Association of metabolic risks with subclinical hypothyroidism: a cross-sectional analysis

Objective: To compare lipid parameters, HbA1c, uric acid and albumin creatinine ratio [UACR] among subjects having euthyroidism, Sub-Clinical Hypothyroidism [SCH] and overt hypothyroidism

Methods: This comparative cross-sectional analysis was carried out from Dec-2015 to Oct-2016 in collaboration between PNS HAFEEZ hospital and department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. Biochemical parameters including lipid indices, HbA1c and UACR were compared between euthyroidism [TSH: 0.5 to 4.0 mIU/L, n=163], subclinical hypothyroidism [TSH: 4.0 to 10 mIU/L, n=16] and overt hypothyroidism [TSH:>/= 10.0 mIU/L, n=9]

Results: LDL-cholesterol, non-HDL-cholesterol and UACR results were as: [[Euthyroid: 2.66 +/- 0.73], [SCH: 2.68 +/- 0.51] and [Overt hypothyroidism: 3.23 +/- 0.59], p-value=0.063], [[Euthyroid: 3.49 +/- 0.64], [SCH: 3.35 +/- 0.59] and [Overt hypothyroidism: 4.01 +/- 0.30], p-value=0.033] and [[Euthyroid: 2.48 [95% CI: 1.63-3.33]], [SCH: 2.27 [95% CI: 0.37-4.90]] and [Overt hypothyroidism: 14.95 [95% CI: 10.71-19.14]], [p-value< 0.001]]. Results for total cholesterol, triglycerides and HDL-cholesterol though increased in overt hypothyroid group were not found to be statistically significant

Conclusion: LDL-cholesterol, non-HDL-cholesterol and UACR increased from euthyroid subjects to overt hypothyroidism group. However, these changes were found to be more subtle in the subclinical hypothyroid subjects than cases with overt hypothyroidism

Insulin resistance and glucose levels in subjects with subclinical hypothyroidism

Objective: To compare insulin resistance and glycemic indicators among subjects with euthyroidism and subclinical hypothyroidism

Study Design: Comparative cross-sectional study

Place and Duration of Study: Department of Pathology and Medicine, PNS Hafeez, Islamabad, in collaboration with the Department of Chemical Pathology and Endocrinology at the Armed Forces Institute of Pathology [AFIP], Rawalpindi, from December 2015 to September 2016

Methodology: Subjects referred for executive screening of apparently healthy population [without any known history of diabetes, hypertension, heart disease or other chronic ailments], were included. Subjects were grouped as euthyroidism and subclinical hypothyroidism

Results: Median [IQR] insulin resistance indices including fasting insulin and Homeostasis Model Assessment for Insulin Resistance in subjects with group-1 [n=176, 87%, Thyroid Stimulating Hormone: 0.5 - 3.5 mlU/L] and group-2 [n=26, 13%, Thyroid Stimulating Hormone: 3.51 -15 mlU/L] were 7.6 [6.70] vs. 11.4 [13.72, p=0.040] and 1.77 [1.79] vs. 2.8 [3.07, p=0.071]

The median differences for fasting plasma glucose were 5.0 [1.0] in group-1 vs. 5.0 [1.47] for Group-2 [p=0.618], and glycated hemoglobin was 5.60 [1.1] vs. 5.60 [1.7, p=0.824]. Homeostasis Model Assessment for beta sensitivity index in paradox showed slightly higher values for group-2 [median [IQR] 86.67 [92.94]] than group-1 [111.6 [189.64, p= 0.040]]

Conclusion: Measures of insulin resistance including Homeostasis Model Assessment for Insulin Resistance and fasting insulin levels were significantly different between subjects with euthyroidism and having subclinical hypothyroidism

Association between NIH stroke scale score and functional outcome in acute ischemic stroke

To evaluate the association between baseline national institutes of health stroke scale score and functional outcome after acute ischemic stroke. Descriptive study. Medical unit-IV, Jinnah Hospital, Lahore, from May 2009 to October 2009. Patients who presented with stroke within 24 hours of onset of symptoms and had a developing infarct on the CT-scan were further evaluated for neurological impairment using NIH stroke scale. The baseline NIHSS score was calculated using a proforma. Age of the patien, gender and time of presentation to the hospital was recorded. Follow-up was done on the 7[th] day of admission using Glasgow outcome scale [GOS]. Total number of subjects was 150. Good outcome [GOS=1-2] was noticed in those subjects who had a low baseline.NIHSS score [0-6] while poor outcome [GOS=3-5] was noticed in those subjects who had a higher baseline NIHSS score [>16] [p value<0.05]. In cases who had a moderate score [7-15]; the ratio of good outcome to bad outcome was almost 70:30. Likewise good outcome [GOS=1-2] was noticed in those subjects who were younger [less than 45 years] while poor outcome [GOS=3-5] was noticed in the elderly [more than 45 years] [p value <0.05]. Similarly patients who presented within 12hrs of symptom onset had a good outcome compared to those who presented after 12hrs [p value<0.05]. Baseline NIH stroke scale score is strongly associated with functional outcome after1 week of acute ischemic stroke

Frequency of hepatitis B surface antigen and anti-hapatitis C antibodies in remote villages of district Skardu

To determine the frequency of hepatitis B surface antigen and anti-hepatitis C virus antibodies in the remote villages of district Skardu. A prospective study in a field setting. 123 Medical Battalion [Civil Hospital Tolti] Oct 2010 to Oct 2011. The study was carried out during establishment of free medical camps at five villages of district Skardu; all above 2600 meters of sea level. They were tested for HBsAg and volunteer an anti HCV with rapid, one step immunochromatic essay. All positive samples were confirmed by a third generation ELISA. Of 3145 volunteers were tested for both viruses; 54 [1.71%] were found positive for HBsAg and 34[1.08%] for anti HCV. This 54[1.71%] were positive for HBsAg and 34[1.08%] for anti HCV. The frequency of HBsAg and anti HCV in these remote villages of Skardu is lesser than more developed areas of Pakistan.

Anaesthetic risks in children with obstructive sleep apnea syndrome undergoing adenotonsillectomy

To determine the frequency of anaesthetic risks in children having Obstructive Sleep Apnea Syndrome [OSAS], undergoing adenotonsillectomy. A case-control study. Department of Anaesthesiology, Armed Forces Hospital, Najran, Saudi Arabia from November 2006 to January 2008. The study was carried out in 60 children scheduled to undergo adenotonsillectomy and divided into two equal groups of 30 each. Group-1 had obstructive sleep apnoea syndrome and group-2 had children without it. Both groups were given a standard general anaesthesia and frequency and rate of complications and medical interventions taken in such children were studied. P-value and odds ratio were determined. The age ranged from 3 to 10 years. The frequency of difficult intubation was higher in the group-1 than in the control group [16.6 vs. 3.3%, odds ratio 5.8]. At the time of induction of anaesthesia desaturation was higher in group-1 [33.3 vs. 6.6%, p=0.021, odds ratio 7]. At the time of extubation, desaturation was significantly higher in group-1 [43.3 vs. 6.6%, p=0.002, odds ratio 10.70]. The complications at extubation, for example cough, laryngospasm and postoperative nausea and vomiting were higher in group-1 but not statistically significant. In the postanaesthesia care unit, the frequency of complications and medical interventions were also higher in group-1. More patients of group-1 required oxygen [63.3 vs. 10%, p < 0.001, odds ratio 15.54] and insertion of an oropharyngeal airway [20% vs. nil, p=0.023] respectively. Children with OSAS, operated for adenotonsillectomy, are at significant risk of certain life-threatening perioperative anaesthetic complications. These results may be used as a guideline for safe and successful anaesthetic management of these children