Utility of gray-scale histogram analysis in the assessment of treatment response in patients with infected cirrhotic ascites.

OBJECTIVE: To evaluate the utility of B-mode gray-scale histogram analysis in the management of patients with infected cirrhotic ascites. METHODS: A total of 97 patients (mean(SD) age : 66.8(14.2) years, 50.5% were males) diagnosed with cirrhotic ascites were included in this non-interventional study. Paracentesis for ascitic fluid analysis [culture tests, white blood cell count, albumin and protein levels, serum ascites albumin gradient (SAAG)] and gray-scale histogram analysis for ascites/subcutaneous echogenicity ratio (ASER) were performed at baseline in each patient and on Day 2 and Day 5 of treatment in patients with infected ascites. Receiver operating characteristics (ROC) curve was plotted to determine performance of ASER in identification of antibiotic resistance with calculation of area under curve (AUC) and ideal cut-off value of % change in ASER to detect antibiotic resistance. RESULTS: Treatment was associated with a significant decrease in median (min-max) ASER [from 0.005(0.0002-0.02) at baseline to 0.003(0.0001-0.01) on Day 2 and 0.0005(0.0001-0.009) on Day 5] and ascitic fluid polymorphonuclear leukocyte (PMNL) count [from 600(300-2200) at baseline to 350(50-1250) on Day 2 and 100(50-1100) on Day 5] (p<0.001 for each). ROC analysis revealed that less than 38% reduction in ASER [AUC: 0.923, 95% CI (0.797-0.982), p<0.001] was a potential marker of antibiotic resistance with a sensitivity of 90.9% and a specificity of 95.0%. CONCLUSIONS: In conclusion, our findings emphasize potential utility of gray-scale histogram based quantitative analysis of ascitic fluid echogenicity as an adjunct non-invasive method in the assessment of treatment response and early recognition of treatment failure in patients with infected ascites.

Evaluation of the activated clotting time and activated partial thromboplastin time for the monitoring of heparin in adult extracorporeal membrane oxygenation patients.

INTRODUCTION: Historically, the activated clotting time (ACT) has been the preferred monitoring test of the heparin effect in extracorporeal membrane oxygenation (ECMO) patients. However, few adult studies have evaluated its correlation to the heparin dose or other monitoring tests, such as the activated partial thromboplastin time (aPTT). This retrospective study sought to evaluate the correlation between the heparin dose and these monitoring tests. METHODS: Patients administered a heparin drip during ECMO were included in this study. The primary endpoints were the correlation between heparin dose and ACT or aPTT and the relationship between paired ACT and aPTT samples. RESULTS: Forty-six patients met the criteria for study inclusion. A better correlation was observed for heparin dose and aPTT (Pearson product-moment correlation coefficient (r) = 0.43 - 0.54) versus ACT (r = 0.11 - 0.14). Among the paired sample data, ACT values did not differ significantly between Groups two (aPTT 60 - 75 seconds) and three (aPTT >75 seconds). CONCLUSION: The heparin dose correlated better with aPTT relative to ACT and, thus, may be considered a more effective tool for the dosing of heparin in adult ECMO patients. Paired ACT and aPTT sample data suggested a poor relationship between these two anticoagulant monitoring tests.

Severe pulmonary haemorrhage accompanying hepatorenal failure in fulminant leptospirosis.

Leptospirosis is a re-emerging spirochetal zoonosis with a worldwide distribution affecting both animals and humans. The clinical syndromes may vary from a subclinical infection to a severe illness. Although it may potentially have a fulminant and fatal course, leptospirosis usually remains as an underdiagnosed cause of multiorgan failure. In this study, we report a patient with leptospirosis who presented with a fulminant course of diffuse alveolar haemorrhage and hepatorenal failure. His clinical condition deteriorated, despite appropriate antibiotic therapy and haemodialysis. However, he showed prompt clinical improvement when corticosteroids and plasma exchange were instituted in addition to the original therapy. We conclude that leptospirosis should be considered in any case presenting with pulmonary haemorrhage and hepatorenal failure. Plasma exchange and corticosteroids may be a choice of treatment in selected patients unresponsive to conventional therapy. Potential benefits of plasma exchange and corticosteroids may be based on a toxin- and/or cytokine-mediated pathogenesis of the disease.

The mean platelet volume in subjects with impaired fasting glucose.

Mean platelet volume (MPV), a determinant of platelet function, is a newly emerging risk factor for atherothrombosis. Impaired fasting glucose (IFG) is probably a frequent glycemic disorder in the general population and is considered as a prediabetic state. The present study was designed to evaluate MPV in subjects with IFG compared with diabetic patients and normoglycemic control subjects. We selected 50 patients with type 2 diabetes mellitus, 50 subjects with IFG, and 50 normoglycemic healthy subjects matched for age, gender, and body mass index. MPV was very significantly higher in diabetic and IFG groups than in control group (p < 0.00, p < 0.05, respectively); it was also higher in diabetic group than in IFG group (p < 0.05). Platelet counts were not different among the study groups (p > 0.05). Platelet mass was significantly higher in diabetic and IFG groups than in normotensives (p < 0.00, p < 0.05, respectively); and it was also higher in diabetic group than in IFG group (p < 0.05). MPV and platelet mass were positively correlated with fasting glucose and HbA1c in diabetic and IFG groups (p < 0.05). In conclusion, our data suggests one possible mechanism by which subjects with IFG may be at increased cardiovascular risk.