Prevalence of acute on chronic liver failure, underlying etiology and precipitating factors

Background: Acute on chronic liver failure (ACLF) was first described in 1995 as a clinical syndrome distinct to classic acute decompensation. Characterized by complications of decompensation, ACLF occurs on a background of chronic liver disease and is associated with high rates of organ failure and significant short-term mortality estimated between 45% and 90%. Despite the clinical relevance of the condition, it still remains largely undefined with continued disagreement regarding its precise etiological factors, clinical course, prognostic criteria, and management pathways. It is concerning that, despite our relative lack of understanding of the condition, the burden of ACLF among cirrhotic patients remains significant with an estimated prevalence of 30.9%. Aim of the study: The present study was aimed at estimating the prevalence of acute on chronic liver failure in our institute, etiology of underlying chronic liver disease, precipitating acute event and mortality rate. Materials and methods: 150 patients admitted and treated with the diagnosis of ACLF in the Institute of Hepatobiliary Sciences, Rajiv Gandhi Government General Hospital during the period from December 2016 to November 2018 were included in the study. Their data regarding etiology of chronic liver disease, precipitating acute events and mortality were collected and analyzed. Results: Out of 386 patients, 150 patients were admitted with acute on chronic liver failure with a prevalence of 39%. In 41% of patients, infection was the precipitating factor for ACLF either in the form of Sepsis, spontaneous bacterial peritonitis, Lower respiratory tract infection or skin, and soft tissue infections. Alcohol was the second most precipitating factor (32%), followed by upper gastrointestinal hemorrhage (12%) and drugs (2%). No precipitating cause could be identified in Premkumar K, Krishnasamy Narayanasamy. Prevalence of acute on chronic liver failure, underlying etiology and precipitating factors. IAIM, 2019; 6(4): 49-54. Page 50 12.7% of patients. Mortality rate was high in ACLF grade 3 (95%), followed by ACLF grade 2 (62%) and ACLF grade 1 (15%). Conclusion: ACLF is a dynamic syndrome presenting with single, two or more organ failure in a patient with chronic liver disease following a triggering event and associated with high short term mortality. In our hospital, the prevalence of ACLF was 39% and the overall mortality rate was 83%. Infection and alcohol were found to be important precipitating factors. A multi-centre study involving a larger number of patients are needed to know the clinical characteristics, other precipitating factors and to form a standard treatment protocol for this dynamic syndrome

Neonatal sepsis: Staphylococcus aureus as the predominant pathogen.

96 consecutive inborn neonates with blood culture proven bacterial sepsis during the period January to June 1997 were studied. Lethargy with refusal of feeds (28%), fever (28%) and respiratory distress (31.3%) were the major presenting features. Half of them (n = 48) were of early onset (< 48 hours) and the remaining half were of late onset (> 48 hours). Staphylococcus aureus (n = 59, 61.5%) was the predominant pathogen and 66% of them were methicillin resistant followed by Klebsiella pneumoniae (n = 24, 21.9), Escherichia coli (n = 13, 13.5%) and streptococci (n = 3, 3.1%). Antibiotic resistance was common, with the sensitivity to various antibiotics being ampicillin 19%, gentamicin 21.6%, cefotaxime 32.8%, amikacin 50%, chloromycetin 59.6% and ciprofloxacin 90.3%.

Effects of short-term isotonic & isometric training on cardiovascular & pulmonary function.

A randomised control trial of short-term exercises on specific cardiovascular and respiratory parameters was undertaken in normal male college students. The effects of isotonic training (5BX programme) and isometric training (a programme of isometric exercises working all major groups of muscles) were compared with a control group with no specific workout. Both isotonic and isometric training resulted in significant cardiovascular improvement but seemed inadequate to improve vital capacity and flow rates. Isotonic training in addition, improved ventilatory efficiency. It is concluded that such isotonic or isometric training of thrice a week for ten weeks, requiring no equipment, less time and space can be promoted to improve physical fitness.

Exercise induced bronchial lability in normal men and women--a comparison.

Normal male (n = 29) and female (n = 39) medical students with a mean age of 19.2 years who were nonsmokers, with no personal history of allergy were studied. The bronchial lability was assessed from peak expiratory flows and forced expiratory spirograms taken before, during and upto 45 minutes after a standard exercise using the Harvard steps. Women had a significantly lower (P < .001) resting FVC, FEV1, FEF 25-75% and PEF as compared to men. Although the exercise lability index was not significantly different in men and women, the latter showed a greater percent increase (P < .02) and a lesser percent decrease (P < .02) of PEF during and after the exercise respectively. They also showed a significantly (P < .005) faster recovery to normal. These results suggest that airway dynamics may be better in women than in men. This could account for the lower incidence and morbidity from respiratory allergic disease seen in women as compared to men.