Introduction: The present study was conducted to compare the efficacy and side effects of Spironolactone and Eplerenone in management of ascites due to liver cirrhosis. Materials and methods: 105 patients of ascites with liver cirrhosis were randomized into three groups of 35 patients each. Group I was given Spironolactone 100 mg, group II was given Eplerenone 100 mg and group III was given Eplerenone 50 mg. All patients were put on salt-restricted diet (less than or equal to 2 g of sodium) and no loop diuretics were used. Patients were followed after 7 days from the baseline and then biweekly for the period of three months and serial measurements of weight, abdominal girth and incidence of side effects especially gynecomastia, mastalgia, hyperkalemia were recorded. Results were compared. Patients having Child–Turcotte–Pugh score-C, massive ascites, hepatic encephalopathy, Hepatorenal syndrome and ascites due to cardiac, renal, malignant causes were excluded. Observations: Difference in mean weight reduction was non significant (P = 0.964) in group I and group II whereas the difference was significant when comparison was made between Group I and III; and Group II and III (P = <0.001, <0.001, respectively). In group I, the incidence of gynecomastia was 14.28% whereas in group II and group III no case of gynecomastia was observed (P <0.001, <0.001). Hyperkalemia was present in one patient (2.8%) in group I whereas no patient developed hyperkalemia in group II and group III (P = >0.05, >0.05). Conclusion: Eplerenone and spironolactone are equally effective in management of ascites due to liver cirrhosis but side effect profile of eplerenone scores over Spironolactone.

Background: Portal hypertension is one of the complications of chronic liver disease due to cirrhosis liver. Portal vein diameter, Splenomegaly and Thrombocytopenia can be used as Non-Invasive markers for the presence of gastro-esophageal varices in cirrhotic patients. Early detection of gastro-esophageal varices can prevent the UGI variceal bleed in cirrhotic patients. Hence the correlation of portal vein diameter, splenomegaly and thrombocytopenia with Gastro-Esophageal Varices helps in early detection of gastro-esophageal varices. Method: This study was conducted on 100 patients of cirrhosis and investigations for platelet count, ultrasonography for portal vein diameter and upper GI endoscopy for esophageal varices detection were undertaken in all the patients.. Results: Our study demonstrated that thrombocytopenia, presence of portal hypertension with splenomegaly and portal vein diameter are strong predictors of developing gastro-esophageal varices in cirrhotic patients. Conclusion: in cirrhotic patients gastro-esophageal varices has direct correlation with Portal hypertension and inverse correlation with platelet count.

Original Research ArticleNeonatal hyperbilirubinemia is common in first week of life. Nearly 60% term & 80% preterm neonates develop jaundice in first week of life. American Academy of Pediatrics recommends that new born discharged within 48 hours should have a follow-up visit after 48 -72 hours for any significant neonatal jaundice. These babies may develop jaundice which may be over looked or delay in recognition unless closely monitored. So it is necessary to measure serum total bilirubin in all jaundiced infants and ensure follow-up evaluation within 2 days of all infants discharged prior to 48 hours. Concern regarding early discharge is bilirubin induced neurological dysfunction (BIND) in healthy term infants even without hemolysis. No upper limit of serum bilirubin levels are defined for development of BIND in icteric new born but serum bilirubin level >20mg/dl is likely to be toxic and leads to significant brain damage. The pathogenesis of BIND is complex and related to the interplay between levels of unconjugated bilirubin, gestational maturity of infants and integrity of blood brain barrier. The concept of prediction of neonatal jaundice is an attractive option for clinical assessment of neonatal jaundice. Our study states that out of 150 neonates, 86 neonates (57.3%) no rebound hyperbilirubinemia seen, 47 (31.3%) developed insignificant rebound hyperbilirubinemia (i.e. serum bilirubin level increases after discontinuation of phototherapy but not crossed cut-off value of starting phototherapy), 10 (6.7%) developed significant bilirubin rebound (SBR) at 12 hours of discontinuation of phototherapy and 7 (4.7 %) developed SBR at 24 hours of discontinuation of phototherapy. So patient having higher serum bilirubin at the time of discontinuation of phototherapy along with risk factors developed more SBR. There are only few options for treatment of neonatal jaundice which are: Phototherapy, Exchange transfusion, Drugs like phenobarbitone, intravenous immunoglobulin.

Background: Patients of CKD are highly exposed to HBV and HCV because of multiple blood transfusions and exposure to contaminated equipments. Infections by HBV and HCV are significant cause of morbidity in CKD patients by causing liver damage and membranoproliferative GN. Present study was done to observe the prevalence of HBV and HCV in patients of CKD and to compare the prevalence of these infections in patients who were on maintenance haemodialysis and who were not on maintenance hemodialysis.Methods: This study had been conducted on 140 patients. Patients were diagnosed as having CKD on basis of Cockcroft-gault equation as per KDOQI guidelines. Stage 3, 4 or 5 patients were included for the study whereas patients with stage 1 or 2 were excluded. These 140 cases were divided into 2 groups, Group I included 70 cases who were on maintenance hemodialysis and Group II included 70 patients who were not on maintenance hemodialysis. The prevalence of HBV and HCV in the two groups was observed. Diagnosis of HBV was made by detection of HBsAg (one step immunoassay) and diagnosis of HCV was made by detection of antibodies to Hepatitis C(enzyme linked immunoassay). Prevalence data of NCDC was used for comparison with general population.Results: In Group I, 15 (21%) patients were positive for HCV and 9 (12.9%) were positive for HBV which is significantly higher compared to Group II patients in which 6 (8.6%) and 2 (2.9%) were positive respectively. Overall out of 140 patients,21(15%) were positive for HCV and 11(7.9%) were positive for HBV, which is significantly higher compared to data of NCDC for general population in which prevalence of HCV and HBV is 1% and 4% respectivelyConclusions: Prevalence of HBV and HCV was significantly higher in patients of CKD than the general population, which was further higher in patients who were on maintenance hemodialysis and have received multiple blood transfusions, emphasizing the need to implement the methods to limit the spread of HBV and HCV.

Background: Helicobacter pylori colonization is a risk factor for Adenocarcinomas of the distal (noncardia) stomach. The presence of Helicobacter pylori is strongly associated with primary gastric lymphoma. The urea breath test, the stool antigen test, and biopsy-based tests can all be used to assess the success of treatment. Helicobacter pylori is susceptible to a wide range of antibiotics in vitro, monotherapy is not usually successful, probably because of inadequate antibiotic delivery to the colonization niche. Current regimens consist of a PPI or H2 blocker, bismuth citrate and two or three antimicrobial agents given for 7-14 days. Research on optimizing drug combinations to increase efficacy continues. Efficacy of Sequential Therapy versus Standard Triple Therapy versus Quinolone-based Triple Therapy for eradication of Helicobacter pylori infection is done in this study.Methods: This study had been conducted on 150 patients divided into three groups randomly 50 Patients each and were treated with Sequential, Standard and Quinolone based triple therapy respectively. Patients were followed up no sooner than four weeks of completing therapy by rapid urease test to confirm eradication.Results: There was no significant difference with regards to presence of GERD, Gastric Ulcers, Duodenal Ulcers (p value>0.05) except for presence of erosive gastritis which was significantly higher in patients in quinolone group (p value<0.05). The eradication rate was 90%, 86%, 82% in Sequential therapy group, Triple therapy group and Fluroquinolone group respectively. However, there was no statistically significant difference in eradication rates in these groups (p value>0.05).Conclusions: Sequential therapy group had better eradication rates (90%) as compared to standard triple therapy group (86%) and fluroquinolone therapy group (82%) but results were not statistically significant when all three groups were compared together.