Clinicohematological profile of pancytopenia: a study from a tertiary care hospital

Background: Pancytopenia is common clinical condition which we encounter in our daily clinical practice. Pancytopenia is characterized by decrease in all the three major components of blood like Red Blood Corpuscles, White blood Corpuscle, and platelets. This study was carried out to look for causes of pancytopenia and clinical presentations at tertiary care hospital in north India.Methods: The study was conducted at MLN Medical College, Allahabad in the Department of Medicine between June 2018 to July 2019. Total 125 patients who attended department of medicine were screened for study. After exclusion 94 patients were studied prospectively.Results: Out of 94 patients 59 were males, and 35 females in the study group. Male to female ratio was 1.6:1. Maximum patients were between 20 years to 35years of age group. Pallor and weakness were most common clinical feature in this study group. Out of various etiological causes vitamin B12 deficiency was the commonest in our study. 48(51%) patients had megaloblastic anemia due to vitamin B12 deficiency. Second most common etiological factor was hypo plastic/aplastic anemia. Other etiological abnormalities were hypersplenism, dengue, malaria, sepsis, myelodysplastic syndrome and multiple myeloma.Conclusions: Bone marrow examinations, aspiration cytology or biopsy are important tool for diagnosis of pancytopenia. Underlying cause and severity of disease determine the outcome of pancytopenia. The present study concluded that most of patients with pancytopenia have treatable cause so early diagnosis will be helpful for management of patients.

Study of prevalence and types of anemia in primary hypothyroidism

Background: Hypothyroidism is common disease with varying frequency between countries. Anemia in hypothyroidism can be normocytic normochromic, microcytic hypochromic and macrocytic hypochromic. Anemia severity is associated with hypothyroidism degree. Objective of this study to study the association between anemia and hypothyroidism and prevalence and types of anemia in primary hypothyroidism (subclinical and overt both).Methods: This cross sectional study was carried out at tertiary care hospital in North India. Newly diagnosed 100 primary hypothyroid patients and 100 controls with age and sex matched evaluated for anemia. Prevalence and types of anemia were studied and severity of anemia was correlated with that of hypothyroidism.Results: Anemia was observed in 90 patients with hypothyroidism. Symptoms due to anemia were higher in cases than in controls. RBCs morphology showed normocytic normochromic in 59, microcytic hypochromic in 26 and macrocytic hypochromic in 15 cases. Serum anti-TPO positivity was present in 71.1% in cases as compared to 33.33% in controls. Anemia was severe in cases with high TSH.Conclusions: Anemia was more prevalent in cases of hypothyroidism than in euthyroid controls. Normocytic normochromic type of anemia was most common type in this study. Serum anti-TPO positivity was 71.1% in cases. There was statistically significant negative correlation between TSH and haemoglobin. Symptoms of anemia were more in hypothyroid patients than in euthyroid anemic patients.

Microbial air contamination with air borne bacteria in the outdoor environment at Janakpurdham, Nepal

Background and Objectives: Bacteria can cause allergic asthma and seasonal allergies, diseases which are increasingly prevalent in developing nations. Allergic asthma is currently affecting millions of people in Nepal. Therefore, the objective of this study was designed to measure the bacterial load in outdoor air. Materials and Methods: Airborne outdoor bacteria were assessed during the spring season using conventional methods to investigate the enumeration of airborne microorganisms. This was determined by sampling air using the ‘settle plate technique’. The air samples were collected during the spring season (February-March) from 10 different areas of Janakpur. Counts of airborne bacteria were measured as CFUs collected by gravity onto Nutrients Agar plates. Samples were taken periodically over a period of 2 months of February and March 2017. Results: A total of 7,404 bacterial colonies were counted on 30 Petri plates that were exposed for 1 hour. The maximum number of colonies of bacteria was 412. Similarly, the least number of bacterial colonies was 32. Higher numbers of CFUs were found in the petri plates which were exposed for 1 hour in comparison to the petri plates which were exposed for 30 minutes. According to the measurement, 36.6% of total CFUs of bacteria were collected during morning hours, 28.4% during day time and 35% during evening hours. Also, the highest numbers of colonies of bacteria were found in the petri plates that were exposed in ward number 7 and the least number of bacterial colonies were obtained in ward number 9. Conclusion: The bacteriological quality of air in janakpur was very poor. Very high microbial load was found in the outdoor air in Janakpur. The microbial count was found higher in morning than the noon and evening.

Efavirenz induced drug hypersensitivity reaction

Efavirenz is the first line non-nucleoside reverse transcriptase inhibitor suggested by World Health Organization for newly diagnosed patients started on antiretroviral therapy. Dermatologic manifestations are the usual side effects associated with this drug. Authors hereby, present a case report of efavirenz induced drug hypersensitivity reported at a tertiary care hospital at Allahabad, Uttar Pradesh. The patient developed rashes and vomiting within a week of start of TLE regimen. Re-challenge test revealed confirmation of the adverse drug reaction by efavirenz. Change of the regimen was done for the patient following hospitalization for the event. This case report explains that strict pharmacovigilance is essential in the initial days of start of antiretroviral therapy. Further trials to improve the safety profile of the patients on ART are the need of the hour.

The Use of Dentascan to Diagnose and Treat Mandibular Premolar with Multiple Canals.

Introduction: For successful endodontic therapy it is vital to have thorough knowledge of morphology of the root canal system and its variations besides proficient aseptic intraoperative condition. Mandibular second premolars are usually single rooted tooth with single root canal system. The incidence of the number of roots and the number of canals varies greatly in the literature. Methods and Results: This case report describes an unusual case of mandibular second premolar with two roots and five root canals. This was confirmed by radiographs, dentascan and dental operating microscope (DOM), and was successfully treated using K files system, guttapercha and AH plus sealer in lateral condensation manner. Conclusion: The clinical significance of this case report is that the precise awareness about the aberrant morphologies of the root canal system can only be appreciated when advanced radiographic techniques, magnification and illumination are used to treat such type of cases.

Synthesis and antimicrobial activity of some newer biphenyl imidazo [2,1-b] [1,3,4] thiadiazole derivatives.

In the present study, we have reported the synthesis of some novel heterocyclic derivatives comprising imidazole and 1,3,4-thiadiazole containing moiety. Imidazothiadiazoles are of interest because of their diverse biological activities and clinical applications. Reactions of biphenyl carboxylic acid with thiosemicarbazide in the presence of phosphorous oxychloride resulted in biphenyl containing 2-amino-1,3,4-thiadiazole which is then further subjected to condensation with α-bromoarylketone under reflux in dry ethanol. The structures of the newly synthesised compounds were characterized by various spectral techniques and screened for antibacterial activity against strains of Escherichia coli, Pseudomonas aeruginosa and Bacillus subtilis, and antifungal activity against Candida albicans, Saccharomyces cerevisiae and Aspergillus niger. The compounds exhibited moderate to good activity when compared with standards.

Genetics of sudden death.

Recent advances in molecular biology have advanced our understanding of the genetic substrate predisposing to sudden death, especially in monogenic disorders. Numerous ion channels along with membrane structural proteins have been extensively investigated for their role in the genesis of serious ventricular tachyarrhythmias. The complex interplay of various biological pathways culminating in the more prevalent form of sudden death due to coronary artery disease however still remains to be unraveled. The concept of multi-factorial causation of arrhythmias where a second clinical or environmental factor is necessary for expression of an underlying genetic susceptibility to ventricular arrhythmias is a serious possibility. This article briefly outlines the current understanding about the role of genetics in sudden cardiac death.

Acute hemodynamic effects of sildenafil in patients with idiopathic dilated cardiomyopathy.

Sildenafil, a phosphodiestrase-5 inhibitor, decreases pulmonary artery pressures (PAP) in patients with idiopathic pulmonary hypertension. There is little data pertaining to its use in unselected patients with idiopathic dilated cardiomyopathy (IDCM). A single oral dose of sildenafil (50 mg) was administered to 11 patients (mean age 44.9 +/- 7 years, 7 males) with IDCM with left ventricular ejection fraction < or = 40% in New York Heart Association class II/III at the time of right heart catheterization. There was a significant decrease in pulmonary artery systolic pressure (from 31.5 +/- 9.7 to 19.0 +/- 5.2 mmHg, p < 0.001) and pulmonary vascular resistance (PVR) (from 3.0 +/- 2.1 to 1.6 +/- 0.8 dyne/s/m(2)/cm(5), p = 0.01) following sildenafil administration. The systemic vascular resistance (SVR) and pulmonary wedge capillary pressure also significantly decreased. No significant differences in heart rate, cardiac index and PVR/SVR ratio were observed. There were no side effects documented. Sildenafil produces favorable vasodilation in both pulmonary and systemic vascular beds with decrease in left ventricular filling pressures, in stable patients with IDCM.

Acute hemodynamic effects of nicorandil in patients with primary pulmonary arterial hypertension.

BACKGROUND: Pulmonary arterial hypertension is managed with vasodilators, and till date no specific drug has been identified with sufficient degree of success. Potassium channels have been implicated in the pathogenesis of primary pulmonary arterial hypertension. We undertook this study to assess the acute effect of oral nicorandil in patients of pulmonary arterial hypertension. METHODS AND RESULTS: We studied acute hemodymanic response of 40 mg oral nicorandil in 10 patients with primary pulmonary arterial hypertension aged between 15 and 39 years (mean age 27.2 +/- 6.7 years). Responders (Group I) were defined as those with > or =20% reduction of pulmonary vascular resistance index and no change or increase in cardiac index; and non-responders (Group II) were those with < 20% reduction of pulmonary vascular resistance index. There were 7 responders (pulmonary vascular resistance index decreased from 22.8 +/- 9.3 to 17.9 +/- 6.5 Wood units) and 2 non-responders (pulmonary vascular resistance index decreased from 26 +/- 3.5 to 25 +/- 1.0 Wood units). The maximum reduction in pulmonary vascular resistance index from baseline was 29.77 +/- 6.53% (23.7-40.5%) in responders and 7.3 +/- 4.2% (4.3-10.3%) in non-responders. The study was halted prematurely in one patient who developed hypotension, requiring intravenous inotropes. CONCLUSIONS: Our results suggest that nicorandil significantly decreases pulmonary artery pressure in primary pulmonary arterial hypertension acutely and can be cautiously tried for the therapeutic use in primary pulmonary arterial hypertension. Further studies are warranted.

Predictors of left atrial appendage clot: a transesophageal echocardiographic study of left atrial appendage function in patients with severe mitral stenosis.

BACKGROUND: The purpose of this study was to prospectively evaluate a large group of consecutive, non-anticoagulated patients with severe rheumatic mitral stenosis and to analyze the left atrial appendage function in relation to left atrial appendage clot and spontaneous echo contrast formation. METHODS AND RESULTS: We prospectively studied left atrial appendage function in 200 consecutive patients with severe mitral stenosis who underwent transesophageal echocardiography and correlated it with spontaneous echo contrast and left atrial appendage clot. The mean age was 30.2 +/- 9.4 years. Fifty-five (27.5%) patients were in atrial fibrillation. Left atrial appendage clot was present in 50 (25%) patients and 113 (56.5%) had spontaneous echo contrast. The older age, increased duration of symptoms, atrial fibrillation, spontaneous echo contrast, larger left atrium, depressed left atrial appendage function and type II and III left atrial appendage flow patterns correlated significantly (p<0.05) with the left atrial appendage clot. Left atrial appendage ejection fraction was significantly less in patients with clot (21.8 +/- 12.8% v. 39.1 +/- 13.2%, p<0.0001) and in those with spontaneous echo contrast (30.3 +/- 16.2 % v. 40.3 +/- 11.8%, p<0.001). Left atrial appendage filling (18.0 +/- 11.7 v. 27.6 +/- 11.8 cm/s, p <0.0001) and emptying velocities (15.4 +/- 7.0 v. 21.5 +/- 9.6 cm/s, p<0.001) and filling (1.4 +/- 1.0 v. 2.5 +/- 1.4 cm, p<0.0001) and emptying (1.5 +/- 1.2 v. 2.1 +/- 1.2 cm, p <0.05) velocity time integrals were also significantly lower in patients with clot as compared to those without clot. On multivariate regression analysis, atrial fibrillation (odds ratio 6.68, 95% CI 1.85-24.19, p=0.003) and left atrial appendage ejection fraction (odds ratio 1.06, 95% CI 1.00 - 1.11, p=0.04) were the only two independent predictors of clot formation. Incidence of clot was 62.59% in patients with left atrial appendage ejection fraction < or = 25% as compared to 10.4% in those having left atrial appendage ejection fraction >25%. Similarly patients with spontaneous echo contrasthadlower filling (21.7 +/- 11.5 v. 29.4 +/- 12.7 cm/s, p<0.0001) and emptying (17.0 +/- 8.1 v. 23.9 +/- 10.9 cm/s, p<0.0001) velocities, as well as filling (1.9 +/- 1.3 v. 2.7 +/- 1.3 cm, p<0.01) and emptying (1.7 +/- 1.0 v. 2.3 +/- 1.4 cm, p<0.01) velocity time integrals as compared to patients without spontaneous echo contrast. In a subgroup of the patients with normal sinus rhythm, the left atrial appendage ejection fraction was significantly less in patients with clot compared to those without clot (31.2 +/- 13.2 v. 41.3 +/- 11.5 %, p<0.01). CONCLUSIONS: In the patients with severe mitral stenosis, besides atrial fibrillation, a subgroup of patients in normal sinus rhythm with depressed left atrial appendage function (left atrial appendage ejection fraction < or = 25%) had a higher risk of clot formation in left atrial appendage and these patients should be routinely anticoagulated for prevention of clot formation.