Correlation of glycosylated hemoglobin with microalbuminuria to predict renal damage in diabetic patients

Background: Regular screening of levels of glycosylated hemoglobin and microalbuminuria, diabetic nephropathy can be prevented. The aim was to assess and compare the levels of glycosylated hemoglobin, microalbuminuria and serum creatinine in type 2 diabetic patients divided in groups of those on default antidiabetic treatment compared with those on regular antidiabetic treatment and to assess its correlation in type 2 of diabetic nephropathy. Methods:Two hundred diabetic patients above 40 years of age and 200 age matched control subjects with levels of glycosylated hemoglobin < 6.5% and on regular antiglycemic therapy were selected. Fasting plasma sugar was estimated by the glucose oxidase (GOD) - glucose peroxidase (POD). Glycosylated hemoglobin and microalbuminuria level was measured by the immunoturbidimetric method and serum creatinine estimation was done by the Jaffe’s kinetic method. p value was drawn using the student’s paired t-test. Results: There is a strong correlation between the increase in the levels of glycosylated hemoglobin with the corresponding rise in the levels of microalbuminuria and serum creatinine. Conclusion: Periodic surveillance of the levels of microalbuminuria should be carried out in the type 2 diabetic patients to prevent further damage by early detection of diabetic nephropathy.

Effect of cardiac surgery on maternal and perinatal outcome in rheumatic heart disease with pregnancy: a comparative study

Background: Rheumatic heart disease remains the commonest heart disease in India with mitral stenosis being the most common lesion and is associated with significant maternal and perinatal mortality and morbidity. The objective of this study was to compare maternal and perinatal outcome in women with rheumatic heart valvular disease who had no surgery or had percutaneous balloon mitral valvuloplasty (PBMV) or had valvular replacement surgery.Methods: It was a retrospective study in 113 women with rheumatic heart disease with various valvular lesion admitted in the hospital in previous 10 years. There were 58 (51.35%) patients without cardiac surgery (Group 1), 24 (21.23%) with PTMC (Group 2) and 31 (27.43%) with valve replacement surgery (Group 3). Maternal and perinatal outcome were compared in three groups.Results: The baseline characteristics were similar in the three group. In cardiac complications New York Heart Association (NYHA) deterioration was significantly higher (24.1%) in non-operated group (Group 1) as compared to Group 2 (12.3%) and Group 3 (16.1%). There was no difference in Group 2 and Group 3. Need of cardiac medication (digoxin) was also highest (67.2%) in Group 1 as compared to Group 2 (24.6%) (p = 0.002) and Group 3 (38.7%) (p = 0.001) but no difference in Group 2 and Group 3. Anticoagulant were given to significantly higher number (54.8% of cases in Group 3 (valve replacement) as compared to Group 1 (3.4%) and Group 2 (12.5%). There was no significant difference in obstetric events and mode of delivery in the three groups. Similarly, there was no difference in fetal outcome in the three groups as regard to mean birth weight, APGAR score, fetal growth restriction, fetal or neonatal death or congenital anomalies in the three groups.Conclusions: Cardiac surgery before or during pregnancy did not significantly improve maternal or perinatal outcome. Only cardiac events and need of medication was reduced with surgery. Hence surgery should be performed judiciously in selected cases

Study of intraoperative squash cytology of intracranial and spinal cord tumors

Background: The aim was to study the cytomorphology of neoplastic lesions of brain and spinal cord by intraoperative squash cytology, compare it with the histopathological diagnosis on excision biopsy/surgical specimen and establish a correlation. The causes of erroneous diagnoses achieved at squash cytology of intracranial and spinal cord tumors were ascertained. Tumor types having the advantage of diagnostic certainty by squash cytology of intracranial and spinal cord lesions was also determined.Methods: Squash preparations of 70 patients suspected to have neoplasia were made and stained with rapid hematoxylin and eosin stain and rapid Papanicolaou stain. A few squash smears were also dry fixed and stained with Giemsa stain. The smears were typed according to the cytomorphological criteria and the cytodiagnoses was compared with the histopathological diagnoses and a correlation was established.Results: A positive predictive value for intraoperative squash cytology for diagnosis of intracranial and spinal cord tumors was seen to be 100% and a negative predictive value of 97.22% were established by this study. The sensitivity was found to be 97.22% and the specificity was 100%. Thus, the accuracy of the study was 98.57%.Conclusions: Squash smear cytology of the brain and spinal cord tumors performed intraoperatively for diagnostic consultation fulfills all the determinants of an excellent diagnostic modality.

A case of broad ligament leiomyoma presenting as an ovarian mass

The broad ligament is the commonest extra uterine site for the occurrence of leiomyoma but with a very low incidence rate. It poses both clinical and radiological challenge in differentiating from an ovarian tumour. A 25-year-old unmarried female presented with history of lower abdominal pain associated with rapidly increasing abdominal distension for last 3 months. General physical examination was unremarkable. Examination of the abdomen revealed a firm, non-tender mass, with limited mobility arising from the pelvis corresponding to a uterine size of 32 weeks. Ultrasonography of abdomen revealed a 20×17×11cm right adnexal multi-loculated cyst. Contrast enhanced computer tomography scan of abdomen and pelvis showed a 12×17×17 cm well defined cystic lesion arising from the pelvis and ascending in to the abdominal cavity. The lesion also showed internal septa and peripheral rim enhancement. Right ovary was not seen separately. Tumor markers including CA-125 (22.4 IU/ ml), CEA (1.83/ml), CA-19.9 (22U/ml), Beta HCG (1.20IU/ ml), LDH (1.17IU/ml), and alpha feto-protein (0.8 ng/ml) were within normal limit. Laparotomy revealed a cystic mass arising from the right broad ligament. Histopathological examination revealed a broad ligament leiomyoma with extensive cystic degeneration. Broad ligament leiomyoma is uncommon tumour of pelvis and its differentiation from ovarian masses may be challenging for the clinicians.