scholarly journals Clinicopathological Study of the Biliary and Duodenal Complications in Patients of Chronic Pancreatitis - A Prospective Observational Study in a Tertiary Care Centre in Eastern India

2021 ◽  
Vol 8 (21) ◽  
pp. 1668-1673
Author(s):  
Shahnawaz Ali ◽  
Purba Haldar ◽  
Amit Ray ◽  
Santanu Roy ◽  
Gaurab Bose ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Observational Study ◽  
Duodenal Obstruction ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Barium Meal ◽  
Clinical Manifestations ◽  
Biliary Cirrhosis ◽  
Tertiary Care Centre ◽  
Conjugated Bilirubin

BACKGROUND Chronic pancreatitis is a chronic inflammatory disease, causing complications related to the duodenum like duodenal obstruction or complications related to the biliary system like cholestasis, cholangitis, secondary biliary cirrhosis and cholangiocarcinoma. The purpose of the study was to observe the occurrence, clinical manifestations and outcome of the complications and foster a deeper understanding of the long-term prognosis of patients suffering from chronic pancreatitis. METHODS This was a prospective observational study. After taking informed consent, total 50 patients admitted in hospital with features suggestive of chronic pancreatitis with or without duodenal or biliary complications were selected and were followed up throughout the course of the disease. All demographic parameters, diabetic status, liver function test, USG findings suggestive of duodenal obstruction or biliary abnormalities, upper GI endoscopy, computed tomography of whole abdomen, MR cholangio pancreatography and barium meal were studied. RESULTS Chronic pancreatitis is more common in male and the common age of presentation is between 45 and 54 years. 12 patients were diabetics. 42 % of the total 50 patients developed transient hyperbilirubinaemia. 5 male patients and 1 female patient had persistent hyperbilirubinaemia and had persistently raised values of alkaline phosphatase. 1 male and 2 female patients also suffered from hypoproteinaemia. About 42 % of the patients of chronic pancreatitis suffered from transient rise in conjugated bilirubin and were managed conservatively. 12 % of the patients suffered from persistently raised conjugated bilirubin, indicating biliary obstruction. 22 % of patients developed cholangitis responding to conservative management. 12 % of cases, 5 males and 1 female suffered from biliary stricture, and were managed surgically with hepaticojejunostomy. No cases of cholangiocarcinoma were detected. CONCLUSIONS The most common complication in patients of chronic pancreatitis is transient biliary stasis, others being cholangitis and persistent hyperbilirubinaemia. No cases of cholangiocarcinoma were detected. KEYWORDS Billiary, Duodenal, Complications, Stricture, Cholestasis, Cholangitis, Chronic, Pancreatitis

scholarly journals Transport characteristics and predictors of mortality among neonates referred to a tertiary care centre in North India: a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044625
Author(s):  
Jasbir Singh ◽  
Poonam Dalal ◽  
Geeta Gathwala ◽  
Ravi Rohilla
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
North India ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Predictors Of Mortality ◽  
Transport Services ◽  
Interhospital Transport

ObjectiveThe paucity of specialised care in the peripheral areas of developing countries necessitates the referral of sick neonates to higher centres. Organised interhospital transport services provided by a skilled and well-equipped team can significantly improve the outcome. The present study evaluated the transport characteristics and predictors of mortality among neonates referred to a tertiary care centre in North India.DesignProspective observational study.SettingsTertiary care teaching hospital in North India.Patients1013 neonates referred from peripheral health units.Main outcome measuresMortality among referred neonates on admission to our centre.ResultsOf the 1013 enrolled neonates, 83% were transferred through national ambulance services, 13.7% through private hospital ambulances and 3.3% through personal vehicles. Major transfer indications were prematurity (35%), requirement for ventilation (32%), birth asphyxia (28%) and hyperbilirubinaemia (19%). Hypothermia (32.5%, 330 of 1013), shock (19%, 192 of 1013) and requirement for immediate cardiorespiratory support (ICRS) (10.4%, 106 of 1013) on arrival were the major complications observed during transfer. A total of 305 (30.1%, N=1013) deaths occurred. Of these, 52% (n=160) died within 24 hours of arrival. On multivariate logistic analysis, unsupervised pregnancy (<4 antenatal visits; p=0.037), antenatal complications (p<0.001), prematurity ≤30 weeks (p=0.005), shock (p=0.001), hypothermia (p<0.001), requirement for ICRS on arrival (p<0.001), birth asphyxia (p=0.004), travel time >2 hours (p=0.005) and absence of trained staff during transfer (p<0.001) were found to be significant predictors of mortality.ConclusionThe present study depicts high mortality among infants referred to our centre. Adequate training of peripheral health personnel and availability of pre-referral stabilisation and dedicated interhospital transport teams for sick neonate transfers may prove valuable interventions for improved outcomes.

scholarly journals Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Infection ◽  
2021 ◽  
Author(s):  
Charlotte Thibeault ◽  
◽  
Barbara Mühlemann ◽  
Elisa T. Helbig ◽  
Mirja Mittermaier ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Median Duration ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Detailed Knowledge ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Duration Of Symptoms

Abstract Purpose Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10–1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00–16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26–46.75, vs 18 days, IQR 16–46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6–15.5) for non-IMV and 49.5 days (IQR 36.8–82.5) for IMV patients. Conclusions Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19.

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