Clinical profile of patients with acute coronary syndrome and its association with biomarker troponin I

Background: Plasma cell dyscrasia (PCD) is the term used to describe the disorders characterized by neoplastic proliferation of plasma cells with the abnormal production of immunoglobulins (Ig). Patients with multiple myeloma frequently have abnormal coagulation tests. Aim of the present study were to correlate prothrombin time (PT) and Activated Partial Thromboplastin time (aPTT) with Ig concentrations in patients with newly diagnosed with PCD and to compare PT and aPTT values in untreated and treated patients diagnosed with PCDMethods: This study was conducted in the department of clinical hematology of SKIMS, a tertiary care hospital in northern India from 2015 to 2016. Patients diagnosed with PCD were advised for coagulogram (PT, aPTT) as a base line investigation. A total of 72 patients were included in the study.Results: 37% of multiple myeloma cases (newly diagnosed) and 22% of light chain disease patients presented with prolonged PT whereas none of the patients in treated cases of PCD had prolonged PT. The mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values. In IgA myeloma, the mean immunoglobulin concentration was 3643 mg/dL with a mean PT and aPTT values of 18.8s and 36.6 (p value: 0.006). The mean free light chain concentration in kappa (k) light chain myeloma was 1727 mg/L with a mean PT value of 20.5 s, mean aPTT value of 37.4 s (p-value: 0.026).Conclusions: Patients with newly diagnosed myeloma presented with prolonged PT as compared to the treated cases. Also, mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values.

A Prospective Study on Klinefelter Syndrome: A Basket of Multiple Systemic Disorders in a Tertiary Care Hospital

Background: When one or more extra X chromosome is added to a normal male karyotype (46-XY), then a new aneuploidy appears called Klinefelter Syndrome (KS). Every day approximately more than 50 new such cases are added in the male population of India. Traditionally they are lean, thin, tall, azoospermic, hypogonadic, infertile males with low social and educational profile. As the age advances level of testosterone decreases and many new symptoms of multiple systemic disorders appear in these cases. Methods: A well designed questionnaire of infertile males attending the above- mentioned OPD’s was filled with history, clinical examination and semen analysis (twice as per the WHO criteria).  Results: In our series of 500 azoospermic males, we encountered 56 classical KS cases (11.2 %) of 47-XXY karyotype, who were hypergonadotrophic hypogonadic and diagnosed with multiple diseases when evaluated in detail. Conclusions: Hence, every KS must receive androgen replacement therapy, which should begin at puberty and continue for lifelong that helps in preventing the development of high comorbidity rate and premature deaths because these are very high in such condition as compared to normal male population.

Vitamin D Status Among the Elderly Persons of South Rajasthan – A Prospective Observational Study

Background: Vitamin D a fat soluble unique micronutrient. Deficiency of vitamin D is widely prevalent in Indian Subcontinent despite wide exposure to sunlight round the year. Vitamin D is considered to be most under evaluated and under treated micronutrient round the world. Elderly persons are more prone to develop Vitamin D deficiency because of risk factors. Methods: This study was done to study the prevalence of vitamin D deficiency in healthy adults for southern Rajasthan and its correlation with gender, dietary habits and habitat (urban or rural residence).We evaluated apparently healthy adults of age more than 50 years presenting to hospital for routine evaluation or as accompanying person with patient between January to July 2015.The serum -25 OH CHOLECALCIFEROL (D2+D3) levels were estimated in all the subjects by COBAS e411 (Hitachi, Roche). Results: The study (Males 121, Females 83), aged 50 – 82 years shows normal level (20-32 nag/ml) in only 26% (53), while 74% (151) had <20ng/ml.  Women were more deficient (64%) than males (36%); vegetarians more [93% (140)] than non-vegetarians [7% (11)]; urban more 90% (51/56) than rural 69% (100/148). All those who received supplementation improved clinically and bio chemically. Conclusions: Despite abundant sunshine Vitamin D deficiency prevalence is very high among females, vegetarians and urban subjects, for which presumably conventional female over clothing, strict vegetarianism and urban crowdedness are responsible. Supplementation normalizes Vitamin D deficiency. Therefore, proper food fortification in healthy looking and diseased elderly persons is advised.