Veer Bahadur Singh

Serum uric acid level as a determinant of the metabolic syndrome: A case control study.

AIMS To determine whether elevations of uric acid levels are associated with the cluster of disorders described in metabolic syndrome and to evaluate whether hyperuricemia may be considered a component of this syndrome. METHODS One year case-control study was conducted in Bikaner, Rajasthan, India from January to December 2013. The study population consisted of 200 subjects, 100 with metabolic syndrome (case) and 100 without metabolic syndrome (control) aged between 18 and 80 years, attending OPD at PBM Hospital were studied. Controls were age and sex matched to the cases. Blood tests and all physical variables were examined using standard methods. Subjects were divided into 6 groups according to their possession of 0, 1, 2, 3, 4 or 5 components of the metabolic syndrome. Statistical analysis was done using ANOVA, linear regression analysis and multivariate linear regression model. RESULTS Mean serum UA level was significantly associated with all components of metabolic syndrome (p<0.001) and had strong positive correlation (r=+0.66 to +0.77, p<0.0001) with all of them except serum HDL with which it showed strong negative correlation(r=-0.71, p<0.0001). It increased as the number of metabolic factors increased showing a highly significant trend (p<0.0001). On multivariate regression analysis UA contributed to 66.84% variance of metabolic syndrome. CONCLUSION The current multivariate regression analysis clearly infers that uric acid can be considered as a marker and potential modifier of metabolic syndrome.

Mean paltelet volume (MPV) the neglected marker of cardiovascular risk and glycosylated hemoglobin in diabetic patient.

INTRODUCTION Platelets activation and aggregation play fundamental role in thrombotic events in diabetes. MPV marker of platelet activity determines this cardiovascular risk. So by using simple parameter like MPV we can indirectly assess vascular complication in diabetic patient in periphery. AIMS AND OBJECTIVES Determining MPV of both T1DM and T2DM with their controls and Relation between HbA1C and MPV in Diabetes Mellitus (DM). METHODOLOGY This cross-sectional study was conducted in department of medicine, SPMC Bikaner from June 2014 - December 2014, included 100 patients attending medical outdoor and 100 healthy matched controls. Diabetics were divided into 3 GROUPS: HbA1c <6.5%, >6.5 but =< 8% and >8%. Groups were compared with regards to MPV and HbA1c. RESULTS MPV was found significantly higher in both T1DM and T2DM compare to control groups (9.606±1.03 and 8.968±1.23 vs 7.85±0.680, p=0.0001). The mean age of diabetic groups were 40.50±5.08 years, 42.26±6.42 years and 44.56±8.25 respectively The mean MPV among diabetic groups were 8.18±0.99, 9.08±1.01, 9.54±1.268 respectively. On statistical comparison the difference was significant (p value-0.001).we also statistically significant difference on comparing HbA1C and MPV in T1DM and T2DM with p=0.006 r- 0.4968 and p=0.013 and r- 0.316 respectively. CONCLUSION This shows that the MPV is significantly higher in patients with high HbA1C levels. Key Words: Glycosylated hemoglobin (HbA1c), Mean platelet volume (MPV).

Paraquat Poisoning: A Case Report

Paraquat is commonly used herbicide by farmers in North West Rajasthan. Despite its easy availability, poisoning of its not common. Fatal dose of paraquat is so small that >10 ml poison can damage lungs permanently. Diagnosis is often difficult without proper history, absence of specific clinical feature and lack of diagnostic test. Inhalation exposures represent one of the most important routes of poisoning. We are reporting a case of inhaled paraquat poisoning with complication of irreversible acute kidney, liver and lung injury.

Seroprevalence of transfusion transmitted infections among blood donors at a Tertiary Care Hospital Blood Bank in North India

Background: Blood transfusion service is a sensitive issue as it is covered by “Drug and Cosmetics Act” and has legal implications. Strict criteria are followed while selecting a donor so that proper blood free of all pathogens is available for recipient. Aim: To study seroprevalence of transfusion-transmitted major infections (HIV, hepatitis B virus [HBV], hepatitis C virus [HCV], syphilis, and malaria) among blood donors at a Tertiary Care Government Hospital Blood Bank in North India and to compare positivity of markers of these infections in voluntary and replacement donors. Subjects and Methods: This study was conducted over a period of 5 years (July 2010–June 2015). A total number of donors screened during this period was 130,920. Samples were tested for HIV, HBV, HCV, syphilis, and malaria and retested if found positive by third generation ELISA tests (HIV, hepatitis B surface antigen [HBsAg], HCV). Comparative analysis was done using Chi-square for linear trend. Comparison between prevalence rates among voluntary and replacement donors was done using Chi-square tests using Microsoft Excel 2007 software. Results: Of total 130,920 donors, 114,214 (87%) were voluntary and 16,706 (13%) were replacement donors. Male donors predominated, 128,781 (98.37%) male and female 2139 (1.63%). Average seropositivity of HIV, HBsAg, anti-HCV, syphilis, and malaria was 0.10%, 1.60%, 0.18%, 0.89%, and 0.04% among all donors. Significant difference (P < 0.001) in the seropositivity of HIV, HBsAg, HCV, and syphilis was seen between voluntary and replacement donors. Seroprevalence of HIV, HBsAg, HCV, syphilis, and malaria was 0.08%, 1.56%, 0.13%, 0.71%, 0.03%, and 0.25%, 1.90% 0.51%, 2.12%, and 0.04% in voluntary blood donor and replacement blood donor, respectively. Conclusion: Comparing a retrospective data over a long period showed decreasing trend in seroprevalence of HIV, HBsAg, anti-HCV, syphilis, and malaria. Results of the study reflect the prevalence of these infections in the healthy population and warrant measures that should be taken to detect these infections and prevent transmission.

Pulmonary cryptosporidiosis in an immunocompetent host treated successfully with nitazoxanide.

Cryptosporidium parvum is an intracellular spore-forming protozoa which predominantly causes intestinal diseases. It causes severe and life-threatening diarrheal diseases in immunocompromised hosts and usually self-limiting disease in immunocompetent hosts. Extra-intestinal manifestations of cryptosporidium infection are very rare. Herein, we report a case of pulmonary cryptosporidiosis in a 35-yrs-old immunocompetent host, who presented with fever, cough and breathlessness which was soon followed by diarrhea and vomiting, had lung consolidation, and treated successfully with nitazoxanide.

Clinical profile of thyroid dysfunction in elderly: An overview

Aim and Objective: To study the presentation and clinical profile of thyroid disorder in elders in the North-West Rajasthan. Subjects and Methods: This study was carried out on 553 elderly patients in the Department of Medicine, S P Medical College, Bikaner, North-Western Rajasthan. All patients above 60 years were included. Clinical examination was done for detection of thyroid disorders and, keep in mind, the sign and symptoms of hypothyroidism and hyperthyroidism. Recently, a new immunoassay methodology has been applied to the measurement of thyroid stimulating hormone (TSH)/T3/T4 level. The analysis was undertaken using SPSS (version 10). Chi-square test was used to examine the association and trends for categorical. Results: There were 456 cases in the age group 60-71 years. 71-80 and >80 years patients were in numbers of 57 and 20, respectively. Prevalence of hyperthyroidism, euthyroidism, and hypothyroidism according to age was 5.9%, 80.9%, and 13.2%, respectively. When we compared TSH with age, no statistically difference was found (χ2 = 9.366, df = 4; P = 0.05). Of 456 cases, 27 (5.9%) were in decrease level, 359 (80.9%) were within normal range, and 60 (13.2%) cases were having increasing pattern of TSH. Around 8 (4.8%) females having decrease level, 135 (81.8%) were having within normal range of TSH, 22 (13.3%) females having increase level. Around 24 (6.5%) male having decrease level while 40 (10.9%) were having increase level of TSH. Weakness is the most common symptoms of thyroid dysfunction. A highly significant difference was found in weakness, feeling cold, constipation, palpitation, and diarrhea (P < 0.001) while significant difference was found in menstrual irregularity, hoarseness of voice, and irritability (P < 0.01). Conclusion: The current study aimed at spectrum of various clinical aspects in the elderly population that differs from typical presentation. As the age advances, the incidence of thyroid disorders increases. Hypothyroidism was more common than hyperthyroidism. Hence, we recommended that more study required knowing clinical presentation of thyroid disorder in elderly populations.

Neuropsychiatric Profile in Malaria: An Overview.

INTRODUCTION Malaria is the most important parasitic disease of humans causes clinical illness over 300-500 million people globally and over one million death every year globally. The involvement of the nervous system in malaria is studied in this paper, to help formulate a strategy for better malaria management. AIM To study the Neuropsychiatric manifestation in malaria. MATERIALS AND METHODS This was a prospective observational study in 170 patients with a clinical diagnosis of malaria admitted in various medical wards of medicine department of PBM Hospital, Bikaner during epidemic of malaria. It included both sexes of all age groups except the paediatric range. The diagnosis of malaria was confirmed by examination of thick and thin smear/optimal test/strip test. Only those cases that had asexual form of parasite of malaria in the blood by smear examination or optimal test were included in the study. RESULTS Out of total 170 patients 104 (62%) reported Plasmodium falciparum (PF), Plasmodium vivax (PV) were 57 (33.5%) followed by mixed (PF+PV) 9 (5.3%) cases. The total PBF-MP test positivity was 84.5%. Maximum patients were belonging to the age range of 21-40 year with male predominance. Neuropsychiatric manifestation seen in falciparum malaria (n=111) as follow: altered consciousness 20 (18.01%), headache 17 (15.32%), neck rigidity 5 (4.5%), convulsion 5 (4.55%), extra pyramidal rigidity 2 (1.8%), decorticate rigidity 1 (0.90%), decerebrate rigidity 1 (0.90%), cerebellar ataxia 3 (2.7%), subarachnoid haemorrhage 1 (0.90%), aphasia 2 (1.8%), subconjunctival haemorrhage 1 (0.90%), conjugate deviation of eye 1 (0.90%) and psychosis 6 (5.40%). Twenty one patients presented with cerebral malaria out of 111 patients. Most patients of cerebral malaria presented with altered level of consciousness followed by headache and psychosis. Acute confusional state with clouding of consciousness was the most common presentation of psychosis (50%). CONCLUSION Neuropsychiatric manifestations are not an uncommon presentation of malaria. Most commonly caused by PF malaria. Malaria should be thought as a differential diagnosis in pyrexia with neuropsychiatric manifestation. Observation obtained in the study will be highly useful for the diagnosis and management of patients suffering from malaria.

Multiple splenic infarctions with a rare etiology

Malaria is the most common parasitic infection in tropical countries such as India, and it causing a major economic burden on the Asian and African countries. Splenic complication is common in Plasmodium falciparum infection, but splenic infarction itself is a rare clinical entity in P. falciparum infection. Herein, we are presenting a case report of an 18-year-old male patient who presented to the department of medicine with a complaint of pain abdomen. On the next day of admission, the patient had complained of fever with chills and rigor. Routine blood investigations including peripheral smear examination for malarial parasites were sent. Contrast-enhanced computed tomography (CECT) of the abdomen was performed to diagnose the cause of abdominal pain after the findings of infarction in ultrasonography. CECT showed multiple infarctions of spleen and peripheral blood film showed ring forms of P. falciparum. Hence, we should always rule out splenic complication in cases of malaria which present with fever and left hypochondrium pain.

Asymptomatic HIV positive patient presenting with myelopathy

A wide variety of disorders of diverse pathogenic mechanisms can trigger spinal cord dysfunction in HIV-1-infected patients. The most common such condition is HIV-1-associated myelopathy (HAM) which characteristically seen during advanced HIV infection in patients with low CD4 cell counts and previous AIDS-defining diagnoses. Histologically seen in approximately 30% of AIDS patients, but only 10% have clinical symptoms related to the disease. We describe an unusual case of HAM in previously asymptomatic patient with relatively low CD4 cell count (78 cells/mm3). The patient unaware of her seropositive status presented with a clinically slowly progressive myelopathy with difficulty in walking without assistance. We discharged a patient on antiretroviral therapy. We also review the disorders reported to derange spinal cord function in previously asymptomatic HIV-1 infected patients with preserved counts.

Multiple splenic abscesses

Splenic abscess is a rare clinical entity with poor prognosis. But owing to imaging technique, diagnosis and prognosis have improved nowadays. Most patients who are presented with splenic abscess are immunocompromised due to predisposing risk factors like diabetes mellitus, intravenous drug abuse, trauma, bacterial endocarditis, human immunodeficiency virus (HIV), chemotherapy, or steroids. Here, we are presenting a rarer case of multiple splenic abscesses with its complication in an immunocompetent healthy adult male without any risk factor.