Thrombophilia Profile of Portal Vein Thrombosis in Young

The abdominal vein thrombosis is an unusual and rare, but potentially a life threatening form of thrombosis. Much is known, studied and published about the venous thrombosis in the lower limbs and to some extent in upper limbs, where as the abdominal vein thrombosis still remains an unexplored area. The diagnosis of abdominal venous thrombosis has increased with awareness of the entity and the availability of better imaging modalities. Despite advances made in the management of venous thrombosis, the knowledge of events predisposing to abdominal thrombosis is largely unknown. This gap in knowledge needs to be studied and analyzed for better patient management. The study aims at analysing various risk factors in patients of abdominal venous thrombosis.

Real-world experience of monoclonal antibodies in mild-to-moderate COVID-19 patients at a tertiary care center

Background

Neutralizing antibodies cocktail (casirivimab and imdevimab) has received emergency use authorization recommendation by Food and Drug Administration (FDA) and WHO for mild-to-moderate COVID-19 infection in specific high-risk groups. Antibodies cocktail has shown promising results in preventing progression to severe disease, but the real-world experience is still evolving. Herein, we present a retrospective analysis of 22 patients who were administered the antibodies cocktail between August 2021 and March 2022 at our tertiary care center.

Methods

We conducted an observational retrospective analysis of clinicoradiological, inflammatory parameters, progression of the disease, and outcome among 22 mild and moderate COVID-19 patients treated with antibodies cocktail.

Results

The mean age was 67.7 years (SD ± 18.3) and comprised of 13 males (59%), while 9 were females (40.9%). Nine (40.9%) patients were fully vaccinated with two doses, nine (40.9%) were partially vaccinated with one dose while four patients (18.2%) were unvaccinated, and the rest were unvaccinated. Diabetes and hypertension were the commonest comorbidities; hematological and solid organ malignancies were other comorbidities. Eight patients had radiological opacities consistent with COVID-19 pneumonia and had shown significant regression in four patients after the therapy. None of our patients required supplemental oxygen or progressed to severe acute respiratory distress syndrome. All patients were discharged in a stable condition within 6 days of the therapy.

Conclusions

The neutralizing antibodies cocktail has shown encouraging results in our analysis in preventing progression to severe disease in patients with high-risk conditions.

Endoscopic ultrasound-guided pancreatic fluid collection drainage: Where are we?

Pancreatic fluid collections (PFCs) result from injury to the pancreas from acute or chronic pancreatitis, surgery, or trauma. Management of these collections has evolved over the last 2 decades. The choice of interventions includes percutaneous, endoscopic, minimally invasive surgery, or a combined approach. Endoscopic drainage is the drainage of PFCs by creating an artificial communication between the collection and gastrointestinal lumen that is maintained by placing a stent across the fistulous tract. In this editorial, we endeavored to update the current status of endoscopic ultrasound-guided drainage of PFCs.

Utility of Serum Transaminases in Predicting Disease Severity in Dengue Fever- A Cross-sectional Study

Introduction: Thrombocytopenia has been known to be a manifestation as well as predictor of severe dengue. However, use of additional biomarkers like Aspartate Aminotransferase (AST)/Alanine Aminotransferase (ALT) alone or in conjunction with platelet count may help in early and better predictability of severe dengue cases. Aim: To determine the correlation between transaminase elevation and severity of dengue fever. Materials and Methods: This was a single centre, cross-sectional study conducted at a tertiary care centre of Western Maharashtra. Total 110 hospitalised patients with a diagnosis of suspected dengue fever, based on clinical signs and symptoms with a positive NS1 antigen test (non structural protein 1)/Immunoglobulin M (IgM) test using rapid test kits were taken as study population. The patients were clinically evaluated on daily basis for development of any warning signs and symptoms along with monitoring of haematological and biochemical parameters. For statistical analysis the technique of percentages, mean and Pearson ‘r’s were employed using IBM Statistical Package for the Social Sciences (SPSS 20.0) version for windows. The p-value of 0.05 was considered as significant value. Results: Out of 110 patients, 83 were males and 27 females. Clinical fluid accumulation was seen in 5 patients (4.5%), bleeding manifestations and fluid accumulation in 4 (3.6%) and bleeding manifestations in 17 (15.5%). Negative correlation was observed between thrombocytopenia with bleeding manifestations (r=-0.17, p=0.04), whereas positive correlation was seen in incidence of bleeding with serositis (r=0.19, p=0.04), AST with serositis (r=0.21, p=0.02) and ALT with Packed Cell Volume (PCV) (r=0.22, p=0.01). Conclusion: Additional biomarkers like AST and ALT alone or in conjunction with platelet count can also help in early prediction of severity of dengue fever.

Venous Thromboembolism Prophylaxis in Medical Intensive Care Unit: An Audit

Introduction: Venous Thromboembolism (VTE) is a major cause of morbidity and mortality in patients admitted to healthcare facilities. This can be prevented by giving thromboprophylaxis to patients after assessing the risk for VTE. This however is not being routinely done leading to underuse of thromboprophylaxis due to inadequate practice of risk assessment. Aim: To conduct an audit of VTE prophylaxis in Intensive Care Unit (ICU) based on Padua score and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Risk Assessment Model (VTE RAM). Materials and Methods: This was a cross-sectional observational study and the data was collected from medical records of patients retrospectively who were admitted to medical ICU between October 2019 and December 2019. Based on medical records risk assessment was done using the Padua score and IMPROVE VTE RAM. The prophylaxis given to patients was scrutinised for appropriateness based on American Society of Haematology (ASH) guidelines. The two validated scores Padua score and IMPROVE VTE RAM were compared with each other for any significant difference in the risk assessment made using Chi-square test and p-value <0.05 were considered significant. Results: Out of the 176 patients risk assessment was not done in any patient. On calculating the Padua score, 149 patients (84.66%) were in high risk for VTE (Padua Score ≥4) and amongst them only 76 (51%) patients received thromboprophylaxis. On calculating the IMPROVE VTE RAM score, 137 patients (77.84%) were in moderate or high risk for VTE requiring prophylaxis and amongst them only 76 (55.47%) patients received thromboprophylaxis. The accuracy of clinician’s judgement without risk assessment was 58.52% (95% CI: 65.80%-51.24%) and 64.20% (95% CI: 71.28%-57.12%) as compared to risk assessment by Padua score and IMPROVE VTE RAM, respectively. There was no significant difference between IMPROVE VTE RAM and Padua score with respect to risk assessment for VTE (p-value of 0.10). Conclusion: The practice of VTE prophylaxis is grossly inadequate and there is a requirement to sensitise the healthcare providers about the importance of risk assessment for VTE.

Rodenticide-induced acute liver failure - Uncommon presentation of commonly available poison

Rodenticide or 'rat poison' is easily available in a predominantly agrarian economy such as India. Metal phosphides or yellow phosphorous are two common rodenticides. Acute liver failure caused by accidental or suicidal poisoning with rodenticides has been infrequently reported in literature. Liver transplantation offers the best chances of survival in severe intoxication. However, the availability of liver transplantation in resource-limited settings presents a challenge. N-acetyl cysteine has been successfully used in paracetamol poisoning. Its use in rodenticide-induced acute liver failure is not so well known. We report three cases of rodenticide-related acute liver failure, one of them being a pregnant lady. All three patients were given N-acetyl cysteine and two patients improved. It is possible that the administration of N-acetyl cysteine contributed to the improvement in these two.