Thyroid Profile in Liver Cirrhosis Patients-Correlation with Disease Severity and Recommendations for Clinical Practice: A Cross-sectional Observational Study.

INTRODUCTION: Liver diseases are increasingly recognized as significant public health concerns in India, prompting investigations into novel approaches for assessing disease severity and prognosis. Recognizing the potential utility of thyroid hormone levels in these assessments, we conducted an observational cross-sectional study at our tertiary care hospital. Our study included 89 patients aged 12 years and above, admitted to medicine wards with ultrasound-diagnosed liver cirrhosis, excluding pregnant women and those on thyroid-altering medications. OBSERVATIONS: Our findings revealed a male-to-female ratio of 4.23:1, with the majority of patients falling within the 40-60 age-group, averaging 46.93 years. Notably, 87.6% of patients exhibited thyroid abnormalities, primarily low free T3 (FT3) syndrome and subclinical hypothyroidism. Classifying patients according to Child-Pugh (CP) score, 2.2% were CP class A, 22.5% were CP class B, and the remaining 75.3% were CP class C. Across all CP classes, low FT3 syndrome was prevalent, particularly in CP class C. Correlations between thyroid hormone levels and liver disease severity, assessed via CP and model for end-stage liver disease (MELD) scoring systems, were observed. Specifically, FT3 levels demonstrated a negative correlation with liver disease severity (p = 0.001), while no significant correlations were found for free T4 (FT4) and thyroid-stimulating hormone (TSH) levels. Based on our findings, we recommend routine thyroid function testing for all liver cirrhosis patients, irrespective of disease severity, to facilitate early detection and intervention. However, our study had limitations, including a small sample size and a precision error of 10% due to resource constraints for thyroid function testing. Moreover, reliance solely on ultrasound for liver cirrhosis diagnosis may lead to missed diagnoses, highlighting the need for complementary noninvasive tests such as FibroScan and aspartate aminotransferase to platelet ratio index (APRI) scores. CONCLUSION: Our study underscores the importance of considering thyroid function in the management of liver cirrhosis patients and provides valuable insights for enhancing clinical practice in this context.

Clinical Profile and Outcome of Patients presenting with Guillain - Barré Syndrome in a Medical Intensive Care Unit of a Tertiary Care Hospital.

BACKGROUND: Guillain-Barré syndrome (GBS) is an inflammatory, autoimmune disorder of the peripheral nervous system that is acute in onset, self-limited, and can result in significant morbidity, placing a burden on the healthcare system. This study aims to study the clinical profile and outcome of patients with GBS who require intensive care unit (ICU) and mechanical ventilation (MV). MATERIALS AND METHODS: After Institutional Ethics Committee approval, a single-center, prospective, observational study was conducted, recruiting 51 patients from the medical ICU with GBS over 18 months. Patients were categorized into three groups as per the timing of the commencement of immunomodulator therapy. The association between dependent variables like the need for MV, patient outcome, and independent factors like time of initiation of immunomodulator therapy from the time of onset of symptoms and age-groups; were analyzed using the Chi-squared test and the overall disability sum score (ODSS) with Spearman's rank correlation test. RESULTS: Out of 51 patients in the study, (52.94%) were male, with a male:female ratio of 1.12:1. Most of them had quadriparesis (98.04%) or bulbar symptoms (56.86%). A total of 24 (47.05%) patients required MV. The presence of bulbar weakness at admission had a statistically significant positive correlation with the need for MV (Spearman's ρ = 0.663, p = 0.001), the need for prolonged MV (Spearman's ρ = 0.457, p = 0.001), duration of MV (Spearman's ρ = 0.512, p = 0.001) and duration of ICU stay (Spearman's ρ = 0.516, p = 0.001); and a negative correlation with improvement in ODSS (Spearman's ρ = -0.409, p = 0.001). Early commencement of immunomodulator therapy was associated with a significantly decreased probability of requiring ventilatory support (p = 0.001), decreased probability of requiring prolonged MV (p = 0.04), and a decreased duration of ICU stay (p = 0.004). CONCLUSION: Early commencement of immunomodulator therapy decreased the probability of requiring ventilatory support and improved the outcome. Breathlessness and bulbar symptoms at admission were poor prognostic indicators in terms of the need for MV and the duration of both the ICU stay and MV.

Clinical Study of Use of Remdesivir and Tocilizumab in Severely Ill COVID-19 Patients.

Introduction: Remdesivir and Tocilizumab are two experimental drugs used in severely ill COVID-19 patients. Various clinical trials studying these drugs are giving conflicting results. Our aim is to study these two drugs and share the experience in our setting. Methods: Our Study is a retrospective analysis of Clinico-laboratory details and outcome of three groups of patients who were given either (i) Remdesivir or (ii) Tocilizumab or (iii)both Remdesivir and Tocilizumab . We compared the outcome of these patients with other patients who did not receive either of these drugs, when it was not available or not introduced as experimental drugs earlier in treatment guidelines. Results: Out of a total of 521 patients, in the above three groups who received either or both Remdesivir or Tocilizumab, 334 survived. Out of 214 patients who did not receive any of the two drugs only 74 survived. The outcome was better individually for all the three groups of patients receiving either or both of the drugs as compared to neither of the drugs.(p <0.01) Conclusion: Remdesivir and Tocilizumab were useful drugs in treatment of severely ill covid -19 patients as compared with the patients who did not receive any of the above drugs.

A Study of Clinical Profile of Patients presenting with Complications of Acute Febrile Illnesses During Monsoon.

BACKGROUND: The objective of this study was to describe clinico-laboratory profile and outcome of complicated acute febrile illnesses among inpatients in a tertiary care hospital during monsoon. METHODS: This was an observational, prospective study conducted in a tertiary care hospital in Mumbai, India. Between July 2016 to October 2016, adult patients admitted to the hospital with complicated acute febrile illness were included. Demographic, clinical and laboratory data were collected and analyzed for each patient. Associations were sought between death and organ specific complications. RESULTS: Out of 276 patients enrolled male gender 187(67.8%) and age group of below 35 years comprised the larger proportion of the cases with total 115(63.2%) dengue,37(80.4%) leptospirosis, 25(69.4%) malaria cases. The most common symptoms reported amongst the enrolled patients included generalized body ache (85.9%), headache (77.4%), vomiting (73.4%), abdominal pain (50%), high coloured urine (34.2%), and breathlessness (32.1%), loose motion (25.1%) and altered Sensorium (8.8%). Clinical signs seen and significantly associated were pedal edema 14.5% (P=0.001), icterus 20.7%(P=0.0001) and tachypnoea 19.4%(P =0.001). Most common complication of dengue was shock (70.9%) followed by hepatic (66.5%) and haematological (65%) derangements, that of malaria was CNS involvement (29.4%), and for leptospirosis it was renal failure (45.9%) followed by respiratory distress (22.3%). Overall mortality in Dengue was 7(3.8%), malaria 2(5.6%), leptospirosis 15(32.6%), Hepatitis E 2(50%). CONCLUSION: The similarity in clinical presentation and diversity of etiological agents demonstrates the complexity of diagnosis and treatment of acute febrile illness. This study of clinico-laboratory profile of complicated febrile monsoon illnesses will be helpful to reduce mortality associated with monsoon illnesses by early referral and prompt treatment. Dengue and leptospirosis remain the commonest etiologies and major killer due to respiratory and renal involvements.

Heterozygous MTHFR A1298C Mutation causing Cerebral Venous Sinus Thrombosis.

A 21 year college student came with a history of generalized tonic-clonic seizures. MR Venography revealed the presence of left sigmoid and transverse sinus thrombosis with secondary venous hemorrhagic infarcts. After thorough investigation into cause of thrombosis patient was found to have a heterozygous MTHFR A1298C mutation which was causing cerebral venous sinus thrombosis.

Leukemoid reaction, a rare manifestation of autoimmune hemolytic anemia in a case of small duct primary sclerosing cholangitis.

A 48 year old lady presented with jaundice and exertional breathlesness. Her laboratory reports showed anaemia, reticulocytosis, leucocytosis, elevated Lactate Dehydrogenase (LDH), alkaline phosphatase levels, hyperbillirubinemia and positive direct Coomb's test. After ruling out all the other causes of autoimmunity and hemolytic anemia, she was diagnosed as leukemoid reaction due to autoimmune hemolytic anemia with primary sclerosing cholangitis. Patient showed immediate improvement after corticosteroids.