A 28-year-old male presented to the emergency department with history of breathlessness and decreased urine output. History of 20 episodes loose stools and 10 episodes of vomiting since the past 3 days .The stools were watery, non-foul smelling and the vomitus contained food particles.Patient had sore throat 2 weeks prior to the episode. No history of pain abdomen, hematuria, fever, headache or seizures at the time of admission.He was not a known case of diabetes, hypertension, epilepsy, asthma, cardiac or chronic kidney disease.

BACKGROUND Dyslipidaemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. It has been seen in many trails and studies that good glycaemic control has prevented the cardiovascular morbidity and mortality. The rationale of this study was to detect the lipid abnormality in diabetic patients. MATERIALS AND METHODS This cross-sectional observational study was conducted to estimate prevalence of dyslipidaemia among diabetic patients of KIMS, Hubli. A total of 100 patients were included out of which 62 were males and 38 females. RESULTS There was a positive correlation between PPBS and dyslipidaemia with p value=0.01. However, when correlation between dyslipidaemia and duration of diabetes was compared, it was not significant with p value of 0.64. CVS status, elevated urea and elevated creatinine were not significant when compared to dyslipidaemia. Parameter correlated between capillary and venous estimate showed that the total cholesterol, triglyceride, LDL, VLDL and HDL were highly significant with p value <0.001. CONCLUSION Our study showed that there is increased incidence of dyslipidaemia in diabetes patients. Hence, constant monitoring of lipid profile is required in diabetes patients to reduce the risk of CVS diseases.

BACKGROUND Diabetic nephropathy is the commonest cause of end-stage renal disease in the developed world. Recent studies have demonstrated that a difference in systolic blood pressure between arms is associated with cardiovascular disease and microalbuminuria. It is considered a predictor for cardiovascular disease and a surrogate marker for early kidney damage among patients with both type 2 diabetes and hypertension. AIMS AND OBJECTIVES The aim was to investigate an association between arm difference in systolic blood pressure and microalbuminuria which can serve as a marker for diabetic nephropathy. MATERIALS AND METHOD This study was conducted on 200 patients with diabetes mellitus and an inter-arm difference in systolic blood pressure was present in 35.7% of the study population. Presence of systolic blood pressure difference of more than 10 mmHg between arms correlated with microalbuminuria and duration of diabetes mellitus with a p value of <0.001. We also found a correlation between arm difference in blood pressure and duration of diabetes mellitus, presence of hypertension and body mass index. CONCLUSION The inter-arm difference in blood pressure could serve as a risk marker for renal damage in diabetes mellitus.

BACKGROUND To investigate relationship between glycated haemoglobin (HbA1c) level and coronary artery disease (CAD) severity. METHODS This cross sectional observational study was conducted over a period of six months, and 100 participants were enrolled and baseline characteristics were collected. Clinical presentations in terms of unstable angina, NSTEMI or acute myocardial infarction were diagnosed. Coronary angiography was performed on all participants to figure out the numbers of coronary artery stenosis in terms of non-significant stenosis (<50% stenosis), single or multiple vessels stenosis (≥50% stenosis). All participants were divided into subgroups according to two categories in terms of severity of clinical presentation (unstable angina, NSTEMI or acute myocardial infarction) and the number of coronary artery stenoses (single, and multiple vessels). Primary endpoint was to evaluate relationship between baseline HbA1c value and CAD severity. RESULTS Consistent to previous studies, participants with CAD had more risk factors such as age, smoking, low HDL-C. Notably, HbA1c level was more prominent in CAD group than that without CAD. As compared to unstable angina subgroup, HbA1c levels were gradually increased in NSTEMI and acute myocardial infarction groups. Similar trend was identified in another category in terms of higher HbA1c level corresponding to multivessel stenosis. Multivariate regression analyses showed that after adjusting for traditional risk factors as well as fasting blood glucose, HbA1c remained strongly associated with the severity of CAD. CONCLUSION HbA1c may be a useful indicator for CAD risk evaluation.

BACKGROUND Cardiovascular disease is a significant health problem in India with an estimate 3.7 million deaths each year. Mechanisms of myocardial ischemia include inflammation, endothelial dysfunction, platelet aggregation and coagulation. Acute coronary syndrome occurs due to rupture of atherosclerotic plaque. Platelets play a role in both development and rupture of the atherosclerotic plaque. Lymphocytes play a role in chronic inflammation of atherosclerosis. Lower lymphocyte count has increased mortality after acute myocardial infarction. METHODS The study was conducted in Department of General Medicine, Karnataka Institute of Medical Sciences, Hubli from February 2019 to December 2020. It is a prospective observational study. Patients aged ≥ 18 years with ST-elevated myocardial infarction (STEMI) were included in the study. Total 156 cases were selected based on inclusion and exclusion criteria. Cardiovascular events during the in-hospital period were noted. The study population was divided into tertiles based on the platelet-lymphocyte ratio (PLR) values. The low PLR group (n = 104) was defined as having values in the lower 2 tertiles (PLR ≤ 148.4) and the high PLR group (n = 52) was defined as having values in the highest tertile (PLR > 148.4). A ‘P’ value < 0.05 was considered statistically significant. RESULTS Out of 156 patients, 103 (66 %) were males and 53 (34 %) cases were female. Mean age group was 59 ± 10 years. Percentage of patients who underwent thrombolysis was higher in high PLR group (65.38 % vs. 48.07 %, P = 0.041). Death rate was higher in high PLR group (28.84 % vs. 8.65 %, P = 0.001). PLR > 148.4 was found to be an independent predictor of in-hospital cardiovascular mortality in multivariate analyses (hazard ratio: 13.222 (2.113-21.749) P = 0.006 with 95 % confidence interval). Receiver operating curve (ROC) analyses, a PLR value of 148.4 for in-hospital mortality rate had sensitivity of 62.5 % and a specificity of 72 % (area under the curve = 0.627, 95% confidence interval 0.485 – 0.769). CONCLUSIONS In our study, higher PLR had significant association with in-hospital mortality in patients with STEMI. KEYWORDS ST Elevation Myocardial Infarction (STEMI), Platelet/Lymphocyte Ratio (PLR), Ischemic Heart Disease (IHD)