Optimal diagnostic tool for surveillance of oesophageal varices during COVID-19 pandemic.

AIM: To study the diagnostic accuracy and utility of triphasic abdominal computed tomography (CT) in the diagnosis and grading of oesophageal varices (OVs) as an alternative to endoscopy during the COVID-19 pandemic. MATERIALS AND METHODS: A prospective analysis was undertaken of retrospective data from cirrhotic patients who underwent oesophago-gastro-duodenoscopy (OGD) and a triphasic abdominal CT from January to December 2019. Endoscopists and radiologists provided their respective independent assessment of OV grading after being blinded to the clinical details. Performance of CT grading of OVs was compared with the reference standard endoscopic grading using weighted kappa (k). Non-invasive scores such, as aspartate transaminase (AST)-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4) Index, platelet: spleen (PS) ratio were correlated between the two techniques. RESULTS: OV grading between endoscopists and radiologists showed 81.73% agreement (85 out of 104 patients) in the comparative analysis of 104 cirrhotic patients, of which no varices (57.1%, n=4), small (85.1%, n=23), medium (72.2%%, n=26), and large varices (94.1%, n=32) with a weighted k score of 0.88 (95% confidence interval 0.82-0.94). Overall, the sensitivity of CT in the diagnosis of no, small, medium, and large OVs was 66.6%, 79.3%, 89.6%, and 94.1%, respectively, with an area under the receiver operating curve (AUROC) score of 0.775, 0.887, 0.839, and 0.914. Performance of APRI, FIB-4, and PS ratio correlated well with the severity of OVs with no difference between OGD and CT grading. CONCLUSION: Triphasic abdominal CT can be an invaluable tool in the diagnosis and grading of OVs during the COVID-19 pandemic.

COVID-19 lockdown: impact on liver transplant recipients - a single centre survey

We conducted a short survey amongst liver transplant recipients to assess the impact and challenges faced during COVID-19 lockdown. Results were analysed using SPSS V 17.0. Chi-square test was utilized to compare variables between the two time periods. A P-value of <0.05 was considered statistically significant. We conducted a short survey amongst liver transplant recipients to assess the impact and challenges faced during COVID-19 lockdown. Results were analysed using SPSS V 17.0. Chi-square test was utilized to compare variables between the two time periods. Whereas, physical exercise (84.5[%] vs 71.4[%], P=0.04), occupation (53.6[%] vs 23.8[%], P=0.00), problems accessing pharmacy (2.4[%] vs 38.1[%], P=0.00), access to emergency doctors (95.2[%] vs 77.4[%], P=0.00), laboratory investigations (98.8[%] vs 46.4[%], P=0.00) and transplant centre (95.2[%] vs 78.6[%], P=0.00) were significantly affected during the lockdown period. Lockdown has significantly affected physical exercise of transplant recipients and the reasons were 'scared of COVID-19' and 'lack of space for exercise'. In patients who carried out physical exercise, the majority (68 patients) switched to indoor walking. Twenty-five (32.6[%]) patients reported a median 3 (1-5) kilograms weight gain in 3 weeks;75[%] of them gained more than 2 kilograms during the same period. Thirty-two (38.0[%]) patients reported difficult accessibility to pharmacy and commonly reported reasons were 'non-availability of immunosuppressive drugs' (17 patients) and 'lack of transport' (15 patients). Similarly, patients who were unable to carry out laboratory tests reasoned out 'accessibility and transport challenges. With accessibility to local emergency doctors and transplant centre most patients reported, 'no necessity at present'. WHO recommended measures of self-hygiene to reduce COVID-19, such as regular hand washing, wearing mask, social distancing was carried out by 82 (97.6[%]), 45 (53.6[%]) and 80 (95.2[%]), respectively. Interestingly only 23 (46.9[%]) were confined indoors during the lockdown period.