Fatal case of acute necrotic pancreatitis secondary to chronic abuse of acetaminophen: a case report

Acetaminophen is a widely used analgesic and antipyretic. It is also known to cause hepatotoxicity and is rarely associated with acute pancreatitis due to overdose. We report the case of a 55-year-old man with no known comorbidities, who presented with severe abdominal pain and vomiting. His medication history revealed chronic abuse of a fixed-dose combination containing 37.5 mg of tramadol hydrochloride and 325 mg acetaminophen 3-6 tablets per day for over 20 years for general body pain without a specific diagnosis. He was diagnosed with acetaminophen-induced acute necrotic pancreatitis after ruling out gallstones and other factors such as alcohol consumption, and family history. Although he got discharged against medical advice, follow-up revealed that he had succumbed to his illness within 15 days. This was a fatal case of acetaminophen-induced pancreatitis due to chronic abuse for over 20 years at a dose of less than 2 g/day. This case highlights the need for periodic monitoring of patients taking acetaminophen at doses within the recommended daily dose

An alternative approach for re-attachment of the fractured fragment: A case report.

  Trauma to the anterior teeth is relatively common. The more commonly affected teeth are the maxillary anteriors due to their position in the oral cavity. Different treatment modalities for complicated crown fractures were proposed depending on their severity of the fracture as well as soft tissue damage. The aim of this article is to discuss a new technique for management of complicated crown fractures.   Clinical relevance: Various treatment modalities have been suggested for complicated crown fractures, however reattachment of the fractured fragment is said to be beneficial in many ways. The flipside of this technique is that realigning the tooth fragment in the arch becomes relatively easier and the composite used to attach the post does not allow discoloration.     Key words: Crown fractures, Dental trauma, fiber post, treatment options of for fracture tooth.   &nbsp

Clinico-aetiological Profile of Neonatal Hypertension: An Observational Study

Introduction: The incidence of hypertension among neonates admitted to the Neonatal Intensive Care Unit (NICU) is increasing. The reported incidence is between 0.2% and 3%. Blood Pressure (BP) among neonates varies considerably in the immediate postnatal period. The BP in neonates determined by birthweight, gestational age at birth and postnatal age. This variability in BP makes it challenging to diagnose neonatal hypertension. There is a paucity of Indian studies on neonatal hypertension. A systematic diagnostic evaluation of neonatal hypertension aids in early identification of the aetiology and further management. Aim: To assess the incidence of hypertension in neonates in the NICU and to evaluate the aetiology and clinical profile of neonatal hypertension. Materials and Methods: This was a hospital-based prospective observational study done at Sri Dharmasthala Manjunatheswara College of Medical Sciences and Hospital, Dharwad, Karnataka, India, between August 2016 and August 2021. A total of 29 neonates who had neonatal hypertension were included in the study after obtaining ethical committee clearance. All relevant data regarding demographic details, risk factors for hypertension, clinical features, probable aetiology, and relevant investigations were collected in a predesigned proforma. These neonates were followed- up once a month until six months of age. All the data were entered in Microsoft Excel version 2203 and analysed using the Statistical Package for Social Sciences (SPSS) software version 20.0. The categorical variables were described as percentages. The numerical variables were compared using a Student’s t-test and a Chi-square test. A p-value of 0.05 was considered statistically significant. Results: In the present study, out of 13,345, a total of 29 (0.22%) neonates had hypertension. Hypertension was more prevalent among term (82.7%). Of the 29 neonates, 19 (65.5%) had an antenatal risk for hypertension. A total of 14 (48.3%) of neonates had an antenatally diagnosed renal and/or cardiac anomaly. The most common presentation of hypertension is asymptomatic. Thirteen (44.8%) neonates had transient hypertension, which resolved at the time of discharge, and 16 (55.2%) neonates had persistent hypertension, requiring antihypertensive medication and follow-up. The most common aetiology for hypertension was renal and renovascular causes (44.8%). Mortality in the present study was 10.3% (n=3). Conclusion: Hypertension is an uncommon yet important problem in the NICU. In the majority of neonates, the presentation of hypertension is asymptomatic. Most common aetiology of hypertension being renal cause. Neonates with persistent hypertension may require long-term antihypertensive treatment and regular follow-up