ABSTRACT
Background: Esophageal variceal bleeding is one among the common complication of cirrhosis which is fatal. Latest studies are focusing more on using non-invasive techniques to classify cirrhotic patients according to their risk of having varices. The platelet count-splenic diameter ratio is considered as one such parameter and is used in predicting esophageal varices in patients with cirrhosis. Objectives of the study was to assess the utility of platelet count-splenic diameter ratio as a useful non- invasive parameter in predicting the presence/ absence /size of esophageal varices in patients with cirrhosis.Methods: Diagnostic evaluation study was done in a tertiary hospital of Kerala state India. 93 adults above the age of 18 yrs with diagnosis of cirrhosis was selected and detailed history, physical, systemic examination and imaging was done. The degree of correlation between platelet count-splenic size ratio and the presence/absence/size of esophageal varices was studied along with its utility as an independent non- invasive marker. Frequency was expressed in percentages.Results: Best cut-off for prediction of esophageal varices Grade 1 was platelet count/spleen diameter ratio of 954, which had Specificity of 85.7% and Positive predictive value of 94.1% Cut-off for prediction of Grade 2 esophageal varices was platelet count/spleen diameter ratio of 916 which had a Sensitivity of 78.9%, Specificity of 88.9%. Whereas cut-off for prediction of Grade 3 esophageal varices was a ratio of 899 which had a high Sensitivity of 88% and Negative predictive value of 93.6 % but Specificity was only 64.7% and Positive predictive value of 47.8% only.Conclusions: The platelet count splenic diameter ratio is accurate to be used as screening tool to predict the presence of Grade 2 Esophageal varices in Patients with Cirrhosis. More studies need to be done around the globe for more evidence.
ABSTRACT
Introduction: Dengue fever is the most common mosquitoborne viral illness in humans. Study was done to determinethe serum levels of pro -inflammatory cytokines (IL-6,IFgamma and TNF alpha) in patients with dengue infection andto determine the correlation of level of cytokine with diseaseseverity, platelet count and SGOT values.Material and methods: Preserved samples of patients withthe clinical features compatible with dengue infection andNSI antigen positivity admitted during the month of Mayand June 2016 in Pushpagiri Institute of Medical science andResearch Centre, Thiruvalla were analysed for levels of pro-inflammatory cytokines (IL-6, IF gamma, and TNF alpha).Disease severity of Dengue patients was assessed from theclinical details obtained from medical records. Total samplesused in this study were 80 of which 49 were patients withdengue fever,11 were patients with severe dengue,10 werepatients with other febrile illness and 10 are from healthyindividuals.Results: The levels of all three cytokines were found to beelevated in the infected groups (dengue and severe dengue)when compared to the control groups (healthy and nondengue). The level of interleukin 6 and TNF alpha were foundto be significantly elevated (p value <0.05) in the severe formof dengue. However no statistically significant difference(p value <0.05) between the infected and control group wasfound in Interferon gamma although it showed an elevation inthe infected group. It was observed that all the three cytokinesshowed a negative correlation with platelet count.Conclusions: IL6 and TNF alpha correlated with diseaseseverity suggesting that these cytokines can be used as amarker to predict the severity of the disease. Thus, necessarytreatments and precaution can be taken in advance. TNFalpha correlated with the degree of thrombocytopenia and IL6correlated with level of SGOT.
ABSTRACT
Introduction: Dengue fever is the most common mosquitoborne viral illness in humans. Study was done to determinethe serum levels of pro -inflammatory cytokines (IL-6, IFNgamma and TNF alpha) in patients with dengue infectionand to determine the correlation of level of cytokine withdisease severity, platelet count and SGOT values.Material and methods: Preserved samples of patients withthe clinical features compatible with dengue infection andNSI antigen positivity admitted during the month of Mayand June 2016 in Pushpagiri Institute of Medical science andResearch Centre, Thiruvalla were analysed for levels of pro-inflammatory cytokines (IL-6, IFN gamma, and TNF alpha).Disease severity of Dengue patients was assessed from theclinical details obtained from medical records. Total samplesused in this study were 80 of which 49 were patients withdengue fever,11 were patients with severe dengue,10 werepatients with other febrile illness and 10 are from healthyindividuals.Results: The levels of all three cytokines were found to beelevated in the infected groups (dengue and severe dengue)when compared to the control groups (healthy and nondengue). The level of interleukin 6 and TNF alpha were foundto be significantly elevated (p value <0.05) in the severe formof dengue. However no statistically significant difference(p value <0.05) between the infected and control group wasfound in Interferon gamma although it showed an elevation inthe infected group. It was observed that all the three cytokinesshowed a negative correlation with platelet count.Conclusions: IL6 and TNF alpha correlated with diseaseseverity suggesting that these cytokines can be used as amarker to predict the severity of the disease. Thus, necessarytreatments and precaution can be taken in advance. TNFalpha correlated with the degree of thrombocytopenia and IL6correlated with level of SGOT.