ABSTRACT
Introduction: In patients with cirrhosis, albumin synthesis isdecreased because of the loss of hepatic cell mass. Adrenalinsufficiency (AI) has been demonstrated in patients withsevere liver disease.The percentage of AI in cirrhotic patientsvaries among different studies and depends on differentmethods and criteria used to evaluate adrenal function. Asboth serum albumin and cortisol levels are low in cirrhoticpatients we want to determine relationship between serumalbumin and cortisol levels. Current research aimed to studyadrenal insufficiency in patients of cirrhosis and to determinethe relationship between serum albumin and serum cortisollevels.Material and Methods: Prospective study was done on50 patients of cirrhosis who were admitted in medicine/gastroenterology ward of DMC & H, Ludhiana. Depending onthe levels of cortisol, patients were categorized into 3 groups.Clinically diagnosed patients of cirrhosis were included inour study whereas HIV/Immunodeficiency, Severe chronicheart disease, Chronic obstructive lung disease, Chronichemodialysis, Severe sepsis, septic shock and patients onsteroid therapy were excluded.Results: The data was analyzed using Microsoft excel andSPSS version 20.0 (IBM SPSS, Chicago, Illinois). Meanand standard deviation were computed for the variables. Thecomparison between groups were done by Chi square andANOVA. AI was present in 14 (28%) patients of Cirrhosis.The difference between cortisol levels with respect to Albuminwas found to be statistically significant (0.05).Conclusion: AI forms important part of spectrum of Cirrhosisand these patients should be evaluated for adrenal dysfunction.
ABSTRACT
Indian population is usually deficient in folic acid. Aim was to study the plasma homocysteine and antioxidant status in type 2 diabetics and healthy individuals before and after folate therapy. Methods: This study was done in four groups of 25 cases each. These included: type 2 diabetics with end stage diabetic chronic kidney disease (CKD) (group A); diabetic renal allograft recipients with normal and stable graft function (group B); uncomplicated type 2 diabetics (group C); and age and sex matched healthy controls (group D). The serum homocysteine and total antioxidant status (TAS) were measured at baseline and after 4 weeks of folate therapy. Results: The plasma homocysteine levels were 18.163.80, 16.150.66, 12.480.82 and 23.361.61 mol/L in group A, B, C and D respectively. The homocysteine levels were significantly low in all diabetic groups when compared to healthy controls. The plasma homocysteine were significantly elevated in stage 5 diabetic CKD and diabetic renal transplant recipients as compared to uncomplicated diabetics. After four weeks of folate therapy, there was a significant decrease of homocysteine in all the groups. The mean values of TAS were 1.42 0.18, 1.49 0.18, 1.17 0.06 and 1.60 0.86 pg/ml in group A, B, C and D respectively. There was no significant correlation between diabetic groups and healthy controls. No change was observed in TAS levels after folate therapy. Conclusions: Our results show significant hyperhomocysteinemia in healthy Indians. Plasma homocysteine were significantly low in all diabetic groups as compared to healthy individuals. We suggest supplementation of Indian diet with folic acid.