BACKGROUND AND AIMS:Esophageal varices (EV) are a major complication of portal hypertension in decompensated chronic liver disease (DCLD), but endoscopy is invasive and resource-limited. This study assessed serum-ascites albumin gradient (SAAG) as a noninvasive predictor of EV occurrence and severity. PATIENTS AND METHODS:Prospective cross-sectional study (January 2023-May 2024) of 76 adults (≥18 years) with DCLD and ascites at RIMS, Ranchi. SAAG was calculated postparacentesis; EV graded via endoscopy (Westaby: Grade 0-3). SPSS v23 analyzed data: t-tests, Analysis of Variance (ANOVA), correlations (r), logistic regression, and receiver operating characteristics (ROC) (P < 0.05). RESULTS:Mean age 43.66 ± 10.16 years; 68.4% male; 67.1% alcoholic etiology. EV present in 81.6% (n = 62). Mean SAAG higher with EV (1.93 ± 0.37 vs. 1.38 ± 0.12 g/dL; t = 9.81, P < 0.001). Point-biserial r = 0.542 (P < 0.001); SAAG rose with grade (ANOVA F = 22.32, P < 0.001). ROC: AUC = 0.951, cutoff 1.585 g/dL (sensitivity 89% and specificity 100%). Serum albumin predicted EV independently (odds ratio [OR] =6.98, P = 0.007); SAAG OR = 25,933 (P < 0.001). CONCLUSIONS:SAAG strongly correlates with EV occurrence/severity, supporting its use for screening in the resource-poor settings. Optimal cutoff: 1.585 g/dL. IMPACT AND IMPLICATIONS:Enables noninvasive risk stratification, reducing endoscopy burden; validate in multi-center trials.

BACKGROUND AND AIM:An infection of the lung that mostly affects the alveolar space is known as pneumonia. According to the Global Burden of Disease Study, infection of the lower respiratory tract was the second most common cause of death and years of life lost. This study aims to study the serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in pneumonia as well as its correlation with Confusion, Urea (Raised blood urea), Respiratory rate (>30/min), Blood pressure (low), 65 (age >65 years) (CURB-65) score for determining the severity of disease. MATERIALS AND METHODS:An institution-based descriptive observational study with cross-sectional design was conducted in the Department of Medicine, RIMS, Ranchi, from October 2023 to September 2024. All adult patients aged 18 years and above were admitted with clinical and radiological signs of community-acquired pneumonia. Descriptive analysis was done in the form of proportion for categorical variables and median (interquartile range) and mean (standard deviation [SD]) for continuous variables. Continuous variables were checked for normal distribution, and nonparametric test (Mann-Whitney U test) was done accordingly. Spearman's correlation and Pearson correlation statistics was performed to assess the relationship between NT-proBNP and severity of the disease. The difference between proportions was analyzed using the Chi-square test, and P < 0.05 was considered statistically significant. Data were entered into MS Excel and analyzed using the SPSS version 20. RESULTS:The study was conducted on 145 patients. The mean (SD) NT-proBNP level was 937.04 (1243.03) pg/ml. Around 11% of the patients expired during hospital stay and 89% were discharged. The respective mean NT proBNP level for the particular variable like patients with age >60, tobacco consumption, diabetes, hypertension, higher grades of the Modified Medical Research Council Scale for Dyspnoea (MMRC) and higher score of CURB 65 score was more than their counterparts. The mean NT-proBNP level was significantly higher among the patients expired during hospital stay than the patients who were discharged from the hospital. NT-proBNP was positively and significantly correlated with age, CURB-65 score, hospital stay, and MMRC grade with Spearman's correlation coefficient of 0.57, 0.83, 0.73, and 0.79, respectively. CONCLUSION:The study demonstrated that levels of NT-proBNP positively correlated with CURB-65, MMRC grades, and mortality among the patients with pneumonia. Hence, NT-proBNP levels might be an effective parameter in predicting the disease course among the patients with pneumonia.

Background:Acute pancreatitis (AP) is an inflammatory disease of the pancreas with varying severity. The mortality rate varies from 20% to 40% among severe acute pancreatitis (SAP). Interleukin-6 (IL-6) is a pro- and anti-inflammatory cytokine that involves various infections, inflammations, and systemic disorders. Injury to acinar cells leads to necrosis, releasing proinflammatory cytokines, including IL-6, which peaks earlier. The lack of extensive data regarding the association of IL-6 with AP influences us to do this meta-analysis for early detection and treatment of AP to prevent multiorgan failure. Methods:We searched the PubMed, Cochrane Library, and Google Scholar databases for relevant articles published from inception to June 2024. We examined the positive and negative likelihood ratios, diagnostic odds ratios, and pooled sensitivity and specificity. We used the QUADAS-2 tool to evaluate the risk of bias. Results:This meta-analysis included 13 studies involving 1386 patients with AP, of which 343 had SAP and 1043 had mild and moderately severe AP. The positive and negative likelihood ratios were 3.5 (95% CI 2.6 to 4.5) and 0.25 (95% CI 0.16 to 0.40). The diagnostic odds ratio of IL-6 to diagnose SAP is 14 (95% CI: 7 to 27), and the summary receiver operating characteristic curve is 0.85 (95% CI: 0.82-0.88). Conclusion:Based on the results of this meta-analysis, serum IL-6 is a promising biomarker for diagnosing SAP in the early stage. However, a larger-scale study involving a more extensive population is necessary due to the considerable variation between the studies.

BACKGROUND AND AIMS:Hypothyroid patients often complain of shortness of breath, fatigue, and exercise intolerance. Both inspiratory and expiratory muscles' weakness is present, and the impairment of pulmonary function may be initiated at the subclinical stage of hypothyroidism. Hence, this study aimed to assess the pulmonary function tests (PFTs) in hypothyroid patients. MATERIALS AND METHODS:This cross-sectional observational study was undertaken on patients attending the medicine outpatient department and indoor, in the Department of Medicine at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, from May 2023 to June 2024. Thyroid profile was estimated by enzyme-linked immunosorbent assay. PFTs (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], and FEV1/FVC) were assessed by spirometry. Data were analyzed using SPSS software (version 22.0). Descriptive analysis was done for almost all variables along with t -test and Chi-square test wherever applicable for finding a significant difference using P value. Pearson's correlation was used to determine the correlation between the variables. RESULTS:The study was conducted on 136 patients, of whom 26% were male and 74% were female. In this study, the mean thyroid-stimulating hormone, free triiodothyronine (T3), and free thyroxine (T4) levels were 19.6 ± 34.7 μIU/ml, 1.1 ± 0.794 ng/ml, and 2.9 ± 2.47 ng/ml, respectively. Spirometry results revealed a predominant restrictive pattern (75.74%). Peak expiratory flow rate (PEFR) had a mean value of 5.89 ± 1.91 L/min. This low level of PEFR suggests restrictive lung disease. Correlation analyses demonstrated a positive relationship between serum T4 levels with FVC ( P = 0.006) and serum T3 level with PEFR ( P = 0.041), indicating lower T3 and T4 levels associated with restrictive lung disease. CONCLUSION:Pulmonary function tests can be affected in hypothyroidism with increased risk of restrictive lung disease.

Background:Coronavirus 2019 (COVID-19) is an infectious disease caused by a novel coronavirus, SARS-CoV-2. Acute kidney injury (AKI) affects approximately 20-40% of patients with COVID-19 admitted to the intensive care unit (ICU), and it is a complication that has been linked to increased morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of acute kidney injury. Methods:Articles were searched from databases such as PubMed, Google Scholar, and Cochrane Library till June 2023. Pooled sensitivity, specificity, area under the curve (AUC), diagnostic odds ratio (DOR), and summery receiver operating curve (SROC) were calculated with 95% confidence interval. I2 statistics and Chi-square test were used to look for the heterogeneity in between studies. Meta-regression was conducted to look for the source of heterogeneity and GRADE analysis was performed to look for the certainty of evidence. Results:Altogether, eight studies were selected (4 serum/5 urine), out of which one study had both serum and urine NGAL data. The total sample size was 1,067 (349 serum/718 urine). For serum and urine NGAL, the pooled sensitivity was 0.79 (95% CI: 0.72-0.84) and 0.75 (95% CI: 0.68-0.80), pooled specificity was 0.87 (95% CI: 0.81-0.91) and 0.85 (95% CI: 0.77-0.91), DOR was 24 (95% CI: 14-43), and 17 (95% CI: 9-32) and AUC was 0.90 (95% CI: 0.87-0.92) and 0.80 (95% CI: 0.76-0.83), respectively. Conclusion:Both serum and urine NGAL have favourable pooled sensitivity, specificity, DOR and AUC for the diagnosis of AKI in COVID-19 infection, however, with low certainty of evidence.

AIM:To assess the diagnostic accuracy of the free androgen index (FAI) in diagnosing polycystic ovary syndrome (PCOS). METHODS:We systematically searched PubMed, Cochrane Library, and Google Scholar databases for relevant studies published up to June 2024. The inclusion criteria were studies that reported the sensitivity and specificity of FAI for PCOS diagnosis. We used a random-effects model to find the pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic area under the curve (SROC AUC). We determined positive and negative likelihood ratios (NLRs) using the Fagan nomogram and assessed heterogeneity using I2 statistics. We performed meta-regression and subgroup analysis to explore sources of heterogeneity and used Deeks' funnel plot to assess publication bias. This study is registered with PROSPERO (ID: CRD42024546829). RESULTS:We included 14 studies with 2870 PCOS patients and 3985 non-PCOS controls. Pooled sensitivity and specificity were 0.81 (95% confidence interval [CI]; 0.73-0.86) and 0.82 (95% CI; 0.72-0.90), respectively. The positive and NLRs were 4.6 (95% CI; 2.8-7.6) and 0.23 (95% CI; 0.17-0.33), respectively. The DOR was 20 (95% CI: 10-39), and the SROC AUC was 0.88 (95% CI: 0.85-0.90). Variability in FAI cutoff values contributed significantly to heterogeneity across studies. CONCLUSION:Serum FAI is a reliable biomarker for diagnosing PCOS, demonstrating sensitivity and specificity exceeding 80%. It is particularly valuable in primary care settings where ultrasound facility is unavailable. FAI assists in diagnosing biochemical hyperandrogenism, especially in cases where clinical criteria are inconclusive.

BACKGROUND:Transfusion Transmitted Malaria is a major concern among blood donors in endemic countries. The Drugs and Cosmetic Act 1940 in India mandated testing of all blood donations for Malaria. Regular screening of malaria prevents severe transfusion-transmitted malaria, and shows its prevalence and enables its control among the population. MATERIAL AND METHODS:This is a 09-year retrospective observational study from 1 st August 2014 to 31 st July 2023 among apparently healthy blood donors in Blood Centre of Rajendra Institute of Medical Sciences, Jharkhand, a tertiary health care centre in tribal population-dominant region of India. Every donor's sample is subjected to a malaria antigen test both for Plasmodium falciparum and Plasmodium vivax by One step, rapid, immunochromatographic test. Positive result by rapid diagnostic Antigen card tests were also analysed by microscopy (peripheral blood smear). RESULTS:In the present study, the total number of blood units collected was 246,147. On screening of the total blood donors, 62,225 (25.27%) were voluntary donors and 183,942 (74.72%) were replacement donors. There were 2,27,731 (92.51%) male donors and 18,416 (7.48%) female donors. Among all the donors, only 61 (0.024%) malaria-positive donors were seen, all male. CONCLUSION:Malaria transmission is strictly monitored and controlled by governments in endemic regions. In addition to the direct spread by mosquito bites, malaria can also be transmitted by transfusion as blood is transfused mainly as whole blood in developing countries. The transmission by transfusion of blood remains a challenge to blood centres because of carriers of malaria in the population in endemic regions like Jharkhand, India. This is first long retrospective observational study of prevalence of malaria among apparently healthy blood donors in a tertiary care centre in Northeastern tribal region of India. It gives a rough idea of the effectiveness of various malaria control programs in remote, malaria-endemic regions.

Background Blood transfusion is an essential and lifesaving procedure for many acute and chronic diseases. Though saving millions of lives, it carries the risk of transfusion of transfusion-transmitted infections (TTIs), including hepatitis B. Detection of this infection prior to transfusion saves potentially vulnerable patients from an additional burden and prevents the further spread of disease. Aim and objectives Our present study aimed to determine the seroprevalence of hepatitis B virus (HBV) in blood donors at the Rajendra Institute of Medical Sciences (RIMS) in Jharkhand, a tribal-preponderant state of India. Materials and methods After obtaining approval from the institutional ethics committee, a retrospective observational study was conducted among the eligible blood donors visiting RIMS from April 2016 to March 2023. A total of 195,507 subjects were included in the study. All blood donation samples collected in ethylenediaminetetraacetic acid (EDTA) vials were tested for five TTIs: human immunodeficiency virus 1 and 2, HBV, hepatitis C virus (HCV), malaria and syphilis. HBV testing was conducted via chemiluminescence technique to check f or the presence of hepatitis B surface antigen (HBsAg) in plasma. Results Among the study sample of 195,507 donors, the prevalence of HBsAg positivity was 0.87%. Among all the TTIs, more than 50% (51.93%) were HBsAg positive. The positivity percentage was higher in male donors and HBsAg positivity rose with an increase in replacement donors. Conclusions HBV is a major health concern in developing countries such as India due to its high endemicity. Therefore, early detection of HBV carriers in the blood donor population helps in curbing the spread of further infection and it also helps policymakers to develop different health programs to reduce further incidence of the infection in the general population.

Background: Leptospirosis presents with highly variable clinical manifestations affecting different organ systems in different individuals. The presentation ranges from an asymptomatic or mild disease to a severe disease associated with multiorgan failure and higher mortality. Leptospirosis is highly underreported due to a lack of diagnostic modalities and less suspicion among clinicians. Methodology: We present this single-center retrospective case series of 12 cases, which include various common and uncommon scenarios by which the disease can present and can be missed due to lack of suspicion. The study contains individual patient characteristics including demographic, laboratory, clinical, and treatment data. The association between these variables and mortality was analyzed using p-values and results were described. A p-value of<0.05 was considered statistically significant. Results: A total of 12 cases were included in the study. The male-to-female ratio was 3:1. The mean age was higher (37.75±9.81 years) in cases who died than those who recovered (34.25±14.09). Factors like history of alcoholism, presence of chronic liver disease (CLD), jaundice, acute renal failure, requirement of dialysis, and requirement of intensive care were significantly associated with increased risk of death (odds ratio >1, p-value <0.05). The most common symptom of presentation was fever in 11 (91.66%) cases. Jaundice and renal failure were significantly associated with death (odds ratio 1.2, p-value 0.04). The requirement of intensive care treatment (odds ratio 2.1, p-value 0.05) and dialysis (odds ratio 39.66, p-value 0.03) were also significantly associated with death. The percentage of death was lower in the group of patients who received combination antibiotic therapy. Conclusion: Leptospirosis has varied presentations in different individuals and the diagnosis can be missed due to lack of specific signs and symptoms. Severe diseases involving multiple organs and preexisting comorbidities are associated with higher mortality rates. Timely diagnosis and treatment are necessary to reduce mortality and increase survival.

Introduction: Hepatitis C is a global health burden with significant morbidity and mortality. It primarily affects the liver and causes acute hepatitis, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Common modes of transmission of hepatitis C virus (HCV) infection are blood transfusion, needlestick injury, and mother -fetus transmission, among which transmission, blood transfusion is one of the most important causes. Blood transfusion is one of the pillars in the management of patients that saves lives and improves morbidity. Blood donation in India is done by voluntary and replacement blood donors of both sexes. The aim of this study is to determine the seroprevalence of HCV among blood donors in the Jharkhand state, a tribal -preponderant region of India, and to see the trend over the years. Material and methods: This is a nine-year retrospective observational study from 2015 to 2023 that screened for anti-HCV antibodies (third -generation kit: Abbott Diagnostics) using the chemiluminescence technique. Results: In this study, in total, 249,461 units of blood were collected, of which the majority of donations were by male and replacement donors (RDs) comprising 230,757 (92.50%) and 188,047 (75.38%), respectively. The mean number of blood donations by replacement and male donors (MDs) was more than for voluntary donors (VDs) and female donors (FDs) (20894.11 +/- 3041.71 RDs vs. 6823.77 +/- 2332.96 VDs, p < 0.0001 and 25639.66 +/- 2810.08 MDs vs. 2078.22 +/- 828.16 FD, p < 0.0001), respectively. The overall prevalence of HCV was 0.63%, and all seropositive donors were male. Conclusion: Replacement blood donation contributes to the major part of blood donation and is primarily done by males in this tribal population -dominant region of India. Seroprevalence of HCV is high in the population of this part of India, and there is a constant or slightly upward trend in hepatitis C infection among individuals.

Background:Hepatic encephalopathy (HE) severe complication of liver cirrhosis with high mortality. Few studies have found zinc deficiency in liver cirrhosis and HE patients and found it as a precipitating factor for the development of HE. This study was done to measure the serum zinc level in patients with liver cirrhosis with HE and a correlation was obtained between serum zinc level with grades of HE. Material and Methods:A cross-sectional observational study was done on 150 patients with liver cirrhosis with HE at a tertiary care center in Jharkhand. All cases were evaluated by history taking, clinical examination, and a questionnaire and classified into different WHC grades of HE and CPC classes of cirrhosis. Routine blood investigations, imaging studies, and morning serum zinc levels were done for all patients. Results:Majority of patients with liver cirrhosis with HE had zinc deficiency. There was a statistically highly significant (P < .00001) association between low serum zinc levels and WHC grades of HE. The serum zinc levels in different classes of cirrhosis showed highly significant differences (P < .00001). The mean serum zinc level was significantly low in patients who died (35.56 ± 11.65 vs 48.36 ± 10.91, P < .0001). The study revealed a strong positive correlation (r = .88, P = .048) between serum zinc and serum albumin levels. Conclusion:Serum zinc is deficient in patients with liver cirrhosis and HE. Zinc deficiency is significantly associated with higher severity of cirrhosis and higher grades of HE. All patients with liver cirrhosis with HE and hypoalbuminemia should be evaluated for zinc deficiency.

Tuberculous meningitis is the most serious complication of tuberculosis.Early diagnosis is crucial to start relevant treatment to prevent death and disability.Electronic databases PubMed, Google Scholar, and Cochrane Library were used to find relevant articles from January 1980 to June 2022.The random-effect model in terms of pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval was adopted to derive the diagnostic efficacy of cerebrospinal fluid (CSF) adenosine deaminase (ADA) for the diagnosis of tuberculous meningitis (TBM) in adult patients.A total of 22 studies (20 prospective and two retrospective data) have been included in this meta-analysis, having 1927 participants.We perceived acceptable pooled sensitivity, specificity, summary receiver operating characteristics (SROCs), and diagnostic odds ratio (DOR) of 0.85 (95% CI: 0.77-0.90),0.90 (95% CI: 0.85-0.93),0.94 (95% CI: 0.91-0.96)and 48 (95% CI: 26-86), respectively, for CSF-ADA for differentiating TBM from non-TBM in adult patients.To ascertain the certainty of evidence for CSF-ADA as a diagnostic marker for TBM, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) analysis was used.CSF-ADA is an auspicious diagnostic test with a high degree of specificity and acceptable sensitivity for the diagnosis of tuberculous meningitis, however, with very low certainty of evidence.

Validation of a risk factor in a multifactorial disease like ischemic stroke is necessary to practice precision medicine. Many risk factors have been attributed to causing ischemic stroke but contribute very little to it. There are many risk factors that need to be validated, and fibrinogen is one such risk factor. Using a meta-analysis technique, we investigated fibrinogen as a risk factor for ischemic stroke. We searched the computerized databases such as PubMed, Google Scholar, and Cochrane to explore articles on ischemic stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random effects model. A total of 10 case-control studies with 6877 cases and 7219 controls were included in the study that match inclusion and exclusion criteria. The Asiatic population was portrayed in four studies, whereas the Caucasian population was portrayed in six studies. Under the recessive model, an elevated level of serum fibrinogen is linked to an increased risk of ischemic stroke as shown by pooled odds ratio (OR: 1.47, 95% CI: 1.19-1.76, I2 = 78.3%, P = 0.000). Our meta-analysis concluded that a high level of fibrinogen is associated with an increased risk of ischemic stroke.

background: pancytopenia is a relatively common hematological entity. it is a striking feature of many serious and life threatening illnesses. the severity of pancytopenia and the underlying pathology determine the management & prognosis. thus identification of etiology will help for better management and complete cure and better treatment of patients. objectives: 1. to find out the underlying etiopathology of pancytopenia. 2. to study the clinical presentations in pancytopenia due to various causes. methods: this study was a cross sectional study that was conducted at department of medicine of rajendra institute of medical sciences on one hundred pancytopenia patients who were evaluated clinically, along with hematological parameters and bone marrow aspiration. results: among 100 cases studied ,most patients presented with generalized weakness. the commonest physical finding was pallor followed by splenomegaly and hepatomegaly. macrocytic anaemia was the predominant blood picture.. the commonest bone marrow finding wasmegaloblastic erythroid hyperplasia. the commonest cause for pancytopenia was megaloblastic anemia (60%), followed by haematological malignancy (20%) and aplastic anemia (12%). other causes of pancytopenia were hypersplenism, leishmaniasis. conclusion: the commonest cause of pancytopenia in our study is megaloblastic anemia. this is in sharp contrast to the commonest cause of pancytopenia in various studies throughout the world where aplastic anemia has been the most common cause.

Posterior reversible encephalopathy syndrome (PRES) is a condition which is characterized by symmetric involvement of posterior white matter on brain imaging and neurological impairments such as seizures, altered mental status, headache, and visual disturbances. This entity has been classically described with hypertension, renal failure and eclampsia but it can also been seen in cases with normal blood pressure especially in patients receiving immunosuppressive therapy, chemotherapy and in patients with underlying autoimmune disease. Although PRES has been reported with several autoimmune disorders, association of Posterior reversible encephalopathy syndrome (PRES) with mixed connective tissue disease (MCTD) is very rare, hence we report a case of Posterior reversible encephalopathy syndrome in a patient with underlying mixed connective tissue disease (MCTD).