Background and aimsNon-invasive assessment of fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) is challenging, especially in resource-limited settings. MR or transient elastography and many patented serum scores are costly and not widely available. There are limited data on accuracy of serum-based fibrosis scores in urban slum-dwelling population, which is a unique group due to its dietary habits and socioeconomic environment. We did this study to compare the accuracy of serum-based fibrosis scores to rule out significant fibrosis (SF) in this population.MethodsHistological and clinical data of 100 consecutive urban slum-dwelling patients with NAFLD were analysed. Institutional ethics committee permission was taken. Aspartate transaminase (AST) to platelet ratio index (APRI), fibrosis-4 index (FIB-4) and FIB-5 scores were compared among those with non-significant fibrosis (METAVIR; F0 to F1; n=73) and SF (METAVIR; F2 to F4; n=27).ResultsAST (IU/mL) (68.3±45.2 vs 23.9±10.9; p<0.0001), alanine transaminase (IU/mL) (76.4±36.8 vs 27.9±11.4; p<0.0001), FIB-4 (2.40±2.13 vs 0.85±0.52; p<0.0001) and APRI (1.18±0.92 vs 0.25±0.16; p<0.0001) were higher and platelets (100 000/mm3) (1.8±0.8 vs 2.6±0.7; p<0.0001), albumin (g/dL) (3.4±0.50 vs 3.7±0.4; p<0.0001), alkaline phosphatase (IU/L) (60.9±10.2 vs 76.4±12.9; p<0.0001) and FIB-5 (−1.10±6.58 vs 3.79±4.25; p<0.0001) were lower in SF group. APRI had the best accuracy (area under the receiver operating characteristic curve=0.95) followed by FIB-4 (0.78) and FIB-5 (0.75) in ruling out SF.ConclusionsAPRI but not FIB-5 or FIB-4 is accurate in ruling out SF in patients with NAFLD in an urban slum-dwelling population.

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Introduction: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. SBP is generally diagnosed based on an increased number of polymorphonuclear neutrophils in the ascitic fluid (>250/mm 3 ) and positive culture. Usually fluid analysis and culture take time and precious hours are lost in starting therapy. Leukocyte Esterase Reagent Strips (LERS) have consistently given a high negative predictive value (>95% in the majority of the studies). Aims and Objectives: Aim was to evaluate the diagnostic utility of leukocyte esterase reagent strip for rapid diagnosis of SBP in patients who underwent abdominal paracentesis and to calculate the sensitivity, specificity, positive, and negative predictive values. Methodology: The study was carried out on 64 patients with ascites. Cell count of AF as determined by colorimetric scale of Multistix 10 SG reagent strip was compared with counting chamber method (PMNL count ≥250 cells/mm 3 was considered positive). Results: Of the 64 patients SBP was diagnosed in 17 patients, 47 patients were negative for SBP by manual cell count. At cut off of 2+; sensitivity to diagnose SBP was 100%; specificity of 94%; PPV being 57% and NPV of 94%. at the cut off level of 3+; sensitivity decreased down to 76%; specificity increased to 100%; PPV of 100% and NPV of 93.75%. Overall accuracy at 2 + and 3 + was respectively 94.5% and 93.75%. Conclusion: In this study we have found good sensitivity and specificity for the prompt detection of elevated polymorphonuclear neutrophil count. A negative test result excludes SBP with a high degree of certainty. Thus, it represents a convenient, inexpensive, simple bedside screening tool for SBP diagnosis.

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Background To investigate the efficacy and safety of Paclitaxel (albumin binding type) combined with S-1 compared with SOX regimen in the treatment of Lauren diffuse-type advanced gastric cancer. Methods The clinical data of 50 patients with advanced Lauren type diffuse gastric cancer in our hospital from August 2018 to June 2020 were retrospectively analyzed. According to the first-line treatment plan, they were divided into treatment group (n=25) and control group (n=25). The treatment group was treated with Paclitaxel (albumin binding type) combined with S-1 compared chemotherapy. The control group was treated with Oxaliplatin combined with S-1 chemotherapy. Then the adverse reaction and clinical efficacy were recorded. Results Total 50 patients were evaluated for efficacy. The disease control rate of the treatment group was 68.0% (17/25), and the control group was 48.0% (12/25). The disease control rate of the treatment group was higher than the control group, and the difference was statistically significant (P < 0.05). The main side effects of the two groups were myelosuppression and gastrointestinal reactions, mostly grade I-II. The incidence of leucopenia, hemoglobin reduction and thrombocytopenia in the treatment group was significantly lower than that in the control group (P < 0.05). Other toxicities were similar. Conclusions Paclitaxel (albumin binding type) combined with S-1 compared with SOX regimen has a significant effect in the first-line treatment of advanced Lauren type diffuse gastric cancer, with no increase in the incidence of adverse reactions, has good safety. It is worthy of clinical promotion. Although the efficacy was better, it should be confirmed by well-controlled randomized clinical trials with more patients.

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