The CREATE-ECLA Randomized Controlled TrialThe CREATE-ECLA Trial Group Investigators* See also pp 427 and 489.

Background: To assess the extent of Ultrasound (USS) abdomen findings in acute viral hepatitis and further assess the role of USS as a prognostic marker.Methods: From May 2013 to September 2016, a total of 220 patients of acute Enterogenic viral hepatitis were studied by routine USS within first seven days of onset of symptoms, followed by routine USS between 10 to 15 days and follow up scan after 12 weeks. Only patients with acute Enterogenic viral hepatitis (Hepatitis A and Hepatitis E) were included. All patients with chronic liver disease and other form of acute hepatitis i.e. Hepatitis B, C and D were excluded from the study.Results: Among 220 patients of acute viral hepatitis routine USS findings including hepatomegaly, bright liver and thickened GB wall and periportal adenopathy were in isolation or in combination up to varying degrees. The commonest routine USS finding in acute phase was thickened GB wall (80%). 14 patients exhibited triad of enlarged Portal Vein (PV), Splenomegaly and Ascites. These 14 patients had prolonged stay in hospital and 11 patients had deranged liver function tests at 12 wks. interval and three patients developed hepatic encephalopathy including one patient who went into fulminant hepatic failure. Out of the patients who did not exhibit this triad 72 patients still had deranged LFT at 12 weeks and maximum of these patients had a combination of USS markers at presentation.Conclusions: USS has very little if any role in the diagnosis of acute viral hepatitis. It can however play an important role as a prognostic marker during the acute phase where it can detect enlarged portal vein, splenomegaly and ascites. This triad of USS findings is suggestive of transient portal hypertension likely due to hepatic congestion. Also, other USS markers if seen in combination at presentation can reliably predict a poorer prognosis

Pneumorrhachis(PR) is a rare phenomenon and post traumatic PR even more so. Presentation can vary from asymptomatic to significant neurological deficit and so the management has to be individualised. We present a case of post-traumatic cervical PR.

No abstract

Background and Objective: The implantation of a permanent cardiac pacemaker for the treatment of bradyarrhythmia is one of the most popular cardiac interventions. The goal of this study is to look at the clinical profiles of individuals who have permanent pacemakers implanted Material and Methods: The study was conducted using observational methods. The study included patients who received a permanent pacemaker for bradyarrhythmias between November 2019 and November 2021. A thorough review of the demographic profile and indications was performed. Results: The vast majority of the 312 patients were older, with the majority being between the ages of 56 and 88 years old (75 % ). Pacemakers were implanted in more men than in women. Complete heart block was the most common ECG finding and the most common presenting symptom was syncope. The most prevalent sign of pacing was acquired A-V block, and the most common pacemaker mode was single chamber (VVI/VVIR). Conclusion: Acquired A-V block and SSS were found to be the most common reasons for pacemaker implantation in our study. Higher implantation rates were linked to advanced age and male gender.