ABSTRACT
Background and Objectives: Severe acute pancreatitis (SAP) affects the nutritional status of the patient. This prospective study was carried to assess the tolerance and outcome of early enteral nutrition via naso-jejunal feeding tube (NJFT).Methods: 30 patients of SAP were given enteral feeding via endoscopically inserted NJFT within 48 – 72 hours of admission. The volume of the feeds was increased as per tolerance. The patients who tolerated the feed (Group A) and those who did not tolerate (Group B) were followed up by biochemical parameters, amount and duration of feeding. The patient outcome noted and the results statistically analyzed. Results: 27 (90%) patients tolerated the feed, reached the goal feed volume and were subsequently started on oral feeds. No complication related to NJFT insertion was encountered. A significantly higher ICU stay (p=0.04) and number of complications (p = 0.048) was observed in Group B patients than in Group A. All nutritional parameters improved in patients in Group A with significant improvement in serum calcium, serum albumin and fasting blood glucose levels. Conclusion: Enteral nutrition is an economical and effective way to provide nutrition to patients with severe acute pancreatitis. The patients who tolerated feeds had less morbidity, mortality and hospital stay.
ABSTRACT
Background and Objectives: Around 20% of the patients of acute pancreatitis develop acute severe pancreatitis in the form of extensive pancreatic or peripancreatic fat tissue necrosis with associated peripancreatic collections. These patients run a protracted clinical course, multiorgan failure, high morbidity and mortality. Methods: Clinically and radiologically diagnosed 30 patients of acute severe necrotizing pancreatitis were prospectively evaluated for the clinical outcome with respect to extent of pancreatic necrosis and severity in terms of CTSI. Results: 18 patients had pancreatic necrosis between 30-50% (Group A) whereas 12 patients had necrosis more than 50% (Group B). The rate of organ dysfunction and mortality (11.11% versus 50.50%) the rate of was significantly higher in the group B. Multiorgan failure (MOF) was present in 5.56% of group A and 58.33% of group B patients. 66.67% patients were managed conservatively of whom 80% survived and 33.33% patients underwent surgical intervention of whom 60% survived. Conclusion: CECT is the modality of choice to help stage the severity of pancreatic necrosis, depict severity of inflammatory processes and local complications. Patients with pancreatic necrosis with transient end organ dysfunction can be treated conservatively with favorable outcome. The need for intervention should be individualized and based on the clinical condition of patient.
ABSTRACT
Background & Objectives: To study the clinical profile of hospitalised patients of malaria aged 15-60 years. Methods: This was a prospective analysis of patients suffering from malaria diagnosed by malaria serology and/or peripheral smear. The mode of presentation, clinical course, treatment history, laboratory investigations and complications were recorded and the data statistically analyzed.Results: P. vivax was the most common (80.39%) plasmodium species, the rest (19.61%) being P. falciparum. The mortality rate was 6.54%. A fall in hemoglobin (p=0.005) and platelet count (p=0.040) was observed in the patients who expired. There was an improvement in the final platelet counts in both the groups (p=0.00052). The mean total bilirubin at admission was higher in P. falciparum group than P. vivax group (p = 0.00789). Renal failure was observed in 16.34% patients. The mean systolic and diastolic blood pressure in patients who expired was lower than patients who were discharged (p=0.007, 0.001). The mean heart rate was higher (109.40) in patients who expired (p = 0.002). Conclusion: Factors associated with poor prognosis in malaria are moderate grade fever, hypotension, tachycardia, anaemia, thrombocytopenia, hyperbilirubinemia, high transaminase and renal failure. A high clinical suspicion, early diagnosis and treatment is recommended in highly prone areas.
ABSTRACT
Background & Objectives : Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal ageing. This cross sectional study was undertaken to study clinical profile of dementia and its association with plasma homocysteine levels. Methods : 30 patients (indoor or outdoor) > 55 years with dementia were screened on Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) Scale. A clinical dementia rating questionnaire was asked and plasma homocysteine levels measured by ELISA using Bio-rad reagents. Data was collected and statistically analyzed. Results : There was a statistically significant correlation between loss of memory (p = 0.047), orientation (p = 0.038), judgement/problem solving (p = 0.048), outer (p = 0.042), household (p = 0.048) and personal care activity (p = 0.0099) with hyperhomocysteinemia. A statistically significant correlation was found between CDR (p = 0.0081) and MMSE (p = 0.0095) score with hyperhomocysteinemia. Interpretation & Conclusion : A significant correlation was seen between memory loss, worsening of cognitive dementia, limitation of household activity, worsening of personal care, impairment of judgment and problem solving with hyperhomocysteinemia. As hyperhomocysteinemia can be effectively treated with a low cost therapy of B vitamin supplements, it is important to recognize these problems and treat them early.