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Introduction Fistulas are abnormal communication between two epithelialized surfaces. Gastrointestinal fistulas are communication between the gut and another epithelialized surface. Fistulas are classified according to anatomic (internal or external), physiologic (output volume), and etiologic characteristics. In the case of clinical suspicion of a fistula, a multidisciplinary approach helps in diagnosing and management. Multidetector computed tomography (MDCT) has an advantage over other imaging modalities due to its ability to reconstruct high-resolution images in seconds, which limits motion or peristalsis artifacts, and is ideal for patients who are uncooperative or who are seriously ill. Aim Evaluation of MDCT as an initial tool in the diagnosis and characterization of gastrointestinal fistulas. Methods During this prospective observational study, MDCT was used to assess patients with clinical suspicion of gastrointestinal fistulas. When necessary, contrast agents were used to identify the enteric fistulous tract. The etiology and characterization of the fistulas were determined. Further, the gastrointestinal fistulas were confirmed via endoscopy, cystoscopy, or surgery. Results The most common type of gastrointestinal fistula is enterocutaneous fistula (ECF) (39%) and the most common cause of gastrointestinal fistulas is postoperative (47%). ECFs were classified according to their etiology, anatomy, and favorable characteristics (85% favorable) along with complexity (64% complex) to aid in the management process. In addition to pancreaticopleural fistulas (22%), biliary (11%), esophageal (8%), and pelvic fistulas (19%) were also observed. There were 19% of fistulas (esophageal and biliary) that were asymptomatic. Endoscopy confirmed such asymptomatic fistulas that were not convincingly detected on CT. Conclusion In this study, we concluded that with the appropriate clinical history, MDCT can accurately depict enteric fistulas. In addition to characterizing fistulas, MDCT is equally useful for detecting secondary complications like inflammation, obstruction, or abscesses.

INTRODUCTION: Coronary artery disease is the disease manifested mainly the process of atherosclerosis and their complications. Platelets have a major part in the atherosclerosis process initiation and the formation of thrombus in the coronary vessels. Larger the size of the platelet , higher the risk of thrombosis as it is metabolically and in enzymatic way more active compared to smaller platelets.1 Since MPV gives the measurement of average size of the platelets, MPV measurement predicts the risk of developing Acute coronary syndrome. METHOD: All patients who come to Emergency Department and Out patient Department of Sree Balaji Medical College and Hospital with chest pain who are not a known case of Acute Coronary Syndrome, and fulfilling the inclusion and exclusion criteria will be taken for our study. As soon as patient got admitted , informed consent was obtained from patients and attenders. Initial evaluation involves thorough clinical history and examination, Electrocardiography and Troponin I (biomarker). Venous samples for troponin I and MPV will be taken at the time of arrival and before the treatment initiation and the platelet volume indices are assessed and the correlation between ACS (STEMI, NSTEMI) and Non ACS patients with MPV values are assessed and also among STEMI and NSTEMI patients. RESULTS: Mean platelet volume (MPV) was assessed in our study and we have found it higher in ACS patients (9.716 ± 0.829) compared to the control group (8.730 ± 0.840) , which was significant , P wave of less than 0.05. It was also determined that high MPV values were there among patients who are diagnosed with STEMI as compared with NSTEMI with values of 9.98 ±0.675 and 9.412 ±0.896 , significant statistically (P less than 0.05). CONCLUSION: In our study, MPV values assessed were obtained to be high in ACS diagnosed patients than with Control group and similarly MPV values were high in the patients with STEMI patients more than in NSTEMI and also proved it to be significant . Hence it could be useful as a simple test with other biomarkers in the prediction of ACS earlier. Large platelets are usually metabolically active more , they carry the higher risk of developing coronary thrombosis leading to the Acute coronary syndrome. As this test could be done in routine analysis and could help in ACS early detection.