Introduction:The changes in the white blood cells counts and other blood parameters are well-recognized feature in sepsis. A ratio between neutrophils and lymphocytes can be used as a screening marker in sepsis. Even though new markers such as Procalcitonin and adrenomedullin have been rolled out in the field, implementation of these markers has been hindered by cost, accessibility, and proper validation. We looked for the ability of simple neutrophil-lymphocyte count ratio (NLCR) when compared to the gold standard blood culture method in predicting bacteremia, on patients presented to emergency department (ED) with features of suspected community-acquired infections.Materials and Methods:A comparative study done on 258 adult patients, admitted with suspected features of community-acquired infections. The study group included all patients who had positive blood culture results on index presentation at ED. Patients with hematological, chronic liver and retroviral diseases, patients receiving chemotherapy, and steroid medications were excluded from the study. The study group was compared with gender- and age-matched control group who were also admitted with a suspicion of the same, but in whom the blood culture results were negative.Results:There was no statistically significant difference for predicting bacteremia by NLCR (>4.63) and culture positivity methods (P = 1.00). NLCR of > 4.63 predicts bacteremia with an accuracy of 84.9%.Conclusion:In our setting, NLCR performs equally well with culture positivity, in detecting severe infection at the early phase of disease. The NLCR may, therefore, be used as a suitable screening marker at ED for suspected community-acquired infections.

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Background and objectives: Hypoglycemia in the body is controlled by counter regulatory hormones. Serum cortisol is one among them not subjected to extensive study, in Type 2 diabetes mellitus cases. Cortisol responses among non diabetics and type 1 diabetics have been studied to a certain extent. The primary objective of our study was to identify the serum cortisol levels in hypoglycemic patients with or without type 2 diabetes and to find out the correlation between the mean cortisol responses in the two groups. Methodology: A total population of 51 symptomatic hypoglycemic patients meeting Whipple's criteria were studied in the ER of a medical college hospital at Kochi. Forty patients were diabetic and 11 non diabetic. Previous history, present illness, comorbidities, medical history and reasons for hypoglycemia were considered. Laboratory investigations on RFT, 7 AM serum cortisol and RBS were made and the results analysed applying standard statistical methods and SPSS II software. Results and discussion: Male female ratio in the diabetic and non diabetic groups was 3:1 and 10:1 respectively. Hypoglycemia was more among males, especially in the diabetic group due to decreased food intake(49%) or concurrent illness(51%), the mean age being 65.7 years in these cases. Hypoglycemia was more frequent in those on sulfonylurea (61.9%), and in habitual insulin users (42.5%). In non diabetic patients, hypoglycemia was caused by renal failure(27.27%), insulinoma(27.27%) or sepsis(18.18%). The mean serum cortisol among the diabetic group was subnormal(17.47), and in the non diabetic group it was 28.56. Age, sex, serum creatinine, GCS, period of stay and condition at discharge showed no correlation with serum cortisol levels. RBS, period of stay and condition at discharge showed no correlation with diabetic status. Conclusion: Diabetic patients with acute symptomatic hypoglycemia demonstrated a subnormal serum cortisol response as compared to non diabetic hypoglycemic patients.

The study aims to identify the correlation between arterial and venous blood gas variables, in patients with metabolic acidosis secondary to renal failure and/or diabetic ketoacidosis(DKA). Paired arterial and venous blood samples of 100 patients, with metabolic acidosis resultant to renal failure and/or diabetic ketoacidosis during 2009-2011, were analyzed and the correlation between the variables were assessed using SPSS software, applying Pearson's product moment correlation coefficient, Linear regression, Statistical parameter R 2 and Chi-square test. Results: Mean ABG values for pH, HCO3, pCO2 and lactate were (7.29 +/-0.448, 12.12 +/-2.61, 25.2 +/-4.0 and 5.39 +/-1.95 respectively) and mean VBG values for the same were (7.292 +/-0.0451, 12,23 +/-2.55, 27.8 +/-3.9, and 5.19 +/-1.81). Pearson product moment coefficient for pH, HCO3, pCO2 and lactate were 0.919, 0.967, 0.966 and 0.924 , with p <0.001. Percentage variation in ABG as explained by VBG for pH = 84.4%, HCO3 =93.6%, pCO2 = 93.2% and lactate = 85.4%. Regression equations to predict arterial from venous values:-Arterial pH = 0.631 +0.913 x venous pH (R 2 =0.844), Arterial HCO3 = 0.990 x venous HCO3 (R 2 =0.936), Arterial pCO2 =-2.546 + 0.997 x venous pCO2 (R 2 =0.932), Arterial lactate = 0.993 x venous lactate (R 2 =0.854). Arterial and venous blood gas values showed significant correlation coefficient for pH, HCO3, pCO2 and lactate. Hence, VBG may be used as an alternative to ABG in the initial management metabolic acidosis secondary to diabetic ketoacidosis and/or renal failure.