Prevalence and predictors of functional evacuation disorder in patients with chronic constipation

Background: Functional evacuation disorder (FED) is the second most common cause of functional constipation (FC) after constipation-predominant irritable bowel syndrome. However, the data on FED is relatively scanty in our region. Hence, the present study was performed to evaluate the demographics of FED and to find out the predictors of FED in patients with chronic constipation. Methods: A total of 134 patients with chronic constipation diagnosed according to the Rome IV criteria who were referred for high-resolution anorectal manometry (HRAM) were retrospectively enrolled in the present study. All FC patients who underwent HRAM were asked to fill a questionnaire and underwent anorectal manometry and were submitted to the balloon expulsion test (BET). Results: The mean age of patients was 43.09 ± 9.32 years old, with a total of 76 (54%) males. The most common symptom was straining during defecation (87%) followed by incomplete evacuation (86%). The prevalence of FED, diagnosed by HRAM and by the BET was 39%. Patients with FED had a significantly higher percentage of straining and sensation of anorectal blockade compared with those without FED (96 versus 82%; p < 0.01; 81 versus 44%; p < 0.001, respectively). On the multivariate regression analysis, straining > 30 minutes (odds ratio [OR] = 3.63; p = 0.03), maximum squeeze pressure (OR = 1.05; p < 0.001), and balloon volume at maximal sensation (OR = 1.06; p < 0.001) were found to be significant independent predictors of FED. Conclusion: Prolonged straining and sensation of anorectal blockade were significant indicators of FED in patients with chronic constipation. (AU)

Relationship of serum vitamin D with hepatic fibrosis in patients with chronic hepatitis C

Background: Serum vitamin D concentration is proposed to have an important role on outcome in patients with chronic hepatitis C virus (HCV) infection. A few studies have shown an inverse association of vitamin D level with stage of fibrosis. The aim of the present study was to verify whether serum vitamin D level is an independent predictor of significant hepatic fibrosis.Methods: Seventy-two treatment naive chronic HCV subjects and 40 healthy age and sex matched controls were included in the study. A serum vitamin D level was assessed in both HCV subjects and controls, and liver biopsy was performed in all HCV subjects to assess for stage of fibrosis.Results: Serum vitamin D levels were significantly lower HCV patients in comparison to age and sex matched controls (18.04±6.92 versus 21.53±8.2, p<0.01). Most common genotype in HCV patients was genotype 3 (62.5%) and blood transfusion was the most common mode of transmission (28%) followed by intravenous drug user (IVDU) (17%). The HCV patients with vitamin D level <20 ng/ml had higher metavir score as compared to vitamin D≥20 ng/ml (1.67±0.66 versus 2.5±0.67, p<0.001). Both univariate and multivariate analysis performed using logistic regression revealed that vitamin D<20 ng/dl is a significant negative predictor of liver fibrosis (p<0.05).Conclusions: Chronic HCV patients had significantly lower vitamin D levels as compared to healthy controls. Serum vitamin D was a negative predictor of stage of fibrosis in patients with chronic hepatitis C.

Clinical profile and outcome of shock in mechanically ventilated patients in pediatric intensive care unit of tertiary care centre

Background: The clinical syndrome of shock, a clinical state characterized by inadequate tissue perfusion, is one of the most dramatic, dynamic and life-threatening problems faced by the physician in the critical care setting.Methods: Retrospective observational study of all critically ill children between 1month-12years who were admitted and mechanically ventilated in our 8-bedded PICU between January 2015 to June 2016; and had clinical evidence of shock. PIM3 (Paediatric Index of Mortality 3) was calculated. Authors noted morbidity and mortality pattern in all types of shock including outcome in Paediatric ICU. The data collected were compiled and tabulated.Results: The frequency of shock in authors’ Paediatric intensive care unit was 8.6% (n=780). However, among mechanically ventilated patients it was present in 65.5% patients. Septic shock was the most commonly encountered shock (n=48, 61.5%). Mortality was highest in cardiogenic shock (n=12, 80%) and obstructive shock (n=4, 80%). Survival was best in Hypovolemic shock. Authors found significant correlation between LOS MV and mortality (p=0.018). Type of shock had no correlation with PIM3 score (p=0.374) and mortality (p=0.884). Blood culture yield was positive in 26.9% patients with Klebsiella pneumoniae, Pseudomonas aeruginosa and MRSA being most common organisms isolated.Conclusions: Shock is a major cause of morbidity and mortality in children especially below 5yrs of age. Septic shock was the commonest form of shock in children. Severe pneumonia was the commonest illness causing septic shock. Mortality was associated with longer length of stay on mechanical ventilation. Larger prospective multicentric study in developing countries is desirable.