Background: Non-alcoholic fatty liver disease (NAFLD) is a common association of Type 2 diabetes mellitus and diabetes mellitus is a leading risk factor for coronary artery disease (CAD). This study aims at estimating the prevalence of NAFLD by ultrasonography and to correlate NAFLD with CAD in a group of patients with Type 2 DM.Methods: Consecutive patients of Type 2 diabetes fulfilling the inclusion criteria were recruited. Clinical and biochemical parameters were recorded. NAFLD was diagnosed by ultrasonography.Results: The prevalence of NAFLD was 41.2% in the study group (n=114) and was higher in females. Prevalence of NAFLD in the younger age group was significantly higher than that in the older age group. Elevated liver enzymes, elevated HbA1C, duration of diabetes, obesity, acanthosis nigricans and metabolic syndrome were all significantly associated with NAFLD. CAD was significantly higher in the NAFLD subgroup (72.46%) compared to the non-NAFLD subgroup (52.63%) (p=0.001). Using binary logistic regression analysis, it was found that NAFLD is an independent predictor of CAD (p=0.002).Conclusions: NAFLD is extremely common in people with Type 2 diabetes and is associated with a higher prevalence of CAD.NAFLD is an independent risk factor for development of CAD. Thus, identification of NAFLD in diabetics might help in predicting the risk of CAD and to adopt the necessary preventive strategy.

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Context:Cerbera odollam is a tree native to South Asia. It belongs to the poisonous Apocynaceae family. Deliberate self-harm with fruit of this plant is a major clinical problem in the developing world. Ingestion of C. odollam kernels is the cause of deaths in more than half of Kerala's plant poisoning deaths. The data on clinical features and complications of C. odollam poisoning are sparse, apart from a few case reports and limited studies.Aims:The present study was done to find the mode of presentation, complications, need for cardiac pacing, inhospital mortality, and the predictors of mortality in patients with C. odollam poisoning.Settings and Design:This was a retrospective study conducted in the department of general medicine in a tertiary care center in Alappuzha district, Kerala. The study period was for 1 year from January 1, 2016, to December 31, 2016.Subjects and Methods:All the patients admitted with a history of ingestion of odollam during the study period were included in the study. Data were collected from case records. The study was approved by the institutional ethics committee and research committee (IEC/TDMCA/EC3.dated29/11/201).Statistical Analysis Used:The data were analyzed using SPSS 16 for Windows (SPSS Inc., Chicago, IL, USA).Results:In this study, 102 patients were identified with C. odollam poisoning, and the mortality rate was 16.7%. Electrocardiogram (ECG) changes were common in our patients, and we observed different types of heart block in the same ECG itself. Ingestion of more than two kernels of odollam, late presentation to hospital, vomiting, bradycardia, hypotension, hyperkalemia, and more severe ECG changes were associated with significantly higher mortality in this study.Conclusions:C. odollam poisoning is a common method of deliberate self-harm in Kerala. It carries a high mortality rate, and the predictors of mortality include vomiting, bradycardia, hypotension, hyperkalemia, and the presence of severe ECG changes.

Background: Coronary artery disease is becoming the leading cause of death in the world. The incidence of CAD in females has increased rapidly in the past decades. This study aimed to analyze the clinical profile of premenopausal women with CAD and elucidate on the possible risk factors.Methods: Premenopausal female patients admitted with an acute coronary syndrome as diagnosed by history, ECG and laboratory tests were recruited. Clinical and biochemical parameters were recorded.Results: Mean age of study participants was 41.6±8.18 yrs. Unstable angina (60%) was the most common clinical presentation. Proportion of women with various risk factors of CAD in our study population were as follows dyslipidemia (65%), family history of premature CAD (57.5%), hypertension (55%), diabetes mellitus (42.5%), hypothyroidism (40%), PAD (37.5%), CKD (35%) and SLE (20%). Most (95%) of the study population had high LDL-c. Three fourth (77.5%) of the study population had low HDL Approximately half of the study population had fatty liver on ultrasonography. Triglyceridemia was found in 72.5% of the study population.Conclusions: Premature CAD is increasingly evident in young premenopausal women in India. Premenopausal CAD in India is of multi factorial causation and dyslipidemia, hypertension, diabetes mellitus, central obesity and family history of premature CAD play a crucial role in its development.

INTRODUCTIONFor most women menopause marks the beginning of uninterrupted oestrogen deficiency and indicates the onset of permanent cessation of ovarian function.Menopause is diagnosed after 12months of amenorrhea and the mean age at menopause is 51years. It has been shown than several symptoms and diseases have a causal association with menopause.1 The Prospective Pittsburgh Study has found that menopause is associated with changes in several heart disease risk factors such as increasing LDL cholesterol and decreasing HDL cholesterol. Natural menopause has an unfavourable effect on lipid metabolism which may contribute to an increase in the risk of coronary artery disease. 2 Women with premature menopause (before the age of 40years) or early menopause (between 40 and 45years) experience an increased risk of overall mortality cardiovascular disease, psychiatric disease, osteoporosis and other sequelae. ABSTRACTBackground: Menopause marks the onset of cessation of ovarian function which is associated with changes in cardiovascular risk factors especially an unfavourable change in lipid profile. This is more pronounced is perimenopausal females who have undergone total hysterectomy with bilateral sapingo oopherectomy. This study aimed at looking into the changes occurring in the lipid profile and other cardiovascular risk in patients who have underwent oopherectomy over a 3 months period. Methods: The study was conducted as a case control one. We studied 70 consecutive perimenopausal patients admitted in a tertiary care teaching medical college hospital in Kerala, South India who were admitted for hysterectomy and bilateral oopherectomy over a 1year period. The lipid profile and anthropometric measurement with blood pressure recording was done prior to surgery and the same patients were followed up after 3 months when the cardiovascular risk assessment and lipid profile estimation were repeated. Here, the cases acted as controls after the end of third month. Results: It was found that after the end of 3 months of surgical menopause there was no significant change in body mass index, waist hip ratio or systolic BP. However, the DBP was higher in patients after surgery (78.68±7.94 vs 83.31±11.03, P <0.001). There was also statistically significant increase in total cholesterol (166.07±28.22 vs 242.94±45.65 [P<0.001]), TG (129.33±31.16 vs 177.06±50.57 P<0.001) and LDLc (107.83±20.06 vs 166.73±48.51 P>0.001). The HDLc was found to be 27% after 3 months of surgical menopause (59.31±8.22 vs 43.73±35 P>0.001. Conclusions: Thus, it was concluded that there was a significant unfavourable effects on lipid profile and diastolic blood pressure 3 months after surgical menopause.