Background and Aim: Respiratory complications in liver cirrhosis can occur due to various mechanisms, such as ascites causing restricted lung expansion and opening of intrapulmonary vascular shunts due to high portal pressures. We aimed to study the effects of the liver dysfunction on the lungs by evaluating arterial blood gas (ABG) and pulmonary function test (PFT) of all study subjects. Subjects and Methods: A cross-sectional study was done between August 2020 and September 2022. Diagnosed cases of the liver cirrhosis were enrolled in the study after informed consent and were subjected to the following investigations: chest X-ray, oximetry, spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), two-dimensional echocardiography, and ABG analysis (ABGA). The cases were divided into three groups based on their Child-Pugh staging, and statistical analysis was done on the collected data. Results: A total of 64 (53 males and 11 females) patients with an average age of 49.82 ± 9.89 years were studied. Alcoholism was the most common cause of cirrhosis in males. Breathlessness (65.6%) and pleural effusion (26.6%) were the most common respiratory symptoms and signs, respectively. Seventeen patients had hepatic hydrothorax, eight patients had hepatopulmonary syndrome (HPS), and six patients had portopulmonary hypertension. Low pH (17.2%) and oxygen partial pressure (PaO2) (20.3%) were the most common ABGA findings. The pH, PaO2, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC), and DLCO were significantly low in Child Pugh Stage C (P < 0.05). The pH, pO2, HCO3, FEV1, FVC, FEV1/FVC, and DLCO were significantly lower in patients with HPS (P < 0.05). Conclusion: Metabolic acidosis and low FEV1/FVC and DLCO were the common findings in study subjects. Pulmonary dysfunction was common in advanced liver cirrhosis. Patients with HPS had worse ABG and PFT parameters than those without HPS.
Tuberculosis (TB), although a preventable and curable disease, accounts for a high burden of morbidity in developing countries like India. Lung scarring and damage is a common sequel of pulmonary tuberculosis (PTB). Here, we report an interesting case of a patient with a history of PTB diagnosed four years ago and on subsequent visits was diagnosed with squamous cell carcinoma of the lung at the site of the TB scar. The development of malignancy in the old PTB scar is a controversial yet often diagnosed sequel of PTB.
BACKGROUND AND AIMS: Liver cirrhosis influences gonadal hormone metabolism by multiple mechanisms and causes gonadal dysfunction. This study aimed to study sex hormones in males with cirrhosis and determine their correlation with prognostic scores. METHODS: An observational study was conducted between October 2019 and August 2021 in India. Sixty males with liver cirrhosis and 60 healthy age-matched controls were enrolled. Serum-free testosterone (T), estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (Prl) were checked. Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD-Na) scores were calculated. RESULTS: Mean age of patients was 46.9±8.38 years. Forty-three were alcoholics. A total of 29 (48.33%) patients had low levels of free T. Cirrhotic males had lower testosterone and higher estradiol levels and lower T:E2 ratio compared to controls. Levels of luteinizing hormone, follicle-stimulating hormone, and prolactin were comparable. Lower testosterone was significantly associated with advancing age, alcoholism, duration of cirrhosis, loss of libido, and ascites. The higher the CTP scores, the lower the free testosterone levels and the higher the E2 levels. There was no significant association between low free testosterone levels and MELD-Na score. CONCLUSIONS: Age, alcohol, duration of disease, and low albumin levels are risk factors for hypogonadism in cirrhosis. There was a significant positive correlation between low free testosterone levels and poor CTP scores.
A rare association exists between systemic lupus erythematosus (SLE) and multiple myeloma (MM). SLE is associated with a variety of symptoms. A combination of MM and SLE is uncommon in the young population. An unusual case of SLE associated with MM is described here. We present the case of a 39-year-old woman who was a known case of SLE and presented with severe chest and abdominal pain. We summarize the clinical characteristics of MM in SLE. The possible mechanisms that could be at the root of this association are also discussed.
Objectives: Globally, the prevalence of obesity is increasing at an alarming rate. Obese patients often suffer from chronic dyspeptic symptoms. The aim of the study was to know the gross and histologic upper gastrointestinal mucosal changes and the prevalence of Helicobacter Pylori (H. Pylori) infection in overweight and obese dyspeptic patients. Materials and Methods: A cross-sectional, observational study was done on 100 patients with dyspepsia and a body mass index (BMI) of ≥25 kg/m2. The study was done between August 2019 and September 2021 at a tertiary care hospital in Maharashtra, India. Statistical Analysis: Chi-square test, Mann-Whitney test, and Fischer exact tests were applied to study the association between categorical variables. A P value of < 0.05 was considered statistically significant with a confidence level of 95%. Results: There were 59 males and 41 females. The mean age of the study subjects was 41.95 ± 12.32 years and the age range was 19-67 years. The maximum number of patients (36%) were in the age group of 50-59 years. Hypertension (45%) and type 2 diabetes mellitus (T2DM) (30%) were the common comorbidities present. Heartburn and regurgitation were the most common symptoms, present in 37% and 35% of the subjects, respectively. Inflammatory lesions oesophagitis (28%) and gastritis (43%) were the common findings in upper gastrointestinal endoscopy (UGIE). The stomach was the most common site with lesions. On histopathological examination, erosive gastritis (33%) and oesophagitis (28%) were confirmed. A total of 86% of obese subjects had at least one grossly abnormal finding. The prevalence of H. Pylori was 32%. Obese subjects had significantly more abnormal findings on UGIE compared to overweight subjects (P < 0.05). Obese patients suffering from type 2 diabetes mellitus had significantly abnormal findings on UGIE compared to non-diabetic obese patients (P < 0.05). Obese patients with higher body mass index (BMI) and the presence of H. Pylori infection were more likely to have abnormal UGIE findings. Conclusions: Inflammatory and erosive lesions of the stomach and oesophagus are more common in obese dyspeptic patients. UGIE should be the investigation of choice and should be performed in overweight and obese patients with dyspepsia to predict and prevent Gastrointestinal (GI) disorders and their related complications.
In December 2019, the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the causative agent of coronavirus disease 2019 (COVID-19), emerged in China and quickly spread to other countries. COVID-19 infection can present in a variety of ways, ranging from mild upper respiratory illness with no symptoms to severe acute respiratory distress syndrome with multiorgan involvement and death. With increasing frequency, new associations and clinical complications, such as thrombotic states, mucormycosis, and others have been reported. Neurological complications can occur during infection, during the immediate recovery period, or as late sequel of infection in COVID-19. We present an intriguing case series of neurological complications following COVID-19 pneumonia.
Liver cirrhosis accompanied with hepatic encephalopathy commonly causes cognitive impairment in patients. To model this disease, two independent patient specific induced pluripotent stem cell-line (iPSC) clones, NCCSi011-A and NCCSi011-B were generated by reprogramming the CD4+ T cells of an Indian male patient suffering from this chronic condition. Both clones expressed the stemness markers, formed embryoid bodies (EBs) with potential for spontaneous differentiation in to all the three lineages, exhibited normal karyotype (46, XY) and demonstrated alkaline phosphatase activity. These generated iPSC lines have potential for use in understanding biology of the disease and evaluation of drugs.
Hepatic Encephalopathy , Induced Pluripotent Stem Cells , Cell Differentiation , Clone Cells , Embryoid Bodies , Humans , Liver Cirrhosis , Male
We generated two human induced pluripotent stem cell-line (iPSC) clones, NCCSi010-A and NCCSi010-B, from a 32-year-old alcoholic cirrhosis patient with minimal hepatic encephalopathy of Indian origin by reprogramming his CD4+ T cells with integration free Sendai viral vector system. The generated iPSC clones showed high alkaline phosphatase activity, expressed pluripotency markers, possessed potential for multi-lineage differentiation and exhibited a normal karyotype (46, XY). These two-patient specific iPSC clones of alcoholic liver cirrhosis can potentially serve as models for disease modeling, drug development and organoid generation (Shah and Bataller, 2016).
Three induced pluripotent stem cells (iPSC) clones NCCSi007-A, NCCSi007-B and NCCSi007-C were generated from CD4+T cells of a 38 years old male patient suffering from liver cirrhosis- alcoholic and minimal hepatic encephalopathy of Indian origin. The CD4+T cells of the patient were reprogrammed using integration free, Sendai viral vector system. Each of the three iPSC clones showed high alkaline phosphatase (ALP) activity, expressed pluripotency markers OCT4, SOX2, NANOG, KLF4, SSEA-4, TRA-1-60, showed normal male karyotype (46, XY) and exhibited multi-lineage differentiation.
Clone Cells/metabolism , Induced Pluripotent Stem Cells/metabolism , Liver Cirrhosis, Alcoholic/genetics , Cell Line , Humans , India , Kruppel-Like Factor 4
BACKGROUND/OBJECTIVES: Spinal tuberculosis (TB) is a destructive extra-pulmonary disease manifestation of Mycobacterium tuberculosis infection. It is responsible for many cases of paraparesis and quadriparesis in developing countries where patients seek treatment late. The aim of this study was to understand and analyze the clinical and radiological profile of patients with spinal TB and correlate it with the anatomical site affected by it. METHODS: A retrospective, observational study of 100 cases of spinal TB admitted over a period of three years. Data on demography, clinical signs and symptoms and investigations were analyzed. RESULTS: Incidence of spinal TB was found to be the highest in the third and fourth decade of life (45%). Incidence among males was 64% and females was 36%. Low socioeconomic class (72%) and past history of pulmonary TB (34%) were found to be risk factors for spinal TB. Average duration between onset of symptoms and time of presentation to the hospital was 154±15.5 days. Patients with bone involvement presented later than those without bone involvement. Paraplegia (91%) and backache (62%) were the most common clinical presentation. Thoracic spine involvement (36%) and vertebral wedging and destruction (58%) were the commonest X-ray findings. 69% patients had compressive lesion with vertebral body destruction being the commonest cause of compression. CONCLUSIONS: Spinal TB with neurological deficits affected the thoracic spine. Compressive spinal cord lesions were the common form of presentation of spinal TB. Paraplegia with backache and neurological bladder-bowel involvement were the most prevalent neuro-deficits. Magnetic resonance imaging of the spine proved to be the most useful investigation to differentiate and localize the site of tubercular lesions.
Fractures, Compression/physiopathology , Fractures, Spontaneous/physiopathology , Paraplegia/physiopathology , Quadriplegia/physiopathology , Spinal Cord Compression/physiopathology , Tuberculosis, Central Nervous System/physiopathology , Tuberculosis, Spinal/physiopathology , Adult , Back Pain/etiology , Female , Fractures, Compression/diagnostic imaging , Fractures, Compression/etiology , Fractures, Spontaneous/diagnostic imaging , Fractures, Spontaneous/etiology , Humans , India , Male , Middle Aged , Myelitis/complications , Myelitis/diagnostic imaging , Myelitis/physiopathology , Paraplegia/etiology , Quadriplegia/etiology , Radiography , Retrospective Studies , Spinal Cord Compression/etiology , Spinal Fractures/diagnostic imaging , Spinal Fractures/etiology , Tuberculosis, Central Nervous System/complications , Tuberculosis, Central Nervous System/diagnostic imaging , Tuberculosis, Spinal/complications , Tuberculosis, Spinal/diagnostic imaging , Young Adult
INTRODUCTION: Obesity is rapidly becoming a pandemic and poses a serious health risk to the individuals. Abdominal obesity is quite common in India and is a prime risk factor for diseases like diabetes, coronary artery disease, Gastroesophageal Reflux Disease (GERD), osteoarthritis etc. A complex and multifactorial aetiopathogenesis of GERD exists in presence of obesity. The current study focuses on high Body Mass Index (BMI), a marker of obesity, as a risk factor for GERD and aims for a better understanding of their complex association. AIM: To study the association between the BMI and symptoms as well as gross endoscopic appearance of GERD. MATERIALS AND METHODS: A prospective cross-sectional study was carried out at a tertiary care hospital in Maharashtra, India, between January 2016 and June 2016. A total of 176 patients referred for upper Gastrointestinal (GI) endoscopy due to dyspeptic symptoms of more than two months duration were selected. BMI (weight in kilograms/square of height in metres) was calculated for all patients and they were classified as normal weight (BMI 18.5 -24.9), overweight (BMI 25-29.9) and obese (BMI≥30). The frequency and severity of GERD symptoms was assessed by a self-administered questionnaire. Data on typical and atypical symptoms of GERD was collected. Upper GI endoscopy was done on all patients. Based on gross endoscopic appearance, the disease was divided as Endoscopy Negative Reflux Disease (ENRD) and true GERD (as per Los Angeles staging system). Association between BMI and frequency, severity and type of symptoms of GERD and also between BMI and gross endoscopic oesophagitis was studied using various statistical tests. All tests were two-tailed with a confidence level of 95%. A p-value < 0.05 was considered to be statistically significant. RESULTS: Typical symptoms of heartburn and acidic regurgitation were present in 71.6% subjects. The frequency and the severity of the dyspeptic symptoms increased significantly with increasing BMI (p<0.05). Based on the endoscopic gross appearance of the oesophageal mucosa, 48.3% participants had ENRD and 51.7% had erosive disease (GERD). High BMI had a statistically significant relationship with occurrence of both ENRD and GERD (p<0.05) but a statistically insignificant relationship with LA classification system for endoscopic oesophagitis. CONCLUSION: The prevalence, frequency and severity of symptoms of GERD increases with increase in the BMI. Erosive oesophagitis has significant correlation with increasing BMI, but the staging and classification of endoscopic erosive oesophagitis is independent of the BMI of the patients.
