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tests. On these 33 patients, ICT and CFF were applied. 35 healthy subjects served as controls for the ICT and CFF. RESULTS: Taking > 9 lures as positive ICT according to receiver operator characteristic (ROC) curve, the sensitivity, specificity, PPV and NPV were 90.9%, 37.1%, 57.6%, 81.3% respectively. Cirrhotics with MHE had significantly higher lures (22 ± 7.8 vs 11 ± 5.6, p < 0.001) or (56% vs 28%) and lower target response (90% vs 97%) compared with controls. For CFF taking < 37 Hz as cut-off, the sensitivity, specificity, PPV and NPV were 57.5%, 94.3%, 90.5% and 70.2%. We also found that CFF is less time consuming as compare to ICT. CONCLUSION: ICT and CFF are useful tools to assess MHE. CFF to be less time to consume, less sensitive but more specific than ICT. INTRODUCTIONHepatic encephalopathy (HE) is a complex neuropsychiatric syndrome present in patients with chronic or acute liver disease after exclusion of other brain diseases. According to recent guidelines (AASLD/EASL 2014), hepatic encephalopathy is a brain dysfunction caused by liver insufficiency and/or portosystemic shunting; it manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma [1] . Patients with cirrhosis with normal neurologic and mental examination can present minimal forms of HE, showing intellectual function impairment that cannot be detected through general clinical examination but can be unveiled using specific neuropsychologic and neurophysiologic tests [2] . MHE has significant negative impact on

Respiratory and reproductive disorders in dairy animals due to various etiological agents have led to significant economic losses to dairy industry. These losses are due to abortions, metritis, retention of placenta, repeat breeding, death of animals, loss of production and trade restrictions etc. The objectives of this cross-sectional study were to detect the seroprevalence of infectious bovine rhinotracheitis (IBR, BHV-1) in dairy animals of western parts of Uttar Pradesh, India. Anti BHV-1 antibodies were measured using a commercial ELISA kit (SYANOVIR® IBR-Ab). Blood samples were collected from a total of 134 animals of different age, gender from 8 districts. Overall individual seroprevalence was 32.84%. The study revealed that BHV-1 is comparatively more widespread in cattle (46.51%) than buffalo (35.28%). Comparison of different sex groups of animals revealed that the higher numbers of infected animals were identified in male (48.00%) than female (29.35%). The seropositivity of IBR increased with age of animals. The highest prevalence of IBR (66.67%) was observed in animals aged more than 8 years. As vaccination against IBR is not practiced in the region and higher percent positivity (>20%) in all age group of animals indicated the natural circulation of BHV-1 virus in the population. Because of less awareness on the vaccination of animals against this virus, the disease may spread rapidly. The results of present study also indicate that strict monitoring and surveillance of IBR is need of today to protect the animals from infection and further spread.

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Aluminium phosphide ingestion is the most common agricultural poisoning in suburban and rural India and with a high mortality rate. Among survivors of acute poisoning there are recent sporadic reports of esophageal complications such as esophageal strictures and tracheo-esophageal fistula. The present study was carried out to determine the incidence, natural history, and treatment outcome of local esophageal complications in survivors of aluminium phosphide poisoning with complaints of dysphagia. All confirmed cases of poisoning with aluminium phosphide ingestion were admitted in Hamidia Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from October 2007 to October 2008. Survivors with complaints of dysphagia underwent a barium study and upper gastrointestinal endoscopy to determine site and nature of esophageal complications. All cases of strictures were treated with fluoroscopy-guided Savary-Gilliard bougie dilation, and patients with tracheo-esophageal fistula underwent surgery. Of 104 confirmed cases, 31 survived. Ten survivors with dysphagia were found to have single short-segment esophageal stricture and two patients with odynophagia and swallow-cough sequence had tracheo-esophageal fistula. All cases of esophageal strictures responded successfully to Savary-Gilliard dilation in six to ten sessions without any major complications. Patients with tracheo-esophageal fistula were treated successfully via surgery. Nearly one-third of survivors of aluminium phosphide ingestion developed esophageal complications. Hence, we conclude that all survivors of aluminium phosphide poisoning must undergo barium swallow and endoscopic examination for early detection of esophageal complications. Prevention of esophageal complications after aluminium phosphide ingestion needs to be given adequate attention because tracheo-esophageal fistula and esophageal stricture are associated with high morbidity. When one finds esophageal stricture or fistula, the possibility of aluminium phosphide ingestion should always be considered.

Background: Ingestion of coins is a common clinical problem in children. Many of the coins are ferromagnetic and can be retrieved with the help of a magnet. We describe the use of a novel endoscopic accessory for removing ferromagnetic coins. Material and methods: Two magnet discs of 1.5 cm diameter were joined to a 200 cm steel wire of 0.75 mm thickness with a terminal 5 cm spring. A Teflon tube (160 cm, 7 F) was used along with this instrument as a sleeve. The use of this accessory was analyzed prospectively in subjects presenting with a history of coin ingestion. The time taken for removal of coins, complications during the procedure and failure rate was noted. Effect of the magnet on cardiac rhythm was also noted during the procedure. Results: A total of 55 children (mean age 5.1 ± 2.3 years) with coin ingestion presented over a period of 1 year. Forty-four coins were ferromagnetic. All ferromagnetic coins were removed successfully. Mean time for removal was 68 ± 22 s. No complications were encountered. Conclusion: The novel magnetic instrument is precise, safe and quick for the removal of ferromagnetic coins under direct vision.

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Background: The true prevalence of both NAFLD and NASH are elusive but estimates based on imaging and autopsy studies suggest that about 20-30% of the adults in United States and western countries have excess fat accumulation in the liver. About 10% of these, strictly speaking about 2-3% of the adult population fulfils the criteria of NASH. True prevalence of NAFLD in Indian patients is not known. So, this study was planned to look for current trend of NAFLD in Indian patients.Methods: This prospective observational study was conducted in the Department of Medicine on 65 patients with ultra-sonography finding of fatty liver disease with no history of alcohol, in one year study duration.Results: It is observed that maximum patients are of middle age from age 31-60 years comprising 76% of patients. Out of total patients, 34% and 66% were males and females respectively. Out of 65 patients, 45(69%) had obesity and maximum number of the patients had waist hip ratio and neck circumference more than the cut off value. Out of 65 patients, 19(29%) had hypercholesterolemia and 42(65%) had hyper-triglyceridemia. Out of 65 patients, 32(49%) had higher alanine transaminase (ALT) level and 17(29%) patients had higher AST level. Out of 65 patients, 29(45%) had the homeostasis model assessment of insulin resistance (HOMA-IR) less than cut off value (less than 2.25) and remaining 36(55%) were having HOMA-IR more than 2.25. The sensitivity for the cut off value for HOMA-IR is 72.7% and specificity is 49.1%.Conclusions: Obesity, neck circumference, and waist hip ratio are higher than its cut off value for both sex, insulin resistance evaluated through HOMA- IR  directly relates to the causation of NAFLD but at some extents higher triglyceride levels are also associated but the values of ALT and AST levels did not give any clue in these cases of NAFLD.