BackgroundSevere cholestatic jaundice may complicate with bile cast nephropathy (BCN) causing severe acute kidney injury (AKI). In this study, we investigate BCN in severe falciparum malaria complicated with jaundice and AKI.MethodsThis prospective study was conducted in a tertiary health care institution with high prevalence of malaria. A cohort of 110 patients with falciparum malaria complicated with cerebral malaria, jaundice and AKI were enrolled. Species diagnosis was made from peripheral blood smear or rapid diagnostic test. Severe malaria was diagnosed from WHO criteria. BCN was diagnosed with the detection of bile casts in urine or in biopsy. The recovery pattern and outcome with and without BCN was assessed.ResultsOut of 110 patients, 20 (18.2%) patients had BCN and 15 (13.6%) patients had hepato-renal syndrome. Patients with BCN had high conjugated bilirubin (26.5 ± 4.1 mg/dL), urea (75.9 ± 10.3 mg/dL) and creatinine (7.2 ± 0.8 mg/dL), longer duration of illness (6.4 ± 1.1 days), higher mortality (25.0%) and prolonged recovery time of hepatic (9.6 ± 2.4 days) and renal dysfunction (15.1 ± 6.5 days) compared with patients without BCN.ConclusionsProlonged duration of illness and increased bilirubin cause BCN among patients with severe falciparum malaria with jaundice and AKI, which is associated with high mortality and morbidity.
Purpose The timely management of cancer surgery suffered due to COVID-19 and nationwide lockdown. Continuing cancer surgery was a challenge faced by all. We present our experience on cancer surgery in a cancer centre with high volume of patients and limited resources during early pandemic. Methods We retrospectively analysed our operation theatre database on surgery and anaesthesia from 1st April to 30th June 2020. Results A total of 457 surgeries were done-complex major, major, intermediate and minor surgeries constituted 43%, 25%, 12% and 20%, respectively. Median age of patient was 50 years, and 76% were below 60. The median ASA class was I (I-IV), and 97% were ASA I and II. The median Eastern Cooperative Oncology Group score was 0 (0-3), and 92% had score 0 and 1. Major cases done under regional anaesthesia were 30.7%. Median length of intensive care unit stay was 1 (1-6) days, and length of hospital stay was 7 (7-15) days. Clavien-Dindo Grade II complication in patients above 60 years was 16.4% and below 60 years was 17.6% (p = 0.76). 10% in ASA I compared to 26% of ASA II (p = 0.00) and 15.9% with ECOG 0 and 1 compared to 30.9% with ECOG 3 and 4 (p = 0.01) had grade II complication. Four (1%) patients had Grade C III CD complication. Covid testing was undertaken in 52% patients pre-operatively, and there was no positive case in post-operative period. Conclusions Adopting and implementing institutional policy catering to limited resource available at our centre, we facilitated cancer surgery.
Background: Viral hepatitis is epidemic to developing country like India. Infection with Hepatitis A virus, Hepatitis B virus and Hepatitis C virus is much more important so far as the disease severity, selection of treatment option and adverse outcome associated with the therapy is concerned. This study was undertaken to assess the clinical and laboratory profile of viral hepatitis with co-infection at a tertiary care centre. Material and Methods: Patients admitted in the hospital with presenting signs and symptoms of viral hepatitis were included. The clinical and haematological profiles were observed and entered in a pre-designed format. Data were extracted and analysed by one-way-analysis-ofvariance (ANOVA) and p < 0.05 was considered statistically significant. Results: The mean age of the patients was 32.86±13.3 years (range, 18-60 years). Eleven patients were positive for hepatitis-E where as 6 patients were co-infected with both hepatitis-A and hepatitis-E. The commonest presenting symptom was yellowness of eyes and urine that accounts in 19 patients followed by fever in 8 patients, abdominal pain in 5 patients and vomiting in 3 patients. The incidence of dengue and leptospirosis was found in one patient each. Two patients had died. Conclusion: Large cohort of patients with different hepatitis virus infections is necessary for better understanding of pathophysiology, clinical profile that will enable treatment regimen tools for the patients for single as well as different co-infection.
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