Search

Introduction: Upper Gastrointestinal Endoscopy is considered the best screening tool for varices among patients with chronic liver disease. However, it is an expensive and invasive procedure that is not routinely available in rural India. Abdominal ultrasonography along with colour Doppler study is an inexpensive test commonly ordered for patients with chronic liver disease. Recent literature suggests that ultrasonographic parameters can be used to predict varices. Aim: To determine if ultrasonography of the entire abdomen and spleno-portal Doppler study findings can predict oesophageal varices in patients with chronic liver disease. Materials and Methods: The present hospital-based observational, cross-sectional study was conducted in the indoor ward of the Department of General Medicine at Medical College and Hospital, Kolkata, India, over a duration of one year from February 2021 to February 2022. Total 100 patients with chronic liver disease, admitted to the hospital ward, were included in the study. Child-Turcotte-Pugh (CTP) scores were obtained for all patients. Ultrasonographic and spleno-portal Doppler indices, such as liver size, spleen size, portal vein diameter, splenic vein diameter, peak systolic velocity of the portal vein, and portal vein/splenic vein diameter ratio, were measured alongside upper gastrointestinal endoscopy to detect varices. The data were analysed using Statistical Package for Social Sciences (SPSS) version 28.0. The Chi-square test was used to test for significant differences in proportions (categorical data), and the independent t-test and Analysis of Variance (ANOVA) with Tukey's Post-hoc test were employed to test for significant differences in means (continuous data). Additionally, Receiver Operating Characteristic (ROC) curves were obtained for statistically significant parameters to predict the presence of varices. Results: The study enrolled 100 patients (63% males, 37% females) with a mean age of 49.19±14.965 years, ranging from 14 to 91 years. (median age of 52, range 14-91 years). Of these, 68 patients (68%) had oesophageal varices, while 32 (32%) did not. The study found that a mean spleen size of 13.55 cm, a mean portal vein diameter of 12.5 mm, and a mean splenic vein diameter of ≥9.05 mm were predictive of varices. Additionally, a mean portal vein/splenic vein diameter ratio of 1.6150 was also predictive of varices. However, there was no significant difference in mean liver size and peak systolic velocity between those with and without varices. Conclusion: The present study suggests that a spleen size, portal vein diameter, splenic vein diameter, and portal vein/splenic vein diameter ratio can be reliably used to predict oesophageal varices among patients with chronic liver disease. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus is a zoonotic infectious disease caused by the Gram-negative coccobacillus Orientia tsutsugamushi. Meningoencephalitis occurs in two-thirds of all the infected cases. Aims and Objectives: The study of these cases was conducted to study the clinical, biochemical, and hematological features of scrub typhus meningoencephalitis. Materials and Methods: We included 12 patients who were admitted in the General Medicine Ward of Medical College and Hospital, Kolkata, between May 2021 and July 2022. The serum scrub typhus immunoglobulin M (IgM) test was used to diagnose the cases after ruling out dengue, malaria, leptospirosis, bacterial, tubercular, and viral meningoencephalitis. Results: A triad of fever, altered sensorium, and meningeal signs were present in all of the cases. 2 patients had seizures, 1 patient had lateral rectus palsy, 1 patient had a generalized maculopapular rash, and eschar was seen in only 2 cases. The most common laboratory abnormalities were hyponatremia, anemia, and transaminitis (each 83.33%). 8 cases (66.7%) had a combination of anemia, hyponatremia, and transaminitis. Cerebrospinal fluid abnormalities included protein elevation (75%) and lymphocytic pleocytosis (83.33%). Scrub typhus IgM was positive in all of them. All the cases showed excellent response to doxycycline. Conclusion: A high degree of clinical suspicion is required to diagnose scrub typhus meningoencephalitis. The eschar is detected in very few cases and it may be difficult to recognize the same among the dark-skinned Indian population. However, as per our study, any case of meningoencephalitis with a combination of anemia, hyponatremia, and deranged liver function tests should always raise the possibility of the aforementioned disease and doxycycline therapy must be started promptly. [ABSTRACT FROM AUTHOR]