Background: Subclinical thyrotoxicosis is a condition in which serum thyroid hormone levels are within the reference range, but serum thyrotropin (TSH) levels are subnormal. It is not known whether differences in patterns of thyroid hormone levels between endogenous and exogenous subclinical thyrotoxicosis result in disparate effects on the skeletal system. There is a paucity of data on patients with subclinical thyrotoxicosis and their bone health status. Objectives: To estimate bone mineral density in patients with subclinical thyrotoxicosis in patients due to different aetiologies in premenopausal women. Methods: This cross-sectional study was conducted at Ramaiah medical college for a period of one year. A total of twenty-six patients were included. Demographical data was analysed by descriptive statistics and expressed as mean with standard deviation. Bone mineral density was measured by hologic v2.0. Results: A total of 26 individuals were included in the study. The mean age of the study population was 34.2 ± 8.1 years. The etiology for subclinical thyrotoxicosis was Graves’ disease in 11 (42.3%), multi-nodular goiter 4 (15.3%), toxic adenoma 3 (11.6%), and iatrogenic in 8 (30.7%) patients. The mean BMI was 25.8 ± 7.2 kg/m2. The mean corrected calcium was 9.15 ± 0.26 mg/dl and phosphorus was 2.98 ± 0.36 mg/dl. The mean 25 hydroxy vitamin D level was 30.3 ± 4.41 ng/dl. Mean BMD at hip and spine was 0.96 ± 0.14 g/cm2 and 0.90 ± 0.06 g/cm2 respectively. No patient had a Z score of <-2 S.D in the hip and spine. The mean Z score at the hip and spine was +0.55 ± 0.88 and +0.22 ± 0.75 respectively. There was no significant difference between the endogenous and exogenous etiology subgroup in BMD at the hip or spine [p = 0.668 CI (-0.0629 - 0.0429)] and [p = 0.604 CI (-0.0879 - 0.1479)]. Conclusion: There was no significant reduction in bone mineral density at the hip or spine as measured by DXA in our cross-sectional study of premenopausal women with subclinical thyrotoxicosis of both endogenous and exogenous etiology. In young females with adequate serum25 hydroxy-vitamin Dlevels, endogenous subclinical thyrotoxic state may not have a deleterious effect on bone health in the short term.

Background and Objectives: Diagnostic markers to detect diabetic nephropathy at the early stage are important as early intervention can slow the loss of kidney function. Currently, there are very few diagnostic markers available. Micro-albuminuria is an accepted sign of early renal injury. Measurement of other markers such as neutrophil gelatinase-associated lipocalin and cystatin C, etc., is costly, and their utility is still under the research. Diabetic nephropathy in type 2 diabetes mellitus is thought to have elevated cytokines. However, their measurement is not easy. Absolute neutrophil count (ANC) and neutrophil-lymphocyte ratio (NLR) can act as a surrogate marker for the same. There is limited research concerning the correlation between ANC, NLR, and diabetic nephropathy. ANC is a very simple and inexpensive laboratory parameter. There are only a few studies done previously studying the association between ANC and albuminuria in the Indian population with type 2 diabetes mellitus. Subjects and Methods: This cross-sectional study was conducted in the hospitals attached to Bangalore Medical College and Research Institute. One hundred and forty-five Type II diabetes patients who gave consent for the study and satisfy the inclusion criteria were included in the study. Data were collected using semi-structured questionnaire, clinical examination, and relevant investigations. Statistical analysis was performed using the SPSS software. P < 0.05 was considered statistically significant. Results: Among the 145 individuals in the study, the mean age of the study population was 53.33 years (standard deviation: 11.90). The female-to-male ratio is 1.01: 1. The mean duration of disease was 5.88 years. The average ANC and NLR was higher in patients with proteinuria as compared to those without proteinuria. P value was statistically significant. It was noted that the NLR progressively increased from KDIGO stage G2 to G4, and the P value was statistically significant at 0.001. Interpretation and Conclusion: The NLR and ANC were significantly higher in patients with micro-albuminuria and macro-albuminuria compared to patients without proteinuria. They are simple, cost-effective parameters and can be considered as a surrogate marker for the detection and prognostic purposes of diabetic nephropathy. We hope this study adds to the existing data on NLR and ANC which are less studied parameters and paves way to future, well-matched, prospective studies which may define more in detail about the temporal correlation between ANC, NLR, and diabetic nephropathy.

Background: The objective of this study was to study the multiple clinical parameters in patients with VAP and to compare the 3 scores namely, APACHE II, SOFA and CPIS in predicting the treatment outcome of patients with ventilator associated pneumonia.Methods: It was a cross sectional observational study conducted on forty patients admitted in ICU between June 2018 and July 2019, who developed VAP after admission to ICU. Logistic regression analysis was applied to estimate the predictive ability of the APACHE II, SOFA and CPIS scoring systems in assessing VAP-related mortality. A p value of <0.05 was considered significant. All analyses were performed using SPSS software version 10.Results: The sample size in our study was 40 patients. The mean age of patients was 43.4±15.9. The mean duration of mechanical ventilation before VAP onset was 8±2 days. Klebsiella species was the most common organism isolated from ET aspirate. Of the three scores only APACHE II was independent predictor of the mortality in the logistic regression analysis.Conclusions: APACHE II score is better at predicting mortality in patients with VAP as compared to SOFA and CPIS scores. Age, co-morbidities, duration of ICU stay, time of acquiring VAP, multi organ dysfunction, need for ionotropes and multi drug resistant organisms play an important role in predicting the outcome of patients.