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.

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: 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.