Surinder Thakur

Scrub typhus associated acute kidney injury—a study from a tertiary care hospital from western Himalayan state of India

Abstract Objective: To report the clinical profile of acute kidney injury (AKI) associated with scrub typhus. Methods: Retrospective study of hospitalized patients of acute febrile illness who were diagnosed scrub typhus and had AKI. Results: 174 (35%) patients (75.9% female), mean age (41.4 ± 15.9 years) were studied. The laboratory abnormalities were: anemia (63.2%), leukocytosis (44.3%), thrombocytopenia (61.5%), hyponatremia (35.6%), hypernatremia (2.9%), and hypokalemia (12.1%), hyperkalemia (11.5%), hypoalbuminemia (56.9%), hepatic dysfunction (70%) and metabolic acidosis (28.7%). The complications of hypotension (5.7%), septic shock (3.4%), pneumonia (10.9%), acute respiratory distress syndrome (ARDS) (11.5%), meningoencephalitis (6.9%), encephalopathy (5.2%), gastrointestinal bleed (1.3%), myocarditis (3.4%), disseminated intravascular coagulation (2.9%) and multi organ failure (MOF) (10.3%) developed during course of hospitalization in these patients. Twenty-five (14.4%) patients required intensive care support (ICU) support and seven (4%) patients were dialyzed. 146 (83.9%) patients survived. Twenty-eight (16.1%) patients died. There was a significant difference in the age, various hematological & biochemical abnormalities, complications and need for ICU support in the non-survival group as compared the survival group. Conclusion: This study shows that AKI in scrub typhus is common and a severe disease. Age, a shorter hospital stay, severities of leukocytosis, thrombocytopenia, azotemia, hypoalbuminemia, hepatic dysfunction and the complications of ARDS, encephalopathy, MOF and need for ICU support are the factors associated with mortality.

Subclinical atherosclerotic vascular disease in chronic obstructive pulmonary disease: Prospective hospital-based case control study.

Introduction: Chronic obstructive pulmonary disease (COPD) is an important non-communicable disease worldwide with a rising global incidence. COPD is associated with multiple co-morbidities. Patients with COPD are at increased risk of atherosclerosis and other cardiovascular events. Cardiovascular diseases are an important cause of morbidity and mortality in COPD. The present case-control study was designed to assess the relationship between sub-clinical atherosclerotic vascular diseases with COPD. Methods: It was a prospective case-control blinded observational study. There were 142 COPD patients and 124 age-and sex-matched controls without COPD and cardiovascular diseases. Frequency of sub-clinical atherosclerosis was assessed by the carotid B-mode duplex ultrasonography assessment of carotid wall intima medial thickness (IMT). Plaque was defined as IMT of more than 1.2 mm. Results: Prevalence of carotid plaqing was significantly higher amongst patients of COPD (38.7%) compared to controls (13.7% , odds ratio 3.9, P < 0.0001). Multinomial logistic regression analysis revealed COPD as an independent predictor of carotid plaqing (r = 0.85, P < 0.023). Conclusion: The frequency of carotid plaqing is high in COPD patients. Carotid plaqing may be due to shared risk factors or the presence of low-grade systemic inflammation. Presence of increased CIMT and carotid plaqing in COPD patients identifies early atherosclerotic changes and future cardiovascular risk. Hence screening of CIMT should be a part of cardiovascular assessment in patients with COPD.

Prevalence of metabolic syndrome among newly diagnosed hypertensive patients in the hills of Himachal Pradesh, India.

To study the prevalence of metabolic syndrome (MS) among newly diagnosed hypertensive patients in a tertiary care hospital in the northern hilly state of Himachal Pradesh, India, located in western Himalayas at a moderate altitude of 2200 m above mean sea level. One hundred and eighteen newly diagnosed hypertensive patients above the age of 20 years were studied in a hospital-based cross-sectional study. MS prevalence was estimated by International Diabetes Federation (IDF) criteria and modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. Students t-test was used to compare the mean of the continuous variables. Chi-square test was used to compare discrete variables. The prevalence of MS in hypertensive patients was 68.6% (modified NCEP-ATP III) and 63.6% (IDF criteria). The most common phenotype of MS with the component of hypertension was the coexistence of waist circumference (90.1%), low high-density lipoprotein (HDL; 70.4%), and high triglycerides (67.9%) as per the modified NCEP-ATP III criteria, and low HDL (76.2%) and high triglycerides (66.4%) as per the IDF criteria. Fasting blood glucose (33.2% as per the modified NCEP-ATP III criteria and 32.6% as per the IDF criteria) was the least significant factor having an association with MS. The prevalence of MS among hypertensive patients was high and indicates the need for metabolic screening in all hypertensive patients at the first diagnosis.

Safety and efficacy of therapeutic membrane plasmapheresis in the treatment of Guillain-Barré syndrome: A study from a tertiary care hospital from India.

Background: Reports on therapeutic plasma exchange (TPE) with the standard hemodialysis equipment are scarce, particularly from developing countries. Materials and Methods: A retrospective analysis of safety and efficacy of membrane-based TPE with a standard hemodialysis equipment for the treatment of severe Guillain–Barré syndrome (GBS) was conducted. Results: A total of 120 TPE sessions were performed in 31 GBS patients over a period of 5½ years. Each patient underwent a mean of 3.8 ± 1.5 TPE sessions. One (3.2%) patient died. Thirty (96.8%) patients survived and recovered. At 2 weeks, there was a significant improvement in the grade of power in both the upper and lower extremities (P = 0.001) and a significant decrease in the GBS disability grade (P = 0.001). Twenty four (77.4%) patients were able to walk unaided. Complications observed were: hypotension in 12 (10%), accelerated hypertension in 3 (2.5%), chills and rigors in 5 (4.2%), bleeding in 5 (4.2%), and filter clotting in 6 (5%) sessions. One patient experienced an anaphylactoid reaction and 1 patient survived a cardiorespiratory arrest. Two patients developed aspiration pneumonia and 1 patient developed catheter site infection. Conclusions: Membrane-based TPE can be conveniently delivered with the standard hemodialysis equipment. It is a safe, effective, and comparatively less expensive treatment option for GBS.

Serum uric acid levels in hypertensive patients with and without metabolic syndrome in the hills of Himachal Pradesh, India

Introduction: The objective was to assess the prevalence of hyperuricemia among newly diagnosed hypertensive patients in a tertiary care hospital in the Northern hilly state of Himachal Pradesh, India. Materials and Methods: In all 118 newly diagnosed patients with hypertension above the age of 20 years were included. Uric acid (UA) was measured using enzymatic uricase method. Hyperuricemia was defined as serum urate level > 6.8 mg/dl. National Cholesterol Education Program-Adult Treatment Panel III criteria modified for Asian subjects, was used for defining metabolic syndrome (MS). Students t-test for mean of continuous variables and Chi-square test for proportions were used for statistical significance. Results: The mean UA level among all the hypertensive subjects was 4.7 ± 1.0 mg/dl. The mean UA of patients with MS was 5.2 ± 1.3 mg/dl while in those without MS was 4.2 ± 0.7 mg/dl. The difference in mean UA in the two groups was statistically significant (P = 0.001). The prevalence of hyperuricemia was 5%, and all the patients were postmenopausal females among the MS group. Conclusion: In this study, cross-sectional associations between hypertension, MS and hyperuricemia were observed.

Reversible MRI changes of prolonged hypoglycemia

Hypoglycemia is most commonly caused by drugs used to treat diabetes mellitus or by exposure to other drugs, including alcohol. Diverse neurologic manifestations of hypoglycemia have been reported frequently. These neurologic symptoms range from focal neurologic deficits to permanent dysfunction or death. Here, we report a case of prolonged hypoglycemia in an alcoholic who was unconscious and in whom there were reversible changes on magnetic resonance imaging.

Clinical Profile of Non-Ischemic Systolic Heart Failure

Heart failure is the end stage of all diseases of the heart and is a major cause of morbidity and mortality. Causes of the heart failure may be ischemic or nonischemic and depends on the predisposing conditions. Nonischemic heart failure is one of the underrecognised, treatable entity as a cause of heart failure in developing nations like India and other Asian subcontinents. This study is conducted in a tertiary care centre situated in Northern India.