Fifty years of vaccines that save lives: 154 million lives are saved by WHO's EPI

 Fifty years of vaccines that save lives: 154 million lives are saved by WHO’s EPI

MAY 7,2024

NR.BALOCH

Researchers have looked at the effects of the World Health Organization’s Expanded Program on Immunization (EPI) on public health, with findings published in The Lancet.

In 1974, the World Health Assembly committed itself to ensuring that everyone may benefit from vaccinations by establishing the Expanded Protection Index (EPI). By 1990, children were to be vaccinated against measles, poliomyelitis, smallpox, pertussis, tetanus, diphtheria, and tuberculosis, according to a WHO plan. As of right now, the EPI offers protection for all ages against other pathogens. The breadth of protection has significantly increased as a result of vaccination programs expanding to include more diseases.

Researchers modeled the effect of EPI on public health in the current study. They calculated the number of years of life gained, years of complete health acquired (i.e., disability-adjusted life-years averted), and years of life gained in WHO member states from June 1974 to May 2024 as a result of vaccination against 14 diseases.

The following diseases/pathogens were made vaccines against: rotavirus, poliomyelitis, rubella, invasive pneumococcal disease, tetanus, meningitis A, hepatitis B, yellow fever, diphtheria, Japanese encephalitis, pertussis, measles, poliomyelitis, and rubella. A uniform structure was created to evaluate the effect for each fully immunized person.

The group combined vaccination coverage estimates from the Vaccine Impact Modeling Consortium (VIMC), Immunization Dashboard, Supplementary Immunization Activities Database, and WHO’s Polio Information System. A total of 24 vaccination initiatives were assessed, divided into disease categories,

Firstly, impact estimates were obtained using the simulation of established measles and poliomyelitis transmission models for a 50-year timeframe. Second, from 2000 to 2024, VIMC transmission models for Japanese encephalitis, rotavirus, rubella, H. influenzae type B, and hepatitis B were expanded. Third, updated static disease burden models were created for diphtheria, tetanus, pertussis, and tuberculosis.

The three modeling approaches made it possible to capture vaccine effects at the individual and population levels. Estimating the effect of EPI on lives prevented, years of life gained, years of full health gained, and the percentage of infant mortality reduction related to vaccinations was the main goal of the study. These indicators were also assessed by the World Bank income stratum and region as secondary outcomes.

Results

According to the researchers, vaccination campaigns against the 14 infections prevented an estimated 154 million fatalities between June 1974 and May 2024, of which 146 million were prevented in children under the age of five. Nine billion life-years and 10.2 billion years of perfect health were also gained during this time. Gained were 58 years of life and 66 years of complete health on average.

Thanks to vaccinations, there have been fewer deaths, years of life preserved, and years of perfect health. The data spans the years 1974–2024. Measles: 93·7 million fatalities prevented, 5·7 billion years of life preserved, and 5·8 billion years of full health gained. Tetanus: 27·9 million fatalities prevented, 1·4 billion years of life preserved, and 1·4 billion years of good health gained. With pertussis, 1 billion years of complete health were acquired, 0.8 billion years of life were spared, and 13.2 million fatalities were prevented. 10·9 million deaths from tuberculosis are prevented; 0.6 billion years of life are preserved; and 0.9 billion years of good health are acquired. For Haemophilus influenzae type B, there were 2.78 million fewer fatalities, 0.2 billion more years of life saved, and 0.2 billion more years of good health gained. Poliomyelitis: 1·6 million fatalities prevented, 0·1 billion years of life saved, and years of

Notably, the prevention of poliomyelitis cases resulted in 0.8 billion years of increased health. The measles vaccination was the single most important factor in the 93.7 million lives that were saved over the course of 50 years in both World Bank income stratum and WHO areas. Additionally, since 1974, there has been a significant drop in infant mortality worldwide, with immunization directly contributing to 40% of this development.

If someone were to live to be 10, 25, or 50 years old in 2024, their chances of surviving the next year would be 44%, 35%, or 16% higher, respectively, than if they had not had any immunizations since 1974. The probability of surviving a life course increased most significantly in the African and Eastern Mediterranean regions, while it decreased most in the European zone. Upon

In conclusion

According to the research, vaccinations have prevented the deaths of an estimated 154 million people since 1974, the most of them (95%) were young children. This indicates that vaccinations have resulted in 10.2 billion extra years of healthy living and nine billion life-years saved. Interestingly, the measles vaccination was the single biggest factor.

Moreover, vaccinations accounted for about half of the decrease in infant mortality worldwide. As a result, the annual survival rate of a child born in 2024 will climb by 40%. Furthermore, the advantages of baby vaccination for survival last for more than 50 years. Areas with higher beginning mortality rates saw larger absolute advances at the expense of smaller relative gains. 

Journal citation: Sim SY, Johnson HC, Shattock AJ, et al. Improving health and survival via immunization: a 50-year retrospective of the Expanded Program on Immunization. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00850-X/fulltext The Lancet, 2024, DOI: 10.1016/S0140-6736(24)00850-X

Is Blockchain Enough for a Major Role?

• Is Blockchain Enough for a Major Role?
  

MAY 6,2024

NR.BALOCH

The emergence of Bitcoin in 2009 marked the general awareness of blockchain technology. It was once heralded as a ground-breaking financial transaction solution, but its potential has now been realized in a wide range of sectors, including supply chain management and healthcare. But even with all of its promise, the question still stands: Is blockchain really ready for the big time?

 

Comprehending Blockchain Technology

Prior to exploring its preparedness, let us understand the basics of blockchain technology. A blockchain is fundamentally a distributed, decentralized ledger that keeps track of transactions over a network of computers. A chain of blocks is created when all of the transactions, or blocks, are safely connected to each other by means of cryptographic hashes. Transparency, immutability, and security are guaranteed by this design.

 

The Promise of Blockchain Immutability and Transparency: Blockchain’s decentralized structure, which allows all network members to access the same data, accounts for its transparency.

 Transactions are irreversible once they are recorded, guaranteeing immutability and user confidence in the system.

Security: Blockchain is extremely secure against fraud and tampering because to its cryptographic algorithms. Because decentralized consensus mechanisms like Proof of Work or Proof of Stake require network participants to validate transactions, they further increase security.

Effectiveness and Economical Benefits:Blockchain promises potential cost savings and operational efficiencies by doing away with middlemen and automating operations through smart contracts. This is especially important for sectors like financial services and supply chain management that have a lot of intricate and time-consuming procedures.

Adoption’s Obstacles

Although blockchain technology has great potential, there are a few obstacles in the way of its general adoption:

• Scalability: Scalability is one of the biggest obstacles. Transaction throughput slows down as blockchain networks expand, causing congestion and increased costs. Although sharding and layer-two scaling are being explored as solutions, they have not yet been widely implemented.
• Regulatory Uncertainty: Blockchain and cryptocurrency regulations are subject to vast variations in international law. Regulations that are too loose or too severe can prevent investors and users from investing in blockchain ventures.
• Interoperability: Since many blockchain networks run independently of one another, interoperability across many platforms can be difficult. The ecosystem’s ability to communicate and share data across heterogeneous networks must be seamless.
• User Experience: Complex procedures and a lack of user-friendly interfaces are common problems with blockchain applications. Enhancing the user experience is crucial for gaining widespread acceptance, particularly in apps that interact with customers.

Utilization Examples and Achievements

Several businesses have adopted blockchain technology in spite of these obstacles:

• Financial Services: Financial firms are very interested in blockchain due to its ability to cut costs and streamline procedures. Projects like Ripple, which seeks to transform international payments, serve as examples of how blockchain is affecting the sector.
• Supply Chain Management: One of the main challenges in supply chain management is tracking the provenance of items and verifying their validity. Transparent and traceable supply chains are made possible by blockchain technologies, such as IBM’s Food Trust, which boost productivity and consumer confidence.
  
• Healthcare: Blockchain has the potential to revolutionize the healthcare industry by securing patient data and streamlining the maintenance of medical records. Blockchain technology is being used by initiatives like Medicalchain to enable telemedicine and secure access to medical records.

Final Thought: Primetime Prospects

Blockchain technology has the ability to upend sectors and spur innovation, despite certain difficulties. With the ongoing development of scaling solutions, regulatory clarity, and interoperability standards, blockchain is progressively becoming a practical solution for practical uses.Collaboration between technology developers, regulators, and industry stakeholders is essential to realizing blockchain’s promise. Blockchain is positioned to become a cornerstone technology in the future digital economy with coordinated efforts to overcome its drawbacks and build on its advantages.

China: A Stablecoin Pilot?

 China: A Stablecoin Pilot?

MAY 6,2024

NR.BALOCH

Hong Kong’s open, market-oriented, and internationally interconnected institutional structure, along with its well regarded monetary and regulatory agencies, make it an excellent choice for prototype financial ventures. The development of a stablecoin for usage in China’s Greater Bay Area that is tethered to the offshore yuan is one such plan.

Hong Kong – As soon as possible, the Financial Services and the Treasury Bureau (FSTB) and the Hong Kong Monetary Authority (HKMA) will set up a regulatory framework for stablecoin issuers operating in the region. Fintech companies and asset managers are apparently keeping a close eye on the initiative. Other administrations ought to follow suit.

One kind of cryptoasset called stablecoins is designed to keep its value consistent with a target currency. Stablecoins that are “collateralized” are supported by a reserve asset pool that may consist of commodities, other cryptoassets, or fiat money. However, not all stablecoins are supported by reserve assets. Unbacked stablecoins, on the other hand, aim to preserve a steady value by other strategies, like supply-limiting algorithms that establish a market value.

As of right now, stablecoins lack both a widely accepted standard and a legal structure to control them. However, the market is huge and expanding quickly. The estimated total market value of stablecoins has increased dramatically from $5.9 billion to over $130 billion since the start of 2020. Because of the US dollar’s dominance in the market, stablecoins linked to it

With almost 70% of the market, Tether is in the lead, followed by USD coin with 20%. According to Tether, as of the end of September 2023, it had $86.4 billion in assets against $83.2 billion in liabilities. These assets included approximately $56.6 billion in US Treasury bonds, $5.1 billion in secured loans, $3.1 billion in precious metals, $1.7 billion in Bitcoin, and $2.3 billion in other investments. During the first quarter of 2023, the company declared a $1.4 billion profit.

Stablecoins aim to provide a more dependable substitute for cryptocurrencies such as Bitcoin, which are highly volatile and dependent on nothing. Collateralized stablecoins have “generally been less volatile than traditional cryptoassets,” according to the Bank for International Settlements. Meanwhile,

Furthermore, as stated by the BIS, “users’ stablecoins could not always be fully and instantly redeemed by stablecoin issuers.” In the end, not one of the more than 200 stablecoins that are now in use satisfies the “essential requirements for being a reliable means of payment in the real economy” and a safe store of value.

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There is cause for optimism that Hong Kong could propel advancement. Since the Hong Kong dollar, the official currency of the region, is fixed against the US dollar, “Digital HKD” is effectively a stablecoin. (The Digital HKD was effectively treated as such in the September 2023 policy statement published by the HKMA.) Above all, Hong Kong’s open, market-oriented, internationally interconnected institutional structure makes it an excellent choice for pilot projects. Its monetary and regulatory agencies are also highly recognized.

The development of a stablecoin based on the offshore renminbi for use in the Greater Bay Area, an economic region with a combined GDP of $1.9 trillion that consists of nine cities in Guangdong province surrounding the Pearl River Delta as well as Hong Kong and Macau, might be one such initiative. This “GBA stablecoin” can be easily traded for the US dollar, Hong Kong dollar, and offshore renminbi, and it could help with the creation, trading, and settlement of new digital financial instruments in Hong Kong. GBA stablecoin may be used to price financial items that are issued outside of China’s mainland.

Under this plan, the financial goods and digital infrastructure—such as offshore bonds issued by GBA firms and local governments—would be sold in Hong Kong, while the majority of their underlying physical assets would be located in mainland China. This system is comparable to H-shares, which are Hong Kong-based stocks of vital mainland-based enterprises traded. In essence, what would emerge from this would be an offshore digital renminbi that is operational and gains from the increased trust in the market that comes from HKMA monitoring. Without endangering the stability of onshore renminbi, this would increase demand for offshore renminbi and hasten the internationalization of the yuan.

Together with its counterparts in mainland China, Thailand, and the United Arab Emirates, the HKMA has already carried out a six-week central bank digital currency (CBDC) experiment. One of the first multi-CBDC programs to settle real-value, cross-border transactions on behalf of enterprises was Project mBridge.

The monetary authorities are currently developing the mBridge platform to speed up cross-border retail or wholesale payments in response to the pilot’s success. This shows that GBA stablecoin could support China’s ambitious multi-country Belt and Road Initiative (BRI) with offshore financing and enable international trade and investment more generally with the right digital financial infrastructure, which makes use of distributed blockchain technology to enable “smart contracts.”

The success of such a pilot would depend on the demands of banks, companies, investors, and consumers in addition to financial institutions’ willingness to issue the stablecoins. Some people might be hesitant to use GBA stablecoin in the existing US dollar-based financial system. However, many market players, including those involved in BRI projects, are looking for a solid alternative to the US currency, including dollar-backed stablecoins, given America’s geopolitically motivated weaponization of global banking.

Which stablecoins succeed will ultimately depend on how well the returns on equity and the risks attached to a particular coin are balanced. There is a lengthy trial and error procedure ahead.

America Has to Take the Lead in Crypto Regulation

America Has to Take the Lead in Crypto Regulation

MAY 6,2024

NR.BALOCH

The United States needs to utilize the upcoming year to encourage transparency and confidence in the digital asset market if it hopes to keep its position as a global rule-maker and avoid turning into a rule-taker. The United States of America has three options for preserving its competitive advantage in cryptocurrency: designation, regulation, and legislation.

Compared to 2022, which proved to be a catastrophic year for the digital asset markets, 2023 was marked by proactive regulatory measures and favorable industry advancements. The largest cryptocurrency exchange in the world, Binance, and US regulators have reached a deal that is expected to increase market-wide responsibility, openness, and confidence. In the meantime, the majority of international financial hubs have established precise rules for the cryptocurrency sector.

Even with this progress, if new regulations are not established in 2024, the US runs the risk of being an exception. Three possible avenues exist for policymakers to manage opportunities and hazards in the cryptocurrency market: designation, legislation, and regulation.

When US President Joe Biden issued his Executive Order on Ensuring Responsible Development of Digital Assets two years ago, it was a significant step toward bringing regulatory clarity. Despite the fact that almost all digital assets are valued in US dollars, legislative measures have since faltered, and the US has lagged behind other nations in industry regulation.

The irony is that international efforts to regulate the cryptocurrency market have been spearheaded by US-led organizations including the Financial Stability Oversight Council, the President’s Working Group on Financial Markets, and the Financial Stability Board. Treasury Secretary Janet Yellen, who chairs the Financial Stability Oversight Committee, has also pushed Congress to move legislation governing stablecoins denominated in dollars. Chair of the Federal Reserve Jerome Powell has repeated these demands.

The potential concerns connected to cryptocurrency are highlighted by these calls for legislation, which are reinforced by international regulatory authorities. Utilizing blockchain and other cutting-edge technologies would be a better course of action than allowing the industry to collapse or imposing strict regulations, as some economists advocate. This is because it will ensure that financial services can meet market demand outside of regular banking hours, a challenge that is particularly relevant to international payments. Now that almost all of the world’s largest banks, asset managers, fintechs, and payment services providers have created digital asset strategies, it is past due for US lawmakers to catch up and enact technology-neutral, morally-based laws that promote competition in the financial markets.

Congress must so provide federal regulatory bodies the authority to create market regulations. In spite of criticism from politicians such as former US President Donald Trump, who is expected to be the Republican Party’s nominee for president in November, this involves investigating digital currencies issued by central banks. Along with modernizing state and federal banking and payment systems, it also entails developing regulations for digital wallets. In order to preserve America’s competitive advantage and prevent a potential fintech “constitutional crisis,” several steps are essential.

The necessity for prompt action has again been stressed by the Treasury Department. Deputy Secretary Wally Adeyemo urged Congress to address the risks associated with illicit operations sponsored by cryptocurrency in November, citing the lack of regulatory control and the opaque nature of some cryptocurrency products. These items are financial fentanyl at worst, and financial alchemy at best.

American interests are threatened by the lack of a US regulatory framework for dollar-referenced stablecoins, which are becoming more and more licensed in places like Singapore, Hong Kong, and the United Arab Emirates. This void might encourage the development of goods that circumvent US laws and take advantage of consumer confidence in the dollar, thereby serving as a haven for unscrupulous operators.

The US must, at the very least, make sure that foreign issuers of stablecoins pegged to the dollar abide by the Bank Secrecy Act, as well as applicable sanctions, anti-money laundering, and counterterrorism legislation. If not, digital dollars might compromise global security instead of reducing the technological threats brought about by dollar primacy.

However, the US needs to create new regulations before labeling cryptocurrency companies or technologies as dangers. Although open-source technologies have previously been categorized as national security threats, significant token issuers or exchanges have not yet been designated as systemically important financial institutions—a designation that would imply they are too large to fail. Rather than permitting unrestrained offshore or near-shore cryptocurrency operations to flourish or letting other nations establish the parameters for a business that is as fundamentally American as the

There is a lot of policy movement because to the stablecoin bill that the House Financial Services Committee advanced in July 2023. If this bill is approved by Congress with bipartisan support, it will be the greatest legislative chance to address the rise in cryptocurrency dollar counterfeiting. Furthermore, it might be America’s last opportunity to continue dominating the markets for digital assets.

It will undoubtedly be challenging to move forward during a divisive presidential campaign. However, if the US wants to continue being a rule-maker rather than a rule-taker, digital asset policy must be advanced. This is especially important now that the Markets in Crypto-Assets (MiCA) framework of the European Union is about to take effect later this year, potentially producing a transatlantic gap in the regulation of digital assets.

This year’s US policy agenda for digital assets must prioritize worldwide regulatory harmonization over regulation, legislation, and designation in order to avert such a result. However, without clear regulations and American leadership in the cryptocurrency business, these initiatives would inevitably fail.

BINANCE NEWS

MAY 5,2024

BY NR.BALOCH

BINANCE NEWS

Investors in altcoins have been the main victims of the latest slump in the cryptocurrency market, according to CryptoPotato, with many of them suffering losses. On the other hand, holders of meme coins, such Dogecoin (DOGE) and Shiba Inu (SHIB), are comparatively better off as a result of prior price hikes.

In spite of a strong start to the year and the halving of Bitcoin (BTC) last month, there has been a significant pullback in the cryptocurrency market. In little than a week, the main cryptocurrency’s price dropped by 10% and fell below $60,000. Leading digital assets including Ripple (XRP), Solana (SOL), and Ethereum (ETH) are also sharply negative.

The top ten cryptocurrency projects with the highest number of holders that are now suffering paper losses were listed by market intelligence portal IntoTheBlock. Investors in Algorand (ALGO) led the

TOP 10 ALTCOIN NETWORKS IN APRIL

  

MAY 5 , 2024

BY NR.BALOCH 

The Top 10 Altcoin Networks in April by User Base are as follows: Ethereum is ranked sixth. Following the disappointing US job report, the cryptocurrency market surged driven by Bitcoin; nonetheless, research firm CryptoRank discovered the altcoin networks with the largest user bases in April. At the time this piece was written, the price of bitcoin was trading at $63,257, up around 7% in the previous day. The top altcoin networks and the number of users they had in April are as follows:

•  Tron (TRX): 54.7 million;
•  Near (NEAR): 53.8 million;
•  BNB (BNB): 35.5 million; 
• Solana (SOL): 35.2 million;
•  Polygon (MATIC): 33.6 million;

•  Ethereum (ETH): 12 million;
•  Base: 10.7 million;
•  zkSync Era: 9.8 million;
•  Arbitrum (ARB): 9.3 million; 
• Linea: 5.6 million

BITCOIN PRICE SWAYS BERORE THE FED

 

MAY 5,2024

BY NR.BALOCH 

 Bitcoin price sways before the Fed announces its rate decision The price of Bitcoin (BTC) dropped to $59,500 on Binance in advance of the Federal Open Market Committee (FOMC) meeting tomorrow. With forecasts for stable interest rates, market players are ready for the Federal Reserve (Fed) to adopt a more aggressive attitude. Only 4.4% of analysts, according to the CME FedWatch Tool, foresee a rate cut—the first in more than ten years—while a commanding 95.6% expect rates to remain unchanged between 525 and 550 basis points. The Kobeissi Letter reports that there is a 36% chance, based on current market data, that there won’t be any interest rate decreases this year. It was just around 3% likely four months ago that present rates would be maintained. It is now anticipated that there will only be one decrease this year. Prior to now, the market

LEEDS UNITED 1-2 SOUTHAMPTON REPORT

LEEDS UNITED 1-2 SOUTHAMPTON REPORT

MAY 5,2024

BY NR.BALOCH

AP/MANCHESTER, England With four goals, including a hat-trick in the first half, Erling Haaland helped Manchester City defeat Wolverhampton 5-1 and maintain control of the Premier League title chase on Saturday.

With yet another impressive haul from Haaland, Pep Guardiola's club responded impressively to first-place Arsenal's 3-0 victory over Bournemouth earlier in the day.

The Norway forward added a fourth goal with a curling effort after scoring twice from the penalty spot in the first half, either side of a powerful header.

Julian Alvarez, a replacement, also scored, but Hwang Hee-chan gave Wolves some solace.

With the win, City, who is vying for a record fourth consecutive league title, closed the gap on the Gunners to just one point. Arsenal has two games remaining, whereas City has three.

Haaland's outstanding performance increased his season total to 36 in all competitions and put him five points ahead of his closest rivals in the Premier League Golden Boot standings at 25. In City colors, it was his ninth hat trick.

There wasn't much of a way out for the Wolves players, though manager Gary O'Neil might have been happy that his touchline ban kept him out of sight.

Although there was disagreement over the first penalty after 12 minutes, City's resolve was evident from the start, and it was not surprising that the hosts quickly took the lead.

Rayan Ait-Nouri tried to clear as Josko Gvardiol was preparing to shoot, and the two clashed. Referee Craig Pawson gave the spot kick, which Haaland comfortably put away, though the call might have gone either way.

With the help of some shoddy Wolves defense, City quickly had additional opportunities when Kevin De Bruyne missed a shot and Jose Sa, the Wolves goalkeeper, blocked Haaland's header. Phil Foden dribbled through the area, but at the crucial time, he lost control.

In the 35th minute, Rodri recovered possession, carried on with his run, and passed to De Bruyne before lofting a cross to the back post, where Haaland soared wonderfully to head past Sa. This was the inevitable second goal.

After being hauled down by Nelson Semedo, the Norwegian completed his trifecta in first-half stoppage time with a second penalty.

Despite evaluating the challenge on the pitchside monitor, Pawson was not persuaded this time and pointed to the location.

Before the half, Wolves didn't do much, but after 53 minutes, against the flow of play, they scored one.

After overcoming a shoulder injury to begin play, City goalie Ederson Moraes palmed a cross from Jean-Ricner Bellegarde into Hwang's path, and the South Korean put the ball into the net.

But, Haaland quickly and decisively crushed any dreams Wolves may have had of mounting a comeback.

From just inside the area, the attacker latched onto a long pass from Foden and cut inside to unleash a fierce shot into the far corner.

Five minutes from time, Alvarez beat Sa once more, and Haaland came close to scoring a fifth moments later when he forced a superb save from the goalkeeper after also stopping Mateo Kovavic.

Katie Ledecky discusses her goals for the 2028 Summer Olympics in Los Angeles and Paris with NPR.

 Katie Ledecky discusses her goals for the 2028 Summer Olympics in Los Angeles and Paris with NPR.

MAY 5,2024

BY NR.BALOCH

Medals are nothing new to Katie Ledecky.

She has 26 world championship medals, 21 of which are gold, and 10 Olympic medals, seven of which are gold.

She is without a doubt the greatest female swimmer of all time thanks to all of that hardware.

A who's who of Democrats are receiving the Medal of Freedom from Biden (and Katie Ledecky)
Polities
A who's who of Democrats are receiving the Medal of Freedom from Biden (and Katie Ledecky)
She will, however, be given a different kind of medal on Friday: the Presidential Medal of Freedom, which is the highest honor bestowed by the American government on a civilian.

Ledecky discussed her thoughts on the July–August Olympics in Paris, the significance of the medal to her, and her motivations for speaking with Juana Summers of All Things Considered. Ledecky discussed her thoughts about the Paris Olympics in July and August, the significance of the medal to her, and her lack of plans to retire after this summer with host Juana Summers of All Things Considered.intends to stay in the workforce following this summer.

Juana Summers will be in Paris covering the Olympics for NPR. You can follow all her reporting on All Things Considered.

Highlights of the interview
Juana Summers: Okay, Katie. Does this medal fit in the same trophy cases as your Olympic medals? How are you going to use it, in your opinion?

Katie Ledecky: Oh, that is so not even on my mind! This one is undoubtedly very special and meaningful. And I could never have dreamed that I would be getting this kind of recognition. Thus, I feel quite honored.

Summers: If we may go forward, this may be yet another extraordinarily significant year for you. Let's look ahead. In a few months, Paris will host the Summer Olympics. How are you feeling in the water these days? Do you think you're prepared?

Ledecky: I'm prepared. Our Olympic trials are in around one month. I have one more meeting before then, so that's what I'm preparing for. Thus, everything is proceeding according to plan, and I'm training well. Additionally, I'm really

Summers: Which Olympic event would you most like to compete in, if the trials go your way and you end up representing the United States?

Ledecky: Alright, so, hopefully I'll be taking part in several competitions. And they're all unique in their own ways. My favorite event to swim in the Olympics has always been the 800 free, which I competed in for the first time in 2012 and won gold in at the age of 15. I therefore have a particular place in my heart for that one. But I adore every event I have. I'm also excited for the trials that come with competing in each race.

Summers: Do you suppose these would be your last ones if you go to Paris? Do you believe you'll return for the Los Angeles 2028 games?

Ledecky: I approach things year by year, but as of right now, I could easily see myself participating in the Olympics in my native country in 2028. It's a really distinctive thing. Not every Olympian athlete understands it. I therefore know for a fact that I will not be retiring after this summer, and 2028 appeals to me greatly. Thus, I believe that at this time, I want to go and participate in at least one event, if not more. But once more, things can change. It's a long way off, and for now my only concern is Paris this summer.

I believe that playing the sport has taught me a lot. And over my more than ten-year foreign trip, I've picked up a lot of knowledge on goal-setting, perseverance, and dedication.


It's never too late to improve your swimming abilities. This is how to launch Life Kit.

It's never too late to improve your swimming abilities. Here's how you kick off summertime: Would you like to share a resilience-related lesson or anecdote with the people who look up to you?

Ledecky: Of course, one tale that I believe many Olympic athletes will share with you is about what happened to us in 2020 and 2021 when the Olympics were moved forward one year. The Olympics represent the zenith of our sport in swimming, and we create four-year programs to compete at our very best and reach our peak. It therefore took a lot of resilience for all of us to have that pushed for a year, to be kind of living under uncertainty, and to not know whether the Olympics would actually happen. We all had to adjust by training in backyard pools, doing weightlifting in our houses or apartments, and doing all those things.

That period taught me a lot about myself, including the fact that change is something you can adjust to. We weren't experiencing the worst of it at the time, so there was another plus. I felt incredibly fortunate to have the Olympics as a target to strive for. I am aware that a great deal of people went through much worse pain at that time than we did. Those experiences, in my opinion, have strengthened me and shown me that I can adjust when things don't turn out the way I had hoped.

Medals from the Paris Olympics will include fragments of the Eiffel Tower.
ACTIVITIES
Medals from the Paris Olympics will include fragments of the Eiffel Tower.
Summers: Katie, if Paris

Ledecky: I haven't given it a lot of thought. Nevertheless, when I think of swimming and my career in it, I remember all the happiness I've experienced in the sport, everything I've learned from it, the people I've met through it, and the places I've been able to experience through competitive swimming. And I believe that I will always continue to play the sport because of the immense delight I've found in it.


Naturally, at some point in the future, my competitive career will come to an end, and I won't be checking the time or having a coach record my times for each set.

Canelo Alvarez vs. Jaime Munguia odds, prediction: Boxing expert on 50-13 run reveals picks for May 4 fight

Boxing analyst Peter Kahn has announced his top picks and wagers for Saturday's bout in Las Vegas between Jaime Munguia and Canelo Alvarez.

 Boxing analyst Peter Kahn has announced his top picks and wagers for Saturday's bout in Las Vegas between Jaime Munguia and Canelo Alvarez.

Canelo Alvarez and Jaime Munguia will compete for the undisputed super middleweight championships on Saturday night in what will be the first all-Mexican major world title showdown at any weight over 160 pounds. For seven years, Alvarez refrained from competing against other Mexican boxers; his most recent victory came against Julio Cesar Chavez Jr. in 2017. On Saturday night in Las Vegas, when he defends his IBF, WBC, WBA, and WBO titles, he will make an exception. Since suffering just one of his two losses on his record in 2022 against Dmitrii Bivol, Alvarez has won three straight fights by unanimous decision.

Canelo vs. Munguia is the main event scheduled to take place later in the evening on Saturday at T-Mobile Arena. The main card is scheduled to start at 8 p.m. ET. In the Alvarez vs. Munguia odds, Alvarez is the -400 favorite (risk $400 to win $100), and Munguia is the +300 underdog. The total number of rounds completed is 10.5 over/under, with the Over shaded to -200. Make sure you check out SportsLine analyst Peter Kahn's boxing predictions and betting recommendations before committing to any Canelo Alvarez vs. Jaime Munguia wagers.

With his finger on the pulse of everything going on both inside and outside the ring, Kahn is a true boxing insider. Through his organization, Fight, he has managed multiple world champions and presently oversees 20 fighters.

Now that Canelo Alvarez and Jaime Munguia are scheduled to face each other, Kahn has thoroughly examined the fight from all aspects and made certain predictions. Only at SportsLine are those selections visible.

 Preview: Canelo Alvarez vs. Jaime Munguia

Alvarez (60-2-2, 39 KOs) hasn't fought another Mexican in a boxing ring since defeating Julio Ceasar Chavez Jr. via unanimous decision in May 2017. Despite having held the WBC middleweight title previously, Chavez Jr.'s career took a severe turn after his defeat by Alvarez, as he lost three of his last four fights, including one against former UFC champion Anderson Silva.

According to Alvarez, he has deliberately avoided playing against Mexicans in order to prevent potentially ruining their careers and leaving the sport with fewer Mexican athletes who are stars and champions.

He did make an exception for Munguia, though, as a loss on Saturday would not be able to mar Munguia's already illustrious career or legacy. Furthermore, Munguia's successes have inspired Alvarez to see their bout as a celebration of Mexico's rich boxing heritage and to use it as a springboard to give fans an unforgettable display.

"I have stated that I am not interested in fighting Mexican fighters," Álvarez stated at a press conference on Tuesday. However, I'm happy that we were able to bring this fight to Munguía, who is a respectful person and has deserved it. I'm really proud of this as it's clearly all Mexican."

Munguia defeated John Ryder in a super middleweight battle held in Phoenix earlier this year, and he comes into this match with a perfect 43-0 record. Before finally winning via TKO in the ninth round, he had four knockdowns. He will feel more confident after that victory because Ryder defeated Alvarez last year.

Munguia will be competing for the third time in this weight class and his sixth world championship. In his previous world championship fights, he was 5-0-0 with two knockouts; versus past or present world champions, he was 2-0-0 with one knockout. The 27-year-old has prevailed via TKO or KO in four of his previous five fights, and eight of his previous ten contests have ended in knockouts. Check who needs to come back here.

 How to choose between Jaime Munguia and Canelo Alvarez

We can discuss Kahn's preference for the Under 10.5 rounds. In addition, he has a sure money-line selection and a method-of-victory prop locked in. His predictions and analysis are exclusively available on SportsLine.


How to choose between Jaime Munguia and Canelo Alvarez
We can discuss Kahn's preference for the Under 10.5 rounds. In addition, he has a sure money-line selection and a method-of-victory prop locked in. His predictions and analysis are exclusively available on SportsLine.

Which prop is a must-back in the Canelo Alvarez vs. Jaime Munguia match? See Peter Kahn's top picks on Saturday at SportsLine right now. The boxing expert has made his fans profiting more than $4,000 on wagers.

In Patients With Chronic Liver Disease, Platelet Count to Prothrombin Time: A Noninvasive Predictor of Esophageal Varices

MAY 4,2024

NRBALOCH

Summary of Introduction

One potentially fatal side effect of portal hypertension in cirrhosis patients is esophageal variceal hemorrhage. The current study measured the platelet count to prothrombin time (PLT/PT) ratio for the assessment of portal hypertension and subsequent diagnosis of esophageal varices (EVs) in patients with chronic liver disease (CLD), even though upper gastrointestinal endoscopy is still the preferred method for EV identification.

Techniques

Using a non-probability consecutive sampling technique, this observational comparison study was carried out at the outpatient department of Patel Hospital in Karachi, Pakistan. The Patel Hospital Ethical Review Committee (PH/IRB/2022/028) granted ethical approval. For parametric data, an independent sample t-test was employed; for non-parametric data, the Mann-Whitney U test was utilized. The category data were compared using the chi-square test.

Outcomes

105 participants with and without EV participated in the trial. Thirty (66.7%) males and fifteen (33.3%) females did not have EV, while 38 (63.3%) males and 22 (36.7%) females did. Additionally, patients with EV had a substantially lower platelet (PLT) count (87.6 ± 59.8) than patients without EV (176.6 ± 87.7) (p < 0.001). those with EV had a PLT/PT ratio that was considerably lower (median: 5.04, IQR: 3.12-9.21) than those without EV (median: 14.57, IQR: 8.08-20.58) (p < 0.001). The PLT/PT ratio’s EV identification sensitivity and specificity were 97.80% and 83.30%, respectively.

In summary

In comparison to cases without EV, we observed a considerably decreased PLT/PT ratio in EV patients. PLT/PT demonstrated a good sensitivity in detecting cases with EVs in CLD after establishing an ideal threshold. Thus, we conclude that the PLT/PT ratio is a noninvasive predictor of the occurrence of EV in individuals with CLD.

Overview

Cirrhosis is the primary cause of morbidity and death worldwide. In 2016, it accounted for 2.2% of deaths and 1.5% of years of life with a disability adjusted for disability, making it the 11th most common cause of death and the 15th most prevalent cause of morbidity globally [1]. Chronic liver disease (CLD) claimed the lives of 1.32 million persons in 2017; nearly two-thirds of these deaths were in males and one-third in females [2]. Portal hypertension and related consequences, such as tissue scarring, mixed regenerating nodules, and liver cell degeneration, are caused by liver cirrhosis. Among Asian countries, Pakistan has the greatest incidence of CLD [3].

Clinically speaking, portal hypertension is defined as a pathological rise in portal vein pressure brought on by a number of factors, the most frequent of which being

Supplies & Techniques

Patient Choice
This non-probability consecutive sampling strategy was used in an observational comparison study conducted in the outpatient department of Patel Hospital in Karachi, Pakistan. The Patel Hospital Ethical Review Committee (PH/IRB/2022/028) granted ethical approval. Six months were dedicated to the study. Every patient has provided written consent. 105 male and female patients with liver cirrhosis between the ages of 30 and 55 were included in the study. The study excluded patients with hepatocellular carcinoma, gastrectomy, lower portal hypertension patients on medication, patients undergoing sclerotherapy, critically ill patients with liver cirrhosis, patients with past portosystemic anastomosis, and other variables associated with ascites.

Biochemical and clinical characteristics

Each patient received a comprehensive evaluation that included a clinical history, laboratory testing to assess liver and renal function, total blood count, PLT, PT, and the international normalized ratio (INR). Our completely automated chemical analyzer was utilized to quantify creatinine and urea. Every laboratory test was done at Patel Hospital’s clinical pathology department. After being calculated, the PLT/PT ratios were statistically examined. After being screened for EGD, the patients were divided into two groups according to whether or not they had EV.

Gastroscopy and abdominal ultrasonography

Every patient had upper gastroesophageal endoscopy for EVs screening in the endoscopy suite and abdominal ultrasonography in the radiology department. The treatments were carried out by skilled gastroenterologists and radiologists. The laboratory and clinical parameters were unknown to the sonologists or the endoscopists. The grading system used to categorize EV was based on size; varices in the mucosa were included in grade I; large varices that did not flatten with insufflation and occupied more than a third of the esophageal lumen were included in grade III; and varices covering more than two-thirds of the esophageal lumen were included in grade IV [16].

Data interpretation

IBM SPSS Statistics, version 26.0, was used to enter and analyze the data (IBM Corp., Armonk, NY). For quantitative variables, descriptive statistics are presented as means and standard deviations; for qualitative variables, the same is true for frequencies and percentages. The data’s normality was examined using the Shapiro-Wilk test. Patients with and without EV were compared for numerical variables; for parametric data, an independent sample t-test was employed, and for nonparametric data, a Mann-Whitney U test. To compare the categorical data of patients with and without EV, the chi-square test was employed. The PLT/PT ratio, sensitivity, specificity, and area under the curve (AUC) cutoff points were assessed using a receiver operating characteristic (ROC) analysis. An

Outcomes

Clinical, biochemical, and endoscopic characteristics of EV-positive and -negative individuals
105 participants with and without EV participated in the trial. There was no discernible variation in the gender distribution among them; 38 (63.3%) men and 22 (36.7%) females had EV, while 30 (66.7%) males and 15 (33.3%) females did not (p = 0.723). There was no significant difference (p = 0.899) in the mean age of patients with and without EV, which was 40.33 ± 15.98 years and 41.93 ± 12.72 years, respectively. Likewise, a negligible correlation was observed in the body mass index (BMI) between the two cohorts (p = 0.131). However, there was a notable difference in the etiology of cirrhosis across the groups (p = 0.029), with the hepatitis C virus being the predominant cause in 31 (51.7%) of the patients with EV. Individuals with EV show notably

ChangeablesEsophageal varices patients, n (%)/mean ± SDIndividuals free of gastric varices, n (%)/mean ± SDp-value
sex

38 males (63.3%)Thirty (66.7%)0.723

22 (36.7%) female; 15 (33.3%)

Years of age 40.33 ± 15.98(kg/m2) 41.93 ± 12.72~0.899 BMI22.26 ± 5.3422.01 ± 4.25<0.131

The cause of cirrhosis

HBV~5 (8.3%)Thirteen (28.1%)0.029* HCV~21 (46.7%)~31 (51.7%)

HBV+HDV~7 (11.7%)Six (13.3%)

Immune 5 (8.3%)2 (4.4%)

The remaining 5 (8.3%)Alcoholics: 3 (6.7%) 7 (11.7%) 0 (0.0%)

1.29 ± 0.20 < 1.13 ± 0.20 INR<0.001* Albumin 3.03 ± 0.687 mg/dL3.64 ± 0.640PLT/PT; median (IQR) 5.04 (3.12-9.21) 14.57 (8.08-20.58) <0.001* Portal vein diameter (cm) 1.12 ± 0.17 1.04 ± 0.18 0.038* Child-Pugh class A 24 (40.0%) 36 (80.0%)B~26 (43.3%) <0.001*Nine (20.0%)

0 (0.0%) C 10 (16.7%)

esophageal

Table 1 lists the etiology, grading, and demographic details of esophageal varices (n = 105).

*p-value at least 0.05 is significant. The information is shown as mean ± SD/median (IQR), n, and percentage.

Standard deviation (SD) and body mass index (BMI) Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are INR is the ratio that is internationalized. Interquartile range is known as IQR and platelet count to prothrombin time ratio as PLT/PT. 

Variations between individuals with and without EV in terms of hematological markers and renal and liver function tests

There was a significant correlation (p = 0.001) between the mean hemoglobin levels of patients with EV (10.28 ± 2.08 g/dL) and those without EV (11.66 ± 2.04 g/dL). Moreover, patients with EV had a significantly lower total leukocyte count (TLC) (4.47 ± 2.33) compared to those without (6.52 ± 2.16), with a highly significant difference (p < 0.001). Patients with EV had a substantially lower PLT (87.6 ± 59.8) than those without EV (176.6 ± 87.7) (p < 0.001). Furthermore, PT, urea, creatinine, and gamma-glutamyl transferase (GGT) levels between the two groups showed significant differences (p < 0.001). However, there were negligible variations in sodium levels, aspartate aminotransferase, alkaline phosphatase (ALP), and mean corpuscular volume (MCV).

ChangeablesEsophageal varices patients, n (%)/mean ± SDIndividuals without gastroesophageal reflux disease, n (%)/mean ± SDHb (g/dL) 10.28 ± 2.08 11.66 ± 2.04 0.001* Complete blood count

(×103/m3) total leukocyte count 4.47 ± 2.33 6.52 ± 2.16<<0.00187.6 ± 59.8~176.6 ± 87.7~<0.001 Platelet count (×103/mm3)* The mean corpuscular volume was 81.2 ± 7.95 against 81.6 ± 7.53 0.789.

Prothrombin time (sec) <0.001; 14.31 ± 2.62 <12.64 ± 2.97*

Test of renal function

(mg/dL) Urea<25.5 ± 18.16~51.22 ± 53.19~<0.001* Creatinine (milligrams/deciliter)~0.80 ± 0.64~2.26 ± 3.56~0.003* Sodium 133.6 ± 20.6 137.5 ± 4.91 0.738 (mEq/L)

Test of liver function

IU/L of alkaline phosphatase: 213.5 ± 180.7 ± 201.8 ± 193.7 0.534

(IU/L) aspartate aminotransferase 86.03 ± 65.7 59.6 ± 41.1 0.134

Alanine transaminase (IU/L) 48.9 ± 43.4~0.271 54.5 ± 33.7

(IU/L) Gamma-glutamyl transferase 72.5 ± 70.9~120.0 ± 155.7~<0.001*

Table 1: *P-value significant at <0.05, the etiology, grading, and demographics of esophageal varices (n = 105). The information is shown as mean ± SD/median (IQR), n, and percentage.

INR is for international normalized ratio; SD stands for standard deviation; BMI for body mass index; HBV for hepatitis B virus; HCV for hepatitis C virus; and HDV for hepatitis D virus. Platelet count to PLT/PT:Table 1: *P-value significant at <0.05, the etiology, grading, and demographics of esophageal varices (n = 105). The information is shown as mean ± SD/median (IQR), n, and percentage.

Standard deviation (SD) and body mass index (BMI) Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are INR is the ratio that is internationalized. Platelet count to prothrombin time ratio (PLT/PT); prothrombin time ratio (IQR): interquartile range; interquartile range

Variations between individuals with and without EV in terms of hematological markers and renal and liver function tests

There was a significant correlation (p = 0.001) between the mean hemoglobin levels of patients with EV (10.28 ± 2.08 g/dL) and those without EV (11.66 ± 2.04 g/dL). Moreover, patients with EV had a significantly lower total leukocyte count (TLC) (4.47 ± 2.33) compared to those without (6.52 ± 2.16), with a highly significant difference (p < 0.001). Patients with EV had a substantially lower PLT (87.6 ± 59.8) than those without EV (176.6 ± 87.7) (p < 0.001). Furthermore, PT, urea, creatinine, and gamma-glutamyl transferase (GGT) levels between the two groups showed significant differences (p < 0.001). However, there were negligible variations in sodium levels, aspartate aminotransferase, alkaline phosphatase (ALP), and mean corpuscular volume (MCV).

ChangeablesEsophageal varices patients, n (%)/mean ± SDIndividuals without gastroesophageal reflux disease, n (%)/mean ± SDHb (g/dL) 10.28 ± 2.08 11.66 ± 2.04 0.001* Complete blood count

(×103/m3) total leukocyte count 4.47 ± 2.33 6.52 ± 2.16<<0.00187.6 ± 59.8~176.6 ± 87.7~<0.001 Platelet count (×103/mm3)* The mean corpuscular volume was 81.2 ± 7.95 against 81.6 ± 7.53 0.789.

Prothrombin time (sec) <0.001; 14.31 ± 2.62 <12.64 ± 2.97* Test of renal function

(mg/dL) Urea<25.5 ± 18.16~51.22 ± 53.19~<0.001* Creatinine (milligrams/deciliter)~0.80 ± 0.64~2.26 ± 3.56~0.003* Sodium 133.6 ± 20.6 137.5 ± 4.91 0.738 (mEq/L)

Test of liver function

IU/L of alkaline phosphatase: 213.5 ± 180.7 ± 201.8 ± 193.7 0.534

(IU/L) aspartate aminotransferase 86.03 ± 65.7 59.6 ± 41.1 0.134

Alanine transaminase (IU/L) 48.9 ± 43.4~0.271 54.5 ± 33.7

(IU/L) Gamma-glutamyl transferase 72.5 ± 70.9~120.0 ± 155.7~<0.001

Table 2 shows the differences in complete blood counts, liver and renal function tests, and esophageal varices comparing patients with and without the condition. *p-value significant at <0.05. The information is displayed as n, %/mean ± SD.

The hepatic and renal function tests as well as the total blood count were compared between individuals with and without esophageal varices in SDTable 2. *p-value significant at <0.05. The information is displayed as n, %/mean ± SD.


Standard deviation (SD) and hemoglobin (Hb) are two different concepts.

PLT/PT ratio’s sensitivity and specificity in detecting EV

According to the receiver operator characteristic curve, the PLT/PT ratio is a significant predictor of EV, with an AUC of 0.823 indicating good discriminative ability and an extremely substantial correlation (p < 0.001). 2.5487 was the ideal cutoff value for the PLT/PT ratio. Table 3 and Figure 1 demonstrate the sensitivity and specificity of the PLT/PT ratio for EV identification, which were 97.80% and 83.30%, respectively.

Talk

To diagnose portal hypertension, a number of diagnostic procedures are available. Directly measuring portal pressure is an intrusive procedure. Therefore, a minimally invasive approach like an upper gastrointestinal tract endoscopy is preferred [17]. The gold standard for diagnosing gastroesophageal varices is still upper gastrointestinal endoscopy (UGIE), but in patients with CLD, the ratio of PLT/PT may be important for evaluating portal hypertension and EV.

A prospective study evaluating the impact of PT on EV initiation was carried out in Bangladesh. A total of sixty liver cirrhosis patients were split into two groups at random: group I consisted of thirty patients with EV, and group II consisted of thirty patients without EV. The mean age of the 60 patients was 37.11 ± 14.81 years, with 11 females and 49 men. The hepatitis B virus was primarily detected in cirrhosis in 43 (71.7%) instances. One patient (1.6%) was afflicted by Wilson’s sickness; twelve patients (20%) were neither B or C; and four instances (6.6%) had the hepatitis C virus (HCV). It was discovered that there was a positive correlation between EV and the longer plasma PT (four seconds) with a sensitivity of 56.67% and a specificity of 73.33% [17]. This research

The frequency and features of EV in patients with liver cirrhosis who received UGIE were further examined in a different retrospective analysis carried out in Pakistan. 92.6% of the 2089 patients had EV, whereas 7.45% did not. 766 (39.5%) instances had grade I EV, 465 (24%) had grade II EV, and 703 (36.4%) had grade III EV. UGIE was performed on a total of 1331 (63.7%) male and 758 (36.3%) female liver cirrhosis patients. 89.1% of the patients who were female had EV overall, compared to 94.6% of the patients who were male. The likelihood of experiencing EV was significantly higher in males (p < 0.01). The mean age of patients diagnosed with EV (51.25 ± 10.03 years) was found to be significantly different from that of patients diagnosed with no EV (49.26 ± 11.11 years).

In a similar vein, 110 patients participated in this cross-sectional descriptive study that was carried out in Pakistan; 49 (44.5%) of the patients were female, and 61 (55.5%) were male. The average age of the patients was 59.89 +/- 9.01 years. The PLT was less than 50,000/uL in 39 (35.5%) of the patients, with the range being between 50,000-99,000/uL in 29 (26.4%), 100,000-150000/uL in 14 (12.7%), and >150,000/uL in 28 (25.5%) patients. Overall, grade I EV was present in 26 (23.6%) of the patients, whereas grades II–IV EV were seen in 27 (24.5%), 37 (33.6%), and 20 (18.2%) of the patients [21]. These results aligned with those of a Taiwanese study that demonstrated male dominance in cirrhotic patients, with 71% of patients being male [22]. The current investigation supported these conclusions and showed that the majority of

Several prior studies used PLT in combination with other noninvasive indicators such as the AST to platelet ratio index (APRI) and the platelet count/spleen diameter ratio (PC/SD ratio) to predict the grading of EV and the necessity for endoscopy in patients with cirrhosis [23]. The PLT/PT ratio was utilized in this investigation because it is easily accessible, noninvasive, reasonably priced, and resource-efficient. Furthermore, no specific knowledge is needed.

It’s interesting to note that a different study evaluated the noninvasive EV markers’ diagnosis accuracy in cirrhosis patients. That investigation found that the PC/SD ratio’s optimal cutoff value was ≤818 and that its sensitivity and specificity were, respectively, 92.05% and 60% (AUC: 0.835) [24]. A different Chinese study with a 73% positive response rate likewise used PSDR <909 as a cutoff number.

In a similar vein, one study evaluated the PLT/PT ratio’s and the PC/SD ratio’s capacity to assess the incidence of EV in Egyptian patients with cirrhosis associated with ≤HCV. 99 patients had liver cirrhosis associated with HCV, of which 41 did not have EV and 58 did not have bleeding EV. The PLT/PT ratio at cutoff ≤9419.3 (AUC: 0.936) was shown to be a more effective test for EV detection than the PLT/SD ratio at cutoff ≤993.75 (AUC: 0.888), according to analyses of receiver operator characteristics. Comparing the PLT/PT ratio to the PLT/SD ratio, the PLT/PT ratio showed superior sensitivity, specificity, PPV, and NPV (95.31, 88.57, 93.8, and 91.2% vs. 89.06, 85.71, 91.9, and 81.1%, respectively) [27]. The current investigation revealed a highly significant p-value and an AUC of 0.823.

Restrictions

This research has certain restrictions. Only cirrhotic patients were included in this short, single-centered investigation. Despite the fact that numerous studies have shown that the PC/SD ratio is a more accurate way to estimate the size and grading of varices, we only employed PLT to evaluate the grading of varices. Cherry red patches, or other indicators of recent or impending bleeding, were not seen in this investigation. It is advised that future multicenter research employ the spleen size ratio, early bleeding symptoms, and a particular cirrhosis cause. To validate the findings, more prospective studies with a larger sample size are required.

In conclusion

PLT/PT was observed to be considerably lower in patients with EVs who had underlying CLD in this study. We discovered that the PLT/PT value had a high sensitivity and specificity in recognizing EVs after establishing an ideal cutoff. Therefore, the results suggest that the PLT/PT ratio is a noninvasive marker of EV occurrence in CLD patients. To create a prediction score and look at other markers and predictors of esophagogastric variceal bleeding, more research is required.

Citations

Cheemerla S, Balakrishnan M: Chronic liver disease: worldwide epidemiology. 10.1002/cld.1061 in Clin Liver Dis (Hoboken), 2021, 17:365–70.

Sepanlou SG, Safiri S, Bisignano C, et al.: A comprehensive analysis for the Global Burden of Disease Study 2017 of the national, regional, and worldwide burden of cirrhosis by cause in 195 countries and territories, 1990-2017. 2020; 5:245–26; 10.1016/S2468-1253(19)30349-8; Lancet Gastroenterol Hepatol.

Genetic predisposition to chronic liver disease in Pakistani individuals Raja AM, Ciociola E, Ahmad IN, et al. 2020, 21:3558 in Int J Mol Sci. 10.3390/ijms21103558

Yoshida H, Mamada Y, Taniai N, et al.: Esophagogastric varices bleeding risk factors. Journal of Japan Medical School, 2013; 80:252–259. 10.1272/jnms.80.252

Kibrit J, Khan R, Jung BH, Koppe S: Portal hypertension: Clinical assessment and therapy. (2018) Semin Intervent Radiol. 35:153–159.