European Journal of Cardiovascular Medicine

Material & Methods: Study Design: Hospital based prospective observational study.Study area:Department of Obstetrics & Gynecology, Mayo institute of Medical Sciences,Barabanki, Uttar Pradesh.Study Period:April 2022 toMarch 2023. Study population:All patients presenting with jaundice to Department of Obstetrics & Gynecologyin antepartum or intrapartum period.Sample size: Study consisted a total of 55 subjects.Sampling Technique:  Simple Random technique. Results: In 29% (n=16) of cases, jaundice is due to obstetric cholestasis, who are mostly presented with pruritis and abnormal LFT’s in their third trimester, In 27% (n=15)it is due to HELLP syndrome which is associated with preeclampsia in 14%, In 12.7%(n=7) cases jaundice is due to sickle cell anemia and Hepatitis B each, haemolytic anemia due to blood transfusion is seen in 5.45% (3), in 3.6%(n=2) cases cause is AFLP who presented with hepatic encephalopathy and hypoglycemia , cirrhosis is the cause of jaundice in 3.6%(n=2) who presented in their first and second trimester,1.8%(n=1) cases are due to malaria, cholelithiasis and autoimmune hepatitis each. So in nearly half of the cases the cause of jaundice is pregnancy specific causes. Conclusion:Jaundice in pregnancy is a dreadful condition resulting in high maternal and fetal mortality. Even though the blood bank facilities has increased, due to their advanced disease state at admission few patients could not be survived. So early referrals are helpful.Team effort is needed in the management of jaundice , team should constitute obstetrician , physician, gastroenterologist, anaesthetist and neonatologist, so that identification and treatment throughout antepartum, intrapartum and postpartum period prevent and reduce maternal and perinatal morbidity and mortality.

Introduction: Acute appendicitis remains one of the most common surgical emergencies, accounting for 1% of all emergency operations. The diagnosis can at times be very difficult, so any test which can contribute towards the diagnosis is very valuable. Even though USG, MRI and CT scan of abdomen and blood tests can confirm the diagnosis but not its severity.  Aim: The aim of this study is to establish the role of deranged liver function tests as a new diagnostic tool and also to predict gangrenous and ruptured appendicitis which would serve the purpose of decreasing the mortality and morbidity in these patients.  Methods: Ninety patients of different age groups from 8 to 70 years of both sexes were included in this study over a span of 14 months. They were confirmed by USG, routine blood examination and clinical findings. LFT were performed, studied and compared with all patients of acute appendicitis.  Results: Out of 90 patients, hyperbilirubinemia was observed in 45 cases (50%). There was an increase in other liver enzymes like SGOT in 18 patients (20%), SGPT in 3 patients (2.7%), and Alkaline Phosphatase in 10 patients (9%). However, serum albumin was found to be normal in all patients. GGT increase is seen in 6 patients (9.23%). Specificity, sensitivity, positive predictive value and p value were highly significant (p<0.001) in complicated appendicitis. Conclusion: The elevated parameters of LFT in patients of complicated appendicitis (ruptured, gangrenous) carried considerable prognostic significance. Hence LFT can be used as a diagnostic and prognostic indicator in patients of acute appendicitis, thus avoiding unnecessary morbidity and mortality in these patients.

Background:  As we all know that liver has been called the custodian of milieu interior, as such any form of liver disorder will result significant effect on homeostasis and also, numerous pathologies of other systems can affect either directly or indirectly 
on liver. Both acute and chronic heart failure may result in abnormalities of liver. Liver receives 25% of cardiac output, a huge percentage of cardiac output, so fall in cardiac output will result in hepatic hypo perfusion.  Therefore our study was planned to 
evaluate the abnormalities of liver function and its role on assessment of prognosis in Congestive Cardiac Failure patients in our setup. Research Question: What are the abnormalities of various liver function tests in Congestive cardiac failure patients?  The setting of the study was at department of General Medicine, Government General Hospital, Government Medical College, Eluru, Andhra Pradesh. A one year observational study was conducted during the period from October 2022 to September 2023 on about 75 Congestive cardiac failure cases of varied etiology admitted during the above period in the department of General Medicine by studying their socio demographic profiles, associated causes for Congestive cardiac failure, assessment of liver function by conducting various biochemical tests and the prognosis of the disease etc. and about 20 healthy individuals were taken as controls for comparison of data.  Results: Among the total study subjects ( CHF cases ) males were 58.6% and females  were 41.3% and among controls it was 60% & 40% and regarding age among cases maximum were found between 41 – 70 years age group. And also with regard to etiological cause of CHF Coronary Atherosclerotic Heart disease accounted for 73% followed by RHD 72% Cardiomyopathy 71%, Cor pulmonale 69% and Hypertensive heart disease 57% were observed and with regard to Prognosis out of total 75 cases about 53(71%) of cases were showed abnormal LFT and out of this total about 47 cases showed remission and 44 got responded towards reduction of serum bilirubin on remission. And about 6 showed exacerbation among total 75 cases. Related to LFTs Sr bilirubin, AST, ALT, SAP has showed significant increased levels and Sr albumin showed mild rise in this study

Background: The laboratory hematological and inflammatory biochemical markers may help to predict COVID-19 prognosis. Many studies were pinpointed various prognostic markers, including D-dimer, C-reactive protein (CRP), lactate dehydrogenase (LDH), and high-sensitivity cardiac troponin, in serum of COVID-19 patients with poor outcomes. Deep analysis of abnormal levels of such factors and the interface between their functions in the organs of the body and mechanisms of viral infection can provide the basis for first-line diagnosis as an efficient screening tool to predict the severity of the disease. Thus our study was planned to evaluate the hematological and inflammatory biochemical parameters to rule out the severity of the SARS Covid-19 among the affected patients in our set up. Research Question: Is  there any difference of Hematological, biochemical and radiological abnormalities between survived and non survived patients affected with SARS - COVID 2 Pneumonia?  The setting of the study was at Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondicherry.  A six months observational study was conducted during the period from January, 2021 to June, 2021 on about 240 SARS Covid-19 patients admitted during the above period in the department of General Medicine by studying their socio-demographic profiles, CBP, LFT, RFT, Serum electrolytes, Serum albumin, RBS & HbA1C, D-dimer and CT- Severity score etc; .Results: Majority (74%) of the study subjects were belong to 50 years and above age group with the mean age 58.5 years      and males (64%) were more when compared to females (36%) in this study. And also it was noticed that, the ratio of male & female was same among both the survivers and non survivors groups. Significantly (P<0.05) about 52.5% of study subjects of Non survivors group fall under severe ARDS when compared to survivors group (15.3%) basing on the NLR report. Also it was observed that significantly (P>0.05) about 70.8%% of study subjects of Non survivors group fall under severe ARDS when compared to survivors group (12.1%) basing on the PF ratio. Furthur with reference to Hematological and Biochemical inflammatory parameters significant results of differences were observed among Total count, Platelet count, Ferritin, LDH, D-dimer, Serum creatinine, Liver function tests of ALP,ALT & AST and Serum electrolytes (Sodium & Potassium) etc; between both the groups of Non survivors and Survivors.

Background: Pre-eclampsia, affecting approximately 5% of pregnancies, is characterized by hypertension and proteinuria after 20 weeks of gestation. It results in maternal and foetal morbidity and mortality during antenatal and postnatal period. In numerous studies it is observed that, plasma levels of anti-angiogenic factors such as soluble FMS like tyrosine kinase-1 was elevated in second trimester of pregnancies. Excess of sFlt-1 binds to placental growth factors and vascular endothelial growth factor and thus, have a pathogenic role in pre- eclampsia. Aims and objectives: To find the association of sFlt-1 with pre-eclampsia among pregnant women. Materials and Method: The study was conducted by taking 110 patients who were categorized into 2 groups of pre-eclamptic participants and healthy participants. Their serum samples were taken and was assayed for serum sFlt-1 levels in ELISA (Sandwich Technique) along with other investigations like LFT and RFT. Results: This study infers that, the cases with pre-eclampsia had significantly higher values of sFlT-1 (5798.2±107.1pg/ml) in contrast to that of controls who had sFlT-1values of (2584.5±181.2pg/ml) with a p value of <0.001. Conclusion: The circulating levels of this anti-angiogenic factor can help in detection of Pre- eclampsia and in further antenatal screening.

Objective: To know the effect of antiepileptic drugs on liver enzymes.  Study Design: Cross sectional study. Materials & Methods: The study was conducted on 108 patients at Santosh Medical College & Hospital, Ghaziabad between Sep 14 to Oct 14. Patients divided into 3 groups, consisting of 36 patients in each group of phenytoin, carbamazepine and valproate. Results: Total No. of Patients was 108, out of which 36 patients were there is each group of Phenytoin, Carbamazepine and valproate. Most of the patients 36 (33.33%) and 32 (29.62%) belongs to age group of >40 – 50 years and >50 year respectively. Regarding raised SGPT, it was seen in 5 (13.89), 3 (8.33) and 3 (8.33) in phenytoin, carbamazepine and sodium valproate group respectively. SGOT were raised in sodium valproate group respectively. Alkaline phosphatase was raised in 10 (27.78), 20 (55.56) and 22 (61.11) in phenytoin group, carbamazepine group, and sodium valproate group respectively.  Conclusion: From the present study we can conclude that sodium valproate is more hepatotoxic than carbamazepine which is more toxic than phenytoin. It is recommended that base line Liver Function Test (LFT) is essential before starting of AEDs and regular monitoring of LFT is also done between the course of treatment.

Background: Liver fibrosis determination is essential for management and prognosis of chronic liver disease. Liver biopsy is gold standard but invasive; transient elastography (FibroScan®) and composite biochemical scores are used as non-invasive alternatives. The Bonacini score (platelet count + AST/ALT ratio + INR) was developed to predict advanced fibrosis and cirrhosis. Objective: To evaluate accuracy and performance of the Bonacini score in predicting liver stiffness measured by transient elastography (FibroScan) in patients with clinically/ultrasonographically diagnosed cirrhosis. Methods: Cross-sectional analysis of 143 adult cirrhotic patients evaluated in Dept. of General Medicine, ESIC PGIMSR (Rajajinagar). Laboratory data (CBC, LFTs, INR, hepatitis panel) were used to compute the Bonacini score. Liver stiffness (kPa) was measured by FibroScan. Primary analyses: correlation (Pearson/Spearman) between Bonacini score and FibroScan, linear regression modeling, and descriptive statistics. All patients had FibroScan values in the advanced range (see Results). Statistical significance set at p < 0.05. Results: N = 143. Mean (±SD) Bonacini score = 9.29 ± 1.23 (range 6–11). Mean FibroScan = 19.61 ± 2.03 kPa (range 12.5–23.4). The Bonacini score correlated strongly with FibroScan: Pearson r = 0.801 (p < 0.000001), Spearman rho = 0.764 (p < 0.0000001). Linear regression predicted FibroScan from Bonacini: FibroScan (kPa) = 7.303 + 1.324 × (Bonacini score); Bonacini coefficient p < 0.000001; model R² = 0.641. Mean FibroScan increased with increasing Bonacini score (Bonacini 6 → mean 14.23 kPa; Bonacini 11 → mean 21.81 kPa). Conclusion: In this cohort of clinically cirrhotic patients, the Bonacini score had a strong positive correlation with liver stiffness on FibroScan and explains ~64% of variation in stiffness. The Bonacini score — an accessible bedside biochemical index — demonstrates good discriminatory association with advanced fibrosis/cirrhosis and can be clinically useful, especially where elastography or biopsy is unavailable. External validation in earlier-stage disease is warranted.

Background: Stroke is increasingly affecting young adults under 45 years, resulting in significant morbidity, mortality, and socioeconomic impact. This hospital-based prospective observational study  aimed to evaluate the clinical profile and risk factors associated with stroke in young patients less than or equal to 45 years. Methods: A total of 100 patients aged 15–45 years with confirmed ischemic or hemorrhagic stroke on CT/MRI and abrupt-onset neurological deficits lasting >24 hours were included. Detailed history, clinical examination, NIHSS scoring, laboratory investigations (CBC, LFT, KFT, electrolytes, lipid profile, HbA1c, coagulation profile, blood culture, CSF if indicated), and imaging studies (ultrasound, 2D echocardiography, CT, MRI, DSA, carotid Doppler) were performed. Data were analyzed using SPSS, with p<0.05 considered significant. Results: The mean age was 33.3±7.4 years, with 57% males. Common presenting symptoms included altered sensorium (70%), hemiparesis (65%), seizures (34%), headache (35%), and vomiting (39%). Ischemic stroke was the most frequent subtype (61%), followed by hemorrhagic stroke (39%),. Stroke severity by NIHSS  19% mild(0-4),32% moderate(5-15),15% moderate to severe stroke(16-20),34% severe (21-42)strokes. Mortality was highest among patients with NIHSS >20 (91%), chronic kidney disease (78%), hypertensive emergency (60%), hemoglobin <8 g/dL (75%), tachycardia >100 bpm (64%), and tachypnea >20/min (61%). Right-sided hemiparesis (77% discharged), anticoagulation therapy (85% discharged), and rheumatic heart disease (93% discharged) were associated with favorable outcomes. Overall, 64% were discharged and 36% expired. Conclusion: Stroke in young adults shows distinct clinical patterns, with ischemic stroke predominating. High NIHSS score, hemodynamic instability, anemia, and kidney disease are independent predictors of poor prognosis, emphasizing the need for early recognition, risk factor management, and targeted interventions.