Clinical, Endoscopic Profile and Management of Patients with Upper Gastrointestinal Bleeding in Tertiary Care Center in Southern Karnataka

Introduction: Upper gastrointestinal bleed (UGIB) is oneof the common medical emergencies and is associatedwith significant morbidity and mortality. Early upper GIendoscopy helps in identifying the etiology and allows fortargeted endoscopic treatment resulting in reduced morbidity,hospital stay, risk of re-bleeding and need for surgery. Thisstudy aimed to assess the clinical and endoscopic profile andtreatment modalities for the patients presenting with upper GIbleed in a tertiary care centre in southern Karnataka.Material and methods: Data of 410 patients presenting withupper GI bleed to tertiary care centre and who had undergoneupper GI endoscopy at AJ hospital and research centre betweenJanuary 2017 to june 2018 were retrospectively analysed.Results: All the patients included in the study were above 18years of age. Majority of the patients were males, with maleto female ratio is 5.1:1, It was found that majority of patientspresented with hematemesis (87.32%). It was found that mostcommon lesion in upper GI bleed was esophageal varices(44.88%). Based on their endoscopic profiles majority of thepatients were managed conservatively (64.15%).Of the 410 patients 83.66% were males and mean age ofstudy population was 54.37%. The most common presentingmanifestation in hematemesis with malena observed in61.95% patients.Conclusion: This study highlights variceal bleed as the mostcommon cause of upper GI bleed in southern India followedby peptic ulcer disease.

Hyperuricemia as an Early Marker in Predicting the Mortality and Morbidity in Patients with Sepsis

Introduction: Serum uric acid can be used as a marker ofoxidative stress, and poor prognosis in patients with sepsis,since high levels of oxy radicals, lower oxidant level in sepsispatients result in multi organ failure. Raised uric acid isassociated with chronic diseases and is used as a prognosticindicator of severe infection as it acutely activates varioustranscription factors. Aim: This study aims to understandthe correlation between hyperuricemia and the mortality andmorbidity rate in patients with clinically suspected sepsis(based on Qsofa Criteria - Quick sepsis related organ failure).The secondary end points of the study are to understandcorrelation between hyperuricemia in clinically suspectedsepsis patients and Acute kidney injury, acute respiratorydistress syndrome, and duration of stay in the hospital.Material and methods: We conducted a prospective cohortstudy in clinically suspected sepsis patients {based on theQsofa Criteria} between September2017-2018 in a tertiarycare center in AJ Institute Of Medical Sciences in South India.Patients or their medical power of attorneys provided writteninformed consent. A total no of 60 patients were enrolled basedon the inclusion criteria, clinically suspected sepsis patientsaged more than 18 years. All pregnant female, patients fromoutside facility admitted in the medical intensive care unit formore than 24 hours were excluded. For the purpose of ourstudy we defined hyperuricemia as greater than or equal to7 mg/ dl in both males and females. Patients were divided intwo groups based on the uric acid levels. The first group hadclinically suspected sepsis patients with uric acid levels morethan 7 and the second group had clinically suspected sepsispatients with uric acid level less than 7.Results: More than half of the patients, 55%, with high uricacid were found to be males. The overall mortality rate inpatients with high uric acid levels was found to be 90%. Theprobability of having hyperuricemia with acute kidney injurywas around 92.9%.Conclusion: Hyperuricemia was associated with poorprognosis in clinically suspected sepsis patients

Spectrum of Bronchogenic Carcinoma

Introduction: The incidence of lung carcinoma has rapidlyincreased since the beginning of there 20th century and currentlyrepresents the main of cancer related mortality. Diagnosticsmethods may adequately explain frequent recognition of thepresence of neoplasm, but also a fact that histological findingshave yielded a considerably higher percentage. More recentlythe emergence of combined PET CT imaging has greatlyaided the investigation of lung carcinoma by allowing evenbetter delineation of areas with increased tracer uptake and byimproving staging and detection of metastatic disease, guidingtherapy and allowing clinical outcome to be predicted. Studyaimed to find the prevalence and associated symptoms of lungcarcinoma.Material and methods: The study included a 109 patientsand was a retrospective study. The method was to note thepresenting symptoms of bronchogenic carcinoma and tonote the site of metastasis of bronchogenic carcinoma withPET CT. To note the variant of bronchogenic carcinoma withhistologically proven.Results: There were a total of 109 patients of which 77were male and 32 were female. The presenting symptom ofbronchogenic carcinoma was cough 75% preceded by weightloss 68%, dyspnea 60%, chest pain 49%, and hemoptysis 35%,bone pain 25%, clubbing 20%, fever 20%, weakness 10%,superior vena obstruction 4%, dysphagia 2%, wheeze andstridor 2%.Out of the 109 patients the frequent presentationof bronchogenic variant is adenocarcinoma 56%, followed bysquamous cell carcinoma 34% and small cell carcinoma 15%.Conclusion: The frequent symptom of bronchogeniccarcinoma presentation was cough followed by weight lossand dyspnea. The frequent site of metastatic of bronchogeniccarcinoma is supraclavicular node followed by contralaterallung, bone metastasis. majority of bronchogenic carcinomapresentation were of adenocarcinoma followed by squamouscell carcinoma and small cell carcinoma