Anaemia and thyrotoxicosis: The need to look for an alternative cause

OBJECTIVES

Anaemia and thyrotoxicosis are both relatively common. It is unclear whether thyrotoxicosis results in anaemia in the absence of other causes. The aim of this study was to determine the prevalence and characteristics of anaemia in patients with thyrotoxicosis.

DESIGN

A prospective cohort study of patients with thyrotoxicosis.

PATIENTS

353 patients referred to a regional endocrinology centre in New Zealand from March 2013 to November 2014 for new-onset thyrotoxicosis.

MEASUREMENTS

Detailed assessment including thyroid function tests, full blood count, inflammatory markers, haematological parameters and coeliac serology. Anaemia was defined as a haemoglobin value <115 g/L (woman) or <130 g/L (men).

RESULTS

Anaemia was present in 31 (8.7%) patients at diagnosis. Of these, pre-existing anaemia was present in 10, and a further 11 had one or more identifiable underlying cause(s) for the anaemia. Only 10 patients (2.8% of the entire cohort) had anaemia not clearly attributable to another cause. Median free thyroid hormone levels were higher in those with anaemia of unknown cause compared to patients with thyrotoxicosis alone. The median duration of anaemia was shorter in patients with thyrotoxicosis-associated anaemia compared to those with anaemia due to an underlying cause (1 vs 6 months, P = .001). In all patients with thyrotoxicosis-associated anaemia, the anaemia resolved, either prior to, or on becoming euthyroid.

CONCLUSION

Anaemia coexisting with thyrotoxicosis is less common than previously reported and is mild and transient. Patients with thyrotoxicosis and significant anaemia should be investigated for other potential causes, particularly when anaemia persists.

Cytological Diagnosis of Primary Thyroid Tuberculosis

Primary thyroid tuberculosis is an extremely rare disease, even in countries where other forms of tuberculosis are abundant. TT has no age bar but usually affects women in fourth and fifth decade. Hereby, we report a case of 16-years-old girl presented with complaint of progressively increasing, painful thyroid swelling. Diagnosis of TT was made on cytology and there was no evidence of involvement of any other organ by tuberculosis. Despite of its rarity, TT is usually misdiagnosed. So, a clinician should always consider this entity in the differential diagnosis of thyroid swelling. Fine needle aspiration cytology is the best diagnostic method and can result in the avoidance of unnecessary thyroid surgeries.

Nutritional composition of ginger powder prepared using various drying methods

A study was undertaken to prepare ginger powder using various drying methods and their nutritional evaluation was carried out. Ginger (Zingiber officinale) was dried using shade, solar, oven and microwave drying methods. All the samples were ground in grinder to make fine powder. Sensory analysis indicated that acceptability of all types of ginger powders were in the range of 'liked very much' to 'liked moderately' by the panelists. The mean score obtained for colour was higher in shade dried ginger powder i.e., 8.20 as compared to oven dried (7.60), solar dried (7.70) and microwave dried ginger powder (7.80). Moisture content ranged from 3.55 % in solar dried ginger powder to 3.78 % in shade dried ginger powder. Slightly higher moisture content was found in shade dried ginger powder. Protein, crude fiber, fat and ash contents ranged from 5.02 to 5.82, 4.97 to 5.61, 0.76 to 0.90 and 3.38 to 3.66 %, respectively. β-carotene and ascorbic acid content was found maximum in shade dried ginger powder i.e., 0.81 mg/100 g and 3.83 mg/100 g, respectively. Polyphenol content was almost similar in all the samples whereas calcium was slightly higher in the shade dried ginger powder i.e., 69.21 mg/100 g. Results have shown that ginger powder prepared from various drying methods had good sensory and nutritional profile.

Comparative effectiveness of videotape and handout mode of instructions for teaching exercises: skill retention in normal children

BACKGROUND

Teaching of motor skills is fundamental to physical therapy practice. In order to optimize the benefits of these teaching and training efforts, various forms of patient education material are developed and handed out to patients. One very important fact has been overlooked. While comparative effectiveness of various modes of instruction has been studied in adults, attention has not been paid to the fact that learning capabilities of children are different from that of adults. The intent of the present study is to compare the effectiveness of video and handout mode of instructions specifically on children.

METHODS

A total of 115 normal elementary-age children aged 10 to 12 years of age were studied. The children were randomized into two groups: A) the video group, and B) the handout group. The video group viewed the video for physical therapy exercises while the handout group was provided with paper handouts especially designed according to the readability of their age group.

RESULTS

Statistical analysis using the student's't' test showed that subjects of both the video and handout groups exhibited equal overall performance accuracy. There was no significant difference between the groups both in acquisition and retention accuracy tests.

CONCLUSION

The findings of the present study suggest that if the readability and instructional principles applicable to different target age groups are strictly adhered to, then both video as well as handout modes of instructions result in similar feedback and memory recall in ten to twelve year-old children. Principles of readability related to the patient age are of utmost importance when designing the patient education material. These findings suggest that the less expensive handouts can be an effective instructional aid for teaching exercises to children with various neuromuscular, rheumatic, and orthopedics conditions and the most costly videotape techniques are not necessarily better.

Relevance of opt-out screening for HIV in emergency and pre-surgery patients in a tertiary care center in Northern India: a pilot study

OBJECTIVE

A preliminary opt-out screening study for HIV was conducted in a tertiary care hospital in India according to Center for Disease Control (CDC) guidelines. A total of 876 cases were screened for HIV during August 2007 to December 2007 using tests approved by the National AIDS Control Organization (NACO).

RESULTS

Data indicates that the prevalence of HIV in emergency and pre-surgical setting was 21 per thousand at the tertiary care center. Positivity rate in the pediatric population was 20.9 per thousand while in adults it was 21.4 per thousand. Most patients were totally unsuspected. Nearly 40000 patients seek admission annually to the emergency department alone. Thus nearly 700 to 800 patients may be missed every year if one does not resort to such a practice.

CONCLUSION

Since India has the second largest number of HIV cases in the world, opt-out screening program and testing in an emergency setting, as recommended by CDC, is extremely relevant. Logistics of implementation of this policy need to be worked out at a national level.

High incidence of Epstein Barr virus infection in childhood acute lymphocytic leukemia: a preliminary study

INTRODUCTION

Epstein Barr virus (EBV) has a unique association with several human malignancies, especially lymphoproliferative disorders, mainly lymphomas in adults. There is paucity of data pertaining to EBV association with various cancers in India .

OBJECTIVE

The study aims to investigate the association of EBV in childhood leukemia.

MATERIAL AND METHODS

Patients attending pediatric oncology services of the referral center have been included in the study. Twenty-five consecutive pediatric patients with acute lymphocytic lukemia (ALL) were subjected to EBV studies employing sensitive polymerase chain reaction followed by hybridization for presence of Bam H1-W region of EBV genome and detection of anti Z EBV replication activator (ZEBRA) antibodies using Western blot. Positive control included a case of Burkitt's lymphoma and infectious mononucleosis each. Raji cells were used as positive control with each test.

RESULTS

The PCR for EBV was positive in 8/25 patients of ALL. Western blot test using anti ZEBRA antibodies was positive in 5/25(20%) cases of ALL. Considering PCR as the gold standard, 32% of the children with ALL had evidence of active EBV replication. The positive controls were consistently positive. None of the 30 healthy laboratory controls, 22 age matched disease controls, 12 cases of AML and 15 cases of multiple myeloma were positive either by PCR or Western blots assays (P < 0. 01). There was no statistically significant correlation between duration of therapy and EBV positivity (P > 0.05).

CONCLUSION

These studies indicate that a significant number of patients with ALL show evidence of active EBV replication.

A single dose of preoperative gabapentin for pain reduction and requirement of morphine after total mastectomy and axillary dissection: randomized placebo-controlled double-blind trial

BACKGROUND

Gabapentin has been recently found to be useful for reducing acute postoperative pain when administered preoperatively. Although various dose regimens have been tried in different surgical settings, the minimum effective dose is not established.

AIMS

We aimed to evaluate the analgesic efficacy of single low dose gabapentin in patients undergoing total mastectomy and axillary dissection.

SETTINGS AND DESIGN

Prospective randomized placebo-controlled double-blind trial in a tertiary care teaching hospital.

MATERIALS AND METHODS

Fifty women scheduled for total mastectomy and axillary dissection were randomized to receive either gabapentin 600 mg or placebo orally 1 h preoperatively. The intraoperative and postoperative management was standardized. Postoperative pain was assessed at rest and on movement for 12 h using the numerical rating scale (NRS). Morphine was administered if NRS exceeded 30. Primary outcome measure was total morphine consumption.

STATISTICAL ANALYSIS

The morphine consumption was compared using independent t test while pain and sedation scores were analyzed using Mann-Whitney U test.

RESULTS

Forty-six patients completed the trial. The postoperative morphine consumption was significantly less (5.8 +/- 4.2 vs. 11.0 +/- 3.4 mg; P 0.001) and the median [IQR] time to first analgesic was significantly longer (90 [37.5-120] vs. 0 [0-90] min; P 0.001) in the gabapentin group than in the placebo group. The incidence of side effects was similar in the two groups.

CONCLUSIONS

A single low dose of 600 mg gabapentin administered 1 h prior to surgery produced effective and significant postoperative analgesia after total mastectomy and axillary dissection without significant side effects.

High rate of mutation K103N causing resistance to nevirapine in Indian children with acquired immunodeficiency syndrome

In north India the number of paediatric cases with acquired immunodeficiency syndrome (AIDS) is on the rise. Most drug combinations used for treatment of AIDS incorporate nevirapine, resistance to which develops very fast if given singly or because of unplanned interruptions. This paper investigates presence of mutations at codon 103 and codon 215 of the HIV pol gene causing resistance to nevirapine and zidovudine (AZT) respectively in 25 children with AIDS. Mutations T215Y and K103N were detected by a nested cum amplification refractory mutation system polymerase chain reaction (ARMS PCR) and the results were confirmed by direct sequencing in five randomly selected cases. Nineteen patients had received nevirapine containing regimen and six were drug naive. Mutation K103N was observed in 56% (14/25) of the children while mutation T215Y was found in none. Two of the six drug naïve children also showed K103N mutation. Thus, Indian children drug naïve or treated with nevirapine containing regimens show a high rate of mutation conferring resistance to nevirapine which calls for a judicious use of nevirapine both in antenatal and postnatal setting.

Hydatid cyst of mediastinum

We report a case of hydatid cyst of the mediastinum in a 32-year-old female patient who was admitted with chest pain. CT scan reported posterior mediastinal mass towards the right side. Surgical exploration revealed a loculated cyst in posterior mediastinum on the right side, adherent to the overlying lung and underlying bone. Posterolateral thoracotomy was performed for cyst aspiration and excision. The patient was discharged on albendazole.

Evidence that differential packaging of the major platelet granule proteins von Willebrand factor and fibrinogen can support their differential release

BACKGROUND

von Willebrand factor (VWF) and fibrinogen are major storage proteins of platelet alpha-granules. VWF is synthesized by the megakaryocyte, the cell from which platelets bud, and fibrinogen is delivered to alpha-granules by endocytosis.

AIM

Considering biosynthetic origins, VWF and fibrinogen might be differentially packaged within platelets. We applied immunofluorescence microscopy to provide whole platelet, global information on the distributions of VWF and fibrinogen.

RESULTS

The distribution of VWF and fibrinogen were characterized in both the resting state and handling activated human platelets. Full cell volume image stacks were collected by spinning-disk confocal microscopy, corrected for a small pixel shift between green and red channels, deconvolved, and visualized in a three-dimensional space. In sum, we found that there was little overlap in the distribution of VWF and fibrinogen in resting state platelets. In an important control, the distributions of green and red secondary antibodies overlapped completely when different color secondary antibodies directed against the same first antibody were used. Moreover, the same result was observed using different first antibodies and switching second antibody color to switch the color of VWF and fibrinogen staining. No accumulation of fibrinogen in late endosomes or lysosomes was detected by co-staining with LAMP2, a late endosome/lysosome membrane protein. Significantly, we found that in handling activated platelets there was differential retention of fibrinogen-positive granules relative to VWF positive granules.

CONCLUSION

Our results indicate that VWF and fibrinogen are differentially packaged in human platelets. Moreover, the results suggest that differential packaging could support differential release of alpha-granule proteins.