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BACKGROUND AND OBJECTIVE:In acute STEMI, due to activation of the Baro receptors, there is activation of the sympathetic nervous system. This leads to release of hormones like vasopressin and also activation of renin angiotensin system. Magnitude of this neurohormonal change is related to the severity of the myocardial damage. Hyponatremia is a reflection of these hormonal changes. So serum Na+ level may be an indicator of the severity of ST elevation MI (STEMI). The aim of this study is to evaluate in hospital prognosis of acute ST segment elevation myocardial infarction with Hyponatremia. MATERIAL AND METHODS: This prospective observational study was conducted in patients presenting with acute ST-elevation myocardial infarction admitted in ICCU, Basaveshwar Teaching and General Hospital, Gulbarga attached to Mahadevappa Rampure Medical College during the period of Jan 2013 to July 2014.Qualifying patients underwent detailed history and clinical examination. Plasma sodium concentrations were obtained on admission and at 24, 48 and 72 hours thereafter. Study population were grouped into two groups, 50 patients with hyponatraemia were included in Group-I and 50 patients with normal plasma sodium level were in Group-II. Hyponatremia defined as plasma sodium level less than 135 mmol/L. In hospital outcome of these two groups of patients were evaluated and compared. RESULTS: The hypo and normo natremic groups were comparable with respect to baseline characteristics and in-hospital management. There was no statistically significant difference between the two groups regarding the incidence of risk factors of IHD. Hyponatremics had higher rates of in-hospital mortality (24%vs 6%p<0.01) composite of death, heart failure (72% vs. 36%, p=0.05) and arrhythmias (30% vs 6% p<0.01) Anterior myocardial infarction was more frequent in patients with hyponatremia, who showed advanced Killip class. After adjustment for covariates, hyponatremia was independently correlated with in-hospital mortality. CONCLUSION: Hyponatremia on admission in patients with acute ST Elevation MI is a strong independent predictor of prognosis and sodium levels may serve as a simple marker to identify patient at high risk.

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Evaluation of pleural fluid cholinesterase level and comparison of study of pleural fluid cholinesterase levels and serum cholinesterase levels to differentiate transudates from exudates. Light's criteria were used to compare transudate from exudate. MATERIALS AND METHODS: 56 patients of pleural effusion of different diseases like tuberculosis, malignancy, Para pneumonic effusion, congestive heart failure, nephrotic syndrome, pancreatitis were selected and studied for pleural cholinesterase levels and then serum cholinesterase levels. RESULTS: In exudates it was observed that the mean PChe and P/S Ch were higher as compared to transudates (P < 0.001).the cutoff value for PChe is taken as 2000 IU/L for the diagnosis, with this level it was found that 4 % of transudates and 0 % of exudates were misclassified. when the cutoff value of 0.50 for P/S Che ratio was used the misclassification decreased to 2 % in exudates and 2% in transudates it was observed that Using Light's criteria a sensitivity of 93 % and specificity of 85 % with positive predicative value (PP V) OF 90 % and negative predictive value (NPV) of 89 %. CONCLUSION: Estimation of pleural cholinesterase levels and ratio of pleural cholinesterase to serum cholinesterase was more efficacious and specific compared to light's criteria. Serum cholinesterase estimation is cost effective specific and more sensitive. It can be used routinely to differentiate transudates from exudates in pleural effusion of varied etiology.