Comparative study of the accuracy of Platelet count/ spleen diameter ratio with other non-invasive parameters in predicting large esophageal varices in patients with chronic liver disease

Introduction: Bleeding from esophageal varices causes significant mortality and morbidity in patients with chronic liver disease. With upper GI endoscopy not available in many centers and in rural India, certain noninvasive methods can help to aid in the prediction of the presence of large esophageal varices. Early identification of large varices helps in prophylaxis to prevent bleeding until definitive management is done. Here in this study, we are using platelet count/spleen diameter ratio in predicting the large esophageal varices and comparing its sensitivity and specificity with non-invasive parameters. Study: This is a cross-sectional study (Prospective study) in a tertiary hospital. Methods: Patients admitted to SSIMS & RC, DAVANAGERE between January 2021 and June 2021 with a diagnosis of chronic liver disease were included in the study. Patients were assessed for ascites, splenomegaly, ultrasonographic measurements like splenic size and portal vein diameter, and laboratory parameters like hemoglobin, platelet count, total bilirubin, prothrombin time and serum albumin. The ratio of platelet count with spleen diameter was calculated. Univariate and multivariate analyses were done. Results: Incidence of large varices were seen in 44%. By ultrasonography, 22 were found to have splenomegaly while 28 were found to have normal spleen dimensions. Patients with large esophageal varices had significantly lower platelet counts as compared to those without. Spleen diameter was greater while platelet count/spleen diameter ratio was lower in patients with large esophageal varices. On multivariate analysis, independent predictors for the presence of large varices were palpable spleen, low platelet count, spleen size >13.8 mm, portal vein >13 mm and splenic vein >11.5 mm. The platelet count/ spleen diameter ratio had a sensitivity and specificity of 87 % and 85% respectively which was more than other parameters. Hence platelet count/ spleen diameter ratio can be a reliable indicator for predicting the presence of large esophageal varices than other non-invasive parameters. Conclusion: Platelet count/ spleen diameter ratio is more accurate and a strong predictor of large esophageal varices than any other non-invasive parameters in patients with chronic liver disease which warrant the need for prophylaxis and early intervention to prevent life-threatening hemorrhage.

Seroprevalence of toxoplasmosis: Comparative study between migrant workers from the Indian subcontinent and local Malaysian workers

Primary toxoplasmosis is usually subclinical, but in severely immunocompromised patients it may be life-threatening. For this reason, it could be important to monitor situations related to non-noticeable diseases among foreign arrivals in a country. In this study, we aimed to survey toxoplasmosis among migrants from Indian subcontinent to Malaysia. In a prospective, observational study, a serological evaluation on toxoplasmosis among 91 migrants from Indian Subcontinent in Malaysia was conducted in a plantation and a detention camp. We used study subject information sheet for demographic information and venous blood samples for serological study to determine Toxoplasma gondii IgG and IgM antibodies. The control group was composed of 198 local Malaysians working in the same plantation and detention camp. The age of study participants ranged from 19-45 years [geometric mean 29.9]. Except for the Nepalese, none of these migrants from the Indian Subcontinent were positive for IgM. IgG positive rates among the Nepalese, Indians and Pakistani were 46.2%, 6.6% and 5.9% respectively. All workers from Sri Lanka had 0.0% prevalence rate for both IgG and IgM. The prevalence rates of 44.9% was significantly [p <0.001] higher among local Malaysian workers when compared to migrant workers [18.8%]. No significant difference in the prevalence rates was noted among the migrants or local workers when they were grouped according to agricultural and non-agricultural occupations. Our data demonstrate that, with the exception of Nepalese population, there is a low frequency of toxoplasmosis infection among migrants from Indian subcontinent to Malaysia. A routine screening for toxoplasmosis may be indicated for sub-groups of migrants in this country

Comparison of epidural analgesia with 0.125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labour

Fifty labouring women were randomized to receive either 0.125% ropivacaine with fentanyl 2 ug/ml or an equivalent concentration of bupivacaine / fentanyl using patient controlled epidural analgesia [PCEA] with settings of :6ml/h basal rate , 5ml bolus, lO.rnin lockout, 30ml/h dose limit.Analgesia, local anaesthetic use, motor block, patient satisfaction and side effects were assessed until the time of delivery. No differences in verbal pain scores, local anesthetic use , patient satisfaction or side effects between groups were observed. Hourly local anesthetic use was similar and did not differ between groups . the mean total volume of ropivacaine /fentanyl administered from epidural catheter placement until delivery was 85.3 +/- 30.6ml ropivacaine and 170.6 +/- 61.2 ug . fentanyl versus 88.2 +/- 25.2ml bupivacaine. and 176.4 +/- 50.4 ug fentanyl PCEA demands and delivered doses were similar between groups however patients administered ropivacaine / fentanyl developed significantly less motor block than an equivalent concentration of bupivacaine / fentanyl.. this statistical significant reduction in motor block decreased the incidence of instrumental delivery in ropivacaine/fentanyl group . Neonatal assessment included APGAR scores umbilical cord blood gas analysis and neurobehavioral testing at delivery,2 and 24h of life using the neurologic and adaptive capacity score [NACS] were reported . Neonatal condition was good and generally similar in all groups. In summary, by using a patient controlled epidural analgesia technique, ropivacaine 0.125% with fentanyl 2ug/ml produces similar analgesia with significantly less motor block than similar concentration of bupivacaine with fentanyl during labour without detrimental effects to the foetus

comparison of laryngeal mask airway with tracheal tube for intra-ocular ophthalmic surgery

Changes in intra-ocular pressure during spontaneous ventilation with a laryngeal mask were compared with controlled ventilation using a tracheal tube in 40 patients undergoing intra-ocular surgery Under general anaesthesia. Intra-ocular pressure was measured before induction, after establishing the airway, at the end of the operation and after removal of the airway device. Anaesthesia was induced with propofol and maintained with isoflurane and nitrous oxide in oxygen. Mean end -tidal carbon dioxide tension was significantly higher during spontaneous ventilation than during controlled ventilation 5 minutes after establishing the airway [42 +/- 0.7 Torr versus 38.5 +/- 0.5 Torr] and at the end of surgery [45.7 +/- 0.7 Torr versus 31.5 +/- 0.2 Torr] [p < 0.001]. Despite this, intra-ocular pressures were lower than the base line and similar in the two groups throughout anaesthesia. At the end of surgery, intraocular pressure [mmHg] was [11.0 +/- 4.5] and [8.2 +/- 3.1] during spontaneous or controlled ventilation respectively, one minute after removal of the device, mean intra-ocular pressure [mmHg] in the tracheal tube group [16.1 +/- 4.5] was slightly higher than base line [15.5 +/- 3.1] and was significantly higher than the laryngeal mask group [10.7 +/- S.4] [p <0.01]. Spontaneous ventilation with a laryngeal mask is an acceptable alternative to controlled ventilation with tracheal intubation in elective intraocular surgery