Js Saini

PREVALENCE OF MICROALBUMINURIA IN NON-INSULIN-DEPENDENT DIABETES MELLITUS

The prevalence of microalbuminuria was assessed in 50 patients of non-insulin dependent diabetes mellitus. The mean age of patients was 52.1 ± 11.6 years and the duration of diabetes was 8.3 ± 6.8 years. Twenty (40%) patients had microalbuminuria. Microalbuminuria was more common in patients with a longer duration of diabetes (more than 5 years), a poor glycaemic control, and higher systolic blood pressure.

Multiparametric imaging-based differentiation of lymphoma and glioblastoma: using T1-perfusion, diffusion, and susceptibility-weighted MRI

AIM To compare the diagnostic performance of T1 perfusion magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and susceptibility-weighted imaging (SWI) for differentiating primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM). MATERIALS AND METHODS This retrospective study comprised a cohort of 70 patients with glioblastoma and 30 patients with PCNSL. T1 perfusion MRI-derived rCBV_corr (leakage corrected relative cerebral blood volume), apparent diffusion coefficient (ADC) derived from DWI, and intratumoural susceptibility signals intensity (ITSS) measured on SWI were evaluated in these 100 patients. The Mann-Whitney U-test was used for pairwise comparison between groups. The diagnostic performance for differentiating PCNSL from glioblastoma was evaluated by using univariate and multivariable logistic regression analyses and receiver operating characteristic (ROC) analysis. RESULTS Minimum ADC, maximum rCBVs_corr, kep (back flux exchange rate), and ITSS scores were significantly lower in patients with PCNSL than in those with glioblastoma (p<0.05). On ROC analysis, ITSS showed the best discrimination ability for differentiation of GBM and PCNSL with an area under the ROC curve (AUC) of 0.80. rCBV_corr and ADC showed AUCs of 0.68 and 0.63, respectively. Multiparametric assessment using ADC, rCBV_corr, kep, and ITSS scores significantly increased the diagnostic ability for differentiating PCNSL from GBM as compared to mean ADC, mean rCBV_corr, and ITSS alone or a combination of these parameters. The multiparametric model could correctly discriminate 84% of tumours with a sensitivity and specificity of 90% and 70% with an AUC of 0.92. CONCLUSION Multiparametric MRI evaluation using DWI, T1 perfusion MRI, and SWI enabled reliable differentiation of PCNSL and GBM in the majority patients, and these results support an integration of advanced MRI techniques for the diagnostic work-up of patients with these tumours.

UPPER GASTROINTESTINAL MUCOSA IN CHRONIC RENAL FAILURE – AN ENDOSCOPIC AND HISTOLOGICAL EVALUATION

Over a three year period, 98 patients of moderate to severe chronic renal failure (S creatinine > 5 mg/dl) admitted in our centre were evaluated for upper GI lesions. All patients underwent upper GI endoscopy. In 68% upper GI mucosa was affected. Various lesions encountered were gastritis (25.5%), duodenitis (10.2%), gastroduodenitis (21.4%), telengiectasia (5.1%), and peptic ulcer in 6.1%. In 74 patients three biopsies, one each from antrum, fundus and duodenum were taken. 45.9% of these had chronic gastritis and 14.8% chronic duodenitis. Prevalence of H pylori on histology was 17.56%. 20 patients (9.6%) developed upper GI bleed during hospitalisation. In 17 (85%) patients, where endoscopy could be done, gastritis/duodenitis/oesophagitis were the common underlying lesions.

ATRIAL FIBRILLATION IN THYROTOXICOSIS

dissociation with interference-lsorrhythmic arrhythmia AVdissociation occurs when atriaand ventricleare undercontrol ofseparate pacemakers[I]. The atria is under control ofeither sinus node, ectopic atrinJ or AVjunctional rhythm. Incomplete AV dissociation is indicated when a single pacemaker establishes control of both atria and ventricle for eitherone beat (capture) or series ofbeats (sinus rhythm, AVjunctional rhythm with retrograde atrial capture [2]. Our ECG reveals both the mechanism. AV dissociation can occur by slowing ofdominant pacemaker, acceleration of latent pacemaker, complete AV blocks and combination ofabove[2]. In our case it was due to combination ofslowing of dominant pacemaker (second strip) and acceleration of latent

SONOGRAPHY : A VALUABLE MODALITY IN EVALUATION OF CHRONIC NON-TRAUMATIC DISORDERS OF THE SHOULDER JOINT

Chronic non-traumatic shoulder pain may be due to arthralgia, shoulder myalgia, glenohumeral synovitis, adhesive capsulitis, or degenerative joint disease. Clinical skills and routine radiography may not be adequate to establish the diagnosis. This study was designed to assess the role of sonography in such a setting. Twenty-six consecutive patients attending the clinical immunology outpatient department for chronic shoulder pain were evaluated. Based on our findings, we have described 4 distinct sonographic patterns. Pattern 1 consisted of the normal sonographic appearance with semicircular smooth humeral head profile parallel to which was an echo-free synovial space measuring 1-2 mm. This pattern indicated shoulder arthralgia or myalgia without intrinsic shoulder joint disease. Pattern 2 consisted of reduction in the echo-free space indicative of adhesive capsulitis. Pattern 3 consisted of uniform increase in this space, thus indicating active synovial inflammation with effusion. Pattern 4 showed irregularity of the humeral head with reduction in the gleno-humeral joint space and loss of parallelism between the humeral head and the surrounding gleno-humeral synovial space. This last pattern indicated advanced deformed inflammatory or degenerative arthritis. It is concluded that these 4 sonographic patterns will be of considerable help in pinpointing the diagnosis in cases of chronic non-trumatic shoulder pain.

OUR EXPERIENCE WITH LASER PHOTOCOAGULATION IN DIABETIC MACULAR OEDEMA

Diabetic macular oedema, focal or diffuse, is primarily responsible for visual loss in cases of diabetic retinopathy. When to start photocoagulation in such cases has often been debatable. Over a 3 year period, 80 eyes of 80 patients were subjected to argon green macular grid photocoagulation in a randomized clinical study keeping the other eye (80 eyes) as controls in patients with diabetic macular oedema. It was observed that in 5 per cent of such eyes the vision did improve while in 6.3 per cent of patients deterioration of vision was present as compared to 16.3 per cent in control group. It is concluded that laser photocoagulation has a definite role in arresting the progression of diabetic maculopathy and early intervention should be resorted to in case of clinically significant macular oedema.

SPECTRUM OF ACUTE RENAL FAILURE IN A SERVICE HOSPITAL

A prospective study of 82 patients with acute renal failure was carried out over the last 2 years. Mean age of the patients was 35.6 years (8-82 years). Male to female ratio was 3.5:1. The etiological factors were septicaemia in 18 patients (21.95%), aminoglycoside toxicity in 16 patients (19.51%), open heart surgery in 8 patients (9.76%), volume depletion and blood loss in 12 patients (14.63%), glomerulonephritis in 4 patients (4.88%), renal allograft dysfunction in 4 patients (4.88%), and miscellaneous causes in 20 patients (24.39%). Non-oliguric renal failure was observed in 39.02 per cent cases. Dialysis support was required in 65.8 per cent of the cases; with average 5.6 (4 to 11) dialysis sessions. Four patients of acute renal failure following open heart surgery were given continuous arterio-venous haemofiltration. Overall mortality was 32.5 per cent, septicaemia accounting for 60 per cent of the deaths.

AIDS AWARENESS IN PATIENTS ATTENDING THE MEDICAL OUTPATIENT DEPARTMENT OF A PUNE HOSPITAL

A bilingual questionnaire was administered to 400 out-patients to assess their acquired immunodeficiency syndrome (AIDS) awareness. Results were analyzed and three scores, namely educational score (%ES), media score (%MS) and AIDS awareness score (%AAS) were devised to give per cent values to these parameters. Only 49 per cent of the males and 26 per cent of the females had studied beyond Class 10. As many as 103 (25.8%) subjects had never heard of AIDS. The remaining 297 patients knew a fair amount but misconceptions were very common. The %AAS was over 80 per cent in students and in civil servants, around 70 per cent in government servants and business persons and around 60 per cent in house wives. It was higher in those from urban backgrounds and in males. The education and media scores of those ignorant of AIDS were poor compared to those aware of AIDS. Risk factors for ignorance were poor educational levels, low exposure to public media and female gender. A very basic take-off level is therefore required when physicians discuss AIDS related issues with their patients.

CARBOHYDRATE METABOLIC DISTURBANCES IN HYPERTHYROIDISM

Twenty five hyperthyroid patients and 25 healthy volunteers were evaluated for carbohydrate metabolic disturbance with an oral glucose tolerance test and glycosylated haemoglobin percentage. Insulin secretory response was studied in 17 hyperthyroids and 10 controls. A varying degree of abnormality was noted in hyperthyroids. Forty per cent patients had a significantly higher glycosylated haemoglobin and 3 (12%) patients had impaired glucose tolerance and 1 (4%) patient had frank diabetes mellitus. Significant hyperinsulinism was seen in the hyperthyroid group. Our data suggests that carbohydrate metabolic aberration exists in hyperthyroids and may reflect insulin resistance.

THYROID HORMONES IN NON-INSULIN-DEPENDENT DIABETES BEFORE AND AFTER THERAPY

Twenty patients of non-insulin-dependent diabetes mellitus (NIDDM) (15 males and 5 females) who developed secondary failure to oral hypoglycaemic drugs, were evaluated for thyroid hormone abnormalities before and after control of diabetic state with insulin. Blood glucose (mean ± SEM mg/dL) fasting and post prandial levels were 260±16 and 370±20 respectively before therapy. After 15 days of intensive insulin therapy these levels fell to 110±14 and 130±12 respectively (p < 0.005). Glycosylated haemoglobin percent (GHb%) (mean ± SEM) was 10±0.4 before therapy and after therapy it fell to 9.2±0.3 (p < 0.05). Serum tri-iodothyronine levels (mean ± SEM ng/mL) were 0.55±0.03 which was significantly lower (p < 0.05) as compared controls. After therapy it significantly (p < 0.05) rose to 1.22±0.08). Serum thyroxine (T4) (mean ± SEM mcg/dL) was 8.5±0.6 before therapy and it did not change significantly after therapy. Serum reverse tri-iodothyronine (rT3) values of (mean ± SEM ng/dl) 0.24±0.05 were higher before therapy and decreased to 0.20±0.82 after therapy. However thyrotropin (TSH) values before and after therapy remained same. There was no significant change in TSH response to thyrotropin releasing hormone (TRH) before and after control of diabetic state. It was concluded that peripheral changes in T3, T4 and rT3 (low T3, high rT3 and low or normal T4) occurred in uncontrolled diabetic state. However, pituitary thyrotroph function in NIDDM with ideal body weight was not significantly affected.