Patterns of aldosterone, renin level and aldosterone/renin ratio in young hypertensive patients

Background: Hypertension is a common disease that affects a vast and diverse patient group. Aldosterone, the primary human mineralocorticoid, is increasingly recognized as playing a key role in cardiovascular morbidity, and its involvement in hypertension has lately been evaluated by studies. It is estimated that it accounts for up to 13% of all hypertension patients and 20% of resistant hypertension cases. This study aimed to observe the patterns of aldosterone, renin level, and aldosterone/ renin ratio in young hypertensive patients. Methods: This was a retrospective observational study and was conducted in the Department of Medicine Popular Medical College Hospital, Dhaka, Bangladesh during the period from June, 2023 to December, 2023. In our study, we included 124 hypertensive patients who visited the outdoor department of medicine of our hospital. Results: In our study, we found mean age was 33.38�49 years. The majority (75%) of our patients were male. The mean SBP and DBP were 136.77�.54 and 88.58�.72 mmHg respectively. The mean aldosterone level was 148.74�5.91 pmol/L. The mean plasma renin activity and aldosterone to renin ratio were 10.03�.04 ng/mL/hr and 22.98�.66 respectively. Conclusions: In our study, we aimed to determine the pattern of ARR ratio in young hypertensive patients. We found that aldosterone renin ratio (ARR) levels play a crucial role in identifying the etiological patterns of young hypertensive patients e.g. Conn's syndrome, Liddle's syndrome, etc.

Surgical Outcome in IDEM Tumors in Short Term Follow Up

Background: To review the clinical and histological aspect of IDEM tumors with functional outcome after surgery of all radiologically diagnosed cases of IDEM. Methods: 12 cases of IDEM tumors, which had been surgically treated and studied in terms of clinical features as pain by VAS, functional score by Nuricks grading, in preoperative and postoperative period. The correlation of histopathology and tumor size in terms of clinical features and outcome was done. Results: Most common diagnosis was schwannoma (83.3%) and rest 2 patients were meningiomas(16.7%), distribution - 3(25%) dorsal, 5(41.6%) lumbar, 2(16.6%) cervical, 1(8%) cervico-dorsal and 1(8%) dorso-lumbar and average percentage of the intradural space occupied by tumor was 77.02%. Average age was 40 years. Meningioma was common in 55 to 60 yr age all female; schwannoma the mean age was 37 year. The most common symptoms were local pain, tingling and numbness, motor weakness which were observed in all the cases. All patients improved postoperatively. VAS score and Nurick grade inproved in all. Conclusion: Most common pathology was schwannoma then meningioma. All the tumors excised through the posterior approach. The postoperative recovery was good in all the cases regardless of any condition. Therefore, aggressive surgical excision is recommended even for cases with a long duration of symptoms or a severe neurologic deficit.

A New Concept in Relation to Blood Biochemical Parameters with Myocardial Infarction in Bangladeshi Population.

Background : Blood testing for biochemical markers of Myocardial injury plays an increasingly important role for the evaluation, diagnosis and triage of patients with chest pain. The guidelines for the diagnosis of Myocardial Infarction ((MI) have recently changed and prominently incorporate the results of cardiac marker testing in the clinical definition of MI. We investigated these updated biomarkers and further compare the differing biology and release kinetics of clinically relevant biomarkers. Methods: Biochemical changes that occurred in the blood of acute myocardial infarction (AMI) patients were investigated. Two hundred and fifty two patients, 180 males and 72 females were included in this study. The mean age was 49.3 ± 9.25 years. Biochemical parameters include serum triglyceride, total protein, albumin , total bilirubin and total cholesterol to albumin ratio were analyzed. Results : Biochemical parameters showed that the increased level of triglyceride and total bilirubin were associated with myocardial infarction. Triglyceride and total bilirubin levels in myocardial infarction patients were 2.3 ±1.4 mmol/ L and 12.3±3.2 μmol/ L respectively, whereas those of healthy controls were 1.7±1.2 mmol/L for triglycerides and 9.7±3.7 μmol/L for bilirubin. On the other hand, serum total protein and albumin concentrations were lower in MI patients compared to those of controls. Total protein level was 65.5 ±3.1 g/L in MI patients and 76.2±5.3 g/L in healthy controls. Albumin levels in both patients and controls were 40.2 ±3.2 g/L and 45.4 ± 4.5 g/L correspondingly. Conclusion : Interestingly, serum total cholesterol level was not significantly different in MI patients compared to controls. In addition, cholesterol/albumin ratio in myocardial infarction patients (0.14 ± 0.04) found to be significantly higher than in healthy controls (0.11± 0.03).

Comparison study of clinicoradiological profile of primary lung cancer cases: An Eastern India experience.

Context: According to the first population-based cancer registry from eastern part of India, Kolkata and its surrounding areas have the highest prevalence of lung cancer in India. However, there is very limited data from this part of the country. Aims: The aim of this study is to find out the demographic and clinicoradiological profile of primary bronchogenic carcinoma. Settings and Design: This is a retrospective review of lung cancer cases diagnosed in two tertiary institutes of Kolkata over a period of 4 years. Materials and Methods: We have reviewed the cases with proven histological or cytological diagnosis of primary bronchogenic carcinoma and chi-square test is done to calculate statistical significance. Results: Out of 607 patients, male 489 and female 118, 67.7% are from rural area, 67.2% are smoker and only 9.4% are ≤40 years of age. Smoking is the major risk factor for primary lung cancer (P = 0.000) but no significance could be established with the different histological subtypes (P = 0.207). Though squamous cell carcinoma (SCC) is the most predominant variety (35.1%), adenocarcinoma and undifferentiated type are overrepresented in ≤40 years. SCC occurs at a significantly higher age group (60.84 ± 12.16 years) than other subtypes (P = 0.000). At least 55.2% cases of nonsmall cell lung cancer and 54% of small cell lung cancer presented in very advanced stage. Conclusions: SCC is the most common histological subtype of primary bronchogenic carcinoma. The relatively increased frequency of adenocarcinoma in our study as compared to other studies from India is probably due to higher proportion of nonsmokers.

Detection of Uropathogens by Using Chromogenic Media (Hicrome UTI agar), CLED agar and other Conventional Media.

This study was undertaken to find media better than routinely used media in isolation of uropathogens.Three hundred urine samples having pus cells >_ 5/ HPF were enrolled for the study. Comparison of isolation and identification of uropathogens among HiCrome UTI Agar media, 5% Sheep Blood agar & MacConkey agar and CLED agar media were done. Among them 95(31.67%) samples showed single growth, 6 (2%) showed mixed growth and 199 (66.67%) showed no growth. Rate of presumptive identification of organisms in primary culture plate were high in HiCrome UTI agar media. For Escherichia coli, it was 94.20% whereas in CLED agar it was 79.71% and by Blood agar and MacConkey agar media in combination it was 82.61%. All the Enterococcus spp. were identified in HiCrome UTI agar media, 33.33% in CLED agar media but none in Blood agar and MacConkey agar media. Among the mixed growth, 100% organisms were identified on HiCrome UTI Agar media due to distinct colour produced by the different organisms, whereas in one (16.67%) sample (mixed Esch.coli and Pseudomonas spp.) organisms were identified on other three media.

Study on Time-related Changes in Aerobic Bacterial Pattern of Burn Wound Infection.

A prospective study was carried out in 50 burn patients admitted in Burn unit of Dhaka Medical College Hospital over a period of one year from January 2005 to December 2005 to evaluate time-related changes in aerobic bacterial colonization and their sensitivity pattern. Periodic swabs were taken from the burn wound on Day 0, Day 7, Day 14 and Day 21 to see the changing pattern of organisms during hospital stay of patients. In the present study burn injury was highest in the age group 11-20 yrs (34%). Male to female ratio was 1.38:1. The mean percentage of burn was 35.79% of total body surface area (TBSA). Fire was the major cause of burn (38%) followed by electric burn (20%). Among the 200 samples, single organism was isolated in 71% samples and mixed organism in 13.5% and no growth in 14.5%. Among single isolates Pseudomonas aeruginosa was leading (28%) followed by Escherichia coli (17.5%), Staphylococcus aureus (16%), coagulse negative Staphylococcus (4.5%) and Klebsiella (2%). Among mixed growth Pseudomonas aeruginosa was still leading (11%) follow by E. coli (9.5%) Staphylococcus (5.5%), Proteus (1%) and Klebsiella (0.5%).There were time -related changes in bacterial isolation from burn wound during hospital stay of patients. On admission 42% of the isolated organisms were Staphylococcus aureus and only 6% each Pseudomonas aerunginosa and E. coli were isolated. No growth was found in 28%. samples. These findings were gradually changing with time and on day 21 Staphylococcus aureus were only 4% whereas Pseudomonas aeruginosa were 40% and E. coli 28%. Antimicrobial sensitivity test showed that pseudomonas aeruginosa was highly resistant to antimicrobial agents. It was most sensitive to Imipenem (98.72%) followed by Aztreonam (33.44%), Ceftazidime (38.32%) and Gentamicin (19.23%). E. coli was also found most sensitive to Imipenem (98.15%) followed by Gentamicin (38.95%), Chloramphenicol (37.1%), Ciprofloxacin (35.25%) and ceftraixone (29.70%). Staphylococcus aureus was 100% sensitive to Vancomycin followed by Amoxiclav and Oxacillin (53.43% each), Gentamicin (44.70%) and Cloxacillin (39.52%). It is crucial for every burn institution to determine the specific pattern of burn wound microbial colonization, the time-related changes in dominant flora, and the antimicrobial sensitivity profiles. This would enable early treatment of septic episodes with proper empirical systemic antibiotics without waiting for culture results, thus improving overall infection related morbidity and mortality.

Factors influencing the outcome of patients with acute extradural haematomas undergonig surgery.

Background: Acute extradural haematoma (EDH) remains most common cause of mortality and disability resulting from traumatic brain injury. In the last three decades, improvements in rescue, neuromonitoring, diagnostic procedure and intensive care have led to better outcomes. The purpose of this study was to evaluate the factors influencing the outcome in patients with EDH undergoing surgery treated in a tertiary hospital in Bangladesh. Methods: In this retrospective study, 102 consecutive patients with acute EDH who underwent craniotomy were included. The study was carried out from July 2003 to December 2005. The diagnosis was made clinically and radiologically by CT scan. Patients were grouped on the basis of Glasgow Coma Scale (GCS) and operative outcomes were evaluated by Glasgow Outcome Scale (GOS) Results: More than half sampled respondents’ (57%) age were more than 20 years while rests of the patients below 20 years with male predominance (Male: Female -12:1). About 7 in 10 respondents (70.6%) were working. Similarly, majority of the respondents (79.4%) had lost more than 30 ml blood. A notable proportion of the respondents (73.5%) had good GCS score (9-15 score) during admission. Similarly majority of the respondents (70.6%) had GCS score 9-15 and 29.4% had GCS score 3-8 before surgery. Road Traffic Accident (RTA) (65%) is the most common cause of EDH followed by assault (20%) and fall from height (12%). Temporal and temporo-parietal locations were the most common site of EDH (56%). Patients with good GCS before surgery had significantly better outcome (89%) compare to those who had bad GCS (10%). Conclusion: Level of consciousness before surgery is the most important factor affecting the outcome. Hence, early diagnosis and surgical intervention is very essential.

Surgical experience with a huge supratentorial primitive neuroectodermal tumour in a 3 years old boy.

The concept of Primitive Neuroectodermal Tumor (PNET) has been evolving for many years, since its nomenclature has been done. A 3 years old boy presented with unable to stand and walk, vertigo, vomiting and visual disturbances. MRI of brain revealed suggestive of malignant tumour with intratumoral hemorrhage involving the frontotemporo- parietal region. A gross total removal of tumor was achieved through craniotomy. The pathological finding was consistent with PNET. This case is an exclusive one as it was huge size. Supratentorial PNETs are rare tumour and carry poor prognosis. Newer modalities of treatment should be tried to improve survival.

Addition of isovitalex in chocolate agar for the isolation of Haemophilus influenzae.

BACKGROUND & OBJECTIVE: The reason for lack of data on burden of Haemophilus influenzae type b (Hib) in developing countries was mainly failure of detection of this fastidious organism in laboratories. Use of isovitalex (IVX) was suggested as an essential supplement for growing this organism. This study was carried out to investigate the impact of IVX supplementation to chocolate agar for detection of Hib. METHODS: Chocolate agar with and without supplementation of IVX was prepared. Clinical samples as well as reference strains of Hib were simultaneously cultured on both the media. RESULTS: H. influenzae isolates (N=194) were simultaneously grown on chocolate agar (CA) with and without isovitalex (IVX). Average colony size of H. influenzae on CA with IVX (CA-IVX) was larger only by 0.10 cm (range 0.05 to 0.16 cm) compared to CA alone. Addition of IVX to CA increased the cost of media by 2.1-fold. INTERPRETATION & CONCLUSION: Isovitalex is not essential for the isolation and growth of H. influenzae almost halving the cost.

A study of pulmonary tuberculosis in the elderly.

The incidence of tuberculosis (TB) is increasing globally. The diagnbsis of TB in elderly is often delayed due to the atypical presentation. There is also therapeutic problems because of presence of comorbidity, nutritional and socio-economic factors and increased incidence of adverse drug reactions and mortality. A prospective study was conducted among patients presenting with pulmonary tuberculosis at the department of TB and respiratory medicine in a tertiary care hospital between January, 2006 to July, 2006. Thirty patients aged more than 65 years were studied for their clinical characteristics, comorbid illnesses, sputum status, radiological features and adverse drug reactions. They were contrasted against the same parameters in 40 patients aged 65 years or less. The study showed that pulmonary TB in the elderly is characterised by (a) atypical symptoms, (b) more extensive radiological lesion with lower zone preponderance, (c) higher sputum positivity, (d) more frequent comorbidity, (e) more frequent side-effects and (f) higher mortality.

Hypoglycemic effect of Catharanthus roseus in normal and streptozotocin-induced diabetic rats.

The effects of crude juice (at 0.5 and 1 ml/kg b.w.) and aqueous extract (at 0.30 and 0.45 gm/kg b.w.) of leaves of Catharanthus roseus on serum glucose level in streptozotocin induced diabetic rats were examined at 8 hours, 12 hours and 24 hours following single oral administration. The administration of crude juice at 1 ml/kg b.w. continued for another 9 doses (total 10 single morning doses given) and its effect was examined on the 4th and 11th day. The rats were made diabetic by single intraperitoneal injection of streptozotocin at 45 mg/kg b.w. Glibenclamide was used in the study for comparison. The crude leaf juice at 0.5 and 1 ml/kg b.w. reduced the serum glucose level in streptozotocin induced diabetic rats throughout the 24-hour period significantly (P varies between 0.05 and 0.001 at different times). The aqueous extract at 0.30 and 0.45 gm/kg reduced the serum glucose level in streptozotocin diabetic rats at 8 and 12 hour significantly (P varies between 0.05 to 0.01 at different times) but not at the 24 hour. Glibenclamide, at 500 mug/kg, also reduced the serum glucose level in streptozotocin induced diabetic rats throughout the 24-hour period (P<0.001).The crude leaf juice at 1 ml/kg also significantly reduced the serum glucose level in the streptozotocin induced diabetic rats on the 4th and 11th day (P<0.001 on both occasions). The effect of crude leaf juice at 1 ml/kg b.w administered daily orally over a 10 day period was also examined on a group of normal rats at different times. The study showed significant reduction at 8 hr (P<0.05), 12 hr, 24 hr and on the 4th day (P<0.01 on these 3 occasions) and also on the 11th day (P<0.001).

Effect of hexane extract of spirulina in the removal of arsenic from isolated liver tissues of rat.

The present study was conducted to investigate whether the active compound(s) of spirulina is present in its -- alcohol extract, hexane extract, DCM extract or in their residues. In phase I the accumulation of arsenic in isolated liver tissues of rat at different incubation period (15, 30, 45 minutes) was seen. In phase II arsenic-loaded liver tissues were incubated in presence and absence of alcohol extract, alcohol extraction residues, hexane extract, hexane extraction residues, DCM extract and DCM extraction residues of spirulina respectively. The percentage removal of arsenic from liver tissues by different extracts and residues of spirulina was estimated by Atomic Absorption Spectrophotometer. In phase III arsenic-loaded liver tissues were incubated in presence and absence of different concentration of hexane extract of spirulina and the percentage removal of arsenic from liver tissues was estimated. This study showed that the accumulation of arsenic in isolated liver tissue was time dependent and highest accumulation found was 0.69 microg/g tissues after 45 minutes incubation, which was highly significant. The percentage removal of arsenic from arsenic loaded liver tissues by alcohol extract, alcohol extraction residues, hexane extract, hexane extraction residues, DCM extract, DCM extraction residues were 33.8%,4.4%,83.0%,10.2%,7.3% and 2.9%, respectively. The percentage removal of arsenic by hexane extract at the concentration of 1, 10, 100 microg were 13.2%, 29.4% and 89.7%, respectively. Among the different extracts and residues of spirulina the hexane extract causes highly significant (p<0.001) removal. In conclusion the present study suggests that the active compound(s) of spirulina is present mostly in its hexane extract.

pH-adjusted periocular anaesthesia for primary vitreoretinal surgery.

PURPOSE: To evaluate the efficacy of pH-adjusted bupivacaine in conjunction with medial orbital periconal block (periocular anaesthesia). METHODS: Sixty consecutive patients undergoing primary vitreoretinal surgery were enrolled prospectively. RESULTS: Adequate anaesthesia and akinesia with no intraoperative supplementation was achieved in 53 eyes (88.3%). Factors influencing intraoperative supplementation were combined vitrectomy with scleral buckling (p = 0.005) and duration of surgery of more than 2 hours (p = 0.001). No ocular or systemic complication resulted. CONCLUSION: pH-adjusted periocular anaesthesia is safe and effective in patients undergoing primary vitreoretinal surgery.

Body iodine status in school children and availability of iodised salt in Calcutta.

Success of Universal Salt Iodization (USI) programme depends on availability of iodised salt to consumers, which should be reflected in their body iodine status. From a monitoring study in Calcutta, it was found that all packed salts were iodised and most of them (98.1% at household level and 93.6% at retailers' outlets) had iodine at a level of > or = 15 ppm. Of the loose salts, 34.6% at household level and 19.9% at retailers' outlet had iodine level < 15 ppm. A few number (0.5% at household level and 1.0% at retailers' outlets) of salts had no iodine. To ascertain the impact of consumption of iodised salt iodine excreted in urine (UIE) was measured in school children of age between 8-12 years of south, east, west, north and central parts of Calcutta. 22.95% of male children and 31.81% of female children had urinary iodine level less than 50 micrograms/l, which is cut off figure of public health concern. Children from poor slum areas were found to be at greater risk.

Incidence of hepatitis B virus (HBV) infection amongst clinically diagnosed acute viral hepatitis cases and relative risk of development of HBV infection in high risk groups in Calcutta.

The present study revealed that 30.5% of acute infective hepatitis were due to the infection of Hepatitis B virus (HBV) however, 8% controls also showed HBV positivity. The possible route of infection of HBV in our country were Parenteral in 51.9%, Sexual in 24% and Unidentified in 24.1% cases. HBV marker positivity was 45.5% amongst health care workers 33.3% in recipients of multiple blood and blood product transfusion, 25% in sexual partners and their children, 20% in S.T.D. clinic attendants and 10% in patients on haemodialysis.

A study of mycetoma in eastern India.

Forty consecutive cases of mycetoma were studied with respect to clinico-epidemiological, histopathological and radiological features. The age of the patients ranged from 17 to 57 years mean being 32.4 +/- 8.68. The disease was equally distributed amongst the sexes. Most of the patients had a rural background and the disease occurred mainly among farmers and housewives. Actinomycetes (32 cases. 80%) were found to be the main pathogenic organism and Eumycetes in 4 cases (20%) only. Clinical features were more or less the same irrespective of the aetiologic agent, consisting of local swelling with discharging sinuses. History of trauma was present in only 20% cases and 80% were incidental. Foot (28/40 i.e. 70%) was the commonest site of infection. Radiological bony involvement was detected in 14 out of 18 cases examined (38.88%). Out of the 32 radiographed patients of actinomyetoma 10(31.25%) showed bony involvement whereas all the four. Eumycetoma cases radiographed, had bony involvement. The notable bony changes were sclerosis, erosions, periosteal thickening and osteoporosis.

Better preservation of Campylobacter jejuni/C. coli in a defined medium.

Campylobacter jejuni and C. coli strains were preserved at -10 degrees C in different stock media to determine their efficacy to preserve the organism for a longer period of time. An improved defined stock culture medium was developed for the organism by removal and effective neutralisation of the toxic metabolites. Comparative study revealed that phosphate buffer saline (PBS), pH 6.7 supplemented with 0.2 per cent charcoal, 0.025 per cent FBP (ferrous sulphate, sodium metabisulphate and sodium pyruvate), 0.1 per cent L-cystein and 10 per cent glycerol could support survival of C. jejuni coli strains for as long as 135 days at -10 degrees C followed by George's medium, brucella broth with 15 per cent glycerol, fetal calf serum with 50 per cent TSYB (tryplicase soy yeast-broth) and glycerol transport broth respectively.

Immunological studies on pulmonary tuberculosis: a preliminary report.

An investigation of 71 patients (61 mantoux positive and 10 mantoux negative) with bacteriologically and radiologically proven primary pulmonary tuberculosis was undertaken for immunological analysis to evaluate cell mediated (E-rosette) and humoral (EAC-rosette and serum immunoglobulins; IgG, IgA & IgM) immune status. 41 age and sex matched normal subjects served as controls. An inverse relationship between cell mediated and humoral immune response was observed in tuberculous patients in general. Defects in cell mediated immune response was pronounced in mantoux negative cases. Fractionation of serum protein revealed a significant diminution in albumin level with a concomitant elevation in globulins particularly gammaglobulin levels. It appeared that there is a definite need to boost up T-cell mediated responses and to control the over activity of B-cell in these cases. Proper handling of the immune system by appropriate therapy might change the course of the disease.