Sri Ramachandra Medical College Research Articles

Role of soluble fms-like tyrosine kinase-1/placental growth factor ratio along with uterine artery Doppler for the prediction of pre-eclampsia – A case–control study

Role of soluble fms-like tyrosine kinase-1/placental growth factor ratio along with uterine artery Doppler for the prediction of pre-eclampsia – A case–control study

Comparative analysis of various laboratory biomarkers based on the severity of COVID-19 in a tertiary care hospital in South India

COVID-19 (Corona Virus Disease 2019) was a life-changing pandemic with impact on social, environmental, health, and economic issues. Various inflammatory and hematological biomarkers studied individually or in combination in the literature have shown significant results with regard to COVID-19 pathology, severity, and prognosis. Yet the question of interest is how covid-19 inflammatory cascade impacts the interlink between the biomarkers during different stages. This study aims to retrospectively analyse ferritin, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin, blood urea nitrogen (BUN), creatinine, D-dimer, Lactate Dehydrogenase (LDH), C Reactive Protein (CRP) and Interleukin-6 (IL-6) levels between two groups based on COVID-19 severity. A retrospective cross-sectional study was conducted with laboratory data of COVID-19 patients admitted at Sri Ramachandra Medical College Hospital, India. The sample size was 104 [Group1: severe disease, n=52; Group-2: mild disease, n=52]. After normality testing, data were compared between the two groups followed by correlation analysis between the variables. A p<0.05 was considered statistically significant. On comparison, Group 2 (severe COVID-19 disease) showed significant difference in the levels of all the biomarkers (p<0.005) except Creatinine (p<0.128) when compared with Group 1 (mild COVID-19 disease). Significant correlation was obtained between all biomarkers (p<0.005) except creatinine. The correlation analysis primarily explains the inflammatory cascade involved in disease. Ferritin appears to have a standalone effect on disease severity, progression, organ dysfunction. This understanding can be used to provide better and more timely care.

Morphometric Study of Humerus in Southern Indian Population

Anthropometry involves measurement of proportions of the human body such as muscles, adipose tissue and bone. The present study was aimed at determining the humeral lengths segments and comparing it with its entire length of humerus in southern part of Indian population. This can be helpful in approximating stature of individuals using typical regression equation. We also compared the data obtained with previous studies conducted on various people in the world, which are valuable both forensic and archaeological studies. One hundred and nineteen fully ossified dried and processed humerus bones (60 right, 59 left humerus) obtained from two medical colleges in Tamil Nadu state SRM medical college, hospital and research centre and Sri Ramachandra Medical College. The morphometric detail of the parts of humerus were measured using digital Vanier caliper. The 6 segments’ length precisely, from utmost proximal point of the head of humerus to the utmost distal point of the circumference of the head as section 1 (Sa-Sb), from the distal point of the circumference of the head to the convergence of two areas of muscle attachment as section 2 (Sb-Sc), and from the convergence of two areas of muscle attachment to the deltoid tuberosity as section 3(Hc-Hd), from deltoid tuberosity to upper margin of olecranon fossa as section 4(Sd-Se), From upper margin of olecranon fossa to the lower margin of the fossa as section 5 (Se-Sf), and from the lower margin of olecranon fossa to most distal point of trochlea as section 6 (Sf-Sg) and maximum length of humerus were measured to the nearest millimeter. The values obtained for the distance of each sections were 35.22±3.939mm, 44.53±5.025mm, 66.27±6.805mm, 125.54±11.429mm, 20.51±1.726mm, and 18.51±1.633mm respectively on the left side, making a total of 310.5763±23.257mm. The values obtained on the right distance segments are as fellow 34.48±3.223mm, 47.05±6.31mm, 67.10±6.942mm, 125.54±11.429mm, 20.51±1.726mm and 17.90±2.447mm respectively on the right side, making a total 311.767±23.435mm. In conclusion present study shows that there is no significant difference obtained for the morphometric measurements between left and right segments except in segment 2.

Evaluation of Preclinical Toxicity of Methanolic Extract of Sargassum tenerrimum using the Zebrafish Model

Introduction: In the field of biomedicine, marine algae have gained significant attention due to the abundance of bioactive compounds they contain. However, studies on the chronic toxicity of algae are limited. Aim: To evaluate the in-vitro, in-vivo acute, and subchronic toxicity of Sargassum tenerrimum (S. tenerrimum) in an adult zebrafish model. Materials and Methods: The current preclinical toxicological interventional study was conducted at the Department of Pharmacology, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, Tamil Nadu, India, in September 2022. The algae S. tenerrimum was extracted with methanol using Soxhlet extraction. In-vitro toxicity of S. tenerrimum was performed using the MTT (3-[4,5-dimethylthiazol-2-yl]- 2,5 diphenyl tetrazolium bromide) assay on the SH-SY5Y cell line. Acute toxicity was carried out for 96 hours according to Organisation for Economic Cooperation and Development (OECD) 203 guidelines, and subchronic toxicity was carried out for 14 days on the zebrafish model using the immersion method. Additionally, histopathological changes were observed after the acute toxicity study, and the Lethal Concentration 50 (LC50) value was analysed. Results: The MTT assay of the methanolic extract of S. tenerrimum revealed an LC50 value of 140.014 μg/mL. An acute toxicity study conducted on zebrafish for 96 hours showed an LC50 value of 504.669 mg/L. Subchronic toxicity was done for 14 days, and on the 14th day of exposure, the LC50 value was found to be 404.196 mg/L. Histopathological changes were observed at higher concentrations (800 mg/L) of algal extract. Conclusion: The present study revealed that the methanolic extract of S. tenerrimum showed a toxic effect at higher concentrations on the zebrafish model. However, at lower concentrations, S. tenerrimum was deemed safe for further exploration of pharmacological activities in a zebrafish model.

Diagnostic tools in diagnosing acute appendicitis - Alvarado Score, CRP, USG, and CT (Abdomen)

Aims. To evaluate scope of diagnosing tools-Alvarado score, CRP, USG, and CT in acute appendicitis. Method. Conducted observational study of 152 patients in Department of Emergency Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India between January to December 2022. The diagnostic tool’s (Alvarado score, CRP, USG, CT (abdomen), sensitivity, specificity, accuracy, and ROC were analyzed to diagnose acute appendicitis. Results. Among 152 study patients, males - 86, females - 66, higher number of age group was <30 years, abnormal variables in study patients are BP - 79%, HR - 80%, RFP pain - 57%, anoxia - 78%, nausea/vomiting - 68%, RIF tenderness - 69%, rebound tenderness - 63.8%, elevated temperature - 62%, pain - 44.7%, leukocytosis - 70.7%, and left shift - 38.2%. In comparison, Alvarado scores-identified 98% patients, (<5 score - 8.2%, 5-6 score - 30.6%, >7-61.2%) (0.0271), CRP - identified 95.1% (<0.001), USG identified (group 1-33%, group 2-12.2%, group 3-11.3%, and group 4-43.5%, and CT identified 152/152 (100%) patients with acute appendicitis. The odds ratio/95% CI of diagnostic tools (USG - 0.878, 0.66, CRP - 7.337, 2.623, Alvarado score - 0.81, 0.687). Sensitivity (Alvarado's score - 84.74%, USG - 83.33%, CRP - 76.43%), and specificity was (Alvarado's score - 84.32, USG - 72.97%, CRP-83.86%. The PPV (Alvarado's score - 74.56%, USG - 75.5%, CRP - 33.16%), NPV (Alvarado's score - 32.5%, USG - 79.1%, CRP - 81.03%), and diagnostic accuracy (Alvarado's score - 72.01%, USG - 73.05%, CRP - 68.81%). ROC in individual tools-Alvarado score was specific than USG, and CRP. ROC in combination tools-Alvarado score and USG was specific than USG, and CRP. Conclusion. Among the diagnostic tools tested, as individual tool-Alvarado score was specific, in combination, and Alvarado score and USG were accurate, specific, sensitive, hence combination of tools will identify acute appendicitis early to reduce mortality by undiagnosed or late diagnosed.

Serum gamma glutamyl transferase levels in metabolic syndrome in obese south Indian population

Background: Increased waist circumference in metabolic syndrome (MS), which reflects central obesity is associated with an increased risk of type 2 diabetes, dyslipidemia, hypertension and coronary vascular disease. Generation of free radicals in central obesity depletes intracellular glutathione, thereby induces release of gamma glutamyl transferase (GGT) into circulation. Elevated GGT levels could be a marker of high oxidative stress which is known to be associated with central obesity and metabolic syndrome. Hence the aim of this study was to determine the association of GGT levels with components of metabolic syndrome in obese South Indian population. Materials and methods: In this case control study conducted at Master Health Check (MHC) Department, Sri Ramachandra Medical College, study population included 60 obese subjects with metabolic syndrome (cases) and 60 non obese subjects (controls) of South Indian population who were non-smokers and non-alcoholics, between the ages of 30-50 years. Components of metabolic syndrome such as waist circumference, blood pressure, fasting plasma glucose, lipid profiles and GGT measured in both the groups. Data between cases and controls compared with unpaired student t-test. Pearson’s correlation was performed to find the association of GGT levels with other variables in Metabolic syndrome. Results: Serum GGT levels were significantly higher in metabolic syndrome patients (cases) than controls with p < 0.0001. High levels of serum GGT were also associated with increase in BP and atherogenic lipid levels and ratios. Conclusion: Elevated serum GGT levels were significantly associated with components of metabolic syndrome in obese South Indian population.

To study about the relation between oxygen delivery and hemodynamics during cardiopulmonary bypass

The study put forth the relation between oxygen delivery and hemodynamics during cardiopulmonary bypass. The study was performed on 26 patients of either sex have age > 10 years and who underwent elective open-heart surgery from June 2017 – May 2018 in Sri Ramachandra Medical College & Research Institute. The patients with valvular heart diseases associated with other cardiac lesions like Intra cardiac shunts (ASD, VSD etc.) and Coronary artery disease (CABG) are excluded in the study. It examined the relationships among VO2, hemodynamics & DO2 during clinical perfusion, namely throughout moderately hypothermic CPB using a non-pulsatile roller pump while managing the alpha-stat acid-base with adults. The results revealed a linear relationship between VO2 and DO2, demonstrating that higher levels of delivery can perfuse and collect additional vascular beds throughout the CPB. Under bodily tissue perfusion, higher deliveries are advised to be avoided. The oxygen demand decreases by 7% for every 1OC decline in patient temperature.

Diffusion-weighted imaging in differentiating benign versus malignant lymphadenopathy: A cross-sectional study

Background: Lymphadenopathy requires differentiation into benign and malignant for appropriate management. The current study was done to find out if diffusion-weighted images and apparent diffusion coefficient (ADC) will be able to differentiate benign from malignant cervical lymphadenopathy. Methods: This cross-sectional study was done in the Department of Radiology at Sri Ramachandra Medical College from April 2016 to August 2018. A total of 54 patients with a history of lymphadenopathy were recruited. Histopathological examination (HPE) and magnetic resonance imaging were done for all patients after a complete history and physical examination. The ADC was correlated with HPE in differentiating benign and malignant lymphadenopathy. Results: Majority (46.30%) were in the age group of 51 years and above. Twenty-eight (51.85%) had benign, whereas 26 (48.15%) had malignant lesions. There was a statistically significant difference between the nature of the lesion in ADC value ([× 10–3 mm2/s] [P < 0.001]). The ADC had good predictive validity in predicting malignancy, as indicated by the area under the curve of 0.904 (95% confidence interval 0.821 to 0.987, P < 0.001). Conclusion: ADC values can be used as a complementary tool in assessing the malignant potential of lymph nodes in various conditions and hence play an essential role in the further course of management.

Seminal Oxidative Stress Biochemistry in Male Infertile Patients-An Overview

Radha Vembu, G Ragesh, Uma Maheshwara Reddy and Anjalakshi Chandrasekar Author informationArticle notesCopyright and License information Department of Reproductive Medicine, Sri Ramachandra Medical College and Hospital, Institute of Higher Education and Research (DU), Porur, Chennai, Tamil Nadu, INDIA Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research

Effectiveness of Minocycline in Multidrug Resistance Gram Negative Bacilli: A Cross-sectional Study

Introduction: Antibiotic resistance is a global public health threat and remains a challenge for the physicians. Due to increased incidence of resistance to the commonly prescribed antibiotics, a newer drug or a re-emerge of an older class of antibiotic will be a choice of treatment of the Multidrug Resistant (MDR) organisms. Aim: To determine the effectiveness of Minocycline in MDR gram negative bacterial isolates by determining its Minimum Inhibitory Concentration (MIC) and to compare its effectiveness with Imipenem and Meropenem. Materials and Methods: A cross-sectional periodical study was conducted during May 2016 to May 2017 using 150 non repetitive MDR gram negative bacterial isolates recovered from various clinical specimens sent to Central Laboratory, Department of Microbiology, Sri Ramachandra Medical College &amp; Research Institute, SRIHER, Porur, Chennai, India. All the isolates were subjected for antibiotic susceptibility testing by disc diffusion method for the routine antibiotics and MIC determination by Epsilometry test (E-Strip) for Minocycline and Meropenem and interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines 2016. Results: Out of the 150 study isolates minocycline was was susceptible in 105 (70%; n=150) followed by imipenem and meropenem both susceptible for 94 isolates (62.7%; n=150). Minocycline was also susceptible among the 84% (79; n=94) of meropenem susceptible strains with a statistically significant p-value of &lt;0.05. Similarly 46.4% (26; n=56) of meropenem resistant strains were susceptible for minocycline which was also statistically significant with a p-value &lt;0.05. Conclusion: Considering the cost of treatment with colistin which is the choice of treatment for carbapenemase producing gram negative bacteria’s, minocycline can be considered as it is cheaper and less toxic. The possibility to switch from injectable to oral formulation is also possible with minocycline and so can also be considered as an alternative for colistin in such conditions.

Morphometric Analysis And Anatomical Variations Of Right Coronary Artery In “Human Cadaveric Hearts” In South Indian Population

Aim And Objective: The study objective is to know the anatomical variations of “right coronary artery” through dissection method and to know its clinical significance. Materials And Methods: In this study, 45 heart samples were implied and approx 30 hearts were calmed from Anatomy Department of “SRM Medical College”. 15 hearts are calmed from the anatomy department of “Sri Ramachandra medical college”. “The right coronary arteries” were observed as well as dissected for its normal anatomy and for any variations, and observations were noted out. Results: The present study shows that during dissection of “right coronary artery”, the “coronary ostium” was examined in all the sample inside the “anterior aortic sinus”, in that 9 sample presents different ostium for “right conus artery” and 1 specimen presents a several ostium for “SA nodal artery” in the same sinus, right marginal artery was present in all specimen with average length of 7.36cms.And with respect to PIV branch, the coronary dominance in right - 75.56%, left – 13.3% and co dominance - 11.11%. Conclusion: In view of this detailed study, I would like to conclude that the noted variations of this artery would be of effective use to the interventional along with “cardiologist plus radiologist” to destine the abnormalities to provide excellent maintainer about “cardiac diseases” and interventional procedures.

Profile of idiopathic intracranial hypertension in Indian population – A prospective study

Background. Idiopathic intracranial hypertension (IIH) also termed pseudotumor cerebri syndrome (PTCS). It mainly affects young overweight women of the reproductive age group. There is a scarcity of literature on IIH among the Indian population. Objective. To evaluate the clinical, demographic profile, laboratory parameters and outcomes of Idiopathic Intracranial hypertension (IIH) patients. Materials and method. The current study was a prospective observational study on 43 patients who were diagnosed as primary PTCS presenting to the neurology department of Sri Ramachandra Medical College and Research Institute from December 2019 to August 2021. Patients were assessed for BMI, papilledema, CSF manometry, MRI brain with MR venography was done. Co-guide software, V.1.03, was used for statistical analysis. Results. The mean age was 33.12 ± 12.29 years (ranged 14 to 55) in the study population. There were 5(11.63%) males and 38(88.37%) females. The mean BMI was 26.72 ± 3.56 kg/m2 (ranged from 17.40 to 34.20). The mean duration of headache was 28.41 ± 26.23 days (ranged 3 to 120) in the study population, and 39(90.69%) had papilledema. The mean CSF manometry was 29.6 ± 5.88(ranged from 16 to 42) cmH2O. Conclusion. In the Indian subcontinent, obesity may not be considered as a major risk factor in the causation of IIH.

Study on self-care practices among type ii diabetes patient attending a rural and urban health training center, Tamilnadu

Background: Diabetes Mellitus is a chronic metabolic and non-communicable disease characterized by high blood glucose levels and has multiple aetiologies. According to the IDF Atlas recent edition, the Global prevalence of diabetes was 9.3% and currently, India holds second position globally with 77 million adults living with diabetes and in 2030 it was expected to cross 101 million. This high prevalence of diabetes was due to the interaction of multiple factors leading to a significant economic burden to the countries health system. Diabetes over the long term causes micro vascular and macro vascular complications, that were sometimes difficult to manage, necessitating the need for self-care practices to prevent the progression of the disease. Objective: To assess the prevalence of self-care practices among type II diabetes mellitus patients in rural and urban health training canters. Methodology: The study was carried out among Type II diabetes Mellitus patients attending Non-communicable disease (NCD) clinic in Rural and Urban health training center of Sri Ramachandra medical college and research institute, Chennai – 600116. After obtaining the informed consent, socio-demographic details were collected and the information on self-care practices was assessed using the revised Summary of Diabetes self-care Activities (SDSCA) questionnaire.

Analytical report on post traumatic hydrocephalus

Post-traumatic hydrocephalus (PTH) is a field and disorder less explored in neurosurgery though we see many cases. The commonest causes in our set up includes head injury for which people have undergone decompressive craniectomies, severe head injuries with raised ICP. We did a clinical analysis on 23 cases in a period of 3 years duration from 2018 -2021. We did Evd in few cases for emergency purposes when there was decerebration and we went ahead with VP shunt in all the patients who had gross ventricular dilatation. We have projected our analytical report in these cases. METHODS A retrospective study was conducted in the Department of Neurosurgery in Sri Ramachandra medical college. The clinical outcome of patients diagnosed with PTH was studied. These cases were treated by surgery. The stastical analysis along with cause of the hydrocephalus with the outcome in pre and postoperative period were studied. RESULTS Among the 23 patients studied 82% were males. Road traffic accident was the main cause of injury. The other main cause was a fall from height. Assault was another reason for head injuries which we recorded. We found all road traffic accidents were only because of bike riders either pillion or the people driving the vehicle. . Craniotomy was done in 50 % of the patients, 90 % of the patients recovered who had a gcs of 13 to 7. People with gcs lss than 7 were intubated recovery rate was 7.5 %. . There was 100%mortality because of primary head injury in all the patients who had brain stem contusions with dilated pupil. CONCLUSIONS Trauma to head and who were operated had the highest incidence of post tramatic head injury. Smaller the decompressive craniectomies had symptomatic post traumatic head ache with post traumatic hydrocephalus.. CT scan of the brain is considered the choice of investigation toearly diagnose PTH.we even analysed the ct scan and found when there was periventricular lucency the patient outcome after VP shunting is good. KEY WORDS Hydrocephalus, Head Injury, Trauma

Evaluation of Lateral Flow Assay for the Diagnosis of Cryptococcal Meningitis and its Comparison with the Gold Standard and Other Laboratory Tests

Introduction: Cryptococcosis is a potentially fatal fungal disease affecting both immunocompromised and immunocompetent individuals. Hence, a Point Of Care Test (POCT) is required with higher sensitivity and specificity (100%), for the rapid detection of cryptococcosis which will be life saving for the patient. Aim: To evaluate the usefulness of Lateral Flow Assay (LFA) for rapid detection of Cryptococcal Antigen (CrAg) from Cerebrospinal Fluid (CSF) sample. Materials and Methods: This diagnostic study was conducted in Mycology Laboratory, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, over a period of six months (June 2019-November 2019). The CSF samples (n=37) from patients with suspected meningitis were considered for the study. Direct microscopy with gram stain, negative stain and histopathological stains was performed for all the CSF samples. Culture was done on basal medium, enriched media and special media. Cryptococcus genus specific Polymerase Chain Reaction (PCR) was also performed to confirm the isolates grown on the culture. Serological tests like Latex Agglutination Test (LAT) and LFA were also performed on all the samples. The LFA results were compared with microscopy, culture and LAT. Results: Among the 37 suspected meningitis patients, three grew Cryptococcus in culture which was considered as the gold standard in the diagnosis of Cryptococcal Meningitis (CM). Direct microscopic techniques had 100% specificity however their sensitivity was less i.e., 67%. LAT had a sensitivity of 100% and specificity of 94%. However, LFA in present study had a very good sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) (100%). Conclusion: LFA for the detection of CM is considered to be an effective method when compared to the other conventional and serological methods with higher sensitivity and specificity. Hence, in present study authors evaluated the use of LFA in diagnosis of CM and found that this assay when used as a POCT, can give the results in short duration. Considering this as a pilot study, further studies including higher number of samples are essential to confirm the effectiveness of the findings.

Role of Lipoprotein Associated Phospholipase A2 in Diagnosis of Coronary Artery Disease

Introduction: Cardiovascular Diseases (CVD) are a major cause of significant morbidity and mortality in industrialized countries, of which Coronary Artery Disease (CAD) is the commonest. The diagnostic workup of CAD has improved over the years starting from conventional investigations like ECG to invasive procedures like coronary angiogram. Moving forward, numerous novel inflammatory biomarkers are coming up to diagnose CAD. Aim: To assess the role of Lipoprotein associated Phospholipase A2 (LpPLA2) as an independent predictor of CAD. Materials and Methods: This case-control study was conducted in the Inpatient Department of Cardiology at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from September 2014 to November 2014. Participants without significant blockage in the coronary arteries and without detectable atheroma served as controls and those with detectable atheroma and significant blockage in coronary arteries served as cases. Peripheral blood samples of 80 male patients aged over 40 years undergoing Coronary Angiography were processed for LpPLA2 levels. Mean and Standard deviation were calculated for the parameters included in the study. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 15.0. Results: Mean age of the participants in the controls group was 51.75±8.74 years and that of the cases group was 59.15±11.31 years. The mean LpPLA2 level in the cases was found to be higher than that in the controls and the difference was statistically significant (p-value &lt;0.05). No correlation was noted between the age and BMI of both the groups with their respective LpPLA2 levels. Conclusion: The current study showed that LpPLA2 can be used as a potential independent predictor of CAD, thus minimising the usage of invasive investigations and favouring the psychosocial and economic welfare of the patients.

Hepatitis Activity Index and its Clinical and Biochemical Parameters in Liver Diseases- A Retrospective Study

Introduction: Hepatitis Activity Index (HAI) is a scoring system devised by Ishak K et al., for grading and staging chronic hepatitis. The HAI provides a numerical score that is both objective and reproducible, it may be useful as either an alternative or supplement to the use of conventional pathological terminology in the study and management of chronic hepatitis patients. Aim: To assess the efficiency of HAI scoring in the non neoplastic liver diseases by relating it with the clinical and biochemical parameters. Materials and Methods: This retrospective study was conducted in the Department of Pathology at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from 2010 to 2015. A total of 57 (58%) neoplastic cases and 41 (42%) non neoplastic cases were retrieved. The data was reassessed, HAI score and grade was noted and compared with the clinical and biochemical parameters. Chronic liver disease was classified as chronic viral hepatitis {Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV)} or cirrhosis. Alkaline phosphatase levels, Serum Glutamic Oxaloacetic Transaminase (SGOT) levels , Serum Glutamic Pyruvic Transaminase (SGPT) levels were analysed. Descriptive analysis was done and the data was represented as frequency and percentage in Microsoft Excel. Results: Among the non neoplastic cases, 21 (51%) belonged to hepatitis and cirrhosis and 20 (49%) belonged to others. In patients with high alkaline phosphatase levels, the predominant HAI score was 4. In cases with high SGOT levels, the predominant HAI score was 5 and 6. In cases with high SGPT levels, the HAI score was 5,6, and 7. Conclusion: The HAI is useful in assessing the extent of active inflammation. It gives an objective guideline to the treating physician. The HAI score in combination with clinical and biochemical parameters offers a better insight into disease severity.

Brain Natriuretic Peptide Levels in Hypertensive Heart Failure Patients with and without Diabetes Mellitus: A Cross-sectional Study

Introduction: Heart Failure (HF) is a major disorder causing mortality and morbidity in the elderly population. Brain Natriuretic Peptide (BNP) is considered as the gold standard biomarker for diagnosis of HF. Aim: To find the association of plasma BNP levels with heart failure in hypertensive patients with and without diabetes mellitus. Materials and Methods: This cross-sectional study consisted of 35 hypertensive heart failure patients who attended the Outpatient General Medicine Department at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, between March 2020 to December 2020. The patients who belonged to class IV heart failure of the New York heart association were included. Total 35 HF patients were divided into two groups. Group 1 included 10 patients with hypertensive heart failure without diabetes mellitus. Group 2 included 25 patients with hypertensive heart failure with diabetes mellitus. Parameters such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), waist to hip ratio, Body Mass Index (BMI), Ejection Fraction (EF), transmitral filling velocities (E/A ratio), Left Ventricular Posterior Wall Thickness (LVPW), Left Ventricular Internal Dimension in diastole (LVIDd) and BNP level, random plasma glucose and HbA1c % were assessed in all the patients. Student’s t-test and Mann-Whitney U test were used to statistically analyze the data and p-value ≤ 0.05 was considered statistically significant. Results: Mean age of patients were 65.80±12.72 years in group 1 and 66.56±11.72 years in group 2. All patients in group 1 and most of the patients in group 2 (15,42%) were males. All the patients were in the obese category (BMI&gt;27 kg/m2 ). Serum BNP level was 1365 (243-3680) ng/L in group 1 and 691 (44.7-4261) ng/L in group 2, but this difference was not statistically significant (p-value=0.23). Echocardiography showed significant differences in left ventricular internal dimension in diastole, left ventricular posterior wall thickness and E/A ratio-integrated between hypertensives and hypertensives with diabetes mellitus. Serum BNP had a significant positive correlation with systolic blood pressure (r=0.33, p-value=0.05). There were highly significant differences in random plasma glucose and glycated haemoglobin between the groups. Conclusion: Plasma BNP levels were associated with systolic blood pressure in heart failure patients with hypertension. The significance of association is the same in hypertensives with diabetes mellitus. Thus, BNP as a biomarker plays a major role in the prediction of heart failure. But BNP could not differentiate whether the heart failure was due to hypertension alone or due to associated metabolic conditions.

Vascular Calcification in Chronic Kidney Disease PatientsA Cross-sectional Study

Introduction: Vascular Calcification (VC) is considered as a cardiovascular risk marker in Chronic Kidney Disease (CKD) patients. VC is a process characterised by thickening and loss of elasticity of muscular arteries walls. The three pathological forms of cardiovascular disease in CKD are cardiac geometry, atherosclerosis and arteriosclerosis of the large vessels (carotid artery or aorta). Aim: To evaluate VC as a cardiovascular risk marker in CKD patients. Materials and Methods: This cross-sectional study was conducted in the Nephrology Department at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from November 2019 to December 2020. The study included 27 CKD patients who were on maintenance haemodialysis. The participants were 20 to 70 years of age, and of both genders. The Intima Media Thickness (IMT) was assessed by ultrasonography. Peak Systolic Velocity (PSV) measurement was done using doppler ultrasonography. Both the measurements were done on common Carotid Artery (CCA), and Internal Carotid Artery (ICA) on both sides of the neck. Student’s t-test and Chi-square test was used in this study. Data were expressed as mean±SD. The p-value &lt;0.05 was considered as statistically significant. Results: Out of 27 study participants, 20 (74%) were male and females were 7 (26%), with mean age of 48 years. There was significant increase in IMT of the ICA on the right side of the neck compared to left side (p-value=0.01). Also, there was significant increase in PSV of ICA on the right side compared to left side of the neck (p-value=0.04). There were no statistically significant differences in IMT and PSV when CCA on the right side was compared to that of the left side of the neck. Conclusion: The IMT was increased in ICA and CCA. But there was statistically significant difference only in ICA, where it was more prominent on the right side compared to left side. CKD patients on haemodialysis management could have the risk factors in the form of increased IMT predisposing them to early mortality from cardiovascular complications.

Comparative Efficacy of Tamsulosin Versus Tamsulosin Plus Finasteride in Patients with Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hypertrophy, a Randomized Open Label Parallel Group Study

Background: Benign prostatic hypertrophy (BPH) is a common entity among elderly men and is responsible for significant disability. Medical treatment for BPH has played a major role in improving the symptoms associated with bladder outlet obstruction. Recent guidelines recommend the combination of an alpha-1 blocker and a 5-ARI as first-line treatment of men with moderate-to-severe LUTS. There is limited study data to support which is the effective therapy for BPH/LUTS in a tertiary care hospital in India. Methods: A randomized, open labelled, double blind, active control parallel group study comparing the safety and efficacy of tamsulosin versus tamsulosin+finasteride in subjects with lower urinary tract symptoms secondary to benign prostatic hypertrophy. The subjects were randomized after obtaining written informed consent. The subjects were recruited from the patient population that was attending the Out-Patient department of Urology, Sri Ramachandra Medical College &amp; Research Institute, Sri Ramachandra University. Results: A total sample of 60 subjects, 30 into each group was enrolled. In the tamsulosin group, according to IPSS score, 11 patients who had moderate symptoms (36.7%) became mild, and among 19 patients who had severe symptoms (63.3%), 12 patients became mild (40%) and 7 patients became moderate (23.3%) with a p value of 0.021 which is statistically significant. In the tamsulosin+ finasteride group, according to IPSS score, 10 patients who had moderate symptoms (33.3%) became mild, and among 20 patients who had severe symptoms (66.7%), 12 patients became mild (40%) and 8 patients became moderate (26.7%) with a p value of 0.020 which is statistically significant. When comparing between the two groups, 76.7% attained mild symptoms in group 1 and 73.3% patients attained mild symptoms in group 2 with a p value of 0.766 which is statistically not significant. Conclusion: To conclude tamsulosin 0.4mg is as effective as the combination therapy of tamsulosin 0.4mg and finasteride 5mg in the treatment of lower urinary tract symptoms secondary to Benign prostatic hypertrophy.