BACKGROUND Portal hypertension is one of the serious complications of cirrhosis of liver leading to unwanted life-threatening variceal bleeding. Loss of liver architecture and fibrosis lead to increased resistance to blood flow through portal vein causing portal hypertension and ultimately leading to ascites, oesophageal varices and splenomegaly. The aim of the study is to find out correlation of portal vein diameter and splenic size with oesophageal varices in cirrhosis of liver. MATERIALS AND METHODS A descriptive study was conducted in Department of Medicine of SCB Medical College, Cuttack and consecutively 50 adult patients of cirrhosis of liver were included in the study. Ultrasonography was done in all patients to measure splenic size and portal vein diameter. Upper GI endoscopy was done in all to record oesophageal varices. RESULTS Out of 50 patients, 34 (68%) had oesophageal varices of various grades and 16 (32%) had no varices. Average portal vein diameter of patients with oesophageal varices was 13.46 ± 0.98 mm and that of patients without varices was 10.91 ± 0.65 mm (p=0.03). Average splenic size in patients with oesophageal varices was 14.7± 0.82 cm and that of patients without varices was 12.2 ± 1.01 cm (p=0.007). Portal vein diameter and splenic size were increased in patients with oesophageal varices than patients without varices.

Background: Though there are many studies on thyroid dysfunction and dyslipidemia in Chronic Kidney Disease (CKD), no study is conclusive. Aim of this study was to correlate abnormalities in thyroid function and lipid profile with the severity of renal failure and also to observe the difference of these abnormalities between patients on conservative management verses hemodialysis. Methods: Hundred consecutive CKD cases admitted to Medicine Department were taken up for the study. They were divided into two groups as Group-A [on conservative management] and Group-B [on regular Hemodialysis (HD)]. Hundred healthy persons were taken as control in Group-C. After evaluation of thyroid function and lipid profile statistical analysis was done by students t-test, chi-square and regression analysis. Results: Hundred CKD cases with 74% male (n=74) and 26% female (n=26) in a M: F ratio of 2.9:1 were found to be in different stages CKD (0, 2, 20, 28 and 50 in stage-1 to stage-5 respectively). In 50 cases of stage-5 CKD, 30 were on HD and 20 on conservative management. Diabetes Mellitus (DM) (40%) was the commonest etiology of CKD followed by Hypertension (HTN), obstructive uropathy, chronic glomerulonephritis (CGN) and polycystic kidney disease (PKD). Thyromegaly was not found in a single case. In all CKD cases (Group-A+B) TT3 (TT3) was significantly low (P =0.0011) when compared with control (Group-C) and no difference was found between Group-A and Group-B. Fall in TT3 worsened with increasing severity of CKD. Lipid profile study revealed Decreased HighDensity Lipoprotein Cholesterol (HDLc) and increased Triglyceride (TG), Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDLc), TC/HDLc and LDLc/HDLc in Group-A than Group-B but only TG and TC increase was statistically significant. The levels of TG and TC and TC/HDLc increased as the stage of CKD progressed and was statistically significant (P= 0.035). Conclusions: There occurs a state of biochemical hypothyroidism without overt clinical hypothyroid state in CKD, the extent of which correlates with the severity of CKD. Increased cardiovascular complications occur due to accelerated atherosclerosis in CKD. This study confirmed that atherogenic lipid profile and thyroid dysfunction worsen with the progression of disease. Difference between patients on conservative management and HD was not found.

Background of study aims and objective: Epicardial fat thickness is a novel parameter for predicting outcome and assessment of severity of coronary artery disease. Our present study aims to establish an association between epicardial fat thickness and coronary artery disease. Materials & Methods: Patients of suspected CAD underwent coronary angiography. 100 subjects proven as confirmed cases were included in the study. Routine clinical examination, risk factor profile and anthropometric variables were also done. Severity of CAD was assessed using Gensini Score. Epicardial fat thickness was measured using 2D ECHO. For comparative analysis, 50 healthy individuals were also included in the study. Results: Epicardial fat thickness was significantly higher in cases (7.53 ± 1.79 mm) than controls (4.24 ± 1.09 mm). Female sex, hypertension, dyslipidemia, obesity were observed to affect EFT significantly. No difference in mean EFT was observed with age, diabetes, smoking, ECG changes and arterial territory involvement. BMI and Gensini scores both showed strong positive correlation with epicardial fat thickness. Conclusion: Epicardial fat thickness is associated and linearly correlates with onset and severity of CAD.

BACKGROUNDCortisol (Glucocorticoid) is the main hormone in host response to stress. Its secretion from adrenal glands depends on integrity of hypothalamic-pituitary-adrenal (HPA) axis. Adrenocorticotropic hormone (ACTH) is the stimulant for cortisol secretion from adrenal glands. Adrenal insufficiency (AI) is often present in critically ill patients and is diagnosed by ACTH stimulation test using intravenous (IV) injection of Synacthen (Tetracosactide) which is not freely available in our part. Another synthetic corticotrophin (Acton Prolongatum) prepared by Ferring pharmaceuticals can be used for intramuscular (IM) ACTH stimulation test for assessment of adrenal function. Aims & Objectives-To measure the basal serum cortisol level at 8.00-9.00 a.m. then at 60 min. & 3 hours after IM ACTH stimulation and to find out glucocorticoid response in critically ill patients.

BACKGROUNDHypomagnesaemia is an emerging electrolyte disturbance in hospitalised patients, especially in critically ill ones and it has been shown to predict mortality in intensive care units (ICUs). This study was aimed to find the impact of admission serum magnesium levels and patient outcome considering mortality, need and duration of ventilator support, length of stay in ICU and APACHE II score. MATERIALS AND METHODSThe present one-year prospective study was conducted in ICU of Department of Medicine, SCB MCH, Cuttack. A total of 100 patients from December 2016 to November 2017 were included in the study. Patients were divided as hypomagnesaemics and normomagnesaemics basing on their serum magnesium values. RESULTSOn admission 68 out of 100 (i.e. 68%) had normomagnesaemia, 28 out of 100 (i.e. 28%) had hypomagnesaemia and 4 out of 100 (4%) had hypermagnesaemia. The patient with hypomagnesaemia compared with patients of normomagnesaemia had higher mortality rate (64.28% vs. 22.06%), higher APACHE II score on admission (29.6 vs. 24.3), a more frequent hypoalbuminaemia and sepsis, and also more duration of hospital stay. There was low GCS (5 -10) in 96.42% of patients with hypomagnesaemia, but only 45.58% of patients with normomagnesaemia. CONCLUSIONThe present study showed patients with hypomagnesaemia at admission are significantly at high risk of mortality, requirement of prolonged ventilator support and longer duration of ICU stay and also predict higher APACHE II score.