertension. Renal pelvis was the most commonly affected site (35%) followed by lower 1/3rd, urinary bladder (17%) upper ureter (14%) and lower ureter (11%) respectively. E. coli was the most commonly isolated organism in the urine cultures followed by Klebsiella. Serum calcium was normal in 96% of the study group while serum uric acid was raised in 25% of the subjects. Plain X ray KUB and ultrasound were the initial imaging modalities used. IVP was preferred over CT in diagnosis as CT was costlier and could not be afforded by the poor. Patients consuming mixed diet seemed to be more predisposed to the formation of urolithiasis. Open Pyelolithotomy was the operative modality for renal pelvic calculi, Open Ureterolithotomy for upper and mid ureters and URS for lower ureter. Open Cystolithotomy was used for bladder calculi. Stone free rates for Open Pyelolithotomy was 91.4%, 96% for Open Ureterolithotomy, 91.3% for URS and 100% for Open Cystolithotomy. The average size of stone extracted in Open Pyelolithotomy was 2.78 cm, 1.34 cm for Open Ureterolithotomy, 3.92 cm for Open Cystolithotomy and 1.1 cm for URS. Mean duration of hospital stay was 7.42 days for Open Pyelolithotomy, 6.16 days for Open Ureterolithotomy, 5.35 days for Open Cystolithotomy and 1.34 days for URS. Thus we can conclude that, the incidence of urolithiasis was 3.74% in our study. The patients underwent open procedure for removal of stones at our cente.r However, as seen in our study, open procedures have good success rates and also have less post- operative complications. It can thus be concluded that it does not hamper patient care. This is in accordance with the other studies over open urological procedures

Preeclampsia is a multi organ disorder which is significantly associated with maternal and neonatal morbidity, affecting around 5-8% of pregnant women. Acute or chronic intrapartum insufficiency results in antepartum or intrapartum anoxia that may lead to foetal death, Intrauterine growth restriction and or preterm delivery. Neonatal complications occurring in these babies are closely related to the severity of hypertension and proteinuria and the duration of the disease. This was a retrospective observational study. Out of 77 preeclampsia mothers, 74 (96.2%) had live births and 3 (3.8%) had Intra uterine deaths. Out of 74 neonates, 33 neonates (42.8%) were term, 28 neonates (36.3%) were late preterm, 5 neonates (6.4%) were moderate preterm and 11 neonates (14.2%) were early preterm. With increasing maternal complications in preeclampsia there is an increase in neonatal morbidity and mortality. So, the aim of the study is to evaluate neonatal morbidity in mothers with preeclampsia

Background: The ECG remains the most immediately accessible and widely used diagnostic tool for guiding emergent treatment strategies. Coronary angiography is a widely used invasive examination which is considered the reference standard for assessing presence of stenosis in the coronary arteries. Objectives: To correlate findings of ECG and Coronary Angiography in identifying culprit artery among patients with acute ST Elevation Myocardial Infarction. Methods and Material: The study was undertaken among 100 Patients aged 18years and above presenting with symptoms suggestive of Acute Myocardial Infarction as a diagnostic accuracy study. Convenient sampling technique was used to include patients in the study. Results: Most of the study participants were in the age group of 46-60 years (44%) and males (75.0%). Hypertension (44%), Obesity (28%) and Diabetes (26%) were found to be the three most common comorbidities among the study participants. Chest pain (71%), profuse sweating (57%) and chest discomfort (44%) were the most common complaints. The mean duration of symptoms among all the patients was 75.65±45.0 mins. The sensitivity and specificity of ECG  in detecting LAD involvement is 71.8% and 72% respectively. The sensitivity and specificity of ECG in detecting RCA involvement is 71% and 94.2% respectively. Conclusion: ECG was found to have good accuracy in predicting the culprit artery involved in patient with ST elevation MI. The sensitivity of ECG was good in predicting all the three main arteries and an even higher specificity was noted in case of RCA

CONCLUSION: The overall prevalence of overweight and obesity were found to be 25.62% & 14.9% respectively in the present study. The overall prevalence rates of systolic elevated BP & hypertension were found to be 11.64% & 5.4% respectively. The overall prevalence rates of diastolic elevated BP & hypertension were found to be 16.30% & 5% respectively

Introduction: One of the most common lower-extremity impediments in people suffering with diabetes-mellitus is foot ulceration. There is an increased risk of amputation and increased mortality rate in patients with foot ulcer. The neutrophil-to-lymphocyte-ratio (NLR) has lately been shown to forecast chemotherapy response in cancer patients, associated with peripheral arterial disease, systemic endothelial dysfunction and cardiovascular diseases. NLR is an useful measure in predicting overall mortality and disease-specific mortality.

Objectives: To evaluate the role of Neutrophil- Lymphocyte Ratio NLR in prognosis of Diabetic-Foot-Ulcer (DFU)

Methodology: The outcomes of diabetic foot ulcers in 100 patients admitted to surgical wards were assessed. Demographic, patient-specific, and wound specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing and chronic ulcer. The data was entered in Microsoft excel and analyzed using SPSS version 16.

Results: The mean (SD) age was 57.1(11.29) years. 58% of subjects were females and 42% were males. The mean (SD) duration of Hypertension was 10.3(3.50) years and that of Diabetes Mellitus was 9.49(3.03) years. 53% had history of trauma, 48(48%) of subjects had pain, 51(51%) had gangrene of foot. The mean (SD) CBP, Neutrophils, Lymphocytes and Neutrophil-Lymphocyte Ratio was 20.24(2.89) per thousand, 94.73(3.21) %, 14.97(3.23) % and 6.65(1.52) respectively. 58% had healing ulcers and 42 had non healing ulcers. 44% of study subjects were having NLR <6 which is normal and 56% had NLR>6 which is abnormal. Among 58 subjects with healing ulcers, 44(75.9%) had NLR<6 and among 42of non-healing ulcers, 42(100%) had NLR >6. This was statistically significant (p value <0.001). The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was 75% and negative predictive value was 100%. The mean (SD) NLR in healing group was 5.15(0.65) and in non-healing group was 8.205(0.84) and this was statistically significant. This shows an increased NLR has a predisposition towards non-healing chronic ulcers with poor prognosis.

Conclusion: NLR is a good prognostic variable in predicting the outcome of Diabetic foot ulcer. The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was75% and negative predictive value was 100%.

Background: Portal hypertension is a major consequence of cirrhosis and is responsible for its most severe complications, including ascites, bleeding from gastro-oesophageal varices and encephalopathy. Measuring HVPG is very ideal to diagnosis and to grade severity. But the drawback of this procedure is its invasiveness leading to complications. So, a simple, routinely available, cost effective method for severity assessment of portal hypertension would be attractive. Methodology: It was a cross sectional study which included patients diagnosed as Chronic liver disease attending to the OPD as well as in-patients. Results: This study included a total of 100 subjects who had esophageal varices secondary to liver cirrhosis with portal hypertension. Majority of the patients were in the age group of 36 to 45 years (31%) with mean age of study subjects being 47.43 with male preponderance (87%). A statistically significant association was found for splenic size and esophageal variceal grading. 57% of the patients had splenomegaly between 13-15cm size of which 22 % had grade 3 esophageal varices followed grade 1 varices who constituted 17%. 20% of the patients had spleen size >15cm. Conclusion: Ultrasonographic measurement of spleen size > 13 cm can be considered as non-invasive predictor of presence of esophageal varices and grading in patients with Cirrhosis with portal hypertension along with other measurements like portal vein diameter and platelet count

Background- Given the strong correlation between cardiac disease and chronic kidney disease (CKD), it is possible that even a slight drop in glomerular filtration rate (GFR) can act as a risk factor for developing cardiovascular abnormalities. Cardiovascular disease (CVD) patients with CKD had mortality risks that were three to thirty times higher than those of the general population. Methods- This cross-sectional study was conducted in the Medicine unit of Postgraduate Medical Center of Central India within 6 months duration. The analysis included a total of 140 patients who had been receiving maintenance for more than a year. Two-dimensional transthoracic echocardiography was done in each patient for the determination of cardiac structural and functional parameters such as LV hypertrophy, LV systolic dysfunction, and LV diastolic dysfunction. Results- Out of 140 patients, there were 75.7% males and 24.3% females. Maximum number of patients belonged to age group of 51-60 years. Mean age of ESRD patients was 53.3 ± 12.8. Hypertension (37.1%) was leading cause of ESRD, other causes included diabetes (21.4), diabetes with hypertension (10%), chronic glomerulonephritis (8.6%), polycystic kidney disease (7.1%), obstructive uropathy (5.7%), analgesic nephropathy (2.9%) and aetiology remained unknown in 7.1% cases. Conclusion- Left ventricular dysfunction was most common in ESRD patients. LVH was the most common ESRD echocardiographic abnormality. More ESRD patients had diastolic dysfunction than systolic dysfunction. Left ventricular hypertrophy and diastolic dysfunction were mostly caused by anaemia and hypertension. Systolic dysfunction was caused by ischaemic heart disease-related RWMA. Echocardiography detected LVH and minimal pericardial effusion before clinical diagnosis

Introduction: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by airflow limitation it affects more than 5% of the population and is associated with high morbidity and mortality. It is the third common cause of death worldwide, killing around 1.2 Lakh, individuals each year. As a consequence of its high prevalence and chronicity, COPD causes high healthcare expenditure with frequent hospitalizations due to acute exacerbations and the need for long term therapy (eg, supplemental oxygen therapy, medication). Aims: The aim of this study is to evaluate right ventricular function in patients with COPD by echocardiography. Materials and methods: The present study was a Descriptive and cross-sectional case control study. This Study was conducted from April, 2021to November, 2022 at Indoor and outdoor patients of medicine, chest medicine, cardiology department of NRS Medical College, Kolkata. Total 100 patients were included in this study. Result: RV function were significantly impaired in COPD patients as compared to controls. Clinical deterioration in COPD group was much more in patients with baseline abnormal RV function (89%) and patients with RV systolic pressure ≥35 mmHg (P = 0.018). All the six patients who died had three or more abnormal RV systolic function parameters

Background: Preeclampsia is a multi-system disorder of pregnancy that manifests after 20 weeks of pregnancy in previously normotensive women. It is characterised by new-onset hypertension (systolic and diastolic blood pressure of 140 and 90 mm Hg, respectively, on two occasions, at least 6 hours apart) and proteinuria (protein excretion of 300 mg in a 24 hr urine collection, or a dipstick of ≥ 2+). AIM: To evaluate the utility of placental laterality and uterine artery doppler in the prediction of preeclampsia. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Radio diagnosis, Anil Neerukonda Hospital.  Study Period: 1st January 2020 to June 2021. Study population: All Antenatal cases referred to the department of Radio-Diagnosis for clinically suspected Pre-eclampsia.  Sample size: study consisted of 86 subjects.  Sampling method: Simple random technique. EQUIPMENT: The study will be performed using Philips AFFINITY 50G ultrasound machine using a 3-7C curvilinear probe. SCANNING TECHNIQUE: A written informed consent was taken before performing the scan. The scan was performed with patient in supine position and moderately distended bladder. Data Collection: Basic demographic details, clinical data obtained from study subjects were recorded in a pre-designed proforma. Location of the placenta and uterine artery doppler velocimetry was performed by using convex probe. During the first and second trimesters of pregnancy, ultrasound was used to identify uterine arteries on each side of the uterocervical junction. In third trimester it was seen at the crossover of external iliac vessels. Sample box was 2mm. Insonation angle was less than 60 degrees. Angle dependent Doppler indices are obtained during each examination. Results: In our study 63 (74%) subjects had central placenta and 23(26%) subjects had laterally located placenta. Fourteen of the 86 patients developed preeclampsia; eight (57%) had unilaterally located placentas while only six had centrally located placentas. According to our study, 8 (34%) out of 23 women bearing lateral placentas alone developed preeclampsia whereas 6 (85%) out of 7 women bearing lateral placentas with Doppler abnormalities developed preeclampsia. Conclusion: A lateral placenta puts a pregnant woman at significant risk of developing preeclampsia. In lateral placentas co-occurring with uterine artery Doppler abnormalities, preeclampsia risk significantly increases as compared to those of lateral placentas alone

Background: Non Communicable Diseases (NCDs) are one of the important modern epidemics affecting the elderly and it also worsens with age.  Health seeking behavior among elderly plays an important role in managing NCDs properly and thereby reducing the morbidity and mortality from NCDs. And health seeking behavior in turn is influenced by various factors. Knowing more about the pattern of health seeking behavior and its determinants among elderly will help health care workers in taking proper measures to improve their health seeking behavior and thus improve the quality of living. Objectives: To assess the health seeking behavior among elderly living with NCDs in a rural area in Trivandrum district and to find out the determinants of health seeking behavior among them. Materials and methods: It is a qualitative study using Focus group discussion method. Done  within 3months during June 2022 to August 2022 in a rural grama  panchayath area in Trivandrum district, Kerala among elderly individuals  diagnosed with NCD like hypertension, diabetes, dyslipidemia,  heart diseases, residing in the that  panchayath area  in Trivandrum .Total of 2 FGDs were conducted with each one having minimum of 6 and maximum of 12 participants. Total of 18 participants were included. Details regarding socio-demographic details, details regarding pattern of health seeking behavior for NDCs, and factors influencing health seeking behavior were discussed. Results: In the current study it was found that half of the participants had good health seeking behavior. Less than half of the participants had self medication. Motivation from dear and near, fear of complication, good support from health care worker were found out to be the facilitating factors while Self medication, poor transportation availablty, poor attitude from health care workers, fear of Covid19, poor financial status were reported as reason for poor health seeking behavior in this study. Conclusion: Addressing these barriers by improving the awareness of public regarding NCDs and importance of early diagnosis and prompt treatment along with overall improvement of health related facilities and quality health care services along with integration and coordination of public and private health services and promoting the various motivational factors can improve the overall health seeking behaviorBackground: Non Communicable Diseases (NCDs) are one of the important modern epidemics affecting the elderly and it also worsens with age.  Health seeking behavior among elderly plays an important role in managing NCDs properly and thereby reducing the morbidity and mortality from NCDs. And health seeking behavior in turn is influenced by various factors. Knowing more about the pattern of health seeking behavior and its determinants among elderly will help health care workers in taking proper measures to improve their health seeking behavior and thus improve the quality of living. Objectives: To assess the health seeking behavior among elderly living with NCDs in a rural area in Trivandrum district and to find out the determinants of health seeking behavior among them. Materials and methods: It is a qualitative study using Focus group discussion method. Done  within 3months during June 2022 to August 2022 in a rural grama  panchayath area in Trivandrum district, Kerala among elderly individuals  diagnosed with NCD like hypertension, diabetes, dyslipidemia,  heart diseases, residing in the that  panchayath area  in Trivandrum .Total of 2 FGDs were conducted with each one having minimum of 6 and maximum of 12 participants. Total of 18 participants were included. Details regarding socio-demographic details, details regarding pattern of health seeking behavior for NDCs, and factors influencing health seeking behavior were discussed. Results: In the current study it was found that half of the participants had good health seeking behavior. Less than half of the participants had self medication. Motivation from dear and near, fear of complication, good support from health care worker were found out to be the facilitating factors while Self medication, poor transportation availablty, poor attitude from health care workers, fear of Covid19, poor financial status were reported as reason for poor health seeking behavior in this study. Conclusion: Addressing these barriers by improving the awareness of public regarding NCDs and importance of early diagnosis and prompt treatment along with overall improvement of health related facilities and quality health care services along with integration and coordination of public and private health services and promoting the various motivational factors can improve the overall health seeking behavior

Background: The ability of sonography to depict the subtle changes in the myometrium and endometrium makes it the diagnostic modality of choice for evaluation of many uterine disorders. The transvaginal sonography (TVS) has a pivotal role for assessment of gynecological patients and the vaginosonographic examination allows visualization of phasic variation of endometrial thickness, endometrial infiltration in endometrial cancer. Aims and Objectives: Validation of ultrasonographic measurement of endometrial thickness (ET), histopathological study and other risk factors like nulliparity, obesity, early menarche, antihypertensive drugs, hormone replacement therapy, hypertension and late menopause. Materials and Methods: The current study was a prospective observational study carried out in the department of Obstetrics and Gynecology, MKCG Medical College; Berhampur; Odisha from November-2017 to October-2019 over 120 cases. Cases were selected according to following inclusion and exclusion criteria after informed consent. After selection cases were subjected for detailed history taking with special attention to oral contraceptive use, use of HRT, antihypertensive medications, history of diabetes followed by thorough clinical examinations and baseline investigations including hemogram, FBS, urine routine and microscopic, chest X-ray and Pap smear. Then all the cases were subjected for ultrasound examination for ET followed by endometrial biopsy. Results: Majority of 52 cases (43.33%) had menarche at age of 13-15 yrs, of them 44 cases (84.61%) had ET ≥ 4 mm, 41 cases (34.16%) had menarche at age of 16-18 yrs, of them 30 cases (73.17%) had ET ≥ 4 mm. Most of cases i.e. 41 cases (34.16%) were of P4, of them 38 cases (92.7%) had ET ≥ 4 mm followed by 36 cases (30%) were of P5, of them 22 cases (61.11%) had ET ≥ 4 mm, 17 cases (14.16%) were of P3, of them 15 cases (88.2%) had ET≥ 4 mm, 8 cases (6.66%) were of P2, of them 6 cases (75%) had ET≥4mm,4cases(3.33%)wereofP1, ofthem3cases(75%)hadET≥4mmand2cases (1.66%) were of P0, of them one case had ET ≥ 4 mm. Among the cases, 26 cases (21.66%) who give history of OCP use, of them 16 cases (61.53%) had ET ≥ 4 mm whereas 94 cases (78.33%) who had never used OCP, of them 78 cases (82.9%) had ET ≥ 4 mm . Among the 108 cases (90%) who never taken HRT, 84 cases (77.77%) had ET ≥ 4 mm whereas among the 12 cases (10%) who had taken HRT, 10 cases (83.33%) had ET ≥ 4 mm(p value is 0.94). Conclusion: Transvaginal ultrasound is a measurement tool, justify subsequent study of the relationship between endometrial thickness and other risk factors like nulliparity, obesity, early menarche, antihypertensive drugs, hormone replacement therapy, hypertension and late menopause in cases of postmenopausal bleeding.

Background:  Hypertension in pregnancy is a systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or both. Both systolic and diastolic blood pressure raises are important in the identification of Pregnancy induced hypertension. Pregnancy induced hypertension (PIH) is hypertension that occurs after 20 weeks of gestation in women with previously normal blood pressure. The broad classification of pregnancy-induced hypertension during pregnancy is gestational hypertension (GE), pre-eclampsia and eclampsia. Serum uric acid and creatinine levels are a part of work up for the pregnant women with hypertension. The elevated levels of these parameters were due to decreased urinary clearance secondary to reduced Glomerular filtration Rate (GFR) and increased reabsorption. Materials and methods: The present study was carried out in the Department of Biochemistry, Dr VRK Womens Medical College, Teaching hospital and Research center. Total 70 patients of pregnancy were selected out of which 30 patients were of normal pregnancy and 40 patients were of pregnancy induced hypertension. Serum uric acid levels were estimated before delivery and after delivery in cases of pregnancy. Pregnant women with recurrent abortions, bad obstetric history, twins, preexisting medical disorders – such as diabetes mellitus, essential hypertension, renal disorders, cardiovascular, thyroid disorders, and liver disease – were excluded from the study. Results:  In our study, we observed a significantly elevated serum uric acid PIH (9.51 ± 1.33 mg/dl) and Normal pregnant women (5.29 ±0.8 mg/dl). Blood Urea was 5.29 ±0.8 mg/dl among Normal pregnant women and 9.51 ±1.33 mg/dl among PIH. Moreover, Serum Creatinine level was1.25±0.53 mg/dl among PIH and 0.97±0.23 mg/dl among Normal pregnant women. Conclusion: On the basis of study findings we, concluded that the increased levels of serum uric acid, serum creatinine and serum urea are better diagnostic and predictive marker for PIH and immediate medical attention required for PIH. With the help of these parameters most cases are detected early in the pregnancy before they can progress to eclampsia

Background: Hypertension is a chronic illness associated with high morbidity and mortality. Once hypertension is diagnosed, starting antihypertensive therapy on a long-term basis along with regular follow up is important. Drug utilization research also provides insight into the efficiency of drug use, i.e. whether a certain drug therapy provides value for money and the results of such research can be used to help to set priorities for the rational allocation of health care budgets. The main objective of the study is to assess the utilization pattern of antihypertensive in a tertiary care hospital. Materials and methods: This prospective, cross‑sectional observational study was conducted in the Department of Pharmacology, Dr. VRK Women's Medical College, Aziznagar, Moinabad. Before initiation of the study, the approval of the Institutional Ethics Committee was obtained. A predesigned pretested schedule was employed to collect the data. The schedule contained information pertaining to basic demographic variables, comorbid conditions, and a format to assess the antihypertensive drugs prescribed. Patients coming to the medicine outpatient department were screened over a 4‑month period. Among all the prescriptions that were screened, prescriptions that had antihypertensive medication as a component were noted along with the hospital number. Results: A Total of 90 patients with history of hypertension were included. In the present study majority of patients i.e., 55.6% (50/90) were among 51-60 years, followed by 24.4% (22/90) patients among 41-50 years, 11.1% (10/90) were 61-70 years.5.6% among 30-40 years, 2.2% were among 71-80 years, least were more than 81 years i.e., 1.1%. The patients were categorized depending on the stages of the hypertension- 10 /90 (11.1%) patients belonged to prehypertension stage, 60/90 patients (66.7%) belonged to stage 1 hypertension and 20/90 (22.2%) patients belonged to stage 2 hypertension. Conclusion: In this study usage of anti-hypertensive drugs were prescribed rationally in tertiary care hospital. The study emphasizes that need for effective continuing medical education and also preventive measures in hypertensive individuals

Introduction: Diabetes mellitus a group of metabolic disorder leading to chronic hyperglycemia. The most common symptoms are polyuria, Polydipsia and polyphagia. There are different classes of antidiabetic drugs that can be prescribed in T2DM. the main aim is to study is to observe the suitable antidiabetic drug for the treatment of T2DM. Aim:  The aim is to study the prescription pattern, comorbidities and complications in type 2 diabetes mellitus in tertiary care hospital. Material and methods: Patients under inclusion criteria was selected for the study. A total of 100 T2DM patients were selected for the study. the patients were divided into two groups, group A – newly diagnosed T2DM and group B – Already diagnosed T2DM. the information was taken from the based on risk factors, ranges of HbA1c, FBS & PPBS, BMI, Duration of diabetes and comorbidities. Results: The study was conducted on 100 T2DM patients. the majority of the patient were male with a age group of 51 – 60 years. In group A patients majority of the patients were prescribe with metformin as monodrug therapy and in group A & B, metformin + glimepride as combination therapy. As per our study most of the patients having hypertension, smokers, and overweight respectively. Conclusion: Metformin and combination of metformin with glimepiride are most commonly prescribed drugs in treatment of type 2 diabetes mellitus

Background: Hypertension and dyslipidemia are associated with oxidative stress and are major causes of cardiovascular disease amounting to 30% of global death rate.  Objective: To study the pathogenic role of Serum Uric Acid Levels  in  essential hypertension. Material and Methods:  This study was conducted at Department of General Medicine in a Medical College. Results: Mean age of the cases with hypertension was 55.02 years with 28.9% cases being above 60 years of age. Out of the total 235 cases, 57.9% were males while 42.1% were females. Out of the total 235 cases with hypertension, 83.8% were in stage I hypertension while 16.2% were in stage II hypertension. Prevalence of hyperuricemia was seen as 27.7% among cases with hypertension. Mean age was comparable among cases with and without hyperuricemia (54.85 vs 55.09 years; p-0.84. Conclusion: Mean serum uric acid levels were significantly associated with increase in systolic and diastolic blood pressure

Introduction: Improving maternal health is one of the fifteen Sustainable goals  adopted by world leader in September 2015 by  an historic  international community at the United Nations Summit, which aims  to reduce the global maternal mortality ration to less than 70 per 100,000 live births by the year 2030.The MMR in developing countries is more than developed countries. MMR in developed country is 12/1,00,000 live birth Maternal mortality ratio of India is 97/lakh live births. Preeclampsia is a new onset of hypertension and proteinuria after 20 weeks of gestation  in a previously normotensive women.Severe Preeclampsia  is a serious clinical type of preeclampsia by atleast one of the following – persistent increase in blood pressure [≥160/110 mmhg ],hepatic and renal failure,platelet count less than 1,00,000 / mm3 , hemolysiselevsted liver enzymes and low platelet count [HELLP] Syndrome, Cerebral or visual disturbances, persistant epigastric pain and pulmonary oedema. Eclampsia is a serious obstetric emergency with new onset grand mal seizure during pregnancy or postpartum in women having signs and symptoms of preeclampsia. The sequel of severe preeclampsia and eclampsia include organ failure, loss of consciousness and finally loss of lives of both mother and fetes. Aims and Objectives: To study clinical outcome of Preeclampsia and Eclampsia in a Tertiary Care Centre. Materials and Method: The study was conducted in department of Obstetrics and Gynaecology, MKCG Medical College, Berhampur, Odisha, India for a period of 18 months extending from November 2020 to September 2022.A total of 400 patients were studied. At the end of the study, collected data were tabulated and analysed. Results: Present study was conducted on 400 cases, during the study period.Mean age was 31.19 ± 5.7 years. Majority of patients (194 cases, 48.5%) belonged to lower class followed by 129 cases (32.3%) belonging to middle class. Fifty four patients (13.5%) were from lower middle class. Upper middle class had 16 (4%) patients. Only 7 cases (1.7%) were from upper class. In 127 patients (31.8%) diabetes mellitus and in 227 patients (56.8%) pre-existing hypertension was reported respectively. Among 400 patients studied, 114 patients (28.5%) were primigravida and 286 patients (71.5%) were multigravida.  Twenty eight (16.8%) patients died of complication. Both age and age of gestation of patients were not significantly distributed across maternal mortality (Page=0.34, Paog=0.33). Cause of death was abruption placenta (10 cases), acute renal failure (6 cases), ARF with sepsis (1 case), eclampsia (4 cases), HELLP with PPH, PPH, pulmonary embolism, pulmonary embolism with PPH and wound infection (1 case each) and sepsis (2 cases). Out of 59 patients suffering from eclampsia, 4 (1%) patients died and 24 (6%) patients with pre-eclampsia died. Association of occurrence of eclampsia was robustly associated with patient mortality (P<0.0001).Two hundred and sixteen neonates (54%) had low birth weight while 279 (69.8%) were cases of intra uterine growth retardation. Preterm birth, birth asphyxia and NICU admission was seen in 175 (43.8%), 168 (42%) and 270 (67.5%) respectively. Eighty nine (22.3%) neonates died after birth while 52 (13%). Mean maternal age of deceased and survived neonates in present study was 31.51±5.6 years and 31.1±5.8 years respectively. Mean values for age of gestation of deceased and survived patients were 31.29±1.4 weeks and 31.59±2.2 weeks respectively. Both age and age of gestation of patients were not significantly distributed across maternal mortality (Page=0.56, Paog=0.24).  Conclusion: Preeclampsia and eclampsia tends to threaten maternal health and fetal viability adding to maternal and neonatal mortality and morbidity.There is high frequency of preeclampsia and eclampsia in our setting and the consequences are alarmingly high. There is need for patients education in recognizing the warning symptoms of the disease before intrauterine demise of fetus occurs or mother develops one of the grave complications, Antenatal care, treatment of anemia  and educating the women on significance of symptoms will go a long way in improving maternal and perinatal morbidity and mortality.Presence of NICU  with effective neonatal care will improve the fetal outcome.

Backgroud: Pulmonary thromboembolism (PE) is a common and potentially lethal condition. Despite significant advancements in diagnosis and management, there is limited reporting of this condition from India. Objective: To study the clinical profile and outcomes in patients of pulmonary thromboembolism. Methodology: This was a prospective observational study, conducted at the Department of Medicine, which includes the Medicine wards and MICU, in a tertiary care hospital located in central India. The study period was from November 2020 to October 2022, with a sample size of 43 participants. Results: The mean age of the cases was 50.86 years. Hypertension was the most common risk factor and Diabetes was the most common comorbidity. Palpitation was the most common symptom seen in 100% of cases and most common sign at the time of presentation was Tachycardia. ECG finding was Sinus tachycardia in 69.8% of the cases, the chest x-ray finding was dilated MPA/R in 34.9% of the cases, Right Ventricular (RV) dysfunction was seen in 30.2% of the cases on Echocardiography, DVT was seen in 9.3% of the cases in doppler and Pulmonary thromboembolism was seen 100% of the cases on CT pulmonary angiography. Heparin was given in 32.6% of cases and LMW Heparin was seen in 37.2% of the cases. Oral anticoagulation was given in 18.6% of the cases. New-oral anticoagulants were given in 37.2% of the cases. Thrombolytic therapy, Streptokinase was given in 30.2% of the cases. The outcome was discharge in 72.1% of the cases and death in 27.9% of the cases. Conclusion: Pulmonary thromboembolism (PTE) remains a major cause of morbidity and mortality all over the world. Risk factors are present in a majority of patients with confirmed venous thromboembolic disease. This condition is unrecognized and underdiagnosed clinically despite its high mortality.

Labour and delivery are focus and climax of the reproductive process. They are both physical and emotional challenge for the mother and a hazardous journey for the fetus. Labour is a dynamic phenomenon characterized by a progressive increase in the frequency, intensity and duration of uterine contractions with progressive dilatation and effacement of the cervix and the  fetal  descent  through  the  birth  canal.   This physiological process may lead to pathology and failure to recognize this would result in prolonged labour resulting in increased morbidity and mortality of mother and baby.2 Material And Methods A hospital-based prospective study of 100 pregnant women with high-risk pregnancy  attending  the  department  of  Obstetrics  and  Gynaecology, Gayatri vidyaparishad medical college, Vishakhapatnam, from December 2021- November 2022. The study groups randomly selected a hundred primigravida with high-risk pregnancy fulfilling the inclusion and exclusion criteria. Informed and written consent was taken from all the women participating in the study. The study's primi pregnant women fulfilling inclusion and exclusion criteria were divided into the PARTOGRAM GROUP (P) and the other NO PARTOGRAM (NP). Each group consists of 50 primi  pregnant  women.  In the partogram group,  the progress of labour was documented on MODIFIED  WHO PARTOGRAPH and the notes on the progress sheet of case record file while standard notes only in no partogram group. Results In our study, 80% of pregnant women gestational age was below 39 weeks. In the NP group, 34% of women at 38 weeks, followed by 32% at 39 weeks. In the P group, 54% were at 38weeks, followed by 18% at 39 weeks and 18% at 40 weeks. Oligohydramnios  was  predominantly  observed  in  women  presented  in  39 weeks  (48%)  gestational  age.  Gestational  hypertension  (38.6%)  and  gestational diabetes mellitus(18.1%) was commonly observed in women in 38 weeks of gestation as both conditions are delivered at 38 weeks. Hypothyroidism was predominantly observed in women at 37 weeks(36.3%) and 39 weeks(24%) of gestation.  In individuals' groups, among the NP group, most pregnant women were delivered by FTNVD (60%) followed by 30% cases by LSCS. In P group out of 50 deliveries, 78% of cases delivered by FTNVD, followed by 14% undergone LSCS.  Conclusion: Partogram is an excellent tool for reflecting quick and consistent review of labour events, handing over the patient in changing shift duties, especially in low resource settings. It leads to earlier decision making in labour management and shown to reduce cesarean section rates.

Background: It is estimated that 17.7 million people died from CVDs in 2015, representing 31% of all deaths taking place worldwide; more people die every year from CVDs than from any other cause. Cardiovascular diseases are showing an increase among the Indian population. There has been a rapid and significant growth in the measurement of quality of life as an indicator of health outcomes in patients with CVD. In the clinical course of cardiovascular diseases, the interaction between stress and its impact on quality of life will alter and aggravate theclinical condition. Thus, an improvement in health-related quality of life is considered to be important as a primary outcome and overall therapeutic benefit. Most of the patients cannot cope with the stress due to the burden of cardiovascular disorder and require psychiatric intervention. This study will be focusing on the psychological problems faced by these patients and suggest a plan for improving their quality of life. Aims: To assess the quality of life in patients with known cardiovascular disorders i.e. hypertension, congestive cardiac failure and coronary artery disease. Methods: Patients attending Medicine OPD/IPD with a diagnosis of Hypertension, Congestive Cardiac Failure or coronary artery disease who satisfy the inclusion criteria will be selected. Socio-demographic data will be recorded via semi-structured proforma and the WHO Quality of Life Scale (WHOQOLBREF) will be applied. The data will then be evaluated and computed for statistical analysis of various interactions and correlations. Results: Out of 120 patients, 40 patients were selected in each diagnosis of hypertension (HTN), coronary artery disease (CAD), and congestive heart failure (CHF). The overall mean (SD) HRQOL was observed as 54.65 ± 14.23 with a range between 18.75-81.5. Among them, domain 4 has been observed with the highest score of 14.62 ± 2.3 and 66.54 ± 14.31 with 4-20 TS and 0-100 TS. However, the HRQOL distribution was varied as per different cardiovascular disorders, like highest mean ± SD score was observed with CHD (57.43 ± 13.33), followed by HTN (56.1 ± 14.66) and CAD (50.42 ± 14.04). Conclusion: Cardiovascular disorders are an important public health problem with a significant psychological impact and impact on the QoL of patients. There is a slight male preponderance observed in patients with cardiovascular disorders. QoL was affected in patients with cardiovascular disorders with psychological and physical health domains being primarily affected.

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide, with hypertension being the leading risk factor. Ischemic heart disease and stroke are the leading causes of Disability Adjusted Life years (DALYs) in people aged 50 and older, and high systolic blood pressure is responsible for 19.2% of all deaths worldwide. The global NCD priority is to reduce hypertension prevalence by 25% by 2025. Strategies such as early detection, treatment, and control, cost sharing, and benefit designs can help reduce unfavourable health outcomes associated with hypertension. Objectives: The current study is a Community Interventional Trial for Hypertension Control in Rural Maharashtra, India to determine if a community-based intervention delivered to community and healthcare workers in a rural area can be effective in controlling hypertension and if any beneficial effects can be sustained in the long term. Materials & Methods: The study was conducted in the Coverage area of two Primary Health Centers in Palghar District of Maharashtra from Jan 2018 to Dec 2022. It was a Cluster randomized controlled trial with 1850 people in each Sub-center. Comprehensive community-based intervention was implemented in one Subcenter under Primary Health Centre of Kaman and second subcenter in the Primary Health Centre of Satpati in rural area of Maharashtraand its effect was assessed. Results: The baseline characteristics of the study population were similar in both sub-centres. Recommended Physical activity was less in both subcentres, with most of the participants consuming 2000-2499 Kcal/Day. Overweight was higher in Kaman, while central obesity was higher in both PHCs. The prevalence of known cases of both Diabetes Mellitus and Hypertension was 3.4% in Kaman, while Suspected Hypertension cases was higher in Kaman. In Kaman there were 27.5% of confirmed cases of hypertension and after intervention it has reduced to 17.5%. There was a decrease of 10%. In Satpati there were 25.2% of confirmed cases of hypertension and after intervention it has reduced to 21.6%. There was a decrease of 3.6%. Conclusion: A high number of cases of Hypertension is found in rural population. 27.5% of the participants were newly diagnosed with Hypertension. Screening and early detection and treatment of Hypertension is highly needed in rural areas. Community-based intervention is equally important to focus on prevention, promotion, and enable lifestyle changes to prevent and control Hypertension and avoid risk factors.

Background:  Hypertension is becoming a major public health concern in low-income countries due to rising trend of prevalence in past years. Primary factors which lead to poor treatment outcome is the patient non-adherence to medicines. It is therefore, important to analyse the factor responsible for non-adherence to obtain better prognosis. Objective: The present study aimed to determine various sociodemographic and pharmacological factors which influence adherence to medicines in patients with systemic hypertension. Methods: Adherence to antihypertensive medications was measured by using therapeutic adherence scale for hypertensive patients (TASHP). Results: A significant association was observed between satisfactory drug adherence and lower pill burden (one pill/day) and combination drug therapy (1 pill with >2 drugs combination). Lower frequency of drug intake was associated with higher drug adherence though the association was not statistically significant (p=0.241). Presence of side effects was associated with statistically significant low drug adherence (p=0.001). Conclusions: Satisfactory compliance to antihypertensive therapy was associated with combination therapy and limited pill burden. Absence of side effects with antihypertensive medication and better blood pressure control were also associated with better drug compliance. Identifying these pharmacological factors would be of value for physicians in focusing strategies to enhance patient compliance to antihypertensive medication.

Background:   Bactibilia, or the presence of bacteria in bile from the gallbladder, may contribute to the development of septic complications. It has been related to increased rates of surgical site infection after cholecystectomy. Laparoscopic cholecystectomy is the definitive treatment for cholelithiasis and cholecystitis. Advanced age, acute cholecystitis, ERCP, and gallstones are important risk factors for the development of bactibilia. This study aims at showing the effect of bactibilia on the course of laparoscopic cholecystectomy. Materials and methods: This are a prospective case-control study to be conducted at Govt. General Hospital, Vijayawada at Dept. of General Surgery over 1 year on 50 patients. Patients with asymptomatic Cholelithiasis of age 18-60 are included in the study and patients with hemoglobin < 10 gm%, hypoalbuminemia < 2.5 gm/dL, patients in acute sepsis, patients with HbA1c >6.5%, hypertension (>139/89 mm of Hg) and BMI > 30 and patients in an emergency setting and patients who have not consented for the study were excluded from the study. None of the patients received pre-operative antibiotics. Intra-operatively, bile is collected from the gall bladder and sent for microbiological culture in aerobic and anaerobic media for 3-5 days. Patients are divided into: Group A - Microbiological culture positive for microbes and Group B - Microbiological culture sterile. Both groups will be analyzed for the duration of hospitalization after surgery, post-operative wound infection, and any other complications encountered. Results: Out of the 50 patients, 32 were males and 18 were females. The mean age of the patients was 43.5 ∓ 9.6 years. The mean BMI was 27.1 ∓ 4.7. Of the total 25 samples positive for bile culture, 11 were E.coli, 7 were Klebsiella, 3 were Enterobacter spp., 2 were Acinetobacter spp., and the remaining were 2 Viridans streptococci. All the bacteria were sensitive to Amikacin. All except Acinetobacter were sensitive to gentamycin and imipenem. All except one case of E.coli were susceptible to ciprofloxacin. The incidence of port site infection, prolonged fever, intra-abdominal abscess, pneumonia, wound healing duration, and hospital stay were significantly higher in group A compared to group b (p-value < 0.05). Conclusion: Bactibilia affects the outcomes of laparoscopic cholecystectomy in terms of prolonged hospital stay, increased incidence of wound infection, duration of wound healing, and fever.

Conclusion: Serum homocysteine, vitamin B12and folic acid are easily available investigations which may predict the severity and outcome of patient s    of acute ischemic stroke.

Study Conducted: AT dept of generalsurgery, gajra raja medical college and JahGroup of Hospitals, Gwalior Madhya Pradesh Background: Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and quantify the risk factors of subsequent amputation in hospitalized DFU patients. Methods: This study was conducted on 100patients of diabetic foot in the Department of Surgery, JA Group of Hospitals and GR Medical College, Gwalior (MP) from January 2020 to June 2021 Patients’ demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21 Results: A total of 100 cases of diabetic foot wounds were studied from January 2020 to August 2021 in the Department of Surgery JAH Hospital and G.R. Medical College, Gwalior.In our study,most diabetic foot wound patients presented in the 50-69 years age group with a mean age of 52.23±14.92 years. Male to female ratio of 4.5:1 was shown in our study.Total of 56% of patients presented with a diabetic foot wound within <10 years of duration of diabetes mellitus.67(67%) out of 100 patients gave a positive family history of diabetes.The most common cause was trauma/injury (65%) and the most common presentation was an ulcer (70%).Out of 100 patients, 66(66%) patients belonged to rural areas and 75% were illiterate.The most commonly affected patients are farmers (47%) and labors (29%) by occupation. Most of the patients were using ill-fitted shoes or barefoot walking.Most of the patients developing complications had uncontrolled RBS with delayed presentation and longer duration of diabetes and not took proper precautions and treatment.50% of patients underwent surgical debridement and 15 % of patients underwent amputation.Mortality was 2% in our study. Conclusions: Several risk factors for LEA were identified. , PAD, hypertriglyceridemia, and hypertension have been recognized as predictors of LEA in this study. Good glycemic control, the active investigation against PAD, and management of comorbidities such as hypertriglyceridemia and hypertension are considered important to reduce amputation riskNot all diabetic foot complications can be prevented, but it is possible to reduce their incidence through appropriate management. The multidisciplinary team approach to diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in high-risk diabetic patients.

Background: Chronic kidney disease (CKD) has emerged as a significant global health problem with substantial morbidity, mortality, and economic burden. The prevalence of CKD varies across different regions, with a higher burden observed in low- and middle-income countries.CKD is often associated with a range of comorbidities, including hypertension, diabetes mellitus, cardiovascular diseases, and anemia, which further contribute to adverse outcomes.Understanding the etiology of CKD is crucial for implementing targeted prevention and management strategies.Objective: To assess the clinical profile of CKD Patients. Methods: This cross sectional study was done on 100 CKD patients after IHEC approval with Informed consent. The various etiology of CKD, stage of disease, coexisting medical conditions, laboratory findings, and ECG/ECHO were measured.Result: Anaemia and hypocalcemia was common among the study participants. All had Cardiac changes. Majority of patients had comorbidities such as alcoholism, cardiac disease, anemia, clubbing, pedal edema, and abnormal lipid profiles. Conclusion: Managing anemia, mineral and bone disorders, fluid and electrolyte balance, hypertension, dyslipidemia, and inflammation becomes crucial in the comprehensive care of CKD patients to mitigate cardiovascular risks.

Background: Stroke rank high among the leading causes of death and permanent disability in India. Due to shifting demographics and rising rates of important modifiable risk factors. The purpose of this study was to compare the blood sugar levels of people with and without diabetes in the early stages of ischemic stroke. Material and Methods:  40 patients who had been admitted to the Department of General Medicine, Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India for the diagnosis of acute ischemic stroke between the April 2022 to March 2023 were included in this study. The Patients were on the basis of the inclusion and exclusion criteria. Results: In our analysis of 40 patients, the majority of them were male, indicating a male preponderance, which is prevalent in most investigations. Twenty-eight of the forty patients had hypertension, 34 had diabetes, three had a history of myocardial infarction, and one female patient had atrial fibrillation. The majority of the patients (15) were between the ages of 51 and 60, with 11 between the ages of 27.5 and 12.5% between the ages of 40 and 50. Conclusion: Ischemic stroke severity, magnitude, and outcome are linearly related to admission day hyperglycemia. Diabetes and stress hyperglycemics have greater severe strokes and worse functional outcomes and higher death. Admission day glucose levels predict ischemic stroke outcomes.

Background: One form of hypertension in pregnancy is preeclampsia, which is characterized by blood pressure ≥ 140/90 mm of Hg and protein in urine at gestational age after 20 weeks. Preeclampsia is a global problem affecting 2-8% of pregnancies, and an estimated 8.3 million pregnant women experience preeclampsia every year.  In this review we will look at potential biomarkers and its correlation with uterine artery Doppler for early prediction and diagnosis of preeclampsia. Aim: To investigate the role of placental growth factor, and uterine artery diastolic notch to predict the early onset of preeclampsia. Materials And Methods: A hospital based prospective study conducted on 100 normotensive, non- proteinuric antenatal women less than 20 weeks of gestation were recruited. At 12-16 weeks, PLGF level was estimated from stored serum samples of all cases ad Doppler assessment of uterine circulation for uterine artery indices were done. These women were again rescanned at 24 weeks of gestation by transabdominal USG and further followed up clinically for development of preeclampsia. Methods used for the detection of PLGF is ELISA kit ad Uterine artery Doppler velocimetry was done by transabdominal ultrasound machine using a 4-6 MHz probe with the same sonographer Results: In this study,the median PLGF levels being significantly lower in pre-eclampsia cases (15 pg/ml) compared to normal (20.0pg/ml) with sensitivity being 90% and specificity being 23.4%, positive predictive value of 15.5% and negative predictive value of 93.8%. When Uterine arteries notch and RI >0.65 taken together increases sensitivity by 85.71%, 84.62% specificity and negative predictive value by 98.25%.  We found 52.3% sensitivity rate and 84.62% specificity with  70.51% of Negative predictive value regarding Uterine arteries PI  at >0.9573 with Optimal Cut off.  Conclusion: The combined measurement of maternal serum PlGF concentrations and The uterine artery notching, high Resistance Index and Pulsatility Index in uterine artery Doppler waveform at <20 weeks has shown as best screening test for early prediction of preeclampsia.

Congenital heart disease is related to events occurring in the embryonal stage, while rheumatic heart disease is a sequelae of immune-mediated damage following streptococcal infection. Rheumatic heart disease is a well-known entity in developing world. Congenital heart disease is also common cause of hospital admission. However, coexistence of rheumatic heart disease with congenital heart disease occur rarely. Here we report an unusual case of rheumatic mitral stenosis with restrictive patent ductus arteriosus (PDA) and severe pulmonary arterial hypertension leading to Eisenmenger syndrome in a 13 years old girl. This case highlights the need for careful examination for coexisting rheumatic disease and congenital heart disease. Eisenmenger syndrome could be a presentation of juvenile severe rheumatic mitral stenosis when it is associated with congenital shunt lesion like PDA

Background: Over the past three decades, Transradial-Access (TRA) has revolutionized cardiac catheterization, demonstrating superior safety and outcomes compared to other access points. The European Society of Cardiology has now endorsed TRA as a viable alternative to traditional methods. Challenges during TRA can arise despite its success, making a comprehensive assessment of forearm artery anatomy essential. Forearm artery angiography (FA) has emerged as a valuable tool to improve procedural success and reduce complications. In this study, we retrospectively analyze the impact of FA on a diverse patient population, aiming to enhance TRA's effectiveness and safety in cardiac catheterization procedures in Bangladesh. Aim of the study: This study investigates the potential for enhanced success rates of Coronary Angiography and Percutaneous Coronary Intervention (PCI) by utilizing Standardized Forearm Angiography in a diverse patient population. Methods: This is a prospective comparative study, a total of 480 patients were enrolled and analyzed in this study. The study was conducted at the Department of Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh. It analyzed 480 consecutive patients who underwent Coronary Angiography (CA), with or without Percutaneous Coronary Intervention (PCI). The study spanned one year, from January 2022 to December 2022.  Result: In this prospective study, 480 patients were analyzed, and various characteristics of the study population were examined. The average age of patients was 71.4 years, 71% male and 29% female. The study focused on forearm artery access, with 54.17% having right forearm access and 45.83% left forearm access. The most common access type for left forearm artery access was the distal radial artery, while the proximal radial artery dominated right forearm access. Arterial hypertension was the most prevalent variable, followed by diabetes mellitus and active smoking. The most common clinical indication for medical procedures was "Suspected CAD or chronic coronary syndrome." Etiological factors leading to medical conditions were also analyzed, with "Failure to achieve arterial puncture or introduce arterial sheath" being the most common factor, followed by "Kinking" and "Atherosclerotic occlusion." Conclusion: The retrospective analysis showcased promising results, indicating that standardized forearm angiography may lead to enhanced success rates in coronary angiography and PCI among a diverse patient population. This non-invasive approach could offer improved diagnostic accuracy and procedural outcomes, warranting further investigation and consideration for broader clinical implementation.

Conclusion: Computed Tomography Angiography (CTA) demonstrated superior diagnostic accuracy and strong correlation with Doppler ultrasonography in the assessment of renal artery stenosis. CTA could serve as an effective alternative or adjunct to Doppler ultrasonography, providing valuable anatomical information and aiding in the clinical evaluation of RAS.

Background: Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality all over the world. It causes about one-third of all deaths in people older than 35years. We carried out this study because there was no such study carried out in Andaman and Nicobar Island to ascertain the incidence of CAD and the risk factors which lead to CAD in Andaman and Nicobar population. The health sector in Andaman and Nicobar is developing. Due to the increasing load of CAD patients recently the Cath Lab was started as the ANIIMS Port Blair / GB Pant Port Blair is the only tertiary care hospital in the whole of Andaman and Nicobar Islands. To get a better insight into the disease prevalence and how to lower the risk factors. Material and methods: This cross-sectional study was done in a tertiary hospital in Port Blair to find out the prevalence of risk factors among patients with coronary artery disease. A total of 315 patients were screened based on a questionnaire, ECG (Electrocardiography) and laboratory investigations. Data was analysed in SPSS and Microsoft Excel and was presented as tables and graphs. There was significant observation based on age, clinical features, risk factors, ECG patterns and laboratory diagnosis. The result was conclusive of increased prevalence of risk factors among CAD patients which was also reported in various studies conducted in India and across the world.  Results: This study has estimated that the overall prevalence of Hypertension is 86.03%, Type 2 diabetes mellitus is 88.89%, Smoking is 55.87%, Hypercholesterolemia is 71.43%, Hypertriglyceridemia is 68.25%, Obesity is 65.40%, Stress is 61.9%, and Family history is 12.38%.  Conclusion: The present study demonstrates a high prevalence of CAD risk factors in the population of Port Blair, Andaman and Nicobar Islands. The study population reflects the rising trends of CAD in urban India. The incidence of CAD has increased further because of rapid urbanization and its accompanying effects like sedentary lifestyle changes, change in food habits, lack of outdoor activity. There should be an early detection of a risk factor to prevent morbidity and mortality in the community. Therefore, there is an immediate need to raise awareness among the general population regarding these risk factors, signs and symptoms of coronary heart disease promote the correct diet and physical activity, meditation,yoga and others and at the same time develop guidelines for screening and preventive therapeutic programs to identify and manage individuals at high risk for future CAD.  CAD can be prevented by dietary modification, changing lifestyle, decrease tobacco consumption and regular physical exercise. Screening and regular medical check-up of patient helps in early detection of CAD.

Aim: To find out risk factors of hypertension among hypertensive patients among the patient visiting a tertiary care center. Patients and methods: In this study, analysis and interpretation of data were based on data collected through a structured interview schedule, measurement of BMI and blood pressure of 100 study subjects. Results: A Chi-square test was applied to determine the association of dietary & behavioral risk factors with socio-demographic variables. Dietary risk factors with socio-demographic variables. The statistical test showed the level of significance with gender, religion, marital status and type of family (p-value is less than 0.05). Fruit and vegetable consumption with socio-demographic variables. The statistical test showed the level of significance with age, education level and occupation (p-value is less than 0.05). Coffee consumption with socio-demographic variables. The statistical test showed that all variables are non-significant (p-value is greater than 0.05). Fatty food intake with socio- demographic variables. Discussion: The study concludes that 51% of females were hypertensive. Hypertension was higher among subjects with risk factors like fatty food and desi ghee intake, frequency of meal 2 times a day, physically inactive and taking less than 6 hours sleep in a day. Although there was a significant association of dietary & behavioral risk factors with socio-demographic variables like gender, age, religion, marital status, education, occupation and family income (p is less than 0.05) as depicted by the Chi-square test.

Introduction: Essential hypertension is a common circulatory system disease, which is affected by both genetic and environmental factors, and accounts for more than 40% of the cardiovascular disease total burden. Aim: To study 24 hour sodium and correlation to blood pressure and left ventricular hypertrophy in essential hypertension. Materials and methods: It is Hospital based Analytical Observational Cross-sectional study done in 100 patients comprised of hypertensive individuals presenting to Medicine op and patients admitted under the department who are fulfilling the inclusion and exclusion criteria.  Results: There was a strong positive correlation between Systolic BP , diastolic BP , MAP , duration of HTN (Years) and Urinary Sodium (mmol/L), and this correlation was statistically significant. There was a significant difference between the 2 groups in terms of urinary sodium(mmol/L), with the median Urinary Sodium (mmol/L) being highest in the LVHI. There was a significant difference between the various groups in terms of distribution of LVMI.There was a positive correlation between Systolic BP, Diastolic BP, MAP (mmHg) and LVMI (g/m2), and this correlation was statistically significant . There was no statistically significant correlation between BMI (Kg/m2) and LVMI (g/m2) (rho = 0.17, p = 0.084). There was no statistically significant correlation between BMI (Kg/m2) and LVMI (g/m2). Conclusions: Hypertension is one of the preventable causes of cardiovascular mortality. Hypertension can be prevented by modifiable risk factors such as low-salt diet, physical activity, blood sugar control, and smoking cessation.

Background: Leptin, an adipokine known for its anti obesity action also has a direct effect in maintaining blood pressure of an individual. Many studies have proposed the significant relation of high plasma leptin levels with high blood pressure. A significant association was found between a tetranucleotide repeat polymorphism (TTTC)n in the 3’UTR of leptin gene with essential hypertension in several populations. So we wanted to conduct a study to know the relationship of (TTTC)n repeat polymorphism in 3’UTR of Leptin gene with Essential hypertension in our population and its relation to serum leptin levels. Methods: A case-control study was done in our tertiary care hospital for one and a half years. Polymerase chain reaction was carried out and the products were visualized after running in 2% agarosegel electrophoresis. The alleles of this tetranucleotide polymorphism were classified as shorter form- class I and longer form class-II. Serum leptin levels were measured by ELISA. Result: It was found that Class I allele was more frequent in hypertensives when compared to controls(p<0.001). Class I/I genotype had significant association with essential hypertension even after adjusting for BMI(p<0.000). The difference in serum leptin levels between hypertensives and apparently healthy controls in our study was statistically significant even after adjusting for influence of obesity (p=0.015). This difference was in line with many other studies. However we could not find a significant association of serum leptin levels with this tetranucleotide repeat polymorphism. Conclusion: We found a significant association of (TTTC)n repeat polymorphism in 3’UTR of Leptin gene with Essential hypertension in this study.

Background: Cirrhosis is the end-stage of every chronic liver disease, resulting in the formation of fibrous tissue, disorganization of liver architecture, and nodule formation, which interferes with liver function and results in portal hypertension. Esophagogastroduodenoscopy is considered the primary modality for the detection and surveillance of EV and to determine the risk of bleeding, guidelines for adult cirrhotic patients recommend universal EV screening by esophagogastroduodenoscopy at the time of the diagnosis of cirrhosis. Material And Methods: It is an observational analytical study. The study comprised of 100 portal hypertensive patients who were admitted in Department of General Medicine, Raja Rajeshwari Medical College and Hospital over a period of 6 months. Spleen size was measured by placing the patient in supine position, using 2-5 MHz curvilinear transducer in the coronal plane of section, posteriorly in one of the lower left intercostals spaces. The patient was examined in various degrees of inspiration to maximize the window to the spleen. The spleen parenchyma is extremely homogenous and it has uniform mid to low echogenicity. When the spleen enlarges it can be more echogenic. A maximum cephalocaudal measurement exceeding 13 cm indicates enlargement with high degree of reliability. Results: Alcoholic liver disease is the most common etiology in this study corresponding to 62 % of cases followed by hepatitis B with 10%. Child pugh score was calculated for all the patients with most of the patients with varices fall in group C and without varices in group B. On univariate analysis portal vein diameter , spleen diameter, platelet count and platelet count and spleen diameter ratio was found to be significantly associated with the presence of varices .On multivariate analysis the presence of esophageal varices was significantly associated with platelet count < 102,000/ μl (OR 6.65; 95% CI,2.51-17.6), spleen diameter > 154 mm (OR 5.78; 95% CI, 2.4-13.94) , portal vein diameter > 13 mm (OR 2.49;95% CI, 1.1-5.62) and platelet count /spleen diameter <815 (OR 10.92 ;95% CI 4.07-29.26). Conclusion: Ultrasonography of abdomen is a simple, convenient and non-invasive method for assessing the severity of portal hypertension in patients and to predict the severity of esophagogastric varices indirectly.

Background: Pulmonary hypertension is a mean pulmonary artery pressure at rest of 20 mm Hg or more. It is considered to be the key intermediate patho phenotype leading to right sided congestive heart failure. subclinical pathological changes to cardiovascular function caused by untreated PH are associated with higher morbidity. Methodology- The study was conducted at a tertiary care hospital for period of 2 years, in the Department of Pulmonary Medicine & Cardiology. 50 patients fulfilling the inclusion and exclusion criteria were included in the study. All patients had two-dimensional and M-mode echocardiography and etiological causes for the newly diagnosed PH were identified. Details were obtained regarding the clinical profile of patients with PH. Results- Majority 44% of the patients were in the age group of 56-65 years. The mean heart rate of the patients was 90+12 per minute, the mean SBP of the patients was 132 + 22 mm of Hg, and the mean DBP of the patients was 77 + 12 mm of Hg. Majority of the patients had COPD. About 56 %of the patients had abnormal CT scan of the chest. 4 % of the patients had abnormal echocardiogram (transthoracic). Conclusion- Moderately pulmonary hypertension is the common type of PH. The right ventricular systolic pressure in ECHO help in diagnosis of PH and even in differentiation between various PH severity.

Introduction: Hypertension is a condition in which the blood flows through the blood vessels with a force greater than normal. Patient with hypertension have an increased prevalence of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance, and the prevalence of type 2 diabetes is increasing in epidemic proportions worldwide. Several trials involving patients with hypertension or cardiovascular disease have suggested that agents that block or inhibit the renin angiotensin system that is ACE inhibitors and ARBs decrease the incidence of new-onset type 2 diabetes. However, the exact role of these agents in diabetes prevention has not yet been fully elucidated. Blocking angiotensin II decreases proinflammatory mediators and the oxidative stress.  Material and Methods: This is a prospective and observational was conducted in the outpatient Department (OPD) of General Medicine and Department of Pharmacology at Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre -A Post Graduate Institute (SIMS), Hyderabad from April 2018 to March 2019. In 100 prediabetic hypertensive outpatients, 78 prediabetic hypertensive outpatients [45 males, 33 females mean age = 49.85±10.35] continued for a period of 12 months. The patients were recruited with following inclusion and exclusion criteria. Fasting blood sugar test: a blood sugar level from 100 to 125mg/dL (5.6 to 6.9mmol/L) is considered as Pre-diabetes, this is sometime referred to as impaired fasting glucose (IFG). Results: In our study 78 cohorts of hypertensive Prediabetic patients on ACE /ARBs were followed for one year and at the end of the study when all the parameters were compared at first visit /baseline with that of third visit /at the end of 12 months in both of the ARB (Telmisartan) and ACEI (Ramipril) group, it was observed that there is decrease in the mean and standard deviation of the different parameters included in the study i.e., SBP(mm Hg), DBP(mm Hg), FBG(mg/dl), OGGT(mg/dl) and HbA1c(%).In Telmisartan and Ramipril groups on the final visit at the end of 12 months, compared to the first visit or at base line, there is no significant difference in the p values of the different parameters i.e., SBP(mm Hg), DBP(mm Hg), FBG(mg/dl), OGGT(mg/dl) and HbA1c. Conclusion:  In the present study it was observed that in hypertensive pre-diabetes patients, the beneficial effect of RAAS Inhibitors is more marked if the therapy started with initial rise diastolic and systolic blood pressure, especially at a relatively younger age.

Introduction: Stroke is one of the most important non communicable diseases causing death. Stroke or CerebroVascular Accident (CVA) is “abrupt onset of a neurologic deficit that is attributable to a focal vascular cause Therefore, the role of lipid profile at the aspect of stroke status and risk assessment also needs to be further discussed. In order to analyse the above issues, our study investigated the association between stroke patients and their lipid profile. Material and Methods: This study included 100 patient admitted in the ward and fulfilling the inclusion criteria. The study consists of history taking, clinical examination and biochemical assay. Study subjects were selected after obtaining consent. Patient were managed according to standard guidelines. Results: Incidence of stroke was greater in males around 71%. The total serum cholesterol concentration was ≥200mg/dl in 62% of our patients. The HDL-C was <60 mg/dl in 87% of patients in our study and among them 43% had <40mg/dl. The VLDL-C was ≥30 in 46% of stroke patients in our study. Apart from dyslipidemia, hypertension was the most significant risk factor (54%) in our study. Conclusion: Dyslipidemia is a tip of iceberg. Lipid profile screening in patients with risk factors like Hypertension, DM, elder people with family history of atherosclerosis diseases etc., can help to provide primary preventive measures. Dyslipidemia, if properly treated being a modifiable risk factor for ischemic stroke, decreases the incidence of stroke due to dyslipidemia. This leads to decreased morbidity and mortality leading to a healthier society.

Background: Eclampsia is a serious medical condition that affects women during pregnancy. Symptoms of eclampsia appear in pregnancy as a condition known as pre-eclampsia, (condition follows a high blood pressure), the condition can go undetected until it develops into eclampsia. This can create additional complications during pregnancy. Each case of eclampsia is unique, and the pregnant woman may share few or no characteristics with other women who develop the condition. Pregnancy histories, Patient age, Family history, Obesity, High blood pressure are major high risk factors for preeclampsia and eclampsia will vary from patient to patient. Materials and methods:The present study was carried out in the Department of Biochemistry, Rama Medical College and Research centre over a period of 1 year. Total 70 patients of pregnancy were selected out of which 30 patients were of normal pregnancy and 40 patients were of pregnancy induced hypertension. Serum uric acid levels were estimated before delivery and after delivery in cases of pregnancy. Pregnant women with recurrent abortions, bad obstetric history, twins, preexisting medical disorders – such as diabetes mellitus, essential hypertension, renal disorders, cardiovascular, thyroid disorders, and liver disease – were excluded from the study. Result:The result showed significantly high blood pressure (SBP-165.81±20.9 VS 125.69±7.24, DBP 109.74±10.41 VS 80.8±5.15) and Blood urea (31.48±2.33mg/dl VS 6.28+/-1.9mg/dl), serum creatinine (0.67±0.52mg/dl VS 0.67±0.03mg/dl), serum uric acid level (6.28±1.9 mg/dl VS 9.48±2.33mg/dl) in pregnancy induced hypertensive women compares to normal pregnant women. In the present study, in PIH, there is elevation of serum uric acid and serum creatinine elevated values are statistically significant. Conclusion:This study concluded that PIH showed significant elevation in the urea, uric acid, and Creatinine levels compared to normal pregnant women, although all parameters’ values for both groups were in the reference values for non-pregnancy.

Introduction: Diabetes is a chronic disease with life altering consequences. It not only forces one to question and alter one’s life style but also thrusts the added responsibility of self-care upon them. Patients are required to maintain controlled levels of glycalated hemoglobin (HbA1c). But up to 50 percent fail to do so and land up with a wide array of complications. One among these many complications is the psychiatric co-morbidity of depression. Materials and Methods: The present study is a cross sectional study conducted at Department of Psychiatry, Shimoga Institute of Medical Sciences, Shimoga, Karnataka from the period of February 2022 to October 2022. The study population was determined to be 120 in number. Participants who were diagnosed with diabetes mellitus under American Diabetic association criteria were randomly selected from outpatient department of General medicine and referred to  Department of Psychiatry, Shimoga Institute of Medical Sciences, Shimoga. Results: 75% of the study population had history of diabetes mellitus for more than 5 years of duration. More than half of the study population did not have any substance use (56.7%), however use of nicotine (13%) or alcohol (11%) or both (2%) were found in 43.3% of the population in total. Systemic hypertension was found to be the most common medical co-morbidity accounting to 88.3% of the study participants. More than 60% of the study population did not have any family history of depression. 31.7% of the study population expressed worthlessness (21.7%), death wishes and suicidal thoughts (8.3%) or attempts (1.7%). Conclusion: Early screening and appropriate intervention may lead to improvement in both mental and physical wellness along with prevention of suicides in these patients. Prevalence of depressive disorders among diabetes mellitus patients is increasing in number and severity. We would like to stress upon the need for screening depression among all patients who have been diagnosed with diabetes mellitus to ensure early detection, diagnosis, management, and suicide prevention.

Background: Coronary artery disease (CAD) imposes a substantial global burden, with millions affected. It remains a leading cause of morbidity and mortality, straining healthcare systems and necessitating proactive prevention and management efforts. Aims and Objectives: The present study aimed to study the prevalence OF Coronary Artery Disease among young Indian adults. Materials and Methods: The present study included 100 non cardiac patients attending the General Medicine OPD of Osmania General Hospital, Hyderabad. After obtaining consent, all the patients underwent detailed history taking, thorough clinical examination and necessary investigations. Data was collected in MS Excel, analyzed and presented as tables and figures. Results: Equal numbers of male and female patients were present in the study. The patients considered for the study fell into two (2) age groups, 20 – 30 years and 30 – 40 years. Both the age groups had almost equal no. of patients. Dyslipidemia was the most common risk factor in our study with 38% of the study population being dyslipidemic, followed by Hypertension (23%), Diabetes (21%), Sedentary Lifestyle (18%), Smoking (13%) and Obesity (9%). Family History of CAD was noted in 6% of study population. Conclusion: The current research highlights a notable occurrence of coronary artery disease (CAD) risk factors among the urban population in India. Consequently, urgent action is necessary to promote awareness about these risk factors, enabling proactive management of individuals at heightened risk for CAD in the future.

Background: Cardiorenal syndrome type 1 (CRS1) represents a critical medical condition characterized by the rapid deterioration of cardiac function leading to acute kidney injury (AKI), posing significant healthcare challenges. Understanding this complex syndrome is crucial for improving patient care. Material and Methods: We conducted a one-year cross-sectional observational study at the Department of Medicine, Indira Gandhi Medical College, Shimla, enrolling consecutive patients with acute heart failure (AHF). We defined CRS1 as the rapid worsening of cardiac function leading to AKI and employed the Framingham Criteria for HF diagnosis. AKI was assessed using the AKIN classification. Various clinical, laboratory, and echocardiographic parameters were examined, and statistical analysis was performed. Results: Among the 92 AHF patients, 15 (16.3%) met the criteria for CRS1, while 77 (83.7%) did not experience kidney injury (NCRS1). Shortness of breath was the most common presenting symptom (93.47%). Patients with CRS1 had significantly lower total leukocyte counts (TLC) but no significant differences in other hematological or biochemical parameters. Dilated cardiomyopathy (DCMP) was a significant predisposing factor for CRS1, while other factors, including smoking, diabetes, and hypertension, did not contribute significantly. Medications for AHF management showed no significant impact on CRS1 development. Patients with CRS1 had higher mortality rates and longer hospital stays, with DCMP and Rheumatic Heart Disease (RHD) being major contributors to mortality. Conclusion: CRS1 is more prevalent in females and the elderly, presenting with shortness of breath and often triggered by infections. Lower TLC and DCMP are associated with CRS1 development. Smoking, diabetes, and hypertension appear unrelated to CRS1. Medications for AHF management showed no significant influence. DCMP emerges as a key underlying etiology, with CRS1 patients experiencing higher mortality rates and extended hospital stays, highlighting the need for tailored management strategies.

Introduction: "Dilated Cardiomyopathy (DCMP)" is characterized by enlargement of one or both Ventricles and is accompanied by impaired LV function.. The causes can be primary (idiopathic) or secondary. Heart failure (HF) is a complex clinical syndrome resulting from the inability of the heart to pump resulting in inadequate metabolic demands of the tissues, or do so only with elevated filling pressures. Common symptoms are Dyspnea, fatigue, edema, syncope, and dysrhythmias. Heart Failure (HF) is predominantly a disorder of the elderly with rates increasing exponentially with time.  Aims and objectives: The objective of this study is to examine and record the clinical characteristics of individuals diagnosed with “Dilated Cardiomyopathy (DCMP”). Method: This retrospective observational study was conducted from September 2022 to August 2023 and involved 400 consecutive dilated cardiomyopathy patients. Patient examinations included clinical, ECG, radiography, and echocardiographic. Echocardiography criteria for impaired left ventricular systolic performance were ejection fraction below 45%, regional wall motion abnormalities, global hypokinesia of LV, heart chamber dilatation without valvular or congenital heart problems, and end-diastolic dimension above 3 cm per body surface area. Result: Smoking, alcoholism, Diabetes and hypertension were the leading risk factors in developing HF. Breathlessness(82.25%), swelling of the feet (50%) and palpitation (48%) were the most common symptoms observed in the patients. Edema of feet (50%), basal crepts (50.5%), raised and Jugular Venous Distention (JVD) (44.75%) were the leading signs in the patients. Chest X-ray (CXR) findings indicate that 62.75%  to 70% of the patients reported with increased Cardiothoracic ratio. ECG findings were : 59.5% had normal QRS axes, 25.5% had LAD, 15.00% had RAD. Common arrhythmias included sinus tachycardia (30.00%), ectopic beats (30.5%), AFib (21.75%), VT (8.00%), SVT (9.25%). LBBB was at 6.75%, RBBB at 3.00%. LA enlargement was 45.75%, RA 19.5%. LVH was present in 12.5% (left), 8.00% (right), and 3.00% (both). Patients with impaired cardiac function had an average EF% of 34.4 ± 6.03 (range: 20-45). LVDD and LVSD measures were 5.53 ± 0.74 cm and 4.46 ± 0.75 cm. Mitral regurgitation (MR) was present in 82%, TR in 14.00%. Wall motion abnormalities were widespread (97.25%). Pericardial effusion was found in 5.7% of patients. Moderate to severe Pulmonary artery hypertension was found in 19.5% Conclusion: The study has concluded that “dilated cardiomyopathy (DCM)” is mainly a disease of middle and elderly people with a higher prevalence among males. Pulmonary hypertension and very low ejection fraction was associated with adverse outcome.

Background: In the West, coronary heart disease, or CHD, is the main cause of mortality. Young people experiencing an acute myocardial infarction (AMI) is comparatively rare. Nevertheless, it remains a significant issue for both the patient and the attending physician. There are few studies of risk factors of coronary artery involvement in AMI in young adults, so the purpose of the present study is to identify the risk factors for acute myocardial infarction in rural India. Methods: This was an institute based Observational Cross Sectional Study, done at General Medicine Ward, Department of General Medicine, Burdwan Medical College and Hospital, West Bengal, India, from May 2020 to July 2021. Total 100 patients admitted with AMI during this period meeting the inclusion and exclusion criteria were included in this study. A Microsoft Excel spreadsheet containing the data was used for data entry, and SPSS (version 2710; SPSS Inc., Chicago, IL, USA) was used for analysis. Result: In the present study mean age of patients was 35.21 ±4.39 years, majority of patients belonged to age group of 36-40 years (56%). The mean BMI was 27.23 ±3.34 kg/m2. The most common presentation was chest pain (90%) followed by profuse sweating (65%), radiation to left shoulder/arm (45%), nausea/vomiting (40%), anxiety (38%), breathlessness (28%). Most common risk factor was smoking (85%) followed by hyperlipidemia (82%), family history of premature coronary artery disease (72%), hypertension (52%), sedentary lifestyle (42%), psychosocial stress (38%), obesity (16%) and diabetes mellitus (14%). Majority of the study subjects had more than 3 risk factors (64%), while 21% had 3 risk factors, 13% had two risk factors. Mean level of cardiac enzyme marker CKMB was 38.42 ±5.67 IU/L. Conclusion: Acute MI in young patients is becoming a rising problem in Indian subcontinent which is more common in men. Smoking was the most common risk factor of MI in them indicating atherosclerosis could be the commonest cause followed by dyslipidemia.

Background and Aim: Diastolic heart failure is a common yet difficult to identify condition. The study's goal was to investigate and link NT-proBNP levels with four classes (grade I to grade IV) of diastolic dysfunction as measured by echocardiography. All patients underwent a thorough clinical examination, blood biochemistry, electrocardiography, chest X-ray, echocardiography, and plasma NT-proBNP testing. Material and Methods: The current study was carried out on 50 DHF patients enrolled from outdoor and indoor patients in the Department of Medicine, Tertiary Care Teaching Institute of India over a one-year period. Clinical assessment and echocardiography were performed on the patients. The autoanalyzer was used to estimate NT-proBNP utilising the electrochemiluminisense method. Echocardiography was used to classify patients into different levels of diastolic dysfunction. Results: The mean levels of NTproBNP in individuals with systemic hypertension were statistically significant (p0.05) higher than in non-hypertensive patients in the current investigation. NT-proBNP levels were observed to be statistically greater in LVH participants compared to those without LVH. (p≤0.05) In the current study of 50 patients with diastolic heart failure, 36 patients (72%) had grade I diastolic dysfunction, 9 patients (18%) had grade II diastolic dysfunction, 3 patients (6%) had a grade III diastolic dysfunction, and 2 patients (3%) had a grade IV diastolic dysfunction. Conclusion: Serum NT-proBNP levels give reliable diagnostic accuracy for detecting diastolic heart failure, and they correlate well with increasing degree of diastolic dysfunction as measured by a well-established modality of echocardiography. In symptomatic individuals, NT-proBNP can accurately detect the presence of isolated diastolic dysfunction and is a valuable diagnostic for ruling out patients with impaired exercise tolerance of non-cardiac origin.

Introduction: World Health Organization clinically defines a stroke as ‘the rapid development of clinical signs and symptoms of a focal neurological disturbance lasting more than 24 hours or leading to death with no apparent cause other than vascular origin’. Hypomagnesaemia leads to neuromuscular hyperirritability, tremors, increased vascular resistance, coronary vasospasm and hypertension. Hypomagnesaemia triggers vasoconstriction enhancing vascular endothelial injury and hence leads to atherosclerosis. Subjects and Methods: It was a case control study, undertaken in the Department of Medicine in S Nijalingappa medical college and HSK Hospital during the period of July 2021–December 2022. 30 patients with acute ischemic cerebral stroke fulfilling the inclusion criteria were selected. 2 ml venous sample for serum magnesium level was taken within 24 hours. Magnesium levels in patients after acute cerebral ischemic stroke were documented in patients, receiving standard management protocol of ischemic stroke. The correlation co-efficient of Hypomagnesaemia with modified Rankin Scale Score was calculated. Results: The mean age of patients was 45-80 years, 36 (60 %) patients were male and 24 (40 %) were females and there was male preponderance. The mean serum magnesium levels were measured. The present study observed a statistically significant correlation between modified Rankin Scale score measured at three months and serum magnesium level. Conclusion: It was concluded through the results of this study that Hypomagnesaemia in the body can cause more severe ischemic stroke.

Background: Central variant of posterior reversible encephalopathy syndrome is clinico-radiological entity associated with hypertension,renal disease, cytotoxic immunosuppressive medications and autoimmune disease. We present a case of adult presented with uncontrolled hypertension and severe headache, unsteadiness of gait. Initial CT was done to rule of intracranial bleed showed hypodense area in pons. MRI finding showed vasogenic edema of brain stem leading to wide range of differential diagnosis. Follow up imaging within week shows marked resolution of MRI finding along with clinical improvement. This case represent importance of clinical and radiological corelation to diagnose central variant of posterior reversible encephalopathy syndrome, to avoid invasive investigation and treatment.It also emphasise the importance of awareness of this atypical central variant of PRES along with typical posterior cerebral variant.

Brucellosis, a major health problem in developing countries, is a zoonotic disease with multisystem infection with a broad spectrum of clinical manifestations. We present a 48-year-old man diagnosed to have brucellosis in our hospital who was admitted through the emergency department with the chief complaint of fever for 25 days, generalized myalgia for 3 weeks, and decreased appetite associated with weight loss of 4-5 kg in a month. Fever was mild to moderate with the intermittent spikes and that subsided with paracetamol. There was no history of chronic cough or cold, joint pains, rashes, nausea or vomiting, urinary symptoms or bleeding manifestations. The blood culture grew out Brucella melitensis. He responded well to combination therapy consisting of doxycycline and beta lactam antibiotics. He recovered fully without relapse during the one-month follow-up.

Purpose: To study the fundus changes in Pregnancy Induced Hypertension (PIH). Methods: It is a hospital based prospective observational study of 100 women with diagnosed PIH. Fundus was examined by direct and indirect ophthalmoscope at bedside. Result: PIH was more common in primigravida (58%); maximum in below 25 years (54%) and in >36 weeks of gestational age (59%). Retinal changes were noted in 45 patients (45%) in which grade I hypertensive retinopathy was 37.7% and grade IV was 24.44%.  Retinal changes were significantly associated with BP (systolic and diastolic), proteinuria and severity of preeclampsia and eclampsia. Most of the changes in the fundus resolved within one week of delivery. Conclusion: All the patients of PIH should be examined by an ophthalmologist for proper management.

Background: As we all know that Stroke is becoming an important cause of disability and premature death in low-income and middle-income countries like India, affecting largely the poorer sections of the society driven by demographic changes and enhanced by the increasing prevalence of the key modifiable risk factors which impoverish their families further. Therefore, our study was planned to evaluate the risk factors and their prognostic value in patients of ischemic stroke in our setup? Research Question: What are the risk factors and their prognostic value in the patients of ischemic stroke?The setting of the study was at department of General Medicine, Government General Hospital, Government Medical College, Machilipatnam, Andhra Pradesh. A one-year observational study was conducted during the period from October 2022 to September 2023 on about 100 Ischemic Stroke cases admitted during the above period in the department of General Medicineby studying their socio-demographic profiles, associated risk factors, assessment of the degree of severity in association with risk factors, clinical course and outcome, etc. Results: Among the total study subjects 61% were male and 39% were female and it was observed that the distribution of the disease was more as age advances and it was also noticed that the severity of the disease was more among males when compared to females. Among all the study subjects 55% had hypertension followed by 45% had diabetes mellitus, 34% had history of smoking, 26% had history of regular alcohol intake, 23% had dyslipidemia, 13% had heart disease, 6% had hypercoagulable states,10% had history of TIA, 6% had history of migraine, 3% had history of OC pills usage and 2% had family history of stroke. Hypertension, Diabetes and smoking were the common risk factors present in the majority of the study subjects. Regarding the outcome of the disease the disability and mortality was more among the study subjects who had hypertension and diabetes when compared to non-hypertensive and non-diabetic study subjects significantly(P<0.001).

Background: The relationship between alteration of serum lipids and vascular complications is more significant in diabetic population. Present study was aimed to study lipid pattern (Serum cholesterol, Triglycerides, HDL & LDL) in Type 2 Diabetes Mellitus subjects. Material and Methods: Present study was single-center, cross sectional study, conducted in patients with duration of Diabetes mellitus of at least 6 months {BSL (Random) ≥200 mg/dl OR BSL (Fasting) ≥126 mg/dl OR HbA1c > 7}, underwent lipid profile estimation. Results: In present study, majority cases were 51-60 years (46 %), were male (64 %), were Obese (More than 25) (42 %) & mean age of the patients was 54.32 ± 7.12 years. Mean weight of cases was 67.38 ± 8.99 kg, mean height of cases was 161.34 ± 8.81 cms, mean BMI of cases was 26.08 ± 3.13 and mean WHR of cases was 1.02 ± 0.11. 19 (38.0) cases had History of Hypertension. It was observed that 16 (32.0) cases were having Normal Cardiac Risk and 34 (68.0) cases were having Increased Cardiac Risk. The BMI is significantly correlated with WHR. The BMI is significantly correlated with HbA1c. The BMI is insignificantly correlated with HDL. The BMI is significantly correlated with LDL. The BMI is significantly correlated with Triglycerides. The BMI is significantly correlated with cholesterol. The WHR is significantly correlated with HbA1c. The WHR is insignificantly correlated with HDL. The WHR is significantly correlated with LDL. The WHR is significantly correlated with Triglycerides. The WHR is significantly correlated with cholesterol. Conclusion: There was a significant association between type of Obesity and Waist hip ratio (WHR), HbA1c, HDL, LDL, triglycerides and Cholesterol.

Objective: Electrical storm (ES) carries a high mortality rate even with current advancements in care. There are limited data about clinical characteristics, risk factors and etiologies of ES from India.  We aim to report the clinical profile and risk factors related to ES from a tertiary care hospital in southern state of India. Methods: This is a retrospective, single center observational study done in the Department of Cardiology & Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research (SJICSR), a tertiary care medical center in Bengaluru, Karnataka. The data collected from medical records of patients presenting with ES from year October 1, 2022-September 1, 2023. Hospital medical chart of all patients who had received ES diagnosis were reviewed for demographic data (age, gender), clinical data (comorbidities, presenting symptoms), lab (complete blood counts and inflammatory markers), Electrocardiogram (ECG), echocardiography data and treatment options (medical and / or surgical). Other parameters assessed included type of procedure patient underwent. Results: A total of 29 ES were identified with mean age of 55.4±14.6 years, predominantly male population. The most common risk factor seen in this patient sample was prior history of MI (58. 6%).Post MI scar VT was the predominant etiology found in 18(72%) patients in our study. MMVT was the predominant form seen in 24 (82.7%) patients with RBBB morphology the dominant pattern on ECG. Cardiac imaging was done in 8 (27.5%) patients. The majority of patients were on amiodarone as the anti-arrhythmic drug of choice, while propranolol and ramipril were the most common beta blockers and RAAS inhibitors prescribed in our study population. In addition to standard care, radiofrequency ablation was performed in 5 patients and cardiac sympathetic denervation (CSD) was done in 2 patients only.  Overall 17 (58.6%) patients died. When compared with patients who survived, presence of severe LV systolic dysfunction had trend towards higher mortality. Conclusion: The study population of ES of southern state of Karnataka is characterized by middle age population with hypertension, tobacco consumption and diabetes as the prominent risk factors. ES portends a high mortality in acute settings particularly in patients with severe LVSD.  There is a considerable scope of taking initiatives to improve patient outcomes in ES.

Objective: To analyze the group of elderly patients diagnosed with COVID-19 with a retrospective cohort study. Methods: The study was conducted in a health institution in Kayseri province in Turkey. In the study, 151 COVID-19 patients were retrospectively analyzed. Chisquare analysis was performed when both independent and dependent variables were categorical. Results: The mean age of the patients was 85.87 years. 61.59% of the patients were female. The most common symptom was fatigue with 73.5%. The most common chronic disease was hypertension. The most common radiologic classification was CO-RADS-1 with 47.6%. The mean incubation period of the disease was 10.25 days. The most common complication was acute renal failure. The mortality rate was 19.21%. Conclusion: We suggested that clinical status at presentation, age, serum CRP, LDH, AST, troponin I and hemoglobin levels are important predictors of the risk of death from COVID-19 and may help identify high-risk COVID-19 cases. 

Background: Diabetes mellitus, characterized by elevated blood glucose levels, poses a significant global health challenge. Type 2 diabetes accounts for the majority of cases and is associated with factors such as obesity, physical inactivity, and poor dietary habits. The global burden of diabetes is substantial, contributing to major complications like blindness, kidney failure, heart attacks, stroke, and lower limb amputation.  Methodology: This study investigates cardiovascular complications in 209 adult diabetic cases with a disease duration exceeding 5 years. The research, conducted at a tertiary care teaching hospital, includes a detailed clinical examination, relevant investigations, and categorization based on disease severity, control status, and treatment type. Various parameters, including fasting blood sugar, postprandial blood sugar, urine examinations, serum cholesterol levels, and hypertension classification, were assessed. Results: The study reveals that 112 cases (53.6%) exhibited cardiovascular complications, with ischemic heart disease (IHD) being the most prevalent (39.7%). The majority of patients were in the 51-60 age group, and 75.6% were male. Poor glycemic control was evident in 79.9% of cases, while 23.9% had severe diabetes. Hypertension and retinopathy were present in 30.1% and 35.8% of cases, respectively. IHD was more prevalent in males (56.6%) and the 51-60 age group. Discussion: The study establishes associations between different complications, emphasizing the frequent coexistence of various cardiovascular issues in diabetes. It explores the distribution of IHD among diabetics, with a peak in the 51-60 age group and a higher incidence in males. The severity of diabetes did not significantly influence IHD incidence. Good glycemic control demonstrated a protective effect against complications. Conclusion: This comprehensive study underscores the substantial impact of cardiovascular complications in diabetes mellitus. It highlights the importance of glycemic control, lifestyle modifications, and weight management in reducing the incidence and severity of complications.

Introduction: Body mass index (BMI) is the most widely used statistic to determine the prevalence of obesity. BMI is defined by the World Health Organisation as "a simple index of weight-for-height that is commonly used to classify adults as underweight, overweight, or obese." It is calculated as follows: kg/m2, which is the weight in kilogrammes divided by the height in metres squared. For instance, a 70 kg adult who stands 1.75 metres tall will have a BMI of22.9.Material and method: Type 2 diabetes, hypertension, elevated blood cholesterol, and triglycerides, which can result in atherosclerosis, are all made more likely by obesity. Previously thought to be a reservoir of excess energy, adipose tissue is now understood to be a functional, autonomous endocrine organ. Adipokines, a group of bioactive mediators that are expressed by adipose tissue and other biological systems, facilitate communication between the two.The adipokineadiponectin is only released by adipocytes. It is widely distributed in the bloodstream as a 360 kDa high molecular weight multimer and a 180 kDa low molecular weight hexamer.Results: This table shows age and sex distribution of cases and controls. Both cases and controls were divided into two groups according to age i.e. 20-35 years and 36-45 years. Maximum cases are within the range of 20-35 years. Percentage of male is more in comparison to controls.Conclusion: Adipokines are substances released by adipose tissue that regulate a variety of physiological processes throughout the human body by way of systemic circulation. Numerous organs and systems experience a disturbance in homeostasis as a result of adipokinedys regulation in obesity. These include insulin resistance, oxidative stress, endoplasmic reticulum stress, synaptic dysfunction, and cognitive decline.

Hypertensive disorders in pregnancy, encompassing conditions like gestational hypertension and preeclampsia, significantly impact maternal and fetal health. Understanding their incidence and associated risk factors is vital for improving prenatal care. Objectives: This study aims to determine the incidence of hypertensive disorders among pregnant women and identify key demographic and health-related factors associated with these conditions. Methods: Design: Cross-sectional study. Setting: Obstetric outpatient Department. Participants: 250 pregnant women, ranging from 18 to 45 years, at various stages of gestation. Data Collection: Medical histories, blood pressure measurements, and relevant biochemical markers were collected. Statistical Analysis: Descriptive statistics, chi-square tests, and logistic regression were used to analyze the data. Results: Incidence: The incidence of hypertensive disorders was found in a specific percentage of the participants. Risk Factors: Key risk factors such as age, BMI, and medical history were significantly associated with the development of hypertensive disorders. Demographics: The study also revealed demographic trends, such as a higher incidence in certain age groups or pre-existing conditions. Conclusion: This study highlights a significant incidence of hypertensive disorders in pregnant women, underscoring the need for targeted prenatal screening and management strategies. The identification of key risk factors can aid healthcare providers in developing personalized care plans.

Background: This study examines the clinical outcomes and efficacy of management strategies for patients in the ICU of Government General Hospital, Nizamabad. It focuses on evaluating the impact of therapeutic interventions like oxygen therapy and CPAP adjustments in a critical care setting, particularly during the challenging period of the COVID-19 pandemic. Methods: A retrospective observational study was conducted involving 50 patients admitted to the ICU. The evaluation criteria included monitoring changes in oxygen saturation levels, the usage and adjustment of CPAP, and the presence of comorbid conditions. The study aimed to categorize patient outcomes into three groups: improvement, stability, and deterioration during their ICU stay. Results: Among the patients studied, 60% (30 patients) demonstrated clinical improvement, marked by increased oxygen saturation, reduced respiratory distress, and stabilized vital signs. 20% (10 patients) maintained a stable condition with no significant change in their health status. In contrast, another 20% (10 patients) experienced a deterioration in their condition, necessitating enhanced respiratory support. The study also found a high prevalence of comorbidities; 40% (20 patients) had hypertension, and 30% (15 patients) had diabetes mellitus. Conclusion: This study offers a comprehensive analysis of the clinical outcomes and management strategies in an ICU setting during a critical period. The findings highlight the effectiveness of personalized treatment approaches, the impact of comorbidities on patient outcomes, and the challenges posed by the COVID-19 pandemic. These insights are crucial for enhancing patient care in critical settings and for guiding future research in the field of critical care medicine.

Background: Tricuspid valve repair for moderate to severe functional tricuspid regurgitation is effectively performed as a concomitant procedure during mitral valve surgery. Although various studies have shown that three dimensional rigid rings are gold standard for tricuspid valve annuloplasty, fashioned prosthetic bands are also used. Our study is aimed to compare the results of using a rigid ring versus prosthetic fashioned band (teflon strip) for functional tricuspid regurgitation in patients undergoing mitral valve surgery. Methods: A single-centre randomized study was designed to allocate patients with functional tricuspid regurgitation undergoing mitral valve surgery to be treated with either a rigid ring or a prosthetic fashioned band (PTFE). A prospective randomized study was done for a period of three years between January 2018 to December 2021 at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru. 188 patients were enrolled in this study. Inclusion criteria: all patients with moderate or more TR secondary to severe mitral regurgitation or stenosis. Exclusion criteria: Patients with mild TR, with no annular dilatation or severe pulmonary hypertension; patients with organic TR, patients with concomitant coronary artery disease and those with isolated TR. The primary outcome was freedom from progression of TR by more than 2 grades at 12-months follow-up in both the groups. Results: The data of 188 adult patients with moderate or more functional tricuspid regurgitation secondary to mitral stenosis or regurgitation receiving tricuspid valve repair using either rigid rings or prosthetic fashioned bands (Teflon) and mitral valve surgery. Patients were classified into two matched groups: rigid ring group (group A) consisting of 96 cases and prosthetic teflon band group (group B) consisting of 92 cases. In-hospital mortality was similar among both the groups. Rigid ring and Teflon strip annuloplasty improved postoperative tricuspid regurgitation grades, systolic pulmonary artery pressure and TAPSE (tricuspid annular plane systolic excursion) as compared to baseline values. Conclusion: Tricuspid valve repair with rigid rings or fashioned flexible bands must be used for moderate or more secondary TR while addressing the mitral valve to prevent further progression of TR grades and eventual right ventricular dysfunction. Our study showed that both rigid rings and flexible bands offer good long-term outcomes in terms of preventing progression of TR, preventing right ventricular dysfunction and providing freedom from re-operations.

Background: This study explores the landscape of maternal health and its impact on neonatal outcomes, focusing on the prevalence of diverse pregnancy-related complications. Recognizing the significance of understanding these complexities, the study investigates conditions such as abruption, gestational diabetes mellitus (GDM), hypertension, and other factors influencing birth weight categories. Objective: To contribute nuanced insights to maternal and neonatal healthcare practices. Materials and Methods: A retrospective analysis was conducted on a cohort of subjects, extracting data from medical records. The study encompassed various pregnancy-related complications, including abruption, GDM, hypertensive disorders, fetal growth restrictions, and other maternal conditions. Statistical analyses, including percentages and prevalence rates, were employed to elucidate the distribution of these complications within the studied population. Results: The findings reveal a diverse spectrum of maternal health conditions. Notable observations include the prevalence of GDM (8.2%), hypertensive disorders (6.6%), and post-term pregnancies (11.5%). Additionally, conditions such as abruption, fetal growth restriction, and preterm births exhibited varying frequencies. Rh-negative pregnancies accounted for 9.8%, emphasizing the multifaceted nature of maternal health complexities within the studied population. Conclusion: This study provides a comprehensive overview of pregnancy-related complications and their prevalence within the studied cohort. The findings underscore the need for personalized antenatal care strategies, early anomaly detection, and focused interventions to optimize maternal and neonatal outcomes. Recognizing the intricate relationships between maternal health conditions and birth outcomes is crucial for informing clinical decision-making and enhancing public health initiatives.

BACKGROUND:Atherosclerotic renovascular disease is a frequently overlooked condition and potentially correctable disease. It is estimated that approximately 1-5% of people have renovascular disease as an underlying cause of hypertension. It is also frequently associated with decreased renal function. Patients with atherosclerotic renal artery disease are at significantly increased risk for other vascular events, including coronary and cerebrovascular complications. The Atherosclerotic RAS is one of the most common causes of secondary hypertension and its prevalence in hypertensive patients undergoing coronary angiography is low, but substantially higher in patients with established peripheral (50%) and/or coronary artery disease (30%), and elderly population. The purpose of this study is to evaluate the prevalence and predictors of RAS among CAD patients with hypertension who underwent coronary angiography. METHODOLOGY: This is a hospital based cross sectional study which included100 patients presenting to department of cardiology, KGH between 1st July 2021 and 30th June 2023 with a diagnosis of coronary artery disease with Hypertension and who underwent Coronary angiography (CAG). After completion of CAG, Renal angiography (RAG) was done selectively using the same Judgkins right catheter.Data were entered in MS-Excel and analysed in SPSS V25. Descriptive statistics were represented with percentages for qualitative data, Mean with SD for quantitative data. Chi-square test, Fisher Exact test was applied for comparison of proportions. P < 0.05 was considered as statistically significant. CONCLUSION:In the present study(n=100), the prevalence of Renal artery stenosis was significant (19% ) where unilateral involvement was seen in 14% and bilateral RAS in 5%.In our study, patients’ age ranged from 32 to 76 years. Mean age was 53.8 ± 8.15 years. In our study, majority (59%) were males and 41% were females. Males were higher (68%) when compared to females (38%) in patients with RAS.Among the risk factors, smoking and dyslipidemia were higher in patients with RAS, when compared to patients with normal renal arteries, though not statiscally significant. The percentage of patients with Diabetes and obesity were similar in both groups. In our study, the presence of stage 2 hypertension and resistant hypertension are independent variables for the presence of renal artery stenosis in CAD with hypertension patients. The presence of age more than 50 years, stage 2 hypertension at presentation, resistant hypertension and triple vessel disease on coronary angiography serve as independent predictors for renal artery stenosis with statistically significant parameters in patients with coronary artery disease and hypertension in our study. Renal angiography is recommended to screen for ARAS in hypertensive patients with multiple risk factors and multivessel disease to prevent ischemic nephropathy a reversible cause of chronic renal failure.

BACKGROUND This study was conductedto assess the BODE index (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) in order to forecast the severity of COPD (Chronic Obstructive Pulmonary Disease) patients' condition and its relationship to pulmonary hypertension.METHODS This was a hospital-based cross-sectional prospective study conducted among 81 patientsclinically diagnosed to have COPD at the Department of General Medicine, Kurnool Medical College, Kurnool, from February 2021 to September 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. RESULTS The majority,i.e., 35.8% of the patients had mild PHT, followed by 33.3% with severe pulmonary hypertension, according to ECHO findings. According to BODE index scoring, 48.1% of COPD patients attending the hospital had mild severity, and 30.9% had severe COPD. A statistically significant increase in pulmonary hypertension intensity and COPD severity was seen. There was a statistically significant associationbetween theseverity of COPD and the number of exacerbations, pack years of smoking, Hbg%, BODE score, MMRC score, and ECG changes. As the severity increased, the number of exacerbations andpack years increased,while HB% was decreasing. No association with BMI, height, or weight was seen. ECG findings were co-related to pulmonary hypertension, which was statistically significant. A statistically significant increase in BODE score with a pulmonary hypertension grading increase was seen. The BODE score significantly assesses the chances of exacerbations according to the ROC curve. CONCLUSION The BODE index can provide an effective, superior, and alternative technique to evaluate the severity of the disease. It may also assist in patient follow-up. The BODE index can be of significant practical utility in a primary healthcare setting to identify people who require additional evaluation at higher referral centers and for improved management of these patients because it just takes a spirometer, which is affordable and easily made available.

Background: Cardiac arrhythmias represent a significant public health concern globally, with serum cholesterol levels being a potential modifiable risk factor. However, the direct correlation between cholesterol levels and the prevalence of cardiac arrhythmia across different demographics remains inadequately understood.This cross-sectional observational study aims to evaluate the association between serum cholesterol levels and the prevalence of cardiac arrhythmias, considering various demographic and health status factors. Methods: The study involved a diverse cohort of participants categorized by age, gender, and health conditions such as hypertension and diabetes. Serum cholesterol levels were classified as desirable (<200 mg/dL), borderline high (200-239 mg/dL), and high (≥240 mg/dL). The prevalence of arrhythmia across these categories and other demographic factors was analyzed. Results: Among the participants, 30% had desirable, 40% had borderline high, and 30% had high cholesterol levels. The overall arrhythmia prevalence was 24%. A significant increase in arrhythmia prevalence was observed with higher cholesterol levels: 6% in desirable, 28% in borderline high, and 43% in high cholesterol levels. Males with high cholesterol and participants with diabetes and high cholesterol exhibited higher arrhythmia prevalence, at 46% and 50%, respectively. Conclusion: The study highlights a significant association between elevated serum cholesterol levels and increased prevalence of cardiac arrhythmias. This association is especially pronounced in individuals with additional risk factors such as hypertension and diabetes.

Background This study was conducted to assess the correlation between various serum lipid profile components (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, VLDL cholesterol, and LDL:HDL cholesterol) and hypertensive retinopathy and its severity. Methods This was a hospital-based cross-sectional clinical study conducted among 100 hypertensive patients attending ophthalmic OPD. The study was undertaken at the Regional Eye Hospital, Kurnool, from November 2017 to October 2019 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results The prevalence of retinopathy increased with the duration of hypertension and showed a significant difference (p<0.0001). Hypertensive retinopathy showed a significant difference (p<0.001) between stages of hypertension. There was a significant difference between the retinopathy group and the non-retinopathy group in various lipid parameters like serum total cholesterol (p < 0.0001), LDL cholesterol (p < 0.0001), serum triglycerides (p = 0.0218) and LDL:HDL ratio (p = 0.0029). The various grades of retinopathy also showed statistically significant differences in various lipid parameters. Higher grades of retinopathy were associated with higher levels of serum total cholesterol (p = 0.035), LDL cholesterol (p = 0.028), serum triglycerides (p = 0.038), and LDL:HDL ratio (p = 0.021). Arcus senilis was higher in the retinopathy group than the non-retinopathy group. There was a significant difference between serum lipid parameters and hypertensive retinopathy (p = 0.045). This shows an association between serum lipid parameters and the prevalence of hypertensive retinopathy. Conclusion Lowering increased serum lipid parameters in hypertensive patients is advisable to preserve sight as well as prevent other end-organ damage. 

Background: Diabetes mellitus (DM) is a rapidly rising chronic illness in developing countries. Glycosylated hemoglobin (HbA1c) is a widely used tool for diagnosing, screening, and managing patients with diabetes, hence proper interpretation of the HbA1c is crucial. Objectives: To investigate the risk factors affecting type 2 diabetes mellitus HbA1c and their correlation with glycosylated hemoglobin (HbA1c). Material & Methods: Diagnosed patients with type 2 diabetes mellitus during study period were enrolled in this study. Criteria for diagnosis were: HbA1c ≥ 6.5% (48 mmol /mol), Fasting plasma glucose ≥ 126 mg/dL (7.0mmol/L) 2-Hour postprandial plasma ≥ 200 mg/dL (11.1 mmol/L). Demographic data and risk factors associated with diabetes were analysed. Results: Majority of the patients (37%) were 51-70 years age group, predominantly male (63%). Among risk factors assessment, 66.5% were overweight or obese, 53.3% had positive family history of DM, 55.3% were hypertensives, 43.5% had dyslipidemia, 32.7% had a family history of CAD, 39.3% were smokers and 32% were physically inactive. HbA1c were significantly associated with the all these risk factors. Conclusion: Age, higher BMI, family history of DM, smoking, physical inactivity, hypertension, dyslipidemia and history of CVD are positively correlated with the HbA1c level. 

Metabolic syndrome (MetS) is a condition characterized by insulin resistance, diabetes mellitus, and impaired glucose intolerance, often associated with obesity, hypertension, dyslipidaemia, or microalbuminuria. The global health pattern is shifting towards chronic diseases like cardiovascular and diabetes mellitus, with a higher burden of non-communicable diseases. In India, the Epidemiological Transition Level (ETL) is <1, indicating a predominance of degenerative, non-communicable diseases and injuries. A community-based cross-sectional study was conducted to estimate the prevalence of Metabolic Syndrome (MET) and associated risk factors among the adult population in the urban field practice area of CIMS Bilaspur, Chhattisgarh. The study involved 540 systematic random samples and analyzed the dietary habits and substance abuse of 540 participants, ranging from 20 to 80 years old. The majority were from class-III socioeconomic status, with low education, bad diet, and obesity being key contributing variables. Recommendations include engaging in regular physical activity to reduce weight, abdominal obesity, and BMI, improving diet by reducing sugar, salt, and fat consumption, regular health check-ups, taking medication regularly, and quitting alcohol, smoking, and other addictions. Large-scale studies are necessary to discover all population risk variables

Introduction: Diabetic cardiomyopathy has been proposed as an independent cardiovascular disease, with causative factors being microvascular disease, autonomic dysfunction, metabolic disorders, interstitial fibrosis, etc. This study will determine any association between diastolic dysfunction and type 2 DM in the asymptomatic subjects and its relation to glucose triad, i.e., HbA1C, fasting blood sugar, and Postprandial blood sugar. Aims and Objectives: To assess the prevalence of diastolic dysfunction in patients with type 2 DM and correlate it with the glucose triad, i.e., HbA1C level, fasting sugar, and Postprandial sugar. Materials and Methods: Inclusion Criteria: 100 Patients between 30- 55 years of age with a history of Type 2 DM for at least 5 years. Exclusion Criteria: Patients with evidence of coronary artery disease, hypertension and valvular disease. The diastolic dysfunction was evaluated using Doppler Echocardiography. Results: In this study, diastolic dysfunction was comparable in patients with fasting blood sugar levels of <100mg/dL (58.33%), 100-125mg/dL (65.31%), and ³ 126mg/dL (51.28%). Diastolic dysfunction was comparable in patients with postprandial blood sugar levels of <140mg/dL (66.67%), 140-199mg/dL (64%), and ³ 200mg/dL (51.22%). A significantly higher number of patients with HbA1C levels between 7-8.49 (84.62%) and HbA1C levels of ³8.5% (66.67%) had diastolic dysfunction. Conclusion: The prevalence of diastolic dysfunction in patients with type 2 DM is 59%. Patients with type 2 DM who have diastolic dysfunction are likely to present with raised FBS levels. Hence, controlling diabetes, viz., glucose triad, i.e., HbA1C, FBS, PPBS, may prevent or postpone diastolic dysfunction in type 2 DM patients.

Background:   End-stage renal disease (ESRD) necessitates maintenance hemodialysis, posing significant healthcare challenges, including high hospitalization and mortality rates. This study aimed to analyze the outcomes of hospitalization in ESRD patients undergoing maintenance hemodialysis in a tertiary care center. Methods:    A prospective observational study was conducted on 130 patients, focusing on demographics, clinical characteristics, comorbidities, hospitalization causes, and outcomes. Results:    The majority of patients were males (66.9%), with the most prevalent age group being 41-50 years (32.3%). Hypertension (87.7%) and diabetes mellitus (28.5%) were the most common comorbidities. Cardiac abnormalities significantly influenced hospitalization rates (p<0.0001), and acute pulmonary edema was the leading cause of hospitalization (31.4%). The overall mortality rate was 6.2%, with acute pulmonary edema, acute hemorrhagic stroke, and uremic encephalopathy being the primary causes of death. Patients under three times weekly maintenance hemodialysis showed higher hospitalization rates compared to those receiving twice-weekly sessions (p=0.004). Conclusion: The study highlights the critical role of comorbid conditions management and the need for individualized care strategies to mitigate hospitalization and improve outcomes in ESRD patients on maintenance hemodialysis

Background:   Tertiary healthcare centres play a pivotal role in managing high-risk pregnancies, with referred cases presenting unique challenges and outcomes. Methods: This prospective observational study analyzed 275 referred cases among 4972 deliveries over 18 months, examining demographics, reasons for referral, delivery, and neonatal outcomes.  Results:   Most referrals involved women aged 21-30 (62.2%) from lower socioeconomic statuses. Common referral reasons included PROM (20.4%) and gestational hypertension (17.5%). Delivery outcomes were predominantly normal vaginal deliveries (53.5%) and caesarean sections (44.3%). Neonatal outcomes highlighted a 23.6% NICU admission rate, with respiratory distress and low birth weight being the leading causes. The study also noted stillbirths (2.2%) and neonatal mortality (1.8%). Conclusion:   The study reaffirms the essential role of tertiary centers in handling complex referrals, highlighting the influence of socioeconomic status on maternal health and the challenges in improving neonatal outcomes. It emphasizes the need for targeted prenatal care and streamlined referral systems.

Background: According to recent research, people with pre-hypertension have a higher risk of developing cardiovascular diseases (CVD) and a higher rate of progression to hypertension. Undergraduate medical students, being future healthcare professionals, are not immune to this growing health issue. Their lifestyle choices and academic stress may predispose them to develop prehypertension at an alarming rate. Objectives:To estimate the prevalence of pre-hypertension among undergraduate medical students and to determine the risk factors for pre-hypertensionMethods: it was an observational cross-sectional study involving a sample size of 230 students from 2nd and 3^rd year MBBS. Students were selected using convenient sampling after obtaining oral and written consent. Students were interviewed using a predesigned and pretested semi-structured questionnaire. Blood pressure, Height and weight were measured using standard procedure.Results:The overall prevalence of prehypertension among the whole group was 35.2 % as 81 of 230 students were prehypertensive.Mixed Diet, sleep < 7 hours, habit of alcohol and smoking, Inadequate physical activity with higher odds was significantly associated with Prehypertension whereas, Family history of Hypertension and male gender had slightly higher odds but not significant.ConclusionHigh Prevalence of Prehypertension among medical students Highlights the necessity for early preventive measures targeted at raising awareness, implementing early screening, and changing lifestyle choices to lower the disease's mounting burden

Background: Stroke poses a significant societal burden, contributing to global mortality and disability. Second only to ischemic heart disease, stroke exhibits the highest mortality rates. Preventive measures involve addressing modifiable risk factors such as diabetes, hypertension, heart disease, obesity, atrial fibrillation, smoking, and alcoholism. This study aims to assess the demographic profile and associated risk factors among stroke patients younger than 45years admitted to PGIMER & Capital Hospital, Bhubaneswar, Odisha.

Methods: Conducted between October 2022, and October 2023, this single-center, cross-sectional observational study enrolled 52 stroke patients at PGIMER & Capital Hospital, Bhubaneswar, Odisha. Data analysis was performed using SPSS version 20.

Results: Of the 52 patients, 34 (65%) were male, and 18 (35%) were female, with a mean age of 32.57 ± 9.6 years. Ischemic stroke occurred in 39 (75 %) patients, while hemorrhagic stroke was observed in 13 (25 %). The middle cerebral artery territory was the most commonly affected in ischemic stroke (22, 42.30%), whereas intracerebral hemorrhage occurred in 11 (78.57%) cases. Smoking and hypertension were prevalent in 51.92% and 51.92 % of ischemic stroke cases, respectively, while hemorrhagic stroke cases showed rates of 23.07 % and 21.15%, respectively. Physical inactivity (50%), alcohol consumption (40.38%), central obesity (46.15%), and dyslipidemia (30.76%) were more frequently associated with ischemic stroke, while significant alcohol consumption (15.38%) was more linked to hemorrhagic stroke.

Conclusions: Stroke predominantly affected males and increasing age groups, with ischemic stroke being more common than hemorrhagic stroke. The most prevalent risk factors for stroke in young patients were smoking, hypertension and central obesity

Conclusion: Hence management and control of uric acid levels and Dyslipidemia in Hypertensive patients will help in developing further complications like Myocardial Infarction

Background:  Aim: To study the perinatal morbidity & mortality in twin gestations  according to chorionicity. Methodology: A prospective study was carried out in all twin pregnancy women of second and third trimesters in department of Obstetrics and Gynaecology in Government maternity hospital from date of approval of scientific and ethical committee to one year. Every patient is asked about history regarding age, parity, gravida, family history of twinning, regarding conception whether conceived spontaneously or used any ART. Results: Among 200 twin pregnancies, Primigravidas constituted for 43% of pregnancies and multigravidas constituted for 57% of pregnancies. The most common age being 25 to 29 years in both mono and dichorionic pregnancies. Most of the cases 83% belong to spontaneous conception,15% were induced by drugs and 2% of cases were induced by IUI. Positive family history was present in 13% of twin pregnancies compared to no family history in 87% of twins. 124 cases were (62%) were dichorionic diamniotic where as 68cases (34%) were monochorionic diamniotic where as 8 cases (4%) were monochorionic and monoamniotic. Gestational hypertension was one of the important maternal risk factor noted in my case which was present in 8% of cases where as preeclampsia was the most commonest maternal risk factor which was present in 25% of cases. Pre term complicating twin pregnancies was present in 44% where as preterm PPROM was present in 17% of cases. There was a stastical significance of preterm and preterm PPROM between monochorionic and dichorionic pregnancies. The maximum deliveries were conducted during 34 – 36 weeks and gestational age more than 37 weeks. Among the monochorionic pregnancies, 47% delivered at a gestational age of 31 -33 weeks where as in dichorionic pregnancies 54% of delivery was at more than 37 weeks. The most common causes for neonatal morbidity was RDS which was present in 80% of MC and 20% of DC where as hypoglycemia was present in 1.6 % of DC pregnancies. Neonatal mortality was found in 15cases(19.73%) in MCDA and MCMA where as 9 cases (8%) of DC. The significance in difference between the two groups was found significant. Conclusion: The present study concluded that Monochorionic-Monoamniotic twins should always be delivered by cesarean section to avoid umbilical cord complications for the non- presenting twin at the time of the first twin's delivery. A woman carrying Dichorionic-Diamniotic or Monochorionic- Diamniotic twins is a good candidate for a vaginal birth.

To evaluate etiology of endocrine secondary hypertension in a series of patients younger than 40 years at hypertension’s onset

Background:   Hypertension, or high blood pressure (BP), is defined as persistent systolic and/or diastolic BP equal to or above 140/90 mmHg. The worldwide prevalence of hypertension among adults (>25 years) was around 40% in 2008, with a slightly lower prevalence in high-income countries. Material and Method: It is a prospective, cross-sectional and descriptive study. This study was conducted in the Department of Physiology, Tertiary Care Teaching Hospital over a period of 1 year. Experimental study design was carried out with a sample of 180 participants. Participants were randomly allocated using sealed envelope method to receive either resistance training. Informed consent was taken from all the participants included in the study. Results: Pre-test of resistance exercise group Mean Pulse Rate is 79.52 ± 4.14 beats/min (Mean±SD) reduced to 76.36 ± 4.01 in post-test. Resistance exercise Mean Systolic Blood Pressure of pre-test 137.34 ± 6.36 mmHg (Mean±SD) is reduced to Post-test 134.65 ± 6.35mm of Hg (Mean±SD). Pre-test of resistance exercise Mean Diastolic Blood Pressure 91.52 ± 4.45 mmHg (Mean±SD) is reduced to Post-test 88.45 ± 4.31 mm of Hg. Pre-test of resistance exercise Mean Peripheral vascular resistance reduced from 1444.34 ± 153.25 mmHg/min/mL (Mean±SD) to Post-test 1094.64 ± 133.64 mmHg/min/mL. Pre-test of resistance exercise group Mean Baroreflex sensitivity increased from 6.35 ± 0.43 (Mean±SD) to Post-test 6.24 ± 0.45. Conclusion: There was complete awareness of hypertension, but a lesser amount of awareness of the role of resistance exercise in hypertension. In comparison to resistance exercise, huge numbers of patients were aware of the role of resistance exercise in hypertension, but only few practiced them. However, there was less awareness of the role of resistance in hypertension and even lesser number of patients practiced them. 

Background:   Hypertension is grouped into two main categories. These include primary and secondary hypertension. Primary hypertension is also known as essential hypertension and it affects ninety-five percent of persons suffering from the disease. Causes of hypertension are not yet known, however, factors as age, high salt intake, low potassium diet, sedentary lifestyle, stress as well as genes have been found as contributing to hypertension. Aerobic exercises, such as running, swimming, and dance, involve prolonged activity of large muscle groups. In many studies aerobic exercise is defined by physical exercise implying a regular, structured, leisure-time pursuit. Material and Method: It is a prospective, cross-sectional and descriptive study. This study was conducted in the Department of Physiology, Tertiary Care Teaching Hospital over a period of 1 years. Experimental study design was carried out with a sample of 180 participants. Participants were randomly allocated using sealed envelope method to receive either aerobic training. Informed consent was taken from all the participants included in the study. Results: In aerobic group Mean Systolic Blood Pressure in pre-test 135.65 ± 6.35 mm of Hg and post-test 133.65 ± 6.12. In aerobic group Mean Diastolic Blood Pressure in pre-test 91.63 ± 5.83 mm of Hg and post-test 87.73 ± 5.33.  Conclusion: The pre test and post test scored are noted and analysis was done using independent‘t’ test which favored the alternate hypothesis. The intra group analysis was done results were analysis using paired‘t’ test, which favored the alternate hypothesis. The study concludes that aerobic and resistance exercises is achieving normal blood pressure level in patients with stage I hyper tension. Thus, this study accepts the alternate hypothesis. 

Background: Hypertension and dyslipidemia are the two co-existing and synergizing major risk factors for cardiovascular diseases. The cellular constituents of blood affect blood volume and viscosity, thus playing a pivotal role in regulating blood pressure. Overweight and obesity are critical determinants of adverse metabolic changes including, an increase in blood pressure. Hypertensive retinopathy is among the vascular complications of essential hypertension. It is known that; the autoregulation of the retinal circulation fails as blood pressure increases beyond critical limit. Materials and Methods:The present study was a cross-sectional study, and it was conducted on 100 patients in the Department of Ophthalmology at Tertiary Care Teaching Hospital from January 2022 to December 2023. All the patients were clinically examined& demographic information such as age, sex, residence, and other general and systemic examination information, case history, past medical history, complaints, etc., was collected and recorded in the Proforma prepared for this study purpose. Patients suffering from ocular diseases like chorioretinitis and uveitis willbe excluded from the study. Results: The clinico-demographic & biochemical profile of the patients with retinopathy and without retinopathy. In lipid profile, the mean±SD of serum triglycerides in retinopathy (130.29±40.20) was significantly higher than the mean±SD of serum triglycerides in non- retinopathy (113.16±33.05) [P=0.0384]. Other parameters of lipid profile such as TC (P=0.5966), LDL (P=0.180), HDL (P=0.8017) showed insignificant results while comparing with and without retinopathy. Relationship between the Severity of Hypertension and the Grade of Retinopathy. In the Grade-II retinopathy patients, the number of patients with grade I hypertension were the majority (36.50%). However, there is no statistically significant association between the group of the severity of hypertension and grade of retinopathy (P=0.669, Not Significant). Conclusion:The correlation between serum lipid parameters& hypertensive retinopathy prevalence has been shown. It is possible to consider dyslipidemia as a significant risk factor for the occurrence &seriousness of retinopathy and other failures of the final organ. Multi-organ intervention in hypertension is a norm rather than an anomaly, considering that injury in various areas does not seem to be either synchronous or standardized. A recommendation for ophthalmologists to review lipid parameters in patients with hypertensive retinopathy is our findings' therapeutic effect, which may better classify patients with life-threatening cerebrovascular and carotid artery conditions.

Background: Metabolic syndrome and cardiovascular disease (CVD) significantly contribute to global morbidity and mortality. Framingham Risk score (FRS) is a widely accepted parameter to grade the 10-year risk of heart disease. In this prospective observational study conducted at our tertiary care centre, we investigated patients with metabolic syndrome and analysed them to find the correlation of serum calcium and magnesium with FRS. Methods: We evaluated 288 adult patients who presented with features of metabolic syndrome, at Karnataka Institute of Medical Sciences, Hubballi, over two years from November 2019 to December 2021. Serum calcium and magnesium venous blood samples were obtained on the patient's visit to the hospital. The study was conducted after obtaining clearance from the Institutional Ethics Committee and written informed consent from the study participants. Results: Out of 288 patients included in the study, 168 (58.3 %) were male and 120 (41.7 %) were female. The mean age among the study population was 55.99 years. The prevalence of metabolic syndrome components in the study population was as follows: 82.6% had diabetes 67.4% were obese, 51% had dyslipidaemia, and 88.9% were hypertensive (51.6% of them on treatment.  A significant history of smoking was present in 28.1%. Furthermore, the 10-year CVD risk as assessed by FRS was as follows: 23.6 % had low risk, 37.2 % had intermediate risk and 39.2% had high risk. The corrected serum calcium and magnesium demonstrated a significant association with diabetes, hypertension, cholesterol, and FRS. Patients with high corrected serum calcium levels and low serum magnesium levels exhibited this pattern. Conclusion:Serum magnesium and corrected serum calcium and can be used as indirect indicators of the severity of diabetes and hypertension. Moreover, they can also be used for assessing the 10-year risk of CVD, due to its association with FRS

Background: Overweight and obesity are associated with diseases like hypertension, cardiovascular diseases (CVDs), diabetes, endocrinal disordersetc. The product of resting heart rate (HR) and systolic blood pressure (SBP) termed as rate pressure product (RPP) is a very reliable indicator of myocardial oxygen demand. Both heart rate and blood pressure are incorporated in the RPP and indirect index of myocardial oxygen consumption (MVO2). Objective: To determine the correlation between body mass index and rate pressure product. Material and Methods: This cross sectional study was conducted in department of physiology VIMSAR Burla which included 100 study participants (66 males and 34 females). Written consent was taken from each participant. The height and weight was measured according to WHO protocol. BMI was calculated by Quitlet index. SBP was measured by sphygmomanometer after 5 minutes rest with the subject in sitting position. Resting HR was measured by palpating radial artery. RPP was derived using SBP and HR. Statistical analysis was done according to Pearson correlation, unpaired t-test. Result: There was positive correlation (r=0.5310) between BMI and SBP significantly (p=0.032). The correlation between BMI and HR was positive (r=0.443) significantly (p=0.001). There was positive correlation between BMI and RPP (r=0.512) significantly (p=0.002). Conclusion: The positive correlation between BMI and RPP suggested that myocardial workload is increased in overweight and obese people.

Aim: To assess risk factors associated with cardiac complications after total joint arthroplasty (TJA) of the hip and knee. Methodology: Thirty-two patients, aged 25 to 70 years who underwent total joint  arthroplasty (TJA) and experienced a cardiac complication during the post operative period (myocardial infarction [MI], congestive heart failure [CHF], unstable angina, arrhythmia, symptomatic hypotension, or pulmonary embolism ) were put on group I and group II had healthy controls consisted of those who had a total joint arthroplasty (TJA) and did not experience a cardiac complication during the post operative period. Risk factors were identified in both groups. Follow-up period up to ninety days. Results: Age group 25-35 years had 3, 36-45 years had 5, 46-55 years had 10 and 56-70 years had 14 patients. The difference was significant (P< 0.05). Age >65 years [OR:1.78 (95%CI: 1.1-3.9)], history of arrhythmia [OR: 2.4 (95%CI: 1.7-4.2)], history of CAD, MI, CHF, and/or valvular heart disease [OR:2.3 (95%CI:1.5-3.8)], and revision surgery [OR:2.3 (95%CI:1.7-2.7)] were independent predictors of postoperative cardiac complications. Conclusion: Risk factors associated for cardiac complications after total joint arthroplasty of the hip and knee includes increasing age, underlying heart disease, and history of heart disease. Further assessment is necessary for  total joint arthroplasty in relation to other risk factors, including as obesity and hypertension, which are frequently linked to an increased risk in non-cardiac surgery.

Purpose- Obesity is a fast growing problem not only in developed countries but also in developing countries like India¹. Obesity is a risk factor in development of short stature, school teasing, precocious puberty, hypertension, diabetes, gall bladder disease and coronary heart disease, certain type of cancers and other comorbidities even at early age than usual². Understanding the prevalence trend and factors contributing in developing obesity in adolescent children will be helpful in prevention of obesity and developing comorbidities in later life.

Methods- A cross sectional analytical study conducted in 6 different schools of identified district of western India from 1st July 2022 to 31st June 2023 including school going adolescent children, of age between 10 to 16 years after taking necessary consent. Information regarding various predictors of obesity were taken by predesigned questionnaire, filled by participant along with his/her parentsand  relevant anthropometric measurements were recorded. Detailed analysis of predictors which were present in obese and non- obese group was done and results interpreted.

Results-Incidence of obesity in present study is 12.6%. Most common age of obesity is 16 years (46%) and most common age group is mid-adolescent (90.4%). Obesity and overweight is most common in upper middle class and in urbanc area. Positive correlation had been observed between adolescent obesity and parental obesity, calorie intake >2000kcal/day, eating >2 times snacks/day, >2 times junk food/week, sleeping > 8hrs/day and watching TV for >60 min, physical activity <30 min and light grade of physical activity.

Conclusion-Restricting the calorie intake, food behavioural changes like restricting junk food and snacks consumption, daily physical activity could limit the development of obesity in adolescent age group.

Chronic kidney disease (CKD) is a growing health concern in India, especially due to the increased prevalence of chronic diseases such as diabetes mellitus and hypertension (Mk, 1993). This study evaluates the prognostic significance of key biomarkers in CKD patients, including 24-hour urinary protein, estimated glomerular filtration rate (eGFR), and serum uric acid levels, alongside renal pathology and immunofluorescence findings. By assessing the relationships between these indicators, the research aims to enhance prognostic accuracy, predict CKD progression, and improve patient outcomes in the Indian context. The findings emphasize the importance of a comprehensive evaluation of these prognostic indicators in managing CKD effectively. Introduction: Chronic kidney disease (CKD) affects a substantial portion of the population in Indian subcontinent as well as globally, leading to adverse outcomes if not managed effectively. This paper aims to assess the utility of 24-hour urinary protein, eGFR, uric acid levels, renal pathology, and direct immunofluorescence findings as prognostic indicators in CKD. By exploring the relationships between these markers and disease progression, the study seeks to provide insights for personalized treatment strategies and improved patient care. Materials and Methods: This study was conducted as a retrospective, observational cohort study. Data has been collected from medical records of 50 CKD patients attending the nephrology OPD at MGM Medical college and Hospital, Kamothe, Navi Mumbai from the period of January 2022 to July 2023. Results: The study revealed significant correlations between 24-hour urinary protein, eGFR, uric acid levels, and specific renal pathologies. Higher levels of urinary protein and lower eGFR were robust predictors of CKD progression, while serum uric acid levels showed potential as a marker of disease severity. The findings underscored the importance of a comprehensive evaluation of prognostic indicators in CKD management. Conclusion: In conclusion, this research paper underscores the value of incorporating diverse prognostic indicators in CKD management to enhance diagnostic accuracy and treatment planning. By analyzing the interplay between traditional markers, renal pathology, and immunofluorescence findings, clinicians can refine prognostic models, predict CKD progression, and optimize patient outcomes. The study's insights offer valuable guidance for personalized care and improved prognostication in CKD patients.

Background: Heart failure with reduced ejection fraction (HFrEF) poses a significant global public health challenge, characterized by frequent episodes of acute decompensation that necessitate hospitalization and carry high morbidity and mortality risks. In India, the rising prevalence of HFrEF underscores the need to identify context-specific triggers of acute decompensation to develop targeted interventions for improving patient outcomes. Material & Methods: This hospital-based, observational study analyzed triggers of acute decompensation in 336 HFrEF patients admitted to two tertiary care hospitals in India from January to April 2024. Data were retrospectively extracted from medical records, including demographic information, clinical characteristics, and details on decompensation triggers. Outcomes recorded were length of hospital stay, in-hospital mortality, and ICU admission. Statistical analysis involved chi-square tests, t-tests, and multivariate logistic regression. Results: The mean age of the patients was 65.3 years, with 60.1% being male. Common triggers included excessive salt and water consumption (30.1%), non-adherence to medication (25%), acute infections (19.9%), myocardial ischemia (17.6%), and systemic hypertension (14.9%). The mean hospital stay was 7.2 days, in-hospital mortality was 7.4%, and 20.2% required ICU admission. Excessive salt and water consumption and non-adherence to medication were significantly associated with ICU admission (p < 0.001). Independent predictors of in-hospital mortality included age (OR: 1.05, p < 0.001), excessive salt and water consumption (OR: 2.5, p = 0.007), non-adherence to medication (OR: 2.1, p = 0.021), and renal failure (OR: 3.0, p = 0.005). Conclusion: This study identifies critical triggers of acute decompensation in HFrEF patients, particularly dietary non-compliance and medication non-adherence. Emphasizing patient education and adherence support is essential for managing heart failure effectively. Addressing these factors through comprehensive care plans can reduce hospitalizations and improve patient outcomes. Future research should validate these findings through prospective studies and explore tailored interventions to mitigate the risks associated with acute decompensation.

Introduction: Hypertension is a prevalent and significant cause of mortality, contributing to 18% of deaths globally. The incidence of essential hypertension escalates with advancing age, and individuals exhibiting higher blood pressure in their youth face an elevated risk of subsequent hypertensive complications. Morphological and physiological alterations in the vasculature have been implicated in the development and persistence of hypertension. This condition elevates the risk of cerebral, cardiac, and renal events. The primary aim of this study was to measure the arterial stiffness index (SI) and reflection index (RI) in both hypertensive subjects and an age-matched control group of normotensive individuals.  Methods: A cross-sectional study involving 200 subjects aged 30 to 60 years was conducted.  Subjects were divided into four groups: Group 1 (control group of healthy individuals) and three hypertensive groups classified by the duration of their illness. Arterial stiffness was assessed using SI and RI, derived from digital volume pulse (DVP) recordings. DVP was measured using a finger pulse photoplethysmography device. The data were analyzed using analysis of variance (ANOVA), with statistical significance defined as P < 0.05 in relation to arterial stiffness indices and hypertension duration. Results: The study found a progressive increase in hypertension prevalence with advancing age and longer hypertension duration. Participants aged 40-49 years exhibited the highest prevalence across all groups. Group I, with normal blood pressure, showed the lowest RI (0.50 ± 0.08) and SI (6.12 ± 0.09). RI and SI increased significantly in Group II, further escalating in Group III. Group IV displayed a slight RI decrease but continued SI increase. ANOVA analysis revealed significant differences in RI and SI among the groups. Pearson correlation analysis showed strong positive correlations between both RI and SI values with the duration of hypertension. Conclusion: The study demonstrates a strong positive correlation between the two arterial stiffness indices, RI and SI, and the duration of hypertension.

Introduction: A potentially fatal consequence of adult sickle cell disease (SCD) is pulmonary hypertension (PHT). However, nothing is known regarding how common pulmonary hypertension is in the pediatric SCD population. Aims: To find out the prevalence of pulmonary hypertension in children with SCD. Materials and method: The present study was an Observational-Cross-sectional study. This Study was conducted from November 2020 to October 2022 at department of Pediatrics and Sickle cell institute, Veer Surendra Sai Institute of Medical Sciences and Research, Burla. Total of 552 patients were included in this study. Result: In our study, the overall prevalence of pulmonary hypertension is 20.4% (113/552). Of them, 77 (13.9%) have moderate pulmonary hypertension and 36/113 (6.5%) have mild hypertension. Pulmonary hypertension was substantially correlated with low hemoglobin (p=0.021), a high number of crises (p=0.000), a high number of blood transfusions (p=0.000), the existence of a loud second heart sound (p=0.000), and the presence of parasternal heave (p=0.000). With age, there was a tendency toward an increase in the prevalence of pulmonary hypertension in children with sickle cell disease. Conclusion: Providing fresh perspective on the prevalence of pulmonary arterial hypertension in children with sickle cell anemia in Western Odisha was the goal of this dissertation. Additionally, a comparison between our study location and the national average for the prevalence of pulmonary arterial hypertension among children with sickle cell anemia was sought. The findings of this study show that children with sickle cell anemia in the age range of 5 to 14 years had a prevalence of 20.4% pulmonary arterial hypertension. In older male sickle cell anemia children, pulmonary arterial hypertension is more prevalent. Depending on the demographic and diagnostic method, children with sickle cell anemia have varying rates of pulmonary hypertension

Introduction:  The COVID-19 pandemic, triggered by SARS-CoV-2, has significantly impacted global health, with varying effects across different regions. In India, Tezpur Medical College & Hospital (TMCH) in Assam has been a crucial site for managing COVID-19 patients. Understanding the clinical-epidemiological characteristics in this setting can enhance regional and national healthcare strategies. Objective: This study aims to analyze the demographic profile, clinical features, co-morbidities, treatment modalities, and outcomes of COVID-19 patients admitted to TMCH from January 2020 to December 2020. Method: A retrospective analysis was conducted on data from 1710 COVID-19 patients admitted to TMCH during the study period. Clinical records were reviewed to assess demographic details, clinical manifestations, co-morbidities, treatment approaches, and outcomes. Descriptive statistics were used to summarize the findings. Result: Among the 1710 patients, 117 (6.8%) died. The most frequently reported symptoms were fever (85.4%), cough (77.8%), and shortness of breath (71.5%). Co-morbidities were present in 60.2% of patients, with hypertension in 35.2%, diabetes in 30.4%, and cardiovascular diseases in 15.8%. Of the patients with co-morbidities, 18.4% died compared to 2.7% of those without co-morbidities. The average age of deceased patients was 68 years, significantly higher than the average age of survivors (52 years). Treatment included supportive care for 90.1% of patients, oxygen therapy for 58.7%, and antiviral medications for 22.3%. Conclusion: The study highlights significant clinical and demographic characteristics of COVID-19 patients at TMCH. High mortality was associated with co-morbidities and older age. These findings underscore the need for targeted interventions and resource allocation in similar settings to improve patient outcomes.

Introduction: Cardiovascular diseases (CVDs) are the leading cause of death globally, with middle-aged adults particularly vulnerable to developing risk factors that can lead to serious health complications. Understanding the dynamics of these risk factors is crucial for effective intervention and prevention. Objective: This study aims to assess the progression of cardiovascular risk factors in middle-aged adults through a longitudinal observational approach, providing insights into the prevalence, trends, and potential early indicators for reducing CVD incidence. Method: A longitudinal observational design of 522 middle-aged adults was selected through stratified random sampling from the Department of Cardiology, Hi-Tech Medical College & Hospital, Bhubaneswar, India. Baseline data collection, beginning in June 2019, included comprehensive health assessments, biochemical analyses, and lifestyle questionnaires. Follow-up assessments were conducted annually until June 2024. Key variables measured were blood pressure, lipid profiles, fasting glucose levels, body mass index (BMI), smoking status, and physical activity levels. Statistical analysis was performed using paired t-tests to compare baseline and follow-up data, with a p-value of <0.05 considered statistically significant. Results: Preliminary results indicate a high prevalence of hypertension (55%, p<0.01), dyslipidemia (47%, p<0.01), obesity (40%, p<0.01), and diabetes (30%, p<0.01) among participants. Over the five years, the incidence of hypertension increased to 60% (p<0.01), dyslipidemia to 52% (p<0.01), and obesity to 45% (p<0.01). Diabetes prevalence rose to 35% (p<0.01). Smoking rates slightly decreased from 25% to 22% (p=0.04), while physical inactivity remained high at 60% (p=0.03). Among urban populations, the increase in risk factors was more pronounced, with hypertension rising from 50% to 65% (p<0.01) and obesity from 35% to 50% (p<0.01). The interrelationship between obesity, hypertension, and diabetes was significant, suggesting a compounded risk for cardiovascular events. Conclusions: The study highlights the escalating prevalence of cardiovascular risk factors in middle-aged adults, emphasizing the need for early and targeted intervention strategies. Public health initiatives must focus on lifestyle modifications and continuous monitoring to mitigate these risks and reduce the burden of CVDs

Background: The adrenal glucocorticoid stress response in humans causes catabolism, increasing blood glucose and heart rate, and possibly potentiates ischemic damage to neurons. These effects could induce secondary brain damage in acute stroke. Materials and methods: In this prospective observational study, 60 patients with acute ischemic stroke were evaluated. Cardioembolic and lacunar strokes were excluded. In the first 24 hours of admission, serum cortisol level, national institutes of health stroke scale (NIHSS), diabetes and hypertension were assessed to determine their value to predict mortality within 90 days.  Result: Mean age was observed in the current series was 74.14 ± 14.58 years. There were 32 (53.3%) male and 28 (46.7%) female. Scandinavian Stroke Scale (SSS) was observed to be 34 (21-47) on admission. History of hypertension, History of stroke, Diabetes mellitus and Atrial fibrillation was observed in 35 (58.3%), 10 (16.7%), 22(36.7%) and 9 (15%) respectively. In univariate logistic regression analysis of the relations to 7 days of mortality, s-cortisol, SSS on admission, and pulse rate reached a significance level. S-cortisol level was higher in patients with insular involvement, 635 nmol/l, in comparison to patients without insular involvement, 589 nmol/l.   Conclusion: Among the patients with acute ischemic stroke, high serum cortisol levels at the time of admission. Clinical severity which is assessed by National Institute of Health Stroke Scale and Poor prognosis and functional outcome after 15 days which is assessed by Modified Rankin Scale

Introduction:   Chronic kidney disease (CKD) significantly elevates the risk of cardiovascular disease (CVD), which is the leading cause of morbidity and mortality in CKD patients. Understanding the cardiovascular outcomes in this population is crucial for developing effective prevention and management strategies. Objective: This study aims to evaluate the incidence and determinants of cardiovascular events in patients with CKD at the Department of Cardiology, Hi-Tech Medical College & Hospital, Bhubaneswar, India, over a period from June 2018 to December 2023. Method: An observational cohort study was conducted with a sample size of 68 CKD patients. Data were collected on traditional and non-traditional cardiovascular risk factors, and patients were followed to document major cardiovascular events such as myocardial infarction, stroke, and heart failure. Statistical analyses included the calculation of incidence rates and multivariate regression to identify independent predictors of cardiovascular outcomes. Results: During the study period, 23.5% of the patients experienced a major cardiovascular event. The incidence rates of myocardial infarction, stroke, and heart failure were 10.3%, 5.9%, and 7.3%, respectively. Significant predictors of cardiovascular events included hypertension (p < 0.01), dyslipidemia (p < 0.05), and elevated levels of inflammatory markers (p < 0.01). CKD progression was also strongly associated with increased cardiovascular risk (p < 0.01). Conclusions: The findings highlight a high incidence of cardiovascular events among CKD patients and underscore the importance of comprehensive cardiovascular risk management in this population. Early identification and intervention for modifiable risk factors are essential to improve cardiovascular outcomes in CKD patients

Introduction: Pregnancy is an incredibly stressful period due to outcome of delivery, anxious about the well-being of the unborn child, added responsibilities once the child is born, financial obligations, adapting to her postpartum body, interpersonal relationships with her spouse and other family members. Aim & Objectives: 1. To determine whether higher anxiety levels in term patients has significant effects on the duration, progress and complications of labour, 2.To assess whether significant maternal anxiety can lead to an increase in caesarean sections or instrumental deliveries, 3.To assess the difference in anxiety levels between term primigravida and term multigravida. Methodology: The study was a descriptive cross-sectional study conducted in the Department of Obstetrics and Gynecology in IGMC&RI.  Antenatal women in the low-risk group with gestational age more than or equal to 37 weeks, who gave consent for participation were included in the study. Antenatal women who refused to give consent or those with known co-morbidities complicating labour like gestational diabetes mellitus, pregnancy induced hypertension, multiple gestation, breech presentation, placental abnormalities like placenta previa or abruption, previous history of caesarean section and cephalo - pelvic disproportion were excluded. Results: The demographic details of the participants are shown in Table 1. Out of the 269 participants analysed for the study, Majority of them were housewives, belonged to the age group of 25-30 years (40%). Majority were graduates (49%) and pregnant for the first time (primi) (56.1%). Conclusion: The significance of this study is that maternal anxiety was found positive in about 105 patients, among which 19 participants had severe anxiety. These anxiety scores if known during the antenatal chechups can help in interventions for the betterment of maternal health including guidance and counselling

Introduction:  Patients with non-acute abdominal symptoms form a formidable number of the total patients visiting the hospital. Globally, studies have reported varying rates of gastrointestinal problems, ranging from 14% to 54%.1,2 The study aims to explore the demographic and clinical profile as well as the impact of healthcare services in these patients. This will help the medical community to identify the trends of abdominal symptoms and risk factors such that the medical community have clarity and ways to provide targeted interventions beyond the generic advices about lifestyle modifications and medications given to patients. Method and Method: This was an observational cross-sectional study conducted in Vydehi Institute of Medical Sciences and Research Centre, Bangalore over a period of 6 months and was designed to explore the clinical and demographic profiles of patients presenting with abdominal symptoms. 100 patients who reported abdominal symptoms that were outlined in the structured questionnaire were included in the study. Results: A total of 100 participants were included in this study. The mean age of study population was 37.48 years (SD = 12.12), with a minimum age of 19 years and a maximum age of 70 years. The majority of participants (37%) were aged between 31 and 40 years, and 83% belonged to ages between 21 and 50 years. The mean height was 162.76 cm (SD = 11.55) and the mean weight was 67.22 kg (SD = 13.52). The mean Body Mass Index (BMI) was 25.33 kg/m² (SD = 4.37), with a minimum BMI of 14.1 and a maximum of 37.0. Overall, 73% of participants had a BMI above normal. 81 participants were non-vegetarians and 19 were vegetarians. 12 participants in the study had diabetes and 14 participants had hypertension. Conclusions: The study emphasizes that the understanding the demographic and clinical profiles of the patients presenting with abdominal symptoms is crucial for effective diagnosis and treatment, and to tailor management strategies and improve outcomes. Future research should continue to explore these relationships across India, and also periodically, to provide relevant targeted interventions to effectively address the growing burden of gastrointestinal symptoms in diverse populations.

Background: Hypertension is a leading contributor to the disease burden worldwide. Hypertension, has an incidence of 3-6% among the adult population, with affected individuals at a higher risk of cerebrovascular accidents, ischaemic heart disease and renal failure.  Objective: To determine the prevalence of hypertension in School children aged 9-16 years in Bagalkot. Method: This cross-sectional study was conducted among School Children aged between 9-16 years from schools in Bagalkot. Study period: 1.5 years, Jan 2020- June 2021. Result: The prevalence of prehypertension and hypertension was found to be 11.9% (n=149) and 6.3%(n=79). Prevalence of hypertension increased with increase in age from 5.2% in 13-14 years children to 6.7% in children of 15-16 years age group. This was statistically significant P=0.002 Prevalence of hypertension in male children (6.9%) was more than in female children (5.5%). However, this was not statistically significant. Prevalence of hypertension in the children with positive family history of hypertension was more than in children with no hypertensives in the family. This correlation was statistically significant P=0.002 Prevalence of hypertension had significant correlation with increased daily screen time P=0.02. Conclusion: The current study evaluated school children aged 9-16 years and found that the prevalence of hypertension and prehypertension to be 6.3% and 11.9% respectively. Amount of daily screen time significantly correlated with Obesity. Hypertension correlated significantly with age, amount of daily screen time, positive family history of hypertension

Introduction: CVD is the most important cause of death all over the world. The burgeoning burden of CAD in India can be explained by the rise in prevalence of risk factors like diabetes, hypertension, dyslipidemia, smoking, obesity, physical inactivity & urbanization. The aim of the study is to compare the risk factors of patients with CAD& their siblings. Method:  It was a case-control study, conducted over a period of 1.5 years. In this study CAD patients and their siblings without CAD; age <60 years were included. Both groups were compared for CAD risk factors. Results: Total 100 patients their 100 siblings were taken. Patients were more smoker(19% patients &4% siblings p =0.001), more heavy alcohol consumption(21% patients &10% siblings p = 0.032), more moderate and high stress level(56% patients & 38 % siblings p= 0.037), more physical inactivity(70% patients &51% sibling p=0.019), more central obese(abnormal WHR for male 41% patients &25% siblings p= 0.024 and for female 21% patients &16% siblings p= 0.037), more hypertensive(40% patients & 22% siblings p=0.003), more diabetic(44% patients &11% sibling p=0.000), more intake of carbohydrate(p= 0.014), & fats(p= 0.033) and low HDL cholesterol(69% patients &46% siblings p= 0.001). Beside this among siblings’ prevalence of prehypertension, prediabetes and dyslipidemia were high. Conclusion: We found that CAD risk factors were high in patients compared to their siblings. Beside this among sibling prevalence of prehypertension, prediabetes and dyslipidemia were high. So, to prevent CAD these factors should be controlled.

Aims: To study of acute kidney injury in Antenatal mothers secondary to hypertensive disorders and Early detection to prevent the serious complications, Maternal morbidity and mortality and improve the perinatal outcome by early detection and treatment. Materials and methods: A hospital based prospective observational study was conducted in the Department of Obstetrics and gynaecology. Subjects were included in the study after written informed consent and data was collected by using pre structured questionnaire. Thorough obstetric, medical and surgical history was taken. the subjects were analysed for the following parameters. Results: 56% were antenatal presentations. Distribution of gravida shows that 56% had 2, 14% had 3, and 20% had 10% gravida. Induced delivery (48%) and Emergency LSCS (38%) were the main modes of pregnancy termination. 82% had medical treatment, 7% had ventilator support and 11% had dialysis. Nine patients died and 1 patient had chronic hypertension. 72% of the babies admitted to NICU, there were 32 fetal deaths and 1 abortion. Neonatal morbidity and mortality are very high because of AKI in pregnancy and with other complications. Pregnancy needs to be terminated immediately, irrespective of gestational age to prevent maternal complications and deaths. Mothers with hypertensive disorders who presented in early preterm (24-32 weeks) delivered babies with less than 1.5 kg and among them, 100% perinatal mortality is observed. For babies with>1.5 kg weight, most of them presented with intrauterine death due to abruption or fetal growth restriction. Conclusion: Knowledge of associated characteristics and outcomes presented in this study provides important prognostic information for patients, a framework for physicians to understand severe pregnancy- related AKI in the current era, and informed strategies to better identify women at risk. And also concluded from this study that prevention is always better than cure.

Introduction: A change in the heart's electrical rhythm is known as a cardiac arrhythmia. This is mostly a sign of a structural heart illness; however, it can also happen when a healthy heart has aberrant conduction, depolarization, or an electrolyte change. Aims: To assess the effectiveness of dabigatran versus warfarin in patients of non-valvular atrial fibrillation in clinical practice in a tertiary care hospital of west Bengal, India Materials and method: Present study was conducted in the department of pharmacology and department of cardiology in a tertiary care hospital from January 2018 to April 2019. A total of 150 patients with newly diagnosed non valvular atrial fibrillation, between 26-90 years were included in the study. Result: In group-A, 45(60.8%) patients had hypertension, 34 (45.9%) patients had diabetes mellitus, 3(4.05%) patients had hyperthyroidism and 46 (62.2%) patients had old stroke/TIA. In group-B, 29 (38.2%) patients had hypertension, 29(38.2%) patients had diabetes mellitus, 4 (5.26%) patients had hyperthyroidism and 41 (53.94%) patients had old stroke/TIA. In group-A, 36 (48.6%) patients had paroxysmal and 38 (51.4%) patients had persistent atrial fibrillation. In group-B, 24 (31.6%) patients had paroxysmal and 51 (67.1%) patients had persistent atrial fibrillation. Conclusion: Dabigatran 110 mg twice daily dose is non-inferior to warfarin INR adjusted dose regarding effectiveness and safety profile in non-valvular atrial fibrillation patients in Indian perspective. The incidence of dyspepsia is significantly high with dabigatran. there is no other significant difference in other adverse drug reactions.

Introduction: A significant contributor to morbidity and death is hypertension. In hypertension, microalbuminuria is thought to be a potent, early, and independent indicator of elevated cardiovascular risk. Micro-Albuminuria shows a strong correlation with left ventricular hypertrophy in hypertensive individuals. This investigation was carried out on both inpatients and outpatients in the Department of General Medicine. Material And Method: A total of 100 Cases admitted in medical wards and those attending medicine outpatient department in Al Ameen Medical College, Athani road, Vijayapura who were recently diagnosed of hypertension. Results: Study was conducted in 100 newly diagnosed hypertensive patients. Out of 100 patients, 70 % patients had Microalbuminuria and 41 % had Left Ventricular Hypertrophy. The relationship between Microalbuminuria and Left Ventricular Hypertrophy was found to be Statistically Significant. Conclusion: In the present study we evaluated the Prevalence of Microalbuminuria and Left ventricular hypertrophy in newly diagnosed hypertensive patients. We found that: 43% were between age group of 40-49 Among 100 patients, 41 patients had LVH and 59 had normal cardiac geometry Among 70 patients with microalbuminuria, 39 patients had Left ventricular hypertrophy showing a significant association between Microalbuminuria and Left ventricular hypertrophy. A significant association was found between Stage of Hypertension with Microalbuminuria and left ventricular hypertrophy. Microalbuminuria is an integrated marker of CV risk and has a statistically significant association with Left ventricular hypertrophy

Introduction: In addition to established risk factors such as smoking, diabetes mellitus, hypertension, homocysteine, C-reactive protein (CRP), fibrinogen, and albumin, coronary artery disease (CAD) is characterised by a chronic inflammatory state. Inflammation plays a significant role in the initiation and progression of atherosclerotic plaque rupture, thrombus formation, and endothelial dysfunction. Two indicators, the fibrinogen to albumin ratio, are altered, and this results in vascular endothelial dysfunction through a variety of mechanisms, including platelet aggregation, thromboxane affinity, and plaque erosion. As a result, FAR has been identified as a new inflammatory marker that is correlated with the severity of coronary artery disease. Materials And Methods: The study included 108 patients who had acute coronary syndrome (ACS) and were admitted to the IPD division of the ICCU at KIMS Hospital. The patients underwent coronary angiography (CAG) while taking into account inclusion and exclusion criteria. Serum fibrinogen and serum albumin were measured at the time of admission, and the fibrinogen to albumin ratio was computed. Written informed consent was obtained from each subject or relative in every case. A detailed clinical history, including complaints, past history, and family history, was also obtained. The angiographic severity of coronary artery disease was assessed using the Gensini risk scoring system. The Chi-square test was employed to evaluate the association between FAR and other risk variables, and the Pearson correlation coefficient was utilised to determine the linear link between Gensini score (GS) and FAR. Results:  108 patients participated in the research; 70 (64.8%) were men and 38 (35.2%) were women. The mean age was 57 years, and the patients' ages varied from 29 to 83 years. Of the 108 patients who had acute coronary syndrome, 51 (47.2%) had diabetes, 65 (60.2%) had hypertension, 7 (6.5%) had a family history of coronary artery disease, and 52 (48.2%) had smoked. 38 (35.2%) patients with coronary angiography (CAG) had single vessel disease (SVD), 63 (58.3%) with double vessel disease (DVD), and 7 (6.5%) with triple vessel disease. The 108 patients who were enrolled in the study were split into three FAR tertiles: low FAR (n = 36; <9), middle FAR (n = 36; <11.8), and high FAR (n = 36; >11.8). Of the 108 patients, ANOVA in one manner, the mean Gensini score for the low FAR group was 34.6, the mean Gensini score for the intermediate FAR group was 38.8 13.8, and the mean Gensini score for the high FAR group was 48.6 16.2 with a statistically significant p <0.001. The pearson correlation coefficient between FAR and Gensini for the 108 patients is 0.446, indicating statistical significance with a p-value of less than 0.001. Conclusion High FAR levels are strongly correlated with angiographic severity of coronary artery disease, as determined by the Gensini risk score method, in individuals with acute coronary syndrome.

Background: Chronic Kidney Disease (CKD) is a progressive condition associated with significant morbidity, mortality, and healthcare utilization. This longitudinal study aimed to analyze disease progression, healthcare utilization patterns, and the impact of medication adherence and comorbidities in CKD patients. Methods: A total of 200 CKD patients were followed for 36 months. Data on demographic characteristics, CKD stage progression, healthcare utilization, medication adherence, comorbidities, mortality, complications, and quality of life were collected and analyzed. Disease progression was defined as advancement to a more severe CKD stage. Healthcare utilization metrics included hospitalizations, outpatient visits, and specialist consultations.Results: The mean age of the patients was 57.3 years, with a balanced gender distribution. At baseline, 70% of patients were in Stage 3 CKD, 20% in Stage 4, and 10% in Stage 5. During the study, 42% of patients experienced CKD progression. Hospitalizations and outpatient visits increased significantly as CKD advanced. High medication adherence was associated with a lower rate of progression (30% vs. 55%) and fewer cardiovascular events. The mortality rate was 9%, with the highest rates in Stage 5 CKD (55%). Comorbidities such as diabetes and hypertension were prevalent and associated with faster CKD progression. Quality of life declined significantly with advancing CKD.Conclusions: CKD progression leads to increased healthcare utilization, morbidity, and mortality. Effective management of medication adherence and comorbidities is crucial in improving outcomes. These findings emphasize the need for targeted interventions to reduce the burden of CKD.

Introduction- Mitral stenosis (MS) is the most common valve disease seen as a sequel of rheumatic fever and usually presents with exertional dyspnoea and right-side heart failure and pulmonary arterial hypertension. Normal Left Atrial function consists of reservoir, conduit and pump function. To assess the outcomes of successful BMV on LA functions in patients with isolated severe rheumatic MS in sinus rhythm over a period of one year follow up. Material & Methods: Prospective observation study done on patients with severe mitral stenosis with suitable valve morphology who are undergoing PTMC. Thorough history taking, full clinical examination, 12 lead ECG, full 2D, M mode & Doppler transthoracic echocardiographic and transesohageal echocardiography study in standard views. Observation & Results: Peak atrial longitudinal stain improved significantly over a period of 12 months. LA dimension also reduced immediately 24 hr after BMV from 42.4 ± 7.6mm to 41.1±5.4. LA volume also reduced significantly 24 hr post bmv (P value-< 0.033) and during 1 month (P value-< 0.021) and 12 months follow up (P value-< 0.011). MVA by planimetry increased significantly from pre BMV value of 0.89±0.11 cm2 to 1.83±0.3 cm2 at 24 hr post BMV. Conclusion: All Left atrial parameters in terms of mitral valve area, left atrial volume index, mean gradient across mitral valve, pulmonary artery systolic pressure has shown significant improvement. However larger study is needed to confirm our findings.

Introduction: Acute Coronary Syndrome (ACS) is a significant cause of morbidity and mortality worldwide, characterized by a spectrum of conditions ranging from unstable angina to myocardial infarction. Traditionally perceived as a disease predominantly affecting older adults, ACS is increasingly being recognized in younger populations, raising concerns about its etiology, presentation, and management in this age group. Aims: The findings will highlight the distinctive characteristics and needs of the very young CAD patients, underlining the necessity for targeted interventions in this emerging subset. This study is especially essential for India, given its significant and growing young population vulnerable to CVD. Materials and Methods: his study was an investigator-initiated, single-center, retrospective observational study aimed at examining the clinico- demographic, risk factors, and angiographic profiles of Acute Coronary Syndrome (ACS) in young adults at a tertiary Cardiology Institute in Central India. Approved by the local ethical committee and conducted according to ICH Harmonized Guidelines for Good Clinical Practice, the study involved a review of medical records from 550 young adults (aged 18 to ≤ 45 years) diagnosed with ACS between January 2018 and July 2023. Result: The comparative analysis of coronary angiographic profiles by age group. Among the cases with single-vessel disease, 22 (8.9%) were under 30 years, while 226 (91.1%) were over 30 years. In cases of double-vessel disease, 1 (0.7%) was under 30 years, and 140 (99.3%) were over 30 years. Notably, no patients under 30 years had triple-vessel disease, whereas all 92 (100%) cases of triple-vessel disease occurred in patients over 30 years. Conclusion: Our study provides valuable insights into the clinico-demographic characteristics, risk factors, and angiographic profiles of ACS in young adults. Young ACS patients exhibit a strong male predominance. Although Obesity and hypertension emerged as the most common risk factor, affecting around 40% of participants, conventional risk factors, such as diabetes and hypertension, are significantly less prevalent in patients younger than 30 years compare to older young patients.

Background: Snakes have always managed to grab human attention and have been an object of fear and veneration since historic civilizations. Snakes are found almost all over the world. Snakebite is a common medical emergency and an occupational hazard, more so in Tropical India, where farming is a major source of employment. Venomous snakes prevalent in India usually belongs to 3 families. Snakebite envenomation is a major public health concern in developing countries. Acute kidney injury (AKI) is an important cause of mortality in patients with vasculotoxic snake bite. In India, renal failure is mostly associated with Russell's Viper & E. Carinatus bites (13- 32%). Several mechanisms including hemorrhage, hypertension, haemolysis, haemoglobinuria rhabdomyolysis and DIC as well as the direct effect of the venom have been incriminated in the pathogenesis of snakebite-related nephropathy. Hemodynamic alterations induced by cytokines & vasoactive mediators leading to renal ischemia are important in ARF's pathogenesis, leading to cortical & tubular lesions. Materials and Methods: After getting institutional ethical committee clearance, the study conducted over the body of the 51 deceased came for medicolegal autopsy fulfilling the inclusion and exclusion criteria and following complete enumeration method.  Socio-Demography related data were gathered from the Police Inquest. After collection, data were analyzed by available statistical software. Results: Total 51 cases had been selected after following the inclusion and exclusion criteria out of which 29 were males and 22 were females. Incidence of snake bite was maximum during rainy season in the month of June, July, August with August having the highest number of victims (12, 23.6%). Maximum number of victims in the study group fall between the age range 41 to 50 years, Highest age is 73 years & the lowest being 08 years. Out of 51 cases, 30 patients were admitted in BMC&H, while the rest 21 were admitted in other health facilities. Most of the victims were treated at a primary centre before referral. No “Brought -Dead” cases due to venomous snake bite were encountered during study period. Highest number (20, 39.2%) of snakebite occurred between 6am to 12pm, more precisely between 6am to 6:30am, followed by those between 6pm to 12midnight (14, 27.5%). Least incident was in between midnight to 6am. Highest number of bite were in the lower limb (41, 80.5%), followed by upper limb (7, 13.7%). Conclusion: In spite of several limitations and time constraints, this current study tried to focus on some socio demographic profile of victims of fatal snake bite which later may be useful to deploy newer preventive measure.

Background: One of the significant groups of pediatric illnesses and major cause of mortality and morbidity in childhood are congenital heart diseases. In the present study, we aimed to study the spectrum of congenital heart diseases in children at a tertiary care hospital of Western Maharashtra. Material and Methods: The present study is cross-sectional Descriptive Study, conducted in children diagnosed with congenital heart diseases. Results: Amongst 50 children, 28 (56%) children belong to the age group of 1 month to 12 months; Males were 26 (52%) and females were 24 (48%). On cardiovascular examination, 21 (42 %) children had ejection systolic murmur, 17 (34%) had pansystolic murmur and 6 (12%) had continuous machinery murmur. The other common cardiovascular examination findings in our study were thrill (40 %), S3 gallop (38 %), precordial bulge (26 %) and loud P2 (20 %). Amongst 50 children, 37 (74%) children were diagnosed as acyanotic congenital heart disease and rest of the 13 (26%) children were cyanotic heart disease. 18 (36%) children were found to have isolated atrial septal defect and 8 (16%) children had isolated ventricular septal defect on 2-D Echocardiography. The other frequently found congenital heart diseases were Tetralogy of fallot (8%), isolated patent ductus arteriosus (6 %), DORV (6%) and Pulmonary Atresia (4%). Few of the children with acyanotic congenital heart diseases had multiple defects with the combination of PDA with ASD (6 %) being the most frequent followed by pulmonary stenosis with VSD (4 %). Conclusion: Congenital heart diseases are one of the major congenital anomalies and a leading cause of mortality in paediatric age group and hence, early diagnosis plays a significant role in improving the quality of life in children with congenital heart diseases as well lessen the burden of congenital heart diseases on the society.

Background: Psoriasis is a chronic inflammatory disease associated with an increased risk of cardiovascular diseases (CVD) due to systemic inflammation and metabolic dysregulation. Objective: This study investigates the association between psoriasis and cardiovascular diseases in patients attending Hamdard Institute of Medical Sciences and Research, New Delhi. Methods: A prospective observational study was conducted from January 2023 to May 2024. A sample of 65 psoriasis patients was assessed for cardiovascular risk factors, including hypertension, dyslipidemia, obesity, and metabolic syndrome. Detailed clinical evaluations, blood tests, and ECG were performed. The prevalence of CVD risk factors and the correlation with psoriasis severity were statistically analyzed. Results: Out of the 65 patients (mean age 43.7 years, 60% male), 45 (69%) showed at least one cardiovascular risk factor. Hypertension was observed in 40% of the patients, dyslipidemia in 35%, and metabolic syndrome in 30%. Psoriasis severity (PASI score) was positively correlated with the presence of multiple CVD risk factors (p<0.05). Furthermore, 12% of the patients had a history of cardiovascular events such as myocardial infarction or stroke. The findings indicated a higher prevalence of cardiovascular risk factors in moderate-to-severe psoriasis cases than in mild cases. Conclusions: Psoriasis patients, especially those with severe forms, exhibit a significantly increased risk of cardiovascular diseases. Early cardiovascular screening and management should be integral to psoriasis care to mitigate this risk.

Introduction: Any situation that necessitates adjustment can lead to stress. While a certain level of stress can be beneficial, excessive stress can negatively affect performance. Individuals vary in their perceptions, interpretations, and coping mechanisms regarding stress. The human body responds to stress with changes in biological functions, particularly in autonomic functions. 1st M.B.B.S. students likely experience significant stress during their first-term internal examinations. This study aims to investigate the effects of exam stress on cardiac autonomic functions in these students and to observe the differences in their individual responses to such stress. Methods: A total 33 students of 1st M.B.B.S included in the study. Written informed consent obtained. Detailed history, which included age, sleeping and reading habits of last 1 week. Depending on sleeping hours, students were divided into 2 groups, students in group I had no afternoon sleep and group II had afternoon sleep. Resting pulse rate (PR) & blood pressure (BP) were recorded after 5 min of rest in sitting position and with handgrip & Valsalva maneuver allowing at least 5 min gap between measurements. All the recordings were taken 1 hour before exam and immediately after the exam. Mean and SD values of age, sleeping time, pulse rate & blood pressure were determined. Statistical significance of the data was measured by applying paired & unpaired t test appropriately. p < 0.05 was considered statistically significant. Results: The data compares two groups of adolescents: Group I (n=14) with an average age of 17.71 years and Group II (n=19) with an average age of 17.73 years. Group I reported an average total sleep of 4.85 hours, significantly lower than Group II's average of 6.3 hours, indicating a notable difference in sleep duration between the two groups. Overall, the results indicate a notable cardiovascular stress response during exams, characterized by decreased heart rates and variations in blood pressure. Conclusion: Individuals exhibit varying responses to stress, as evidenced by their sleep patterns and autonomic responses. Students who demonstrate a sustained blood pressure response should be monitored regularly to assess their risk of developing hypertension in the future.

Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder interrelated with hyperlipidaemia, abdominal obesity, hypertension which are report to be related to sympathetic hyperactivity. The main aim of this study is to determine and compare autonomic status in between PCOS cases and control on the basis of heart rate variability (HRV). This case control study was conducted in RNT Medical College and Attached Group of Hospital, Udaipur (Rajasthan). The sample size of 160 cases of PCOS   were included in this study with equal number of the control group. The mean outcomes were the values of HRV in the time (mean RR interval, SDNN, RMSSD, pNN50%) and frequency (Total Power, Low Frequency (LF), LF norm, High Frequency (HF), HF norm and LF/HF ratio) domains. There was significant difference in the values of the time domain (mean RR, SDNN, RMSSD, pNN50%) between the groups. In the frequency domain, women with PCOS showed significantly higher LF (P = <0.001), and LF/HF ratio (P=<0.001) than the control group. HF norm was significantly lower in the women with PCOS than in the controls. This low frequency (LF) indicates sympathetic activity, high frequency (HF) indicates vagal activity and LF/HF ratio indicates sympathovagal balance. The present study concluded sympathovagal imbalance with high sympathetic dominance in women with PCOS.

Laparoscopic surgery involves creating a pneumoperitoneum with insufflation of CO2 into the abdomen to visualise during the surgery. Insufflation with CO2 has advantages such as reduced risk of venous air embolism however few disadvantages like sudden tachycardia and hypertension and hypercarbia.  This study aimed at measuring the ETCO2 (End Tidal CO2) after intubation, after insufflation and 10 mins after pneumoperitoneum to analyse the rise of PaCo2 due to pneumoperitoneum with CO2 during laparoscopic surgeries.  This study included 113 patients between 18-65 years of age, both sexes with ASA 1 & 2 posted for laparoscopic surgeries. Patients with History of Cardiovascular disorders, neurological disorders and pregnant patients were excluded from the study.  After the start of the anaesthesia after intubation, the initial ETCO2 was noted and followed by wich the measurements were noted immediately after pneumoperitoneum and 10 mins after the pneumoperitoneum. Result was found that there was an immediate increase in ETCO2 value after pneumoperitoneum when compared to before and after 10 mins of pneumoperitoneum. This may be attributed to the absorption of co2 as a result of higher CO2 tension gradient between the pneumoperitoneum and the blood perfusing the peritoneum.

Background: Complications of hypertension are the third leading cause of pregnancy relaed deaths, superseded only by hemorrhage and embolism. Pre-eclampsia is associated with increased potential risks of placental abruption, acute renal failure, cerebrovascular and cardiovascular complications, disseminated intravascular complication and maternal death. Consequently, early diagnosis of pre-eclampsia and close observation and timely drug intervention is needed. Labetalol is generally considered to be more effective than methyldopa for treating pre-eclampsia and pregnancy-induced hypertension (PIH) and Labetalol is quicker and more effective at controlling blood pressure and causes fewer side effects than methyldopa. Drowsiness is a common side effect of methyldopa. And also, Labetalol has a beneficial effect on renal function, ripening effect on the uterine cervix, decreases proteinuria/preeclampsia and decreases fetal/newborn death compared with methyldopa.1 Methyldopa is the medicine of choice for hypertensive conditions in pregnancy in several countries. Despite this, there is little proof of its safety in early pregnancy. So far, most methyldopa safety studies have focused on therapy during the second and third trimesters2,3,4. Thus this study was planned to know the efficacy of the two commonly used drugs comparatively in our set up. Research Question: What is the efficacy of the drugs Labetalol Vs Methyldopa on obstetric outcome in women with pre-eclampsia? The setting of the study was at department of Obstetrics and Gynaecology, Government Medical College, Machilipatnam. A one year observational study was conducted during the period from March ,2023 to February, 2024 on about 200 Pre-eclampsia patients admitted during the above period in the department of Obstetrics and Gynaecology by studying their socio-demographic profiles, type of hypertensive disorders, mode of delivery & preterm or term delivery, maternal complications and evaluation of efficacy of the drugs Labetalol and Methyl Dopa comparatively etc ; Results: The disease was more among the pregnant women  between 21-25 years of age group (49.5%) and the Mean age was 52 years and very few about 3% was observed among >31 years of age group. And most of them are primigravidae. And also, majority of the study subjects were belonging to low socioeconomic group & early marriages (adolescent marriages) were also high in number. There was a significant reduction of Blood Pressure noticed by both the drugs but the more significant reduction was seen among those treated by Labetalol. And also, significantly (P<0.05), about 32% of spontaneous vaginal deliveries happened with Labetalol users when compared to 20% among Methyldopa users & 25% induced deliveries with Labetalol as against 21% with Methyldopa and also significantly 43% LSCS with Labetalol as against 59% LSCS with Methyldopa but totally among both the groups LSCS was little bit more happened among the study subjects. Further it was observed that Preterm deliveries were only 23% with Labetalol as against 40% with Methyldopa which was highly significant (P >0.001). With reference to Birth weight LBW babies were more among Methyldopa users (55%) when compared Labetalol users (50%).

Background: Acute Coronary Syndrome (ACS) is a predominant cause of mortality, particularly in the elderly population (>60 years). This study aimed to evaluate the correlation between thyroid hormone profiles and the severity of ACS  in old  patients, using Killip classification and TIMI flow grade. Material and Method: This hospital-based cross-sectional study involved 95 patients aged over 60 years, presenting with ACS at Shri B M Patil Medical College. Exclusion criteria included known coronary artery disease, thyroid disorders, use of medications affecting thyroid function, and other conditions impacting thyroid tests. Thyroid profiles were measured within 72 hours of admission using the Electrochemiluminescence method. ACS severity was assessed using the Killip classification and TIMI flow grade. Statistical analysis was performed using JMP SAS 16 Software, with significance set at p<0.05. Results: The mean age of patients was 66.2 years, with 64.2% being male. Chest pain (91.5%) was the most common symptom. Hypertension (50.5%) and diabetes (46.3%) were prevalent comorbidities. ECG indicated STEMI in 64.2% of patients, with positive Troponin I in 85.3%. Single, double, and triple vessel diseases were observed in 31.6%, 42.1%, and 26.3% of cases, respectively. TIMI flow grade 2 was most common (48.4%), and Killip class 2 was the most frequent clinical severity (32.6%). Lower T3 and T4 levels were significantly associated with higher Killip classes, indicating severe ACS, while higher T3 levels correlated with higher TIMI grades, indicating better perfusion. Conclusion: The study found a strong relationship between thyroid hormone levels and the severity of ACS in older people. Lower thyroid hormone levels are related with more severe ACS, implying that thyroid profiling might be an important tool in the risk assessment and treatment of older ACS patients. More study is needed to investigate the underlying processes and corroborate these findings across a variety of clinical contexts.

Background: Hypertension and dyslipidemia are major risk factors for cardiovascular diseases and may also impact retinal microvasculature. This study investigates the correlation between serum lipid profiles and retinal microvascular changes in hypertensive patients. Objective: To assess the association between serum lipid levels and retinal microvascular measurements, including central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR), in hypertensive patients. Methods: A cross-sectional study was conducted on 100 hypertensive patients. Baseline demographic data, blood pressure, and serum lipid profiles (total cholesterol, LDL, HDL, triglycerides, and VLDL) were recorded. Retinal microvascular measurements were assessed using fundus photography. Pearson correlation and multivariate regression analyses were performed to evaluate the relationship between lipid levels and retinal microvascular changes, adjusted for age, gender, BMI, and blood pressure. Results: Total and LDL cholesterol were negatively correlated with CRAE (r = -0.32, p = 0.002; r = -0.29, p = 0.005) and positively correlated with CRVE (r = 0.28, p = 0.006; r = 0.34, p = 0.001). HDL cholesterol was positively correlated with CRAE (r = 0.35, p = 0.001) and AVR (r = 0.29, p = 0.005). Multivariate analysis confirmed these findings, showing that total cholesterol, LDL, and triglycerides negatively impacted retinal microvasculature, while HDL had a protective effect. Conclusion: Dyslipidemia is associated with retinal microvascular changes in hypertensive patients, suggesting its potential role in hypertensive retinopathy development. Lipid management may help in preserving retinal microvasculature.

Introduction: Coronary artery disease (CAD) remains a major global health concern, with left main coronary artery (LMCA) disease posing high risks due to the large myocardial area it supplies. Despite coronary artery bypass grafting (CABG) being the preferred revascularization strategy for unprotected left main coronary artery (ULMCA) disease, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has emerged as a viable alternative. However, data on ULMCA PCI outcomes in the Indian subcontinent are scarce. Materials and Methods: This single-center, retrospective study evaluated 253 patients who underwent ULMCA PCI using DES between January 2018 and June 2023 in Central India. Clinical, angiographic, and procedural data were analyzed with a median follow-up of 753.5 days. Comparative analyses were conducted based on SYNTAX scores and imaging-guided versus non-imaging-guided interventions. Results: The cohort's mean age was 61.3 years, with a predominantly male population (77.5%). Imaging guidance was employed in 30.4% of cases. The composite outcome (cardiovascular death, myocardial infarction, stroke) occurred in 11.6% of patients. Higher age and hypertension were identified as significant predictors of adverse outcomes. Conclusion: In this study, PCI for unprotected left main coronary artery (ULMCA) disease using drug-eluting stents (DES) demonstrated favorable short- and mid-term outcomes in an Indian cohort, even in a resource-limited setting. While procedural success was high, factors such as SYNTAX score and patient comorbidities such as age >60 yrs, hypertension significantly influenced outcomes. Imaging- guided interventions, though not altering mortality rates, appeared to enhance procedural safety. These findings support the feasibility of PCI as an alternative to surgery in select high-risk patients, emphasizing the need for further research to refine risk stratification and optimize intervention strategies.

Background: Chronotherapy in hypertension control is considered to better control nocturnal blood pressure patterns. This study aimed at studying relation between diurnal blood pressure patterns and timing of antihypertensive medication. Method: Hypertensive patients of age group 19 years to 65 years who were on antihypertensives for a minimum period of one month and were free of any cardiovascular complication or chronic kidney disease were included in the study. After doing routine workup, they were subjected to 24-hour ambulatory blood pressure monitoring. Results: In this study of 105 patients (mean age 44±10.9), morning administration of antihypertensive medication resulted in significantly higher blood pressure surges and less nighttime BP decrease compared to nighttime administration, with a p-value of 0.001. No significant difference was found across medication classes for nocturnal dipping. Conclusion: Taking antihypertensive drugs in night appears to results in better control of hypertension.

Background: Accurate blood pressure (BP) measurement is crucial for hypertension management. Despite recommendations for back and feet support during BP measurements, adherence varies. The impact of unsupported back positions on BP readings remains controversial, necessitating further evaluation, particularly with oscillometric devices commonly used in clinical and home settings. Objective: To assess the impact of back and feet support on oscillometric blood pressure measurements. Methods: This study included 100 patients aged 18 and above of both genders visiting the outpatient department. BP was measured using an Oscillo metric device under two protocols: back and feet supported and unsupported. The SBP and DBP readings in the same position was recorded as the final BP. Differences between unsupported and supported conditions were calculated as delta BP and PV were calculated as (delta BP/BP with unsupported position) * 100. Paired sample t-test and ANOVA determined the significance of delta BP and PV across age, sex and hypertension history. Results: The study population had a mean age of 39.2±12.6 years, with 44 females and 56 males, 38 of whom had hypertension. BP readings were higher with unsupported back and feet (119.8±15.5/69.9±8.9 mmHg) than with support (119.2±16.4/68.2±8.8 mmHg), differing by 0.7±4.9/1.8±3.0 mmHg. SBP and DBP levels were consistently higher in the unsupported position across all subgroups, with no significant delta SBP/DBP differences between subgroups. The mean delta SBP and DBP were 5.5±1.56 mmHg and 4±1.52 mmHg, respectively. PV in SBP and DBP was 4.2±1.33% and 4.9±1.99%, with females and hypertensive patients showing larger PV. Conclusion: Proper back and feet support significantly affect the accuracy of oscillometric BP measurements, with unsupported positions leading to higher SBP and DBP. These findings emphasize the importance of standardizing patient placement during BP measurement to obtain accurate readings.

Background: Cardiovascular diseases (CVD) are one of the leading causes of mortality and morbidity worldwide. Among them the spectrum of ischemic heart disease which encompass stable ischemic heart disease, unstable angina, NSTEMI & STEMI is the commonest cause. Coronary no-reflow is a frequent phenomenon that develops in patients with ST-segment elevation myocardial infarction during reperfusion therapy. In this study, we focused on to assess the prevalence of coronary no reflow in STEMI patients undergoing primary PCI. Methodology: This study was conducted in patients in Cath lab, Coronary Care Unit and different wards of the department of Cardiology in Apollo Multispecialty Hospital Limited during the period of 18 months spanning from November 2021 to April 2023. Consecutive patients of STEMI who had undergone PPCI were enrolled in this study. The patients to be included are those with STEMI above age≥18 years. They were divided into no reflow and normal flow and their characteristics were studied. Results: The prevalence of no reflow was 9.93%. Majority of the patients had age more than 60 years (55%) whereas 45% of the patients were younger than 60 years with males (71%) and females (29%). Common associated condition with patients undergoing percutaneous coronary intervention in present study was hypertension (86%), dyslipidemia (80%) and diabetes mellitus (93%). TIMI thrombus scale and Myocardial blush grade (MBG) was significantly higher in patients with hypertension. There was a significant difference found in TIMI thrombus scale and MBG between diabetic and non-diabetic patients. There were significant differences found in mean LVEF in respect to myocardial blush grade (MBG). Conclusion: The TIMI thrombus scale and myocardial blush grade was found to be higher in patients with no reflow undergoing PCI. The prevalence of no reflow after primary PCI is 9.93%. The co morbidities like DM, hypertension and dyslipidemia were more common among these patients.

In India awareness of hypertension, its risk factors and complications are very poor. Hence, hypertension goes undiagnosed and untreated for a long time. Hence, there is a gross increase in the number of elderly populations in India. Isolated systolic hypertension is the commonest cause of raised blood pressure in the older population. Hence the present study is undertaken to study the clinical profile of isolated systolic hypertension (systolic > 140 and diastolic ≤ 90 mmHg in elderly (above the age of 60 years), to find out any other associated risk factors, any end organ complications, specially on cardia through electrocardiography and echocardiography and on kidney through creatinine clearance. Methodology: The present cross-sectional study was undertaken on patients attending the Outpatient Department as well as in-patients of Department of General Medicine, Narayana Medical college, Nellore from November 2022 to October 2023. The study group comprised of 75 elderly patients (Male=49, Female=26) of the age group of 60 to 89 years. All of these patients had isolated systolic hypertension i.e. (SBP> 140 mmHg and DBP ≤ 90 mmHg), first time detected. Detailed evaluation of these patients was done. The evaluation comprised of detailed clinical history, thorough physical examination with relevant investigations. Results: 53.33% of the patients are in the age group of 66-75 years. Females are presented more in the age group of < 70 years than males with p=0.063. Male population – 65.33%, Female population – 34.67%. As the age increases, the blood pressure also increases significantly with f=16.439, p<0.001. Patients with stage III BP are more likely to develop abnormal retinal changes with p=0.087. 36% of the patients had ECG, LVH as per Sokolow-Lyons Positive criteria. 28%of the patients had ECG, LVH as per Romhilt-Estees score criteria. As the stage of blood pressure increases the incidence of increased LVMI increases. Patients presenting with stage III blood pressure are 2.90 times more likely to develop increased LVMI with p=0.044. Conclusion: ISH is the commonest cause of high blood pressure in the elderly. The incidence increases with age advancement. It is riskier in nonwhite population. Waist/hip ratios, DM, dyslipidaemia are significant associated risk factors. ISH associated with risk factors has definite effect mainly on cardia in terms of LV hypertrophy. and on kidney in terms of reduced creatinine clearance is an even better predictor of morbidity and mortality than is diastolic blood pressure. Several large trials have documented a clear benefit to treating ISH. Even small reductions in BP have a substantial impact on patient outcome.

According to the present statistics, end of this decade the non-communicable disease will cause 70% of deaths in developing countries. The use of thrombolytic strategies like Streptokinase has been reason for reduction in mortality and Reperfusion arrhythmias have been considered successful markers of reperfusion. The prevalence of reperfusion arrhythmias during and within 48 hours of intravenous streptokinase therapy, to assess the prognosis of myocardial infarction (MI) secondary to thrombolytic therapy, and find if the reperfusion arrhythmias are non-invasive markers of successful thrombolysis using the electrocardiogram. Methodology: 100 Patients admitted to NRI Institute of Medical Sciences, Sangivalsa, tertiary care, teaching hospital in South India, with features suggestive of acute myocardial infarction who have undergone thrombolytic therapy are selected for the study. These 100 patients were divided into 5 age groups as 35-45,46-55, 56-65,66-75 and 76-85years. Each age group was further divided into male and female groups. Adult patients of both sexes and different age groups after obtaining formal consent from the patients or relatives were included. Reperfusion arrhythmias during and within 48 hours of thrombolytic therapy using electrocardiography (ECG) were assessed. Results: Among all types of myocardial infractions (MI), Reperfusion Arrhythmias are more prevalent in anterior wall MI (43%) and less observed in inferoposterior wall MI (7%). The prevalence of the age and sex has been depicted. Maximum incidence of reperfusion arrhythmias was present in age group of 46-55 years i.e 28% followed by 66-75 i.e 26%,56-65-16%,35-45 and 76-85-15%. Among males and females, 57% of males and 43% of females showed maximum incidence. Results showed that there was no significant relationship between age and gender with reperfusion arrhythmias.  There was a significant relationship observed between reperfusion arrhythmias and Diabetes (p=0.023). Incidence with hypertension (HTN) was 53%, and although hypertension was high in MI, the p-value was not significant between reperfusion arrhythmias and hypertension. Reperfusion arrhythmias incidence in risk factors such as alcoholics and smokers which was not significant, suggests that there was no statistical significance between these risk factors and arrhythmias. Observations drawn from results suggest that window period hospital presentation and types of myocardial infarction do not influence the occurrence of reperfusion arrhythmias (P=0.778) and there was a significant relation between reperfusion arrhythmias and survival of the effected patients of the study group (p=0.014).

Conclusion:

• Arrhythmias are most frequently seen during or following thrombolysis of Acute MI. Mortality and morbidity of Acute MI can be modified by early recognition and management of these arrhythmias.
• Acute MI is a major cause of hospitalization in the elderly and is associated with higher mortality and morbidity, most frequently seen between the 4^th to 7^th decades, with male preponderance.
• Mortality was high in Anterior wall MI, Ant Inf wall MI, which were associated with Ventricular Tachycardia, Ventricular Fibrillation, showing 100% mortality which must be intervened immediately.
• Reperfusion Arrhythmias are not an event of serious concern as they are usually well-tolerated and are amenable to treatment. Early streptokinase therapy has a favorable impact on mortality in MI and hence should be tried in all the Acute MI patients who do not have contraindications for streptokinase therapy.

Background: Stillbirths constitute a major part of perinatal deaths. It is influenced by a wide range of maternal social and circumstantial factors. The study was done to find out the various factors associated with stillbirth in our hospital with the help of the existing ReCoDe System.  Materials And Methods: A cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur by collecting data from all pregnant women who had during the study period of 12 months, i.e., from 1^stJanuary 2022.Data was then collected using a semi-structured interview after obtaining informed and signed consent. The questionnaire included general information, detailed clinical history. The relevant investigations, ultrasonography (growth parameters, liquor, biophysical profile, doppler parameters) were noted. After delivery, the stillborn baby Placenta, Umbilical cord and Amniotic fluid examined for any abnormalities. Results: Out of the134 cases of stillbirths during the study period of 12 months majority (52, 38.8%) were in the age group of 20 – 25 years, and 25 patients were included in the high-risk group in which 10 (7.5%) were below 20 years and 15 (11.2%) were above 35 years. Among the study participants, 51 (38.1%) were overweight and 27 (20.1%) were obese, 10 (7.5%) women had a Bad Obstetric History. There were 58 (43.3%) primigravida women. There were 4 (3.0%) women who were unbooked, while 20(14.9%) women had irregular antenatal care. 15 of the participants had maternal infection in the antenatal period of which 5 (3.7%) had viral and 10 (7.5%) had bacterial infection. 47(35.1%) patients had anemia in our study. A significant number of pregnant women (60, 44.8%) had gestational hypertension which was the most common cause leading to intra uterine fetal death. Gestational diabetes accounted for 49 (36.6%) of stillbirth in our study, 47 (35.1%) had hypothyroidism. IUGR was present in 51 (38.1%) of the study participants, and this was the second most common cause identified, resulting in stillbirth. Conclusion: Hypertensive Disorders of pregnancy was seen as the most common cause associated with intra uterine foetal demise. Intra uterine growth restriction and Gestational diabetes were the other important associated factors identified that led to stillbirth.

Background: Over the past fifty years, significant lifestyle and environmental changes have led to an increase in metabolic syndrome (MetS), a cluster of metabolic risk factors including hypertension, central obesity, impaired glucose tolerance, low HDL, and elevated triglycerides. MetS has been shown to negatively impact reproductive health and fertility. Obesity, a common component of MetS, is associated with hormonal imbalances and ovulatory dysfunction, potentially leading to diminished ovarian reserve and reproductive challenges. This study investigates the prevalence of MetS among infertile women with diminished ovarian reserve and explores correlations between MetS components and reproductive outcomes. Method: A cross-sectional observational study was conducted from January to December 2023 in the Department of Medicine at MGM College and MY Hospital, Indore. The study involved 298 women aged 20–40 years with primary infertility, recruited through the endocrine and infertility OPDs. Data collection included demographic and clinical information, medical history, laboratory investigations, and sonographic ovarian reserve assessments. The modified Asian NCEP ATP III criteria were applied to define MetS, and statistical analysis was performed using SPSS-25, with a p-value < 0.05 considered significant. Results: Among the participants, 36.9% (n=110) had metabolic syndrome. Elevated waist circumference (≥80 cm) was found in 70.1%, while 64.1% had high fasting triglycerides (≥150 mg/dL). Obesity (BMI ≥ 25 kg/m²) was observed in 52.7% of women. A significant association was noted between MetS components, particularly BMI and waist circumference, and primary infertility in women with diminished ovarian reserve.  Conclusion: This study reveals a high prevalence of metabolic syndrome (36.9%) in women with primary infertility, highlighting the significant impact of obesity and metabolic risk factors on reproductive health. Lifestyle modifications targeting metabolic syndrome components could potentially enhance reproductive outcomes. Early identification and management of modifiable risk factors may improve fertility outcomes in women with MetS.

Hypertension, or high blood pressure, is a chronic health condition affecting over 1.13 billion individuals globally and a significant contributor to cardiovascular diseases, kidney failure, and strokes. Known as the “silent killer” due to its often-asymptomatic progression, hypertension poses extensive public health challenges worldwide. It results from a complex interaction of non-modifiable factors, such as age, sex, and genetic predisposition, alongside modifiable lifestyle factors, including diet, physical inactivity, obesity, stress, and socio-economic determinants. The prevalence of hypertension has notably increased in recent years, particularly in low- and middle-income countries (LMICs), where urbanization, dietary shifts, and sedentary behaviours exacerbate the risk. This systematic review provides a detailed analysis of these key risk factors, highlighting the genetic, environmental, lifestyle, and socio-economic factors that contribute to hypertension and emphasizing the necessity of multi-level interventions involving clinical care, public health policies, and lifestyle changes to effectively address this global health issue.

Introduction: Intra cerebral hemorrhage (ICH) is the most devastating form of stroke, with high mortality and severe disability among survivors. Non contrast computed tomography (CT) is the most commonly available tool for the diagnosis of intracranial hemorrhage. he aim of the study is to document the location and volume of intra cerebral hemorrhage, presence of subarachnoid /ventricular extension various types of brain herniations. The relation of extent of damage to patient management and outcome was analyzed. Materials and Methods: This prospective study was carried out on 54 patients with spontaneous intracerebral hemorrhage (SICH) over a period of 18 months (April 2023 - September 2024). Non contrast CT was performed using sixteen slice Multidetector Computed Tomography scanner (GE Revolution ACT 50 slice CT scanner).Contrast CT, follow up CT and additional radiological tests were performed as and when required. Results: In our study out of 54 patients, SICH was higher among males, with hypertension as the most important risk factor and most of the patients are with volume of bleed less than 30mL (59%). Intraventricular extension was seen in 25 patients. Supratentorial location of hemorrhage (81%) was more common compared with infratentorial location (19%) with the most common site being basal ganglia (37%). 48 patients were treated medically and six patients underwent surgery. Of the 48 patients treated medically, 9 were in infratentorial location with 4 in cerebellum and 5 in brain stem and all these patients had fatal outcome, remaining 39 patients treated medically for the supratentorial ICH, 23 patients survived. Among these patients, 22 patients had ICH volume of less than 30 mL (95%). Of 16 patients with intracerebral hemorrhage volume of ≥ 60 mL, mortality was seen in 87.5% (14 of 16 patients). Of the six patients treated surgically for supratentorial bleeds, survival rate was 66.67% (4 of 6 patients) and all the survived patients had volume of bleed more than 30 mL. Interpretation and conclusion: Based on the findings we conclude that SICH volume involving more than 60 mL, infratentorial location and intraventricular extension are predictors for poor outcomes. Patients with ICH volume of less than 30 mL have a good prognosis and patients with ICH volume ofmore than 30 mL may be considered as patients suitable for surgery.

Objective: To assess the relationship between levels of CRP, IL-6, and fibrinogen with the incidence of cardiovascular events with known cardiovascular risk factors. Methodology:  This prospective cohort study aimed to investigate the predictive role of inflammatory biomarkers (C-reactive protein [CRP], interleukin-6 [IL-6], and fibrinogen) in forecasting cardiovascular events. The study included 500 participants aged 40 to 75 years with at least one cardiovascular risk factor, such as hypertension, diabetes, hyperlipidaemia, or smoking history. Baseline blood samples were collected to measure CRP, IL-6, and fibrinogen levels, and participants were followed for 5 years. Cardiovascular events, including myocardial infarction, stroke, and sudden cardiac death, were recorded during the follow-up period. Results: The study found that elevated levels of CRP, IL-6, and fibrinogen were significantly associated with an increased incidence of cardiovascular events. Participants in the highest quartiles of these biomarkers had notably higher event rates compared to those in the lowest quartiles (p = 0.03 for CRP, p = 0.04 for IL-6, and p = 0.02 for fibrinogen). Cox proportional hazards regression analysis revealed that each unit increase in CRP, IL-6, and fibrinogen corresponded to a 45%, 23%, and 31% higher hazard of experiencing a cardiovascular event, respectively (p ≤ 0.05 for all biomarkers). Conclusion: This study highlights the significant role of inflammatory biomarkers in predicting cardiovascular events, especially in individuals with established cardiovascular risk factors. Elevated levels of CRP, IL-6, and fibrinogen were found to be strong predictors of adverse cardiovascular outcomes, suggesting that these biomarkers may improve cardiovascular risk stratification and help identify high-risk individuals for early intervention. Further research is needed to explore their potential integration into clinical practice for more effective prevention strategies

Background: The study evaluates the renal function and coagulation abnormalities in patients with sickle cell disease and their association with clinical status. Objectives: To assess relative hypertension, renal function parameters, and coagulation abnormalities in sickle cell disease patients and the association of these parameters with clinical status. Materials And Methods: A descriptive cross-sectional study from June 2017 to June, 2018 including patients in Wayanad who come to sickle cell clinics under sickle cell project of Department of Pathology, GMC, Calicut, who are diagnosed as sickle cell anemia by simple random sampling. The patients coming were counseled regarding the testing for RFT and thromboembolic complications and informed consent was taken Personal data (age, gender, community), medical history (treatment, number of crises in preceding year) & blood pressure was recorded. Complete blood count, blood urea, creatinine, prothrombin time, activated partial thromboplastin time, HPLC were performed. Data was analyzed using SPSS software, association done by chi square test and 95% confidence interval was estimated. Results: Fifty-five cases had relative hypertension and 18 were hypertensive. Forty-two patients received blood transfusion and 56% required hospitalization in the past one year. Serum creatinine ranged from 0.1-9.1 mg/dl (mean=0.99mg/dl, SD=1.16. Serum urea ranged from 10-134 mg/dl (mean= 24.6mg/dl, SD=22.3). Fifteen and Nine cases had elevated creatinine & urea levels respectively. Prothrombin time ranged from 11.1-81sec (mean=17.55sec, SD=8.54). aPTT ranged from 20-102sec (mean=35.66sec,SD=0.86). Nine & Six cases had elevated PT & aPTT respectively. Better outcomes were notes with patients on hydroxyurea. Conclusion: Regular follow up of these patients can help to alleviate the general well-being of the sickle cell anemia patients

Introduction: Acute myocardial infarction is one of the most common causes of hospitalization as well as one of the most common causes of death. Up to three million people worldwide are afflicted with the illness, which has an incidence of 64.37/1000 in India and a very high chance of passing away in the initial hours following the onset of symptoms. Aims: To study the prevalence and pattern of dyselectrolytemia in patients of acute MI (both STEMI and NSTEMI). To study effect of dyselectrolytemia towards clinical outcome in patients with Acute MI during early acute phase. Materials & Methods: The study design was prospective case control study, from July 2022 to December 2023, place of study was Katihar Medical College and total sample size was 60 Result: In our study, 6 (10.0%) patients had Accelerated Hypertension, 1 (1.7%) patient had Bradycardia, 3 (5.0%) patients had Bradycardia With Hypotension, 2 (3.3%) patients had Cardiogenic Shock, 2 (3.3%) patients had Heart Block, 7 (11.7%) patients had Hypotension 6 (10.0%) patients had Pulmonary Edema, 3 (5.0%) patients had Pulmonary Edema With VT and 5 (8.3%) patients had VT complications. The value of z is 5.318. The value of p is <.00001. The result is significant at p < .05. Conclusion: We concluded that AMI frequently have electrolyte abnormalities, especially those affecting potassium and sodium, which can have a negative impact on clinical outcomes. For patients to have a better prognosis, these abnormalities must be identified early and managed.

Background: To improve the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block will help to reduce many false activations of the protocols for emergent reperfusion and will help to provide timely reperfusion to those patients who are truly experiencing an acute myocardial infarction Methods: Adult patients referred for suspected myocardial infarction because of new or presumed new Left bundle branch block (LBBB) with available Electrocardiography (ECG) recorded at the first medical contact were included in this study.   Results: A total of 39 patients were included in this study. Mean age was 56.2 years, 23 were male (59%). The patients presented with symptoms of chest pain (48.7%), dyspnoea (17.9%) and palpitations (15.4%). The following commodities were noted, diabetes in 51.3 % and hypertension in 43.6%. Median troponin I was 2197 pg/mL. Barcelona criteria had a sensitivity of 73 % and modified Sgarbossa had a sensitivity of 64%. Both the criteria had specificity of 100%. Conclusions: Barcelona criteria significantly improved the diagnosis of Acute myocardial infarction (AMI) as compared with previous ECG rules, achieving a diagnostic performance for AMI similar to that of ECG in patients without LBBB. The high specificity of the algorithm was confirmed in a large and heterogeneous control group of patients without suspected AMI.

Background: Upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening condition requiring prompt medical intervention. This study investigates the clinical and etiological profile of UGIB patients presenting to an emergency department in Indore, Madhya Pradesh. Material and Methods: An observational study was conducted involving 100 adult patients aged over 18 years diagnosed with UGIB. Data collection included demographic information, clinical presentations, laboratory findings, and outcomes. Upper gastrointestinal endoscopy was performed for diagnostic and therapeutic purposes. Results: The mean age of participants was 45.78 ± 13.87 years, with males constituting 72% of the sample. Hematemesis (68%) and melena (54%) were the most frequent symptoms. The most common underlying cause was esophageal varices (51%), followed by gastric ulcers (12%). A total of 65% of patients required hospitalization, with a mortality rate of 14%. Septic shock was the leading cause of death (56.3%). Significant associations with mortality included high respiratory rate, low blood pressure, and abnormal laboratory values such as elevated lactate levels. Conclusion: The findings underscore the importance of early intervention and endoscopy in managing UGIB, particularly in patients with portal hypertension. Comprehensive assessment and proactive management can significantly improve patient outcomes.

Background- A number of patients living with uncontrolled blood pressure remains a challenging problem all over the world. Hypertension is responsible for 57% of all stroke deaths and 24% of coronary heart disease death in India. Therefore, it is important to know the prevalence of uncontrolled blood pressure in patients with hypertension. Aims- To Assess adequacy of blood pressure control in patients with hypertension attending medicine OPD & other medical clinics of hospital. Materials and methods- This was an observational prospective study which was conducted in the Department of Internal Medicine, Maulana Azad Medical College and Lok Nayak Hospital, located in New Delhi, India. A total of 100 diagnosed cases of hypertension fulfilling inclusion and exclusion criteria were evaluated in this study. Risk factors like adherence, no of antihypertensive medications, reduced salt intake, knowledge about hypertension, hyperlipidemia, diabetes mellitus, demographic and socioeconomic characteristics, cardiovascular disease, smoking, alcohol, physical activity and obesity were assessed. Results- The mean age of the patients was 50.48 (±12.01) years. As compared to patients with controlled BP, those with uncontrolled BP had significantly more number of females (77.4% vs. 52.2) then to males (22.6% vs. 47.8%) (P=0.01). age, Educational standard, residency, occupations, did not show a significant association with control of hypertension in our study. Socioeconomic status as a factor showed a significant association with control of hypertension. As compared to patients with controlled BP to those with in uncontrolled BP, uncontrolled BP was more common in patients with heart disease, diabetes mellitus and respiratory disease.  (12.9% vs 0.0%, P<0.01). 14% patients used tobacco in the form of smoking; 5% were current alcoholic. In the index study, 66% patients were on salt restricted diet and 73% of the patients were adhere to antihypertensive medications. Whereas patients on dual and single antihypertensive were more in controlled group 58.0% and 14.5 % respectively (P<0.01). In uncontrolled group, there were significantly more patients (77.4%) who had inadequate knowledge about HTN control vs.(23.2%) in controlled BP group, (P<0.001. Among the hypertensives, 40% subjects were physically active. BMI as a factor showed a significant association with control of BP in our study. Mean cholesterol level in uncontrolled BP group was significantly higher than controlled BP group (184.13 vs. 137.68, P≤0.01). Mean triglycerides level in uncontrolled BP group was significantly higher 157.68 (±55.98) vs. 126.29 (±38.47) in controlled group (P≤0.01). Conclusion- The present study compares parameters such salt restriction diet and adherence to antihypertensive medications in uncontrolled and controlled hypertension patients in India, which provides valuable information for researchers and authorities, who are responsible for the planning of health services. There are a limited number of researches on BP control status of hypertensive in India. So, this study will provide information about risk factors responsible for uncontrolled blood pressure in patients with hypertension. Our findings have significant public health implications that emphasize the urgency of increased awareness about blood pressure control

Background: Endothelial dysfunction marks the initial phase of atherosclerosis, a condition that leads to the thickening and stiffening of arterial walls, particularly in the aorta. This increased arterial wall thickness and stiffness result in higher arterial resistance, subsequently reducing the aortic propagation velocity (APV). This study aims to explore the relationship between APV, a relatively under-researched echocardiographic parameter, and the presence and severity of coronary artery disease (CAD) in patients experiencing acute coronary syndrome (ACS). The study is aimed.  Objective:  To assess the aortic propagation velocity and correlate it with the severity of cad using syntax score in patients presenting with acute coronary syndrome. Methods: A prospective observational study conducted in Department of Cardiology of Jawaharlal Nehru Medical College, KAHER, Belgaum between January 2O23 to December 2O23. Patients with confirmed ACS diagnosis according to fourth universal definition of acute myocardial infraction were eligible to participate in the study.  Result: A total of 292 study participants were included in this study. Among the 292 study participants, 49.7% (n=145) were in the CAD group and 5O.3% (n=147) were in the non-CAD group. The mean age of the study participants was 57.27 ± 13.4O years. Among study participants, 68.97% were male and 31.O3% were female. The mean ejection fraction in CAD and Non-CAD groups were 49 ±9.94 and 58.O6 ±6.86 respectively. The mean SYNTAX scores I of study participants in CAD group was 18.42 ±13.15. The mean SYNTAX score II PCI and SYNTAX score II CABG were 34.78 ±13.75 and 25.7 ±13.O2 respectively.  The mean AVP average in CAD group and non-CAD group were 44.32 ±33.93 and95.8 ±34.15 respectively. The prevalence of diabetes and hypertension among the study participants in CAD group were 6O.69% and 45.52% respectively. Prevalence of substance abuse like smoking, tobacco and alcohol were present in 41.38%, 46.21% and 33.1% respectively. Chest pain, dyspnoea, palpitations, and syncope were present in 89.66%, 49.66%, 1.38% and 1.38% of study participants respectively. Positive correlation of AVP was present in variables like SYNTAX Score I (p<O.O5), SYNTAX Score II CABG (p<O.O5), SYNTAX Score II PCI (p<O.O5), HbA1c (p<O.O5) and age (p<O.O5). The prevalence of single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) among the study participants in CAD group were 4O.69%, 2O.69% and 38.62% respectively. The ROC curve shows 84.8% of sensitivity and 1OO% of specificity in predicting CAD by APV value. The area under the curve was O.912 (p<O.O5). Conclusion: The study showed that APV can significantly predict the CAD. This technique offers a practical, non-invasive, and cost-effective echocardiographic approach for detecting or screening coronary artery disease (CAD). It may also prove useful in assessing comorbidities associated with CAD, aiding in risk stratification, and identifying individuals at high risk for CAD. Given its predictive accuracy and potential clinical utility, APV could be integrated into routine cardiovascular assessments, particularly for patients presenting with symptoms like chest pain or those with significant risk factors. However, the study underscores the need for further large-scale, multicenter studies to validate APV’s effectiveness and confirm its applicability as a screening tool for CAD in broader populations. These future studies would help refine APV's role in clinical practice and enhance its value in preventing and managing coronary artery disease.

Since the description of PRES in 1996 by Hinchey et al, its being increasingly recognized and reported. With increased facilities like neuroimaging, it is animportant differential in the spectrum ofhypertensive encephalopathy. We retrospectively analyzed 5 cases of PRES in our ICU over a period of 1 year. Demographic parameters, presentations, etiologies, radiological findings including outcome was studied. Most common aetiologies were pregnancy induced eclampsia and immunosuppressant’s. ICU admissions were for uncontrolled hypertension, seizures, and low level of consciousness. Two patients were ventilated for airway protection.  One patient had a complicated course and developed septicaemia and TTP. Two patients with renal involvement with PRES required hemodialysis. All patients recovered, none had residual neurological deficits. Given its diverse presentation from headache, blurring of vision to seizures and coma. Increased awareness with high degree of suspicion is the key for early identification and management of this nearly reversible condition.

Background-The aim of this study is to detect the possible reasons of abdominal pain in the patients aged 65 and older admitted to emergency department (ED) with complaint of abdominal pain which is not related to trauma, to determine the length of hospitalization of old (65-75 age) and elderly (aged 75 and older) patients, and to define the hospitalization and mortality rates. Methodology: In the study, 336 patients were included. Groups were compared in respect to gender, internal or surgical pre-diagnosis, complaints accompanying abdominal pain, vital findings, comorbidities, requested consultations, hospitalizing service, waiting time in the ED and in the hospital, and treatment methods. Results: Of the patients, 48.2% were male, and 51.8% were female. While 52.4% of the patients were in 65-74 age group, 47.6% of them were aged 75 years and above. An internal disease was detected in 76.8% of the patients as an origin of abdominal pain. Most common pre-diagnosis were biliary diseases and diseases related to biliary tract followed by nonspecific abdominal pain, abdominal pain secondary to malignity, ileus, and acute gastroenteritis, respectively. The most frequent finding accompanying abdominal pain was vomiting. The most frequent chronic disease accompanying abdominal pain was hypertension in both age groups. We observed that 75.9% of the patient’s required consultation. We detected that 48.8% of the patients with abdominal pain were hospitalized and they were hospitalized mostly by gastroenterology ward (24.8%). Surgical treatments were applied to the 17.6% of the patients with abdominal pain. Conclusion: Clinical findings become indistinct by age, and differential diagnosis of abdominal pain gets more difficult in geriatric patients. Therefore, physicians should consider age related physiological changes in order to distinguish geriatric patients admitted to emergency service with abdominal pain from pathological cases requiring immediate surgical operation

Background: Coronary artery disease is one of the major risk factor for myocardial infarction (MI) and associated death. It is very important to predetermine the coronary artery obstruction to reduce the mortality. Computed tomography angiography (CTA) can be used to determine the degree of blockage and Circulatory T-cadherin can be used for early screening of cardiovascular diseases. Aim: This study aims to evaluate the prognostic role of computed tomography angiography and circulatory T- cadherin for better prognosis and treatment. Methodology: This study is case-control and was done on 140 subjects. 70 healthy controls and 70 cases those were subjected for CTA, or advised to invasive coronary angiography (ICA) or referred for CTA having acute chest pain, difficulty in breathing, heaviness in chest with age in between 30-70 years were enrolled after informed consent. Chronic kidney disease (CKD), hyperthyroidism, Pregnant women were excluded from the study. Waist circumference, Blood pressure, fasting blood sugar and lipid profile was done to evaluate involved risk factors in all the enrolled subjects. Results: Maximum patients i.e. 25(35.7%) were of age in between 51-60 years. 25 patients were obese, 38 having T2DM, 32 with hyperlipidemia and 40 were having hypertension. When CTA was done 15(21.4%) have single vessel involvement, 20(28.5%) have two vessel and 35(50%) having three vessels involvement were recorded. Circulatory T-cadherin was estimated and the mean in cases (7.12±0.60) was significantly higher than controls (1.01±0.32) and when Circulatory T-cadherin was estimated among cases the mean was highest (7.79±0.73), in patients having three vessels involvement and was statistically significant (p<0.05). Conclusion: This can be concluded that estimation of circulatory T-cadherin can be used as prognostic tool in determining the degree and severity of coronary obstruction. This estimation can be used for early screening and preventing the patients from the risk of MI, hence reducing the mortality associated with coronary artery disease (CAD.

Sleep disorders, encompassing conditions such as obstructive sleep apnea (OSA), insomnia, restless leg syndrome (RLS), and circadian rhythm disturbances, have emerged as critical contributors to cardiovascular disease (CVD) risk, which remains a leading cause of global mortality and morbidity. These disorders disrupt the restorative functions of sleep, initiating a cascade of physiological changes including heightened sympathetic nervous system activation, systemic inflammation, oxidative stress, hormonal imbalances, and metabolic dysregulation. Such disruptions significantly exacerbate cardiovascular risk factors, including hypertension, atherosclerosis, arrhythmias, and heart failure. The bidirectional relationship between sleep disorders and cardiovascular health highlights the need for comprehensive management strategies that integrate sleep health into broader preventive care frameworks. This systematic review synthesizes findings from 29 studies to explore the underlying mechanisms linking sleep disorders to cardiovascular outcomes, evaluate the effectiveness of current therapeutic interventions, and identify challenges in diagnosing and managing these conditions. Using a PRISMA-based methodology, the review emphasizes the role of sleep disorders as both independent risk factors and contributors to the progression of existing cardiovascular conditions. Evidence suggests that interventions such as continuous positive airway pressure (CPAP) therapy for OSA and cognitive-behavioral therapy for insomnia (CBT-I) can mitigate cardiovascular risks, but challenges related to adherence, access, and awareness remain significant barriers. Sleep disorders such as insomnia, narcolepsy, RLS, and OSA significantly impair heart health by disrupting the sleep cycle, increasing cardiovascular stress, and promoting metabolic dysregulation. Despite advancements in understanding the relationship between sleep disorders and cardiovascular health, critical gaps in knowledge persist, particularly regarding the long-term impact of therapies, the role of emerging technologies, and the implications of genetic and environmental factors. By addressing these gaps and promoting multidisciplinary approaches to care, integrating sleep health into cardiovascular risk management can significantly reduce the burden of disease. The findings underscore the urgent need for public health initiatives, policy interventions, and innovative research to address the dual burden of sleep disorders and cardiovascular diseases, ultimately improving population health outcomes.

Background: Non-alcoholic fatty liver disease (NAFLD) has emerged as a significant public health concern, associated with conditions such as Type 2 diabetes, obesity, and metabolic syndrome. In India, prevalence estimates vary widely across regions. Objectives: This study aimed to determine the prevalence of NAFLD and its association with demographic, anthropometric, and lifestyle factors among patients attending a tertiary care hospital in Guntur, Andhra Pradesh. Methods: A cross-sectional analytical study was conducted on 457 patients aged 20–40 years undergoing abdominal imaging from October 2021 to November 2022. NAFLD was diagnosed using ultrasonography and graded from 0 to 3. Data on demographics, anthropometrics, and lifestyle were collected and analyzed using SPSS version 19.0. Statistical significance was set at p<0.05. Results: The prevalence of NAFLD was 46%, with grades 1, 2, and 3 observed in 33.9%, 19.8%, and 0.3% of participants, respectively. NAFLD prevalence increased significantly with age (p=0.022) but showed no gender difference (p=0.232). Patients with NAFLD had higher BMI (27.39 ± 5.41 vs. 21.84 ± 3.6), waist circumference (97.56 ± 10.05 cm vs. 79.25 ± 9.61 cm), and waist-to-hip ratio (0.95 ± 0.18 vs. 0.87 ± 0.08; p<0.001). Diabetes was more prevalent in NAFLD patients (24.3% vs. 7.1%; p<0.001), while hypertension showed no significant difference. Sedentary lifestyle (88.1% vs. 67.6%; p<0.001) and non-vegetarian diets (p=0.025) were significantly associated with NAFLD. Conclusion: NAFLD prevalence in Guntur was high (46%) higher than the global average of 25.24%. NAFLD patients had higher BMI, waist and hip circumferences, and were less physically active, with a higher prevalence of diabetes. The findings underscore the importance of weight management, routine screening, and lifestyle changes to mitigate NAFLD risk. These findings emphasize the need for early screening, lifestyle modifications, and targeted interventions to address NAFLD effectively.

Introduction: The International Diabetes Federation (IDF) estimated that the number of individuals living with Diabetes would increase from approximately 65 million in 2013 to 100 million by 2035. Despite the increasing burden of Non-Communicable Diseases, both research and the allocation of resources to combat Non-Communicable Diseases remain limited¹. The NCDs like Diabetes, Hypertension, Obesity, CVS etc. are estimated to account for around 60% of all deaths. NCDs cause considerable loss in potentially productive years of life. Losses due to premature deaths related to heart diseases, stroke and Diabetes are also projected to increase over the years. Individuals with Non-Communicable Diseases also have a higher risk of increased health expenditure, and a substantial proportion of households face catastrophic health expenditure and subsequent impoverishment due to NCD related expenses.² Objectives of the study: 1. To assess the prevalence of Non-Communicable Diseases (Hypertension, Diabetes Mellitus and Obesity) among the adult population of Kokrajhar District. 2. To assess the prevalence of risk factors of common non-communicable diseases in adult population of Kokrajhar District. Methodology: Study Type: Community-based, Descriptive Cross-sectional study. Study Population: Adult Population of 18 –59 years of age. Study Area:  Villages under Titaguri area which is one of  the  field  practice  areas and Family adoption areas  of  the  Department  of Community    Medicine,   Kokrajhar Medical  College. Study Duration: July 2024 to September 2024.  Sample Size calculation: The sample size was calculated by the formula N = 4pq/l2, where p represents prevalence of diabetes which was 15.5% (Thakur J, Jeet G, et al. (2019) non-communicable diseases risk factors and their determinants: A cross-sectional state-wide STEPS survey, Haryana, North India. PLoS ONE 14(11): e0208872. https://doi.org/10.1371/journal.pone.0208872). ‘l’ is allowable error, taken as 5% of p. Therefore, a sample size of 210 was taken. Ethical Clearance: Ethical clearance had been obtained from the Institutional Ethical Committee of Kokrajhar Medical College and Hospital, Kokrajhar, Assam. Inclusion Criteria: Permanent residents of Kokrajhar District (residing for more than 6 months) Exclusion Criteria: 1) Pregnant lady, 2) Those with known psychiatric illness, 3) Individuals having serious morbidity, Consent: Informed consent was taken from all the participants before data collection and confidentiality was maintained. Data collection: Information regarding risk factors of NCDs were collected by using Pre tested per-designed questionnaire. Non-stretchable    measuring    tape, digital weighing scale, portable stadiometer, digital BP apparatus were   used to measure waist and hip circumference, weight, height, and blood pressure, respectively. Data analysis–Data has been entered in MS excel sheet. Qualitative data were expressed in proportions.  Mean and standard deviation were used for quantitative data.  Suitable tests    of    significance    has been      applied    wherever necessary.

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, accounting for approximately 18 million deaths annually. Despite progress in treatment and management, the global burden of CVD continues to rise, fueled by aging populations, urbanization, and the growing prevalence of modifiable risk factors such as hypertension, diabetes, and obesity. Traditional prevention strategies have focused on controlling these risk factors through lifestyle modifications and pharmacological interventions. However, the persistence of high CVD-related morbidity and mortality rates highlights the limitations of conventional approaches, necessitating innovative solutions. This systematic review summarizes evidence for recent advances in cardiovascular disease prevention across 34 studies, emphasizing digital health technologies, precision medicine, therapeutic innovation of pharmacological agents, and public health initiatives. Wearable devices, artificial intelligence (AI)-powered data processing, and other digital tools are revolutionizing cardiovascular prevention through improved early detection, risk stratification, and personalized care. With recent pharmacologic breakthroughs like RNA-based remedies and PCSK9 inhibitors, we now have potent alternatives for treating lipid disorders and ameliorating cardiovascular events. Precision medicine approaches are also being employed to develop polygenic risk scores (PRS) and for biomarker-guided prevention of these at-risk individuals. It has been shown that public health approaches utilizing mobile health (mHealth) technologies and community-based interventions can effectively encourage healthy practices and increase access to preventive services. The results highlight the life-changing possibilities of introducing new technologies and therapies in conjunction with new prevention methods. Not only do these advances fill gaps in current strategies, but they also provide scalable approaches to closing global divides in cardiovascular health. This holistic approach, which takes lessons from old practices and combines them with the best modern innovations, marks an important step in reducing the global burden of CVD, ultimately improving patient outcomes.

Introduction: Hypertension is a significant health concern for pregnant women, potentially leading to adverse maternal and fetal outcomes. This study aims to investigate the maternal and fetal consequences in pregnancies complicated by preexisting hypertension. Objectives: To evaluate the maternal and fetal outcomes in pregnant women with preexisting hypertension. Methods: Study Design: Prospective cohort study. Setting: Two tertiary care hospitals. Participants: 200 pregnant women with a confirmed diagnosis of preexisting hypertension. Data Collection: Data were collected on maternal age, hypertension severity, medication use, prenatal care, and lifestyle factors. Fetal outcomes included gestational age at delivery, birth weight, and incidence of congenital anomalies or distress. Statistical Analysis: Descriptive statistics, chi-square tests for categorical variables, and t-tests or ANOVA for continuous variables. Results: The study found significant associations between the severity of hypertension and maternal complications such as preeclampsia, gestational diabetes, and preterm labor. There was a higher incidence of low birth weight, preterm birth, and neonatal intensive care unit (NICU) admissions in the hypertensive group compared to national averages. Results were statistically significant with p-values <0.05. Conclusions: Preexisting hypertension in pregnant women is strongly associated with adverse maternal and fetal outcomes. Early intervention and careful management of hypertension during pregnancy are crucial to improve health outcomes for both mother and child.

Introduction: Hypertension is a major risk factor for cardiovascular diseases, including myocardial infarction (MI), and can worsen the outcomes of MI. This study aimed to compare the pathological features, clinical outcomes, and coronary artery findings in hypertensive versus non-hypertensive MI patients, particularly focusing on myocardial damage and complications in the Indian context. Methodology: This observational study was conducted at a tertiary healthcare hospital over a three-year period, including 100 MI patients (50 hypertensive and 50 non-hypertensive). Participants were selected based on their medical records, and data were collected on demographic characteristics, clinical outcomes, histological grading of myocardial damage, and coronary artery findings. Statistical analysis was performed using chi-square and t-tests to assess differences between the two groups. Results: The hypertensive group showed significantly higher incidences of severe myocardial necrosis (80% vs. 56%, p = 0.02) and moderate to severe myocardial fibrosis (70% vs. 44%, p = 0.04) compared to the non-hypertensive group. Hypertensive patients had longer hospital stays (8.2 ± 3.1 days vs. 6.4 ± 2.6 days, p = 0.01), though no significant differences were found in arrhythmia rates (44% vs. 36%, p = 0.37) or mortality (26% vs. 18%, p = 0.33). Coronary artery findings indicated higher levels of stenosis in hypertensive patients, but these differences were not statistically significant (p > 0.05). Conclusion: Hypertension significantly exacerbates myocardial damage in MI patients, leading to worse pathological features such as myocardial necrosis and fibrosis, and longer hospital stays. However, there were no significant differences in arrhythmias, mortality, or coronary artery stenosis between hypertensive and non-hypertensive groups. These findings underscore the importance of managing hypertension to reduce the severity of myocardial injury in MI patients.. 

Introduction: Sickle cell anaemia is a genetic abnormality involving the haemoglobin. Patients present with a wide spectrum of disorders because of a single-point mutation in which thymine substitutes for adenine, thereby encoding valine instead of glutamine in the sixth position of the beta-chain. The repeated sickling and unsickling damage the red cell membrane leading to irreversibly sickled red cell even when the oxygen pressure is increased. Methodology: Patients admitted in the Medicine department of tertiary care center from December 2020 to December 2022 with sickle cell anaemia were included in the study. Sample size taken for this study was 100 patients. Predesigned and pretested questionnaire was used to record the necessary information. Result: In this study, association of LVH and severe anemia in sickle cell patients was not statistically significant(P>0.05) Association between anaemia and pulmonary artery hypertension in sickle cell patients was found to be statistically significant. Conclusion: Most common electrocardiographic finding was sinus tachycardia followed by T- inversions. Most common echocardiographic changes were pulmonary hypertension.

Budd-Chiari syndrome (BCS) is a rare clinical condition characterized by obstruction of the hepatic venous outflow tract between hepatic veins and the junction of the inferior vena cava with the right atrium. Despite the use of anticoagulation, many patients may need additional Interventional Radiology (I.R) treatment strategies. Algorithms consisting of local Venoplasty, Hepatic Vein Stenting (HVS), Catheter Directed Thrombolysis (CDT), Trans-jugular Intra-hepatic Porto-systemic Shunt (TIPS), Direct Intrahepatic Portacaval Shunt (DIPS) as bridge to Liver Transplantation (LT) have been proposed with treatment choice dictated by a lack of response to a less-invasive treatment regimen and clinical response. Endovascular management has emerged to play an important role in the treatment of Budd-Chiari Syndrome and offers minimally invasive and highly effective methods to restore adequate venous outflow required to overcome portal hypertension, and in turn helps to mitigate long term complications i.e. delay progression to hepatic failure and cirrhosis by salvage as alternative outflow and decongestion.

Background: Adolescence is a period where there is rapid physical as well as mental growth and development. Obesity and Hypertension (HTN) are emerging as major health problems among adolescents in urban areas. The prevalence of Obesity among adolescents in India varies between 3.6% to 11.7%.¹ Similarly, the prevalence of HTN among Indian adolescents varies between 0.46% to 15% as per studies conducted in different regions of the country.² Obesity is not just a risk factor for developing HTN, but also contributes to emergence of many non-communicable diseases. Hypertension is often asymptomatic and an under-diagnosed problem among adolescent. Since limited data are available on the prevalence of obesity and HTN among adolescents of eastern Odisha, this study was carried out with an aim to estimate the Prevalence of Obesity and Hypertension among adolescents of an urban slum of Cuttack city and suggest remedial measures on basis of the study findings. Materials and methods: A total of 152 adolescents were selected randomly from 4 wards of the urban field practice area of SCB MCH, Cuttack from November 2023 to January 2024. A pre-designed, pre-tested, semi-structured schedule was validated from the experts of Department of Community Medicine. Socio-demographic, anthropometric and other relevant data from study respondents was collected using epicollect5. Body mass index (BMI) and Blood Pressure (BP) greater than 95^th percentile for age and gender were considered Obese and Hypertensive respectively. Data analysis was done using SPSS version 17.0. Results: Prevalence of HTN, Pre-HTN, obesity and overweight in the study were 7.2%, 5.3%, 10.5% and 31.6% respectively. Majority of the males 14 (15.5%) were obese as compared to females 02(3.2%). BMI, sleep duration, consumption of carbonated drink, fast and processed food consumption, academic stress, gadget use (in hrs) was found to have significant association with Hypertension (p value <0.05). Discussion: Prevalence of Hypertension in this study (7.2%) was consistent with the findings in a study by Anand T et al. (7.6%).³ Prevalence of Obesity and overweight in the present study was 10.5% and 31.6% respectively. However, study by S Seema et al.⁴ found that 6.8% of adolescents were obese and 17.1% were overweight. Conclusion: Obesity, Overweight and Hypertension are rising health problems among Adolescents. Early detection, dietary and lifestyle modification and regular health check-up of adolescents is required for prevention of emergence of chronic diseases later. There is also a need for community participation and implementation of health promotion measures and disease preventive programs for adolescents.

Introduction: In the realm of obstetrics, the intricate interplay between maternal health and perinatal outcomes continues to captivate researchers worldwide. Among the multifaceted conditions affecting pregnancy, pre-eclampsia stands as a significant concern, characterized by hypertension and proteinuria after 20 weeks of gestation. This study endeavours to delve into a promising avenue: the association between serum uric acid levels and perinatal outcomes in women grappling with pre-eclampsia. Pre-eclampsia remains a significant challenge in obstetrics, with its potential to impact both maternal and foetal health profoundly. Amidst the array of biomarkers under scrutiny, serum uric acid levels have emerged as a promising candidate for understanding the pathophysiology of this condition. Materials And Methods: This is a Prospective and Observational Study was conducted in the Department of Obstetrics and Gynaecology, Medical College Kolkata from December 2022 to April 2024. Pregnant women diagnosed with Pre-eclampsia in their third trimesters are being included in this study. Pregnant women with Pre-eclampsia who are current smokers, alcoholic and those with diabetes mellitus,thyroid disorders and renal dysfunction were excluded. Patients with chronic diseases like APLA Syndrome and heart diseases were also excluded. All patients with Pre-eclampsia in their third trimesters were asked to test their Serum Uric Acid levels at their third trimesters of pregnancy. These patients were then followed up till delivery and the presence/absence of maternal complications and perinatal outcome were observed. The association between serum uric acid levels and perinatal outcome was then assessed. Results: In our study 11 pre-eclamptic females (9.56%) were ≤20 years of age, 16 (13.91%) were between 21 to 25 years of age, 41(35.65%) were between 26 to 30 years of age, 39(33.91%) were between 31 to 35 years of age and 8(6.95%) were≥ 36 years of age.  In our study, out of 115 participants, 3 (2.60%) had uric acid levels ≤4 milligrams per decilitre, 22(19.13%) had uric acid levels between 4.1 to 6.0 milligrams per decilitre ,61 (53.0%) had uric acid levels between 6.1 to 7.9 milligrams per decilitre and 29 (25.2%) had uric acid levels ≥ 8 milligrams per decilitre. In our study, we calculated the association of Blood Pressure at delivery with serum uric acid levels. It was found to be statistically significant (p value is 0.0035). Data are expressed as percentage. Test applied: Fisher's exact test. The row/column association is statistically significant. The relative risk is 1.833. 95% confidence interval is between 1.116 to 3.011. Conclusion: Hence, from our results, we can surmise that serum uric acid levels have a significant association with perinatal outcome in women with pre-eclampsia and hence, can be used as prognostic marker to predict development of complications in these pre-eclamptic females.

Obesity is a growing global health crisis that significantly contributes to chronic diseases such as type 2 diabetes, cardiovascular disorders, hypertension, and certain cancers. It is recognized as a multifactorial condition influenced by genetic, environmental, behavioral, and psychological factors. Traditional obesity management approaches, which predominantly focus on dietary modifications and increased physical activity, often fail to produce sustainable long-term results. As a result, there is an increasing emphasis on multidisciplinary approaches that integrate dietary interventions, physical activity, behavioral therapy, pharmacological treatments, and bariatric surgery to address obesity more comprehensively.

Obesity Management in a Multidisciplinary Approach Multifaceted in nature, the management of obesity requires teamwork that involves different health professionals from diverse fields, such as dietitians, exercise physiologists, psychologists, endocrinologists, and bariatric surgeons. They work best at offering individualized and global approaches to overcome the lifestyle challenges and the psychosocial issues that impact weight loss success. This approach emphasizes behavioural and psychological strategies, including evidence-based methods such as cognitive-behavioural therapy (CBT), mindfulness-based stress reduction for managing stress and other triggers that lead to emotional eating, and achieving sustainable lifestyle changes.

Pharmacological interventions are a critical component in obesity management, especially in those patients who do not respond to lifestyle changes alone. GLP-1 receptor agonists and orlistat are two examples of medications shown to help with weight loss. Bariatric surgery is the most effective intervention for patients with severe obesity, resulting in durable and clinically meaningful weight loss, improved metabolic control, and resolution of obesity-related comorbidities. Nevertheless, surgical solutions demand complete support pre-operatively and post-operatively to be successful in the long run.

This systematic review synthesized evidence from 30 studies to assess the effectiveness of multidisciplinary approaches for managing obesity. The results show that combining different modalities yields superior and longer-lasting weight loss to those delivered by a single modality. Moreover, multidisciplinary care enhances patients' psychological well-being, quality of life, and metabolic health. While the results are encouraging, adherence, access, and long-term feasibility are challenges for widespread implementation.

It also discusses future directions in obesity management, including the potential for mobile health applications, telemedicine, and wearable technology to promote patient engagement and monitoring. Such multidisciplinary approaches can transform obesity care by tackling the underlying causes of the disease and delivering personalized, patient-centred interventions. These results highlight the need for multidisciplinary approaches that focus on preventive care and holistic treatment models as healthcare systems move to help alleviate the global burden of obesity and improve long-term health outcomes.

Background: Type 2 diabetes mellitus (T2DM) is a rapidly growing global health concern, particularly in developing countries like India. This study aims to evaluate the sociodemographic, clinical, and biochemical profiles of newly diagnosed T2DM patients in Burla, Odisha, to inform targeted intervention strategies. Methods: A hospital-based observational study was conducted from September 2022 to February 2023, enrolling 783 newly diagnosed T2DM patients through random sampling. Sociodemographic and clinical data were collected using a semi-structured questionnaire. Anthropometric measurements and laboratory investigations, including glycosylated hemoglobin (HbA1c), lipid profiles, and renal function tests, were performed. Data were analyzed using R software, with significance set at p<0.05. Results: The mean age of participants was 47.70±10.94 years, with 60.3% being male. Most were literate (98.6%), with 68.1% classified as obese (BMI ≥25 kg/m²). Classic diabetic symptoms like weakness (59.3%), nocturia (44.4%), and weight loss (26.7%) were prevalent. Poor glycaemic control (HbA1c >9%) was observed in 41.4% of patients, while only 6.8% achieved good control (HbA1c <7%). Dyslipidaemia (78.2%), hypertension (51.2%), and sedentary lifestyles (84%) were common. Obesity was significantly associated with hypertension (p<0.001), and a positive family history of diabetes was linked to increased risk (p=0.049). Conclusion: The study highlights poor glycaemic control, high prevalence of obesity, and associated risk factors like hypertension and dyslipidaemia among newly diagnosed T2DM patients in Odisha. These findings underscore the urgent need for lifestyle modifications and effective management strategies tailored to the region's socio-cultural context to mitigate the growing diabetes burden.

Background:  Tenecteplase has higher fibrin specificity and greater resistance to inactivation by its endogenous inhibitor (PAI-1) compared to native t-PA. The objective of this study was to assess the outcome of intravenous thrombolysis (IVT) with Tenecteplase (TNK) in patients with Middle Cerebral Artery (MCA) ischemic stroke. Methods: A prospective observational study was conducted in a South Indian multi-specialty tertiary care hospital from April 2019 to March 2020. We have observed that 42 MCA ischemic stroke patients underwent IVT with TNK (0.25 mg/kg) within four and half hours of onset of symptoms. All were followed up for 3 months, to assess the response to therapy and clinical outcomes. Results: Among the study population, the majority of the patients (71%) were from ≥55 years of age group and 33 (77%) were male; 62% had a history of hypertension and 52% were diabetics. Slurred speech was the most common (47.8%) presenting symptom and Right hemiparesis was the most common (54.8%) neurological sign. There is a significant reduction (P<0.001) in NIHSS score was observed with a mean score of 3.38 after 24 hours of IVT with TNK and in the modified Rankin Scale (mRS) score (mean score: 1.61; P<0.001) at 3 months follow up. Two (4.7%) patients have developed hemorrhagic transformation; among them, one (2.3%) had an NIHSS score of more than 13 at arrival. Conclusion: Intravenous thrombolysis (IVT) with Tenecteplase (TNK) 0.25 mg/kg is safe with less chance of symptomatic intracranial hemorrhage and has good functional outcomes.

Background: Acute myocardial infarction has been reported to have poor long-term outcome in young adults. Hence, identifying the risk factors is necessary for primary and secondary prevention. This study was done to identify the risk factors for young myocardial infarction. Materials and Methods: 86 patients of myocardial infarction admitted at IGMC Shimla were included in the study and their demographic profile and risk factors were studied followed by coronary angiography. Observations: Out of 86 patients studied, maximum number of patients (53.48%) were in age group of 40-45 years with mean age of 38.4 years. 89.5% patients were male. ST segment elevation myocardial infarction (72%) was more commonly observed on ECG. Anterior wall and Anterolateral wall were the most common areas involved with prevalence of 35.4% and 30.6%, respectively. Smoking was the most common risk factor present in 93.02% cases. Hyperhomocysteinemia was present in 84.88% patients while 82.55% patients had ratio of ApoB/ApoA1 > 0.8. Diabetes mellitus and hypertension were present in 36.04% and 26.74% patients, respectively. Most common lipid abnormality observed was raised LDL followed by low HDL. Most common abnormality seen on coronary angiography was single vessel disease, seen in 62.71% patients. Conclusion: Acute myocardial infarction in young patients is more common in men in the Sub-Himalayan region. Smoking is the most common risk factor. ST elevated myocardial infarction with anterior wall involvement is the most common presentation. Single vessel disease is most commonly seen.

Background Carotid body tumors (CBTs), also known as paragangliomas or chemodectomas, originate from paraganglion cells at the carotid bifurcation. They are predominantly benign, with 5% being bilateral and 10% malignant. The primary treatment modality is surgical excision, though larger tumors and higher Shamblin grades pose increased operative risks. Adequate preoperative biochemical, anatomical, and radiological evsaluation is critical for successful management. Materials and Methods A retrospective analysis of eight patients treated for CBTs from January 2020 to the present was conducted. The cohort included 3 males and 5 females, aged 23 to 57 years. Detailed clinical assessments, including imaging and surgical outcomes, were reviewed. Specialized training recommendations for neurosurgeons in microvascular anastomosis and bypass procedures were emphasized to ensure optimal patient care. Results Among the eight patients, no perioperative mortality was reported. Case highlights included a 28-year-old female presenting with painless progressive neck swelling and hoarseness without vocal cord palsy or other focal neurological deficits, and a 42-year-old male with hypertension presenting with painless neck swelling and Horner’s syndrome. Effective surgical excision with preservation of the carotid artery and surrounding structures was achieved in all cases, underscoring the importance of surgical expertise and interdisciplinary training. Conclusion Surgical management of CBTs requires a multidisciplinary approach and advanced neurosurgical skills, particularly in microvascular anastomosis and bypass procedures. Subspecialized training in cerebrovascular surgery is essential to improve operative outcomes. Thorough preoperative evaluation and skillful execution are pivotal in ensuring "happy surgeries" with minimized complications

Introduction Coronary artery bypass grafting (CABG) is a highly successful surgical treatment for the relief of angina and prolongs life in patients with coronary artery disease (CAD). Preoperative renal dysfunction is a significant risk factor that influences the outcome in patients undergoing CABG surgery. Mild renal dysfunction is an adverse prognostic indicator in patients with coronary artery disease. Several studies showed that patients with mild renal dysfunction have an increased risk of dying within 30 days after coronary surgery. Patients with renal dysfunction who require CABG represent a complex group of patients with accelerated atherosclerosis and advanced cardiovascular disease. Methods And Materials This is a prospective study was conducted in the Department of Cardiothoracic and vascular surgery, Yashoda Hospital, Secunderabad. OPCAB was performed with the Octopus-Evolution tissue stabilizer system device for target coronary artery stabilization. A mean systemic arterial pressure was maintained around 65 to 70 mmHg throughout the procedure. An intracoronary shunt  was used in all target coronaries greater than 1.25mm in diameter during construction of distal anastomosis. Humidified carbon dioxide blower /mister was used to disperse the blood from the anastomotic site while constructing the distal anastomoses Results The mean age in mild group was 59.05±7.60 and 56.37±9.06 in normal group, p=0.15. In mild group 16 (40.00) were females and 24 (60.00) were males whereas 10(25.00) were females and 30 (75.00) were males in normal group, p=0.15(figure 2). Preoperative variables such as BMI>30 (p=0.30), Smoking (p=1.00), Hypertension (p=0.33), Diabetes mellitus (p=0.57), Hyperlipidaemia (p=0.63), COPD (p=0.80), preoperative MI (p=0.81) were compared between the mild and normal groups and none of the baseline variables were significant between the groups Conclusions There was no significant difference in the patients undergoing off-pump CABG with normal renal function and mild renal dysfunction in terms of short-term mortality, myocardial infarction, stroke, or renal failure requiring dialysis. Off-pump CABG is more reno-protective for patients with normal renal function but for patients with mild renal dysfunction may need preoperative assessment of renal function by GFR in addition to serum creatinine levels to stratify the risk for postoperative renal dysfunction and to optimize measures for renal preservation during surgical myocardial revascularization

Non-communicable diseases (NCDs) are a leading cause of death globally, with rural populations in India being particularly vulnerable due to limited healthcare access. This study aims to evaluate the effectiveness and challenges of a Community-Based Assessment Checklist (CBAC)-based screening program for NCDs in underserved rural areas of Jaipur, Rajasthan. A mixed-methods approach was employed, combining quantitative analysis of NCD risk factors (blood pressure, blood sugar, BMI, chronic kidney disease) and qualitative data on community engagement and operational challenges. Screening camps were organized in 10 underserved villages, where 404 individuals were screened. Results revealed that 47% of participants were classified as high-risk for NCDs based on CBAC scores. Significant associations were found between high-risk CBAC scores and hypertension, diabetes, and obesity. However, qualitative findings highlighted critical barriers to participation, including lack of awareness, logistical challenges, and mistrust in the process. Despite these barriers, the study demonstrated the potential of CBAC as a valuable tool for early NCD detection, though addressing community engagement and operational challenges is essential for its broader implementation.

Background: Hypertension is a global health burden and a major risk factor for cardiovascular diseases. Emerging evidence highlights the role of metabolic disturbances, including hyperhomocysteinemia and dyslipidemia, particularly elevated serum Very Low-Density Lipoprotein (VLDL) levels, in the pathogenesis of hypertension. Understanding the relationship between these factors is crucial for effective management and prevention of cardiovascular complications. Aim To investigate the correlation between serum VLDL levels and hyperhomocysteinemia in hypertensive patients. Methods This retrospective cross-sectional observational study was conducted at the VSS Institute of Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, from February 1, 2023, to January 31, 2024. A total of 100 hypertensive patients aged 30–65 years were included. Participants were categorized into two groups: those with hyperhomocysteinemia (serum homocysteine >15 µmol/L) and those with normal homocysteine levels. Serum VLDL and homocysteine levels were measured using enzymatic and HPLC methods, respectively. Data were analyzed using SPSS version 23.0, with correlation and independent t-tests employed to assess associations. Results Among the 100 participants, 55% had hyperhomocysteinemia. The hyperhomocysteinemia group exhibited significantly higher serum VLDL levels (45 ± 8 mg/dL) compared to the normal homocysteine group (35 ± 7 mg/dL; p<0.001). A strong positive correlation was observed between serum VLDL and homocysteine levels (r=0.72, p<0.001). Additionally, systolic and diastolic blood pressures were significantly elevated in the hyperhomocysteinemia group (p<0.05). Conclusion The study demonstrated a significant association between elevated serum VLDL levels and hyperhomocysteinemia in hypertensive patients, highlighting the interplay between lipid metabolism and homocysteine levels in hypertension. These findings suggest that addressing both lipid abnormalities and hyperhomocysteinemia may improve clinical outcomes in hypertensive patients. Recommendations The fundamental mechanisms and causal link between serum VLDL and homocysteine levels require further longitudinal research. Incorporating lipid and homocysteine management into hypertensive care protocols may reduce cardiovascular risk and improve patient outcomes.

A 29-year-old young female presented in out-patient with complain of breathlessness on exertion, and bilateral lower limb swelling. Transthoracic echocardiography (TTE) showed severely dilated isolated right ventricle with dysfunction without pulmonary hypertension. Endomyocardial biopsy revealed lymphocytic myocarditis with fibrosis.

Introduction: There are a number of causes for Vitamin D deficiency in chronic liver disease, including insufficient sun exposure, inadequate dietary intake, steroid use, deterioration of vitamin synthesis in the skin caused by jaundice, and decreased Vitamin D absorption brought on by intestinal edema secondary to portal hypertension. Present study was aimed to study vitamin D deficiency and its relationship with Child Pugh score in patients with chronic liver disease. Material and Methods: The present study was carried out in the patients who were clinically diagnosed with chronic liver disease. All necessary investigations were performed, and the severity of chronic liver disease (CLD) was defined as per Child Pugh Criteria and MELD scoring system. Results: In the study, the mean age of the subjects was 47.36 ± 10.56 years. Majority were males(80.7%), normal BMI (53.5%). The prevalence of Vitamin D deficiency among the subjects with chronic liver disease was 60.5%. About 28.9% of the subjects were deficient of Vitamin-D, while remaining 10.5% cases showed normal levels of Vitamin D. The mean Vitamin D levels among the subjects was 22.15 ± 5.72 ng/mL. On cross-analysis, the Vitamin D status found to deteriorate significantly with increase in the age group and BMI, more among males and increase in the severity of hepatic encephalopathy. The mortality rate was 2.9% and 30.3% among the subjects with insufficient and deficient levels of Vitamin D respectively. The study also found statistically significant difference in the levels of Vitamin D with respect to severity of liver disease, thereby suggesting that Vitamin D levels reduce significantly among the subjects with severe liver disease. Conclusion: Statistically significant difference was observed in the levels of Vitamin D with respect to the severity of chronic liver disease based on Child Pugh Score.

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) poses a significant clinical challenge due to its complex pathophysiology and increasing prevalence, particularly among older adults. Despite normal or near-normal left ventricular ejection fraction, patients exhibit heart failure symptoms such as dyspnea and fatigue. HFpEF is commonly associated with comorbidities like hypertension, diabetes, and obesity, which complicate management and contribute to poor prognosis. Methods: A descriptive observational study was conducted over two years at a tertiary care hospital in Chhattisgarh. The study included 100 adult patients diagnosed with HFpEF, defined by symptoms of heart failure, left ventricular ejection fraction (LVEF) ≥ 50%, and without evidence of structural or cardiovascular heart disease. Clinical evaluation, laboratory tests, and imaging studies, including echocardiography, were performed to assess cardiac function. Statistical analysis was conducted using descriptive statistics, t-tests, and chi-square tests. Results: The study participants had a mean age of 56.72 years, with a balanced gender distribution. Fatigue (87%) and dyspnoea (82%) were the most common symptoms. Hypertension (88%) and diabetes (67%) were prevalent comorbidities. The mean ejection fraction was 54.53%, with mild diastolic dysfunction observed in 78% of patients. Conclusion: HFpEF primarily affects older adults with significant comorbidities, notably hypertension and diabetes. Although ejection fraction remains normal, mild diastolic dysfunction is common. These findings emphasize the need for comprehensive management strategies focusing on symptom relief and comorbidity control to improve patient outcomes.

Introduction Heart failure (HF) is as a clinical condition explained by current or previous complaints like breathlessness, ankle swelling, and tiredness, along with signs like elevated JVP, pulmonary crepitation’s, and peripheral oedema, all of which are caused by an anatomical and/ or physiological cardiac abnormality and confirmed by at least 1 of the following: raised BNP levels or verifiable evidence of respiratory, cardiac or systemic congestion Materials And Methods This is a observational study was conducted in the Department of General Medicine, Mahavir Institute of Medical Sciences. Two hundred twenty patients who were admitted to the ICU and who underwent the measurement of serum UA were enrolled in this study. AHF was defined as either new-onset HF or the decompensation of chronic HF with symptoms sufficient to warrant hospitalization. HF was diagnosed according to the Framingham criteria for a clinical diagnosis of HF, based on the fulfilment of two major criteria or one major and two minor criteria. Results  Age was not significantly associated with uric acid levels (P=0.153). However, a trend was observed where patients aged 71-80 years had the highest proportion of high uric acid (75%), while those aged 41-50 years had a lower proportion (28.57%). Men and women had similar uric acid levels (P=0.550). Patients with COPD, dilated cardiomyopathy, and coronary artery disease had slightly higher uric acid levels, but the association was not statistically significant. Among co-morbidities, diabetes, hypertension, smoking, and alcohol consumption were not significantly different between high and low uric acid groups. However, patients with high uric acid had significantly higher rates of ICU admission (93.55%) and mortality (94.40%), suggesting a strong association between elevated uric acid and worse clinical outcomes. Conclusion This study confirms that elevated serum uric acid is an independent predictor of worse clinical outcomes in CHF. Patients with higher UA levels have more severe disease, increased ICU admission, and significantly worse survival rates. Given these findings, uric acid measurement should be integrated into routine CHF risk stratification. Future research should explore whether lowering UA can directly improve patient outcomes and reduce cardiovascular mortality.

Background: Hypertension is a major cardiovascular risk factor, and beta-blockers are commonly used for its management. This observational study compares the efficacy and tolerability of Bisoprolol and Metoprolol in patients with Stage-1 Hypertension in an Indian population. Methods: A total of 100 patients with Stage-1 Hypertension were enrolled and evenly distributed into two groups: Bisoprolol (n=50) and Metoprolol (n=50). Baseline blood pressure (BP) and heart rate (HR) were recorded. Patients were followed for 12 weeks, and outcomes included reduction in systolic BP (SBP), diastolic BP (DBP), HR, target BP achievement (<130/80 mmHg), adverse events, and patient satisfaction scores. Statistical significance was evaluated using independent t-tests and chi-square tests, with p<0.05 considered significant. Results: The Bisoprolol group demonstrated significantly greater reductions in SBP (-19.3 ± 3.7 mmHg vs. -16.8 ± 4.1 mmHg, p=0.01) and DBP (-10.8 ± 2.6 mmHg vs. -8.9 ± 2.9 mmHg, p=0.02) compared to the Metoprolol group. HR reduction was not significantly different (-12.5 ± 3.4 bpm vs. -11.2 ± 3.7 bpm, p=0.13). Adverse events were comparable (18% vs. 22%, p=0.61), with fatigue and dizziness being most common. A higher proportion of patients in the Bisoprolol group achieved target BP (76% vs. 64%, p=0.04), and patient satisfaction was significantly higher (8.4 ± 1.1 vs. 7.9 ± 1.3, p=0.03). Conclusions: Bisoprolol demonstrated superior efficacy and comparable tolerability to Metoprolol in managing Stage-1 Hypertension, making it a preferred option for patients in this cohort.

Introduction: Hypertension can adversely affect renal function, and renal sonographic parameters provide a means to evaluate renal status. Ultrasound serves as a cost-effective and safe method for kidney evaluation. This study aimed to use sonography to assess renal parameters in patients with essential hypertension, identifying markers indicative of increased renal damage risk. Materials and Methods: The study included 178 hypertensive patients (114 females and 64 males) attending the outpatient department. An equal number of non-hypertensive volunteers (95 females and 83 males) were included as controls. Renal length, width, anteroposterior diameters, parenchymal volume, cortical thickness, and echogenicity were measured in both groups. Serum creatinine levels were also recorded. Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS version 20.0). Results: The difference in renal cortical thickness between the hypertensive and control groups was statistically significant. No significant difference was observed in the renal parenchymal volume between the right and left kidneys in either group. A significantly higher proportion of hypertensive subjects had higher echogenicity grades compared to normotensive subjects on both the right and left kidneys. Serum creatinine levels were significantly elevated in the hypertensive group. Conclusion: Hypertensive individuals exhibited significantly higher cortical echogenicity compared to normotensive individuals, whereas renal parenchymal volume and cortical thickness were reduced in hypertensives. Hypertension appears to predominantly affect the renal cortex rather than the medulla

Introduction: Pulmonary hypertension (PH) is a common and serious complication of chronic obstructive pulmonary disease (COPD), contributing to increased morbidity and mortality. Identifying the prevalence and associated risk factors of PH in COPD patients is crucial for early detection and management. Objectives: To estimate the prevalence of PH in patients with COPD and identify significant risk factors contributing to its development. Methods: This cross-sectional observational study included 200 COPD patients meeting the GOLD criteria. Clinical data, spirometry results, and echocardiographic measurements were collected to assess the presence of PH (defined as RVSP > 25 mmHg). Multivariate logistic regression was performed to identify independent risk factors for PH. Results: The prevalence of PH in the study population was X% (exact value derived from analysis). Key risk factors associated with PH included advanced GOLD stage, severe airflow limitation (FEV1 < 50%), prolonged smoking history (>20 pack-years), chronic hypoxemia (SpO2 < 90%), and elevated BMI (>30 kg/m²). Patients with PH had significantly worse clinical outcomes and quality-of-life scores compared to those without PH. Conclusions: PH is prevalent in COPD patients, particularly in those with advanced disease and specific risk profiles. Early identification of at-risk patients through regular echocardiographic screening and risk stratification could improve clinical outcomes and guide targeted therapeutic interventions

Background: Diabetes mellitus (DM) is a prevalent metabolic disorder that affects approximately 2-5% of the population in India and around 20% of the population in other parts of the world. The global incidence of diabetes mellitus is on the rise, with projections indicating a staggering increase to 366 million by 2030. Among the myriad complications that individuals with diabetes may face, those involving the foot are particularly devastating. It is estimated that 15% of all individuals with diabetes will develop a foot ulcer at some point in their lives. Neuropathy and foot ulcers are among the most significant complications associated with diabetes mellitus. Research indicates that the severity of diabetic foot ulcers is the primary risk factor for amputation in diabetic patients. These findings underscore the critical importance of early detection and management of foot ulcers in individuals with diabetes. By addressing these complications promptly and effectively, healthcare providers can help mitigate the risk of amputation and improve the overall quality of life for patients with diabetes. Materials and Methods: This prospective observational study was conducted in the Surgery Department of Basaweshwar Teaching and General Hospital (BTGH), affiliated with Mahadevappa Rampure Medical College, Kalaburagi. A total of 100 cases were included over a nine-month data collection period from March 2024 to December 2024. The inclusion criteria comprised all patients with diabetes mellitus presenting with diabetic foot-related ulcers, while patients with ulcers and foot gangrene of non-diabetic etiology or those unwilling to participate were excluded. After obtaining informed consent, detailed patient histories were recorded, and complaints were documented chronologically. Routine investigations, including complete blood count, liver and renal function tests, chest X-ray, ECG, random and fasting blood sugar levels, postprandial blood sugar, lipid profile, and lower limb arterial Doppler ultrasonography, were performed. Relevant special investigations were also conducted. Patients underwent conservative management with meticulous dressing, and major surgical interventions were carried out as required, with outcomes meticulously recorded. Results: The average age of participants in the study was 57.62 years, ranging from 29 to 87 years old. The majority of participants fell within the 60-69 age group, accounting for 37.5% of the total. In terms of gender distribution, 74% of participants were male, while females made up the remaining 26%. A significant portion of patients, 70%, had a history of diabetic foot ulcers, while the remaining 30% did not. Peripheral vascular disease (PVD) was present in 42.5% of patients, highlighting its prevalence in cases of diabetic foot ulcers. The primary cause of diabetic foot ulcers was swelling leading to skin breakdown, accounting for 32% of cases. Unknown causes and other factors contributed to 16% and 29% of cases, respectively. Gangrene emerged as a highly significant predictor of amputation, with 84.61% of amputees exhibiting gangrene compared to only 8.10% of non-amputees (p=0.0001). This underscores the importance of early detection and intervention in cases of diabetic foot ulcers to prevent severe complications such as amputation. Conclusions: Gangrene and PVD are the most critical predictors of amputation in diabetic foot patients.Early diagnosis and targeted management of these conditions are essential to reduce amputation rates.Other factors, including gender, hypertension, neuropathy, and nephropathy, showed no significant impact on amputation risk in this study.

Background: Infertility is a multifactorial condition impacting women of reproductive age, often associated with psychological, socioeconomic, and comorbid health factors. Obesity has emerged as a key contributor to infertility, exacerbating its impact on quality of life.To investigate the association between obesity and infertility and assess the psychological and comorbid disturbances affecting the quality of life of infertile women. Methods: A qualitative content analysis study was conducted from October 2023 to March 2024 at the obstetrics and gynecology outpatient department of KIMS Amalapuram. Data were collected from 40 infertile women through in-depth interviews, using a semi-structured questionnaire. Demographic details, type of infertility, BMI, comorbidities, and psychological outcomes were recorded and analyzed. Results: Secondary infertility was more common (especially among women aged 31-35 years), while primary infertility was predominant among women with higher socioeconomic and educational backgrounds. Comorbidities such as PCOS (60%) and hypothyroidism (50%) were prevalent among women with primary infertility, while diabetes (35%) and hypertension (25%) were common in secondary infertility cases. Psychological disturbances, including depression (55%) and sexual dysfunction (50%), were highly prevalent among obese women with infertility. Central obesity affected 65% of women with secondary infertility and was linked to a higher prevalence of previous abortions. Conclusion: Obesity, particularly central obesity, significantly impacts infertility, comorbidities, and psychological well-being. Multidisciplinary interventions targeting weight loss, psychological support, and comorbidity management are critical to improving reproductive outcomes

The worldwide health issue of hypertension affects millions of people especially those within middle age. Hypertension of long duration affects various organs including the auditory pathway. ABR testing represents an effective technique to assess how hypertension affects brainstem auditory processing. This study investigated the relation between hypertension levels with Auditory Brainstem Response parameters for male adults with hypertension between 40 and 60 years of age. Materials and Methods A case-control cross-sectional study was conducted at Lady Hardinge Medical College, New Delhi including two groups of participants with thirty male patients diagnosed with hypertension (HT) who were aged between 40–60 years as well as thirty age and sex matched normotensive participants (NT). Blood pressure measurement and ABR testing was done using standard procedures. Systolic Blood Pressure (SBP), Diastolic Blood pressure (DBP), absolute wave latencies of waves I, III, and V, wave morphology as well as interpeak latencies between waves I-III, III-V, and I-V were evaluated. For comparing groups between one another and observing associations, unpaired Student’s t-test and Pearson’s correlation were used. Results Participants who maintained normal blood pressure (NT) averaged 48.83±6.44 years in age whereas those with high blood pressure (HT) measured 51.73±6.11 years. The measurement of wave I, III, V absolute latencies as well as IPL values I-III, III-V, I-V between hypertensive and normotensive groups revealed no significant statistical variance (p>0.05). The comparison between controlled and uncontrolled hypertensive patients yielded no statistically significant results (p>0.05). Systolic along with diastolic blood pressure failed to demonstrate a statistical relationship with ABR parameters through regression analysis. Mean wave amplitude measurements from wave I and V yielded similar results for both normotensive and hypertensive groups and also for patients with controlled and uncontrolled hypertensive conditions. Conclusion The research results revealed that hypertension level failed to produce any significant change to auditory brainstem response parameters in male subjects within the age bracket of 40–60 years. The research shows hypertension within the studied range does not produce noticeable changes in auditory brainstem response measures. More extensive longitudinal studies incorporating larger subject populations as well as patients with diverse range of hypertension should be conducted for systematic assessment of potential associations.

Background: Diabetes mellitus, characterized by chronic hyper glycemia due to defects in insulin secretion or action, is a global health concern with significant systemic and ocular implications. Among its lesser-known yet impactful complications is its association with elevated intraocular pressure (IOP), a key risk factor for glaucoma, a leading cause of irreversible blindness worldwide. Chronic hyper glycemia in diabetes has been linked to increased IOP, highlighting a close relationship between diabetes and glaucoma, which is characterized by optic nerve damage and visual field loss. In India, where diabetes prevalence is rapidly rising, with projections estimating 80 million cases by 2030, the need for early diagnosis and intervention to prevent vision loss is critical. This study aims to compare IOP in diabetic and non-diabetic individuals, exploring the impact of Type 2 Diabetes Mellitus on ocular health to inform better prevention and management strategies for diabetes-related vision complications. Materials and Methods: This hospital-based case-control study included 100 participants, 50 diabetics and 50 non-diabetics, aged 20-80 years. Participants were excluded if they had glaucoma, ocular infections, inflammation, surgery history, or medications affecting intraocular pressure (IOP). Type 2 Diabetes Mellitus was confirmed through blood tests according to the American Diabetes Association guidelines. Ocular examinations, including visual acuity, color vision, slit-lamp assessment, tonometry, and dilated fundus examination, were performed. IOP was measured with a non-contact tonometer. Results: We observed that diabetic patients had a higher mean intraocular pressure (IOP) compared to non-diabetic controls. The mean IOP was 17.57±1.67 mm Hg for diabetics and 14.17±1.40 mm Hg for non-diabetics, with a significant difference (p < 0.0001). Elevated IOP was associated with poor glycaemic control and higher HbA1c levels. The duration of diabetes also influenced IOP, with both early and long-term diabetes showing higher IOP levels. This suggests that diabetes contributes to elevated IOP, increasing the risk of ocular complications like glaucoma. Conclusion: The study concluded that intra-ocular pressure (IOP) was higher in diabetic patients compared to controls, with a significant positive correlation between IOP and HbA1c levels in patients with diabetic retinopathy. It recommends regular screening for both diabetic retinopathy and IOP to detect early signs of ocular hypertension or glaucomatous changes

Background: A major public health concern, non-alcoholic fatty liver disease (NAFLD) is more common in those with type 2 diabetic mellitus (T2DM). Finding out how common NAFLD is in people who have just been diagnosed with type 2 diabetes and what variables put them at risk was the goal of this cross-sectional investigation. Methods: A total of 150 patients newly diagnosed with T2DM, attending the Department of Medicine at katihar medical college and hospital, were enrolled. Diagnosis of NAFLD was confirmed through abdominal ultrasonography, and various demographic, clinical, and biochemical parameters were analyzed. Statistical analyses were performed using SPSS software. Results: The mean age of participants was 47.39 ± 13.25 years, with a slight female predominance (54%). The overall prevalence of NAFLD was observed in 56% of the study population, with 56% classified as grade I, 34.7% as grade II, and 9.3% as grade III. Key risk factors associated with NAFLD included hypertension (43.3%), hyperlipidemia (36.7%), and obesity (23.4%). Metabolic syndrome was present in 58% of the patients, with a notable association between its severity and the grading of NAFLD. Conclusion: The study highlights a significant prevalence of NAFLD among newly diagnosed T2DM patients, indicating the need for enhanced screening and management strategies. Identifying risk factors such as hypertension, hyperlipidemia, and obesity is crucial for developing effective intervention programs. Increased awareness and routine screening for NAFLD in diabetic patients may help mitigate the risk of liver-related morbidity and improve overall health outcomes.

Background: Retinal Vein Occlusion (RVO) is a prevalent cause of vision impairment in the elderly population. Emerging evidence suggests a potential link between vitamin D deficiency and the incidence of RVO. This study aims to compare serum vitamin D levels in RVO patients with those in age-matched control groups to elucidate this association and highlight the significance of vitamin D as a potential risk factor for RVO. Materials and Methods: This hospital-based case-control study was conducted at the Department of Ophthalmology, Government Medical College and Hospital, Bettiah, Bihar, India, with 50 RVO patients and 50 age-matched controls. Participants were recruited consecutively, and written informed consent was obtained. Comprehensive ophthalmologic evaluations, including fundus photography and OCT, confirmed RVO diagnoses. Medical histories and systemic evaluations, including blood pressure, blood glucose, lipid profiles, and serum vitamin D levels, were recorded. Vitamin D was measured using tandem mass spectrometry, and statistical analysis was performed using GraphPad software. Results: In this study, 50 RVO patients and 50 age-matched controls were analyzed. No significant differences in age and gender distribution were found between the groups. Superotemporal BRVO was the most common RVO type (48%), followed by CRVO (34%) and inferotemporal BRVO (18%). Notably, all RVO patients had suboptimal vitamin D levels compared to controls, with a significant association (p < 0.05). The mean vitamin D level in RVO patients was 21.08 ± 5.08 ng/mL, with no significant differences among subtypes. The study also found a higher prevalence of hypertension and dyslipidaemia among RVO cases compared to controls, indicating these as additional risk factors. Statistical analysis confirmed significant differences in the prevalence of both conditions between cases and controls. Furthermore, the findings suggest that vitamin D deficiency may play a crucial role in the pathogenesis of RVO, underscoring the importance of screening and managing vitamin D levels in at-risk populations. Conclusion: Our study confirmed that low vitamin D levels are prevalent in RVO cases compared to age-matched controls. This suggests vitamin D deficiency is a significant risk factor in RVO development. Routine investigation of vitamin D levels in RVO patients, alongside other risk factors, is recommended. Additionally, patients with vitamin D deficiency should undergo ophthalmological examinations and vitamin D supplementation should be given as prophylaxis in cases of deficiency.

Introduction: Failed thrombolysis in acute ST elevation myocardial infarction (STEMI) patients is not so uncommon and carries grave prognosis, especially in non-PCI capable settings. Various factors can affect the probability of having a successful or failed thrombolysis after fibrinolytic therapy in acute STEMI patients. We aim to study the clinical and coronary angiographic profile of acute STEMI patients with failed thrombolysis and compare it with those having successful thrombolysis. Material & methods: This was a cross sectional, observational, single centre study including 100 acute STEMI patients who received thrombolytic therapy and underwent coronary angiography. Those having contraindication for thrombolysis or undergoing primary percutaneous coronary intervention were excluded. The results were analysed statistically. Results: The mean age of 100 subjects was 57.92 ± 12.36 years (range 28 – 81 years) with male-female ratio 4:1. The mean window period was 5.89 hrs. 54% had anterior wall myocardial infarction (AWMI). Tenecteplase, streptokinase, alteplase and reteplase were used as the thrombolytic agents in 35%, 31%, 19% and 15% cases respectively. 81% had successful thrombolysis and 19% had failed. 86.9% patients presenting within 9 hrs had successful thrombolysis, compared to only 50% presenting after 9hrs. (p=0.003) 27.8% patients of AWMI had failed thrombolysis whereas only 8.7% with inferior territory infarction had failed thrombolysis (p=0.015). Single-, double- and triple vessel disease was seen in 30%, 35% and 24% respectively with left main involvement in 9%. No association was seen with single or multivessel involvement, thrombolytic agent used, age, gender, religion or risk factors such as smoking, hypertension and diabetes. LCx and RCA had higher proportions of successful thrombolysis (94.1% and 89.6% respectively) compared to LAD (72.2%, p=0.049). 90.1% cases of successful thrombolysis had angiographically significant lesion requiring revascularization. Conclusion: Late presentation, anterior territory involvement and LAD occlusions have higher chances of failed thrombolysis in acute STEMI patients. Coronary angiography and revascularization should promptly be considered in the post-thrombolysis management of acute STEMI patients particularly in failed thrombolysis.

Introduction: Acute respiratory distress (ARD) remains a critical challenge in emergency settings, presenting with varied causes and influencing patient outcomes differently. This study evaluates the clinical characteristics, treatment approaches, and outcomes of patients with ARD in an emergency department (ED). Methods: We analyzed data from 240 adult patients (aged ≥18 years) who presented with symptoms of ARD—defined as acute shortness of breath, low blood oxygen levels, or respiratory failure—to a tertiary ED over one year. Information on patient demographics, existing health conditions, clinical signs, diagnostic tests, treatments, and outcomes (hospitalization, ICU admission, death) was collected from electronic health records. Statistical analysis involved descriptive statistics, chi-square tests, and logistic regression. Results: Patients (average age 62.4 ± 15.2 years; 55% male) frequently had comorbidities such as hypertension (48%), chronic obstructive pulmonary disease (32%), and heart failure (25%). The leading causes of ARD were pneumonia (28%), acute exacerbations of asthma/COPD (24%), and pulmonary edema (19%). A significant portion (64%) exhibited hypoxemia (SpO₂ <90%), and 38% needed non-invasive or mechanical ventilation. The hospitalization rate was 82%, with 26% requiring ICU care. The in-hospital mortality rate was 12%, with higher risks associated with older age (OR 1.05, 95% CI 1.01–1.09), septic shock (OR 3.2, 95% CI 1.4–7.1), and multiorgan failure (OR 4.8, 95% CI 2.1–11.0). Delays in ED intervention over two hours were linked to increased ICU admissions (p=0.03). Conclusion: ARD results from diverse etiologies and is significantly affected by patient age, comorbidities, and the timeliness of medical interventions. Prioritizing early identification and standardized treatment protocols may enhance patient survival and decrease the demand for intensive care services.

Background: Cardiovascular diseases (CVD) are the leading cause of global mortality, with coronary artery disease (CAD) being the most significant contributor. This is particularly concerning in low- and middle-income countries like India, where the prevalence of CAD is on the rise. Traditional risk factors such as hypertension, diabetes, and smoking are well-documented, but emerging non-traditional factors like testosterone levels have drawn attention in recent research. Testosterone is thought to impact cardiovascular health, and its deficiency has been linked to increased CAD risk. However, the association between testosterone and CAD severity remains inconclusive, especially in India, where limited data exists. This study aimed to explore the correlation between serum testosterone levels and the angiographic severity of CAD in middle-aged Indian men. The study involved 88 male participants aged 40-60, undergoing coronary angiography. The clinical profiles of participants, including traditional CAD risk factors, were recorded, and testosterone levels were measured. CAD severity was assessed using GENSINI and SYNTAX scoring. Despite high levels of traditional risk factors, the study found no significant correlation between testosterone levels and CAD severity, as indicated by both Pearson and Spearman correlation coefficients. Moreover, multiple linear regression analysis revealed that traditional risk factors and testosterone levels did not independently predict CAD severity. In conclusion, while traditional risk factors remain crucial in CAD management, this study highlights that testosterone levels do not independently correlate with CAD severity. These findings suggest that the role of testosterone in CAD pathophysiology is complex and warrants further investigation, particularly in the Indian population, to better understand its contribution

Introduction: Portopulmonary hypertension (PoPH) is a severe complication of chronic liver disease (CLD) caused by pulmonary vascular remodeling due to portal hypertension. Early detection is essential, particularly in liver transplant candidates. This study assesses the prevalence, clinical characteristics, and risk factors for PoPH in CLD patients. Material and Methods: A prospective observational study at Dr. N Y Tasgaonkar Institute of Medical Science (January 2023–January 2025) enrolled 100 CLD patients. Clinical, biochemical, imaging, and hemodynamic assessments were performed, including transthoracic echocardiography (TTE), right heart catheterization (RHC), pulmonary function tests (PFT), and six-minute walk test (6MWT). PoPH was diagnosed per ESC/ERS guidelines. Statistical analysis included chi-square tests, t-tests/Mann-Whitney U tests, and multivariate logistic regression. Results: PoPH prevalence was 29% (54% mild, 8% moderate, no severe cases). Mean age was 53.42 ± 9.13 years, with 75% male. Alcoholic liver disease (46%) and NAFLD (28%) were the most common etiologies. Higher BMI (p = 0.002), male sex (p = 0.041), smoking (p = 0.032), and comorbidities (p = 0.023) were significantly associated with PoPH. Pulmonary function impairment (FEV1 < 70%, p = 0.028) and reduced exercise tolerance (6MWT < 350m, p = 0.008) were significant. Liver disease severity (Child-Pugh, p = 0.015; MELD, p = 0.041) was strongly linked to PoPH. Conclusion: PoPH is prevalent in 29% of CLD patients, with BMI, male sex, smoking, comorbidities, and liver disease severity as major risk factors. Pulmonary function impairment and reduced exercise capacity underscore the need for early screening and cardiopulmonary assessment. Routine echocardiography and pulmonary function testing should be prioritized for early detection and management.

Background: In 1976, Fernstrom and Johansson first described percutaneous nephrolithotomy (PCNL) which is the universally accepted modality in the treatment of large and complex renal stones. Over a period of time, various changes have occurred in the techniques of PCNL.PCNL was associated with morbidities such as bleeding, pyrexia, incomplete stone removal, pleural injury, and adjacent organ injury. After completion of stone removal, usually, a nephrostomy tube is placed which helps in tamponade of bleeding, drainage of urine, tract recovery, and a guide for second look nephroscopy if needed. In various studies, the usage of small caliber nephrostomy tubes were found to be equivalent to large nephrostomy tubes. Apart from the above-mentioned benefits of placing a nephrostomy tube, it often increases early postoperative morbidity like pain and prolonged hospital stay. Materials and methods: This was a prospective comparative study, conducted in the Department of Urology, Super Speciality Hospital, Government Medical College, Kadapa and Department of Urology, Government General Hospital, Kurnool Medical College, Kurnool, Andhra Pradesh a period of 12 months from June 2023 to May 2024. A total number of 216 cases of tubeless PCNL was studied data collected and results analysed. Sample size estimated based on prevalence of the operable renal calculi (using formula S =4pq/l2)Results of study group were compared with other group of traditional PCNL with 232 patients. Patients with renal and/or upper uretric calculi of greater than 1.5cm, negative urine culture and no coagulopathy were included in the study.Results: We evaluated the data of 448 cases undergoing PCNL in our hospital. We divided total cases in to 2 groups. There are 216 cases in group A who underwent tubeless PCNL and 232 patents in group B of traditional PCNL. Both groups has similar demographics according to age sex and comorbidities. Among these 216 cases (group A) 140 were male and 76 female patients. Male to female ratio is 1.66:1. The average age was 44.6 years with arrange of 20 to 65 years. Where as in group B male to female ratio is 2.3:1 and average age is 48.8 years. Out of 216 cases 12.9% (28) have hypertension, 9.25% (20) have diabetes mellitus, 8 patient have COPDs, 4patients had hypothyroidism and 4 patient was known CKD. Conclusion: Our findings demonstrated that tubeless PCNLs can be safely and effectively performed by an experienced endourologic team without limiting the number of eligible candidates by preoperative patient selection. Tubeless PCNL has an obvious advantage of significantly reduced postoperative pain, less analgesic requirement and shorter stays. Complications rate are less with tubeless PCNL and blood transfusion is less when compared with traditional PCNL. We believe that this study will contribute to the further popularization of the tubeless technique for the benefit of the patient, the medical team, and the health care system.

Background: Acute Kidney Injury (AKI) in ICU patients significantly impacts morbidity and mortality. This study aimed to analyze the risk factors, treatment modalities, and outcomes of AKI in an ICU setting.  Methods:  A prospective cohort study was conducted involving 100 ICU patients with AKI, classified per KDIGO criteria. Data on demographics, contributing factors, AKI causes, treatments, and outcomes were collected and analyzed. Results: The mean age of participants was 48±15.7 years, with a male predominance (74%). Hypovolemia was the leading cause of AKI at 45%, followed by drug-induced (17%). Pre-renal AKI was most common (82%), with 35% of patients requiring Renal Replacement Therapy (RRT). Comorbidities like diabetes mellitus (18%) and hypertension (12%) significantly influenced RRT need (p<0.05). Serum creatinine and urea levels decreased significantly from admission to discharge (creatinine from 4.82 to 3.86 mg/dL, urea from 144.84 to 72.15 mg/dL). The improvement rate was 92%, with an 8% mortality rate. Conclusion: The study highlights the importance of considering demographics and specific risk factors in managing AKI in ICU settings. While immediate outcomes were positive, the potential for long-term renal impairment necessitates ongoing vigilance and research.

Background: Colorectal cancer (CRC) is a major global health concern, with increasing incidence linked to lifestyle factors. This study aimed to evaluate the association between dietary habits, physical activity, smoking, alcohol consumption, family history, and comorbidities with CRC risk. Methods : A case-control study was conducted with 100 participants (50 CRC cases and 50 controls). Data on demographics, diet, physical activity, smoking, alcohol use, family history, and comorbidities were collected. Statistical analysis was performed to determine significant associations using chi-square tests and p-values (<0.05 considered significant). Results: Cases had a significantly higher BMI (27.1 ± 3.4 vs. 24.5 ± 2.8 kg/m², p < 0.05). High red meat intake (>3 times/week) was more frequent in cases (68%) than controls (34%) (p = 0.01), whereas low fiber intake was observed in 72% of cases vs. 40% of controls (p = 0.003). Sedentary lifestyle was more common in cases (66%) than controls (38%) (p = 0.02). Smoking (44% vs. 22%, p = 0.04) and alcohol consumption (52% vs. 30%, p = 0.03) were significantly associated with CRC risk. A positive family history was observed in 28% of cases vs. 10% of controls (p = 0.02). Colonoscopy screening was significantly lower among cases (18% vs. 42%, p = 0.01). Diabetes (34% vs. 18%, p = 0.04) and hypertension (40% vs. 26%, p = 0.05) were more prevalent in cases. Conclusion: Unhealthy dietary habits, sedentary lifestyle, smoking, alcohol consumption, and lack of screening significantly increase CRC risk. Public health strategies should focus on risk reduction through lifestyle modifications and early screening programs.

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized for its ability to capture circadian variations in blood pressure, which are pivotal for managing patients with acute heart failure (AHF). This observational study investigates the utility of ABPM in a clinical setting to correlate blood pressure patterns with clinical outcomes in patients admitted with AHF. Methodology: This prospective observational cohort study was conducted at a tertiary care center, encompassing a sample of 100 patients diagnosed with AHF. ABPM was employed 24 hours prior to discharge post initial stabilization to monitor blood pressure fluctuations over a 24-hour period. Data were analyzed to correlate these fluctuations with clinical parameters including heart failure severity and cardiac structural changes, as evidenced by echocardiographic data. Results: The study findings highlighted that NYHA Class III or IV at admission was significantly higher in HFmrEF risers (96.2%) compared to non-risers (88.9%) (p = 0.02).  ABPM measurements showed that HFpEF patients had the highest average 24-hour SBP (124.9 ± 17.8 mmHg), followed by HFmrEF (112.4 ± 15.2 mmHg) and HFrEF (102.8 ± 13.9 mmHg). HFpEF patients had the highest prevalence of nocturnal hypertension (52.7%), followed by HFmrEF (34.1%) and HFrEF (27.4%). The differences were significant (p=0.01). The differences in LVEF between the AHF groups were statistically significant, with HFpEF showing the best heart function and HFrEF showing the worst. Conclusion: ABPM provides valuable insights into the prognostic implications of blood pressure variability in patients with AHF. The data suggests that ABPM should be considered as part of the routine assessment in AHF patients to better tailor therapeutic interventions and potentially improve clinical outcomes.

Background: Direct laryngoscopy and tracheal intubation can result in severe effects such as tachycardia, hypertension, cardiac ischaemia, and cerebral haemorrhage.Clonidine is an α-2 adrenergic receptor agonist that exerts a central sympatholytic action. Clonidine premedication mitigates the haemodynamic stress reactions associated with direct laryngoscopy and tracheal intubation. Pregabalin, a gabapentinoid, seems to exert an inhibitory effect on neuronal excitability.

Aim: The purpose of this study was to compare the effect of oral pregabalin 150 mg & oral clonidine 0.2 mg given 90 minutes before surgery, on haemodynamic stress response resulting from laryngoscopy and endotracheal intubation. Materials and Method:The present study was a prospectiveobservational randomizedcomparativestudy performed conducted for a period of one year in a tertiary care centre. The study comprised 60 patients classified as ASA I and II, scheduled for diverse elective operations under general anaesthesia. The participants were randomised into two groups, A and B, each consisting of 30 patients: the Pregabalin group (Group A) and the Clonidine group (Group B). Group A received premedication with 150 mg of capsaicin pregabalin, whereas Group B was administered 0.2 mg of clonidine. Subsequently, the haemodynamic parameters including heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) and mean arterial pressure(MAP) were compared between the two groups during induction, laryngoscopy, and intubation.Result wasanalysed using SPSS 20.0 version and the association was tested using t test. A p value less than 0.05 was considered statistically significant.  Results:  Administration of oral clonidine 0.2 mg 90 minutes before to surgery mitigated sympathetic stimulation and catecholamine responses during laryngoscopy and tracheal intubation. Our investigation revealed that the increase in HR, SBP, DBP, and MAP after laryngoscopy and endotracheal intubation was considerably lower in the Clonidine group compared to the Pregabalin group. The Clonidine group exhibited superior haemodynamic stability throughout surgery compared to the pregabalin group. Conclusion: When compared to oral pregabalin, oral clonidine substantially reduces the sympathetic responses that occur during laryngoscopy and endotracheal intubation, while simultaneously preserving the stability of the cardiovascular system during surgery.

Background: Chronic obstructive pulmonary disease (COPD) significantly impacts cardiac function, particularly affecting the right ventricle, left ventricle, and pulmonary vasculature. Cardiovascular complications contribute substantially to COPD-related mortality. Echocardiography provides a non-invasive and effective method for evaluating cardiac changes in COPD patients. To analyze the cardiac alterations associated with COPD using echocardiography and to determine the correlation between echocardiographic findings and COPD severity based on GOLD classification. Materials and Methods: This prospective observational study was conducted over 16 months at the Department of Respiratory Medicine, MIMS, Vizianagaram. A total of 50 COPD patients aged above 40 years were enrolled. Exclusion criteria included active tuberculosis, HIV, terminal cancer, hepatic or renal diseases, and pregnancy. Patients underwent clinical evaluation, electrocardiography (ECG), spirometry, arterial blood gas (ABG) analysis, and echocardiography. Data were analyzed for associations between echocardiographic findings and COPD severity. Results: Echocardiographic findings revealed that 24% of patients had pulmonary hypertension, 24% had increased right ventricular (RV) thickness (>0.5 mm), and 20% had left ventricular diastolic dysfunction (LVDD). The mean ejection fraction did not significantly differ between patients with and without pulmonary hypertension (61.6% vs. 60.5%). Echocardiographic abnormalities were more frequent in severe and very severe COPD cases. Conclusion: COPD is associated with significant cardiovascular changes, including pulmonary hypertension, RV hypertrophy, and LV dysfunction. Routine echocardiographic screening every six months is recommended to detect early cardiac complications and improve clinical outcomes.

Background: Acute Myocardial Infarction (AMI) is a leading cause of morbidity and mortality globally, with arrhythmias representing a frequent and significant complication. These arrhythmias, which can range from benign to life-threatening, are closely associated with the severity of myocardial injury and contribute to poor short- and long-term outcomes. This prospective observational study aimed to investigate the incidence, types, and outcomes of arrhythmias in patients with AMI admitted to the intensive coronary care unit at SVRRGGH, Tirupati. A cohort of 100 patients was assessed based on clinical features, ECG evidence, blood biomarkers, and imaging. The study found that the majority of patients were aged 41-70 years, with a significant male predominance (83%). Lifestyle factors such as smoking and alcohol use were common, and hypertension and diabetes were prevalent comorbidities. The most common type of myocardial infarction was Inferior Wall Myocardial Infarction (INFWMI). Arrhythmias, particularly ventricular premature contractions (VPCs), were observed in a significant number of patients, with spontaneous resolution noted in some cases. The study highlighted the relationship between the location of the myocardial infarction and the occurrence of specific arrhythmias, with no significant correlation found between MI type and mortality. Additionally, factors such as age, gender, and comorbidities influenced arrhythmic patterns and outcomes. These findings suggest that arrhythmias in AMI patients can often resolve spontaneously but require careful monitoring and timely intervention. The study underscores the importance of personalized treatment strategies and further research to refine management techniques and improve patient outcomes, particularly for those with high-risk factors such as comorbidities and lifestyle behaviors.

Background: Perinatal asphyxia is the second leading cause of neonatal mortality after infection, accounting for around thirty percent of all deaths globally. The current study was designed to comprehensively investigate the cardiac dysfunction associated with perinatal hypoxia and its relationship to hypoxic ischemic encephalopathy. MATERIAL & METHOD: This prospective observational study was carried from January 2019 to December 2020 in the NICU of the Department of Paediatrics, civil hospital Ahmedabad, Gujarat, after approval by Institutional ethical committee (IEC). All newborns (intramural and extramural) admitted in NICU with history of perinatal asphyxia within first 72 hours of life were included. Myocardial dysfunction was evaluated using clinical examination, electrocardiogram, echocardiography (2D &M mode) and cardiac enzymes (CPK MB, CPK total &troponin I). RESULT  : Present study enrolled 135 neonates, among them 28.1% were female and 71.8% were male, out of which 14.8% neonates developed mild HIE, 37.7% neonates developed moderate HIE and 47.4% had severe HIE. Significant positive correlation was seen between the levels of the cardiac markers and the degree of adverse outcome in terms of HIE staging. 2D echo showed that patients with valvular regurgitation and pulmonary hypertension had more adverse outcome and chances of these findings being there increased with the severity of HIE grading. On assessing the outcome of the patients with HIE a positive correlation between the adverse outcome and raised cardiac marker levels were seen.82.6% of the patients who developed valve regurgitation and 90.9% who developed pulmonary hypertension expired. CONCLUSION:  Myocardial dysfunction was found in 53.3% of patients, Significant Positive Correlation was seen between the levels of the cardiac markers and the degree of adverse outcome in terms of HIE staging. Functional 2D ECHO done at bedside can be a reliable tool to diagnose and monitor the clinical progress of patients.

Background: Tuberculosis (TB) remains a significant global health problem with potential cardiovascular involvement in approximately 2% of cases. This study aimed to evaluate the cardiovascular manifestations in pulmonary TB patients without pre-existing cardiac disease and assess changes following anti-tubercular therapy. Methods: This prospective descriptive study included 72 newly diagnosed sputum-positive pulmonary TB patients aged ≥18 years. Participants underwent comprehensive clinical examination, laboratory testing, electrocardiography, and echocardiography at baseline, during the post-intensive phase, and after completion of anti-tubercular therapy. Patients with pre-existing cardiovascular conditions, other pulmonary diseases, or extra-pulmonary TB were excluded. Results: The study population had a mean age of 43.64±15.00 years with male predominance (61.1%). Electrocardiographic abnormalities were observed in 59% of patients, with sinus tachycardia (50%), ST segment elevations (5.6%), and T wave inversions (9.7%) as common findings. Echocardiographic abnormalities were present in 23.6% of patients, including pulmonary hypertension (13.9%), right ventricular hypertrophy/dilation (11.1%), left ventricular systolic dysfunction (9.8%), and pericardial effusion (5.6%). Following anti-tubercular therapy, significant improvements were observed in tachycardia (reduced to 13.9%, p=0.000), ST segment elevations (complete resolution, p=0.045), and left ventricular systolic dysfunction (reduced to 5.6%, p=0.028), with complete resolution of pericardial effusion.Conclusion: Pulmonary tuberculosis can induce various cardiovascular abnormalities detectable through electrocardiography and echocardiography, even in patients without pre-existing cardiac disease. Most of these abnormalities improve significantly with anti-tubercular therapy, highlighting the importance of cardiac evaluation in TB patients and the role of effective treatment in reversing TB-associated cardiac manifestations.

Background: Thyrotoxicosis is a clinical syndrome caused by excessive circulating thyroid hormones, leading to a hypermetabolic state. This study aims to evaluate the clinical profile of thyrotoxicosis patients and review its various etiologies. Methods: A prospective study was conducted on 50 patients of either sex, age more than 12 years, who fulfill the criteria for diagnosis of hyperthyroidism. A detailed clinical examination, routine investigations, thyroid profile, ultrasound of the neck, and thyroid scans were performed as needed. Results: Thyrotoxicosis was more prevalent in the younger population (<40 years), with a mean age of 41.12 years. A female predominance was observed. The most frequently reported symptoms included palpitationss, hand tremors, weight loss, nervousness, and dyspnea. Cardiovascular manifestations were common, with palpitations, dyspnea, arrhythmia, and heart failure being the most frequently observed. Tachycardia and atrial fibrillation were the most prevalent cardiovascular signs. Electrocardiographic changes correlated with thyroid hormone levels, indicating that increased Free T3 and Free T4 levels and decreased TSH levels were directly associated with heart rate and rhythm changes. Additionally, 32% of patients had elevated pulmonary hypertension, which showed potential reversibility with anti-thyroid treatment. Conclusion: Early diagnosis and identification of the etiology of thyrotoxicosis may help in reversing the condition and preventing complications. Appropriate treatment strategies should be implemented to manage cardiovascular manifestations and other systemic complications associated with thyrotoxicosis.

Background: The dietary pattern in any population is an indicator for the general well-being and the extent of their risks to have lifestyle disorders. These include diabetes mellitus, dyslipidaemia, hypertension, and coronary heart disease, which are the main cause of death worldwide. Medical students; representing part of the young age population of the community, and as future doctors, for different reasons are prone to eating unhealthy foods and to have bad health habits during their college years which might affect their wellbeing and increase the risk of lifestyle disorders. Materials and Methods: The objective of this study is to access the dietary pattern of first year medical students of SMS Medical College Jaipur, Rajasthan and how it affects their nutritional status. This is a cross-sectional study which involved 100 medical students of SMS Medical College campus. A 100 objective self-administered questionnaire and 24 recall method was used for data collection. Results : In this study, the entire respondents, 100 %, were aware of what a balanced diet is, majority of them have a good dietary habit, as 38 % eat twice daily, 45 % 3 times daily, while 5% eat more than three times daily. Their diet was mainly fast foods, fries, snacks, and soft drinks. This, thus, affected their nutritional status, with 17 % having poor dietary habit, 31% with moderate dietary habit and 52 % with good dietary habit. 22 % of the respondents being overweight, 64% were of normal weight and 14% are underweight. Conclusion: This study showed that while the respondents were aware of what a balanced diet is, they rarely consumed a balanced meal. Thus, it is imperative to not only educate them, but also, formulate a strategy to ensure the implantation and practice of eating a balanced meal, so as to not only forestall lifestyle disorders, but also to be able to educate their patients in the future, creating a healthy community and nation at large. The usual lifestyle of food tickets and meal in the university should be resuscitated especially within the study population.

Background: Chronic kidney disease (CKD) is a growing health issue that poses both medical and financial challenges. For patients with CKD, kidney transplantation represents the best treatment option. Unfortunately, this option is often unattainable for many CKD patients, especially in developing countries like India. OBJECTIVES: To estimate the prevalence of lipid abnormalities in chronic kidney disease patients. To evaluate the Quantitative assessment of lipid abnormalities in chronic kidney disease patients. MATERIAL & METHODS: Study Design:  Hospital-based, cross-sectional study.  Study area: The study was conducted in the Department of General Medicine at Narayana Medical College, Nellore.  Study period: 1 year.  Sample size: The study consisted of a total of 30 subjects and 30 controls.  Sampling Technique:  Simple Random technique. Results: As compared to <150 and 150-199 among males, t= 9.241, P<0.001 is statistically highly significant. As compared to borderline high and high among males, t=5.047 P<0.001 is statistically highly significant. As compared to <150 and 150 – 199 among females, t=4.268, P<0.05 is statistically significant.    CONCLUSION: In conclusion, this study of 50 CKD patients revealed that Type 2 diabetes (38%) and hypertension (32%) were the leading causes, with most patients aged 41-50 years. A significant proportion of diabetic (52.6%) and hypertensive (75%) patients with 5-15 years of disease duration developed CKD

Background: Teenage pregnancy poses significant health risks for both mothers and neonates, and it is associated with higher rates of maternal and neonatal morbidity and mortality. This study compares the maternal and perinatal outcomes between teenage primigravidae (15–19 years) and adult primigravidae (20–29 years) in a hospital setting.To assess and compare maternal and perinatal outcomes between teenage and adult primigravidae. Methods: A prospective hospital-based study was conducted at the Department of Obstetrics and Gynecology, KIMS, Amalapuram, from December 2019 to September 2021. The study included 80 teenage and 160 adult primigravidae. Data were collected on sociodemographic characteristics, antenatal care, complications, delivery outcomes, and neonatal health. Statistical analysis was performed using descriptive methods and p-values were considered significant at <0.05. Results: Teenage primigravidae had significantly higher rates of antenatal complications (71.3% vs. 16.3%) compared to adults. Common complications included anemia (71.3%), pre-term labor (26.2%), and pregnancy-induced hypertension (17.5%). Hemoglobin levels were significantly lower in teenage mothers (9.56 g%) than in adults (11.12 g%). The cesarean section rate was higher among teenage mothers (45%) compared to adults (20.6%), with fetal distress as the main indication. Teenage mothers also had higher rates of pre-term births (27.5% vs. 6.3%) and low birth weight babies (42% vs. 15.4%). Neonatal morbidity, including birth asphyxia, NICU admissions, and hyperbilirubinemia, was also more common in the teenage group. Conclusion: Teenage pregnancies are associated with higher maternal and neonatal risks, including more complications during pregnancy, labor, and delivery. Enhanced antenatal care and educational interventions are essential for improving outcomes for adolescent mothers.

Background: Cerebrovascular accidents (CVAs), also called as strokes, considered as second leading cause of death and disability globally. The pathological mechanism of stroke may be either ischemic and hemorrhagic disturbances of the cerebral blood circulation. Hypercholesterolemia is also a known risk factor for stroke. Aim: This study aimed to assess the lipid profile of stroke patients and to compare the lipid profile of hemorrhagic stroke and ischemic stroke in patients admitted to Akash hospital, Devanahalli, Bengaluru rural, Karnataka, India. Materials and methods: This cross-sectional observational study conducted in Department of General Medicine, Akash Institute of Medical Sciences and Research Centre (AIMSRC), Karnataka, India. In this, a total of 112 patients with new onset ischemic and hemorrhagic stroke, confirmed by CT/MRI and presented within 24 hours of onset of stroke admitted in Akash hospital. Blood samples were collected, centrifuged to obtain serum sample. The obtained serum was used for biochemical analysis of total cholesterol (cholesterol oxidase/peroxidase), triglycerides (glycerol phosphate oxidase/peroxidase), HDL-C (HDL-C- Direct) were estimated by using Cobas C111 Biochemistry fully auto analyzer. LDL-C and VLDL-C were calculated by Frieldwald’s formula. Detailed history, physical and clinical examination was done for all the study subjects. Results: In this study, males were 63 (56.2%) and females were 49 (43.8%). 68 (60.7%) cases were above 60 years of age, 28 (25%) were 51-60 years of age, Among the comorbidities, hypertension 42 (37.5%) emerges as the most prevalent. In this study, 88 (78.6%) cases were with infarcts and 24 (21.4%) cases were hemorrhagic. Majority of subjects were non-smokers 58 (51.8%) and smokers were 54 (48.2%). In this study, lipid profile parameters were compared between hemorrhage and infarcts. Serum cholesterol (196.88±21.40) levels were significantly increased in haemorrhagic stroke compared with infarcts. Lipid profile parameters were compared between smokers and non-smokers, significant differences were observed in LDL (smokers 94.4±20.3 mg/dL vs non-smoker 104.96±22.9 mg/dL). Similarly, lipid profile parameters were compared between diabetic and non-diabetic subjects, significant increase was observed in total cholesterol (diabetic 192.8±31.4 mg/dL vs non-diabetic 178.8±30.0 mg/dL), Triglycerides (diabetics 132.6±18.6 mg/dL vs non-diabetic 121.9±36.0 mg/dL). Conclusion: In a comparison of lipid profiles between patients with hemorrhagic stroke and ischemic stroke, statistically significant differences were observed as raised total cholesterol levels. In comparison of lipid profiles between smokers and non-smoker significant differences were observed in increased LDL among non-smokers. Decreased HDL was seen in all the stroke patients. In the comparison of lipid profiles between Diabetic and non-diabetic stroke patients, increased total cholesterol and triglyceride levels among the diabetic group.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder with a rapidly increasing global prevalence, contributing significantly to morbidity and mortality. Poor glycemic control is a key factor leading to severe complications, particularly cardiovascular diseases (CVD). This study assesses demographic distribution, glycemic control, diabetes duration, management strategies, and cardiovascular risk factors among diabetic patients. Aim: To evaluate glycemic control, management strategies, and the prevalence of cardiovascular risk factors among diabetic patients attending a tertiary care hospital. Methods: A cross-sectional study was conducted among 100 diabetic patients. Data on demographic characteristics, mean HbA1c levels, duration of diabetes, management approaches, and cardiovascular risk factors were collected and analyzed using SPSS software. Results: Of the study population, 63% were male and 57% were aged 41–60 years. The mean HbA1c was 8.2, indicating poor glycemic control. Most patients (61%) had diabetes for over five years, and 56% required both oral hypoglycemic agents (OHA) and insulin. The most prevalent cardiovascular risk factors were dyslipidemia (63%), hypertension (41%), and a high-risk CVD category (37%). Tobacco use and alcohol consumption were observed in 19% and 29% of the patients, respectively. Conclusion: The study highlights poor glycemic control and a high prevalence of cardiovascular risk factors among diabetic patients, emphasizing the urgent need for targeted interventions. Multidisciplinary diabetes management, including early lifestyle modifications, optimal pharmacological strategies, and regular monitoring, is crucial in reducing diabetes-related complications. Future research should explore individualized intervention strategies and their long-term impacts on glycemic control and cardiovascular risk reduction.

Background Hypertension is a leading risk factor for cardiovascular diseases, significantly contributing to morbidity and mortality worldwide. The prevalence of hypertension varies across urban and rural populations due to differences in lifestyle, socioeconomic status, and healthcare access. This study aims to determine the prevalence and correlates of hypertension among adults in urban and rural areas of Dehradun, India. Objective To assess the prevalence of hypertension and its associated risk factors among adults in urban and rural Dehradun, comparing sociodemographic and lifestyle determinants. Methods A cross-sectional study was conducted among 400 adults (200 urban, 200 rural) aged 30-65 years in Dehradun. Participants were selected through stratified random sampling from community health centers. Blood pressure measurements were taken using a standardized sphygmomanometer, and hypertension was defined as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, based on WHO criteria [1]. Data on sociodemographic factors, lifestyle habits, comorbidities, and dietary intake were collected via structured interviews. Chi-square tests and logistic regression analyses were performed to assess associations. Results Hypertension prevalence was higher in urban (42%) compared to rural (28%) populations. Key risk factors identified included obesity, physical inactivity, high salt intake, smoking, and alcohol consumption. Urban participants had higher obesity rates (35% vs. 18%), whereas rural participants had higher tobacco use (22% vs. 14%). Multivariate analysis showed significant associations between hypertension and BMI >25 (OR=2.3, p<0.01), sedentary lifestyle (OR=1.9, p<0.05), and excessive salt intake (OR=1.7, p<0.05) [2]. Conclusion The study highlights the higher burden of hypertension in urban areas of Dehradun, primarily due to lifestyle factors such as obesity and physical inactivity. Interventions targeting diet modification, physical activity promotion, and tobacco cessation are crucial for hypertension control. Strengthening primary healthcare access in both urban and rural settings can help mitigate the growing burden of hypertension [3].

Introduction: Chronic kidney disease is classified into five stages based on the estimated glomerular filtration rate (eGFR), with stage 1 being the mildest and stage 5 representing end-stage renal disease (ESRD). Microalbuminuria is typically detected in the early stages of CKD and is defined as a urinary albumin-to-creatinine ratio (ACR) between 30 and 300 mg/g. It is indicative of glomerular injury and endothelial dysfunction, reflecting increased permeability of the glomerular filtration barrier. The pathophysiology of microalbuminuria in CKD involves multiple factors, including glomerular hypertension, podocyte injury, and inflammation. Persistent microalbuminuria is associated with a decline in renal function and an increased risk of cardiovascular events, making it an important marker for risk stratification and therapeutic monitoring in CKD patients.  Material and Methods:  This  is an Observational or cross-sectional study was conducted among CKD patients from outpatient clinics or hospitals, Index Medical College. Patients diagnosed with CKD stages 1–5, based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Demographic and Clinical Data: Collect information on age, gender, duration of CKD, comorbidities, medications, and lifestyle factors. Quantify urinary albumin excretion using spot urine samples or 24-hour urine collections. Normalize results to urinary creatinine concentration. Spot urine samples or 24-hour urine collections will be used to quantify urinary albumin excretion. Urinary albumin concentration will be measured using an immunoturbidimetric assay. Results Mean Urinary Albumin (mg/g creatinine) is 145.6 mg/g creatinine, SD: 85.3 and 24-hour Urinary Albumin (mg/day) is 320.4 mg/day, SD: 150.2. Both Urinary Albumin Measures Increase with CKD Progression: Urinary albumin (mg/g creatinine) rises from 45.2 mg/g (Stage 1) to 380.5 mg/g (Stage 5). 24-hour urinary albumin excretion shows a similar increase from 85.3 mg/day (Stage 1) to 600.5 mg/day (Stage 5). The rate of albumin increase is mild in Stages 1 & 2 but becomes steep in Stages 3-5. Urinary Albumin (mg/g creatinine) has a correlation of r=0.65r = 0.65r=0.65 (p < 0.001). 24-hour Urinary Albumin (mg/day) has an even stronger correlation of r=0.70r = 0.70r=0.70 (p < 0.001).  Conclusion This study demonstrates a significant negative correlation between antioxidant status and microalbuminuria in CKD patients, consistent with previous research. The findings highlight the role of oxidative stress in CKD progression and suggest that interventions targeting oxidative stress may help reduce microalbuminuria and slow disease progression

Background Cardiac implantable electronic devices (CIEDs) are life-saving interventions, but complications such as pocket infections and erosions pose significant clinical and economic challenges, particularly in resource-limited settings. Objective: This study evaluates the incidence, risk factors, microbial profile, and outcomes of management strategies for pacemaker pocket complications at Assam Medical College, Dibrugarh, India. Methods: A retrospective analysis was conducted on 1,056 patients who underwent pacemaker implantation between January 2022 and July 2024. Data on demographics, comorbidities, device types, and outcomes were collected for 33 patients (3.1%) who developed pocket complications. Infections were classified per EHRA guidelines into localised (Grade A) and systemic (Grade B). Management approaches included explantation, conservative strategies, and debridement with reimplantation. Results: The mean age of patients with pocket complications was 69.3 years, with a male-to-female ratio of 2.3:1. Diabetes (48%), hypertension (55%), and COPD (33%) were common risk factors. Box changes had the highest erosion rate (5.06%). Most pus cultures showed no microbial growth (82%), followed by Staphylococcus aureus (12%). Device explantation and reimplantation were the most successful strategies, with 87.5% favourable outcomes. Conservative management had limited success, with reinfections in 5 of 6 patients. Conclusion: Pacemaker pocket infections are a significant concern, particularly in populations with high comorbidities and limited healthcare access. While device explantation and reimplantation offer the best outcomes, conservative approaches are less effective and should be reserved for select cases. Strengthening perioperative care and follow-up protocols is essential to reduce the burden of these complications.

Background: William Cole introduced the term "stroke" in 1689.1 A stroke is a neurological injury resulting from a sudden localized interruption in the central nervous system. This interruption can arise from intracerebral bleeding, subarachnoid haemorrhage, or cerebral infarction.2 The World Health Organization characterizes a stroke as a rapid onset of clinical symptoms due to a specific disruption in cerebral function.  Objectives: • To find the serum levels of vitamin D in patients with acute stroke and without stroke. • To find out the association between vitamin D and acute ischaemic stroke. Material & Methods: Study Design: Observational Case-Control study.   Study area:  The study was conducted in a Teaching hospital AIMSR & District headquarters hospital, Chittoor. Study Period: 1 year.   Study population: This study included a total of 120 subjects out of which 60 are cases (acute ischaemic stroke) and 60 are controls. Sample size: The study consisted of a total of 120 cases. Results: Among the cases, 28 participants (46.7%) were classified as deficient in vitamin D, 27 participants (45%) were classified as insufficient, and 5 participants (8.3%) were classified as having sufficient levels of vitamin D. The p-value associated with serum vitamin D levels was less than 0.001, indicating a significant difference in the distribution of vitamin D levels between cases and controls. Conclusion: In conclusion, this study found significant differences in serum vitamin D levels and other risk factors, such as hypertension, diabetes, TLC, and FBS, between acute ischemic stroke patients and healthy controls. Lower vitamin D levels in stroke cases suggest a potential link between vitamin D deficiency and increased stroke risk, highlighting its role as a modifiable risk factor.

Background: Metabolic Syndrome (MetS) is a cluster of conditions including obesity, hypertension, dyslipidemia, and insulin resistance, which significantly increase the risk of cardiovascular diseases (CVD). Emerging evidence suggests that gut microbiota plays a pivotal role in regulating metabolic homeostasis and inflammatory responses. This study aimed to evaluate the impact of gut microbiota modulation through dietary interventions and probiotics on inflammatory markers and cardiovascular risk in patients with MetS. Materials and Methods: A total of 120 adult patients diagnosed with MetS, aged between 30 and 65 years, were randomly divided into three groups: Group A (Dietary intervention), Group B (Probiotic supplementation), and Group C (Control - standard care). Interventions were administered over a 12-week period. Serum inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were measured pre- and post-intervention. Cardiovascular risk was assessed using lipid profiles and arterial stiffness indices. Statistical analysis was performed using ANOVA and paired t-tests, with a significance level set at p < 0.05. Results: Following the intervention, Group A exhibited a significant reduction in CRP (from 4.8 ± 0.6 mg/L to 3.2 ± 0.5 mg/L, p < 0.01), IL-6 (from 12.5 ± 1.2 pg/mL to 9.3 ± 1.1 pg/mL, p < 0.01), and TNF-α (from 18.6 ± 2.1 pg/mL to 14.8 ± 1.8 pg/mL, p < 0.01). Similar trends were observed in Group B with reductions in CRP (from 4.7 ± 0.7 mg/L to 3.4 ± 0.6 mg/L, p < 0.05), IL-6 (from 12.4 ± 1.3 pg/mL to 10.1 ± 1.0 pg/mL, p < 0.05), and TNF-α (from 18.4 ± 2.0 pg/mL to 15.0 ± 1.7 pg/mL, p < 0.05). However, Group C showed no significant changes. Lipid profiles improved significantly in Groups A and B compared to the Control group. Conclusion: The modulation of gut microbiota through dietary interventions and probiotic supplementation significantly reduces inflammatory markers and improves cardiovascular risk profiles in patients with MetS. These findings highlight the potential of gut microbiota-targeted therapies as an adjunctive approach for managing MetS and reducing CVD risk.

Background: Type 2 diabetes mellitus (T2DM) is a global health concern, with microvascular complications such as diabetic nephropathy contributing to significant morbidity. Glycated haemoglobin (HbA1c) is a glycemic control marker, while albuminuria is an early indicator of renal dysfunction. Their interplay remains a crucial factor in diabetes management. Methods: This cross-sectional study included 150 patients with T2DM at Sheth V. S. General Hospital, Ahmedabad. Data collection included demographic parameters, disease duration, biochemical markers (HbA1c, lipid profile, serum creatinine, urine albumin-creatinine ratio), and complications such as neuropathy, retinopathy, and hypertension. Results: Among the participants, 66.6% had normoalbuminuria, 24% had microalbuminuria, and 9.3% had macroalbuminuria. Higher HbA1c levels (>7%) were significantly associated with microalbuminuria (75%) and macroalbuminuria (50%) (p<0.05). Dyslipidemia was prevalent, with 75% of microalbuminuric patients having total cholesterol >200 mg/dL. Hypertension was significantly linked to albuminuria (p=0.0382). Retinopathy was more frequent in microalbuminuric patients (p=0.0305). Conclusion: Poor glycemic control, dyslipidemia, and hypertension were strongly associated with albuminuria in T2DM patients. Early screening and aggressive management strategies targeting glycemic and lipid control may help mitigate renal complications

Introduction: Diabetes and hypertension are the primary factors contributing to chronic kidney disease (CKD) on a global scale. Majority patients with CKD die due to cardiovascular events before reaching ESRD due to both traditional and non-traditional risk factors. Present study was aimed to study prevalence of cardiovascular changes on 2D echocardiography in chronic kidney disease patients. Material and Methods: Present study was prospective, cross sectional study, conducted in patients of age > 12 years with known chronic kidney disease. Results: Among 100 patients, mean age was 54.41 ± 11.97 years. The study constituted 63% of males, and 37% of females. Common etiological factors for chronic kidney disease noted were hypertension (70 %) followed by diabetes (35 %), obstructive uropathy (32 %), polycystic kidney disease (25 %) & NSAID (20 %). Stage I [>90]CKD was seen in 0% of the study population. Stage II [60-89], stage III [30-59], stage IV [15-29] and stage V [<15] CKD was seen in 3%, 13%, 33% and 51% of the study population respectively. ECG findings were normal in 40% of the study population. LVH, Tachycardia, Tall T waves and arrhythmias was seen in 30%, 10%, 15% and 5% of the study population 2d echocardiography findings were normal in 30% and abnormal in 70% of the study population. LV hypertrophy was seen in 70% cases, Fractional Shortening [FS](<30%) was seen in 8% cases, LVEF(<60%) was seen in 25% cases, E/A ratio (<0.75 or >1.8) was seen in 62% cases, Pericardial effusion (<10mm) was seen in 11% cases, Valvular calcification was seen in 6% cases and Mitral regurgitation was seen in 7% cases Conclusion: Cardiac abnormalities are prevalent across all stages of CKD, with significant increases in both systolic and diastolic dysfunction, LVH, and valvular heart disease as the disease progresses.

Background: Dilated cardiomyopathy (DCM) is a primary myocardial disease with dilation of the left ventricle and systolic dysfunction, resulting in high morbidity and mortality. The purpose of the present study was to compare the clinical, echocardiographic, and electrocardiographic profiles of patients with DCM. Methods: A prospective observational study was carried out for one year in the Department of General Medicine, SVRRGGH, Tirupati. Sixty patients diagnosed with DCM according to clinical, echocardiographic, and electrocardiographic criteria were recruited. Demographic data, clinical presentation, electrocardiographic findings, echocardiographic indices, and risk factors were recorded and analyzed through SPSS version 20. Results: The study population consisted mainly of males (63%) aged 53.2 years on average. The most frequent symptoms were dyspnea (100%), easy fatigability (83%), and pedal edema (70%). Echocardiography showed severe left ventricular dilatation (mean LVIDd: 60.81 mm) with decreased ejection fraction (mean EF: 28.6%). Valvular regurgitation (64%), pericardial effusion (30%), and pulmonary hypertension (24%) were common. Electrocardiography demonstrated left axis deviation (46%), left ventricular hypertrophy (38%), and increased QRS duration (>0.10 sec) in 67% of the cases. Alcoholic DCM was responsible for 15% of the cases. Conclusion: DCM occurs mostly in elderly individuals with a male predominance and marked functional impairment. Echocardiographic evidence of left ventricular enlargement and decreased ejection fraction are important prognostic determinants. Prompt recognition and control of modifiable risk factors, including alcohol intake, may enhance patient outcomes.

Background: Hypertension and obesity are common comorbidities in patients with type 2 diabetes mellitus (T2DM) and are associated with an increased risk of cardiovascular and microvascular complications. This cross-sectional study is aimed to investigate the association between body mass index (BMI) and hypertension in patients with T2DM. Methods: A total of 100 patients with T2DM were included in the study. Demographic and clinical data, including BMI, blood pressure measurements, and laboratory investigations, were collected. Participants were classified as underweight, normal weight, overweight, or obese based on BMI categories. Hypertension was defined according to the American College of Cardiology guidelines. Logistic regression analysis was performed to evaluate the association between BMI and hypertension, adjusting for potential confounders. Results: The mean age of participants was 58.5 ± 11.2 years, and 55% were male. The prevalence of hypertension increased significantly with increasing BMI categories, from 20% in the underweight group to 64% in the obese group (p < 0.001). Compared to the normal weight group, the overweight group had 2.67 times higher odds of hypertension (95% CI: 1.12-6.35, p = 0.027), while the obese group had 6.21 times higher odds (95% CI: 2.38-16.21, p = 0.0002). Conclusions: Overweight and obesity are the significant risk factors for hypertension in patients with T2DM. Effective strategies to control weight can keep a check on hypertension thus reducing the risk of cardiovascular and microvascular complications in patients with T2DM.

Background: The most common significant health concern during pregnancy is hypertension, which remains a vital factor in both maternal and fetal morbidity and mortality. Preeclampsia is a pregnancy-related hypertensive disorder that occurs after twenty weeks of gestation and involves multiple systems.

Objectives:

1) To study maternal outcome in severe pre- eclampsia & eclampsia.

2) To study perinatal outcome in severe pre- eclampsia & eclampsia.

3) To enumerate variable factors associated with maternal and perinatal morbidity and mortality.

Material & Methods: Study Design:  Prospective Observational Study.  Study area: Department of Obstetrics & Gynecology, GGH, GMC, KADAPA.  Study Period: 1 year. (March 2023 – April 2024). Study population: 100 Pregnant women admitted with severe PE and eclampsia. Sample size: Study consisted a total of 100 subjects. Sampling Technique:  Convenience Sampling technique. Results: In this study 22% of cases had no proteinuria, 25 % of the cases had trace amounts of protein in urine, among them only 2% developed HELLP. Among 77% of the cases with proteinuria, 13% developed HELLP and there was significant association between proteinuria and HELLP i.e as severity of proteinuria increases chances of HELLP increases. Conclusion: Severe preeclampsia leads to higher risks of life-threatening complications, preterm delivery, and IUGR, with maternal mortality observed in multigravida cases. Early detection and proper management, including evidence-based protocols, are crucial to reducing morbidity and mortality. Effective secondary and tertiary prevention improves outcomes for both mother and neonate.

Introduction: The cardiac manifestations of OPs poisoning occur in a majority of affected patients and may range from harmless electrocardiographic (ECG) changes such as sinus tachycardia, to life-threatening complications such as cardiogenic pulmonary edema. Present study was conducted to estimate the cardiovascular complications and in hospital outcomes in patients of organophosphorus compound poisoning in tertiary care hospital. Material and Methods: Present study was prospective, observational study, conducted in patients of more 18 years, presenting with history of exposure to and signs and symptoms of organophosphorus compound poisoning. Results: Majority of patients fall within the 21-40 years age group (50.7 %), were male (85.3%) & chlorpyrifos is the most commonly consumed compound (38 %). Most common symptom was excessive salivation (75.3 %), followed by sweating (66.0%), lacrimation (55.3%), vomiting (22.7%). At admission, the majority (74.6%) had normal sinus rhythm. However, 20.6 % had sinus tachycardia, while smaller proportions experienced sinus bradycardia (0.6 %), ST depression (3.3%), and ST elevation (0.7%). During hospitalization common ECG changes were QTC prolongation (6 %). ventricular premature beats (3.3%), ST depression (2.7%), and first-degree heart block (1.3%). 2D echo findings shows that 39.3% had normal findings, while 6.7% had global left ventricular (LV) hypokinesia and 1.3% had anterior wall hypokinesia. Cardiovascular complications reveals that 20.7% of patients experienced sinus tachycardia. Hypotension (8.0%), cardiac failure (6.7%), and type 2 myocardial infarction (6.0%) were also notable. Other complications such as QTC prolongation (5.3%) and sinus bradycardia (0.7%) were less common. The association of cardiac failure hypertension and STEMI are statistically significant with level of serum cholinesterase. The association of hypotension VPCs and type 2 MI are statistically significant with Peradeniya score. Conclusion: The findings from this study underscore the need for early recognition and aggressive management of cardiovascular symptoms in patients of organophosphorus compound poisoning.

Vitamin D has emerged as a potential modulator of cardiovascular health. Epidemiological studies link vitamin D insufficiency with higher risks of hypertension and cardiovascular disease (CVD) events. Receptors of Vitamin D are expressed in cardiac and vascular tissues and severe deficiency of vitamin D is reported worldwide. However, does vitamin D play a causal protective role in cardiovascular health remains under debate, given inconsistent trial results. This review details the physiological role of Vitamin D in cardiovascular health which includes its role in the renin-angiotensin-aldosterone system (RAAS), vascular endothelial health, inflammation and oxidative stress, vascular calcification, disease risk in deficiencies and supplementation. In summary, vitamin D shows biological plausibility and modest signals of benefit for cardiovascular health, but robust evidence for routine supplementation to prevent heart disease or improve vascular outcomes is still lacking.

Pulmonary arterial hypertension (PAH) is a rare and progressive condition characterized by elevated blood pressure in the pulmonary arteries, often presenting with symptoms such as dyspnea, fatigue, and chest pain, particularly during exertion. This case report details a 37-year-old male patient with a history of kyphoscoliosis, who was referred for evaluation due to worsening breathlessness, anxiety, and abdominal distention over the past year. Clinical examination revealed significant cyanosis and respiratory distress, with imaging studies confirming PAH indicated by dilated pulmonary arteries and an enlarged cardiac silhouette. The patient's complex presentation also included mild hepatic changes and the identification of Pseudomonas aeruginosa, suggesting possible infection. This case underscores the challenges in diagnosing PAH, particularly in patients with multifactorial health issues. It emphasizes the necessity for comprehensive evaluations, including imaging and hemodynamic assessments, to facilitate timely and accurate diagnosis. A multidisciplinary approach to management is crucial for improving patient outcomes, highlighting the importance of early recognition and individualized treatment strategies to enhance quality of life in PAH patients.

Introduction. Alcohol causes around 4.5 million deaths a year, making it the fourth most important risk factor for disease burden worldwide. A variety of problems, such as excessive use, abuse, dependence, and addiction, are included in the category of alcohol use disorders (AUD). Alcohol withdrawal syndrome (AWS) is a well-known disorder that happens when severe or continuous drinking is abruptly stopped, whether it's intentionally or unintentionally. Acute and long-term alcohol use can cause hypomagnesemia and other electrolyte abnormalities. The primary causes of magnesium deficiency in these individuals include insufficient intake, malnutrition, losses due to vomiting, and urinary losses related to ethanol metabolism. Hence the present study was done to measure serum magnesium levels in chronic alcoholic patients who have abstained from alcohol for at least 6 hours and also the relationship with severity of alcohol withdrawal. Methodology: A cross-sectional study was done on 100 patients with alcohol withdrawal symptoms who gave consent at King George hospital, Visakhapatnam. Alcohol withdrawal symptoms severity was measured with the help of the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised) scale and serum magnesium levels were measured. Details like age, hypertension, diabetes and smoking were also studied. Results: The Mean age of the study participants is 40.86 ±11.28 years. There was a significant positive correlation between CIWA-Ar scores and the duration of alcohol intake (r = 0.464), and a significant negative correlation with serum magnesium levels (r = -0.802). Conclusion: Longer alcohol consumption is associated with higher withdrawal severity, while higher levels of serum magnesium are associated with lower withdrawal severity.

Background: Dyspnea is a frequent and multifactorial symptom in chronic kidney disease (CKD), often overlooked in early stages. While commonly attributed to fluid overload, other contributors such as anemia, left ventricular dysfunction (LVD), pulmonary hypertension, and pulmonary parenchymal and airway diseases significantly affect symptom burden and prognosis. Methods:   A prospective observational study was conducted on 120 adult CKD patients at a tertiary care center in Maharashtra. Patients were followed for 18 months. Dyspnea was assessed using the Modified Medical Research Council (mMRC) Dyspnea Scale. Echocardiographic, laboratory, and pulmonary parameters were analyzed. Patients were grouped based on dyspnea severity (mMRC ≥2 vs. ≤1) and change in LVEF (≥10% decline vs. maintained/minimal reduction). Multivariate logistic regression was used to identify predictors of worsening LVEF. Results:  Of 110 patients analyzed, 48 (43.6%) had significant dyspnea. Prevalence increased with CKD stage, reaching 83.3% in stage 5. Dyspneic patients had lower hemoglobin (9.2 ± 1.4 vs. 10.3 ± 1.5 g/dL, p = 0.002), higher NT-proBNP (2142 ± 1186 vs. 1297 ± 927 pg/mL, p = 0.004), more LVH (64.6% vs. 42.0%, p = 0.02), and pulmonary hypertension (41.7% vs. 22.6%, p = 0.03). LVEF was lower in dyspneic patients (50.8 ± 9.2% vs. 55.7 ± 7.8%, p = 0.01). Worsening LVEF was observed in 28 patients (25.5%). Independent predictors of worsening LVEF were elevated NT-proBNP (OR: 1.004, p = 0.002), LVH (OR: 2.86, p = 0.014), ischemic heart disease (OR: 3.02, p = 0.021), and diabetes mellitus (OR: 2.25, p = 0.045). Conclusions:  Dyspnea in CKD is common, multifactorial, and warrants early evaluation. Relevant investigations to detect Cardiac, Pulmonary and Hematological disturbances are crucial for timely interventions. NT-proBNP, LVH, diabetes, and IHD are independent predictors of worsening LVEF in CKD.

Background: and Aim: Chronic Obstructive Pulmonary Disease (COPD) is often associated with cardiovascular complications that significantly impact prognosis and quality of life. This study aimed to evaluate echocardiographic findings in COPD patients to identify cardiac manifestations and their relationship with disease severity.  Material and Methods: A cross-sectional study was conducted on 44 COPD patients at a tertiary care hospital from January to December 2023. All patients underwent spirometry for disease staging and transthoracic echocardiography to assess cardiac involvement.Results: Pulmonary arterial hypertension (PAH) and right ventricular (RV) enlargement were more prevalent in patients with advanced COPD. PAH was observed in 100% of Stage IV patients, while RV enlargement increased progressively with severity, being absent in Stage I and present in all Stage IV cases.  Conclusion: The study underscores the importance of echocardiographic screening in COPD patients, particularly in moderate to severe stages, for early detection of cardiac complications and timely intervention.

Background: Subclinical hypothyroidism (SCH), characterized by elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) levels, has emerged as a potential contributor to cardiovascular risk. Its prevalence in patients with ischemic heart disease (IHD) remains under-investigated, particularly concerning its impact on clinical outcomes. This study aims to assess the prevalence of SCH among individuals diagnosed with IHD and to evaluate its clinical implications. Materials and Methods: A cross-sectional observational study was conducted over a period of 12 months at a tertiary care center. A total of 150 patients with confirmed ischemic heart disease were enrolled. Thyroid function tests (TSH, FT4) were performed, and demographic, clinical, and biochemical parameters were recorded. Patients were classified into euthyroid and SCH groups based on TSH levels. Statistical analyses included chi-square test and logistic regression to identify associations between SCH and cardiovascular risk factors. Results: Out of 150 patients with IHD, 38 (25.3%) were found to have subclinical hypothyroidism. The SCH group had a significantly higher mean TSH level (6.9 ± 0.5 µIU/mL) compared to the euthyroid group (2.8 ± 0.7 µIU/mL, p<0.001). Patients with SCH also exhibited increased prevalence of hypertension (68.4% vs 51.2%, p=0.03), higher LDL cholesterol levels (137 ± 20 mg/dL vs 120 ± 15 mg/dL, p=0.02), and reduced left ventricular ejection fraction (48% vs 55%, p=0.04). Multivariate analysis indicated SCH as an independent risk factor for poor cardiac function. Conclusion: Subclinical hypothyroidism is notably prevalent among patients with ischemic heart disease and is associated with adverse cardiovascular parameters. Early identification and management of SCH in IHD patients may improve clinical outcomes and reduce disease burden.

Background: Vitamin D is an essential vitamin with various vital functions in the body including calcium and phosphate homeostasis and bone formation. It is said that it also has various roles in immune function, inflammation, cell proliferation, differentiation and apoptosis. Vitamin D deficiency has been linked with a number of health outcomes such as osteoporosis, osteomalacia, diabetes, hypertension, heart disease, cancer, autoimmune disease and infectious disease. Vitamin D deficiency has been well documented in the general population. However, there are very few studies on Vitamin D deficiency among health care professionals. AIM: To assess the vitamin D status among health care workers in a tertiary care hospital. Materials And Methods: This was a cross-sectional study. After taking informed consent from the participants, each subject was interviewed personally by the investigator and their physical examination was carried out. Data regarding age, sex, body weight, height, body mass index (BMI), Sunlight exposure and use of sun screen usage were recorded from each subject. Serum Vitamin D levels were estimated using chemiluminescent immuno assay (CLIA) method. Vitamin D levels recorded and less than 20ng/ml was taken as deficiency. The prevalence of vitamin D deficiency among health care workers was estimated. Results: Total 75 participants were registered. Out of which 37 were males and 38 were females. The mean value of age of study subjects was 45.55±13.88 years. 65 out of 75 (87%) subjects were either deficient or insufficient of vitamin D. Conclusion: In this study we found that 87% of healthy health care professionals including doctors of various speciality were Vitamin D deficient which is highly prevalent. And there was no significant association between Vitamin D levels and age, sex, physical activity, and BMI. However inadequate sun light exposure seems to be the major cause for vitamin d deficiency.

Background: The gut microbiota has been increasingly recognized as a modulator of cardiovascular disease (CVD) risk, influencing factors such as hypertension, dyslipidemia, and inflammation through microbial metabolites like short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO). This systematic review evaluates the impact of gut microbiota modulation on cardiovascular risk, focusing on dietary interventions, probiotics, prebiotics, and fecal microbiota transplantation (FMT). Methods: A conceptual systematic review was designed following PRISMA guidelines, synthesizing evidence from hypothetical studies (25 RCTs, 15 observational studies, 22 preclinical studies) identified through a literature search up to April 2025. Eligible studies investigated microbiota-targeted interventions and their effects on cardiovascular risk factors (e.g., blood pressure, lipids, inflammation) or clinical outcomes. Data were qualitatively analyzed, with trends derived from established research patterns. Results: Dietary interventions, particularly high-fiber and Mediterranean diets, consistently increased SCFA production, reducing blood pressure (3-8 mmHg) and LDL cholesterol (5-12 mg/dL) in 70% of RCTs. Probiotics (Lactobacillus, Bifidobacterium) and prebiotics (e.g., inulin) modestly improved lipids and inflammation in 60-80% of trials, while FMT reduced TMAO by 20-40% in small-scale studies. Preclinical models supported these findings, showing attenuated atherosclerosis. Clinical CVD events were rarely assessed, with observational data suggesting a 15-20% risk reduction. Heterogeneity in study design and short-term focus limited conclusions. Conclusion: Gut microbiota modulation, especially via diet, offers a promising strategy to mitigate cardiovascular risk by targeting metabolic and inflammatory pathways. However, modest effect sizes and limited clinical outcome data highlight the need for long-term, large-scale trials to confirm efficacy and guide therapeutic application.

Background: Chronic Total Occlusions (CTOs) represent a complete blockage of a coronary artery persisting for more than three months. These lesions are common in patients with chronic stable angina but may also occur in those with non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA). Historically considered complex with high procedural risks, CTO interventions have seen significant advancements in safety and success rates due to improvements in technology and operator expertise. Successful revascularization has been shown to improve myocardial perfusion, alleviate symptoms, and enhance overall cardiovascular outcomes.

Aims and Objectives:

1. To study the clinical and angiographic profile of patients undergoing CTO angioplasty at a tertiary care center.
2. To assess the immediate procedural outcomes and complication profile in this cohort.

Methods: This was a record-based descriptive study conducted in the Department of Cardiology, Government Medical College, Alappuzha. Data were collected from the CTO registry for a 2-year period (November 2022 to November 2024). Patients aged ≥18 years with angiographically confirmed CTO (duration >3 months) who underwent percutaneous coronary intervention (PCI) were included. Those with severe comorbidities, uncontrolled systemic conditions, or inability to provide consent were excluded. Data were extracted on demographics, comorbidities, clinical symptoms, angiographic features, procedural success, and complications, and were entered into a master chart for descriptive statistical analysis. Results: A total of 220 patients underwent CTO angioplasty during the study period. Most patients were elderly, with 66.36% aged >60 years. Males constituted 84.09% of the cohort. Hypertension (76.36%), type 2 diabetes mellitus (86.36%), and smoking (67.27%) were the most common risk factors. Prior PCI was seen in 50.90% and previous CABG in 15.45%. The predominant presenting symptoms were dyspnea on exertion (83.18%), easy fatigability (79.09%), and effort angina (71.36%), with most in NYHA Class II. The most common clinical presentation was UA/NSTEMI (55.45%), followed by chronic stable angina (37.27%) and STEMI (7.27%). Angiographically, double vessel disease was most frequent (69.54%), and the LAD was the most commonly involved CTO vessel (52.72%), followed by LCX (39.54%) and RCA (38.18%). Procedural success was achieved in 82.72% of cases. The most frequent complication was coronary perforation (15.45%), followed by nonfatal myocardial infarctions (10.45%), arrhythmias (8.18%), and no-flow/slow-flow phenomena (8.18%). Stroke and acute kidney injury were rare (1.36% and 0.91%, respectively). All-cause and cardiac-specific mortality were low at 0.91%. No patients required emergency CABG. Conclusion: CTO angioplasty, once considered a high-risk and low-success intervention, is now feasible and effective with a high procedural success rate and low mortality. Despite the complexity of cases and comorbid burden, the outcomes reflect improved technical capabilities and procedural safety. Early recognition, appropriate case selection, and expertise are crucial for favorable outcomes.

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, with an increasing burden in Bangladesh. Identifying the prevalence, risk factors, and angiographic patterns of CAD is essential for effective prevention and management. This hospital-based study aimed to assess the demographic characteristics, risk factors, severity, and treatment approaches among Bangladeshi patients with CAD. Methods: This cross-sectional study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital, from November 2023 to December 2024. A total of 107 patients admitted with suspected CAD were included. Results: The study included 107 patients, with a male predominance (76.6%) and a mean age of 51.7 ± 11.3 years. Hypertension was the most prevalent risk factor (38.3%), followed by smoking (33.6%) and diabetes mellitus (22.4%). Obesity and a family history of CAD were present in 22.4% and 16.8% of cases, respectively. Among the study population, 72.0% had confirmed CAD. Single-vessel disease was the most common pattern (30.8%), followed by triple-vessel disease (22.4%) and double-vessel disease (18.7%). Percutaneous coronary intervention (PCI) was performed in 23.4% of patients, while 7.5% were recommended for coronary artery bypass grafting (CABG). Optimal medical therapy (OMT) was the primary management approach in 21.5% of cases. Conclusion: This study highlights a high burden of CAD in Bangladesh, with modifiable risk factors playing a crucial role. Early screening, lifestyle modifications, and optimal management strategies are essential to reduce the impact of CAD in this population.

Background: Obesity   is   emerging   as   an   important   health   issue. The rising prevalence of obesity in India has a direct correlation with the increasing prevalence of    obesity-related co-morbidities such as metabolic syndrome, dyslipidemia, type 2 diabetes mellitus (T2DM), hypertension and cardiovascular disease (CVD).  Aim: This study aimed to assess the correlation between BMI and serum lipid profile parameters among the young medical students of NRI Institute of Medical Sciences (NRIIMS), Visakhapatnam, Andhra Pradesh, India. Methods: This cross-sectional study was conducted in Department of Biochemistry, NRI Institute of Medical Sciences (NRIIMS), Sangivalasa, Visakhapatnam, Andhra Pradesh, India. This study involved 300 undergraduate medical students of MBBS, BDS, BPT, Nursing and MLT. Age of study subjects was 17 to 25 years and both genders were included. This study was approved by the Institutional Ethics Committee (IEC) and informed consent was obtained from all the subjects. Under aseptic conditions, 5 ml of fasting venous blood samples were collected and centrifuged to obtain clear serum. Serum sample was used for estimation of total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDLC). Low density lipoprotein cholesterol (LDLC) and very low-density lipoprotein cholesterol (VLDLC) were calculated by using Frieldwald’s formula.  BMI was calculated. Based on BMI value, subjects were classified as underweight [BMI <18.5 kg/m²], normal weight [BMI 18.5-24.9 kg/m²], overweight [BMI 25.0-29.9 kg/m²] and obese [BMI >30.0 kg/m²]. Results: In this study, a total of 300 medical students of male and females were included. Out of 300 subjects, males were 146 (48.7%) and females were 154 (51.3%). Based on BMI value, study subjects were categorized as underweight, normal weight, overweight and obese. In this study, underweight subjects were 58 (19.3%), normal weight subjects were 173 (57.6%), overweight subjects were 51 (17%) and obese subjects were 18 (6%).  Overall, significant increase in serum cholesterol (156.3±38.4 mg/dl), triglycerides (108.2±62.1 mg/dl) and VLDLC (21.6±12.4 mg/dl) was observed in overweight subjects compared to other groups. LDLC (82.7±36.6 mg/dl) was increased and HDLC (50.3±11.4mg/dl) was decreased in obese subjects compared to other groups. Significant positive correlation was observed for total cholesterol (r=0.171), triglycerides (r=0.252), LDLC (r=0.195), VLDL (r=0.252) with BMI and HDLC (r= -0.252) showed significant negative correlation with BMI. Lipid profile parameters were compared in MBBS students. Increase in serum cholesterol (158.3±29.6 mg/dl), triglycerides (109.2±67.6 mg/dl), LDLC (79.2±22.3 mg/dl) and VLDLC (21.8±13.5 mg/dl) were observed in overweight subjects, but not reached statistical significance. Significant decrease was observed in HDLC (55.9±7.6 mg/dl) in obese subjects than other groups. In MLT students, total cholesterol (199.2± 55.2 mg/dl), LDLC (135.6±45.2 mg/dl) were increased and HDLC (39.8±1.3 mg/dl) was decreased in obese subjects. Triglycerides (122.6±45.5 mg/dl) and VLDLC (24.5±9.1 mg/dl) were significantly increased in overweight subjects and HDLC (39.8±1.3 mg/dl) was decreased in obese subjects compared to other groups. In nursing students, HDLC (44.2±15.6 mg/dl) is decreased in obese subjects remaining all parameters not shown any differences.  Conclusion: This study may conclude that significantly elevated cholesterol, triglycerides, LDLC, VLDLC and significantly low HDLC levels in obese young medical students comparative to other groups. Obesity in young age medical students may be due to lack of awareness and unhealthy life styles. Therefore, health education and preventive measures should be followed.

Background: Dizziness is a pretty common complaint, and while doctors often think about heart issues particularly in patients who are already diagnosed with cardiac conditions, but when patients with heart disease feel dizzy, there are plenty of other potential causes. This study looks into those other causes of dizziness in cardiac patients who came to hospitals in a rural part of Jammu and Kashmir (J&K), India. Methods: We reviewed medical records of cardiac patients who showed up at Govt. Medical College Doda in remote area of J&K, complaining of dizziness, between January 2019 and December 2023. We collected information like their age, sex, heart diagnoses, non-heart-related causes of dizziness, and what the doctors found. We used some basic statistical methods to analyze the data, and we also compared our findings with what other studies have reported. Results: Over those 5 years, 2476 cardiac patients came to the hospitals because of dizziness. Their average age was 47.5 years and about 53% were female. The most common heart problems were Hypertension, coronary artery disease, heart failure, and cardiac arrhythmias. In a pretty significant number of these patients—around 1039 (42%)—the dizziness wasn't due to their heart. The most frequent non-cardiac causes were:

• Vestibular disorders: 280 (26.94%) Benign Paroxysmal Positional Vertigo (BPPV): 145 (13.95%), Meniere's disease 83 (7.99%), Vestibular Neuritis: 52 (5%).
• Medication-related: 218 (20.98%) Diuretics: 135 (12.99%), Beta-blockers:83 (7.98%).
• Neurological disorders: 177 (17.03%) (Peripheral Neuropathy: 114 (10.97%), Migraine: 63 (6.06%).
• Psychogenic factors: 135 (12.99%) anxiety disorder 83 (7.98%), Depression 52 (5%).
• Metabolic disorders: 11 (10.87%) (Anemia: 73 (7.02%), Hypoglycemia: 41 (3.95%).
• Cervical spine issues: 116 (11.36%).

Conclusion: Non-cardiac causes of dizziness are quite common in cardiac patients in this rural part of J&K. Inner ear problems and medication side effects were particularly frequent. Neck issues also seem to be a factor. These results suggest that when cardiac patients have dizziness, doctors really need to consider all the possible reasons, not just their heart condition. More in-depth studies with larger numbers of patients would help to confirm these findings and figure out who might be more at risk

Introduction: Hypertension is a major public health issue globally, with varying prevalence across different demographics and geographical locations. This study aims to assess the prevalence and associated risk factors for hypertension in urban and rural populations to identify targeted interventions. Methods: This cross-sectional study involved 500 participants, equally divided between urban and rural settings. Data were collected through health surveys and physical examinations, focusing on hypertension status, demographic variables, lifestyle factors, and access to healthcare services. Statistical analysis included chi-square tests, t-tests, and logistic regression. Results: The prevalence of hypertension was significantly higher in rural areas (40.8%) compared to urban areas (34.8%) (p=0.045). Rural participants were older and had higher mean body mass index. Factors such as smoking and family history of hypertension were more prevalent in rural populations. Urban residents reported better healthcare access and higher engagement in health awareness programs. Lifestyle factors such as dietary salt intake and physical activity also differed significantly between the two groups. Conclusion: Hypertension prevalence is significantly influenced by geographic location, with rural populations exhibiting higher rates and associated risk factors. Differences in lifestyle behaviors and healthcare accessibility suggest the need for region-specific health policies and programs to manage and prevent hypertension effectively.

Background: Hypertensive disorders during pregnancy, including gestational hypertension and preeclampsia, are significant contributors to maternal and fetal morbidity and mortality. Emerging evidence suggests that alterations in serum magnesium and lipid profiles may play a role in the pathophysiology of these conditions. Objective: To evaluate and compare serum magnesium levels and lipid profiles among normotensive pregnant women and those with hypertensive disorders of pregnancy (HDP). Methods: A prospective case-control study was conducted involving 100 pregnant women beyond 32 weeks of gestation. Fifty women diagnosed with HDP formed the case group, while fifty normotensive pregnant women served as controls. Fasting blood samples were analyzed for serum magnesium, total cholesterol, triglycerides, HDL-C, LDL-C, and VLDL-C. Statistical analysis was performed using SPSS version 25. Results: Women with HDP exhibited significantly lower serum magnesium levels and higher levels of total cholesterol, triglycerides, LDL-C, and VLDL-C compared to controls. HDL-C levels were notably lower in the HDP group. These findings suggest a correlation between dysregulated mineral and lipid metabolism and the development of hypertensive disorders during pregnancy. Conclusion: Monitoring serum magnesium and lipid profiles in pregnant women may aid in the early detection and management of hypertensive disorders, potentially improving maternal and fetal outcomes.

Background: This case report examines the diagnostic challenges and management of a young female patient who presented with hemorrhagic stroke, later determined to be due to renal artery stenosis likely caused by fibromuscular dysplasia. FMD is a hyperplastic arterial disorder primarily affecting medium-sized and small arteries, though larger arteries can also be involved. It is more common in young females and typically targets the renal and carotid/vertebral arteries but can also affect other arteries. While FMD usually presents as renovascular hypertension, it can also manifest as a stroke in young adults. Case Description A 27-year-old female presented with an acute hemorrhagic stroke. Upon admission to Divisional Railway Hospital, Kharagpur, South Eastern Railway, extensive diagnostic evaluation was conducted. Imaging studies confirmed the presence of hemorrhagic stroke. Given her young age and atypical presentation, further investigations were necessary. Angiographic studies revealed abnormalities consistent with fibromuscular dysplasia, characterized by the string of beads appearance in the renal arteries. The renal artery stenosis, likely due to FMD, was a significant factor contributing to her stroke. Her management involved acute stroke treatment, long-term blood pressure control and regular monitoring. Conclusion This case highlights the importance of considering FMD in the differential diagnosis of young stroke patients, especially in the absence of traditional risk factors. Early recognition and timely treatment of FMD can significantly improve the patient quality of life and ensure favorable long-term prognosis. The case illustrates the need for thorough investigation and high index of clinical suspicion in diagnosing and managing such conditions.

Background: Seroma formation following breast surgery can significantly impact recovery, morbidity, and adjuvant therapy timing. This study evaluates the role of comorbidities (diabetes mellitus and hypertension) and nutritional status (serum albumin) in the development of seroma post-Modified Radical Mastectomy (MRM). Methods: This prospective study involved 100 patients undergoing MRM at a tertiary care hospital in North India. Comorbidities (diabetes, hypertension), hematological parameters (hemoglobin, leukocyte count), and serum albumin levels were recorded. Patients were monitored postoperatively for seroma formation over a 3-week period. Results: Of the 100 patients, 26% developed seroma. The incidence of seroma was significantly higher among diabetics (58.33%) and hypertensives (60.71%) compared to non-diabetics and normotensives (p<0.001). Serum albumin <3.5 g/dL was associated with a seroma rate of 73.08%, also statistically significant. No correlation was found with hemoglobin or leukocyte count. Conclusion: Diabetes, hypertension, and hypoalbuminemia are significant predictors of seroma formation post-MRM. Optimizing systemic and nutritional status may reduce postoperative morbidity and enhance recovery.

Stroke is a leading cause of morbidity and mortality globally. Alterations in serum magnesium (Mg) and potassium (K) levels play a significant role in the prognosis of acute ischemic stroke (AIS). This study aimed to evaluate serum Mg and K levels as prognostic markers in AIS patients. Materials and Methods: This hospital-based prospective study included 90 AIS patients admitted to the Department of Medicine, GMSH, Chandigarh, over six months. Detailed demographic and clinical data were recorded, and serum Mg and K levels were analyzed. Neurological severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Statistical significance was evaluated for various parameters, including comorbidities such as diabetes mellitus (DM), hypertension, and coronary artery disease (CAD). Results: Serum Mg levels ≤1.7 mg/dl were associated with higher NIHSS scores at admission, day 5, one month, and three months, indicating worse prognosis (p < 0.05). The mean serum K level was 4.02 ± 0.56 mg/dl. Lower K levels (<3.5 mg/dl) were observed in patients with higher NIHSS scores at one month (p < 0.05), although no significant correlation was found with other clinical outcomes. The mean serum Mg level was 1.98 ± 0.31 mg/dl, significantly lower in patients with DM, CAD, and hypertension compared to those without these conditions. Conclusion: Serum Mg levels were significantly associated with higher NIHSS scores and the presence of comorbidities such as DM, CAD, and hypertension, highlighting their potential role as prognostic markers in AIS. Serum K levels showed limited prognostic value, with significance observed only at one-month NIHSS scores.

Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a major healthcare problem around the world, with significantly higher morbidity and mortality in patients with coexisting conditions such as diabetes mellitus and hypertension (1). As zinc deficiency results in altered numbers and dysfunction of all immune cells, subjects with suboptimal zinc state have an increased risk for infectious diseases, autoimmune disorders, and cancer (5-8).    Aim & Objectives: To estimate the serum levels of zinc and CRP (C-reactive protein) in COVID-19 positive patients and to correlate serum zinc levels with CRP in COVID- 19 positive patients. Materials and Methods: Total of 86 patients who were COVID-19 positive by RTPCR (reverse transcription polymerase chain reaction) were included in the study. 5 ml of venous blood is collected, serum separated and utilized for the estimation of serum zinc and CRP by fully automated analyser according to the instructions provided in the kit by the manufacturer. Results: The mean value of serum zinc (97.53 mcg/dl) in male patients is more when compared to the mean value (87.11 mcg/dl) in female patients and the difference is not statistically significant (p =0.26). The mean value of CRP in male patients(2.14 mg/dl )  is lower than the mean value in female patients (3.15mg/dl) and the difference is not statistically significant (p=0.168).The mean value of serum in zinc in patients with age >50 years (100.22 mcg/dl) is more when compared to the mean value of patients with age group <50 years (85.68 mcg/dl)  and the difference is  not statistically significant (p=0.121).The mean value of CRP in patients with age >50 years (2.91 mg/dl) is slightly more when compared to the mean value of patients with age <50 years (2.39 mg/dl) and the difference is not statistically  significant (p=0.480). Conclusion: The present study showed that the mean value of serum zinc is high and CRP is low in male patients compared to the female patients, the mean value of zinc is high in patients with age >50 years than in patients with age <50 years. Further research is required considering a large sample size and other comorbidities.

Background: The COVID-19 pandemic has posed unprecedented challenges, especially for individuals with underlying comorbidities. Among these, metabolic syndrome (MetS) — characterized by central obesity, dyslipidemia, hypertension, and insulin resistance — has emerged as a key determinant of adverse outcomes. This study aims to prospectively assess the long-term post-COVID complications in patients with pre-existing MetS, focusing on cardiometabolic, respiratory, and neuropsychiatric sequelae. Materials and Methods: A prospective cohort study was conducted across three tertiary healthcare centres in India. A total of 300 patients aged 30–65 years with laboratory-confirmed COVID-19 and pre-existing MetS (as per IDF criteria) were enrolled. Follow-up assessments were conducted at 3-, 6-, and 12-months post-recovery. Clinical outcomes including new-onset type 2 diabetes, exacerbation of hypertension, pulmonary fibrosis, persistent fatigue, and cognitive decline were evaluated using structured clinical assessments, laboratory tests, and imaging modalities. A control group of 200 COVID-19-recovered patients without MetS was also followed for comparison. Results: At 12 months follow-up, 42.3% of patients in the MetS group reported persistent fatigue compared to 18.5% in the control group (p<0.01). New-onset type 2 diabetes was observed in 26.7% of MetS patients versus 8.0% in controls (p<0.001). Pulmonary complications such as reduced DLCO and fibrotic changes were documented in 33.1% of MetS cases and 14.5% of controls (p<0.05). Neurocognitive issues, including memory deficits and anxiety, were more prevalent in the MetS group (38.5%) than in controls (21.0%) (p=0.02). Conclusion: Individuals with pre-existing metabolic syndrome are at significantly increased risk of developing long-term post-COVID complications, including cardiometabolic dysfunction, chronic respiratory impairment, and neuropsychiatric disturbances. These findings highlight the need for tailored post-COVID monitoring and management strategies in this high-risk population.

Background: Hypertension, traditionally associated with older adults, is increasingly observed in younger populations, particularly in urban environments characterized by sedentary lifestyles, dietary transitions, and psychosocial stress. Early-onset hypertension among young adults poses a significant threat to long-term cardiovascular health, yet remains under-investigated in many developing urban regions. Materials and Methods: A community-based cross-sectional study was conducted over a 6-month period in three metropolitan areas. A total of 800 young adults aged 18–35 years were selected through multistage random sampling. Data on sociodemographic characteristics, family history, physical activity, dietary habits, and substance use were collected using a pre-tested questionnaire. Blood pressure was measured using a calibrated sphygmomanometer following standard protocols. Hypertension was defined per the American Heart Association (AHA) guidelines (SBP ≥130 mmHg or DBP ≥80 mmHg). Statistical analysis was performed using SPSS v25. Chi-square test and multivariate logistic regression were used to determine associations and identify independent risk factors. Results: The overall prevalence of hypertension among the participants was 24.8% (n=198). A higher prevalence was noted in males (28.3%) compared to females (20.4%). Significant risk factors included positive family history of hypertension (OR: 2.45, 95% CI: 1.60–3.74, p<0.001), BMI ≥25 kg/m² (OR: 1.92, 95% CI: 1.27–2.91, p=0.002), low physical activity (OR: 1.66, 95% CI: 1.09–2.53, p=0.018), and high dietary salt intake (OR: 2.17, 95% CI: 1.43–3.29, p<0.001). Conclusion: The study underscores a notable burden of hypertension among young urban adults and highlights modifiable lifestyle-related risk factors. Early identification and targeted interventions addressing diet, physical activity, and routine screening may help in mitigating the rising incidence of hypertension in this age group.

Background: Laryngoscopy and endotracheal intubation is accompanied by intense sympathomimetic stimulation resulting in increase in Heart Rate (HR) and arterial Blood Pressure (BP). This response is transient and less significant in healthy individuals. But in patients with reduced myocardial reserve / hypertension / cerebro-vascular insufficiency / raised intracranial or intraocular pressure this response is very hazardous and may predispose to pulmonary edema / myocardial infarction / cerebro-vascular accident / dysrhythmias Objective: To compare the efficacy of Dexmedetomidine in reducing the hemodynamic stress response in two different doses (0.6 mcg/Kg and 1 mcg/Kg body weight) which was given prior to laryngoscopy and endotracheal intubation. Methods: 80 ASA 1& 2 patients between the age group of 18-60 years included in this study will be randomly divided into two groups. Group A patients:  Received 0.6 mcg/kg Dexmedetomidine diluted in 100 ml normal saline 10 minutes prior to induction over 10 minutes. Group B- patients:  Received 1 mcg/kg Dexmedetomidine diluted in 100ml normal saline 10 minutes prior to induction over 10 minutes.  After premedication, anesthesia was induced with inj. Thiopentone sodium till the abolition of the eyelash reflex. After checking the adequacy of the mask ventilation, inj. Succinylcholine 1.5 mg/kg was given for intubation. Laryngoscopy and intubation were done with Macintosh blade laryngoscope after one minute. HR, SBP, DBP, MAP and SpO2 were recorded at various interval.  Result: In both groups, HR, SBP, DBP & MAP reduced significantly. During intubation, 1- and 3-minutes following intubation there was minimal rise in blood pressure compare to value at the time of induction in Group A but in group B there was marked fall continuously.  Conclusion: Both doses of Dexmedetomidine (0.6mcg/kg & 1 mcg/kg) attenuated the stress response of laryngoscopy and intubation effectively. The reduction in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was more in 1 mcg/kg group. Hence dexmedetomidine at a dose of 0.6mcg/kg itself is adequate to control the stress response of laryngoscopy and intubation.

Background: Pre-eclampsia, affecting approximately 5% of pregnancies, is characterized by hypertension and proteinuria after 20 weeks of gestation. It results in maternal and foetal morbidity and mortality during antenatal and postnatal period. In numerous studies it is observed that, plasma levels of anti-angiogenic factors such as soluble FMS like tyrosine kinase-1 was elevated in second trimester of pregnancies. Excess of sFlt-1 binds to placental growth factors and vascular endothelial growth factor and thus, have a pathogenic role in pre- eclampsia. Aims and objectives: To find the association of sFlt-1 with pre-eclampsia among pregnant women. Materials and Method: The study was conducted by taking 110 patients who were categorized into 2 groups of pre-eclamptic participants and healthy participants. Their serum samples were taken and was assayed for serum sFlt-1 levels in ELISA (Sandwich Technique) along with other investigations like LFT and RFT. Results: This study infers that, the cases with pre-eclampsia had significantly higher values of sFlT-1 (5798.2±107.1pg/ml) in contrast to that of controls who had sFlT-1values of (2584.5±181.2pg/ml) with a p value of <0.001. Conclusion: The circulating levels of this anti-angiogenic factor can help in detection of Pre- eclampsia and in further antenatal screening.

Background: Body mass index (BMI) is a widely accepted indicator of body fatness and has been associated with various cardiovascular risk factors. Elevated BMI is often linked to increased blood pressure (BP), which can predispose individuals to hypertension and related complications. This study aimed to evaluate the correlation between BMI and both systolic and diastolic blood pressure among young adults. Materials and Methods: A cross-sectional study was conducted among 100 young adults aged 18–25 years. Participants’ height and weight were measured to calculate BMI (kg/m²), which was categorized based on WHO criteria. Blood pressure was measured using a calibrated sphygmomanometer in a seated position after 5 minutes of rest. The average of two readings was recorded. Pearson correlation coefficient was used to assess the relationship between BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP). A p-value <0.05 was considered statistically significant. Results: The mean BMI was 24.1 ± 3.8 kg/m². Mean systolic and diastolic blood pressures were 122.6 ± 12.5 mmHg and 78.4 ± 9.2 mmHg, respectively. A statistically significant positive correlation was observed between BMI and SBP (r = 0.48, p = 0.001), as well as BMI and DBP (r = 0.42, p = 0.003). Participants in the overweight and obese categories showed notably higher mean blood pressure levels compared to those with normal BMI (p < 0.05). Conclusion: The findings indicate a moderate positive correlation between BMI and both systolic and diastolic blood pressure in young adults. These results highlight the importance of maintaining a healthy body weight to reduce the risk of early-onset hypertension.

Background: A biomarker is a characteristic that is objectively measured and evaluated as an Indicator of normal biologic processes, pathogenic processes or pharmacologic responses to therapeutic intervention. Biomarkers may be prognostic predictive, pharmacodynamics or suggest clinical endpoint or Surrogate endpoint. The former ones are biomarkers Type 1, while the latter is biomarkers type 2. Serum cystatin C is a definitive biomarker indicating progression of disease and cardiovascular involvement. This is a type 1 biomarker, showing ESRD as the end point. Plasma levels of Transforming Growth Factor Receptor (TGFR-1) and Endothelial Growth Factor (EGF) are surrogate end point indicators and are examples of type 2. In the absence of advanced biochemical or genetic assays, clinical biochemistry offers effective alternative to indicate susceptibility, initiation and progression of kidney disease. In this study, serum Parathormone, serum uric acid along with serum creatinine levels were compared with indicators of right ventricular function such as RVSP and TAPSE to evaluate the effectiveness of the former as biomarkers of right ventricular dysfunction. Aims And Objectives: To evaluate serum levels of Parathormone, uric acid and creatinine as markers of right ventricular dysfunction in ESRD. To predict the severity of disorder by correlating the markers with RVSP, TAPSE and hemoglobin. Materials And Methods: Study: Retrospective analysis Study population: All patients with ESRD who presented for preanaesthetic check for renal transplantation.Study period: Dec ’24 to March ’25. Study place: DSMCH, Siruvachur, PERAMBALUR. Study sample: 30 Parameters Age, Gender, hemoglobin, RVSP (right ventricular systolic pressure), TAPSE (tricuspid annular plane systolic excursion), uric acid, creatinine, parathormone Methods: The preanaesthetic assessment charts along with routine work-up charts of thirty patients were analysed for the aforesaid parameters. The results were tabulated and compared. Results: A total of 30 patients who underwent successful renal transplantation in the above study period were examined for the aforesaid parameters. Most of them were in the age group of 35–40 years of age. The haemoglobin of males ranged from 7 to 9.5 g/dl and in females from 8.2 to 8.4 g/dl. The right ventricular systolic pressure was inversely proportional to the haemoglobin levels. The lowest hemoglobin of 6.4 g/dl had an RVSP of 58 mm Hg. From the scatter plot diagram below, we may appreciate more number of patients’ hemoglobin between 7.0 g/dl and 9.0 g/dl had RVSP between 30 to 50 mm Hg which is mild to moderate pulmonary hypertension (p = 0.185). TAPSE, which is more sensitive of right ventricular dysfunction, showed p of 0.123 with hemoglobin levels. Parathormone levels were more sensitive and statistically significant indicator of RVSP (right ventricular systolic pressure) (p = 0.132) than uric acid (p = 0.63) or creatinine (p = 0.53). Serum creatinine showed significant probability variation with TAPSE (0.177). Conclusion: Left ventricle is the earliest to be involved in chronic kidney disease, initially show as hypertrophy then progresses to left ventricular dilated cardiomyopathy. In End stage Renal disease, the severity, progression and cardiac dysfunction secondary to renal disorders is reflected as right ventricular dysfunction described in terms of RVSP and TAPSE by echocardiogram. A high serum parathormone level appears to signify pulmonary hypertension as increase in right ventricular systolic pressure (p = 0.132) and serum creatinine levels seems to be a sensitive indicator of right ventricular dysfunction by ablation of TAPSE (p = 0.177).

Background: Hypertension is a major risk factor for cardiovascular diseases and can lead to significant changes in the heart's anatomy. This study aims to compare the anatomical variations of the heart between hypertensive and normotensive individuals and evaluate the correlation between hypertension duration and severity with cardiac structural changes. Objectives: To assess cardiac anatomical parameters, such as left ventricular wall thickness, left ventricular mass, and chamber dimensions in hypertensive individuals. To compare these anatomical parameters between hypertensive and normotensive individuals. To evaluate the correlation between hypertension duration and severity with observed cardiac anatomical variations. Methods: A total of 200 participants, including 100 hypertensive individuals and 100 normotensive controls, were included in this comparative study. The study employed echocardiographic measurements to assess left ventricular wall thickness, left ventricular mass, and chamber dimensions. The data were analyzed using independent t-tests, chi-square tests, and Pearson correlation to evaluate the significance of differences and associations. Results: Hypertensive individuals showed significantly higher left ventricular wall thickness, left ventricular mass, and chamber dimensions compared to normotensive controls (p<0.001 for all parameters). A significant positive correlation was observed between hypertension duration and severity with increased left ventricular wall thickness (r=0.58–0.64), left ventricular mass (r=0.62–0.67), and chamber dimension (r=0.47–0.52), indicating that longer duration and greater severity of hypertension are associated with more pronounced cardiac structural changes. Conclusion: This study confirms that hypertension leads to significant anatomical alterations in the heart, including increased left ventricular wall thickness, mass, and chamber dimensions. The findings highlight the importance of early intervention and regular monitoring to prevent further cardiac remodeling and adverse outcomes in hypertensive patients.

Background: Hypertension is a major contributor to global cardiovascular morbidity and mortality, with rising prevalence in both urban and rural populations, particularly in low- and middle-income countries like India. Understanding its epidemiological pattern at the district level can inform local health strategies. Methods: A descriptive cross-sectional study was conducted over 18 months (Nov 2022–Jul 2024) in District Jalaun, Uttar Pradesh, among 1600 adults aged 30–60 years (800 each from urban and rural areas). Participants were selected using simple random sampling and surveyed through house-to-house visits. Data on socio-demographics, dietary patterns, and blood pressure (measured using JNC 8 criteria) were collected using a pretested semi-structured questionnaire. Data analysis was done using SPSS, with significance set at p<0.05. Results: Among the participants, 45.3% were pre-hypertensive, 16.3% hypertensive, and only 38.3% had normal BP. Hypertension was more prevalent in urban (18%) than rural (14.6%) areas, though not statistically significant (p=0.0677). However, BP classification distribution showed a significant urban–rural difference (p=0.03), with urban residents more likely to have elevated BP. Non-vegetarian diet, high salt intake (>5g/day), and use of extra salt were significantly associated with higher BP levels (p=0.001). Conclusion: The study highlights a high burden of pre-hypertension and hypertension among mid-life adults in District Jalaun, especially in urban settings. Lifestyle factors like excess salt intake and non-vegetarian diet are key modifiable risks and warrant targeted interventions in both rural and urban populations