ABSTRACT
Background: NAFLD (Non Alcoholic Fatty Liver Disease) is being considered the hepatic component of metabolic syndrome. It is now the most common cause of chronic liver disease worldwide and needs to be addressed urgently as it is asymptomatic and widely prevalent and can progress to cirrhosis and hepatocellular carcinoma. There is a need for simpler methods to diagnose the condition in modern day practice which will help in identifying vulnerable subjects and in bringing about awareness and lifestyle modifications focused on reversal of the condition. Aim of this study was to check the applicability of the fatty liver index in modern day out patient practice using formula based FLI calculator.Methods: It was a cross sectional study on patients with metabolic syndrome in a tertiary care hospital. 60 patients with metabolic syndrome, both male and female above the age of 30 years and who were non-alcoholics were enrolled in the study. BMI, waist circumference, lipid profile and GGT were obtained and FLI calculated. It was compared with the ultrasound and Elastography reports. Chi square test, Independent t test and ANOVA test were used for comparing parameters. A p value of <0.05 was considered statistically significant.Results: Among 60 patients all had fatty liver which emphasizes that fatty liver is the hepatic component of metabolic syndrome. There is a significant correlation between BMI (Body Mass Index) and waist circumference in predicting fatty liver and to some extent its grade. Patients with higher BMI had a greater grade of fatty liver.Conclusions: The fatty liver index is a reliable predictor of fatty liver in people with metabolic syndrome. The grade of fatty liver increases with increase in waist circumference and increased BMI. Ultrasound and Elastography are reliable non invasive methods of detecting fatty liver. BMI and Waist circumference are strong predictive factors for fatty liver.
ABSTRACT
Auto Immune Mixed Haemolytic Anaemia (AIHA) is defined as presence of both warm and cold antibodies against patient’s own red blood cells which is diagnosed by monospecific Direct anti-globulin test. Hereby we report a middle-aged women old women who was a known case of hypothyroidism on regular medication, presented with history of fatigability, exercise intolerance and exertional breathlessness of 1 month duration. The patient was subjected for preliminary investigations, which revealed severe anaemia with hemoglobin of 3.6 g% and an increased reticulocyte count of 12% with normal total leukocyte and platelet counts. Peripheral smear revealed anisopoikilocytosis, nucleated RBCs and schistocytes. Biochemical tests for haemolysis was evaluated which showed and elevated LDH levels (780U/L), and a reduced serum haptoglobulin levels. Liver Function test revealed a total bilirubin of 6.8mg/dl with indirect bilirubin of 5.4 mg/dl with normal liver enzymes. Baseline evaluation of Auto immune haemolytic anaemia with coombs test turned out to be positive. Patient was subjected for Mono specific DAT, Indirect Anti-globulin test (IAT) and antibody screening. Mono specific DAT showed both Anti IgG and anti C3 antibodies. IAT test was positive at 4⁰C and negative at 22⁰C and 39⁰C which confirmed that the AIHA was of mixed warm and cold type. On evaluation for connective tissue diseases, patient serum was reactive for ANA and ds-DNA and found to have Systemic Lupus Erythematosus which is a rarity and was responded to corticosteroids.