Background: Hyponatremia is one of the common electrolyte abnormalities in hospitalized patients. The spectrum of different etiologies of hyponatremia have both prognostic and therapeutic implications. Aims and Objectives: To evaluate the clinical and etiological profile of hyponatremia, and to study the outcome of hyponatremia. Study Design: A prospective cohort Study. Materials and Methods: A total of 100 consecutive patients with hyponatremia over a period of one year were enrolled. Detailed clinical history, physical examination, baseline biochemical and metabolic profile followed by serum and urine osmolality and urine sodium was done in all patients. Results:Out of 100 consecutive patients enrolled in this study, thirtyeight were males and sixty-two were females with male to female ratio of 1:1.6, with mean age of 61.2 years. Commonest neurological complaints were confusion (46%), lethargy (20%) and seizures (10%). Diuretic use was the most common cause of hyponatremia 34%, followed by SIADH 29%, gastrointestinal losses 10% and chronic kidney disease in 8% of patients. Chronic liver disease and chronic heart failure contributed 6% each. Other rare causes like hypothyroidism, primary adrenal failure, primary polydipsia and Beer potomania was found in 7% of patients. 46% patients were euvolemic, 37% hypervolemic and 17% hypovolemic. Conclusion: Diuretics are the most common cause of hyponatremia followed by SIADH and gastrointestinal losses. Mortality rate in our study was 12%, with maximum mortality(50%) in SIADH group .

Background: The COVID-19 pandemic caused by SARS-CoV-2 has made nearly 120 million people sick with more than 2 million dead. Many survivors of severe COVID-19 are experiencing post-COVID complications beyond 4 weeks from the disease onset. The decrease in lung function and pulmonary fibrosis are the serious manifestations of COVID-19. The burden of even a relatively mild fibrotic change could have considerable morbidity and mortality, especially in the elderly and those with comorbidities. Aim: To evaluate the effect of early intervention with anti-fibrotic pirfenidone and corticosteroids in preventing pulmonary fibrosis in severe COVID pneumonia patients. Methods: This randomised open-label pilot trial was conducted was conducted at Government Medical College, Srinagar for evaluating the role of anti-fibrotic drugs in preventing post-COVID pulmonary fibrosis. In this study, 60 patients with severe COVID-19 infection were screened and randomised into two groups, one receiving anti-fibrotic drug– pirfenidone (n = 17) and other receiving corticosteroids (n = 19). The study participants were evaluated at the baseline and after 6 ± 1 week using 6-min walk test, spirometry and high-resolution computed tomography (HRCT). Results: The mean (±standard deviation [SD]) age of the pirfenidone and steroid group was 64.16 ± 11.36 and 67.19 ± 13.32 (P = 0.929), respectively. There were no significant differences in clinically relevant baseline characteristics at the time of enrolment in the two treatment groups. The initial CT severity score was 14.84 ± 4.031 and 14.81 ± 4.722 (P = 0.400) in pirfenidone and corticosteroids groups. The mean (±SD) baseline forced expiratory volume in the first second (FEV1) in pirfenidone and corticosteroid was 73.32 ± 18.10 and 71.71 ± 17.92 (P = 0.670), while FEV1/forced vital capacity was 95.89 ± 23.40 and 90.00 ± 21.09 (P = 0.920), respectively, between the two groups. The final fibrosis score was 115.52 ± 12.32 and 138.22 ± 43.90 (P = 0.004) in the pirfenidone and corticosteroids groups, respectively. At the 6th week, the proportion of patients who had died was less in the pirfenidone group as compared in the corticosteroid group (02 patients [11.76%] in the pirfenidone group vs. 08 patients [42.10%] P < 0.001). Conclusion: Pirfenidone, an anti-fibrotic agent, has a better outcome than corticosteroids in preventing post-COVID pulmonary fibrosis without serious adverse effects. Our study concludes that early initiation of pirfenidone therapy in patients with severe COVID-19 infection, especially those at higher risk like the elderly and those with co-morbidities has a better treatment and survival outcome compared to corticosteroids.

Background:Corticosteroid insufficiency in acute illness can be difficult to discern clinically. Occult adrenal insufficiency (i.e., Δmax ≤9 μg/dL) after corticotropin may be associated with a high mortality rate.Objective:To assess the prevalence of occult adrenal insufficiency and the prognostic value of short corticotropin stimulation test in patients with septic shock.Materials and Methods:A total of 30 consecutive patients admitted in the adult intensive care unit of the Sheri Kashmir Institute of Medical Sciences who met the clinical criteria for septic shock were prospectively enrolled in the study. A low dose (1 μg) short corticotropin stimulation test was performed; blood samples were taken before the injection (T0) and 30 (T30) and 60 (T60) minutes afterward.Results:The prevalence of occult adrenal insufficiency was 57%. The 28-day mortality rate was 60% and the median time to death was 12 days. The following seven variables remained independently associated with death: organ system failure scores, simplified acute physiology score II score, mean arterial pressure, low platelet count, PaO2:FIO2, random baseline cortisol (T0) >34 μg/dL, and maximum variation after test (Δmax) of ≤9 μg/dL. Three different mortality patterns were observed: (I) low (T0 ≤34 μg/dL and Δmax >9 μg/dL; a 28-day mortality rate of 33%),(II) intermediate (T0 >34 μg/dL and Δmax >9 μg/dL or T0 ≤34 μg/dL and Δmax ≤9 μg/dL; a 28-day mortality rate of 71%), and (III) high (T0 >34 μg/dL and Δmax ≤9 μg/dL; a 28-day mortality rate of 82%).Conclusion:A short corticotropin test using low-dose corticotropin (1 μg) has a good prognostic value. High basal cortisol and a low increase in cortisol on corticotropin stimulation test are predictors of a poor outcome in patients with septic shock.

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Rheumatic Heart Disease (RHD) is still a major public health problem in developing countries such as India. Present study was conducted in urban population of district Srinagar of J&K state (India). A study had been conducted in the same population in 1983 & the prevalence at that time was 5.9 / 1000. The aim of the present study was to know the present status of Acute Rheumatic Fever (ARF) & RHD in the same population since we have observed a significant decline in the attendance of these patients in OPD & wards of Sheri-Kashmir Institute of Medical Sciences (SKIMS) Srinagar. A survey of school children aged between 6-16 years studying in randomly selected private and government schools of Srinagar-city was done. A total of 5661 school children were examined. Eleven school children were found to have heart disease. Of these 4 had RHD, confirmed on Echocardiography while 7 had congenital heart disease (CHD) and were excluded from the study. No case of ARF could be identified. As per our study the prevalence of RHD is 0.7/1000 school children. The results observed were lower than that reported in earlier studies from developing countries, but are comparable to large studies conducted in Christian Medical College Vellore in 2003 & Gorakhpur in 2005-2006. Therefore it is concluded that there has been a dramatic decline in prevalence of RHD over last two decades.