Diabetes Mellitus is a chronic, common metabolic disorder characterised by high blood sugar levels over a prolonged period. Atherosclerosis involving the coronary, cerebral and peripheral (lower extremity) arteries is the predominant cause of diabetes related mortality, responsible for up to 70% of all deaths in patients with this disease. Coronary angiography (CAG) has been considered as the gold standard for the assessment of the degree of Coronary atherosclerosis but measurement of carotid intima thickness by ultrasonography is a non invasive and quantitative method of evaluating early atherosclerosis. The aim of this study was to assess carotid artery intima media thickness and to assess any correlation between carotid artery intimal thickness and coronary artery disease in Type II DM. This study was carried out in the department of medicine, Dr. Baba saheb Ambedkar hospital, Delhi to assess carotid intima media thickness (CIMT) as a risk factor for CAD in type II diabetes using Ultrasound B scan to assess CIMT. In this study, 30 patients of DM type II with CAD, 30 patients of DM type II without CAD & 30 patients were age and sex matched controls who did not have any disease. Mean CIMT was found to be significantly increased in DM type 2 with CAD group as compared to DM type 2 without CAD and the difference was found to be statistically significant (P<0.001). Also the mean CIMT was significantly increased in DM type 2 with and without CAD as compared to controls and the difference was statistically significant. Also, patients with more than 3 cardiovascular risk factors had significantly greater CIMT than patients who had less than 3 cardiovascular risk factors and the difference was statistically significant.

Introduction: Hepatitis B virus (HBV) coinfected HIV patients are likely to have chronic hepatitis B infection and associated severe liver disease, however effect of hepatitis B on HIV has not been proven to be off any effect. Similarly in HIV/HCV co-infection majority of the studies have shown no significant influence of hepatitis C on the course of HIV infection, although some studies have demonstrated an association between HCV infection and faster HIV disease progression.14,15 Therefore, further studies are needed to study the impact of HBV/HCV co-infection on course of HIV, specially, in India. Aims and Objectives: To study the clinical, biochemical and immunological profile of PLHIV co-infected with either hepatitis B or hepatitis C virus, the severity of liver disease and hepatitis B and hepatitis C viral loads in these co-infected PLHIV and the association of WHO stage of HIV and immunosuppression with hepatitis B and hepatitis C viral loads as well as severity of liver disease. Method: It was an observational cross-sectional study, involving 30 PLHIV co-infected with either hepatitis B or C. A detailed history and physical examination was done. Complete Haemogram, Liver function tests, kidney function tests, Ultrasonography abdomen, CD4 cell counts, hepatitis B surface antigen (HBsAg), hepatitis B envelope antigen (HBeAg), hepatitis B Viral DNA (HBV DNA) and HCV RNA levels were done. Severity of liver disease was assessed by FIB 4 SCORE. Results: Among the 30 PLHIV subjects 30% were co-infected with HCV 70% were co-infected with HBV (HBsAg positive). All the subjects were asymptomatic for their liver disease. All the subjects were on Anti-Retroviral Therapy (ART) and 80% were in Early WHO stage (T1 and T2) and 20% were in Advanced WHO stage (T3 and T4). It was similar in both HBV and HCV co-infected group. The mean CD4 count of the subjects was 416.70±189.50 cells/mm3 with the range of 69 – 909 cells/mm3 . Five subjects (16.67%) had a CD4 count <200 cells/mm3 . Fifty seven percent subjects had no fibrosis or moderate fibrosis (FIB 4 <1.45) and 13.3% (4 subjects) had extensive fibrosis or cirrhosis (FIB 4>3.25). In HCV co-infected subjects 3 of 9 (33.33%) had severe liver fibrosis and only 1 of 21 (4.7%) among HBV co-infected had severe liver fibrosis.Among the 9 HCV co-infected subjects, 3 (33.33%) had undetectable HCV RNA. More number of subjects with detectable hepatitis C viral load had severe liver disease as compared to undetectable viral load.In HIV and HBV co-infected subjects the HBeAg positivity was seen in 42.86% subjects and 38.1% subjects had detectable HBV DNA load. Significant correlation was seen between HBeAg positivity and HBV DNA load. No correlation could be found between FIB 4 score and hepatitis B envelope antigen (HBeAg) positivity or HBV DNA load.No correlation between severity of liver disease (FIB 4) score and WHO staging or CD4 count could be seen. WHO staging and CD4 count also did not correlated with HCV RNA load, HBeAg positivity and HBV DNA load. Conclusions: There is no correlation of CD4 count and WHO stage with liver disease severity or hepatitis viral load in patients on HAART. In HIV and HBV co-infected patients high prevalence of HBeAg positivity is seen. Thus it becomes important to look for deranged liver enzymes and HBeAg positivity in PLHIVcoinfected with hepatitis B so that ART can be initiated in these patients irrespective of CD4 count. Hepatitis C co-infected subjects are more likely to have severe liver disease inspite of good CD4 count, so specific treatment for hepatitis C virus should be considered.

Background: The objective of the study was to study maternal and fetal outcome in pregnancy complicated with deranged liver function test and jaundice. Methods: Total 150 antenatal patients with clinical or laboratory evidence of abnormal liver function test and jaundice were selected for study done for a period of one-and-half year at a tertiary care hospital in north India. Results: All cases were in their third trimester of pregnancy out of which 93.3% were unbooked cases. Most of the patients presented with pregnancy induced hypertension, fever and jaundice at time of admission. Other presenting complaints were nausea, vomiting, pedal edema, abdominal pain and including 3 cases of altered sensorium. Acute viral hepatitis was most important cause of jaundice in this study followed by preeclampsia and ICP were other causes of jaundice in this study. Hepatitis B was the most common cause of acute hepatitis (26.7%) followed by hepatitis C (6.7%). Maternal mortality was seen in 4 cases (3 cases of Eclampsia & HELLP syndrome and one case of multi-organ failure). 138 patients were kept in ICU for intensive monitoring. Preterm delivery was most common maternal complication. Of all the deliveries, 26.7% were preterm, 31(21%) were IUFD, 57(38%) had fetal distress with meconium stained liquor, 27 (18%) had PROM, 50 (33%) had fetal growth restriction. Conclusions: Deranged liver function and jaundice in pregnancy results in a very high perinatal as well as maternal morbidity and mortality, and requires an early diagnosis and intensive care management.

Although there is a general predisposition towards hyper-coagulability during brain tumour surgery, hypocoagulability may exist in certain cases even before surgery, detectable only when the physical characteristics of clot formation are studied by viscoelastic point-of-care tests like thromboelastography (TEG). Herein we present a case of a 66-year old male patient with left frontal convexity meningioma, scheduled for craniotomy and excision of tumor. Patient’s preoperative coagulation profile (as assessed by conventional tests) was within normal limits but he was bleeding profusely from the beginning of the surgery and there was massive bleeding during tumour resection. Based on findings of TEG which revealed a severe hypocoagulable picture (low a angle, MA value and CI value with high K value), 10 units of cryoprecipitate and 4 units of random donor platelets were transfused intra-operatively in addition to 2 units of PRBCs. Haemodynamic stability was achieved and subsequent intra-operative course was better. One more unit of PRBC was transfused in the immediate post-operative period and a repeat TEG after 4 hours showed a trend towards normalization of TEG parameters suggesting a restoration of coagulation competency which also correlated with improved clinical condition of the patient.