ABSTRACT
Background: Although hypothyroidism accompanying dyslipidemia previously recognized as important risk factor for cardiovascular disease, but now subclinical hypothyroidism emerged as important risk factor for atherosclerosis and myocardial infarction especially in elderly people. Subclinical Hypothyroidism (SCH) is a state characterized by normal serum T3 and T4 level with elevated TSH level having minimal signs and symptoms. There are limited studies on SCH and dyslipidemia in elderly people in India, so this study was undertaken to correlate thyroid function abnormality with lipid profile in elderly population. Methods: This observational study was conducted in 74 elderly people more than 60 years age group having symptoms of SCH i.e. fatigue, weakness mild thyroid swelling, weight gain etc. who did not previously have a diagnosis of hypothyroidism, diabetes mellitus, previous thyroidectomy, renal failure, hepatic failure, systemic hypertension etc. They had normal T3, T4 level and raised TSH value. Cases with TSH value >5 mIU/L but normal T3, T4 level were evaluated further for lipid profile. Results: Elderly females suffered more from SCH in the age group of 60-70 years. Participants with SCH had significantly higher cholesterol (p value=0.0216), higher LDL (p value=0.0241) and higher triglyceride (p value =0.0004) with increasing TSH showing positive correlation. There is no significant correlation between decreasing HDL and TSH value.Conclusions: All elderly people should be routinely screened for thyroid function abnormality. Those have SCH should also be evaluated for dyslipidemia so that they can be treated with lipid lowering drugs and low dose thyroxine judiciously to prevent atherosclerosis.
ABSTRACT
Background: Glasgow-Blatchford bleeding score (GBS), was developed to predict the need for hospital-based intervention (transfusion, endoscopic therapy or surgery) or death following upper gastrointestinal bleeding. Study evaluated the Glasgow Blatchford score’s (GBS) ability to identify high risk patients who needed blood transfusion in patients with UGI haemorrhage.Methods: A total of 270 cases admitted with upper gastrointestinal bleeding in the Medical ICU/Wards of MKCG Medical College were put on Blatchford scoring system and classified as those requiring (high risk = GBS >1) and not requiring blood transfusion (low risk) based on the score assigned on admission and a correlation between initial scoring and requirement of blood transfusion was done.Results: Units of blood transfusion required, the GBS and duration of hospital stay were significantly lower among the low risk group, all with p value <0.001. No blood transfusion was required in patients with GBS <3. There was significant correlation between GB score and requirement of blood transfusion (p <0.001) and duration of hospital stay (p <0.001). GBS had 100% sensitivity, negative predictive value and positive likelihood ratio, when a cut off of > 16 was used in predicting mortality.Conclusions: Patients presenting with Upper GI bleeding can be triaged in casualty with Glasgow Blatchford scoring. Patients with a low score of less than or equal to 3 can be safely discharged and reviewed on follow up thereby reducing admission, allowing more efficient use of hospital resources.
ABSTRACT
Background: Pancytopenia (anemia, thrombocytopenia and leukopenia) is a common haematological condition with various etiologies like ineffective haematopoiesis, bone marrow suppression, bone marrow infiltration and peripheral destruction of blood cells. The present study was done to see the clinical features and etiologies of pancytopenia in this geographical region.Methods: About 150 patients above 15 years of age after fulfilling the inclusion criteria were included in the study. They were evaluated with appropriate laboratory tests including bone marrow study, if indicated to find out the underlying etiology.Results: Common symptoms were generalized weakness (93.3%), fever (75.3%) and dyspnoea (54%). Common physical findings were pallor (100%), lymphadenopathy (43.6%) and hepatosplenomegaly (32%). Most common causes were aplastic anemia (28%), megaloblastic anemia (20%) followed by infections like malaria (13.3%), dengue (5.3%) and sepsis (1.3%). Bone marrow was hypocellular in 50 patients (41.7%), hypercellular in 45 patients (37.5%) and normocellular in 25 patients (20.8%).Conclusions: There are some reversible causes of pancytopenia like megaloblastic anemia, malaria, dengue and sepsis. Conditions like disseminated TB, collagen vascular diseases also can be treated with specific treatment if diagnosed early to avoid further complications.