MKCG Medical College Research Articles

Role of Serum Retinol Binding Protein 4 (RBP4) Concentration in Patients with Primary Hypertension: A Case-control Study

Introduction: Serum Retinol Binding Protein 4 (RBP4), an adipokine that transports vitamin A from the liver to other tissues, is reported to be elevated in hypertensive subjects. Positive correlation between RBP4 and cardiovascular risk factors has been noted in a few studies. Aim: To evaluate serum RBP4 levels in newly diagnosed primary hypertensive cases and non hypertensive controls and to correlate serum RBP4 levels with lipid profile. Materials and Methods:This case-control study was conducted at the Department of Biochemistry in collaboration with the Department of Medicine, from August 2019 to June 2020 in MKCG Medical College and Hospital, Berhampur, Odisha, India. A total of 51 newly diagnosed primary hypertensive patients and 51 healthy age and sex-matched individuals between the ages of 18 to 50 years were enrolled in the study. Systolic and Diastolic Blood Pressure (SBP and DBP) were measured in both cases and controls.Serum RBP4 was measured by Enzyme-Linked Immunosorbent Assay (ELISA) and other biochemical parameters were measured by TBA120FR autoanalyser. Result: The mean age for controls was 36.98±8.7 years and that in cases was 39.00±8.4 years. Proportion of males was higher (56.8%) than females (43.2%). The mean systolic blood pressure in the case group was significantly higher as compared to the control group. The cases had a higher level of serum RBP4 (31.82 mg/L) compared to the control groups (15.5 mg/L) RBP4 (p<0.001). The cases had a higher level of mean serum triglyceride (196.20±67.81 mg/dL) and lower level of mean serum High-Density Lipoprotein cholesterol (HDLc) (37.53±11.90 mg/dL) as compared to the control groups which had a mean triglyceride of 104.25±39.89 mg/dL and HDLc of 57.18±10.73 mg/dL (p<0.001). The serum RBP4 level positively correlated with SBP (r=0.644, p<0.001), DBP (r=0.444, p<0.001), serum triglycerides (r=0.649, p<0.001), and negatively correlated with HDLc (r=-0.313, p=0.025). Conclusion: A high serum RBP4 level was found in the newly diagnosed hypertensive cases as compared to normotensive controls. A significant positive correlation was observed between RBP4 with systolic and diastolic blood pressure along with triglyceride levels. A significant negative correlation was observed between RBP4 with HDLc.

Correlation of Serum Leptin with Body Mass Index and Insulin Resistance in Polycystic Ovarian Syndrome in a Tertiary Care Centre of Southern Odisha, India

Introduction: Leptin is an adipocyte derived hormone encoded by ob gene which serves as a relay link between metabolic signals and brain that regulate the hypothalamic pituitary ovarian axis. Leptin is related with obesity which is a most important cause of Polycystic Ovarian Syndrome (PCOS) in women of reproductive age group. Aim: To evaluate leptin concentration and to analyse its correlation with Body Mass Index (BMI) and insulin resistance in PCOS. Materials and Methods: This case-control study was conducted from December 2018 to December 2019 at Department of Biochemistry in collaboration with Department of Obstetrics and Gynaecology, MKCG Medical College and Hospital, Berhampur, Odisha, India. A total of 60 PCOS subjects, aged between 15-30 years (30 obese PCOS and 30 lean PCOS) and 30 age matched, normal ovulatory healthy controls were included in the study. Parameters such as serum leptin, fasting plasma insulin, Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), Fasting Plasma Glucose (PPG), Postprandial Plasma Glucose (PPPG) were estimated using commercial kits. One-way Analysis of Variance (ANOVA) test was used for data analysis and the Pearson’s correlation method was used to find the correlation between the parameters. Results: The mean age of women in all the three PCOS groups was found to be 22.4±3.13 years. The BMI of obese PCOS patients (31.9±4.7 kg/m2 ) and lean PCOS patients (21.4±2.2 kg/m2 ) were higher than that of healthy controls (20.7±1.8 kg/m2 ) which was statistically significant (p-value <0.001). The serum leptin in obese PCOS were significantly higher (28.0±17.8 ng/mL) than lean PCOS (5.8±2.2 ng/mL) and fasting plasma insulin in lean PCOS were (10.9±2.4 µIU/mL) significantly lower than obese PCOS (30.2±14.8 µIU/mL). Mean serum leptin levels had significant positive correlation with BMI in lean and obese PCOS and insulin resistance in obese PCOS. Conclusion: In the present study, high leptin concentration was observed in PCOS patients and there was positive correlation of leptin with BMI in both lean and obese PCOS groups and leptin was positively correlated with insulin resistance in obese PCOS.

Role of Serum Irisin During Early Pregnancy to Predict The Development of Gestational Diabetes Mellitus at 24-28 Weeks of Pregnancy in high-risk patients.

Aims:The aim of this prospective study was to investigate the role of serum irisin during early pregnancy to predict the development of GDM at 24–28 weeks in high-risk patients.Methodology:This study was conducted among the pregnant women attending the Department of Endocrinology and antenatal clinic of Department of Obstetrics and Gynecology of MKCG Medical College for a period of one year with at least one risk factor for the development of gestational diabetes mellitus (GDM). Blood samples were collected for measurement of fasting plasma glucose, serum insulin, serum irisin, lipids (TC, LDL, HDL, TG), and HbA1c. Oral glucose tolerance test was performed using 75 g of glucose during the first trimester and between 24–28 weeks of pregnancy. Patients were diagnosed as GDM based upon IADPSG criteria at 24–28 weeks. Serum irisin, glycemic parameters, and homeostatic model assessment of insulin resistance during first trimester were analyzed for predicting GDM between 24–28 weeks.Results:Sixty-five patients were included in the study, out of which 20 (30.8%) patients developed GDM and the rest 45 patients had normal glucose tolerance (NGT). The first trimester mean serum irisin concentration was significantly lower in women who later developed GDM compared with women who had NGT (111.65 ± 25.43 μg/L vs 185.89 ± 28.89 μg/L). Serum irisin concentration was the best predictor with an optimal threshold value of 149 μg/L, which had sensitivity, specificity, positive predictive value, and negative predictive value of 90%, 91.1%, 81.8%, 95.3%, respectively, for predicting GDM at 24–28 weeks of pregnancy.Conclusion:We suggest the utility of serum irisin as an early biomarker to predict the development of GDM later in pregnancy in high-risk patients.

Six Sigma Metrics: An Evolving Indicator of Quality Assurance for Clinical Biochemistry

Introduction: The analytical phase of the total testing process is the one in which the clinical biochemist can directly intervene to improve the quality of tests reporting. The sigma metrics and Operational Process Specification (OPSpec) chart can specify to which category the laboratory belongs. Aim: To apply sigma metrics to analytical process of testing, do the root cause analysis and apply the corrective measures according to Westgard Rules to improve laboratory performance towards the quality assurances. Materials and Methods: This was a retrospective-prospective study carried out in a clinical laboratory of MKCG Medical College and Hospital, Berhampur, Odisha, India, from July 2020 to March 2021. A retrospective secondary data analysis of six months duration was carried out in a clinical chemistry laboratory with a follow-up prospective study for three months. During this period, 16 analytes were tabulated to analyse the Internal Quality Control (IQC). External Quality Control (EQC) for the same analytes were obtained on monthly basis and the sigma metrics was calculated for each analytes. For analytes with sigma value <3, appropriate measures were taken according to Westgard rules to improvise the quality of laboratory investigations. The statistical analysis of sigma metrics was performed in “R” v-3.6.3. Results: Out of total 16 analytes, three analytes at level 1 and two analytes at level 2 Quality control (QC) showed a world class performance whereas four analytes showed a poor performance at both the QC levels with sigma metrics value <3. From Quality Goal Index (QGI) and root cause analysis, the source of error was detected and corrected. Conclusion: The inaccuracy and imprecision of different parameters in the analytical phase of the testing process can be addressed by calculating the sigma metrics and do the root cause analysis. Application of corrective measures according to Westgard rule can improve the laboratory performance towards the quality assurance.

EVALUATION OF RENAL CHANGES IN SICKLE CELL DISEASE IN A REFERRAL GOVERNMENT INSTITUTE OF SOUTHERN ODISHA

Objective: The objective of the study was to study various renal manifestations in sickle cell disease (SCD) and to establish a cause and effect relationship with the evaluation of risk factors. Methods: This prospective observational cross-sectional study was conducted on 82 SCD patients belonging to the age group of 15–50 years of both the genders over a period of 2 years from January 2019 to December 2020 in MKCG Medical College and Hospital, Berhampur, Odisha, India. Eighty-two patients, 32 (39.02%) having sickle cell anemia (SCA) and 50 (60.98%) having sickle cell trait (SCT), admitted to medicine and nephrology wards of the hospital were included in this study. SCD patients with other hemolytic anemia and with renal congenital/structural abnormality and patients with systemic diseases such as diabetes mellitus, systemic hypertension, and systemic lupus erythematosus were excluded from the study. Various laboratory investigations such as complete blood count, hemoglobin (Hb), serum sodium, serum potassium, serum urea, serum creatinine, fasting blood sugar, erythrocyte sedimentation rate, liver function test, urine routine, and microscopic test were carried out. Diagnosis of SCD patients was based on sickling test and high-performance liquid chromatography testing. Radiologic imaging (Sonography for renal changes) was done at radiodiagnosis department of the hospital. Results: Glomerular and tubular dysfunction was more in SCA (Hb SS) patients than SCT (Hb AS) patients and the abnormality was more in patients in crisis. Albuminuria in 78.12%, hematuria in 46.87%, cast and crystal in 28.12%, epithelial cell in 31.25%, and hyposthenuria in 56.25% were found in SCA patients. In SCT patients, albuminuria in 38%, hematuria in 16%, cast and crystal in 22%, epithelial cell in 12%, and hyposthenuria in 24% were found. All the above findings were more in percentages in crisis patients of both the groups. In SCA, 37.5% and in SCT, 2% were found to have chronic kidney disease. Conclusion: Renal involvement in the form of glomerular and tubular dysfunction occur in SCD and more in crisis patients, leading to renal complications, and end-stage renal disease.

English

BACKGROUND Dengue is an acute viral haemorrhagic fever with large number of fatalities worldwide. According to WHO, 50 - 100 million infections occur annually, out of which 5 lakhs are dengue haemorrhagic fever. India is no way better like any other tropical country. Southern part of Odisha shows high prevalence of dengue cases which are referred to MKCG Medical College, Berhampur. Dengue is a vector borne disease, which is of much epidemiological importance throughout India. No clinical study has been undertaken in recent past on this disease as regard to clinical parameter, course and outcome. Hence, it was decided to carry out a study to assess the epidemiological profile of dengue patients, the prevalence and pattern of liver and kidney dysfunction and outcome of hospitalized patients in MKCG Medical College and Hospital. METHODS This cross-sectional study was carried out on laboratory confirmed dengue patients admitted to hospital in Department of Medicine, MKCG Medical College & Hospital, Berhampur from January 2018 to December 2018. RESULTS More number of patients (58 %) were male and from rural area (72 %). Alanine aminotransferase (ALT) and aspartate aminotransaminase (AST) were elevated in 68 % of cases to more than 3 times of normal. Mortality is 4 % among the admitted patient. More death observed with high international normalized ratio (INR) value. CONCLUSIONS Mortality is high in patients of dengue with deranged liver function and kidney function. Early screening of dengue patients by clinical and laboratory parameter will help clinicians to predict mortality for dengue cases. Dengue cases with liver and kidney dysfunction need aggressive monitoring and appropriate management to prevent complications and death. KEYWORDS Severe Dengue, Early Parameters, AST / ALT, Outcome, Mortality

English

BACKGROUND Decrease in haemoglobin concentration in blood, with normal blood volume results in lower V̇ O2max and endurance performance. This may be due to the reduction of the oxygen carrying capacity of blood. Conversely, increase in haemoglobin concentration is associated with increased V̇ O2max and endurance capacity. Increase in endurance capacity is also proportional to the increase in the oxygen carrying capacity of blood. Maximal aerobic capacity (V̇ O2max) is the maximum capacity of individual’s body to transport and use oxygen during incremental exercise which reflects physical fitness of that individual. Queen’s College Step Test is a standard method to measure one’s maximal aerobic capacity using sub maximal exercise in the form of bench stepping suitable for adults. The biological significance of oxygen transport by haemoglobin is well illustrated in anaemia where decreased haemoglobin also decreases exercise performance. The objective of the study is to find out the correlation between haemoglobin concentration and V̇ O2max by using Queen’s College Step Test. METHODS The study was conducted in the Department of Physiology, MKCG Medical College, Berhampur. A total of 150 1st year MBBS students aged between 17 and 24 yrs. were taken as subjects. Out of them 90 were males & 60 were females. Each subject performed the exercise for 3 minutes by Queen’s College Step Test. V̇ O2max was obtained by calculation. Haemoglobin concentration was measured by Acid Haematin method in Sahli’s Haemoglobinometer. RESULTS There was a significant positive correlation between haemoglobin concentration with VO2max in both males (r = 0.8618, P < 0.0001) and females (r = 0.5112, P < 0.0001) subjects. CONCLUSIONS Increase in Haemoglobin concentration is an indicator of increased V̇ O2max; hence persons with increased haemoglobin concentration may have increased exercise capability in both male and female subjects. KEYWORDS V̇ O2max, Haemoglobin concentration, Queen’s College Step Test

English

BACKGROUND Population based studies indicate that the incidence and prevalence of seizure disorders in adults increase with age, especially in elderly, after the age of 60 years. The underlying etiological spectrum is variable across geographies. Analysis of aetiology of seizure is essential for proper treatment to reduce the morbidity and mortality associated with it. The present study was planned to analyse the aetiology of new onset seizures in adult population (> 18 years of age). METHODS The cross sectional study was carried out in the Department of Medicine of MKCG Medical College & Hospital for a period of two years. 100 consecutive cases of new onset seizures admitted in the in-patient department (indoor / ward) were included in the study as per the inclusion and exclusion criteria. The data was collected by the investigators in a pre-tested Case Record Form. Data analysis was done using Microsoft Excel and GraphPad Prism trial version 7.0. Descriptive statistics were presented as proportions for discrete variables and as mean ± SD for continuous variables. P value of ≤ 0.05 was taken as statistically significant. RESULTS Acute symptomatic seizures accounted for 89 % of cases. Neuro-infection was the leading aetiology in 35 % of cases, followed by cerebrovascular accidents (30 %) and metabolic causes (10 %). Neurocysticercosis was seen in 11 % cases, followed by meningitis and cerebral malaria. Among the vascular causes, stroke accounted for 20 %. Prevalence of neuro-infection was highest in the age group of 15 - 35 years. 89 % of idiopathic seizures were generalized tonic-clonic seizure (GTCS). The prevalence of status epilepticus was 8 %. CONCLUSIONS Adult onset seizures have a varied spectrum of aetiology. With a thorough history, clinical examination and appropriate investigations, the aetiology can be identified. Accordingly, treatment can be instituted thus reducing the morbidity and mortality associated with it. KEYWORDS Aetiology, New Seizures, Stroke, Vascular, Neuro-Infection

CLINICAL PROFILE AND ETIOLOGICAL EVALUATION OF NON-TRAUMATIC MYELOPATHIES USING MAGNETIC RESONANCE IMAGING

Objective: The present study was conducted with an objective to identify the etiology of non-traumatic myelopathies of both compressive and non-compressive types with the aid of magnetic resonance imaging (MRI).
 Methods: This retrospective observational cross-sectional study was conducted on 100 patients with a clinical diagnosis of non-traumatic myelopathy belonging to the age group of 15–75 years from August 2018 to July 2020 in the Departments of General Medicine and Radiodiagnosis of MKCG Medical College and Hospital, Berhampur, Odisha. Detailed history, clinical evaluation, laboratory investigations, and findings of MRI spine and brain were compiled. Results were analyzed using descriptive statistics.
 Results: Among 100 patients of non-traumatic myelopathy, 65 patients presented with compressive myelopathy and 35 patients with non-compressive myelopathy where 56 patients presented with paraparesis and 44 with quadriparesis. Pott’s spine (n=25, 38.46%) and acute transverse myelitis (ATM) (n=24, 68.57%) were the most common etiologies found in compressive and non-compressive groups, respectively.
 Conclusion: Pott’s Spine, spondylotic myelopathy, and ATM were the most common etiologies of non-traumatic myelopathy. MRI has proven to be the ultimate imaging modality for their etiological evaluation.

ECHOCARDIOGRAPHIC ASSESSMENT OF HYPERTENSIVE CHANGES IN ELDERLY PATIENTS OF ISOLATED SYSTOLIC HYPERTENSION WITH SPECIAL REFERENCE TO CARDIOVASCULAR COMPLICATIONS

Objective: The objective of the study was to assess the echocardiographic changes and cardiovascular complications in patients with isolated systolic hypertension (ISH).
 Methods: This was an observational cross-sectional study done in the Departments of General Medicine, Cardiology, and Radiodiagnosis of MKCG Medical College and Hospital, Berhampur, Odisha, India. Seventy patients above the age of 65 years with systolic blood pressure (BP) ≥140 mm Hg and diastolic BP <90 mm Hg, without any secondary causes of hypertension and antihypertensive drug therapy were selected for this study. Echocardiography and electrocardiography studies were implemented for demonstrating the development of cardiovascular complications.
 Results: Of 70 cases (41 males and 29 females), 64.3% were asymptomatic and 35.7% were symptomatic, with palpitation being the major symptom, 40% (28 cases) developed retinopathy, 45.71% developed increased left ventricular mass index (p=0.04), 18.57% had increased in LV volume (>90 ml/m2), 30% cases had regional wall motion abnormalities, 27.1% had reduced ejection fraction (<56%), and 52.66% showed LA enlargement in this study (p=0.048). Doppler measurements of diastolic filling were significant in patients with ISH with higher peak atrial velocity (A wave) of 79.71±11.79 cm/s and a lower ratio of peak early to atrial velocity of 0.82±0.29.
 Conclusion: This study demonstrates that elderly patients with ISH had a prevalence of concentric left ventricular hypertrophy (LVH) which was found to be more in female patients than in male patients followed by left atrial enlargement.

A Prospective study for assessing the role and significance of haematological parameters in diabetes in Southern Odisha

Background: In the present situation globally, there is an increasing burden of diabetes mellitus in the developing and developed countries alike. With an increase in the carbohydrates intake due to the consumption of junk and unhealthy food, the cases of diabetes mellitus are alarmingly increasing. Diabetes is not a single disease in itself. It has been estimated that nearly 59.2 million patients around the world suffer from diabetes mellitus. Aim: To assess the role and significance of haematological parameters in diabetes in Southern Odisha Materials and Methods: It was a prospective study carried out at the Department of Pathology at the MKCG Medical College Berhampur, Ganjam (Odisha). The study period was from March 2019 to August 2019. One hundred subjects were registered for the study, among which 50 of the patients were in the diabetic group, and the remaining 50 were in the non-diabetic group (Group 1). The diabetics were further divided into two groups diabetics with HbA1c 7 with 25 patients (Group 3). There are chances that patients with very low haemoglobin may show erroneous HbA1c values. Thus, to overcome this, we measure HbA1c of every patiente twice using Sebia Capillary Flex-Piercing instrument to acertain the accuracy and reliability of the study. The biological reference range in both males and females for RBC count is 3.8-6.5 million/cu.mm, Hb is 11.5-17mg/ dl, Hematocrit is 37-54%, MCV is 80-100m3 , MCH IS 27-32 pg, MCHC is 32-36g/dl and RDW is 11-16%. All the patients who had hypo/hyperthyroidism, CKD, an inflammatory disorder, and congenital heart disease were excluded from the study. Result: Most of the patients were aged between 41-60 years in group 1, group 2, and group 3. It was also evident from the above table that the number of female patients was more as compared to the number of males. Among different values of red blood cell parameters in group 1 and group 2, there was a statistically significant difference betwe

Association of Osteocalcin with Metabolic Syndrome and its Correlation with Insulin Resistance

Introduction: Metabolic Syndrome (MetS) is an important public health burden associated with five-fold risk of developing Type 2 Diabetes Mellitus (T2DM) and two fold risk of Cardio Vascular Disease (CVD). Recent studies described that osteoblasts produce osteocalcin which increases insulin secretion and adiponectin production resulting in insulin sensitivity. Aim: To determine the association of serum osteocalcin with MetS and to assess the correlation of insulin resistance Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) with osteocalcin. Materials and Methods: This case-control study was carried out in the Department of Biochemistry at MKCG Medical College, Brahmapur, Odisha, India. By observing the mean and standard deviation from previous studies, with 95% Confidence Interval (CI) and 80% power of study, the sample size was calculated to be 45. Forty eight cases between 20-45 years of age meeting the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria of MetS and 50 age and sex matched healthy individuals were taken as controls. Individuals with any systemic illness or on any kind of medications were excluded from the study. Fasting blood sugar, lipid profile were measured by standard procedures. Serum osteocalcin and serum insulin was estimated by Enzyme-linked Immunosorbent Assay (ELISA) LISA SCAN READER and ROCHE e COBAS 411 electrochemiluminiscence, respectively. Statistical analysis was done in Statistical Package for the Social Sciences (SPSS) 22.0 version software. Results: Serum osteocalcin was found to be lower in cases as compared to controls (7.74±4.62 ng/mL and 23.24±9.74 ng/mL) respectively. Osteocalcin was also found to be significantly negatively correlated with HOMA-IR, Waist Circumference (WC), triglyceride and fasting blood sugar in cases with (r=-0.322, p=0.025), (r=-0.519, p<0.001), (r=-0.401, p=0.005), (r=-0.539, p<0.001), respectively and also in controls with (r=-0.494, p<0.001), (r=-0.176, p=0.245), (r=-0.398, p<0.05), (r=-0.141, p<0.05), respectively. Conclusion: Serum osteocalcin being negatively correlated with insulin resistance may have therapeutic role in prevention of MetS which may be substantiated with further study.

Renal Function among HIV Infected Patients on Combination Antiretroviral Therapy: ALongitudinal Cohort Study

Introduction: A large number of Human Immunodeficiency Virus (HIV) infected patients are taking combination Antiretroviral Therapy (cART) worldwide as it has led to dramatic improvements in them with a decreased viral load as well as an increase in Cluster of Differentiation (CD4+) T cell count. Though the incidence of HIV associated Chronic Kidney Disease (CKD) has decreased with the use of effective cART, the prevalence of End Stage Renal Disease (ESRD) in HIV positive patients has increased due to the risen longevity owing to them. Aim: To study the renal function abnormalities in HIV infected patients and to compare the change in renal function of treatment naïve patients with patients on triple drug regimen (cART). Materials and Methods: This prospective longitudinal cohort study was conducted on 54 Enzyme Linked Immunosorbent Assay (ELISA) positive HIV patients belonging to the age group of 18-70 years of both the genders over a period of two years from August 2017 to September 2019 in MKCG Medical College and Hospital, Berhampur, Odisha, India. Forty nine HIV infected patients naive to cART and five patients on cART for a minimum period of three months were included in this study. All patients were treated with triple therapy regimens of either ZLN (Zidovudine 300 mg+Lamivudine 150 mg+Nevirapine 200 mg) or TLE (Tenofovir 300 mg+Lamivudine 150+Efavirenz 600 mg) daily; in a single dose at bed time. Renal function parameters like serum urea, serum creatinine, Creatinine Clearance (CrCl), estimated Glomerular Filtration Rate (eGFR) and CD4+ T cell count of treatment naive patients were compared with the same patients on cART after six months duration. GFR was calculated by Modification of Diet in Renal Disease (MDRD) equation. Results were analysed using the Statistical Package for the Social Sciences (SPSS) software for Windows Version 17.0. Results: Out of 54 patients, 53.7% (n=29) were males and 46.3% (n=25) were females. The mean CrCl of HIV positive patients on cART (79.09±25.705 mL/min) was higher than treatment naive (69.65±25.506 mL/min) patients and was highly significant (p-value=0.003). The mean eGFR of HIV positive patients on cART (102.711±26.9424 mL/min/1.73 m2) was higher than treatment naïve (90.189±28.2575 mL/min/1.73 m2) patients and was highly significant (p-value=0.003). The mean serum urea of HIV positive patients on cART (25.78± 4.721 mg/dL) was lower than HIV positive treatment naïve (26.19±4.742 mg/dL) patients but was non-significant (p-value=0.640). The mean serum creatinine of HIV positive patients on cART (0.815±0.1393 mg/dL) was lower than HIV positive treatment naïve patients (0.906±0.1687 mg/dL) and was also highly significant (p-value=0.003). The mean CD4+ T cell count of HIV positive patients on cART (401.63±225.816 cells/μL) was higher than HIV positive treatment naïve (287.13±198.263 cells/μL) patients and was very highly significant (p=0.001). Conclusion: Renal impairment (CrCl <60 mL/min) and eGFR (<60 mL/min/1.73 m2) were higher in HIV positive treatment naive patients than those on cART. Radiological parameters like size of the kidney and cortical echogenicity became normal after six months on cART.

Clinical Profile and Immediate Outcome of Multisystem Inflammatory Syndrome in Children Associated with COVID-19: A Multicentric Study.

Introduction:Following an asymptomatic or mildly symptomatic coronavirus disease (COVID-19), otherwise healthy children may develop serious manifestations in the form of cardiac, neurological, respiratory, gastrointestinal, and dermatologic dysfunction. Many such cases were being observed in Odisha, an eastern state of India, and have been reported from different health-care facilities. We related these unexplained serious manifestations to multisystem inflammatory syndrome associated with COVID-19 (MIS-C) and planned this study.Methods:This retrospective observational study was carried out at the following three tertiary care centers: Kalinga Institute of Medical Sciences, Bhubaneswar; MKCG Medical College, Berhampur; and Jagannath Hospital, Bhubaneswar. The study population included all children aged from 1 month to 18 years admitted to the hospitals with MIS-C according to the WHO diagnostic criteria. All the data were analyzed by SPSS software.Results:A total of 21 children were included in our study. Majority of the cases were male (76.2%), and the predominant age group was 6–10 years (47.6%). Common symptoms and signs in our observation included fever, pain abdomen, seizure, and hypotension. Most of these cases were positive for severe acute respiratory syndrome coronavirus antibody (80.95%). Response to immunotherapy was dramatic. Mortality (9%) of our study was higher than 1.8%–3% from that of Western literature. None of our patients had coronary abnormality, while two patients had mild cardiac dysfunction at discharge comparable to that of other studies.Conclusion:MIS-C following exposure to COVID-19 infection in children is a clinical syndrome, which needs early suspicion and appropriate intervention to prevent mortality.

Changes in Inspiratory and Expiratory Flow Rates with Sustained Hand Grip and their Correlation with Fat Free Mass Index in Healthy Young Adults

Introduction: Aerobic exercises which are isotonic in nature have been proved to be beneficial in a number of cardiovascular and lifestyle diseases. But the effect of isometric exercises on cardiovascular and respiratory system is not fully evaluated. Existing literature on effect of isometric exercise on respiratory flow parameters are scanty and needs to be studied. Further, the impact of muscle mass on respiratory flow parameters need to be evaluated. Aim: To investigate the change in respiratory flow parameters (Peak Inspiratory Flow (PIF), Maximal Inspiratory Flow (MIF) 50, Peak Expiratory Flow (PEF), Maximum Expiratory Flow (MEF) 25-75, MEF 25, MEF 50 and MEF 75) in response to Sustained hand grip exercise and to find out any correlation between these flow parameters and Fat Free Mass Index (FFMI). Materials and Methods: A cross-sectional study was conducted at Department of Physiology, MKCG Medical College, Berhampur University, Odisha between October 2011 and August 2014. A total of 150 healthy volunteers aged between 17 to 25 years were included in the study. Anthropometric measurements were recorded using standardised instruments. Body fat percentage was measured by Bioelectric Impedance Analysis technique and then Fat Free Mass (FFM) and FFMI were calculated using standard formulae. Respiratory Flow parameters were assessed using Flow handy Spirometer as per the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. Sustained hand grip exercise was performed with Physilab Grip Dynamometer. IBM SPSS Statistics Version 24.0, was used for statistical analysis. Paired sample t-test was used to compare lung volumes at baseline and after 3 minutes of sustained hand grip exercise. The p-value <0.05 was considered statistically significant. Karl Pearson Correlation coefficient was used to study the linear relationship between FFMI and various inspiratory and expiratory flow rates. Results: The mean values of all respiratory flow parameters under study decreased at 3 minutes of sustained hand grip exercise as compared to baseline values. This change was statistically significant for PEF (p-value 0.012), MEF 25-75 (p-value 0.041), MEF 50 (p-value 0.001), MEF 75 (p-value 0.012) and MIF50 (p-value 0.004) (p<0.05). All the flow rates studied except MEF 25 showed significant positive correlation with FFMI (r-values between 0.231 to 0.380, p<0.05) but the strength of association was low. Conclusion: There was a statistically significant reduction in both inspiratory and expiratory flow parameters with isometric sustained hand grip exercise. So, isometric exercises should be avoided in patients with obstructive airway diseases. But muscle mass should be improved for better ventilation as authors observed a positive correlation between FFMI and respiratory flow rates.

Bacteriological profile of postoperative wound infection in LSCS patients in MKCG Medical College, Berhampur

Bacteriological profile of postoperative wound infection in LSCS patients in MKCG Medical College, Berhampur

Comparison of distal radiocephalic fistula vs proximal radiocephalic fistula.

Background:Distal radiocephalic fistula (DRCF) at wrist is the first option of vascular access in patients undergoing hemodialysis. In patients with a failed DRCF or unsuitable for DRCF the current recommendation is to perform a brachiocephalic fistula. Proximal forearm radiocephalic fistulas (PRCF) are created less frequently. The aim of the present study was to evaluate the outcomes of PRCF and DRCF.Material and Methods:A longitudinal study was conducted in the department of MKCG Medical College from January 2018 to July 2019. Data was collected and entered in Microsoft excel. The analysis was done by R version 3.6.1. Quantitative data were presented in the form of Mean and SD and were tested by unpaired t-test. Categorical data were presented as count and proportion and was tested by Chi-square test or if applicable Fischer's exact test. Comparison between two procedures was done by Kaplan-Meier method and evaluated by the log-rank test. With the 95% of Level of significance, P value <0.05 was consider statistically significant during analysis.Results:The demographic data of the two patient groups were similar except that those with PRCF were more likely to have had a previous access and caliber of distal vessel was less. Early failure was lower for PRCF than DRCF (6.06% vs 15%). Primary patency rate at one year was 87.87% in PRCF vs 70% in DRCF.Conclusion:A PRCF can be a suitable alternative to a brachiocephalic fistula in patients who cannot receive a DRCF.

A prospective study to determine the efficacy and tolerability of antihypertensive drugs in diabetic and non-Diabetic patients at a tertiary care centre in Ganjam, Odisha

Background: Hypertension and Type 2 diabetes are the two factors having a great impact on the mortality and morbidity of a substantial amount of population over the globe. It has also been identified that Hypertension and Type 2 diabetes co-exist in the majority of the patients. There is a wide range of antihypertensive drugs available for the management of hypertension namely, enzyme inhibitors (ACEIs), diuretics (D), beta-blockers (b Bs), calcium-channel blockers (CCBs), and angiotensin receptor blockers (ARBs). Aim: To study the Efficacy and tolerability of antihypertensive drugs in Diabetic and Non-Diabetic patients at a tertiary care centre in Ganjam, Odisha Materials and Methods: A prospective study with 400 patients was conducted in which 200 were included in the non-diabetic group, and 200 were included in the diabetic group. The study period was six months, from June 2019 to November 2019, and it was conducted at the MKCG Medical College Berhampur, Ganjam Odisha. Patients with Type 1 diabetes were excluded from the study. All the patients suffering from mild and moderate hypertension were included in the study. Also, the patients with and without type 2 diabetes were included in the study. Results: Fifty of the non-diabetics with hypertension belonged to 51-70 years of age group. Similarly, 52.5% of the patient in the Diabetics with Hypertension group belonged to 51-70 years. There was no statistically significant difference among the different mean values among the diabetic and non-diabetic patients except the mean values of diabetic and non-diabetic patients under AST when given ßB + CCB + D + ACEI. There was no statistically significant difference among the renal function of various drugs among the diabetic and non-diabetic group. More people were given two drugs combination as compared to monotherapy, three drugs combination and four drugs combination. There was no statistically significant difference among the various drug combination

A randomized study to determine the efficacy of pregabalin for the treatment of moderate or severe baseline neuropathic pain at a tertiary care centre in Ganjam, Odisha

Background: Neuropathic pain (NeP) is caused by a disease like lesion; it is the disease of the somatosensory nervous system. NeP also caused some severe health disorders such as diabetic peripheral neuropathy (DPN), postherpetic neuralgia (PHN), and spinal cord injury (SCI). Along with the severe health issues, NeP adversely affects the quality of life (QOL) as well as an economic burden on the infected persons and their family plus society. Aim: The aim of the study is to define the efficiency of pregabalin for the treatment of moderate or severe baseline neuropathic pain at a tertiary care centre in Ganjam, Odisha. Materials and Methods: It was a randomized study conducted between August 2019 and January 2020 at the MKCG Medical College Berhampur, Ganjam, Odisha on 700 patients. Simple randomization technique was employed to give patients either pregabalin or placebo. All the patients aged >18 years were selected for the study. The pain was assessed for all the patients using the 11-point numeric rating scale, where 0 = no pain and 10 = worst possible pain. All the patients having pain score >4 were involved in the study. Patients who were below 18 years of age were omitted from the study. Further, the patients whose pain score was below four were also omitted from the study. Results: It was observed that there were 455 patients in the Pregabalin group, and in the placebo group, there were 245 patients. The patients were also bifurcated as per the severity of their discomfort, in which 513 patients were comprised in the moderate section, whereas 187 patients were encompassed in the severe section. 63-71 years was the median age. In the moderate and severe pain group, standard mean pain scores were equivalent among the pregabalin and placebo treatment groups. There was a statistically significant difference among both the groups with respect to the change in pain score. This implies that pregabalin reduced pain more significantly as compared to the

Screening and quantitative estimation of factor VIII inhibitors by Nijmegen-Bethesda assay in hemophilia a patient of Southern Odisha, India

Background: The current treatment of haemophilia is replacement of factor VIII or IX which is effective till development of inhibitor against factors. There has been no study on factor VIII inhibitors in Southern Odisha using Nijmegen–Bethesda assay. This study was planned with objectives to screen factor VIII inhibitors in hemophilia-A patients, to do quantitative estimation of it using Nijmegen-Bethesda assay and to explore factors associated with development of inhibitors. Methods: This cross-sectional study was carried out from September 2016 to August 2018 in Department of pathology, MKCG medical college, Berhampur. Haemophilia-A patients coming to MKCG medical college and registered Haemophilia-A cases under Haemophilia society of Berhampur were included. Patients denying consent and having multiple clotting factors deficiencies were excluded. 1.8ml blood was collected. Mixing study was done to screen factor VIII inhibitors and then in positive cases inhibitors level measured by Nijmegen-Bethesda method. All data were analysed using SPSS (version 16.0).Results: 70 cases of Hemophilia-A patients were studied. Majority (50%) were with severe hemophilia-A. 7 patients developed inhibitors where 3 were high and 4 were low responders. Inhibitor level ranged from 0.8 to 64 Nijmegen-Bethesda units. Patients with severe hemophilia A, more than 10 transfusions and who switched to receive recombinant FVIII from other blood products developed inhibitors which were significant.Conclusions: Severity of hemophilia, increase frequency of transfusion and switching of blood products significantly increases chances of inhibitor development and hence intensive inhibitor screening is needed in these cases. Quantification of inhibitor is needed to monitor treatment and to manage bleeding episodes effectively.