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Comparison on Blood Cell Count, Blood Indices, Corrected Serum Calcium and Phosphorus in Patients With and Without Thyroid Dysfunction at a Tertiary Care Hospital in Chennai: A Cross Sectional study
No full textINTRODUCTION:
Thyroid disorders are most common endocrine problem next to diabetes mellitus. Thyroid disorders affect women more compared to men. Thyroid glands secrete, store, and release triiodothyronine (T3) and thyroxine (T4). The hormone T4 gets converted into T3 at tissue level and produces its effect. Iodine is necessary for production of thyroid hormone. Iodine in food is trapped by thyroid gland and is utilized in hormone production. Pituitary and hypothalamus control thyroid gland hormone secretion. TRH from hypothalamus modulates through pituitary to produce TSH, which in turn controls thyroid hormone production. If T4 and T3 are low, TSH level increases to stimulate thyroid gland to secrete more hormone. T3 and T4 hormones have profound effect on the body. Almost all the tissues are stimulated, and body metabolism is increased. T3 and T4 affect cardiovascular system, GI tract, brain,
metabolism, weight, bone, etc. With increased T4 and T3, there is tachycardia, diarrhea, hyperglycemia, lowering of cholesterol, increased growth rate in infant, normal brain development, and sexual function. Undiagnosed hypothyroidism in infants not only affects physical and bony growth but also damages brain growth. If untreated, it leads to permanent damage.Thyroid functions are affected by congenital absence of thyroid glands, autoimmune thyroid disease, surgical removal, infiltrative diseases, and after radiation to neck. Drugs like amiodarone, lithium, interferon alpha, and interleukin 2 prevent thyroid glands from making hormone and causing hypothyroidism.Pituitary damage by tumor radiation or surgery can affect thyroid glands and cause secondary hypothyroidism.For brain maturation and brain function, thyroid hormone is necessary. Thyroid diseases like hypothyroid can cause lethargy, hyporeflexia, depression, memory impairment, weight gain, dry skin, and constipation along with dyslipidemia. Hyperthyroidism produces weight loss, tremors, irritability, and hyperreflexia. Glucose intolerance can also be caused by hyperthyroidism.
Thyroid hormone acts through T3 with nuclear receptors and regulation of gene expression.
Hormone deficiency can cause retarded brain maturation and neurological impairment.
Thyroid hormone deficiency is caused by congenital and maternal hypothyroidism.
Hypothyroidism causes lethargy, hyporeflexia, poor motor coordination, and memory impairment. Hypothyroidism is also associated to bipolar affective disorders, depression, or
loss of cognitive functions, especially in the elderly. Thyroid hormone deficiency, even of short duration, may lead to irreversible brain damage.
AIM OF THE STUDY:
Comparison on Blood Cell Count, Blood Indices, Corrected Serum Calcium and Phosphorus in Patients With and Without Thyroid Dysfunction at a Tertiary Care Hospital in Chennai - A Cross Sectional Study.
OBJECTIVES:
PRIMARY:
To compare the blood cell count, serum calcium and phosphorus in patients of age between 18 to 80 with hypothyroidism , hyperthyroidism and healthy controls in euthyroid status attending Outpatient Department of general medicine in Government Kilpauk Medical College.
SECONDARY:
1. To compare the blood indices in patients of age between 18 to 80 with hypothyroidism and hyperthyroidism with healthy controls in euthyroid status attending Outpatient Department of general medicine in Government Kilpauk Medical College.
2. To calculate corrected serum calcium, phosphorus in patients of age between 18 to 60 with hypothyroidism and hyperthyroidism with healthy controls in euthyroid status attending Outpatient Department of General Medicine in Government Kilpauk Medical College.
METHODS:
After obtaining institutional ethics committee clearance, 100 patients with hypothyroidism , 100 patients with hyperthyroidism and 100 patients with euthyroid status attending thyroid clinic, Department of Internal Medicine in Government kilpauk medical college and giving consent to take part will be enrolled in the study.
All the patients who took part in study were divided into 3 clusters based on the thyroid function tests and further investigated with complete blood count, serum calcium and phosphorus.
RESULTS:
300 Patients were clustered in 3 categories as euthyroid, hypothyroid, hyperthyroid evenly, and the blood parameters were compared, the euthyroid cluster were kept as control and the hypothyroid and hyperthyroid clusters were studied.
• The whole blood count, red blood cell count, haemoglobin, red blood indices like MCV, MCH, MCHC and RDW showed high statistical significance in all three groups.
• The platelets had no difference in the three groups.
• Leucopenia was significant in the hypothyroidism cluster.
• RDW was significantly increased in the thyroid dysfunction signifying disequilibrium in haemoglobin synthesis.
CONCLUSION:
• The purpose of our study to clarify the various hematological changes in the thyroid dysfunction cases.
• The cases should be screened for hematological changes, calcium and phopshorus levels in all thyroid dysfunction cases.
• The study though focussed on the local population, it had various subsets so can attributed to entire sample set.
• Tedious followup and rigorous early intervention has to undertaken to prevent thyroid dysfunction cases to land up in moribund complications
A Comparative study of Ripasa and Alvarado Score for the Diagnosis of Acute Appendicitis
No full text
Comparison of Pulp Score, Boey’s Score, ASA Classification to Predict Outcomes, Mortality, Morbidity in Peptic Ulcer Perforation
No full textRelationship between Gut Mucosal Microbiome and Anastomotic leak in Ileocolic Anastomoses: A Case Control study (Gumbal Study)
No full textThe Efficacy of World Society of Emergency Surgery Classification in the Management of Splenic Injury: An Observational study
No full textINTRODUCTION:
• The spleen is the most frequently damaged organ in trauma to the abdomen of any cause
• An unrecognized splenic injury is a very preventable cause of severe hypovolemic shock and traumatic death
• It is the most vascular organ in the body, hence bleeding from splenic injuries is arterial, and can cause significant hemoperitoneum. Bleeds from the spleen are mainly intraperitoneal.
• Any lower left chest or upper left abdominal trauma has the propensity to carry the risk of injury to the spleen. It is highly vulnerable to injury during trauma due to its juxtaposition in tge left upper abdomen to the 9th, 10th and 11th ribs. The trauma can be penetrating, blunt, or indirect trauma (tear in the splenic capsule during traction exerted on the splenocolic ligament)
• The spleen is a very important organ in terms of its function in the immunity process, and lymphopoeisis. The normal splenic function is essential for carrying out opsonisation of encapsulated organisms and in the subsequent immune response mounted by the body against them.
AIMS AND OBJECTIVES:
Primary objective: To assess the efficacy of the WSES (World society of Emergency surgery) classification in becoming a heralded standard algorithm for the management of splenic injury.
Secondary objective: To assess effect on patient morbidity and mortality following the use of this algorithm To employ the WSES classification in order to:
- Categorize patients suffering from splenic injury
- Guide the management of said patients as per the category they are placed under
- To assess the morbidity and mortality data.
MATERIALS AND METHODS:
Sample size : 65 cases.
Study design : Observational study (Prospective &
Retrospective).
Study population : 65 cases.
Study period : August 2021 to August 2022 (1 year).
Study Centre : Institute of General Sugery, Madras Medical College, Rajiv Gandhi Government General hospital, Chennai
SUBJECT SELECTION:
Inclusion criteria:
1. Age more than 15 years.
2. Patients of blunt trauma to the abdomen.
Exclusion criteria:
1. Paediatric population (age less than 15 years).
2. Patients who died before complete diagnostic workup.
3. Patients with penetrating trauma to the abdomen.
RESULTS:
The data collected during the study was formulated into a master chart in Microsoft office excel and statistical analysis was done with help of computer using statistical software package SPSS V.21 for windows.
Using this software, frequencies, range, mean, standard deviation and ‘p’ value were calculated through independent sample ‘t’ test and also univariate analysis was done using chi square test to find out the association between the variables. p value of < 0.05 was taken as statistically significant.
CONCLUSION:
The aim of this study was to suggest the WSES classification as a standard in trauma centers for the stratification of splenic injuries and their subsequent management.
From the results of the study discussed above, it can be inferred that age of the patient, systolic blood pressure at arrival, number of packed cells transfused, AAST grade, as well as the WSES category were all influencers of the ultimate outcome of the patient and the success of whichever line of management was decided upon in the emergency room.
It can be said with a degree of confidence that in the present day, the failure of non-operative management has drastically reduced and that it is no longer associated only to the AAST grade of the lesion. The physiopathological status of the patient, rather than the anatomy of the splenic injury, should guide the therapeutic decision making.
From the study, it is learnt that all the factors that related to operative management and failure of non-operative management were in relation to the physiopathological status of the patient rather than the anatomy. This brings the WSES classification to the forefront, as it considers the physiological parameters from the beginning, and hence influences the stratification of patients differently.
The current school of thought is to embrace non-operative management rather than perform rampant splenectomies, and in order to avoid unnecessary surgery, it is imperative to know what to do for which patient as a standard protocol that can be employed by all trauma centers with adequate facilities to undertake non-operative management.
According to our study, WSES IV represents the only factor related to proceeding with operative management immediately, thus proving that the hemodynamic status is the only determinant of the necessity to proceed to the operating room.
The large-scale application of the WSES classification has the potential to realistically increase the rate of non-operative management and improve and standardize management of splenic injury. It also allows to reduce the rate of splenectomy and thus improve the short and long-term survival of the patient
A Study on Utility of Ultrasonography and Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) Scoring System in Necrotising Fasciitis
No full textAIM:
To follow up all the cases of soft tissue infections with ultrasonography of the local part and laboratory scoring system. Thereby checking the efficacy of ultrasonography in soft tissue infections.
OBJECTIVE:
1. To diagnose the progression of soft tissue infections to necrotising fasciitis at the earliest and thereby reducing morbidity and mortality.
2. To follow up cases of soft tissue infections using laboratory scoring system LRINEC.
3. To follow up cases of soft tissue infections using ultrasonography of the local part.
MATERIALS AND METHODS:
➢ It is a prospective observational study.
Study period 9 months.
➢ The study participants will be enrolled as per inclusion and exclusion criteria.
➢ Informed consent will be taken.
➢ Patients presenting to our hospital with features of soft tissue infections will be followed up with regular blood investigation s and ultrasonography of the affected part. The study aims at assessing the LRINEC scoring and ultrasonographic imaging finding in the cases of soft tissue infections which progresses to necrotising fasciitis and thereby assessing their utility in early diagnosis, reducing morbidity and mortality in cases of necrotising fasciitis.
➢ Ultrasonography aims at assessing the following aspects
Subcutaneous thickening, Fascial fluid, Air.
INCLUSION CRITERIA:
1. Patients with age more than 20 years of age and less than 60 years of age.
2. Patients with soft tissue infections with features of cellulitis.
3. Patients who are not on course of antibiotic either systemic or topical at the time of presentation.
4. Patients who are consenting for the study
EXCLUSION CRITERIA:
1. Patients with age less than 20 and more than 60 years.
2. Patients who have undergone surgical debridement for the present episode of soft tissue infection.
3. Patients who are on systemic or topical antibiotic theraphy before the study.
4. Patients with furuncles, burns and other soft tissue infections without the evidence of cellulitis.
5. Patients who have already progressed to necrotising fasciitis at the time of presentation.
CONCLUSION:
This study shows that:
1. There exists a statistically significant correlation between Utility of Ultrasonography in the form of a STAFF exam and LRINEC scoring system in early diagnosis of the patients with soft tissue infections with clinical suspicion of Necrotizing fascitis
