Admission leukocytosis and its implications on intra cerebral haemorrhage

Background: Intracerebral haemorrhage is one amongst the most common subtype of stroke. It is a catastrophic disease with significant rate of mortality and may lead to severe disabilities. Immediate and effective treatment is a prime requisite of ICH, as rapid mortality occurs within first 24 hours. Definitive diagnosis of ICH is difficult as its symptoms are similar to ischemic stroke. Aim of current investigation was to establish a relationship between intra-cerebral haemorrhage and leukocytosis and to use it as an early tool for detecting haematoma expansion for prognostication and developing newer drugs using a suitable therapeutic target.  Methods: Current investigation was an observational study carried out on 100 patients with intra-cerebral haemorrhage. Differential counts were studied with respect to influence of particular subtypes on hematoma expansion. Follow up NCCT was done after 48 hours of the event.  Results: Results of present investigation revealed that mean age of the patients was 56 years, 82% were males and all the patients were hypertensive. It was observed that majority of patients with neutrophilic leukocytosis, did not show hematoma expansion and neutrophilic leukocytosis was preferentially present in patients with higher initial bleed volumes. Significant association was observed between monocytosis and haematoma expansion and association between lymphocytosis and volume expansion was observed to be non-significant.  Conclusions: Current study findings can aid in early risk stratification and prognostication of ICH patients and can also provide a tool for identification of new therapeutic targets for controlling haematoma expansion.</jats:p

The vitamin B12 levels in type 2 diabetes mellitus patients on metformin and not on metformin

Background: Type 2 diabetes mellitus (T2DM) is one of the major global public health concerns, metformin is one of the most widely used drugs and considered as first-line therapy for management of T2DM. Vitamin B12 malabsorption is observed in patients on metformin therapy leading to biochemical and clinical vitamin B12 deficiency. The aim of the current study was to assess the relationship between metformin therapy and development of vitamin B12 deficiency.Methods: Current observational cross sectional study was conducted at Madras medical college and Rajiv Gandhi Government general hospital. Serum vitamin B12 and other blood investigation parameters of T2DM patients, on metformin therapy for long duration (6 months or more than 2 years) were measured and correlated with vitamin B12 levels of T2DM patients not on metformin therapy. Patients were given appropriate treatment and were regularly followed up.Results: Results of the current study findings depicted that significant difference was observed in percent haemoglobin, total blood cells, platelet count, mean corpuscular volume (MCV) and albumin values of patients on metformin therapy when compared to patients who were not on metformin therapy. Study findings also revealed that substantial difference in vitamin B12 deficiency was observed in T2DM patients based on the duration of metformin therapy.Conclusions: Current study revealed that, metformin therapy for 2 years or more, can lead to significant vitamin B12 deficiency which is also associated with macrocytosis. It was concluded that longer the duration of metformin therapy, more significant would be vitamin B12 deficiency.</jats:p

Emphysematous cystitis – An uncommon yet fatal urinary tract infection

Emphysematous cystitis is an uncommon form of complicated urinary tract infection mostly caused by Gram-negative organisms in elderly, debilitated or immune-compromised patients. It has a varied spectrum of clinical manifestations ranging from asymptomatic to generalised sepsis. Radiological investigations such as conventional abdominal radiography and computed tomography are quintessential for diagnosis. Treatment with culture-specific antibiotics forms the mainstay of management. We present the case of an elderly patient who presented with gastric carcinoma and, during his stay, developed an unexplained fever with rapid clinical deterioration. Emphysematous cystitis was diagnosed radiologically, and urinalysis revealed Klebsiella pneumoniae. Culture-specific antibiotics were started after obtaining the culture report, and despite early and aggressive management, the patient succumbed to generalised septicaemia. Although Emphysematous cystitis is known to have lower mortality compared to other gas-forming infections of the urinary tract, high degrees of clinical suspicion and early management are of paramount importance in obtaining a favourable outcome. </jats:p

Study of serum Zinc status among type 2 diabetes mellitus patients

Background: Both microvascular and macrovascular complications in diabetes are related to oxidative stress. Zinc which has antioxidant property, delays diabetic complications. The present study was conducted with the objective to study the relationship between serum Zinc level and HbA1C level in newly diagnosed type 2 diabetes mellitus and to compare serum Zinc level with its risk factors.Methods: The present study was a cross sectional study, conducted on 100 patients attending the outpatient department at Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai during the period from May 2015 to October 2015. Of them 50 were newly diagnosed type 2 diabetics and considered as diabetic group and other 50 were considered as controls, who attended the master health check-up. All patients were subjected to thorough general and systemic examination. Under strict aseptic precautions blood sample was collected from all the patients and the serum was investigated for creatinine, urea, zinc, HbA1c, cholesterol, triglycerides and fasting blood glucose. The data obtained were analysed using Microsoft excel software. Correlation was found out in SPSS by using regression equation.Results: The body mass index (BMI) and mean systolic blood pressure (SBP) was significantly higher (p&lt;0.001) in diabetic group as compared to controls. Serum levels of HbA1C and fasting blood glucose (FBG) levels were found to be significantly higher in diabetic group than in controls (p&lt;0.001). Serum zinc levels were significantly higher in control group (p&lt;0.001). Mean zinc value decreases with increase in HbA1c, FBG, BMI, SBP, DBP, triglycerides and cholesterol and the difference was statistically significant (p value &lt;0.01). The relation between Pearson correlation coefficient for zinc and the above parameters were higher in diabetics than controls.Conclusions: Lower serum zinc levels were found to be responsible for the development of macrovascular complications in type-2 diabetics. Hence there is a need for zinc supplementation in diabetic patients to prevent long term complications associated with it.</jats:p

Relationship between thyroid function and ICU mortality (sick euthyroid syndrome)

Background: Sick euthyroid syndrome refers to alterations that occur in thyroid hormone levels in response to any critical illness like sepsis, ARDS, patients on mechanical ventilation and also any ICU patients. This study aimed at the relationship between thyroid hormone level changes and critical illness in ICU patients and predict the mortality based on thyroid hormone levels.Methods: A prospective study was designed to carry out in intensive care unit (ICU), Institute of internal medicine, Rajiv Gandhi government general hospital, Chennai for six months from May to August 2015. A total of 40 patients were selected who fulfilled the selection criteria.Results: APACHE II scores were calculated for all the 40 patients to assess whether thyroid function tests could independently predict the outcome of the patients. Again, the thyroid profile was compared with APACHE II scores in predicting the outcome. Values showed statistically significance.Conclusions: Thyroid profile can be used as an independent factor in predicting the outcome of the patients. Thyroid profile can also increase the sensitivity of APACHE II score in predicting the outcome.</jats:p

Contrast-enhanced computed tomography – an effective tool in identifying pancreatic duct disruption in acute pancreatitis: A case series

Pancreatic duct disruption may follow acute pancreatitis, chronic pancreatitis, pancreatic surgery, and trauma. Diagnosis in these patients is usually made by endoscopic retrograde cholangiopancreaticogram or secretin-stimulated magnetic resonance cholangiopancreaticogram. We report five cases where pancreatic duct disruption was diagnosed by contrast-enhanced computed tomography (CECT). Five patients with acute pancreatitis were studied; three were secondary to alcohol and two were posttraumatic. Three patients developed pancreatic ascites, one developed pancreatico-pleural effusion, and the other had pancreatic pseudocyst. CECT of the abdomen revealed pancreatic ductal injury in all the patients. In one patient with pancreatic ascites, multiple peripancreatic collections and dilated and disrupted pancreatic duct communicating with the peritoneal cavity were noted. The patient of traumatic pancreatitis had a fracture of the head of the pancreas, with peripancreatic collection communicating with the main pancreatic duct (MPD). In the other traumatic pancreatitis, there was a pseudocyst near the head of pancreas communicating with the MPD. CECT can provide a comprehensive assessment in acute pancreatitis including duct integrity, type and location of pancreatic ductal injury and can be an effective noninvasive alternative imaging modality in diagnosing pancreatic duct disruption