Perfil clínico de pacientes pediátricos con diagnóstico de hepatitis autoinmune en un centro de alta complejidad del suroccidente colombiano

2021 ◽  
Vol 51 (2) ◽  
Author(s):  
Carolina Aristizábal-Henao ◽  
Laura Torres-Canchala ◽  
Eliana Manzi ◽  
Verónica Botero-Osorio
Keyword(s):  
Acute Hepatitis ◽  
Autoimmune Hepatitis ◽  
Tertiary Care ◽  
World Population ◽  
Type I ◽  
Tertiary Care Centre ◽  
Paediatric Patients ◽  
Clinical Responses ◽  
Few Data

Introduction. Autoimmune hepatitis is a progressive inflammatory liver disease that is rare in children, characterized by inflammation in liver histology, the presence of autoantibodies and high levels of immunoglobulin G. There are few data in children and in some studies performed in Latin America, but limited in Colombia. The aim of this study is to describe the demographic, clinical, paraclinical and therapeutic data as well as, the outcome of paediatric patients diagnosed with autoimmune hepatitis in a tertiary care centre in south-western Colombia. Methods. This is a descriptive study of a retrospective cohort of paediatric patients (≤ 18 years) with a diagnosis of autoimmune hepatitis, attended in a third-level hospital in Colombia between 2011 and 2019. Statistical analyses were performed using the program Stata 14.0. Results. A total of 40 patients were included, 57.5% were female, with a median age of 10.5 years (IQR 4-13). The 62.5% presented with acute hepatitis, 20% had liver failure, a 27.5% with cirrhosis at diagnosis; 75% presented compatible liver biopsy, and 82.5% were classified as type 1 autoimmune hepatitis. All patients received a steroid plus immunomodulator; presenting biochemical remission in 75% relapse in the 22.5%. Four of the patients required liver transplantation. Conclusions. Autoimmune hepatitis is an infrequent entity, although not negligible, in children in our environment. A higher prevalence of type I autoimmune hepatitis was found. Most patients were female and presented with symptoms of acute hepatitis at the initial diagnosis. The characteristics and clinical responses, in this cohort, are similar to those described in different series in the world population.

scholarly journals Three delay model: to find out the reason for maternal deaths

2020 ◽  
Vol 8 (4) ◽  
pp. 1273
Author(s):  
Neha Agrawal ◽  
Seema Patel ◽  
Mayank Badkur
Keyword(s):  
Tertiary Care ◽  
Delay Model ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Health Care Centre ◽  
Maternal Deaths ◽  
Adequate Treatment ◽  
Study Region ◽  
Delay In Diagnosis

Background: Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these, an estimated 67,000 maternal deaths and one million new-born deaths occur each year. A woman dies as a result of complication arising during pregnancy and childbirth every 90 seconds in the world, and every 7 minutes in India. The three delay model can be used to find the causes of delays in relation to maternal deaths.Methods: A retrospective study was carried out in a tertiary care centre. All cases of maternal mortality between July 2010 to June 2016 were included in the study. Then data analysis was done.Results: Out of the total 382 maternal deaths, Majority of maternal deaths 43% were due to type 1 delay. 150 patients had delay in seeking help, 9 patients refused treatment and 5 patients refused admission to health care centre. 13% maternal deaths were due to type 3 delay which include delay in receiving adequate treatment, Delay in diagnosis and intervention, Lack of facilities etc.Conclusions: Type-1 delay was major contributors of maternal deaths in the study region. Therefore, to prevent the preventable maternal deaths effective action should be taken.

scholarly journals Gallbladder perforation: management in a tertiary care centre

2018 ◽  
Vol 5 (10) ◽  
pp. 3346
Author(s):  
Prashant Tubachi ◽  
K. Sphurti Kamath ◽  
Mallikarjun Desai ◽  
Harsha Kodliwadmath
Keyword(s):  
Surgical Treatment ◽  
Acute Cholecystitis ◽  
Computerized Tomography ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Diagnostic Procedures ◽  
Gallbladder Perforation ◽  
Type I ◽  
Tertiary Care Centre ◽  
Intravenous Antibiotics

Background: Retrospective study in the management of perforated gallbladder and clinical outcome in a tertiary care centre.Methods: Total of 583 patients underwent laparoscopic or open cholecystectomy between 2015 to 2017. Out of these eleven patients had perforated gallbladder (1.9%). Niemeier’ classification used for gallbladder perforation. Both Ultrasonography and Abdominal computerized tomography was used in this study. The parameters like age, gender, method of management, diagnostic procedures, time between date of admission to time of surgery, surgical treatment, duration of hospital stay and post-operative morbidity were evaluated.Results: Out of the eleven cases, eight patients were male and three were female. Nine patients were above the age of fifty years. According to Niemer classification, seven patients had type I perforation, three patients had type II perforation and one had type one perforation. Out of the eleven cases, eight were clinically diagnosed to be acute cholecystitis and three were clinically diagnosed to have peritonitis. The cases diagnosed to have peritonitis- underwent immediate intervention. The remaining eight cases were initially managed conservatively with intravenous antibiotics, imaging and workup was done, following which intervention was done.Conclusions: Early diagnosis and emergency surgical treatment of gallbladder perforation with peritonitis is of crucial importance. If the patient is stable then intervention after optimising has better outcome. Abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation. 

scholarly journals Study of maternal deaths with COVID-19 infection in a tertiary care centre

2021 ◽  
Vol 11 (1) ◽  
pp. 74
Author(s):  
Niranjan Chavan ◽  
Shikhanshi . ◽  
Deepali Kapote ◽  
Prasad Deshmukh ◽  
Ashwini Sakhalkar
Keyword(s):  
Maternal Mortality ◽  
Tertiary Care ◽  
Health Sector ◽  
Tertiary Referral Hospital ◽  
Tertiary Care Centre ◽  
Susceptible Population ◽  
Medical College ◽  
Co Morbidity ◽  
Substantial Risk

Background: COVID-19 has been a major speed braker not only for world economy and development but also for health sector. The susceptible population including elderly, co-morbid adults and pregnant females were likewise affected in both major COVID-19 waves in India. Association between COVID-19 cases and pregnancy has been studied throughout the world.COVID-19 is associated with substantial risk of morbidity and mortality in postpartum patients and their infants world-wide, compared with their not-infected pregnant counter-parts, especially if these individuals were symptomatic or have comorbidities.Methods: This single-centre prospective observational study, included all consecutive maternal mortalities with COVID-19 infection admitted to Lokmanya Tilak municipal medical college and general hospital (Mumbai, India), a tertiary referral hospital, from 1 April 2020, to June 2021.In this study, a total of 390 patients were included who were found COVID-19 positive during the study period and 17 patients who died during their admission in hospital. The relation of risk factors and demographics were studied for all the patients.Results: The COVID-19 related maternal mortality was more in women of age group 20-30 years (89%). Most women presented to our centre with complaints of fever, cough, cold or breathlessness (55.5%). Patients who succumbed to COVID-19 were mostly primiparous patients (52.9%) and died within 5 days of delivery (46%). 64% of patients died following 5 days of diagnosis of COVID-19.The co-morbidity present in most patients with COVID-19 associated maternal mortality was pre-eclampsia (31.5%). Most patients were referred with only 17% patients registered at our centre and the type of delay involved in management was mostly Type 1 and 2 (82.2%)Conclusions: Multi-centre retrospective analysis with larger population size is required in order for this to be statistically significant.

scholarly journals P569 The role of multidrug-resistant infections in IBD patients undergoing surgery

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S480-S480
Author(s):  
F Colombo ◽  
G M B Lamperti ◽  
S Antinori ◽  
M Corbellino ◽  
G Maconi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Status ◽  
Antibiotic Therapy ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Tertiary Care Centre ◽  
Bowel Diseases ◽  
Resistant Infection ◽  
Few Data ◽  
The Impact

Abstract Background Inflammatory bowel diseases (IBD) patients are particularly vulnerable to an increased incidence of infections, due to both innate characteristics and prolonged pharmacological therapies as steroids, biologics and antibiotics. Very few data are available in the literature about multidrug-resistant (MDR) infections and previous studies have not taken into account the impact of the surgical treatment on infections. We focused on the identification of risk factors for the development of MDR infections in IBD patients undergoing surgical procedures, we investigated the involved microorganisms, and finally, we proceeded to a costs/complications analysis of the treatment. Methods 472 consecutive, unselected IBD patients (285 Crohn’s disease and 187 ulcerative colitis) undergoing surgery from 2016 to 2018 in our Tertiary Care Centre were divided into three groups: MDR infections, antibiotics sensitive infections (no-MDR) and no infections. Results In 37 CD patients nutritional status (p < 0.0008), preoperative biologics (p < 0.008) and antibiotic therapy (p < 0.001), duration of surgical procedure (p < 0.0001) and preoperative hospitalisation length (p < 0.0001) were risks factors for MDR infection development. In 14 UC patients multidrug-resistant infection was related to age at surgery (p < 0.003), disease duration (p < 0.008), inflammatory/nutritional status (p < 0.04), preoperative antibiotic therapy (p < 0.04), and suture leakage (p < 0,01). In the MDR CD group Gram + cocci (54%) were the most implicated pathogens, with a prevalence of 19% of Enterococcus faecium; while in MDR UC patients Gram – bacilli (59%) were the most involved pathogens, with prevalence of Escherichia coli ESBL+ (47%). The antibiotic therapy cost for the CD group was higher in MDR (3249 €) and no-MDR (924 €) groups vs. non-infected patients (41€). In UC we found higher cost only in the MDR group (1408€ vs. 33€). Conclusion Preoperative risk factors involved in the development of MDR infections in IBD patients undergoing surgery were identified. Some factors, such as nutritional status or preoperative antibiotic therapy, were found to be common between CD and UC patients, while some others were found to be specific for UC or CD. Some of these elements appear to be non-modifiable, while some others are part of the multidisciplinary approach, for which further studies are needed to improve the preoperative ‘patient optimisation’ in order to reduce surgical complications.

scholarly journals Autoimmune Hepatitis in a North American Aboriginal/First Nations Population

2008 ◽  
Vol 22 (10) ◽  
pp. 829-834 ◽  
Author(s):  
GY Minuk ◽  
S Liu ◽  
K Kaita ◽  
S Wong ◽  
E Renner ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
First Nations ◽  
North American ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Immunoglobulin A ◽  
Tertiary Care Centre ◽  
Increased Risk ◽  
Aboriginal Populations ◽  
Elevated Bilirubin

North American Aboriginal populations are at increased risk for developing immune-mediated disorders, including autoimmune hepatitis. In the present study, the demographic, clinical, biochemical, serological, radiological and histological features of autoimmune hepatitis were compared in 33 First Nations (FN) and 150 predominantly Caucasian, non-FN patients referred to an urban tertiary care centre. FN patients were more often female (91% versus 71%; P=0.04), and more likely to have low serum albumin (69% versus 36%; P=0.0006) and elevated bilirubin (57% versus 35%; P=0.01) levels on presentation compared with non-FN patients. They also had lower hemoglobin, and complement levels, more cholestasis and higher serum immunoglobulin A levels than non-FN patients (P=0.05 respectively). Higher histological grades of inflammation and stages of fibrosis, and more clinical and radiological evidence of advanced liver disease were observed in FN patients, but the differences failed to reach statistical significance. The results of the present study suggest that in addition to being more common, autoimmune hepatitis may be more severe in FN populations, compared with predominantly Caucasian, non-FN populations.

scholarly journals Comparative study of type I tympanoplasty using temporalis fascia and tragal cartilage with perichondrium as graft material

2018 ◽  
Vol 4 (3) ◽  
pp. 789
Author(s):  
Arvinder Singh Sood ◽  
Pooja Pal ◽  
Anshul Singla
Keyword(s):  
Tertiary Care ◽  
Chronic Otitis Media ◽  
Type I ◽  
Graft Material ◽  
Hearing Improvement ◽  
Temporalis Fascia ◽  
Tertiary Care Centre ◽  
Fascia Graft ◽  
Uptake Rates

<p class="abstract"><strong>Background:</strong> Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy. The purpose of this study was to compare graft acceptance and auditory outcomes of tympanoplasty using cartilage versus temporalis fascia as graft material.</p><p class="abstract"><strong>Methods:</strong> This prospective study included 40 consecutive cases of chronic otitis media in a tertiary care centre randomised in two groups of 20 patients each to be subjected to tympanoplasty using either tragal cartilage-perichondrium or temporalis fascia graft from January 2011 to November 2012. Graft uptake rates and subjective as well as objective hearing improvement at 2 months and 6 months postoperative follow-up were compared.  </p><p class="abstract"><strong>Results:</strong> The mean age of presentation was 34.4 years (range 15-60 years). At 2 months post operatively, the graft uptake was better with tragal cartilage group (95%) than temporalis fascia (90%), while at the end of 6 months graft uptake was better with temporalis fascia (75%) compared to tragal cartilage (70%). Hearing improvement was better for tragal cartilage group compared to the temporalis fascia group at both 2 months and 6 months follow-up. The subjective improvement in hearing at the end of 6 months was also better for tragal cartilage- perichondrium group than the temporalis fascia group.</p><p class="abstract"><strong>Conclusions:</strong> Both temporalis fascia and tragal cartilage–perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with temporalis fascia, while hearing improvement was better with tragal cartilage- perichondrium, although the results were not statistically significant.</p><p class="abstract"> </p>

scholarly journals Comparative Study of Infiltration of Lidocaine with Adrenaline versus Sterile Water in Type 1 Tympanoplasty Performed under General Anaesthesia

2018 ◽  
Vol 26 (3) ◽  
pp. 213-218
Author(s):  
Santosh Uttarkar Pandurangarao ◽  
Sridurga Janarthanan
Keyword(s):  
Pain Relief ◽  
Comparative Study ◽  
General Anaesthesia ◽  
Tertiary Care ◽  
P Value ◽  
Sterile Water ◽  
Tertiary Care Centre ◽  
Type 1 Tympanoplasty ◽  
Post Operative Pain

Introduction It is a common practice to infiltrate 2% lignocaine with 1:2,00,000 adrenaline for Type 1 Tympanoplasty, even when the surgery is done under general anaesthesia. The purpose of this study is to evaluate the necessity of infiltration of lidocaine with adrenaline (2% lidocaine with 1:2,00,000 adrenaline) in Type 1 Tympanoplasty surgeries performed under general anaesthesia in terms of per-operative bleeding and post-operative pain relief.   Materials and Methods A double blinded, prospective randomized comparative study was conducted in a tertiary care centre. A total of 50 patients planned for Type 1 Tympanoplasty under general anaesthesia, for chronic otitis media, inactive, mucosal disease were selected and divided into two groups randomly. Group A (25 patients) received local infiltration of 2% Lidocaine with 1:2,00,000 adrenaline and Group B (25 patients) patients received infiltration of sterile water. The per -operative bleeding and post-operative pain relief were assessedat 2nd, 4th and 6th post-operative hour in both the groups and the results were analysed.   Results P value for per operative bleeding was <0.77 (non-significant). And the P value for post-operative pain relief at 2nd hour was <0.002 (significant). But the P value for 4th (<0.133) and 6th (<0.358) post-operative hours were not significant.   Conclusion Infiltration of 2% lidocaine with 1:2,00,000 adrenaline, doesn’t have any significant impact in per-operative bleeding and post-operative pain relief at 4th and 6th hour. But there is a significant pain relief, for 2 hours after surgery, when 2% lidocaine with 1:2,00,000 adrenaline is used for infiltration.

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