Retrospective analysis of endoscopic retrograde cholangio pancreatography (ERCP) procedures in a tertiary care centre in coastal Odisha

Background: ERCP is commonly performed for radiologic visualisation and therapeutic procedure for treating various pancreatico-biliary disorders. There is no comprehensive data available till date about ERCP procedures from Odisha. The aim of this study was to review the indications and complications of endoscopic retrograde cholangiopancreatography (ERCP) procedures in a tertiary care centre in Odisha.Methods: From July 2013 to December 2016, consecutive patients undergoing ERCP procedure were included in the study. Patients with any previous papillary intervention like papillotomy, sphincterotomy or stent placement were excluded from the study. Patients’ demographic characters, ERCP indications and post-ERCP complications were reviewed.Results: Three hundred and fourteen patients were included in the study. Among them male patients were 161 and females were 153. Mean age was 50.75 years and the age range was 18 to 82 years. Most common indications for ERCP was malignant obstructive jaundice (N = 171, 54%) and choledocholithiasis (N = 137, 43.6%). Post ERCP complications developed in 25 patients (8%). Pancreatitis was the most common post-ERCP complication.Conclusions: ERCP is a safe procedure. ERCP complications in our centre are similar to those reported from other centres

Management Of Extracranial Schwannomas In Head And Neck Region - An Observational Study

ABSTRACT Background: Schwannomas, benign tumors arising from Schwann cells, often manifest as slow-growing lesions in the peripheral nerve sheath. While typically asymptomatic, they can affect cranial and peripheral nerves. Surgical excision is the primary treatment, but preserving nerve function poses challenges. Methods: This retrospective study analyzed 12 cases of benign head and neck schwannomas diagnosed at Department of ENT, SCB Medical College, Orissa, India between 2021 and 2023. Data encompassed patient demographics, tumor characteristics, diagnostic methods, surgical approaches, histopathology, and follow-up outcomes. Pre-operative investigations included Fine Needle Aspiration Cytology, Ultrasonography, and imaging. Results: Predominantly middle-aged and male patients presented with painless swelling, commonly in the cervical region, tongue, nose, and hard palate. Mean symptom duration was 8.5 months. Imaging depicted characteristic features, guiding surgical planning. Various approaches ensured complete excision, preserving nerve function. Histopathology confirmed the diagnosis, with positive S-100 staining. No cases showed malignancy or recurrence during follow-up. Conclusions: Head and neck schwannomas, though rare, present diagnostic and management challenges. Pre-operative diagnosis relies on imaging and biopsy, with surgical excision essential for treatment. Nerve preservation minimizes post-operative complications. Despite diagnostic difficulties, maintaining a high index of suspicion for schwannomas in patients with painless, slow-growing swellings is crucial

Assessing the performance of multiple drug supply chain management in Odisha health services using LSAT score and stock-out situation

Purpose of the article is to assess the performance of Odisha’s health services’ multiple drug supply chain management using logistics system assessment tool (LSAT) and logistics indicators assessment tool (LIAT). Data were collected on public health supply chains at different levels, state, district, sub-district, or block. For that purpose 13 block level institutions from two districts of Odisha were included. Drug and logistics supply chains of essential drugs, and national programmes were studied. Poorly coordinated Supply chain lead to stock-out of more than 15% of total number of products was higher in backward districts and rural areas. The mean for number of days of stock-out per product were found to be highest at the block level. When we looked for Logistic management unit they were present only at the state head quarters for specific national programmes

Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy The SCARLET Randomized Clinical Trial

Importance: Previous research suggested that soluble human recombinant thrombomodulin may reduce mortality among patients with sepsis-associated coagulopathy. Objective: To determine the effect of human recombinant thrombomodulin vs placebo on 28-day all-cause mortality among patients with sepsis-associated coagulopathy. Design, Setting, and Participants: The SCARLET trial was a randomized, double-blind, placebo-controlled, multinational, multicenter phase 3 study conducted in intensive care units at 159 sites in 26 countries. All adult patients admitted to one of the participating intensive care units between October 2012 and March 2018 with sepsis-associated coagulopathy and concomitant cardiovascular and/or respiratory failure, defined as an international normalized ratio greater than 1.40 without other known etiology and a platelet count in the range of 30 to 150 × 10 9/L or a greater than 30% decrease in platelet count within 24 hours, were considered for inclusion. The final date of follow-up was February 28, 2019. Interventions: Patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06 mg/kg/d [maximum, 6 mg/d]; n = 395) or matching placebo (n = 405) once daily for 6 days. Main Outcome and Measures: The primary end point was 28-day all-cause mortality. Results: Among 816 randomized patients, 800 (mean age, 60.7 years; 437 [54.6%] men) completed the study and were included in the full analysis set. In these patients, the 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group (106 of 395 patients [26.8%] vs 119 of 405 patients [29.4%], respectively; P =.32). The absolute risk difference was 2.55% (95% CI, -3.68% to 8.77%). The incidence of serious major bleeding adverse events (defined as any intracranial hemorrhage; life-threatening bleeding; or bleeding event classified as serious by the investigator, with administration of at least 1440 mL [typically 6 units] of packed red blood cells over 2 consecutive days) was 23 of 396 patients (5.8%) in the thrombomodulin group and 16 of 404 (4.0%) in the placebo group. Conclusions and Relevance: Among patients with sepsis-associated coagulopathy, administration of a human recombinant thrombomodulin, compared with placebo, did not significantly reduce 28-day all-cause mortality. Trial Registration: ClinicalTrials.gov Identifier: NCT01598831

Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy The SCARLET Randomized Clinical Trial

Importance: Previous research suggested that soluble human recombinant thrombomodulin may reduce mortality among patients with sepsis-associated coagulopathy. Objective: To determine the effect of human recombinant thrombomodulin vs placebo on 28-day all-cause mortality among patients with sepsis-associated coagulopathy. Design, Setting, and Participants: The SCARLET trial was a randomized, double-blind, placebo-controlled, multinational, multicenter phase 3 study conducted in intensive care units at 159 sites in 26 countries. All adult patients admitted to one of the participating intensive care units between October 2012 and March 2018 with sepsis-associated coagulopathy and concomitant cardiovascular and/or respiratory failure, defined as an international normalized ratio greater than 1.40 without other known etiology and a platelet count in the range of 30 to 150 × 10 9/L or a greater than 30% decrease in platelet count within 24 hours, were considered for inclusion. The final date of follow-up was February 28, 2019. Interventions: Patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06 mg/kg/d [maximum, 6 mg/d]; n = 395) or matching placebo (n = 405) once daily for 6 days. Main Outcome and Measures: The primary end point was 28-day all-cause mortality. Results: Among 816 randomized patients, 800 (mean age, 60.7 years; 437 [54.6%] men) completed the study and were included in the full analysis set. In these patients, the 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group (106 of 395 patients [26.8%] vs 119 of 405 patients [29.4%], respectively; P =.32). The absolute risk difference was 2.55% (95% CI, -3.68% to 8.77%). The incidence of serious major bleeding adverse events (defined as any intracranial hemorrhage; life-threatening bleeding; or bleeding event classified as serious by the investigator, with administration of at least 1440 mL [typically 6 units] of packed red blood cells over 2 consecutive days) was 23 of 396 patients (5.8%) in the thrombomodulin group and 16 of 404 (4.0%) in the placebo group. Conclusions and Relevance: Among patients with sepsis-associated coagulopathy, administration of a human recombinant thrombomodulin, compared with placebo, did not significantly reduce 28-day all-cause mortality. Trial Registration: ClinicalTrials.gov Identifier: NCT01598831