Comparative study of prevalence of hypothyroidism in cirrhotic patients and normal individuals

Background: Alcoholic cirrhosis has worse prognosis than primary billiary cirrhosis and cirrhosis due to hepatitis. The risk of death due to all cause is increased 12-fold with cirrhosis. Alcoholic liver cirrhosis develops between 10-20% of individuals who drink heavily for a decade or more. Chronic hepatitis B is probably the most common cause of cirrhosis worldwide. The aim and objective of thisstudy was tocompare the prevalence of hypothyroidism between cirrhotic patients andnormal healthy individuals.Methods: The present study constitutes of 50 patients with cirrhosis of liver who met our inclusion criteria. They were selected from the patients admitted in medical wards and gastroenterology ward of RNT medical college, Udaipur.Results: Majority of patients were of serum albumin level class III about 67%. Increased TSH level as compare to level of serum albumin in cirrhotic patients. When serum albumin level decreases then percent of TSH level increases. Majority of patientswere from serum bilirubin class III (71%). Majority were from serum bilirubin class III about 70%. Conclusions: All cirrhotic patients should undergo for evaluation of endocrinological evaluation as these patients are associated with development of hypothyroidism. After diagnosis the treatment of endocrinological disorder especially hypothyroidism may increase survival.

Correlation of Vitamin D Levels with COVID-19 Severity and Outcome

Background and aims: Low vitamin D levels have been associated with an increase in inflammatory cytokines and a significantly increased risk of pneumonia and viral upper respiratory tract infections. Vitamin D deficiency is associated with an increase in thrombotic episodes, which are frequently observed in coronavirus disease 2019 (COVID-19). These conditions are reported to carry a higher mortality in COVID-19. So, we conducted a study to prove the correlation of vitamin D levels with COVID-19 infection and severity. Material and methods: The present study was conducted at RNT Medical College, Udaipur, Rajasthan. This study was done over a period of 2 months after getting approval from Institutional Ethics Committee. Written and informed consent was obtained from patients. In this study, 81 patients admitted in COVID wards and ICU, with COVID reverse transcriptase-polymerase chain reaction (RT-PCR) positive reports were included. Results: Out of a total 81 patients, 37 (45.7%) were in the 41-60 years age group, 29 (35.8%) were more than 60 years of age and 15 (18.5%) were less than 40 years of age. Seventeen patients had severe vitamin D deficiency, 27 patients had moderate vitamin D deficiency, 20 patients had mild vitamin D deficiency and 17 patients had normal vitamin D level. Out of 17 patients who had severe vitamin D deficiency, 11 (64.7%) patients required invasive mechanical ventilation and out of these 17 patients, 13 (76.47%) patients died. Out of 17 patients who had normal level of vitamin D, 16 (94.1%) maintained SpO2 at room air and only 1 patient required invasive mechanical ventilation. As the level of vitamin D increased from severely low to normal level, requirement of high oxygen support decreased and SpO2 at room air increased. Mean of vitamin D among the patients who died was 10.4963 while mean of vitamin D level among patients who survived and were discharged was 27.2362. All 17 patients who had normal level of vitamin D were discharged from the hospital. Mean of serum ferritin and mean of interleukin (IL)-6 was high in patients who died and low in patients who were discharged. Conclusions: Vitamin D level plays an important role in COVID-19 disease. Vitamin D have significant role in protection from severe form of disease.

Clinico-Laboratory Profile and Response to Current Treatment Regimens of Malaria in South Eastern Rajasthan

ntroduction: Malaria continues to be one of the importantpublic health problems in India. Rajasthan is an endemic zoneof malaria with still a high prevalence rate. A revisedknowledge of present scenario of malaria is almost undercontrol. This prospective study was conducted to analyzevarious types of presentation of Malaria in adults, itscomplications and response to current treatment regimensavailable.Materials and Methods: This cross sectional study wascompleted over a period of 12 months; from 1st November2015 to 31st December 2016; carried out in Department ofMedicine RNT medical college and attached group of hospitalsUdaipur (Raj). 200 patients who presented with fever andassociated symptoms with test positive for malaria by slideand/or MPQBC (Malaria Parasite Quantitative buffy coat) andinclusion criteria were enrolled in the study. These patientswere then subjected to treatment regimens with regular vitalmonitoring and laboratory tests. The main method to establishdiagnosis was microscopy of PBF, however MPQBC helped indiagnosis of cases missed on slide examination and mixedinfections. The presence of various complications, treatmentresponse and outcome was studied.Results & Conclusion: P. falciparum was the major parasitetype causing malaria as 56% cases. All complications cerebralmalaria, respiratory distress, haematological, malariahepatopathy, acute renal failure and electrolyte disturbanceswere noted in greater frequency in P. falciparum. Howevereven P. vivax accounted for complicated cases of malaria inthis region. For dysnatremia, hyponatremia was more commonthan hypernatremia with increase frequency amongstP.falciparum cases and higher in cerebral malaria. There was agood response to artesunate and quinine drug with 2nd linedrugs. However 14 patients in artesunate group weresubsequently shifted to quinine based therapy after treatmentfailure. A total of 4 deaths were reported all P.falciparumpositive. However an early diagnosis and adequate treatmentwith antimalarials with timely supportive therapy withHemodialysis and blood component transfusion can save livesin malaria.

A Study to Assess the Association between Colonoscopic Finding & Upper Gastro Intestinal Endoscopy Findings in Patients with Portal Hypertension

Introduction: Portal hypertension and its complications are theleading causes of death and liver transplantation, in patientswith cirrhosis. Portal hypertension causes hemodynamic andmucosal changes in the entire gastrointestinal (GI) tract. Thesemucosal changes in upper and lower gastro intestinal tractresult in various hemorrhagic manifestations.Methodology: This study was conducted in RNT MedicalCollege and attached hospitals, Udaipur, Rajasthan. Theobjective of study was to find relationship betweencolonoscopic finding and upper GI endoscopy finding in portalhypertension patients. A total of 100 patients’ diagnosed casesof portal hypertension were included in study. A predesignedand pretested Performa were used for obtaining informationregarding socio-demographic variables and laboratoryinvestigations including upper GI endoscopy and colonoscopyat endoscopy laboratory.Result: In present study, 75% patient had esophageal varicesand 93% patient had portal hypertensive gastropathy. Rectalvarices, rectopathy and portal hypertensive colopathy werefound in 57% of cases,39% cases and 32% cases respectively.While hemorrhoids were found in 53% of cases. Among thepatients who had esophageal varices, rectal varices werepresent in 64%. In patients without esophageal varices, rectalvaries was present in 36%. Association was found statisticallysignificant (p = 0.01). There was no statistical significantassociation found between esophageal varices and othercolonic lesions like rectopathy, colopathy and haemorrhoids. Inpresent study there was no statistically significant associationbetween portal hypertensive gastropathy and portalhypertension related colonic lesions (PHC, rectal varices,rectopathy and hemorrhoids).Conclusion: Upper gastro intestinal lesions gastropathy andesophageal varices are more common finding than lowergastro intestinal lesions. Rectal varices are only significantlower gastro intestinal finding on colonoscopy among thepatients of portal hypertension who had esophageal varices onupper GI endoscopy.

Computed tomographic studies on ossification status of medial epiphysis of clavicle: Effect of slice thickness and dose distribution.

The accuracy of technique adopted for Forensic age diagnostics of young adults and adolescents especially in case of livings lies in the standardization of the technical parameters used. The emerging radiological techniques, when used in standardized way may minimize the possibilities of misinterpretation, as it has been practically shown in present study. CT scans of 100 live subjects were performed on 16-slice (Siemen’s Sensation 16) CT scan machine and the volumetric data acquired was reconstructed into five separate sets of slice thickness for each one of the subjects included in the study and the ossification status for each set of slice thickness was determined for all the subjects separately. The results are almost identical while evaluating ossification stages from 1 and 2 mm thick slice data but the differences are found in the ossification stages when evaluated using 3 mm, 5 mm and 7 mm slice thickness as compared those found in 1 and 2 mm slice thickness. It was concluded that by increasing slice thickness the rate of error-nous interpretation are also increasing. Thus, the minimum reliable thickness to produce high resolution scans in order to get maximum accuracy is 2 mm for staging medial clavicular ossification from CT scan and the reconstruction should be done using kernel (filter) B60F at window setting osteo (1500/450HU).