We describe the use of Cytosorb TM , a synthetic extracorporeal haemoperfusion adsorption column, in the management of two patients with drug induced cholestasis and a third with alcoholic hepatitis and subsequent acute on chronic liver failure. Cytosorb was used in these patients to remove bilirubin and bile acids by supporting impaired excretory hepatic function, alleviating symptoms with the intention of serving as a bridge to endogenous recovery. The first two cases demonstrate favourable biochemical and symptomatic responses; the third case demonstrated a good biochemical response but subsequently died from the complications of multiple organ failure. These cases suggest Cytosorb TM be evaluated as an adjunct to support liver excretory functions in other arenas, such as acute liver failure or overdose. It remains unclear whether extracorporeal therapies removing liver toxins allow faster or more complete spontaneous recovery of endogenous function.

Aims: Coronary risk stratification using GRACE score [Global Registry of Acute Coronary Events] and early treatment is beneficial in NSTEMI [Non ST elevation Myocardial Infarction]. We aimed to evaluate utility of peak systolic Global Longitudinal Strain [GLS] score along with GRACE score in identifying patients at high risk for cardiac events & to observe any gender related impact of these scores in predicting MACE [Major Adverse Cardiac Events] following an episode of NSTEMI. Methods: We prospectively studied 636 patients admitted to Medical College, Kottayam, India with diagnosis of NSTEMI during the period of 3 years from 2014 to 2017. All patients were categorised in to low, moderate and high GRACE score groups along with GLS score measurement. 6 months MACE was statistically analysed. Results: Females with NSTEMI had less negative GLS scores compared to male counterparts. The optimal cut off value of GLS for prediction of significant Coronary artery disease [CAD] in at least one coronary arterial territory in the study population was found as ≥-15.7 (AUC 0.797, p value 0.009). The sensitivity, specificity and positive predictive value [PPV] of GLS for detecting significant CAD were 89%, 70%, and 83.3% respectively. 6 months MACE was high in females compared to males with similar levels of GRACE score. MACE in different GRACE groups were higher when the GLS score was ≥-15.7. Conclusion:In patients with NSTEMI, simple bedside echocardiographic assessment of peak systolic GLS score calculation, when used with the GRACE score can increase the prognostic value, especially in females. For comparable GRACE scores ,the risk of cardiac events were higher in females compared to males when the GLS score is ≥-15.7.