To Evaluate Correlation of Serum Copeptin with Severity of Liver Cirrhosis.

INTRODUCTION: Cirrhosis is defined as a diffuse process in the liver characterized by the development of extensive Fibrosis and replacement of the normal hepatic architecture by structurally abnormal nodules of fibrotic tissue. Because of its key role in circulatory homeostasis and its systemic vasoconstrictor effects AVP might be particularly interesting as a marker of circulatory dysfunction and prognosis in cirrhosis. Copeptin is secreted with AVP in equimolar amounts and strongly correlates with AVP over a wide range of osmolalities. These properties make copeptin an interesting surrogate marker of AVP in clinical practice. So, we evaluated the correlation of serum copeptin with the severity of liver cirrhosis. MATERIALS: We collected data from 80 patients with cirrhosis and divided them into CTP Class A, B, and C. Serum Copeptin levels were measured by a Human Copeptin ELISA Kit. The levels of Serum Copeptin were compared between the CTP Class A, B, and C. RESULT: The mean (SD) Serum Copeptin(pmol/L) in CTP Class A, B and C is 11 (0.29), 14.20 (0.40) and 23.98 (7.64) respectively. The findings of our study show that there is a significant difference in serum Copeptin levels (pmol/L) (p = <0.001) between the 3 groups as per CTP Class. CONCLUSION: The result of our study shows that measurement of Serum Copeptin levels can be used as an additional, simple, non invasive, easily accessible, and cost-effective parameter to predict the severity of liver cirrhosis. Chiranth S, Geeta Kampani Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, Delhi, India Introduction: Acute pancreatitis (AP) is a potentially life threatening disease. Early identification of patients at increased risk of severe and fatal disease is crucial to improve prognosis through a prompt medical/endoscopic treatment and admission to a specialized intensive care unit. Due to limitations of the commonly used scoring systems, it is difficult to assess the severity of AP at presentation. MATERIALS: An observational cross sectional study was conducted on 85 patients admitted at a referral hospital. Patients of AP were divided into 2 groups- mild acute pancreatitis (MAP) and moderately severe/ severe acute pancreatitis (MSAP/SAP)and all necessary investigations were done. RESULT: Out of 85 patients with AP, 55 had MAP, 17 had MSAP and 13 had SAP. Mean serum calcium was significantly lower in patients with MSAP/SAP than in MAP. Red cell distribution width (RDW) at 0 hr and at 24 hours and RDW/Total serum calcium (TSC) were significantly higher in patients with MSAP/SAP than in MAP. BISAP index followed by Modified Marshall Score were the best predictors of severity followed by RDW/TSC. RDW/TSC was a better predictor of severity of AP when compared to RDW at admission and at 24 hrs. No individual parameter was an independent significant predictor of AP. CONCLUSION: RDW and RDW/Total serum calcium ratio are comparable to BISAP index as predictors of severity in acute pancreatitis. They are cheap, easily available and can be used to predict the severity of AP at admission, thereby effecting prompt intervention at admission.

Congenital malformations of the brain and spine.

In this chapter we briefly address the most common congenital brain and spinal anomalies as well as their most salient imaging, especially magnetic resonance, findings. Some of them, such as Chiari II, and open spinal defects, have become relatively rare due to their detection in utero and repair of the spinal malformation. Regardless of the type of brain anomaly, the most common clinical symptoms are mental retardation, hydrocephalus, and seizure; the latter two may need to be surgically and medically addressed. The most commonly found spinal congenital anomalies include the filum terminale lipoma which is generally asymptomatic and incidental and the caudal regression syndrome for which no primary treatment exists. Any spinal congenital anomaly may present in adulthood as a consequence of spinal cord tethering and/or development of syringomyelia.