Abstract : Objectives: To determine the level of serum uric acid level in diabetics and pre diabetics individuals. To compare the level of serum uric acid , FPG , HBA1C in pre diabetics and diabetics. Results: There was a significant relation between prediabetics who were younger in age compared to diabetics (almost a decade younger). The gender distribution was identical between the two groups. 53% had complaint <1 year.39% had isolated HTN; 9% had IHD whereas 19% had both. The diabetics had HbA1c significantly higher than prediabetics. Although proportionately more prediabetics had raised creatinine levels, but the difference was not significant. The difference of mean uric acid wrt HbA1c was not significant, although people with lower HbA1c values had a higher uric acid levels. The difference was not significant wrt uric acid levels with FBS values in prediabetics. The difference was not significant, although people with lower PPBS had higher uric acid levels in prediabetics. There was a significant relation of lower uric acid mean values for people with elevated HbA1c over 7g% amongst diabetics. There was no significant relation, although mean uric acid levels were raised for people with FBS<110 amongst diabetics. There was no significant relation but uric acid levels were higher in people with PPBS <140 amongst diabetics Conclusion: Younger age in India is predisposed to prediabetes and diabetes. Often patients are silent, without symptoms and detected only by investigations, so investigations for prediabetes and diabetes should be mandatorily routine. Lower uric acid levels have correlation with impaired glycemic control and should be part of check ups for metabolic syndromes. Hypertension and heart disease commonly coexist with diabetes and should be tackled together. Uric acid monitoring should have a role in guiding glycemic goals

Keyword : serum uric acid , FBS, PPBS , pre diabetics , diabetics

Abstract : ABSTRACT Nutritional status of pancreatitis patients varies among new cases and recurrent patients. Under nutrition is one of the major risk factors in the mortality and morbidity of patients with pancreatitis. Severe malnutrition will adversely affect outcomes, as occurs in other critical diseases. Malnutrition is known to occur in 50-80% of chronic alcoholics and alcohol is a major etiological factor. Excess body fat, lack of lean body mass, muscle wasting and poor immune status are some of the indicators of malnutrition associated with poor prognosis in patients. This study was an observational prospective study conducted on 22 subjects in two multi-specialty hospitals of Mysore city in the period of 2 months. Patients admitted to the hospital with diagnosis of pancreatitis and who were above 17 years of age were recruited for the study. Questionnaire was designed and data such as demographic profile, anthropometric, biochemical, clinical symptoms, medications, 24 hr dietary recall of hospital and home were collected. Results were expressed as Mean ± Standard deviation. Statistical analysis was conducted using student t test and chi square test by means of SPPS 16.0 software. Among 22 subjects, 17 were diagnosed with acute pancreatitis and 5 with chronic pancreatitis, 19 subjects had a history of chronic alcoholism. The serum protein levels was in the lower end of normal (6.73±0.93 g/dl) while liver enzymes and pancreatic enzymes were high(AST-75±81.28 U/L, ALT-47.11±48.44 U/L, P.lipase-485.18±431.65, P.amylase-667.45±824.53). The mean weight on admission was 62.2±9.59 kg, a weight loss of 2-4 kg was seen among majority of the patients at discharge, which could be attributed to the low-calorie intake (mean 367±488 kcal) during hospital stay. Even though the mean BMI was 23.41±4.17, the weight was attributed to empty calories acquired by daily alcohol consumption rather than diet. The mean intake of home recall was 1507 ±288 and that of hospital recall was 367±488. Malnutrition was found to be present among subjects and significant difference (p value-0.000) was seen in patients’ calorie intake. Nutritional status plays a major role in prognosis of patients and early nutrition support must be practiced for better recovery, reduction in length of stay and improvement in nutritional status of the patient. Keywords: Pancreatitis, Nutritional status, dietary recall, Malnutrition, Acute Pancreatitis, Chronic Pancreatitis

Keyword : Pancreatitis, Nutritional status, dietary recall, Malnutrition, Acute Pancreatitis, Chronic Pancreatitis

Abstract : Introduction: Polycystic ovary syndrome is a multifactorial disease caused by both genetic and environmental factors acting concurrently with rising prevalence at an alarming rate. It is a health problem that affects 1 out of 10 women of childbearing age. PCOS have negative impact on quality of life resulting in depression. Objective: The present study was designed to assess health related quality of life and depression among polycystic ovary syndrome patients in Pakistan. Methodology: A descriptive cross sectional study design was used to assess health related quality of life and depression among 152 women with PCOS diagnosed by Rotterdam criteria using PCOSQ-50 and HADS. Data was collected and statistically analysed. Results: Significant difference (p ≥ 0.05) among different domain of HRQoL and level of depression among women with PCOS was observed. Unmarried patients had better emotions while body hairs, weight and infertility effect married women. Rural patients had relatively poor HRQoL. Women with PCOS in age group 26-35yrs had impaired HRQoL due to infertility, emotions and increased weight. Obese patients with PCOS had relatively more impaired HRQoL as all domains were affected in them. Women with PCOS residing in rural areas were found relatively more depressed and those belonging to low educational and income background were comparatively found more depressed. Conclusion: The results of the present study concluded that polycystic ovary syndrome had a negative impact on health related quality of life of patients across all domains with a significant likelihood of depression. While all domains were affected, the greatest impact was seen on infertility followed by body hairs and role limitation due to increased psychological and emotional problems. Low educational and income background had negative effect on mental and emotional HRQoL of polycystic ovary syndrome patients and depression. More attention should be given on improvement of health related quality of life among PCOS patients to decrease the rate of treatment failure and improve treatment response.

Keyword : Depression, health related quality of life, poly cystic ovary syndrome (PCOS), women, Pakistan.

Abstract : Background & Objective: An acute deterioration of liver function in a patient with previously compensated chronic liver disease is a result of relentless progression of underlying liver disease. This research was conducted to elucidate clinical profile, precipitating factors, prognostic factors, predicting the survival and outcome of Acute-on-chronic liver failure in cirrhotic patients. Methods: This prospective observational study of hundred patients was conducted in PVS Memorial Hospital, Cochin, Kerala, India in 2015-16. Patients were followed up during hospital stay and outcome was noted at 28 day. The clinical manifestations, laboratory parameters and other imaging findings were analyzed. Results: Out of 100 patients studied, 87 were males and 17 females with sex ratio 4.9:1. The mean age of all subjects was 54.21 ± 11.23 years. Alcohol was the primary etiology for cirrhosis in 69 (69%) patients while 25 (25%) patients etiology could be identified and labeled as NASH/Cryptogenic. 13% had grade 3-4 hepatic encephalopathy. Liver, renal, coagulation, cerebral, circulatory and respiratory failure were seen in 67%, 32%, 39%, 15%, 39%, 30%, and 13% respectively. Most frequent complication was coagulopathy i.e. INR >2.5, which was found in 36% of patients. The most striking differences were seen in MELD, MELD Na, APACHE II and SOFA scores between no ACLF and ACLF group. Among all four scores, APACHE II had highest sensitivity of 92.7% (p<0.001). Mortality at 28 days was recorded in 55% (55 patients). Mortality was highest in ACLF group II (77.8%) and ACLF group III was (95.7%). Conclusions: It is evident that alcohol is the most common etiology for cirrhosis followed by NASH. APACHE II has a better sensitivity in predicting the mortality compare to other scores. More refine and precise ACLF classification system is required in order to diagnose high-risk patients and predict mortality and survival rates.

Keyword : Chronic hepatic decompensation, Cirrhosis, CLIF – SOFA score, ACLF, APACHE II, MELD, NASH.

Abstract : ABSTRACT Cervical spondylotic myeloradiculopathy is a common cause of neck pain and radiating arm pain which develops when one or more of the intevertebral discs in the cervical spine start to degenerate. Multiple techniques and modalities of fixation are used in Anterior Cervical Discectomy and interbody Fusion (ACDF), among them use of standalone PEEK cage is standard one. To evaluate the result of ACDF by standalone PEEK cage for degenerative cervical disc disease. This prospective study was conducted in the Department of Orthopaedics, BSMMU, Dhaka from July 2015 to June 2020. A total number of 64 (40 male and 24 female) patients with cervical spondylotic myeloradiculopathy with single or two level involvement confirmed by MRI were selected for the study who were failed to improve after conservative treatment. Modified Odom’s criteria, visual analogue scale (VAS), Nurick Grading and bridwell criteria for cervical spondylotic myelopathy was used for evaluation of the results. Mean age of the patients was 51.6 ± 7.42 years. Most of the patients were farmers 24 (37.5%). Single level involvement was in 38(59.4%) cases and two level involvement were in 26(40.6%) cases. Most commonly involved level was C5/6 (35 cases, 55%). Preoperative VAS score was 7.66 ± 0.53 which significantly reduced to 1.22 ± 0.31 after 12 months of operation. Grade I fusion was observed in 53(82.8%) patients in 12 months by Bridwell grade of fusion. Acording to modified Odom’s criteria, postoperative outcome at 12 months of follow up, 51(79.7%) patients showed excellent, 11(17.2%) patients showed good outcome and 2(3.1%) showed fair outcome. No poor outcome was found. P value was 0.003. ACDF is the best technique for the treatment of cervical disc disease with excellent functional outcome which is achieved by using standalone PEEK cage. This can be used with minimum risk as well excellent fusion rate. Keywords: Cervical spondylotic myeloradiculopathy, ACDF, standalone PEEK cage

Keyword : Cervical spondylotic myeloradiculopathy, ACDF, standalone PEEK cage