Archive for the ‘ Medicine ’ Category

 Abstract  : Background;Malaria is of immense importance among tropical diseases in India. Pathophysiology of complicated   malaria is multifactorial in origin involving  tissue hypoxia, liver dysfunction, and impaired renal handling of bicarbonate. Acidosis is an important contributor to death from severe falciparum malaria. Metabolic acidosis results from abnormal microcirculatory perfusion and anaerobic glycolysis as a result of sequestration of parasitized erythrocytes and, also, cellular dysfunction consequent on release of host and parasite-derived toxic mediators.Material and methods:The study was conducted at Victoria and Bowring & lady Curzon hospitals, attached to Bangalore medical college & research institute, Bangalore. A total of 40 patients with complicated malaria with respect to serum lactate levels measured serially every 24hours were studied.Results:During our study, 24 out of 40 patients had lactate levels >19.8mg/dl. Out of these 24 patients,10 were given blood transfusion,3 were given platelet transfusion,9 were given inotropic support and 2 were dialysed as compared to patients with normal lactate levels who were 4,1,2 and 0 respectively; implying the fact that the incidence of complications are high in patients with hyperlactatemia. Also, 3 patients died during the study; all of them were from increasing levels  of lactate levels on day 3 when compared to levels at the time of admission.

COMPLEMENT C 3 LEVELS IN METABOLIC SYNDROME ASHOK.M.L* , PRASHANTH. V.N** , HEMANTH KUMAR***

ABSTRACT   

Background: The metabolic syndrome consists of constellation of central obesity, hyperglycemia, hypertension, hypertriglyceridemia and low HDL cholesterol. Elevated serum Complement C3 levels independently predicted incident type 2 diabetes and increased cardiovascular risk in prospective studies in apparently healthy men and women.

ABSTRACT  Background: Diabetic nephropathy is the single most frequent cause of end stage renal disease. GFR is the best index of renal function in health and disease. Its direct measurement with inulin or EDTA requires specialized technical personnel. Properties of an ideal endogenous blood substance to estimate GFR should include release into blood stream at constant rate and free filtration by glomerulus. Serum Creatinine is the most commonly used filtration marker in clinical practice but its accuracy is significantly hampered by the confounding influence of diet, age, gender and muscle mass. Microalbuminuria is first detectable functional abnormality, but there is 40% day to day variability. Several factors can increase urinary albumin like exercise, UTI, CCF. Cystatin C is s 13kDa protein expressed in all nucleated cells and produced at constant rate. It is freely filtered by glomerulus. It does not return to blood stream and is not secreted by renal tubules. It has been suggested to be “ideal” endogenous marker.

ABSTRACT Background: Tuberculosis (TB) remains a major health problem across the world and commonly involves the lungs. Analysis of adenosine deaminase activity is a very useful diagnostic approach to achieve a more rapid and precise diagnosis in serosal fluids and serum of pulmonary tuberculosis.  Objectives: To estimate the serum adenosine deaminase (ADA) levels in pulmonary tuberculosis and other common respiratory diseases & to evaluate the role of serum ADA estimation in differentiation of tubercular and common non tubercular respiratory diseases. Methods:  The study was a hospital based, non randomized comparative study conducted at Kempegowda Institute of Medical Sciences, Bangalore and DOT centres of RNTCP, BBMP, Bangalore.                                        We measured serum adenosine deaminase levels in 3 groups, group Ι: 41 cases of pulmonary tuberculosis, group ΙΙ: 30 cases of tubercular pleural effusion, group ΙΙΙ: 49 cases of non tubercular respiratory diseases viz, bronchiectasis, chronic bronchitis in the age group of 20 – 64 years over a period of one year. Age and sex matched 30 healthy volunteers, were taken as controls. Estimation of serum ADA was done by sensitive colorimetric method described by Giusti and Galanti m Results: Mean serum ADA levels in cases of pulmonary tuberculosis (50.93 ± 9.22 U/L), tubercular pleural effusion (42.48 ± 8.2 U/L), non tubercular respiratory diseases (21.03±3.64 U/L) were significantly more than controls (17.07±2.71U/L). But the mean serum ADA value between  pulmonary  tuberculosis and non tubercular respiratory diseases shows higher significant mean difference and was  statistically significant with a p value < 0.01. The mean difference of serum ADA levels between the tubercular pleural effusion and non tubercular respiratory diseases was also statistical significant with a p value < 0.01. Conclusion: We conclude that elevated serum ADA level in pulmonary tuberculosis is statistically significant compared to non tubercular respiratory diseases and healthy controls.

ABSTRACT BACKGROUND: Pneumonia is a common cause for hospital admissions and in-hospital mortality. Mortality in pneumonia is accelerated in the presence of co-morbid conditions. Diabetes mellitus being the most common co-morbid condition due to its high prevalence, we studied the effect of diabetes on the clinical profile of pneumonia in comparison with those without pneumonia. METHODS: We randomly selected 60 patients of pneumonia over a period of 1 year  among whom, 30 were diabetics and 30 were non-diabetics. A thorough clinical history and examination was carried out. Laboratory investigations including, microbiological, radiological, haematological investigations were carried out. Patients were followed up until their hospital stay (death or discharge). Results were analysed and compared between diabetic and non diabetic group with reference to age, sex, underlying concomitant disease, clinical features, complications, organisms, PSI scoring and mortality. Clinical data was compared with the observations of various other workers RESULTS: Poly-microbial etiology (20%), multi-lobe involvement (66.7%), complications, duration of hospital stay (12.30±4 vs 9.10±5.24 days) and PSI score was significantly higher among diabetics compared with non-diabetics. There was not statistical significant difference in mortality between diabetics (23.3%) and non diabetics (10%). Mortality in diabetics was more common in patients with age > 60yrs. Complications were more common in diabetic group like pleural effusion (6.7%), septic shock (20%), MODS, renal failure, VF (3.3% each) and cardiac arrest (6.7%). No relation was found with sex, duration of hospital stay, bacteremia, pleural effusion, signs of consolidation with mortality. CONCLUSION: In patients with pneumonia, Diabetes Mellitus is associated with poor prognosis, polymicrobial etiology, multilobe involvement, increased ICU admissions, increased severity in the form of high PSI score and mortality. This study suggests that this adverse outcome is more attributable to the underlying circumstances of patients than to uncommon microbiological findings. Certainly age, prior co morbidities as well as multilobe infiltrates have already been related to poor prognosis; however, in this study, diabetes also remained a significant prognostic factor of mortality in patients with pneumonia.

PROFILE OF POISONING IN A TERTIARY CARE HOSPITAL – Srinivasa V,Kavya S.T,Madhumathi R, Amogh Dudhwewala

ABSTRACT Aims – The aim of this prospective study was to analyze the rate and characteristics of acute poisoning cases admitted to adult intensive care unit (ICU).We report the socio-demographic, laboratory, and clinical features of cases, mortality rate, and the results of our treatment modalities.Methods – The study was done in patients admitted with history of poisoning in the department of medicine at Victoria Hospital, Bengaluru from January 2011 to December 2011.This study includes 81 consecutive poisoning Patient who were admitted to ICU care. Detailed history and clinical examination were done in all patients. Ventilator support was given to required patient.Results – Most of the cases were organophosphorus compound poisoning(n=61, 71.3%). Others had consumed drugs which included analgesics, amitryptilne,decongestants, antihypertensives, benzodiazepines.3 had consumed aluminium phosphide and all 3 of them died. The most common indication for mechanical ventilation was respiratory failure which mainly consisted of OP poisoning.Conclusion – Pesticides were the major cause of poisoning(80.2%), the reasons being agriculture based economic, poverty and easy availability of highly toxic pesticides.The poisoning related mortality could be decreased by improving ICU condition and appropriate supportive care.