No abstract

A 30-year-old, non-pregnant female from Himachal Pradesh, northern India, presented to Medical Outpatient department in March 2011 with chief complaints of progressively increasing generalized weakness and easy fatiguability, of 3 months duration. Patient denied having any history of upper or lower gastrointestinal bleeding, menorrhagia, jaundice, passage of worms in stools or bleeding from any other site, fever, rash, joint pains, drug intake, neck lumps or swellings or weight loss. There was no history of decreased urine output, passage of frothy urine, early morning facial puffiness or pedal oedema. There was no past history of blood transfusions or of any indigenous drug intake. Physical examination revealed a markedly pale looking female who had a regular pulse rate of 84 beats per minute and a blood pressure of 130/84 mm of Hg. Icterus, clubbing, oedema, lymphadenopathy, haemorrhagic spots, malar rash and gum hypertrophy were absent. Thyroid was not enlarged. There was no sternal tenderness or any joint deformity. Systemic examination did not reveal any organomegaly. Investigations showed Hb-3.4 gm%, TLC-4200/ cu mm, DLC-54% Neutrophils, 44% Lymphocytes, 1% Monocytes and 1 % Eosinophils. Platelet Count -1.8 lac/ cu mm, RBC count-3.2 million/ cu mm, MCV-83.9, MCH-30.1, MCHC-35.9. PBF showed a marked degree of anisopoikilocytosis, with normocytic RBCs with moderate hypochromia, with few microcytes and few large oval macrocytes. Corrected reticulocyte count was 0.8%. Serum Bilirubin was 0.8 mg/dl, SGOT-15 IU/L, SGPT-18 IU/L. B. Urea-25 mg/dl, S. Creatinine-0.8 mg/dl. LDH-248 U/L. Direct and indirect Coomb's tests were negative. HBsAg, anti HCV and HIV were non reactive. Serum Iron studies showed normal findings, as did serum Vit. B12 (843.11 pg/ml) and serum folic acid (> 20 ng/ ml) studies. Serum electrolytes were normal and so was the urine complete examination. Stool for occult blood showed negative results. Bone marrow aspiration showed a normocellular marrow with micronormoblastic and megaloblastic changes and a myeloid: erythroid ratio of 4:1. Chest radiographs and ultrasonography of abdomen showed normal results. Patient was transfused 3 units of blood and she was also put on oral haematinics. Patient was discharged in a stable condition with her Hb level measuring 11.2 gm % and she was advised follow up in Medical Outdoor Dept, which she failed to do.Two months later, she again presented to Medical Outdoor department with gross pallor and generalized weakness. Her Hb was 3.6 gm%. Her peripheral blood smears and bone marrow findings were same as before. She was given 4 units of blood along with oral haematinics and was discharged with Hb levels of 10.8 gm%. Her subsequent weekly OPD visits revealed a progressive fall in Hb and at six weeks of follow up, her Hb level was 7.6 gm%. Haemoglobin electrophoresis was done three months after last blood transfusion, which showed HbF< 0.01% (N), Peak A2-4.60% (N), Hb Adult-81.40% (slightly low), HbA2-6.20% (2×ULN) findings, which were suggestive of a diagnosis o...

Background Neurotrauma has been labeled as a “silent epidemic” affecting both the developed and the developing nations. Traumatic brain injury (TBI) in humans leads to the proteolytic cleavage of tau protein called cleaved tau (C-tau) protein. The objectives of the study are to the role of serum cleaved tau (C-tau/τC) protein as a biomarker in patients with mild TBI and correlate it with the clinical progression (GCS) and clinical outcome (GOS) in emergency settings. Materials and Methods The study has been approved by the institutional ethical committee. The study included 40 cases with mild TBI and 40 controls. C-tau protein levels were measured in venous samples in emergency using human cleaved microtubule-associated protein tau ELISA kit (by CUSABIO). Results The mean serum C-tau protein level in cases was 44.76 ± 23.10 pg/mL (range: 12.32–96.44, 95% CI: 37.37–52.15) and controls was 33.82 ± 13.65 pg/mL, (range: 2.48–66.54, 95% CI: 29.46–38.19, p = 0.091). At admission the mean serum C-tau level was 65.15 ± 22.41, 43.87 ± 9.67, 26.15 ± 9.13 pg/mL in patients with GCS 13, 14, and 15, respectively. Serum cleaved tau protein levels in the good outcome group were significantly lower, that is, 40.77 ± 19.63 pg/mL (mean ± SD) (range: 12.32–88.71, 95% CI: 34.13–47.42) compared with the poor-outcome group 80.66 ± 23.10 pg/mL (mean ± SD) (range: 46.55–96.44, 95% CI: 43.88–117.43, p = 0.004). Conclusion In this study, serum C-tau levels in patients with mild TBI were comparatively higher than those in the controls. Reaching a definitive conclusion will be too early and beyond the scope of this study. Thus, more studies are required in identifying its role as a diagnostic and prognostic marker in mild TBI.

Objectives: To determine the frequency of Acute Mitral Regurgitation in Post Percutaneous Transvenous Mitral Commissurotomy (PTMC) patients with severe mitral stenosis (MS). Methodology: A cross-sectional study was conducted at the Tabba Heart Institute, Karachi, Pakistan between September 2019 and April 2021. All patients irrespective of gender, aged between 19-80 years, and those who did not undergo PTMC were eligible to partake in the study. Patients with mitral regurgitation along with mitral stenosis, or those with clot in left atrium, or those suffering with the last stage of renal disease were excluded from the study. A predefined Proforma was used as a research instrument through which medical records of patients of PTMC are collected. The variables of the Proforma include patient’s age, name, sex, echo findings, treatment procedure, post-procedure data and complications. Results: A mean age of 40.6 ± 12.63 years was reported. 86 (81.9%) of the patients developed ‘no complications’, 15 (14.3%) of the PTMC patients suffered from ‘severe mitral regurgitation’, 2 (1.9%) had local hematoma, and one patient had a cardiac tamponade after the procedure. Only one patient died post-procedure. Post-stratification analysis showed that the majority of the female patients and 83% of the patients with no previous commissurotomy history did not have any complications. While a total of 14.7% who had no history of previous commissurotomy suffered from severe MR. Conclusion: Our study revealed that only a small number of patients who underwent PTMC suffered from severe mitral regurgitation. Overall, the procedure is safe with a good outcome.