ABSTRACT
Background: Acute pancreatitis is an acute inflammation of the pancreas is an increasingly common abdominal disorder presenting as major surgical challenge to general surgeons worldwide. Early identification of patients at risk of developing a severe attack has great importance for instituting therapeutic interventions and improved outcome. Accurate prediction of severity is important in order to improve survival. There are several assessment criteria in order to predict prognosis and severity of acute pancreatitis, which help in guiding patient triage and management. However, nothing is proven to perform significantly better in clinical settings than good clinical judgment. Ideal predicting criteria should, therefore be simple, non-invasive, accurate and quantitative and assessment tests are easily available. Aim and objectives: It was a prospective study to assess the accuracy of BISAP scoring system vs Ranson’s scoring system in predicting Severity in an attack of acute pancreatitis and to compare predictability of organ failure, necrosis and mortality between BISAP scoring and Ranson’s Scoring system. Materials and methods: All patients admitted to Govt. Stanley Hospital with complaints of pain abdomen diagnosed to have Acute Pancreatitis on clinical examination and further investigations. Sample size consists of 100 patients with acute pancreatitis. BISAP score and Ranson’s score is calculated in all such patients based on data obtained within 24 hours of hospitalization and at 48 hours. Results: In this study, the two different scoring systems (BISAP and Ranson’s) were compared and analyzed to assess the severity in patients with acute pancreatitis. An attempt also made to compare this study with previous similar studies done by others. Acute pancreatitis found to be 10 times more J. Lalithkumar, T. Chitra, N. Kodieswaran. Comparative study between BISAP and Ranson’s score in predicting severity of acute pancreatitis. IAIM, 2016; 3(9): 23-33. Page 24 common in males than females in this study. The mean length of hospital stay was 12.03 ± 6.8 days in this study. In this study, increasing BISAP and Ranson’s scores was correlated well with the duration of hospital stay. In this study, 86 patients were diagnosed to have mild and moderately severe acute pancreatitis grouped under MAP, and 14 patients found to have severe acute pancreatitis. All the 14 patients were correctly predicted by BISAP score. The scores were assessed by correlating the scores with three factors: organ failure, necrosis and mortality. The analysis for organ failure showed BISAP score has sensitivity of 71.43%, specificity of 95.35%, PPV of 71.43%, NPV of 95.35%, diagnostic accuracy of 92%; whereas Ranson’s score has sensitivity of 78.57%, specificity of 74.42%, PPV of 43.33%, NPV of 95.52 %, diagnostic accuracy of 88%. In this study, 7/20 patients with BISAP> 3 and 8/14 patients with Ranson’s >3, developed pancreatic necrosis. The statistical analysis for the prediction of necrosis has sensitivity of (81.82%, 90.91%), specificity of (94.35%, 77.53%), PPV of (64.29%, 43.56%), NPV of (97.67%, 98.57%), diagnostic accuracy of (93%, 91%) for BISAP and Ranson’s respectively. In this study, 4 patients with severs acute pancreatitis were expired. All 4 deaths were correctly predicted by BISAP score. The statistical analysis for the prediction of necrosis has sensitivity of (100%, 88.57%), specificity of (95.83%, 64.42%), PPV of (50%, 31.33%), NPV of (100%, 96.52%), diagnostic accuracy of (96%, 93%) for BISAP and Ranson’s respectively. In this study, patients developed pancreatic necrosis, acute renal failure, MODS, septicemia. These complications were more likely seen in patients with BISAP ≥ 3, and Ranson’s > 3, hence concluded that these are the patients in high risk group, who requires intensive monitoring and probably early intervention if necessary. Conclusion: From this study, alcohol (59%) was found to be the most common etiological factor for acute pancreatitis. Males were more commonly affected than females with a ratio of 10:1. The most common age groups of patients affected were in 4th decade of life. The overall mortality in patients with severe acute pancreatitis was 4% BISAP score is equally effective in finding out the frequency of severity and predicting mortality in patients with acute pancreatitis as Ranson's score. Moreover, its components are easily available and it does not require 48 hours for completion of assessment as compared to Ranson's score. It is an accurate tool to classify patients into mild and severe disease; it is easy to perform and can be done on the bedside of patients with acute pancreatitis in every setup.
ABSTRACT
Background: Solitary nodular goitre is clinically defined as a single nodule in otherwise normal thyroid gland. It can be benign or malignant. Solitary nodule has a higher risk of malignancy (15- 20%) when compared to multi-nodular goitre (3-5%). Aim: We conducted a study to evaluate the clinical and radiological factors associated with occurrence of malignancy in Solitary Nodular Goitre (SNG); to find out the incidence of SNG in this part of North Chennai; to analyze the correlation of preoperative cytological and postoperative histopathological results. Materials and methods: It was a prospective study on fifty patients who were clinically diagnosed as SNG. All patients were evaluated with an Ultrasonogram (USG) Thyroid and Fine Needle Aspiration Cytology (FNAC). After surgery, the Histopathological Examination (HPE) reports were compared with the FNAC findings. Results: SNG was more common in the age group of 21-40 years. 86% of SNG patients were females. The incidence of malignancy in SNG this study was 12% which commonly involved males. Among the malignancies, papillary carcinoma was the most common and Hashimoto’s thyroiditis was found to be associated with it. The presence of microcalcifications and paratracheal nodes in USG were more in favour of malignancy. The FNAC report correlated well with the HPE reports, the accuracy of FNAC being 90% in this study. Conclusion: SNG has a high risk of malignancy, especially in males and the most common type being papillary carcinoma. FNAC is the gold standard pre-operative investigation that is well correlated with post operative HPE results
ABSTRACT
Background: After gastrointestinal surgery like anastomosis, patients are usually not allowed to take feed orally for five days. This is to prevent post operative nausea and vomiting and also to protect the anastomotic site allowing it to heal. Aim: This randomized control study sought to compare the outcome of early Enteral feeding versus delayed feeding after gastrointestinal surgery. Materials and methods: 60 patients were randomly selected and classified into two groups, early feeding group and late feeding group and following were noted; anastomotic leak, infection (wound, intra-abdominal abscess, pulmonary complication, sepsis), length of hospital stay. Results: The mean length of hospital stay was 9.3 vs 10.90. The difference was 1.6 days (P value: 0.129). Wound infection was 20% vs 26.7%. 6.7% had intra-abdominal abscess in the early feeding group which was statistically insignificant. There were two patients (6.7%) with sepsis in late feeding group (p= 0.150). There were no anastomotic leak and no deaths in the both the groups. Conclusion: The present study indicated that there was no significant difference between the two groups. Late feeding doesn’t confer any significant advantage. There was no advantage of dietary restriction. Hence we recommend that early post-operative feeding is safer
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Background: The objective was to evaluate the outcome of late second trimester emergency cerclage in patients with advanced cervical dilatation with bulging membranes. Methods: Setting: department of obstetrics and gynaecology, PSG Institute of medical sciences & research, Coimbatore, Tamil Nadu, India. This is a retrospective study of case files of patients who underwent emergency late second trimester cerclage for advanced cervical dilatation with bulging membranes between January 2009 to January 2014. McDonald’s technique was used in all the cases. Results: Altogether, 7 patients (100%) underwent late second trimester emergency cerclage between 20-28 weeks of gestational age, out of which three patients (42.86%) had term deliveries (>37w), and 3 patients (42.86 %) carried on their pregnancies to more than 32 weeks resulting in healthy live born babies. Two of them delivered by normal vaginal delivery, 4 underwent LSCS, and one patient had severe abdominal pain with bleeding and draining per vaginum after 3 days of cerclage, in view of which the stitch was removed. Subsequently, the patient expelled a live foetus weighing 620gms, which died in the Neonatal Intensive Care Unit (NICU) after 3 hours. This procedure prolonged the duration of pregnancy in all patients with a mean duration of 70.4 days. The mean gestational age at the time of delivery was 34.33 weeks. The mean birth weight was 2.18 kg and ranged between 1.97 to 2.64 kg. The mean APGAR at one minute was 8/10 and the mean duration of stay in NICU was 1.66 days. All the new-born babies were healthy at the time of discharge. The live birth rate following emergency late second trimester cerclage in this series was 85.75%. Conclusion: Favourable neonatal outcome can be accomplished in patients with cervical incompetence in the second trimester of pregnancy following emergency cervical suturing, even if performed when the membranes are bulging through the cervix.
ABSTRACT
Background & objectives: As adult dengue fever increases it also affects women with pregnancy. Dengue fever is mainly treated conservatively. However, complications like pre-eclampsia, pre-term labour, increased risk of caesarean section and fetal transmission have been noted. During dengue epidemic in our region we noted many women with dengue fever and observed certain different problems. Methods: A retrospective analysis of all pregnant women admitted in obstetric ward with dengue fever over a period of 18 months was done. Results: The striking feature observed was the presence of severe thrombocytopenia in 78.57% of the study population. In addition, coexistence of other vector borne diseases was also noted. Conclusion: Most cases only require conservative treatment. Only women who went into labour required platelet transfusion. Outcome seemed to correlate with gestational age of occurrence of dengue fever.