Assessment of different stress responses after laparoscopic and open cholecystectomy in patients attending tertiary care hospital, Bhuj, Gujarat, India: a prospective study

Background: Surgical trauma by incision and dissection of tissue stimulates the body to respond proportionately to the extent of injury. This study was conducted with an aim to compare metabolic and inflammatory responses after laparoscopic and open cholecystectomy namely serum cortisol and C-reactive protein levels before and after operation at Bhuj, Kutch, India.Methods: Present study was non-randomized, and comparative study carry out in the General Surgery Department at Gujarat Adani prospective institute of Medical Science, Bhuj, Kutch, Gujarat, India for an era of two years. One hundred and two patients were included in this study and were divided into two groups of open and laparoscopic cholecystectomy. Out of these 102 patients, 41 undergo open cholecystectomy and 61 laparoscopic cholecystectomy. Preoperative, intraoperative, postoperative and anesthetic medications were consistent in all the patients.Results: It was found that metabolic responses like serum cortisol were significantly higher after open procedure 6 hours and 48 hours postoperatively. Similarly, inflammatory response indicator C-reactive protein was raised significantly higher 48 hours after open as compared to laparoscopic cholecystectomy.Conclusions: Open cholecystectomy caused further tissue responses as compared to its laparoscopic alternative.

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Utility of Blood Markers in Early Prediction of Bacteraemia in Acute Febrile Paediatric Patients – An Observational Cohort Study in a Tertiary Care Hospital of North India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/467 ◽

2021 ◽

Vol 8 (28) ◽

pp. 2526-2531

Author(s):

Rabindra Bhunia ◽

Bindu T. Nair ◽

Vandana Negi

Keyword(s):

Tertiary Care Hospital ◽

Leukocyte Count ◽

Tertiary Care ◽

North India ◽

Total Leukocyte Count ◽

Care Hospital ◽

C Reactive Protein ◽

Reactive Protein ◽

Neutrophil Percentage ◽

Observational Cohort

BACKGROUND Bacteraemia is a common cause of children presenting to the paediatric emergency with acute febrile illness. Blood cultures remain the gold standard for detection of bacteraemia but the positivity is low and also takes time to show positive results. A rapid and reliable biomarker like procalcitonin (PCT), C-reactive protein (CRP), total leucocyte count (TLC), and neutrophil-lymphocyte count ratio (NLCR) can be used to identify febrile children with greater risk for bacteraemia or serious bacterial infections. This would be very helpful to start early treatment of bacteraemia with antibiotics. METHODS The study was an observational cohort study conducted in the Department of Paediatrics of a tertiary care hospital in North India in children between age group 6 months to 12 years presenting with fever of > 100.4° F for 2 - 7 days. Blood samples were sent for PCT, CRP, TLC, NLCR and blood cultures. RESULTS The most sensitive biomarker was total leukocyte count (47.36 %) followed by the neutrophil percentage (26.32 %), C-reactive protein (21.05 %), and procalcitonin (15.79 %). The most specific biomarker was procalcitonin (75.14 %) followed by C-reactive protein (58.56 %), neutrophil percentage (22.65 %) and total leukocyte count (11.05 %). The only biomarker that was statistically significant between the bacteraemia and non-bacteraemia group in the present study was total leukocyte count (P – value < 0.05). CONCLUSIONS The sensitivity and specificity of each single biomarker is low and hence these cannot be used singly to predict bacteraemia. There should be a combination of biomarkers with adequate sensitivity and specificity that can be used to create an algorithm to aid in diagnosis and prognostication. KEYWORDS Procalcitonin, C-Reactive Protein, Blood Culture, Acute Febrile Patient

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Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study

Galician Medical Journal ◽

10.21802/gmj.2020.4.3 ◽

2020 ◽

Vol 27 (4) ◽

pp. E202043

Author(s):

Aamir Hussain Hela ◽

Haseeb Mohammad Khandwaw ◽

Rahul Kumar ◽

Mir Adnan Samad

Keyword(s):

Laparoscopic Cholecystectomy ◽

Retrospective Study ◽

Bile Duct ◽

Surgical Site Infection ◽

Tertiary Care Hospital ◽

Open Cholecystectomy ◽

Tertiary Care ◽

Care Hospital ◽

Site Infection ◽

The Mean

Introduction: Laparoscopic cholecystectomy is the most commonly performed surgical procedure of digestive tract. It has replaced open cholecystectomy as gold standard treatment for cholelithiasis and inflammation of gallbladder. It is estimated that approximately 90% of cholecystectomies in the United States are performed using a laparoscopic approach. The aim of this study was to evaluate the outcome of Laparoscopic cholecystectomy in context to its complications, morbidity and mortality in a tertiary care hospital. Methods: This retrospective study was conducted on 1200 patients, who underwent laparoscopic cholecystectomies, during the period from January 2019 to December 2019, at Government Medical College Jammu J & K, India and necessary data was collected and reviewed. Results: In our study, a total of 1200 patients were studied including 216 males (18%) and 984 females (82%). The mean age of the patients was 43.35±8.61. The mean operative time in our study was 55.5±10.60 minutes with range of 45 – 90 minutes. Conversion rate was 2.6%. 2 patients were re-explored. Bile duct injury was found in 6 patients (0.5%). Conclusions: Gallstone disease is a global health problem. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first choice of treatment for gallstones. Gall stone diseases is most frequently encountered in female population. The risk factors for conversion to open cholecystectomy include male gender, previous abdominal surgery, acute cholecystitis, dense adhesions and fibrosis in Calot’ s triangle, anatomical variations, advanced age, comorbidity, obesity, suspicion of common bile duct stones, jaundice, and decreased surgeon experience. The incidence of surgical site infection has significantly decreased in laparoscopic cholecystectomy compared to open cholecystectomy. In our study we could not find any case of surgical site infection.

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Association between C reactive protein and obesity: a study in a tertiary care hospital

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20194212 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1535

Author(s):

Lavanya Mandli

Keyword(s):

Blood Pressure ◽

Blood Glucose ◽

Cardiovascular Diseases ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Obese Patients ◽

Elevated Blood ◽

C Reactive Protein ◽

Reactive Protein

Background: Obesity and dyslipidemia, especially in children and adolescents coupled with impaired blood glucose metabolism and elevated blood pressure may result in atherosclerosis in the older ages. This study was conducted to assess the association between high levels of CRP with obesity.Methods: Details including height and weight for BMI and serum for C reactive protein estimation was collected for all 134 patients.Results: 60.4% were females and 49.6% were males. Among the obese patients, clinically raised CRP levels was observed in 29.2% and elevated CRP levels in 45.8% levels, while in overweight patients, 21.4% had clinically raised CRP and 46.4% has elevated CRP levels. In normal BMI patients, elevated CRP was seen in 22% and clinically raised in 1.9%.Conclusion: Detection of CRP levels in overweight and obese patients is imperative in the early stages itself to prevent cardiovascular diseases.

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A high C-reactive protein/procalcitonin ratio predicts Mycoplasma pneumoniae infection

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2019-0194 ◽

2019 ◽

Vol 57 (10) ◽

pp. 1638-1646 ◽

Cited By ~ 3

Author(s):

Olivia L. Neeser ◽

Tanja Vukajlovic ◽

Laetitia Felder ◽

Sebastian Haubitz ◽

Angelika Hammerer-Lercher ◽

...

Keyword(s):

Logistic Regression ◽

Mycoplasma Pneumoniae ◽

Viral Infections ◽

Tertiary Care ◽

Multivariate Logistic Regression Analysis ◽

Empiric Antibiotic Therapy ◽

Care Hospital ◽

C Reactive Protein ◽

Neutrophil Lymphocyte Ratio ◽

Reactive Protein

Abstract Background Discriminating Mycoplasma pneumoniae (MP) from Streptococcus pneumoniae (SP) and viral etiologies of community-acquired pneumonia (CAP) is challenging but has important implications regarding empiric antibiotic therapy. We investigated patient parameters upon hospital admission to predict MP infection. Methods All patients hospitalized in a tertiary care hospital between 2013 and 2017 for CAP with a confirmed etiology were analyzed using logistic regression analyses and area under the receiver operator characteristics (ROC) curves (AUC) for associations between demographic, clinical and laboratory features and the causative pathogen. Results We analyzed 568 patients with CAP, including 47 (8%) with MP; 152 (27%) with SP and 369 (65%) with influenza or other viruses. Comparing MP and SP by multivariate logistic regression analysis, younger age (odds ration [OR] 0.56 per 10 years, 95% CI 0.42–0.73), a lower neutrophil/lymphocyte ratio (OR 0.9, 0.82–0.99) and an elevated C-reactive protein/procalcitonin (CRP/PCT) ratio (OR 15.04 [5.23–43.26] for a 400 mg/μg cut-off) independently predicted MP. With a ROC curve AUC of 0.91 (0.80 for the >400 mg/μg cutoff), the CRP/PCT ratio was the strongest predictor of MP vs. SP. The discriminatory value resulted from significantly lower PCT values (p < 0.001) for MP, while CRP was high in both groups (p = 0.057). Comparing MP and viral infections showed similar results with again the CRP/PCT ratio providing the best information (AUC 0.83; OR 5.55 for the >400 mg/μg cutoff, 2.26–13.64). Conclusions In patients hospitalized with CAP, a high admission CRP/PCT ratio predicts M. pneumoniae infection and may improve empiric management.

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