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Background: Organophosphorus insecticides are one of the most common causes of poisoning in India. It has a high mortality rate and accounts for a third of suicidal deaths in south-east Asia.Methods: The objectives were to estimate serum pseudocholinesterase and creatine phosphokinase (CPK) levels in organophosphorus poisoning and correlate them with theseverity and prognosis described by the Peradeniya organophosphorus poisoning (POP) scale at initial presentation.This was a cross-sectional study conducted over 18 months. A total of 180 organophosphorus-poisoning subjects were divided into mild, moderate and severe grades based on POP scale at admission. Serum pseudocholinesterase and CPK levels were estimated at admission. The outcome was noted, and the results were statistically analysed.Results:It was found that 112 (62.2%), 51 (28.3%) and 17 (9.4%) patients had mild, moderate and severe poisoning, respectively, according to POP scale. Mean pseudocholinesterase level (units/litre) was 2393.29, 1104.37 and 638.18 and mean serum CPK level (units/litre) was 153.41,344.94 and 280.53 in mild, moderate and severe poisoning, respectively. ICU and ventilator were required for 84 (46.75%) and 72 (40%) patients, respectively. Mortality was 17.8%. Negative, weak and significant correlation was seen between POP score and pseudocholinesterase (r=-0.265, p=0.00). Positive, moderate and significant correlation was seen between POP score and CPK levels (r=0.449, p=0.00).Conclusions: POP scale applied at admission along with serum pseudocholinesterase and CPK levels serve as a simple and effective system to determine early need for ventilation and mortality in rural, peripheral centres in developing nations.
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Background: Microalbuminuria is a marker of endothelial dysfunction and an important risk factor for cardiovascular diseases. Microalbuminuria may be seen due to hypoxemia in patients with chronic obstructive pulmonary disease (COPD). The objectives were to study the presence of microalbuminuria in patients with chronic obstructive pulmonary disease and to determine the relationship of microalbuminuria with severity of COPD using GOLD staging.Methods: The study was done on 68 patients of COPD. Urine spot albumin measurement, pulmonary function tests, spirometry and GOLD staging were done. Severity of COPD was assessed by GOLD staging. Pearson Co-relation test and ANOVA test were used for statistical analysis.Results: Statistical analysis showed that strong and statistically significant positive correlation of Microalbuminuria with GOLD staging(r =0.749, p = 0.001).Conclusions: Microalbuminuria(MAB) was found to increase in patients with increasing severity of COPD. Hence its potential role as a marker of severity of disease and in predicting risk of cardiovascular disease can be explored.
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Background: The aim of the study was to assess the relationship between clinical and biochemical parameters with outcome of aluminium phosphide toxicity.Methods: Total 46 patients with aluminium phosphide poisoning admitted to the Hospitals attached to BMCRI between November 2018 and April 2019 were prospectively studied. After adequate history was obtained and immediate first aid measures given, clinical and biochemical parameters such as liver enzymes, serum creatinine, serum potassium and magnesium levels were studied. The patients were then followed up until outcome. Data was analysed using Descriptive statistics like mean, Standard deviation and percentages were calculated. Inferential statistics like Mann-Whitney test was used to compare the parameters between the two outcome groups (discharged and death) using SPSS software.Results: Among the study population, between the two outcome groups males were 80.6% and females were 19.4%. the outcome was death in 10 patients and 36 patients were discharged. Tachycardia and hypoxia at presentation, Low Serum Magnesium and higher levels of serum creatinine at admission were found to be associated with higher mortality in patients with aluminum phosphide toxicity and were statistically significant.Conclusions: These clinical and laboratory parameters can be considered as manifestation of hemodynamic compromise and are hence associated with poorer prognosis. Serum magnesium levels, can be used in prognostication of aluminium phosphide toxicity, owing probably to their effects of cardiotoxicity. Increased serum creatinine levels as a result of acute kidney injury, could also indirectly point to circulatory compromise. Hence these clinical and laboratory parameters at presentation have important implications.
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A case of diffuse nesidioblastosis in an adult patient is reported in this study. A 24-year-old female with no known comorbidities presented with multiple episodes of documented recurrent hypoglycaemia and Hypoglycaemia induced seizures both in fasting and postprandial state. Her blood investigations revealed low plasma glucose levels, high insulin and C-peptide levels with positive 72-hour fast test. Her transabdominal USG and CECT abdomen did not reveal any abnormality, 68Ga DOTANOC PET CT done showed ill-defined diffuse somatostatin receptor expression in the pancreatic head and tail suggestive of nesidioblastosis. As patient was not willing for surgical treatment, hence started on medical treatment with oral nifedipine. Nesidioblastosis is very rare in adults. It is an important differential diagnosis in adults with hyperinsulinemic hypoglycemia although the incidence is very rare in adults. PET SCAN was used to non-invasively diagnose nesidioblastosis in this case. Surgery being the preferred choice of treatment in nesidioblastosis, there is limited data on medical line of management in nesidioblastosis.
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Background: Neutrophil lymphocyte ratio (NLR) is an indicator of subclinical inflammation. Subclinical inflammation may be associated with increased cardiovascular risk. Raised NLR is associated with metabolic syndrome and is found to be a predictor of cardiovascular disorders. There are only few studies assessing the correlation between NLR and glycemic control. The aim of the present study is to investigate the relationship between NLR and glycemic control in type 2 diabetes patients.Methods: This observational study was conducted in Department of Medicine, Bangalore medical college. 100 patients diagnosed to have type 2 diabetes mellitus were assessed. They were divided into three groups based upon HbA1c levels: Group 1, HbA1c ≤7%; group 2, HbA1c 7-9%, and group 3, HbA1c>9%. Complete blood count and other relevant investigations were performed. SPSS software was used for statistical analysis. T test was used for continuous variables and chi square test for categorical variables. ANOVA test was used to compare three groups. A p value of <0.05 was considered statistically significant.Results: Out of 100 patients, the white blood cell count (WBC count) was higher in group 3 as compared to group 1 and group 2(p 0.008). Similarly, the absolute neutrophil count was higher in group 3 as compared to group 1 and group 2(p.017). The neutrophil lymphocyte ratio (NLR) was significantly higher in group 3 as compared with group 1 and group 2(p.009). NLR had a positive correlation with HbA1c and was found to be an independent predictor of poor glycemic control in patients with type 2 diabetes mellitusConclusions: Our study found a significant positive correlation between NLR and glycemic control. Increased NLR is associated with elevated HbA1c and poor glycemic control. Type 2 diabetes mellitus patients with raised NLR should be evaluated for cardiovascular, renal and ocular complications of diabetes.
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Introduction: The AIMS 65 score is a new bedside scoreproposed for the assessment of liver function which issimple and more independent. Different scores have beenrecommended to predict outcomes in the setting of uppergastrointestinal bleeding (UGIB), limited comparative studieshave been published between simplified versions of olderscores and recent scores. In this present study, we aimed toretrospectively compare the performance of AIMS 65 scorewith Child-Pugh score, MELD score and ALBI score forpredicting the outcome in patients with upper GI bleed inchronic liver disease.Material and Methods: Data of patients with chronic Liverdisease secondary to ethanol were retrospectively reviewed.Child Pugh score, MELD score, ALBI score and AIMS 65score were calculated for the patients and results . ROC curvesderived from comparison with outcome and were analysed.Results: In our study conducted on 112 patients, the agedistribution was between 20-85 years with mean age ofpatients being 46.47 ± 10.9 years, sex ratio Male: Female:105:7 with mortality rate of 33.92%. The Area under curves ofROC of AIMS65, Child Pugh score, MELD score, ALBI scorewas 0.779, 0.864, 0.763 and 0.777 respectively.Conclusion: AIMS 65 is a simple and non-endoscopic scorefor the prediction of in hospital mortality. No statisticaldifference was observed between AIMS-65 and other scoressuch as Child Pugh score, ALBI and MELD score.