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BACKGROUND: This study was planned with an aim to identify the nature and distribution of cranial lesions on magnetic resonance imaging (MRI) and its correlation with clinical and laboratory data in eclampsia and severe preeclampsia. MATERIAL AND METHODS: 40 patients admitted for indication of severe preeclampsia or eclampsia with or without neurological signs were first stabilized and then underwent cranial MRI. Following MRI they were divided into two groups; Group MP (n=24) including patients with positive finding on the cranial MRI and Group MN (n=16) which included patients with normal Cranial MR imaging. Nature and distribution of the lesions were documented and statistical comparison was made on the basis of clinical findings, arterial blood pressure and laboratory data in both the groups. Patient with cerebral changes in the MRI were also called back for repeat MRI postnatal after two 2 months. RESULTS: Out of the 40 patients who underwent cranial MRI 24 patients had cerebral changes (Group MP) whereas 16 patients had normal scan (Group MN). In 21 out of 24 (87.5%) MRI finding positive patients the finding was consistent with diagnosis of posterior reversible encephalopathy syndrome (PRES). The most commonly involved areas in patients with PRES were parietal (85.7%,), frontal (71.42%) and occipital lobe (71.42), followed by temporal lobe (38.09) and basal ganglia (33.33) and cerebellum. All the patients who were diagnosed with PRES had a normal MR scan on the follow up at two months after the initial presentation. There was a significantly greater incidence of seizures and neurological disturbances in patients with positive MRI findings as compared to patients with no MRI findings (p<0.001). There was no statistical difference between the blood pressure measurements of the two groups. Markers of endothelial dysfunction like Serum LDH (p=0.002) Serum creatinine (p=0.006) and abnormal red blood cell morphology (0.002) was significantly higher in patients with positive MRI findings compared to MRI Finding Negative group. CONCLUSION: Our study suggests that PRES is the core component of the pathogenesis of cerebral findings of eclampsia and development of PRES is associated with endothelial dysfunction and not elevated blood pressure alone.

METHODS:Women eligible for inclusion in the present study were those who initiated prenatal care prior to 20 wks gestation, were 18 years of age or older and planned to carry the pregnancy to term. Women excluded from the study were those with previous history of preterm delivery, pregnancy induced hypertension or those with gestational diabetes mellitus. Of the total 106 women who participated in the study, 6 were excluded (those who experienced an abortion or fetal demise prior to 28 weeks of gestation and those with multi-fetal pregnancies). Thus, a cohort of 100 women remained for analysis. Gestational age was based on the last menstrual period and confirmed by USG conducted prior to 20 weeks gestation. Maternal blood samples were collected at 12-14 weeks gestation. Serum CRP concentrations were measured by an ultra-sensitive competitive immunoassay. We categorized preterm delivery cases according to gestational age at delivery as very preterm delivery (≤34 weeks gestation) and moderate preterm delivery (between 34 and 37 weeks). RESULTS: We observed increased risk of preterm delivery among women with CRP concentrations ≥ 7.5 mg/l as compared with women whose concentrations were < 2.0 mg/l. We noted little evidence of an association between maternal serum CRP concentrations& moderate preterm delivery. However, elevated CRP concentrations were associated with an increased risk of very preterm delivery. CONCLUSIONS: From this study, we concluded that determination of CRP status using serum collected in early pregnancy served to clarify the temporal relationship between elevated maternal serum CRP concentrations and subsequent risk of preterm delivery i. e., elevated CRP concentration in early pregnancy is associated with an increased risk of Preterm delivery. But there were some limitations of the study as only single measurement of serum CRP was done & the relatively small number of subjects available for subgroup analyses. Keywords: CRP, early pregnancy, preterm delivery. Maternal Serum C-Reactive Protein Concentration in Early Pregnancy and Subsequent Risk of Preterm Delivery.

Background : Acute variceal bleeding is a most common complication of portal hypertension. Despite advancement in management of variceal bleeding still carries a very high morbidity and mortality. The present study was undertaken to study mortality associated with variceal bleed in cirrhotic patients attending a tertiary care hospital. Method : This prospective study was conducted between June 2016 to may 2018. Total 60 patients included in the study who admitted with acute variceal bleeding episode with underlying cirrhosis. Results : Majority of patients were male ( 76 %). The mean age of patients was 54 +/- 13.7. Most common etiology of cirrhosis was Alcohol related liver disease (51.7% ). Most common presenting symptom was hematemesis with melena(41.7%). Majority of patients presented with recurrent bleeding episodes (61.7% ). 18.3% Patients had rebleeding episode within 5 days of admission. Total 21 (35 % ) patients died during study period. Univariate analysis showed advance age, presence of ascites, Encephalopathy, high creatinine, bilirubin and INR were important predictors of mortality. In multivariate analysis only signicant predictors was serum creatinine (OR 43.1 (CL3.05 to 608.64)). Conclusion: Patients with cirrhosis are always at risk of variceal bleeding. The survival after a bleeding episode was inuenced by age, comorbidities, in hospital complications, ascites, high CTPand MELD score , beta blocker therapy