Etiological Profile of Chronic Liver Disease: An Experience from Northern India

Introduction: In present age of globalization, etiological differences in disease profiles are getting narrower between different regions of world. However there are still regions were etiological profile of diseases is quite different for given particular disease that demands scrutiny from time to time so as to develop and update clinical acumen’s for correct clinical diagnosis and management of that public health problem. Chronic liver disease (CLD) is an emerging epidemic that is projected to pose enormous challenge to us in near future. So to study its various aspects from time to time is of utmost importance. Aims and objective: To study etiological profile in cases of chronic liver disease in our region.Materials and Methods: This observational prospective study was carried out in Department of Gastroenterology and Hepatology, Government Medical College; Srinagar: India over period of two years in 2018- 2020. Patients with documented CLD or diagnosed CLD on admission followed by complete etiological workup were included in study.Results: Over 2 year’s period, 246 patients were enrolled. Mean age of patients was 57.09 ± 13.90 years. Hepatitis B virus is a major etiological contributor to the burden of CLD amounting to 28% in Kashmir with Non Alcoholic Fatty Liver Disease (NAFLD)not so far behind at 23%. Whereas Alcohol related CLD disease is almost non-existent.Conclusion: Our region has etiologic profile in CLD unique in a sense that chronichepatitis B is leading contributor of CLD burden whereas Alcohol related CLD is rare in this region. Most patients were presenting at advanced stages signifying need of sensitizing people for emerging epidemic of CLD

“Acute versus chronic hemodynamic response of Carvedilol in Chronic Liver Disease with Portal hypertension”

Background: Hemodynamic studies give objective method to measure the response but need to be repeated during the course of therapy. Data comparing acute with chronic hemodynamic response of Carvedilol is scarce and needs to be studied further to elucidate the course and predictors of response, so the single hemodynamic study envisages the long-term response. Aims and Objectives: The purpose of this study was 1.To assess and compare the acute and chronic hemodynamic response to Carvedilol along with their predictors in Cirrhotic patients.2.To evaluate if acute response is maintained long term. Methods: In one hundred two consecutive patients of chronic liver disease with esophageal varices, Hepatic Venous Pressure Gradient (HVPG) was measured at baseline and 90 minutes after initial administration of 12.5 mg of Carvedilol to assess the acute response. These patients were reassessed at 3 months of dose optimization for chronic response. The acute responders were compared with chronic responders. Results: Acute response was seen in 51% and chronic in 62% patients. Most of the patients who responded to optimized therapy after no acute response belonged to CTP A. Mean reduction of HVPG in responders was 4.5± 2.2 mmHg to loading dose and 5. 5± 1.7 mmHg at 3 months. Low Cardiac output (CO), more than 2.5 mmHg drop acutely and dose optimization were independent predictors of response for acute, chronic and chronic response with no acute response respectively. Conclusion: Acute response assessed by hemodynamic study at initiation of treatment is important predictor of chronic response and is maintained over period of time. Dose optimization to achieve response is more appropriate for CTP A then B and C

A comparison of Intravenous Iron versus Oral Iron for the Management of Iron Deficiency Anemia: A Changing Paradigm

Background: Iron deficiency is one of the major morbidities worldwide. The standard treatment is the oral iron therapy, however, the concerns of slower response makes it a less feasible option in situations where quicker response is desired. The objective of this study was to compare the response, the quickness of the response and tolerability of intravenous iron with that of oral iron. A prospective, observational cohort study was conducted on 300 patients of iron deficiency anemia in District Hospital Srinagar wherein 110 patients received oral iron and 190 patients received intravenous iron. The mean hemoglobin increase at 3 weeks in oral iron group was 1.71 g/dl and in intravenous group it was 2.75 g/dl. Conclusion: Intravenous iron therapy is more effective than oral iron in terms of rapidity of the response