Study to analyze the association of cortisol level and prevalence of Coronary Artery Disease in patients with Type 2 Diabetes Mellitus

INTRODUCTION : Type 2 diabetes is the predominant form of diabetes worldwide, accounting for 90% of cases globally. An epidemic of Type 2 diabetes is underway in both developed and developing countries. Globally the number of Type 2 DM is expected to rise from the current estimate of 150 to million in 2010 and 300 million in 2025. So Type 2 DM has become one of the world’s most important public health problems. DM both insulin dependent and non-insulin dependent is a risk factor for CAD, accounting for 14%- 50% of new cases of CAD. CAD is the most common cause of death in adults with DM. In diabetes the incidence of CAD relates to the duration of DM, level of glycemic control and its pathogenesis involve endothelial dysfunction and Increased lipoprotein peroxidation, increased inflammation, prothrombotic state and associated metabolic abnormalities. Increased activity of hypothalmopituitary axis and elevated cortisol level may underlie metabolic syndrome and coronary artery disease in patients with Type 2 DM. People with Type 2 DM are at increased risk of cardiovascular disease risk and hyperactive hypothalmopituitary axis thus suitable for study of association of cortisol level with cardiovascular risk. AIM OF STUDY : To analyze the association of Cortisol level and prevalence of coronary artery disease in patients with Type 2 Diabetes Mellitus. DISCUSSION An attempt has been made to study fifty cases of type 2 diabetes mellitus to study the association of cortisol level and coronary artery disease. In the cohort of 50 diabetic patients 23 had coronary artery disease, which comes to 46% of total patients. In the 50 type 2 diabetic patients, 22% had acute coronary syndrome; 24% had ischemic heart disease. The Framingham Heart study revealed a marked increase in congestive heart failure, coronary artery disease and sudden cardiac death in type 2 diabetes mellitus patients(The risk increases from one to five fold in DM).The American Heart association has designated DM as a major risk factor for cardiovascular disease(2). Among 50 DM patients, 52% were males and 48% were females. According to the Centre for Disease Control and Prevention (CDC), the prevalence of DM is similar in men and women throughout most age ranges but is slightly greater in men more than 60 years(2). Conventional risk factors for coronary artery disease are diabetes mellitus, systemic hypertension, dyslipedemia, etc. Diabetes mellitus is the major risk factor for coronary artery disease. Newly proposed theory is that there is an overactivity of hypothalamopituitary adrenal axis and elevated cortisol level(19). Elevated cortisol is a single risk factor for coronary artery disease. According to Edinburg type 2 diabetes study, type 2 diabetic patients have hyperactive hypothalamopituitary adrenal axis and have elevated cortisol level and it was concluded that there is an increased chance of metabolic syndrome and coronary artery disease in patients with elevated cortisol level. Out of 50 diabetic patients, 10 patients had elevated cortisol level.8 out of 10 patients with elevated level had coronary artery disease. This shows that there is an association between elevated cortisol level and coronary artery disease(19). In our population, cortisol is only moderately elevated. Also, cortisol is elevated in patients who are having more than one complication of diabetes like dyslipedemia, central obesity, proteinuria and hypertension. Also, there is an association between elevated cortisol and coronary artery disease. The study was conducted at Coimbatore Medical Hospital, Coimbatore during period of September 2009 to September 2010. 50 patients of Type 2DM were included in the study. No patients had been counted if he/she got admitted again after discharge during this period. MATERIALS &METHODS : Design of study: Cross sectional study. Methodology: 50 Type 2DM patients who got admitted in Coimbatore Medical College, Hospital were included in the study. 50 consecutive were recorded. In those patients BP, Waist Circumference, Blood Glucose Levels, Lipid profile, fasting cortisol level and Urine Protein were measured and ECG, Echocardiogram was taken to study whether there is an increased association of cortisol level with prevalence of coronary artery disease in patients with Type 2DM. Inclusion Criteria: 1. Type 2 DM Patients, 2. Age group above 50 years, 3. Both Sexes, 4. First Admission. Exclusion Criteria: 1. Cushing disease / Syndrome, 2. Patients who are on steroid treatment, 3. Age group below 50 years. CONCLUSION : There is hyperactivity of hypothalamopituitary axis in type 2 DM patients. Out of 50 patients,10 had mild to moderate elevation of fasting serum Cortisol. There is an association of elevated cortisol and high prevalence of coronary artery disease in patients with type 2 DM. Further studies are needed to find out the mechanism of hypothalamopituitary axis overactivity. Further studies are needed to find out the pathogenesis behind elevated cortisol causing coronary artery disease

A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFECT OF CHARAKOKTA MUTRAVIRECHANIYA MAHAKASHAYA IN MUTRAKRICHRA OR LOWER URINARY TRACT INFECTION

Mutrakrichra the disease of Mutravaha Srotas is caused due to Sanga (obstruction). Mutrakrichra means difficulty in micturition. Mutrakrichra can be compared to lower urinary tract infection (LUTI) symptoms. LUTI is the most common infection known to mankind and a common condition seen in general practice. Urinary tract infection affects more than 150 million people every year worldwide. Objective: To evaluate the effect of Mutravirechaniya Mahakashaya in LUTI and to compare its efficacy with Tab. Norfloxacin. Methods: 45 patients of either gender with the symptoms of LUTI were randomized into three groups of 15 patients each. Group A- received Mutravirechaniya Mahakashaya 50ml. Group B- received Tab. Norfloxacin 400mg and Group C- Mutravirechaniya Mahakashaya and Tab. Norfloxacin in the above mentioned dose for ten days. Efficacy outcomes were assessed through subjective parameters and routine urine and microscopic examination. Observation and results: When compared all the groups showed better results in relieving the clinical symptoms of LUTI. Overall patients treated with Mutravirechaniya Mahakashaya and Tab. Norfloxacin showed better results, but there was no significant difference between the groups (P<0.351). Conclusion: Mutravirechaniya Mahakashaya was able to meet the efficacy outcomes measures in comparison to Tab. Norfloxacin. Clinical effects of Mutravirechaniya Mahakashaya were similar to Tab. Norfloxacin owing to its diuretic, analgesic and anti-inflammatory properties

A critical review on Mutrakrichra w.s.r. to lower urinary tract infection

Mutrakrichra is a disease which is well explained by all the Acharyas. The word Mutrakrichra comprises of two words, Mutra and Kruchra, which means Kruchra Pravrutti of Mutravahana (diificulty in micturition). Mutrakrichra can be an independent disease as well as associated symptom in other disease. In the contemporary science, the disease with similar signs and symptoms are Lower urinary tract infection. The Nidana of Mutrakrichra causes change in the concentration of urine which enhances the growth of microbes in urinary tract. Similarly, the Lakshanas of Mutrakrichra are aslo similar to that of symptoms of lower urinary tract infection. The Chikitsa and Oushadha Yogas mentioned by Acharyas are having antibacterial and diuretic property. Hence in the present study, an attempt is made to critically analyse the disease Mutrakrichra with it Nidana, Samprapti, Lakshana and Chikitsa with the disease lower urinary tract infection

A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFECT OF CHARAKOKTA MUTRAVIRECHANIYA MAHAKASHAYA IN MUTRAKRICHRA OR LOWER URINARY TRACT INFECTION

Mutrakrichra the disease of Mutravaha Srotas is caused due to Sanga (obstruction). Mutrakrichra means difficulty in micturition. Mutrakrichra can be compared to lower urinary tract infection (LUTI) symptoms. LUTI is the most common infection known to mankind and a common condition seen in general practice. Urinary tract infection affects more than 150 million people every year worldwide. Objective: To evaluate the effect of Mutravirechaniya Mahakashaya in LUTI and to compare its efficacy with Tab. Norfloxacin. Methods: 45 patients of either gender with the symptoms of LUTI were randomized into three groups of 15 patients each. Group A- received Mutravirechaniya Mahakashaya 50ml. Group B- received Tab. Norfloxacin 400mg and Group C- Mutravirechaniya Mahakashaya and Tab. Norfloxacin in the above mentioned dose for ten days. Efficacy outcomes were assessed through subjective parameters and routine urine and microscopic examination. Observation and results: When compared all the groups showed better results in relieving the clinical symptoms of LUTI. Overall patients treated with Mutravirechaniya Mahakashaya and Tab. Norfloxacin showed better results, but there was no significant difference between the groups (P&lt;0.351). Conclusion: Mutravirechaniya Mahakashaya was able to meet the efficacy outcomes measures in comparison to Tab. Norfloxacin. Clinical effects of Mutravirechaniya Mahakashaya were similar to Tab. Norfloxacin owing to its diuretic, analgesic and anti-inflammatory properties.</jats:p

Exploring veracity of trauma through individual memory in Life and Times of Michael K by J.M. Coetzee

The novel, Life and Times of Michael K, depicts the individual memory that is socially produced based on collective thoughts and the individuals’ problematic situation in Africa. The protagonist in the novel brings out the unconscious traumatic memories that can be replayed as horrifying simulations while he is detached from the repressed traumatic experience. However, memories of suffering are shaped by violence; trauma symptoms occur while the collective memory of the character’s response to his traumatic past and present. This paper tries to explore the veracity of trauma throughout the individual’s life which represents the never-ending struggles of individuals and subjugated societies to confront unconscious trauma. It depicts the process of natives returning to their innocence or pre-colonial condition to face the trauma. Eventually, it elaborates on how, disagreements go unresolved, and difficulties become inescapable.&nbsp; The exploration of the novel through Trauma and Individual memory highlights numerous areas of societal conflict

Exploring Veracity of Trauma Through Individual Memory in Life and Times of Michael K by J.M. Coetzee

The novel, Life and Times of Michael K, depicts the individual memory that is socially produced based on collective thoughts and the individuals' problematic situation in Africa. The protagonist in the novel brings out the unconscious traumatic memories that can be replayed as horrifying simulations while he is detached from the repressed traumatic experience. However, memories of suffering are shaped by violence; trauma symptoms occur while the collective memory of the character's response to his traumatic past and present. This paper tries to explore the veracity of trauma throughout the individual's life which represents the never-ending struggles of individuals and subjugated societies to confront unconscious trauma. It depicts the process of natives returning to their innocence or pre-colonial condition to face the trauma. Eventually, it elaborates on how, disagreements go unresolved, and difficulties become inescapable.&nbsp; The exploration of the novel through Trauma and Individual memory highlights numerous areas of societal conflict

Effect of pesticide ban on suicide trend – a 20-year study from a tertiary care center in Central Kerala from 2001 to 2020

Introduction: We assessed the effect of the pesticide regulations implemented in 2011 on suicide trend in Kerala state of India. Materials and methods: Data were collected from case records of suicide autopsies done in a single tertiary care hospital in Thrissur district of Kerala in 2001–2020. Linear trends in overall suicide rates were identified using joinpoint regression analysis. We used Poisson regression models to estimate the annual expected number of suicides in 2011–2020 and calculated the rate ratios between the observed number of suicide and that expected according to the linear pre-ban suicide trend (2005–2010). Results: There were a total of 14,593 suicide autopsies (2501 pesticide autopsies) in 2001-2020. Carbofuran was the commonest pesticide identified, followed by quinalphos, zinc phosphide, and chlorpyrifos. In 2011–2020, overall suicide rates were 22%–48% and pesticide suicide rates were 20%–55% lower than those expected according to pre-ban suicide trends (2005–2010), with the only exception of a 16% higher-than-expected pesticide suicide rate in 2011. There was no change in trend in hanging suicides. Conclusion: Lower-than-expected overall and pesticide suicide rates were found in Thrissur district after the 2011 bans of pesticides in Kerala, with no evidence of means replacement to hanging.</p

Proceedings of the 2nd International Conference on Modern Trends in Engineering Technology and Management

This proceeding contains articles on the various ideas of the academic community presented at The 2nd International Conference on Modern Trends in Engineering Technology and Management (ICMEM 2023) organized by the Sree Narayana Institute of Technology Adoor-691554, Kerala, India on 4th-6th May 2023.  ICMEM 2023 aimed to provide a forum for the exchange of ideas, issues, challenges, discoveries, opportunities, and applications of Modern Trends in Engineering Technology and Management. The ever-changing scope and rapid development of science and technology generate new problems, questions, and curiosity, necessitating the exchange of brilliant ideas and raising awareness of this vital research field in a variety of directions.  Conference Title: 2nd International Conference on Modern Trends in Engineering Technology and ManagementConference Acronyms: ICMEM 2023Conference Date: 4th-6th May 2023Conference Location: Hybrid ModeConference Organizer: SNIT Adoor, Kerala, Indi