Key words: New diagnostic tool, Rule of 15, Portal vein thrombosis. Background: Portal vein thrombosis(PVT) can develop in patient’s with cirrhosis. It can be benign or malignant. Differentiation of these are important because outcome is different for both. Aims: Find out variables that can differentiate between benign and malignant PVT. Methods: Cross-sectional study. Patients with cirrhosis with PVT were taken up for the study. Results: There were 31 benign and 73 malignant PVT. Among the variables analyzed Age , Bilirubin , INR , Eosinophil count , Portal vein diameter and AFP were statistically significant between Benign and Malignant Thrombus. Cut off of Portal Vein diameter of > 15 mm with AFP level of > 15 was suggestive of Malignant portal vein thrombus with sensitivity of 76.7% and Specificity of 97% and accuracy of 83 %. Conclusions• Contrast enhanced CT(CECT) abdomen has sensitivity of 86% sensitivity and 100 % specificity in detecting malignant PVT from benign, But due to impaired renal function which is common among cirrhotics CECT cannot be used in all patients with cirrhosis for PVT characterization. In this situation rule of 15 aids in diagnosis of nature of thrombus• This rule of 15 is a simple diagnostic tool to differentiate benign from malignant thrombus especially in the setting of malignant thrombus without focal lesion and in cirrhotics with renal impairment with a comparable sensitivity and specificity to CECT and it needs to be validated by further studies so that this score can be applied for characterization of portal vein thrombosis in all cirrhotics irrespective of renal impairment.

The aim of this study was to propose a simple predictive score to differentiate NASH from simple steatosis. This study included 64 patients who had biopsy-proven NAFLD, of which 34 patients had steatohepatitis and 30 had simple steatosis. Clinical, anthropometric, and biochemical variables of the study population were analyzed. Univariate analysis showed platelet count, ferritin, and transaminases (ALT&AST) were predictors of NASH. This led to the proposal of a new diagnostic tool, FAT score (F signifies Ferritin, A indicates AST&ALT, T denotes t in Platelet) with AUROC of 0.95. The ROC curves for the significant variables were plotted and cutoff values were identified. Each component is awarded a score of 0 or 1, based on this cutoff value. The component is awarded a score of 1 if the component score is above the cutoff value and 0, if the score is below cutoff. The maximum score which can be obtained is 4. A score of ≥ 3 was able to predict NASH from simple steatosis with a sensitivity of 76.5% and a specificity of 100%. The score was validated with a cohort of 84 liver biopsy patients wherein a cutoff ≥ 3 was found to give a specificity of 100% in the validation cohort. FAT score is a simple predictive model to differentiate NASH from simple steatosis (cutoff of more than or equal to 3) without performing a liver biopsy. A FAT score less than 3 rules out the need for biopsy.

BACKGROUND & OBJECTIVES:Sarcopenia is one of the most common complication associated with mortality in cirrhotic patients. However, the lack of an objective and reliable method to quantify muscle mass has limited the general incorporation of sarcopenia into cirrhosis prognostic scores. In this article, we highlight crosssectional imaging-based estimation of skeletal muscle mass for diagnosing sarcopenia in cirrhotic patients and its effect on health related quality of life.METHODS:After getting ethical clearance and informed consent, all patients with cirrhosis were taken and assessed for sarcopenia using thigh muscle based index The average feather index was used in conjunction with BMI in determining the probability of sarcopenia. The CLDQ was used to assess the health related quality of life. The chi-square and Pearsons coefficient were used for analyzing correlation between sarcopenia and other variables.RESULTS & DISCUSSION:In our study, out of the 288 patients, sarcopenia was present in 132 patients (45.83%). Sarcopenia was present in 18.2% in CHILD A,42.4 % in CHID B and 90.5 % in CHILD C cirrhotics. Sarcopenia was highest in autoimmune hepatitis related cirrhosis (80%), followed by NASH (61.9%),followed by ethanol (42.4%), followed by HCV (28.5%) and HBV (16.6%). Sarcopenia had a moderate negative correlation with health related Quality of life as assessed by CLD Q particularly in relation with systemic symptoms and activity.CONCLUSION:The factors like high MELD, CHILD C cirrhosis, NASH as etiology, were associated with higher prevalence of sarcopenia.NASH related cirrhotics have high prevalance of sarcopenia even in CHILD A patients. The patients with sarcopenia were having a low overall quality of life as per CLDQ,especially in specific aspects related to systemic symptoms and activity.