Case Report: Clinical Features of Congenital Portosystemic Shunts in the Neonatal Period

Objective: The aim of this single-center retrospective study was to analyze the clinical characteristics, treatment options, and course of neonatal-onset congenital portosystemic shunts (CPSS).Methods: We included all patients with CPSS who presented with clinical symptoms within the neonatal period in our institution between 2015 and 2020.Results: Sixteen patients were identified, including 13 patients with intrahepatic portosystemic shunts (IPSS) and three patients with extrahepatic portosystemic shunts (EPSS). The median age of diagnosis was 16 days (range prenatal 24 weeks−12 months). Hyperammonemia (60%), neonatal cholestasis (44%), elevated liver enzyme (40%), hypoglycemia (40%), thrombocytopenia (38%), and coagulation abnormalities (23%) appeared in neonatal CPSS. Twelve patients (75%) presented with congenital anomalies, of which congenital heart disease (CHD) (44%) was the most common. Thirteen patients with IPSS initially underwent conservative treatment, but two of them were recommended for the catheter interventional therapy and liver transplantation, respectively, due to progressive deterioration of liver function. Spontaneous closure occurred in nine patients with IPSS. The shunt was closed using transcatheter embolization in one patient with EPSS type II. Another patient with EPSS type II underwent surgical treatment of CHD firstly. The remaining patient with EPSS type Ib received medical therapy and refused liver transplantation.Conclusion: Hyperammonemia, neonatal cholestasis, elevated liver enzyme, hypoglycemia, and thrombocytopenia are the main complications of neonatal CPSS. Moreover, CPSS is associated with multiple congenital abnormalities, especially CHD. Intrahepatic portosystemic shunts may close spontaneously, and conservative treatment can be taken first. Extrahepatic portosystemic shunts should be closed to prevent complications.

Elevated Extracellular Levels of Granzymes in Patients with Scrub Typhus

Scrub typhus is an acute febrile disease caused by Orientia tsutsugamushi, which is transmitted through chigger mites. Delayed treatment results in various complications and, in severe cases, death. Granzymes are secreted by cytotoxic T lymphocytes or natural killer cells and are known to play an important role in controlling intracellular pathogens. To date, few studies have been done on granzymes in patients with scrub typhus. In this study, granzymes A and B showed a significant increase during the acute stage of scrub typhus compared with healthy control subjects, and decreased sharply after treatment. In addition, granzymes A and B were significantly high in the moderately elevated liver enzyme group. In conclusion, it appears that the host during the acute phase of scrub typhus increases cytotoxic T-cell activity to control infection.

Determining the Target Population That Would Most Benefit from Screening for Hepatic Fibrosis in a Primary Care Setting

Due to its high prevalence, screening for hepatic fibrosis in the low-risk population is called for action in the primary care clinic. However, current guidelines provide conflicting recommendations on populations to be screened. We aimed to identify the target populations that would most benefit from screening for hepatic fibrosis in clinical practice. This study examined 1288 subjects who underwent magnetic resonance elastography. The diagnostic performance of the Fibrosis-4 (FIB-4) index and NAFLD fibrosis score was compared in the following groups: (1) ultrasonography (USG)-diagnosed NAFLD, (2) elevated liver enzyme, (3) metabolic syndrome, (4) impaired fasting glucose, and (5) type 2 diabetes regardless of fatty liver. Decision curve analysis was performed to express the net benefit of groups over a range of probability thresholds (Pts). The diabetes group showed a better area under the receiver operating characteristic curve (AUROC: 0.69) compared with subjects in the USG-diagnosed NAFLD (AUROC: 0.57) and elevated liver enzyme (AUROC: 0.55) groups based on the FIB-4 index. In decision curve analysis, the diabetes group showed the highest net benefit for the detection of significant fibrosis across a wide range of Pts. Patients with diabetes, even in the absence of fatty liver, would be preferable for hepatic fibrosis screening in low-risk populations.

CHARACTERISTICS OF USING 3RD AND 4TH GENERATION CEPHALOSPORIN AT THONG NHAT HOSPITAL

Objective: Describing characteristics of using 3rd and 4th generation Cephalosporin antibiotics at Thong Nhat Hospital in the period of 2019 - 2020.Subjects and methods: cross-sectional descriptive study on 158 medical records of patients discharged from hospital from February 20th, 2020 to February 24th, 2020 (5 days) was kept at themedical records store, Department of general planning, Thong Nhat hospital.Results: The majority of patients had no diagnosis of infection but had signs of infection, accounting for 69.92%. Duration of C3G/C4G antibiotic treatment of group with signs of infection was 9.22± 2.79 days. Cefotaxim was used the most, accounting for 26.58%. The majority of indications for the use of antibiotics C3G/C4G for patients were appropriate or partly appropriate, accounting for 74.05%. Efficiency of using appropriate or partially appropriate antibiotics had achieved high results, accounting for 39.24%. Most of the cases diagnosed or showed signs of infection after using antibiotics C3G/C4G obtained treatment efficacy, accounting for 75%. The majority of patients using C3G/C4G antibiotics achieved effectiveness in preventing wound infection in the patient with no signs of infection, accounting for 77.78%. The rate of elevated liver enzyme was 7.59%, the rate of thrombocytopenia was 3.16%.Conclusion: Duration of C3G/C4G antibiotic treatment of group with signs of infection was 9.22 ± 2.79 days. Cefotaxim were used the most. Most of indications to use antibiotics C3G/C4G were appropriate or partially appropriate. Efficiency of using appropriate or partially appropriate antibiotics had achieved high results. The rate of elevated liver enzyme was 7.59%, the rate of thrombocytopenia was 3.16%.

Factors Determining the Intensive Care Need in Help Syndrome & AFLP in Pregnancy

To compare factors affecting mortality and morbidity in HELLP (Hemolysis, Elevated Liver Enzyme Levels, and Low Platelets) syndrome & AFLP (Acute fatty liver of pregnancy).

Emergency LSCS in a Parturient with Pre-eclampsia and HELLP Syndrome with Altered Renal Functions Managed with Regional Anaesthesia

Haemolysis, Elevated Liver enzyme levels, and Low Platelet (HELLP) syndrome is characterised by haemolysis (abnormal peripheral blood smear, increased unconjugated bilirubin), elevated liver enzyme and decreased platelet count. It is an advanced stage of pre-eclampsia. Pre-eclampsia is defined as blood pressure >140/90 mmHg with proteinuria with or without pedal oedema. HELLP syndrome account for 24% of maternal mortality and 40% of perinatal mortality. Anaesthetic management of such parturient is also challenging. This report is about a 35-year-old female patient with HELLP syndrome and altered renal function requiring LSCS. She was managed with regional anaesthesia.

COVID-19 in a patient with severe asthma using mepolizumab

Background: There is a lack of information about the course of coronavirus disease 2019 (COVID-19) in patients with severe asthma who were treated with biologics. Some reports indicated that treatment with benralizumab, dupilumab, and omalizumab in patients with severe asthma was not associated with significant adverse effects during COVID-19.Methods: Asthma itself or the biologic agents used to treat asthma can have a positive effect on the course of COVID-19.There seem not to be any cases that specifically reported the use of mepolizumab in a patient who was infected with COVID.Results: We reported of a 55-year-old woman with a diagnosis of severe asthma for; 3 years and who was being treated withmepolizumab, with no evidence of loss of asthma control, at the time of contracting COVID-19 and who had been followed up inthe allergy clinic. In addition, there are no data on mepolizumab therapy in patients with elevated liver enzyme levels.Conclusion: With this case, we also reported that no adverse effects were observed during mepolizumab treatment in a patient with elevated liver enzyme levels.

HUBUNGAN EDEMA DENGAN PROTEIN URINE PADA IBU HAMIL DI RSU PRIMA HUSADA SIDOARJO

Ibu hamil memiliki resiko yang tinggi dengan adanya penyakit komplikasi berupa sindroma HELLP (hemolysis, elevated, liver enzyme, low platelet) edema, gangguan ginjal, perdarahan, infeksi, tekanan darah tinggi saat kehamilan, komplikasi persalinan, aborsi hingga kematian. Preeklamsi terjadi akibat peningkatan hipertensi dimana sebelumnya tidak pernah mengalami hipertensi sebelum kehamilan. Preeklamsi menimbulkan proteinuria dan edema. Penelitian ditujukan untuk mengetahui hubungan kadar protein urine dengan edema pada Ibu Hamil. Desan penelitian menggunakan pendekatan cross sectional. Populasi penelitain merupakan pasien dari RSU Prima Husada, dengan jumlah sampel minilam sebanyak 30 sampel. Hasil penelitian yang dilakukan uji berdasarkan uji spearman menunjukkan bahwa signifikansi p> 0,05 yaitu 0,456 hal tersebut menunjukkan bahwa tidak ada hubungan antara edema dengan protein urine pada Ibu hamil.