Evaluation of admission serum magnesium levels in patients with septic shock and its correlation with outcome

Background: Admission hypomagnesemia has been linked with an increased risk of septic shock. The purpose of this study was to evaluate admission serum magnesium levels in patients with septic shock and to determine its correlation with the outcomes.Methods: It was a prospective observational study. Total 50 patients fitting the Sepsis-3 definition between time period of June 2017 to November 2018 were included in the study. Patients with suspected infection were identified at the bedside with qSOFA. Admission serum magnesium levels was measured for all patients included. APACHE II scores were calculated at the end of 24 hours after admission. Routine standard of care treatment was provided to all patients. The patients were monitored for organ dysfunctions based on daily SOFA scores, ventilator free days, vasopressors free days, dialysis free days, length of intensive care unit stay, length of hospital stay. The data was analysed using Statistical Package for Social Sciences for MS Windows.Results: In this study hypomagnesemia was prevalent in 18%, normomagnesemia in 62% and hypermagnesemia in 20% of total included patients. The mean vasopressor free days in Hypomagnesemia group (7.11�.79 days) were higher than those in normomagnesemic patients (5.06�51 days) and hypermagnesemia patients (1.70�09 days). Out of total 50 patients 18 died and 32 recovered. 11 patients out of 32 who recovered had abnormal admission serum magnesium levels whereas 8 pts out of 18 who died had abnormal admission serum magnesium levels. SOFA score in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients was statistically significant.Conclusions: Author did not find any statistically significant correlation between admission magnesium levels in septic shock patients and outcomes although SOFA score was higher in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients. Serum magnesium may not truly reflect body抯 magnesium status. RBC magnesium may need to be studied to see whether it is a more reliable biomarker.

Evaluation of thyroid lesions by FNAC among youth and children: A hospital based observational study.

Introduction: Thyroid lesions are rare in children and youth. compared to adult, they show high mlignancy rate. peak incedence is between 20 to 24 years of age. Objectives: To evaluate the utility of Fine Needle Aspiration Cytology (FNAC) of thyroid lesions in children and youth by “The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)" . Materials and Methods: A prospective study was conducted over a period of 18 months. FNAC was performed on 106 children and youth of 1 year to 24 years age and classified according to TBSRTC.Results: Median age was 18.9 years. Majority (57.5%) were females in 20 years to 24 years age group. Out of 106 patients, 4.7%, 85.8%, 4.7%, 1.9%, 0.9% and 2% were distributed among diagnostic categories I, II, III, IV, V and VI of TBSRTC respectively. Six (5.6%) patients underwent. surgery and histopathological study was done. The sensitivity, specificity and accuracy rates were 100%, 97.8% and 98% respectively. Conclusion: TBSRTC for FNAC of thyroid is a definitive diagnostic test to triage patients on the requirement of surgery and to differentiate maligant from non-malignant lesions in children and youth.

Safe Blood transfusions: Still a risk in India.

Introduction: Nucleic acid testing (NAT) is the latest approved method for detection of transfusion transmitted infections. With higher prevalence of infections in window period and occult infections, blood safety can be compromised when testing is done using only serological techniques. With this background this study had been taken up to compare the results of serological test with NAT. Material and methods: Voluntary blood donations were screened for hepatitis B, hepatitis C and human immunodeficiency virus using ELISA. All samples were sent for ID-NAT and results of both methods were compared, analyzed individually. Results: A total of 11,393 blood units were collected during the study period. ELISA test results. showed 176 (1.54%) positivity for these transfusion transmitted infections (TTIs) in total. Among them, 133 (75.56%) was HBV, 22 (12.5%) was HCV and 21 (11.93%) was HIV as shown by ELISA. ID- NAT test results showed 174 (1.52%) positive in total. As analyzed by individual test results, 37 (0.32%) of total blood samples showed positivity in NAT which showed negative results in ELISA. Also 38 (0.33%) of total blood samples (HBV = 27, HCV = 08, HIV = 03) which showed positivity in ELISA were negative in NAT. Conclusion: ID-NAT is definitely a useful screening method for HBV, HCV, HIV. It clarifies infections in window period, occult infections and false seroreactive cases.

Awake craniotomy - for management of intracranial lesions safely in eloquent areas of brain.

The awake craniotomy is a procedure where the craniotomy and excision of the lesion is done in awake patient without general anaesthesia. This surgical technique enable surgeons to avoid damaging normal cerebral regions and allow real-time patient feedback while operating on important functional areas of brain like motor cortex and speech areas (motor, somatosensory, and language areas). Such surgical interventions would not be possible without anesthesia. This technique was originally introduced for the surgical treatment of epilepsy and has subsequently been used in patients undergoing surgical management of supratentorial tumours, deep brain stimulation and near critical brain regions. This surgical approach aims to maximize lesion resection while sparing important areas of the brain.

Aplasia cutis congenita of the scalp: therapeutic modalities.

Agenesis of scalp is an uncommon but well-recognized clinical entity. Congenital scalp and skull defects can be either obvious or occult; over 300 cases have been reported in literature. Aplasia cutis congenita (ACC) is recognized as a heterogeneous disorder, all characterized by focal absence of the epidermis, dermis and sometimes the calvarium and/or dura. We present a case of ACC in an infant whose mother was exposed to a teratogenic drug (Methimazole--an antithyroid drug) during pregnancy. This case report is presented to highlight the steps to successful management. Definitive full thickness scalp cover at the earliest avoids secondary infection, eschar formation and exsanguination.

MURCS association.

The MURCS association i.e. MUllerian duct aplasia, Renal aplasia, Cervicothoracic Somite dysplasia is a rare developmental disorder. The authors report a case of MURCS association with supernumerary ribs in a 7-month-old infant who presented with failure to thrive.

Cytogenetic, fluorescent in situ hybridization & reverse transcriptase-polymerase chain reaction analysis in acute promyelocytic leukaemia patients.

BACKGROUND & OBJECTIVES: The presence of t(15;17) or PML-RAR alpha fusion transcript is the diagnostic hallmark of patients with acute promyelocytic leukaemia (APL). Cytogenetic (CG), fluorescent in situ hybridization (FISH) and reverse transcriptase-polymerase chain reaction (RT-PCR) are mainly the techniques used for detecting this abnormality. The objective of this study was to compare and assess the role of CG, FISH and RT-PCR in the diagnosis of APL. METHODS: CG, FISH and RT-PCR analysis were performed in 29 patients with APL (28 M3, 1 M3v; 27 studied at diagnosis and 2 at relapse). RESULTS: Karotypes obtained in 25 patients revealed t(15;17) in 21 normal karyotype in 3 and trisomy 8 in 1 patient. In 26 patients FISH was positive for PML-RAR alpha fusion in both interphase (IP) and metaphase, two were negative and one patient had no cells for FISH analysis. IP FISH confirmed the fusion of PML-RAR alpha in all patients with t(15;17) detected by CG. RT-PCR was positive in the 22 patients analyzed (7 patients did not have RT-PCR). PCR was positive in the 3 patients with cytogenetically normal karyotypes and in one patient when karyotyping was a failure. CG detected 21 (72.4%) patients with t(15;17) of which additional chromosomal abnormalities were detected in 20 per cent of patients with successful karyotype. INTERPRETATION & CONCLUSION: FISH and RT-PCR were useful in detecting PML-RAR alpha fusion in cytogenetically normal patients and those in when karyotyping was a failure and can be used in routine analysis for rapid confirmation of t(15;17) in patients with acute myeloid leukaemia.

Vectorial efficacy of Phlebotomus argentipes in Kala-azar endemic foci of Bihar (India) under natural and artificial conditions.

Ability of Phlebotomus argentipes to acquire Leishmania donovani the causative agent of Indian Kala-azar was evaluated in the laboratory. Flies were fed artificially on infected blood suspensions, using a chick-skin-membrane feeding apparatus, and naturally on Leishmania donovani infected mice. In addition flies collected from different endemic areas were dissected and examined for natural infection. Flies fed on infected mice showed significantly higher feeding rate (14.4%, p < 0.01) compared to that of other experiments (9%, 8.75%) but the percentage of infection was very low (2.43%). No Chi-square comparison was made between infection rate and feeding rate because of low value in infection rate (less than 5). Flies dissected for natural infection showed only 0.1% infection. Not much difference was observed in the intensity of Leishmania donovani infection in the mid gut of sandflies examined from any of these experiments. These observations have confirmed that Phlebotomus argentipes has ability to acquire infection and it provides the final piece of evidence that Phlebotomus argentipes is the vector of Leishmania donovani in Bihar State.

Leptospirosis in Madras--a clinical and serological study.

Leptospirosis was confirmed by Microscopic Agglutination Test (MAT) and/or ELISA in 57 patients admitted to the Government General Hospital, Madras, India, during November and December of 1990 and 1991 with symptomatology suggestive of the disease. Fifty (88%) of the 57 cases were males; the mean age of all the cases was 39.6 years (range 17-72). The main clinical features were: fever 100% jaundice 84%, Myalgia 82%, acute renal failure 72% and conjunctival suffusion 58%. Non-azotemic jaundice occurred in 19% of cases. Renal failure was non-oliguric in 24% of cases. 3.5% of patients died. 23 patients underwent peritoneal and/or hemodialysis. ELISA IgM titres ranged from 1:80 to 1:10240 (geometric mean tire 911). MAT titres > or = 1:1600 and > or = 1:800 occurred in 39 of 54 and 51 of 54 cases respectively. Autumnalis was the serogroup most commonly recorded serologically, and Leptospira interrogans serovar autumnalis was isolated from one patient. This study shows that leptospirosis is a significant health problem in Madras, though normally grossly underestimated due to the absence of routine laboratory diagnostic facilities for the disease. Gross under-reporting is also likely in other high rainfall third world areas.