Diabetes has emerged as a major concern in the Indian health-care setting but has been underrecognized as a significant challenge in the context of public health policy due to the necessity to handle acute health conditions. Trends obtained from national and regional surveys over time strongly point to the increasing diabetes burden. In addition, people with undiagnosed and prediabetes can aggravate the burden in the near future. Long-term concerns arise from the rapid transformations such as urbanization, rural–urban migration, and lifestyle changes happening across different populations of India. Attempts at creating a rational diabetes prevention and management policy are severely hindered by a lack of comprehensive, standardized data on diabetes prevalence, and trends in the evolution of the epidemic. The impact of diabetes is multifaceted, ranging from the clinical impact of higher secondary complications to personal, psychosocial, and financial effects on the individual which create a cycle of negative outcomes. Given the chronic nature of diabetes, the impact is likely to remain as a self-perpetuating burden on the health-care system. The magnitude, spread, and impact of the diabetes epidemic are substantial, and it has transitioned to being a pandemic with potentially catastrophic implications for the Indian Public Health System. It is therefore essential to create public health policy specific to diabetes care that is effective in reducing the multidimensional impact of diabetes catastrophe and prevent further multiplication of this pandemic.

Background: Our objective in this research was to study the clinical profile of patients having iron deficiency anaemia.Methods: This was an observational cross sectional study conducted in Medicine out-patient and in-patient departments of Baroda Medical College and SSG Hospital, Vadodara from February, 2018 to November, 2018 and included all patients (N=50) above eighteen years of age who were diagnosed on admission with microcytic hypochromic or normocytic normochromic anaemia. Following detailed history, general examination and basic haematological investigations like complete blood count, haemoglobin, mean corpuscular volume, etc., statistical analysis of the data was performed.Results: In the present study, it was found that maximum number of patients belonged to a younger age group (mean=36.82 years) with a majority being females (74%). Most common presenting complaint was weakness seen in 96% cases while the commonest clinical finding was pallor present in 100% cases followed by koilonychia in 32%. The most common cause of iron deficiency anaemia was nutritional seen in 60% patients.Conclusions: Generalised weakness, breathlessness, and pedal edema were the commonest presenting complaints in our study while pallor, koilonychia, and pedal edema were the most common clinical findings. Maximum number of patients had IDA due to a nutritional cause. Chronic gastrointestinal bleeding, inflammatory bowel disease, and menorrhagia are other causes of IDA. Amongst addicted, alcohol addiction seen in most cases.

Ellis-van Creveld (EVC) syndrome is a relatively rare chondroectodermal dysplasia considered mainly as a generalised disorder of the maturation of endochondral ossification. Congenital heart disease occurs in approximately half of the patients with EVC syndrome, 60% of which is a common atrium. Common atrium is a rare variety of interatrial communication characterised by absence or virtual absence of the atrial septum. Patients with this syndrome rarely survive to an old age. We report a case of EVC who presented for the first time at 60 years of age, as survival to an advanced age is exceptional in case of EVC.

Background: The diagnosis of heart failure (HF) remains essentially clinical-Based. However, the history, physical examination, and chest radiograph findings are often inadequate in the diagnosis because multiple other conditions that affect the cardiopulmonary system mimic the symptoms of HF. N-terminal pro-BNP (NT-proBNP) has long been used for diagnosing HF. N-terminal pro-BNP values vary with different patient parameters. There is a scarcity of Indian studies on this topic. Especially with the use of newer drugs like angiotensin receptor neprilysin inhibitor (ARNI), it is important to have data from our own population on the same. Aims and objectives: (i) To assess the role of NT-proBNP in the diagnosis of HF. (ii) Achieve diagnostic clarity in cases having cardiorespiratory symptoms and signs like acute onset dyspnea, pedal edema, and basal crepitations. (iii) To study the effect of various factors like age, body mass index (BMI), and creatinine on NT-proBNP. (iv) Establish a relation between NT-proBNP levels and left ventricular ejection fraction (LVEF), disease severity, and etiology of HF. Materials and methods: An observational prospective study of 50 patients presenting with acute onset breathlessness was carried out, fulfilling inclusion and exclusion criteria over a period of 10 months. Detailed history and examination of the patients were obtained. Venous sample for the measurement of NT-proBNP was collected within 24 hours of onset of symptoms. Other relevant blood and radiographic investigations were obtained. The NT-proBNP “cut-offs” set forth by the American Heart Association (AHA)/American College of Cardiology (ACC) were used to “rule in” or “rule out” HF. Two-dimensional echocardiography (2D Echo) was used to confirm the diagnosis. The correlation between NT-proBNP and various parameters like age, BMI, creatinine, and LVEF was obtained. Sensitivity and specificity tests were applied as well. Results: Out of the 50 patients presenting with acute onset dyspnea, the most common cause was ischemic heart disease (IHD) (44%) followed by dilated cardiomyopathy (DCM) (32%), chronic obstructive pulmonary disease (COPD) (10%), anemia (4%), followed by other causes. The median NT-proBNP value was the highest for IHD patients (9485 pg/mL), followed by DCM (8969 pg/mL), followed by COPD (2846 pg/mL), and followed by anemia (850 pg/mL). There is a significant positive correlation between NT-proBNP and age (coefficient of correlation r = 0.4007, significance level p = 0.0389, and class interval = 0.137–0.61). There is a significant negative correlation between creatinine clearance and NT-proBNP (coefficient of correlation r = –0.372, significance level p = 0.007, and class interval = –0.58 to –0.105). There was significant negative correlation between LVEF and NT-proBNP (coefficient of correlation r = –0.36, significance level p = 0.009, and class interval = –0.58 to –0.09). Higher LVEF is associated with lower NT-proBNP values. There is marked heterogeneity in the values though. Conclusion: It is seen that the values of NT-proBNP vary with factors like age, BMI, and creatinine clearance in addition to LVEF. This may lead to falsely positive or falsely negative diagnosis of HF. With the above observations in mind, it can be concluded that NT-proBNP can help diagnose HF but only in addition to clinical findings.

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