Background: Pulmonary involvement in diabetes mellitus may precede overt respiratory disease, but structural abnormalities are not routinely evaluated. Chest computed tomography can depict subtle parenchymal changes that are not visible on conventional radiography. Objective: To describe chest CT findings in adults with type 2 diabetes mellitus and examine their associations with glycemic control and duration of diabetes. Methods: This cross-sectional observational study included 60 adults with type 2 diabetes mellitus evaluated at a tertiary hospital in Tamil Nadu between May 2018 and March 2019. Participants underwent low-dose chest CT. Two radiologists assessed the examinations for ground-glass opacities, interstitial thickening, pulmonary nodules, fibrotic changes, pleural effusion, and mediastinal lymphadenopathy. CT findings were compared across HbA1c and diabetes-duration categories. Results: The mean age was 54.2 ± 9.8 years; 38 participants (63.3%) were men. Forty-eight participants (80.0%) had at least one abnormal CT finding. Ground-glass opacities were most frequent (27/60, 45.0%), followed by interstitial thickening (20/60, 33.3%) and pulmonary nodules (15/60, 25.0%). Any abnormality was more common with HbA1c ≥7% than with HbA1c <7% (89.7% vs 61.9%; p=0.017). Diabetes duration >10 years was associated with interstitial thickening (57.1% vs 20.5%; p=0.004), fibrotic change (33.3% vs 7.7%; p=0.025), and any abnormal CT finding (95.2% vs 71.8%; p=0.042). In the reported multivariable model, HbA1c ≥7% and diabetes duration >10 years remained associated with abnormal CT findings. Conclusion: Chest CT abnormalities were common in this hospital-based sample and were associated with suboptimal glycemic control and longer diabetes duration. These findings support further prospective research that includes a non-diabetic comparison group and pulmonary function testing before CT-based screening is considered.

Background: Hypertension is a major modifiable cardiovascular risk factor. Carotid Doppler ultrasonography permits non-invasive assessment of subclinical vascular disease through carotid intima-media thickness (CIMT), plaque detection, and haemodynamic indices. Objective: To evaluate carotid Doppler ultrasonography as a tool for cardiovascular risk assessment in patients with hypertension. Methods: This hospital-based cross-sectional study included 48 patients aged 30-70 years with essential hypertension who were evaluated at a tertiary care hospital in Tamil Nadu, India, between July 2018 and February 2019. Bilateral carotid Doppler ultrasonography was used to assess CIMT, carotid plaque, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI). Associations between CIMT and demographic, clinical, and biochemical variables were analysed. Results: The mean CIMT was 0.94 ± 0.18 mm, and 33 patients (68.8%) had abnormal CIMT (>0.9 mm). Carotid plaques were identified in 25 patients (52.1%), most commonly at the carotid bifurcation. CIMT was positively correlated with age (r=0.52, p<0.001), duration of hypertension (r=0.48, p=0.002), systolic blood pressure (r=0.41, p=0.006), and LDL cholesterol (r=0.36, p=0.018). Patients with carotid plaque had a significantly higher RI than those without plaque (0.76 ± 0.08 vs 0.67 ± 0.06; p=0.001). Conclusion: Carotid Doppler ultrasonography identified a substantial burden of subclinical carotid atherosclerosis in this hypertensive cohort. CIMT, plaque assessment, and RI may provide useful complementary information for cardiovascular risk stratification in patients with hypertension.

Background: Diabetic nephropathy and retinopathy remain the most devastating microvascular complications of diabetes mellitus, accounting for substantial morbidity and mortality worldwide. Advanced glycation end products (AGEs) and oxidative stress have emerged as central pathogenic mechanisms linking chronic hyperglycemia to end-organ damage. Objective: This study aimed to investigate the biochemical relationships between circulating and tissue AGE levels, oxidative stress markers, and the development and progression of diabetic nephropathy and retinopathy in patients with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted involving 280 patients with type 2 diabetes mellitus (mean age 58.7 ± 12.4 years, 54.3% male) and 120 age- and sex-matched healthy controls. Serum AGEs were measured by competitive ELISA using anti-AGE monoclonal antibody. Serum malondialdehyde (MDA) and urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured as markers of oxidative stress. Diabetic nephropathy was assessed by urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). Diabetic retinopathy was evaluated by fundus photography and optical coherence tomography. Results: Serum AGE levels were significantly elevated in diabetic patients compared to controls (12.8 ± 4.2 vs. 4.6 ± 1.8 U/mL, p<0.001). MDA and 8-OHdG levels were also markedly higher in diabetic patients (MDA: 4.92 ± 1.58 vs. 2.08 ± 0.72 μmol/L, p<0.001; 8-OHdG: 9.12 ± 3.34 vs. 3.28 ± 1.12 ng/mL, p<0.001). AGE levels correlated positively with UACR (r=0.72, p<0.001) and negatively with eGFR (r=-0.68, p<0.001). Patients with diabetic retinopathy (n=94, 33.6%) had significantly higher AGE levels compared to those without retinopathy (15.4 ± 4.6 vs. 11.2 ± 3.8 U/mL, p<0.001). Multivariate regression analysis identified AGEs (OR 3.42, 95% CI 2.18-5.36, p<0.001) and MDA (OR 2.68, 95% CI 1.72-4.18, p<0.001) as independent predictors of diabetic nephropathy. Conclusion: Elevated AGE levels and enhanced oxidative stress are strongly associated with the presence and severity of diabetic nephropathy and retinopathy. The AGE-RAGE-oxidative stress axis represents a critical pathogenic pathway in diabetic microvascular complications, offering potential targets for therapeutic intervention.

Introduction This study evaluated the clinical characteristics of the acute coronary syndromes (ACS) in chronic kidney disease (CKD) patients and established prognostic values of the biomarkers and echocardiography the risk of coronary artery disease (CAD) in patients with chronic kidney disease (CKD) is comparable with the risk of CAD in patients with traditional risk factors. The association of the classic cardiovascular risk factor and the specific uraemia-related risk factors accelerates the atherosclerosis Materials and Methods This  prospective  study  included  140  ACS  patients  admitted  Department of General Medicine, JIIU’s Indian Institute of Medical Science and Research over a period of 1 year. Data were collected on demographics, clinical history, diagnostics and therapeutic interventions, with rigorous ethical considerations and informed consent. Statistical analysis was conducted using descriptive statistics to explore the clinical and therapeutic characteristics of ACS in patients with CKD. Results Demographics Mean age 65.4 ± 10.8 years, 60% male. CKD stages: Stage 3 (40%), Stage 4 (35%), Stage 5 (25%). Risk Factors Hypertension (80%), diabetes (62%), dyslipidemia (68%), smoking (28%). ACS Types STEMI (38%), NSTEMI (47%), Unstable Angina (15%). Management PCI (48%), CABG (12%), antiplatelets (90%), statins (85%). Outcomes In-hospital mortality (8%), MACE at 30 days (15%), renal function decline (18%). Laboratory Findings Mean eGFR 32.4 ± 8.7 mL/min/1.73m²; hyperkalemia in 20%, LDL-C 120 ± 28 mg/dL. Adverse Events Heart failure (22%), dialysis initiation (10%), major bleeding (12%).CKD Stage Trends PCI use decreased with CKD severity (Stage 3: 57%, Stage 5: 37%). 6-Month Follow-Up Mortality (18%), ACS readmission (12%), ESRD progression (15%). Key Insight CKD patients with ACS have worse outcomes, necessitating tailored management strategies Conclusion CKD significantly complicates the management and prognosis of ACS. Despite advances in cardiovascular care, CKD patients remain at a disproportionately high risk for adverse events. There is a critical need for tailored interventions, robust risk stratification tools, and multidisciplinary collaboration to improve outcomes in this vulnerable population.

Irritable bowel syndrome (IBS) is a common disorder characterized by abdominal pain and altered bowel habit. Hence, IBS is associated with a significantly impaired health-related quality of life (HRQOL) and reduced work productivity around the world. The incidence of IBS is rising dramatically worldwide. Currently, 7 – 10 % of people have IBS worldwide and it is 1.5 times more prevalent in younger women than in men. Much research has been undertaken during the past several decades, which has led to deep understanding about IBS, particularly the pathogenesis and management. This review summarizes the epidemiology, underlying pathophysiology, diagnosis and treatment about IBS that has been published in recent years. We hope this review can help to provide some reference in clinical practice for physicians in the management of IBS.

Peripheral Vascular Disease (PVD) is a growing medical problem and presents itself mainly in two different clinical forms. Intermittent claudication is an early moderate manifestation, while patients with critical limb ischemia suffer from severe muscle tissue loss or ulcers and are at high risk of limb amputation. Despite recent advances in surgical and radiologic vascular procedures, a large number of patients are not eligible for these revascularization procedures. Recent evidence indicates that adult stem cells (ASC) are a potential new therapeutic target. This review discusses the potential of ASC in patients with PVD. The safety of stem cells must be scrutinized and assessed throughout the entire treatment and research process. Guidelines and strategies must also be developed to ensure that every aspect of stem cell use from identification and isolation of stem cells to stem cell transplant is stringently coordinated.

Abbreviations: Peripheral Vascular Disease (PVD), Adult Stem Cell (ASC), Intermittent Claudication (IC),Critical Limb Ischemia (CLI),Peripheral Arterial Occlusive Disease (PAOD), Vascular Endothelial Growth Factor (VEGF), Fibroblast Growth Factors (FGFs),Bone Marrow (BM), Endothelial Progenitor Cells (EPC), Bone Marrow Mononuclear cells (BM-MNC), Granulocyte Colony Stimulating Factor (G-CSF),Peripheral Blood Mononuclear Cells (PB-MNC), Therapeutic Angiogenesis using Cell Transplantation (TACT).

Open and laparoscopic surgery is evolving fastest ever; however the professional advice regarding patient’s postoperative care and transient lifestyle changes remains historical. This study aimed to evaluate the knowledge-based advice from surgical trainees and general practitioners about accumulative postoperative care after routine surgical operations in comparison to patient’s journey back to routine life activities. Materials and Methods: Patients aged 65 years or less, who had routine surgical procedures over a six-month period completed a self-devised questionnaire with regards to time taken to return to normal activities following surgery. A further questionnaire was distributed to GPs and surgeons, including trainee doctors. Results: Varicose vein surgery: Patients take a shorter time to return to heavy work, driving and normal activities than that advised by both sets of doctors. Open hernia repair: Patients take longer to return to office work and normal activities than that advised by both sets of doctors. Laparoscopic hernia repair: Patients take a shorter time to return to heavy work, than that advised by both sets of doctors. Laparoscopic cholecystectomy: Patients take longer to return to office work, but a shorter period of time to return to heavy work than that advised by both sets of doctors. Conclusion: The advice received by the patients with regards to their post operative recovery robustly varies between surgeons and non-surgical professionals, and does not reflect the real time experience of patients. A consensus among surgeons and primary care physicians is essential to streamline surgical care pathway.

The impact of extending the cut-off time for the provision of Troponin T assay from 4:00 to 7:00 pm, focusing specifically on same-day patient discharge was studied over a four-month period. The number of patients discharged on the same day, who would have otherwise been admitted overnight, was determined. The fiscal benefit of the extended laboratory service was then calculated. Of the 140 patients included in the study, 36 (26%) patients were discharged on the day of hospital presentation based on a negative Troponin T concentration; all except one had a Troponin T <0.03ug/L. Based on the cost of overnight stay of £657 we concluded that the extended service would save the hospital £70,956 annually. Extending the provision of Troponin T assay for 3 hours daily is cost effective and reduces the number of unnecessary hospital admissions of patients presenting with chest pain of non-cardiac origin.

Background and objectives: Loss of a limb for any a reason is a major event with profound implications on the psychological health of an individual involved. Due to prevailing sociopolitical disturbances in Kashmir Valley (Indian administered) and lack of epidemiological data, a study of amputation and its co-morbid psychiatric conditions seems crucial for planning care management for these patients. The aim of our current study was to study various socio-demographic variables of amputees and to find prevalence of psychiatric disorders in amputees from the out-patient population. Methods: A total of 100 consecutive cases of amputation were studied. Patients who had an amputation were identified and diagnosed according to DSM-IVcriteria for psychiatric co morbidities. Epidemiological and demographic data obtained from the interview of the subjects was analysed and simple percentages were obtained. Prevalence of psychiatric co-morbidities and indication for the amputation were calculated. Results: In our study we found that, majority (45%) of the amputees were males in the age group of 15-30 years from rural areas (81%) with low literacy rates. Motor vehicle accident accounts for majority (53%) of amputations followed by 21% from ongoing sociopolitical disturbance (landmines, blast, firearms). The most common co-morbid psychiatric condition in our study was major depressive disorder (63%). 40% of patients were suffering from anxiety disorders which included 20% as PTSD (Post Traumatic Stress Disorder), 4% as ssPTSD (sub syndromal PTSD), 10% as GAD (Generalized Anxiety Disorder), and 6% as panic disorder. Conclusion: Most of the patients with psychiatric co-morbidities were males of younger age group from rural areas. Major depressive disorder was the most common co- morbidity.

I would suggest looking at potential short- and long-term risks as well as the benefits of any intervention. What evidence do we have for the risks of vitamin D use for prevention? One recent study using a single dose of 500,000 IU of vitamin D daily showed an increased relative risk of fractures,5 but the dose of vitamin D in that study was far higher than other randomized controlled trials. Bischoff-Ferrari et al reviewed documented cases of hypercalcaemia in the randomized controlled trials;2 those authors add that only one trial reported nephrolithiasis, the Women’s Health Initiative.6 It is noteworthy that only the self-reported vitamin D and calcium dose was determined in that study, not the vitamin D status of the subjects. My opinion is that hypercalcaemia is uncommon and its complications are rare.