Atherosclerosis and Associated Cardiovascular Risk Factors in Nonalcoholic Fatty Liver Disease and Metabolic Syndrome

Background: Allergic rhinitis (AR) is associated with disturbed sleep and subsequent functioning, and an impaired quality of life (QoL). The symptoms of AR exhibit prominent circadian variations, with symptoms being more common at the night-time or early morning. Addressing these allergy-related sleep issues, impaired QoL, and circadian variation in symptoms is important from the patient perspective and should be considered in the management of AR. Objective: To review the efficacy of cetirizine, a second-generation antihistamine and selective H1-receptor antagonist, in relation to improvement in the QoL of the patients, addressing the sleep disturbances and circadian variations in the symptoms of AR in clinical practice, and establishing its role as a contemporary antihistamine for the management of AR compared to newer antihistamines. Methods: Systematic literature review of the databases such as PubMed/MEDLINE, Google Scholar, and the Cochrane Central Register of Controlled Trials from 1990 to 2020. Results: The symptoms of AR exhibited a circadian variation, with symptoms being worse during the night and early morning. The patients with AR encountered several sleep-related symptoms, including poor sleep quality, daytime somnolence, fatigue, and impaired productivity and QoL. Impaired QoL in AR was related to the disease severity. Administration of cetirizine at bedtime provides effective control of sleep impairment and symptoms of AR, besides improving the QoL. The efficacy of cetirizine has been demonstrated to be superior or comparable to the newer second-generation antihistamines. Cetirizine exhibits a tolerability profile comparable to the newer antihistamines. Conclusion: With long years of clinical experience and a good tolerability profile, cetirizine represents a valuable therapeutic option for the management of AR, even 30 years after its introduction. Cetirizine is included in the National List of Essential Medicines of India for the management of allergic disorders in view of its established efficacy and safety profile as well as being a cost-effective option.

Familial hypercholesterolemia supravalvular aortic stenosis and extensive atherosclerosis

Familial hypercholesterolemia is an autosomally dominant disorder caused by various mutations in low-density lipoprotein receptor genes. This can lead to premature coronary atherosclerosis and cardiac-related death. The symptoms are more severe in the homozygous type of the disease. Premature malignant atherogenesis leading to aortic root abnormalities causing supravalvular aortic stenosis is rare. Our case demonstrates the diagnostic imaging findings of the phenotype of patients who have severe elevated LDL with familial hypercolesterolemia.

Image Guided Management of Various Liver Abcess

ackground: Amoebic liver abscess is an important cause of inflammatory space occupying lesion of liver in the tropics. The primary aim of our study is to study the clinical presentations, investigations, diagnosis and management of amoebic liver abscess. Methods: All patients diagnosed with liver abscess in Hi-Tech Medical and hospital, Bhubaneswar, Odisha, over a period of two years from September 2014 to September 2016.After obtaining clearance and approval from the institutional ethical committee, detailed history of all patients is taken with thorough clinical examination; required Investigations were done and entered into a proforma during their stay and follow up. Therapeutic aspiration reserved for the following cases where: Size of abscess is more than 5 cm in diameter (125ml). When pain and fever persist for more than 3 to 5 days after starting Antiamoebic therapy. Four clinical variables-abdominal pain, fever, anorexia, and hepatomegaly-were assessed on daily basis. Finally, The patients were asked to visit for reassessment once a month for 3 months. Results: A total of 30 patients of amoebic liver abscess were included and studied during the time period. Out of 30 patients of liver abscess, 14 patients gave history of alcohol consumption, comprising 47% of the study population. than 5 cms were treated conservatively. In Patients treated by percutaneous aspiration, 12 were having cavities ranging 11-25 cms and 5 with cavities ranging 6-10 cms. 60% of patients were treated by ultrasound guided percutaneous aspiration and 40% of patients were treated by conservative management. Conclusion: Ultrasonography helps in early diagnosis and reducing morbidity and mortality. It also confirms the site, size and number of amoebic liver abscess and knowing the prognosis.