Study of acute febrile illness with thrombocytopenia in a tertiary care centre

Background: In the recent period there is an upsurge in the incidence of fever with thrombocytopenia in the Northern Kerala. This may be due to the several emerging and re emerging infections which causes frequent epidemics in the region. Early diagnosis and meticulous management will prevent fatal out come. Studies on fever with thrombocytopenia are very few in the Northern part of Kerala.Methods: This was a descriptive study conducted at Academy of Medical Sciences Pariyaram over a period of one year from November 2015 to October 2016. The study includes 251 cases attending outpatient and inpatients units in the department of medicine. All patients with a platelet count less than 150000 was included in this study and detailed clinical and laboratory evaluation was done and assessed for the etiology and outcome.Results: Among the 251 cases, Dengue fever accounts 54.5 % of cases and 26.2% are other viral fever where the exact causative organism was not detected. Leptospirosis, malaria were also important causes of fever with thrombocytopenia. Major incidence of hemorrhagic manifestation occurred in the age group of 20 to 30 years whose platelet count was in the range of 10000 to 40000/mm3.Conclusions: In this study more than 50 % had dengue fever and in 26.2% cases an exact etiology cannot be determined. This finding highlights the fact that there may be many unidentified infection which cause fulminant thrombocytopenia and there is a need for wider screening of infection.

Clinical profile of dengue fever in a tertiary care centre in North Kerala

Background: Dengue fever is the most common arboviral disease and fifty percent of world population is at risk. Frequent outbreaks are reported from all states of our country and incidence increases every year. This case study is of 305 patients from Academy of Medical Sciences, which is a tertiary care centre and research Institute in North Kerala. The objective of this study was to study the clinical profile of dengue fever.Methods: Study was prospective observational study conducted during the epidemic for a period of one year. All the cases which fulfilled WHO criteria for diagnosis of dengue fever and those who are positive for IGM antibody detected by enzymelinked immunosorbent assay (IgM ELISA) were only included in this study.Results: There is male preponderance, and those above the age of 30 years affected more. All patients had fever. Gastrointestinal manifestation like nausea and vomiting were commonly observed symptoms. Hepatomegaly, rash and conjuctival suffusion were important physical findings, whereas splenomegaly noted only in 8.2% cases. Thrombocytopenia is noticed in 73.96%.Conclusions: The mortality is 2.6%. Hypotension and thrombocytopenia are the two important determinants of mortality. Dengue Shock syndrome and Dengue Hemorrhagic Fever were relatively less when compared to other epidemics from different regions

Study to assess the changing pattern of clinical profile and determine the prognosis in hepatic encephalopathy

Background: Hepatic encephalopathy (HE) is a common complication of liver disease that requires intensive care management. The prevalence of HE is increasing during recent period. The most important factors of HE are alcohol consumption, chronic hepatitis, hepatotoxic drugs and unhealthy changes in life style. There were only relatively few studies from our region on the changing profile of hepatic encephalopathy under the background of life style changes. This study was conducted with the aim to detect the changing pattern of clinical profile, precipitants and to assess the prognosis of patients with hepatic encephalopathy.Methods: This was a prospective study for a period of 18 months since January 2012 at Academy of Medical Sciences, Pariyaram, Kannur, a tertiary care centre situated in the northern part of Kerala. Patients admitted in the medical and gastroenterology wards and intensive care units that fulfilled the inclusion criteria were enrolled in this study.Results: Among the 76 patients with HE, 60 were suffering from CLD and 16 due to acute liver failure. The common etiologies for HE in CLD patients were Alcoholic cirrhosis (63%), Cryptogenic cirrhosis (17%) and cirrhosis due to chronic HBV (10%) and HCV hepatitis (7%) respectively. Among the CLD patients at the start of observation majority were in Child Pugh class B and C. Based on West Haven grading most of them had Grade 2 and 3 HE. Majority with Grade 1, 2 and 3 improved where as those with Grade 4 and Grade 3 in Child Pugh class C worsened. The common precipitants of HE were GI bleed, dyselectrolemia, constipation and infections. Among these precipitants a statistically significant association for a worse outcome was present only with infection. Leptospirosis and deliberate self-harm due to ingestion of hepatotoxic rodenticide and paracetamol were the leading cause of hepatic encephalopathy in acute liver failureConclusions: In present study HE was most commonly seen in patients with alcoholic liver disease. Cryptogenic cirrhosis associated with other life style diseases was the second common condition. Among all precipitating factors infection appeared as a statistically significant factor predicting a worse outcome. Health education among alcoholic patients and life style modifications to prevent cryptogenic cirrhosis are of paramount importance in curtailing the increase in incidence of HE in this region

Cross-sectional study of glycosylated haemoglobin in type 2 diabetes mellitus patients of South Indian origin

Background: Prevalence of Type 2 Diabetes Mellitus in Indian population is on rise and is leading to significant morbidity and mortality. The revised ADA guidelines since 2010 have suggested glycated haemoglobin (HbA1c) as a diagnostic test for Type 2 diabetes. HbA1c level is having geographic and ethnic variability independent of glycaemic status and this has not been extensively studied in many regions.Objective: To study the characteristics of HbA1C in the South Indian population and to determine the cut off value for HbA1C in diagnosing Diabetes in them. Methods: This is a hospital based observational study conducted at a Tertiary care centre in North Kerala. Patients with age ≥30yrs with Fasting Plasma Glucose (FPG) ≥ 100 or Random Plasma Glucose (RPG) ≥ 200 with symptoms of hyperglycaemia with no previous history of anti diabetic treatment were selected for the study. A preset questionnaire was used to collect the data which was later analysed using relevant statistical techniques.Results: Out of the consecutive diabetic patients attending medicine OPD 99 newly detected diabetics/prediabetics who were not under any anti diabetic medications were studied. New onset diabetes/prediabetes patients showed a mean HbA1c of 8.26(SD=2.31). There was no significant correlation of HbA1c values with age, sex and duration of diabetes in the study population. The HbA1c values also had no significant correlation with systolic blood pressure, total cholesterol values or triglyceride levels. However it was significantly related to Fasting plasma glucose, Post prandial plasma glucose and serum LDL cholesterol values. In newly detected diabetic patients (with FPG≥126 taken as gold standard) ROC analysis determined a HbA1c cut off at 6.45% (AUC=0.76, sensitivity=79%, specificity=60%).Conclusion: The study provides a reliable cutoff of glycated haemoglobin (6.45%) among South Indian population which is in accordance with the ADA recommendations.

Analysis of cerebrospinal fluid adenosine deaminase level in tuberculous meningitis and validation of sensitivity and specificity

Background: Tuberculous meningitis is an important cause of morbidity and mortality in developing countries especially in India. The mortality associated with tuberculous meningitis is very high if not detected early and meticulous treatment is not given. CSF analysis and imaging are the most commonly used tools for diagnosis of meningitis. But these are often inadequate in making a definitive diagnosis. CSF Adenosine Deaminase estimation (ADA) is useful in differentiation of tuberculous meningitis from non-tuberculous meningitis. Though few studies have proved efficacy of Adenosine Deaminase level for the diagnosis, studies to assess the sensitivity and specificity of ADA levels were limited. This study was conducted to assess its usefulness and to validate the sensitivity and specificity of ADA level in tuberculous meningitis (TBM).Methods: This was a prospective study conducted at Academy of Medical Sciences, Pariyaram for a period of 18 months from December 2013 to June 2015, Adenosine deaminase level was studied in the cerebrospinal fluid of 50 patients who got admitted with symptoms and signs of meningitis in the medical wards and intensive care units who fulfilled the inclusion criteria.Results: In this study 50 patients were diagnosed clinically and with CSF analysis as meningitis. The mean cerebrospinal fluid adenosine deaminase activity was 23.08+17.5in Tuberculous meningitis 3.8 +1.92U/l in Bacterial meningitis and 4.8+2.3U/l in Viral meningitis. The adenosine deaminase activity in Tuberculous meningitis cases were significantly higher than non-tuberculous meningitis. The sensitivity and specificity of this test for diagnosis of tuberculous meningitis was 90% and 100% respectively with ADA value of more than 10U/L.Conclusions: This study found out that estimation of CSF Adenosine level is a very useful test for the diagnosis of tuberculous meningitis. The sensitivity and specificity attained in this study were comparable to other studies. This study also found out that ADA estimation is very useful in distinguishing tuberculous and viral meningitis

Study of acute febrile illness with thrombocytopenia in a tertiary care centre

Background: In the recent period there is an upsurge in the incidence of fever with thrombocytopenia in the Northern Kerala. This may be due to the several emerging and re emerging infections which causes frequent epidemics in the region. Early diagnosis and meticulous management will prevent fatal out come. Studies on fever with thrombocytopenia are very few in the Northern part of Kerala.Methods: This was a descriptive study conducted at Academy of Medical Sciences Pariyaram over a period of one year from November 2015 to October 2016. The study includes 251 cases attending outpatient and inpatients units in the department of medicine. All patients with a platelet count less than 150000 was included in this study and detailed clinical and laboratory evaluation was done and assessed for the etiology and outcome.Results: Among the 251 cases, Dengue fever accounts 54.5 % of cases and 26.2% are other viral fever where the exact causative organism was not detected. Leptospirosis, malaria were also important causes of fever with thrombocytopenia. Major incidence of hemorrhagic manifestation occurred in the age group of 20 to 30 years whose platelet count was in the range of 10000 to 40000/mm3.Conclusions: In this study more than 50 % had dengue fever and in 26.2% cases an exact etiology cannot be determined. This finding highlights the fact that there may be many unidentified infection which cause fulminant thrombocytopenia and there is a need for wider screening of infection.

Metabolic syndrome and Non alcoholic fatty liver disease among asymptomatic adults in North Kerala

Background: Non-alcoholic fatty liver disease [NAFLD] is considered as the hepatic component of Metabolic syndrome (MS) and is a common cause of Chronic Liver Disease. Early identification of NAFLD in patients having metabolic syndrome is important in reducing the long-term morbidity.Methods: A cross sectional observational study of apparently healthy subjects attending routine health check in the hospital clinic between the age group of 18 years and 65 years for a period of six months was done. Data including medical history, anthropometric measurements, biochemical investigations and ultrasound scan abdomen were collected. Patients were categorised as metabolic syndrome based on IDF consensus criteria (2009) using population and country specific definition for waist circumference.Results: 168 consecutive subjects attending the clinic were studied out of which 75.60% (127) had NAFLD. Out of the study subjects, 80 (47.62%) had metabolic syndrome according to IDF 2009 criteria. There is a significant difference between the prevalence of NAFLD among subjects with and without metabolic syndrome (p=0.002). Logistic regression analysis showed that BMI and waist circumference were significantly contributing to the prediction model for the occurrence of NAFLD. Conclusion: Prevalence of NAFLD in those with metabolic syndrome is considerably higher than those who do not satisfy the criteria for metabolic syndrome. The study points to the importance of screening and aggressive life style intervention in patients with abdominal obesity to prevent the development of NAFLD and Metabolic Syndrome

Analysis of cerebrospinal fluid adenosine deaminase level in tuberculous meningitis and validation of sensitivity and specificity

Background: Tuberculous meningitis is an important cause of morbidity and mortality in developing countries especially in India. The mortality associated with tuberculous meningitis is very high if not detected early and meticulous treatment is not given. CSF analysis and imaging are the most commonly used tools for diagnosis of meningitis. But these are often inadequate in making a definitive diagnosis. CSF Adenosine Deaminase estimation (ADA) is useful in differentiation of tuberculous meningitis from non-tuberculous meningitis. Though few studies have proved efficacy of Adenosine Deaminase level for the diagnosis, studies to assess the sensitivity and specificity of ADA levels were limited. This study was conducted to assess its usefulness and to validate the sensitivity and specificity of ADA level in tuberculous meningitis (TBM).Methods: This was a prospective study conducted at Academy of Medical Sciences, Pariyaram for a period of 18 months from December 2013 to June 2015, Adenosine deaminase level was studied in the cerebrospinal fluid of 50 patients who got admitted with symptoms and signs of meningitis in the medical wards and intensive care units who fulfilled the inclusion criteria.Results: In this study 50 patients were diagnosed clinically and with CSF analysis as meningitis. The mean cerebrospinal fluid adenosine deaminase activity was 23.08+17.5in Tuberculous meningitis 3.8 +1.92U/l in Bacterial meningitis and 4.8+2.3U/l in Viral meningitis. The adenosine deaminase activity in Tuberculous meningitis cases were significantly higher than non-tuberculous meningitis. The sensitivity and specificity of this test for diagnosis of tuberculous meningitis was 90% and 100% respectively with ADA value of more than 10U/L.Conclusions: This study found out that estimation of CSF Adenosine level is a very useful test for the diagnosis of tuberculous meningitis. The sensitivity and specificity attained in this study were comparable to other studies. This study also found out that ADA estimation is very useful in distinguishing tuberculous and viral meningitis