Association between insulin resistance and hypothyroidism in females attending a tertiary care hospital.

The effect of thyroid status on insulin sensitivity is of great interest but despite various studies there is conflicting data on this subject. The study group comprised of 25 female subjects each with subclinical hypothyroidism, overt hypothyroidism and euthyroid controls. Serum samples of all the patients were assayed for thyroid profile, Insulin and lipid profile.

Impaired antigen processing and presentation machinery is associated with immunotolerant state in chronic hepatitis B virus infection.

Background And Aims: The mechanism of hepatitis B virus (HBV)-specific T cell hyporesponsiveness in hepatitis Be antigen (HBeAg)-positive subjects is not well understood. Inefficient antigen processing and transport to major histocompatibility complex class I molecules, namely due to low molecular weight protein (LMP) 2 and 7 and transporter associated with antigen processing (TAP) 1 and 2 genes could be playing a role.

Patients And Methods: Forty patients with chronic hepatitis B (CHB) infection, hepatitis B surface antigen, and HBeAg positive; 26 with raised (Gr.

Progressive multifocal leukoencephalopathy in a patient with idiopathic CD4+T lymphocytopenia.

Progressive multifocal leukoencephalopathy (PML) is demyelinating of central nervous system caused by JC virus infection and often occurs in immunodeficient individuals. We report progressive PML in a 30-year-old male with idiopathic severely depressed CD4+T lymphocyte count. He was sero-negative for human immunodeficiency virus (HIV) infection.

Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis.

Background: Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients. Diagnosis of MHE requires cumbersome tests. Lactulose is effective in the treatment of MHE.

Florid xanthogranulomatous cholecystitis masquerading as invasive gallbladder cancer leading to extensive surgical resection.

Xanthogranulomatous inflammation of gallbladder wall can extend and infiltrate adjacent organs which can be mistaken for malignancy on preoperative investigations and, intraoperatively, often leads to extensive surgical resections. Only the histopathologic examination of the specimen allows correct diagnosis. We hereby review clinicopathologic findings of six cases which underwent extensive surgeries on clinical, radiological and intraoperative suspicion of gallbladder carcinoma which turned out to be xanthogranulomatous cholecystitis (XGC).

Congenital lobar emphysema: pitfalls and management.

Congenital lobar emphysema is a rare entity presenting in the first month of life. It appears with varying degrees of respiratory distress, clinical and radiological evidence of over-aeration of the upper and middle lobes, mediastinal shift and hypoxia. Its early recognition and surgical intervention can be life-saving.

Anesthetic management of patient with myasthenia gravis and uncontrolled hyperthyroidism for thymectomy.

The relationship between myasthenia gravis (MG) and other autoimmune disorders like hyperthyroidism is well known. It may manifest earlier, concurrently or after the appearance of MG. The effect of treatment of hyperthyroidism on the control of MG is variable.

Acute normovolemic hemodilution is not beneficial in patients undergoing primary elective valve surgery.

The objective of this study was to evaluate the effectiveness of acute normovolemic hemodilution (ANH) as a sole method of reducing allogenic blood requirement in patients undergoing primary elective valve surgery. One hundred eighty eight patients undergoing primary elective valve surgery were prospectively randomized into two groups: Group I (n=100) acted as control and in Group II (n=88) autologous blood was removed (10% of estimated blood volume in patients with hemoglobin (Hb) > 12g% and 7% when the Hb was < 12g%) in the pre-cardiopulmonary bypass (CPB) period for subsequent re-transfusion after protamine administration. The autologous blood withdrawn was replaced simultaneously with an equal volume of hydroxyl-ethyl starch solution.

Modification of Jaffe's kinetic method decreases bilirubin interference: A preliminary report.

The negative interference of bilirubin on serum creatinine determined by the kinetic alkaline picrate (Jaffe) reaction is the unresolved problem. Though high performance liquid chromatography and gas chromatography with mass spectroscopy have been proposed to be gold standards for creatinine estimation but they are not readily available in most of the clinical chemistry laboratories due to economic and technical constraints. Most of the present day analyzers use Jaffe's kinetic method without deproteinization.

Predictors of nonresponse to lactulose in patients with cirrhosis and hepatic encephalopathy.

Background And Aims: Lactulose is commonly used in the treatment of hepatic encephalopathy (HE). However, all patients do not respond to lactulose. We evaluated predictors of nonresponse to lactulose in patients with cirrhosis and HE.

Study of cenesthesias and body image aberration in schizophrenia.

Background: Abnormal body sensations are reported frequently by schizophrenic patients. Cenesthesias are infrequently recognized and diagnosis of cenesthopathic schizophrenia is rarely made. There are very few studies regarding the same.

Paraoxonase: a multifaceted biomolecule.

Background: Paraoxonase enzyme was first identified as a protective barrier against organophosphorus poisoning. After painstaking research spanning the last three decades, the knowledge about this enzyme has increased immensely. The present review attempts to elaborate the role of paraoxonase enzyme in normal physiology as well as provide an overview of the various disorders in which the enzyme may have a role in etiopathogenesis.

Correlation of prolactin and thyroid hormone concentration with menstrual patterns in infertile women.

Introduction: The increased prevalence of upper normal limit of TSH and raised anti-thyroperoxidase antibody titer indicate, relatively more frequent occurrence of compensated thyroid function in infertile women. This finding necessitates considering such cases for a thorough investigation of pituitary-thyroid axis. In addition, as some patients may exhibit the clinical picture of hypothyroidism despite normal TSH and free thyroxin (FT4) concentrations, this hospital-based study was undertaken to review the impact of thyroid status on the menstrual function and fertility of the subjects.

Biochemical markers of liver and kidney function are influenced by thyroid function-a case-controlled follow up study in Indian hypothyroid subjects.

Thyroid hormones regulate the renal hemodynamics and basal metabolic rate of most cells. This hospital-based case-control study was done to evaluate the changes in biochemical markers of liver and kidney function in hypothyroid subjects before and after treatment. The study included 176 subjects randomly selected from Thyroid clinics.

Clinical, laboratory, and hemodynamic parameters in portal hypertensive gastropathy: a study of 254 cirrhotics.

Background: Portal hypertensive gastropathy (PHG) is the most common gastric mucosal injury in patients with liver cirrhosis. It is a cause of both acute and chronic upper gastrointestinal bleeding even in the absence of esophageal or gastric varices. The pathogenesis of PHG is unclear.

Left atrial thrombus formation immediately after mitral valve replacement: a case report.

Mechanical dysfunction from valve thrombosis is a dreaded complication of valve replacement surgery, usually presenting months to years after the procedure. Here we report acute deterioration of prosthetic valve function due to intraoperative obstruction by a thrombus.

Making and using inexpensive manually constructed tissue micro-array: experience of a tertiary care hospital in India.

Background: Tissue micro-array enables the analysis of a large number of tissues simultaneously. Widespread use of this technology is hampered by the high cost of commercial array instruments. We describe our experience of constructing tissue micro-array in a simple method using easily available and inexpensive instruments.

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL).

The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on acute-on-chronic liver failure (ACLF) in 2004, with a mandate to develop consensus guidelines on various aspects of ACLF relevant to disease patterns and clinical practice in the Asia-Pacific region. Experts predominantly from the Asia-Pacific region constituted this working party and were requested to identify different issues of ACLF and develop the consensus guidelines. A 2-day meeting of the working party was held on January 22-23, 2008, at New Delhi, India, to discuss and finalize the consensus statements.

Systemic and pulmonary hemodynamics in patients with extrahepatic portal vein obstruction is similar to compensated cirrhotic patients.

Background: Patients with cirrhosis and portal hypertension exhibit a hyperdynamic circulation manifesting as increased cardiac output, heart rate and plasma volume; and decreased arterial blood pressure, systemic vascular resistance, and pulmonary vascular resistance. It is believed that these changes are related to both hepatocellular dysfunction and portal hypertension. However, the role of portal hypertension per se in producing these changes in circulation has not been clear.

Association of IL-18 promoter polymorphism with liver disease severity in HCV-infected patients.

Introduction: Interleukin (IL)-18 plays an important dual role in Th1 polarization and viral clearance, as well as in the development of liver fibrosis. Single-nucleotide promoter polymorphisms influence the transcription of IL-18 mRNA. Promoter polymorphisms are linked to delayed virus clearance and disease susceptibility in many diseases.

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver.

The Asian Pacific Association for the Study of the Liver (APASL) set up a Working Party on Portal Hypertension in 2002, with a mandate to develop consensus guidelines on various clinical aspects of portal hypertension relevant to disease patterns and clinical practice in the Asia-Pacific region. Variceal bleeding is a consequence of portal hypertension, which, in turn, is the major complication of liver cirrhosis. Primary prophylaxis to prevent the first bleed from varices is one of the most important strategies for reducing the mortality in cirrhotic patients.

Coronary-to-pulmonary artery collateral in tetralogy of Fallot.

Angiography in a 14-year-old boy with cyanosis since birth confirmed the diagnosis of tetralogy of Fallot with a subaortic ventricular septal defect, large overriding aorta, severe pulmonary stenosis, and a large collateral arising from the left circumflex artery. The collateral was isolated and ligated at its origin, and the patient underwent an uneventful repair with ventricular septal defect patch closure, infundibular resection, pulmonary valvotomy, and right ventricular outflow tract reconstruction with an autologous pericardial patch.

Golden jubilee of hypertrophic cardiomyopathy: is alcohol septal ablation the gold standard?

In the golden jubilee year of the first recognition of hypertrophic obstructive cardiomyopathy, we are discussing the intricacies and impact of alcohol septal ablation (ASA) in the treatment of this clinical entity. Since its first revelation 14 years ago, ASA has become a well-established treatment modality for symptomatic hypertrophic obstructive cardiomyopathy patients. With better recognition of the implication of first septal branch and right dose of alcohol to be used for ablation, the incidence of complications like complete heart block are coming down along with better procedural success rates.

TNF-alpha/IL-10 ratio and C-reactive protein as markers of the inflammatory response in CAD-prone North Indian patients with acute myocardial infarction.

Background: Cytokines are responsible for the modulation of immunological and inflammatory processes and play a significant role in the pathogenesis of coronary artery disease (CAD). Tumor necrosis factor (TNF)-alpha is the major pro-inflammatory cytokine while interleukin-10 (IL-10) is the major anti-inflammatory cytokine in patients with CAD. We determined the significance of the TNF/IL-10 ratio and C-reactive protein (CRP) in patients of acute myocardial infarction as a marker for CAD in the atherosclerosis-prone North Indian population.