Background: Non-alcoholic fatty liver disease (NAFLD) is a common chronic condition of which diabetic fatty liver accounts for a large proportion, with 50 to 75% of the subjects demonstrating fat in the liver on ultrasound. As a result of epidemic increase in diabetes mellitus, hypertension, obesity and hyperlipidemia, the prevalence of NAFLD is increasing worldwide.Methods: A study was conducted on a total 100 type-2 diabetes mellitus patients attending Geetanjali Medical College and Hospital, Udaipur, Rajasthan. Patients with known chronic liver disease and history of alcohol intake were excluded. These patients were evaluated by abdominal ultrasonography to determine the presence of fatty liver. They were divided into fatty liver group and non-fatty liver group; and were further evaluated by measurement of body mass index, Central obesity, HbA1c and lipid profile. The data obtained was analyzed using SPSS version 20.0.Results: Of the 100 diabetic patients enrolled in this study, 64 (64%) presented with NAFLD. The highest prevalence of NAFLD was recorded in the age group of 50-59 years at 37.5%. The prevalence rate among males (65.62%) was higher than for females (34.38%). A comprised NAFLD patients (64%) and Non-NAFLD patients (34%).Conclusions: This study revealed that the NAFLD is a vital part of cluster of abnormalities such as dysglycemia, dyslipidemia, hypertension and obesity. Age and duration of diabetes are also important contributing factors in occurrence of NAFLD.
Background: To evaluate quality of life of females after mastectomy and factors affecting the same, in various domains of life, and to assess whether a policy of mastectomy is practical or pragmatic in the scenario of low socioeconomic status prevalent in our region.Methods: Two hundred and forty post-operative mastectomized patients were clinically examined and subjected to a questionnaire designed by WHOQOL-BREF along with an ethically cleared questionnaire prepared according to the local prevailing conditions and Quality of Life was evaluated.Results: 52% patients reported no change in body image, only 2% patients reported depression. The total score of the quality of life was good for 40% of the patients with score of 96-130, followed by 55% with moderate 61-95 and only 5% patients with poor with score of <60.Conclusions: In developing countries like India where, there are no proper facilities for advanced haematological and radiological investigations, there is a severe lack of compliance between doctor and patient and there are no facilities for adjuvant and neo-adjuvant treatment, surgeons are forced to choose mastectomy as the surgery of choice for malignant breast lesions.
Background Using therapeutic hypothermia (TH) reduces the core body temperature of survivors of cardiac arrest to minimize the neurological damage caused by severe hypoxia. The TH protocol is initiated following return of spontaneous circulation (ROSC) in non-responsive patients. Clinical trials examining this technique have shown significant improvement in neurological function among survivors of cardiac arrests. Though there is strong evidence to support TH use to improve the neurologic outcomes in shockable and nonshockable rhythms, predictors of TH utilization are not well-characterized. Our study tried to evaluate TH utilization, as well as the effect of the teaching status of hospitals, on outcomes, including mortality, length of stay, and total hospitalization charges.
Background Management of Ulcerative Colitis (UC) is challenging, and clinicians are often obliged to attempt a variety of therapies in sequence until an adequate clinical response is achieved. This study examined the rates of inadequate response to advanced therapies among UC patients in clinical practice in Germany. Methods Using a retrospective chart review, patients with UC treated with an advanced therapy (adalimumab, infliximab, golimumab, vedolizumab, and tofacitinib) between 01/2017 through 09/2019 were selected from 18 outpatient gastroenterology practices across Germany. Patients with at least 12 months of data before (baseline) and after initiating an advanced therapy (Index Date) were included. Data was collected up to 24 months after index date. Inadequate response was defined as at least one of the following events: index therapy discontinuation due to lack of response, therapy escalation, augmentation with newly prescribed conventional therapies, corticosteroid (CS) dependency (use for ≥12 weeks), CS use during the maintenance phase, UC-related hospitalisations, surgery or emergency visit. Subgroups included patients with prior exposure to biologics, with and without remission (clinical remission defined as partial Mayo Score ≤1) at one year, and concurrent use of CS at the index date. Kaplan-Meier analysis was used to examine the rates over time. Patients were censored at the end of the study period. Results Among 149 patients (females: 50.3%; median age: 40 years; median follow-up: 25.9 months), 96 (64.4%) patients were biologic-naïve. Nearly half of the patients (45.5%) had ≥1 indicator for an inadequate response within two years after the index date (Figure 1). Among those who discontinued (N=43), 82.0% had switched to another advanced therapy. Therapy escalation was observed in 20 (16.3%) patients, and augmentation with conventional therapies was observed in 19 (15.6%) patients. 14 patients (11.3%) received CS during the maintenance phase of the index therapy, and 14 patients (10.1%) were CS dependent for ≥12 weeks. Inadequate response rates were significantly higher in patients without (n=80) vs. with remission (n=54) after one year (53.4% vs. 35.5%; p<0.05, Figure 2) and in patients with (n=42) vs. without concurrent CS (n=107) at the index date (67.0% vs. 36.9%; p<0.05). There was no significant difference between biologic-naïve and biologic-experienced patients. Conclusion Nearly half of the patients with UC experienced an inadequate response to their advanced therapy within two years. Higher rates of inadequate response were observed in patients without remission and in those with concurrent use of CS at baseline. More effective therapies are needed to achieve better outcomes in UC.
Aim: The aim was to do a retrospective analysis and audit of our 90 days and in-hospital mortality after gastrointestinal and hepatopancreatic biliary surgery performed in our department and analyze factors predicting it.Patients and methods:All patients who underwent gastrointestinal and hepatopancreatic biliary surgery in our department in the last 3 years were evaluated for 90 days postoperative and in-hospital mortality and various factors affecting it. Categorical values were analyzed using the chi-square test or fisher's exact test wherever appropriate. Continuous variables were analyzed using the student t-test for parametric data and Mann Whitney U test for nonparametric data after skewness and kurtosis analysis. Multivariate analysis was done using logistic regression analysis. A p-value less than 0.05 was considered statistically significant. Statistical analysis was done using SPSS version 23(IBM).Results:412 patients underwent gastrointestinal and hepatobiliary surgery in the last 3 years at our institute. Ninety days all-cause mortality was 5.8%, all-cause in-hospital mortality was around 4.6%. 90 days mortality in elective and emergency surgeries were respectively 3.2% and 18%. In-hospital mortality in elective and emergency surgeries were respectively 2.35% and 15.2%. On multivariate analysis age, nontechnical complications, open surgery, and emergency surgery independently predicted 90 days mortality. On multivariate analysis age, acute kidney injury, non-procedural complications, and emergency surgeries independently predicted in-hospital mortalities.Conclusion:Age, non-technical complications, open surgery, and emergency surgeries are independently associated with 90 days mortality, and age, acute kidney injury, non-procedural complications, and emergency surgery independently predict in-hospital mortality.
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