Prevalence of hepatitis C in patients with chronic kidney disease at a tertiary care hospital in north India: a retrospective analysis

Background: Hepatitis C and chronic kidney disease (CKD) both present an unsolved public health problem Hepatitis C virus (HCV) is easily transmitted in haemodialysis units and by kidney transplantation. HCV leads to increased mortality and morbidity due to cirrhosis and hepatocellular carcinoma, while accelerating the progression of CKD. The aim of the  study was to describe the demographic, clinical/biochemical profile and prevalence of patients with CKD who have HCV infection.Methods: This was a retrospective analysis of patients with CKD who presented to out/in patient department of medicine in a tertiary care center in Jammu from a period of Feb 2016 to Nov 2018. Detailed clinical history along with previous lab reports were noted and tests for HCV infection were conducted in all patients. Diagnosis of HCV was made via HCV RNA(RT PCR) and positive  Anti HCV IgG serology.Results: Total 67 patients were included with median age of 54 years (range 43-72 years) with majority 76.1% being males, and 71.6% within 41-60 years age group. 31.4% were HCV positive out of which 81% were males. 7 patients were found to have co-infection with HIV and HBsAg. Genotype 1 (72%) was found to be more common than Genotype 3. Ultrasonography and Upper GI endoscopy showcased 57% with dilated spleenoportal axis  and oesophageal varices respectively.Conclusions: Prevalence of HCV infection in CKD patients is high with genotype 1 being commonest. False negative Anti HCV antibody is common hence screening with HCV RNA is recommended. Strict universal precautions should be employed in hospitals and dialysis units to prevent transmission

Evaluation of eosinophil count and neutrophil-lymphocyte count ratio versus C-reactive protein levels in patients with sepsis

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

Profile of endoscopic removal of foreign bodies from upper gastrointestinal tract at a tertiary care hospital in North India

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

A study of the effects of large dose of parenteral vitamin D (D3) on insulin resistance in type 2 DM patients

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 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

Direct laryngoscopy using a videogastroscope: A new technique

Background and objectives: Although indirect laryngoscopy is commonly used method for evaluation of laryngeal disorders in outpatient Ear, Nose and Throat Department (ENT) but proper and accurate diagnosis is not possible in every patient. The direct laryngoscopy using fiberoptic- or video- laryngoscopy has been shown to be a valuable tool in the examination of laryngeal and supraglottic anatomy and pathology. Our goal was to develop a new diagnostic method wherein direct laryngoscopy can be performed by videogastroscope which unlike fiberoptic- or video- laryngoscopy, is readily available at most of the centres. Methods: Between May 2009 and December 2009, 1462 consecutive patients underwent indirect laryngoscopy for evaluation of laryngeal disorders at ENT outpatient department. Fifty-two (93.6%) consecutive patients who had unsuccessful, inconclusive or incomplete examination underwent direct laryngoscopy with videogastroscope. Results: The study group consisted of 39 males and 13 females with mean age of 34.8 ± 11 years (range 14 to 58 years). The following abnormalities were found in vocal cords in 31 (59.6%) patients: cancer in 8 patients; leukoplakia, 6; cases, nodules, 6; palsy, 5; epitheloid granuloma, 2; submucosal hemorrhages, 2; and polyp in 2. Conclusions: Direct laryngoscopy using videogastroscope is safe, feasible and highly accurate for the diagnosis of laryngeal disorders