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Peritoneal tuberculosis is a common cause of ascites in areas endemic to Mycobacterium tuberculosis. The presentation of tuberculous ascites can mimic ovarian malignancy when it is associated with elevated cancer antigen 125 (CA-125) levels. We hereby discuss a case of a four months post-partum female patient who presented with gradual abdominal distension and was diagnosed with peritoneal tuberculosis after proper evaluation. She was started on anti-tubercular therapy and the treatment was successful. This case report highlights the importance of considering peritoneal tuberculosis as a differential diagnosis in cases of ascites with raised serum CA-125 levels in a Mycobacterium tuberculosis endemic region.
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Validation of a risk factor in a multifactorial disease like ischemic stroke is necessary to practice precision medicine. Many risk factors have been attributed to causing ischemic stroke but contribute very little to it. There are many risk factors that need to be validated, and fibrinogen is one such risk factor. Using a meta-analysis technique, we investigated fibrinogen as a risk factor for ischemic stroke. We searched the computerized databases such as PubMed, Google Scholar, and Cochrane to explore articles on ischemic stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random effects model. A total of 10 case-control studies with 6877 cases and 7219 controls were included in the study that match inclusion and exclusion criteria. The Asiatic population was portrayed in four studies, whereas the Caucasian population was portrayed in six studies. Under the recessive model, an elevated level of serum fibrinogen is linked to an increased risk of ischemic stroke as shown by pooled odds ratio (OR: 1.47, 95% CI: 1.19-1.76, I2 = 78.3%, P = 0.000). Our meta-analysis concluded that a high level of fibrinogen is associated with an increased risk of ischemic stroke.
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Background: Worldwide stroke is the second major cause of mortality and the fourth prominent cause of disease load after coronary heart disease and all types of malignancy. Greater than 3/4th of these cases are in low-priced and middle-priced nations. Several epidemiological studies have shown that alcohol consumption is a risk factor for stroke. The correlation between alcohol consumption and stroke involves various processes. For excessive alcohol consumption, GGT (gamma glutamyl transferase) is used as a marker. The study aims to see whether serum GGT level is an independent risk factor for stroke in young and elderly patients who do not have a history of alcohol intake. Material and Method: The study is an analytical cross-sectional comparative hospital-based study done in the Department of Medicine, RIMS, Ranchi from November 2019 to April 2021. A total number of 100 cases including both sexes who presented with the first episode of stroke have been compared with 100 age-sex-matched healthy control subjects without any cerebrovascular or cardiovascular disease meeting inclusion and exclusion criteria. Analysis of data is done by SPSS software and R studio software. Result: Serum GGT is lower in the age group of 40-60 years (24-hour GGT mean 50.70 U/L+SD 16.86) than the age group of 60-80 years (24-hour GGT 65.89 U/L+SD59.04) with a P value of 0.005. This is also true in 48-hour GGT (48.02 U/L+SD16.02) in 40-60 years compared to 57.94 U/L+SD42.81 in 60-80 years with a P value of 0.001 and 72-hour GGT (44.80 U/L+SD16.98) in 40-60 years compared to the mean (56.16 U/L+SD43.82) in 60-80 years with a P value of 0.001. This suggests that serum GGT level is significantly lower in the 40-60 years age group with a P value < 0.01. The serum GGT level in the case population is mean 58.30 (U/L) + SD43.87, and that in the control group is mean 17.48 (U/L) + SD4.32 with P value < 0.001. This implies an increased level of serum GGT level in stroke patients. Conclusion: Serum GGT level is independently correlated with stroke even in the presence of other risk factors for stroke such as diabetes mellitus, hypertension, and dyslipidemia. Serum GGT level is more in hypertensive, dyslipidemic, and ischemic stroke patients than in non-hypertensive, non-dyslipidemic, non-ischemic stroke patients, but serum GGT level cannot predict the outcome (survival or death) in stroke patients.
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This review article aimed to determine the obstetric and maternal outcomes after B-Lynch compression sutures to control atonic postpartum hemorrhage (PPH). This meta-analysis was performed after registering the protocol in the PROSPERO database with the registration number CRD42022355358. Two independent reviewers systematically searched electronic databases and search engines (PubMed, Cochrane Library, and Google Scholar) to retrieve published articles from inception to July 2022. The obstetric and maternal outcomes after the B-Lynch compression suture were computed using the random-effects model in pooled proportion with a 95% confidence interval (CI). Meta-regression analysis and subgroup analysis were performed to explain any source of possible heterogeneity. Quality assessment of the included studies was done using Joanna Briggs Institute (JBI) tools which are critical appraisal tools for systematic reviews and meta-analyses. This meta-analysis included a total of 30 studies involving 1,270 subjects. The pooled proportion of B-Lynch suture alone was 91% (95% CI = 82-97%). The combined proportion of B-Lynch suture plus another compression suture was 1% (95% CI = 0-3%), and the pooled proportion of B-Lynch suture plus vessel ligation was 3% (95% CI = 1-6%). The pooled proportions of PPH controlled and hysterectomies were 94% (95% CI = 91-97%, I2 = 65.3%) and 7% (95% CI = 4-10%, I2 = 72.13%), respectively. Therefore, B-Lynch suture (either alone or in combination with other techniques) is a simple and effective measure to control atonic PPH.
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Background Some literature has shown a high prevalence of pre-clinical diastolic dysfunction in subjects with type 2 diabetes mellitus. The current study was carried out to determine the association of glycosylated hemoglobin (HbA1c) levels with left ventricular diastolic dysfunction (LVDD) in patients with type 2 diabetes. Methods An observational cross-sectional study was conducted in a tertiary health care center in Jharkhand. A total of 100 subjects diagnosed with type 2 diabetes mellitus who gave informed consent and fulfilled the inclusion and exclusion criteria were studied in our center from April 2019 to September 2020. Logistic regression was carried out to determine the association of potential variables with outcomes. Multivariable logistic regression analysis was conducted to determine the independent effects of variables for LVDD prediction. Results The mean HbA1c of the population with LVDD was found to be higher (11.07 ± 3.66%) as compared to the population with normal LVDD (9.11 ± 2.95%), which was found statistically significant (probability value (P) =0.004). This signifies that a higher level of HbA1c in a patient with diabetes will have a higher incidence of LVDD. On applying multivariate analysis to determine the independent effect of variables for LVDD, HbA1C was found to be significant with an odds ratio (OR) of 1.26, 95% CI 1.08-1.48. The duration of diabetes was also found to be significant with OR 1.48 and CI 95 % (1.20-1.82) P <0.001. On plotting the receiver operating characteristic curve (ROC), the area under the ROC curve to predict the left ventricular function with the model was 0.8137. Conclusions Patients who have higher HbA1C are linked to a higher risk of left ventricular diastolic dysfunction in patients with type 2 diabetes. The combination of diabetes and left ventricular dysfunction can lead to increase morbidity and mortality in those patients in whom it is not identified timely and appropriate measures are not taken. Our work emphasizes the requirement of screening intermittently symptomless diabetic patients for diastolic dysfunction through a Doppler echocardiography so that timely action can be taken.
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Discovery and validation of genetic factors for multifactorial and polygenic disorders like stroke are needed to make progress in precision medicine. Although some traditional risk factors for stroke have been identified, they do not fully explain the pathophysiological mechanism of ischemic stroke. The research of genetic risk factors is becoming increasingly relevant in the understanding of stroke mechanisms and the finding of population-specific therapeutic targets. The methylenetetrahydrofolate reductase (MTHFR) gene is involved in homocysteine metabolism, and a high homocysteine level is a risk factor for stroke. Using a meta-analysis technique, we investigated the link between the MTHFR C677T gene polymorphism and the risk of ischemic stroke. We used the electronic databases PubMed, Medline, Embase, and Google Scholar to find articles in the Journal of Stroke. If heterogeneity was more than 50%, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model; otherwise, a fixed-effects model was used. A total of 67 case-control studies with 17,704 cases and 21,981 controls met our inclusion criteria. The Asian population was represented by 41 studies, whereas the Caucasian population was represented by 26. Under the recessive model, a gene polymorphism at the 677 location of the MTHFR gene is related to an elevated risk of ischemic stroke (OR: 1.29, 95% CI: 1.22-1.37, P < 0.001). People who have the MTHFR C677T gene polymorphism have a greater risk of stroke than people who do not.
