ABSTRACT
Introduction: Mortality and morbidity following perforated peptic ulcer (PPU) remains high, and mortality proportions of 25–30% have been reported in population–based studies.The aim of this study was to evaluate the efficacy of PULP SCORE in predicting 30 day mortality. Patients and methods: A series of 52 patients were enrolled in the study.Patients who underwent surgical treatment for perforated peptic ulcer were allotted points according to the PULP scoring system and stratified into high and low risk groups. All the data was prospectively analyzed. Observations and results:46 patients were in low risk and 6 patients were in high risk category. 5 patients were deceased in high risk group but none in low risk group. The PULP SCORE had a sensitivity of 83.33% and specificity of 97.83% in predicting mortality. In the ROC curve the AUC was 91.8%. 4 variables out of 8 variables in the score were found to be most important in predicting mortality. They were : 1. Treatment delay >24 hrs, 2. Shock on admission, 3. High ASA score, 4. Age >65 years. Conclusion:The prognostic predictors included in the PULP score can be readily identified prior to surgery, easy to use and feasible in emergency. The PULP score can assist in accurate and early identification of high–risk patients, and thus assist in risk stratification and triage of patients.
ABSTRACT
In order to evaluate the impact of copper on the energetics of a fish, the levels of glucose, glycogen, pyruvate and lactate, the rate of tissue oxygen consumption and the activities of glycogen phosphorylase, isocitrate dehydrogenase (ICDH), succinate dehydrogenase (SDH) and lactate dehydrogenase (LDH) were estimated in the whole body of the fry of Cyprinus carpio immediately after 1, 7, 15 and 30 days on exposure to a sublethal concentration of copper 0.08 mgl(-1) at pH 7.5 (normal), 6.0 (weak acidic) and 9.0 (weak alkaline). Aprogressive increase in glucose level and glycogen phosphorylase activity with the corresponding decrease in glycogen level over the time of exposure at pH 7.5 indicated glycogenolysis. Increase in the rate of oxygen consumption, pyruvate level and ICDH and SDH activities at days 1 and 7 (day 1 > 7) followed by their decrease at days 15 and 30 (day 15 < 30) at pH 7.5 indicated an initial elevation in the energetics of the fish fry with a gradual suppression of it on prolonged exposure. During this period the animal might have relied more on energetically less efficient glycolysis as evident by the progressive increase in the level of lactate and LDH activity. The degree of glycogenolysis was relatively more at pH 6.5 than at pH 7.5. At that pH, a progressive decrease in glucose level with an increase in the pyruvate and lactate levels and in LDH activity and a decrease in the rate of oxygen consumption and ICDH and SDH activities revealed greater reliance of the fish on anaerobic glycolysis than on oxidative metabolism. At pH 9.0 also the fish fry initially exhibited glycogenolysis, but gradually it came to normal on day 30 (day 1 > 7 > 15 > 30). Decrease in the glucose level, increase in pyruvate level, rate of oxygen consumption, and ICDH and SDH activities at all the days of exposure suggested an elevation in oxidative metabolism, but it also came to normal on prolonged exposure. Even the lactate level and LDH activity initially increased but gradually reached to normal on day 30. These results indicated that copper suppresses the energetics of the fish fry at pH 6.0, elevates at pH 9.0 relative to the changes at pH 7.5 suggesting that the toxicity of copper is dependent on pH of the water.