Background: Changes in the lipid profile have been reported as a risk factor for ischemic stroke in a few kinds of literature. The aim of the present study was to evaluate the lipid profile levels in ischemic stroke patients and its association with acute ischemic stroke within the first 24 hour. Materials and methods: It was a cross-sectional analytical study, conducted among above 35 years old aged acute ischemic stroke patients. A total of 48 cases and 48 controls were taken. Computed tomography (CT) scan, clinical examination, and fasting lipid profile of the admitted patients were done. A standard questionnaire was used for data collection. Results: History of hypertension, and diabetes mellitus was significantly higher among stroke patients (64.6 and 52.1%, respectively) than in the control group. The present study has found that the mean of total cholesterol (TC) was significantly higher (221.50 ± 42.89 mg/dL) in the stroke group than the control group (163.25 ± 18.01 mg/dL). The triglyceride level, very low-density lipoprotein (VLDL), and low-density lipoprotein (LDL) cholesterol level among the stroke patients’ group were significantly higher (193.95 ± 39.23, 38.77 ± 7.83, 144.32 ± 42.15 mg/dL, respectively) compared to the control group (139.12 ± 18.28, 27.82 ± 3.65, 91.94 ± 17.62 mg/dL, respectively). High-density lipoprotein (HDL) cholesterol level was significantly lower (36.81 ± 3.35 mg/dL) than the control group (44.10 ± 3.15 mg/dL). Multivariate logistic regression found that a higher triglyceride level had 0.94 odds of having ischemic stroke (95% CI: 0.88–0.99). Conclusion: Increased level of TC was found as a risk factor in ischemic stroke whereas high triglycerides (TG) levels had a protective role against ischemic stroke events. Reduction of cholesterol levels can reduce the incidence of ischemic stroke.

Background: Coronavirus disease-2019 (COVID-19) is both an infective and inflammatory disorder. The liver is the principal site for the orchestration of inflammatory cascade after entry of SARS-CoV2 in humans. The study of liver-related parameters has immense potential to understand the pathophysiologic alteration and identify the therapeutic targets related to COVID-19 infection. Method: A single-center, prospective, cross-sectional, and non-interventional study was conducted on the patients who were COVID-19 positive through RT-PCR test. Comparing and correlating the parameters of liver function test (LFT) between the disease severity group (severe vs non-severe) and also the in-hospital-outcome group (discharge and death) and the assessment of the strength of association (by calculating odds ratio [OR]) of individual LFT parameters for disease severity and in-hospital outcomes. Results: Among the total number of patients 507 suitable patients were identified. Liver function tests at presentation were considered for the study. Individual parameters in LFT were compared and the strength of association was measured with disease severity and in-hospital outcomes. Disease severity was measured by CURB 65, q SOFA, and AIIMS/ICMR 2021 Clinical severity scores. In-hospital outcomes were defined as discharge or death. We observed significant differences with respect to serum albumin level, SGOT, SGPT, and albumin globulin ratio between severe and non-severe groups of COVID-19-positive patients. Hypoalbuminemia followed by transaminitis were the commonest abnormalities. Conclusion: Among the individual LFT parameters, hypoalbuminemia followed by transaminitis were the most frequent abnormalities. The altered liver functions were strongly associated with disease severity and outcomes. Hypoalbuminemia and high transaminase (SGOT and SGPT) levels had strong association with disease severity and outcomes.

Background: The incidence of type 2 diabetes mellitus (T2DM) is increasing in India. Left ventricular diastolic dysfunction (LVDD) is a complication of T2DM, which may develop irrespective of glycemic and hypertension control. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, e.g., empagliflozin and canagliflozin have been shown to reduce all-cause mortality including cardiovascular mortality in T2DM patients. Aims and objectives: The aims of this study were to evaluate the effect of canagliflozin on cardiac and renal parameters and improvement of LVDD at the end of 6 months in T2DM patients. Materials and methods: About 100 T2DM patients meeting inclusion and exclusion criteria were put on Canagliflozin (100 mg/day) and followed up for 6 months. Clinicodemographic profiles with blood pressure (BP) and body mass index (BMI) and fasting blood sugar, HbA1c, serum creatinine, eGFR, urine albumin/creatinine ratio (UACR) were assessed at baseline and 6 months. Also, echocardiographic parameters like average E/e’, septal and lateral e’ velocity, TR velocity and LA volume index (LAVI) were assessed and statistically analysis by SPSS 22.0 software. Results: Majority of patients were male (56%), aged between 45 and 60 years (57%), and obese (51%). Significant findings were, (1) Canagliflozin for 6 months improved E/A in 60 years and LAVI in <45 years’ age-group. (2) It improved LAVI in hypertensives and patients of <10 years of disease duration. (3) It improved serum creatinine and UACR.

Background: Cardiovascular performance is well-known to be compromised due to low level of thyroid hormone levels in terms of reduced cardiac performance, reduced chronotropy, and increased systemic vascular resistance. Persistent subclinical hypothyroidism (SCH) is also a known risk factor for cardiomyopathy and heart failure. Yet, the direct effect of hypothyroidism on the heart, independent of its effect on loading function remains to be elucidated. In this study, we wanted to see the effect of hypothyroidism correction within 6 months on cardiac performance as measured by pre-defined echocardiographic parameters. Objectives: To find out the change in left ventricular systolic and diastolic function as well as left ventricular mass index (LVMI) with treatment of primary hypothyroidism with levothyroxine replacement in 6 months time frame and to detect reversibility, if present at all, of E/E(E—early transmitral diastolic velocity, E– tissue Doppler early diastolic velocity), left ventricular ejection fraction (LVEF) and LVMI after patient become biochemically euthyroid. Results: A total of 51 cases of primary hypothyroidism were selected after excluding other comorbidities ranging from age 12–67 years, to undergo assessment of E/E, LVEF, and LVMI echocardiographically at first OPD visit (t = 0) and at 6 months. Age- and sex-matched healthy controls were taken for comparison. Meanwhile, they were being treated with levothyroxine supplementation at an appropriate dosage to establish a euthyroid status during this period. They were monitored at regular intervals. At 6 months all of them became euthyroid biochemically and their echo parameters were compared. The mean age of the study group was 44.57 ± 10.53 years among cases. In case arm, 23 out of 51 (45.1%) patients were female and 28 (54.9%) patients were male. Male–female ratio was ~ 1.2:1. The mean thyroid stimulating hormone (TSH) at t = 0 (mean ± SD) was 19.90 ± 23.90 mIU/L. The mean FT4 at t = 0 (mean ± SD) of patients was 1.12 ± 0.15 ng/dL. The association of E/E at t = 0 in case vs control group was statistically significant (p < 0.0001). The association of EF at t = 0 in case vs control group was statistically significant (p = 0.0068). The association of LVMI at t = 6 months vs at t = 0 group was statistically significant (p = 0.0339). There was significant improvement in E/E (p = 0.0010), EF (p < 0.0001), in LVMI (p < 0.0001) after 6 months. The positive correlation between E/E at t = 6 months vs TSH at t = 6 months was not statistically significant (p = 0.48). Negative correlation between EF at t = 6 months vs TSH at t = 6 months was not statistically significant (p = 0.57). The positive correlation between LVMI at t = 6 months vs TSH at t = 6 months was not statistically significant (p = 0.89). Negative correlation between TSH at t = 6 months vs FT4 at t = 6 months was not statistically significant (p = 0.348). Conclusion: Primary hypothyroidism is associated with diastolic dysfunction, left ventricular systolic dysfunction, and abnormal left ventricular mass. The most affected age group is the 5th decade or above. Diastolic dysfunction is more severe than systolic dysfunction. Levothyroxine supplementation can potentially revert these dysfunctions. It takes at least 6 months for cardiac function to reverse. Early diagnosis of hypothyroidism and levothyroxine supplementation can prevent potentially dangerous complications of cardiovascular system including heart failure

Background: Polycythemia vera (PV) is associated with the gain of a function point mutation in Janus 2 tyrosine kinase (JAK-2), leading to an increase in the activity of JAK2V617F. The anxiety associated with PV is mostly incidentally detected post diagnosis. Aim: To study the impact of JAK2V617F mutation status on the PV phenotype in terms of clinical and laboratory features. The mental anxiety of patients with PV was assessed at diagnosis and subsequently. Material and methods: A retrospective study was done on 50 patients with PV for the last 5 years. For the measurement of anxiety among patients, a self-administered questionnaire was used as a screening tool and severity measure for generalized anxiety disorder questionnaire and scores were used and graded accordingly. Results: On analysis of our 50 patients with PV. There was a significant statistical difference in terms of median age at presentation (61 vs 44.5 years; p = 0.002), median hemoglobin (Hb) at time of presentation (20.7 vs 17.5 gm/dL; p = 0.001), median total leukocyte count (TLC) at time of presentation (15,700 vs 8,100 µL; p = 0.001), median platelet counts at the time of presentation (3,20,000 vs 1,90,000 µL; p = 0.044) and low serum erythropoietin (EPO) level (p = 0.00) between JAK2 mutated and unmutated group. At one year when anxiety levels were checked in PV patients, it was found that none of the patients was severely anxious about their disease entity and few were moderately anxious. Conclusion: The age of patients and laboratory parameters such as (Hb, TLC, platelet counts, and serum EPO levels) showed a statistically significant difference between JAK2 mutated and Unmutated group. Thrombosis was also more common in JAK2V617F mutated patients. With the passage of time gradually the stress and anxiety declined among patients with PV.

Aim and background: Diabetes mellitus virtually affects every organ in the body. Gastrointestinal effects include small intestinal bacterial overgrowth (SIBO), gastrointestinal reflux disease, gastroparesis, neuropathy, pancreatopathy, and non-alcoholic fatty liver disease. Our study aimed to assess and identify various causes of dyspepsia in type 2 diabetes mellitus (DM) patients. Materials and methods: After screening the patients for inclusion and exclusion criteria, enrolled participants were subjected to a urea breath test (UBT), glucose hydrogen breath test (HBT), upper gastrointestinal endoscopy (UGIE), pancreatic fecal elastase (PEF), and gastric scintigraphy. Results: The study revealed that 42.5% of patients had positive UBT for H. pylori gastritis, while 37.5% had organic causes of dyspepsia. Pancreatic exocrine insufficiency (PEI) was present in 37.5% of patients, and slow gastric emptying in 12.5% suggested gastroparesis. There was significant negative correlation between HbA1c and pancreatic fecal elastase levels. In 26.8% of patients, no cause of dyspepsia could be identified, 34.2% had dyspepsia secondary to a single etiology; and 26.8% of patients had two underlying etiologies of dyspepsia. In contrast, the remaining had multiple causes of dyspepsia. Conclusion and clinical significance: The study identified multiple causes of dyspepsia in type 2 diabetic patients in India, with a large proportion having PEI. Further studies are needed to determine if pancreatic enzyme supplementation can alleviate dyspeptic symptoms. In conclusion, dyspepsia in diabetic patients can be attributed to multiple coexisting causes, necessitating etiology-directed management.

Background: Controversy exists regarding how and to what extent portal hypertensive gastropathy (PHG) varies with different grades of liver dysfunction. Our aims and objectives were to assess the correlation of PHG with different grades of liver dysfunction. Materials and methods: Seventy (70) patients diagnosed with chronic liver disease (CLD) with gastrointestinal bleeding admitted to the Department of Medicine, R. G. Kar Medical College and Hospital, Kolkata were considered as the study group in this retrospective study design. Portal hypertension (HTN) was confirmed by endoscopic features and their history, clinical, hematological, and biochemical data. Patients with systemic disorders, such as diabetes, renal failure, septicemia, and congestive cardiac failure were excluded from the study. Endoscopically, it was found that 35 patients had congestive gastropathy (CG), while another 35 patients without gastropathy served as controls. The Child's Pugh scoring system was applied to assess the severity of liver dysfunction. Results: The prevalence of esophageal varices and CG were frequently observed in the patients with portal HTN in this study. Congestive gastropathy is more commonly located in the fundus and body (74.28%). Mild gastropathy (57.14%) is more commonly encountered than severe gastropathy (42.85%). The number of patients with bleeding episodes is found to be more in patients with PHG [34(97.14%)] compared with non-PHG group [28(80%)]. In patients with mild PHG, child's grade A was found in 2 (10%) cases, grade B in 13 (65%) cases, and grade C in 5 (25%) cases. In patients with severe PHG, child's grade A was found in 2(13.3%), grade B in 4 (26.6%), and grade C in 9 (60%) cases. Conclusion: Severe PHG was associated more with grade C liver disease (severe grade liver dysfunction). The correlation between severity of PHG and liver dysfunction was found to be significant. More studies are needed to enable one to predict which patients will develop PHG and which will bleed from it.

Tropical pyomyositis is an infectious disease that primarily targets skeletal muscle, presenting either as a widespread inflammation or a rapidly progressing necrotic process. Staphylococcus aureus is responsible for 90% of the cases, while other less common pathogens include group A Streptococcus, Pneumococcus, Neisseria, Haemophilus, Serratia, Yersinia, Pseudomonas, Klebsiella, and Escherichia. The rarity of the disease and the nonspecific initial symptoms often lead to a delayed diagnosis. This report discusses the case of a 56-year-old male with newly diagnosed type 2 diabetes who developed pyomyositis with multiple muscle abscesses, requiring extensive antibiotic treatment and surgical drainage. Early diagnosis is crucial, as pyomyositis can be fatal if not promptly treated.

Background: The prevalence of polypharmacy and hyperpolypharmacy in India is a growing concern, particularly among the elderly. With over 49% of the elderly population engaged in polypharmacy and 31% in hyperpolypharmacy, the resultant issues of potentially inappropriate medications (PIMs) are increasingly evident. These medications, often unnecessary, can lead to severe adverse effects, diminishing the quality of life for a significant portion of this demographic. Addressing these issues is imperative for enhancing healthcare outcomes and necessitates the development of deprescribing guidelines that cater specifically to the Indian healthcare context. Objective: This opinion aims to provide a structured approach to deprescribing, targeting the minimization of risks associated with unnecessary medication use among the elderly in India. The primary goal is to establish evidence-based, practical guidelines adaptable to diverse healthcare settings across the country, ensuring both safety and efficacy in medication management. Methods: The development of this opinion involved a comprehensive interdisciplinary approach, incorporating inputs from clinical pharmacologists, geriatricians, internal medicine experts, endocrinologists, gastroenterologists, cardiologists, primary care physicians, pharmacists, and patient advocacy groups. An expert panel was formed to conduct extensive literature reviews, ensuring a robust evidence base for the opinion development. Consensus meetings were held to harmonize expert opinions and integrate clinical practices with empirical evidence. Pilot testing in various healthcare settings, both urban and rural, was crucial for evaluating the practicality and effectiveness of the guidelines. Feedback from these tests was used to refine the guidelines further, ensuring their relevance and applicability across different regions and healthcare systems within India. Results: The opinion outlines a systematic approach to deprescribing, including the identification of PIMs through validated tools like the Beers and STOPP/START criteria. They emphasize the importance of assessing individual patient risks, such as drug-drug and drug-disease interactions, before initiating any changes to medication regimens. A key component is the implementation of a patient-centered care model, emphasizing shared decision-making between healthcare providers and patients. This approach is expected to foster better patient engagement and compliance. The anticipated impact of these guidelines includes a reduction in adverse drug events, increased medication adherence, and overall improvement in the health and well-being of the elderly population. Conclusion: The opinions presented are poised to transform prescribing practices across India by reducing unnecessary medication use among the elderly. By focusing on evidence-based interventions, patient-specific considerations, and collaborative care approaches, these guidelines are expected to mitigate the risks associated with polypharmacy and enhance the quality of life for older adults. The successful implementation of these guidelines requires ongoing education and support for healthcare providers, as well as regular updates based on emerging evidence and clinical outcomes.