Background/Aim:Current guidelines recommend screening cirrhotic patients with an endoscopy to detect esophageal varices and to institute prophylactic measures in patients with large esophageal varices. In this study, we aimed at identifying non-endoscopic parameters that could predict the presence and grades of esophageal varices.Patients and Methods:In a prospective study, 229 newly diagnosed patients with liver cirrhosis, without a history of variceal bleeding, were included. Demographic, clinical, biochemical and ultrasonographic parameters were recorded. Esophageal varices were classified as small and large, at endoscopy. Univariate analysis and multivariate logistic regression analysis were done to identify independent predictors for the presence and grades of varices.Results:Of the 229 patients (141 males; median age 42 years; range 17-73 years) with liver cirrhosis, 97 (42.3%) had small and 81 (35.4%) had large varices. On multivariate analysis, low platelet count (Odd’s Ratio [OR], 4.3; 95% confidence interval [CI], 1.2-14.9), Child Pugh class B/C (OR, 3.3; 95% CI, 1.8-6.3), spleen diameter (OR, 4.3; 95% CI, 1.6-11.9) and portal vein diameter (OR, 2.4; 95% CI, 1.1-5.3) were independent predictors for the presence of varices. Likewise, for the presence of large esophageal varices, low platelet count (OR, 2.7; 95% CI, 1.4-5.2), Child Pugh class B/C (OR, 3.8; 95% CI, 2.3-6.5) and spleen diameter (OR, 3.1; 95% CI, 1.6-6.0) were the independent risk factors.Conclusion:The presence and higher grades of varices can be predicted by a low platelet count, Child-Pugh class B/C and spleen diameter. These may be considered as non-endoscopic predictors for the diagnosis and management of large grade varices.

The p38 MAPK family of proteins comprised of four members; p38α, p38β, p38γ, and p38δ. All p38 MAPKs are strongly activated by environmental stresses and inflammatory cytokines. MAPKs have been shown to play a pivotal role in diverse diseases, including cancer. Majority of studies have focussed on targeting p38 MAPK isoform alpha. However, the report computational in silico molecular docking analysis of 34 bipyrazole analogs as possible p38 MAPK inhibitors. Results obtained are compared and it was observed that the top hit in all cases was found to be compound 26 with dock scores more than 200 kcal/mol whereas reported inhibitors in literature SB203580, SB202190, PD169316 resulted in dock scores between 164-189 kcal/mol. Hence, it is worthwhile to study these bipyrazole analogs as a new class of p38 MAPK inhibitors.

Autoimmune hemolytic anemia is uncommon. The estimated overall (not age-adjusted) annual incidence is about 1 case per 100,000 populations; after age 60 years, the annual incidence reaches 10 per 100,000. The disorder can occur at any age, but most patients are older than 40 years. About 65% of patients with primary autoimmune hemolytic anemia are women, and almost all cases that complicate systemic lupus erythematosus occur in women. A 65 years old male presented with generalized weakness, breathlessness on exertion, swelling of lower limbs and pain abdomen of 6 months duration. He was previously admitted elsewhere on several occasions (within past 3-4 months) with similar complaints, and had received multiple blood transfusions. On clinical examination, patient had pallor and bilateral pitting pedal edema. Abdominal examination revealed massive Splenomegaly (12 cm below left costal margin), moderate Hepatomegaly. Investigations revealed Hb% of 8.6 g/dl, Platelet count = 1 lakh/cmm, ESR = 120 mm, retic count -2.2 %. Peripheral smear showed evidence of hemolysis. Serum LDH was high, Serum bilirubin predominantly indirect hemoglobin= 2, S. Haptoglobin below 6.63. These findings suggested hemolysis as a cause of his anemia and splenomegaly. Further evaluation was done to find out the cause of hemolysis in this elderly male. Hb Quantification using HPLC was normal. Serum G6PD activity was normal. ANA was negative. Hams test was negative. Direct & Indirect Coomb's tests were positive. Bone marrow examination showed erythroid hyperplasia. CT Abdomen showed hepatosplenomegaly. Upper GI endoscopy and colonoscopy were normal. Based on these findings a diagnosis of warm antibody type auto immune haemolytic anaemia (AIHA), probably of idiopathic type, was made and patient was started on steroid therapy. After 2 weeks, repeat haemoglobin was 12.8 gm%, WBC count was 7020/cumm reflecting response to steroid therapy. Severe AIHA can be a medical emergency. Red cell transfusion poses a special problem as the transfused cells are rapidly destroyed, but can be lifesaving and in the meantime steroids can exert their effect. This unique situation requires good liaison and understanding between the clinical unit and the serology lab. Thus it is very important to diagnose this condition and treat accordingly. Untreated, chronic auto immune hemolysis progresses to severe anaemia and associated complications. It is important to consider the diagnosis of autoimmune hemolysis in elderly males also, although this condition is usually seen in females. It is important to rule out malignancies and connective tissue disease in elderly presenting with autoimmune hemolysis.

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BACKGROUND:The metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, which includes abdominal obesity, hypertension, hyperglycemia, dyslipidemia, and insulin resistance. Recent evidence implicates inflammation in the development of insulin resistance and MetS. Evidence has emerged demonstrating that high concentrations of high-sensitive C-reactive protein (hsCRP) are associated with MetS and may predict diabetes and cardiovascular events, independent of traditional risk factors. It has also been suggested that hsCRP may be included in the criteria for MetS. OBJECTIVES OF THE STUDY: To study the significance of high sensitivity C-reactive protein as a biochemical marker in metabolic syndrome. To correlate high sensitivity C-reactive protein titres with fasting plasma glucose, body mass index, blood pressure, waist circumference, triglyceride and high density cholesterol levels. MATERIALS AND METHODS: 50 cases and 50 controls were taken into the study. Cases were selected according to new IDF criteria. RESULTS: In the present study, there were 23 males & 27 females in each study group with mean Age distribution of 48.32±14.2 among cases and 48.12±14.1 among controls. Mean BMI in our study was 30.48±1.76 among cases and 23.42±1.52 among controls, with all cases meeting criteria for metabolic syndrome according to new IDF criteria. In our study 84% of cases were hypertensives, 10% of controls had systolic Blood. Pressure >130mmHg. 82% of cases were known diabetics on treatment. 82.6% of cases (Males) had HDL <40. All cases (females) had HDL<50. All cases had hsCRP >3, 88% of controls had hsCRP <3. Age, waist, circumference, BMI, SBP, DBP, FBS, TG levels correlated positively whereas HDL levels correlated negatively with hsCRP levels. CONCLUSIONS: There is a positive association between increasing age and the increase in prevalence of metabolic syndrome. Waist circumference and BMI correlated positively with hsCRP values, implying that obesity plays an important role in inflammation and pathogenesis of metabolic syndrome. There is a positive correlation between individual components of metabolic syndrome with increasing hsCRP titres. hsCRP titres increased significantly with increasing values of FBS, SBP, DBP, TG levels. hsCRP titres increased significantly with decreasing values of HDL. KEYWORDS: Metabolic Syndrome, high sensitivity C reactive protein, Waist circumference, Obesity, Diabetes, Hypertension, Dyslipidemia. INTRODUCTION:The metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, which includes. abdominal obesity, hypertension, hyperglycemia, dyslipidemia, and insulin resistance. 1 Recently, several lines of evidence implicate inflammation in the development of insulin resistance and MetS. 2 Furthermore, abundant evidence has emerged demonstrating that high concentrations of high-sensitive C-reactive protein (hsCRP) are associated with MetS and may predict diabetes and cardiovascular events, independent of traditional risk factors.