scholarly journals Mannheim’s peritonitis index a more simpler prognostic index than APACHE II score

2020 ◽  
Vol 7 (9) ◽  
pp. 3041
Author(s):  
Jyoti S. Maran ◽  
Archana Shukla ◽  
Bhupendra Singh Parmar
Keyword(s):  
Roc Curve ◽  
Prognostic Index ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Age Group ◽  
Roc Curve Analysis ◽  
Medical College ◽  
Gandhi Medical College ◽  
Time Of Admission

Background: The study was done with the aim to determine the clinical profile of patients with hollow viscous perforation and to compare MPI and APACHE II scoreMethods: This study was a prospective and retrospective observational study conducted in the department of General Surgery, Gandhi Medical College and associated Hamidia Hospital from the June 2017 to August 2019The possible score ranges from 0-47. All necessary preoperative data was recorded. Blood sample was taken and relevant blood investigations were done. Patients were resuscitated with iv fluids. Nasogastric tube and urinary cather insertion were done. The parameters of modified APACHE II score and Manheim’s peritonitis index were recorded at the time of admission. Patients underwent emergency laprotomy and correction of pathology was done.Results: Out of total 100 patients 79% were males, 21% were females, majority 45% belonged to the age group 26-35 years.  To calculate the cut off point for mortality ROC curve was constructed. ROC curve analysis predicted that Manheim’s score of 22 or more would predict mortality. Out of total 16 deaths, 14 cases had Manheim’s score of 22 or more thus, giving the score a sensitivity of 87.5% and specificity of 77.38% and overall accuracy of 79% in our study. ROC also predicted that APACHE II score of 15 or more would predict mortality. Thus, giving APACHE II score a sensitivity of 93.75%, specificity of 100% and accuracy of 99%.Conclusions: We consider MPI to be a more simpler prognostic indicator than APACHE II score.

scholarly journals STUDY OF COMPLICATIONS OF MALARIA IN ADULTS PATIENTS: A PROSPECTIVE STUDY FROM BHOPAL

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Nikhil Gupta ◽  
RS Maniram ◽  
Garima Vijayvergiya
Keyword(s):  
Leukocyte Count ◽  
Severe Anemia ◽  
Major Health Problem ◽  
Major Health ◽  
Medical College ◽  
Major Complications ◽  
Gandhi Medical College ◽  
A Prospective Study ◽  
Time Of Admission ◽  
Poor Population

Background: Malaria is a major health problem all over the globe. WHO recorded that 228 million people suffered and 405000 died due to malaria in 2018. Severity of malaria is known to be the cause of serious morbidity and mortality in poor population. Understanding of its current symptoms and associated complication can help in early diagnosis. Aims and objectives: To study the malarial complications among the adult patients. Materials and Methods: Hundred malaria patients were studied at Gandhi Medical College and associated with Hamidia Hospital from Jan 2019 to Dec 2019. For all the subjects’ medical history, demographic details and medical complications were recorded. Results: Major symptoms at the time of admission were fever, nausea and headache. Major complications in SM patients were severe anemia, prostration, hyperpyrexia (9%) respiratory distress in (6%), thrombocytopenia (70%), low leukocyte count (21%), and cerebral malaria was recorded in 4%. No mortality was recorded during this study. Conclusion: Severe anemia, prostration, hyperpyrexia, ARDS, thrombocytopenia and low leukocyte count are the major complications of SM. Keywords: nausea, anemia, prostration, hyperpyrexia, thrombocytopenia

scholarly journals A New Non-touch Technique (Partha’s Technique) of Administering Spinal Anaesthesia in Paediatric Age Group- A Pilot Study

2020 ◽  
Author(s):  
S Parthasarathy ◽  
Indubala Maurya
Keyword(s):  
Pilot Study ◽  
Failure Rate ◽  
Spinal Anaesthesia ◽  
Lateral Position ◽  
The Novel ◽  
Age Group ◽  
Medical College ◽  
Paediatric Age ◽  
Group A ◽  
Gandhi Medical College

Introduction: Paediatric spinal anaesthesia is often the technique of choice in many short duration surgeries. However, the failure rate is higher with spinal anaesthesia in children than in adults. Aim: To evaluate if a non-touch technique of paediatric spinal anaesthesia can reduce anaesthetic failure. Materials and Methods: A pilot study was done in 10 paediatric patients from January 2018 to July 2018 in Mahatma Gandhi Medical College and Research Institute, Puducherry, India. Ten children posted for infra-umbilical surgeries in the age group of 4-10 years were given a sedative premedication with a combination of Pethidine and Midazolam They were kept in lateral position with the back much inside the edge of the table so that there was a considerable space between the table edge and the baby. Identification of the L3-L4 space was done by touching the patient. The 25-gauge quincke needle was pricked and the hub was held with the hand in the table without touching the patient. Results: The anaesthesia was successful with adequate level in all the patients; T8 in five patients and T10 in the other five patients. There were no significant side effects. Conclusion: From this pilot study on 10 patients, it can be suggested that the novel non-touch Partha’s technique is feasible and more successful with absent failure rate when administering spinal anaesthesia in the paediatric age group.

scholarly journals Prognostic Value of Pretreatment Systemic Immune-Inflammation Index in Glioblastoma Multiforme Patients Undergoing Postneurosurgical Radiotherapy Plus Concurrent and Adjuvant Temozolomide

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Erkan Topkan ◽  
Ali Ayberk Besen ◽  
Yurday Ozdemir ◽  
Ahmet Kucuk ◽  
Huseyin Mertsoylu ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Roc Curve ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
Curve Analysis ◽  
Newly Diagnosed ◽  
Roc Curve Analysis ◽  
Adjuvant Temozolomide ◽  
Prognostic Utility ◽  
Immune Inflammation

Objectives. To evaluate the potential prognostic utility of pretreatment systemic immune-inflammation index (SII) in newly diagnosed glioblastoma multiforme (GBM) patients who underwent postneurosurgical radiotherapy and concurrent plus adjuvant temozolomide. Methods. The retrospective data of GBM patients who underwent postneurosurgical radiotherapy and concurrent plus adjuvant temozolomide were analyzed. For each patient, SII was calculated using the platelet, neutrophil, and lymphocyte measures obtained on the first day of treatment: SII=platelets×neutrophils/lymphocytes. The receiver operating characteristic (ROC) curve analysis was utilized for the evaluation of optimal cut-off values for SII those linked with the outcomes. Primary and secondary endpoints constituted the overall (OS) and progression-free survival (PFS) per conveyance SII group. Results. A total of 167 patients were included. The ROC curve analysis identified the optimum SII cut-off at a rounded 565 value that significantly interacted with the PFS and OS and stratified patients into two groups: low-SII (SII<565; n=71) and high-SII (SII≥565; n=96), respectively. Comparative survival analyses exhibited that the high-SII cohort had significantly shorter median PFS (6.0 versus 16.6 months; P<0.001) and OS (11.1 versus 22.9 months; P<0.001) than the low-SII cohort. The relationship between the high-SII and poorer PFS (P<0.001) and OS (P<0.001) further retained its independent significance in multivariate analysis, as well. Conclusions. The outcomes displayed here qualified the pretreatment SII as a novel independent prognostic index for predicting survival outcomes of newly diagnosed GBM patients undergoing postneurosurgical radiotherapy and concurrent plus adjuvant temozolomide.

scholarly journals Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 402
Author(s):  
Renée Blaauw ◽  
Daan G. Nel ◽  
Gunter K. Schleicher
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Area Under The Curve ◽  
Threshold Value ◽  
High Plasma ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Proxy Indicators

Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU), correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (<420 µmol/L), normal (420–700 µmol/L), or high (>700 µmol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 µmol/L) and 14.2% high (median 898.9 µmol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p < 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p < 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p < 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.

Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis

2008 ◽  
Vol 43 (11) ◽  
pp. 1387-1396 ◽  
Author(s):  
Chie Morioka ◽  
Masahito Uemura ◽  
Tomomi Matsuyama ◽  
Masanori Matsumoto ◽  
Seiji Kato ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adamts13 Activity

scholarly journals Prognostic Indicator in Severe Acute Pancreatitis

2018 ◽  
Vol 3 (05) ◽  
Author(s):  
Dr. Ajay Khanolkar ◽  
Dr. Manish Khare
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Surgical Intervention ◽  
Financial Burden ◽  
Fluid Collection ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Management Decision ◽  
Apache Ii Score ◽  
Local Complication

Aim of study: - To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis. Material and Methods: This prospective study entitled “To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis” was carried out on patients hospitalized for acute pancreatitis in the surgery department at Chandulal Chandrakar Memorial Medical College and CM Hospital, Bhilai from March 2015 to October 2017.50 patients with the diagnosis of first attack of acute pancreatitis of both sexes and all age groups were selected for the study. Conclusion:- On the basis of observation and result of the study, it can be safely stated that APACHE II Scoring is quick, safe, reproducible, ongoing and cost effective. It can be done by resident or intelligent nursing staff. Give an idea regarding improving or worsening of patients. APACHE II Scoring system when complimented by high quality CECT abdomen can further refine the results and give an idea of likelihood of patients developing local complication. Thus it can also be used along with CECT abdomen for Risk Stratification of subset of patients who are likely to develop local complication who might need surgical intervention. CECT on 3rd day adds nothing to management. It has a tendency to over predict the regional complication, which are in anyway apart of natural course of history of disease (acute fluid collection). Management decision could not be based on CECT abdomen on 3rd day alone, since it is not needed to make a diagnosis of acute pancreatitis it should be abundant, thus reducing the financial burden of patients and institute. CECT abdomen done after 2nd week in the course of illness along with APACHE II Score and clinical finding are better guide for management and surgical intervention.

Decreased Activity of Plasma ADAMTS13 Parallels Enhanced Endotoxemia in Patients with Severe Acute Pancreatitis: Relationship to Multiorgan Failure

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4541-4541
Author(s):  
Chie Morioka ◽  
Masahito Uemura ◽  
Tomomi Matsuyama ◽  
Masanori Matsumoto ◽  
Masao Fujimoto ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Sofa Score ◽  
Multiorgan Failure ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Healthy Controls ◽  
Endotoxin Concentration ◽  
Plasma Endotoxin

Abstract Background: Severe acute pancreatitis (SAP) frequently progresses to pancreatitis-associated multiorgan failure (MOF) with high mortality. Decreased plasma ADAMTS13 activity (ADAMTS13:AC) results in the accumulation of unusually large von Willebrand factor multimers (UL-VWFM) and the formation of platelet thrombi, ultimately leading to MOF. We demonstrated that the imbalance between decreased ADAMTS13:AC and increased UL-VWFM could contribute to SAP pathogenesis through enhanced thrombogenesis, and serve as an early prognostic indicator for SAP patients (Scand J Gastroenterol, 2008, 26:1). Endotoxin has been considered to be the principle activator of the systemic inflammatory response syndrome, which predisposes patients for MOF and/or pancreatic necrosis, ultimately leading to SAP. We investigated the relationship of endotoxin to ADAMTS13:AC and its related parameters, and tried to explore their potential role on the development of MOF in patients with SAP. Methods: We sequentially determined plasma endotoxin concentration, ADAMTS13:AC and its related parameters in 13 SAP patients (APACHE-II score mean 6.6 ± 2.7), who were admitted into intensive care unit of our hospital between 2004 and 2006. Eleven patients were survivors and two were non-survivors whose APACHE II scores were 10 and 12 died of MOF, respectively. The degree of MOF was evaluated according to the SOFA score. Endotoxin concentration was determined by a chromogenic substrate assay (Toxicolor LS –M Set, Seikagaku Kogyo Co.) with kinetic analysis after pretreatment with detergent, Triton X-100, and heating at 70 °C for 10 min. Plasma ADAMTS13:AC was determined by a sensitive chromogenic ELISA (ADAMTS13-act-ELISA: Kainos Inc.). Plasma UL-VWFM was analyzed by a vertical SDS-1.0% agarose gel electrophoresis. Plasma VWF antigen (VWF:AG), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor -α (TNF-α) were measured by ELISA. Results: In normal healthy controls (n=20), plasma endotoxin concentration was 7.9±1.7 pg/ml (mean ± SD). The concentration in the SAP patients significantly increased at day 1 (means 65 pg/ml, p&lt;0.001) and at day 2 (88 pg/ml, p&lt;0.001) as compared to healthy controls. The values, thereafter, gradually decreased in 8 survivors (55 pg/ml at day 5, 53 pg/ml at day 7, 27 pg/ml at day 14), while in remaining 3 survivors needing necrosectomy, the concentration further increased (98 pg/ml at day 5, 178 pg/ml at day 7), and decreased to 20 pg/ml at day 14 at the recovery phase. In two non-survivors, the endotoxin levels increased from 37 pg/ml at day 1 to 462 pg/ml at day 2 in one needing necrosectomy, and showed 51 pg/ml at day 1 in another at the age of 91. Within 1 or 2 days after admission, the ADAMTS13:AC was lower in SAP patients (mean 29%, p&lt;0.001) than in healthy controls (99%), and gradually recovered in the 11 survivors but further decreased in the 2 non-survivors. On admission, VWF:Ag was higher (402%, p&lt;0.001) in SAP patients than controls (100%). VWF:Ag gradually decreased in the survivors, except in the 3 survivors needing a necrosectomy, but remained high in the non-survivors. UL-VWFM positive patients showed lower ADAMTS13:AC (25% vs. 42%, p&lt;0.05) and higher VWF:Ag ( 481% vs. 332%, p&lt;0.05), resulting in higher ratio of VWF:Ag to ADAMTS13:AC (25.2 vs. 9.1, p&lt;0.02), as compared to UL-VWFM negative ones. Patients with higher endotoxin concentration more than 50 pg/ml showed lower ADAMTS13:AC than those without (22% vs. 43%, p&lt;0.05). Plasma endotoxin concentration positively correlated with the ratio of VWF:Ag to ADAMTS13:AC (r=0.732, p&lt;0.005). The SOFA score correlated positively with plasma endotoxin concentration (r=0.604, p&lt;0.03), IL-8 (r=0.843, p&lt;0.001), and the ratio of VWF:Ag to ADAMTS13:AC (r=0.700, p&lt;0.01), and inversely with the ADAMTS13:AC (r= − 0.601, p&lt;0.03). Conclusion. The imbalance between decreased ADAMTS13:AC and increased UL-VWFM is closely related to enhanced endotoxemia, which may contribute to the development of SAP and subsequent MOF through enhanced thrombogenesis.

scholarly journals Combination of dirty mass volume and APACHE II score predicts mortality in patients with colorectal perforation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Daichi Ishikawa ◽  
Yukako Takehara ◽  
Atsushi Takata ◽  
Kazuhito Takamura ◽  
Hirohiko Sato
Keyword(s):  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Postoperative Mortality ◽  
Apache Ii ◽  
Prognostic Indicators ◽  
Apache Ii Score ◽  
Colorectal Perforation ◽  
Roc Curve Analysis ◽  
Mass Volume

Abstract Background “Dirty mass” is a specific computed tomography (CT) finding that is seen frequently in colorectal perforation. The prognostic significance of this finding for mortality is unclear. Methods Fifty-eight consecutive patients with colorectal perforation who underwent emergency surgery were retrospectively reviewed in the study. Dirty mass identified on multi-detector row CT (MDCT) was 3D-reconstructed and its volume was calculated using Ziostation software. Dirty mass volume and other clinical characteristics were compared between survivor (n = 45) and mortality groups (n = 13) to identify predictive factors for mortality. Mann–Whitney U test and Χ2 test were used in univariate analysis and logistic regression analysis was used in multivariate analysis. Results Dirty mass was identified in 36/58 patients (62.1%) and located next to perforated colorectum in all cases. Receiver-operating characteristic (ROC) curve analysis identified the highest peak at 96.3 cm3, with sensitivity of 0.643 and specificity of 0.864. Univariate analysis revealed dirty mass volume, acute disseminated intravascular coagulation (DIC) score, acute physiology and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score as prognostic markers for mortality (p<0.01). Multivariate analysis revealed dirty mass volume and APACHE II score as independent prognostic indicators for mortality. Mortality was stratified by dividing patients into four groups according to dirty mass volume and APACHE II score. Conclusions The combination of dirty mass volume and APACHE II score could stratify the postoperative mortality risk in patients with colorectal perforation. According to the risk stratification, surgeons might be able to decide the surgical procedures and intensity of postoperative management.

scholarly journals Prevalence of impaired fasting glucose in different grades of obesity

2019 ◽  
Vol 6 (6) ◽  
pp. 1736
Author(s):  
Jitendra Kumar Rai ◽  
J. L. Wadhwani ◽  
Manuj Sharma ◽  
T. N. Dubey
Keyword(s):  
Impaired Fasting Glucose ◽  
Fasting Glucose ◽  
Fasting Blood Glucose ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Age Group ◽  
Medical College ◽  
Obese Subjects ◽  
Gandhi Medical College

Background: Impaired fasting glucose (IFG) is a pre-stage to type 2 diabetes mellitus (T2DM) in adults and generally in obese population. In different studies this occurrence varied significantly, but the true prevalence is unknown due to lack of larger representative cohort studies. Authors objectives was to study the prevalence of IFG in different grades of obesity.Methods: One hundred obese subjects of obesity Grade1 (BMI >25 kg/m2 but <30) and Grade 2 (BMI >30 kg/m2) were studied at Gandhi Medical College, Bhopal from April 2019 to June 2019. Physical examination, blood investigations including fasting blood glucose and oral glucose tolerance test (OGTT) was carried out for all the patients.Results: Out of 100 subjects, 18(9%) males and 18(9%) females had IFG. Among male subjects highest IFG was recorded in the age group of 60+ years and in the weight rage of 71 to 80 kg. In female subjects, highest prevalence was in the age group 51 to 60 years and in weight range of 51-60 kg. Out of 24 males and 34 female of with Grade 1 obesity, 7% and 10.4% had IFG similarly, out of 25 males and 17 females with grade 2 obesity, 11% and 7.6% had IFG.Conclusions: IFG is highly prevalent in different grades of obesity. Obesity is the risk factor for the development of diabetes.

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