Monoclonal gammopathy associated with visceral leishmaniasis

Monoclonal gammopathy can accompany diverse conditions and is usually benign. It should be distinguished from monoclonal gammopathy of undetermined significance (MGUS) which can rarely turn malignant. Visceral leishmaniasis has only rarely been associated with monoclonal gammopathy. We describe the case of a 55-year-old male who had monoclonal gammopathy associated with visceral leishmanisais, which reversed with stibogluconate therapy.

Monitoring oxidative stress across worsening child pugh class of cirrhosis.

CONTEXT :Oxidative stress has been increasingly implicated in the pathogenesis and progression of cirrhosis. AIMS :We studied oxidative stress in patients with cirrhosis by measuring markers reflecting pro-oxidant (serum malondialdehyde-MDA) and antioxidant factors (RBC catalase-CAT, superoxide dismutase-SOD and blood reduced glutathione-GSH) factors. The level of oxidative stress was also assessed with respect to functional compromise of liver, as determined by Child Turcotte Pugh (CTP) scoring. DESIGN :Case-controlled retrospective study. MATERIALS AND METHODS :Twenty-three patients of cirrhosis along with 23 age and sex matched healthy controls were studied. Exclusion criteria were concurrent use of anti-oxidant drugs; co-existing diseases like DM, CKD; alcohol use, gastrointestinal bleed or blood transfusion within previous 2 weeks. Besides routine investigations, MDA, CAT, SOD and GSH levels were measured and compared with controls. STATISTICAL ANALYSIS :Continuous variables were recorded as mean +/- SD; ANOVA-f test, followed by Tukey's test, was used to evaluate the significance of difference (P < 0.05) among groups. RESULTS :Mean age of patients was 41.04 +/- 12.3 yrs. Patients showed a significant increase in MDA {control 3.31 +/- 0.25 (95% CI 3.21-3.41), Child B 6.30 +/- 0.4 (95% CI 6.03-6.53), Child C 8.05 +/- 0.66 (95% CI 7.29-8.81) nmol/l} and a significant decrease in levels of SOD {control 845.13 +/- 36.44 (95% CI 829.92-860.34), Child B 582.91 +/- 42.12 (95% CI 557.45-608.32), Child C 489.5 +/- 17.66 (95% CI 479.3-499.7) U/gm Hb}, CAT {controls 2.54 +/- 0.22 (95% CI 2.45-2.63), Child B 1.93 +/- 0.23 (95% CI 1.72-2.14), Child C 1.46 +/- 0.10 (95% CI 1.40-1.52) U/ gm Hb} and GSH {controls 6.52 +/- 0.25 (95% CI 6.42-6.52), Child B 3.85 +/- 0.18 (95%CI 3.74-3.96), Child C 2.99 +/- 0.30 (95% CI 2.82-3.16) mmol/ gm Hb}. CONCLUSIONS : Oxidative stress is associated with the development and progression of cirrhosis.