ABSTRACT
Background: Literature regarding safe dose of carvedilol is limited and also safe dose across different child classes of chronic liver disease is not very clear. Aim: We aimed primarily to study, the effect of reasonably safe dose (12.5 mg) of carvedilol in acute reduction of portal pressure and compared it with chronic reduction of portal pressure, after proper optimization of dose of carvedilol. Second aim of our study was to define predictors of response for acute and chronic reduction of portal pressure and to assess difference in dose tolerated and response across different child class on chronic basis. Methods: One hundred two consecutive patients of cirrhosis of liver with significant portal hypertension were included and hepatic venous pressure gradient was measured at the base line and after 90 minutes of administration of 12.5 mg carvedilol. After proper dose optimization of carvedilol, hepatic venous pressure gradient was again measured after 3 months to assess the chronic response. Results: The mean age of study population was 58.3±6.6 years. A total of 42.2%, 31.9% and 26.6% patients had child class A, child class B and Child class C cirrhosis, respectively. Mean pre-drug hepatic venous pressure gradient was 16.75±2.12 mmHg which dropped to 13.07±2.32 mmHg after 90 minutes of administration of 12.5 mg of carvedilol. The mean drop of hepatic venous pressure gradient was 4.5±2.2 mmHg and 2.4±1.9 mmHg among responders and non-responders, respectively. Overall, 51% showed acute response while 49% were nonresponders. Low cardiac output and high mean arterial pressure were significantly predicting the acute response, while, low baseline cardiac output was found as an independent predictor. After dose optimization, number of responders increased from 52 to 62. Mean dose of carvedilol was higher in non–responders as compared to responders, though statistically insignificant (p>0.05). Mean reduction of hepatic venous pressure gradient from baseline and after 3 months was 5.5±1.7 mmHg and 2.8±1.6 mmHg among responders and non responders on chronic basis, respectively (p<0.001). Absence of any adverse events (OR 11.3, 95% CI; 1.9-67.8), and more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response (OR 8.7, 95% CI; 3.1-25.3) were found as independent predictors of chronic response (p<0.05). Univariate analysis found that no adverse events, no ascites, low baseline cardiac output, more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response, as predictors of chronic response. However, etiology, child class, variceal size (large vs small) and gender were not significantly associated with chronic response Conclusion: At safe dose and with proper optimization of dose, carvedilol may achieve greater response with minimum side effects among different child classes of liver disease.
ABSTRACT
Background: Posterior reversible encephalopathy syndrome is a clinico-radiological entity that is characterized by variable associations of seizure activity, consciousness impairment, headaches, visual abnormalities, nausea, vomiting and focal neurological signs. No large data exists on the association of posterior reversible encephalopathy syndrome with renal failure. Materials and Methods: This case series of five patients was collected to examine the association of two conditions and evaluate outcome. All these patients were enrolled in a tertiary care hospital over a period of two years. No informed consent was sought because the study was merely observational and did not demand deviations from standard. Results: Four patients presented with acute renal failure and one patient had established End- Stage Renal Disease. All the patients had hypertension at presentation besides other risk factors. All the patients had Magnetic Resonance Imaging documented posterior reversible encephalopathy syndrome. Despite intensive management, two patients did not show any improvement of blood pressure control and died. This observation raises the possibility that renal failure increases mortality in patients with posterior reversible encephalopathy syndrome. However, our series is limited by small number of enrollees and hence no definite conclusions can be drawn from this observation. Conclusion: Posterior reversible encephalopathy syndrome should be considered in all those patients who have renal failure and associated neurological abnormalities. The association needs to be taken urgently and seriously.
ABSTRACT
Background: This study was conducted to evaluate the prevalence of metabolic syndrome in Kashmir valley of North India. Materials and Methods: The study was done among the attendants who accompanied patients in inpatient and outpatient departments of Sher-i-Kashmir Institute of Medical Sciences, Srinagar (Kashmir). A stratified random sampling procedure was adopted for the study. A total of 500 subjects were studied over a period of one year which included 257 men and 243 women. All subjects underwent anthropometric assessment and blood pressure measurements. Fasting blood sample was obtained for blood glucose and lipids. Subjects were screened for the components of metabolic syndrome according to criteria given by adult treatment panel (ATP-III). Analysis and inference were drawn using Student's test, chi-square test, Man Whitney U test, and logistic regression analysis. Results: The mean age of both men and women was 37 years. The prevalence of metabolic syndrome was 8.6% ( n =43); with males constituting 7.4% ( n =19) and females constituting 9.9% ( n =24). Though prevalence was more in females, it was insignificant ( P =0.323). The prevalence of hypertension in males was 24.9% and in females it was 12.3%. The prevalence of hyperglycemia in males was 9.3% and in females it was 7.4%. 9.7% males and 25.9% females had low HDL-cholesterol. 17% males and 13.2% females had elevated triglyceride levels. Conclusion: Our study showed low prevalence of metabolic syndrome as compared to South and North Indian population.