Background and Objectives: To describe the clinical and biological characteristics of patients with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) and to evaluate the effectiveness of therapeutic plasma exchange (TPE) in the management of HTG-AP. Materials and Methods: A cross-sectional study was conducted on 81 HTG-AP patients (30 treated with TPE and 51 treated conventionally). The main outcome was a decrease in serum triglyceride levels (<11.3 mmol/L) within 48 h of hospitalization. Results: The mean age of participants was 45.3 ± 8.7 years, and 82.7% were male. Abdominal pain was the most frequent clinical sign (100%), followed by dyspepsia (87.7%), nausea or vomiting (72.8%), and a bloated stomach (61.7%). The HTG-AP patients treated with TPE had significantly lower calcemia and creatinemia levels but higher triglyceride levels than those who received conservative treatment. They also had more severe diseases than those treated conservatively. All patients in the TPE group were admitted to the ICU, whereas the ICU admission rate in the non-TPE group was 5.9%. The TPE patients were more likely to experience a rapid decrease in triglyceride levels within 48 h of treatment than those treated conventionally (73.3% vs. 49.0%, p = 0.03, respectively). The decrease in triglyceride levels did not depend on the age, gender, or comorbidities of the HTG-AP patients or the severity of disease. However, TPE and early treatment in the first 12 h of disease onset were effective in rapidly reducing serum triglyceride levels (adjusted OR = 3.00, p = 0.04 and aOR = 7.98, p = 0.02, respectively). Conclusions: This report demonstrates the effectiveness of early TPE in reducing triglyceride levels among HTG-AP patients. More randomized clinical trials studies with a large sample size and post-discharge follow-up are needed to confirm the effectiveness of TPE methods in managing HTG-AP.
Background: Bungarus candidus is a common accident, leading to respiratory failure due to respiratory muscle paralysis. Artificial ventilation is an essential intervention to cure. Objective: Assess results of artificial ventilation in patients bitten by Bungarus candidus. Subjects and Methods: The ventilation method is volume control with 2 different Vt levels: Vt 8-10ml/kg with PEEP 5cmH2O versus Vt 12-15ml/kg with out PEEP. To describe figures of ventilation, complication and microbiology causes of pneumonia. Results: 64 patients were put on ventilation. Average time of artificial ventilation was 9.8±7.1 days. Complications were due to ventilator-associated pneumonia (59.4%), the most common is Acinetobater baumanii 45%, followed by P. aeruginosa, K. pneumoniae, S. and Candida albicans. Complete recovery is 94%, sequelae is 3% and mortality is 3%. Sequelae and mortality mainly is due to respiratory failure and complications associated with mechanical ventilation. Conclusion: High Vt 12-15ml/kg mode is less atalectasis than Vt 8-10ml/kg with PEEP 5cmH2O. Complications mainly related to ventilator-associated pneumonia, the most common etiology is A.baumanii. Key words: Bungarus candidus, mechanical ventilation, respiratory muscle paralysis, complications.
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