Aim: To determine the relationship of carotid plaque, intima media thickness (IMT), resistivity index (RI) and pulsatility index (PI) and prevalence of different risk factors with acute ischemic stroke and stroke subtypes in both diabetic and non-diabetic subjects. Materials and methods: 80 cases of acute ischemic strokes and 40 healthy controls were included in the study. The plaque, IMT, RI and PI were measured by carotid duplex ultrasound. Results: 31 subjects were Type 2 diabetic, 54 hypertensive while 25 were both diabetic and hypertensive. 23 cases (28.75%) had lacunar stroke (LACI), 32 (40%) stroke involving partial anterior circulation(PACI), 10(12.5%) stroke in posterior circulation (PACI) and 15(18.75%) stroke involving total anterior circulation(TACI) respectively. The mean IMT (0.88 ± 0.19mm), RI(0.76 ± 0.05) and PI(1.71 ± 0.19) of patients and mean IMT (0.6±0.09mm), RI (0.61 ± 0.06) and PI (1.53 ± 0.11) of controls were statistically significant (p-0.000). The mean values of IMT, PI and RI were significantly higher in diabetics (IMT-0.90 ± 0.16 VS 0.64 ± 0.11, p-0.013; PI-1.76 ± 0.20 VS 1.49 ± 0.09, P-0.000 and RI-0.76 ± 0.04 VS 0.59 ± 0.06, P-0.000) and similarly the mean values for IMT, PI and RI in hypertensives as compared to controls (IMT-0.88 ± 0.16 vs 0.65 ± 0.10, P-0.006; PI1.69 ± 0.18 vs 1.49 ± 0.09, P-0.000 and RI 0.76 ± 0.04 vs 0.59 ± 0.06, P-0.000). The mean IMT, PI and RI were increased significantly in smokers compared to controls (IMT-0.93 ± 0.20 vs 0.63 ± 0.06, P-0.000; PI-1.82 ± 0.22 vs 1.49 ± 0.09, P-0.000 and RI-0.77 ± 0.04 vs 0.59 ± 0.06, P-0.000). Type 3 plaque accounted for 27 (56.2%) cases and Type 2 plaque 12 (25%) cases. The total number of plaques in patients as compared to controls were significantly more (P-0.0034) and the mean plaque area was 46 mm2 for cases and 20 mm² for control (P-0.0001). TACI was the most common type of ischemic stroke seen in DM (60%), HTN (66.6%) and smokers (66.7%). Plaques (73.3%), IMT (0.90 ± 0.12), PI(1.72 ± 0.14) and RI (0.76 ± 0.13) were more commonly associated with TACI subtype. On multivariate analysis using ANOVA, the mean PI was highly significant (0.000) in relation to types of plaque. Summary and Conclusions: IMT, RI, PI and plaque type are useful diagnostic parameters for acute ischemic stroke and its subtypes. They can be used as noninvasive tools for predicting and preventing ischemic stroke in smokers as well as subjects with DM and hypertension

No abstract

BACKGROUND Early detection and accurate diagnosis of heart failure remain a huge clinical challenge in patients with acute dyspnoea of various aetiologies. Different biomarkers of left ventricular dysfunction are being studied to differentiate acute cardiogenic from noncardiogenic dyspnoea. Amongst those, Brain Natriuretic Peptide (BNP) is an important biomarker for diagnosing acute stage of cardiac dyspnoea. The aim of this study is to assess the Plasma N-Terminal Pro-Brain Natriuretic Peptide (NT-ProBNP) level in acute dyspnoea of various aetiologies and to establish the diagnostic or prognostic value of plasma NT-ProBNP in acute dyspnoea of cardiac diseases. MATERIALS AND METHODS In our study, we have taken 84 cases of acute dyspnoea. The acute dyspnoea above 15 years of age were included in the study. Whereas dyspnoea due to chest trauma, renal insufficiency (serum creatinine > 2.5 mg/dL), previously known as valvular heart diseases and severe coronary ischaemia identified as > 0.1 MV ST-segment elevation or ST depression on 12-lead ECG were excluded from the study. After taking patient's history, the clinical examination with routine blood test, electrocardiography and chest x-ray were done. In addition, blood sample was collected for NT-ProBNP measurement. RESULTS In our study group, out of 84 cases Male= 55 (65.4%) and Female= 29 (34.6%). Among those cases 40 (47.6%) had acute cardiac dyspnoea, whereas 44 (52.4%) had non-cardiac dyspnoea. The mean + SD NT-ProBNP concentration of cases with acute cardiac dyspnoea was (4539.7 + 4342.9 pg/ mL), which was significantly higher than the cases with non-cardiac dyspnoea (136.6 + 94.7 pg/ mL), (P < 0.00001). On the evaluation of acute heart failure according to NYHA (New York Heart Association classification), 44 (52.4%) had NYHA Class-I symptoms, 3 (7.5%) had NYHA Class-II symptoms, 10 (25%) had Class-III symptoms and 27 (67.5%) had Class-IV symptoms that demonstrate the significant relationship of NT-ProBNP of NYHA symptom severity with analysis using ANOVA (P < 0.00001). The median NT-ProBNP level was 150 pg/ mL (IQR-713 pg/ mL) in patients with left ventricular ejection fraction (LVEF) > 50% and 4580 pg/ mL (IQR-3180 pg/ mL) in those with LVEF < 50% (P < 0.00001). CONCLUSION The serum NT-ProBNP measurement is a useful parameter for diagnosing cardiac causes of dyspnoea and also acute heart failure as per NYHA class. It can be used for early detection and management of acute heart failure.

No abstract

A Hindu male patient aged about forty years admitted to the medicine ward due to weakness in both proximal and distal muscles of both the limbs since last 10 days. Subsequently, he was unable to move both legs after 1 week. He was experiencing pain abdomen 1 day before admission. There was no history of fever, loose motion, convulsion, sensory loss and bowel or bladder involvement. He had a past history of weakness and muscle cramps for last one year for which he was treated several times. During that period, he noticed weight loss despite good appetite. There was increase in frequency of urination around 9 to 10 times a day, particularly more during the night time for which he wakes up several times. He had no past history of any gastrointestinal or cardiovascular problems, although he felt uneasiness with sweating sometimes. He had undergone such type of repeated attack mostly in the night during this period, which was followed after a heavy meal or after exertion. The patient was a non-smoker and a farmer by profession, married since 5 years with no children. He was not under any medications or addicted to any drug. There was no evidence of any similar illness within the family. DIFFERENTIAL DIAGNOSIS The differential diagnosis in this condition, which includes the diseases like Hypokalaemic palsy, Guillain-Barré syndrome, channelopathies like hypokalaemic periodic paralysis and tubulopathies like Bartter and Gitelman syndrome.