Ayyali Ambresh

Introduction: Stroke is the second leading causes of death worldwide and approximately 80% of strokes are due to ischemic cerebral infarction and 20% due to brain haemorrhage. Diabetes Mellitus is a very common metabolic disorder and it is an independent risk factor for stroke. Glucose intolerance in a stroke patient may or may not reflect glycemia prior to the event. This study is to assess the clinical profile of Acute Ischemic stroke in type 2 Diabetes Mellitus. Objectives: To evaluate the clinical profile of acute ischemic stroke in type 2 Diabetes Mellitus. Materials and Methods: This a cross sectional descriptive study. Results: This is an cross sectional study including 64 patients.Maximum number of patients were in the age group of 60 – 69 years, with mean age of 63.59±12.59 years.The male to female of 1.37:1. There were 25 patients (39.1%) well controlled Diabetes patients, 16(25.0%) fairly controlled and 23 (35.9%) were poorly controlled Diabetic patient. The common risk factors were Diabetes mellitus, hypertension, smoking, dyslipidemia, Rheumatic heart disease and Retroviral disease.HbA1c should be considered as an independent risk factor for poor clinical outcome and worse prognosis.Early diagnosis and treatment of diabetes including lifestyle modification and periodic monitoring of HbA1c levels may reduce the development of stroke and morbidity and mortality associated with it. Conclusion: Commonest clinical presentation was motor weakness (100%), cranial nerve dysfunction(45.3%), altered sensorium (29.7%), language disturbances (45.3%), sensory impairment(26.6%).   Keywords: Stroke, Diabetes, Acute Ischemic stroke, clinical Presentation

Introduction: Stroke is the second leading causes of death worldwide and one of the leading causes of disability. The most common cause of stroke is represented by cerebral ischemia and approximately 80% of strokes are due to ischemic cerebral infarction and 20% due to brain haemorrhage. Diabetes Mellitus is a very common metabolic disorder and it is an independent risk factor for stroke and is associated with 2 to 6 fold increased risk compared with non-diabetic subjects and worsens survival of patients with acute stroke. Glucose intolerance or even fasting hyperglycemia may follow an acute vascular event, and ensuing physical inactivity and poor food intake may lead to continued glucose intolerance. Thus, glucose intolerance in a stroke patient may or may not reflect glycemia prior to the event. Measurement of HbA1C rather than glucose as an indicator of prior glycemia offers a new perspective. The rate of non-enzymic glycosylation of hemoglobin is believed to depend largely or solely on plasma glucose concentration. Hence this study is to correlate HbA1c levels with clinical profile and Infarct size in patients with Acute Ischemic stroke. Objectives: To see the levels of HbA1c in Acute Ischemic stroke patients. To calculate the infarct size and severity of stroke in Acute Ischemic stroke patients. To estimate the HbA1C levels and correlate HbA1C levels with clinical profile and size of infarct in Acute ischemic stroke patients. Materials and Methods: This a cross sectional descriptive study. Results: This is an cross sectional study including 64 patients. Maximum number of patients were in the age group of 60 – 69 years, with mean age of 63.5912.59 years. The male to female of 1.37 : 1. There were 25 patients (39.1%) well controlled Diabetes patients,16(25.0%) fairly controlled and 23 (35.9%)were poorly controlled Diabetic patient. The common risk factors were Diabetes mellitus, hypertension, smoking, dyslipidemia, Rheumatic heart disease and Retroviral disease. The NIHSS score increased as the infarct size increased from well controlled to poorly controlled diabetes.Increased severity of stroke is seen in poorly controlled diabetes which correlates with the infarct size. Conclusion: HbA1c levels, NIHSS score correlates well with the infarct size.  Patients with poorly controlled diabetes were found to have increased NIHSS score and increased severity of stroke. Severity of the stroke worsened from well controlled diabetes to poorly controlled diabetes. HbA1c should be considered as an independent risk factor for poor clinical outcome and worse prognosis. Early diagnosis and treatment of diabetes including lifestyle modification and periodic monitoring of HbA1c levels may reduce the development of stroke and morbidity and mortality associated with it.   Keywords: HbA1c levels, NIHSS

Introduction: Diabetes Mellitus is a very common metabolic disorder and it is an independent risk factor for stroke and is associated with 2 to 6 fold increased risk compared with non-diabetic subjects and worsens survival of patients with acute stroke. Glucose intolerance or even fasting hyperglycemia may follow an acute vascular event, and ensuing physical inactivity and poor food intake may lead to continued glucose intolerance. Glucose intolerance in a stroke patient may or may not reflect glycemia prior to the event. Measurement of HbA1C rather than glucose as an indicator of prior glycemia offers a new perspective. Hence this study is to find out association between HbA1c levels with NIHSS score in stroke. Objectives: To find out association between HbA1c levels with NIHSS score in stroke. Materials and Methods: This a cross sectional descriptive study. Results: In this study well controlled Diabetes has moderate stroke severity, fairly controlled Diabetes has moderate to severe stroke severity and poorly controlled Diabetes has severe stroke. It is observed that severity of the presenting complaints worsened from well controlled Diabetes to poorly controlled Diabetes. The NIHSS score correlates with the HbA1C, with increase in severity of the stroke from well controlled Diabetes to poorly controlled Diabetes. Conclusion: Severity of the score increases as the infarct size increases. Poorly controlled Diabetes has more severe stroke as per NIHSS score with large sized infarcts. Stroke is a medical emergency and can cause permanent neurological damage, complications and death. National Institutes of Health Stroke Scale (NIHSS) is a well-validated, reliable scoring system for use specifically with stroke patients. The National Institutes of Health Stroke Scale (NIHSS) can be used as a standard measurement instrument by physicians to evaluate the severity of a patient and outcome.   Keywords: Diabetes, NIHHS Score, HbA1C, Stroke, Metabolic disorder

Introduction: The most prevalent form of the disease, type 2 Diabetes Mellitus is often asymptomatic in the early stages and it may remain undiagnosed for many years.The insulin resistance in the liver leads to failure of the hyperinsulinaemia to suppress the gluconeogenesis, which increases fasting glucose levels and decreases Postprandial hypertriglyceridemia results in a proatherogenic environment which leads to atherosclerosis and macrovascular complications in type 2 diabetes mellitus. It is believed that atherosclerosis is a postprandial phenomenon with respect to lipids, as we are in the postprandial state for most of the day. Increased glucose production in the liver occurs early in the course of diabetes, and it is likely in skeletal muscles after the onset of the insulin secretory abnormalities and the insulin resistance Due to the insulin resistance in the adipose tissue and obesity, the free fatty acid (FFA) flux from the adipocytes is increased, which in turn leads to an increase in lipid [very low-density lipoprotein (VLDL) and triglycerides] synthesis in the hepatocytes. This is responsible for the dyslipidaemia which is found in type2 diabetes mellitus [elevated triglycerides, reduced HDL, and increased low-density lipoprotein (LDL) particle.Individuals with type 2 diabetes mellitus are at increased risk of developing microvascular and macrovascular complications. Increased postprandial glucose (PPG) concentrations contribute to suboptimal glycemic control. Objective: To correlate fasting and postprandial dyslipidemia with macrovascular complications of diabetes. Materials and Methods: This is a cross-sectional study, wherein written informed consent was taken after giving detailed information to the participants regarding the study. Patients who were in the age group of 35-65 years, admitted in the Department of Medicine, RRMCH from November 2017 for next 18 months with Diabetes Mellitus who met a predefined inclusion and exclusion criteria were studied. The study was initiated after obtaining clearance from the institution's ethical committee. Results: IHD changes were found in 8 cases and 3 controls, LVH by voltage criteria was found in 15 cases and 8 controls. IHD changes found in cases and controls are 16% and 6% respectively. LVH changes found in cases and controls are 30% and 16% respectively.Abnormal 2D Echo findings in our study were mainly IHD and LVH. The occurrence of IHD was more in cases compared to controls with statistical significance(p Conclusion: It could be said that there is an increase in the occurrence of postprandial dyslipidemia with increasing age, irregular treatment, increase in HbA1c, FBS ,PPBS and with the past history of HTN, CVA, PVD and IHD.All macrovascular complications (IHD, CVA, PVD) were found more in the case compared to controls with statistical significance. So it could be said that there is an increase in the occurrence of macrovascular complications with an increase in postprandial dyslipidemia. Keywords: T2DM, IHD, CVA, PVD, LDL, TG, TOTAL Cholesterol.

Introduction: Diabetes Mellitus (DM) is a group of metabolic diseases, which is characterized by chronic hyperglycaemia, which results from the defects in the insulin action, insulin secretion or both. The most prevalent form of the disease, type 2 Diabetes Mellitus is often asymptomatic in the early stages and it may remain undiagnosed for many years.The insulin resistance in the liver leads to failure of the hyperinsulinaemia to suppress the gluconeogenesis, which increases fasting glucose levels and decreases. glycogen storage by the liver in the postprandial phase. Increased glucose production in the liver occurs early in the course of diabetes, and it is likely in skeletal muscles after the onset of the insulin secretory abnormalities and the insulin resistance. Due to the insulin resistance in the adipose tissue and obesity, the free fatty acid (FFA) flux from the adipocytes is increased, which in turn leads to an increase in lipid [very low-density lipoprotein (VLDL) and triglycerides] synthesis in the hepatocytes. This is responsible for the dyslipidaemia which is found in type2 diabetes mellitus [elevated triglycerides, reduced HDL, and increased low-density lipoprotein (LDL) particlesIndividuals with type 2 diabetes mellitus are at increased risk of developing microvascular and macrovascular complications. Objective: To find out the significance of postprandial dyslipidemia in diabetic patients. Materials and Methods: This is a cross-sectional study, wherein written informed consent was taken after giving detailed information to the participants regarding the study. Patients who were in the age group of 35-65 years, admitted in the Department of Medicine, RRMCH from November 2017 for next 18 months with Diabetes Mellitus who met a predefined inclusion and exclusion criteria were studied. The study was initiated after obtaining clearance from the institution's ethical committee. Results: There was a significant elevation of mean values of total serum cholesterol, LDL and TG of cases and controls in the postprandial state compared to their fasting state, statistical significance was found (P Conclusion: Prevalence of diabetes was highest in the age group 56-65 years in our hospital.As the duration of diabetes increases, there is an increased prevalence of dyslipidemia in the cases.Past history of HTN, IHD, PVD and CVA were found significantly more in subjects with fasting and postprandial dyslipidemia (cases) compared to those without(controls).Patients on irregular treatment (63%) were more in the study group(cases) compared to controls. So it could be said that patient not on regular treatment are more prone to have dyslipidemia. (fasting as well as postprandial). There was a significant increase in total serum cholesterol, LDL and TG in postprandial states of cases compared to that in controls, so it could be said that diabetic patients with fasting dyslipidemia are more prone to have dyslipidemia in the postprandial state. Keywords: T2DM, IHD, CVA, PVD, LDL, TG, TOTAL Cholesterol

Introduction: In the modern world, the growing incidence of type 2 diabetes mellitus (T2DM) is a critical problem. In type 2 DM, abnormal lipid profile in the postprandial state has more significance than abnormal lipid profile in fasting state in causing atherosclerotic complications. The high cardiovascular morbidity and mortality in type2 DM are due to prolonged postprandial hyperglycemia and triglyceridemia. Postprandial hypertriglyceridemia results in a proatherogenic environment which leads to atherosclerosis and macrovascular complications in type 2 diabetes mellitus. It is believed that atherosclerosis is a postprandial phenomenon with respect to lipids, as we are in the postprandial state for most of the day.It is not clearly known whether diabetic patients with macrovascular disease have greater abnormalities of postprandial TG metabolism than those without.Hence this study is being carried out to find out the characteristics of post prandial lipid levels in patients with type 2 diabetes mellitus and itsimpact on macrovascular complications. Objective: To study fasting & postprandial lipid abnormality in type 2 DM patients in comparison to controls. Materials and Methods: This is a cross-sectional study, wherein written informed consent was taken after giving detailed information to the participants regarding the study. Patients who were in the age group of 35-65 years, admitted in the Department of Medicine, RRMCH from November 2017 for next 18 months with Diabetes Mellitus who met a predefined inclusion and exclusion criteria were studied. The study was initiated after obtaining clearance from the institution's ethical committee. Results: There was a significant elevation of mean values of total serum cholesterol, LDL and TG of cases and controls in the postprandial state compared to their fasting state, statistical significance was found (P Conclusion: Patients on irregular treatment (63%) were more in the study group(cases) compared to controls. So it could be said that patient not on regular treatment are more prone to have dyslipidemia. (fasting as well as postprandial). There was a significant increase in total serum cholesterol, LDL and TG in postprandial states of cases compared to that in controls, so it could be said that diabetic patients with fasting dyslipidemia are more prone to have dyslipidemia in the postprandial state. This study concluded that all macrovascular complications (IHD, CVA, PVD) were found more in the case compared to controls with statistical significance. So it could be said that there is an increase in the occurrence of macrovascular complications with an increase in postprandial dyslipidemia. Keywords: T2DM, IHD, CVA, PVD, LDL, TG, Total Cholesterol.

Introduction: Diabetes is one of the most common chronic hyperglycemic syndrome. Diabetic Nephropathy is one of the major complications of DM characterized by persistent albuminuria, increased arterial blood pressure, a relentless decline in glomerular filtration rate (GFR) & a high risk of cardiovascular morbidity & mortality. The biological marker of DN is fibrinogen. Fibrinogen, is increased in diabetic patients. An increase in plasma fibrinogen levels is also considered an independent risk factor for diabetic nephropathy. Fibrinogen is the major coagulation protein in blood. Objectives:To find out whether the levels of Plasma Fibrinogen levels can be used as markers for the early diagnosis of DN. Materials and Methods: Study design: A case control study. The study includes total of 150 patients, of which 50 were diabetic without any complications, 50 were diabetic nephropathy patients and remaining 50 were age matched healthy controls. Results: The mean plasma fibrinogen level in control group was 190.34 72.83 mg/dl. The mean plasma fibrinogen levels in DM & DN groups were 522.76 115.79 mg/dl & 657.64 124.61 mg/dl respectively. In our study, fibrinogen levels were increased significantly in DM group compared to controls which was further increased in DN group. Hence above studies interpret that fibrinogen increases in diabetes with complications. Conclusion: Fibrinogen correlated positively with FBS, HbA1c , TC, triglyceride, LDL, Blood Urea, serum creatinine, TC/HDL, LDL/HDL & urine A/C ratio in both DM & DN group, whereas there was negative correlation of fibrinogen with HDL & eGFR. Thus fibrinogen could be used as early biomarkers for the diagnosis of DN. Keywords: Conclusion: Fibrinogen correlated positively with FBS, HbA 1c, TC triglyceride, LDL, Blood Urea serum creatinine, Diabetes Miletus, Diabetic Nephropathy.

Introduction : Chronic liver disease can vary from mild hepatic inflammation without fibrosis to advanced hepatic fibrosis and cirrhosis. The use of ultrasound for the confirmation of complications during biopsy procedures increases the cost of treatment and may also increase the duration of hospitalization. Fibro Q test (FQT), Aspartate amino transferase – Alanine amino transferase ratio (AAR) & Aspartate amino transferase- platelet ratio index (APRI) are the three non-invasive and simple indices proposed for assessing fibrosis in CLD. Objectives: To know the efficacy of the indices- Fibro Q test, AAR, APRI as markers of Fibrosis in CLD. To know which among these indices would be the high sensitive marker of liver fibrosis. Materials and Methods: This study includes 60 subjects, out of which 30 were clinically diagnosed as CLD and were confirmed by abdominal ultrasound and 30 were age matched healthy controls. Results: Fibro Q, AAR & APRI were significantly increased in cases compared to controls. The increase in Fibro Q test in cases was highly significant (p-0.0001) when compared to controls. Conclusion: Fibro Q test, AAR & APRIindicesare efficient markers to evaluate liver fibrosis in CLD patients. Fibro Q, a novel non-invasive test, is highly sensitive marker than AAR & APRI. Keywords: Fibro Q Test, Alanine amino transferase ratio (AAR), Aspartate amino transferase platelet ratio index (APRI), Chronic liver Disease.

Pleural effusion is one of the common condition encountered in day to day practise. A correct diagnosis of the underlying disease is essential to rational management. Today there are a number of laboratory tests available to differentiate exudates and transudates which are considered cost effective to the patients, so this study was designed for the measurement of pleural fluid cholesterol to differentiate transudative and exudative pleural effusions (sensitivity-97.8%, specificity-100%) with the advantage that a contemporary blood sample is not required, thereby lowering cost of diagnostic procedure. Objectives: To study the diagnostic value of Pleural fluid Cholesterol in differentiating transudative and exudative pleural effusions. Materials and Methods: This cross sectional descriptive study was conducted on patients of pleural effusion (n=60) age >18 years patients with definitive clinical diagnosis and evidenced by radiological diagnosis of pleural effusion were taken as inclusion criteria. Results: The results showed majority of the patients were males (63.3%) and females (36.7%). According to lights criteria 46 patients were exudates and 14 patients were transudates and according to Pleural fluid Cholesterol criteria 45 patients were exudates and 15 patients were transudates with sensitivity of 97.8% and specificity of 100% and accuracy of 98.3%. Conclusion: The pleural fluid cholesterol criteria were found to be the most efficient criteria. Since this parameter involves the measurement of only pleural fluid values of cholesterol, it has following advantages- Economically it reduces number of biochemical tests and Simpler as there is no need to take simultaneous blood sample at the time of thoracocentesis. Keywords: Pleural Effusion, Transudates, Exudates. Cholesterol.

Need for the study: In view of the long-term disabilities caused by stroke the need for an accurate early prediction of future functional abilities is paramount for setting therapeutic goals, starting early rehabilitation planning, implementing home adjustments and community support tailored to patients needs, and informing patients about their prospects and prognosis.in this study we have assessed significance of the national institute of health stroke scale (NIHSS) score on the day of admission in predicting the severity and outcome on 30th day ,in acute stroke patients. Materials and Methods: It is a observational prospective study, study conducted on 93 patients of stroke who were admitted in Shri B M Patil Medical College hospital who were diagnosed and admitted with acute stroke on the basis of the History, Clinical examination and proved on CT/MRI scan. Patients were selected on the basis of the inclusion and exclusion criteria. NIHSS score is noted on the day of admission and then after 30days of stroke and the patient is independent at home or requires assistance is also noted and statistically analyzed. This study was conducted between December 2017 to July 2019. Results: In this study, after 1 month of stroke among 3 patients who had baseline NIHSS score 1-4, all 3(100%) are independent at home, among 73 patients who had baseline NIHSS score 5-15, 47(64.4%) are independent and 26(35.6%) required assistance, among 7 patients who had score 16-20, 1(14.3%) patient was independent at home, 6(85.7%) required assistance, and among 10 patients who had score more than 20, 7(70%) died, 3(30%) required assistance and none of them are home independent. With the p value  Conclusion: Baseline NIHSS score helps in predicting the outcome of the patient. Lesser the baseline score better will be the outcome. Keywords: NIHSS Score, Stroke, MRI, CT Scan.