AIMS AND OBJECTIVES:
The study has been undertaken to identify the incidence, clinical presentation and response to treatment of nerurocysticercosis (NC) in Western Orissa.

MATERIALS AND METHODS:
150 patients presenting with convulsion were investigated for NC with CT scan and ELISA and confirmed cases of NC were given albendazole, steroid and anticonvulsant and were followed up at regular interval for 3 months.

RESULT:
Out o f150 patients with convulsion 40(26.6%) were diagnosed to have NC. Out of 40 patients of NC 8 (20%) were vegetarian and 32(80%) were non-vegetarian including 5 pork eaters. 24 (60%) cases had presented with focal convulsion. In 32 (80%) cases CT showed single ring enhancing lesion (SSEL) and 8 (20%) showed multiple enhancing and non-enhancing lesions.

The common site of lesion is in parenchyma. In 30(75%) cases the lesion were found in the parietal lobe, ELISA for IgG NC was found 32(80%) and 24(60%) cases in CSF and serum respectively. Repeat CT Scan 3 month after treatment with albendazole (15 mg/kg/day fro 28 days) steroid and anticonvulsant, showed complete resolution in 36 (90%) cases. Remaining 4 (10%) cases those not resolved were calcified lesion.

CONCLUSION:
NC is a common cause of late onset focal convulsion in this part of country. As very few 5(12.5%) cases consumed pork, transmission fo NC through raw vegetable is a strong possibility, which may be due to contamination through the bio-fertilizer commonly used in this part of the country

Aims and Objective:
Dyslipidemia is associated with 50% of all diabetic people and contributes to substantial increased risk (3-4 fold) of premature, extensive and accelerated atherosclerosis leading to CAD, PVD and MI etc. It remains silent in majority of patients with diabetes. This peculiarity makes CAD in diabetes the single most important cause of premature mortality accounting for 60-65% of all deaths. The aims of the present study was to determine the pattern of dyslipidemia in patients of CAD with type � 2 DM so as to initiate anti-lipidemic therapy for secondary prevention.

MATERIALS AND METHODS:
We studied 100 cases of type 2 DM with CAD and without CAS admitted to V.S.S. Medical College and Hospital, Burla, Orissa. The mean age group of the study was 30-69 years from both the sexes. The FBS and 2 hour PPBG was done by glucose oxidase method and serum lipid profile was estimated by enzymatic methods and compared to study the pattern of dyslipidemia.

Results:
In the present study dyslipidemia was found in 92% of diabetic patients with LDL hyperlipoproteinemia in 76% (LDL > 100mg%)HDL dydlipidemia in 64% (HDL < 40 mg%), hypertriglyceridemia in 925 (TG > 150 mg%) and hypercholesterolemia (56%) (> 200,g%). The lipid profile was significantly altered in patients with coronary artery disease compared to patients without coronary artery diseases.

Conclusion:
The major concern in the present study highlights the high percentage of LDL and TG dydlipidemia. However TC and HDL levels were of less significance. In the present study more than 90% of patients were smokers and alcoholics, LDL dyslipidemia is more significant from prognostic and therapeutic point of view, hence pharmacotherapy in the form of statins and TG dyslipidemia can be brought down by blood glucose control itself. Glycemic control should be the first priority followed by fibric acid derivatives or high dose statins.

Aims and Objective:
To study the correlation of ECG changes in hypokalemic periodic palsy with serum potassium level.
Material and Method:
Thirty five cases of clinically diagnosed hypokalemic periodic palsy were included in this study admitted to medicine wards of VSS Medical College Hospital, Burla during the period of February 2004 to June 2004. Correlation between electrocardiographic changes i.e PR � interval , QRS � duration, QTc � interval, ST- Segment depression, flattening of T-wave and presence of U-wave and AV block with corresponding serum potassium level was studied.

Secondary causes of hypokalemia were excluded in this study.

Observation:
ECG Changes of 35 cases are tabulated below with serum potassium level
Se. K+ level in mEq/L Total Cases Prolonged PR interval Presence of U-wave
Mild (3.1 � 3.5) 1 0 1
Moderate (2.6-3) 14 1 14
Severe (<2.5) 20 05 20

There were one (2.9%) cases of mild, 14(40%) cases of moderate and 20(57.1%) cases of severe hypokalemia. At the time of admission all 35 (100%) cases showed flattering of T-wave with presence of U-wave in ECG and prolonged QTc � interval in 32(91.4%) cases. ST �depression was found only 20 (57.1%) cases. Out of 10 cases of AV � block, 6(17.1%) cases had first degree AV-block with prolonged PR interval and 4(11.4%) cases had second degree AV � block.

Out of 10 cases of AV- block 9 (90%) cases had AV-block with serum potassium level &#61603;2.5 mEq/L and 1(10%) case had AV block with serum potassium 2.8 mEq/L.

Conclusion:
Various types of ECG changes occur in moderate to sever hypokalemia and do not specify level of hypokalemia. However AV � block was present in majority cases of severe hypokalemia and presence of AV � block with other features of hypokalemic ECG changes preclude immediate potassium supplementation before the availability of serum potassium level reports.

AIM:
To study the pentoxyfylline as an adjuvant therapy in treatment of severe falciparum malaria in patients of sickle cell anaemia.

MATERIALS AND METHODS:
Patients having clinical features suggestive of severe falciparum malaria (according to WHO guidelines) excluding pregnant woman were investigated for sickling test and hemoglobin electrophoresis. Biochemical and haematological investigations e.g hemoglobin concentration, total leucocyte count, differential count, urine for sugar , albumin, red cell , pus cell, hemoglobin, serum for direct and indirect bilirubin, AST, ALT, alkalaine phosphatase, urea, creatinine, sodium and potassium were done on the day of asmission and on 3rd and 8th day. Detailed daily clinical examination was done. Forty cases of severe falciparum malaria with sickle cell disease were studied. Twenty cases treated with quinine and pentoxyfylline and other twenty cases were treated with quinine only.

RESULT:
Patients who received pentoxyfylline and quinine had less duration of unconsciousness, had significant fall of bilirubin concentration as compared to those received quinine only. There was no significant difference in BUN and overall mortality between the two groups.

CONCLUSION:
This study shows that simultaneous administration of pentoxyfylline and quinine leads to early recovery from coma and reduction of serum bilirubin concentration . So pentoxyfylline may be useful in severe falciparum malaria in sickle cell disease.

Abstract:
A rare case of cirrhosis of liver following autoimmune hepatitis is reported in a young female patient. The pathophysiology, clinical presentation and management of this condition are reviewed.
Key Words: Autoimmune, cirrhosis, hepatitis
Introduction:
Autoimmune hepatitis (formerly called autoimmune chronic active hepatitis) is a chronic disorder characterized by continuing hepatocellular necrosis and inflammation, usually with fibrosis, which tends to progress to cirrhosis and liver failure. The prominence of extrahepatic features of this disorder supports an autoimmune process in its pathogenesis. Because autoantibodies and other typical features of autoimmune disorder do not occur in all cases, a �broader� more appropriate designation of this type of chronic hepatitis is idiopathic or cryptogenic.
Case Report
A 33 year old female patient came to us with history of amenorrhoea for last 6 months, gradual distension of abdomen for last 3 months, one episode of hematemesis 2 months back and scanty urination for 10 days.
One month prior to admission, the patient was diagnosed provisionally as a case of cirrhosis of liver and sclerotherapy was done for bleeding esophageal varices. Patient was on regular treatment with propranolol 40mg /day, Pantoprazole, Sucralfate and other supportivce drugs. Patient had no further hematemesis after sclerotherapy, but symptoms of progressive liver failure persisted. She is not a known case of DM, HTN, SCD, Pul, TB. There is no history of intake of heparotoxic drugs or joint pain. On examination, the patient was edematous with mild pallor, mild icterus, with a pulse rate of 68/min, regular, BP 110/90 mm Hg, CVS-NAD, chest-bilateral basal fine crepitions, abdomen-moderate ascites with engorged abdominal veins, the 24 hr urine output was 100ml.
Investigation
Hb% - 8.4%,
TLC � 7,900/mm3, DC-N 80%, E 6%, L-14%
RBS � 104m%
Urine Sugar Nil, Albumin - +
Sr. urea � 5-6%, Sr. creatinine 2mg%
Sr. Na+ - 100 mmol/lt, Sr. K+ - 2.0 mmol/lt
Sr. RA factor � Negative
HbsAg � Negative
LE cell � Negative
Anti nuclear antibody � positive (Odd ratro 1.64), (+ve>1.0)
Anti ds DNA � Borderline positive
LFT:
S. bilirubin 1` - 0.72mg%
S. bilirubin 30` - 2.11mg%
SGPT � 25IU/lt
SGOT � 62 IU/lt
Sr. Alk. Phosphate � 135 IU/lt
Sr. GGT � 12.2 IU/lt
Sr. Alb � 1.7 gm/dl
Sr. Protein � 6.5gm/dl
A: G ratio � 0.35
USG of abdomen � Ascites with splenomegaly, dilated portal vein
Chest X ray PA view � NAD
Needle biopsy of liver showed portal and periportal mononuclear infiltrate with areas of piecemeal necrosis and fibrosis.
The patient was diagnosed as a case of autoimmune cirrhosis of liver, started on oral prendisolone 30mg/day and other supportive treatment. The patient showed marked improvement after starting oral prednisolone. The condition of the patient was found to be stable on regular follow up since last six months.
Discussion:
Autoimmune hepatitis (AIH) � an inflammatory liver disease of unknown etiology characterized by suppressor � T cell defects and the production of autoantibodies directed against hepatocyte surface antigens. Two main types are recognized according to the presence of circulating autoantibodies.
Type I � After adults or childredn antinuclear antibodies (ANA) and / or
Antismooth muscle antibodies (SMA)
Type II � Affect children
Anti liver/kidney microsomal type I (LKM I) antibodies.
Clinical Features
Predominantly affects young and middle aged women, 25% present with acute hepatitis and features of an autommune disease e.g. fever, malaise, utticarial rash, polyrthritis, pleurisy or glumerulonephritis. The remainder present insidiously or are symptomatic and diagnosed incidentally with signs of chronic liver disease. Amenorrhoea is common.
Associations:
� Autommune thyroiditis
� Autoimmune hemolytic anemia
� Penicious anemia
� Diabetes mellitus (Type I)
� Ulcerative colitis
� Glomerulonephritis
� HLA AI, B8 and DR3 haplotype
Tests
� Abnormal LFT (AST&#61613;)
� Hypergammaglobulinemia
� +ve for autoantibodies (ANA,SMA orLKM)
� Anemia TIC & TPC (Hypersplenism)
� Liver biopsy : Mononuclear infiltrate of portal and periportal areas with piecemeal necrosis, fibrosis and other features suggestive of cirrhosis.
� An ERCP should be performed to exclude primary sclerosing cholangitis if alkaline phosphatase is disproportionately raised.
Treatment
Immunosuppression (prednisolone, azathioprine )
Liver transplantation, but recurrence may occur
Prognosis : There is paucity of literature about autoimmune hepatitis among Indian population. The disease however shows variable natural history. Mild cases are marked by remissions and exacerbations, response to immunosuppression being excellent. Overall mortality without treatment is as high as 40%. Moderate to severe cases progress to cirrhosis of liver, hepatic failure and rarely hepatocellular carcinoma. In general, immunosupression remains the mainstay of treatment and treatment often slows down the disease process. Hence early diagnosis and institution immunosuppression is rewarding.
Conclusion
The diagnosis of autoimmune hepatitis requires a high degree of suspicion, thus many cases remain undiagnosed. All cases of hepatocellular failure where no obvious cause like viral hepatitis, alcoholism, ingestion of hepatotoxic drugs etc. are found should be investigated for autoimmune hepatitis.
References:
1. Krawitt E.L: Autoimmune hepatitis. N. Engl. J. Med. 334;897,1996.
2. Czaja A.J. et al. atommne hepatitis; Evolving concepts and treatment strategies. Dig. Dis. Sci. 40; 435,1995.
3. Czaja A.J. et al. Associations between alleles of the major histocompatibility complex and type I autoimmune hepatitis, Hepatology 25; 317, 1997.
4. Johnson P.J. et al. Meeting report; International autoimmune hepatitis group. Hepatology 18:998,1993.