A study of platelet count/ spleen diameter ratio as a predictor of esophageal varices in patients of cirrhosis

Background: Todays guidelines are clear that there are no substitute markers to determine the presence and size of esophageal varices, and endoscopy is still the only valid method to investigate varices. Objective: To validate the PC/SD ratio as a predictor of the presence and absence of esophageal varices in patients with chronic hepatopathy. Methodology: This study is an analytical cross-sectional validation study of a diagnostic test. The study was done in cases diagnosed of having hepatic cirrhosis by histology or physical, biochemical, and imaging examinations compatible with the disease and treatment from February 1, 2013 to December 31, 2014. Various hematological, biochemical and radiological work up was done. Results: Of the total cases, 29(70.7%) had PC/SD ratio more than 909 and only 12(29.3%) had less than 909. The sensitivity of PC/SD ratio of 909 in predicting varix is 89.66% and specificity was 75%. Thus it can be considered a good and reliable tool for predicting varices. Conclusion: The use of platelet count/ splenic diameter ratio in cirrhotic patients for screening and follow up for esophageal varices can substantially reduce the cost of health care and discomfort for patients as well as reduce burden of endoscopy unit

Prevalence of diastolic dysfunction in Normotensive diabetics below 45 years of age

Introduction: Dengue rarely affects the heart but clinical symptoms of cardiac involvement may range greatly from silent illness to severe myocarditis resulting in death. Clinical features are asymptomatic and most are transient among patients with DF/DHF. Material and methods: It was an observational study conducted at the Department of General Medicine, Peoples College of Medical Sciences and Research Centre, Bhopal. The total duration of the study was One and a half years from November 2016 to APR 2018. All normotensive diabetic patients less than 45 years of age presenting to the Department of General Medicine, Peoples College of Medical Sciences and Research Centre, Bhopal during one and half years from which data was collected using as per given proforma. Results: In the present study, It was found that significant Pearson's correlation between age of diabetics and diastolic changes in ECHO, and serum creatinine and diastolic changes in ECHO. The rest of the parameters like blood urea, blood pressure, RBS, FBS, PPBS, and duration of diabetes were not significantly correlated. Conclusion: It was concluded that in the present study, diabetes mellitus is itself a risk factor for developing diastolic dysfunction though its prevalence increases with increasing age, serum creatinine and there is no association found between duration of diabetes and diastolic dysfunction. So screening of every young normotensive diabetic for diastolic dysfunction should be done to prevent early cardiovascular disease

Cardiac involvement in patients of dengue fever in reference to ECG and Echocardiography – A tertiary care center study

Introduction: Dengue rarely affects the heart but clinical symptoms of cardiac involvement may range greatly from silent illness to severe myocarditis resulting in death. Clinical features are asymptomatic and most are transient among patients with DF/DHF. Material and methods: It was an observational study conducted at the Department of General Medicine, Peoples College of Medical Sciences and Research Centre, Bhopal. The total duration of the study was One and a half years from Dec 2018 to May 2020. All dengue patients presenting to People’s Hospital during one and half years from which data was collected using as per given proforma. Results: In the present study group of 58 patients, it was found that 49 patients (84.5%) have not shown any cardiac abnormalities and 9 patients have abnormal values (15.5%) but are not significant. It is also found that the incidence of cardiac manifestations was more common in DHF and dengue shock syndrome which was 15.5% and 3.4%, respectively. Conclusion: Clinical manifestations of cardiac involvement can vary widely from silent disease to severe myocarditis resulting in death. Rhythm abnormalities, hypotension, arrhythmias, myocarditis, myocardial depression with symptoms of heart failure and shock, and pericarditis have been reported. Involvement of multiple organs, as well as the presence of metabolic derangement, can further confuse the picture

Cardiac changes in patients with chronic liver disease: A prospective descriptive study

Background: The systemic circulation in patients with cirrhosis is hyperdynamic with an increased cardiac output and heart rate and a reduced systemic vascular resistance as the most pronounced alterations. The concomitant cardiac dysfunction has recently been termed “cirrhotic cardiomyopathy”, which is an entity different from that seen in alcoholic heart muscle disease. Objective: To study cardiac changes in patients with chronic liver disease. Methodology: The present study was a prospective descriptive clinical study consisting of thirty five patients with cirrhosis who were inpatients in the department of Medicine, tertiary care Institute, from Oct 2011 to Oct 2013.The patients were evaluated for presence of cirrhotic cardiomyopathy. Results: In A group there is no patient, while in Child- Pugh Score- B group 14 subjects have cirrhotic cardiomyopathy out of 16 and in C group 18 have cirrhotic cardiomyopathy out of 19. We analyzed that there was no relation between severity of liver disease and cirrhotic cardiomyopathy (p value- 0.446). Conclusion: Indian patients with cirrhosis do have diastolic dysfunction. In the absence of other risk factors for cardiac disease, this dysfunction can be attributed only to cirrhotic cardiomyopathy