Emphysematous pancreatitis presenting as new-onset diabetes mellitus with multi-organ dysfunction: Managed successfully with medical management alone

Emphysematous pancreatitis is one of the rare and potentially fatal complications of acute pancreatitis. We present here the case of a 69-year-old man who presented with abdominal discomfort, vomiting, and constipation with features of sepsis due to Klebsiella pneumoniae bacteremia and new-onset diabetes mellitus. Elevated serum lipase levels and abdominal computed tomography scan showing pancreatic necrosis with air bubbles suggestive of emphysematous pancreatitis. He was managed conservatively as the surgical intervention was differed in view of unstable hemodynamics and thrombocytopenia. The entire emphysematous pancreatitis and sepsis resolved with medical management alone although surgical necrosectomy may be indicated at presentation.

A study of expressed emotion, perceived stress and socio-demographic profile in patients of dissociative disorder

Background: Dissociation is understood as one of coping mechanism to deal with intense stressors. Individuals vary widely in their subjective response to a similar stressful event depending on number of factors including their family and social support system. So, authors tried to study the expressed emotion in patients of dissociative disorder along with other socio-demographic factors and its relation with perceived stress.Methods: This cross-sectional descriptive study was done on 100 patients with primary diagnosis of dissociative disorder. Hamilton depression rating scale (HAM-D) was used to assess comorbid Depressive symptoms and Hamilton anxiety rating scale (HAM-A) was used to asses comorbid anxiety symptoms. Perceived stress scale (PSS) was used to assess the perception of stress. Family emotional involvement and criticism scale (FEICS) was used to measure perceived criticism (PC) and intensity of emotional involvement (EI).Results: Mean perceived stress in this study was 25.8. Mean score for perceived criticism (PC) was 16.5 and emotional involvement (EI) was 15.7. Both measures of expressed emotions were significantly higher in females and subjects belonging to joint families and rural area. In this study perceived stress by subjects was significantly (p=0.001) correlated to perceived criticism (Pearson r = 0.78) and emotional involvement (Pearson r = 0.77).Conclusions: High perceived criticism and emotion over involvement of family member was associated with perceived stress in dissociation patients.

Significant perceived stressors in irritable bowel syndrome: a stress interventional module analysed

Background: Psychological stress is an important factor for the development of irritable bowel syndrome (IBS). More and more clinical and experimental evidences are showing that IBS is a combination of irritable bowel and irritable brain. As IBS is a stress sensitive disorder, its treatment should focus on managing stress and stress-induced responses.Methods: This is a hospital based longitudinal study. 72 patients fulfilling the Rome IV criteria for irritable bowel syndrome were enrolled into the study. Perceived stress was assessed using student stress dimension questionnaire (SSDQ) while IBS severity was assessed using IBS severity scoring system (IBS-SSS). The stress interventional module (SIM) consist of specific domain targeted psychological interventions given to the patients weekly based on the stress domain mapping. The effectiveness of these interventions on reducing stress as well as IBS severity was assessed at baseline, and weeks 2, 4 and 6 follow-ups.Results: Of the studied IBS patients, most had SPS in multiple life domains while familial and interpersonal domains were affected in 78%. Also, total stress load in form of mean cumulative stress load at baseline was 451.1 which decreased significantly to 274.4 over 6 weeks. This SIM brought about a reduction in mean irritable bowel syndrome severity score from 27.5 to 20.6 in 6 weeks. This reduction in IBS severity score overtime was significant (p=0.001).Conclusions: Patients of irritable bowel syndrome show significant stress in multiple domains of life, which require proper assessment and management. Authors propose that individual-specific interventions aimed at reducing stress in all psychosocial life domains are efficacious and should be an integral part of managing IBS.