Background: Model for end-stage liver disease (MELD) score was originally developed to predict mortality after trans jugular intrahepatic portosystemic shunt. Hyponatremia is the most common electrolyte abnormality in end stage liver disease (ESLD). Incorporating serum sodium into MELD score increases its predictive accuracy.Methods: This is an observational study conducted on 50 patients of ESLD admitted from October 2012 to September 2014. Study population was divided into survivor and non-survivor groups. MELD score and MELD-Na score was calculated and compared between the groups.Results: Out of 50 participants, 20 (40%) died in the hospital due to cirrhosis related complications. The average age was 44.7±12.040 years in the survivor group and 54.1±9.910 years in the non-survivor group. The mean MELD score and MELD-Na score was found to be higher in non-survivors group (28.5 and 30.5) compared to survivors group (22.03 and 25.67) which was statistically very significant. Majority of the patients in survivor group had MELD score between 10-19 (43.3%) and 30-39 (36.7%). In the non-survivor group majority of patients had score of more than 20 (80%). MELD-Na score has better sensitivity (90%) compared to MELD score (80%) at a cut off value above 22. However, MELD score has better specificity (60%) compared to MELD-Na score (43.3%) at the same cut off value.Conclusions: MELD-Na score was higher in non-survivor group with good predictability for in-hospital mortality and there was good correlation between both the scores in terms of degree of agreement and MELD-Na score was more sensitive compared to MELD score.
Arteriovenous malformation (AVM) is a rare vascular anomaly of the lung, which manifests predominantly as dyspnea (due to right to left shunting) and paradoxical embolism. Hereditary Hemorrhagic Telangiectasia (HHT) being a rare genetic disorder is one of the most common causes of pulmonary arteriovenous malformation (PAVM). Here we report an interesting case of recurrent anemia in an elderly female, who was subsequently found to have multiple cutaneous and mucosal telangiectasias and a large pulmonary AVM.
Background: Cerebrovascular accident (also known as stroke) is a leading cause of mortality and morbidity in India. Renal dysfunction may be associated with increased recurrence of stroke and poorer long-term outcomes. Aims and Objectives: a) To find the relationship between CKD and occurrence of acute stroke b) To estimate the incidence of AKI in patients admitted with acute ischemic and hemorrhagic stroke. Materials and Methods: This is a retrospective analysis of renal function in patients admitted in K.V.G. Medical College Hospital with the diagnosis of “Acute stroke.” All patients admitted in Medical Intensive Care Unit (M-ICU) and general wards from 1st November 2018 to 31st March 2020 were included in the study. Results: In this study, we included 80 patients who were admitted with the diagnosis of acute stroke. Sixty-four patients (80%) had ischemic stroke and remaining sixteen (20%) had haemorrhagic stroke. Twenty-eight patients (35%) had renal dysfunction. The distribution of different types of renal dysfunction among different types of stroke was statistically insignificant (p value = 0.529). Incidence of acute kidney injury (AKI) in our study is 25%. 12 patients (15%) were found to have chronic kidney disease (CKD). The prevalence of CKD varies from 20 to 35% in ischemic stroke and 20 to 46% in haemorrhagic stroke. Conclusion: Renal dysfunction occurs frequently in patients with stroke. There was a significant proportion of patients with renal dysfunction. However, further prospective cohort studies are needed to find out the effect of renal dysfunction on stroke recovery and mortality.
This case report highlights the necessity to have in consideration about the ischemic complications post snake envenomation along with the traditional hemmorhagic events. We report a case of 28-year-old male who developed ischemic cerebral vascular accident post snake envenomation. The manifestations of snakebite may cause severe and sometimes fatal thrombotic or hemorrhagic sequelae. Some of these venom constituents and the mechanisms by which cerebral infarction have been discussed here. Physicians should also take into consideration that snake bite may cause both procoagulant and anticoagulant state. Complications can be prevented by prior identification of the snake bite and early administration of anti-snake venom.
Background: Parkinson’s disease (PD) is the second most common movement disorder after essential tremor. Diminished visual acuity, color vision, and contrast sensitivity are also described in PD. Optical coherence tomography (OCT), a producible test for axonal degeneration, helps in prognosticating diseases such as Alzheimer’s, Parkinson’s, and multiple sclerosis. Aims and Objectives: To assess the severity of Parkinson’s disease with the changes in various variables of OCT. The objective is to evaluate variables such as (RNFL, CMT, TMV) of both eyes with SD – OCT. Materials and Methods: It is a hospital-based cross-sectional study conducted for a period of 22 months at the department of neurology. A total of 55 PD patients and 30 age- and sex-matched controls were evaluated. Results: There was a significant difference between patients and controls in average retinal nerve fiber layer (RNFL) and all RNFL quadrants in both the eyes (P<0.001). A significant negative correlation was found between the RNFL thickness and Unified Parkinson’s Disease Rating Scale (UPDRS) motor score and Hoehn and Yahr (H&Y) score in both the eyes (P<0.001). A significant negative correlation was found between total macular volume (TMV) and central macular thickness (CMT) with UPDRS motor score in both the eyes (P<0.001). A significant negative correlation was found between CMT and H&Y stage in both the eyes (P<0.001). There was a significant difference between patients and controls in CMT and TMV in both the eyes (P<0.001). Conclusion: A significant negative correlation between severity and stage of the PD with OCT values was identified, which may suggest the possibility of dopaminergic depletion in the retina corresponding with basal ganglia dopamine depletion.
Sarcoidosis is a multi-system disease of unknown aetiology, characterised by non-caseating granulomas. It can involve any organ in the body, but commonly affects the lungs and lymph nodes. The worldwide prevalence of sarcoidosis is 20-60 per/100,000 and people, while in India, it is 61.2 per 100,000. The probable cause is an inflammatory response triggered by various environmental agents in genetically sensitive individuals. Approximately one-third of patients with sarcoidosis remain asymptomatic. Typical symptoms include non-specific pulmonary symptoms such as cough, dyspnoea and chest pain. Cutaneous or ocular manifestations may include malar rash, erythema nodosum, keratoconjunctivitis, anterior uveitis and chorioretinitis. The presence of hilar lymphadenopathy on chest X-ray is highly suggestive of sarcoidosis. In this case, a 68-year-old female patients, presented with complaints of anorexia and fatigue for the past three months. She was found to have anaemia, hypercalcaemia, and abnormal renal function. Abdominal ultrasonography (USG) showed normal findings. The patient was initially evaluated for Tuberculosis (TB) and started on empirical Anti-Tubercular Therapy (ATT). However, as the patient did not show any improvement, further evaluation was conducted, leading to a diagnosis of sarcoidosis. Treatment options for sarcoidosis include systemic steroids, immunosuppresants, and cytotoxic drugs. Biologics such as anti-Tumour Necrosis Factor (TNF) agents (etanercept, golimumab, and infliximab) have also been considered in the treatment. Sarcoidosis can present a diagnostic dilemma as seen in this patient who initially had features resembling disseminated TB. This highlights the importance of strong clinical suspicion by the treating physician and thorough evaluation.
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