Association of serum sodium and 24-hour urinary sodium level with the severity and complications of ascites in cirrhotic patients.

Hyponatremia is an independent predictor of mortality in cirrhotic patients but little is known regarding the relationship between the level of serum sodium and 24-hour urinary sodium with the development of severity and complications of cirrhotic ascites. To observe the association of serum sodium and 24-hour urinary sodium levels with different grades of ascites and its complications in cirrhotic patients. In the department of Gastroenterology in a tertiary care hospital, this cross-sectional study was conducted from April 2019 to September 2020. A total of 96 admitted cirrhotic patients with ascites were enrolled in this study by consecutive sampling. Out of 96 patients with cirrhotic ascites, 48 patients had mild, moderate, and severe ascites and 48 patients had complications of ascites like refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome. The mean serum sodium level was 131.69 ±â€…4.90 and 124.88 ±â€…5.67 mmol/L and the 24-hour urinary sodium level was 76.82 ±â€…45.64 and 35.26 ±â€…22.57 mmol/L in uncomplicated and complicated ascites groups respectively with P value < .001. In grade 1, grade 2, and grade 3 ascites, there was a significant (P = .001), association between mean serum sodium (mmol/L) level (R -0.777) and 24-hour urine sodium (mmol/L) level (R -0.704) but no significant difference was seen when refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome were considered. In our finding, low serum sodium and low 24-hour urinary sodium levels were associated with the development of severe complications of cirrhotic ascites. Hence, Serum sodium and 24-hour urinary sodium levels can be good predictors of grading and complications of cirrhotic ascites.

Bidirectional ventricular tachycardia with myocardial infarction: a case report with insight on mechanism and treatment.

Bidirectional ventricular tachycardia (BVT) is a rare variety of tachycardia with morphologically distinct presentation: The QRS axis and/or morphology is alternating in the frontal plane leads. Since its original description in association with digitalis,(1) numerous cases of this fascinating tachycardia with disparate etiologies and mechanisms have been postulated. We report a patient with BVT in association with non-ST elevation myocardial infarction and severe cardiomyopathy in the absence of digoxin toxicity.

Effect of spironolactone on ventricular arrhythmias in patients with left ventricular systolic dysfunction and implantable cardioverter defibrillators.

AIMS/OBJECTIVES: Patients with implantable cardioverter defibrillators (ICD) often receive an adjunctive anti-arrhythmic therapy. We propose that an addition of spironolactone will reduce the number of clinically significant ventricular arrhythmias and ICD-related therapies. METHODS AND RESULTS: In a multicentre retrospective study, 64 patients with ischaemic and non-ischaemic dilated cardiomyopathy whose left ventricular ejection fraction (LVEF) was <35% and with ICD were selected. Amongst these patients, 28 patients were on spironolactone and 36 were not taking spironolactone. The ICD interrogation data were analysed for a maximum of 12 months. Wilcoxon Rank Sum test was used to compare the study and control groups. The outcomes were: (1) the number of shocks/anti-tachycardia pacing (ATP) episodes and (2) the number of episodes of ventricular tachycardia (VT) requiring ATP, non-sustained VT (NSVT), and ventricular fibrillation (VF) over the study period. The spironolactone group had fewer monthly, VTs (P=0.027) (requiring ATP). The two groups did not differ in the number of NSVT or VF per month. CONCLUSION: Addition of spironolactone as an adjunct to ICD therapy in patients with congestive heart failure (CHF) reduces VT requiring ATP, but does not affect NSVT or VF per month.

The colon in patients with ankylosing spondylitis and in normal controls in Bangladesh: a macroscopic and microscopic study.

The objective of this paper is to study the macroscopic and microscopic aspects of colonic mucosa in patients with ankylosing spondylitis (AS) and in controls without colonic symptoms in Bangladesh. This observational study was done in a tertiary care center of Dhaka. Twenty-eight consecutive cases of AS were included, fulfilling modified New York Criteria with pure axial form or combined axial and peripheral joint involvement. Ten controls were enrolled in the study from people in whom endoscopy of upper gastrointestinal tract (GI) tract was performed and who had no musculoskeletal complaints and no colonic symptoms. Short colonoscopy (up to 60 cm) and colonoscopic biopsy were done in all. Histological features were evaluated following Cuvelier grading and Rubio and Kock scoring system. Demographic data including age and sex were similar in the AS and control groups. Out of 28 patients, ten had axial and 18 combined axial and peripheral joint disease, mostly pauciarticular. In the AS group, macroscopic and microscopic lesions were found in four and 14 subjects, respectively. Out of 22 subjects without diarrhea, seven had stage II and two had stage I changes. Six subjects in the AS group gave a history of diarrhea, of them three had stage I and two had stage II changes. In the control group, no macroscopic abnormalities were found. On histological examination, the mean diameter of transversely cut rectal glands, interglandular linear distances, number of glands per area, and total digital scores varied between 45-90 microm, 4.6-27 microm, 5-25, and 17-18 respectively. In eight of the ten controls, eosinophilic infiltration was found. Subclinical inflammatory lesions in the colonic mucosa are common in patients with ankylosing spondylitis. Colonic mucosa in normal individuals does not differ from that found in western studies, except for the presence of frequent mild eosinophilic infiltration in the lamina propria.