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  1. Article ; Online: Profile of Patients Admitted with Acute-on-Chronic Liver Disease in a Tertiary Care Hospital Bal Kishan Gupta, Shyam Lal Meena, Vijay Kumar Meena; Jigyasa Gupta

    Bal Kishan Gupta / Shyam Lal Meena / Vijay Kumar Meena / Jigyasa Gupta

    RUHS Journal of Health Sciences (2023)

    2023  

    Abstract: Introduction: Chronic liver disease (CLD) and cirrhosis of liver are 12th leading cause of death. Acute-on-chronic liver failure (ACLF) is an increasingly recognized entity encompassing an acute deterioration of liver function in patients with cirrhosis ... ...

    Abstract Introduction: Chronic liver disease (CLD) and cirrhosis of liver are 12th leading cause of death. Acute-on-chronic liver failure (ACLF) is an increasingly recognized entity encompassing an acute deterioration of liver function in patients with cirrhosis and it is associated with high mortality. Methodology: A total of 100 consecutive patients admitted with ACLF were studied. Chronic liver disease was defined as per 2014 ICD-10 CM Diagnosis Code K 76.9. ACLF was defined as per the Asian Pacific Association for the Study of the Liver (APASL) criteria. Grading of severity of ACLF was done as per the CANONIC study. Prognostic scores including Child- Pugh scoring system were also calculated. Results: Out of 100 patients 84 were males (mean age 44.31±13.58 years) and 16 females (mean age 40.19±19.11 years). Underlying etiology of CLD was alcoholic (76 cases), Hepatitis B virus (HBV) (10 cases), cryptogenic (seven cases), autoimmune (four cases) and Heapatitis C virus (HCV) in (three cases). There were 74% from rural area, 51% illiterate and 82% belonged to the low socio-economic status. Most common presentation of ACLF was hemetemesis (36%) followed by melena (30%), vomiting (30%), sepsis (28%), pain abdomen (27%), hepatic encephalopathy (17%) and hepato-renal syndrome (16%). Mortality rate in our study was 9% and all belonged to the alcoholic group. Severe anemia, hypoalbuminemia, hyperbilirubinemia, renal dysfunction, sepsis, hyponatremia, high PT-INR and high Child Pugh score 10-15 were associated with poor prognosis. Conclusion: Knowledge and early recognition of various risk factors may help in prevention of acute- on- chronic liver failure and early identification of various prognostic features may help in decreasing the mortality in patients of acute-on-chronic liver failure.
    Keywords Not available ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2023-10-01T00:00:00Z
    Publisher Sonali Sharma on behalf of Rajasthan University of Health Sciences
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Cardiovascular involvement in severe vivax and falciparum malaria

    Kailash Chandra Nayak / Shyam Lal Meena / Bal Kishan Gupta / Surendra Kumar / Vikas Pareek

    Journal of Vector Borne Diseases, Vol 50, Iss 4, Pp 285-

    2013  Volume 291

    Abstract: Background & objectives: Recently, vivax malaria is also presenting as severe malaria causing multiorgan dysfunction similar to falciparum malaria. The present study was undertaken to evaluate the involvement of cardiovascular system in severe malaria. ... ...

    Abstract Background & objectives: Recently, vivax malaria is also presenting as severe malaria causing multiorgan dysfunction similar to falciparum malaria. The present study was undertaken to evaluate the involvement of cardiovascular system in severe malaria. Methods: This is a clinical prospective study conducted on the cases of severe malaria in S.P. Medical College and PBM Hospital, Bikaner, India. In total, 100 cases (45 males, 55 females; age range 13-75 yr) of severe malaria ( P. vivax 60; P. falciparum 28; and mixed 12) diagnosed by peripheral blood smear examination, rapid card test and PCR were studied. Evaluation of cardiovascular system was done by clinical examination, chest Xray, ECG, high resolution transthoracic echocardiography and estimation of cardiac markers. Results: In all, 17% cases (9 P. falciparum , 5 P. vivax and 3 mixed) were found to be suffering from cardiovascular involvement (11% circulatory failure, 7% congestive cardiac failure and 2% pulmonary edema). ECG showed sinus tachycardia in all the 17 patients, one had atrial ectopic and eight had non-specific ST-T changes. Cardiomegaly was seen in eight cases and pulmonary edema in two on X-ray chest. Echocardiography was within normal range but cardiac dimensions were increased in all the 17 cases. Troponin-I and CPK-MB were increased in 14 cases. Cardiovascular involvement in P. falciparum and mixed infection was associated with high parasite density but P. vivax infection was associated with relatively low parasite density. Involvement of cardiovascular system was associated with increased hospital stay (7.67 ± 2.23 vs 6.59 ± 0.87 days; p <0.001) and high mortality (5 died out of 17 patients). Significant ECG changes and cardiac markers indicate myocardial involvement in severe malaria. Interpretation & Conclusion: The present study indicates involvement of cardiovascular system in severe malaria as evidenced by changes in ECG and cardiac markers (Trop 1 and CPK-MB). The present study also highlights that vivax malaria is no more benign and pathophysiology of vivax malaria should be re-evaluated.
    Keywords Cardiac markers; circulatory failure; congestive cardiac failure; falciparum malaria; pulmonary edema; vivax malaria ; Public aspects of medicine ; RA1-1270 ; Medicine ; R
    Language English
    Publishing date 2013-12-01T00:00:00Z
    Publisher National Institute of Malaria Research
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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