A comparative study of intravenous labetalol VS intravenous nitroglycerin in the treatment of hypertensive crises.

Hypertensive crises is still a major public health problem, causing end organ damage like myocardial infarction, stroke, and renal failure. Labetalol and nitroglycerine are among the two most commonly used medicine to control the blood pressure, but there is no head to head comparison between these two medicines. This was a prospective randomized non-blinded study which included 50 patients of hypertensive crises, out which 25 patients received intravenous labetalol and 25 patients received intravenous nitroglycerine. We found that labetalol controlled the blood pressure more rapidly in comparison to nitroglycerine, without causing any extra side effect.

Association of Mean Platelet Volume with Risk Factors and Functional Outcome in Acute Ischemic Stroke.

Background Stroke is the second leading cause of death in the world and a major cause of disability, with ischemic stroke contributing to 87% of all strokes. Platelets are central in the formation of thrombus, and in the process, they enlarge in size, become active, and secrete prothrombotic factors. This is supported by the presence of large platelets in ischemic stroke, where they may be implicated in the pathogenesis of vessel occlusion, leading to stroke. The mean platelet volume (MPV) is an important laboratory marker of platelet function and activation. Materials and Methods The present study was conducted to assess the role of MPV in the pathogenesis, severity, and outcome of ischemic stroke. It was an observational study in 100 acute ischemic stroke (AIS) patients (excluding cardioembolic stroke) admitted to the Medicine wards, Department of Medicine, Jawaharlal Nehru Medical College, a tertiary care hospital at Aligarh. The MPV was correlated with the conventional risk factors of ischemic stroke and outcome (using modified Rankin scale [mRS]). The study revealed statistically significant correlation between MPV and hypertension, type 2 diabetes mellitus, and carotid intima media thickness (CIMT). Also, the MPV at presentation positively correlated with mRS (correlation coefficient 0.818); thus, high MPV was associated with more severe disability. Conclusion The MPV at the time of presentation of ischemic stroke may be useful in predicting the severity of stroke and neurological recovery. However, a larger study including diverse population is required to endorse its predictive value in AIS.

Correlation between bone mineral density and oxidative stress in postmenopausal women.

BACKGROUND: Postmenopausal osteoporosis affects large fraction of elderly women. Oxidative stress (OS) appears to be involved in its pathogenesis. The scarcity of human studies focusing on the correlation between bone mineral density (BMD) and OS in postmenopausal women has prompted us to study on this issue. MATERIALS AND METHODS: We conducted a cross sectional study in 95 subjects, between 21-65 years of age, including postmenopausal osteoporotic females (n = 35), healthy postmenopausal females (n = 30) and healthy females in reproductive age group (n = 30). We measured serum antioxidant activity of superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx), and total antioxidant power (TAP). BMD was obtained at lumbar spine and femur neck by dual-energy X-ray absorptiometry scan. Osteoporosis was considered when subjects had a BMD of 2.5 standard deviations or more below the mean value for young adults. RESULTS: Serum GPx, SOD, catalase and TAP level were found significantly lower in osteoporotic postmenopausal group as compared to healthy postmenopausal women and women in healthy reproductive age group healthy reproductive women (P < 0.005). but correlation between BMD and serum antioxidants were not found to be statistically significant (P > 0.005). CONCLUSION: These findings support that oxidative stress plays an important role in pathogenesis of postmenopausal osteoporosis. We did not find any significant association between BMD and serum level of antioxidants (P > 0.05). The failure to detect this association does not preclude the role of OS in osteoporosis because OS is complex and dynamic process.

Correlation between serum neuron specific enolase and functional neurological outcome in patients of acute ischemic stroke.

CONTEXT: The use of biomarkers to predict stroke prognosis is gaining particular attention nowadays. Neuron specific enolase (NSE), which is a dimeric isoenzyme of the glycolytic enzyme enolase and is found mainly in the neurons is one such biomarker. AIMS: This study was carried out on patients of acute ischemic stroke with the aims to determine the correlation between NSE levels on the day of admission with infarct volume, stroke severity, and functional neurological outcome on day 30. MATERIALS AND METHODS: Seventy five patients of acute ischemic stroke admitted in the Department of Medicine were included in the study. Levels of NSE were determined on day 1 using the human NSE ELISA kit (Alpha Diagnostic International Texas 78244, USA). Volume of infarct was measured by computed tomography (CT) scan using the preinstalled software Syngo (version A40A) of Siemen's medical solutions (Forchheim, Germany). Stroke severity at admission was assessed using Glasgow coma scale (GCS) and functional neurological outcome was assessed using modified Rankin scale (mRS) on day 30. STATISTICAL ANALYSIS USED: Statistical analysis was performed using the SPSS software for windows version 15.0 (SPSS). RESULTS: A positive correlation was found between concentration of NSE on day 1 and infarct volume determined by CT scan (r = 0.955, P < 0.001). A strong negative correlation was found between GCS at presentation and concentration of NSE on day 1 (r = -0.806, P < 0.001). There was a positive correlation between NSE levels at day 1 and functional neurological outcome assessed by mRS at day 30 (r = 0.744, P < 0.001). CONCLUSIONS: Serum levels of NSE in first few days of ischemic stroke can serve as a useful marker to predict stroke severity and early functional outcome. However, larger studies with serial estimation of NSE are needed to establish these observations more firmly.

Complications associated with Plasmodium vivax malaria: a retrospective study from a tertiary care hospital based in Western Uttar Pradesh, India.

BACKGROUND: Plasmodium vivax (p. vivax) malaria was traditionally considered as benign tertian malaria, however, recent studies have pointed out that p. vivax have potential to cause all severe complications previously attributed to p. falciparum infection only. The aim of this report is to study the incidence of various clinical and biochemical complications associated with severe p. vivax malaria. METHODS: A retrospective analysis was performed on all patients with p. vivax malaria admitted to our center between January 2009 and December 2011. Severe malaria was defined as per World Health Organization (WHO) criteria. Clinical and laboratory parameters were recorded. Patients with evidence of p. falciparum, mixed malarial infection and chronic systemic diseases were excluded from the study. RESULTS: Sixty-two patients met the criteria for severe malaria during the study period. The complications observed were Hepatic dysfunction in 18 (29%), renal dysfunction in 13 (21%), cerebral malaria in 10 (16.1%), acute respiratory distress syndrome (ARDS) in 6 (9.7%), shock in 10 (16.1%), severe anemia in 16 (25.8%), thrombocytopenia in 35 (56.5%), and hypoglycemia in 3 (4.8%) patients. Three mortalities were observed. CONCLUSIONS: P. vivax has immense potential to cause life threatening complications and even death, more research is required to understand the exact pathogenesis of various complications encountered in vivax malaria.

Widespread intracranial calcification, seizures and extrapyramidal manifestations in a case of hypoparathyroidism.

Hypoparathyroidism can present with neurological complaints like seizures, parasthesias, depression, psychosis, extrapyramidal manifestations and features of raised intracranial pressure. Hypoparathyroidism and pseudohypoparathyroidism are the most common causes of pathological basal ganglia calcification. A 50 year male presented with generalized seizures and extrapyramidal features like tremors and rigidity. Investigations revealed that he had hypocalcemia, hyperphosphatemia and very low PTH levels, CT scan of head showed calcification of bilateral basal ganglia, cerebellum and subcortical white matter of frontal and parietal lobes. He showed remarkable recovery on restoration of normal serum calcium levels. Hypoparathyroidism should be kept in the differential diagnosis of patients presenting with seizures and extrapyramidal features.

Role of serum fibrinogen in patients of ischemic cerebrovascular disease.

Fibrinogen is an independent risk factor for coronary events in population-based studies and inpatients with coronary heart disease, but there is an uncertainty about its prediction for stroke, particularly in secondary prevention. In view of this uncertainty, study was conducted to establish the role of serum fibrinogen in ischemic stroke. Fifty six patients with acute ischemic stroke of less than 7 days duration were recruited for the study. Fourty two age and sex matched candidates served as control. Baseline characteristics and blood pressure were recorded at admission to hospital. Computer tomography head was done in all patients as per protocol. Sampling took place in the early morning (7-9 AM) using all necessary precaution and serum fibrinogen was measured by method of Clauss. Statiscal analysis was performed using student t test and fisher exact test. In present study, mean plasma fibrinogen in patients group was 326.45 mg/dl, which was significantly higher than control group (202.23 mg/dl) (p<0.001). Mean plasma fibrinogen level in lacunar infarct and non-lacunar infarct did not differ significantly (307.47 mg/dl Vs. 333.19 mg/dl). Smoking was found to be a significant predictor of fibrinogen with 36.7% predictability whereas other parameters (risk factors for ischemic stroke) had little or no predictable value regarding serum fibrinogen. After adjustment for other possible ischemic stroke risk factors; plasma fibrinogen levels was found to be still significantly high in patients as compared to controls (p<0.001). Mean plasma fibrinogen level between patients who survived and who expired does not differ significantly. Present study concluded that fibrinogen is a powerful predictor of ischemic stroke though it does not predict the type and prognosis of stroke.

Evaluation of serum erythropoeitin response to anaemia in macroalbuminurics of diabetic and non-diabetic etiologies.

This case-control study was undertaken in 75 subjects categorized into 3 equal groups (A: diabetic subjects with macroalbuminuria, B: non-diabetic subjects with macroalbuminuria and C; control subjects). Serum erythropoietin (EPO) was estimated and analyzed in relation to hemoglobin levels in the three groups. The Pearson's coefficient (r) for hemoglobin and log natural EPO was significant for groups A (0.01), B (0.05) and C (0.01). Linear regression analysis of hemoglobin and log natural EPO showed significant differences between the study and control groups; however no significant difference could be demonstrated amongst the study groups. Hence, it was concluded that an inadequate EPO production occurs in renal failure, which accounts for the anaemia and diabetes does not confer an additional discrepancy in this mechanism over non-diabetic macroalbuminuria.

ST-deviation, C-reactive protein and CPK-MB as mortality predictors in acute myocardial infarction.

Prognosis varies widely in patients with acute coronary syndromes because of the heterogeneous nature of this condition. Successful outcome depends upon early risk stratification and an early decision regarding the approach of management of these patients. We studied 120 patients admitted with acute myocardial infarction, who were subsequently divided into two groups based on their final outcome (improvement or expiry). C-reactive protein and CPK-MB were quantitatively estimated at the time of hospital admission. Also, the number of ECG leads showing ST deviation and its sum was calculated and correlated with the biochemical markers. Differences in these variables were analysed between the two groups of patients. Significant differences were found in the mean levels of CRP, CPK-MB, the number of ECG leads with ST deviation and its sum between the two groups. Also, significant correlation was found between the levels of biochemical markers and the sum of ST deviation at admission in all patients of acute myocardial infarction.