Validity of bedside index of severity in acute pancreatitis score in comparison with C reactive protein in assessing the severity of acute pancreatitis

Background: Acute pancreatitis is a process of acute inflammation of the pancreas usually caused by biliary stones, alcohol ingestion, metabolic factors or drugs. The assessment of the severity of acute pancreatitis has a significant role in its management. There is a need for a simple and clinically oriented severity scoring system that can predict severity of acute pancreatitis at the time of presentation.Methods: A cross-sectional study was conducted at a tertiary care centre on 100 patients diagnosed as acute pancreatitis who fulfilled the inclusion criteria. Severity index, their BISAP Score, BMI and CRP values were calculated and statistical analysis was done using SPSS 17 Software.Results: In our study, there were 100 patients with pancreatitis. 65% were alcoholic pancreatitis followed by gall stone pancreatitis (17%), idiopathic pancreatitis (13%), drug induced (1%), trauma (1%), post ERCP (1%) and malignancy (2%). On the basis of CT Severity index, it was found that 15% of alcoholic group, 8% of biliary group and 1% each of idiopathic, drug induced, trauma and malignancy group were found to have severe pancreatitis. On the basis of BISAP Score it was found that 17% in alcoholic group, 7% in gall stone group, 4% in idiopathic group, 2% in malignancy group and 1% each in drug induced and trauma group were having acute pancreatitis. With the C reactive Protein level, it was found that 16% in alcoholic group, 9% in biliary group and 1% each in idiopathic, trauma and malignancy group were found to have severe pancreatitis. The sensitivity and specificity for BISAP score were 77.8% and 84.9% and the sensitivity and specificity for CRP were 66.7% and 86.3%. The K-score was found to be 0.593 for BISAP Score and 0.524 for C - reactive protein levels. This indicates that both are in moderate agreement with the gold standard test (CT Severity Index).Conclusions: BISAP score and CRP levels are not superior to the each other in predicting severity. BISAP score can be used as a predictor of severity at admission and CRP levels ≥150 can predict severity when serially monitored during the course of admission

Delay in diagnosis of breast cancer in a developing country: a single centre observational study in a tertiary care hospital in North Kerala, India

Background: Around the world breast cancer is the most common cancer in women. In India, peak incidence is between 45-50 years of age. Early diagnosis improves survival, hence reducing diagnostic delay in breast cancer will have major social and economic implications besides improving the quality of life. This observational study aims to decipher various factors influencing diagnostic delay so that early treatment can be instituted.Methods: We interviewed 212 consecutive patients who attended the twice weekly breast clinic conducted by Department of general surgery and department of radiotherapy, government medical college, Kozhikode between September 2014 and February 2015. All patients with primary breast cancer were included in the study. Exclusion criteria included recurrence, second primaries, history of partial treatment and incomplete records. Finally, we interviewed 202 patients with the help of a pretested semi-structured questionnaire.Results: In present study, the commonest age group was 40-50 years with 62.4% participants presenting with early breast cancer and 37.6% having advanced breast cancer. Most of present study subjects were educated up to high school and unemployed. Awareness about breast cancer was 74.25% but many were ignorant of its symptomatology. Practice of breast self-examination (BSE) was low at 32.1%. Side and quadrant were statistically significant factor.Conclusions: In present study religion, educational status, marital status, breast cancer awareness, practice of BSE and location of tumor were statistically significant factors influencing delay in diagnosis. There was a general lack of knowledge about the importance of self-examination in breast cancer which needs health education and need for active social propaganda in print and electronic media regarding its importance. In future institution of a screening programme will hasten diagnosis and improve survival of breast cancer patients