J Clin Diagn Res
· 2017 Sep · PMID 29207767
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An automated haematology analyser provides blood cell histograms by plotting the sizes of different blood cells on X-axis and their relative number on Y-axis. Histogram interpretation needs careful analysis of Red Blood...An automated haematology analyser provides blood cell histograms by plotting the sizes of different blood cells on X-axis and their relative number on Y-axis. Histogram interpretation needs careful analysis of Red Blood Cell (RBC), White Blood Cell (WBC) and platelet distribution curves. Histogram analysis is often a neglected part of the automated haemogram which if interpreted well, has significant potential to provide diagnostically relevant information even before higher level investigations are ordered.
J Clin Diagn Res
· 2017 Sep · PMID 29207766
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Over the past decade, the Anti-Microbial Resistance (AMR) among members of Enterobacteriaceae family is on rise mainly due to rapid spread of strains producing Extended-Spectrum Beta-Lactamases (ESBLs) and Metallo Beta-L...Over the past decade, the Anti-Microbial Resistance (AMR) among members of Enterobacteriaceae family is on rise mainly due to rapid spread of strains producing Extended-Spectrum Beta-Lactamases (ESBLs) and Metallo Beta-Lactamases (MBLs). Hence, the choice of drugs available for these resistant strains is diminishing and their treatment is becoming more challenging. This is a case of complicated Urinary Tract Infection (cUTI) due to ESBL producing leading to septic shock which was successfully managed with Antibiotic Adjuvant Entity (AAE), a combination of ceftriaxone+sulbactam+EDTA.
J Clin Diagn Res
· 2017 Sep · PMID 29207765
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Guillain-Barré Syndrome (GBS) is an inflammatory polyradiculoneuropathy which is known to produce syndrome of inappropriate Secretion of Antidiuretic Hormone (SIADH). However, the hyponatremia is usually seen after the o...Guillain-Barré Syndrome (GBS) is an inflammatory polyradiculoneuropathy which is known to produce syndrome of inappropriate Secretion of Antidiuretic Hormone (SIADH). However, the hyponatremia is usually seen after the onset of weakness. Here, we report a case of SIADH that presented with hyponatremic seizures which preceded the onset of GBS by ten days.
J Clin Diagn Res
· 2017 Sep · PMID 29207764
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Renal artery thrombosis is a rare medical emergency and needs to be diagnosed early and treated urgently to prevent irreversible renal injury. We report a case of 35-year-old male, who presented with the total thrombotic...Renal artery thrombosis is a rare medical emergency and needs to be diagnosed early and treated urgently to prevent irreversible renal injury. We report a case of 35-year-old male, who presented with the total thrombotic occlusion of right renal artery and was managed with percutaneous transluminal angioplasty with a drug eluting stent.
J Clin Diagn Res
· 2017 Sep · PMID 29207763
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Antiepileptic Drugs (AEDs) are commonly associated with haematological disorders, including anaemia, thrombocytopenia, neutropenia and even bone marrow failure. Fatal disorders like aplastic anaemia are uncommon. On expl...Antiepileptic Drugs (AEDs) are commonly associated with haematological disorders, including anaemia, thrombocytopenia, neutropenia and even bone marrow failure. Fatal disorders like aplastic anaemia are uncommon. On exploring through the literature, older AEDs are more associated with haematological alterations than newer AEDs, and careful monitoring is warranted especially with phenytoin, carbamazepine and valproate. The exact cause of these alterations is not established, though immune mechanisms and pharmacology of individual drugs are the proposed mechanisms, a further research along this path is underway. Of worth mentioning here, this predilection of older AEDs towards haematological disorders is pronounced in children compared to adults. We present here a case of congenital heart disease with history of brain abscess and seizures, on carbamazepine who presented to our hospital with toothache. Routine screening prior to tooth extraction revealed thrombocytopenia. Further evaluation revealed the association of carbamazepine and thrombocytopenia, which mandated discontinuation of drug and switching patient to alternative AED.
Gangula RS, Stanley W, Vandanapu A
… +1 more, Prabhu MM
J Clin Diagn Res
· 2017 Sep · PMID 29207762
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Guillain-Barre Syndrome is very rare in parasitic and rickettsial infection. Here we report a case of Plasmodium falciparum and scrub typhus mixed infection, presented with quadriparesis. Clinical, Serological, CSF analy...Guillain-Barre Syndrome is very rare in parasitic and rickettsial infection. Here we report a case of Plasmodium falciparum and scrub typhus mixed infection, presented with quadriparesis. Clinical, Serological, CSF analysis and Nerve Conduction Studies were consistent with Acute Inflammatory Demyelinating Polyneuropathy (variant of GBS). After administration of antimalarials and antibiotics for the mixed infection, patient gradually improved.
Jaggi S, Kumar A, Garg K
… +2 more, Aggarwal D, Kundu R
J Clin Diagn Res
· 2017 Sep · PMID 29207761
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Foreign body aspiration mostly presents as acute emergency with cough, choking and dyspnoea. Rarely aspiration of foreign body may be the underlying cause in patients presenting with long term symptomatologies. Here is a...Foreign body aspiration mostly presents as acute emergency with cough, choking and dyspnoea. Rarely aspiration of foreign body may be the underlying cause in patients presenting with long term symptomatologies. Here is a case of 60-year-old male who came for surgical management of cholelithiasis. During his workup, X-ray chest revealed right paracardiac opacity. Fibre-optic bronchoscopy showed a mass lesion in right main bronchus. It was taken out of the airways by flexible bronchoscope but could not be retrieved. Subsequent chest radiographs showed marked improvement.
Mirchandani LV, Kamath SS, Kutty JT
… +1 more, Iyer A
J Clin Diagn Res
· 2017 Sep · PMID 29207760
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Primary pulmonary tuberculosis can involve regional lymph nodes which may resolve spontaneously or on treatment; or they may enlarge causing extrinsic bronchial compression; or cause endobronchial inflammation and ulcera...Primary pulmonary tuberculosis can involve regional lymph nodes which may resolve spontaneously or on treatment; or they may enlarge causing extrinsic bronchial compression; or cause endobronchial inflammation and ulceration; or a node may erode through the bronchial wall with extrusion of caseous materials into the bronchial tree, causing focal or lobar pneumonia. This erosion is seen radiologically as hilar lymphadenopathy, with atelectasis and consolidation and described as "epituberculosis". It is more common in infants than older children. We hereby describe the case of a 13-year-old child with right hilar lymphadenopathy and right upper lobe consolidation on chest x-ray. We demonstrated by fibreoptic bronchoscopy that this epituberculosis resulted from perforation of a lymph node and discharge of caseous material into the upper lobe bronchus with resultant endobronchial obstruction. Thus a tuberculous ruptured lymph node may lead to clinical and radiological worsening, but this does not indicate development of drug resistance in these patients and they respond well to the same treatment regimen.
Pradhan A, Shukla A, Jain M
… +2 more, Mehrotra A, Sethi R
J Clin Diagn Res
· 2017 Sep · PMID 29207759
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Combined hereditary thrombophilia is an uncommon entity associated with higher risk of early onset thrombosis. We report a case of 39-year-old male with combined deficiency of natural anticoagulants (protein C, S and ant...Combined hereditary thrombophilia is an uncommon entity associated with higher risk of early onset thrombosis. We report a case of 39-year-old male with combined deficiency of natural anticoagulants (protein C, S and anti thrombin) along with hyper homocystenemia and factor V Leiden mutation, presenting with life threatening bilateral pulmonary embolism. The clinical implications of combined thrombophilia are also discussed.
Chogtu B, Malik DV, Magazine R
… +1 more, Shenoy VP
J Clin Diagn Res
· 2017 Sep · PMID 29207758
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Non Tuberculous Mycobacteria (NTM) are a group of rapidly growing mycobacteria and are generally considered to be of low virulence. Of late, there has been an increase in incidence of infections due to these organisms. A...Non Tuberculous Mycobacteria (NTM) are a group of rapidly growing mycobacteria and are generally considered to be of low virulence. Of late, there has been an increase in incidence of infections due to these organisms. Among them, are the common species which have been identified. Though they are occasionally implicated in pulmonary infections, NTM are very commonly associated with cutaneous infections, especially surgical site infections. Identification of NTM infection at such sites should be suspected when there is delayed healing of the wound. Histopathological Examination (HPE) of the wound site may reveal a classical picture of granulomas, epithelioid cells and giant cells which may lead to a suspicion of tuberculosis. It is important to perform mycobacterial culture and sensitivity testing of the wound tissue as this helps to differentiate tuberculous and non tuberculous infections. Here, we present a case of a patient who underwent mesh hernioplasty for umbilical hernia and was diagnosed with infection at the site of umbilical hernioplasty.
Sandhya P, Mahasampath G, Mashru P
… +3 more, Bondu JD, Job V, Danda D
J Clin Diagn Res
· 2017 Sep · PMID 29207757
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INTRODUCTION: Vitamin D is a steroid hormone belonging to the class of secosteroids with myriad immune functions and has been implicated in aetiopathogenesis of various autoimmune diseases. Although, there have been vari...INTRODUCTION: Vitamin D is a steroid hormone belonging to the class of secosteroids with myriad immune functions and has been implicated in aetiopathogenesis of various autoimmune diseases. Although, there have been various studies showing the association of vitamin D in rheumatoid arthritis and lupus in different populations, there have been limited studies on vitamin D and primary Sjögren's Syndrome (pSS). There are no studies on association of vitamin D and pSS from any tropical country including Indian subcontinent. AIM: The purpose of the study was to look for any association between 25-hydroxyvitamin D (25(OH)D) levels and disease manifestations in Indian patients with pSS. MATERIALS AND METHODS: This is a retrospective cross-sectional study done at a tertiary teaching hospital in southern India in 235 patients with pSS. Patients satisfying the American European Consensus Group (AECG) or American College of Rheumatology (ACR) 2012 for pSS between 2008 and 2015 were included if baseline 25(OH)D levels using electrochemiluminescence were available in hospital's laboratory record, 25(OH)D <20 ng/ml,20-30 ng/ml and >30 ng/ml was defined as deficiency, insufficiency and normal, respectively. Clinical laboratory data and disease activity scoring by EULAR Sjögren's syndrome disease activity index (ESSDAI) were retrieved retrospectively. Latitude corresponding to residence of each patient and the season of performing the assay were recorded. Chi-square statistics was done to find associations between categorized 25(OH)D and outcomes and was reported as odds ratio(95% confidence interval). RESULTS: Mean 25(OH)D for 235 patients with pSS was 19.98(12.55)ng/ml. A vitamin D deficiency, insufficiency and sufficiency was seen in 141(60%), 60(25.5%) and 34.0(14.5%), respectively. No association was noted between latitude or season of performing assay and the levels. pSS with 25(OH)D ≤30ng/ml had more than two fold risk of higher grading on lip biopsy as well as Rheumatoid Factor (RF) positivity. However, low 25(OH)D seemed to be associated with lower ESSDAI and less pulmonary involvement. CONCLUSION: Prevalence of 25(OH)D deficiency in Indian patients with pSS was comparable to that of general Indian population. Low 25(OH)D level ≤30ng/ml was associated with higher odds for RF positivity and positive grading on lip biopsy. Surprisingly, low 25(OH)D was associated with lower ESSDAI score.
Nongchang P, Wong WL, Pitaksanurat S
… +1 more, Amchai PB
J Clin Diagn Res
· 2017 Sep · PMID 29207756
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INTRODUCTION: Out of Hospital Cardiac Arrest (OHCA) is a leading cause of death worldwide. The Emergency Medical Service (EMS) provides early care to critical OHCA patients. Pre hospital intervention has been improving O...INTRODUCTION: Out of Hospital Cardiac Arrest (OHCA) is a leading cause of death worldwide. The Emergency Medical Service (EMS) provides early care to critical OHCA patients. Pre hospital intervention has been improving OHCA survival rate, however it is still unclear for the recommendation of routine infusion of Intravenous (IV) fluids during cardiac arrest resuscitation. AIM: This study aimed to determine whether IV fluid administration was associated with increasing survival of resuscitated OHCA patients and to assess the survival rate of resuscitated OHCA patients. MATERIALS AND METHODS: This cross-sectional analytical study was conducted among 33,006 resuscitated OHCA patients who received emergency medical service in Thailand. Data set from the EMS Registry of the OHCA patients who received Advanced Life Support (ALS) and Cardiopulmonary Resuscitation (CPR) during January 2011 to December 2015 was enrolled as per inclusion criteria. Data were analysed by using both descriptive statistic and multiple logistic regression. RESULTS: The result indicated that 27,270 OHCA patients (82.62%:95%CI=82.121-83.030%) survived until they reached hospital. In addition, after adjusting for effect modifiers and covariates, it was found that adult (≥18 years) with IV fluid administration were more likely to survive (adjusted OR=4.389; 95% CI: 3.911-4.744) when compared to children (<18 years) with IV fluid administration (adjusted OR =2.952; 95% CI: 2.040-4.273). Other factors associated with OHCA patients' survival were female gender (adjusted OR =1.151; 95% CI: 1.067-1.241), response time per minutes (adjusted OR =0.993; 95% CI: 0.989-0.997), scene time per minutes (adjusted OR=0.948; 95% CI: 0.944-0.952) and transport time per minutes (adjusted OR=0.973, 95%CI: 0.968-0.978). CONCLUSION: This study revealed that IV fluid administration was significantly associated with survival of OHCA patients while controlled other covariates including female gender, response time, scene time and transport time. Therefore, it is recommended that the IV fluid administration should be medicated for resuscitated OHCA patients.
Agarwal A, Avarebeel S, Choudhary NS
… +2 more, Goudar M, Tejaswini CJ
J Clin Diagn Res
· 2017 Sep · PMID 29207755
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INTRODUCTION: Zinc, copper, manganese and magnesium are essential trace elements whose role in chronic liver disease and its complications is not clear. AIM: To study the concentration of these elements in patients with...INTRODUCTION: Zinc, copper, manganese and magnesium are essential trace elements whose role in chronic liver disease and its complications is not clear. AIM: To study the concentration of these elements in patients with Chronic Liver Disease (CLD) with respect to Child-Torcotte-Pugh (CTP) scoring. MATERIALS AND METHODS: This was an observational study carried out in the Department of Medicine, JSS Hospital, Mysore, India, between October 2013 and October 2015. A total of 75 patients with cirrhosis were prospectively enrolled. Severity of liver disease was assessed based on CTP score and patients were grouped into Class A, B and C. Routine investigations were done and following trace elements were assessed in all-zinc, copper, manganese and magnesium. RESULTS: The serum concentrations of zinc decreased with severity of liver disease, and the mean difference between different severity classes was statistically significant (p<0.001). There was a significant negative correlation between zinc and CTP Score (r= -0.439; p<0.001). Copper concentration was increased in patients with more severe cirrhosis and mean level difference of copper among the CTP groups were statistically significant (p<0.001). Moreover, copper showed significant positive correlation with CTP Score (r=0.385; p<0.001). The serum levels of manganese were significantly higher in patients with CTP C class in comparison to patients with CTP A and B class (p<0.05); Manganese showed significant positive correlation with CTP Score (r=0.271; p= 0.019). The concentrations of magnesium did not differ significantly between CTP class with the mean level difference not statistically significant. CONCLUSION: Increasing liver dysfunction alters the metabolism of trace elements towards excess of copper and deficiency of zinc.
Nagaraju SP, Laxminarayana SLK, Kosuru S
… +5 more, Parthasarathy R, Attur RP, Rangaswamy D, Matteti UV, Guddattu V
J Clin Diagn Res
· 2017 Sep · PMID 29207754
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INTRODUCTION: Diffuse Crescentic glomerulonephritis (CrGN) is characterized by rapidly progressive renal failure and has grave prognosis. There is significant regional and temporal variation in aetiology, prevalence and...INTRODUCTION: Diffuse Crescentic glomerulonephritis (CrGN) is characterized by rapidly progressive renal failure and has grave prognosis. There is significant regional and temporal variation in aetiology, prevalence and prognosis of diffuse crescentic glomerulonephritis (CrGN) with limited data available in adult Indian population. AIM: This study aims to identify the aetiology, clinico-pathological features and outcomes of diffuse CrGN in south Indian population. MATERIALS AND METHODS: In this retrospective study, clinical records of all adults (>18 years) over a 5-year period (2010-2014) with a histopathological diagnosis of diffuse CrGN (>50% crescents) were reviewed. Clinical, serological, biochemical and histopathological data were collected. Follow-up data at six months including renal outcome and mortality were studied. Data was analysed using SPSS version 15. RESULTS: There were 29 cases of diffuse CrGN accounting for an incidence of 2.9% among 1016 non-transplant kidney biopsies. The most common cause was pauci-immune crescentic GN. The median creatinine at admission was 7.2 mg/dl {(interquartile range (IR) 3.3 - 10.4)} and 75.9% of patients required haemodialysis at admission. Complete/partial recovery was seen in 34.5%. At the end of six months 31% were dialysis dependent and the mortality was 27.6%. On univariate analysis, the significant predictors of renal loss and mortality were oliguria (p=0.02), requirement of haemodialysis and serum creatinine (p=0.001) at admission (>5.5mg/dl) (p=0.003). Histopathological features did not influence the outcome in our study. CONCLUSION: In our cohort, the most common cause for diffuse CrGN is pauci-immune CrGN. Diffuse CrGN carries a poor prognosis. Patients with pauci-immune and AntiGBM disease have worst prognosis compared to immune complex CrGN. The presence of oliguria, high serum creatinine and requirement of haemodialysis at admission are associated with poor outcomes.
J Clin Diagn Res
· 2017 Sep · PMID 29207753
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INTRODUCTION: It has been observed that metabolic syndrome is risk factor for Coronary Artery Disease (CAD) and exerts its effects through fat deposition and vascular aging. CAD has been acknowledged as a leading cause o...INTRODUCTION: It has been observed that metabolic syndrome is risk factor for Coronary Artery Disease (CAD) and exerts its effects through fat deposition and vascular aging. CAD has been acknowledged as a leading cause of death. In earlier studies, the metabolic risk has been estimated by Framingham risk score. Recent studies have shown that Neck Circumference (NC) has a good correlation with other traditional anthropometric measurements and can be used as marker of obesity. It also correlates with Framingham risk score, which is slightly more sophisticated measure of CAD risk. AIM: To assess the risk of CAD in a subject based on NC and to correlate the NC to Framingham risk score. MATERIALS AND METHODS: The present cross-sectional study, done at Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, includes 100 subjects. The study duration was of one year from 1 January 2015 to 31 December 2015. Anthropometric indices Body Mass Index (BMI) and NC were correlated with 10 year CAD risk as calculated by Framingham risk score. The correlation between BMI, NC, vascular age and Framingham risk score was calculated using Karl Pearson's correlation method. RESULTS: NC has a strong correlation with 10 year CAD risk (p≤0.001). NC was significantly greater in males as compared to females (p≤0.001). Males had greater risk of cardiovascular disease as reflected by higher 10 year Framingham risk score (p≤0.0035). CONCLUSION: NC gives simple and easy prediction of CAD risk and is more reliable than traditional risk markers like BMI. NC correlates positively with 10 year Framingham risk score.
Guleri N, Rana S, Chauhan RS
… +3 more, Negi PC, Diwan Y, Diwan D
J Clin Diagn Res
· 2017 Sep · PMID 29207752
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INTRODUCTION: Increased Left Ventricular Mass (LVM) is an independent risk factor for cardiovascular morbidity and mortality. AIM: This study was done to find the prevalence and determinants of LVM in the Northern Indian...INTRODUCTION: Increased Left Ventricular Mass (LVM) is an independent risk factor for cardiovascular morbidity and mortality. AIM: This study was done to find the prevalence and determinants of LVM in the Northern Indian population. MATERIALS AND METHODS: A prospective cross-sectional observational study was carried out in a tertiary care centre in Himachal Pradesh, India and the study population included all consecutive patients fulfilling the inclusion criteria attending cardiology OPD on seeking medical attention with various symptoms for dyslipidaemia, hypertension but not on medication over a period of one year. Focused history was taken; physical examination and investigations were done. Data collected was analysed using Epi-info software version 3.5.1. We calculated means of LVM index for categorical variables i.e., sex, tobacco consumption, alcohol consumption and sedentary lifestyle etc., and also calculated p-values as test of significance for mean difference across the exposure variable groups. The Pearson correlation coefficient was calculated and 2 tailed significance at p< 0.05 was taken as statistically significant. RESULTS: Mean age of study population was 42.30±9.8 years and 62.9% were males. The mean LVM index was significantly higher in men than in women 77.7 ± 11.4 vs.71.3 ± 15.7 (p-value <0.01). Strong positive correlation was observed between increased waist hip ratio and increased Left Ventricular Mass Index (LVMI). The Pearson correlation coefficient was 36.77 and it was statistically significant with p-value 0.04. CONCLUSION: We found positive and independent correlation of increased LVMI with increased Waist Hip Ratio (WHR). A positive independent correlation was also observed with higher fasting blood sugar levels.
J Clin Diagn Res
· 2017 Sep · PMID 29207751
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INTRODUCTION: Azithromycin usage in patients with baseline cardiovascular risk is associated with increased risk of cardiovascular mortality, following which Food and Drug Administration (FDA) issued a black box warning...INTRODUCTION: Azithromycin usage in patients with baseline cardiovascular risk is associated with increased risk of cardiovascular mortality, following which Food and Drug Administration (FDA) issued a black box warning regarding safety of azithromycin in patients with cardiovascular morbidity particularly with prolonged QTc. Cetirizine is a second generation anti histaminic and is found to be commonly used for Upper Respiratory Tract Infections (URIs) along with azithromycin on outpatient basis. Whether, usage of these two drugs in combination confers a similar risk, is unknown. AIM: To assess the effect on QTc among patients treated with azithromycin and cetirizine combination for upper respiratory tract infection. MATERIALS AND METHODS: We conducted a prospective longitudinal study from August 2014 to July 2016. The study was done on 45 patients above 18 years of age without any cardiovascular morbidity in whom azithromycin and cetirizine were prescribed for upper respiratory tract infections. We compared the QTc on day 1 and day 4. Data was analysed using Student's paired t-test. RESULTS: During three days of azithromycin and cetirizine for upper respiratory tract infections, we observed that on day 4 there was significant increase in QTc in 43 patients (95.6%) as compared with the QTc on day 1. We also observed that in 8 (17.8%) out of 45 patients, QTc on day 4 crossed the upper limit of normal {430 milliseconds (ms)}, but this was not statistically significant. However, analysing these eight patients, we obtained the baseline QTc of 377.50 ms above which if prescribed, this combination of drugs have a chance of prolonging the QTc above 430 ms with a sensitivity of 87.5% and specificity of 40.5%. CONCLUSION: During three days treatment with azithromycin and cetirizine, there was significant change in QTc between day 1 and day 4. Patients with baseline QTc greater than 377.5 ms were at risk of QTc prolongation above 430 ms on day 4.
J Clin Diagn Res
· 2017 Sep · PMID 29207750
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INTRODUCTION: Ankylosing Spondylitis Disease Activity Score (ASDAS) is a complex score for monitoring disease activity in Ankylosing Spondylitis (AS). AIM: To develop a simplified version of the ASDAS. MATERIALS AND METH...INTRODUCTION: Ankylosing Spondylitis Disease Activity Score (ASDAS) is a complex score for monitoring disease activity in Ankylosing Spondylitis (AS). AIM: To develop a simplified version of the ASDAS. MATERIALS AND METHODS: Consenting 254 AS patients (modified New York and/or Assessment in Ankylosing Spondylitis 2009 criteria) were recruited. Sociodemographic data and disease characteristics such as Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and AS Quality of Life (ASQoL), Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP) were collected. Simplified ASDAS (SASDAS) was calculated as the simple sum of patient global assessment, back pain (BASDAI question no.2), peripheral pain and swelling (BASDAI question no.3), morning stiffness (BASDAI question no.6), and either ESR in mm/hour (for SASDAS-ESR) or CRP in mg/L (for SASDAS-CRP); this sum was divided by 10 to obtain the final score. RESULTS: Most patients (224/254; 88.19%) were males with the median age of 30 years. SASDAS-ESR and SASDAS-CRP showed good correlation with ASDAS-ESR and ASDAS-CRP respectively (r2=0.78 and 0.58 respectively; p-value<0.0001). SASDAS-ESR showed good correlation with CRP (r=0.50) and is fairly correlated with backpain (r=0.19), morning stiffness (r=0.21) and peripheral pain (r=0.21); SASDAS-CRP showed good correlation with BASFI (r=0.32), and ESR (r=0.55) (all p-value<0.0001). Using established ASDAS cut-off values, corresponding cut-off points between 'inactive', 'moderate', 'high', and 'very high' disease activities (with optimum sensitivity and specificity) were 1.83, 2.45 and 4.45 for SASDAS-ESR, and 0.79, 1.50, and 3.26 for SASDAS-CRP. Both the SASDAS scores showed good correlation with BASDAI. CONCLUSION: SASDAS-ESR and SASDAS-CRP are reliable, easy-to-calculate scores for disease activity assessment in Asian Indian AS patients; which can be used in daily clinical practice.
J Clin Diagn Res
· 2017 Sep · PMID 29207749
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INTRODUCTION: Cirrhosis of the liver and diabetes mellitus are two chronic illnesses with significant impact on the quality of life. Studies from different part of the world have shown the combination to be associated wi...INTRODUCTION: Cirrhosis of the liver and diabetes mellitus are two chronic illnesses with significant impact on the quality of life. Studies from different part of the world have shown the combination to be associated with higher incidence of complications of cirrhosis and reduced survival. However, data on the impact of pre-cirrhotic and post-cirrhotic diabetes on cirrhosis is minimal. AIM: The aim of the study was to determine the complications of cirrhosis patients with and without co-existent DM and to compare the relation between cirrhosis patients with antecedent DM and hepatogenous DM. MATERIALS AND METHODS: The present prospective study was conducted at a tertiary care hospital in Kerala, India, over a period of three years. Cirrhosis patients with and without diabetes, along with subcategorization as antecedent and hepatogenous diabetes, were studied for various complications and outcome including death. Chi-square and Mann-whitney tests were used for comparing data. RESULTS: Patients with cirrhosis and diabetes had higher incidence of gall stones (27.6% versus 13.2%; p=0.008) and urinary infection (29.3% versus 7.5%; p=<0.001). Incidence of hepatocellular carcinoma and mortality were similar between the groups. Patients with antecedent diabetes and hepatogenous diabetes were similar with respect to complications and mortality. Child-Turcotte-Pugh (CTP) score, Model for End stage Liver Disease (MELD) score, urinary tract and respiratory infections and duration of cirrhosis were independent predictors of mortality in patients with cirrhosis. CONCLUSION: Coexistent diabetes mellitus increases the incidence of complications and hospitalizations in cirrhosis patients but without impact on mortality rates. There is no significant morbidity or mortality difference between cirrhotics with antecedent diabetes and hepatogenous diabetes.