The Journal of Clinical and Scientific Research: The leap forwards! TS Ravi Kumar, P V. L. N Srinivasa Rao Journal of Clinical and Scientific Research 2019 8(1):1-1

Usefulness of transoesophageal echocardiography in ischaemic stroke Deshmukh Dnyaneswar Shivajirao, K Josehva Caleb, Bimal Prasad Padhy, H Radhakrishna, Vishanji Karani Journal of Clinical and Scientific Research 2019 8(1):2-6 Background: Aorta can be a source of embolic stroke, and study of aorta can sometimes give us insight into the atheromatous process going on in the vascular tree. Another important source for emboli can be the left atrium and its appendage. Transoesophageal echocardiography (TEE) is useful in studying the different parts of aorta, mitral valve apparatus, interatrial septal identification and measuring patent foramen ovale, aneurysmal atrial septum and myxoma of the left atrium. Methods: We retrospectively studied the TEE findings in 500 patients with ischaemic stroke seen at CARE Hospital, Nampally, Hyderabad, Telangana state from their care records. Results: There were 362 males (male: female = 2.6). Different grades of abnormalities were seen in the aorta, more commonly in the arch and descending aorta. The atrial septal abnormalities were seen in 18 cases. Clots or masses within the atria or ventricles were seen in 22 patients. The mitral valve was more often diseased in ischaemic stroke patients, though aortic valve disease or even multiple valve disease was also seen in many patients, and the valve disease was of different grades. Conclusions: TEE was useful in identifying an embolic source in 10% of patients and helped in initiating anticoagulation. It was also useful in identifying complex aortic atheroma in another 92 (18.4%) cases and helped in starting different antiplatelet drug combination or anticoagulation. TEE helped in identifying the pathogenesis of strokes with difficult to identify mechanisms.

Burnt-out diabetes in diabetic nephropathy patients on maintenance haemodialysis A Anjani, N Harini Devi, RD Nagaraj, V Siva Kumar Journal of Clinical and Scientific Research 2019 8(1):7-10 Background: Diabetic nephropathy contributes to about 50% of end-stage renal disease (ESRD) worldwide. Diabetic ESRD patients experience spontaneous resolution of hyperglycaemia with normalisation of blood glucose and glycosylated haemoglobin leading to discontinuation of antidiabetic medicines, which progress to burnt-out diabetes state. The occurrence of burnt-out diabetes state needs to be identified for reducing the occurrence of hypoglycaemic episodes in diabetes patients on maintenance haemodialysis (MHD). Methods: A cross-sectional study was conducted in ESRD patients on MHD at the dialysis unit, the Department of Nephrology at Sri Venkateswara Institute of Medical Sciences, Tirupati, during the period January–April 2016. The diabetic ESRD patients on MHD were further subgrouped as burnt-out and non-burnt-out patients. Results: Among the patients with diabetes, burnt-out state was observed in 12 (23%) and non-burnt out were of 40 (77%) patients. The serum triglycerides, very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol and parathyroid hormone levels were found to be increased, whereas body mass index, blood urea, serum high-density lipoprotein (HDL) and 25 hydroxy vitamin D (25 OHD3) levels were found to be decreased in burnt-out diabetic patients compared with non-burnt-out diabetic patients which were not statistically significant except for urea and HDL. Conclusion: Approximately, one-fourth of our patients were belonging to burnt-out diabetes state. If burnt-out diabetes state is recognised, unnecessary administration of insulin and other drugs which precipitate hypoglycaemia can be avoided so that the future risk of cardiovascular disease and mortality is minimised.

Comparison of upper-lip bite test with other four predictors for predicting difficulty in intubation N Hemanth, T Rajasekhar, Swami Devi Prasad Ilapanda, Prabhu Gnapika Putta, Pabba Shravani, Dyva Manogna, MH Rao Journal of Clinical and Scientific Research 2019 8(1):11-15 Background: Unanticipated difficult tracheal intubation remains a primary concern of anaesthesiologists. The aim of the present study was to compare upper-lip bite test (ULBT) with other four predictors namely modified Mallampati test (MMT), thyromental distance (TMD), sternomental distance (SMD) and interincisor distance (IID) for predicting difficulty in intubation. Methods: Airway assessment indices were evaluated and compared in 60 American Society of Anesthesiologists physical status Grade I and II patients undergoing general anaesthesia at a tertiary care teaching hospital in South India. The cut-off points for defining the difficult intubation (DI) were as follows: for ULBT, Class III; MMT, Classes 3 and 4; TMD <6 cm; SMD <11 cm and IID <3.5 cm. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each of the predictive tests. Results: DI was observed in 26.7% of all patients studied. Sensitivity, specificity, PPV, NPV and accuracy for ULBT were 6.3%, 97.7%, 50%, 74.1% and 73.3%, respectively, whereas those for MMT were 25%, 86.4%, 40%, 76% and 70%, respectively. MMT showed 50% sensitivity and 84.5% specificity in assessing difficulty in intubation when compared with ULBT, whereas all the other methods have shown 0% sensitivity. MMT is a better predictor of difficulty in intubation when compared with ULBT due to its high sensitivity, better specificity, PPV and accuracy. Conclusions: No single airway predictor was accurate in predicting DI. A combination of at least two or more airway predictors has to be analysed to arrive at a near-ideal difficult airway prediction.

Biochemical and serological characterisation of beta-haemolytic streptococci from various clinical samples in a tertiary care hospital, South India VS Srikala, KK Sharma, N Ramakrishna, DT Katyarmal, R Jayaprada Journal of Clinical and Scientific Research 2019 8(1):16-23 Introduction: Beta-haemolytic streptococci (BHS) are one of the most frequent human pathogens capable of producing a variety of diseases ranging from pharyngitis, impetigo, to more severe and life-threatening diseases such as toxic shock syndrome, neonatal sepsis, pneumonia, meningitis and acute rheumatic fever. Methods: This was a hospital-based prospective study which was carried out on BHS isolated from various clinical specimens submitted in microbiology laboratory from inpatients and outpatients, and these isolates were studied biochemically by pyrrolidonyl arylamidase (PYR), hippurate hydrolysis and sugar fermentation tests. Differentiation of various serogroups was done with bacitracin (0.04 U), co-trimoxazole (sulphamethoxazole-trimethoprim [23.75/1.25 mcg]) and penicillin (10 units/disc) discs (n = 220). The isolates were identified serologically by Hi Strep™ Latex agglutination test Kit (Himedia). Results: The findings showed that the highest percentage of streptococci isolated was from throat swabs (35.5%), followed by sputum (15.9%), urine (14.1%), blood (10.5%), pus (8.6%), cerebrospinal fluid (6.4%), bronchoalveolar lavage (5.9%) and endotracheal tips (3.2%). The highest percentage of BHS belongs to Group C (74, 33.6%), followed by Group G (51, 23.2%), Group B (42, 19.1%), Group F (28, 12.7%), Group A (21, 9.5%) and Group D (4, 1.8%). Conclusions: Rapid identification and consequent prompt treatment of patients with BHS can reduce the risk of spread and aid in the prevention of infections and their serious complications, such as rheumatic fever/rheumatic heart disease, nephritis and local or systemic infections.

Brown adipose tissue in adult humans: A mini review VS Kiranmayi, KM Bhargav Journal of Clinical and Scientific Research 2019 8(1):24-28 Adipose tissue is of two types: white adipose tissue (WAT) and brown adipose tissue (BAT). For a long time, it was considered that BAT is present only in hibernating animals and newborns, conferring them a protection from the cold environment. However, radionuclide imaging studies have shown that BAT is also present in adult human beings and plays an important role in energy metabolism. This has resulted in a resurgence of interest on BAT in the researchers. The molecular mechanisms underlying the thermogenic role of BAT and various factors that can induce the formation and activity of BAT are being explored. The thermogenic effect of BAT is mediated by uncoupling protein 1, also known as thermogenin. Several factors such as exposure to cold, stimulation by sympathetic nervous system, thyroid hormones and other endocrine factors induce brown adipogenesis and its activity. An inverse relationship exists between BAT and body weight. The increasing prevalence of obesity globally and its association with various complications makes it essential to search for therapeutic strategies to prevent and treat obesity. In this regard, BAT with its ability to dissipate energy in the form of heat appears to be a potential therapeutic target for the management of obesity.

Pancreatic ascites with 'inflammatory transudate' M Rajendra Prasad, P Gopalakrishna, MS Madhuri, MS Sridhar Journal of Clinical and Scientific Research 2019 8(1):29-31 Pancreatic ascites is not an uncommon condition but requires a high degree of suspicion for prompt diagnosis. Since both hepatic cirrhosis and pancreatitis are related to ethanol abuse, routine investigation of patients with cirrhotic ascites for the rise of ascitic fluid amylase levels will facilitate early diagnosis. The combination of inflammation of pancreas and portal hypertension due to hepatic cirrhosis could give a picture of 'inflammatory transudate'.

Isolated breast tuberculosis in an elderly diabetic woman Priyanka , MV S. Subbalaxmi, Anu Kapoor, Shantveer Uppin Journal of Clinical and Scientific Research 2019 8(1):32-34 The manifestations of tuberculosis (TB) are myriad and can affect any organ. Involvement of breast by TB is rare and the condition is often mistaken with breast cancer or pyogenic breast abscess. We report the case of a 75-year-old woman with long standing type 2 diabetes mellitus who presented with a swelling in the left breast. Core biopsy of the swelling showed necrotizing epithelioid granulomas with acid-fast bacilli. The patient responded well to short-course anti-TB treatment. The present case documents the uncommon isolated occurrence of TB of the breast in a patient with long standing type 2 diabetes mellitus.

Invasive pulmonary Aspergillus infection in an immunocompetent host following severe dengue S Bhavana Reddy, Sudha Vidyasagar, Nandakrishna Bhat, Muralidhar Varma Journal of Clinical and Scientific Research 2019 8(1):35-38 Aspergillus species are widespread in the environment with Aspergillus fumigatus being the most common pulmonary pathogen. In a person with normal immunity, Aspergillosis in the lung can mainfest as hypersensitivity reaction. It can also present as an invasive infection in immunocompromised patients. In its severe form, invasive pulmonary aspergillosis (IPA) is commonly seen in severe immunodeficient individuals and is often fatal. We report a case of IPA in an immunocompetent patient following severe dengue fever who was successfully treated with voriconazole.

How technological innovations are changing medical practice KN Ganesh Journal of Clinical and Scientific Research 2019 8(1):39-41