European Journal of Cardiovascular Medicine

Background: - Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Although conventional lipid parameters are routinely used for cardiovascular risk assessment, they may not fully represent the true atherogenic burden. Apolipoproteins, the structural protein components of lipoproteins, have emerged as stronger predictors of CAD risk. Among them, Apolipoprotein B (ApoB) reflects the total number of atherogenic particles, while Apolipoprotein A-I (ApoA-I) represents anti-atherogenic HDL particles. The ApoB/ApoA-I ratio integrates these opposing effects and may serve as a superior marker of atherogenic risk. Aim: To assess the association of Apolipoprotein B, Apolipoprotein A-I, and their ratio with coronary artery disease and its severity, and to compare their predictive value with conventional lipid parameters. Materials and Methods:  This case–control study included 100 participants—50 angiographically confirmed CAD patients and 50 age- and sex-matched healthy controls. Fasting blood samples were analyzed for lipid profile and serum apolipoproteins (ApoB and ApoA-I) using immunoturbidimetric methods. The ApoB/ApoA-I ratio was calculated, and CAD severity was graded based on the number of diseased coronary vessels. Statistical analysis was performed using SPSS version 25. Continuous variables were compared using Student’s t-test, and correlation analyses were performed using Pearson’s coefficient. Results: CAD patients had significantly higher total cholesterol (212.4 ± 35.7 vs 176.8 ± 28.9 mg/dL, p < 0.001), triglycerides (176.2 ± 42.6 vs 138.4 ± 30.7 mg/dL, p < 0.001), LDL-C (134.8 ± 28.9 vs 105.3 ± 24.6 mg/dL, p < 0.001), and ApoB (130.7 ± 24.8 vs 96.5 ± 18.1 mg/dL, p < 0.001). Conversely, HDL-C (37.6 ± 7.8 vs 48.2 ± 8.5 mg/dL, p < 0.001) and ApoA-I (110.5 ± 18.6 vs 142.8 ± 20.2 mg/dL, p < 0.001) were significantly lower in CAD patients. The ApoB/ApoA-I ratio was markedly elevated in CAD patients (1.21 ± 0.28 vs 0.68 ± 0.19, p < 0.001) and increased proportionally with disease severity (SVD: 1.05 ± 0.20, DVD: 1.20 ± 0.22, TVD: 1.39 ± 0.25; p < 0.001). ApoB correlated positively with LDL-C (r = 0.69, p < 0.001), while ApoA-I showed a positive correlation with HDL-C (r = 0.71, p < 0.001).

Introduction: Psychiatric comorbidity with type 2 diabetes mellitus is common. Comorbidity of diabetes and psychiatric disorders can present in different patterns, which are associated with impaired quality of life, increased cost of care, poor treatment adherence, poor glycaemia control and increased emergency room visits. The present study was planned to assess the relationship between psychiatric comorbidities in individuals with type 2 diabetes mellitus and quality of life. Aim And Objectives: To study the relationship between psychiatric comorbidities in individuals with type 2 diabetes mellitus and quality of life and to study the association between psychiatric comorbidity, socio demographic and clinical variables in such patients. Material And Methods:  This is a hospital based observational study where 150 consecutive patients visiting the Department of Medicine OPD or admitted in ward for the treatment of Diabetes, at Rama Medical College, Hospital & Research Centre Hapur and fulfilling the inclusion and exclusion criteria were recruited. All the subject under study were interviewed and a detailed history and clinical examination was done by using a semi-Structured performa, General Health Questionnaire 12 (GHQ12), Hospital Anxiety and Depression Scale (HADS), Brief Psychiatric rating scale (BPRS), WHO Quality Of Life BREF (Brief Hindi Version) and KUPPUSAMY SOCIO ECONOMIC STATUS SCALE. The results were tabulated and analyzed using the Chi (χ2) square test. The correlation coefficient was measured between scores of all scales using Pearson’s formula. Results: 51(51.5%) patients with psychiatric comorbidity and 43(84.3%) patients without psychiatric comorbidity were males. While 48(48.5%) patients with psychiatric comorbidity and 8(15.7%) patients without psychiatric comorbidity were females. The P value was found to be significant (0.00). 48(32.0%) patients had generalized anxiety disorder, 30(20%) had depression, 13(8.6%) had mixed anxiety and depressive disorder, 6(4%) had specific phobia (needle phobia) and 2(1.2%) had adjustment disorder. In patients without Psychiatric Co-morbidity, the mean Overall quality of life (mean± s.d.) of patients was 3.00± 1. 732.In patients with Psychiatric Comorbidity, the mean Overall quality of life (mean± s.d.) of patients was 2.46±1.593. Distribution of mean Overall quality of life with Psychiatric Co-morbidity was statistically significant (p=0.032). Conclusion:  This study concludes that in patients with Type 2 Diabetes disorder socio demographic variables like marital status, family type, education, socioeconomic status occupation have a significant impact on patient of Type 2 Diabetes disorder with psychiatric comorbidity. Quality of life is poor in patients with Type 2 Diabetes disorder with comorbidpsychiatricillness.

Background: The present study compared Phacoemulsification versus manual small incision cataract surgery.  Materials & Methods: The present study was conducted on 64 patients of cataract of both genders. They were divided into 2 groups of 32 patients each. Group I were non- diabetic patients in which conventional extra capsular cataract surgery and small incision cataract surgery was performed on 32 patients each and group II comprised of diabetic patients in which both techniques were performed on 32 patients each. Following surgery, postoperatively patients were examined 1st day, after 2 weeks and 6 weeks. Complications in both groups were assessed. Results: In group I, CECC technique showed iridodialysis in 1 case, MSICS showed iris prolapse in 1 case, constricted pupil in 1 case and retained cortex in 1 case. In group II, iris prolapse was seen in 1 case, retained cortex in 1 case and PC rent in 1 case while, MSICS showed iridodialysis in 1 case, iris prolapse in 1 case, retained cortex in 1 case, PC rent in 1 case and vitreous loss in 1 case. The difference was significant (P< 0.05). Post- operative complications were iris prolapsed 1 in MSICS in group II, wound leak 1 in CECC in group I, II and MSICS 1 in group II, secondary glaucoma 1 in MSICS in group I and 2 in group II, posterior capsule opacity 1 in MSICS in group I and cystoids macular edema 1 in CECC and MSICS each in group II. The difference was significant (P< 0.05).  Conclusion: Conventional extra capsular cataract extraction found to be effective as compared to manual small incision cataract surgery in non-diabetic than diabetics. Common complications were iris prolapsed, wound leak, secondary glaucoma, posterior capsule opacity and cystoids macular edema.

Background: Gastrointestinal perforation represents a life-threatening surgical emergency with diverse etiologies and significant morbidity. While peptic ulcer-related perforations have declined due to proton pump inhibitors, newer challenges including drug-induced, malignant, and infective causes continue to contribute to case load. Early diagnosis, prompt surgical intervention, and meticulous postoperative care remain critical determinants of outcome. Materials and Methods This prospective observational study was conducted over one year in the Department of Surgery, Andhra Medical College. All consecutive patients presenting with acute hollow viscus perforation and undergoing surgical intervention were included. Detailed clinical history, laboratory and radiological findings, operative notes, and postoperative complications were documented. Patients were followed for 3 months post-surgery to assess complications and outcomes. Results Out of 46 patients enrolled, 65.2% were males and the mean age was 42.6 years. The most common cause of perforation was gastro-duodenal ulcer (47.8%), followed by appendicular perforation (32.6%). Other causes included typhoid ileal perforation (6.5%), malignant colonic perforation (4.3%), and non-specific small bowel perforation (2.2%). Common presenting symptoms included abdominal pain (100%), vomiting (73.9%), and distension (60.9%). All patients underwent emergency laparotomy. Morbidity included wound infections (26.1%) and respiratory complications (10.9%). One patient (2.2%) succumbed to sepsis-related multi-organ failure. Conclusion Gastrointestinal perforations continue to present a significant burden in emergency surgery. Peptic ulcer disease and appendicitis remain leading causes. Timely intervention and aggressive resuscitative efforts play a vital role in reducing morbidity and mortality. Focused strategies for early diagnosis and preventive care, especially among high-risk populations, are essential.

To compare the clinical outcomes of medical versus surgical treatment in women with moderate-to-severe endometriosis, focusing on symptom relief, recurrence rates, and quality of life. This randomized controlled trial involved 200 women diagnosed with moderate-to-severe endometriosis, who were randomly assigned to either medical management (GnRH agonists and oral contraceptives) or surgical treatment (laparoscopic excision of endometriotic lesions). Outcome measures included symptom resolution, recurrence rates, quality of life (measured by the Endometriosis Health Profile-30), and adverse effects. Both medical and surgical treatments resulted in significant symptom relief (p < 0.05). Surgical treatment demonstrated superior long-term outcomes with a lower recurrence rate (15% vs. 30%, p = 0.02). However, medical treatment had a shorter recovery time and fewer complications. Both medical and surgical treatments are effective for managing endometriosis, but laparoscopic surgery offers superior long-term results, including lower recurrence rates. However, medical treatment may be preferred in women seeking less invasive options with quicker recovery times.

Introduction: Fever is one of the common reasons for OPD as well as in patient admission department. Due to improvements of laboratory facilities & imaging the incidence and etiological profile of fever have drastically changed. Proper history taking and systematic examination remains the gold standard for fever evading diagnosis. Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever. Result: In this study typhoid fever was the most common cause of undifferentiated fever (28.9%) followed by malaria (17.8%), dengue fever (13.3%), Acute gastroenteritis (16.7%), Pneumonia (12.2%), Bronchiolitis (5.6%), Hepatitis  (3.3%) and Pharyngotonsillitis (2.2%). Treatment- Enteric fever was treated with Ceftriaxone. Chloroquine was used for treatment of Malaria. Dengue was treated symptomatically and with fluids according to Dengue protocol. If fever persisted even after 6 days of antibiotics, then Azithromycin was added. In the undiagnosed fever category, received empirical antibiotics. Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians

Aim: To assess obstetric patients treated in anesthesiology intensive care unit. Methods: We retrospectively screened 269 patients. In all patients, gestational age, mode of delivery, parity, referring clinic, previous medical disease, diagnosis at admission, APACHE II Score and GCS score were recorded. Clinical course in intensive care unit and cause of death in non-survivors were recorded. Results: The percentage of obstetric patients treated in intensive care unit was 9.4% with a mortality rate of 3.7%. Preeclampsia, eclampsia and HELLP syndrome were leading causes for intensive care unit admission. Conclusion: Most common cause of death was postpartum bleeding and its complication.

The immune system is highly dependent on precise communication between cells for optimal function, and any damage to the signaling systems involved will result in an impaired ability to mount an immune response. A cross- sectional survey of 212 participants from different cities of Iraq was conducted to explore the effect of eating fruits & vegetables and taking vitamins on the immunity status like recurrent infection, COVID19 and chronic diseases. The data collected by using survey targeted to all cities of Baghdad. The questionnaires were distributed online using Google Forms. It will be a convenient sample. The collected data was analyzed by using statistical package social science (SPSS) program version 23.0 and demonstrated in tables and graphs. Sample test was used to decide if there is statistical difference or not. The survey generated 212 responses. Regarding on the question about the chronic disease 94.3% of the answers don’t have chronic diseases and 5.7% were had chronic diseases. Concerning the question about COVID19 infection65.1% of the answers was not infected and 34.9% were infected. The question regarding the recurrent infection 18.4%suffered from recurrent infection and 81.6% were not. The question regarding eating fruits & vegetables89.2% eating frequently and 10.8% were not. The question regarding taking vitamins50.0% of participants were taking vitamins and 50.0% were not. The increase immune protection by immunostimulant factor from food like eating fruits & vegetables or by therapeutic adjuvant like vitamins and minerals is useful in increase immunological status and help in protection against microbial infection.

Background: Bile duct injury is severe and potentially life threatening complication of cholecystectomy. It ruins the patient physically, mentally, socially and financially. The incidence of bile duct injury is alarming in our country. Management of such patients needs to be explained. Methods: It is a cross- sectional descriptive study carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during the period January 2018 to July 2020. A total of 70 patients diagnosed as bile duct injury were included in the study. Bile duct injury that occurs during liver or pancreases surgery or accident was excluded. Data were collected using a predesigned data collection sheet and analyzed using computer software SPSS (Statistical Package for Social Sciences) version 22. Results: Young and female patients suffer more 44(62.9%) than male. Occurrence was common during laparoscopic cholecystectomy 42(60%). Most of bile duct injury occur when cholecystectomy done on acute condition of gall bladder 59(84.3%). Most of bile duct injury patient came to specialized center after several week of injury with billiary stricture 54 (77.14%) with jaundice, some patients presented with abdominal pain 48(68.6%), abdominal distension 18(25.7), biliary peritonitis 16(22.9) and biliary fistula 14(20%). Patients with bile duct injury were evaluated by USG, liver function test, ERCP and MRCP. Maximum BDI patients were Bismath Type II 32(45.7%) and Bismath Type III 18(25.7%). Out of 70 cases USG performed 68 cases (2 patients repair at the time of surgery) and these investigations provided valuable information about condition of biliary tree, hepatic parenchyma and ductal system also intra-abdominal collection. 14 patients were done ERCP. Billiary stricture in different level seen among most of the patients (10). Bile leakage seen among 4 patients and all were underwent ERCP stenting. Conclusion: The present study showed that bile duct injury occurs mostly in young female with acute cholecystitis. Common presentation was obstructive jaundice and biliary sepsis. Bismuth Type II and III were most common form of stricture. Biliary reconstruction (Roux-en-Y hepaticojejunostomy) was the treatment for biliary stricture. Peritoneal toileting, controlled fistula and later on biliary reconstruction was the treatment of biliary sepsis.