Biochemical Profile Of Patients Research Articles

A Study of Clinical, Hematological and Biochemical Profiles of Patients with Pancytopenia

This study aimed to investigate patients’ clinical, hematologic, and biochemical profiles with pancytopenia. This prospective observational study was conducted at a tertiary care hospital from January 2019 to June 2020 on 80 patients, 39 (48.7%) were males and 41 (51.2%) were females, over the age of 18 presenting with pancytopenia. All the patients were subjected to thorough clinical and physical examinations. A complete blood count (CBC), peripheral smear examination, bone marrow aspiration, and reticulocyte count were performed. The data was analyzed using the IBM SPSS 20.0 software. Most of the cases had moderate (Hb<7-9.9g/dl) anemia (63.7%, 51/80 cases), while severe anemia (<7g/dl) was seen in 31.2% (25/80) cases, and 5% (04/80) cases showed mild anemia (Hb<10-11.9g/dl). Most patients with severe anemia had vitamin B12 deficiency anemia (12/80), that is, 15%. Macrocytic anemia was noted in preponderance (50% cases, 40/80), whereas microcytic hypochromic and normocytic hypochromic anemia constituted 21.3% (17/80), and dimorphic anemia was seen in 7.5% (06/80) cases. Based on WBC counts, 56.3% of cases (45/80) showed counts between 2000 and 4000 cells/cu.mm, while counts between 1000 and 2000 cells/cu.mm were seen in 31.3% of cases (25/80), and 12.5% of cases (10/80) had counts of <1000 cells/cu.mm. The study highlighted that 28.8% (23/80) had a platelet count between 50,000 and 1 lakh/cu.mm (mild thrombocytopenia), 36.3% (29/80) cases had a platelet count between 20,000 and 50,000/cu.mm (moderate thrombocytopenia), and 35% (28/80) cases had a platelet count less than 20,000/cu.mm (severe thrombocytopenia). The most common diagnosis of bone marrow aspiration was megaloblastic anemia, seen in 50.0% (6/12) cases. Megaloblasts were seen in 50.0% (6/12) cases of megaloblast anemia. The bone marrow aspirate of a patient with dengue fever and malaria showed macrophages containing engulfed red blood cells, lymphocytes, and platelets. Myeloblasts (>20%) were seen in 1 (8.3%) case of AML, and decreased myelopoiesis was seen in 25% of cases (two cases of aplastic anemia and one case of MDS). This study concludes that vitamin B12 deficiency is the most common cause, which is more common in people who are strict vegetarians, with a predominance in the younger age group. The study also emphasized the vitality of the physical findings, detailed primary hematologic and biochemical investigations, and peripheral blood pictures, all of which provide precious information in the work-up of pancytopenia patients.

The role of kidney biopsy in deciphering diabetic versus non-diabetic origin of kidney disease among patients with type 2 diabetes mellitus and nephrotic range proteinuria: A retrospective study

BackgroundDiabetes mellitus (DM) is tightly associated with the increased prevalence of diabetic kidney disease (DKD). Nonetheless, severe renal function impairment and/or nephrotic range-proteinuria could also result from non-diabetic renal disease (non-DRD) among patients with DM. The ‘Gold standard’ for the differential diagnosis between DKD and non-DRD is kidney biopsy, although no real consensus exists. Thus, this study intends to associate the clinical and biochemical profile of patients with DM and renal disease with the histopathological data of kidney biopsy.In addition, we aimed to evaluate the role of kidney biopsy, especially when other causes, other than DM, are highly suspected among patients with DM and kidney disease. MethodsThirty two patients with T2DM and nephrotic range levels of proteinuria or with co-existing factors pointing towards a non-diabetic origin of kidney disease were studied, retrospectively. All 32 patients underwent kidney biopsy and were classified according to histopathological findings into 3 groups: a) isolated diabetic kidney disease (DKD), b) non-diabetic kidney disease (NDKD) and c) mixed kidney disease (MKD). ResultsFifteen out of the 32 patients had findings of an isolated DKD, while 17 out of 32 patients suffered from NDKD (13 patients) or MKD (4 patients). DKD patients were younger (p = 0.016) and had a higher HbA1c value (p = 0.069, borderline statistical significance), while the NDKD patients had significantly shorter disease duration (p = 0.04). Furthermore, the incidence of diabetic retinopathy (DR) was lower among the NDKD patients (p < 0.001), who had also significantly less interstitial fibrosis (p = 0.02). Finally, the presence of DR, higher levels of interstitial fibrosis and longer T2DM duration were recognized as factors, which were positively associated with DKD. ConclusionThis study advocates the usefulness of kidney biopsy in patients with T2DM and nephrotic range levels of proteinuria, especially when DR is absent and shorter disease duration is observed.

The clinical, hematological, and biochemical profiles of patients with complications due to Plasmodium vivax malaria: A case series

Malaria, a protozoal infection caused by the six species of the genus Plasmodium, is one of the most important diseases known to humankind, with most infections caused by either of the two species – Plasmodium vivax and Plasmodium falciparum. Previously, it was held that falciparum malaria was responsible for causing severe, life-threatening disease, with vivax malaria causing mild or uncomplicated infections. In this case series, the clinical, hematological, and biochemical profiles of eight patients with features of complications due to P. vivax malaria, along with their clinical course, response to treatment, and clinical outcomes have been described. Among these, the most common clinical features were fever, headache, and myalgias. Five patients had altered mental status, two were prostrated, two were hypotensive, and one had recurrent generalized seizures. Three patients had pancytopenia, two had both anemia and thrombocytopenia, and one had evidence of disseminated intravascular coagulation. Six patients had clinical jaundice, four had elevated transaminases, and four had acute kidney injury. All cases showed excellent response to anti-malarial therapy. Hence, this case series revealed that P. vivax is capable of causing severe, life-threatening organ dysfunction akin to those seen in P. falciparum malaria and that early diagnosis and treatment initiation are associated with positive patient end outcomes.

Inside the Brain: Cerebrospinal Fluid Insights in Meningitis.

Background Our study focused on meningitis, an infection that can spread through the bloodstream as a primary or secondary infection from other body parts, such as sinuses, ears, and lungs. It can affect patients who have experienced trauma or surgery, as well as those with congenital defects like spina bifida. Specifically, we examined bacterial, viral, and tuberculous meningitis (TBM) cases. The primary method for confirming the diagnosis of these types of meningitis is to analyze the cerebrospinal fluid (CSF). Early diagnosis can utilize cytological and biochemical parameters. Our objective is to determine CSF's cytological and biochemical profile in patients with these specific types of meningitis. Methods A study was carried out at the central pathology lab from October 24, 2017, to April 24, 2018.CSF samples from suspected meningitis patients were examined for various parameters, including hematological, biochemical, microbiological, and cytomorphological aspects and specific tests for bacterial, fungal, and TBM. The study focused on patients aged 16 and above, excluding those under 16, non-compliant patients, and individuals with specific health conditions. Data were analyzed using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States), and the results were presented through the use of mean, standard deviation, and percentages. Statistical tests were utilized to compare categorical variables and mean, with a significance level of p<0.05. Results We included a total of 156 cases, with the mean age of presentation being 56.628 years. The male-to-female ratio was 1.0526:1. Of the patients, 81 (52.1%) had been diagnosed with TBM, had elevated adenosine deaminase (ADA) levels of 48.8733±37.43740 IU/L, and CSF lymphocytosis (99%). Additionally, cases of bacterial meningitis showed markedly raised mean total leukocyte count (TLC) of 2085.50±445.47727 cells/mm3 and mean CSF protein levels of 349.45±113.73105 mg/dL. The study found a significant increase in protein levels and a decrease in glucose levels in the CSF of TBM and bacterial meningitis patients compared to those with other causes of meningitis (p<0.001). Guillain-Barre syndrome (GBS)and multiple sclerosis (MS) patients had TLC and ADA within normal limits.CSF ADA level greater than 6 IU/L showed a sensitivity of 97.53% and a specificity of 96.0%, making it the most specific test. A protein level in the CSF greater than 45 mg/dL demonstrated a sensitivity of 98.78% and a specificity of 24.32%, indicating it is sensitive but less specific in diagnosing TBM. Lymphocytic predominance, defined as TLCof more than 5 cells/mm3 with at least 50% of the cells being lymphocytes in the CSF of TBM patients, showed a sensitivity of 97.53% and a specificity of 6.67%. CSF glucose had a sensitivity of 38.27%, making it the least reliable indicator for diagnosing meningitis. Conclusion The CSF analysis is the primary diagnostic method for detecting meningitis. Its cost-effectiveness is a key factor, especially for patients from lower socioeconomic backgrounds in government medical colleges in India, where access to expensive diagnostic tests is limited. The efficiency of CSF analysis for early diagnosing different types of meningitis aids in management, helping to prevent complications and fatal outcomes.

Clinical and Biochemical Profile of Patients with 46, XY Disorders of Sex Development

Abstract Background Disorders of sex development (DSD) comprise a wide range of conditions with varying features and pathophysiology that most often present in the newborn or the adolescent. Affected newborns are born with ambiguous genitalia, whereas adolescents present with atypical sexual development during the pubertal years. Aim of the Work To study the clinical and biochemical profile of patients with 46, XY disorders of sex development. Patients and Methods This was a descriptive study, conducted on 50 patients with 46, XY DSD attending the Pediatric Endocrinology clinic, Children's Hospital, Ain Shams University were recruited from April 2019 till April 2020. Results In our study 88% of cases were reared as males, while 12% were reared as females. The mean age at diagnosis was 2.48 ± 1.33 years with a range of 1-7 years. Parental consanguinity was present in 28 (56.0%) patients and a positive family history in 10 (20.0%). Mean external masculinization score (EMS) in our study was 3.30 ± 1.81 and ranged from 0 to 9 with a median of 3. The mean of stimulated Testosterone / Dihydrotestosterone (T/DHT) ratio was 17.5 (7.8-26) and ranged between 1.5 and 66.6. The median of Anti Mullerian Hormone (AMH) was 56 ng/ml and ranged between 19.08 and 105 ng/ml. There was correlation between EMS final score and stimulated DHT (r = 0.54, P = 0.000). Of note 6 (12.0%) patients had reconstruction of scrotum, 7 (14%) had undergone inguinal hernia repair, 12 (24%) had undergone correction of hypospadias, 6 (12.0%) bilateral gonadectomy,6 (12.0%) left orchiopexy, 3 (6.0%) right orchiopexy and 10 (20%) bilateral orchiopexy. Conclusion Due to the overlapping clinical and biochemical parameters in various subsets of DSD, only a preliminary etiological diagnosis can be made in some cases. Genetic examination with long-term follow-up are needed for a precise diagnosis. Management of these patients is multidisciplinary which needs an endocrinologist, gynecologist, psychologist, pediatrician, and clinical geneticist.

Hematological and Biochemical Profiles of Patients with Dengue Virus Infection in Lalitpur, Nepal

Dengue viral infection is a disease transmitted by mosquitoes of the Aedes genus, and it arises as a result of being bitten by mosquitoes that are carrying the virus. This infection induces a wide range of changes in the body’s immune system. Thus serological evaluation together with hematological and biochemical parameters in cases of dengue viral infection make an accurate clinical diagnosis. The main objective of this study was to study the serological, hematological, and biochemical parameters among patients infected with Dengue virus. A total of 102 blood samples were collected at Asrik Diagnostic Lab, Lalitpur during the period of August to October 2022. Samples were analyzed by following methods: hematological tests were done by coulter counter, Biochemical tests were done by fully automated analyzer and serological tests were done by ELISA. Of the 102 blood samples NS1 antigen was detected in 62 (60.9%) whereas anti-dengue IgM antibody was detected in 10 (9.8%). Leukopenia and thrombocytopenia were present in 33 (53.1%) and 32 (51.6%) of the 62 NS1 positive samples, respectively. Of the 62 cases, only 16 samples were tested for the alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Out of 16 samples, ALT and AST level were significantly higher in 11 (68.8%) and 14 (87.5%) positive cases, respectively. The statistical analysis showed that there was no significant association between NS1 and IgM. It can be concluded that the investigation of leukocytes, thrombocytes, ALT, and AST helps to diagnose the dengue efficiently.

Comparative Analysis of Biochemical Profile in Patients with Chronic Renal Failure Undergoing Hemodialysis

Background: Chronic Renal Failure (CRF) necessitates hemodialysis, a crucial treatment modality that involves the removal of waste products and excess fluid from the blood of patients with end-stage renal disease. The biochemical profile, including electrolyte levels in patients undergoing hemodialysis, plays a vital role in patient management and outcome. Objective: The primary objective of this study was to evaluate the impact of hemodialysis on the electrolyte levels (sodium, potassium, and calcium) of patients with chronic renal failure and to assess the clinical implications of these changes. Methods: This study was conducted with ethical approval, adhering to the Declaration of Helsinki principles. A total of 60 patients undergoing hemodialysis at the Institute of Kidney Diseases, Peshawar, were randomly selected. Blood samples were collected both pre- and post-hemodialysis to analyze changes in sodium, potassium, and calcium levels. The biochemical analysis was conducted using gel tubes for blood collection, with samples transported under controlled conditions to the laboratory. Statistical analysis was performed using SPSS version 25, employing paired T-tests and the Shapiro-Wilk test to assess data normality and changes in electrolyte levels. Results: The study revealed significant changes in electrolyte levels post-hemodialysis. Sodium levels decreased from a pre-hemodialysis mean of 142.37 ± 27.140 mmol/L to a post-hemodialysis mean of 123.13 ± 13.733 mmol/L (P=0.006). Potassium levels saw a reduction from 4.93 ± 1.219 mmol/L to 3.90 ± 1.311 mmol/L (P=0.054). Calcium levels also decreased from 9.777 ± 0.3743 mg/dL pre-hemodialysis to 9.663 ± 0.7629 mg/dL post-hemodialysis (P&lt;0.001). Conclusion: Hemodialysis significantly impacts the electrolyte balance in patients with chronic renal failure, highlighting the necessity for vigilant monitoring and management of electrolyte levels to mitigate adverse clinical outcomes. This study underscores the importance of tailored therapeutic interventions to maintain electrolyte homeostasis, ultimately improving the quality of life and healthcare outcomes for patients undergoing hemodialysis.

Variation of hematological and biochemical profile in dialyzed patients before and after this treatment

Introduction: Chronic kidney disease has developed in recent years and has become one of the top 10 leading causes of death worldwide. Patients undergoing dialysis require monitoring of hematological and biochemical parameters to detect the progression of the disease and assess the quality of treatment.Objective: To evaluate the variation in different parameters of the hematological and biochemical profile in patients before and after dialysis.Methods: a comprehensive literature review was conducted with 24 scientific articles obtained from digital databases such as Google Scholar, SciELO, PubMed, Elsevier, related to chronic kidney disease and the measurement of hematological and biochemical parameters in patients during pre and post-dialysis.Results: Most hematological parameters, such as red blood cells, hemoglobin, MCV, MCH, and platelets, significantly increase after treatment. On the other hand, both urea and creatinine decreased during post-dialysis measurements, although they did not decrease enough to reach normal values.Conclusions: Dialysis produces positive changes in hematological profile parameters, as levels increase after treatment. It also helps eliminate toxins from the blood by demonstrating a decrease in urea and creatinine

Postoperative micronutrient changes in bariatric surgery patients compliant with nutritional supplementation.

Bariatric surgery is commonly used in patients with body mass indexes over 35kg/m and obesity-related comorbidities. Despite the significant clinical benefits of bariatric surgery, nutritional deficiencies post-surgery remain a challenge for both patient and healthcare provider [Toninello et al. in Nutrients 13:1565, 2021, Gasmi et al. in Eur J Nutr 61:55-67, 2022]. Nutritional supplementation is a way of reducing the likelihood of postoperative deficiencies; however, prior studies have shown varying degrees of mostly poor to moderate patient adherence [Spetz et al. in Obes Res Clin Pract 16:407-412, 2022, Mahawar et al. in Obes Surg 29:1551-1556, 2019, Santonicola et al. in J Am Nutr Assoc 41:11-19, 2022, Sherf Dagan et al. in Obes Surg 27:2258-2271, 2017]. Our present study aims to provide insights into the micronutrient biochemical profile in patients previously found to be compliant with supplementation following roux-en-y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG). An 11-point outpatient survey was administered to consecutive patients ≥ 18years who had undergone either RYGB or VSG to determine adherence with nutritional supplementation. Medical records were retrospectively reviewed to determine preoperative and postoperative lab values, including vitamins A, B1, B12, and D, thyroid stimulating hormone (TSH), iron binding capacity, transferrin, ferritin, folate, iron, albumin, hemoglobin A1C, zinc, glomerular filtration rate (GFR, and liver function values. Values were classified as "abnormal" or "normal." Preoperative and postoperative values were compared for differences. Postoperative values were also compared between RYGB and VSG. There were no significant differences between preoperative and postoperative values for any nutritional marker aside from vitamin B12. A total of 51/60 patients (85.0%) had normal preoperative B12 measurements, compared with 40/65 (61.5%) patients postoperatively (P = 0.03). Notably, of 25 "abnormal" postoperative measurements, 20 (80%) were elevated values. There were no differences in postoperative deficiencies between RYGB and VSG. Patients in our sample did not have worsened micronutrient deficiencies following bariatric surgery, and there were no differences in micronutrient deficiencies between surgical technique.

To study risk factors and biochemical profile of diabetic ketoacidosis patients with special emphasis on serum amylase

Background: Diabetes mellitus (DM) is a complex endocrinological disorder with altered metabolism of blood glucose. Diabetic ketoacidosis (DKA) is one of the life-threatening acute complications of DM that mainly occurs in type 1 diabetes patients, as well as in some patients with type 2 diabetes. The mortality rate associated with DKA depends on the experience of the treating hospital in dealing with this condition; thus, it is critical that patients detect DKA and get medical help as soon as possible. Aims and Objectives: To study risk factors for DKA, clinical and biochemical profile of DKA patients. Correlation between serum amylase level, serum bicarbonate level and mean duration of hospital stay. Materials and Methods: A cross-sectional analytical study was carried out on 100 DKA patients in the Department of Medicine, SGMH Rewa, Madhya Pradesh from January 2021 to June 2022. The data extracted included clinical presentation, precipitating factors, laboratory profile, complications, and hospitalization outcomes. Results: Of the 100 patients admitted for DKA; 70 had type 2 diabetes (70%) and 30 (30%) were type I diabetes. The average age at the time of presentation was 48.61±19.59 years. The commonest precipitating factor was infection (38%) followed by other factors (62%). The most common clinical features at the time of presentation were altered sensorium, fever, vomiting, polyuria, polydipsia, weakness, lethargy, myalgia, headache, anorexia, abdominal pain, and orthopnea. The values for RBS, HCO3, and pH were 525.0±62.4, 12.6±2.69, and 7.14±0.31, respectively. There was no significant difference in clinical and biochemical profile of patients with type 1 and type 2 diabetes. The mortality rate was 3% and factors found to be significant predictors were comorbid condition, severity of mental status, severity of dehydration, RBS at the time of presentation, and severe acidosis. Conclusion: The most common precipitating factors are infection and omission of insulin or irregular treatment. The most common clinical features at the time of presentation are nausea, vomiting, abdominal pain, headache, and dehydration. There is no significant difference in the clinical and biochemical profile of patients with type 1 and type 2 diabetes. The mortality rate in DKA is 3% and the most notable predictors of poor prognosis are; severity of altered sensorium, severity of comorbid condition, severe dehydration, severe acidosis, and identification and treatment of precipitating factors are more important. Patient education plays a crucial role in the prevention of DKA.

Prognostic analysis and clinical and nutritional characteristics of critical Covid-19 patients

The Covid-19 pandemic represented a challenge for health systems, in large part due to the high mortality rate of the disease in older population, multiform clinical manifestations and prognosis related to nutritional diagnosis and biochemical profile of patients. Objective: to correlate Covid-19 patients admitted to an Intensive Care Unit (ICU) with laboratory tests, anthropometric data and the clinical outcome of the disease. Methodology: an epidemiological and cross-sectional study was performed using secondary databases, analyzing the laboratory (hemoglobin, hematocrit, leukocytes, rods, platelets, creatinine, d-dimer, oxaloacetic transaminase, pyruvic transaminase and C-reactive protein) and nutritional (upper arm circumference, calf circumference and body mass index) parameters of Covid-19 patients admitted to the ICU between March 2020 and March 2021. Sociodemographic, laboratory and clinical data were collected from hospitalized Covid-19 patients in the hospital. Results: inverse correlations were observed between age and anthropometric indicators. The use of a greater number of medications (average 2.1) was associated with lower final Body Mass Index (average 29.2 kg/m²) and arm circumference (average 32.3 cm) values. Patients who died were older, had shorter hospital stays, higher creatinine levels and lower baseline anthropometric indicators. Conclusions: older patients had lower anthropometric values. Patients with chronic diseases had a worse prognosis in the evolution of Covid-19.

Non-alcoholic Fatty Liver Disease in Overt Hypothyroidism: A Cross-Sectional Study in a Tertiary Care Hospital.

The termnon-alcoholic fatty liver disease (NAFLD) describes a condition in which excess fat accumulates in the liver, similar to alcohol-induced liverinjurybut affecting those whodon't consume alcohol. Liver steatosis may vary fromsimplehepatic steatosis to more serious conditions, including non-alcoholic steatohepatitis and cirrhosis, and is linked to an increased risk of hepatocellular carcinoma (HCC). There is an estimated 20-30% prevalence of non-alcoholic fatty liver disease over the globe. The incidence rate among Indians is 26.9%. Metabolic diseases like insulin resistance, obesity, type-2 diabetes mellitus, and dyslipidemia are risk factors for NAFLD.A correlation between overt hypothyroidism and NAFLD has been discussed. To determine the magnitude of non-alcoholic fatty liver disease in overt hypothyroidism and to estimate the clinical and biochemical profile of patients with overt hypothyroidism and its relationship. Throughout the course of a year, researchers from the medical department of a large hospital in southern India collected data in a cross-sectional observational study. Thyroid profile, fasting lipid profile, liver function tests, and ultrasound of the abdomen and pelvis were administered to a total of 100 male and female patients (18-60 years old) with newly diagnosed overt hypothyroidism who were visiting the outpatient department (OPD) and hospitalized in wards of general medicine. About 75% of subjects were females, with a mean age of 37.63±7.6 years and a mean body mass index (BMI) of 25.07±1.5 kg/m2.A significant correlation was found between dyslipidemia and thyroid-stimulating hormone (TSH) levels (p-value <0.001), and between dyslipidemia andultrasonogram(USG)finding of NAFLD (p-value <0.001). A significant correlation was seen between TSH values andNAFLD findings (p-value <0.001). NAFLDis a risk factor for developing hepatocellular carcinoma and is a known contributor tocryptogenic cirrhosis. Hypothyroidism is being studied as one of the causes of NAFLD. When hypothyroidism is diagnosed and treated early, it may reduce the likelihood of NAFLD and associated consequences.

Alterations in Biochemical Profiles of Patients with Severe COVID-19 Pneumonia: Analysis of Repeated Laboratory Tests

Alterations in Biochemical Profiles of Patients with Severe COVID-19 Pneumonia: Analysis of Repeated Laboratory Tests

Biochemical characteristics of patients with imported malaria.

This study aimed to investigate the clinical and biochemical profiles of patients with imported malaria infection between 1 January 2011 and 30 April 2022 and admitted to the Fourth People's Hospital of Nanning. This cohort study enrolled 170 patients with conformed imported malaria infection. The clinical and biochemical profiles of these participants were analyzed with malaria parasite clearance, and signs and symptoms related to malaria disappearance were defined as the primary outcome. A multivariable logistic regression model was used to evaluate the odds ratios (ORs) with 95% confidence intervals (CIs) for cerebral malaria. The Cox model was used to estimate the hazard ratios (HRs) with 95% CIs for parasite clearance. Adenosine deaminase and parasitemia were found to be independent risk factors for severe malaria in patients with imported malaria (OR = 1.0088, 95% CI: 1.0010-1.0167, p = 0.0272 and OR = 2.0700, 95% CI: 1.2584-3.4050, p = 0.0042, respectively). A 0.5-standard deviation (SD) increase of variation for urea (HR = 0.6714, 95% CI: 0.4911-0.9180), a 0.5-SD increase of variation for creatinine (HR = 0.4566, 95% CI: 0.2762-0.7548), a 0.25-SD increase of variation for albumin (HR = 0.4947, 95% CI: 0.3197-0.7653), a 0.25-SD increase of variation for hydroxybutyrate dehydrogenase (HR = 0.6129, 95% CI: 0.3995-0.9402), and a 1.0-SD increase of variation for ferritin (HR = 0.5887, 95% CI: 0.3799-0.9125) were associated with a higher risk for increased parasite clearance duration than a low-level change. Aspartate aminotransferase, urea, creatinine, albumin, hydroxybutyrate dehydrogenase, and ferritin are useful biochemical indicators in routine clinical practice to evaluate prognosis for imported malaria.

The clinical and biochemical effects of atrial fibrillation on heart failure with reduced ejection fraction; a sub-saharan African perspective

Abstract Background Sub Saharan Africa (SSA) has seen one of the sharpest increases in cardiovascular disease-related mortality. This increase is evidenced by a growing burden of heart failure and atrial fibrillation (AF) risk factors. Atrial fibrillation is a common comorbidity of heart failure with reduced ejection fraction (HFrEF) which predisposes to an increased risk of morbidity and mortality. Studies done in high income countries (HIC) suggest that there may be an essential role for ethnic differences. However, in the absence of accurate epidemiological data in Sub-Saharan Africa, this cannot be proven. To date, there has never been a prospective systematic description of patients with HFrEF/AF and HFrEF/sinus rhythm (SR). Aim Our study aimed to describe the clinical and biochemical profile of patients with HFrEF/AF and HFrEF/SR in a Sub-Saharan African cohort. Methods The study was conducted inthe division of our Academic Hospital in South Africa. We enrolled 141 patients, consecutively, with HFrEF. Baseline clinical characteristics and exploratory biomarkers were recorded. All participants underwent comprehensive echocardiography. Novel left atrial strain was measured using 2D-speckle tracking echocardiography. These values were compared between patients in SR and in AF. Results The prevalence of AF was 21.38%. Hypertensive heart disease was the leading cause of HFrEF (36%). HFrEF/AF patients were significantly older (66.7±11.9) than those in SR (53.7±14.4) (p=0.000) with significantly different racial proportions (p=0.001). Coronary artery disease was prevalent in patients with HFrEF/AF. Patients with HFrEF/AF had significantly lower Kansas City Cardiomyopathy Questionnaire scores (29.83±15.27) compared to those in SR (44.26±16.30) (p=0.000) as well as worsening functional class (NYHA III–IV; 64.3% vs 22.7%, p=0.000). Measured levels of sST2 were greater in HFrEF/AF patients 40.45ng/mL (17.6–68.6) vs 20.8 (7.9–44.0) in HFrEF/SR (p=0.031). Patients with HFrEF/AF had a significantly greater left atrial volume (ml) (83.9 [64–99.9]) than those with HFrEF/SR (61.53±25.46) (p=0.038). Left atrial strain reservoir function (%) was significantly lower in patients with HFrEF/AF (29.00±13.60) compared to those with HFrEF/SR (41.56±15.46) (p=0.0004) Conclusion Our findings demonstrate that patients with HFrEF/AF are older than those in SR but much younger compared to patients in HICs. Hypertensive heart disease is a major cause of HFrEF in South Africa. We demonstrate that patients with HFrEF/AF are clinically worse off than those with HFrEF/SR. Atrial fibrillation is a marker of fibrosis and disease severity in HFrEF. Patients with HFrEF/AF had elevated sST2 levels a more deformed left atrium morphologically and poor tissue doppler function. On strain imaging, HFrEF/AF patients had poor left atrial reservoir function. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The South African Medical Research Council

INCIDENCE OF HEPATIC DYSFUNCTION IN PATIENTS WITH DIABETES MELLITUS ADMITTED IN DARBHANGA MEDICAL COLLEGE AND HOSPITAL

Objective: The objective of the study was to find out the difference in the severity of the disease, pattern of liver injury, and clinical and biochemical profile in patients with liver dysfunction with and without diabetes mellitus (DM) and metabolic syndrome. Methods: It was an observational study, the study conducted in the Department of General Medicine, Darbhanga Medical College and Hospital. Fifty consecutive patients with liver dysfunction along with diabetes and 50 consecutive patients with liver dysfunction without diabetes who satisfied the following inclusion criteria and did not have any of the exclusion criteria were selected for the study during the study period from January 2020 to December 2021. Results: The mean age in patients with and without D.M. was 52.54 years and 52.58 years, respectively, with no significant difference between the two groups (p=0.283). The causes of liver dysfunction were as follows: Alcohol in 40 patients (24 without D.M. and 16 with D.M.), cryptogenic in 41 (14 without D.M. and 27 with D.M.), hepatitis C virus in eight (three without D.M. and five with D.M.), and hepatitis B virus in 12 (nine in without D.M. and two in with D.M.). The D.M. group had a considerably higher frequency of patients with cryptogenic cirrhosis (p=0.007). Diabetic individuals exhibited a significantly higher frequency of anemia, hypoalbuminemia, and hypercreatininemia than non-diabetic patients, according to laboratory testing. The majority of the patients of both groups showed mild ascites (88% without D.M. vs. 82% with D.M.). It shows diabetic patients had significantly higher MELD and higher Child-Pugh scores (p=0.001 and 0.004, respectively). Conclusion: D.M. is found all over the world, and there is a growing body of evidence associating it with cirrhosis. As a result, both are likely to rise in value. Coexisting diabetes appears to be linked to more severe liver injury and consequences preceding cirrhosis, as well as greater mortality once cirrhosis has developed.

Clinical Profile and Outcome of Diabetic Ketoacidosis in Type 1 and Type 2 Diabetes: A Comparative Study

Objectives: To Compare the Clinical and Biochemical Profile of DKA in Type 1 and Type 2 DM in terms of various complications and Mortality. Material and Methods: In this comparative study, a total of 95 patients admitted to tertiary care centres with DKA from October 2018 to December 2020, were enrolled. They were analysed for clinical profile and outcome in both groups. Results: Out of 95 patients, Type 1 DM was 18 (18.95%) and 77 (81.05%) were Type 2 DM. Among the clinical presentations, abdominal pain (61.11%) and breathlessness (55.55%) were common in Type 1 DM while breathlessness (40.25%) was the predominant presentation seen in Type 2 DM. There was no significant difference in the biochemical profile of patients in both groups with DKA. The mortality rate was higher in Type 2 DM (12.63%) than Type 1 DM (3.15%). Septicaemic shock (40%) was the most common cause of mortality and the next common was pneumonia in 33%. Severe acidosis, low Glasgow Coma Scale (GCS), high doses and longer duration of insulin therapy, higher acute physiology, and chronic health evaluation II (APACHE-II) score, and high serum osmolality had a bad outcome and were associated with high mortality. Conclusion: DKA is commonly observed in Type 2 DM also. Infection is the most common precipitating factor for DKA. Type 2 DM had the more severe presentation of DKA as compared to Type 1 DM with DKA. Increased APACHE-II, the requirement of insulin, and length of hospital stay are a predictor of mortality. However, GCS, APACHE-II score, and ABG parameters can predict outcomes in DKA.

Galectin-3 as a Potential Biomarker of Microvascular Complications in Patients with Type 2 Diabetes.

Human Galectin-3 is a 32- to 35-kDa size lectin, mainly comprises a C-terminal carbohydrate recognition binding domain (CRD) and N-terminal domain. It acts as a powerful pro-inflammatory signalling factor, which plays an important role in the activation, chemotaxis, and cytokine release of inflammatory cells. Galectin-3 has also been studied in relation to development of insulin resistance. The levels of galectin-3 have been observed to be associated with both diabetes prevalence and incidence, independent of traditional diabetes risk factors. It is also associated with development of microvascular complications of diabetes mellitus like retinopathy, nephropathy and neuropathy. Tertiary care hospital-based cross-sectional prospective study. 150 patients selected by simple random sampling and were divided into 3 groups., Group A - Patients of Type 2 Diabetes mellitus without microvascular complications (n=50), Group B - patients of Type 2 diabetes mellitus with microvascular complications (n=50) and Group C - Healthy control (n=50). Descriptive statistics was performed by calculating mean and standard deviation for the continuous variables. chi-square goodness-to-fit test, Student T test (unpaired) and Analysis of variance (ANOVA) and multivariate analysis were used to compare means. The p-value was taken significant when less than 0.05 (P<0.05) and a confidence interval of 95%. In group A, B and C majority of patients were between 56-60 years with 34%, 40% and 36% cases, respectively. The mean BMI shows that the Patients with complications had significantly higher BMI than those without complications and controls had significantly lower BMI than patients having diabetes. The data shows statistical significance with deranged biochemical profile in patients with DM with complications as compared to patients without complications and control group. In both groups A and B patients with HbA1c between 9.1-12 had mean serum galectin level (20.2 in group A, 25.9 in group B) significantly higher than patients with HbA1c between 6.5-9 (18.5 in group A and 20.4 in group B). patients with deranged lipid profile had significantly higher serum galectin level in all 3 groups, with cases from group B having higher values than group A. While controls had the lowest value of serum galectin (P value<0.001). There was a highly significant correlation between high serum galectin levels and the incidence of both non-progressive and progressive retinopathy (P value=0.0001). The mean galectin of patients with neuropathy was 28.3 ± 3.1 ng/ml, which was significantly higher than patients from group B without neuropathy (24.5 ± 2.6 ng/ml). The mean serum galectin level of patients with macroalbuminuria was 30.1± 1.3 ng/ml which was significantly higher than those with microalbuminuria having mean galectin level of 22.8 ±4.8 ng/ml. There was a highly significant correlation between high serum galectin levels and the incidence of both micro and macroalbuminuria (P value=0.0001). This study concludes that elevated serum Galectin-3 levels are associated with diabetes-related chronic inflammatory processing pathway, and closely relates to the severity of diabetes in T2DM both with and without complications. Therefore, Galectin-3 may be helpful in the diagnosis and prognosis of microvascular and macrovascular complications in T2DM patients.

Clinical profile of NAFLD patients and predictors of advanced fibrosis

Background and Aim: Nonalcoholic fatty liver disease (NAFLD) is a frequently encountered condition in clinical practice, particularly in obese and diabetic patients. Spectrum of liver disorders in non alcoholic patients comprises of fatty liver, steatohepatitis, fibrosis and cirrhosis. The present study is designed to study the clinical and biochemical profile of patients with NAFLD with varying degrees of severity as diagnosed by Ultrasonography and evaluate the relationship between fibrosis as accessed by fibroscan with various parameters.

Matrix Calculi in the Urinary Tract- A Prospective Cohort Study

Introduction: Matrix calculi are infrequently encountered in the urinary tract. Their biochemical composition and unusual radiological appearance make it difficult to differentiate them from fungal balls or tumours of the urinary tract. Aim: To study radiological, biochemical and microbiological characteristics of matrix calculi in the urinary tract and their management. Materials and Methods: This prospective observational cohort study was conducted at a tertiary care hospital, from July 2016 to August 2019. Analysis of the clinical, radiological and biochemical profiles of patients who were found to have matrix renal or ureteric calculi was done. These patients underwent Percutaneous Nephrolithotomy (PCNL) or Ureteroscopic Lithotripsy (URSL) and the stone material evacuated was sent for analysis. Data was analysed using Microsoft Excel, version 2016. Results: Matrix urinary stones were found in a total of 21 patients, out of which 15 were renal matrix calculi and six were ureteric matrix calculi. Mean age of the patient population was 44.5 years. Male to female ratio was 1.33:1. Total 7 (33.3%) patients were found to have Chronic Kidney Disease (CKD). The mean radiodensity of all the stones was 403 Hounsfield Unit (HU). Six patients also had a concomitant crystalline calculus. Histopathological analysis of these matrix calculi revealed an amorphous lamellated appearance. The postoperative course of all the patients was uneventful. One patient presented with a non matrix stone in the opposite kidney after one year of follow-up. Conclusion: Matrix calculi of the urinary tract are usually radiolucent on plane radiographs and have a low radiodensity on Computerised Tomography (CT) scan. Biochemical analysis of these calculi shows protein to be the predominant component. These calculi are more often seen in patients with Diabetes Mellitus (DM) or CKD and are frequently associated with a positive urine culture. They can be managed successfully with a combination of PCNL and URSL. Complete clearance is necessary to minimise recurrence.