Ascitic fluid analysis with special reference to serum ascites cholesterol gradient and serum ascites albumin gradient

Background: Ascites being a common clinical problem with a vast spectrum of etiologies, less expensive and widely available biochemical parameters are required to differentiate ascites which can correlate with pathogenesis and pin point towards an etiology with high sensitivity and significant accuracy. Aims of the study were to determine the sensitivity, specificity and diagnostic efficacy of serum ascites albumin Gradient (SAAG) and that of ascitic fluid total protein (AFTP), evaluating their diagnostic role in identifying the etiology of ascites, to determine the diagnostic efficacy of Ascitic fluid cholesterol and serum ascites cholesterol gradient (SACG) in diagnosis of malignant ascites.Methods: In this study, 100 patients of ascitis were evaluated for ascitic fluid total protein, albumin, cholesterol, SAAG and SACG along with ultrasound and other required investigations.Results: Sensitivity, Specificity, and Diagnostic accuracy of SAAG for Portal hypertension were 97%, 85%, 96% respectively, whereas those of AFTP for exudative/transudative ascitis were 78.5%, 66%, 68% respectively. Ascitic fluid cholesterol and Mean SACG were significantly elevated in malignant ascites when compared with Non-Malignant Ascitis with p=0.0001. Similarly with a cut off level of 70mg% and 54 mg%, Ascitic fluid cholesterol and Mean SACG are having diagnostic accuracy of 90% and 93% respectively.Conclusions: SAAG is much more superior to AFTP in differential diagnosis of Ascitis. Ascitic fluid cholesterol and Mean SACG are simple and cost effective methods to separate malignant ascitis from non-malignant causes even in small centres with limited diagnostic facilities

Antenatal sonographic assessment of cross sectional area of umbilical cord components and its reference value in normal pregnancy

Background: Measuring the cross-sectional area of umbilical components in normal pregnant women helps in assessing the fetal abnormalities. Very few literatures were available on evaluation of reference values of cross sectional areas of umbilical cord components. The present study was conducted with the aim to determine the normal reference values of cross sectional areas of umbilical arteries, umbilical vein and Wharton’s jelly and to correlate them with the gestational age of the fetus.Methods: A cross sectional study was conducted on 300 normal pregnant women at the Department of Radiodiagnosis, Sri Siddhartha Medical College, Tumakuru, Karnataka to assess the reference range of cross sectional areas of umbilical cord arteries, umbilical vein and Wharton’s jelly at different gestational age of the fetus to analyze their growth.Results: A statistically significant correlation was observed between cross sectional areas of umbilical artery and vein and gestational age before and after 34 weeks (p=0.005 and 0.006 respectively) but no significant correlation was noticed with the cross-sectional area of Wharton’s jelly (p=0.088).Conclusions: Cross sectional area measurements of umbilical cord components can be considered as important tools for estimation of fetal growth

Increased IL-12 and decreased IL-33 serum levels are associated with increased Th1 and suppressed Th2 cytokine profile in patients with diabetic nephropathy (CURES-134).

The role played by recently discovered novel cytokine IL-33 in controlling T-helper (Th)1 and Th2 cytokines under conditions of diabetic nephropathy (DN) is less well studied. In the present study, we estimated the levels of IL-33 along with both Th1 and Th2 cytokines in the serum of normal glucose tolerant (NGT), diabetic subjects with (DN) or without nephropathy (DM) and correlated it with the clinical risk factors of diabetes and nephropathy. 222 study subjects were recruited from the Chennai Urban Rural Epidemiology Study (CURES): 61 NGT, 79 DM and 82 DN. IL-33 level was estimated by ELISA while other Th1 (IL-12, IFN-gamma and IL-2) and Th2 (IL-4, IL-5 and IL-13) cytokines were measured using a Bio-plex bead assay. DM subjects showed a mixed Th1-Th2 profile (increased IFN-g, IL-12, IL-4 and IL-13 and decreased IL-33) while DN subjects showed enhanced Th1 profile (increased IFN-g, IL-2 and IL-12) with suppression of Th2 cytokine (decreased IL-33 and IL-13). The IL-33 levels showed a serial decline with increasing severity of insulin resistance and microalbuminuria. DN was associated with enhanced Th1 response and suppression of Th2 responses which might be due to inreased levels of IL-12 and decreased levels of IL-33 cytokines respectively

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Bilateral carotid body tumor in a 13-year-old child: Our experience

Carotid body tumors are rare neuroendocrine tumors derived from the extra-adrenal paraganglioma of the autonomic nervous system. Very few cases have been reported in literature in the pediatric age group <14 years of age. We present our experience in managing a Shamblin III carotid body tumor in a 13-year-old boy who underwent an unsuccessful attempt at excision at another hospital. Surgical excision of the tumor along with ligation of the internal carotid artery was done without any postoperative neurological sequel. The tumor on the contralateral side was being managed conservatively with serial follow-up