Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder with high morbidity and mortality. Neutrophil–lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) have emerged as novel indicators of subclinical inflammation and can be used as potential indicators of vascular complications and poorer outcome in patients with DM. This study was conducted to evaluate the role of NLR and PLR as inflammatory biomarkers of type 2 DM.
Aim: The aim of this study is to assess NLR and PLR as predictive inflammatory markers in DM.
Materials and methods: This was a cross-sectional study carried out in Sri Siddhartha Medical College, Tumkur, from September 2018 to November 2018. The source of data included patients attending medicine outpatient department (OPD) with type 2 DM aged between 18 years and 60 years without other comorbidities. The values of glucose parameters and HbA1c were obtained from the case files. Complete blood count (CBC) was measured using the Sysmex XN 330 automatic hematology analyzer.
Results: The study was carried out on 150 diabetics and 50 subjects were used as controls. Out of 150 cases, 110 patients had well-controlled DM (HbA1c7%). Diabetic patients had a significantly higher NLR and PLR as compared to the controls (p = 0.003 and p = 0.008, respectively). Patients with poorly controlled DM had a significantly higher NLR and PLR as compared to subjects with well-controlled DM (p = 0.02 and 0.007).
Conclusion: Increased levels of NLR and PLR are associated with poor glycemic control. It can be used as a disease monitoring tool during the follow-up of the diabetic patients.
Clinical significance: NLR and PLR parameters are widely available, reliable, and inexpensive and are used in the prediction of diabetes-related complications in the future so that effective measures can be taken to prevent complications.
Shushan S Jayker,
Jyothi A Raj,
Sharmila P Surhonne,
Introduction: The spleen belongs to the reticuloendothelial system and is involved in hematopoietic disorders as much as in infectious/inflammatory and metabolic disorders.
Aims and objectives: To study the spectrum of splenic pathology in morbid and autopsy specimens; to correlate the clinicopathological findings in the former and the possible cause of death in the latter.
Materials and methods: All resected and autopsy specimens of spleen received over a period of 7 years were included in the study. Tissues were routinely processed and stained; immunohistochemistry (IHC) and special stains were performed where indicated. The clinical findings were correlated with gross features and microscopic findings, and the results were analyzed.
Results: Out of 133 specimens of spleen studied, 114 were from autopsy and 19 were surgically resected. Most specimens were from males and in the 3rd decade. Pathology of spleen ranged from the benign cysts and infections to hematopoietic neoplasms like chronic myeloid leukemia and follicular lymphoma, accounting for 4% neoplastic and 96% non-neoplastic etiologies. Chronic venous congestion was the most common pathology in both autopsy and morbid spleens.
Conclusion: The spleen is uncommon among histopathology samples. Most spleens received for histopathologic evaluation are from autopsy, while resected specimens are few and far in-between. Pathological diagnosis helps in better postoperative management, while autopsy studies enhance our knowledge of splenic pathology. Some of the rare lesions reported in this study were follicular lymphoma in a resected spleen and Littoral cell angioma in autopsy.
Deepesh K Maurya,
Aim: The aim of this study is to study the effect of levothyroxine treatment on lipid profile in patients of subclinical hypothyroidism.
Materials and methods: A randomized control trial, prospective study conducted on 22 cases of subclinical hypothyroidism with 22 control at the Downtown Hospital, Guwahati. Inclusion and exclusion criteria were undertaken. Levothyroxine therapy was given and was followed up after 3 months with thyroid and lipid profiles. Pretreatment and posttreatment values were compared using the paired t test using the statistical software SPPS v.19.
Results: A statistical significance between pretreatment and posttreatment values is found to be in values of thyroid-stimulating hormone (TSH), cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride (p < 0.05). There was no significant difference in the pretreatment and posttreatment T3 and T4 values. There was a mild increase in the value of HDL, a significant decrease in the value of TSH, cholesterol, very low-density lipoprotein (VLDL), and triglyceride.
Conclusion: Lipid profiles are altered in patients with subclinical hypothyroidism compared to controls. Levothyroxine therapy has beneficial effect on lipid profile in patients with subclinical hypothyroidism.
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Umesh S, Nayak VB, Hiremathada S. Impact of Asymptomatic Carotid Artery Disease on Cognitive Functions in Patients Undergoing Off-pump Coronary Artery Bypass Grafting with and without Near-infrared Spectroscopy Monitoring and Intervention Intraoperatively. J Med Sci 2019; 5 (2):43-48.
Background: Postoperative cognitive dysfunction (POCD) is one of the known complications after cardiac surgeries. The incidence of cognitive dysfunction varies considerably but may be as high 50–70% at 1 week after surgery, declining to 30–50% after 2 months. Carotid artery atherosclerosis is a major risk factor for stroke and subsequent cognitive impairment. Near-infrared spectroscopy (NIRS) is a system used for monitoring the activity of the brain.
Materials and methods: Forty-three patients with asymptomatic carotid artery lesion (>70%) undergoing elective off-pump coronary artery bypass (OPCAB) underwent preoperative and postoperative neuropsychological evaluations with the Montreal cognitive assessment (MoCA) score. The patients were randomized to receive or not to receive neuromonitoring with NIRS and subsequent management according to an algorithm. Twenty-one patients received NIRS monitoring and were managed accordingly and twenty-two patients did not receive NIRS monitoring and management.
Results: There was no statistically significant difference in the incidence of POCD between the groups that did or did not receive neuromonitoring and subsequent management based on NIRS at 1 hour, 24 hours, and 1 week post-extubation.
Conclusion: Neuromonitoring with NIRS and subsequent management does provide a systematic way of troubleshooting problems of cerebral desaturation. However, it has not shown any statistically significant difference in the MoCA scores taken at 1 hour, 24 hours, and 1 week post-extubation.
Osteoid osteoma is a benign bony tumor affecting children and young adults. Surgical excision, despite being the gold standard, is associated with morbidities and local recurrence, and radiofrequency ablation (RFA), being minimally invasive, is a viable therapeutic alternative.
Anusha R Musti,
Kallur T Venkateshmurthy
Pheochromocytoma, the neuroendocrine tumors arising from chromaffin tissue, poses a very significant challenge to the anesthetists, especially when they are undiagnosed. They present with varied symptoms and sometimes they are silent and nonfunctional. The anesthetic management of these tumor excisions varies depending on the surgical approach and perioperative hemodynamic instability encountered by the anesthetist. Here, we are presenting three different cases of pheochromocytoma who underwent adrenalectomy in our hospital with varied presentation and their successful anesthetic management.
How to cite this article:
Godbole RD. Ventricular Tachycardia Caused by Intramyometrial Infiltration of Vasopressin during Laparoscopic Myomectomy: An Anesthesiologist\'s Nightmare. J Med Sci 2019; 5 (2):57-58.
All endoscopic procedures demand minimal blood loss during surgery to achieve good visibility which facilitates the speed of surgery. Vasopressin is often used for local infiltration during uterine myomectomy. It has good clinical effects but its systemic absorption may pose significant challenges for the anesthesiologist. It may sometimes lead to lethal complications. The loss of peripheral pulse along with bradycardia, non-measurable blood pressure, and cardiac complications have been reported after intramyometrial injection of vasopressin. Here, we describe a patient with multiple uterine fibroids who developed ventricular tachycardia within 2–3 minutes after intramyometrial infiltration of vasopressin diluted in normal saline. The total dose of vasopressin being 5.36 units (0.067 units/mL) with severe peripheral arterial vasospasm, increased blood pressure, and ventricular tachycardia followed by pulmonary edema. The patient was successfully resuscitated.