A Study on the Profile of Various Scoring Systems in Assessing the Severity of Acute Pancreatitis

BACKGROUND: Acute pancreatitis is one of the most common cause of abdominal pain. About 10to 20% of patients will progress to Severe Acute Pancreatitis (SAP) with a mortality rate of 6 to 10 %.Individual patient’s response to pancreatitis is highly variable. Because of this, it is of utmost importance to predict who is at the risk of developing severe pancreatitis as this will help to institute more intensive treatment. This will in turn improve the mortality. For this purpose various scoring systems are used. This study compares the strength of various prognostic factors in assessing the severity of acute pancreatitis. We also compared the sensitivity and specificity of various scoring systems in assessing the severity and mortality of acute pancreatitis. METHODS: A prospective, observational, clinical and investigational study was carried out in 50 patients admitted with acute pancreatitis in Government Rajaji Hospital Madurai. Twelve individual parameters -Age, WBC count, RBS, Blood Urea, S.Creatinine, PaO2, S.Calcium, S.LDH, S.bilirubin, S.Albumin, S.AST and S.ALT were assessed for their strength of association with severity of acute pancreatitis. Five scoring systems APACHE II, Ranson’s, Imrie’s, Bank’s, Pitchumani & Agarwal system were compared for their sensitivity and specificity for assessing the severity and mortality of acute pancreatitis. RESULTS: Among the 50 patients 18 patients developed Severe Acute Pancreatitis (SAP) marked by evidence of end organ failure, local complications like psuedocyst, and /or prolonged ICU stay of more than 7 days. Among this 8 patients died. Among the individual parameters B.Urea,S.Creatinine, PaO2 and WBC count, Age, S.Calcium and S.LDH levels showed a significant association with severity of acute pancreatitis. APACHE II systems had a sensitivity of 77.78% and specificity of 96.88% in predicting severity. Sensitivity and specificity of Ranson’s score was 83.33% and 96.88% respectively. Imrie’s score had a sensitivity of 55% and specificity of 100% .Both Bank’s score and Pitchumani score had comparatively low sensitivity and specificity. Conclusion: APACHE II score and Ranson’s score are the best scoring systems in predicting the severity of acute pancreatitis. Among individual parameters Hypoxia, Acute renal failure, leukocytosis, advancing age, hypocalcemia and increase in serum LDH levels were the factors significantly associated with Severe Acute Pancreatitis (SAP)

Profile of glomerular diseases associated with hepatitis B and C: A single-center experience from India

Hepatitis B and C are known to affect kidneys in a number of ways. Glomerular diseases associated with hepatitis B and C include membranous nephropathy (MN), membranoproliferative glomerulonephritis (MPGN), focal segmental glomerulosclerosis, immunoglobulin A nephropathy, rarely amyloidosis, and fibrillary and immunotactoid glomerulopathy. In a retrospective analysis of kidney biopsy of 534 patients, we found 16 (2.9%) patients of hepatitis B and 11 (2.05%) patients of hepatitis C with glomerular disease. The most common form of glomerulonephritis in hepatitis B patient was MN and in hepatitis C patient was MPGN

A leap toward brighter future – deceased-donor renal transplantation: Three years of experience in Sawai Man Singh Hospital, Jaipur, India

Background: With an increase in the prevalence of risk factors for chronic kidney disease, the prevalence of end-stage renal disease (ESRD) is increasing in India, adding 1.75 lakh ESRD patients each year. Renal transplant is one of the best modalities of renal replacement therapy; however, it is available only in a few centers. Despite an increase in trend, deceased-donor renal transplant (DDRT) rate is only 0.34/million populations, one of the lowest rates in the world. Materials and Methods: We analyzed 25 DDRT recipients transplanted in the last 3 years. The patients were followed till death or graft loss whichever was earlier. Posttransplant outcome and complications were evaluated. Results: The patient survival was 84% (21/25), and death-censored graft survival was 84% (21/25). 16% (4/25) had the second renal transplant with a history of failed previous live renal transplant. Delayed graft function (DGF) and biopsy-proven acute rejection were seen in 16% and 12%, respectively. The mean posttransplant creatinine in recipients with functioning graft on the last follow-up was 1.14 ± 0.2 mg/dl. The most common medical complication was sepsis (40%, 10/25). Conclusion: The short-term outcome of DDRT in our center is comparable to other centers in India. DGF was the most important determinant of graft survival