Spontaneous Migration of Spiral Fin Overtube During Motorized Spiral Enteroscopy.

Motorized spiral enteroscopy (SE) is a novel technique for evaluation and management of small bowel lesions. Total enteroscopy rates are higher with SE. Power spiral tube with spiral soft fin helps in advancement of the scope. SE has low adverse event profile; however, perforation and pancreatitis have been reported. We report the unusual adverse event of power spiral tube with spontaneous dislodgement of spiral fin in 2 cases.

Scoring Systems that Predict Mortality at Admission in End-stage Liver Disease.

BACKGROUND: Various scoring systems have been developed to assess the severity and survival in end-stage liver disease. AIM OF THE STUDY: Prospective study to compare and analyze the efficacy of scoring systems in predicting mortality in ESLD patients who present with cirrhosis specific complications to the emergency room. MATERIALS AND METHODS: This prospective, single point study was conducted over a two year period from September 2014 to August 2016 among 162 ESLD patients seeking admission to the emergency unit of Gleneagles Global Health City, Chennai. Baseline investigations incorporated hemogram, liver biochemical parameters, coagulation parameters (PT/INR), serum creatinine, serum electrolytes and blood gas analysis, to calculate the CTP score, MELD, MELD-Na, MESO, iMELD, Updated MELD, UKELD, SOFA and APACHE II. Comparison of MELD snd non MELD scores were done between survivors and nonsurvivors. The mortality rate for the same admission was calculated. RESULTS: Of the 162 patients requiring emergency admision, 148 were men (91.4%). The median age of patients was 56 years (range 25-75 years). The cause for liver cirrhosis was alcohol followed by nonalcoholic steatohepatitis and hepatitis B. The indications for emergency admissions were fever, tense ascites, reduced urine output and altered sensorium. Thirty patients (18.5%) expired during the same admission. The predictive accuracy of all scores for predicting mortality by ROC curves was between 0.7 and 0.8 (p < 0.05). CONCLUSION: Although, all scores appear to be equally good, simple scores like CTP and MELD is all that is required to ascertain the prognosis of patients seeking emergency admission. HOW TO CITE THIS ARTICLE: Mangla N, Bokarvadia R, Jain M, Varghese J, Venkataraman J. Scoring Systems that Predict Mortality at Admission in End-stage Liver Disease. Indian J Crit Care Med 2019;23(10):445-448.

Prevalence and clinical presentation of cirrhotic cardiomyopathy: A single centre experience from southern India.

BACKGROUND: There are scanty data from India on the prevalence and clinical profile of cirrhotic cardiomyopathy (CCM). AIM: To identify the prevalence and clinical presentation of CCM in patients with liver cirrhosis. METHODS: Five hundred and eighty-six patients with liver cirrhosis were recruited based on inclusion criteria and evaluated for cardiac parameters using electrocardiography, 2-dimensional echocardiography, dobutamine stress test and coronary angiography as needed. Baseline demographic data, liver biochemistry, endoscopic and radiological findings were recorded in all the patients. Appropriate statistical analyses were performed.  RESULTS: Four thousand eight hundred and seventy-seven patients with liver disease were registered during the study period. Five hundred and eighty-six cirrhotic patients had cardiac evaluation as per the study protocol. One hundred fifty-nine had coronary artery disease and were excluded. One hundred and ninety-eight of 427 remaining patients (46.4%) had CCM. The median age of patients with CCM was higher compared with those without CCM (52 years vs. 46 years; p-value < 0.00001). Likewise, cirrhosis-related complications ([isolated or in combination], lower pulse rate [< 60/min] and prolonged corrected QT interval [QTc]; p<0.00001) were more frequent in patients with CCM. After excluding known risk factors for CCM such as alcohol, diabetes, hypothyroidism, hypertension, the true prevalence of CCM was 8.2% (48 out of 586). Hepatotropic viral infections (p 0.03) and prolonged QTc (p 0.0004) were commoner in CCM. CONCLUSION: Prevalence of CCM in our setting is 33.8%. CCM is commoner in males and is independent of the etiology of cirrhosis, comorbidity and severity of liver disease. Diastolic dysfunction and prolonged QTc interval are common in CCM.