A cross-sectional study to know the prevalence of thyroid dysfunction in systemic lupus erythematosus

Background: Systemic lupus erythematosus (SLE) is a persistent autoimmune disease, the pathogenesis of which remains elusive. Autoimmune factors may be a cause of SLE and thyroid dysfunction. Many studies have revealed that the prevalence of thyroid disorder is higher in SLE patients than in the general population. SLE is a multisystem and hypothyroidism is an organ specific autoimmune disorder and can occur successively or simultaneously. Aims and Objectives: The aim of the study was to study the prevalence of thyroid disorder in patients with SLE. Materials and Methods: Patients admitted with definite clinical features of SLE and Antinuclear Antibodies positive, in medicine ward and healthy blood donors are taken as control. Sample was tested by fully automated analyzer. Results: Subclinical hypothyroidism was found in 24% of study group and 8% of control group which is statistically significant. Central and secondary hyperthyroidism was found in 10% of study group and 12% of control group but it was statistically insignificant. Several studies have documented an association between SLE and other autoimmune diseases such as Sjogren’s syndrome, autoimmune hemolytic anemia, and antiphospholipid syndrome. Subclinical hypothyroidism was higher than another thyroid dysfunction such as primary, central, and subclinical hypothyroidism was found to be higher in frequency, probably depicting the slow destructive process which is pathognomic of autoimmune thyroiditis. Conclusion: Subclinical hypothyroidism was more prevalent in SLE than that of overt hypothyroidism as compared with general population.

Comparative study of closed versus open lateral internal sphincterotomy in the management of chronic anal fissure

Background: Anal fissure is a painful tear in distal anal canal extending from just below the dentate line to anal verge. Patient presents with pain during or after defecation and passage of bright red blood per anus. Various studies investigating chronic anal fissures show a large variation in healing rates for different modalities. The present study was carried out to evaluate effectiveness of closed versus open lateral internal sphincterotomy in treatment of patients with chronic anal fissure.Methods: A prospective study was conducted in the Department of Surgery, Pt. B.D. Sharma PGIMS, Rohtak. Group A and group B included 20 patients each with chronic anal fissure and managed by closed and open lateral internal sphincterotomy respectively and effectiveness was evaluated with regards to fissure healing, pain reduction, recurrence and incontinence after surgical treatment.Results: The mean pain scores on visual analogue scale at end of 1 week in group A and group B was not found to be statistically significant, whereas it was found to be statistically significant at 3 week and at 6 weeks. Delayed healing was seen in 1 patient of group B, whereas no patient in group A had delayed healing or absence of healing postoperatively.Conclusions:There was a significant difference between closed and open methods of lateral internal sphincterotomy in terms of relief in post-operative pain but as a whole both techniques did not show any statistically significant difference in terms of fissure healing, postoperative complications or recurrence at 3 months.

A Novel Calculation of Priming Volume and Required Packed Cell Transfusion to Maintain Optimal Haematocrit During Cardiopulmonary Bypass

Introduction: Hemodilution during cardiopulmonarybypass is an acceptable method to avoid the complications ofcontinuous flow at the microcirculatory level. Hemodilutionalanemia during cardiopulmonary bypass can lead to inadequateoxygen delivery and, which may result in ischemic organinjury to all the organs especially to the brain, kidney, lungs andliver. Study aimed to investigate the effectiveness of a novelformula for calculating priming volume (PV) and requiredpacked cell (PC) volume to maintain optimal hematocrit levelduring cardiopulmonary bypass.Material and methods: This Prospective interventional studywas done on 150 patients who underwent open-heart surgeriesin our Institute from January 2018 to December 2018. GroupA-75 patients: perfusionist’s old protocol for calculatingpriming volume and required packed cell volume calculationand the nadir hematocrit (Hct) during CPB and postoperativeoutcome monitored. Group B- 75 patients: customizednovel formula was applied for calculating PV and requiredPC volume and the nadir Hct during CPB and postoperativeoutcome monitored and both the groups compared.Results: In our study results showed that maintaining optimalHct of 25% (>20%) in adult and 30% (>25%) by using ournovel customized formula for calculating prime volume andrequired packed cell volume was significantly improvedthe nadir Hct from 19.16% to 21.8% as well as average Hctvalues from 19.7% to 23.4%. Complications of Hemodilutionwere significantly reduced in the study Group B. Mortalitywas reduced to 2.7% from 5.3%. Respiratory complicationlike reintubation rate and nonfatal noncardiogenic pulmonaryedema rates reduced from 34.7% to 17%. Coagulopathy withpostoperative blood products requirement reduced from 20%to 7%.Conclusion: Our Study showed that application of this novelformula is very useful and easy for both the perfusionists andthe surgeons in maintaining optimal Hct during CPB therebyimproving the postoperative results following open heartsurgeries.

Fatal aspergillosis of the renal vasculature in a combined liver-kidney transplant recipient

Invasive aspergillosis remains a problem in solid organs and haematopoietic stem cell transplants. We report a case of 12-year-old female with primary hyperoxaluria with regular haemodialysis for the end-stage renal disease. She underwent a combined liver and renal transplantation which got infected by aspergillosis. In this case study, it is speculated that the most likely source of Aspergillus was contaminated preservative solution (perfusate), resulting in infection within the donor kidney and subsequent systemic infection in the recipient. This case study calls for critical analysis and needs for the routine culture of the preservative solution before transplantation, to detect any fungal contamination and manage it prophylactically.

Efficacy and safety of prucalopride in the treatment of chronic constipation

Background: Chronic constipation is a common condition that significantly impacts health care utilization, productivity, and quality of life. Laxatives are commonly used, although often insufficient in restoring normal bowel function or providing adequate relief. There remains a significant need for the development of novel agents to optimize treatment of this condition. Prucalopride, a selective, high-affinity 5-hydroxytryptamine 4 receptor agonist, stimulates gastrointestinal and colonic motility and alleviates common symptoms of chronic constipation. Here authors are evaluating efficacy and safety study of this drug in chronic constipation patient.Methods: This is a prospective observational study where chronic constipation patient treated with prucalopride 2 mg daily once were enrolled during 6 month period. Data at one week and four weeks were observed along with adverse effects. Efficacy assessed by the number of Spontaneous Complete Bowel Movements (SCBMs) per week recorded by patient diaries. Patients were defined as responders when they had a mean of three or more SCBMs per week over the whole treatment period. The primary efficacy end point was proportion of responders after 1 week and after 4 weeks of treatment.Results: A total of 43 patients diagnosed with chronic constipation and treated with prucalopride were included in study. The proportions of patients in the present study with at least three SCBMs per week (responders) were 44.2% (19 out of 43 patients) at 1 week and 46.5% (20 out of 43 patients) at 4 weeks. Treatment was well tolerated with minimal side effects. Common adverse effects reported in our study were gastrointestinal disorders like diarrhea, nausea and abdominal pain and nervous system disorders like headache and dizziness.Conclusions: Prucalopride is effective, has a good safety profile, and is well tolerated in chronic constipation treatment.

Twin pregnancies: Maternal and perinatal outcome in a tertiary health centre

Background: Twin gestation brings double happiness but at the same time implies twice the unforeseen complications to the health of the mother and the fetus. Objective: To study the maternal and neonatal outcome in multi fetal pregnancy in a tertiary health centre. Materials and methods: A retrospective observational analysis of 30 twin pregnancies admitted and managed in our centre. Patients were studied for any adverse antenatal complications, mode of delivery and maternal and perinatal outcome. Results: In our study, maximum patients were in age group of 31-35 years (33.3%) and primigravida (46%), admitted with gestational age 32-37 weeks (46.6%). Commonest maternal complication observed was anemia (60%) followed by preterm labour (53.3%), premature rupture of membranes (40%), pregnancy induced hypertension (33.3%). Cesarean section was mode of delivery in maximum (60%), with common indication being Malpresentation (50%). Out of 56 live births, 51.6% were admitted in neonatal ICU for causes like prematurity (58.06%). Prematurity was the leading cause of perinatal mortality and morbidity in twin gestation. Conclusion: Twin gestation has significantly increased risk to both the mother and the fetus. Early recognition and adequate management of twin gestation can decrease associated complications and betterment of maternal and neonatal outcome.

Cardiovascular and biochemical studies on the effects of thrombin and dabigatran and the interaction with vasopressor molecules.

Background: The effect of serine protease thrombin and its directly acting inhibitor dabigatran were evaluated on the heart rate, blood pressure, and phospholipase C (PLC) enzyme activity and the intracellular calcium levels in the platelets. Methods: Heart rate and blood pressure were estimated using electrophysiology equipment. Results: While thrombin was unable to significantly affect the heart rate and blood pressure, the inhibitor dabigatran was able to reduce the heart rate appreciably but its effects on the blood pressure were minimal. The thrombin induced increase in PLC enzyme activity, and intracellular calcium levels were attenuated by dabigatran in the platelets. The posterior pituitary hormone, vasopressin, and the adrenergic agonist noradrenaline were used to stimulate the PLC and calcium levels in platelets. Conclusion: The thrombin inhibitor, dabigatran reduces vascular oxidative stress and inflammation, improves endothelial function, and decreases atherosclerosis in rodents.

Anti-amnesic effect of aqueous extract of Crataeva nurvala stem bark in scopolamine induced amnesia.

Aim of the study was to evaluate the anti-amnesic effects of Crataeva nurvala stem bark in scopolamine induced amnesia in rats. The standardized aqueous extract of Crataeva nurvala (AECN) was freshly dissolved in distilled water and administered orally to rats at the dose of 500 mg/kg for evaluation of its effects against scopolamine (3 mg/kg, i.p.) induced retrograde and anterograde amnesia. The effects of the extract on escape latency during the acquisition trial (Days 1-4) and the time spent in target quadrant (TSTQ) during the retrieval trial (Day 5) were determined using the Morris water maze test. In order to indicate the probable mechanism of C. nurvala, its effects on acetylcholinesterase (AchE) and TBARS levels in the brain were determined. In scopolamine induced retrograde amnesia treatment with AECN showed a significant (p<0.05) increase in TSTQ and reduction (p<0.001) in levels of both AchE and TBARS in brain. In the anterograde amnesia model AECN significantly (p<0.001) reduced the escape latency and increased (p<0.01) the TSTQ. The extract also lowered the levels of AchE (p<0.01) and TBARS (p<0.001) in the brain of scopolamine induced anterograde amnesic rats.The study proved that AECN possesses positive effects on memory and learning, which may be due to decrease in AchE levels and inhibition of lipid peroxidation in the brain.

Evaluation of the effect of metformin on the inhibitory effect of oxytocin on potassium chloride stimulated goat ileum.

The posterior pituitary hormone, oxytocin is expressed in the myenteric and submucous ganglia and nerve fi bers along the entire human gastrointestinal (GI) tract. The role for oxytocin in the physiology and pathophysiology of the bowel remains to be clearly elucidated. Many studies have described that oxytocin exerts stimulatory or inhibitory effects on gut functions. Recently, mRNA for oxytocin and its receptor was found throughout the entire human GI tract. In this study, we examined the responses of the posterior pituitary hormone, oxytocin on the contractile responses to KCl and the effect of metformin on these responses as it affects the glucose transport and causes monoamine release in the gut.

Reduction in lung functions in type-2 diabetes in Indian population : Correlation with glycemic status.

The purpose of this study was to evaluate pulmonary functions in patients with Type-2 diabetes mellitus and to determine their correlation with glycemic status of diabetes in Indian population. Forty Type-2 diabetic patients, aged 30-60 years, with diabetic duration of 1-20 years, were included in the study. FVC, FEV1, & FEV1% are recorded by Benedict’s Roth spirometer. PEFR and MEP were recorded by Wright’s Peak flow meter & Modified Black’s apparatus. Glycemic status of subjects was determined by FBS & PPBS by Glucose oxidase & peroxidase methods. And results were analyzed by calculating Mean±SD, using Student’s t test, and Pearson correlation. All the respiratory parameters are reduced in Type- 2 diabetic patients compared to control of which FEV1, FEV1%, & MEP show very highly significant reduction (P=0.000). Lung functions are negatively correlated with glycemic status & duration of diabetes. (r = – 0.390, & –0.342) Reduction in dynamic lung functions and its negative correlation to glycemic status might be due to respiratory muscle weakness as indicated by highly significant reduction in MEP. Hence strict glycemic control and breathing exercises to strengthen the respiratory muscles may improve lung function in diabetics.

Psammomatoid Ossifying Fibroma - An Unusal Presentation.

Psammomatoid juvenile ossifying fibroma (PsJOF) is a well defined clinical and histological entity with earlier onset at (childhood or adolescence) classified under the broad category of fibro-osseous lesion. Histological PsJOF is one of the entity of juvenile ossifying fibroma (JOF) characterized by small spherical ossicles resembling psammoma bodies and the other with trabecular or fibrillar osteoid and woven bone which is termed as trabecular juvenile ossifying fibroma (TrJOF). This case of PsJOF involved maxilla, premaxilla, antrum, lateral wall of nose on left side of face. The size, extent and aggressive behavior of the tumor which has lead to facial disfigurement and difficulty in breathing, inability to speak, eat and drink is rare in literature. The treatment done by resection with safe margins is adequate with no recurrence as patient is under follow up for more than one year.

A study of high-sensitivity c-reactive protein in bronchial asthma.

Background. Relevance of C-reactive protein an acute phase reactant and a sensitive marker of low-grade systemic inflammation in bronchial asthma has not been fully studied. Objective. To evaluate the significance of high-sensitivity C-reactive protein (hs-CRP) in atopic and non-atopic asthma using an ultra sensitive assay. Methods. The levels of hs-CRP of 200 patients with bronchial asthma and 50 non-asthmatic control subjects were measured using a Latex enhanced immunoturbidimetric test. Spirometry with reversibility study, serum immunoglobulin-E (IgE) measurement and skin test for allergy was done in all the patients. Results. There was a significant increase in hs-CRP levels with age in atopic asthmatics but no such association was observed in the non-atopic asthmatics and control subjects. The hs-CRP levels were not influenced by sex in any group. Smokers in all the three groups had a significantly higher hs-CRP levels as compared to non-smokers. Patients with asthma had higher hs-CRP values as compared to controls. Patients with non-allergic asthma had higher mean hs-CRP as compared to atopic asthmatics and control subjects. Conclusions. The study suggests that there exists a certain degree of low-grade systemic inflammation in addition to the local bronchial inflammation in non-atopic asthmatics. Hence, hs-CRP may be used as a surrogate marker for the airway inflammation in non-atopic asthma patients.

Rare causes of voice hoarseness: a case report.

We report two contrasting and rare cases of voice hoarseness in young patients of tubercular aetiology. First case report is of isolated tubercular recurrent laryngeal nerve palsy in a patient who presented with hoarseness of voice. Chest radiograph showed a left hilar prominence and bronchial washings isolated acid-fast bacilli. Hoarseness of voice as an initial symptom due to isolated vocal cord palsy with no morphological lesions in the larynx and without obvious parenchymal infiltration often poses a diagnostic dilemma. Second case report highlights the possibilities of tuberculosis of the vocal cords mimicking tumour of the larynx. This patient had an ulcerative growth involving the vocal cord which was initially mistaken for malignancy. Patient also had concomitant miliary shadowing in the lungs and laryngoscopic biopsy revealed the growth to be tuberculosis. Early diagnosis and intervention with antitubercular treatment is vital as it results in complete recovery with reversal of vocal hoarseness.

Diagnostic potential of IS6110, 38kDa, 65kDa and 85B sequence-based polymerase chain reaction in the diagnosis of Mycobacterium tuberculosis in clinical samples.

PURPOSE: The correlation between the presence of specific gene sequence of M. tuberculosis and specific diagnosis of clinical tuberculosis is not known. This study compared the results of polymerase chain reaction (PCR) amplification of M. tuberculosis specific DNA sequences (IS6110, 65kDa, 38kDa and mRNA coding for 85B protein) from different clinical samples of pulmonary and extrapulmonary tuberculosis. METHODS: One hundred and seventy-two clinical samples from suspected tuberculosis patients were tested for smear examination, culture (LJ and rapid BACTEC 460 TB system) and PCR. PCR was performed with specific primers for the targets: IS6110, 65 kDa, 38 kDa and 85 B. RESULTS: Each PCR test was found to have a much higher positivity than conventional test and BACTEC culture (P < 0.05). Smear positive samples (56) and the samples (36) showing positive results by conventional methods (smear and LJ medium culture) and BACTEC were found to be positive by all PCR protocols. No significant difference was found between the four PCR protocols (P> 0.05). The primer specific for amplifying the 123bp IS6110 fragment gave the highest positivity (83%), followed by 65kDa, 38kDa and 85B RT-PCR in descending order. CONCLUSIONS: These data suggest that the presence of IS6110 correlates more closely with the diagnosis of clinical tuberculosis than that of 65kDa, 38kDa and 85B proteins.

Median pancreatectomy: a report of three cases.

Conventional pancreatic resections may be unnecessary for tumors of the pancreas that are benign or of low malignant potential and can place the patient at increased risk of developing postoperative exocrine and endocrine complications. Median pancreatectomy is an option that has been investigated in the management of such tumors located in the body of the pancreas. We present our experience with three women who underwent this procedure successfully for neuroendocrine tumors (2) and cystadenoma (1).