Platelet Lymphocyte Ratio as a Diagnostic Marker in Pancreatic Malignancy

Platelet lymphocyte ratio as a diagnostic marker in pancreatic malignancy Pancreatic cancer is the eighth most common cause of cancer related deaths worldwide. Pancreatic cancer has an overall poor prognosis – the 1 and 5 year survival rate for all stages combined are 25% and 6% respectively. Hence early diagnosis is very crucial. CA 19-9 is a carbohydrate antigen which is the best accepted marker for prognostication and diagnosis of pancreatic cancer. Platelet lymphocyte ratio (PLR) as a tumour marker has been found to have a role in prognostication of pancreatic cancer. But its use as a diagnostic marker has not been extensively studied. The aim of the study is to assess the demographics of pancreatic malignancy in our hospital and to assess the role of PLR and CA 19-9 as a diagnostic marker in pancreatic malignancy. Aims and Objectives: 1. To asses the demographics of histologically proven pancreatic malignancy in our hospital. 2. To assess the role of Platelet lymphocyte ratio and CA 19-9 in the diagnosis and management of pancreatic malignancy. Study design: Cross sectional study. Inclusion criteria: 1.All patients admitted with impression of pancreatic malignancy indicated by imaging (pancreatic mass on USG abdomen/ CECT abdomen) and with/without clinical features of malignancy such as jaundice, abdominal mass, pruritis. Exclusion criteria: 1. Patients with clinical of biochemical features of cholangitis. 2. Patients in whom histopathological confirmation was not available. Methodology: Cross sectional study for the period Nov 2013 to Nov 2014 was done in Govt. Stanley Hospital. The patients admitted in Govt. Stanley hospital during this period were included. Method of collection of data: Details of the patients, detailed history, clinical examination, symptoms and signs of pancreatic malignancy were recorded. Parameters taken into account were: Jaundice, Loss of weight( >10% of body wt in the last six months or less), Previous history of pancreatitis, Alcohol intake (equal to or more than 80g of ethanol per day for 5 years was considered significant ). Patients admitted with features of pancreatic malignancy were subjected to the following investigations: Blood: • Complete blood count • Liver function test (SGOT, SGPT, ALP, S.Bilirubin) • CA19-9 ( normal value < 39 U ) • PLR ( cut off at 150 ) The following imaging investigations were done: • Ultrasound (transabdominal) • Doppler USG (where indicated) • CECT abdomen (pancreas protocol CT) • MRI/MRCP (where indicated) Other investigations: Esophagogastroduodenal scopy – end or side viewing scopy. ERCP (where indicated) FNAC – USG or CT guided. Statistical methods: Derivations from continuous measurements were presented on mean +/- standard deviation, and from categorical measurements were presented in number (%). Significance – 5% level of significance. Significance on parameters on continuous scale – student t test was usedand for intergroup analysis chi squared test was used. Diagnostic statistics such as sensitivity, specificity, ppv, npv were calculated for CA 19-9 and PLR . Statistical software – XLSTAT and Socialstatistics.com were used

Drugs used in wheeze associated respiratory infection among children in tertiary care teaching hospital

Background: This study was done to study the drugs used in wheeze associated lower respiratory infected paediatric patients in tertiary care teaching hospital.Methods: Sample size was calculated as 78 and patients were selected based on the inclusion and exclusion criteria. The study was a prospective observational study and conducted in Department of Pediatrics, Rajah Muthiah Medical College and Hospital (RMMCH), Annamalai University.Results: Our study shows that male children (63%) are affected with more than female children (37%). The most frequently prescribed drugs are antibiotics (96%), antipyretics (63%), expectorants and antitussives (54%) followed by beta adrenergic agonist (46%), beta adrenergic agonist with anticholinergic combination (14%) corticosteroids (18%). Our study also shows wheeze associated lower respiratory infection (WALRI) in children were significantly associated with bacterial infections (72%).Conclusions: Our study concluded that antibiotics and antipyretics are the most commonly prescribed drugs for WALRI followed by expectorants and antitussives, beta adrenergic agonist, corticosteroids, beta adrenergic agonist with anticholinergic combination. Most of the treatment strategies are adopted from Standard Treatment Guidelines (STG) and World Health Organisation (WHO). The average number of prescribed drugs per encounter was more than that of WHO standards. The percentage of encounters in which an antibiotics and injections was higher than the ideal WHO standards it leads to anti-microbial resistance and costly forms of drug therapy

ARC technique – An innovative method to assess true defect in postburn contracture release

Most commonly, skin grafts are used to resurface the raw areas resulting after the release of postburn contractures but in the extensively burned patient, donor sites may be limited. There is no accurate technique described in literature for the assessment of the true defect preoperatively. We describe a technique to accurately assess the true defect which helps to determine the amount of skin graft required preoperatively

Association of HLA class II DR/DQ alleles in children and adolescents with rheumatic heart disease from a tertiary care centre in North India

Introduction: Rheumatic fever and RHD constitutes an important public health problem in India. The relatively low attack rate of RF, the high concordance rate for RF in monozygotic twins (19%) compared to dizygotic twins (2.5%), and the high familial incidence of RF suggest the involvement of host genetic factors in susceptibility to RF with consequential progression to RHD. Objective: To study the association of HLA CLASS II DR/DQ alleles in children and adolescents with RHD from a tertiary care center in North India. Methods: 30 RHD patients and 30 age and sex-matched controls were included in our study and blood samples for HLA typing were processed through LAB Type™ reverse SSO DNA typing method. The assignment of the HLA typing was based on a comparison with already published HLA gene sequences. Results: The mean age of RHD patients and matched control groups were 12.97 ± 2.95 and 11.93 ± 3.23, respectively. In the cases and control group, males accounted for 63.3% and 50% of the patients respectively. A significant difference was found between the cases and controls for HLA DR∗ 15 (p-value 0.002), HLA DR∗ B4 (p-value 0.045), HLA DR∗ B5 (p-value 0.017), and HLA DQB1∗ 02 (p-value 0.005). Conclusion: Our study suggests that HLA class II haplotypes may provide insight into the molecular mechanism of RHD and be a useful tool in predicting the clinical outcome in RF patients, thereby affording new means of intervention or vaccine design. Larger studies are needed to address this in our population