BACKGROUND: Alcoholic hepatitis is an acute form of alcohol induced liver injury. Its severity is measured using Maddrey's discriminant function (DF). DF>32 indicates severe hepatitis and poor outcome. TNF is responsible for liver injury in alcoholic hepatitis. Pentoxifylline (PTX) is a nonselective phosphodiesterase inhibitor which inhibits TNF production. The drug is safe, cheap and found effective in improving short term survival in severe acute alcoholic hepatitis. The present study compares the outcome of patients treated with pentoxifylline with other patients who were given only supportive care in the Indian scenario. MATERIALS AND METHODS: 50 patients with signs and symptoms of acute alcoholic hepatitis admitted at GGH, Guntur were studied. Diagnosis was done based on clinical and biochemical profile. RESULTS: Majority of the patients (54%) were in the age group of 40-50 years. All the patients presented with jaundice; others include fever (84%), abdomen distension (74%), generalized weakness (68%). Altered sleep pattern and altered sensorium were present in 34% and 10% of patients respectively. All the patients had hyperbilirubinimia, elevated AST with AST/ALT ratio>2:1 and prolonged prothrombin time. Most of the patients 68% had INR < 2 and 32% > 2.The mortality in pentoxifylline treated group was 16.7% compared to 47.8% in patients who did not receive pentoxifylline, indicating that there is significant difference in the mortality in the above two groups. (p=0.037). CONCLUSIONS: Patients with severe alcoholic hepatitis (Maddrey's discriminant function, ≥32; or MELD score, ≥21: or GAHS, ≥9) who do not have sepsis should be given a trial of prednisolone at a dose of 40 mg per day for 28 days. In situations where corticosteroids are contraindicated, pentoxifylline is safe, economical, and useful in improving short term mortality in severe acute alcoholic hepatitis in Indian scenario.
BACKGROUND: Tuberculosis, a major public health problem in most of the developing countries is posing a still bigger threat with the epidemic of HIV and association has been termed as "cursed duet". There is significant difference in the clinical profile of tuberculosis in HIV infected compared to immunocompetent host. So prompt diagnosis and treatment of tuberculosis in HIV infected will improve the morbidity and mortality associated with dual infection. So the objective of the study was to determine the clinical profile of TB in HIV infected in relation to CD4 counts. MATERIALS AND METHODS:Hundred patients with HIV infection and having symptoms of tuberculosis admitted in the medical wards in Government General Hospital, Guntur were studied. Diagnosis of tuberculosis was based on clinical evaluation, sputum smears, bacteriological and biochemical examination of body fluids, histopathological studies and radiological studies. CD4 T cell counts were done in all patients. RESULTS: 51% had only pulmonary tuberculosis, 43% had only extrapulmonary involvement while 6% had disseminated disease. Sputum positivity was seen in 27.45% of pulmonary tuberculosis. Chest X-ray findings were mixed and varied with infiltrative lesions seen in 83.33% and fibrocavitatory lesions in 11.11%. 55.55% of infiltrative lesions were seen in mid and lower zones. Mean CD4 counts in this study was 133.78 ± 75 cells/μL. Most of the patients with extra pulmonary TB and disseminated TB had CD < 200 cells/μL. Sputum positivity and upper zone lesions in chest X-ray were seen more in patients with CD4 > 200 cells/μL. CONCLUSION: Tuberculosis has a varied clinical presentation in patients with HIV infection. Sputum negative TB, extrapulmonary TB and disseminated TB were common when CD4 < 200 cells/μL and chest X-ray findings were atypical when CD4 < 200 cells/μL.
BACKGROUND:Metabolic syndrome is a specific clustering of cardiovascular risk factors, which increases the mortality and morbidity. Hence, we aimed to know the incidence of METS in coronary artery disease proven by coronary angiogram and assess its various components and its impact on the in hospital prognosis of 1 week. METHODS: A total of 100 CAD cases admitted to CCU of Government General Hospital, Guntur were studied over a period of 1 year. Cases were categorized according to the NCEP ATP III METS criteria (presence of ≥3 of the following: hyperglycemia; triglycerides ≥150mg/dl; HDL-C ≤40 mg/dl for males, ≤50mg/dl for females; blood pressure ≥130/85mg/dl; waist Circumference >102 cm in men or >88 cm in women). RESULTS: Among the 100 cases, 44 (44%) fulfilled the criteria for METS and were more likely to be women. Low HDL-C (95%) was the most prevalent component followed by high TGs (95%), hyperglycemia (82%), HT (86%) and high WC (39%). In hospital complications (1week) were higher in METS patients compared to those without and associated with four fold (odds ratio 3.8, p value <0.001) increased risk of complications including heart failure (52%). CONCLUSION: The prevalence of METS was high in coronary artery disease, associated with worse in hospital prognosis of 1week and with four fold higher risk of development of complications including heart failure. KEYWORDS: Metabolic syndrome, Myocardial infarction. INTRODUCTION:Coronary Heart Disease (CHD) has reached enormous proportions striking more and more at younger subjects. It will result in coming years the greatest epidemic mankind has faced; unless we are able to reverse the trend by concentrating on research into its cause and prevention. 1 Coronary Heart disease and its major manifestations were a medical rarity prior to first world war. 2 The prevalence of coronary heart disease is on the raise in our country, more so in South India cutting across all class and age distinctions, imposing severe burden on the health care system. Hence the present study aims to address the reasons for high prevalence of CAD and the risk factors involved, namely the Metabolic Syndrome. 3 Metabolic syndrome refers to constellation of interrelated cardiac risk factors that appear to directly promote development of atherosclerotic cardiovascular disease. 4 A recent review of insulin resistance syndrome revealed a rapid escalation of this syndrome among Indians and the prevalence of predominant component of METS varies from region to region. 5 Studies have revealed the pathophysiology of this syndrome, with close to a six fold increase in cardiovascular mortality in those possessing this disorders. 6 The increased risk of morbidity and mortality associated with the METS makes it essential that there be a clear understanding of the dimensions of this syndrome for the allocation of health care and research resources and for other purposes. 7 Data regarding the prevalence of metabolic syndrome in coronary artery disease from this part of the country is scanty and con...
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