scholarly journals An enigmatic triad of acute pancreatitis, diabetic ketoacidosis and hypertriglyceridaemia: who is the culprit?

2019 ◽  
Vol 12 (7) ◽  
pp. e217272 ◽  
Author(s):  
Umasankar Mathuram Thiyagarajan ◽  
Amirthavarshini Ponnuswamy ◽  
Alex Chung
Keyword(s):  
Acute Pancreatitis ◽  
Diabetic Ketoacidosis ◽  
Acute Abdomen ◽  
Causal Factor ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
The Real ◽  
Common Causes ◽  
Recent Diagnosis ◽  
The Common

Acute pancreatitis(AP) is one of the common causes of acute abdomen and known to be associated with high morbidity and mortality in severe cases. Though most common causes of AP are cholelithiasis and alcoholism, it has also been reported in association with diabetic ketoacidosis (DKA). Triad of AP, hypertriglyceridaemia (HTG) and DKA is rare co-association and here the causal factor of AP is still not fully established. We report a case of AP in a DKA patient with recent diagnosis of hyperlipidaemia and diabetes. Usually AP has been associated with severe HTG; interestingly, our patient showed only moderate raise in triglycerides but still suffered AP during DKA. Hence, it raises question about the real culprit in this enigmatic triad.

Acute stroke management and late referrals-Clinician and community unawareness, A one month case series from Tumbi regional referral hospital Pwani, Tanzania

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Adam M Gembe ◽  
◽  
Erhad Bilaro ◽  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Developing World ◽  
Case Series ◽  
Referral Hospital ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Stroke Management ◽  
Regional Referral Hospital ◽  
The Common

Stroke is among the common emergency department presentations in Tanzania at large. In the developing world, still there are challenges in diagnosis, management and monitoring of these cases hence high morbidity and mortality. A one month case series is presented here, from Pwani region Tanzania, to demonstrate the encountered challenges. Keywords: Acute stroke management clinician; Community unawareness.

Early immunosuppression – Timely protective response or earlier prognosis of high morbidity and mortality in patients with acute pancreatitis

Pancreatology ◽  
2016 ◽  
Vol 16 (3) ◽  
pp. S38-S39
Author(s):  
Georgi Minkov ◽  
Krasimira Halacheva ◽  
Stoyan Nikolov ◽  
Evgeni Dimitrov ◽  
Alen Petrov ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Protective Response

scholarly journals Acute necrotising pancreatitis – early management in the district general hospital and tertiary hepato-pancreatico-biliary unit

2018 ◽  
Vol 20 (3) ◽  
pp. 263-267
Author(s):  
Rajiv P Lahiri ◽  
Nariman D Karanjia
Keyword(s):  
Acute Pancreatitis ◽  
Nutritional Support ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Early Management ◽  
Surgical Emergency ◽  
High Dependency ◽  
Necrotising Pancreatitis ◽  
Acute Necrotising Pancreatitis ◽  
Acute Necrotising

Acute pancreatitis is a common general surgical emergency presentation. Up to 20% of cases are severe and can involve necrosis with high associated morbidity and mortality. It is most commonly due to gallstones and excess alcohol consumption. All patients with acute pancreatitis need to be scored for severity and patients with severe acute pancreatitis should be managed on the high dependency unit. The mainstay of early treatment is supportive, with care to ensure strict fluid balance and optimisation of end organ perfusion. There is no role for early antibiotic use in acute necrotising pancreatitis and antibiotics should only be used in the presence of positive cultures. Nutritional support is vitally important in improving outcomes in necrotising pancreatitis. This should ideally be provided enterally using an naso-jejunal tube if the patient cannot tolerate oral intake. Patients with significant early necrosis, persisting organ dysfunction, infected walled off necrosis requiring intervention or haemorrhagic pancreatitis should be referred to a regional hepato-pancreatico-biliary unit for advice or transfer. Percutaneous and endoscopic necrosectomy has replaced open surgery due to improved outcomes. Acute necrotising pancreatitis remains a complex surgical emergency with high morbidity and mortality that requires a multidisciplinary approach to attain optimum outcomes. The mainstay of treatment is supportive care and nutritional support. Patients with significant pancreatic necrosis or infected collections requiring drainage require input from a tertiary HPB unit to guide management.

scholarly journals Hydronephrosis as an Unusual Cause of Acute Pancreatitis

2015 ◽  
Vol 5 ◽  
pp. 21 ◽  
Author(s):  
Nata Pratama Hardjo Lugito ◽  
Edy Gunawan ◽  
Margaret Chandra ◽  
Andree Kurniawan
Keyword(s):  
Acute Pancreatitis ◽  
Bile Duct ◽  
Renal Stones ◽  
Distal Segment ◽  
Urinary System ◽  
Common Cause ◽  
Duct Obstruction ◽  
Common Causes ◽  
The Common ◽  
Head Of Pancreas

Acute pancreatitis is an inflammatory disease of the pancreas. The most common cause of acute pancreatitis is gallstone impacting the distal common bile–pancreatic duct (38%) and alcoholism (36%). There have been a few reports in the literature of acute pancreatitis associated with an obstructed urinary system. This case describes a 38-year-old male with acute pancreatitis occurring in the setting of hydronephrosis. A magnetic resonance cholangiopancreaticography (MRCP) showed right-sided severe hydronephrosis pushing the duodenum and head of pancreas anteriorly, thus obliterating distal segment of the common bile duct. There were also multiple right renal stones causing ureteral obstruction and hydronephrosis. Right nephrostomy was performed to release bile duct obstruction. However, sepsis and disseminated intravascular coagulation developed as a complication of acute pancreatitis, and the patient passed away. Although gallstone and alcoholism are the most common causes of acute pancreatitis, other causes should always be considered. Physicians should be aware of right hydronephrosis as one of the possible causes of acute pancreatitis in their workup of patients.

Increased morbidity and mortality in acute human organophosphate-poisoned patients treated by oximes: a meta-analysis of clinical trials

2006 ◽  
Vol 25 (3) ◽  
pp. 157-162 ◽  
Author(s):  
Roja Rahimi ◽  
Shekoufeh Nikfar ◽  
Mohammad Abdollahi
Keyword(s):  
Clinical Trials ◽  
Relative Risk ◽  
Meta Analysis ◽  
Clinical Situation ◽  
Morbidity And Mortality ◽  
Organophosphate Poisoning ◽  
High Morbidity ◽  
Inclusion Criteria ◽  
Common Causes ◽  
The Third World

Organophosphates are one of the most common causes of poisoning, especially in the Third world, with high morbidity and mortality. The treatment of this type of poisoning involves the use of atropine and oximes. Atropine has been used successfully in large doses to counteract the muscarinic effects of organophosphate poisoning, but the efficacy of oximes in the management of this poisoning remains under question. In this study, we undertook a meta-analysis by reviewing all clinical trials to evaluate the efficacy of oximes in the management of organophosphate poisoning. The databases of PUBMED, EMBASE, Cochrane, SCOPUS, and the search engine of Google were searched for all clinical trials on the use of oximes in organophosphate poisoning. The inclusion criteria were death, development of intermediate syndrome, and need for ventilation. Six clinical trials met the inclusion criteria and were included in the metaanalysis. The x2 tests for heterogeneity (P–0.25, 0.16, and 0.33, respectively) indicated that the included studies were not significantly heterogeneous and could be combined. A significant relative risk (P–0.0017) for death among oxime-exposed was 2.17 (95% CI of 1.34 / 3.51). The ‘need for ventilation’ in patients who received oxime was higher (P–0.03) than those who did not receive oxime with a relative risk of 1.53 (1.16 / 2.02). The incidence of ‘intermediate syndrome’ for oximeexposed patients was significantly higher (P–0.01) than oxime non-exposed patients with a relative risk of 1.57 (95% CI 1.11 / 2.11). It can be concluded that oximes are not effective in the management of organophosphate-poisoned patients and, surprisingly, they can be dangerous and worsen the patient's clinical situation.

scholarly journals Ischemic stroke due to protein C deficiency

2016 ◽  
Vol 4 (2) ◽  
pp. 123-124
Author(s):  
Debasish Kumar Saha ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
Madhurima Saha ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Cardiovascular Diseases ◽  
Protein C ◽  
Young Patients ◽  
High Morbidity ◽  
Protein C Deficiency ◽  
Common Causes ◽  
The World ◽  
The Common

Cardiovascular diseases are one of the common causes of high morbidity and mortality all over the world. Usually stroke occur in elderly, but stroke in younger group (age <45 years) are increasingly common now-a-days. The disease can occur in young patients without any apparent risk factors. It is therefore important to exclude all aetiological causes in order to reduce their chances for a subsequent event.Bangladesh Crit Care J September 2016; 4 (2): 123-124

A review of neonatal morbidity and mortality in Aminu Kano Teaching Hospital, northern Nigeria

2007 ◽  
Vol 37 (3) ◽  
pp. 130-132 ◽  
Author(s):  
M Mukhtar-Yola ◽  
Z Iliyasu
Keyword(s):  
Birth Weight ◽  
Teaching Hospital ◽  
Birth Asphyxia ◽  
Neonatal Morbidity ◽  
Obstetric Care ◽  
Morbidity And Mortality ◽  
Early Referral ◽  
Normal Birth ◽  
Common Causes ◽  
The Common

Neonatal morbidity and mortality still poses a serious challenge in developing countries. Low level of obstetric care, unsupervised home deliveries and late referrals lead to poor outcome even in special care baby units (SCBU). To identify the common causes of neonatal morbidity and mortality among babies admitted to the SCBU in Aminu Kano Teaching Hospital (AKTH) the case-notes of all admitted neonates from January 1998 to December 2004 were retrospectively reviewed. A total of 2963 (98.3%) babies had complete records. There were 1455 (49.1%) in-born (delivered in AKTH) and 1508 (50.9%) out-born (delivered elsewhere) babies. The sex ratio was1.25:1in favour of males. A total of1868 (63.0%) were of normal birth weight, while 951 (32.1%) and 134 (4.5%) were low birth weight and macrocosmic, respectively. The leading diagnoses were birth asphyxia (27%) (severe birth asphyxia 18.1%, moderate asphyxia 8.9%), neonatal sepsis (25.3%) and prematurity (16.0%). Out of the 2963 babies, 501 (16.9%) died. The risk of dying was significantly higher (20.5%) among out-born babies compared with those delivered in AKTH (6.4%) (odds ratio = 1.71, 95% confidence interval = 1.4-2.1). In conclusion, the causes of neonatal morbidity and mortality at this centre are similar to those reported from other units. They could be prevented through effective antenatal care, supervised delivery and appropriate care and early referral of sick neonates.

scholarly journals Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Lovekesh Kumar ◽  
Mahendra Singh ◽  
Ashish Saxena ◽  
Yuvraj Kolhe ◽  
Snehal K. Karande ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Dengue Fever ◽  
Surgical Complications ◽  
Acalculous Cholecystitis ◽  
Acute Acalculous Cholecystitis ◽  
Diagnostic Dilemma ◽  
The Common ◽  
Careful History

Dengue fever is the most important arbovirus illness with an estimated incidence of 50–100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked acute appendicitis leading to unnecessary appendectomy. A careful history examination for dengue-related signs, and serial hemogram over the first 3-4 days of disease may prevent unnecessary appendectomy.

scholarly journals Management of Appendicitis

2022 ◽  
Author(s):  
Vishal P. Bhabhor
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Medical Management ◽  
Surgical Intervention ◽  
Life Time ◽  
Morbidity And Mortality ◽  
Surgical Emergency ◽  
First Choice ◽  
Common Causes ◽  
India And China

Appendicitis is one of the most common causes of acute abdomen with life time risk between 6 and 8% and it’s a most common non obstetric surgical emergency during pregnancy. Appendicitis is claimed to be unknown in the villages of India and China in paper by A. M. Spencer. The reason is simply due to the fact that diagnostic facilities do not exist and cases are not recognized. So diagnosing acute appendicitis accurately and efficiently can reduce morbidity and mortality from perforation and other complications. Surgical intervention is the first choice for appendicitis with medical management being reserved for special situations.

Minimally Invasive Esophagectomy

2019 ◽  
pp. 308-318
Author(s):  
Brandon Merling ◽  
Frank Dupont
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Anesthetic Management ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Perioperative Morbidity ◽  
Invasive Esophagectomy ◽  
Common Causes

Esophageal cancer is the eighth most common malignancy worldwide, producing a high morbidity and mortality rate around the globe. Minimally invasive esophagectomy (MIE) is most commonly performed on patients with this devastating disease. Esophagectomy is a high-risk procedure, and perioperative mortality remains around 5%–8%. Because esophageal cancer is associated with chronic alcohol and tobacco use, patients have serious comorbid conditions that affect anesthetic management and perioperative care. Among them, pulmonary complications and anastomotic failure remain the most common causes of perioperative morbidity and mortality. The anesthesiologist managing a patient during MIE must be able to reduce the effect of the patient’s multiple comorbidities intraoperatively while mitigating the factors that lead to adverse postoperative outcomes.

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