Thyroid storm: Is there a role for thyroid function test?

INTRODUCTION: Thyroid storm (TS) is an endocrine emergency. Early diagnosis for prompt treatment is essential as it has a high mortality rate. CASE REPORT: A 31-year-old lady with underlying hyperthyroidism, dilated cardiomyopathy with severe mitral regurgitation presented with shortness of breath. She was intubated and admitted due to decreasing Glasgow Coma Score. Her blood investigations revealed increased white cell count, raised free thyroxine with suppressed thyroid stimulating hormone, deranged liver, renal and coagulation profiles. As her condition did not improve with initial treatment, plasmapheresis was commenced on day 4. Biochemically, her thyroid function test (TFT) showed improvement; however, she succumbed due to multi-organ failure. DISCUSSION: Plasmapheresis is considered in TS if there is no clinical improvement within 24-48 hours of initial treatment. The improvement in patient's TFT post plasmapheresis signifies its role in treating TS. Unfortunately, there was a delay in commencing plasmapheresis due to haemodynamic instability in this patient.

Incidence and predictors of hospitalization for tendon rupture in type 2 diabetes: the Fremantle diabetes study.

AIMS: To determine the incidence and predictors of tendon ruptures requiring hospitalization of representative patients with type 2 diabetes. METHODS: A total of 1296 patients from the longitudinal observational Fremantle Diabetes Study, Phase I, and 5159 de-identified age- and sex-matched control subjects without diabetes from the same urban area were studied. The patients' mean (sd) age was 64.0 (11.3) years and 48.6% of them were male. Their median (interquartile range) diabetes duration was 4.0 (1.0-9.0) years. The main outcome assessed was any tendon rupture requiring hospitalization in the Fremantle Diabetes Study subjects and the matched control subjects. Independent predictors of spontaneous ruptures in the patients from the Fremantle Diabetes Study were assessed using Cox proportional hazards modelling. RESULTS: The incidence rate ratio for any tendon rupture requiring hospitalization in patients vs control subjects was 1.44 (95% CI 1.10-1.87; P = 0.005). Independent predictors of spontaneous ruptures in patients were BMI [hazard ratio 1.05 (95% CI 1.002-1.10] for 1 kg/m2 increase; P = 0.010] and alcohol consumption [hazard ratio 1.52 (95% CI 1.11-2.09) for √1 standard drink/day increase; P = 0.010]. Adjustment of the incidence rate ratio for overall rupture requiring hospitalization for these variables using the BMI and alcohol consumption data from the contemporary Australian general population suggested it could be as high as 1.84. CONCLUSIONS: There is a greater risk of tendon rupture requiring hospitalization in people with type 2 diabetes. Alcohol consumption and adiposity are potentially modifiable risk factors of spontaneous ruptures in patients with diabetes.

Feeding practice in acute stroke patients in a tertiary care hospital.

BACKGROUND: Feeding is a basic component of care and it is the most common and difficult management issue for stroke patients. Objective of this study was to know the practice of feeding (oral & nasogastric tube feeding), different types of food used and their caloric value in stroke patients. MATERIALS & METHODS: This direct observational study was done from June 2010 to November 2010, in different medicine wards of Dhaka Medical College Hospital, and included 100 acute stroke patients confirmed by CT scan or MRI of brain and duration of hospital stay for at least 24 hours. RESULTS: Out of 100 cases, 22% took their feeding orally and 78% cases through nasogastric tube. Artificial milk powder 66% cases (NG tube vs. Orally, 58% vs. 8%), juice 18% (NG tube 13% vs. orally 5%), horlicks & juice & soup 10% (NG tube vs. Orally, 7% vs. 3%), khichury 2% orally, bread & egg & shuji 4% cases orally. In 100 cases studied, none of them fulfilled the calorie requirement up to the standard level according to the guideline of Nutrition & Food Science Institute, of Dhaka University, Bangladesh. CONCLUSION: Though this study was small scale but the magnitude of under nutrition among stroke patients revealed is alarming and needs urgent attention.

Highly sensitive and selective catalytic determination of formaldehyde and acetaldehyde.

A highly sensitive, simple and selective kinetic method was developed for the determination of ultra-trace levels of formaldehyde and acetaldehyde based on their catalytic effect on the oxidation of N,N-diethyl-p-phenylenediamine (DPD) with hydrogen peroxide. The reaction was monitored spectrophotometrically by tracing the formation of the red-colored oxidized product of DPD at 510nm, within 30s of mixing the reagents. The optimum reaction conditions were: 20mmolL(-1) DPD, 250mmolL(-1) H(2)O(2), 150mmolL(-1) phosphate, 150mmolL(-1) citrate and pH 6.60+/-0.05 at 25 degrees C. Following the recommended procedure, formaldehyde and acetaldehyde could be determined with linear calibration graphs up to 0.50 and 1.4microg mL(-1) and detection limits, based on the 3S(b)-criterion, of 0.015 and 0.035microg mL(-1), respectively. In addition, analytical data for other 10 aldehydes were also presented. The high sensitivity and selectivity of the proposed method allowed its successful application to rain water, mainstream smoke (MSS) and disposed tips of smoked cigarettes (DTSC). A sample aliquot was directly analyzed for its total water-soluble aldehyde content. A second sample aliquot was heated at 80 degrees C for 10min to expel acetaldehyde and the aliquot was analyzed for its content of other water-soluble aldehydes (expressed as formaldehyde equivalent), and acetaldehyde was determined by difference. The analytical results were in excellent agreements with those obtained following the standard HPLC method based on pre-column derivatization with 2,4-dinitrophenylhydrazine. Moreover, published catalytic-spectrophotometric methods for the determination of aldehydes were reviewed.

A novel kinetic determination of dissolved chromium species in natural and industrial waste water.

A highly sensitive, selective and simple kinetic method was developed for the determination of dissolved chromium species based on the catalytic effect of Cr(III) and/or Cr(VI) on the oxidation of 2-amino-5-methylphenol (AMP) with H(2)O(2). The fixed time and initial rate variants were used for kinetic spectrophotometric measurements by tracing the oxidized product at 400nm for 10min after starting the reaction. Boric acid and Tween-40 exerted pronounced activating and micellar sensitizing effects on the studied redox reaction, respectively. The optimum reaction conditions were: 3.0mmoll(-1) AMP, 0.45moll(-1) H(2)O(2), 0.50moll(-1) boric acid, 4v/v% Tween-40, 10mmoll(-1) phosphate buffer and pH 6.45+/-0.02 at 35 degrees C. Both Cr(III) and Cr(VI) ions exerted the same catalytic effect on the studied reaction. Linear calibration graphs were obtained for the determination of up to 6.0ngml(-1) Cr with detection limits of 0.054 and 0.10ngml(-1) Cr; following the fixed time and initial rate methods, respectively. The proposed method was successfully applied to the speciation and determination of trace levels of dissolved Cr(III) and Cr(VI) in natural and effluents of industrial waste water. The total dissolved Cr(III) and Cr(VI) species was determined first. In a second run, Cr(VI) was determined alone after precipitation of Cr(III) ions in presence of Al(OH)(3) collector, where Cr(III) is then determined by difference. Moreover, published catalytic-spectrophotometric methods for chromium determination were reviewed.