Non Invasive Predictor of Oesophgeal Varices in Cirrhosis- Platelet Count/Spleen Diameter Ratio

BACKGROUND : Current guidelines recommend that all cirrhotic patients must undergo screening endoscopy for the presence of oesophageal varices. With increasing number of patients with chronic liver disease and their improved survival, these guidelines impose a burden on the endoscopic units, available facilities and also economically. In this study we aim to identify the value of Platelet count/Spleen diameter ratio as a non invasive predictor of oesophageal varices in patients with cirrhosis and its predictive efficacy. MATERIALS AND METHODS : 60 patients with newly diagnosed cirrhosis admitted during a one year study period were evaluated prospectively. Patients with unstable vitals at admission, bleeders and history of prior treatment (Medical or Surgical) were excluded. All patients underwent biochemical work up, UGI scopy and ultrasonographic measurement for spleen diameter. Platelet count/spleen diameter ratio was calculated for all patients. RESULTS : Platelet count/spleen diameter ratio was found to be significantly different in patients with oesophageal varices and in those without. At a cutoff of 909, it had a sensitivity of 95.2% and specificity of 88.8%. Prevalence adjusted positive predictive value of the test was found to be 95% and negative predictive value of 89%. It also correlated significantly with other non invasive parameters such as ascites, platelet count, splenomegaly and Child-Pugh score. CONCLUSION : Platelet count/spleen diameter is valuable tool in non invasive prediction of oesophageal varices in patients with cirrhosis. Its use would avoid unnecessary endoscopy without a significant risk of missing oesophageal varices

The Werner Syndrome Protein Is Distinguished from the Bloom Syndrome Protein by Its Capacity to Tightly Bind Diverse DNA Structures

Loss of Werner syndrome helicase-exonuclease (WRN) or of its homolog Bloom syndrome helicase (BLM) results in different inherited disorders. Whereas Werner syndrome is characterized by premature onset of aging and age-associated diseases, Bloom syndrome involves developmental abnormalities and increased predisposition to diverse malignancies. To identify biochemical differences between WRN and BLM that might contribute to the dissimilar outcomes of their loss, we compared their abilities to unwind and bind in vitro diverse DNA structures. Full-length recombinant WRN and BLM proteins expressed in and purified from Sf9 insect cells unwound to comparable extents and with similar Km values partial DNA duplex, splayed arm DNA and G'2 bimolecular quadruplex DNA. However, WRN resolved bubble DNA ∼25-fold more efficiently than BLM. The two enzymes were mainly distinguished by their contrasting abilities to bind DNA. WRN bound partial duplexes, bubble and splayed arm DNA and G'2 bimolecular and G4 four-molecular quadruplexes with dissociation constants of 0.25 to 25 nM. By contrast, BLM formed substantial complexes with only G4 quadruplex DNA while binding only marginally other DNA structures. We raise the possibility that in addition to its enzymatic activities WRN may act as a scaffold for the assembly on DNA of additional DNA processing proteins

Utilization of Integrated Child Development Services (ICDS) Scheme by child beneficiaries in Coastal Karnataka, India

Background: India’s main early childhood development intervention the ICDS Scheme has been sustained for 40 years and has been successful in some ways. However, nearly half of the children under six years are still under nourished. The program in reducing the proportion of undernourished children over the past decade has been modest and slower in India than what has been achieved in other countries with comparable socio-economic indicators. Aims & Objectives: 1. To study the utilization of services offered to children under ICDS, 2. To assess the perception about the services. Materials & Methods: A community based cross sectional study was done among mothers of 271 children in the age group three to six years registered in anganwadis. Results: Median duration of absenteeism to anganwadi was five months during the last six months enquired. About 95.9% of registered child beneficiaries utilized supplementary nutrition services and only 48.7% mothers of child beneficiaries were attending nutrition and health education sessions. Among mothers who were aware of growth monitoring, only 73.6% of their children’s weight was checked regularly.  About 60% of mothers were not happy with the quality of food served to their children in the anganwadi. Among children adherent to anganwadi, 72.5% children’s weight remained normal. Conclusion: Only 75% children were regularly attending. Median duration of adherence to anganwadi services was only 12 months and the most common reason for not adhering to the services is due to their simultaneous enrollment in other private nursery school