Medicine

Background: Posterior circulation stroke is less common than stroke involving the anterior circulation. Posterior circulation stroke accounts for approximately 20% of all strokes with varied clinical presentation, which differ from strokes in anterior circulation, with reference to etiology, clinical features, and prognosis. Early diagnosis of stroke is essential so that appropriate preventive therapies may be instituted. Results: The total number of posterior circulation stroke patient was 80, 10.05% of 796 total stroke patients, posterior circulation ischemic stroke in 12.68% of cases out of 481 ischemic stroke patients in our study. In our study, 76.25% patients had ischemic stroke and 23.75% patients had hemorrhagic stroke. Average age of patient in hemorrhagic stroke was 57.9 years and average age of patient in ischemic stroke was 61.0 years. Hypertension (72.50%) was the most common associated risk factor followed by dyslipidemia (48.75%) followed by tobacco chewing (32.50%). Motor involvement (72.5%) was commonest clinical feature among posterior circulation stroke followed by speech involvement (58.75%) and altered sensorium (48.75%). Conclusions: There are very few studies on clinical profile and outcome in PCS we would need more studies solely on PCS elucidating particularly the causes and predictors of outcomes to help establish an appropriate management strategy for PCS.

The present study was undertaken to assess the prevalence of systolic and diastolic dysfunction, to determine the prevalence of left ventricular hypertrophy (LVH) from left ventricular mass index (LVMI), to correlate the degree of cardiac dysfunction with severity of chronic kidney disease (CKD) by echocardiography in patients of CKD on conservative management. Material & method: 75 CKD patients were taken in the study which were divided into three groups-Group A  Age and sex matched healthy controls (n=20). Group B  Patients with mild to moderate CRF (n=45) (S. Creatinine =1.5-6.0 mg/dl). Group C  Patients with severe CRF (n=30) (S. Creatinine > 6.0 mg/dl). Results: The prevalence of LVH along with systolic dysfunction was 10.0% (p<0.2653) in severe CRF (group C), higher than mild/moderate CRF (group B) which was 2.2% (p<1.0). The prevalence of LVH along with diastolic dysfunction was 76.7% (p<0.0001) in group C, which was significantly higher than group B which was 44.4% (p<0.0001). 51.1% (p<0.0001) patients were found to have LVH in mild to moderate CRF (group B) and 76.7% (p<0.0001) of patients had LVH in severe CRF (group C). 48.9% patients had concentric LVH in group B and 73.3% had concentric LV hypertrophy in group C. In diabetic CRF patients LV dysfunction was predominantly diastolic irrespective of the degree of LV hypertrophy. Conclusion: Systolic dysfunction was well preserved in majority cases of CKD as found from the Ejection Fraction and Fractional Shortening parameter whereas diastolic dysfunction was more commonly found in CKD patients. Key words: chronic kidney disease, left ventricular hypertrophy, left ventricular mass index systolic dysfunction, diastolic

Background: The cerebrovascular stroke is one of the leading causes of morbidity & mortality in adult life. Indian studies have shown a stroke prevalence of 471.58/100000 population. Stroke mostly occurs in elderly people. Risk factors for stroke differ between young and elderly patients. The aim was to study the clinical presentation, risk factors, types, topography as per CT scan findings in ≤45 years and >45 years patients from PRM medical college and hospital, Baripada. Methods: This is a retrospective study of all new patients managed for stroke in the medical ward of PRM medical college and hospital, Baripada, from June, 2018 to January, 2019. Results: Incidence of stroke in elderly (≥45 years) was than young (<45 years) patients with male predominance in both the groups. Most common clinical presentation from both age groups was hemiplegia (84.88% in young vs. 84.69% in elderly). Common risk factors in were HT and dyslipidemia in both the groups. Most common type of stroke in both age groups was Hemorrhagic (65.66% in young vs. 51.02% in elderly), followed by ischemic. Common sites of hemorrhage in young and elderly were basal ganglia and ventricular. Most common infarction site in both age groups is MCA territory. Conclusion: The cerebrovascular stroke was more in elderly with hypertension and dyslipidemia. The most common type of stroke was haemorrhagic.

ABSTRACT
Background: Stroke is one of the leading causes of morbidity and mortality in India. The objective was to study the
clinical profile, risk factors, neurological characters, pattern of brain stroke, areas of brain affected as per CT scan
findings in patients with stroke.
Methods: This observational study was carried out from June 2018 to Jan 2019 of all new patients admitted with
stroke in Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, India.
Results: The incidence of stroke is maximum in 46-60 years of age group. The average age+SD was 59.3+13.5 in our
study. 274 (46.52%) patients had ischemic stroke and 315 (53.48%) patients had hemorrhagic stroke. The male to
female ratio was 1.46:1. Anterior circulation (86.42%) was the most common territory involved in the brain. The most
common risk factor was hypertension with 77.76% followed by dyslipidemia (53.99%). The most common clinical
presentation was hemiplegia (85.23%).
Conclusions: The incidence of stroke is maximum in 46-60 years of age group. The average age+SD was 59.3+13.5
in our study. 274 (46.52%) patients had ischemic stroke and 315 (53.48%) patients had hemorrhagic stroke. The male
to female ratio was 1.46:1. Anterior circulation (86.42%) was the most common territory involved in the brain. The
most common risk factor was hypertension with 77.76% followed by dyslipidemia (53.99%). The most common
clinical presentation was hemiplegia (85.23%).
Keywords: Cerebrovascular stroke, Diabetes, Hemorrhagic stroke, Hypertension, Ischemic stroke, Risk factors

ABSTRACT
Background: Tuberculosis is the ninth leading cause of death worldwide. India contributes to about one fifth of
global TB burden. It is very important to diagnose early and treat tuberculosis to cut down transmission of
tuberculosis.
Methods: Author conducted a retrospective study in Department of Pulmonary Medicine SLN Medical College,
Koraput, Odisha to analyze the utility and yield of CBNAAT. Study period was from April 2018 to March 2019.
Inclusion criteria was all patients whose samples were subjected to CBNAAT were included in our study. Sputum
samples from pulmonary tuberculosis patients, and extra pulmonary samples (pleural fluid, ascitic fluid, CSF,
synovial fluid and gastric lavage etc. were included in our study population. Exclusion criteria was patients who were
under anti tubercular therapy for pulmonary, extra pulmonary and MDR TB were excluded from this study. Data were
collected from Pulmonary Medicine Department, ART center, DOTS center and CBNAAT center. Total number of
samples tested for CBNAAT, different sample collection sites, age and sex distribution of patients, HIV status of all
patients, result of smear microscopy for AFB and CBNAAT and Rifampicin resistance status were analyzed.
The detail statistical analysis was done in tabulation form.
Results: A total of 2621 samples were tested in CBNAAT during the study period. Mean age of the study population
was 38.03 years. 1881 tested were negative and 740 samples were positive for CBNAAT. Of these 2621 samples,
2526 were pulmonary samples (sputum, pleural fluid samples) and 95 were extra pulmonary samples. Author found
rifampicin resistance rate of 0.54% (4/740)) in pulmonary tuberculosis cases. There was no rifampicin resistance
detected in extra pulmonary samples. CBNAAT could identify 536 cases (23.2%) that were smear negative. Author
found TB- HIV co-infection rate of 6.22%.
Conclusions: CBNAAT is an important diagnostic modality especially in sputum negative patients for early
diagnosis and treatment. In our study it detected Mycobacterium tuberculosis in 23.2% of patients with negative
smear for microscopy. Rifampicin resistance rate detected was very low compared to other studies.

ABSTRACT
Background: Globally, an estimated 10.0 million (range, 9.0 to 11.1 million) people infected with tuberculosis (TB).
Developing country like India accounts for one fourth of the global tuberculosis burden. TB is associated with diffuse
functional impairment of most endocrine organs.
Methods: We conducted a study to evaluate the thyroid profile status in new sputum positive pulmonary tuberculosis
patients, aged 12 years and above; attended and admitted to chest and TB, Medicine Department of SLN MCH,
Koraput, Odisha from January 2019 to December 2019. Patients with H/o old pulmonary tuberculosis, patient with
known neurological, hypothalamic-pituitary or thyroid disorders, kidney disease, malignancies and patients receiving
medications known to interfere with thyroid hormone metabolism were excluded from the study. Statistical analysis
was done by using SPSS version 21.0 software. Results were expressed in average±SD, frequencies and percentages.
Continuous data were compared using Student’s t-test. A p value <0.05 was considered as statistically significant and
p value <0.001 was considered as statistically extremely significant.
Results: Mean age of the study group was 37.31±15.63 years. 54 patients (40.30%) were in 20 to 40 years of age
group. We found, 48 (35.82%) pulmonary tuberculosis patients had sick euthyroid syndrome out of 134 pulmonary
tuberculosis patients.
Conclusions: Sick euthyroid syndrome occurs commonly in pulmonary tuberculosis patients with increasing
incidence with advanced age, and also seen in patients with advanced pulmonary tuberculosis patients; therefore,
requires monitoring of thyroid function test for its timely initiation of therapy.

Objective: Efforts can be made to normalize the hematological parameters so that the morbidity and mortality in these patients could be effectively reduced. Methods: This observational study was carried out among 69 cirrhosis patients that fulfills the inclusion and exclusion criteria, attended the medicine outpatient department, and admitted in medicine ward Results: In our study, we had 59 male and 10 female patients with an average age of 49.8±13.19 years. About 92.75% of the patients were alcoholic. Abdominal distension (92.75%) and ascites (84.06%) were the most common presenting complaints. Pallor was present in 42 (60.87%) cases. Splenomegaly was present in 35 (50.72%) cirrhotic patients. Renal dysfunction was present in 23 (33.33%) cases. Sixty-six (95.65%) patients had anemia and 47 (68.12%) patients had thrombocytopenia. Conclusions: From this study, we can conclude that, in cirrhosis of liver patients, various hematological changes are very common which need to be identified and corrected early to reduce morbidity and mortality.

ABSTRACT
Background: Lipids are essential component of biological membranes: also a part of free molecules and metabolic
regulators which control cellular function and homeostasis in the body. Liver plays a central role in lipid metabolism.
Cardiovascular disease (CVD) risk stratification includes serum lipid profile. In the general population; global
prevalence of cirrhosis from autopsy studies ranges from 4.5% to 9.5%. Deaths from cirrhosis have been estimated to
increase and would make it as the 12th leading cause of death in 2020. Although several studies have been conducted
on dyslipidemia in cirrhotics in developed countries, there is a paucity of data in this regard in India.
Methods: This observational study was carried out amongst 60 cirrhosis patients that fulfils the inclusion and
exclusion criteria and attended the medicine OPD and admitted in medicine ward of Pandit Raghunath Murmu
Medical College and Hospital, Baripada, Dist. Mayurbhanj, Odisha, India from June 2018 to Jan 2019.
Results: In our study we had 52 were male and 8 were female. The average age of the patients in the study was
49.62±13.59 yrs. 91.67 % of the patients were alcoholic. Abdominal distension (93.33%) and ascites (81.67%) were
most common presenting complaints. Pallor was present in 65.00% cases. Splenomegaly was present in 29 (48.33%)
patients of cirrhosis of liver. Renal dysfunction was present in 22 (36.67%) cases. We found decreased HDLC (<40
mg/ Dl) in 34 (56.67%) cases. Hypolipidemia, in particular decreased HDLC level is also an important risk factor for
cardiovascular disease and vascular events.
Conclusions: From this study we can conclude that lipid abnormalities are commonly seen in patients with liver
cirrhosis and screening for the same is important for intervention with appropriate therapy to prevent cardiovascular
events. Further studies on lipid abnormalities in these patients and the need for treatment are recommended.

ABSTRACT
Background: Chronic kidney disease (CKD) is a worldwide public health problem. Globally, CKD is the 12th cause
of death and the 17th cause of disability, respectively. Yearly incidence of ESRD in India is approximately 150-200
pmp.
Methods: The observational study was conducted in Department of General Medicine, Pandit Raghunath Murmu
Medical College Hospital, Baripada between May 2018 and January 2019. 244 patients of Chronic Kidney Disease
above 15 years of age satisfying the inclusion and exclusion criteria were included in the study.
Results: Study group constitutes 64.34% (157) of male and 35.66% (87) of female patients with M:F of 1.8:1. The
average age of the patients in the study was 55.91±12.49 yrs. 42.21% (103) of the patients were between 46 and 60
years of age. Maximum number of cases (190 cases) (77.87%) are in stage 4 and 5 with e-GFR <30 ml/ min. The
average serum electrolytes in this study group for serum sodium, potassium, calcium are 137.31±10.05 mEq/L,
4.12±1.48 mEq/L and 1.10±0.19 mmol/L respectively. When association of hypokalemia with risk factor (known and
unknown) is compared, chi-square value found to be 13.664 (p=0.0002) which is statistically extremely significant.
Conclusions: Authors found significant number of cases, more commonly younger patients, presented with atypical
manifestations having no specific etiology; the cause may be defect in rennin-angiotensin system or, may be genetic
or, may be environmental.

Objective: Efforts can be made to normalize the hematological parameters and slow the progress of the disease so that the morbidity and mortality in these patients with chronic kidney disease could be effectively reduced. Methods: The observational study was carried out in the seventy patients of chronic kidney disease (CKD) above 15 years of age, satisfying the inclusion and exclusion criteria, were included in the study. Results: In our study, 179 (66.30%) were male, and 91 (33.70%) were female with M:F of 1.97:1. The average age of the patients in the study was 55.72±12.77 years. About 42.59 % (115) of the patients were between 46 and 60 years of age. About 35.56% of CKD cases had determined etiology and, 64.44% of cases had unknown etiology. Hemoglobin, RBC, and packed cell volume were significantly lower in the patients with CKD compared to the controls (p=0.0001), and RDW was considerably higher in the patients with CKD compared to the controls (p=0.0001). Microcytic anemia was the most prevalent type of anemia. There was a hugely significant association between the prevalence of thrombocytopenia and the severity of CKD (p=0.006). Conclusion: This study concluded that patients with CKD show abnormal hematological parameters. Evaluation of hematological parameters in these patients helps in classifying the type of anemia, aids in choosing the correct treatment modalities, and decreases mortality.

Objective: Chronic Kidney Disease (CKD) is a silent epidemic of the 21 st century. Cardiovascular disease (CVD) is a major cause of morbidity and mortality among patients with CKD. This study aims to evaluate the type of dyslipidemia in CKD patients and correlates with the severity of renal dysfunction in CKD patients. Methods: The observational study was conducted in the Department of General Medicine, PRM MCH, Baripada between May 2018 and January 2019. 262 patients of CKD above 15 y of age, satisfying the inclusion and exclusion criteria were included in the study. Results: Out of 262 patients, 64.50% (169) were male and 35.50% (93) were females with M: F of 1.8:1. The age range was from 20 to 95. The average age of the patients in the study was 56.66+12.22 y. 45.04 % (118) of the patients were between 46 and 60 y of age. 68.70% of the patients had dyslipidemia. The comparison between lipid profiles of cases and controls showed a significant increase in total cholesterol, triglyceride, LDL and decrease in HDL. Conclusion: The prevalence of dyslipidemia in non-diabetic CKD is high. A high degree of abnormality is found in HDL with disease progression, which is statistically significant. Therefore, maintenance of desired lipid levels either through diet or early initiation of lipid-lowering drugs can be helpful in decreasing the risk of cardiovascular complications in CKD patients.

INTRODUCTION Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability. 1 Stroke, the sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is lost by blockage or rupture of an artery to the brain, is also a leading cause of dementia and depression. 2 Globally, 70% of strokes and 87% of both stroke-related deaths and disability-adjusted life years occur in low-and middle-income countries. 3-5 Over the last four decades, the stroke incidence in low-and middle-income countries has more than doubled. During these decades stroke incidence has declined by 42% in high-income countries.3 On average, stroke occurs 15 years earlier in-and causes more deaths of-people living in low-and middle-income countries, when compared to those in high-income countries. 2 Strokes mainly affect individuals ABSTRACT Background: Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability. According to WHO estimation, by 2050 nearly 80% of stroke cases may occur in low and middle-income countries like China and India. It is critical that we understand the etiology causing the stroke so that appropriate treatment can be initiated in a timely fashion. Furthermore, understanding the risk factors associated with stroke is important before primary and secondary preventive measures can be prescribed to the patient. Methods: This observational study was carried out amongst 481 acute ischemic stroke patients that fulfils the inclusion and exclusion criteria and admitted in medicine ward Results: In our study, 481(60.43%) patients had ischemic stroke and 315 (39.57%) patients had hemorrhagic stroke. The incidence of stroke is maximum in 51-70 years of age group which comprises of 59.46% of total patients. The average age + SD were 61.4±13.1 in our study. The most common risk factor was hypertension with 69.85% followed by dyslipidemia 51.77%. Most common clinical presentation was hemiplegia (72.35%) followed by speech involvement (59.46%). Most common site of infarct was parietal (22.25%), followed by periventricular (12.68%). Conclusions: Most of the patients had ischemic stroke as compared to hemorrhagic stroke. It was more common in males. The study contributes to understanding of demographic characteristics, risk factors, and stroke subtypes in acute ischemic stroke. The importance of various risk factors among ischemic stroke subtypes should be stressed for prompt preventive strategies and treatment.

The present study was undertaken to assess the prevalence of systolic and diastolic dysfunction, to determine the prevalence of left ventricular hypertrophy (LVH) from left ventricular mass index (LVMI), to correlate the degree of cardiac dysfunction with severity of chronic kidney disease (CKD) by echocardiography in patients of CKD on conservative management. Material & method: 75 CKD patients were taken in the study which were divided into three groups Group A  Age and sex matched healthy controls (n=20). Group B  Patients with mild to moderate CRF (n=45) (S. Creatinine =1.5-6.0 mg/dl). Group C  Patients with severe CRF (n=30) (S. Creatinine &gt; 6.0 mg/dl). Results: The prevalence of LVH along with systolic dysfunction was 10.0% (p&lt;0.2653) in severe CRF (group C), higher than mild/moderate CRF (group B) which was 2.2% (p&lt;1.0). The prevalence of LVH along with diastolic dysfunction was 76.7% (p&lt;0.0001) in group C, which was significantly higher than group B which was ...

Background: Globally, an estimated 10.0 million (range, 9.0 to 11.1 million) people infected with tuberculosis (TB). Developing country like India accounts for one fourth of the global tuberculosis burden. TB is associated with diffuse functional impairment of most endocrine organs.Methods: We conducted a study to evaluate the thyroid profile status in new sputum positive pulmonary tuberculosis patients, aged 12 years and above; attended and admitted to chest and TB, Medicine Department of SLN MCH, Koraput, Odisha from January 2019 to December 2019. Patients with H/o old pulmonary tuberculosis, patient with known neurological, hypothalamic-pituitary or thyroid disorders, kidney disease, malignancies and patients receiving medications known to interfere with thyroid hormone metabolism were excluded from the study. Statistical analysis was done by using SPSS version 21.0 software. Results were expressed in average±SD, frequencies and percentages. Continuous data were compared using St...

Background: Posterior circulation stroke is less common than stroke involving the anterior circulation. Posterior circulation stroke accounts for approximately 20% of all strokes with varied clinical presentation, which differ from strokes in anterior circulation, with reference to etiology, clinical features, and prognosis. Early diagnosis of stroke is essential so that appropriate preventive therapies may be instituted.

Background: Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability. According to WHO estimation, by 2050 nearly 80% of stroke cases may occur in low and middle-income countries like China and India. It is critical that we understand the etiology causing the stroke so that appropriate treatment can be initiated in a timely fashion. Furthermore, understanding the risk factors associated with stroke is important before primary and secondary preventive measures can be prescribed to the patient.Methods: This observational study was carried out amongst 481 acute ischemic stroke patients that fulfils the inclusion and exclusion criteria and admitted in medicine ward of Pandit Raghunath Murmu Medical College and Hospital, Baripada, Dist. Mayurbhanj, Odisha, India from June 2018 to January 2019. Results: In our study, 481(60.43%) patients had ischemic stroke and 315 (39.57%) patients had hemorrhagic stroke. The incidence ...

Background: Tuberculosis is the ninth leading cause of death worldwide. India contributes to about one fifth of global TB burden. It is very important to diagnose early and treat tuberculosis to cut down transmission of tuberculosis.Methods: Author conducted a retrospective study in Department of Pulmonary Medicine SLN Medical College, Koraput, Odisha to analyze the utility and yield of CBNAAT. Study period was from April 2018 to March 2019. Inclusion criteria was all patients whose samples were subjected to CBNAAT were included in our study.  Sputum samples from pulmonary tuberculosis patients, and extra pulmonary samples (pleural fluid, ascitic fluid, CSF, synovial fluid and gastric lavage etc. were included in our study population. Exclusion criteria was patients who were under anti tubercular therapy for pulmonary, extra pulmonary and MDR TB were excluded from this study. Data were collected from Pulmonary Medicine Department, ART center, DOTS center and CBNAAT center. Total num...

Background: Tuberculosis is one of the most common infection in India and is associated with high mortality. India ranks 14th out of top 22 countries who are burdened with TB infections.Methods: It is a prospective study after getting the ethical committee clearance from the institute. The patients admitted to Chest and TB, Medicine Department of SLN medical college and Hospital, Koraput, Odisha from Jan 2019 to December 2019 with pulmonary tuberculosis were included in the study.Results: A total of 65 adult patients with active PTB were included in this study with age ranging from 15 to 69 years. The mean age of patients was 38.80 + 15.03 years. The total mean serum sodium levels among the subjects was 135.5+7.23. Among 65 patients, 26 (40%) patients had low sodium levels which was less than 135mmol/l out of which 21 (42%) were males and 5 (33%) were females. In all the groups of hyponatremias, majority were found to be males when compared to the females in their respective groups....

Background: Lipids are essential component of biological membranes: also a part of free molecules and metabolic regulators which control cellular function and homeostasis in the body. Liver plays a central role in lipid metabolism. Cardiovascular disease (CVD) risk stratification includes serum lipid profile. In the general population; global prevalence of cirrhosis from autopsy studies ranges from 4.5% to 9.5%. Deaths from cirrhosis have been estimated to increase and would make it as the 12th leading cause of death in 2020. Although several studies have been conducted on dyslipidemia in cirrhotics in developed countries, there is a paucity of data in this regard in India.Methods: This observational study was carried out amongst 60 cirrhosis patients that fulfils the inclusion and exclusion criteria and attended the medicine OPD and admitted in medicine ward of Pandit Raghunath Murmu Medical College and Hospital, Baripada, Dist. Mayurbhanj, Odisha, India from June 2018 to Jan 2019....