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Introduction: Cirrhosis of the liver is a major health problem in our country. Patients with cirrhosis are at risk of developing esophageal varices and variceal bleeding with high mortality. They must undergo routine upper gastrointestinal endoscopy to screen for the presence of varices. This poses an economic, social, and medical burden. Thus, this warrants a non-invasive predictor of esophageal varices in a cirrhotic patient. The aim of this study was to find the correlation between SAAG and esophageal varices in portal hypertension due to cirrhosis of liver. Methods: Patients (45 males and 35 females) above 18 years of age and with cirrhosis of the liver underwent cross sectional observational study at Nepal Medical College Teaching hospital between October 2015 and December 2017 AD. Serum albumin and ascitic fluid albumin were analyzed on the same day and serum-ascites albumin gradient (SAAG) was calculated. Upper GI endoscopy was done to evaluate for the presence of esophageal and gastric varices. Pearson's chi-square test was applied to see the relation between SAAG and esophageal varices. Results: Among the 80 patients studied, 56.2% were male and 93.75% had varices. Majority of the patients who had esophageal varices had SAAG of more than 1.1 g/dL. A positive correlation was found between serum-ascites-albumin gradient and esophageal varices but was statistically not significant. A cut-off of >1.6 for SAAG to discriminate between presence and absence of varices yielded a sensitivity of 78.66% and a positive predictive value of 92.18%. Conclusion: This study highlighted that SAAG has a positive correlation with esophageal varices with high sensitivity and positive predictive value in estimating the presence of varices but without statistical significance. It has a low specificity. Due to statistically insignificant correlation and low specificity, SAAG cannot be used in place of upper GI endoscopy in diagnosing gastroesophageal varices

Adult-onset Still’s disease (ASD) is a rare clinical entity with unknown etiology, characterized by arthritis, fever, evanescent rash and other systemic presentations. This case report describes a 19-year-old male who presented with sore throat, fever, arthritis, evanescent rash, raised liver enzymes and hyperferritinemia. It also reveals the diagnostic dilemma faced during the diagnosis of the disease. He was diagnosed to have ASD based on Yamuguchi criteria after the exclusion of other potential diagnoses. Patient was treated with prednisolone and there was a good response with improvement in symptoms and laboratory indices.

Background: Peripheral edema is one of the common causes of visit to medical outpatient department. After history taking and investigations few patients are left without diagnosis. This study was designed to find if there is any association between pedal edema and subclinical hypothyroidism when there is no other systemic disease is found.Materials and Methods: This is a cross-sectional observational hospital based study done in one of Medical colleges in Kathmandu for a period of 2 years .All patient coming to medical OPD for the first time with bilateral painless limb swelling were evaluated data were tabulated and analyzed using Ms Excel.Results: Out of 300 patients, 146 patients were exclude from history and clinical evaluation, 154 patients underwent laboratory evaluation. After investigations 46 patients were left without any other systemic disease. Out of them only 3 were male. About 40% of them are overweight or obese. 57% of them had high TSH level, which was significantly associated with limb swelling (t=0.012)Conclusion: Subclinical hypothyroidism is significantly associated with painless bilateral limb swelling when there is no other systemic cause. It is logical to investigate a limb swelling with thyroid function test however there needs to be a larger interventional study to exactly point out the cause in these patients.

Background and aim: Type 2 diabetes mellitus is associated with the development of premature arteriosclerosis and a higher cardiovascular morbidity and mortality. Diabetic dyslipidaemia is believed to play an important role in the pathogenesis of accelerated atherosclerosis in this condition. B-mode ultrasound enables non-invasive, direct visualization of the arterial wall. The aim of this study was to correlate intima media thickness of the carotid artery (CIMT) quantification as a reliable marker of atherosclerotic burden in diabetes patients.Method: It was a Cross Sectional Study done on 50 patients in the age group of 30-70 years with type II Diabetes Mellitus of more than 5 years duration without hypertension. Carotid Intima Media Thickness (CIMT) was measured using an echotomographic system with a 7.5-MHz linear transducer probe. With the carotid bulb and the longitudinal projection of the common carotid artery 2cmx from carotid bulb, the site of the greatest thickness including a plaque lesion was sought along both near and far walls bilaterally.Results: The mean CIMT of subjects with fasting triglyceride level less than 150 mg/ dL was 13.2±0.48 mm with a range of 0.6-2.4 mm. Similarly the level between 150- 200 mg/dL was 1.89±0.54 mm with a range of 1.3-2.6 mm and level more than 200 mg/dL was 2.00±0.63 mm with a range of 0.8-2.6 mm. From the present study, it is clearly evident that age, duration of disease, fasting triglycerides and postprandial triglycerides have a significant impact on the CIMT, whereas other variables are having any significant impact on CIMT.Conclusion: The present study concludes both fasting and postprandial triglyceride levels correlate significantly with carotid intima media thickness. But, the correlation of postprandial triglyceride levels with carotid intima media thickness is better than that of fasting triglyceride levels with carotid intima media thickness, the postprandial hypertriglyceridemia despite normal fasting triglyceride level can be considered as an independent risk factor for atherosclerosis in type 2 diabetes mellitus.

Hyperlipidaemia is one of the major contributors to atherosclerosis and CoronaryHeart Disease (CHD) in our society. Numerous clinical and epidemiological studieshave shown repeatedly that an elevated blood cholesterol level is one of the majormodifiable risk factors associated with the development of CHD. In particular, thesestudies have demonstrated that low- density lipoprotein (LDL) cholesterol is theprimary lipoprotein mediating atherosclerosis. Non-pharmacological therapy especiallydietary therapy and exercise remains the first line of treatment in hyperlipidaemia,with pharmacotherapy reserved for use in patients at high risk of coronary heartdisease or patients who do not respond to non-pharmacological therapyKey Words: Hyperlipidaemia, LDL Cholesterol, HDL Cholesterol, coronary HeartDisease (CHD), Atherosclerosis, National Cholesterol Education Program (NCEP)