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Papers by malini kulshrestha

Introduction: Glycosylated Hemoglobin A1c (HbA1c) is formed by the glycation of the valine of the... more Introduction: Glycosylated Hemoglobin A1c (HbA1c) is formed by the glycation of the valine of the β-chain of hemoglobin and used commonly as a screening test for diabetes in clinical practice. (1) ADA endorsed an HbA1c > 6.5% as diagnostic for diabetes. Hence current research aimed to study whether elevated Hba 1C in Hypothyroidism has any correlation with anaemia. Material and methods: 140 non diabetic hypothyroid patients were selected and their Hba 1C was done (40 microcytic hypochromic anaemia, 40 normocytic normochromic, 60 non anaemia) and 140 age, sex, fasting glucose level and anaemia status matched controls were selected. Diabetes was excluded by doing fasting and post prandial blood sugar levels. We excluded pregnant patients, patients having haemolytic anaemia, other haemoglobinopathies, anaemia due to other chronic illnesses, renal disease that shorten erythrocyte survival may proportionately decrease Hba 1C levels and are also associated with iron deficiency. Results...

Introduction: Risk of developing cerebrovascular disease (CVD) is two times more and type 2 diabe... more Introduction: Risk of developing cerebrovascular disease (CVD) is two times more and type 2 diabetes mellitus is four times more in people with metabolic syndrome as compared to subjects without metabolic syndrome. A prospective cross-sectional study was undertaken to explore the prevalence of metabolic syndrome in subjects with abdominal obesity in Rohilkhand region of U.P. attending Rohilkhand medical college (RMCH), Bareilly. Material and methods: The prevalence of Metabolic syndromewas assessed in a group of 100 patients having abdominal obesity (waist circumference >90 cm in male and >80 cm in female) attending outpatient department of RMCH, Bareilly. We have noted the prevalence of metabolic syndrome and the presence components of metabolic syndrome in the subjects taken for the study. For all subjects the following parameters were noted: age, sex, blood pressure, waist circumference, blood sample for blood sugar and lipid profile. Blood pressure was taken in left arm in...

Introduction: Paucity of data exists in the literature regarding the clinical features, natural h... more Introduction: Paucity of data exists in the literature regarding the clinical features, natural history, and prognosis in young patients with acute myocardial infarction (MI). Literature quotes few studies which have focused on assessment of various epidemiologic features and anatomy of the coronary arterial system in young adults with the evidence of coronary heart diseases. Hence present study evaluated young patients presenting with acute MI on the basis of various demographic details and morbidity and mortality. Material and methods: The present study was conducted among 600 patients who were admitted with MI within 24 hours of the onset of the clinical symptoms. Patients were divided into young aged, middle aged and the older individuals. All the demographic and clinical details of the patients were recorded and assessed. All the results were analyzed by SPSS software. Multivariate analysis and chi-square test were used for the assessment of level of significance. Results: Mean...

Introduction: Tobacco smoking is one of the common cause of the preventable deaths globally. It c... more Introduction: Tobacco smoking is one of the common cause of the preventable deaths globally. It contains nicotine which causes physi cal and psychological dependencies in creases the blood coagulability and causes conduction block, re-entry and ventricular fibrillation. Cigarette components causing cardiovascular abnormalities as sessed by doing cheapest method ECG. Material and Methods: A prospective case control study was done on 100 smokers and 100 non smokers. Detailed clinical examination was done to rule out any other physical illness. BP and 12 lead ECG were done in all participants.Systolic blood pressure, diastolic blood pressure, Resting heart rate, the p wave, the PR interval,the QRS complex,QTc(corrected QT interval),ST segment,T wave abnormalities were assesed in both group and statstical analysis was done by unpaired T test. Result: Prevalence of hypertension was higher in smoker's.A significant correlation with elevated systolic blood pressure,diastolic blood pres...

Introduction: Subclinical diastolic dysfunction and ongoing atherosclerosis is a common occurrenc... more Introduction: Subclinical diastolic dysfunction and ongoing atherosclerosis is a common occurrence in diabetics. Carotid Intimal-Medial Thickness (CIMT) is being used as a marker to assess subclinical atherosclerosis. Study was aimed to find out prevalence of subclinical atherosclerosis and diastolic dysfunction in asymptomatic diabetics and correlate CIMT with left ventricular diastolic dysfunction (LVDD). Material and methods: A prospective, cross sectional study was conducted over 12 months in asymptomatic diabetics attending OPD/IPD of a tertiary care teaching hospital in north India. Patients were screened to rule out cardiovascular involvement and any other complication related to diabetes. After noting Weight and Height, BMI was calculated. CIMT was measured by B mode high resolution ultra sound. Echocardiography was done and E/A ratio calculated. Patients were divided into those with and without diastolic dysfunction; Also they were divided in two groups taking CIMT into con...

Indian journal of applied research, 2018

Occurrence of anaemic retinopathy and conjunctival pallor is common in patients withanaemia. Magn... more Occurrence of anaemic retinopathy and conjunctival pallor is common in patients withanaemia. Magnitude ofretinal manifestations depends upon the severity of anaemia. Retinal damage in anaemia occurs due to anoxia, venous stasis, angiospasm and increased capillary permeability. Methodology: Non interventional study was conducted in 52 adult patients diagnosed with nutritional anaemia in medicine department. Patients with diabetes, hypertension,anaemia other than nutritional causes and media opacities were excluded. After obtaining informed consent ocular examination was carried out with direct ophthalmoscope. Fundus examination was done after dilatation of pupils with tropicamide(mydriatic) eye drops. Patients were examined in more detail in the Ophthalmology O.P.D (whenever possible). Results: Conjunctival pallor is the most common finding and is seen in all patients. Flame shaped retinal haemorrhages were the second most common finding and was seen in 38.46% of patients. Deep haemo...

Paripex Indian Journal Of Research, 2018

Diabetes mellitus refers to a group of common metabolic disorder with micro and macro vascular co... more Diabetes mellitus refers to a group of common metabolic disorder with micro and macro vascular complications. Cardiac autonomic neuropathy (CAN) is a common but frequently overlooked complication of diabetes mellitus. CAN is an important cause of morbidity and mortality in diabetic patients as it is associated with high risk of cardiac arrhythmias and sudden death related to silent myocardial ischaemia. Numerous non invasive tests have been described for the diagnosis of CAN. These tests although sensitive and reproducible, are time consuming and not suitable for screening a large population. Prolongation of the corrected QTinterval (QT C ) in the electrocardiogram (ECG) has been found to be a specific, rapid and objective method for detecting cardiac autonomic neuropathy in many studies. The present study aims to evaluate the correlation between QT C interval and diabetic cardiac autonomic neuropathy. 50 patients of Type 2 Diabetes Mellitus who fulfilled the inclusion and exclusion...

Internet Journal of Medical Update - EJOURNAL, 2015

Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are keystones for ther... more Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are keystones for therapy of hypertension in diabetes because they show favourable effects on diabetic nephropathy and cardiovascular disease outcomes. A prospective, randomized, interventional clinical study of one year duration was conducted to comparatively evaluate anti-hypertensive efficacy and tolerability profile of ramipril versus telmisartan in stage 1 hypertensive patients associated with type 2 diabetes mellitus, amongst patients of either sex attending the medicine OPD of Rohilkhand Medical College and Hospital, Bareilly. Clearance from institutional ethical committee and written informed consent of the participants was taken. The enrolled 222 patients were randomized into ramipril and telmisartan groups, of these only 192 patients completed the study. The data obtained were statistically analyzed by paired and unpaired t-test using SPSS software. Prevalence of hypertension in diabetics was more in 41 to 50 years age group, in females (male: female ratio= 0.92:1) and in rural areas (rural: urban ratio= 0.61:1). Baseline BP values were equally matched in both groups. The SBP and DBP were reduced from baseline in all the ten follow-ups and were statistically significant (p <0.0001 for both groups). Regarding adverse effects, both drugs were well tolerated though dry irritating cough and dizziness was more in ramipril group. Both ramipril and telmisartan as monotherapy were equally effective in lowering SBP and DBP on prolonged use in diabetic hypertensives but the incidence of adverse effects was higher with ramipril hence telmisartan be preferred.

The Journal of the Association of Physicians of India, 2001

The Journal of the Association of Physicians of India, 2000

Context: Status Epilepticus (SE) is a neurological emergency which is associated with heterogeneo... more Context: Status Epilepticus (SE) is a neurological emergency which is associated with heterogeneous aetiopathologies, which vary with time and cultural and environmental factors. Aim: To analyze the current trends of the clinical profile of SE in our region and to study the predictors of the response of Anti Epileptic Drugs (AED). Settings and Design: A prospective, cross sectional study was done on 50 patients who presented with SE with a duration of 5 minutes or more, at a medical college which is located in the state of Uttar Pradesh, India. Materials and Methods: A detailed history was taken and neurological examinations and baseline investigations were done in all the patients. Cerebrospinal Fluid (CSF) analysis was done wherever it was indicated and CT scan / MRI of the brain was carried out in a majority of the patients. The response to the first line of drugs and the outcome were noted and they were correlated with the aetiology and the duration of SE. Results: The mean age ...

International Journal of Advanced and Integrated Medical Sciences, 2016

Brugada syndrome is a rare inherited arrhythmic disorder, which predisposes to ventricular arrhyt... more Brugada syndrome is a rare inherited arrhythmic disorder, which predisposes to ventricular arrhythmia that is responsible for sudden and unexpected nocturnal death syndrome.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2015

Those suffering from Type-1 DM. 2. Diabetic patients with pregnancy/ gestational diabetes. 3. Pat... more Those suffering from Type-1 DM. 2. Diabetic patients with pregnancy/ gestational diabetes. 3. Patients who did not give consent for detailed screening/ evaluation.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2013

Introduction: Stroke is a growing epidemic in the developing countries. The risk factors of strok... more Introduction: Stroke is a growing epidemic in the developing countries. The risk factors of stroke are the same as those of atherosclerosis, but the relative incidences of the various risk factors keep changing with time and cultural and environmental factors. So, a periodic analysis should be done. Aims and Objective: The generation of the data which pertained to the clinical profile of stroke in our institution by using the WHO Steps Stroke Manual, version 2 and to make note of the risk factors and the correlation of the outcome with the Glasgow's Coma Scale (GCS) at admission and with the Modified Rankin Scale (MRS) on the 28th day. Material and Methods: A prospective study was conducted on 157 cases of stroke patients who were admitted to the Medicine Department of a tertiary care institute during June 2011 through June 2012. Observations: Amongst the 157 cases (92 males and 65 females), 86 % were above 40 years of age and this was the most

Journal of clinical and diagnostic research : JCDR, 2017

Diabetes Mellitus (DM) is the most common chronic disease. DM is considered a Cardiovascular Dise... more Diabetes Mellitus (DM) is the most common chronic disease. DM is considered a Cardiovascular Disease (CVD) risk equivalent. Its macrovascular complications are associated with two-fold increased risk of premature atherosclerotic CVD. Most of the diabetics with cardiovascular involvement are asymptomatic. Electro Cardio Graph (ECG) abnormalities are found to be predictors of silent ischaemia in asymptomatic persons. An abnormal ECG response is associated with statistically significant high risk for cardiac mortality and morbidity. The aim of the study was to evaluate ECG changes in asymptomatic Type 2 DM patients. A cross-sectional comparative study was conducted in a tertiary care hospital in North India. One hundred diabetics presenting to Medicine OPD/IPD were included in the study who had no symptoms of heart disease and no diabetic complications. Fifty person with age and sex matched controls were included in the study. Relevant history and physical examination findings were rec...

International Journal of Scientific Research, Apr 1, 2015

Journal of Medical Science And clinical Research, 2015

An acute symptomatic seizure is defined as a clinical seizure occurring at the time of a systemic... more An acute symptomatic seizure is defined as a clinical seizure occurring at the time of a systemic insult or in close temporal association with a documented brain insult (an acute medical or neurological illness). These etiologies may vary with time and place .This study was conducted with an aim to study the clinical profile of acute symptomatic seizures presenting to a tertiary care centre at North India. All patients admitted in medicine wards with recent onset seizure either alone or in association with some medical complaints were considered in the study. Detailed history, neurological examination and baseline investigations were done in all the patients. Cerebrospinal fluid (CSF) analysis was done wherever indicated and CT scan / MRI brain were carried out. EEG was done within 48 hours of seizure (if the condition of patient permitted). Total number of patients was 47 (27 male: 20 female). Majority of patients were less than 40 years (n=32) and most common presentation was single seizure (n=24, 51.1%).Status Epilepticus was seen in (n=12, 25.5%). Thirty cases had generalized tonic clonic seizures and 17 had partial seizure. CNS infections was the most common etiology (n=44.7%) neurocysticercosis being the commonest (14/47; 31%) followed by metabolic causes (n=10; 21.3%), post stroke epilepsy (7/47; 14.90%) and brain tumor (3/47; 6.3%). Three had non specific gliosis. Outcome was good in cases with single seizure. Four patients who had status epilepticus expired.