Background: Hemodialysis in end-stage renal disease patients causes disability in different domains of patient's lives, leading to impaired (quality of life [QOL]). Studies measuring the QOL in patients on renal replacement therapy are limited in the Indian scenario. Aims: To evaluate the QOL in adult patients on maintenance hemodialysis by applying the World Health Organization QOL (WHOQOL)-BREF scale. Material and Methods and Study Design: Health-related QOL was evaluated in 100 adult patients on maintenance haemodialysis for 3 months or more in Dayanand Medical College and Hospital, Ludhiana. The WHOQOL-BREF was applied in these patients and the physical, psychological, social, and environmental health domains were assessed. Results: Most common age group was 31–60 years (56%) with a mean age of 54.44 years, male: 74%. Patients with age more than 60 years had better QOL scores in the social domain which was statistically significant ( P = 0.005). Male patients had better scores in all four domains and was significant in the social domain ( P = 0.025). Married patients had better QOL scores in social domain. Duration of dialysis had a reverse correlation with QOL scores in physical domain with better scores in dialysis duration of <12 months. Frequency of dialysis did not significantly affect the QOL scores. QOL scores were directly related to the monthly family income in all four domains with the highest income group showing better scores ( P < 0.05). Conclusion: The present study provided an insight into the factors that affect the QOL in hemodialysis patients. Patients with age >60 years had better QOL scores in the social domain. Female gender, low serum proteins, HD duration of more than 1 year, and low monthly income were found to be associated with impaired QOL domains in patients undergoing maintenance hemodialysis.

Aims: The etiological spectrum and clinical profile of admitted patients presenting with pancytopenia were studied. Study Design: This was a prospective study conducted on 200 patients presenting to the Department of Medicine, Department of Oncology and the Allied Specialities of Medicine, Dayan and Medical College and Hospital, Ludhiana and were found to have pancytopenia during hospital stay. Results: Mean age of the patients was 45.69 ± 17.05 years with maximum number of patients (23%) in the age group of 51-60 years and 119 patients were males and 81 patients were females. Most common physical finding was pallor (95%), followed by splenomegaly (22%) and hepatomegaly (17%). Total of 107 patients were vegetarians (53.5%) and 93 patients (46.5%) were non-vegetarians. Mean hemoglobin was 7.16 ± 2.04 g/dl, mean total leucocyte count was 2.51 ± 1.02 x 103/cu. mm, mean platelet count was 54885.37 x 103/ul ± 40320.96 and mean the absolute neutrophil count was 1.59 x 103 /cu.mm ± 0.84. Ten patients of pancytopenia were because of tropical fever which included 4 cases of dengue, 3 cases of malaria, 2 cases of enteric fever and 1case of mixed infection (malaria + scrub typhus). Viral markers were positive in 14 out of the 63 patients tested. Out of these 14 patients, 4 were HBsAg reactive, 7 were HCV +ve and 3 were HIV +ve. Most common red blood cell picture on peripheral blood film was normocytic normochromic (34.5%), followed by mixed morphology (33.5%). Macrocytic and microcytic morphology was seen in 19.5% and 12.5% of the patients respectively. Hypercellular marrow was seen in 82 patients (42.9%), normocellular marrow was seen in 58 patients (30.3%) and hypocellular marrow was seen in 51 patients (26.7%). The most common cause of pancytopenia in this study was megaloblastic anemia in 59 patients (29.5%), the 2nd common cause was leukemias in 28 patients (14%) and the 3rd cause was aplastic anemia in 22 patients (11%). Drug induced pancytopenia was seen in 21 patients (10.5%) and hypersplenism in 9 cases (4.5%). Conclusion: This study has helped us in knowing the various etiologies of pancytopeniain this hospital. Megaloblastic anemia was the most common etiology in this study followed by leukemiasand aplastic anemia. The study helped us in understanding of the age and gender distribution, the hematological parameters, the peripheral blood film in pancytopenia and the bone marrow picture in these patients.

Background and Objectives: Diabetes mellitus is associated with poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics of patients with type 2 diabetes with COVID-19, and to determine the impact of type 2 diabetes on clinical outcome of patients with COVID-19. Material and Methods: This single-center, retrospective, observational study enrolled patients admitted from March 2020 to June 2021 with COVID-19. The clinical and biochemical characteristics of patients with known type 2 diabetes, newly diagnosed diabetes, type 2 diabetes with comorbidities and those who succumbed to illness were analyzed. Results: Of 4,559 patients with COVID-19, 2,090 (45.8%) had type 2 diabetes. Patients with COVID-19 with diabetes were older, more likely to receive mechanical ventilation, had higher odds of mortality from COVID-19 as compared with patients without diabetes. In addition, patients with diabetes had significantly higher levels of serum creatinine, C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Compared with previously diagnosed patients with diabetes, newly diagnosed patients had higher mortality (33% vs. 27%, P = 0.049). Among patients with COVID-19 and diabetes, nonsurvivors had significantly higher levels of inflammatory markers and had severe impairment of cardiac, renal, and coagulation parameters as opposed to survivors. Conclusion: Patients with COVID-19 with diabetes were more likely to have severe disease and had higher mortality. Presence of chronic kidney disease and coronary artery disease in patients with diabetes with COVID-19 was associated with adverse outcome. Patients with newly diagnosed diabetes had higher odds of severe disease at presentation and had higher mortality.

Background: The physiological changes associated with menopause are responsible for increase in cardiovascular disease after menopause. BMI, physical inactivity, metabolic syndrome, hypertension and diabetes mellitus increase in post-menopausal women which are all powerful predictors of cardiovascular events. The risk factor profile between pre-menopausal and post-menopausal women presenting with acute coronary syndrome was thus studied.Methods: This study was a prospective cross-sectional hospital based study and was conducted in the Department of Medicine and Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana wherein 50 pre-menopausal women and 50 post- menopausal women who presented with acute coronary syndrome were enrolled. The risk factor profile and angiography findings amongst the 2 groups were compared.Results: There was no difference in the incidence of Diabetes Mellitus and Hypertension among the pre & post-menopausal groups. The prevalence of family history of cardiovascular disease was higher in the pre-menopausal group. The post-menopausal women showed a significant decrease in physical activity due to sedentary lifestyle. Both the groups had high BMI and increased waist circumference. Lipid parameters did not show any significant difference between the two groups. However, pre-menopausal women had higher LDL-C and triglyceride levels and lower HDL-C levels. On analysis of the angiographic findings in diabetics and non-diabetics, of both the groups diabetes mellitus was much higher in subjects presenting with triple vessel disease suggesting extensive atherosclerosis.Conclusions: study showed physical inactivity as an important cardiovascular risk factor in post-menopausal women. Obesity is an important risk factor for coronary artery disease in both pre- and post-menopausal women.

Background: Parathyroid hormone (PTH) mobilizes calcium by increasing calcium resorption from bone and by raising calcium reabsorption in the proximal kidney tubule. Primary hyperparathyroidism (PHP) results from inappropriate overproduction of parathyroid hormone from one or many parathyroid glands and presents with hypercalcemia. In the surgical management of PHP intraoperative PTH (IO-PTH) assays have been shown to improve the success of parathyroid gland surgery. Minimally invasive parathyroidectomy (MIP) has replaced the traditional four-gland bilateral exploration as the procedure preferred by many institutions. Hence; the present study was undertaken for assessing the outcome of surgery in patients with PHP. Subjects and Methods: The present study included assessment of outcome of surgery in patients with PHP. Once the suspicious parathyroid was identified, careful dissection with blunt instruments was done to free gland from surrounding fascia. Bipolar was used to ligate the vascular supply and the specimen was removed. Patients with above mentioned inclusion criteria underwent preoperative localization with USG neck and technetium Tc-99m (99mTc) Sestamibi scan (CT/ MRI Neck when required). Based on results of MIBI and USG neck, the findings were defined as concordant and discordant. Patients with concordant findings of USG neck and Sestamibi scan underwent MIP. All the results were summarized in Microsoft excel sheet and were analyzed by SPSS software. Results: CT/MRI was done in only 4 patients where 50% of the patients showed involvement of right superior and inferior glands. Minimal invasive parathyroidectomy (MIP) was done in 95.2% patients (20/21) while bilateral neck exploration (BNE) was done in only 1 case of multiple adenoma. The USG neck (n=20) was able to accurately localize abnormal parathyroid glands in 17 patients (85%). Conclusion: In patients undergoing surgical treatment for PHP, Minimal Invasive Parathyroidectomy has excellent prognosis.