BACKGROUND Diabetes is the most important contributor to the growing burden of end stage renal disease, and patients with diabetes are also at a greater risk of requiring hospitalizations and experiencing acute kidney injury. Because of the morbidity and mortality associated with acute kidney injury, it is important for primary care physicians to identify patients who are at a high risk of developing this type of injury and to implement preventive strategies. Though many studies have evaluated the development or progression of chronic kidney disease, only few studies have assessed the risk factors and outcomes of AKI in Type 2 diabetics. Hence, we conducted this study. Early recognition and appropriate management of acute kidney injury in hospitalized patients is one of the ways to curb the growing burden of end stage kidney disease in diabetics. MATERIALS AND METHODS We conducted a Cohort study to analyze the causes, recovery of renal function and mortality of AKI in 100 adult diabetic patients admitted in ICU and wards under the Dept. of Medicine and Nephrology in relation to age, sex, mean FBS, PPBS, electrolytes, blood urea and serum creatinine levels. RESULTS AKI was predominantly encountered in older males. Most common causes of acute renal failure were found to be infection and urinary tract obstruction. NSAID was most common cause of drug induced renal failure. 69% had a good outcome of which 10% had partial recovery and 59% had full recovery. 31% had poor outcome of which 10% went in for maintenance hemodialysis and 21% expired during the period of study. CONCLUSION Most common causes of renal failure in the study were found to be infection and urinary tract obstruction. Acute renal failure recovered in 69%.

BACKGROUND Diabetes mellitus is associated with long-term organ complications, microvascular and macrovascular. It is associated with cardiovascular disease, which is correlated to microalbuminuria and proteinuria. Diabetes is a risk factor for coronary artery disease and congestive heart failure. The present study is aimed to assess cardiac function in diabetes and prevalence of diabetic complications and the relation to glycaemic control in these patients. Aims and Objectives-1. To assess cardiac function in 30 cases of diabetes mellitus. 2. To assess the prevalence of complications. 3. To assess the relation of glycaemic control to complications. 4. Prevalence of other risk factors. MATERIALS AND METHODS Thirty consecutive patients with diabetes of 5 to 10 years duration, attending the diabetic clinic of Govt. Medical College, Kozhikode, Kerala were randomly selected. Detailed history regarding onset and duration of diabetes, symptoms of target organ involvement was taken. Detailed clinical examination and necessary investigations were done. RESULTS 1. Retinopathy was present in 43.33%; 2. Proteinuria was present in 40%; 3. Neuropathy was present in 56-66%; 4. Commonest lipid abnormality was increased HDL followed by low LDL; 5. LV mass was increased; 6. Exercise stress test was positive in 30%; 6. Diastolic dysfunction was present in 26.66%; 7. Increase in mean IVS thickness was noted. CONCLUSION 1. Diastolic dysfunction is common in diabetes (26.66% in this study); 2. Subclinical ischaemic heart disease contributes more to cardiac dysfunction in diabetes than diabetic cardiomyopathy (75% in this study); 3. Left ventricular mass is increased in diabetic patients; 4. Silent ischaemia is common in diabetes (30% in this study).

BACKGROUNDA complex relationship exists between the thyroid gland and the liver in both health and disease. Many studies have been carried out on liver disease patients assessing their thyroid status, mostly in European countries. Most of these studies are limited by the number of patients in these studies. This study tries to find out the relationship between thyroid function and chronic liver disease in a tertiary care hospital in India. Aim-To study the thyroid function abnormalities in chronic liver disease and its relationship with liver function. MATERIALS AND METHODSAfter obtaining clearance from the Institutional Review Board, this hospital-based cross-sectional study was conducted in patients admitted in the ward under the Department of General Medicine. A total of 150 subjects were selected after explaining the purpose of the study and the procedure in detail and after obtaining their consent in written format. Data collection was done by history, clinical examination and investigations. With physical examination aided by abdominal imaging, patients who had ascites were graded into mild, moderate and severe refractory ascites. Hepatic encephalopathy was graded into grade 0 to 4 according to We st Haven criteria. RESULTS24.6% of the study population showed abnormalities in thyroid function tests. The commonest was sick euthyroid syndrome in 18% of patients. Subclinical hypothyroidism was present in 4.7% of patients. Thyroid hormone levels had significant correlation with various liver function indices. Serum levels of total T3 and free T3 had significant positive correlation with serum albumin level and negative correlation with serum bilirubin and INR value. Free T4 had a weak negative correlation with serum bilirubin. Serum T3 and Free T3 were found to be decreased in patients with hepatic encephalopathy and ascites according to the severity. When severity of liver dysfunction was assessed using Child-Pugh score, it was found that there was statistically significant decrease in serum T3 and FT3 levels as the severity of liver dysfunction increased. CONCLUSIONChronic liver diseases were associated with abnormalities in thyroid function tests, although most of the patients remained clinically euthyroid. Serum T3 and FT3 levels had an inverse correlation with the severity of liver dysfunction.

BACKGROUND Hypertension is a disease that increases the risk for development of cerebral, cardiac and renal events. Many patients with essential hypertension may present with overt or subclinical target organ damage at the time of their initial diagnosis. The cost effectiveness of BP reduction using drug therapy is greater in the presence of target organ abnormalities and/ or co-morbidities. Assessment of subclinical target organ damage has become the key element in evaluating hypertensive patients. Microalbuminuria is one of the earliest indications of kidney injury in patients with diabetes mellitus and hypertension and is associated with high incidence of cardiovascular morbidity. A renewed interest in microalbuminuria and essential hypertension occurred when several studies pointed out the importance of microalbuminuria as a risk factor for renal and cardiovascular disease in patients with diabetes mellitus and hypertension. It possibly reflects a state of increased renal endothelial permeability and is an early marker of diffuse endothelial dysfunction. Aims and Objectives-1. To study the relative frequency of microalbuminuria in essential individuals suffering from essential hypertension. 2. To study the relationship between microalbuminuria, and age of the patient, duration of hypertension, levels of blood pressure and other coronary risk factors. 3. To look for evidence of target organ damage. 4. To study the relation between microalbuminuria and the indices of target organ damage. MATERIALS AND METHODS A total of 150 patients admitted in Government Medical College, Kottayam, Kerala with essential hypertension were studied. Detailed history regarding onset and duration of hypertension, drug treatment and symptoms of target organ involvement was taken. Detailed clinical examination and necessary investigations were done. Microalbuminuria was estimated by immunoturbidimetry method on the urine sample collected over 24 hours. RESULTS The prevalence of microalbuminuria was 26.7%. Distribution of the end organ complications in patients with microalbuminuria were LVH in 59.1%, Stroke in 52.4% and Retinopathy in 34.7%. This difference was found to be highly significant. Microalbuminuria was found to be more prevalent in patients with longer duration, greater severity of hypertension and dyslipidaemia. CONCLUSION Control of risk factors amenable to prevention (control of hypertension, weight and lipid levels) may have a favourable effect in preventing, delaying and lessening microalbuminuria. Microalbuminuria in hypertensive subjects seems to be a very important test to be considered in the evaluation of target organ damage.