Background: One major problem encountered in the intensive care unit is differentiating the inflammatory response from an infective process. Clinical and standard laboratory tests are not very helpful because most critically ill patients develop some degree of inflammatory response, whether or not they have sepsis. Numerous biomarkers have been evaluated to predict mortality in critically ill patients, although none have proved entirely useful. Objective of the study was to evaluate eosinophil count and neutrophil-lymphocyte count ratio with C-reactive protein levels in patients with sepsis.Methods: 71 patients >18 years of age of either sex with a diagnosis of sepsis were enrolled in this one-year observational study. Patients were classified according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine into sepsis group (n=50) and no sepsis group (n=21). Sepsis group were further divided into subgroups: sepsis (n=19), severe sepsis (n=16) and septic shock (n=15). Absolute eosinophil cell, neutrophil and lymphocyte counts for first 4 consecutive days and then on alternate days up to one week were also noted down. C-reactive protein levels on day 3 were also noted down.Results: In the sepsis group, mean eosinophil count was significantly (p<0.0001) low, mean neutrophil/lymphocyte count ratio was significantly (p<0.0001) high, mean CRP count was significantly (p=0.019) more as compared to that of no sepsis group. Among 16 mortalities, significant (p<0.05) decrease was noted in mean eosinophil count from day 3 onwards in patients of sepsis and septic shock subgroups. Mean N/L ratio showed no significant difference in patients of sepsis, severe sepsis or septic shock. Mean CRP count showed significant (p<0.05) increase in severe sepsis patients and mean Apache II score showed significant (p<0.05) deterioration in patients of septic shock.Conclusions: Neutrophil/lymphocyte count ratio (NLCR) and absolute eosinophil count (AEC) came out as better independent biomarker of sepsis in critically ill patients with infection admitted in intensive care unit. Diagnostic performance was better in these two diagnostic markers as compared to CRP marker. NLCR presented with sensitivity of 89.58%, AEC with 82.35% and CRP with 80.77%. Outcomes of NLCR and AEC were quick, easy and economical in establishing diagnosis of sepsis.
Background: Over the past decade, vitamin D is more known as a hormone because of its extra - skeletal outcomes in various disease conditions, including diabetes. Most cells, including the pancreatic β-cells, contain the vitamin D receptor and they also have the capability to produce the biologically active 1,25-dihydroxyvitamin D [1,25(OH)2D3] which allows intracrine and paracrine functions. In vitro studies have shown that the active vitamin D metabolite 1,25(OH)2D stimulated insulin release by the pancreatic β-cells. Vitamin D is known to have immune modulatory and anti-inflammatory effects and reduces peripheral insulin resistance by altering low-grade chronic inflammation. This study was done to assess whether supplementation of vitamin D in type 2 diabetes mellitus (T2DM) patients with Vitamin D deficiency has any favourable effect on insulin resistance.Methods: It was a short term interventional study conducted at ASCOMS hospital Jammu including a total of 50 vitamin D deficient [25(OH) D <50 nmol/l] T2DM patients with an in-adequate glycemic control (HbA1c > 7.0%). All the 50 study participants completed the study and there were no changes either in anti-hyperglycemic drugs (including insulin) or antihypertensive drugs being used. After supplementation with a single high dose (600000 IU) of parenteral vitamin D3 changes in HOMA-IR (Homeostasis model assessment insulin resistance) were seen on follow up at 3 months.Results: Vitamin D3 supplementation improved insulin sensitivity, HOMA-IR decreased from 4.05±1.42 to 3.93±1.28 (p =0.011). It decreased equally in males (3.85±1.43 to 3.76±1.30) (p value=0.023) and females (4.24±1.42 to 4.10±1.27) (p value=0.021). HOMA-IR showed negative association with Vitamin D levels both at baseline and after 3 months of follow up.Conclusions: This improvement in insulin sensitivity is evidenced in our study by decrease in fasting insulin levels (FIL) and improvement in fasting blood sugars (FBS). It is due to both direct and indirect effects of Vitamin D3 on both insulin sensitivity and secretion.
BACKGROUNDTuberculosis (TB) is one of the oldest diseases known to affect humans and a major cause of death worldwide. According to World Health Organization, incidence of TB is approximately 9.4 million cases per year, of which 1.98 million cases are from India and close to 500,000 per year die of the disease in India. It has been estimated that 2-3% of patients with abdominal TB have isolated colonic involvement. The diagnosis of intestinal TB is a challenge for physicians due to its diverse clinical manifestations that mimic other infectious diseases, autoimmune, and neoplastic disorders and therefore, a high index of suspicion is essential to reach the correct diagnosis. MATERIALS AND METHODSThis was a retrospective analysis of colonoscopic findings of patients with isolated colonic tuberculosis who presented between April 2015 -July 2016. All the patients above 18 years of age with suspected diagnosis of intestinal tuberculosis were included in the study. Patients with ulcerative colitis, Crohn's disease, microscopic colitis and indeterminate colitis or carcinoma colon, HIV positive patients were excluded from the study. These patients were taken up for colonoscopy and distal ileoscopy after proper preparation. The findings observed in any part of the colon with particular reference of any aphthous ulcers, granularity, deep ulcers, nodules, polypoidal lesions and luminal narrowings were recorded. A confirmed diagnosis of isolated colonic tuberculosis was made when there were caseating granulomas and or acid fast bacilli on biopsy samples. A suspected diagnosis was made when there was clinical suspicion, with family history of colonic tuberculosis, biopsy showing noncaseating granulomas with chronic inflammation and response to antitubercular therapy. Those patients who had confirmed or suspected diagnosis of isolated colonic tuberculosis were started on antitubercular therapy for a period of 6 months. RESULTSThe data of a total of 43 patients was retrieved from the records for this study. Out of these 43 patients, 6 patients were lost to followup. A total of 3 patients did not respond to the antitubercular treatment and were subsequently diagnosed as Crohn's disease on further evaluation. Finally, a total of 34 patients were evaluated in this study, out of which 22 were males and 12 were females. The minimum age in all these patients was 18 years with a maximum age of 79 years. The most common symptom of presentation was pain abdomen (91.17%) followed by anorexia (88.23%), Fever (73.52%), weight loss (70.58%), chronic diarrhoea (52.94%), constipation (26.47%) patients, mass abdomen (20.58%) and bleeding per rectum (14.70%) of patients. The colonoscopic findings were aphthous ulcers in 18 (52.94%), deep ulcers in 16 (47.05%), nodules in 19 (55.88%), luminal narrowing in 8 (23.52%) and polypoidal lesions in 5 (14.70%) of patients. The commonest site involved in our patients with isolated colonic tuberculosis was ileocecal valve with caecum in 29 (84.29%) of patients, followed by isolated ascending co...
Background: Foreign body (FB) ingestion is a common clinical problem seen in medical practice. Its size can range from a pin head size to coin size. The aim of this study is to report the outcome of patients coming with FBs in their gastro intestinal tracts (GIT) using upper GI endoscopy (UGIE).Methods: The records of all the patients who presented to the department of gastroenterology and who underwent UGIE between May 2015 to May 2017 were reviewed with details on age, sex, type of FBs and its anatomical location and outcome.Results: A total of 31 patients with history of FB ingestion, were subjected to UGIE, over a period of 2 years. The patients were in the age group of 3 years to 100 years. The mean age was 51.27±20.63 years, with males constituting 74.19% of the patients. Most patients were in the age group of 41-60 years (41.9%) followed by 21-40 years age group (22.58%). The majority of FBs found were pieces of bone (n=9) and meat bolus (n=7), making 29.03% and 22.58% respectively. The other FBs included food bolus, coins, dentures, fruit seeds and round worm impaction.Conclusions: It is recommended that all those patients with a history of FB ingestion should be evaluated and if it is located in the upper gastrointestinal tract, should be subjected to UGIE for endoscopic removal.
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