Lipid Profile as an Indicator of Severity in Cirrhosis of Liver: Hospital based Cross-sectional Study.

BACKGROUND: Various scoring systems are available to assess the severity of cirrhosis, that is, the Child-Pugh score and Model for End-Stage Liver Disease (MELD) score. Since the liver is the major site for converting excess carbohydrates into various lipids, the deranged lipid profile can act as a prognostic biomarker of cirrhosis. We assessed the lipid profile abnormalities among patients with cirrhosis of the liver and correlated them with the severity of cirrhosisMaterials and methods: This is an analytical cross-sectional study on lipid profile as an indicator of severity in cirrhosis of the liver among patients admitted to the medical ward of a tertiary care teaching hospital in Tamil Nadu. Following detailed investigation and confirmation of cirrhosis, a fasting serum lipid profile was measured in all eligible patients with cirrhosis. Total serum cholesterol, triglyceride (TGL), and high-density lipoprotein (HDL) were measured by direct method and serum low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) were calculated by using the Friedwald formulaResults: A total of 120 patients were studied. Of them, 76 (63%) were male. Of them, alcohol (84, 75.0%), hepatitis B (8, 7.1%), and nonalcoholic steatohepatitis (NASH) (6, 5.4%) were the most common cause of cirrhosis. A clear dose-response relationship (decreasing trend) is seen in the levels of lipids for increasing severity based on the Child-Pugh score and MELD score (except for a score of ≤10). Further, the cholesterol, LDL, and HDL were significantly lower among patients with ascites or with spontaneous bacterial peritonitis compared to their respective groups. However, none of the lipid profiles significantly differed based on the presence of upper gastrointestinal (UGI) bleeding Conclusion: This study observed that there is a significant reduction in levels of lipid profile parameters like serum total cholesterol, LDL, VLDL, TGL, and HDL in patients with cirrhosis as the severity increases. Further formulation of the scoring system in association with a preexisting scoring system may provide a better assessment of patients' prognosis in view of morbidity and mortality. We recommend it is necessary to assess the fasting lipid profile in all patients with cirrhosis and prognosticate their disease progression.

Evaluation of Febrile Thrombocytopenia Cases in a South Indian Tertiary Care Hospital.

Objective: This study is aimed at analyzing the clinical symptomatology and hematological evaluation with an emphasis on platelet indices in relation to predicting the outcome of the febrile thrombocytopenic patients admitted in Coimbatore medical college hospital.. Methods: This is a prospective study involving 100 adult patients who presented to our hospital with fever and thrombocytopenia (platelet <1,50,000). This study excluded patients with known causes of thrombocytopenia like ITP and patients on chemotherapy etc. Results: Out of 100 patients 34 were dengue positive, 66 were dengue negative. Dengue specific symptoms like myalgia and retro-orbital pain were present in 58.88% of dengue positive and 10.60% of dengue negative patients. Laboratory evaluation revealed sharp rise in hematocrit with fall in platelet count in both the groups more significant in dengue positive group. Bleeding manifestation and rashes were 29.4% and 26.4% in dengue positive, 12.12% and 7.57% in dengue negative group respectively. MPV was significantly lower in patients with bleeding manifestations irrespective of platelet count in both the groups. Mortality in our study was 2%. Conclusion: MPV is an independent predictor of bleeding manifestation and poor outcome. Dengue virus may suppress the bone marrow as evidenced by alteration in MPV in addition to other mechanisms of thrombocytopenia.

Multifocal Tuberculosis.

Multifocal Tuberculosis represents the many faces of an age old disease. It is characterized by the presence of large multifocal tuberculous areas in same or different organs. A 50 year old male patient, presented with features suggestive of renal failure, low grade fever and cough with mucoid expectoration. He was found to have pulmonary TB, genitourinary TB and tuberculous lymphadenitis. He was started on antituberculous treatment to which he showed good response.

Lipemia Retinalis due to Secondary Hyperlipidemia in Type 1 Diabetes Mellitus.

Lipemia retinalis is a rare and asymptomatic condition which occurs when high levels of triglycerides and chylomicrons are present in blood. We report a rare case of secondary hyperlipoproteinemia in a 27 year old type 1 diabetes patient who presented with diabetic ketoacidosis and this peculiar ocular manifestation. The fundoscopic abnormality and creamy white serum cleared as the level of chylomicrons in the plasma dropped with intensive insulin therapy.

Wilson's Disease with Systemic Lupus Erythematosus.

Case reports of Wilson's disease occurring in combination with SLE are rarely reported in literature. Drug induced lupus have been observed in patients taking D-penicillamine for Wilson's disease. Here we report a case from Coimbatore Medical College hospital, who presented with fever and neuropsychiatric symptoms as the initial manifestation and found to have both SLE and Wilson's disease on subsequent evaluation.

Cerebral Sinus Venous Thrombosis as a Rare Complication of Primary Varicella Zoster Virus Infection.

We present the case of a 23 year old with acute onset left hemiparesis and meningeal irritation, associated with recent history of chickenpox 15 days prior. Varicella-IgG and IgM was positive in the CSF and blood along with reduced serum/CSF ratios of VZV immunoglobulins. MRV showed thrombosis (CVT) of superior sagittal, transverse, right sigmoid sinuses with haemorrhagic infarct in right frontoparietal region. Patient responded well to intravenous heparin, Acyclovir and oral anticoagulant therapy.

Idiopathic CD4 Lymphocytopenia.

We report a 42 year old male who was an interesting case of "idiopathic CD4 lymphocytopenia"(ICL) in a non-HIV adult with-extra pulmonary tuberculosis along with the diffuse splenic calcification and whose symptoms improved with Antitubercular treatment. He was found to have low CD4 counts on two occasions.

Pulmonary Thromboembolism Presenting as Multiple Pulmonary Cavities.

A 38 years old male patient presented to the emergency department with acute severe retrosternal chest pain and was found to have pulmonary thromboembolism. The patient developed new necrotic lung cavities each day due to the dissemination of emboli from the thrombus. The cause of thrombus was found to be protein C deficiency, which is an inherited thrombophilia. The interesting features in this case are multiple lung cavitations and high grade fever, which was attributed to pulmonary thromboembolism. The patient improved symptomatically with anticoagulants and antiplatelets.

Transient ST Segment Elevation following Indian Red Scorpion Sting with Non-Occlusive Right Coronary Artery Disease.

A 50 yr old female developed transient ST segment elevation due to an acute coronary vasospasm following a Indian Red Scorpion sting and the angiogram revealed 50% occlusion in right coronary artery (RCA).The possible mechanism is that the sympathetic over-activity could have aggravated the occlusion in the RCA as the RCA is more commonly prone to spasm compared to the other coronary arteries.