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Background:Non-alcoholic fatty pancreas disease (NAFPD) is an emerging clinical entity. NAFPD is characterised by excessive fat deposition in the pancreas in the absence of alcohol consumption. Recent studies suggest that NAFPD might be associated with beta cell dysfunction, insulin resistance and inflammation which might lead to development of diabetes. NAFPD might be used as an initial indicator of glucometabolic disturbances and identify the patients with prediabetes. Methods:This was a cross sectional study in which the glycemic status of 50 patients with NAFPD with ultrasonographic evidence of increased echogenicity of pancreas was assessed and association between glycemic variability and NAFPD was determined. The patients were also assessed for the ultrasonographic evidence of fatty liver.Results:Pre-diabetes was noted in 32% subjects while diabetes was noted in 20% subjects. Thus, 52% patients with NAFPD had abnormal glycemic status. The 48% subjects i.e., 24 patients had normoglycemia. The presence of fattyliver was statistically significant in normoglycemia and diabetes mellitus with p=0.001 and 0.045 respectively. No statistically significant association was noted between fatty liver and prediabetes with p=0.175. No causal relationship was seen between fatty liver and glycemic variability in patients with NAFPD.Conclusions:NAFPD is associated with impaired glycemic status. It is also seen frequently with fatty liver. Its early detection may help to identify the patients with prediabetes who may benefit from timely introduction of interventions to reduce the rising morbidity and mortality due to diabetes mellitus.
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Background:Coronary artery disease(CAD)is major cause of death and mortality in the developed world. Coronary atherosclerotic disease involves the epicardial coronary arteries and may manifest as an acute or chronic coronary syndrome. Acute coronary syndrome(ACS) arises from atherosclerotic plaque rupture leading to coronary thrombosis and/or spasm. Methods:The present study was conducted in department of medicine, Guru Nanak Dev hospital attached to government medical college, Amritsar from May 2021 to December 2021. This was a prospective observational study in which a total of 50 patients of ACS were enrolled. Serum albumin levels of the patients were recorded and clinical outcomes based on the albumin levels were compared between the patients.Results:The patients with low serum albumin levels had worse outcomes. The mean serum albumin level of STEMI and NSTEMI patients in hypoalbuminemia group was 2.88±0.11 g/dl and 3.15±0.26 g/dl (p=0.047). The mean serum albumin levelof patients having mortality in hypoalbuminemia group was 2.87±0.06 g/dl and those who didn’t have mortality was 3.19±0.21 g/dl (p=0.013). The mean serum albumin level of patients developing new onset heart failure in hypoalbuminemia group was 2.85±0.06 g/dl and those not developing had 3.11±0.19 g/dl (p=0.021).Conclusions:We conclude that ACS patients presenting with hypoalbuminemia are more likely to develop worse outcomes in the form of heart failure, cardiogenic shock and mortality. ACS patients presenting with low serum albumin levels have more chances of developing STEMI.
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Background:A stroke or cerebrovascular accident is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Stress hyperglycemia has been defined as hyperglycemia in previously euglycemic patients that corrects once the acute process resolves.Methods: The present study was conducted in the medicine department, Guru Nanak Dev hospital attached to government medical college, Amritsar from April 2021-December 2021 after taking approval from institutional ethics committee. This was a prospective observational study. A total of 50 non-diabetic patients of acute stroke with age group >18 to <75 of either sex wereenrolled in this study. Comparison of mortality was done in hyperglycemic and non hypergylcemic non-diabetic patients on1stday of admission and up to 10thday during hospital stay.Results: Mortality percentage on day 1 was higher among those who had high blood glucose levels but there was no significant association between glucose levels and day 1 outcome (survival or death) observed in our study (p=0.078). Mortality percentage on day 10 was higher among those who had high blood glucose levels and there was significant association between glucose levels and day 10 outcome (survival or death) observed in ourstudy (p=0.001). A significant association was observed between glucose levels and overall outcome in our study (p<0.001).Conclusions:We conclude that even in non-diabetic patients, hyperglycemia on admission is independently associated with a higher risk of in-hospital mortality.
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Priapism is a rare presenting feature of Chronic Myeloid Leukemia (CML). It is an urological emergency which requires urgent treatment to prevent long term complications, in particular erectile dysfunction. Author report a case of 18 year old male presenting with persistent painful erection of penis for around 14 hours. The patient underwent immediate irrigation and decompression of priapism in emergency and was started on cytoreductive therapy. During hospitalization, peripheral blood smear and bone marrow aspiration confirmed the diagnosis of CML
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Scrub typhus is a rare rickettsial disease which is endemic in the state of Himachal Pradesh. It is caused by bacteria called Orentia tsutsugumasi and transmitted by larvae of Trombiculid mites. Though rarely seen in the plains, it should be kept as differential for a patient presenting as fever with seizure. Eschar may or may not be seen in all cases. We report a case of scrub typhus in a patient who presented with fever and seizures but no eschar.
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Background: Olfactory dysfunctions albeit commonly studied in research study are rarely tested in clinical practice and commonly overlooked in elderly. With ageing, rate of decline in olfactory and cognitive functions increases. Diabetic patients are more prone to develop these olfactory and cognitive dysfunctions. Elderly diabetic patients with olfactory dysfunction were found to have increased incidence of cognitive impairment as compared to patients without olfactory dysfunction. So olfactory function testing can be used as screening tool to detect cognitive impairment at earliest and can halt the progression of cognitive impairment by appropriate measures. Methods: A cross-sectional study done on 200 elderly diabetic patients. Olfactory dysfunctions were detected by open essence test and cognitive testing was done with MMSE. Patients with psychosis, apparent dementia, any nasal disease were excluded. Results: Out of 200 patients total number of patients with MMSE <23, 24-26 and >26 were 19, 51 and 150 with average Open Essence (OE) score 6.05±, 6.74±0.92 and 8.5±0.54 respectively indicating that patients with lower OE score were found to have lower MMSE score. Conclusion: With ageing, olfactory as well as cognitive dysfunction increases. Diabetes accelerates these processes substantially. Olfactory dysfunction precedes the development of cognitive impairment. So elderly patients with diabetes should be screened for olfactory functions so that proper measures could be taken to decrease the incidence or severity of cognitive dysfunction.
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Background: Pleural effusion is the abnormal and excess accumulation of serous fluid in the pleural space. A number of biochemical tests are required to differentiate transudative from exudative pleural effusion. Pleural fluid to serum protein ratio, pleural fluid to serum lactate dehydrogenase ratio and pleural fluid to serum bilirubin ratio and serum cholesterol are commonly done to differentiate transudative from exudative pleural effusion. Methods: In this study on 25 patients with pleural effusion, by predefined criteria, these patients were divided into three groups as transudative, tubercular and non tubercular exudative group. All patients were investigated to differentiate transudative from exudative pleural effusion. Apart from routine investigations, biochemical tests of pleural fluid as well as blood were performed. Pleural fluid to serum protein ratio and pleural fluid to serum bilirubin were done in all patients. Results: Pleural fluid to serum protein ratio to differentiate exudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 86.66%, 100%,100% and 83.33% respectively. Pleural fluid to serum protein ratio to differentiate transudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 100%, 86.66%, 83.33% and 100%. Pleural fluid to serum bilirubin ratio to differentiate exudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 100%,85.71%,84.62% and 100% respectively. Pleural fluid to serum bilirubin ratio to differentiate transudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 85.71%,100%,84.62% and 84.62% respectively. Conclusion: It is concluded that pleural fluid bilirubin to serum bilirubin is a simple, easy, cost effective and highly useful parameter to distinguish transudative from exudative pleural effusion but it does not tell the etiology of pleural effusion.
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Guillain-Barre syndrome (GBS) is an acute fulminant polyradiculopathy, which typically manifests as areflexic paralysis with variable sensory and autonomic involvement. Typical cerebrospinal fluid (CSF) picture consists of an elevated CSF protein without pleocytosis (albumin-cytologic dissociation). There have been many case reports of atypical presentations of GBS; with normo-reflexia or even hyper-reflexia from Chinese/Japanese and European population but only a few from Indian Subcontinent. Also the typical CSF picture if not found, makes the diagnosis of GBS even more difficult. A 24-year‑old man presented with weakness of all 4 limbs of 4 days duration with the antecedent history of loose stools and fever. On examination, there was flaccid paralysis involving all the 4 limbs (lower limb weakness more than the upper limb) with preserved reflexes, no sensory or cranial nerve deficit, no bladder-bowel involvement; and a normal CSF study at presentation, which 1 week later showed albumin-cytologic dissociation. On electro-diagnostic studies, it was proven as a case of acute motor axonal neuropathy. Patient was managed with routine empirical antibiotics and intravenous methyl prednisone; after 3 weeks, patient was discharged in a stable condition without any residual deficit. Our understanding about the GBS has changed manifolds over the last few decades with many atypical variants being reported across the world. This case study is to lay stress on the fact that even in the absence of typical clinical features and a normal CSF study the diagnostic possibility of GBS should be kept if there is strong clinical suspicion.
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Under regional anesthesia, geriatric patients are prone to shivering induced perioperative complications that Anesthesiologists should prevent rather than treat. We investigated the prophylactic efficacy of oral tramadol 50 mg to prevent the perioperative shivering after transurethral resection of prostate [TURP] surgery under subarachnoid blockade [SAB]. Shivering is usually overlooked in patients undergoing urological surgery under spinal anesthesia and may result in morbidity, prolonged hospital stay and increased financial burden. Use of prophylactic measures to reduce shivering in geriatric patients who undergo urological procedures could circumvent this. Oral formulation of tramadol is a universally available cost-effective drug with the minimal side-effects. Prospective, randomized, double-blinded, placebo-controlled study. A total of 80 patients who were scheduled for TURP surgery under subarachnoid block were randomly selected. Group I and II [n = 40 each] received oral tramadol 50 mg and placebo tablet respectively. After achieving subarachnoid block, the shivering, body temperature [tympanic membrane, axillary and forehead], hemodynamic parameters and arterial saturation were recorded at regular intervals. T-test, analysis of variance test, Z-test and Fisher exact test were utilized while Statistical Product and Service Solutions, IBM, Chicago [SPSS statistics [version 16.0]], software was used for analysis. Incidence of shivering was significantly less in patients who received tramadol [7.5% vs. 40%; P < 0.01]. The use of tramadol was associated with clinically inconsequential side-effects. We conclude that the use of oral tramadol 50 mg is effective as a prophylactic agent to reduce the incidence, severity and duration of perioperative shivering in patients undergoing TURP surgery under SAB