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.

Mutation in mexR-gene leading to drug resistance in corneal keratitis in human.

The present study deals with the genetic polymorphism of the mexR gene which is involved in the resistance to drugs like ciprofloxacin. Mutations in mexR result in increased resistance to multiple antibiotics due to overexpression of this efflux system. The MexR product contains 147 amino acids with a molecular mass of 16,964 Da. We detected 28 point mutations in 14 samples from corneal scraping infected with Pseudomonas aeruginosa, which were screened for ciprofloxacin resistance. Twenty four were silent mutations and four missense mutations. Mapping these mutations was done by using in silico methods on the protein 3D- structure obtained from PDB database, localized at 3 specific sites. Single amino acid changes (mutations) may influence MexR stability or its ability to dimerise, and thus result in the conformation changes at the DNA-binding domain, of the structure. Hence it is concluded that the mutations in the DNA binding domain of mexR gene could be one of the factors contributing to the possible drug resistance in these patients.

In vitro cytogenetic studies of cypermethrin on human lymphocytes.

Assessment of cytotoxicity and response to external factors like pesticides were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide (MTT) or MTT assay, which measures mitochondrial metabolism in the entire cell culture and provides information about the percentage of cell survival. Utilizing the MTT assay, the cytotoxicity of cypermethrin was determined on lymphocyte cultures from human peripheral blood samples, the short-term lymphocyte cultures were incubated with various aliquots of the cypermethrin and the LC50 was found to be 33.6 microM. Lymphocytes treated with low-doses (1/10 of LC50) of cypermethrin showed an increase in the frequency of chromosomal aberrations and found to be significant. Karyotype analysis revealed more satellite associations and chromosomal breaks in cypermethrin treated samples. Low-doses of the pesticide also induced single-strand breaks in the DNA as assessed by comet assay. The pesticide caused increase in the comet tail length with increase in pesticide concentration, implicating genotoxicity in somatic cells. It is concluded that In vitro assays could give important information of the mechanism of toxicity at low dosages and impact on genetic material of human origin.

Post-BCG vaccination check based on serum IgG to culture filtrate antigens.

Since there are no reliable methods to demonstrate the effect of BCG vaccination in children, culture filtrates of BCG were evaluated for their specificity and sensitivity. BCG culture filtrate (BCG-CF), BCG sonicate and tuberculin were used as antigens and tested against serum, for the presence of IgG class of antibodies by ELISA and Western blot. Methodology: Children in the age-group of 1 to 10 years, were categorized as: (a) normal, and vaccinated, n=35; (b) normal, without a scar and with no evident history of vaccination, n=15; and (c) children with tuberculosis (meningitis, miliary and lymphadenitis) n=15. Results: The mean values of optical density (OD) in group (a), 4.0+0.08, were significantly high (P<0.001) to BCG-CF, compared to that of groups (b) (1.0+0.02) and (c) (1.4+0.03). The Western blot results revealed that a greater number of children (71%) in the vaccinated group reacted to low molecular weight proteins (10-30kDa) compared to other groups (unvaccinated: 17% and TB: 20%). The overall specificity, sensitivity, positive predictive value and negative predictive value of BCG-CF were higher in the vaccinated group. Conclusions: The results of the study suggest that the secreted antigens of BCG induce antibody formation, which are specific and are directed mostly towards the low molecular weight proteins. The presence of these antibodies could probably be exploited in an assay to distinguish children immunized by BCG from the unvaccinated and those having tuberculosis.