Association of vitamin D deficiency and bone mass with liver and heart iron overload in transfusion dependent thalassemia

Background: Transfusion dependent thalassemia patients are reported to have Vitamin D insufficiency/deficiency in many countries. Vitamin D hydroxylation occurs in the liver; whether liver iron overload interferes with this step has not been addressed till date. This study helps to establish an association between liver iron concentration (LIC) and heart iron concentration (MIC) with vitamin D levels and Bone Mass Density in these patients.Methods: A cross sectional study was done by including transfusion dependent Thalassemia patients (TM) if they had an assessment of Liver and cardiac iron done by T2*MRI and bone mineral density by DEXA. Clinical data regarding age, gender, type of iron chelation therapy and laboratory data of S. ferritin and Vitamin D was collected. Data was assessed using appropriate statistical methods.Results: Among 40 TM patients were taken and mean age was 17.6 years. Vitamin D deficiency was identified in 26(65%). 20 out of them had an LIC>7mg/g DW and 6 had MIC>1.65mg/g DW. There was a significant association between LIC>7mg/g and vitamin D level<20 ng/ml and a significant inverse correlation between LIC and vitamin D, suggesting that liver iron overload may indeed affect vitamin D metabolism. Osteopenia was present in 32.5% and osteoporosis was present in 27.5 % of all TM patients. Reduced Bone Mass Density was also found to be linked with iron over load.Conclusions: Regular monitoring of vitamin D levels and supplementation is required in patients with severe liver and heart iron load. More studies are needed to confirm these results.

Study of pattern and management strategies of solid visceral injuries in blunt trauma abdomen in tertiary care centre

Background: Blunt trauma abdomen is a leading cause of morbidity and mortality among all age groups. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality still remain large. The aim was to evaluate pattern and management strategies of solid visceral injuries in blunt trauma abdomen patients.Methods: This was a prospective study on 100 consecutive patients admitted in Department of General Surgery at a tertiary care center with an antecedent history of blunt abdominal injury. All patients proven to have penetrating injury and hollow viscus injury were excluded. The pattern of injury, presentation and parameters associated with management strategies were evaluated.Results: In the present study, solid viscera injury in blunt trauma abdomen is more common in age group 21-30 years (43%) with male predominance (92%). RTA (75%) were the most common mode of injury followed by fall. Most common clinical presentation was abdominal pain (86%) followed by tachycardia (34%) and hypotension (6%). Most common viscera injured is liver (48.2%) followed by spleen (36.7%), kidney (12.3%) and pancreas (2.8%). Majority of patients were managed conservatively (84%).Conclusions: It was concluded from the study that irrespective of the solid organ injury in blunt trauma abdomen, patients can be managed conservatively due to aggressive resuscitation with supplement drug therapy, use of analgesia or sedation in ICU setup and close monitoring. Patients are grossly hemodynamically unstable at presentation do require intervention either immediate or in due course of time.

Evaluation of pattern and prognostic factors of head injury cases in a tertiary care centre

Background: Head injury is a major public health problem worldwide and requires appropriate attention both regionally and globally. This study was done to find the patterns and to evaluate prognostic factors for final outcome of cranio-cerebral trauma.Methods: A prospective study of 200 cases of head injury was conducted in a tertiary care hospital during one year duration. Apart from patient’s demographic profile detailed history and examination was recorded. Final outcome of all patients was noted at discharge and during follow up, various prognostic factors were studied by taking Glasgow outcome scale (GOS) at 3 months of head injury.Results: This study included 156 (78%) males and 44 (22%) females with average age of 35.95 years. Assault followed by RTI was the main cause of TBI. The factors which correlated with poor prognosis are presence of increasing age, less GCS at admission, alcohol intoxication and multiple lesions on CT scan.Conclusions: Prognostication of patients with head injury will help to provide timely multimodality approach which will ultimately help in improving outcome of these patients.

Pattern and Etiology of Patients with Gastrointestinal Perforations: An Observational Prospective Study

Introduction: Perforation peritonitis is the most commonsurgical emergency encountered all over the world. Theobjective of the study was to highlight the spectrum ofperforation peritonitis as encountered in a tertiary care centrein haryana.Material and methods: It was observational prospectivestudy of 100 cases of perforation peritonitis treated in thedepartment of surgery. The maximum number of patients inthe present study were in age group of 21-30 years (26%) witha mean age was 31 years. Male female ratio was 8.09:1.Results: The most common etiology of perforation peritonitiswas peptic ulcer disease (41%) followed by enteric fever (15%)and tuberculosis (13%)The most common site of perforationin this series was gastroduodenal (43%) followed by terminalileum (30%). Mortality rate was 5% and significantly high inpatients coming to the hospital after 24 hours.Conclusion: Early recognition of symptoms and referral isvery important in reducing mortality and morbidity