Introduction: This study focuses on the Malaria endemic in the Thar Desert- The most populated desert in the world. Malarial endemicity in a desert environment is a unique and rare geographical presentation, as malaria is usually common in areas where there is rainfall and water stagnation - like ponds, fields, etc. In this study, we want to highlight the unique clinical presentation, lab findings, and reason behind the existence of malaria in the desert. Most importantly we also would like to share our innovative idea to eliminate breeding sites using Quadcopters and drones. Materials and methods: Study type – Prospective observation study, Study duration – October 2020 to December 2020, Sample size-103 cases, Inclusion criteria – all smear-positive Malaria cases, Exclusion criteria – Cases Referred to higher centers because of complications.Tools used for breeding site identification – Quadcopters and Drones with HD cameras. Since the area to be surveyed was vast (>30km), it was very difficult to do a manual survey in the harsh desert climate. The patients’ demographics, Clinical Presentations, and laboratory parameters were collected systematically in a predesigned format and entered into an excel sheet. The finding of our study was compared with the malaria cases from different parts of the country. Results: All malaria was identified as Plasmodium vivax. The mean age group was 36 years (min-21 and max-56). Clinical features- out of 103 cases, 78% of the patients presented with all 4 symptoms of fever, chills, headache, and bodyache.22% presented with atypical isolated symptoms of abdominal pain, vomiting, myalgia, severe joint pain. 77% of patients had mild hepatosplenomegaly, 7 patients presented with hypotension, and 2 were in sepsis. Lab parameters – 88% of the patients had anemia, of which 5% had severe anemia, 40% had leucopenia while 6% had leucocytosis.87%had thrombocytopenia, out of which 56% had a platelet count less than 50,000/ml. 2% had mild AKI, bilirubin levels were elevated in 53%, and 36% had transaminitis. Using technology, the survey of the entire area was done in 1 week and all the breeding sites were eliminated on the same day of identification and a drastic drop in malaria cases was noted. Conclusion: We conclude that desert malarial presentation of Plasmodium vivax is unique in clinical presentation and lab derangements compared to other malarial cases. Usage of technology like quadcopters and drones for breeding site identification played a major role in curtailing cases drastically in a very short period in an effective way.

Objective: To find an accurate cut-off value for Portal vein diameter as a diagnostic tool for Portal hypertension on comparing with Doppler ultrasound, CT abdomen, or endoscopy of collateral circulation. Materials and methods: This was a cross-sectional study, with a sample size of 100 patients. Inclusion criteria were patients above the age of 15 years who underwent routine USG abdomen for various conditions in the Radiology Department of a tertiary hospital. Distribution of age, gender, chronic liver disease, portal hypertension, and portal vein diameter of all the patients were measured and recorded. Portal hypertension was diagnosed using the presence of collaterals either on upper endoscopy (if done), Doppler USG, or CT multiphase abdomen. Results: Portal vein diameter of 10.5mm was found to have a sensitivity of 61.22%, specificity of 60.78%, a positive predictive value of 60.00%, a negative predictive value of 62.00%, and accuracy of 61.00%. 45 out of 59 (76.3%) and 37 out of 49 (75.5%) patients of the 50-70 years age group had chronic liver disease and portal hypertension respectively. 45 out of 65 (69.2%) males 37 out of 65 (56.9%) males developed CLD and PHTN. Conclusion: Using portal vein diameter as a diagnostic indicator of PHTN has an accuracy of %, so it can be used in routine USG abdomen of CLD patients to prevent the dreaded complications of PHTN and treat it early. Male gender and patients above the fifth decade were increasingly predisposed to both CLD and PHTN.

Background: Non-Alcoholic Steatohepatitis (NASH) is an aggressive form of Non-Alcoholic Fatty Liver disease (NAFLD), with liver inflammation and scarring. Due to a lack of clinical biomarkers and asymptomatic nature, NASH is often under-diagnosed. It is the most common cause of chronic liver disease in the USA. Liver biopsy is the gold standard to diagnose NASH, but it is invasive and life-threatening and histologic evaluation of a liver biopsy sample is imperfect as a reference because of sampling variability due to the irregular distribution of fibrosis. Aim: Validating AST/ALT ratio as a stand-alone scoring system in NASH is scarce and so this study aims to establish a correlation between FibroScan values and AST/ALT ratio. Methodology: All NASH patients, who underwent FibroScan were included. Their demographics, FibroScan, AST, ALT values were recorded in M S Excel and Pearson correlation between FibroScan values and AST/ALT ratios of 150 NASH patients was calculated using SPSS. Results: Out of 150 NASH patients, 72% were males and 57.33% belonged to 40-50 years age group. FibroScan values and AST/ALT ratio showed positive Pearson correlation of 0.245, (p value=0.003). FibroScan values and splenic size also showed a positive Pearson correlation of 0.289 (p value<0.001). Conclusion: Males of 40-50 years age group had higher distribution of NASH, so middle aged males should be screened routinely as they are at a higher risk. FibroScan value with AST/ALT ratio and splenic size showed a positive correlation, thus showing that AST/ALT ratio and splenic size increases with increase in liver stiffness.