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Background: Stroke is one of the most important causes of long-term disability and the second leading cause of death worldwide. Increasing interest has been focused on the role of hyperglycaemia in the evolution of acute ischaemic stroke because of its risk on stroke outcome and also hyperglycaemia occurs in 30-40% of patients with acute ischaemic stroke; most of these individuals do not have a history of diabetes mellitus.Methods: This study subjects consisted of 100 consecutive patients who presented to the Narayana Medical College and Hospital, Nellore with acute ischaemic stroke within 24 hrs of symptom onset and had capillary blood glucose (CBG) measured on presentation. Patients with hyperglycaemia (CBG>140 mg/dl) were then stratified into those with stress hyperglycaemia, newly detected diabetes mellitus and with pre-existing diabetes mellitus for the purpose of analysis. The outcome of stroke in terms of functional impairment and 90-day mortality were studied.Results: Patients with hyperglycaemia exhibited significantly greater functional impairment (p<0.0001) than those with normoglycemia. The outcome was poor in patients with hyperglycaemia. Stroke severity (p<0.001) and functional impairment (p<0.001) were both significantly worse in patients with Hyperglycaemia and no prior history of DM; when compared to a patient with hyperglycaemia and previously diagnosed DM.Conclusions: This study concludes that hyperglycaemia at stroke onset is associated with a higher risk of poor outcome independent of the other variables. Patients with hyperglycaemia at stroke onset, without prior history of DM, have a particularly poor prognosis, then that of patients with known diabetes. Thus, hyperglycaemia is not solely a stress response to neurological insult, as it predicts outcome. Hence, hyperglycaemia needs to be treated to have reduced morbidity and mortality pertaining to stroke outcome.

Background: To compare TIMI & HEART SCORE for their risk stratification in Acute Myocardial Infarction Patients,  prognostic accuracy and Arrhythmia incidence.Methods: This observational study is conducted in a Tertiary care hospital over a period of 2 years from August 2017 to July 2019. A total of 100 patients presented to ER with Chest Pain are selected for study. Patients were monitored for a period of one month in ICCU.Results: In present study out of 61 cases with TIMI score ≥5, mortality of 11.5%(7 cases, p value 0.028). Heart score more than 6  constitutes high risk group, out of which mortality was observed in 7.45% cases (p=0.48). Most of the arrhythmias (70.49%) in present study observed in patients with TIMI score ≥5 (High risk group) which is statistically significant with p value 0.002. Most of the arrhythmias in present study observed in patients with HS ≥8 which is not statistically significant with p value 0.135.Conclusions: In present study, overall mortality rate was 7% and these patients who died constitutes to high risk group with TIMI. HEART SCORE identified more patients as low risk compared to TIMI SCORE. TIMI SCORE is a good predictor of arrhythmia incidence.

Background: Malaria is a major health problem in many parts of India and some parts of Andhra Pradesh, which is also one of the endemic areas for malaria. Several factors have been attributed to increased morbidity and mortality in malaria especially with altered hematological and coagulation parameters playing an important role. The aim of present study was to study the hematological and coagulation abnormalities that correspond to severity and the final outcome.Methods: The present study was    carried out on 100    patients admitted during the period of November 2016 to October 2018 at Narayana Medical College and hospital, Nellore. All of these patients were confirmed by Peripheral Smear or MPQBC or Antigen Assay   followed by detailed clinical history, physical examination and investigated with hematological and coagulation parameters. Then subsequently required routine and special investigation which was followed by monitoring the outcome of the patients with respect to morbidity and mortality.Results: Out of 100 patients 20 patients had severe anemia (Hb% <7 gm%) and most of them patients were falciparum and mixed infection cases. Thrombocytopenia was observed in 63% of the patients and severe thrombocytopenia (<50,000 mm3) was seen in 12% of the patients. PT and APTT were increased in 18% and 13% of the cases respectively. BT was increased in 5% of the cases.  None of the patients expired in this study.Conclusions: severe anemia is a poor prognostic factor and has adverse outcome. Thrombocytopenia, increased PT, APTT does not have any correlation to mortality.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia which is as associated with increased cardiovascular morbidity, mortality and preventable stroke. AF is common in rheumatic heart disease (RHD) particularly mitral stenosis (MS). Left atrial (LA) dilatation is the predisposing factor for the development of AF in rheumatic mitral valve disease. Aim was to study the correlation between AF and LA size in rheumatic mitral valve disease in the population of Southern Andhra Pradesh.  Methods: This is a prospective, observational study conducted in 42 patients diagnosed to have RMVD in Narayana Medical College and Hospital, Nellore, Andhra Pradesh between August 2018 and July 2020. Detailed patient history and complete clinical examination were performed. Standard 12 lead Electrocardiography (ECG) and 2-D echocardiography were done. Left atrial size was measured and compared with patients in AF and with sinus rhythm.  Results: The age of patients ranged from 20-76 years with the mean age of 40.33 years. Out of 42 patients 26 were in AF and 16 in sinus rhythm. Among 26 patients in AF, 22 (84.6%) had LA size ≥4 cm and 4 (15.38%) had <4 cm with mean LA size of 4.6 cm whereas among 16 patients in sinus rhythm, 10 (62.5%) had LA size <4 cm and 6 (37.5%) had ≥4 cm with a mean of 3.83 cm.  Conclusions: Left atrial size ≥4 cm is the predisposing factor for the development of AF in rheumatic mitral valve disease. Therefore, if patients in sinus rhythm who are at high risk of developing AF are identified, prophylactic anticoagulation and antiarrythmic drugs might prevent AF induced complications like embolism and symptom exacerbation in rheumatic mitral valve disease.