Feto-Maternal Outcome in Patients with Jaundice During Pregnancy

Objective: To find out causes and feto-maternal outcome among patients presented with jaundice during pregnancy. Material and methods: This study was conducted at Isra university Hospital over period of one year from January 2018 to December 2019 in OBS and gynecology department. A total of 50 females having singleton pregnancy and having jaundice were included in the study after taking verbal informed consent. All the patients underwent normal vaginal deliveries and cesarean section as per indications and Hospital protocol. All the information regarding demographic characteristics including maternal and fetal outcome in terms of complications and mortality was collected via self-made study proforma and data was analyzed by SPSS version 20. Results: Total 50 patients were included in this study and 50% belonged to the age group of more than 30 years. 50% were un-booked, multigravida were 80% and 60% women poor socioeconomically. Most of the females had jaundice occurrence during the third trimester. Most patients 40% had jaundice due to viral hepatitis. Major maternal complications were the coagulation failure and renal impairment among 40% and 20% of the cases respectively, followed by septicemia, hepatic coma, hepatic coma, ICU admission, Abruptio placenta, PPH and maternal mortality were found with the percentage of 12.0%, 10.0%, 20.0%, 28.0%, 30.0% and 4.0% respectively. As per neonatal complications, fetal distress was 20.0%, still births were 10.0% and IUD were 10.0%. Conclusion: As per study conclusion the most common cause of jaundice was viral hepatitis. Coagulation failure, renal impairment, abruptio placenta and PPH were observed to be the commonest maternal complications, while fetal distress, IUD and still birth were the frequent fetal complication among patients presenting with jaundice during pregnancy. Keywords: Jaundice, feto-maternal outcome, viral hepatitis

A population-based cohort study of mortality of intensive care unit patients with liver cirrhosis

Background: The impact of liver cirrhosis on the outcomes of admission to intensive care unit (ICU) is not completely understood. Our purpose is to identify risk factors for mortality in ICU patients with liver cirrhosis. Methods: Using reimbursement claims from Taiwan’s National Health Insurance Research Database from in 2006-2012, 1,250,300 patients were identified as having ICU stays of more than one day, and 37,197 of these had liver cirrhosis. With propensity score-matching for socioeconomic status, pre-existing medical conditions, and cirrhosis-related morbidities, 37,197 ICU patients without liver cirrhosis were selected for comparison. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of cirrhosis associated with 30-day, ICU, and one-year mortality were calculated. Results: Compared with control, cirrhotic patients had higher 30-day mortality (aOR 1.60, 95% CI 1.53 to 1.68), particularly those with jaundice (aOR 2.23, 95% CI 2.03 to 2.45), ascites (aOR 2.32, 95% CI 2.19 to 2.46) or hepatic coma (aOR 2.21, 95% CI 2.07 to 2.36). Among ICU patients, liver cirrhosis was also associated with ICU mortality (aOR 144, 95% CI 1.38 to 1.51) and one-year mortality (aOR 1.40, 95% CI 1.35 to 1.46). Associations between cirrhosis of liver and increased 30-day mortality were significant in both sexes and every age group. Conclusions: Liver cirrhosis was associated with 30-day mortality in ICU patients. Jaundice, ascites, hepatic coma, more than 4 admissions due to cirrhosis, and more than 30 days of hospital stay due to cirrhosis were exacerbated factors in cirrhotic ICU patients.

A population-based cohort study of mortality of intensive care unit patients with liver cirrhosis

Background: The impact of liver cirrhosis on the outcomes of admission to intensive care unit (ICU) is not completely understood. Our purpose is to identify risk factors for mortality in ICU patients with liver cirrhosis. Methods: Using reimbursement claims from Taiwan’s National Health Insurance Research Database from in 2006-2012, 1,250,300 patients were identified as having ICU stays of more than one day, and 37,197 of these had liver cirrhosis. With propensity score-matching for socioeconomic status, pre-existing medical conditions, and cirrhosis-related morbidities, 37,197 ICU patients without liver cirrhosis were selected for comparison. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of cirrhosis associated with 30-day, ICU, and one-year mortality were calculated. Results: Compared with control, cirrhotic patients had higher 30-day mortality (aOR 1.60, 95% CI 1.53 to 1.68), particularly those with jaundice (aOR 2.23, 95% CI 2.03 to 2.45), ascites (aOR 2.32, 95% CI 2.19 to 2.46) or hepatic coma (aOR 2.21, 95% CI 2.07 to 2.36). Among ICU patients, liver cirrhosis was also associated with ICU mortality (aOR 144, 95% CI 1.38 to 1.51) and one-year mortality (aOR 1.40, 95% CI 1.35 to 1.46). Associations between cirrhosis of liver and increased 30-day mortality were significant in both sexes and every age group. Conclusions: Liver cirrhosis was associated with 30-day mortality in ICU patients. Jaundice, ascites, hepatic coma, more than 4 admissions due to cirrhosis, and more than 30 days of hospital stay due to cirrhosis were exacerbated factors in cirrhotic ICU patients.

Glutamic acid and its Sodium salt Glutamate(Aji-no-moto)

Glutamic acid is an alpha amino acid that is used by almost all living beings. It is non–essential acidic amino acid. MSG (Mono Sodium Glutamate) is a food additive. MSG is a flavour enhancer. It is traded under the name Aji–no–moto. MSG elicits a unique taste known as UMAMI as a 5th basic taste different from the other basic tastes(bitter, salty, sour, sweet). It is generally used in treatment of hepatic coma. It causes various health hazards. A higher dose of Aji–no–moto is associated with increased risk of obesity. Excessive consumption of it promotes cancer growth.

Heroic Measures for an American Hero: Attempting to save the Life of General Douglas MacArthur

General Douglas MacArthur was a towering public figure on an international stage for the first half of the 20th century. He was healthy throughout his life but developed a series of medical problems when he entered his 80s. This article reviews the General's medical care during two separate life-threatening medical crises that required surgical intervention. The first episode occurred in 1960 when MacArthur presented with renal failure due to an obstructed prostate. Four years later after his 84th birthday, MacArthur developed bile duct obstruction from common duct stones. He underwent an uncomplicated cholecystectomy and common duct exploration but developed variceal bleeding requiring an emergent splenorenal shunt. His terminal event was precipitated by strangulated bowel in long-ignored very large inguinal hernias. MacArthur died, despite state-of-the-art surgical intervention, due to renal failure and hepatic coma.

Chemical pleurodesis using bleomycin in treatment of patients with transsudative pleural effusion in hepatic failure

OBJECTIVE. The authors analyzed the efficacy of bleomycin application as sclerosing agent in patients with transudative pleural effusion in consequence of hepatic failure. MATERIAL AND METHODS. The research included 7 patients with right side hepatic transudative pleural effusion who didn’t respond to conservative medical treatment. Drainage of the right pleural cavity with following injection of bleomycin were performed for all the patients. RESULTS. This procedure was effective in 6 out of 7 patients (86 %). There was a single case of recurrence and lethal outcome (14 %) due to hepatic coma. There weren’t noted any severe side effects during 6 months after induction of bleomycin. CONCLUSIONS. Pleurodesis using bleomycin appeared to be effective and safe method of treatment for patients with hepatic transudative pleural effusions.

Is there any relationship of age & sex to the etiology and outcome of medical coma?

As the diseases behave differently in males and females and even in different age groups, particular attention was made to classify and observe the distribution of various causes of coma according to age and sex of the patient in order to formulate our indigenous database for future reference. We studied the coma etiology with particular reference to the age and sex of the patient, and the outcome. All the 517 (312 male {60.35%} and 205 female {39.65%}) patients were divided into 7 groups according to decades from age 12 to 80 years. Patients older than 40 years predominated (318 {61.5%}). Metabolic coma was predominant cause in almost all age groups. Structural coma was increasing progressively with the age. Poisonings were the common cause in patients under 30, representing 35.85% of all comas in the age group 12-20, and 33.70% in the group from 21-30 years. In the next two decades (31-50 years), hepatic and renal failure predominated making up more than half of all causes. Leading causes among males we re poisonings (69 cases), hemorrhagic CVA (48 cases), ischemic CVA (24 cases), renal failure (28 cases) and hepatic coma (35 cases). Similarly among females causal distribution revealed renal failure (34 cases), followed by hepatic coma (29 cases), and hemorrhagic CVA (26 cases). Out of the 476 (92%) patients whose outcome could be determined 297 (57.4%) were discharged after recovery and 179 (34.6%) died. Eighty out of 205 female patients died (39%), while 99 out of 312 males had a fatal outcome (31.7%). We conclude that coma etiology has a significant effect on prognosis, while such significance could not be assigned to age or sex.