Study of Association of Erectile Dysfunction with Metabolic Syndrome and Its Correlation with Endothelial Dysfunction in an Indian Population.

BACKGROUND: Metabolic syndrome (MS) has emerged as a new health risk, and its associated metabolic derangements have detrimental effects on the cardiovascular system. In recent years, MS has been reported to affect reproductive health in males. It has been reported to be associated with erectile dysfunction (ED) and has been attributed to be due to endothelial dysfunction. Poor endothelial function in ED usually affects small-sized vasculature, so it can be looked at as a predictor for the endothelial dysfunction of macro vasculature. The aim of the present study was to determine the association of ED in patients with MS and to determine its correlation with endothelial dysfunction. MATERIALS AND METHODS: It was a hospital-based case-control study in which 120 male patients with MS and 120 age-matched controls were enroled. Demographic profiles, anthropometry, past illnesses, and medical history of patients were obtained. MS was diagnosed according to the International Diabetes Federation (IDF) criteria and was measured using the flow-mediated dilation (FMD) method with the help of ultrasound used to assess endothelial dysfunction. Diagnosis of ED was based on the International Index of Erectile Function (IIEF) scale. RESULTS: The study participants had a mean age of 40.91 ± 11.41 years. The majority of cases (57.5%) had ≤6 months of history of MS. The prevalence of ED was 31.7% in cases compared to 5% in controls, thus showing a significant difference between cases and controls. Mean IIEF scores were significantly lower in cases (18.82 ± 5.59) compared to those in controls (23.00 ± 2.57). A moderate positive and significant correlation was observed between FMD and IIEF scores. With an increasing number of MS components, there was a significant increase in the prevalence of ED. Those with ED had significantly lower mean FMD values (5.1 ± 1.1%) compared to those not having ED (10.9 ± 3.3%). CONCLUSION: The findings of the present study showed that there is a significant association between ED and MS. We observed that the increase in components of MS increased the prevalence of ED in MS. Endothelial dysfunction measured by FMD was correlated with ED.

Correlation of Serum Calcium with Severity and Outcomes in Patients of COVID-19 Pneumonia.

Background: Calcium is an essential electrolyte with critical physiological functions. Recently, it has been implicated in the pathogenesis and outcomes of COVID-19. This retrospective study was conducted to estimate serum ionic calcium and its correlation with clinical severity, inflammatory markers, and in-hospital outcomes in moderate to severe COVID-19 patients. Methods: We retrospectively analyzed data from 377 COVID-19 patients, aged between 23 and 79 years, with a mean age of 54.17±11.53 years. Severity of the disease was determined using ICMR criteria. Parameters including age, gender, inflammatory markers, calcium levels, and clinical outcomes were assessed. Results: The study showed a prevalence of moderate and severe COVID-19 in 58.1% and 41.9% patients, respectively. Severity was significantly associated with younger age, higher mean inflammatory markers, notably IL-6, procalcitonin, D-Dimer, and lower ionic and total calcium levels, as well as vitamin D levels. Mortality and referral rate were significantly higher in the severe group. Hypocalcemia was prevalent in 39% of the patients and was significantly associated with disease severity, ARDS, and mortality. On multivariate assessment, only age and ionic calcium were significantly associated with COVID-19 severity. Conclusion: Lower serum ionic calcium levels are associated with increased severity and poor outcomes, including higher mortality in COVID-19 patients, underscoring the potential role of calcium as a diagnostic and prognostic marker in COVID-19 pneumonia and may be an important factor in various other forms of pneumonia.

Incidence, Pattern, Causes, and Outcome of Acute Chest Pain Among Patients Presenting in the Emergency Department of a Tertiary Care Hospital in North India.

BACKGROUND: Acute chest pain is a common presentation in emergency departments worldwide. Differentiating between cardiac and non-cardiac chest pain is crucial for patient management and resource allocation. METHODS: This study analyzed 714 patients presenting with acute chest pain in a tertiary care hospital in North India. We investigated demographic characteristics, chief complaints, risk factors, ECG findings, and final diagnoses to identify patterns associated with cardiac (CCP) and non-cardiac chest pain (NCCP). RESULTS: CCP was diagnosed in 53.7% (n=383) and NCCP in 46.3% (n=331). Significant predictors of CCP included age (OR=1.05, p<0.001), smoking (OR=2.22, p<0.001), diabetes (OR=1.57, p=0.003), hypertension (OR=1.82, p<0.001), and family history of ischemic heart disease (IHD) (OR=1.42, p=0.01). Central chest pain was more common in CCP (60% vs. 40%, p<0.001), as were abnormal ECG findings such as ST-segment depression (35% vs. 10%, p<0.001) and elevation (29% vs. 6%, p<0.001). Normal ECG was more prevalent in NCCP (60%, p<0.001). CONCLUSION: Traditional cardiovascular risk factors remain strongly associated with CCP. Smoking has a particularly high odds ratio, suggesting the need for targeted interventions. ECG findings significantly aid in differentiating CCP from NCCP. This study underscores the importance of a comprehensive approach in evaluating acute chest pain to ensure accurate diagnosis and effective treatment.

Study of Correlation of Bone Mineral Density with Severity of Liver Cirrhosis.

INTRODUCTION: Liver cirrhosis is a common ailment that is widely prevalent in our country and across the world. There are several manifestations of this disease. Metabolic bone disease also has an association with cirrhosis. The present study was designed to study the correlation between bone mineral density (BMD) and the severity of liver cirrhosis. MATERIALS AND METHODS: This was a case-control study. A total of 35 diagnosed cases of liver cirrhosis and 35 age and sex-matched controls were included in the study. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at the hip joint and lumbar spine. Child-Turcotte-Pugh (CTP) score was used for assessing the severity of liver cirrhosis. RESULTS: Out of the 35 cases of cirrhosis, 25 had either osteopenia or osteoporosis. The mean T-score at the hip joint in cases was -1.47 ± 1.62 and in controls, it was -0.56 ± 1.67 (p < 0.001). The mean T-score detected in the lumbar spine was -1.33 ± 1.66 and in controls -0.41 ± 1.67 (p < 0.001). There was a significant inverse correlation between CTP scores and BMD. CONCLUSION: The present study revealed that abnormal BMD is highly prevalent in patients with liver cirrhosis. There is also a significant relationship between the severity of cirrhosis and BMD.

An Unusual Case of Hyperthyroidism.

INTRODUCTION: Thyroid gland dysfunction greatly alters the hemodynamics of the body resulting in major changes in cardiac output, blood pressure and pulmonary vascular resistance amongst others. Hyperthyroidism is associated with an increased morbidity and mortality from cardiovascular disease. Thyrotoxicosis is commonly associated with exacerbation of underlying coronary heart disease, with atrial fibrillation and systolic dysfunction. It is less well appreciated that hyperthyroidism is also associated with pulmonary arterial hypertension (PAH) and right heart failure. MATERIALS: History -We present a 46 years old female, Presented to our hospital with complaints of Breathlessness on exertion since 3 months gradually progressed from MMRC grade 1 to grade 4 over the period of 2 months without any diurnal/postural variation Cough with expectoration since 3 weeks associated with weight loss. RESULT: Examination-Patient is severely malnourished with BMI 11.6 kg/m2 . Bilateral multiple cervical lymph nodes palpable, 6-8 in number discrete, mobile, soft consistency, measuring 1 cm in size changes. Thyroid is symmetrically enlarged, soft in consistency, moving with deglutition, Systemic examination-Apex beat palpable at 5th intercostal space 2 cm lateral to the MCL with normal character Parasternal heave grade 3+ Palpable P2+ A high pitched, rumbling, pansystolic murmur of grade 3, non radiating heard best with the diaphragm of stethoscope with patient in supine position. Unique features-Both thyroid lobes appear enlarged in size and show homogeneously increased radiotracer uptake. CONCLUSION: IMPRESSION- Well-visualized thyroid gland with increased trapping function. In the given clinical context scan findings favour hyperthyroid status-Graves'disease. Take home message-Hyperthyroidism is a reversible cause of pulmonary hypertension.

Prevalence of Comorbidities in Survivors and Non-Survivors of Severe COVID-19 at a Dedicated COVID Care Centre.

Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. Diseases such as diabetes, hypertension, cardiovascular and pulmonary diseases are common comorbidities in COVID-19 patients and have been correlated with increased disease severity. Comorbidities lead the COVID-19 patient into a vicious infectious circle and are substantially associated with significant morbidity and mortality. This study was aimed to estimate prevalence of comorbidities in severe category of COVID survivors and non survivors. More than 90% patients with multiple comorbidities admitted to ICU did not survive compared to those with one or two comorbidities. Diabetes followed by hypertension was the most common comorbidity in these patients. Thus comorbid individuals must adopt vigilant preventive measures including vaccination and they require intensive management for better outcome.

Phase III, Randomized, Double-blind, Placebo controlled trial of Efficacy, Safety and Tolerability of Antiviral drug Umifenovir vs Standard care of therapy in non-severe COVID-19 patients.

OBJECTIVE: To test efficacy, safety and tolerability of Umifenovir in non-severe COVID-19 adult patients. METHODS: We carried out randomized, double-blind, placebo-controlled, multicenter, phase III trials involving adult (18-75 years), non-severe COVID19 patients, randomized 1:1 on placebo or Umifenovir (800 mg BID, maximum 14 days) respectively along with standard-of-care. The primary endpoint for Asymptotic-mild patients was time to nasopharyngeal swab RT-PCR test negativity. For Moderate patients, the average change in the ordinal scale from the baseline scores on the eight-point WHO ordinal scale was assessed. RESULTS: 132 patients were recruited between 3rd October to 28th April 2021, of which 9 discontinued due to various reasons. In Mild-asymptomatic patients (n=82), we found that 73% patients in the Umifenovir arm were RT-PCR negative, while 40% patients in the placebo arm were negative (P=0.004) on day 5. However, in the moderate group (n=41), the WHO scores for the Umifenovir arm was not statistically significant (P=0.125 on day 3), while it was statistically significant in the Mild-asymptomatic group (P=0.019 on day 5). CONCLUSION: Umifenovir meets the primary and secondary endpoint criteria and exhibits statistically significant efficacy for Mild-asymptomatic patients. It is efficacious, safe and well-tolerated at the tested dosage of 800mg BID, maximum 14 days.

Study of Association of Metabolic Syndrome and Risk Factors of Nephrolithiasis.

BACKGROUND AND AIM: The increasing incidence of nephrolithiasis in recent decades is coinciding with rising epidemic of obesity, metabolic syndrome, and type 2 diabetes. This temporal concordance suggests that a link might exist between these metabolic abnormalities and urinary stone disease. Therefore, the present study was aimed to investigate the association between presence of risk factors of nephrolithiasis and metabolic syndrome. METHODS: In a hospital-based, case control study, hundred patients of metabolic syndrome diagnosed according to IDF criteria and hundred age and matched controls were studied for presence of risk factors of nephrolithiasis. RESULTS: Patients with metabolic syndrome had significantly higher uricosuri a,hypercalciuria,oxaluria and hypocitraturia. The prevalence of risk factors of nephrolithiasis was also higher in patients with metabolic syndrome. The most prevalent was low urinary pH in 40% patients with mean pH of 5.8±1.6. Amongst other factors, 33% had hyperuricemia, 29% had hypercalciuria, 15% had oxaluria 13% had hypocitraturia and 10% had hyperuricosuria. Significant correlation was observed between risk factors of nephrolithiasis and components of metabolic syndrome. CONCLUSION: The present study provides an evidence of association between risk factors of nephrolithiasis and metabolic syndrome and suggests that nephrolithiasis may be a systemic disorder representing the interaction of multiple metabolic derangements. Determining common modifiable risk factors for the development of kidney stones might uncover new preventive strategies.

Study of Endothelial Dysfunction by Flow Mediated Vasodilation in Individuals with Asymptomatic Hyperuricemia.

INTRODUCTION: Asymptomatic hyperuricemia is a condition where the serum uric acid levels are elevated but the individual does not have any sign or symptoms of gout or renal stones. The relationship of hyperuricemia with hypertension, diabetes and chronic kidney disease is established. There are studies which show an association of hyperuricemia with endothelial dysfunction thus increasing the cardiovascular risk in these individuals. We therefore undertook this study to observe endothelial dysfunction in individuals of asymptomatic hyperuricemia. METHODOLOGY: This was a case control study where 40 individuals with asymptomatic hyperuricemia and 40 age and sex matched healthy controls with normal serum uric acid levels were included. Endothelial function was studied by flow mediated vasodilation in the brachial artery. RESULTS: The mean age of cases was 45.03±16.44 years while that of control subjects was 44.70±14.31. There were 22 females and 18 males among the cases while there were 24 females and 16 males among the controls. The mean serum uric acid level in cases was 7.27±1.13 mg% while that of controls was 4.52±1.05 mg%. The FMD was 5.57±1.39% in cases while it was 7.73±1.56% in controls and this difference was statistically significant. CONCLUSION: The present study showed that significant endothelial dysfunction is present in individuals of asymptomatic hyperuricemia in comparison to healthy age and sex matched controls.

Emphysematous Pyelonephritis in Type 2 Diabetes - Clinical Profile and Management.

Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on the management of EPN. A prospective observational study was conducted at the Department of General Surgery, RML Institute of Medical Sciences, Lucknow, as well as at Eras Lucknow Medical College, Lucknow, from 2015 to 2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with EPN. A total of 76 diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). The mean age of the patients was 58.4 ± 6.5 years. The mean duration of diabetes was 5.3 ± 3.3 years. 12 (82%) of the 15 patients with diabetes mellitus had a glycosylated hemoglobin level higher than 7.5. Renal dysfunction at presentation was seen in 11 (73.3%) patients. Among the unilateral involvement, the left kidney was more affected. Escherichia coli in 11 (73.3%), Klebsiella sp. in one (6.6%), Pseudomonas in one (6.6%), and one each with polymicrobial and fungal urinary tract infection, respectively. Of 15 EPN patients, 13 (86.6 %) survived, and one (6.6 %) expired. Two of them underwent nephrectomy both survived. All patients with Stage I, II, and IIIa EPN (n = 12) were managed with antibiotics with or without percutaneous catheter drainage (PCD). In EPN Stage IIIb/IV (n = 3), all the three (20%) patients were managed with antibiotics and PCD, and later two (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation, and thrombocytopenia were associated with poor outcome in EPN patients (P <0.05) Multiple logistic regression tests showed shock (P = 0.04) and disturbance of consciousness (P = 0.05) on (hospital admission as being the independent factors for poor outcome. EPN in diabetics needs a high index of suspicion, timely diagnosis, and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes.

Association of Genetic Non-alcoholic Fatty Liver Disease with Insulin Resistance-Are we Different?

INTRODUCTION: Metabolic risk factors such as obesity, insulin resistance, type 2 diabetes mellitus and dyslipidemia are associated with non-alcoholic fatty liver disease (NAFLD). In the development and progression of NAFLD genetic mutations also play a significant role. NAFLD associated with the rs 738409 polymorphism of patatin-like phospholipase domain containing 3 gene (PNPLA3) G allele does not feature the typical metabolic abnormalities of NAFLD, including insulin resistance. In the light of rising epidemic of metaobesity in our population this study aimed to evaluate the relation of PNPLA3 polymorphism with insulin resistance. METHODS: In this case control hospital based study, 100 patients of NAFLD were recruited based on ultrasound findings of hepatic steatosis. Healthy subjects age and gender matched(n = 100) from the institute who volunteered to be part of the study were recruited as controls based on the sole criteria of the absence of fatty liver on ultrasonography and normal alanine and aspartate transaminases (ALT and AST) levels. Anthropometry, biochemical profiles and insulin resistance by homeostatic model assessment of insulin resistance (HOMA-IR) were assessed. RESULTS: A higher frequency of CG and GG genotypes of rs738409 polymorphism of PNPLA3 was observed in patients with NAFLD than controls. These patients with G allele had increased ALT, dyslipidemia and insulin resistance. The polymorphism had positive correlation with severity of hepatic steatosis. CONCLUSION: The presence of the PNPLA3 G allele is associated with a risk of NAFLD. Our study shows that subjects with variant PNPLA3 are not only at increased risk for the development and progression of NAFLD, but also have increased insulin resistance.

Association of Sonographically Assessed Visceral and Subcutaneous Abdominal Fat with Insulin Resistance in Prediabetes.

INTRODUCTION: Visceral abdominal Fat, not Subcutaneous Abdominal Fat better correlates with insulin resistance. Hence the present study was undertaken to study the association of sonographically assessed visceral and subcutaneous abdominal fat with insulin resistance in patients with pre-diabetes. MATERIAL AND METHODS: It was a hospital based cross sectional study done in prediabetes subjects. All the subjects were called fasting overnight and were given a structured questionnaire designed by investigator. Fasting and postprandial blood sugar, lipid profile, HB1Ac and fasting insulin levels was done in every subject. Ultrasound assessment of subcutaneous and visceral abdominal fat, fatty liver and fatty pancreas was done. RESULTS: Seventy Five patients (males 35 and females 40) were studied. Twenty nine patients had fatty liver and 40 patients had fatty pancreas. Among all sonographic parameters visceral abdominal fat thickness (VAF) showed a significant positive correlation with insulin resistance (p< 0.05). Subcutaneous abdominal fat thickness (SAF) had a positive though statistically non significant correlation with insulin resistance. Visceral abdominal fat thickness correlated best with fatty pancreas and had a significant positive correlation with insulin resistance. CONCLUSION: Fatty pancreas and visceral abdominal fat prove to be two important indices which mark the risk of insulin resistance thus may be considered an important predictor for screening of metabolic syndrome.

A Study of Prevalence of Peripheral Arterial Disease in Type 2 Diabetes Mellitus Patients in a Teaching Hospital.

Introduction: Diabetes mellitus is a major health problem in India as also the world. Peripheral arterial disease (PAD) is a known complication of diabetes which is relatively less commonly studied in comparison to other complications. The present study was undertaken to study the prevalence of PAD in diabetic patients in a teaching hospital. Materials and Methods: 200 type 2 diabetic patients from indoor as well as outdoor of a teaching hospital were included in the study. Ankle brachial pressure index was used to assess PAD. ABPI values of 0.9 or less were taken as indicative of PAD. Results: Out of 200 patients 72(36%) had evidence of PAD. There was a significant association between PAD and duration of diabetes, waist circumference, hypertension and microvascular complications. Conclusion: The prevalence of PAD in Type 2 diabetics was found to be 36% in our study. Screening for PAD should be done in all diabetic patients to detect this complication early.

Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as early markers of diabetic nephropathy.

INTRODUCTION: Diabetes mellitus (DM) is a major cause of concern because of its increasing prevalence rate and related microvascular as well as macrovascular complications, including kidney disease. Microalbuminuria has been accepted as the earliest marker for diabetic nephropathy; however, a large proportion of renal impairment occurs in nonalbuminuric state. We planned to investigate the serum and urinary levels of the tubular damage markers (neutrophil gelatinase-associated lipocalin [NGAL] and cystatin C [Cys C]) in patients of type 2 diabetes to detect early kidney injury. MATERIALS AND METHODS: This cross-sectional hospital-based study included 180 patients with type 2 DM according to the American Diabetes Association criteria. Serum NGAL (S.NGAL) and urine NGAL (U.NGAL) and Cys C were measured in all study participants and investigated for correlation with microalbuminuria. RESULTS: Our results showed that U.NGAL and S.NGAL levels were significantly high in patients with microalbuminuria as compared to normoalbuminuric controls. Serum Cys C was also higher in microalbuminuric patients than who had normoalbuminuria. A positive correlation of urinary albumin excretion with S.NGAL and U.NGAL was noted. U.NGAL also showed positive correlation with duration of diabetes, glycated hemoglobin, and dyslipidemia. Receiver operating characteristic curve analysis showed that the area under the curve for U.NGAL and S.NGAL were 1 and 0.8, respectively, which indicates that they are sensitive markers for early renal damage. CONCLUSION: Urinary biomarkers were significantly elevated in normoalbuminuric type 2 diabetic patients compared with nondiabetic controls and could be used as markers of nephropathy at a very early stage even before the development of microalbuminuria, the current gold standard for early diagnosis. Despite the promise of these new biomarkers, further large, multicenter prospective studies are still needed.

Soft Drinks Consumption and the Risk of Nonalcoholic Fatty Liver Disease.

INTRODUCTION: The increased consumption of sugar-sweetened beverages (SSBs) has been implicated in the increased incidence of obesity and metabolic syndrome Little of the research on sugar-sweetened beverage intake has examined the consumption patterns of sugared beverages by college students, despite the vulnerabilities of this population to weight gain. The current study sought to characterize sugar-sweetened beverage intake of undergraduate students who belong to high socio-economic strata and to study its correlation with presence of non-alcoholic fatty liver disease. MATERIAL AND METHODS: In a cross sectional, a self reported questionnaire based study about soft drink consumption (≥2/day, 1/day, <1/day). That included undergraduate medical students. Anthropometry and blood pressure were recorded and fasting glucose, insulin and lipid profile and abdominal ultrasonography for the presence of fatty liver was assessed. RESULTS: A total of 242 students were studied. The students in group 1 (≥2/day) had significantly higher BMI, waist circumference and diastolic blood pressure than students of other groups. They also had higher triglycerides, fasting insulin, HOMA-IR and significantly lower levels of HDL-cholesterol. Overall (40%) students had metabolic syndromes in group 1 compared to 8% and 3% in other groups while presence of NAFLD was observed in 75%, 16% and 4% in three groups respectively. Duration of soft drink consumption had positive correlation with presence of NAFLD. CONCLUSIONS: Substantial consumption of soft drinks is leading to increased obesity and cardio-metabolic risk factors in young adults. Artificially sweetened diet soft drinks have been posed as a healthier alternative due to their lack of calories but they do not guarantee protection against non-alcoholic fatty liver disease.

Osmotic Demyelination Syndrome in a Eunatremic Patient with Chronic Kidney Disease.

Osmotic demyelination syndrome is classically associated with rapid correction of hyponatremia. However, it can occur in normonatremic patients with other electrolyte abnormalities. One must suspect osmotic demyelination syndrome in susceptible patients with other electrolyte abnormalities like hypokalemia and hypophosphatemia.

A Study of Endothelial Dysfunction in Patients of Non-Alcoholic Fatty Liver Disease.

INTRODUCTION: The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing worldwide rapidly and is regarded as the hepatic manifestation of metabolic syndrome. The present study was undertaken to study the endothelial dysfunction by flow mediated vasodilatation in NAFLD patients. MATERIAL & METHODS: 32 cases and 16 age and sex matched controls were included in the study. Flow mediated vasodilatation of the brachial artery was studied in both cases and controls. Anthropometric, clinical and biochemical assessment was also done. RESULTS: It was found that NAFLD patients had a significant endothelial dysfunction as assessed by flow mediated vasodilatation as compared with controls. Percentage change in FMD among NAFLD patients (13.54±3.65%) was found to be lower than that in controls (16.84±4.61%) and difference was found to be statistically significant (p 0.010). CONCLUSION: From the present study it can be concluded that NAFLD patients have significant endothelial dysfunction even in the absence of traditional risk factors of cardiovascular disease.

Simple Renal Cysts: Can They be Overlooked?

BACKGROUND / OBJECTIVE: The availability and use of abdominal ultrasonography and computed tomography for diagnostic purposes has led to frequent detection of asymptomatic renal cysts. Recent evidence suggests their association with hypertension. The aim of our study was to evaluate the presence of simple renal cysts in patients with hypertension and prehypertension. METHODS: In a hospital based cross-sectional study, all consecutive adult patients aged > 25 years were enrolled. Detailed medical history and physical examination was done in all the study participants. Abdominal ultrasonography and biochemical parameters were also performed. All the patients who had history or evidence of structural or functional kidney disease were excluded. RESULTS: A total of 6230 patients were enrolled and divided into three groups: normotension (n=3510), prehypertension (n=1850) and hypertension (n=870) groups. There were significant differences in age, gender, prevalence of diabetes, family history of hypertension, regular exercise, smoking, BMI, systolic blood pressure, diastolic pressure, fasting plasma glucose, total cholesterol, triglyceride, HDL cholesterol, creatinine, estimated glomerular filtration rate in three groups. Simple renal cysts (SRCs) were present in significantly greater numbers in patients with prehypertension and hypertension. SRCs ≥2 in number or ≥2 cm in size were significantly associated with both prehypertension and hypertension independent to other risk factors. CONCLUSIONS: The presence of SRCs should not be overlooked. In present study, SRCs ≥2 in number or ≥2 cm in size are important determinants of prehypertension and hypertension.

Study of Hepatic Osteodystrophy in Patients with Chronic Liver Disease.

INTRODUCTION: Chronic Liver Disease (CLD) is a major cause of morbidity and mortality worldwide. It involves haemodynamic and metabolic complications. Hepatic Osteodystrophy is a metabolic bone disease that may occur in individuals with chronic liver disease. It can significantly affect morbidity and quality of life of these patients. Fractures are also associated with an excess mortality. It has been an under recognized and inadequately studied complication among Indian population. An early diagnosis is essential to correct reversible risk factors which predispose to bone mass loss. AIM: To assess the prevalence of metabolic bone disease and identify the risk factors associated with hepatic osteodystrophy in patients with cirrhosis. MATERIALS AND METHODS: This was an observational, cross-sectional, hospital based study conducted at a medical college hospital. All patients more than 20-year-old, diagnosed with chronic liver disease/Cirrhosis were enrolled. They were subjected to haematological, biochemical investigations, evaluation of Vitamin D and other hormonal parameters. Bone Mineral Density (BMD) was estimated by Dual Energy X-ray Absorptiometry (DEXA). RESULTS: A total of 72 patients with mean age 50.04±11.24 years were included in the study. Amongst causes of chronic liver disease were alcoholic liver disease 22 (30.6%), CLD due to hepatitis B 24 (33.3%) and chronic hepatitis C 26 (36.1%). Twenty one (29.2%) patients had normal BMD while 51 (70.8%) had a low BMD. Out of these 51 patients, 36 (70.6%) were diagnosed of osteopenia and 15 (29.4%) others were found to have osteoporosis. Vitamin D levels and severity of liver disease had correlation with low BMD. CONCLUSION: Low BMD is highly prevalent in patients with chronic liver disease of variable aetiologies. We advocate more randomised and prospective studies to be conducted on homogeneous groups with chronic liver disease in its various stages. In view of numerous therapeutic options available both for liver disease and bone disease, it is prudent to characterize this condition in order to give these patients a better chance of survival with good quality of life.