Non-invasive evaluation of renal arterial blood flow in alcoholic cirrhosis of liver

Introduction: Studies of renal perfusion when kidney function tests are still normal could be useful in understanding the pathophysiology of functional kidney impairment in cirrhosis. Kidney functional failure in cirrhosis is considered as a consequence of active renal vasoconstriction. The same have been studied by invasive and non-invasive methods. The present study is aimed at non-invasive assessment of renal artery resistance in patients of cirrhosis of liver. Materials and methods: The present study included 30 cases, patients with different stages of cirrhosis, who were clinically stable, while those with major complications like hepatic encephalopathy, major bleeding etc were excluded. All patients were evaluated clinically and a series of laboratory investigations were done. The resistance in the renal artery was calculates as Resistivity index, by using a color Doppler ultrasonography. Results: In our study, we found the main resistivity index was higher in cases with MELD >20. There was further increase in resistivity index as a severity of the cirrhosis increases. Similarly the MDRD EGFR was decreasing as the severity of cirrhosis was increased. Conclusion: Within limitations of the present study, we conclude that the estimation of the resistivity index in the kidney appears to be a sensitive and easy method for studying the early renal hemodynamic alterations in cirrhotic patients and thus by better understanding the Pathophysiology of hepatorenal syndrome.

Comparison of different techniques of cataract surgery in bacterial contamination of the anterior chamber in diabetic and non-diabetic population.

Aim: To compare the bacterial contamination of the anterior chamber (AC) between manual small incision cataract surgery (SICS) and phacoemulsification (Phaco). To study the conjunctival flora and bacterial contamination of AC between well-controlled diabetics and non-diabetics. Materials and Methods: Three hundred and sixty-eight patients were randomized to manual SICS and Phaco. Sixty-eight patients were excluded for not completing follow-up or for intraoperative complications like posterior capsule rupture. One hundred and fifty patients in each group were finally analyzed. Conjunctival swabs were taken on admission, after one day of topical ofloxacin and 15 min after 5% Povidone Iodine (PI) instillation. AC aspirate at the end of the surgery was also cultured. Results: Fifty-six (18.66%) patients had positive conjunctival swab on admission which was reduced to 19 (6.33%) with topical ofloxacin and to five (1.66%) with instillation of 5% PI. AC contamination in both manual SICS and Phaco was 0.66%. The conjunctival flora in diabetics was similar to non-diabetics. None of the diabetics had AC contamination. Statistical analysis was performed by Chi-Square test (with Yates’ correction). Conclusion: Statistically significant reduction in conjunctival flora was achieved with topical ofloxacin and 5% PI instillation and AC contamination in both manual SICS and Phaco was minimal (0.66%). Well-controlled diabetics who underwent cataract surgery in this study had similar conjunctival flora and AC contamination as non-diabetics.

Relationship of nutritional status with tuberculin sensitivity.

Objective. To estimate the prevalence of under- nutrition among school children and to find out the relationship between nutritional status and tuberculin sensitivity. Methods. A cross sectional study was carried out among 3335 children between 5-8 years of age, attending 60 schools in Bangalore city, selected by stratified random sampling. The nutritional anthropometric indices were calculated using reference median as recommended by World Health Organization, classified according to standard deviation units termed as Z-scores. The nutritional status of the children was assessed by weight for age, height for age and bio-mass-index (BMI). Results. Depending upon the method for classifying nutritional status, the prevalence of under-nutrition (including mild and severe under-nutrition) varied between 14.9-29.8%. The prevalence of severe under-nutrition varied from 2.9-6.7%. The frequency distributions of reaction sizes to tuberculin were found to be similar among children classified by nutritional status. The differences in proportions of significant reactions (≥10mm) and mean tuberculin reaction sizes between children classified by nutritional status were not found to be statistically significant. Conclusion. Tuberculin sensitivity was not influenced by nutritional status among apparently healthy school children.

A light microscopic study of fibrosis involving muscle in oral submucous fibrosis.

Oral submucous fibrosis (OSF) is a common pre-malignant condition of the mouth in arecanut chewers in Indian subcontinent. It is characterized by restriction in opening of the mouth, tongue protrusion, and cheek flexibility. Reports of muscle changes in OSF, using light microscopy are few. Incisional biopsy sections of thirty OSF patients were stained with Masson's Trichrome stain, to study the fibrosis involving the muscle. Wide spectrum of changes were observed where fibrosis was being evident sub-epithelially, not extending in to the muscle to cases where only a few remnants of muscle fibers were seen and the missing muscle bundle area being replaced by fibrous tissue. The probable mechanism by which these changes occur is discussed.