Pancreaticopleural fistula causing pleural effusion: a case report and review of the literature.

BACKGROUND: Pancreaticopleural fistula is a rare complication of pancreatitis and poses diagnostic and therapeutic challenges. This case report sheds light on the unique challenges posed by pancreaticopleural fistula as a rare complication of pancreatitis. The aim is to contribute valuable insights to the scientific literature by presenting a case involving a middle-aged man with acute necrotizing pancreatitis and associated pleural effusion. CASE PRESENTATION: A 41-year-old Asian male with a history of pancreatitis and chronic alcohol use presented with severe dyspnea, chest pain, and left-sided pleural effusion. Elevated serum amylase lipase levels and imaging confirmed acute necrotizing pancreatitis with a computed tomography severity index of 8/10. Magnetic resonance cholangiopancreatography revealed pancreatic necrosis and pseudocyst formation and findings suggestive of pancreaticopleural fistula. The patient was then treated with octreotide therapy. CONCLUSION: The management of pancreaticopleural fistula demands a comprehensive and individualized approach. Recognition guided by high clinical suspicion coupled with appropriate investigations and a careful balance between medical, endoscopic, and surgical interventions is crucial for achieving favorable outcomes. This case report adds to the scientific literature by providing insights into the complexities of pancreaticopleural fistula and emphasizing the importance of personalized strategies in its management.

Prevalence of Intermediate Syndrome among Admitted Patients with Organophosphorous Poisoning in a Tertiary Care Hospital.

INTRODUCTION: Organophosphorous poisoning is a common problem prevalent in Nepal. Intermediate syndrome is a common clinical feature seen among the patients those have ingested poison. There is a scarcity of data related to intermediate syndrome and other general complications in patients with organophosphorous poisoning in context of Nepal. This study was carried out to observe the prevalence of intermediate syndrome and the general complications of oraganophosphorus poisoning among admitted patients in a tertiary care hospital. METHODS: This was a descriptive cross-sectional study conducted at a tertiary care hospital from April 2008 to June 2009 after ethical approval was from Institiutional Review Board of tertiary care hospital. Forty four patients with history of ingestion of organophosphorus poisoning within 24 hours were included in our study through convenience sampling. Clinical examinations were done to look for Intermediate syndrome. Data was entered in Statistical Package for Social Sciences and point estimate at 95% of CI was calculated along with frequency and proportion for binary data. RESULTS: Out of 44 patients, features of intermediate syndrome were seen in 40 (90.9%) at 95% of CI (84.2-97.6) patients in the study. The frequency of intermediate syndrome signs like weakness of neck flexion, inability to sit up and swallowing difficulty were seen among the patients. Complications like pneumonia 4 (9.09%), hyponatremia 3 (6.8%), hypokalemia 1 (2.27%) and bradycardia 1 (2.27%) were seen in the study. Mortality seen in the study was 2 (4.5%) among the admitted patients. CONCLUSIONS: Prevalence of intermediate syndrome was higher compared to other studies done in similar settings. Complications like pneumonia, hyponatremia, hypokalemia and bradycardia were seen among the patients.

Correlation of Uric Acid with Glomerular Filtration Rate in Chronic Kidney Disease.

INTRODUCTION: Chronic Kidney Disease is a worldwide public health problem that affects millions of people from all racial and ethnic groups. Identification of a Chronic Kidney Disease is a major risk factor for cardiovascular morbidity and mortality and is attributed to hyperuricemia. Evidences show that high serum uric acid contribute directly to glomerulosclerosis, interstitial fibrosis and atherosclerosis that correction of hyperuricemia associated with Chronic Kidney Disease will slow the progression of chronic renal failure. This study is done to correlate between serum uric acid level and estimated glomerular filtration rate in chronic kidney disease patients. METHODS: A hospital based cross-sectional study on chronic kidney disease patients including 57 patients on conservative treatment attending Bir Hospital with diagnosis of chronic kidney disease was performed. Detailed clinical history, examination and investigations including uric acid were done. Chronic Kidney Disease staging was done according to estimated glomerular filtration rate estimated by Cockcroft-Gault equation. Prevalence rate of hyperuricemia in Chronic Kidney Disease and its stages were calculated and compared with each other. RESULTS: A total of 57 Chronic Kidney Disease cases were enrolled, with male to female ratio of 2:1 and mean age 51.63±17.75 years. Hyperuricemia was present in 55 (96.49%) of study population. Though prevalence of hyperuricemia increased with Chronic Kidney Disease stage, there was no significant difference in mean value of uric acid in different stages. Hyperuricemia and stages of Chronic Kidney Disease had negative correlation which was statistically significant. CONCLUSIONS: Hyperuricemia is highly prevalent among Chronic Kidney Disease patients with conservative management. The severity of hyperuricemia increases as Chronic Kidney Disease stage progresses.