Amoebic liver abscess (ALA) is often associated with significant complications. Contemporary prospective data comprehensively characterizing complicated and uncomplicated ALA are limited. This prospective cohort study followed 150 patients with ALA and found that 60.7% experienced at least one complication. The significant complications were peritoneal rupture, pleural rupture, venous thrombosis, biliary fistula, secondary bacterial infection, and organ dysfunction. Patients with complicated ALA had larger abscesses, higher inflammatory markers, and greater liver dysfunction than those without complications. The types of complications were influenced by the location of the ALA. Additionally, subcapsular abscesses and lower baseline HDL-cholesterol levels were independently linked to complicated cases of ALA. Although complications were common, both groups showed favourable outcomes. Mortality was 2%, occurring only in the complicated group. At three months, both groups had comparable rates of symptom resolution, cavity disappearance, and relapse.

Strongyloides stercoralis can cause chronic infections that may escalate into life-threatening hyperinfection, especially in immunocompromised patients. Severe intestinal strongyloidiasis has been associated with bacteraemia and sepsis, classically due to translocation of enteric organisms across a disrupted intestinal mucosal barrier. We report a patient with lepromatous leprosy on steroids who developed Strongyloides hyperinfection presenting with ulcerative duodenitis and septic shock.

BACKGROUND Salt restriction is commonly recommended for patients with cirrhosis to manage ascites; however, its safety and efficacy in patients with hyponatremia remain unclear. AIM To evaluate the effects of a salt-restricted diet (SRD; 5 g/day) vs a salt-unrestricted diet (SUD; 10 g/day) on renal, nutritional, and hemodynamic outcomes, as well as short-term mortality in patients with cirrhosis with moderate to severe hyponatremia. METHODS A total of 150 patients with serum sodium < 130 mEq/L were randomized to either SRD or SUD. After excluding patients who died, were non-adherent, or were lost to follow-up within 4 weeks, 105 participants (SRD: 51; SUD: 54) were included in the outcomes analysis. The primary outcome was the incidence of acute kidney injury (AKI) over 6 months; secondary outcomes included ascites control, nutritional markers, and mortality. RESULTS Baseline characteristics were largely comparable. AKI occurred in 45 patients (42.8%), which was significantly more in the SRD group (58.8% vs 27.7%; P = 0.005). SRD was an independent predictor of AKI (odds ratio: 4.85), and the risk of AKI was 66% lower in the SUD group (hazard ratio: 0.34; P < 0.001). While ascites control was numerically better in the SUD group, the difference was not statistically significant. The SUD group exhibited better hemodynamic and nutritional indices, including mean arterial pressure, mid-arm circumference, handgrip strength, and serum albumin. Mortality was significantly lower in the SUD group (29.6% vs 54.9%; P = 0.009), and survival analysis consistently favored SUD. CONCLUSION Salt restriction in patients with cirrhosis with moderate to severe hyponatremia may predispose them to renal dysfunction, nutritional decline, and increased short-term mortality without providing a clear benefit in ascites control. These findings underscore the need for individualized sodium recommendations in patients with advanced cirrhosis.

The role of feeding jejunostomy (FJ) in recovery after pancreaticoduodenectomy (PD) remains unclear due to conflicting evidence and selection bias. This study objectively assesses the clinical impact of FJ on postoperative outcomes using the Comprehensive Complication Index (CCI) as a measure of overall morbidity. A retrospective observational cohort study was conducted on patients undergoing classical PD between January 2018 and December 2024 .Patients were categorized based on the use of FJ. Propensity-score matching (1:1) was applied to balance baseline demographic and operative variables. Postoperative outcomes, including overall morbidity measured by the CCI and procedure-specific complications, were compared between the matched cohorts. Of 198 patients who underwent PD, 75 received a FJ and 123 did not. After 1:1 propensity-score matching, 124 patients (62 per group) were analyzed. The incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) was similar (41.9

Amoebic liver abscess (ALA), a common tropical infection, is caused by Entamoeba histolytica (EH). For decades, the first-line treatment for ALA has been metronidazole which has several drawbacks. The thioredoxin reductase enzyme in EH is essential for its anti-oxidative defence and survival during tissue invasion. Recently, the benzimidazole nucleus of proton pump inhibitors has been found to inhibit it quite effectively. An in vitro study found pantoprazole to be over 100 times more potent than metronidazole. We therefore conducted a randomised open-label pilot study, comparing adjunct pantoprazole with standard medical therapy in patients with uncomplicated ALA. We found this resulted in a shorter hospital stay and faster resolution of fever, abdominal pain, and leucocytosis, compared to standard therapy.

Objective:Chronic pancreatitis (CP) leads to enduring abdominal pain and functional insufficiency, alongside notable risks posed by vascular complications. Pseudoaneurysms (PSA) are common in CP, necessitate careful management due to potential life-threatening hemorrhage. Literature suggests a 5-10% incidence of gastrointestinal bleeding in CP, often related to PSA affecting nearby arteries. Our study aims to evaluate the prevalence and outcomes of vascular complications in CP, aiding in improved management strategies. Material and Methods:This retrospective observational study was conducted on the patients diagnosed with CP at a tertiary care center in Northeast India from April 2018 to December 2023. Demographic data and risk factors such as smoking and alcohol use were collected from medical records. The diagnosis and etiological assessment followed the M-ANNHEIM criteria, employing contrast-enhanced computed tomography. Results:In our study of 86 patients with CP, predominantly male (68.6%), the median age at presentation was 37.4 years. Arterial PSAs were identified in 11 patients (12.79%), with a median onset of 18.2 months from symptom onset. Univariate analysis revealed that male sex (p=0.015), alcohol abuse (p=0.001), smoking (p=0.035), pseudocyst formation (p=0.008), and absence of parenchymal calcification (p=0.002) were significantly associated with PSA development. Interestingly, inflammatory head mass was more prevalent in patients without PSA (49.3% vs. 9.1%, p=0.02), suggesting a potential protective effect. On multivariate analysis, independent predictors of PSA formation included an alcohol abuse [odds ratio (OR): 10.75, 95% confidence interval (CI): 0.967-119.53, p=0.05], a pseudocyst presence (OR: 27.41, 95% CI: 1.591-472.39, p=0.02), and a bulky pancreatic head (OR: 12.72, 95% CI: 2.97-54.51, p=0.0006), while parenchymal calcification remained inversely associated (OR: 0.1279, 95% CI: 0.016-1.02, p=0.05). Conclusion:Arterial PSA formation in CP is independently associated with alcohol abuse, pseudocysts, and inflammatory head mass, while parenchymal calcification appears protective. Endovascular coiling has emerged as a promising intervention, demonstrating effective management of PSA and successful prevention of hemorrhagic complications.

Acute liver failure (ALF) and acute-on-chronic LF (ACLF) are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections (BI), despite significant systemic inflammation. Literature indicates that 30%-80% of ALF patients and 55%-81% of ACLF patients develop BI, attributed to immunological dysregulation. Bacterial sepsis in these patients is associated with adverse clinical outcomes, including prolonged hospitalization and increased mortality. Early detection of bacterial sepsis is critical; however, distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis. Conventional sepsis biomarkers, such as procalcitonin and C-reactive protein, have shown limited utility in LF patients due to inconsistent results. In contrast, novel biomarkers like presepsin and sTREM-1 have demonstrated promising discriminatory performance in this population, pending further validation. Moreover, emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization. Although preliminary findings are encouraging, further studies are necessary to validate these results across diverse patient cohorts, including those with LF. This article provides a comprehensive review of the magnitude, impact, and diagnostic challenges associated with BI in LF patients, focusing on novel advancements in early sepsis detection and characterization.

Background: Anaemia remains one of the most common global public health challenges, particularly in developing countries like India. It affects individuals across all age groups and genders, leading to significant morbidity, impaired quality of life, and increased risk of mortality, especially in vulnerable populations. Objectives: • To determine the clinical and hematological profile of patients presenting with anaemia at a tertiary care hospital. • To categorize anaemia based on morphological classification and etiological factors. Methods: A cross-sectional study was conducted at the Department of General Medicine, AIIMS, Patna, Bihar, India from November 2020 to October 2022. A total of 150 patients diagnosed with anaemia (hemoglobin <12 g/dL in females, <13 g/dL in males) were enrolled. Detailed clinical evaluation, complete blood counts, peripheral smear examination, reticulocyte count, serum ferritin, vitamin B12, and folate assays were performed. Anaemia was classified morphologically and etiologically. Results: Microcytic hypochromic anaemia was the most common morphological pattern observed, predominantly associated with iron deficiency. Nutritional deficiency remained the leading cause across all age groups, followed by anaemia of chronic disease. Female preponderance was noted. A substantial proportion of patients presented with moderate to severe anaemia requiring specific therapeutic interventions. Conclusion: Anaemia continues to impose a substantial health burden, predominantly due to preventable and treatable causes like nutritional deficiencies. Early diagnosis through detailed clinical and hematological evaluation can facilitate timely management and reduce the morbidity associated with anaemia. Targeted public health measures focusing on nutrition, infection control, and chronic disease management are necessary.

INTRODUCTION:Laparoscopic Heller myotomy (LHM) is the preferred treatment approach to reducing lower oesophageal sphincter pressure (LOSP). However, less than half of the patients show high LOSP. This study primarily aims to evaluate how LOSP affects operative results. PATIENTS AND METHODS:From 2019 to 2023, a total of 52 patients were treated with LHM combined with partial fundoplication, diagnosed by integrated relaxing pressure (IRP) >15 mmHg on high-resolution manometry (HRM). Based on HRM, patients were assigned into two arms: normal LOSP (≤35 mmHg, n = 30) and high LOSP (>35 mmHg, n = 22). Symptoms were assessed preoperatively, and the median duration of follow-up of 24 months using the Eckardt score (ES), the achalasia-specific quality of life (ASQ) score and the SF-36 questionnaire quality of Life (QOL). Treatment failure was defined as ES ≥4 or an ASQ score ≥16. RESULTS:Pre-operative Eckardt and ASQ scores were similar between groups. The high LOSP group had significantly younger populations (≤50 years: 90.90% vs. 60%, P = 0.013). The normal LOSP group had significantly less dysphagia ( P = 0.007) and regurgitation ( P = 0.011), reflecting significantly lower post-operative ES (0.80 vs. 2.00, P = 0.002). In addition, post-operative ASQ scores (11 vs. 14, P = 0.005) and QOL were significantly better in the normal LOSP group. The high LOSP group experienced a significantly greater failure rate (31.80% vs. 6.7%, P = 0.027). CONCLUSION:Normal LOSP results in better surgical outcomes and QOL, as younger patients with high LOSP have poorer responses, due to higher LOS muscle tone.

Granulomatous liver disease presents a significant diagnostic challenge, as it encompasses a broad spectrum of aetiology. Diagnosing the underlying cause can be particularly difficult when classic clinical clues are absent.

Background: Diabetes mellitus is a well-established risk factor for the development and progression of coronary artery disease. Acute myocardial infarction (AMI) in diabetic patients is often associated with atypical presentation, delayed diagnosis, increased complications, and higher mortality rates compared to non-diabetic patients. Objectives: • To compare the complications and in-hospital mortality following acute myocardial infarction between diabetic and non-diabetic patients. • To analyze the clinical profile, risk factors, and outcomes associated with AMI in the two groups. Methods: A prospective observational study was conducted at the Department of General Medicine, AIIMS, Patna, Bihar, India from January 2020 to December 2020. A total of 200 consecutive AMI patients were enrolled, comprising 100 diabetic and 100 non-diabetic individuals. Clinical presentation, risk factors, in-hospital complications, and mortality were recorded and compared between the groups. Statistical analysis was performed to assess differences and predictors of adverse outcomes. Results: Diabetic patients with AMI had a higher incidence of heart failure, arrhythmias, cardiogenic shock, and multi-organ dysfunction compared to non-diabetics. In-hospital mortality was significantly higher among diabetic patients. Diabetics also exhibited a greater prevalence of multi-vessel coronary artery disease. Poor glycemic control and the presence of associated comorbidities were significant predictors of adverse outcomes in the diabetic cohort. Conclusion: Diabetes mellitus adversely influences the clinical course and short-term outcomes following acute myocardial infarction. Diabetic patients experience higher complication rates and mortality compared to nondiabetics. Aggressive risk factor control, early diagnosis, and tailored management strategies are essential to improve survival in diabetic individuals presenting with AMI.

INTRODUCTION:Procedural anxiety is the fear or worry associated with medical procedures that may interfere with the ability to receive appropriate care. It can lead to heightened pain perception, greater sedation requirements, reduced cooperation, and compromised procedural safety and patient satisfaction. METHODS:A quantitative, quasi-experimental post-test-only design was employed among 120 patients undergoing endoscopy, selected through a non-probability convenience sampling technique. Anxiety levels were assessed using the Hamilton Anxiety Rating Scale. RESULTS:The study findings revealed a mean difference of 8.31 (95% CI: 6.10-10.52) between the control and experimental groups, indicating that the nurse-led intervention was effective in reducing pre-procedural anxiety among patients undergoing endoscopy. In the experimental group, pre-procedural anxiety showed a significant association with the patient's educational level, dietary pattern, purpose of the endoscopic procedure, and previous exposure. In contrast, in the control group, significant associations were observed with dietary pattern, patient's diagnosis, previous hospitalization, purpose of the endoscopic procedure, and previous exposure. CONCLUSION:Nurse-led interventions significantly reduced pre-procedural anxiety among endoscopy patients. Integrating such approaches to patient groups particularly prone to anxiety offers a promising pathway to enhance overall patient experience and procedural success.

Chronic hepatitis B (CHB) remains a significant global health challenge, affecting more than 250 million individuals worldwide. A functional cure, defined as the loss of hepatitis B surface antigen (HBsAg) and suppression of hepatitis B virus (HBV) DNA to undetectable levels, represents the optimal therapeutic endpoint for managing CHB. However, the complex pathogenesis of CHB, which includes HBV DNA integration, persistence of covalently closed circular DNA, and impaired immune responses, presents substantial barriers to HBsAg clearance. Current therapies offer limited success in achieving a functional cure, with HBsAg seroclearance occurring in only 3%-5% of patients after 10 years of nucleos(t)ide analogs (NAs) therapy and 8%-14% within 3-5 years of pegylated interferon treatment. To overcome these limitations, novel direct-acting antivirals targeting different stages of the HBV life cycle are being investigated. Additionally, immunomodulatory approaches, including therapeutic vaccines and immune checkpoint inhibitors, are being explored to enhance HBV-specific immune responses. The concept of NAs cessation in carefully selected non-cirrhotic patients may accelerate HBsAg loss, although the risks of hepatic flare and hepatocellular carcinoma necessitate rigorous monitoring. This review provides a comprehensive overview of the current understanding of HBsAg seroclearance in CHB, discussing its clinical significance, therapeutic challenges, and evolving treatment landscape in the pursuit of a functional cure.

AbstractMalignant biliary strictures represent a significant clinical challenge worldwide, with the majority of cases being unresectable at the time of diagnosis, necessitating palliative biliary drainage. In some cases, preoperative drainage is required to optimize surgical outcomes. Biliary drainage can be performed through either endoscopic or percutaneous methods, each tailored to specific clinical scenarios. Endoscopic techniques include endoscopic retrograde cholangiopancreatography, endoscopic nasobiliary drainage, and endoscopic ultrasound-guided biliary drainage, while percutaneous options involve percutaneous transhepatic biliary drainage and biliary stenting. The choice of technique is guided by imaging findings, the clinical condition of the patient, and the expertise of the interventionist to ensure effective drainage and minimize complications. Although endoscopic methods are well-established and extensively studied, the percutaneous approach offers distinct advantages in certain complex cases. This review provides a comprehensive overview of biliary drainage techniques, with a particular focus on the percutaneous approach.

Amoebic liver abscess (ALA) remains a major health burden in tropical regions. Our observational study evaluated the association between serum lipid profiles and disease severity in 118 patients with ALA. Patients were classified into uncomplicated and complicated ALA groups. Serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in ALA patients compared to controls and further reduced in complicated cases. HDL-C emerged as an independent predictor of complicated ALA and demonstrated better predictive value than conventional inflammatory markers such as total leucocyte count and C-reactive protein. Lower HDL-C levels were also linked to an increased need for percutaneous catheter drainage and longer hospital stay. Post-treatment assessments showed significant improvement in HDL-C levels. These findings suggest that HDL-C is a valuable, low-cost biomarker for assessing ALA severity and guiding clinical decisions, especially in resource-limited settings.

Objective:This study aimed to evaluate and compare the diagnostic performance of the Platelet/Spleen Length (P/SL) ratio and a novel metric, the Platelet-Albumin/Spleen Length (P*Alb/SL) ratio, in predicting esophageal varices (EVs) among patients with chronic liver disease (CLD). Methods:A cross-sectional study was conducted over a period of 6 months, enrolling 121 newly diagnosed CLD patients without prior treatment for EV or CLD. Data collected, included demographic and clinical details, platelet count, serum albumin, and spleen length via ultrasonography. All patients underwent upper gastrointestinal endoscopy to assess EVs. The P/SL ratio was calculated by dividing platelet count (cells/μL) by spleen length (mm), and the Platelet-Albumin to Spleen Length (P*Alb/SL) ratio by dividing the product of platelet count and serum albumin (g/dL) by spleen length. Diagnostic performance was evaluated using receiver operating characteristic curve analysis and calculating sensitivity and specificity. Results:The P/SL ratio demonstrated an optimal cutoff of 856 with an area under the curve (AUC) of 0.924 (95% CI: 0.849-0.998), sensitivity of 92%, and specificity of 85.7%. The P*Alb/SL ratio had an optimal cutoff of 2194.5, achieving an AUC of 0.928 (95% CI: 0.864-0.992), sensitivity of 81%, and specificity of 95.2%. Both ratios exhibited strong diagnostic performance, with no significant difference between their AUCs (P = 0.712). The diagnostic odds ratios were 69 and 85.26 for the P/SL and P*Alb/SL ratios, respectively. Conclusion:The P/SL ratio proved to be an effective screening tool for EVs in CLD, with high sensitivity for early detection. The P*Alb/SL ratio showed similar or slightly superior diagnostic performance, with high specificity and fewer false positives, making it ideal for confirmation. Together, the sequential tandem use of P/SL followed by P*Alb/SL provides a practical strategy for risk stratification and patient management, while reducing reliance on the endoscopy and improving resource allocation, especially in resource-limited settings.