Background: Pleural effusion is the abnormal and excess accumulation of serous fluid in the pleural space. A number of biochemical tests are required to differentiate transudative from exudative pleural effusion. Pleural fluid to serum protein ratio, pleural fluid to serum lactate dehydrogenase ratio and pleural fluid to serum bilirubin ratio and serum cholesterol are commonly done to differentiate transudative from exudative pleural effusion. Methods: In this study on 25 patients with pleural effusion, by predefined criteria, these patients were divided into three groups as transudative, tubercular and non tubercular exudative group. All patients were investigated to differentiate transudative from exudative pleural effusion. Apart from routine investigations, biochemical tests of pleural fluid as well as blood were performed. Pleural fluid to serum protein ratio and pleural fluid to serum bilirubin were done in all patients. Results: Pleural fluid to serum protein ratio to differentiate exudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 86.66%, 100%,100% and 83.33% respectively. Pleural fluid to serum protein ratio to differentiate transudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 100%, 86.66%, 83.33% and 100%. Pleural fluid to serum bilirubin ratio to differentiate exudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 100%,85.71%,84.62% and 100% respectively. Pleural fluid to serum bilirubin ratio to differentiate transudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 85.71%,100%,84.62% and 84.62% respectively. Conclusion: It is concluded that pleural fluid bilirubin to serum bilirubin is a simple, easy, cost effective and highly useful parameter to distinguish transudative from exudative pleural effusion but it does not tell the etiology of pleural effusion.

Background: Thyroid disorders are established risk factor for insulin resistance. In this study we find out whether association exists between insulin resistance in type 2 diabetes patients with and without nephropathy and thyroid disorders. Methods: Serum T3 T4 TSH, fasting and postprandial blood sugar, HbA1c, serum insulin levels, serum creatinine, and urinary albumin creatinine ratio were estimated in 100 patients with type 2 DM. These patients were divided into two groups of 50 patients, Group 1-type 2 DM without nephropathy and Group 2-type 2 DM with nephropathy. Results: In our study we found a statistically significant correlation between TSH and serum insulin levels in patients with diabetic and diabetic nephropathy. Out of 100 patients thyroid dysfunction was more prevalent in diabetic nephropathy group as compared to diabetic without nephropathy group. P-value for thyroid dysfunction in diabetic nephropathy was statistically significant. In present study higher prevalence of thyroid dysfunction in women as compared to men. Conclusion: Routine assessment of thyroid hormone level in addition to other biochemical parameters in the early stage of diabetes and diabetes nephropathy will help in the management of those patients whose condition are difficult to manage.

Background: Alcohol intake is most widely used social drink worldwide. Chemically it is ethyl alcohol which is produced by fermentation. Habitual and regular intake of alcohol causes damage to every system of our body and is associated with HBV, HCV and other viral infections. Methods: In this study involving 194 patients of ALD, we found HBsAg was positive in 4.6% of patients of ALD. Most of the cases had developed cirrhosis and its complications. Results: Of all HBsAg positive patients, 44.4% presented with gastrointestinal bleeding and 44.4% with hepatic encephalopathy. The mean value of SGOT and SGPT were significantly higher in HBsAg positive patients as compared to HBsAg negative patients. Conclusion: The study concluded that alcoholics are more prone to infection with Hepatitis B as compared to non alcoholics and are more prone to develop cirrhosis and its complications.

Alcohol consumption and hepatitis C virus (HCV) infection have a synergic hepatotoxic effect, and the coexistence of these factors increases the risk of advanced liver disease. The main mechanisms of this effect are increased viral replication and altered immune response, although genetic predisposition may also play an important role. Traditionally, HCV prevalence has been considered to be higher (up to 50%) in alcoholic patients than in the general population. Due to the toxic combined effect of HCV and alcohol, patients with HCV infection should be screened for excessive ethanol intake. Patients starting treatment for HCV infection should be specifically advised to stop or reduce alcohol consumption because of its potential impact on treatment efficacy and adherence and may benefit from additional support during antiviral therapy. This recommendation might be extended to all currently recommended drugs for HCV treatment. In Our study on 194 patients of ALD, we found anti Hcv ab was positive in 18.6% of patients of ALD. Most of cases had developed cirrhosis and its complications. Of all Anti HCV Ab positive patients 55.6% presented with Gastrointestinal bleeding and 46.7% with Hepatic encephalopathy. The mean value of SGOT and SGPT were significantly higher in Anti HCV Ab positive patients as compared to Anti Hcv ab negative patients. The study concluded that alcoholics who are Anti HCV Ab positive are more prone to develop cirrhosis of liver with its various complication