scholarly journals Proportion of Pancreatic Necrosis among Patients with Acute Pancreatitis and Association between High-Density Lipoprotein (HDL Cholesterol) and Pancreatic Necrosis – A Prospective Observational Study from Kerala, South India

2021 ◽  
Vol 8 (20) ◽  
pp. 1489-1494
Author(s):  
Jayas Siby ◽  
Preetha S ◽  
Sindhu R.S
Keyword(s):  
Acute Pancreatitis ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Pancreatic Necrosis ◽  
Hdl Cholesterol ◽  
Government Medical College ◽  
Medical College ◽  
Low Hdl ◽  
Life Threatening ◽  
The Mean

BACKGROUND Acute pancreatitis is a very common disease and severe acute pancreatitis is life threatening and needs early identification. Current severity predicting indices in acute pancreatitis are cumbersome. There have been previous reports of low HDL cholesterol in life threatening acute pancreatitis. Previous studies in this regard were done in a single ethnicity population and needed to be validated in other ethnic groups. We wanted to estimate the proportion of pancreatic necrosis among the patients with acute pancreatitis attending Government Medical College, Thiruvananthapuram. We also wanted to compare the mean HDL values in those who developed pancreatic necrosis and those who didn’t develop pancreatic necrosis and evaluate the association between HDL value measured 48 – 72 hours of onset of symptoms and pancreatic necrosis. METHODS This was a prospective observational study conducted among 271 patients diagnosed with acute pancreatitis in Government Medical College Hospital, Thiruvananthapuram. Consecutive sampling method was used. RESULTS There were 42 cases of pancreatic necrosis out of 271 cases. The mean HDL of those patients with pancreatic necrosis was found to be less than those without necrosis (P < 0.001). Mean HDL value among those having pancreatic necrosis was 17.7 whereas those without necrosis was 34.9. CONCLUSIONS Proportion of pancreatic necrosis was 15.5 %. The mean HDL measured at 48 hours of symptom onset among the necrotising pancreatitis patients was significantly low when compared to the non-necrotic group (17.7 vs 34.9). All the patients with pancreatic necrosis had their HDL less than 40. Thus, an inference that low HDL at 48 hours of symptom onset was associated with higher incidence of pancreatic necrosis and severe pancreatitis could be made. KEYWORDS Pancreatitis, HDL, Pancreatic Necrosis

scholarly journals Xuezhikang Therapy Increases miR-33 Expression in Patients with Low HDL-C Levels

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Ruihua Cao ◽  
Yongyi Bai ◽  
Lan Sun ◽  
Jin Zheng ◽  
Mian Zu ◽  
...  
Keyword(s):  
Hdl Cholesterol ◽  
Pcr Analysis ◽  
Chain Reaction ◽  
Low Hdl ◽  
The Mean ◽  
Polymerase Chain ◽  
Baseline Levels ◽  
Hdl Metabolism ◽  
To Receive ◽  
Plasma Mirnas

Background. MicroRNA-33a and -b (miR-33a/b) have been revealed to be posttranscriptional regulators of HDL metabolism. Xuezhikang (XZK) is a marked natural HDL-raising polypill. We aim to evaluate the effects of XZK on the expression of circulating miR-33a/b in patients with low plasma HDL-C levels.Methods. A total of 42 participating patients with low baseline levels of HDL cholesterol were assigned to receive an XZK capsule, 600 mg twice daily for 6 months. The expression of circulating miR-33a/b was detected at baseline and after XZK therapy measured with quantitative reverse-transcription (RT) polymerase chain reaction (PCR).Results. The mean (SD) HDL-C level after XZK treatment was 1.19 (0.13) mmol/L, representing an increase of 11.2% from baseline (P<0.001). Q-PCR analysis of plasma miRNAs revealed an increase in relative miR-33a/b expression with XZK treatment. The miR-33a expression was raised from 0.81 to 1.73 (P=0.012); miR-33b expression was increased from 1.2 to 2.75 (P<0.001). The changes of miR-33a and miR-33b were inversely related to the posttreatment LDL-C levels (r=-0.37,P=0.019;r=-0.33,P=0.035, resp.).Conclusion. In patients with low HDL-C levels, XZK therapy raised plasma levels of miR-33a and miR-33b, which may inhibit cellular cholesterol export and limit the HDL-raising effect of XZK.

scholarly journals Anaesthesia and Perioperative Care in Remote Health Camps- Patients’ Concerns

2010 ◽  
Vol 49 (179) ◽  
Author(s):  
Balkrishna Bhattarai ◽  
A Ghimire ◽  
BK Baral ◽  
A Shrestha ◽  
Y Dhungana
Keyword(s):  
Observational Study ◽  
Perioperative Care ◽  
Local Anaesthesia ◽  
Prospective Observational Study ◽  
Main Concern ◽  
Surgical Experience ◽  
Female Ratio ◽  
Male Female Ratio ◽  
The Mean ◽  
Remote Health

INTRODUCTION:Identifying patients' concerns and expectations regarding anaesthesia and perioperative care in mobile surgical camps is relevant for the camp workers. This prospective observational study was conducted to assess knowledge, concerns, and expectations about anaesthesia and perioperative care in patients undergoing surgery in mobile surgical camps in remote mountainous districts of Eastern Nepal.METHODS:A questionnaire with seven items related to anaesthesia and perioperative care was used for interviewing 80 individuals of age > or = 12 years, 20 from each camp at Solukhumbu, Sankhuwasabha, Khotang and Bhojpur districts.RESULTS:Data of two patients were lost leaving only 78 individuals for analysis. The mean age of the subjects was 30.5 (+/- 14.6) years with the male: female ratio of 43: 35. Fifty-eight (74.4%) patients had some gross idea about the modality of administration of anaesthetics. Twenty-six (33.3%) individuals preferred GA over local anaesthesia, whereas 22 (28.2%) were happy either way if there was no pain. Pain was the main concern for 73.1% of the patients. Of the 25 patients expressing fear of GA, death or not being able to wake up anymore was the main concern for 60.0%. Increasing age was associated with lower fear of GA (p < 0.05). Surgical experience was distressing for 17 (21.8%) patients. The overall experience of the anaesthesia and surgery was worse than expected for 25.6% of the patients.CONCLUSIONS:Patients presenting to these health camps have limited knowledge regarding anaesthesia and perioperative care but have valid concerns and expectations in respect of their safety, comfort and outcome.

scholarly journals Role of JIGSAW method of teaching in improving clinical diagnosis among final year medical students – A prospective observational study

2021 ◽  
Vol 12 (12) ◽  
pp. 44-49
Author(s):  
Appandraj S ◽  
Sivagamasundari V ◽  
Varatharajan Sakthivadivel
Keyword(s):  
Observational Study ◽  
Test Score ◽  
Prospective Observational Study ◽  
Coronary Syndrome ◽  
Post Test ◽  
Jigsaw Method ◽  
The Mean ◽  
The Difference ◽  
Didactic Lecture ◽  
Teaching Learning

Background: The Jigsaw method is a form of cooperative learning, in which students are actively involved in the teaching-learning process that improves the long-term retention of acquired knowledge. Aims and Objectives: The objective of this study was to assess the knowledge acquired by students using the Jigsaw learning method in Internal Medicine. Materials and Methods: A prospective observational study was conducted with 100 students. The acute coronary syndrome was taken for 1 h as a didactic lecture, and a pre-test was conducted. The students were divided into five groups and were put for the intervention “Jigsaw.” The pre- and post-test were conducted, and feedback was collected from the students. Paired t-test was used to perform analysis of pre- and post-test. Feedback evaluation was done by a 5-point Liker scale. P<0.05 was considered statistically significant, and the data were analyzed using CoGuide software. Results: The mean pre-test score was 8.44 ± 2.33 ranged (3–14) and the mean post-test score was 11.03 ± 2.07 (ranged 6–15). The difference of 2.39 (95% CI: 2.19–2.59) increase in marks post-test after the Jigsaw method was statistically significant (P<0.001). The satisfaction level was 50–55% on the Likert scale based on the questionnaire given. There was a significant improvement in the post-test scores of the students after Jigsaw. Conclusion: The Jigsaw method improved knowledge in the short-term by engaging students in group work and motivation to learn. Overall response based on the questionnaire about the Jigsaw method was positive.

scholarly journals COMPARATIVE STUDY OF CLINICAL VERSUS USG IN DIAGNOSIS OF EARLY TRIMESTER BLEEDING PV

2020 ◽  
pp. 60-62
Author(s):  
Narendra Nath Hait ◽  
Brahmarshi Das ◽  
Ratan Chandra Mandal ◽  
Haricharan Roy ◽  
Debarshi Jana
Keyword(s):  
Statistical Analysis ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Common Cause ◽  
Clinical Method ◽  
Medical College ◽  
Threatened Miscarriage ◽  
Obstetrics And Gynaecology ◽  
Threatened Abortion ◽  
The Difference

Background: Threatened abortion is till most common cause of early trimester bleeding PV and can be diagnosed and managed by early USG diagnosis. Materials and methods: This was a prospective observational study. Place of the study was Department of Obstetrics and Gynaecology and Department of Radiodiagnosis, Midnapore Medical College and Hospital from January 2019 to June 2020. Eighteen months. Result: When the clinical method to diagnose threatened miscarriage was compared to the sonographic method, it was evident that sonographic method was reliable than the clinical method and the difference was statistically significant. Conclusion: In case of missed miscarriage and complete miscarriage, although the percentage of discrepancy was 100%, on further statistical analysis, the discrepancy was not statistically significant. And the cause behind this was probably inadequate sampling.

scholarly journals A prospective observational study conducted in tertiary teaching hospital of Uttar Pradesh to compare safety and efficacy of PPIUCD and interval IUCD (380A)

2018 ◽  
Vol 8 (1) ◽  
pp. 295
Author(s):  
Nidhi Gupta ◽  
Akanksha .
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Uttar Pradesh ◽  
P Value ◽  
Efficacy And Safety ◽  
Puerperal Sepsis ◽  
Medical College ◽  
Tertiary Teaching ◽  
Reversible Method ◽  
Tertiary Teaching Hospital

Background: The objective of this study was to compare the efficacy and safety of PPIUCD and interval IUCD.Methods: This was a prospective observational study conducted on women attending the OPD and indoor services of S.N. Medical college, Agra. 800 women willing for PPIUCD insertion were included in the study after informed consent excluding chorioamnionitis, PROM>18 hours, unresolved PPH and puerperal sepsis. Another 200 willing women were inserted interval IUCD according to MEC criteria of WHO. All were followed up for 1 year.Results: It was found that rate of expulsion was more in PPIUCD group compared to interval IUCD group (6%vs 1.5% p value <.05),rate of removal was almost similar in both groups (11.5%inPPIUCD and 14%in interval IUCD group), cause of removal was mainly social in PPIUCD group while bleeding was more in interval IUCD group compared to PPIUCD (85.7%vs26%).Conclusions: Postpartum insertion of IUCD is a safe effective, feasible and reversible method of contraception.

Laparoscopic Cholecystectomy for Acute Cholecystitis: Indication, Risk, and Outcome

2021 ◽  
Vol 8 (06) ◽  
pp. 5508-5513
Author(s):  
Dr. Shiladitya Shil ◽  
Dr. Ashutosh Deb Sarma ◽  
Dr. Md. Alomgir Islam ◽  
Dr. Md. Abdullah-Hel-Baki Abdul ◽  
Dr.Monira Begum
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Prospective Observational Study ◽  
The Other ◽  
Surgical Indication ◽  
College Hospital ◽  
Female Ratio ◽  
Medical College ◽  
The Mean ◽  
Good Treatment Option

Background: A laparoscopic cholecystectomy is a fundamental approach to treating acute cholecystitis, and the timing of performing this given treatment is associated with clinical outcomes. It is unknown whether surgical indication, risk, and consequences of laparoscopic cholecystectomy for acute cholecystitis differ from those for the chronic form, making it questionable whether urgent laparoscopic cholecystectomy is the best approach even in severe acute cases. Objective: This study aimed to evaluate surgical indication, risk, and outcomes of laparoscopic cholecystectomy for acute cholecystitis. Methods: This prospective observational study was carried out at Bangladesh Medical College Hospital (Uttara Campus) from July 2006 to November 2008. A total of 103 acute cholecystitis patients were observed to evaluate the safety, risk, and outcomes (includes hospital stay, joining to routine daily works) of laparoscopic cholecystectomy. Result: Male and female ratio is 1:4, and the mean age in our series is 47 years. Acute calculas cholecystitis ultra-sonogram feature shows the highest percentage (85.4%) compare to the other four parts. The study also confirmations around 69% did not get any complications, and bleeding was the most frequently observed (16%) complication. The overall outcomes in this research were observed around 75% of total operated patients did not experience any difficulty and said they fit entirely. The other 19% who had some complications include Pain, RTI, Seroma, Jaundice, Cholangitis, Wound infection). Conclusion: Regarding bile duct injury and prolonged complications, laparoscopic surgery is not a very good treatment option for acute cholecystitis.

Severe acute pancreatitis- it's diagnosis and management- A study of 20 cases

2019 ◽  
Vol 8 (2) ◽  
pp. 17-29
Author(s):  
Mohammad Monir Hossain ◽  
S M Shakwat Hossain ◽  
Delowar Hossain
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Military Hospital ◽  
Fatty Tissue ◽  
Ct Findings ◽  
Contrast Enhanced Ct ◽  
Management Protocol ◽  
Life Threatening

Background: Severe acute pancreatitis is defined as pancreatitis in which there is persistent organ failure that does not resolve within 48 hours. Severe acute Pancreatitis is characterized by pancreatic necrosis, a severe systemic inflammatory response and often multiorgan failure. Severe acute pancreatitis is a serious and life threatening disease. Mortality varies from 20 to 50 percent. Objective: The objectives of this study are to develop our knowledge about presentation and diagnosis of severe acute pancreatitis, and to develop a standard management protocol to rescue that patient suffering from severe acute pancreatitis. Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, during the period of August 2014 - Feb 2015. A total 20 patients of severe acute pancreatitis were studied prospectively, evaluated and managed. Results: In this study, out of 20 patients 12(60%) male and 08(40%) female. Male: Female = 3:2. The youngest patient of this series was 03 years and oldest was of 55 years. First categorization of severity of acute pancreatitis was done on the basis of Ranson score. Those patients whose score is 3 or more are categorized as severe. After categorization subsequent management was planned on the basis of laboratory and CT findings. Out of 20 patients all have raised WBC, serum Calcium level decrease in 16 patients, LDH raised in 16 patients, PaO2 decrease in 14 patients, Base deficitincreased in 12 patients, and blood urea nitrate raised in 14 patients. Contrast enhanced CT scan done in all patients and 12 patients were found with reduced enhancement in pancreas, peripancreatic edema and stranding of fatty tissue and remaining 8 patients have fluid collected in peri- and retro pancreatic space. Total 12 patients were given conservative treatment. Remaining 8 patients were operated whose CT findings were reduced enhancement in pancreas and these patients were suspected for infective pancreatic necrosis. In this study 3 patients were expired. Out of these three patients, 2 patients underwent operative intervention and 1 patient was given conservative treatment. Conclusion: Severe acute pancreatitis is a life threatening condition. Its serious regional and systemic involvement causes multiple organ or system failure. Early diagnosis and effective treatment can significantly reduce the mortality and morbidity. CBMJ 2019 July: Vol. 08 No. 02 P: 17-29

A PROSPECTIVE OBSERVATIONAL STUDY ON SURGICAL INDICATIONS FOR SPLENECTOMY IN A TERTIARY CARE CENTER.

2021 ◽  
pp. 18-19
Author(s):  
Vijaya Bhaskara Reddy. M. G ◽  
Salman Ahmed. F ◽  
Santosh Kumar Rajput ◽  
Ganashyam. K. R
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Recent Trend ◽  
Care Center ◽  
Tertiary Care ◽  
Splenic Abscess ◽  
Surgical Indications ◽  
Spleen Preservation ◽  
Medical College ◽  
Operative Outcomes

Background: Spleen mediates important immunologic, storage and hematologic functions. A person can undergo a splenectomy for various causes which includes both surgical and non surgical. The recent trend being towards spleen preservation, it is necessary to critically analyse the indications for splenectomy and assess if the desired post operative outcomes are achieved by splenectomy. Materials and Methods: This prospective observational study was carried out on patients of Department of General Surgery, Mysore Medical College and Research Institute, Mysore, from august 2017 to November 2019. 45 adult subjects (both male and females) aged ≥ 18 years, who underwent elective or emergency splenectomy for various indications were studied. Results: The most common indication for splenectomy was trauma in 27 patients(60%) followed by splenic abscess(15.6%). Most of the patients underwent emergency splenectomy i.e., 25 cases(55%) . In our study the majority received blood transfusion, 15.5% developed wound infection and 2 cases(4.4%) needed reexploration due to rebleeding.

(Un) conventional complicated pancreatitis

2021 ◽  
Vol 75 (1) ◽  
pp. 61-67
Author(s):  
Michal Rybár ◽  
Ivo Horný
Keyword(s):  
Acute Pancreatitis ◽  
Multidisciplinary Approach ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Secondary Infection ◽  
Abdominal Ultrasound ◽  
Stent Migration ◽  
Endoscopic Extraction ◽  
Threatening Condition ◽  
Life Threatening

Acute pancreatitis is sudden inflammatory disease of pancreas, which can vary from a mild form to severe life threatening condition. The management of pancreatitis usually consists of intensive care and multidisciplinary approach, often including surgical intervention or digestive endoscopy. In this article, we present a 68-year-old female with recidivous acute pancreatitis who underwent a series of endoscopic examinations and at the end also an unusual surgical intervention due to numerous complications. At first, it seemed that there was an idiopatic etiology because neither an anamnesis of alcohol consumption nor metabolic risks or CT signs of cholelithiasis were found. The condition was complicated by the development of acute necrotic collection, gastrointestinal bleeding and development of walled-off pancreatic necrosis (WOPN). Later, the biliary etiology was revealed after cholecystolithiasis was found on abdominal ultrasound. The WOPN was endoscopically drained because of the local compression syndrome. After the drainage, we noticed two cases of stent migration and the secondary infection of the WOPN. At the end, the migrated stents caused transient bowel obstruction and were stuck in the distal ileum. After three unsuccessful attempts to endoscopic extraction, the condition was solved by surgical intervention and double enterotomy was performed. The postoperative care was not easy anyway, being complicated by the dehiscence of the surgical wound with the need of opening the wound and use the VAC system to heal it up.

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