Impact of baseline fluorescent antinuclear antibody positivity on the clinical outcome of patients with primary autoimmune hemolytic anemia

Abstract Introduction Autoimmune haemolytic anaemia (AIHA) is an autoimmune disorder that can present in primary or secondary forms. The literature looking at impact of baseline fluorescent antinuclear antibody (FANA) positivity on outcomes of AIHA patients is infrequent. Objective To study the impact of baseline FANA positivity in patients with primary AIHA. Method A prospective cohort study involving 29 consecutive primary AIHA patients presenting to the Haematology department from 2013 to 2015 was analysed. After recording baseline investigations including fluorescent ANA, all patients were treated as per the standard therapeutic protocols. Clinical remission, disease free survival, relapse, mortality were compared between the FANA positive and FANA Negative AIHA groups. Results Baseline FANA positivity was found in 17 patients (58.62%). Both the groups were comparable in terms of age, sex, Hemoglobin, LDH at presentation, number of lines of treatment needed and duration of follow up. Evan's syndrome was seen in six of FANA positive patients which was statistically significant (0 v/s 6, p= 0.023). FANA positive patients had significantly higher rates of relapse per patient month follow up (1.22 v/s 3.57, p= 0.023) and lower rates of complete response (83.33% v/s 35.29%, p= 0.0118) and relapse free survival at five years. Morbidity and mortality were numerically higher in FANA positive patients. Conclusion Baseline FANA positivity among AIHA patients was found to be associated with lower complete response rates and higher relapse rates with possible higher rates of morbidity. Presence of FANA will give us prognostic value and help us in deciding the treatment options.

Did general surgeons surgical spectrum changed over time? A retrospective comparative study in a South Indian tertiary care centre between 2009 and 2018

Background: General surgery discipline has fragmented into several subspecialties over the past. This division has affected the surgical spectrum of general surgeons. Studies comparing the changes in the general surgeon's work spectrum were done in the ’90s but not in the recent past. Our study aims to compare the surgical spectrum of general surgeons between two time periods in our institute.Methods: We performed a retrospective study comparing the elective surgeries performed by general surgeons in the year 2009 and 2018 in an academic tertiary care centre.Results: There was a 28.9% rise in the total number of elective surgeries (1567 vs. 2020) in our study. There was a significant rise in the mean age of surgical patients (39.7 years vs. 41.9 years) but with no change in M: F ratio (1.7: 1). There was a significant rise in Hernia surgeries and Varicose veins surgeries (p<0.001) along with a rise in anal surgeries (p=0.018). There was a significant decrease in Breast surgeries (p=0.02) and Thyroid surgeries (p<0.001). There was a dramatic rise in the laparoscopic cholecystectomy rate (23.2% vs. 52%) and a fall in the laparoscopic appendectomy rate (26.3% vs. 8%). Open inguinal hernia surgeries were the most common surgeries performed in both the years.Conclusions: There was an increase in the surgical volume for general surgeons but the surgical spectrum has narrowed. We recommend conducting periodic surgical audits in institutions to monitor and maintain the standards of surgeries performed by general surgeons.

Evaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks / 대한마취과학회지

Background@#Regional nerve blocks are an integral part of multimodal analgesia and should be chosen based on their efficacy, convenience, and minimal side effects. Here, we compare the use of pectoral (PEC II) and serratus-intercostal fascial plane (SIFP) blocks in breast carcinoma cases undergoing modified radical mastectomy (MRM) in terms of the postoperative analgesic efficacy and shoulder mobility. @*Methods@#The primary outcome of this prospective controlled study was to compare the postoperative static and dynamic pain scores, and the secondary outcome was to assess the shoulder pain, range of shoulder joint motion, and hemodynamic parameters. Sixty patients were randomly allocated to three groups and given general anesthesia. All patients received paracetamol, diclofenac, and rescue doses of tramadol based on the Institute's Acute Pain Service (APS) policy. No block was performed in group C (control), whereas groups P and S received PEC II and SIFP blocks, respectively, before surgical incision. @*Results@#The groups were comparable in terms of age, weight, height, and body mass index distribution (P > 0.05). Dynamic pain relief was significantly better 12 and 24 h postoperatively in groups P (P = 0.034 and P = 0.04, respectively) and S (P = 0.01 and P = 0.02, respectively) compared to group C. Shoulder pain relief and shoulder mobility were better in group S, while the hemodynamic parameters were more stable in group P. @*Conclusions@#Both SIFP and PEC blocks have comparable dynamic and static pain relief with better shoulder pain scores in patients receiving SIFP.

Social capital as a mediator of the influence of socioeconomic position on health: Findings from a population-based cross-sectional study in Chandigarh, India

Background: Social capital has been recognized as part of the WHO's Social Determinants of Health model given that social connections and relationships may serve as resources of information and tangible support. While the association between socioeconomic position and health is relatively well established, scant empirical research has been conducted in developing countries on the association between social capital and health. Objective: Based on the WHO's Social Determinants of Health framework, we tested whether social capital mediates the effect of socioeconomic position on mental and physical health. Methods: A population-based study was conducted among a representative sample (n = 1563) of men and women in Chandigarh, India. We used standardized scales for measuring social capital (mediator variable) and self-rated mental and physical health (outcome variable). Results: A socioeconomic position index (independent variable) was computed from education, occupation, and caste categories. Mediation model was tested using path analysis in IBM SPSS-Amos. Participants' mean age was 40.1 years. About half of the participants were women (49.3%), and most were relatively well educated. The results showed that socioeconomic position was a significant predictor of physical and mental health. Social capital was a significant mediator of the effect of socioeconomic position on mental health but not physical health. Conclusion: Besides removing socioeconomic barriers through poverty alleviation programs, interventions to improve social capital, especially in economically disadvantaged communities, may help in improving population health.

Phytochemical evaluation and pharmacological screening of ethanolic and aqueous leaf extracts of Pupalia lappacea for antihyperlipidemic and antihyperglycemic activities in alloxan induced diabetic Albino wistar rats

Background: Diabetes is associated with damage to the liver, pancreas and kidney. The damage may vary among patients. This study assessed the hypoglycaemic and antihyperlipidemic activities of leaves ethanolic and aqueous extracts of Pupalia lappaceae in alloxan induced diabetic albino wistar rats.Methods: There were Fifty four rats divided into nine groups containing six rats each. Group 1 consists of normal rats that were given only normal saline and served as a control group. Group 2 consists of normal rats that were given alloxan monohydrate (150mg/kg b.w). Group 3 consists alloxan induced diabetic rats that were given daily sterile solution. glibenclamide+simvastatin (5mg/kg) Group 4 consists of alloxan induced diabetic rats that were given daily sterile solution, AEPL extract (100mg/kg). Group 5 consists of alloxan induced diabetic rats that were given daily sterile solution, drug extract AEPL (200mg/kg). Group 6 consists of alloxan induced diabetic rats that were given daily sterile solution, drug extract AEPL (400mg/kg) Group 7 consists of alloxan induced diabetic rats that were given daily sterile solution, drug extract EEPL (100mg/kg), Group 8 consists of alloxan induced diabetic rats that were given daily sterile solution, drug extract EEPL (200mg/kg) Group 9 consists of alloxan induced diabetic rats that were given daily sterile solution, drug extract EEPL (400mg/kg respectively for 21days by an intragastric tube with free access of food and water.Results: Chemical composition of the plant was estimated by GCMS technique several biochemical parameters were assessed. Oral administration of the extract resulted in significant reduction in mean values of blood glucose, triglycerides, total cholesterol, cholesterol ratio, LDL, VLDL, accompanied by increase in the mean value of the HDL in diabetic rats and histopathology of liver, pancreas, and kidney showed significant changes.Conclusions: The effects produced were closely similar to standard antidiabetic and antihyperlipidemic drug. It can thus be concluded that the ethanolic and aqueous extract of Pupalia lappaceae exhibit antihyperlipidemic and antihyperglycemic activities in alloxan induced diabetes in rats.

Cytomegalovirus reactivation and disease amongst patients with allogeneic haematopoietic stem cell transplantation in Eastern India: Epidemiology, outcome and healthcare cost

Purpose: Data from developing countries about incidence, prognosis and healthcare cost of cytomegalovirus (CMV) reactivation amongst patients with allogeneic hematopoietic stem cell transplantation (AHSCT) remain scarce. The purpose of the study was to describe the epidemiology, outcome and cost implications of CMV reactivation and CMV disease amongst patients with AHSCT in cancer hospital in Eastern India. Materials and Methods: The study design was a retrospective audit of clinical records. Results: Ninety-nine per cent of patients and 94% of the donors were found to be CMV seropositive. CMV reactivation rate was 43.8% amongst patients with AHSCT (n = 130 patients). CMV reactivation occurred 118 days after AHSCT (median; range: 28–943 days). Patients with any grade of graft-versus-host disease (GVHD) had higher CMV reactivation rate than patients without GVHD. Patients with CMV reactivation had more frequent GVHD than patients without CMV reactivation. Use of steroids was associated with CMV reactivation. We found no differences in overall survival of patients with or without CMV reactivation. The cost of in-house CMV-polymerase chain reaction at our centre was USD $57 (Rs. 3650), cost for intravenous ganciclovir was USD $26 (Rs. 1665) per infusion and oral valganciclovir USD $8 (Rs. 512)/900 mg tablet. The median duration of anti-CMV therapy was 14 days (interquartile range: 14–28 days) and the average cost per patient per month directed towards CMV management ranged between USD $800 and USD $1,300 (Rs. 51,238–Rs. 83,264). Three patients (2.3%) in this series had CMV disease, all of whom died. Conclusion: In an increasingly globalised world, where medical tourism is common, data from developing countries regarding cost and outcome of CMV infections in AHSCT patients are of relevance.

Evaluation of antidiabetic potential of hydroalcoholic extract of Annona squamosa (HAEAS) leaf in alloxan monohydrate induced diabetic Albino rats

Background: Diabetes is almost growing health concern worldwide and now emerging as an epidemic world over. Recently, full attention is being paid to the study of natural products as potential antidiabetics. Objective of the study was to evaluate the antidiabetic effect of hydroalcoholic leaf extract of Annona squamosa (HAEAS) plant in alloxan monohydrate induced diabetic albino rats.Methods: Almost a 30 Albino rats with 150- 200 grams weight were weighed and grouped into 5 equal groups taking 6 rats in every group. Group A served as normal control, Group B as diabetic control, received alloxan monnohydrate. Group C and D was received alloxan + HAEAS suspension at 350 and 700 mg/kg doses orally respectively, Group E was given alloxan + standard drug (Glibenclamide 5mg/kg) suspension for 28 successive days and the effect of HAEAS on blood sugar(BS) levels was measured at regular intervals. At the end portion of this investigational research study samples of blood were collected from all rats on 0day (initial), after 72 hrs and after 28th day (29thday) of given test drug HAEAS treatment for biochemical estimation of BS and the BS values were observed.Results: The present research study revealed that HAEAS leaves has antidiabetic effect against alloxan monohydrate induced diabetic rats on i.p. alloxan injection at 150mg/kg.b.w. and confirms that on i.p. alloxan injection causes a significant rise off BS in untreated albino rats when compared to control group. Diabetic rats treatment with HAEAS leaves for 28 days caused dose a dependent fall in BS values. Glibenclamide treated diabetic rats also showed a significant (P <0.00) fall in BS content after 28 days of treatment.Conclusions: This research study confirms that HAEAS leaves has shown significant antidiabetic effect at 350 and 700 mg/kg. b.w. doses in alloxan monohydrate induced diabetic rats.

Evaluation of antidiabetic activity of fruit of Coriandrum sativum. Linn methanolic extract in Streptozocin induced diabetic wistar Albino rats

Background: Diabetes prevalence is estimated to increase annually. Numerous people use traditional medicine, such as India also considered as the diabetic capital in the world. Diabetes is a metabolic disorder characterized by disturbances in lipid, carbohydrate and protein metabolism. The present study to evaluate the antidiabetic potential of coriandrum sativum. linn fruits methanolic extract in streptozocin induced diabetic wistar albino rats model.Methods: Diabetes induction in wistar albino rats by administration of streptozocin (50mg/kg, i.p.) in citrate buffer. 30 wistar albino rats were divided into 5 groups (A, B, C, D, E). Group A: served as normal control, whereas Group B: diabetic control, Group C, D methanolic coriandrum sativum Linn. fruits extract (CSFME) at a dose of 100, 200mg/kg orally, Group E was given standard drug Glibenclamide (0.5mg/kg) orally. All groups are administered for the period of 14 consecutive days and blood sugar levels was measured at regular intervals up to end of the study.Results: This present research study confirms that the test drug compound CSFME has sustained oral hypoglycaemic activity and statistically significant (p ?0.05) and which is comparable with standard drug Glibenclamide.Conclusions: This research study confirms that the CSFME has antidiabetic activity against streptozocin induced wistar diabetic albino rats. It could be a novel antidiabetic agent and also a dietary adjunct in the type 2 diabetes management and its complication. Further studies are necessary required to confirm the antidiabetic activity of individual phytochemical compounds of Coriandrum sativum.

Griscelli syndrome type 2: A rare and fatal syndrome in a South Indian boy.

Griscelli syndrome (GS) is a rare autosomal recessive disorder caused by mutation in the MYO5A (GS1), RAB27A (GS2), and MLPH (GS3) genes, characterized by a common feature, partial albinism. The common variant of three, GS type 2, in addition, shows primary immunodeficiency which leads to recurrent infections and hemophagocytic lymphohistiocytosis. We, herewith, describe a case of GS type 2, in a 4‑year‑old male child who presented with chronic and recurrent fever, lymphadenopathy, hepatosplenomegaly, and secondary neurological deterioration; highlighting the cytological and histopathological features of lymph nodes. Hair shaft examination of the child confirmed the diagnosis.

Healthcare-associated methicillin-resistant Staphylococcus Aureus: clinical characteristics and antibiotic resistance profile with emphasis on macrolide-lincosamide-streptogramin B resistance

Objectives: Healthcare-associated methicillin-resistant Staphylococcus aureus [MRSA] is a common pathogen worldwide and its multidrug resistance is a major concern. This study aimed to determine the clinical characteristics and antibiotic susceptibility profile of healthcare-associated MRSA with emphasis on resistance to macrolide-lincosamide-streptogramin B [MLSB] phenotypes and vancomycin

Methods: This cross-sectional study was carried out between February 2014 and February 2015 across four tertiary care hospitals in Mangalore, South India. Healthcare-associated infections among 291 inpatients at these hospitals were identified according to the Centers for Disease Control and Prevention guidelines. Clinical specimens were collected based on infection type. S. aureus and MRSA isolates were identified and antibiotic susceptibility tests performed using the Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of vancomycin was determined using the Agar dilution method and inducible clindamycin resistance was detected with a double-disk diffusion test [D-test]

Results: Out of 291 healthcare-associated S. aureus cases, 88 were MRSA [30.2%]. Of these, 54.6% were skin and soft tissue infections. All of the isolates were susceptible to teicoplanin and linezolid. Four MRSA isolates exhibited intermediate resistance to vancomycin [4.6%]. Of the MRSA strains, 10 [11.4%] were constitutive MLSB phenotypes, 31 [35.2%] were inducible MLSB phenotypes and 14 [15.9%] were macrolide-streptogramin B phenotypes

Conclusion: Healthcare-associated MRSA multidrug resistance was alarmingly high. In routine antibiotic susceptibility testing, a D-test should always be performed if an isolate is resistant to erythromycin butsusceptible to clindamycin. Determination of the minimum inhibitory concentration of vancomycin is necessary when treating patients with MRSA infections

Effect of High Normal Thyroid Stimulating Hormone Levels on Lipid Parameters in Non-diabetic Subjects.

Aim: To investigate relationship between serum TSH and lipid parameters in subjects with different levels of TSH. Study Design: Cross-sectional study. Place and Duration of Study: Clinical Biochemistry Department of Kasturba Medical College, Hospital Mangalore, between January 2014 to June 2014. Methodology: 348 subjects were screened of which 194 were selected. Lipid parameters, TSH, T3, T4 and glycemic status were determined. Association between TSH and serum lipids were studied by categorizing subjects into three groups based on their thyroid status. Group 1 [TSH= 0.27-2.5 mIU/L], Group 2 [TSH= 2.6-4.12 mIU/L] and Group 3 [TSH= 4.13-9.9mIU/L].Statistical analysis was performed by ANOVA followed by Tukey’s multiple comparison test. The relationships between TSH and different parameters were evaluated by Pearson’s correlation analysis. Results: TSH showed a significant positive linear correlation with total cholesterol (r=0.288; P = 0.001), Triglycerides (r=0.129; P=0.016), LDL cholesterol (r=0.305; P =0.001) and negative correlation with HDL (r = - 0.129; P=0.750). Increasing TSH showed a consistent linear association with altered lipids quite evident from the uppermost part of the reference range that is considered clinically normal and there on. Conclusion: A subtle variations of TSH alone in clinically normal thyroid state can alter serum lipids and hence asserts the role of TSH in maintaining lipid homeostasis.

Factors Correlating with Severity of Coronary Artery Disease in Type 2 Diabetic Patients on Treatment for More Than 5 Years.

Aims: To evaluate the correlation between insulin resistance and other conventional risk factors with respect to severity of coronary artery disease (CAD) in patients with more than 5 years of treatment for type 2 diabetes mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine and Department of Cardiology, Kasturba Medical College, Hospital Mangalore, between February 2013 and December 2013. Methodology: 61 people with more than 5 years of type 2 diabetes who underwent Original Research Article British Journal of Medicine & Medical Research, 4(26): 4364-4372, 2014 4365 coronary angiogram for the evaluation of CAD were recruited in this study. Insulin resistance (HOMA-IR), anthropometric and biochemical parameters were determined, and was correlated with severity of CAD which was assessed by syntax score. Results: There was significant positive linear correlation between log HOMA-IR and syntax score in people with more than 5 years of type 2 diabetes [r=0.605 (95%CI 0.417–0.744), P<0.001]. The correlation of syntax score with other known risk factors of CAD was not significant. Further multivariate analysis after adjusting for conventional risk factors showed a significant association of Log-IR with severity of CAD in people with type 2 diabetes mellitus of more than 5 years of duration (β=0.667, P<0.001) Conclusion: In type 2 diabetes mellitus with treatment more than 5 years of duration, high HOMA-IR appears to be a good indicator of severity of CAD in Type 2 diabetes mellitus and might be a marker of severity of disease, thus helping us in identifying high risk type 2 diabetes mellitus subjects.

Central Giant Cell Granuloma ; A Case Report.

Central giant cell granuloma ( CGCG) was classified as rarely aggressive idiopathic benign intraosseous lesion that occurs mostly exclusively in the jaws. It occurs most frequently in young women. It is usually slow growing and non neoplastic lesion which exhibits a spectrum of clinical behavior ranging from non aggressive to aggressive variants. The striking feature of this case is its aggressive nature and presence of this lesion in the anterior part of maxilla which considers being a rare finding as the lesion commonly occurs in the mandibular region anterior to first molar.

Prediction of Outcome in ICU Patients Using SAPS II Scoring-A Prospective Study.

Introduction: Since 1981, several severity scores have been proposed for ICU patients. The first ones were acute physiology and chronic health evaluation(APACHE, APACHEII),Simplified acute physiology score (SAPS); later, mortality probability model(MPM) and APACHE III were introduced. The SAPS II scoring system, have been used as a method for converting the score to a probability of hospital mortality.The present prospective study is designed to predict the ICU outcome in medical ICU patients. Objective of the Study: To predict the mortality and morbidity of the patients admitted in ICU for various emergencies using SAPS II scoring system and correlate it with the outcome of the patient on discharge. Materials and Methods: The study prospective type, data was obtained from the patients admitted to ICU ,SAPS II scoring was given and were followed up till they got discharged to assess the outcome .Results:45 patients were studied the total mortality was 26.6%. The SAPS II Scores of the patients and the number of deaths in the different groups are given in table below. The chi-square value was 23.04, df= 6with a p + 0.0007 and this study is well within the p value of 0.05, hence it is significant which means the higher the score the more is the risk of morbidity and mortality, when score is >50 there is increased risk of morbidity and mortality, when score is >50 there is increased risk of mortality. Conclusion:The present study imposes on the following conclusions -SAPS II scoring is useful in predicting the ICU outcome of patients admitted in the ICU even when the primary diagnosis is not specified.

A Comparative Study of Mechanical Properties of The Pulse Straightened And Spinner Straightened Australian Stainless Steel Wires.

The purpose of the present study is to evaluate and compare the mechanical and structural properties of Spinner straightened and pulse straightened wires. Materials and methods; The objective of the study is to evaluate and compare the structural and mechanical properties of all grades of Australian A.J. Wilcock Stainless round wires(A.J. Wilcock, Whittlesea, Victoria, Australia). Premium plus (Spinner straightened) Premium plus( pulse straightened) of 0.016” size and Supreme grade ( pulse straightened and spinner straightened) of 0.011” size wires were subjected to Tensile testing, Three point bend test, Jig test, Frictional resistance. Analysis of the difference between each corresponding grade of wire is done by using the students ‘t’ test of significance between means at confidence interval of 95%. Results: The properties of Australian wire were found to possess significantly different physical and mechanical properties depending upon the process of manufacturing . Conclusions: Pulse straightened wires superior strength and stiffness compared to spinner straightened wires

Effect of HMG Co-A reductase inhibitors on arterial wall thickness in hypertensive subjects undergoing long term treatment.

Background: Cholesterol lowering drugs are very widely used among patients with hypertension in order to prevent atherosclerosis and death. However several other changes are produced in such patients as a result of inhibition of cholesterol synthesis. Therefore in this preliminary study we evaluated the intima/media thickness in hypertensive subjects. Material and methods: Cross section study in 20 hypertensive subjects on statins for more than an year and 20 hypertensives who were not on statins were studied. Twenty normal non hypertensive individuals were control subjects.Their Common carotid artery (CCA) was ultrasonologically examined and the Intima – Media thickness were determined. Results: The Intima - Media thickness in Hypertensive subjects were significantly higher than those of control groupand also those hypertensive patients who were administered with statins (p<0.001). There was no statistically significant difference among the controls and statin administered patients. Further there was no gender difference in the results. Conclusion: Hypertensive subjects who were on statin for more than an year have significantly reduced arterial wall thickness. Undesirable side effects of such thinning of vessel wall, which might result in aneurysmal dilatations, should be kept in mind especially while treating elderly hypertensive with HMG CoA reductase inhibitors.