Mukul P Agarwal

MONITORING OXIDATIVE STRESS ACROSS WORSENING CHILD PUGH CLASS OF CIRRHOSIS

CONTEXT Oxidative stress has been increasingly implicated in the pathogenesis and progression of cirrhosis. AIMS We studied oxidative stress in patients with cirrhosis by measuring markers reflecting pro-oxidant (serum malondialdehyde-MDA) and antioxidant factors (RBC catalase-CAT, superoxide dismutase-SOD and blood reduced glutathione-GSH) factors. The level of oxidative stress was also assessed with respect to functional compromise of liver, as determined by Child Turcotte Pugh (CTP) scoring. DESIGN Case-controlled retrospective study. MATERIALS AND METHODS Twenty-three patients of cirrhosis along with 23 age and sex matched healthy controls were studied. Exclusion criteria were concurrent use of anti-oxidant drugs; co-existing diseases like DM, CKD; alcohol use, gastrointestinal bleed or blood transfusion within previous 2 weeks. Besides routine investigations, MDA, CAT, SOD and GSH levels were measured and compared with controls. STATISTICAL ANALYSIS Continuous variables were recorded as mean +/- SD; ANOVA-f test, followed by Tukeys test, was used to evaluate the significance of difference (P < 0.05) among groups. RESULTS Mean age of patients was 41.04 +/- 12.3 yrs. Patients showed a significant increase in MDA {control 3.31 +/- 0.25 (95% CI 3.21-3.41), Child B 6.30 +/- 0.4 (95% CI 6.03-6.53), Child C 8.05 +/- 0.66 (95% CI 7.29-8.81) nmol/l} and a significant decrease in levels of SOD {control 845.13 +/- 36.44 (95% CI 829.92-860.34), Child B 582.91 +/- 42.12 (95% CI 557.45-608.32), Child C 489.5 +/- 17.66 (95% CI 479.3-499.7) U/gm Hb}, CAT {controls 2.54 +/- 0.22 (95% CI 2.45-2.63), Child B 1.93 +/- 0.23 (95% CI 1.72-2.14), Child C 1.46 +/- 0.10 (95% CI 1.40-1.52) U/ gm Hb} and GSH {controls 6.52 +/- 0.25 (95% CI 6.42-6.52), Child B 3.85 +/- 0.18 (95%CI 3.74-3.96), Child C 2.99 +/- 0.30 (95% CI 2.82-3.16) mmol/ gm Hb}. CONCLUSIONS Oxidative stress is associated with the development and progression of cirrhosis.

Acute hepatic failure due to dengue: A case report

Dengue is an arboviral disease endemic in many parts of the world. Although it is known to cause hepatic involvement commonly, it only occasionally results in acute hepatic failure. We present the case of a young male who developed acute hepatic failure due to dengue. The differentials and the management is discussed.

Serum organochlorine pesticide levels in patients with metabolic syndrome

Introduction: Organochlorine pesticides (OCPs) are endocrinal disruptors that tend to accumulate in adipose tissue and have been found to be associated with Metabolic Syndrome (MS). Aim and Objectives: 1. To measure serum OCP levels in patients of MS and control subjects, 2. To identify differences, if any, in serum OCP levels, in patients with MS and control subjects. Materials and Methods: Cross-sectional study was conducted in the Departments of Medicine and Biochemistry at University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), Delhi. Nine OCPs [α-HCH (Hexachlorocyclohexane), β-HCH, g-HCH, α-endosulfan, β-endosulfan, aldrin, dieldrin, p, p’-DDT (Dichloro-diphenyl-trichloro-ethane), and p, p’-DDE (Dichloro-diphenyl-dichloro-ethylene)] were studied. Fifty subjects ≥18 years with MS (study group) and 50 age and sex-matched controls were included in the study. Exclusion criteria: (1) Persons having chronic occupational exposure to OCPs such as workers of pesticide factories, (2) Recent exposure to OCPs within 4 weeks. Results: Levels of all nine OCPs were higher in cases as compared to controls. However, only the mean value of β-HCH in cases (8.40 ± 8.64 ng/ml) was significantly (P < 0.001) higher as compared to controls (2.58 ± 2.34 ng/ml). After adjustment of confounding factors like age, sex, smoking, alcohol, and body mass index (BMI), only β-HCH and aldrin levels were positively and significantly associated with the risk of having MS. Adjusted Odds Ratio (OR) was 1.34 [CI = 1.14-1.57 (P < 0.001)] and 1.23 [CI = 1.01-1.50 (P = 0.045)], respectively. Conclusion: There was a significant association of β- HCH and aldrin levels with MS.

Acute viral hepatitis E presenting with haemolytic anaemia and acute renal failure in a patient with glucose-6-phosphate dehydrogenase deficiency.

The association of acute hepatitis E viral (HEV) infection with glucose-6-phosphate dehydrogenase (G6PD) deficiency leading to extensive intravascular haemolysis is a very rare clinical entity. Here we discuss such a patient, who presented with acute HEV illness, developed severe intravascular haemolysis and unusually high levels of bilirubin, complicated by acute renal failure (ARF), and was later on found to have a deficiency of G6PD. The patient recovered completely with haemodialysis and supportive management.

Concurrent reactive arthritis and myelitis – a case report

Reactive arthritis is a post infectious multisystem illness which usually occurs after episodes of diarrhoea or urinary tract infections. It can cause many manifestations other than the musculoskeletal system including skin, urogenital system and eyes. However the central nervous system is only occasionally involved. We discuss the case of a 32 year old male who presented with myelitis in association with reactive arthritis.

Purpura fulminans caused by meningococcemia

A 15-year-old girl presented with a two-day history of fever, confusion and rash. On examination, she had hypotension, stiffness of the neck and a purpuric rash covering her extremities ([Figure 1A][1]). A lumbar puncture showed a cloudy cerebrospinal fluid with 4400 cells, 90% neutrophils, a

A woman with fatigue, dyspnoea, and orthopnoea

A 55 year old woman presented to the emergency department with a history of generalised fatigue of about four months and breathlessness of one month. She had also experienced shortness of breath when lying flat during the past week. She had no history of chest pain or cough, no relevant medical history, and she was not taking drugs. On arrival, her blood pressure was 92/66 mm Hg, her pulse was 67 beats/min, her respiratory rate was 20 breaths/min, and oxygen saturation on air was 94%. On examination, her neck veins were distended and cardiac sounds were muffled. She had coarsening of the facies and the deep tendon reflexes showed delayed relaxation. Her chest radiograph showed an increased cardiothoracic ratio, with the appearance of a globular heart. The pulmonary parenchyma seemed to be normal (figure⇓). Electrocardiography revealed low voltage complexes. Chest radiograph showing an increased cardiothoracic ratio, with the appearance of a globular heart ### 1 What is the diagnosis on the basis of the clinical findings, chest radiography, and electrocardiography? #### Short answer The diagnosis is pericardial effusion with features of tamponade. #### Long answer The pericardium has two layers, a single cell visceral pericardium and a fibrous parietal pericardium. The pericardium is thought to act as a barrier to infection and to have a mechanical function in restraining the cardiac volume. The space between the two layers is called the pericardial sac. It normally contains around 15-35 ml of serous fluid.1 The fluid is an ultrafiltrate of plasma that lubricates the two layers of pericardium. Abnormal increases in the volume of fluid …

A young lady with hypotension and engorged neck veins

The classical Beck’s triad is not usually seen in slow-developing effusion. However, the presence of pallor, dry skin and prolonged progressive fatigue suggest a long-drawn process. The possibilities to be considered in chronic pericarditis include chronic infections (tuberculosis, fungal), neoplastic (lymphoma, metastasis from breast, lung), uremia, myxedema, collagen vascular diseases (systemic lupus erythematosus (SLE), rheumatoid arthritis, scleroderma), severe chronic anemia, chylopericardium etc.[1]

Scalp swelling: An unusual presentation of small cell lung carcinoma.

Departments of Dermatology, Sexually Transmitted Diseases and Leprosy, and Paediatrics, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India Address for correspondence: Prof. Iffat Hassan, Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India. E‐mail: hassaniffat@gmail.com

Plasmodium Vivax Associated Myocarditis

Plasmodium infection in human beings is often associated with complications. Complications such as cerebral malaria, acute respiratory distress syndrome, acute kidney injury and cardiac complications including myocarditis, pericarditis and hypoglycaemia may be seen in infection by Plasmodium falciparum. However, these complications have rarely been reported with Plasmodium vivax infections. Myopericarditis complicating P. vivax malaria is particularly rare and only a few cases have been reported so far. We report on a case of myopericarditis due to P. vivax malaria to add to the literature