RESUMO
INTRODUCTION: Early detection of type 2 diabetes mellitus (T2DM) is imperative to prevent the complications associated with the disease. Current guidelines for diagnosis rely on the assessment of serum glucose (fasting and post-prandial) and glycosylated hemoglobin (HbA1c) levels. Insulin resistance, a phenomenon associated with T2DM, has been observed before the changes in these metrics. The homeostatic model assessment for insulin resistance (HOMA-IR) has been widely used to assess the degree of insulin resistance. The triglyceride-fasting glucose (TyG) index is a newer marker of insulin resistance that merits further study. Aim: The study aimed to assess the validity of the TyG index and HOMA-IR as markers for the development of T2DM in non-obese individuals. Materials and methods: One hundred eight non-obese patients without T2DM were included in this prospective cohort study and followed up for eight years. Anthropometric and biochemical parameters, including fasting glucose levels, HbA1c, fasting serum insulin, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG), were measured at enrolment and eight years follow-up, and HOMA-IR and TyG index were calculated. Results: Twenty participants out of 108 (18.5%) developed T2DM over eight years. On performing the area under the curve (AUC)-receiver operating characteristic curve analysis, TyG of >8.61 and HOMA-IR of >1.5 had the highest validity (ability) to predict new-onset T2DM in the study population (TyG: AUC: 0.612 (95% CI: 0.514-0.705); HOMA-IR: AUC: 0.529 (95% CI: 0.431-0.626)); however, this was not statistically significant. Conclusion: At an eight-year follow-up, TyG and HOMA-IR were unreliable predictors of the development of T2DM in non-obese individuals.
RESUMO
Leprosy is a chronic granulomatous infection that primarily affects developing and underdeveloped countries. Co-infection with the hepatitis B virus can complicate its natural course by altering the host immune system response and thereby the disease outcomes. Early detection and treatment of the disease is thus imperative for preventing debilitating deformities. Several studies have shown positive viral markers for human immunodeficiency virus (HIV) and hepatitis B in patients with leprosy. However, in the Indian subcontinent, we have limited evidence highlighting this correlation. We present a case of a 42-year-old male with chronic hepatitis B infection presenting with new-onset lepromatous leprosy. The patient was successfully managed with a multibacillary multidrug regimen. In patients with hepatitis B co-infection, clinicians must be vigilant about the higher risk of complications and poorer patient outcomes. Extensive longitudinal studies assessing the correlation between leprosy and hepatitis B in India can help tailor future guidelines for management.
RESUMO
Background This study addresses the participation gap in scholarly activities among internal medicine residents. While the Accreditation Council for Graduate Medical Education emphasizes the importance of these activities, the variability in their definition and support across residency programs presents a challenge. This study investigates these discrepancies and aims to identify the specific barriers and benefits residents perceive in scholarly writing, especially in case report writing, and to propose effective educational interventions. Methodology A voluntary online survey, pre- and post-educational intervention, was conducted among residents at Sparrow Hospital, Michigan State University. The intervention comprised a two-hour session focusing on case report writing, presentation skills, scientific literature searches, and research project engagement. Responses were obtained on a five-point Likert scale, and the data were analyzed as respective frequencies and percentages. Results Of 45 residents, 23 completed the pre-survey. With a response rate of 51% from the internal medicine residents, the post-intervention data revealed considerable improvement in the residents' understanding and appreciation of scholarly activities. There was a marked enhancement in their skills related to scientific literature search and in recognizing the benefits of scholarly engagement. Additionally, the intervention successfully increased their confidence in presenting scholarly work, networking, and identifying relevant venues for their research. Conclusions The study highlights the challenges residents face in scholarly activities, such as lack of training and mentorship. It suggests that focused workshops and mentorship can significantly enhance residents' research skills and confidence.
RESUMO
Microinjection is a technique used for transgenesis, mutagenesis, cell labeling, cryopreservation, and in vitro fertilization in multiple single and multicellular organisms. Microinjection requires specialized skills and involves rate-limiting and labor-intensive preparatory steps. Here, we constructed a machine-vision guided generalized robot that fully automates the process of microinjection in fruit fly (Drosophila melanogaster) and zebrafish (Danio rerio) embryos. The robot uses machine learning models trained to detect embryos in images of agar plates and identify specific anatomical locations within each embryo in 3D space using dual view microscopes. The robot then serially performs a microinjection in each detected embryo. We constructed and used three such robots to automatically microinject tens of thousands of Drosophila and zebrafish embryos. We systematically optimized robotic microinjection for each species and performed routine transgenesis with proficiency comparable to highly skilled human practitioners while achieving up to 4× increases in microinjection throughput in Drosophila. The robot was utilized to microinject pools of over 20,000 uniquely barcoded plasmids into 1,713 embryos in 2â days to rapidly generate more than 400 unique transgenic Drosophila lines. This experiment enabled a novel measurement of the number of independent germline integration events per successfully injected embryo. Finally, we showed that robotic microinjection of cryoprotective agents in zebrafish embryos significantly improves vitrification rates and survival of cryopreserved embryos post-thaw as compared to manual microinjection. We anticipate that the robot can be used to carry out microinjection for genome-wide manipulation and cryopreservation at scale in a wide range of organisms.
Assuntos
Robótica , Animais , Humanos , Peixe-Zebra/genética , Microinjeções/métodos , Drosophila melanogaster/genética , Animais Geneticamente ModificadosRESUMO
Vitrification-based cryopreservation is a promising approach to achieving long-term storage of biological systems for maintaining biodiversity, healthcare, and sustainable food production. Using the "cryomesh" system achieves rapid cooling and rewarming of biomaterials, but further improvement in cooling rates is needed to increase biosystem viability and the ability to cryopreserve new biosystems. Improved cooling rates and viability are possible by enabling conductive cooling through cryomesh. Conduction-dominated cryomesh improves cooling rates from twofold to tenfold (i.e., 0.24 to 1.2 × 105 °C min-1 ) in a variety of biosystems. Higher thermal conductivity, smaller mesh wire diameter and pore size, and minimizing the nitrogen vapor barrier (e.g., vertical plunging in liquid nitrogen) are key parameters to achieving improved vitrification. Conduction-dominated cryomesh successfully vitrifies coral larvae, Drosophila embryos, and zebrafish embryos with improved outcomes. Not only a theoretical foundation for improved vitrification in µm to mm biosystems but also the capability to scale up for biorepositories and/or agricultural, aquaculture, or scientific use are demonstrated.
Assuntos
Vitrificação , Peixe-Zebra , Animais , Criopreservação , Temperatura Baixa , NitrogênioRESUMO
BACKGROUND: Pre-eclampsia and eclampsia are common causes of morbidity and mortality, especially in low-income countries. Reducing adverse outcomes associated with hypertensive disorders of pregnancy has been the ultimate priority in recent years. We aim to evaluate the association between calcium supplementation and preeclampsia and gestational hypertension risk among pregnant women. METHODS: A systematic literature search was performed in electronic databases from inception to 15th July 2023, including only randomized controlled trials. Odds ratio (OR) were, and their corresponding 95% confidence interval (95% CI). RESULTS: A total of 26 studies with 20,038 patients (10,003 patients with calcium supplements and 10,035 patients with placebo group) were included in the analysis. The Pooled analysis of primary outcome shows that calcium supplements reduce the risk of preeclampsia by 49% (OR, 0.51(95%CI: 0.40-0.66), P<0.001), and reduce the risk of gestational hypertension by 30% (OR, 0.70 (95%CI: 0.58-0.85)), P<0.001) compared to placebo. There was a trend of lower incidence of preterm delivery (OR, 0.88 (95%CI: 0.71-1.09), P=0.23), labor induction (OR, 0.90 (95%CI: 0.78-1.03), P=0.13), small for gestational age (OR, 0.70 (95% CI:0.37-1.32), P = 0.27), low birth weight (OR, 0.96 (95%CI: 0.86-1.08), P=0.53), perinatal mortality (OR, 0.88 (95%CI: 0.72-1.09), P=0.24), and maternal mortality (OR, 0.48 (95%CI: 0.12-1.84), P=0.28) among calcium supplementation group compared with the placebo group, however, statistical signifance was not achieved. CONCLUSION: This study shows that calcium supplements are associated with a significant reduction in the risk of preeclampsia and gestational hypertension and a trend toward better maternal and fetal-related outcomes.
Assuntos
Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Recém-Nascido , Gravidez , Feminino , Humanos , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/prevenção & controle , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/prevenção & controle , Cálcio , Suplementos Nutricionais , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Ischemic and nonischemic cardiomyopathy (NICM) are one of the leading causes of sudden cardiac death (SCD). Evidence supporting Implantable Cardioverter Defibrillator (ICD) for the prevention of SCD and mortality has shown conflicting results to date. OBJECTIVE: We aim to evaluate the impact of ICD therapy with conventional care for the primary prevention of death of various causes in adults with ICM and NICM. METHODS: We performed a systematic literature search on the electronic database for relevant articles from inception until 30th May 2023. Pooled odds ratios (OR) were calculated using a random effect model, and a p-value of <0.05 was considered statistically significant. RESULTS: A total of 13 randomized controlled trials involving 7857 patients were included in the study. Pooled analysis showed that ICD therapy was associated with a significant reduction in the incidence of all-cause mortality (OR, 0.69 (95%CI:0.55-0.87), P = 0.001), with a similar trend among ICM and NICM compared with the control group. ICD therapy also reduces the incidence of SCD (OR, 0.32(95%CI: 0.24-0.43), P<0.00001) with a similar trend in ICM and NICM, as well as death due to arrhythmia (OR, 0.35(95%CI: 0.19-0.64), P<0.001). However, the incidence of cardiovascular mortality in the ICD group (OR, 0.77(95%CI: 0.58-1.02), P=0.07) was comparable to the control group. CONCLUSION: ICD therapy was associated with a reduction in the incidence of all-cause mortality, sudden cardiac death, and death due to arrhythmia among ischemic and nonischemic cardiomyopathy patients.
Assuntos
Cardiomiopatias , Desfibriladores Implantáveis , Adulto , Humanos , Desfibriladores Implantáveis/efeitos adversos , Cardiomiopatias/complicações , Cardiomiopatias/terapia , Arritmias Cardíacas/etiologia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Prevenção Primária/métodos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Post-stroke depression (PSD) is a prevalent neuropsychiatric sequelae following stroke, often associated with diminished functional recovery and heightened mortality risk. Emerging evidence suggests neuroinflammation, triggered in response to stroke events, may be instrumental in precipitating PSD. AIM: This study aims to assess the significance of high-sensitivity C-reactive protein (Hs-CRP) and homocysteine (Hcy) in post-stroke individuals with PSD. METHODS: We systematically searched all electronic databases from inception until May 30, 2023. Outcomes were reported as standard mean difference (SMD), and their corresponding 95% confidence interval (95% CI). RESULTS: A total of 12 studies with 3,230 patients were included in this study. The mean age of the overall cohort was 65.7 years, and patients with PSD were observed to be older than patients without PSD (68.3 years versus 63.1 years). We observed a higher female prevalence in the PSD group (44.4% versus 40.7%). PSD patients were more likely to be widowed (19.4% versus 8.4%) and more likely to have a family history of psychiatric disorder (11.3% versus 4.9%) compared to non-PSD patients. We also observed that patients with PSD had higher levels of baseline Hs-CRP [SMD 0.16, (95% CI 0.08 to 0.25), p<0.001], and Hcy [SMD 0.14, (95% CI 0.05 to 0.22), p<0.001] than patients without PSD. Meta-regression analysis did not reveal any effect modifier for higher Hs-CRP in the study group, however, history of widowhood was a significant effect modifier when assessing Hcy levels between the two groups (coefficient 1.998, p=0.038). CONCLUSION: Baseline levels of Hs-CRP and Hcy were significantly higher in patients with PSD, highlighting the role of recognizing demographic and biochemical markers in understanding the complexities of post-stroke depression.
Assuntos
Proteína C-Reativa , Acidente Vascular Cerebral , Humanos , Feminino , Idoso , Proteína C-Reativa/metabolismo , Depressão/epidemiologia , Depressão/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Biomarcadores , Progressão da DoençaAssuntos
Amiloidose , Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Amiloidose/cirurgia , Resultado do Tratamento , Fatores de RiscoRESUMO
Current guidelines have shown the superiority of coronary artery bypass grafting (CABG) over medical therapy. However, there is a paucity of data evaluating the optimal revascularization strategy in patients with ischemic left ventricular systolic dysfunction (LVSD). Objective: The authors aimed to evaluate the clinical outcomes of postpercutaneous coronary intervention (PCI) and CABG among patients with LVSD. Methods: The authors performed a systematic literature search using the PubMed, Embase, Scopus, and the Cochrane Libraries for relevant articles from inception until 30 November 2022. Outcomes were reported as pooled odds ratio (OR), and their corresponding 95% CI using STATA (version 17.0, StataCorp). Results: A total of 10 studies with 13 324 patients were included in the analysis. The mean age of patients in PCI was 65.3 years, and 64.1 years in the CABG group. The most common comorbidities included: HTN (80 vs. 78%) and DM (49.2 vs. 49%). The mean follow-up duration was 3.75 years. Compared with CABG, the PCI group had higher odds of all-cause mortality (OR 1.15, 95% CI 1.01-1.31, P=0.03), repeat revascularization (OR 3.57, 95% CI 2.56-4.97, P<0.001), MI (OR 1.92, 95% CI 1.01-3.86, P=0.048) while the incidence of cardiovascular mortality (OR 1.23, 95% CI 0.98-1.55, P=0.07), stroke (OR 0.73 95% CI: 0.51-1.04, P=0.08), major adverse cardiovascular and cerebrovascular events (OR 1.36, 95% CI 0.99-1.87, P=0.06), and ventricular tachycardia (OR 0.79, 95% CI 0.22-2.86, P=0.72) was comparable between both the procedures. Conclusion: The results of this meta-analysis suggest that CABG is superior to PCI for patients with LVSD. CABG was associated with a lower risk of all-cause mortality, repeat revascularization, and incidence of myocardial infarction compared with PCI in patients with LVSD.
RESUMO
This case report presents a unique case of a 15-year-old male with post-streptococcal glomerulonephritis (PSGN) who developed posterior reversible encephalopathy syndrome (PRES). The patient presented with symptoms of fever, headache, emesis, visual disturbances, and involuntary movements of all four limbs. On examination, the patient had elevated blood pressure, decreased visual acuity of the left eye, leukocytosis, and uremia. MRI findings showed symmetrical enhancement of superficial and deep watershed areas, predominantly in the occipital and temporal regions. Treatment with antibiotics and anti-hypertensives resulted in the complete resolution of hyperintense lesions seen in brain MRI after three weeks, and the patient remained symptom-free for one month. This case highlights the rare association between PSGN and PRES and emphasizes the importance of monitoring and managing hypertension in patients with PSGN. Understanding the association between these two conditions may lead to earlier diagnosis and treatment of PRES, ultimately improving patient outcomes.
RESUMO
The safety and clinical outcomes of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) among patients with solid organ transplants is not well understood. This study aimed to evaluate the clinical outcomes of TAVR and SAVR among patients with a history of solid organ transplantation. We performed a systematic literature search of databases for relevant articles from inception until May 1st, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a P-value of <0.05 was considered statistically significant. A total of 3240 studies were identified of which 3 studies with a total of 2960 patients were included in the final analysis. For solid organ transplants patients, the odds of in-hospital mortality (OR 0.37, 95% CI 0.20-0.71, P < 0.001), 30-day mortality (OR 0.51, 95% CI 0.35-0.74, P < 0.001), acute kidney injury (OR 0.45, 95% CI 0.35-0.59, P < 0.001), and bleeding (OR 0.35, 95% CI 0.27-0.46, P < 0.001) were significantly lower in patients undergoing TAVR compared to SAVR. In contrast, the odds of pacemaker implantation (OR 2.60, 95% CI 0.36-18.90, Pâ¯=â¯0.34), postprocedural stroke (OR 0.36, 95% CI 0.13-1.03, Pâ¯=â¯0.06) were similar between both groups of patients. Length of hospital stay was significantly lower in TAVR compared to SAVR patients (SMD -0.82, 95% CI -0.95 to -0.70, P < 0.001). In solid organ transplant patients, TAVR appeared to be a safe procedure with fewer postprocedure complications, shorter length of hospital stay, and lower in hospital mortality compared with SAVR.
Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Transplante de Órgãos , Substituição da Valva Aórtica Transcateter , Humanos , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Fatores de Risco , Resultado do Tratamento , Substituição da Valva Aórtica Transcateter/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversosRESUMO
Globalization and the expansion of essential services over continuous 24 h cycles have necessitated the adaptation of the human workforce to shift-based schedules. Night shift work (NSW) causes a state of desynchrony between the internal circadian machinery and external environmental cues, which can impact inflammatory and metabolic pathways. The discovery of clock genes in the lung has shed light on potential mechanisms of circadian misalignment in chronic pulmonary disease. Here, the current knowledge of circadian clock disruption caused by NSW and its impact on lung inflammation and associated pathophysiology in chronic lung diseases, such as asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and COVID-19, is reviewed. Furthermore, the limitations of the current understanding of circadian disruption and potential future chronotherapeutic advances are discussed.
Assuntos
Asma , Relógios Circadianos , Jornada de Trabalho em Turnos , Humanos , Ritmo Circadiano/fisiologia , Jornada de Trabalho em Turnos/efeitos adversosRESUMO
Ischemic heart disease (IHD) is a pressing public health concern with high prevalence, mortality, and morbidity. Although the value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as markers of the acute coronary syndrome are well recognized, there is a paucity of data deciphering their role in screening for stable ischemic heart disease (SIHD) in the presence of type 2 diabetes mellitus (T2DM). The present study investigates the value of NLR and PLR as markers of SIHD in T2DM. We evaluated the predictive value of NLR and PLR for SIHD by comparing T2DM patients having angiographically proven SIHD to T2DM patients without IHD at different cutoff levels by evaluating the area under the curve (AUC) obtained from receiver-operating-characteristic analysis. Raised NLR and PLR were significantly associated with SIHD ( P < .001 for each). On performing AUC-receiver-operating-characteristic analysis, NLR of > 2.39 and PLR of > 68.80 were associated with the highest prevalence of SIHD (NLR, AUC: 0.652 [0.605-0.699]; CI: 95%; P < .001, PLR, AUC: 0.623 [0.575-0.671] CI: 95%; P < .001). The sensitivities and specificities for these cutoff values were 50% and 73% for NLR and 73% and 46% for PLR, respectively. NLR and PLR were significantly higher in SIHD compared to those without; however, these markers had limited predictive potential in the setting of T2DM.
Assuntos
Diabetes Mellitus Tipo 2 , Isquemia Miocárdica , Humanos , Neutrófilos , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Plaquetas , LinfócitosRESUMO
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease, with the skin being the second most affected organ after the joints. We present a unique case of a 44-year-old female who presented with an acute flare of SLE and the concurrent onset of keratoderma on both lower limbs. She presented with high-grade fever, arthralgia, and generalized edema of four months duration. A general physical examination revealed pallor and scaly hyperpigmented plaques on both lower limbs, which was confirmed to be keratoderma on histopathological examination. Blood investigations revealed pancytopenia, elevated erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP), and positive titers for anti-nuclear antibody (ANA) and anti-Po ribosomal P proteins (RPP) antibodies. Immunosuppressive medications and topical keratolytics were used to treat her successfully. Post medical management, she showed significant improvement in her symptoms. On follow-up, the patient had a complete resolution of the symptoms and remained well. This case demonstrates keratoderma as a rare incidental finding in a patient with SLE flare. Understanding SLE's various cutaneous manifestations are critical for holistically diagnosing and treating the disease.
RESUMO
Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome (NS) and one of the leading causes of end-stage kidney disease. Endocrinological abnormalities due to the urinary loss of hormone-binding proteins, such as transient hypothyroidism, are well documented in FSGS. Secondary FSGS can arise due to viral infections, drugs, and pre-existing glomerular diseases. Few reports have highlighted the occurrence of FSGS in the background of hypothyroidism. We present a case of a young male with primary hypothyroidism who developed the tip variant of FSGS. A combination of oral corticosteroids and angiotensin-converting enzyme (ACE) inhibitors was successful in causing remission of the FSGS with no relapse.
RESUMO
BACKGROUND: The recent outbreak of Human Monkeypox (MPXV) in nonendemic regions of the world is of great concern. OBJECTIVE: We aimed to systematically analyze the current epidemiology, clinical presentation, and outcomes of the Monkeypox virus. METHOD: Systematic literature was conducted in PubMed, Embase, Google Scholar, and Scopus using predefined MESH terms by using "AND" and "OR." The following search terms were used: Monkeypox [MeSH] OR "Monkeypox virus" [MeSH] OR "POX" OR "Monkeypox" AND "Outbreak" AND "Outcomes" from December 2019 till 14th June 2022 without restrictions of language. RESULTS: A total of 1074 (99.90%) patients tested positive for Monkeypox virus through RT-PCR while 1 (0.09) patient was suspected. There was a gender difference with male predominance (54.23% vs. 45.48%) compared with female patients. Mean age (±SD) of patients was 20.66 ± 16.45 years. The major symptoms were rash (100%), fever (96%), and other important symptoms were upper respiratory symptoms (97%), headache (95%), vomiting (95%), oral ulcers (96%), conjunctivitis (96%) and lymphadenopathy (85%). The average mean duration of treatment was 5 days, while the mean hospitalization duration was 13.3 ± 6.37 days. The outcome of 20 patients was available, 19 of 20 patients recovered fully from monkeypox, however, 1 patient was not able to survive resulting in death. CONCLUSION: The recent monkeypox virus outbreak has shown that the virus could transmit in ways that were not previously expected. Further research is needed to understand the possible outcomes and association with humans and their different organ systems.
Assuntos
COVID-19 , Mpox , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto Jovem , Surtos de Doenças , Mpox/diagnóstico , Mpox/epidemiologia , Monkeypox virus/genética , PrognósticoRESUMO
Introduction: Although aortic valve replacement in severe symptomatic Aortic Stenosis (AS) are clearly outlined, the role of surgical intervention in asymptomatic severe AS remains unclear with limited evidence. The aim of our meta-analysis is to evaluate the efficacy and safety of early surgical aortic valve repair compared to conservative management. Methods: A systematic literature search was performed in PubMed, Scopus, Embase and Cochrane databases for studies comparing the early surgery versus conservative management among asymptomatic aortic stenosis patients. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of < 0.05 was considered statistically significant. Results: A total of 5 articles (3 observational studies and 2 randomized controlled trials) were included. At a median followup of 4.1 years, here were significantly lower odds of all-cause mortality [OR = 0.30 (95 %CI:0.17-0.53), p < 0.0001], cardiovascular mortality [OR = 0.35 (95 %CI:(0.17-0.72), p = 0.005], and sudden cardiac death (OR = 0.36 (95 %CI: 0.15-0.89), p = 0.03) among early surgery group compared with conservative care. There was no significant difference between incidence of major bleeding, clinical thromboembolic events, hospitalization due to heart failure, stroke and myocardial infarction between the conservative care groups and early surgery. Conclusion: Among asymptomatic patients with AS, early surgery shows better outcomes in reducing all-cause mortality and cardiovascular mortality compared with conservative management approaches.
RESUMO
Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding caused by bleeding from the ampulla of Vater into the duodenum. HP most commonly results from a rupture of pseudoaneurysms secondary to chronic pancreatitis. The low incidence of HP and the wide spectrum of its clinical presentation poses diagnostic challenges. We present a case of a 39-year-old male with acute-on-chronic pancreatitis resulting in HP and obstructive jaundice due to pancreatic pseudocyst with secondary hematoma. This case highlights the rare occurrence of hypovolemic shock due to massive hemorrhage in HP and the successful management with prompt cardiovascular support and angiographic coil embolization of a bleeding pancreatic pseudoaneurysm.
RESUMO
BACKGROUND: The association of serum prolactin (PRL) with diabetes is still uncertain, with a paucity of data in the south Indian population. This study aims to compare the serum PRL levels between type 2 diabetes mellitus (T2DM) patients and normoglycaemic volunteers and correlate the serum PRL level with fasting plasma glucose (FPG), postprandial plasma glucose (PPG), glycated haemoglobin (HbA1c) levels, and the lipid profile in the study population. METHODS: This was a comparative cross-sectional study among 112 T2DM participants and 112 healthy volunteers in a tertiary care centre in India. All participants were tested for FPG, PPG, HbA1c, fasting serum lipid profile, and serum PRL, which were compared between T2DM patients and healthy volunteers. RESULTS: The serum PRL in T2DM patients was significantly lower compared to healthy volunteers (8.67 ± 4.37 vs. 13.76 ± 6.55 ng/ml, P < 0.001). FPG, PPG, and HbA1c correlated inversely with serum PRL in our study population. On multivariable logistic regression adjusted for age and sex, a higher serum PRL level within the physiological range was protective for T2DM (adjusted odds ratio: 0.83, 95% CI: 0.77-0.90, P < 0.001). Serum PRL levels were inversely correlated with serum total cholesterol, low-density lipoprotein cholesterol, and triglycerides, but not with high-density lipoprotein cholesterol. CONCLUSIONS: A high serum PRL within the physiological range was inversely associated with the prevalence of T2DM in the south Indian population. Serum PRL also correlated inversely with glycaemic and blood lipid parameters. Larger longitudinal studies are required to further validate the association of serum PRL with various components of metabolic syndrome in the south Indian population.