Clinico-pathological study of liver abscesses with special reference to different treatment options

Background: Liver abscess is a serious life threatening condition if left untreated. Most of them were amoebic in nature in tropical countries. The present study was done with the aim to assess the epidemiology of liver abscesses, to determine the fast, accurate and cost effective diagnostic approaches and to find out the best mode of management for amoebic liver abscess (ALA) and pyogenic liver abscess (PLA) in the study population.Methods: This was a prospective study done at KPC Medical College and Hospital for a period of 2 years, from June 2013 to May 2015. A total of 50 patients diagnosed with liver abscess were included in the study. Patients were categorized into ALA and PLA cases based on the type of abscess cavity. Authors have studied correlation of socio-demographic factors with disease, etiology, diagnostic findings, types of treatment and their outcome in the study population.Results: ALA was the most common type among the study groups (90%). Male preponderance was seen. Majority of them belongs to low-socioeconomic status (80%). The most common etiology of PLA was E. coli. Ultrasonography (USG) of the abdomen was accurate and cost-effective diagnostic procedure for assessing liver abscesses. Percutaneous catheter drainage was the most effective method of treatment (with a 100% success rate) in both ALA and PLA cases.Conclusions: Most of the patients in the study had ALA and had a chronological association with alcohol addiction, diabetes and low-socioeconomic status. Rapid diagnosis of the condition (ALA and PLA) with USG will reduce the rate of morbidity and mortality in the patients.

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Clinicopathological study and management of liver abscess in tertiary care center

International Surgery Journal ◽

10.18203/2349-2902.isj20191272 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1332 ◽

Cited By ~ 1

Author(s):

Jigar Ratnottar ◽

Harish Chauhan ◽

Foram Modh

Keyword(s):

Socioeconomic Status ◽

Clinical Features ◽

Liver Abscess ◽

Early Recognition ◽

Care Center ◽

Tertiary Care ◽

Cost Effective ◽

Amoebic Liver Abscess ◽

Percutaneous Catheter Drainage ◽

Liver Abscesses

Background: Liver abscess is a burning problem in tropical nations, with often lethal consequences and diagnostic/therapeutic challenges. We have determined etiopathology, clinical, radiological, and bacteriological characteristics of this condition and review its management strategies.Methods: During the period of the month from August 2017 to August 2018, a prospective study was performed involving 125 patients admitted to the in-patient ward of the Department of General Surgery of SMIMER Medical College their diagnosis was made on the basis of clinical features (such as right upper abdomen pain, and fever), laboratory investigations and radiological evidence of liver abscess.Results: Amoebic liver abscess was the most common (88%) type of liver abscess among the study groups. There was a strong correlation with the occurrence of liver abscesses and addiction to alcohol, history of diabetes mellitus and low socioeconomic status. The most common etiology of pyogenic liver abscess was Escherichia coli. Ultrasonography (USG) of the abdomen was accurate and cost-effective in diagnosis of liver abscesses. Percutaneous catheter drainage was the most effective method of treatment (with a 100% success rate).Conclusions: Most patients in our study had liver abscess of amoebic origin and had temporal relationship with diabetes, alcoholism, and staggering socioeconomic status. We suggest early recognition of clinical features and prompt abdominal USG as cost-effective means for treatment initiation and reducing complications.

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Clinical Pattern of Liver Abscess among the Patients Admitted in Rajshahi Medical College Hospital

Bangladesh Journal of Medicine ◽

10.3329/bjmed.v26i2.25449 ◽

2015 ◽

Vol 26 (2) ◽

pp. 55-60

Author(s):

Chanchal Kumar Ghosh ◽

Fakhrul Alam ◽

M Mahmuduzzaman ◽

AKM Shamsul Kabir ◽

M Saif Uddoula ◽

...

Keyword(s):

Socioeconomic Status ◽

Liver Abscess ◽

Low Socioeconomic Status ◽

Middle Aged ◽

College Hospital ◽

Low Socioeconomic ◽

Clinical Pattern ◽

Palm Wine ◽

Medical College ◽

History Of

Introduction: Liver abscess is an important clinical problem in tropical regions of the world. Current assessment of liver abscesses should allow for better understanding of the aetiopathogenesis of the disease. This study was conducted to find the clinical pattern and aetiopathogenesis of liver abscess in patients admitted in Rajshahi Medical College Hospital.Methodology: The present cross-sectional study was carried out in the Department of Medicine, Rajshahi Medical College Hospital (RMCH) on consecutive 34 patients of liver abscess admitted between the period of July 2002 and June 2003. Detailed history and clinical examination were performed in all patients. All routine investigations were done. Liver abscess was confirmed by ultrasonography (USG). Aspiration of liver abscess was done under sonographic guidance in the Nuclear Medicine Department of RMCH to diagnose the cause of liver abscess. Aspirated materials were sent for microscopical examination and culture and sensitivity in the Department of Microbiology of the same Institute.Result: The findings showed that early middle-aged population were usually affected by liver abscess followed by middle aged (mean age around 40 years). The patients were predominantly male with males being 16 times more likely to suffer from the disease than the females. Most of the patients belong to low socioeconomic status (82.4%). All patients had fever and malaise. Other common manifestations were loss of appetite, lump in the abdomen, intercostal tenderness, nausea/ vomiting, loss of weight. Less common presentations were diarrhoea (29.4%), jaundice (23.5%), cough (11.8%), chest pain (11.8%) and breathlessness (2.9%). Liver span of the patients measured by ultra-sonogram showed hepatomegaly in all cases. All patients with pyogenic liver abscess and 75% of the patients with amoebic abscess had the history of prolonged intake of fermented palm juice (palm wine). Microscopic examination of the pus/aspirate drawn from the liver revealed trophozoite in 7(20.6%) cases. However, on culture of the specimen, 12(35.3%) were culture positive and 22(64.7%) were culture negative.Conclusion: Middle-aged male with low socioeconomic status with the history of prolonged palm wine intake are the most common characteristic of patients with liver abscess. Multi-center study with large sample size is recommended to verify the findings of the present study.Bangladesh J Medicine Jul 2015; 26 (2) : 55-60

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The relation of toddy (palm wine) intake to amoebic liver abscess in a predominantly toddy-drinking population: a cross-sectional study

Tropical Doctor ◽

10.1177/0049475519840242 ◽

2019 ◽

Vol 49 (3) ◽

pp. 197-200 ◽

Cited By ~ 1

Author(s):

Ashish Kumar Jha ◽

Praveen Jha ◽

Madhur Chaudhary ◽

Shailesh Kumar ◽

Vidyut Prakash ◽

...

Keyword(s):

Liver Abscess ◽

Low Socioeconomic Status ◽

Cross Sectional Study ◽

Amoebic Liver Abscess ◽

Sectional Study ◽

Chronic Alcoholic ◽

Cross Sectional ◽

Low Socioeconomic ◽

Palm Wine ◽

Demographic Profiles

The role of toddy (palm wine) as an independent risk factor for amoebic liver abscess (ALA) is not clear. In a cross-sectional study, the clinico-demographic profiles of inpatients with ALA were examined. Microscopy examination of toddy (n = 43) samples was performed. A total of 198 patients with ALA were enrolled, most of whom were: admitted during the May–August months (48%); chronic alcoholic (85% [70% toddy]); malnourished (85%); and of low socioeconomic status (88%). Clinical and laboratory parameters were comparable between toddy and distilled alcohol drinkers. None of the toddy samples revealed presence of cysts and trophozoites of Entamoeba histolytica.

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Assessing the potential return on investment of the proposed UK NHS diabetes prevention programme in different population subgroups: an economic evaluation

BMJ Open ◽

10.1136/bmjopen-2016-014953 ◽

2017 ◽

Vol 7 (8) ◽

pp. e014953 ◽

Cited By ~ 9

Author(s):

Chloe Thomas ◽

Susi Sadler ◽

Penny Breeze ◽

Hazel Squires ◽

Michael Gillett ◽

...

Keyword(s):

Socioeconomic Status ◽

Cost Effectiveness ◽

Cost Saving ◽

Low Socioeconomic Status ◽

Return On Investment ◽

Diabetes Prevention ◽

Cost Effective ◽

Baseline Hba1c ◽

Low Socioeconomic ◽

Diabetes Prevention Programme

ObjectivesTo evaluate potential return on investment of the National Health Service Diabetes Prevention Programme (NHS DPP) in England and estimate which population subgroups are likely to benefit most in terms of cost-effectiveness, cost-savings and health benefits.DesignEconomic analysis using the School for Public Health Research Diabetes Prevention Model.SettingEngland 2015–2016.PopulationAdults aged ≥16 with high risk of type 2 diabetes (HbA1c 6%–6.4%). Population subgroups defined by age, sex, ethnicity, socioeconomic deprivation, baseline body mass index, baseline HbA1c and working status.InterventionsThe proposed NHS DPP: an intensive lifestyle intervention focusing on dietary advice, physical activity and weight loss. Comparator: no diabetes prevention intervention.Main outcome measuresIncremental costs, savings and return on investment, quality-adjusted life-years (QALYs), diabetes cases, cardiovascular cases and net monetary benefit from an NHS perspective.ResultsIntervention costs will be recouped through NHS savings within 12 years, with net NHS saving of £1.28 over 20 years for each £1 invested. Per 100 000 DPP interventions given, 3552 QALYs are gained. The DPP is most cost-effective and cost-saving in obese individuals, those with baseline HbA1c 6.2%–6.4% and those aged 40–74. QALY gains are lower in minority ethnic and low socioeconomic status subgroups. Probabilistic sensitivity analysis suggests that there is 97% probability that the DPP will be cost-effective within 20 years. NHS savings are highly sensitive to intervention cost, effectiveness and duration of effect.ConclusionsThe DPP is likely to be cost-effective and cost-saving under current assumptions. Prioritising obese individuals could create the most value for money and obtain the greatest health benefits per individual targeted. Low socioeconomic status or ethnic minority groups may gain fewer QALYs per intervention, so targeting strategies should ensure the DPP does not contribute to widening health inequalities. Further evidence is needed around the differential responsiveness of population subgroups to the DPP.

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Barriers to the Initiation of Home Modifications for Older Adults for Fall Prevention

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211002161 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110021

Author(s):

Jessica M. Wiseman ◽

David S. Stamper ◽

Elizabeth Sheridan ◽

Jeffrey M. Caterino ◽

Catherine C. Quatman-Yates ◽

...

Keyword(s):

Older Adults ◽

Socioeconomic Status ◽

Low Socioeconomic Status ◽

Cost Effective ◽

Cross Sectional ◽

Low Socioeconomic ◽

Promising Tool ◽

Home Modifications ◽

Risk Of Falls ◽

Areas Of Interest

Introduction: Home modifications are associated with decreased risk for falls and facilitate safe aging in place. The purpose of this study was to identify barriers to procurement of home modifications for older adults. Materials and Methods: Cross-sectional interviews by 2 separate (1 male and 1 female) researchers in a Midwestern city of home repair (“handyman”) and construction businesses within 15 miles of the areas of interest (neighborhood with a high socioeconomic status and neighborhood with low socioeconomic status) with a publicly listed phone number (n = 98). Estimated cost, earliest date of installation, and duration for a home modification project (installation of 3 grab bars) were collected. Results: At least 1 response was attained only 43% of the time (n = 42), and residential grab bar installations were not provided by most businesses (n = 24). The average quote for materials and labor was $394.31 (range $125-$1300). Five of the 7 businesses that responded to both researchers with the same representative differed in cost estimates, generally offering a reduced quote for the low socioeconomic status neighborhood by as much as $300. Quotes provided to the female researcher were also higher than those obtained by the male researcher by about $30 regardless of socioeconomic status. The average wait for home modifications was 23 days and the average anticipated duration of the project was 2.6 hours. Discussion: There are financial and procedural barriers to accessing home modifications for older adults who independently attempt to acquire them. There is a need for pathways in clinical and community settings to reduce barriers to home modifications to reduce the risk of falls. Conclusion: Home modifications are a promising tool to reduce falls and fall-related injuries in older adults. However, further work to identify cost-effective and timely options to reduce acquisition barriers is necessary to leverage the preventive power of home modifications.

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