The main aim of this study is to understand the existing knowledge gap between thyroid function tests and the severity of liver cirrhosis as measured by the Child-Pugh score. Materials and methodsThis is a cross-sectional study conducted on 100 patients diagnosed with cirrhosis of liver. Serum triiodothyronine (free T3), thyroxine (free T4), and thyroid stimulating hormone (TSH) levels were measured, and the severity of liver cirrhosis was measured by Child-Pugh score and statistical analysis were done to investigate the association of free T3, free T4 and TSH levels with Child-A, Child-B, and Child-C severity groups. ResultsThe results revealed that there is a statistically significant positive correlation between TSH levels and Child-Pugh score, whereas a statistically significant negative correlation was associated between free T3 (fT3), free T4 (fT4) levels, and Child-Pugh Score. Further, we also observed that the Child-C group has 7.5fold risk of increased TSH levels (odds ratio {OR} = 7.553, 95% CI = 2.869-19.883, p = 0.000), has 5-fold risk of decreased fT3 levels (OR = 5.023, 95% CI = 1.369-18.431, p = 0.009) and has 6.4-fold risk of decreased fT4 levels (OR = 6.402, 95% CI = 2.516-16.290, p = 0.000). ConclusionOur results demonstrated that there is a positive and direct correlation associated between increasing TSH with severity of liver cirrhosis as measured by Child-Pugh score, whereas a negative and inverse correlation was observed between decreasing fT3 and fT4 levels with the severity of liver cirrhosis as measured by Child-Pugh score. This suggests that the Child-Pugh score can be used as a prognostic indicator in cirrhotic patients.
Aims and Objectives: To study the profile of blood stream infections with Candida species, their current epidemiological trend at our setting, clinical management, resistance trends and outcome in terms of mortality. Methods: This is a prospective observational study conducted among all adult in-patients, at AIMS, Kochi from August 1st 2014 to February 28th 2016, both in wards and ICUs, who have positive isolates of Candida species in bloodstream infection among the positive blood culture samples. Incidence rate of Candidemia was calculated and distribution of Candidemia with respect to characteristics like age, gender, comorbid illness, mechanical ventilation, prior antibiotic therapy, prolonged ICU stay. Results: Out of 1600 blood stream infection isolates, Candidemia was fourth most common blood stream isolate infection in our study with an incidence rate of 7.5%. Candida tropicalis was the predominant species in our study (30.8%). Mortality rate due to Candidemia was (61%). Urethral catheterization, Central venous access, neutropenia at presentation, prior antibiotic therapy, renal failure, Dialysis patients, prolonged ICU stay were some of the risk factors found to be statistically significant in assessing the mortality of patients in our study with a p value of <0.001. Conclusion: All patients with Candidemia should be treated with an antifungal agent at the earliest without any delay, as delay causes increase in mortality. All vascular catheters should be removed to help clear Candida from blood more quickly. Improved survival was found with the use of an Echinocandin and the removal of central venous catheters.
We present a case of hemophagocytic lymphocytosis (HLH) that occurred secondary to a combination of Epstein Barr virus (EBV) infection and systemic lupus erythematosus (SLE) in early pregnancy. A 29-years-old lady presented with complaints of fever, vomiting and loose stools. She underwent successful in-vitro fertilization (IVF) and embryo transfer 20 days prior to the onset of these symptoms. Her blood investigations revealed anemia, neutropenia, hyperferritinemia and hypertriglyceridemia, eventually resulting in a diagnosis of HLH further substantiated by bone marrow examination. Additional investigations revealed positive anti-dsDNA and EBV IgM antibodies amongst other findings, adding SLE and EBV to the diagnoses. They were considered potential triggers for HLH. However, the occurrence of these events following IVF poses the question of whether pregnancy played a role in the development of HLH. Our patient responded well to pulse steroid therapy and has had an uneventful course till date.
Aims and Objectives: To look for mortality predictors of Leptospirosis, with specific importance given to oliguric renal failure and hypotension as possible predictors. Materials and Methods: A Prospective Cohort study conducted over two years which enrolled patients with clinically and serologically confirmed Leptospirosis. Of these, 30 patients were included who had hypotension and 30 patients who had oliguric renal failure, as per statistical requirements. Epidemiological, clinical, and laboratory data was collected at admission and the patients were followed up to look for outcome (discharge/death). Results: A total of 83 patients were included in this study. Of these 8 patients died (Mortality of 9.6%). Data analysis with Chi Square Test showed that oliguric renal failure was significantly associated with mortality in Leptospirosis (p<0.05). Other factors were also found which were associated with mortality including elevated bilirubin and AST levels, anemia, Type 2 Diabetes Mellitus, Alcohol Dependence Syndrome, and Chronic Liver Disease. However, hypotension was found to not be significantly associated with mortality. Conclusion: In patients with Leptospirosis, significant mortality predictors included oliguric renal failure, elevated bilirubin and AST levels, anemia, Type
Background There is a high prevalence of left ventricular diastolic dysfunction (LVDD) in patients with type 2 diabetes mellitus (T2DM). The influencing factors of LVDD in T2DM are not fully understood. Objective This study aimed at assessing the prevalence of LVDD in T2DM as well as looking at the association between various parameters related to T2DM with LVDD in patients with T2DM. Materials and methods This was a single-centre cross-sectional study in Kerala, India. The primary objective of the study was to assess the prevalence of LVDD in T2DM. The secondary objectives were to look for an association between higher glycated haemoglobin (HbA1c), complications of T2DM, age, and gender of the patient with the presence of LVDD. Results A total of 80 patients were included in the study. There were 40 patients with LVDD with a prevalence of 50%. There was a statistically significant positive association between increased age, longer duration of diabetes, higher HbA1C, the presence of diabetic neuropathy, diabetic retinopathy, and diabetic nephropathy with the prevalence of LVDD. A logistic regression analysis demonstrated that the presence of diabetic retinopathy is a risk factor for LVDD in the study subjects.
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