Hyperacute Liver Failure with Multi-organ Dysfunction Syndrome (MODS) by Leptospirosis: A Case Report

Introduction: Leptospirosis may have multi-organ involvement in its severe form with potentially life-threatening consequences. However, acute fulminant hepatic failure is very uncommonly reported. A case study is presented here with fulminant hepatic failure and a diagnostic dilemma for etiology. Case history: A 40-year-old man with no significant medical history presented with fever, muscle pain, weakness, and pain in the upper abdomen. On clinical work, he has developed multi-organ hepatic, respiratory, and renal failure. A timely workup was done, but due to the rapid progression of the disease, the patient succumbed to the disease in the intensive care unit by the time his report for positive leptospirosis test arrived. Conclusion: Leptospirosis must be considered as an important differential diagnosis of acute liver failure patients. An early suspicion for leptospirosis in patients with fulminant hepatic failure and multi-organ failure in India particularly in the rainy season is warranted owing to its high mortality rate.

Is Follow-up Co-Morbidity Assessment via Laboratory Investigations in Older High Energy Trauma Patients Justified? - A Prospective-Retrospective Study

@#Introduction: The objective of the current study was to test our hypothesis that older patients sustaining high energy trauma need to be evaluated for their comorbidities similar to geriatric patients sustaining low energy trauma. Materials and methods: This study was a retrospectiveprospective analysis of 173 patients of more than 50 years of age enrolled between November 2017 and December 2018. Herewith, we have compared retrospectively collected laboratory investigations of 124 fragility fracture patients with prospectively collected laboratory investigations of 49 patients with high energy trauma. The laboratory investigations, including the liver function tests, renal function tests, indices of calcium metabolism, serum electrolytes, complete blood counts, and bone mineral density (BMD) scores. Results: Both groups were similar to each other as far as baseline demographic characteristics were concerned. The proportion of female patients and patients with nonosteoporotic range BMD (T-score >-2.5) was significantly higher in the high-energy fracture group (P value <0.05). Hypoalbuminemia (<3.4gm/dl) 17.3%, abnormalities sodium (<135mmol/L or >148mmol/L) 23.2%, Anaemia (<10g/dl) 12.7%, Hypercalcemia (>10.4mg/dl) 16.3%, Vitamin D deficiency (<20ng/ml) 17.3% are the common laboratory abnormality found in study population. No statistically significant difference was found among the two groups in terms of laboratory investigation abnormalities. Conclusion: The laboratory investigation abnormality in an older patient with a clinical fracture is independent of the mechanism of injury. The results of the current study emphasise the need for a comprehensive laboratory workup in older patients with either high- energy fractures or fragility fractures.

Technology-based Tobacco Cessation Training in Indian Context

In tobacco use disorders (TUDs), technology-based training of health-care professionals can reduce the treatment gap and bring attitudinal change. The study aimed to assess the practices and determine the change in knowledge and attitude among health-care professionals following an online training program (OTP). Half-day OTP on tobacco cessation using prepost quasi-experimental study design with a structured questionnaire?based assessment was conducted. Among 293 completed surveys, knowledge post?OTP was higher but insignificant (P = 1.2). Post?OTP, participants felt less angry and disappointed toward tobacco users(mean of difference (MOD) =0.21, P = 0.0007); more sympathetic and concerned (MOD = ?0.22, P = 0.0005); and acknowledged tobacco users deserve the same medical care as nonusers (MOD = ?0.177, P = 0.001). Post?OTP scores in attitudes did not change significantly for the responsibility domain (P < 0.05). In practice, relatively greater number of health-care professionals asked about tobacco use and advised cessation, however lesser assessed, assisted, and referred. To conclude, technology-based training program can result in attitudinal changes toward tobacco users.

Giant vesical calculus.

A giant vesical calculus more than 100 gram is rare entity. Fewer than 30 cases are reported in English literature of vesical calculus more than 100 gm. Largest vesical calculus was of weight 6294 gm by Arthure et al. Available treatment options for vesical calculi include open surgical removal, extracorporeal fragmentation and endoscopic crushing followed by extraction of pieces. Recently, endosurgical mechanical cystolithotripsy followed by percutaneous extraction has been evolved for small or moderate-sized calculi. Our case report demonstrated vesical calculus of 400gms which is a rare finding in today urologic practice.

Short Term Visual Prognosis After Retinal Laser Photocoagulation for Diabetic Retinopathy.

To assess the outcome of laser photocoagulation treatment for diabetic retinopathy in relation to various risk factors. Method: The change in visual acuity shortly after laser photocoagulation for diabetic retinopathy was assessed in 50 eyes of 25 patients and was compared to the age of onset of diabetes, type of retinopathy, pre treatment duration of diabetes, hypertension, microalbuminuria, smoking, dyslipedemia, associated complications of diabetes and type of treatment of diabetes. Results: Visual improvement was good in young diabetics, short duration of diabetes and parents having mild diabetic retinopathy. Factors having adverse effect on prognosis were longer duration of diabetes, hypertension, dyslipedemia, nephropathy and severe diabetic retinopathy. There was no significant influence of smoking, glycemic control, type of treatment, age of onset and sex of patients on visual outcome. Conclusion: Early diagnosis of retinopathy and initiation of specific treatment by laser photocoagulation at earlier stages with proper control of risk factors viz hypertension, dyslipidemia and nephropathy lead to a favourable visual outcome.

Peripheral Vascular Disease a Silent Assassin: Rising trend in State of Punjab.

Peripheral vascular disease is a major macrovascular complication of diabetes mellitus. This study was done to determine the prevalence of peripheral arterial disease in type 2 diabetes mellitus using the ankle brachial pressure index. An 12 MHz doppler probe was used in the arms and legs to assess the ankle brachial index (ABI) in 200 type 2 diabetes mellitus patients aged more than 40 years. Thorough history of patients including age, smoking history, history of symptoms of peripheral arterial disease, complete physical examination and routine investigations were collected at the time of enrolment for all subjects. A ratio of the highest blood pressure from the posterior tibial or pedal arteries of each leg to the highest blood pressure from the brachial arteries < 0.9 was considered abnormal. Abnormal ABIs were found in 33% (66/200) patients with type 2 diabetes mellitus. 45.5% patients had ABI 0.80–0.89, 33.3% patients had ABI 0.50–0.79 and 21.2% patients had ABI <0.5 Prevalence of peripheral vascular disease in type 2 diabetes mellitus is on rise in northern India so there is need to educate the patients regarding risk factor modification and importance of early intervention to prevent future progression of peripheral vascular disease.

Prevalence of Thyroid disorders in Patients of type 2 Diabetes Mellitus.

Background: Diabetes has become a major health challenge worldwide. Various studies have found that diabetes and thyroid disorders mutually influence each other and both disorders tend to coexist. Objective: To find out the prevalence of thyroid disorders in patients of type 2 diabetes mellitus. Material and methods: The study was conducted on 200 patients of type 2 diabetes mellitus aged between 40-70 years. All the patients were evaluated for thyroid dysfunction by testing thyroid profile (T3, T4 & TSH). The correlation of prevalence of thyroid disorder with gender distribution, age distribution, HbA1C, duration of diabetes, hypertension, family history of thyroid disorder, BMI, usage of OHA’s and insulin and dyslipidemia was then done. The observations and interpretations were recorded and results obtained were statistically analyzed. Results: There was a high prevalence (16%) of thyroid disorders in patients of type 2 diabetes mellitus, most common was subclinical hypothyroidism (7.5%) which was further found to be more in females, elderly patients, patients with uncontrolled diabetes i.e. HbA1C values ≥7 or patients on insulin and patients with BMI >30. Conclusions: Screening of thyroid dysfunction should be done in all diabetic patients especially in patients with poor diabetic control.

Assessment of urban air pollution and it’s probable health impact.

The present study deals with the quantitative effect of vehicular emission on ambient air quality during May, 2006 in urban area of Lucknow city. In this study, SPM, RSPM, SO2, NOx and 7 trace metals associated with RSPM were estimated at 10 representative locations in urban area and one village area for control. Beside this, air quality index (AQI), health effects of different metals and mortality were assessed. The 24 hr average concentration of SPM, RSPM, SO2 and NOx was found to be 382.3, 171.5, 24.3 and 33.8 μg m-3 respectively in urban area and these concentrations were found to be significantly (p<0.01) higher by 94.8, 134.8, 107.4 and 129.6% than control site respectively. The 24 hr mean of SPM and RSPM at each location of urban area were found to be higher than prescribed limit of National Ambient Air Quality Standard (NAAQS) except SPM for industrial area. The 24 hr mean concentration of metals associated with RSPM was found to be higher than the control site by 52.3, 271.8, 408.9, 75.81, 62.7, 487.54 and 189.5 % for Fe, Cu, Pb, Zn, Ni, Mn and Cr respectively. The inter correlation of metals Pb with Mn, Fe and Cr; Zn with Ni and Cr; Ni with Cr; Mn with Fe and Cu with Cr showed significant positive relation either at p<0.05 or p<0.01 level. Metals Pb, Mn and Cr (p<0.01) and Cu (p<0.05) showed significant positive correlation with RSPM. These results indicate that ambient air quality in the urban area is affected adversely due to emission and accumulation of SPM, RSPM, SO 2 , NO x and trace metals. These pollutants may pose detrimental effect on human health, as exposure of these are associated with cardiovascular and respiratory diseases, neurological impairments, increased risk of preterm birth and even mortality and morbidity.

In vitro percutaneous absorption of verapamil.

The in vitro percutaneous absorption of verapamil hydrochloride (VHCl) was investigated in order to assess its feasibility for transdermal development. The experiments were carried across mice and guinea pig skins using Keshary-Chien diffusion cell. The values of diffusion rate (J) and permeability coefficient (Kp) across guinea pig skin were lowered as compared to mouse skin. Increased drug concentration in donor compartment increased value of J but decreased value of Kp. Under similar conditions, values of J and Kp were lowered for dorsal skin as compared to abdominal skin, both for mice and guinea pig. The results indicate that verapamil can be administered transdermally.

In vitro transdermal delivery of atenolol using mouse and guinea pig.

In vitro percutaneous absorption of atenolol was done in order to assess its feasibility for transdermal development across mouse and guinea pig skins using Keshary-Chien type of diffusion cell. Values of diffusion rate (J) and permeability coefficient (Kp) across guinea pig skin were lowered as compared to those in mouse skin. When the concentration of drug in donor compartment was increased a decrease in Kp and increase in J value were observed with both the skins. Under the same conditions, values of J and Kp were lowered for dorsal skin compared to abdominal skin both for mouse and guinea pig. The results suggest that atenolol can be pursued further for transdermal system development.

Insulin dependent diabetes in children.

We present our experience with twenty children with insulin dependent diabetes mellitus admitted during the past 2 1/2 years. Sixteen patients were admitted with acute onset of ketoacidosis while four were having gradual onset. Active and symptomatic treatment was started in all diabetic ketoacidotic patients. One patient died during the acute stage. Eleven patients were followed for 3-6 months or more. Glycosylated hemoglobin was considered as a criteria for control. Three had good control, two fair and six poor control; six developed diabetic ketoacidosis and three developed hypoglycemia.

An attempt to reduce the loss of pain and touch sensations in leprosy patients.

An attempt was made to improve the perception of pain and touch sensations at the leprosy lesions. The loss of pain and touch sensations in a lesion was graded using Pain/Touch-Sensation-Testing-and-Grading devices. Application of a solution containing 1 mg of histamine per ml of DMSO, at the affected area decreased the grades of the loss of pain sensation in 11 (31.4%) patients and of touch sensation in 8 (22.8%) patients, out of the 35 patients tested, indicating an improvement in the perception at the lesion. This effect, however, did not persist even for 5 minutes. A higher concentration (2 mg/ml) of histamine produced reduction in the sensory loss in a larger percentage (47% for pain and 35.3% for touch) of patients, though the duration of this effect was still not prolonged.