BACKGROUNDHyponatraemia is one of the complications in cirrhotic patients, occurring in more than one-third of the patients with chronic liver disease and is believed to be caused by defective water homeostasis. The objective of our study is to establish the prevalence of hyponatraemia in cirrhosis and to investigate if hyponatraemia predicts a rate of severity of complications in cirrhosis. MATERIALS AND METHODSA cross-sectional study was done in patients diagnosed with cirrhosis by a combination of clinical, biochemical and radiological findings. Demographic data and biochemical parameters including serum sodium levels were recorded at the time of admission or at the time of presentation in the outpatient department and patients were stratified into three groups: Group A-serum sodium < 130 mmoL; Group B-serum sodium between 131 -135 mmol/L; Group C-serum sodium > 136 mmol/L. A detailed case report proforma was used for data collection for each patient. RESULTSHundred patients were included in the study. 44 patients had serum sodium level of < 130 mmol/L (Group A), 26 patients had serum sodium 131 -135 mmol/L (Group B) and 30 patients noted to have serum sodium > 136 mmol/L (Group C). Majority of Group A patients belonged to 31 -40 years of age (34%) and male gender (77%). Group A patients had rising serum bilirubin levels of 10.01 to 20 mg/dL (34%) compared to Group B and C (3.85% and 3.3% respectively). 84% of Group A patients had serum albumin < 3.5 g/dL. Blood urea levels > 40 mg/dL and serum creatinine > 1.3 mg/dL are associated with > 50% of Group A patients. 37 patients had worsening hepatic encephalopathy in Group A. 38% of Group A are associated with spontaneous bacterial peritonitis. 95% of Group A patients had portal hypertension compared to 65% of Group B and 11% of Group C. The incidence of class 3 Child-Turcotte Pugh score was significantly higher in Group A (70.28%). High MELD score (20 -29) is associated with Group A patients (43.18%). CONCLUSIONThis study was undertaken to establish serum sodium as an independent variable in the prognosis of patients with decompensated liver disease, irrespective of the aetiology. MELD Na scores calculated using serum sodium values have been recently found to supersede MELD scores to determine prognosis. By comparing MELD vs. MELD Na scores, this study concludes that MELD Na scores have been found to be more significant as a prognostic marker in patients with cirrhosis and its complications.

Background: Hospitalization is an important landmark in the history of heart failure. Patients admitted for acute heart failure have a high chance of readmission. We require predictors which can foresee readmission. Functional capacity assessment by the 6-minute walk test is one such predictor. Objectives: To compare the mean 6-minute walk distance among acute heart failure patients readmitted within 30 days, those readmitted within 60 days, those readmitted within 90 days, and those not readmitted at 90 days following discharge after the first admission. Methodology: This is a follow-up study conducted in Madras Medical College from March 2021 to August 2021. The study included patients who were admitted for the first time in their life for acute heart failure. The clinical details were noted, and the patients were managed as per standard protocols. Before discharge, a 6-minute walk test was performed. The patients were followed up at the end of 30, 60, and 90 days. Results: 25% of the patients had one readmission at the end of 90 days. Majority of readmissions occurred at the end of 30 days. A low 6-minute walk distance at discharge was a significant predictor of readmission at the end of 30 days. A distance of 200 m was a reasonable cutoff in our population. A lower time walked was also a significant predictor of readmission at the end of 30 days. A slower walking speed was also a significant predictor of readmission at the end of 30 days. Some other parameters such as a longer duration of stay, a longer duration of intravenous (IV) diuretic requirement, discharge respiratory rate, and lower serum albumin at admission were also significant predictors of readmission at the end of 30 days.

A 24-year-old male presented with symptoms of acute onset altered sensorium and seizures. He was diagnosed with hypertensive encephalopathy and retinopathy. He was a candidate of double valve replacement surgery, which he underwent 3 years back. Further workup with renal artery Doppler revealed unilateral renal artery stenosis with extensive collateral circulation. Patient underwent a complete CT aortogram, which revealed large vessel vasculitis. We report this case as it is a rare initial presentation of Takayasu arteritis in a male to involve double valves of the heart.

BACKGROUND The purpose of this study is about the clinical profile with electrodiagnostic features of GBS in South Indian populations admitted at a tertiary care centre to correlate the clinical and electrodiagnostic features with disability of the disease and thereby to identify the poor prognostic clinical and nerve conduction features in a much earlier course of the disease. MATERIALS AND METHODS Cross-sectional study (prospective cum retrospective) done in patients with acute inflammatory demyelinating polyradiculopathy. Patients with other causes of weakness like hypokalaemic periodic paralysis, diphtheria, trauma, paraneoplastic condition and botulism were excluded. History for each patient was obtained through a questionnaire and further subject to thorough clinical examination. Apart from routine blood investigations, cerebrospinal fluid analysis and nerve conduction studies were also done for each patient. RESULTS In our study group of fifty patients with GBS, majority of patients belonged to the age group 20-40 years, comprising 66%. This correlates well with various GBS study groups conducted at NIMHANS, Kerala. The age and sex distribution did not seem to affect the outcome of the disease-death or degree of recovery with the p value being greater than 0.05. The commonest subtype of GBS in our study population was demyelinating type comprising 60% and with axonal variants comprising 30%. The Pong Kuohyo et al study group had 49% of the patients who were of demyelinating type. Cranial nerve involvement was present in 42% of the patients and the facial nerve paralysis was the most commonly observed palsy. Ito M Kuwabara et al found that the facial involvement is the most common, present in 70%. Dysautonomia was present in 36% of the patients in our study population and it was directly related to ventilator dependence and mortality. Mechanical ventilation was required in 24% of the patients and the average duration of ventilator dependence was 14.5 days. Decreased CMAP < 10% was present in 18% of the patients. It had higher significance with morbidity and mortality with p value of < 0.001. Statistical Method-Data was analysed using SPSS (Statistical Package for Social Science) package. CONCLUSION GBS is the commonest cause of acute flaccid quadriparesis in our country. Our study group of 50 patients showed that axonal variant of GBS with cranial nerve involvement, dysautonomia, dependence on mechanical ventilation and decreased CMAP on nerve conduction study to be associated with higher mortality and morbidity in comparison to other parameters. Early identification of the above-mentioned adverse clinical and electrodiagnostic profile can be helpful in initiating prompt treatment and thereby attenuating the morbidity and mortality.

BACKGROUND Tuberculosis (TB) is one of the major causes of mortality across the world. Patients with CKD are at high risk of developing TB due to the immunosuppressive effects of uraemia. There is limited information on the magnitude of problem of TB in patients with CKD. Aim: The aim of the study was to find out the clinical profile and response to treatment of TB in CKD patients. MATERIALS AND METHODSThis is a descriptive study carried out on 55 cases of CKD. The patients were grouped into various stages of CKD based on GFR calculated using the MDRD equation. The microbiological, histopathological, radiological and newer diagnostic investigations were noted for each patient with TB. Also, the duration of ATT taken, and any incidence of adverse drug reaction were observed. RESULTSIn our study subjects, the mean age was 40 yrs., of which 75% constituted males and 25% females. Majority the patients were of post-renal transplant and stage V (31% each). Pulmonary TB contributed 64% cases (Majority in Stage IV and V) and extrapulmonary TB 36% (especially in post-renal transplant subjects). The mean duration of ATT was 7 months with 28 cases of treatment completed, 23 cured, 1 failed and 3 defaulters. Only 1.8% patients developed adverse drug event in the form of peripheral neuropathy, due to INH, despite taking pyridoxine supplements. CONCLUSIONIncidence of Pulmonary TB is more common in post-transplant subjects, whereas extrapulmonary TB (Lymph node) is more common in CKD subjects. A high index of suspicion should be maintained by ensuring early screening for risk factors like smoking, alcoholism and diabetes mellitus as they predispose CKD patients to tuberculosis. GeneXpert assay is a novel and reliable diagnostic modality for TB, especially in CKD subjects for whom many of the conventional methods may be negative.