ABSTRACT
BACKGROUND: Inflammatory bowel disease (IBD) is increasingly diagnosed in South Asia. This survey by the Tamil Nadu Chapter of the Indian Society of Gastroenterology (TNISG) documents the demography, clinical profile, and therapeutic practices related to IBD in Tamil Nadu. METHODS: TNISG members from 32 institutions completed an online cross-sectional questionnaire on IBD patients from March 2020 to January 2021. RESULTS: Of 1295 adult IBD patients, 654 had Crohn's disease (CD), 499 ulcerative colitis (UC), and 42 IBD-unclassified (IBD-U). CD and UC showed a unimodal age distribution. A total of 55% were graduates or postgraduates. A positive family history was noted in 30, other risk factors were uncommon. In CD, the pattern of involvement was ileocolonic (42.8%), ileal (34.7%), colonic (18.9%), and upper gastrointestinal (3.5%); while in UC, disease was characterized as extensive (44.9%), left-sided (41.7%), or proctitis (13.4%). Perineal disease, perianal fistulae, and bowel obstruction were noted in 4.3, 14.0, and 23.5%, respectively, of CD. The most widely used drugs were mesalamine, azathioprine, and corticosteroids. Surgery was undertaken in 141 patients with CD and 23 patients with UC. Of the 138 patients with pediatric IBD (≤16 years), 23 were characterized as very early onset IBD (VEO-IBD), 27 as early-onset, and 88 as adolescent IBD. VEO-IBD were more likely to have a positive family history of IBD and were more likely to have perineal disease and to have the IBD-U phenotype. Among pediatric IBD patients, corticosteroids, mesalamine, and azathioprine were the most commonly used medications, while 25 pediatric patients received biologics. CONCLUSION: This study provides important information on demography, clinical profile, and treatment practices of IBD in India.
ABSTRACT
BACKGROUND: Acute liver failure (ALF) is characterized by severe and sudden liver cell dysfunction. Baseline demographic, clinical, and biochemical factors associated with the survival of ALF patients were identified in a few selected Western studies, but very few studies have been done in India. The aim of the current study is to provide an overview of the factors associated with the survival of ALF patients and to suggest an optimum cutoff value for clinically significant parameters. MATERIALS AND METHODS: The patients suffering from ALF were reviewed in this study. The factors studied were age, sex, total serum bilirubin, serum creatinine, serum albumin, urea, aspartate aminotransferase, alanine aminotransferase (ALT), and recent hepatitis E virus infection. RESULTS: Total n = 41; Male 73%; median age 43 years. The median survival time of patients in the age group of 18-40 years was 238 days. The median survival time of patients >40 years of age was 129.10 days. Elevated serum urea and serum ALT levels at the time of admission were found to be significant predictors of mortality in patients suffering from ALF in our study. In Receiver Operator Characteristic (ROC) curve analysis, the optimum cutoff value of urea was found to be 42 mg/dL, and ALT was found to be 400 IU/L. CONCLUSIONS: Elevated serum urea and serum ALT levels at the time of admission were found to be significant predictors of mortality in patients suffering from ALF in our study. The use of these two parameters, along with King's criteria for the prognosis of ALF, can be more useful in the management of such patients in India.
Subject(s)
Decompression, Surgical/methods , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestine, Small/pathology , Peritoneal Fibrosis/complications , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Biopsy, Needle , Follow-Up Studies , Humans , Immunohistochemistry , Intestinal Obstruction/pathology , Intestine, Small/surgery , Laparotomy/methods , Male , Peritoneal Fibrosis/diagnostic imaging , Peritoneal Fibrosis/pathology , Peritoneal Fibrosis/surgery , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed/methods , Treatment Outcome , Young AdultABSTRACT
PURPOSE: To report a rare case of periorbital emphysema concurrent with cervicofacial and mediastinal emphysema in an elderly woman who underwent upper gastrointestinal endoscopy for chronic liver disease. CASE REPORT: An elderly woman with decompensated chronic liver disease presented with features of periorbital, facial, and mediastinal emphysema, characterized with crepitant swelling over the right periorbital area, face, neck, and mediastinum after undergoing upper gastrointestinal endoscopy. There was no history of trauma or Valsalva maneuver. Ocular findings were stable with no evidence of orbital compartmental syndrome. Urgent computed tomography scans of the orbit and chest were performed, and emergency systemic treatment with nasogastric decompression and antibiotics was initiated. However, she suddenly collapsed and succumbed despite all resuscitative efforts. CONCLUSION: Our case demonstrates that periorbital emphysema can occur following procedures such as upper gastrointestinal endoscopy, in the eyes without history of local trauma. This complication should be suspected especially if there is associated cervicofacial and mediastinal emphysema. Subcutaneous emphysema is usually self-resolving; however, extension of air into deeper planes can cause dangerous complications such as blindness due to orbital emphysema or mortality due to mediastinal emphysema. Hence, prompt diagnosis and urgent intervention are crucial to avoid vision and life threatening complications.
