INTRODUCTIONPTB is associated with weight loss, nutritional deficiency and impaired metabolism [6]. In the prebiotic era, sun exposure, TB sanatorium and cod liver oil were commonly used to treat patients infected with TB. All these incidentally are good sources of Vit D [2,7]. DOTS is the current treatment modality for TB which comprises of administration of anti-tubercular drugs in two phases, intensive phase and continuous phase [8]. With the advent of effective antituberculosis drugs, enthusiasm for treating TB with the earlier Vit D rich modalities subsided [9]. Impaired metabolism in PTB may possibly worsen the effects of VDD [6]. In TB, liver functions may be hampered by diffuse hepatic involvement, granulomatous hepatitis or local abscess formation [10].Previous reports on the interaction between Vit D and anti-tubercular drugs have shown that, rifampicin causes an accelerated loss of Vit D due to increased clearance as it acts as an agonist to pregnane X receptor and inducing the activity of CYP3A4 and limiting the formation of active one alpha 25(OH)2D3 [11]. CYP3A4, a hepatic cytochrome P450 enzyme is involved in drug metabolism, and catabolism of Vit D via a similar pathway as CYP24A1 (an enzyme catalysing the hydroxylation steps of Vit D2 and Vit D3) [12]. Isoniazid causes impairment of 25-hydroxylation leading to impaired Vit D action [13,14], although pyrazinamide, isoniazid and rifampicin have all been associated with hepatotoxicity and the risk is enhanced when these drugs are used in combination. Studies have reported 1-31% of TB patients experience drug related hepatotoxicity following TB treatment [15]. However, isoniazid and ethambutol have been associated with acute kidney injury, rifampin is the most common as reported by most studies [16,17]. Immune responses to TB are influenced by a variety of factors, including younger age [18], diabetes mellitus, tobacco smoking, alcohol, immunosuppressive drugs [19], HIV status, and concurrent infections. Cachexia has been linked to poor prognosis and is a major risk factor for mortality [20]. All these factors are also associated with VDD [21]. The underlying mechanism of how Vit D metabolisms could be linked to the pathophysiology of PTB is complex and not fully understood. This research was carried out to study the changes in Vit D levels in active PTB, the effect of DOTS on Vit D status and alterations in hepatic and renal profiles possibly contributing to the effects.

Protein-energy malnutrition is the most widespread nutritional deficiency disorder in India, commonly occurring in children aged 6 months-2 years, as per the National Family Health Survey, 2007. The dermatologic manifestations are more florid and characteristic in kwashiorkor than in marasmus.Here, we present a case of a 1½ years old male, with extensive skin lesions, owing to severe malnutrition. Malnourishment is one of the foremost conditions seen in the developing countries. It is essential to provide adequate nutritional support to the growing children and to impart proper education to the mothers with regard to weaning and care during the illness of children aged under 5 years.

Tumor lysis syndrome has been observed in patients with malignancies with high cellular burden and high cell turnover, tumor sensitive to therapy, especially after initiating medical treatment. It very rarely occurs spontaneously. The case described here is of 6 months male infant who presented with fever since 1 month and loose stools associated with blood since 15 days. The laboratory investigations showed lactate dehydrogenase (LDH) of 6,192 IU/L and serum uric acid 18.2 mg/dl along with pancytopenia. The infant presented with electrolyte abnormalities and renal failure.

Introduction: CA 125 (Cancer/Carbohydrate antigen 125) is a surface antigen expressed mostly by the ovarian cancer cells. Hence, it is widely used as a tumour marker for detection and monitoring the progression of such cancers. CA 125 is also expressed by cells of different tissues such as pleura, pericardium, Mullerian epithelium, peritoneum etc. Objective: To identify the different causes leading to elevation of CA 125 and to estimate the elevation of CA 125 in ovarian and non-ovarian causes. Materials and Methods: A total of 1800 patients testing for CA 125 during the time period January 2011 to December 2013in Kasturba Medical College constituent hospitals, Mangalore were screened. Out of these, OPD patients and in-patients with CA 125 < 35 U/mL were excluded and remaining 236 in-patients were included as the study subjects. Patients were categorized into four groups based on CA 125 level as Group I(35-200 U/mL), Group II (201-500 U/mL), Group III (501-1000 U/mL) and Group IV (>1000 U/mL). To find association of CA 125 with age, patients were stratified into 3 groups based on their age as Group A (15-35 years), Group B (36-55 years) and Group C (≥ 56 years). Parameters like age, BP, hemoglobin, CA 125,renal profile and diagnosis of all the patients were evaluated. Results: Out of 236 patients 54.7% were suffering from malignant ovarian diseases, 31.3% benign ovarian disease, 12% non-gynecological diseases and 2% from gynecological diseases of non-ovarian origin. Mean age for malignancies was 55 ± 10.6 years for benign diseases was 34±12.7 years. Incidence of malignancy among the 4 groups (based on CA 125 level) was 34.4%, 48.8%, 68.7% and 91.6% respectively. Increase in both age and CA 125 levels was highly significant in patients suffering from ovarian malignancies when compared to those with benign ovarian diseases (p<0.001).Difference in CA 125 levels was also statistically significant between malignant and non gynaecological disorders and between benign ovarian and non gynaecological disorders as well (p<0.001). Conclusion: In spite of higher levels of CA 125 in ovarian carcinoma cases compared to other diagnosis in our data, results confirm the high false positive rate and non-specificity associated with CA 125 as a biomarker as it was seen to increase in numerous other diseases.