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Early detection of cardio toxicity in organophosphorus poisoning

Sat, 01 Apr 2023 00:00:00 GMT

Title: Early detection of cardio toxicity in organophosphorus poisoning Authors: Dr. Raveesha., A; Dr. Anitha., A; Dr. Shashidhar., K.N; Dr. Suresh., T.N; Dr. Minni, Meka; Dr. Meghashri., V Abstract: Introduction: The widespread use and easy availability of organophosphorus(OP) and carbamates as agricultural insecticides has increased the likelihood of poisoning with these compounds in developing countries. Organophosphate poisoning has been postulated both in animal and human studies to cause myocardiotoxic damage (myocardial necrosis).Cardiac complications often accompany poisoning with these compounds, which may be serious and often fatal. These complications are potentially preventable if they are recognised early and treated adequately. Objective: To detect early cardiotoxicity in organophosphorus poisoning by using, troponin-T, ECG and serum electrolyte levels. Methodology: A prospective observational study carried out from January 2019 to January 2020 and total of 110 adult patients with consumption of OP compound were included after satisfying the inclusion criteria. Electrocardiogram(ECG) was recorded as soon as patient presented to emergency department and daily. Cardiac activity was monitored using cardiac monitor and additional ECG was recorded if required. Blood samples was drawn on 1st ,3rd and 5th day of admission for cardiac enzymes ( trop-I) and electrolyte estimation (Na+, K+, Ca2+). Conclusion: Cardiac markers like Trop I can be used as an early predictor of cardiotoxicity in OP poisoning patients. Dyselectrolytemia recognized early can be corrected and is reversible which can prevent mortality in organophosphorus poisoning patients.

Correlation of Six Minute Walking Test, Sit to Stand Test and Pulmonary Function Test in Patients with Chronic Obstructive Pulmonary Disease

Sun, 01 Jan 2023 00:00:00 GMT

Title: Correlation of Six Minute Walking Test, Sit to Stand Test and Pulmonary Function Test in Patients with Chronic Obstructive Pulmonary Disease Authors: Meghashri., V; Raveesha, A.; Guruprasad., T J; Charchit, Mehta.; Deepthi, Manchu Abstract: Introduction: Assessment of functional capacity in Chronic Obstructive Pulmonary Disease (COPD) patients helps in determining the severity of the disease. While spirometry is the gold standard, six Minute Walk Test (6MWT) and one minute Sit To Stand Test (STST) are simple and practical tests to assess exercise capacity and physical condition. Aim: To find the diagnostic accuracy of these of 6MWT and one minute STST in comparison with spirometry. Materials and Methods: This cross-sectional study was conducted in the Department of General Medicine at Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India, from January 2019 to December 2019. All cases of COPD diagnosed using GOLD 2018 criteria were included in the study. Patients performed 6MWT and one minute STST. Heart rate, blood pressure, oxygen saturation, SpO2, dyspnoea, and fatigue (Borg scale) were noted pretest and post-test. The sensitivity, specificity, predictive values and diagnostic accuracy of the screening test with the decided cut-off values along with their 95% CI were presented. A p-value <0.05 was considered statistically significant. Results: The mean age of the patients was 64.09±8.31,while there were 112 (94.9%) males and 6 (5.1%) female. Overall, 81.54% of the participants had severe/very severe COPD group, walked <332.49 meters, and only 18.46% could walk more than 332.50 m. The SpO2 decreased from 93.98±0.82 to 91.75±1.39. During the one minute STST, SpO2 decreased from 93.98±0.82 to 91.75±1.39. A positive correlation was observed between the one minute STST, and it had good predictive validity in predicting COPD, as compared with spirometry {Area Under the Curve (AUC) of 0.915 (95% CI 0.866 to 0.963, p-value <0.001)}. 6MWT has a sensitivity of 81.54%, the specificity of 79.25%, and one minute STST had a sensitivity of 89.23%, specificity of 67.92% in predicting COPD. Conclusion: In a remote clinical setting, where spirometry is not available, 6MWT and one minute STST are the best methods for assessing COPD severity.

Correlation of Relation of Serum Prolactin Level to Child-Pugh Score in Cirrhosis of Liver in Assessing Disease Severity

Sat, 01 Jul 2023 00:00:00 GMT

Title: Correlation of Relation of Serum Prolactin Level to Child-Pugh Score in Cirrhosis of Liver in Assessing Disease Severity Authors: Vemanamanda, S.; Srinivasa, S.V. Abstract: Aim: To find the accuracy of prolactin levels and identify the severity and complications. Materials & Methods: This was a cross-sectional study performed in the Department of Medicine at Sri R.L. Jalappa Hospital and Research Centre. Participants: The study involves participants who are diagnosed with liver cirrhosis of age above 18 years. Participants with other health complications were excluded from the study. Interventions: Child pugh scores were compared with serum prolactin levels and the predictive value of serum prolactin was assessed. In the 69 subjects studied mean age was 50.93±8.84 the study population, with the majority of them being males (85.51%) and females 14.49%. The difference in serum prolactin between Child-Pugh scores was statistically significant (P value - < 0.001). Results: The present study found a significant (P <0.001) higher median prolactin levels in grade 4 hepatic encephalopathy compared to grade 3, 2, and grade 1 (grade 4- 66.00(61.5 to 71.5), grade 3- 47.00(42.0 to 54.0), grade 2-43.00(39.25 to 50.5) and grade 1-40.50(31.25 to 48.25), whereas in cirrhosis cases without hepatic encephalopathy, we found significantly lesser prolactin levels (median- 27.00(range 25.0 to 33.0) compared to cases present with hepatic encephalopathy. The serum prolactin had a sensitivity of 82.61% specificity was 73.91% and diagnostic accuracy was 76.81% in predicting severe child pugh score. Conclusions: There was a higher frequency of cirrhosis complications in patients who had higher blood prolactin levels at admission. Hence, serum prolactin can be considered as a low-cost, biomarker for liver cirrhosis.

Congenital dyserythropoietic anaemia type II in a teenager presenting with severe anaemia

Sun, 01 Jan 2023 00:00:00 GMT

Title: Congenital dyserythropoietic anaemia type II in a teenager presenting with severe anaemia Authors: Christopher Jude, Pinto.; Mohith, H N.; Ameet Vasantrao, Khatawkar.; Jana, Poornima Abstract: BACKGROUND Congenital dyserythropoietic anaemias (CDAs) are a group of hypoproliferative anaemias characterised by ineffective erythropoiesis.1–4 The most studied variety in this category is CDA type II. The prevalence data of CDA type II is unavailable due to its rarity; however, over 300 cases have been reported in literature. CDAs collectively remain mainly undiagnosed and are often mistaken for other congenital or acquired forms of anaemia.3 4 The diagnosis of CDA is often made in childhood with diagnostic workup done in lieu of reticulocyte counts disproportionate to the anaemia.1–4 CDA type II has an autosomal-recessive mode of inheritance, with congenital defects at the locus of CDAN2 impairing the coded protein SEC23B. This protein has an important role in the assembly of the midbody during cytokinesis.1 Clinical features are variable depending on the degree of ineffective erythropoiesis. Historically, CDA type II has been known by many names: familial benign erythropoietic polyploidy, haemolytic-splenomegalic- erythopolydyskaryosis and hereditary erythroblastic multinuclearity with positive acidified serum lysis test.1 3 As described by its synonyms, virtually all patients with CDA type II have pallor and hepatosplenomegaly with peripheral smear studies showing normocytic anaemia with normal to mildly raised reticulocyte counts.1–4 Diagnosing CDA type II requires a trephine biopsy, which may show binuclearity with erythrocyte hyperplasia in conjunction with laboratory tests ruling out other causes of dyserythropoiesis.1 3 CASE PRESENTATION A female patient in her mid-teens presented as a referral to our emergency department with abdominal distention, pedal oedema and easy fatiguability for the last 2 weeks. Medical history was significant for the diagnosis with β-thalassaemia intermedia when she was an infant, and has since required regular blood transfusions (six packed cell volumes per year prior to current admission). The patient reported that she missed her last four blood transfusions due to financial constraints. The patient belonged to a rural impoverished community. Medical history and laboratory data are mentioned in table 1. The patient was born to a consanguineously married couple (second degree). There was no history of recent deaths or known blood disorders within the family. The patient had a pulse rate of 84 bpm, a blood pressure of 100/60 mm Hg and a temperature of 36.1°C. On examination, the patient had facial puffiness, severe pallor, mild icterus and raised jugular venous pressure. The abdomen was distended, the liver was palpable under the right costal margin and the spleen was located midway between the xiphisternum and the pubic symphysis, and was hard in consistency. With these features of icterus, anaemia and hepatosplenomegaly, a wide differential list including extravascular haemolytic diseases and hepatitis were made. INVESTIGATIONS The patient’s profile was negative for hepatitis antigens and antibodies. Further evaluation was necessary to confirm β-thalassaemia and rule out myelodysplastic syndromes and abdominal tubercular granulomatous bleeding (endemic). The results of the laboratory investigations are as seen in table 2. Radiological investigations including a contrast CT of the abdomen showed massive splenomegaly with regenerative benign liver nodules (figure 1). The bone marrow biopsy showed numerous binucleate erythrocyte precursors (>30% of observed erythroblasts) with binucleation distinctly visualised, by two equal-sized polychromatophilic erythroblasts with equal size nuclei, under H&E stain through multiple sections. Occasional