scholarly journals Usefulness of clinical and laboratory parameters for differentiation of biliary atresia from idiopathic neonatal hepatitis: Experience in a tertiary care hospital of Bangladesh

2015 ◽  
Vol 4 (1) ◽  
pp. 30-36
Author(s):  
Kaniz Sultana ◽  
Ariful Haque ◽  
Nadira Musabbir ◽  
Syeda Afria Anwar ◽  
Faika Hussain ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Biliary Atresia ◽  
Tertiary Care ◽  
Neonatal Hepatitis ◽  
Care Hospital ◽  
Neonatal Cholestasis ◽  
Cross Sectional ◽  
Laboratory Parameters ◽  
Upper Limit ◽  
Idiopathic Neonatal Hepatitis

Background: The two most common and important causes of neonatal cholestasis (NC) are biliary atresia (BA) and Idiopathic neonatal hepatitis (INH). There is no single test that can definitely differentiate these two entities. Objective: To evaluate the diagnostic accuracy of clinical and laboratory parameters for diagnosis of biliary atresia. Methods: This cross-sectional study was conducted at the department of Pediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from August 2013 through July 2015 among purposively sampled infants with neonatal cholestasis. Results: Total 86 neonatal cholestatic cases were studied. Term baby and good birth weight are significantly higher in BA cases. The presence of persistent pale colored stool is significantly more in patients with BA (p 0.000). GGT is the only liver enzyme that was found to be useful differentiating BA from INH at a cut-off value ≥ 524U/L or 9.5 times higher than upper limit normal with sensitivity and specificity of 81.6% and 72.9% respectively. In the present study the diagnostic accuracy of persistent pale colored stool found to be highest (79.1 %). Conclusion: The present study showed that Persistent pale colored stool and serum level of GGT with a cut-off value ≥524 U/L or 9.5 times higher than upper limit normal can be considered as predictive markers for differentiation of Biliary atresia from Idiopathic neonatal hepatitis. CBMJ 2015 January: Vol. 04 No. 01 P: 30-36

scholarly journals Cholestatic Jaundice in Infants – An Experience in Tertiary Care Hospital

2014 ◽  
Vol 32 (1) ◽  
pp. 9-15 ◽  
Author(s):  
FR Chowdhury ◽  
K Chowdhury ◽  
ASMB Karim
Keyword(s):  
Birth Weight ◽  
Biliary Atresia ◽  
Tertiary Care ◽  
Age At Onset ◽  
Cholestatic Jaundice ◽  
Neonatal Hepatitis ◽  
Biliary Cirrhosis ◽  
Care Hospital ◽  
Neonatal Cholestasis ◽  
Cross Sectional

Background: Neonatal cholestasis is defined as prolonged elevation of serum levels of conjugated bilirubin beyond the first 14 days of life. Cholestasis in a newborn can be due to infectious, genetic, metabolic, or undefined abnormalities giving rise to mechanical obstruction of bile flow or to functional impairment of hepatic excretory function and bile secretion. Early detection and timely accurate diagnosis are important for successful treatment and a favorable prognosis. Objective: The present study has been designed to determine the etiology of cholestatic jaundice in infants along with their clinical profile. Methodology: This cross-sectional study was conducted from August 2010 through January 2011 in the Paediatric Gastroenterology & Nutrition Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. For the study purpose 40 consecutive cases of cholestatic jaundice were included who fulfilled the inclusion criteria. Result: Biliary atresia was the commonest (42.5%) cause of cholestatic jaundice followed by neonatal hepatitis/ idiopathic neonatal hepatitis. Other causes of cholestatic of the infants were term and of normal birth weight in cases of biliary atresia (BA) but in NH/INH group significant number of infants were preterm and of low birth weight. Mean age at onset of jaundice was 10.1 ± 4.18 days, and mean age at presentation was 113.7 ±15.38 days. In cases of BA Jaundice, intermittent / persistent pale stool, dark urine was found in all cases and hepatomegaly and splenomegaly were found in 88.2% and 64.8% of cases respectively. Ultrasonographically in most of the cases of BA gallbladder was found either small in size or absent or bile ducts were not visualized. In cases of NH/INH visualization of normal gallbladder while fasting and contraction was observed after meal. Histologically typical features BA were found in 12 out of 17 cases of BA and features of early biliary cirrhosis in 4 infants and 10 patients showed features of INH. Conclusion: Biliary atresia was found to be the commonest cause of neonatal cholestasis in the present study. DOI: http://dx.doi.org/10.3329/jbcps.v32i1.21029 J Bangladesh Coll Phys Surg 2014; 32: 9-15

Idiopathic Neonatal Hepatitis in One DNA Fingerprint Identical Twin

PEDIATRICS ◽  
1992 ◽  
Vol 89 (2) ◽  
pp. 329-330
Author(s):  
PIETRO VAJRO ◽  
ANGIOLA FONTANELLA ◽  
EMILIA VUTTARIELLO ◽  
ANNA DE VINCENZO ◽  
GIULIANA FORTUNATO
Keyword(s):  
Biliary Atresia ◽  
Hepatobiliary Disease ◽  
Identical Twin ◽  
Dna Fingerprint ◽  
Neonatal Hepatitis ◽  
Neonatal Cholestasis ◽  
Injury Site ◽  
Extrahepatic Biliary Atresia ◽  
Dizygotic Twins ◽  
Idiopathic Neonatal Hepatitis

For the practicing pediatrician, the most commonly encountered causes of neonatal cholestasis are idiopathic neonatal hepatitis (INH) and extrahepatic biliary atresia (EHBA). However, despite extensive research, little improvement in our understanding of the etiology of INH and EHBA has occurred.1 It has been proposed that both of them may be part of a continuum of hepatobiliary disease caused by a common insult with a different predominant injury site.2 In this respect, it is interesting that, up to the present, several cases of discordance for EHBA in twins of various zygosity have been reported,3-8 whereas no data are available about either concordance or discordance for INH both in monozygotic and dizygotic twins.

scholarly journals Diagnostic accuracy of transabdominal ultrasound in respect to transvaginal ultrasound in diagnosing ectopic pregnancy in a tertiary care hospital of Kolkata taking histopathology as gold standard: a prospective study

2021 ◽  
Vol 9 (7) ◽  
pp. 1965
Author(s):  
Prasun Das ◽  
Raj Saha ◽  
Srijak Bhattacharyya ◽  
Swadha Priya Basu ◽  
Debopriya Das
Keyword(s):  
Diagnostic Accuracy ◽  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Care Hospital ◽  
Cross Sectional ◽  
Diagnostic Parameters ◽  
Acute Pelvic Pain

Background: Ectopic pregnancy (EP) represents an important cause of acute pelvic pain in women of reproductive age. Initial evaluation consists of appropriate history and clinical examination followed by pelvic ultrasonography (US) and hormonal assays. Objective of the study was to measure diagnostic accuracy of TAS in respect to TVS in detecting ectopic pregnancy.Methods: This prospective cross sectional study was done for 1 year duration in Nilratan Sircar Medical College and Hospital, Kolkata. 50 patients with suspected ectopic pregnancy were transferred from Gynae emergency ward and trans-abdominal, transvaginal ultrasound were subsequently performed on each. The results were corroborated with histopathology reports..Results: Diagnostic parameters of TAS in respect to HPE:sensitivity 75.5, specificity-80,PPV-97.1, NPV-26.6 (all in percentages). Diagnostic parameters of TVS in respect to HPE:sensitivity 86.6, specificity-80, PPV-97.5, NPV-40 (all in percentages).Conclusions: Sonography by transvaginal route stood way ahead of trans abdominal scan in terms of all diagnostic parameters to correctly evaluate ectopic pregnancy.

scholarly journals Aetio-Clinical Profile of Cholestatic Jaundice During Infancy- Study of 30 Cases in a Tertiary Care Hospital

2014 ◽  
Vol 41 (2) ◽  
pp. 34-39
Author(s):  
F Hamid ◽  
A Afroza ◽  
PC Ray
Keyword(s):  
Liver Biopsy ◽  
Biliary Atresia ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Clinical Profile ◽  
Neonatal Hepatitis ◽  
Hepatobiliary Scintigraphy ◽  
Care Hospital ◽  
Young Infants ◽  
Significant Difference

Cholestasis in young infants has a varied etiology. There is considerable delay in presentation of cholestatic cases, both in India (average delay of 3 months in referral centers) and Bangladesh (3.5 months). Early diagnosis is important as the effects of cholestasis are profound and wide-spread. EHBA comprises a significant proportion of cases of cholestatic diseases. If treatment of EHBA is delayed beyond the first 90 days of life, the only option thereafter is liver transplantation, which is not presently feasible on a large scale in developing countries. So, the aim and objective of this study is to determine the cause and to categorize the clinical profile and treatment options of conjugated hyperbilirubinaemia in infancy. A total of 30 patients, who fulfilled inclusion and exclusion criteria were included. A detailed history and physical examination was done daily. Complete blood count, liver function tests, HBsAg and TORCH screening, thyroid function test, Urine was tested for non-glucose reducing substances. Ultrasonography of the hepatobiliary system and hepatobiliary scintigraphy was done. Liver biopsy was done in appropriate patients. Patients were followed up daily during hospital stay. The management and its response were also monitored and recorded. Out of 30 patients 24 (80%) were male and 6 (20%) were female. 63% were term and 37% were preterm. Out of 12 patients in BA, 11 were term and only 1 was preterm, whereas in NH group, out of 18 babies, 10 were preterm. Most of the patients were male in both studied groups. Mean value of birth weight in BA was 2.65±0.13 and in NH was 2.40±0.31. Mean age (days) at onset of jaundice in 2 groups were 3.92 ± 2.43 in BA and 6.5 ±4.5 in NH. Most patients of BA (91%) had persistent acholic stool, whereas in Neonatal hepatitis group 83% had intermittent acholic stool. No statistically significant difference was observed when hepatosplenomegaly and ALT values were considered in 2 studied groups. In BA group 33% & In NH group 72% babies had positivity for CMV infection. Normal ultrasonic findings were seen in 2 patients of BA group, and 7 in NH group. No patient had shown contracted gall bladder after meal in BA, Choledocal cyst was found to be responsible for 5 (42%) patients in BA group and none in NH group. HIDA showed 47% had biliary atresia, 43% neonatal hepatitis and 10.0% had normal liver. Liver biopsy revealed that 12 (40.0%) had biliary atresia and 18 (60.0%) had neonatal hepatitis. Out of 12 babies in Biliary atresia group almost all, 11(92%) received surgical management where as in Neonatal hepatitis group; all 18 babies (100%) received medical treatments. Early detection of cholectatic cases by observing stool colour is very important for physicians to direct the very specific investigations to find out the cause and start appropriate treatment immediately. DOI: http://dx.doi.org/10.3329/bmj.v41i2.18804 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 34-39

scholarly journals Diagnostic Accuracy Of RIPASA Scoring System In Presumptive Accurate Diagnosis Of Acute Appendicitis : A case control study

2021 ◽  
Author(s):  
Mehwish Mooghal ◽  
Wajiha Khan ◽  
Shahid Mehmood ◽  
Lal Bux ◽  
Asrar Ahmad ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Accurate Diagnosis ◽  
Negative Appendectomy ◽  
Care Hospital ◽  
Cross Sectional ◽  
Ripasa Score

Introduction: The RIPASA scoring system was established specifically for Asians. Chong CF in his study consisting of 312 patients who had an emergency appendectomy concluded that optimal cut-off threshold score for negative appendectomy was 7.5. Objective: To determine the diagnostic accuracy of RIPASA scoring system in presumptive accurate diagnosis of acute appendicitis by taking histopathology as the gold standard. Materials and methods: This Cross Sectional Study was carried out at Surgery department at a tertiary care hospital, Karachi over a period of 6 months, from 15th December 2019 to 15th June 2020. A total of 141 patients of both gender of suspected cases of acute appendicitis presenting with sign and symptoms were included in the study. Patients underwent detailed history, general and physical examination and scoring of patients according to RIPASA scoring scale and then decision of appendectomy was taken on the basis of RIPASA score. Removed appendix samples were sent for histopathology. Results: Age range in this study was from 15 to 50 years with mean age of 30.191±6.09 years and mean RIPASA score was 5.375±1.77. Majority of patients were males (58.9%). RIPASA score diagnosed 28(19.9%) and histopathology diagnosed 27(19.1%) patients with acute appendicitis. RIPASA score showed sensitivity of 85.2%, specificity 95.6%, diagnostic accuracy 94%, PPV 82.1% and NPV was 96.4%. Conclusion: We conclude that RIPASA scoring system is the scoring system of choice in diagnosis of the acute appendicitis with good sensitivity albeit a hit high and specificity albeit a bit low profile.

scholarly journals Effectiveness Of Urine Dipstick In Diagnosis Of Pre-eclampsia

2019 ◽  
Vol 10 (1) ◽  
pp. 3-6
Author(s):  
Ferhat Uzair ◽  
Urooj Naz ◽  
Samia Shuja ◽  
Abdul Waheed ◽  
Tahira Assad
Keyword(s):  
Diagnostic Accuracy ◽  
Pregnant Women ◽  
Predictive Value ◽  
Tertiary Care ◽  
First Trimester ◽  
P Value ◽  
Care Hospital ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
Urine Dipstick

Objective: To determine the efficacy of urine dipstick in Pre-eclamplasia. Study Design and Setting: This was a cross-sectional study conducted at the department of obstetrics & gynecology of a tertiary care hospital from May-2017 to September-2018. Methods: All the pregnant women of age 15-45 years, BP=140/90 mmHg on two occasions 4 hours apart or single diastolic value of 100 mmHg, gestational age >20 weeks, singleton pregnancy, booked in first trimester of pregnancy were included in the study. Statistical package SPSS 22 was used for the analysis of data chi-square tests were applied for the diagnostic accuracy of urine dipstick in detection of Pre-eclampsia in pregnant women. P-value was <0.05 was considered as significant. Results: Total 211 pregnant women were enrolled in the study. Mean (SD) age was 28.26(3.86) years. Overall sensitivity and specificity of urine dipstick was found to be 94% and 95.4% respectively, positive predictive value 95%, negative predictive value 94.5% and excellent diagnostic accuracy 94.7% of urine dipstick was observed for the diagnosis of spot urine protein creatinine ratio CONCLUSION: Urine dipstick found to be sensitive and reliable test to screen pre-eclampsia

Confidence toward vaccination as reported by parents of children admitted to a tertiary care hospital in Riyadh, Saudi Arabia: A cross sectional study

Vacunas ◽  
2020 ◽  
Vol 21 (2) ◽  
pp. 95-104 ◽  
Author(s):  
Y.M. AlGoraini ◽  
N.N. AlDujayn ◽  
M.A. AlRasheed ◽  
Y.E. Bashawri ◽  
S.S. Alsubaie ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional

Causes of Epilepsy in Elderly Patients Presenting in a Tertiary Care Hospital of Karachi

2020 ◽  
Keyword(s):  
Elderly Patients ◽  
Cerebrovascular Disease ◽  
Neurodegenerative Disorder ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Traumatic Head Injury ◽  
Keywords Epilepsy ◽  
College Hospital ◽  
Cross Sectional

Background: Epilepsy is fairly a frequent occurrence in the elderly. It is commonly diagnosed after the episode of two or more unprovoked seizures. Unprovoked seizures in elderly are recurrent rather than younger individuals. This study was designed to estimate the concrete burden of frequent causes of epilepsy. Methods: A descriptive cross-sectional study with a total of 153 patients diagnosed case of epilepsy were included in this study at Jinnah Medical College Hospital from February 2018-August 2018. Mean was calculated for age, duration of disease of the patients. Causes of epilepsy, gender, and education was calculated and presented as percentages. Electrolyte readings were taken i.e., Sodium, Calcium and Magnesium levels and imaging was planned to rule out stroke, primary neurodegenerative disorders and tumors. Post stratification Chi square test was applied and p-value less than or equal to 0.05 was considered significant. Results: The mean age of the patients was 63.91±5.68 years and mean duration of the disease was 4.61± 1.07 months. The common causes of epilepsy were found to be cerebrovascular disease 56.9%, cryptogenic 54.2%, neurodegenerative disorder 20.3%, traumatic head injury 11.8%, metabolic abnormalities or electrolyte disturbances 10.5% and brain tumor 7.8%. Conclusion: Elderly patients with first seizure should present to a facility designed in a way that neurologist, cardiologist, rehabilitation and geriatrics work together to identify and treat the condition in a better way. Keywords: Epilepsy; Seizures; Cerebrovascular Disease; Neurodegenerative Disorder.

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