Frequency of High MELD Score in Cirrhotic Patients undergoing Liver Resection due to Hepatocellular Carcinoma

Objective: To determine the frequency of high MELD score in cirrhotic patients undergoing liver resection due to hepatocellular carcinoma also compare the frequency of mortality in patients with high or low MELD score. Study Design: Cross sectional study Place and Duration: Department of Gastroenterology, Shaikh Zayed Hospital, Lahore. Duration: 6months i.e. 23 12-2017 to 22-06-2018. Methodology: 75 patients were enrolled. Then blood sample was obtained. Reports assessed and MELD score calculated. Scores were labeled as high or low. Patients underwent liver resection according to BCLC. The mortality was noted. All the collected data was entered and analyzed on SPSS version 22. Results: In this study out of total 75 cases 60 were males and 15 females. The mean age of patients was 39.44±9.76 years, male to female ratio was 4:1. Low MELD class was noted in 45 (60%) cases and high MELD class noted in 30(40%) cases. Mortality occurred in 27(36%) cases. Insignificant difference found between the MELD class with mortality. Conclusion: High MELD score was seen in 40% cirrhotic patients undergoing liver resection due to HCC. Post HCC resection, mortality occurred in 36% patients within three months of surgery. No significant association was found between the mortality and MELD score. Keywords: MELD, Hepatocellular Carcinoma, Mortality, Cirrhosis

Identifying the critically ill cirrhotics who benefit the most from nutrition therapy: The mNUTRIC score study

Background Malnutrition increases risk of mortality in critically ill cirrhotics. Modified Nutrition Risk in Critically ill (mNUTRIC) score is a validated tool to identify patients at nutrition risk that may benefit the most from goal directed nutrition therapy. We aimed to study the association between mNUTRIC score and 28-day mortality and its modulation by nutritional adequacy in critically ill cirrhotics. Methods A prospective study in critically ill adult cirrhotics was designed with collection of baseline and follow-up data pertaining to mNUTRIC score, clinical, hemodynamic, biochemical, nutritional parameters, use of mechanical ventilation (MV), length of ICU stay, and development of new onset infection (NOI). Daily nutritional adequacy was calculated as percentage of prescribed energy and protein received. Results 150 cirrhotics [(males-83%, age-51 ± 12.1 years, BMI-24 ± 4.7kg/m2; median LOS 6 (2–24 days)] were enrolled. At ICU admission 116 (77%) had high NUTRIC Score (HNS) and 34 (23%) low NUTRIC score (LNS). Patients with HNS had significantly higher mortality [54% vs. 10%; p = 0.008; OR(95%CI) adjusted 3.0(1.39,6.9;p = 0.006)] for etiology and blood sugar ; longer MV days [5(2–24) vs. 3(1–24) ; p = 0.02]; and high incidence of NOI [32% vs. 2.6%; p = 0.002; OR(95% CI:7(2,24.5)] compared to LNS. A logistic regression analysis for interaction of nutritional adequacy and 28 day survival revealed that the probability of survival increases with increase in nutritional adequacy (p < 0.01) in patients with HNS. Conclusion mNUTRIC score is a useful tool in recognizing nutrition risk in critically ill cirrhotics and goal directed nutrition therapy; especially in patients with high mNUTRIC score can significantly improve survival.

What makes practice perfect? How tertiary piano students self-regulate play and non-play strategies for performance success

Self-regulated practice is critical to musicians’ development, but it is unclear what components of practice contribute to performance quality. This study aimed to explore tertiary music students’ practice using performance evaluations as indicators of practice efficacy. Five tertiary piano students prepared a quick study task of two pieces for a mock performance, in 2 hours over 2 days. An expert panel evaluated the mock performances and performers were ranked accordingly. Practice session recordings and interview transcripts were analysed according to the three phases of Self-Regulated Learning (forethought, performance, self-reflection) and linked to the pianists’ final performance evaluations. Successful pianists planned their practice and set interpretative goals, while their less successful peers practiced reactively without planning. The highest-ranked pianist’s self-regulation was facilitated by non-play practice which involved taking long pauses and using strategies such as score study, mark score, and listen to own recording. The lowest-ranked pianist failed to identify problems or self-evaluate effectively. Future studies should explore the use and content of non-play practice strategies, especially self-recording, to empower music students to develop and self-regulate their practice. The quick study task provided an effective practice assessment tool and could be used to diagnose and track practice approaches.