Platelet distribution width as a prognostic factor of outcome in hemorraghic stroke

Background: Hematocrits have always been helpful to doctors as they are important parameters used on a daily basis. With the latest technology one can measure different indices of platelets mainly Plateletcrit, PC, MPV, PDW. Aim and objectives: To study the role of platelet distribution width as a prognostic factor of outcome in hemorrhagic stroke. Materials and methods: This study included 35 patients of hemorrhagic stroke coming to MGM hospital, Kamothe. Results: The study contained of 13 females and 22 male patients. Group A consisted of 5 patients. As the patients expired within 24 hours, only a single value of PDW was available in these patients. The mean of the PDW of these patients was 16.92 with a SD of 1.22. Conclusion: PDW may act as a prognostic factor of mortality in hemorrhagic stroke.

Dyskeratosis Congenita: A Rare Case.

Dyskeratosis congenita (DKC) is a rare genodermatosis which exhibits oral leukoplakia, nail dystrophy, and reticular skin pigmentations as its primary features. Dyskeratosis congenita has increased risk of developing constitutional anemia and malignancies and early diagnosis enables the patient to be monitored and proper interventional therapy to be instituted. Here, we present an interesting and rare case report of DKC. Very few are being reported in our country and we, as physicians, should be aware of DKC, presenting as pyrexia, and anemia.

Degree of Impairment of Liver Function in Dengue Fever Correlates to the Severity of its Complications.

Background: Dengue fever with its severe manifestations, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) has emerged as a major public health problem of international concern. Dengue, presenting as dengue fever (DF) or DHF or DSS, also has some effect on liver function. This study was conducted to find out the impact of dengue on liver function and correlation between clinical manifestation of dengue fever and degree of liver injury. Materials and methods: This prospective randomized study was done on 200 outpatient department/inpatient department (OPD/IPD) patients in age group of 12 to 60 years including both sexes who confirm to the predetermined inclusion and exclusion criteria. Investigation included measurements of serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), prothrombin time/international normalized ratio (PT/INR) and creatinine. Degree of liver involvement was classified in four groups. Results Out of 200 cases, 181 (90.5%) were diagnosed as dengue fever, nine (4.5%) as DHF, five (2.5%) as DSS, five (2.5%) as hepato-renal involvement; 24 (12.0%) had grade 0 liver injury, 126 (63.0%) had grade 1 liver injury, 34 (17%) had grade 2 liver injury, 10 (5.0%) had grade 3 liver injury and six (3.0%) had grade 4 liver injury. Conclusion: Mild elevation of the liver enzymes is a common feature of dengue infection. There is high relation between the degree of liver damage and the appearance of the complications.

Effect of Smoking on Serum Lipid Levels: A Hospital-based Study.

Aim: To study the effect of smoking on the levels of serum cholesterol, serum triglycerides, HDL-C and LDL-C in men between the age group of 20 and 30 years. Materials and methods: The study recruited 50 smokers and 50 controls. Controls were age, BMI and dietary habits matched nonsmokers. The variables compared between the two groups were total cholesterol, triglycerides, LDL-C, HDL-C. dyslipidemia with relation to the severity of smoking was studied in smoker group. Results: The present study showed statistically significant differences in all variables in two groups (p < 0.001). Smokers as compared to nonsmokers had higher total cholesterol (189.14 ± 19.888 vs 159.22 ± 23.221 mg/dl), triglycerides (149.98 ± 32.068 vs 116.86 ± 19.937 mg/dl) and LDL-C (121.14 ± 18.212 vs 93.28 ± 23.726 mg/dl). While the mean HDL-C was lower in smokers as compared to nonsmokers (38.02 ± 4.515 vs 42.56 ± 3.215 mg/dl). Conclusion: The prevalence of dyslipidemia in both smokers as well as nonsmokers according to the NCEP ATP III guidelines was 40% in smokers with just 18% in that of nonsmokers group. The study also showed a linear increase in the values of total cholesterol, triglycerides and LDL-cholesterol with the severity of smoking which was statistically significant. While HDL-C levels linearly decreased when progressing through pack years. Abbreviations: BMI: Body mass index; HDL-C: High-density lipoprotein-cholesterol; LDL-C: Low-density lipoproteincholesterol; NCEP ATP III: National Cholesterol Education Program, Adult treatment panel III; VLDL-C: Very low density lipoprotein-cholesterol; FFA: Free fatty acids.

Anterior Circulation Stroke Following Snakebite: A Rare Presentation.

India is estimated to have the highest snakebite mortality in the world. Most fatalities are due to delay in getting the defnitive treat ment. Most snakebites are inficted on the lower limbs of farmers, plantation workers, herdsmen, and hunters in rural areas. The viper is one of India’s most commonly encoun tered poisonous snakes and envenomation following viper bite usually leads to consumption coagulopathy. Clinical characteristics include cellulites, renal failure, hemorrhagic manifestations including pituitary and intracranial hemorrhage. In the setting of viper envenomation, large-vessel thrombosis is a very rare occurrence. Also, bilateral anterior cerebral artery infarction, when unrelated to anatomical abnormalities, surgery or trauma, itself is an exceedingly rare event. The following case is an unusual one of bilateral cerebral infarction in ACA territory in an otherwise healthy individual.

Expanding horizons of anticoagulant therapy: Dabigatran etexilate a novel oral anticoagulant.

Thrombo-embolic disease is a major challenging clinical problem associated with significant mortality and morbidity. Anticoagulation with the existing heparin products and vitamin K antagonist (VKA) anticoagulants are still the mainstay of management. However, due to the risk of bleeding and well-documented drawbacks, the quest for a novel oral anticoagulant has led to the clinical development of dabigatran etexilate. Dabigatran etexilate is a direct thrombin (IIa) inhibitor which has recently been approved in India for prevention of venous thromboembolic events (VTE) in patients who have undergone major orthopaedic (total knee or hip replacement) surgery and for prevention of stroke, systemic embolism and reduction of vascular mortality in adult patients with atrial fibrillation. Thus dabigatran etexilate is a promising alternative to the current heparin products and VKAs in patients who require long-term oral anticoagulation.

Camurati-Engelmann Disease.

Camurati-Engelmann disease (CED) is a very rare autosomal dominant genetic disorder that causes characteristic anomalies in the skeleton. It is a connective tissue disorder known for marked variability of its clinical presentation. The authors report CED in a 25-year-old male with atypical involvement of metacarpals (acrosclerosis) and features of neuromuscular disease along with the classical features of the disease.

Varying Arrhythmias during Single Hospital Stay in a Case of Systemic Lupus Erythematosus.

Cardiac involvement is present in more than half of the patients with systemic lupus erythematosus (SLE). However, studies on the prevalence of arrhythmias in this disease and laboratorial correlations predictive of their development do not exist. Possible pathophysiological mechanisms include autoimmune process, atherosclerosis and adverse effects of the drugs especially chloroquine used for treatment of this disorder. We present a unusual case of SLE with varying arrhythmias during a single hospital stay.