scholarly journals Etiology, clinical characteristics, and outcomes of acute pancreatitis in patients at Assiut University Hospital

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Enas Ahmed Reda Alkareemy ◽  
Lobna Abdel-Wahid Ahmed ◽  
Muhammad Abbas El-Masry ◽  
Hany Ayad Habib ◽  
Mohamed H. Mustafa
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Characteristics ◽  
Research Study ◽  
University Hospital ◽  
High Morbidity ◽  
Severe Attack ◽  
Multicenter Studies ◽  
Idiopathic Pancreatitis ◽  
Severe Pancreatitis ◽  
Multi Disciplinary Team

Abstract Background Acute pancreatitis is one of the main causes of acute abdomen. It may cause multi-organ failure or even death. High morbidity and mortality are associated with it. The research study aimed at evaluating the clinical characteristics and results of acute pancreatitis in our community. Results Mean age of patients was 50.96 ± 9.71 years and 30 (60%) patients were males. Gallstone was the most frequent etiology (56%) followed by idiopathic pancreatitis (26%). The majority of patients improved and only four patients died. Old age, presence of comorbidities, and leucocytosis were risk factors for a severe attack while old ages, presence of comorbidities, severe pancreatitis, and presence of complications were associated with mortality. Conclusion Acute pancreatitis could have serious outcomes if not correctly and early managed. It is recommended to perform multicenter studies with a large sample of patients. A multi-disciplinary team is required to assess idiopathic pancreatitis.

Acute Pancreatitis - ERCP / Endoscopic Papillotomy (EPT) Yes Or No?

Swiss Surgery ◽  
2000 ◽  
Vol 6 (5) ◽  
pp. 246-248 ◽  
Author(s):  
Scheurer
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
First Trimester ◽  
Biliary Pancreatitis ◽  
Recurrent Pancreatitis ◽  
Endoscopic Papillotomy ◽  
Idiopathic Pancreatitis ◽  
Severe Pancreatitis ◽  
First Trimester Of Pregnancy ◽  
Pancreatic Duct Stones

Until the mid eighties ERCP and EPT were considered to be contraindicated in acute pancreatitis, because of possible aggravation of active pancreatitis or induction of new attacks of pancreatitis. This attitude was revised with the new knowledge obtained from four prospective randomised studies, which compared the effects of endoscopic treatment with conservative management of acute pancreatitis. Although the four studies are not strictly comparable their results indicate that there is no advantage to ERCP +/- EPT over conservative treatment alone in mild biliary pancreatitis. In severe biliary pancreatitis, however, ERCP with EPT reduced the number of purulent cholangitis and incidence of morbidity and in one study mortality was also significantly reduced. There is evidence, that ERCP + EPT may be important in a deteriorating acute mild pancreatitis, in the smouldering type of pancreatitis and in pancreatitis with persistent cholostasis. To avoid recurrent severe pancreatitis in patients unfit for surgery without bile duct stones but with gallbladder stones, EPT is recommended. ERCP and EPT in acute severe biliary pancreatitis during the first trimester of pregnancy have been successfully performed in four patients. Sludge and microlithiasis may be the cause of recurrent "idiopathic" pancreatitis and ERCP + EPT is effective especially in cholecystectomised patients. Furthermore in patients with recurrent pancreatitis due to malformations, such as pancreas divisum, ERP and minor-papillotomy produced similar results to surgical treatment. Acute pancreatitis in patients with pancreatic duct stones or ductal leaks may be treated by ERP and EPT in selected patients. Alcoholic, metabolic and infectious pancreatitis remain within the domain of conservative treatment.

scholarly journals Comparison between Ransons score and modified CTSI in predicting the severity of acute pancreatitis based on modified Atlanta classification 2012

2019 ◽  
Vol 6 (5) ◽  
pp. 1596
Author(s):  
Manjunath B. D. ◽  
Mohammed Arafath Ali ◽  
Abdul Razack ◽  
Harindranath H. R. ◽  
Avinash K. ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Severe Disease ◽  
P Value ◽  
Early Assessment ◽  
Idiopathic Pancreatitis ◽  
Severe Pancreatitis ◽  
Gall Stones ◽  
Patients At Risk ◽  
Multiorgan Dysfunction Syndrome

Background: Acute pancreatitis is an inflammatory process of the pancreas with possible peripancreatic tissue and multiorgan involvement inducing multiorgan dysfunction syndrome (MODS) with a high mortality rateand hence early identification of patients at risk for severe disease is of vital importance.Methods: Data were collected from 50 patients who presented to the emergency department of hospitals attached to BMCRI, Bangalore, having acute pancreatitis.Results: The study included 50 patients- 40 males and 10 females and median patient age was 54.5years.Out of the 50 patients, 40% had gall stones, 56% were alcoholic and 4% had idiopathic pancreatitis.56% were found to have a Ransons score of >3 and 44% had score < 3; 52%had a modified CTSI score of 0-2, 52%had a score of 4-6 and 22% had a score of 8-10. The incidence of severe acute pancreatitis in patients with Ransons score >3 has a p value <0.002. Also, the incidence of severe acute pancreatitis in patients with modified CTSI score >4 has a p value of <0.001.With respect to mortality, all 4 patients who died had a modified CTSI score of >4 (p=0.002) and 3 patients had Ransons score >3 (p=0.03) which is statistically significant.Conclusions: In our country where facility for CECT is not available to a major proportion of population, early assessment of severe pancreatitis can be performed by Ransons scoring, which is found to be comparable to modified CTSI scoring.

scholarly journals HYPERTRIGLYCERID-ASSOCIATED ACUTE PANCREATITIS: CLINICAL CHARACTERISTICS AND TREATMENT RESULTS

2020 ◽  
Vol 115 (1) ◽  
pp. 47-52
Author(s):  
Mariia Onishchenko ◽  
Ivanna Shchigel ◽  
Tetiana Ivanets ◽  
Liudmyla Levchenko ◽  
Andrey Gorlach
Keyword(s):  
Body Mass Index ◽  
Acute Pancreatitis ◽  
Body Mass ◽  
Clinical Characteristics ◽  
Pharmacological Therapy ◽  
Normal Weight ◽  
Severe Pancreatitis ◽  
History Of ◽  
Comorbidity Index ◽  
Normal Triglyceride

The aim of the study is to evaluate the clinical characteristics of patients with hypertriglyceride associated acute pancreatitis. A single-center observational study of a series of cases was performed on the basis of the Kyiv Department of Surgery for Liver, Pancreas and Bile Tracts named after V.S. Zemskov in the period from 2018 to 2019. Investigation includes patients with acute pancreatitis and hypertriglyceridemia (the triglycerides level is more than 1.7 mmol/l). Exclusion criteria: patients with acute pancreatitis with normal triglyceride levels, patients with acute pancreatitis with elevated triglycerides, that have not been treated enough. All patients were evaluated by Charlson index of comorbidity, body mass index, alcohol history, relapses and severity of disease. All patients were monitored throughout inpatient treatment, from hospitalization to discharge to home or death. The end point of the study was the discharge of the patient to home after the elimination of the manifestations and complications of acute pancreatitis or death of the patient. The 234 patients who were hospitalized and treated with a diagnosis of acute pancreatitis, 27 patients had hypertriglyceridemia and 3 of them were excluded from the study. The study involved 24 patients. Therefore, the frequency of acute pancreatitis associated with high triglycerides was 11.5% (27/234), with the average level of triglyceridemia was 10.1 ± 2.4 mmol / l (range 5.8 - 13.6 mmol / l) , 75% of patients (18/24) had moderate hypertriglyceridemia (2.3 - 11.2 mmol / l), 25% (6/24) - severe (11.2 - 22.4 mmol / l) . The median age was 32 years (quarterly interval 31.5 - 35 years). There were 18 men (75%) and 6 women (25%). Alcohol-induced pancreatitis was observed in 17 (70.8%) patients with hypertrtiglyceridemia. The median body mass index is 28.9 kg / m 2. Normal weight was 33% (8/24) patients, excessive - 25% (6/24), obesity I stage - 29% (7/24) obesity II stage - 8% (2/24) obesity III stage - 4% (1/24). The Charlson comorbidity index ranged from 0 to 5 points, in 1 patient it was 5 points, in 3 patients - 2 points, in 3 patients - 1 point. Diabetes mellitus were in 25% of patients (6 /24), two of them was diagnosed at first. Recurrent cases of disease were in 58.3% of patients (14 /24), 10 of 14 had a history of two cases of acute pancreatitis. In 71% (17 /24) observed a light stage of the disease, 25% (6 /24) - pancreatitis medium degree of severity and in 4% (1 /24) of the patient severe pancreatitis. Mortality was 4%. Conclusions. The frequency of hypertriglyceride-associated acute pancreatitis is 11.5%. In light, moderate and severe pancreatitis, the average degree of hypertriglyceridemia (blood triglycerides 2.3 -11.2mmol/l) was prevailed. Hypertriglyceride-associated acute pancreatitis has no specific complications, but has a tendency to recurrence. Patients with hypertriglyceridemia need constant laboratory monitoring (determination of triglycerides), pharmacological therapy and follow-up to prevent the development of acute pancreatitis.

scholarly journals 648 The Use of Antibiotics in Acute Pancreatitis - A Re-Audit of Current Practice

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Rai ◽  
S Kudchadkar ◽  
A Munasinghe
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Current Practice ◽  
University Hospital ◽  
First Line ◽  
Nice Guidelines ◽  
Severe Pancreatitis ◽  
Intravenous Antibiotics ◽  
Number Of Patients ◽  
Male Preponderance

Abstract Introduction The NICE guidelines do not advocate the use of prophylactic antibiotics in the management of acute pancreatitis. In severe pancreatitis with necrosis, local antimicrobial guidelines state that it ‘maybe reasonable to use antibiotics with good spectrum anaerobic cover’ and suggest the use of Amoxycillin, Metronidazole and Gentamicin as first line, and Meropenem as second line if needed. Previous audit showed 74% of patients receiving antibiotics without clear indication. Method A retrospective re-audit of the use of antibiotics in patients admitted with a clinical or radiological diagnosis of acute pancreatitis was undertaken in a single-centre University Hospital between July and October 2020. Results 78 patients were admitted during this period, with a mean age of 52years (range 6-89 years), and male preponderance. All patients were conservatively managed with intravenous fluids, analgesics and antiemetics. 31(40%) received intravenous antibiotics, of whom, 14 (45%) had no clearly documented indication for their use. The remaining 17 had pancreatic necrosis (4), cholangitis/cholecystitis (4), infected pseudocyst (2), UTI (2), fever spike (1), positive blood cultures (1) and pancreaticoduodenal fistula (1). Metronidazole was the most commonly used antibiotic (58%), followed by Amoxicillin (38.7%), Co-amoxiclav (35.4%), Gentamicin (22.5%) and Meropenem (22.5%). Conclusions In line with the recommendations made from previous audit and improved awareness, there was a significant improvement in the number of patients receiving antibiotics without indications from 74% to 45%. We hereby stress the importance of the use of appropriate clinical judgement in decision-making and avoiding the unwarranted use of antibiotics in acute pancreatitis.

scholarly journals Heparin-binding protein is significantly increased in acute pancreatitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Martina Sjöbeck ◽  
Hanna Sternby ◽  
Heiko Herwald ◽  
Henrik Thorlacius ◽  
Sara Regnér
Keyword(s):  
Acute Pancreatitis ◽  
Disease Severity ◽  
Fluid Balance ◽  
Binding Protein ◽  
Pearson Correlation ◽  
University Hospital ◽  
High Morbidity ◽  
Heparin Binding ◽  
Significant Group ◽  
Heparin Binding Protein

Abstract Background Most patients with acute pancreatitis (AP) experience mild, self-limiting disease with little or no need for hospital care. However, 20–25% of patients develop a more severe and potentially life-threatening condition with progressive systemic inflammatory response syndrome (SIRS) and multiorgan failure, resulting in high morbidity and mortality rates. Predicting disease severity at an early stage is important, as immediate supportive care has been demonstrated to reduce the incidence of SIRS and organ failure, improving patient outcome. Several studies have demonstrated elevated levels of heparin-binding protein (HBP) in patients with sepsis and septic shock, and HBP is believed to play a part in endothelial dysfunction leading to vascular leakage. As HBP levels increase prior to other known biomarkers, HBP has emerged as a promising early predictor of severe sepsis with organ dysfunction. Methods Patients admitted to Skåne University Hospital in Malmö between 2010 and 2013 fulfilling the criteria for AP were identified in the emergency department and prospectively enrolled in this study. The primary outcome was measured levels of HBP upon hospital admission in patients with confirmed AP. Correlations among HBP concentrations, disease severity and fluid balance were considered secondary endpoints. The correlation between HBP levels and fluid balance were analysed using Pearson correlation, and the ability of HBP to predict moderately severe/severe AP was assessed using a receiver operating characteristic (ROC) curve. Results The overall median HBP level in this study was 529 (307–898) ng/ml. There were no significant group differences in HBP levels based on AP severity. Fluid balance differed significantly between patients with mild versus moderately severe and severe pancreatitis, but we found no correlation between HBP concentration and fluid balance. Conclusions HBP levels are dramatically increased in patients with AP, and these levels far exceed those previously reported in other conditions. In this study, we did not observe any significant correlation between HBP levels and disease severity or the need for intravenous fluid. Additional studies on HBP are needed to further explore the role of HBP in the pathogenesis of AP and its possible clinical implications.

STUDY ON CLINICAL CHARACTERISTICS AND RESULT OF TREATMENT BENIGN VOCAL CORD TUMOR WITH RIGID LARYNGEAL ENDOSCOPIC SURGERY

2012 ◽  
pp. 58-65
Author(s):  
Duy Thai Truong ◽  
Van Dung Phan ◽  
Tu The Nguyen
Keyword(s):  
Vocal Cord ◽  
Endoscopic Surgery ◽  
Clinical Characteristics ◽  
University Hospital ◽  
High Rate ◽  
Treatment Rate ◽  
Reinke’S Edema ◽  
Vocal Nodules ◽  
A Prospective Study

Objective: Study on clinical characteristics and result of treatment benign vocal cord tumor with suspensive laryngeal endoscopic surgery. Materials and Methods: A prospective study was undertaken in 43 patients who had benign vocal cord tumor and performed a suspensive laryngeal endoscopic surgery at ENT Dept. of Hue University Hospital, from 3/2010 to 5/2011. Results: The most common was group was 31 - 45 (44.2%). There was no difference of gender. Moderate hoarness was 67.4%. Classification of benign laryngeal tumor: vocal nodules (13 cases), vocal cyst (18 cases), vocal polyp (10 cases) and Reinke’s edema (2 cases). The successful treatment rate of vocal benign tumor was 88.4%. Conclusions: Suspensive laryngeal endoscopic surgery was the best method to cure benign vocal cord tumor. The surgeon had a clear operative field, easy manoeuver, high rate of cure and less complication.

CLINICAL AND PARA-CLINICAL CHARACTERISTICS OF SICK NEWBORN BABIES TREATED AT PEDIATRIC DEPARTMENT OF HUE UNIVERSITY HOSPITAL

2011 ◽  
pp. 112-117
Author(s):  
Thi Kieu Nhi Nguyen
Keyword(s):  
Respiratory Distress ◽  
Congenital Malformation ◽  
Clinical Characteristics ◽  
Descriptive Study ◽  
Neonatal Unit ◽  
University Hospital ◽  
Pediatric Department ◽  
Sick Newborn ◽  
Observational Descriptive Study

Objectives: 1. Describe neonatal classification of WHO. 2. Identify some principal clinical and paraclinical signs of term, preterm, post term babies. Patients and method: an observational descriptive study of 233 newborns hospitalized in neonatal unit at Hue university‘ s hospital was done during 12 months from 01/01/2009 to 31/12/2009 for describing neonatal classification and identifying principal clinical and paraclinical signs. Results: Premature (16.74%); Term babies (45.5%); Post term (37.76%); Premature: asphyxia (43.59%), hypothermia (25.64%), vomit (30.77%), jaundice (61.54%), congenital malformation (17.95%); CRP > 10mg/l (53.85%); anemia Hb < 15g/dl (12.82%). Term babies: poor feeding (21.7%); fever (24.53%); CRP > 10mg/l (53.77%); Hyperleucocytes/ Leucopenia (35.85%). Post term: respiratory distress (34%); lethargy (29.55%); vomit (26.14%); polycuthemia (1.14%); hypoglycemia (22.73%). Conclusion: each of neonatal type classified by WHO presente different clinical and paraclinical. Signs. The purpose of this research is to help to treat neonatal pathology more effectively.

CLINICAL AND PARACLINICAL CHARACTERISTICS AND RESULTS FROM TREATMENT OF FOREIGN BODIES INGESTION

2016 ◽  
pp. 63-69
Author(s):  
Hoang Cuong Vo ◽  
Thanh Dang ◽  
Phuong Nam Tran ◽  
Thanh Thai Le
Keyword(s):  
Foreign Body ◽  
Clinical Characteristics ◽  
Foreign Bodies ◽  
University Hospital ◽  
Age Group ◽  
Central Hospital ◽  
Results Of Treatment ◽  
Rigid Esophagoscopy ◽  
Flexible Esophagoscopy ◽  
Esophageal Foreign Bodies

Background: Foreign bodies ingestion is a emergency in otology, knowledge of people about foreign bodies ingestion is not enough. Objective: To study the clinical characteristics, paraclinical characteristics and results of treatment from foreign bodies ingestion in Hue Central Hospital and Hue University Hospital. Methods and patiens: A cross descriptive and prospective study over the period from 6/2014 to 5/2016, total are 137 patients come to be diagnosised and treatmented. Results: the average age is 35 years old. Gender: male (51.8%) and women (48.2%). Adults (84.7%) having more than children (15.3%). Age group from 16-30 years is highest (32.8%). There are 95.7% of organic foreign bodies, 4.3% are inorganic foreign bodies. There are 90.5% of patients on diagnosis and treatment in stages less inflammation, arthritis 8.0% in the period and 1.5% in the period complications. Foreign body in the throat problems (73.7%), esophageal foreign bodies (26.3%). Pick up directly foreign bodies 54%, indirectly by the mirror 11.7% and endoscopy 8%, rigid esophagoscopy is 17.5%, flexible esophagoscopy is 7.3%, cervicotomy is 1.5%. Conclusion: Practing direction with in the oropharynx foreign body, using the larynx mirror or endoscopy with in the laryngopharynx for the esophagus foreign bodies, rigid esophagoscopy is better. Key words: Foreign bodies ingestion

scholarly journals Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030430
Author(s):  
Thomas Ott ◽  
Jascha Stracke ◽  
Susanna Sellin ◽  
Marc Kriege ◽  
Gerrit Toenges ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Research Study ◽  
University Hospital ◽  
Simulated Patients ◽  
Stressful Situation ◽  
Simulation Research ◽  
Simulation Centre

ObjectivesDuring a ‘cannot intubate, cannot oxygenate’ situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient’s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a ‘cannot intubate, cannot oxygenate’ situation.DesignDue to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study.SettingWe collected data in our institutional simulation centre between November 2016 and November 2017.ParticipantsWe included 40 experienced staff anaesthesiologists at our tertiary university hospital centre.InterventionThe participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records.Primary outcome measuresThe difference in ‘time to ventilation through cricothyrotomy’ between the two situations was the primary outcome measure.ResultsThe results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3–40.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time.ConclusionCricothyrotomy, which is the most crucial treatment for cardiac arrest in a ‘cannot intubate, cannot oxygenate’ situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.

scholarly journals Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Clinical Characteristics ◽  
National Registry ◽  
Injection Drug ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Increased Risk ◽  
History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P <  0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P <  0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P <  0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P <  0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P <  0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P <  0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P <  0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P <  0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P <  0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

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