A study of the role of intervention in the final outcome of acute pancreatitis

Background: Acute pancreatitis is a common disease which varies in severity, from mild self-limiting pancreatic inflammation to severe pancreatic necrosis with life-threatening sequelae. As per the recent recommendations early intensive care with delayed intervention and step-up approach when indicated has definite survival advantages over the risks associated with early surgical procedures. The present study was aimed at evaluating the mortality and morbidity risk in patients undergoing procedural intervention in acute pancreatitis.Methods: This was a prospective study done in Sri Ramachandra Medical College and Hospital from April 2012- September 2014. All patients with a diagnosis of acute pancreatitis were included in this study. A total of 110 patients were analysed. Routine lab parameters, serum amylase, lipase, lipid profile, calcium, CRP, LDH, CT abdomen, CXR and 2D Echo was done for all patients. Procedural intervention was planned as per the guidelines.Results: Patients were given early intensive care as per the initial severity scores. 25 patients required intervention. Serum LDH, amylase, lipase and CT severity index were better predictors of requirement of intervention and death. Open necrosectomy was done in 15 patients (13.6%), laparoscopic necrosectomy in 3 patients (2.7%) and step up approach was tried in 7 patients (6.4%). Patients who were tried step up approach were monitored closely for any deterioration in their clinical condition to decide about surgery. 7 out of 8 patients who underwent surgery died.  Alcoholic pancreatitis that underwent intervention had a high risk of mortality.Conclusions: Intensive care monitoring with delayed intervention had a better survival benefit. Patients subjected to minimally invasive interventions had a better chance of survival.

A study of rheumatological manifestations of leprosy

BACKGROUND AND AIMS: Rheumatic manifestations are a common feature of leprosy. The present study was performed to assess the incidence of rheumatic manifestations in leprosy. METHODS: Seventy cases of leprosy attending the indoor and outdoor departments were studied. RESULTS: Out of the 70 cases studied, rheumatic manifestations were seen in 61.42% of cases: arthritis in 54.28% and soft tissue rheumatism in 17.14%. Enthesitis was seen in 2.84% of cases. The incidence of arthritis in lepra reactions was 57.57%. CONCLUSIONS: Musculoskeletal manifestations can occur at any time during the infection. Articular inflammation in leprosy usually occurs in reactive states, particularly erythema nodosum leprosum (ENL). Leprosy can present with arthritis as the first symptom

A study of rheumatological manifestations of leprosy

BACKGROUND AND AIMS: Rheumatic manifestations are a common feature of leprosy. The present study was performed to assess the incidence of rheumatic manifestations in leprosy. METHODS: Seventy cases of leprosy attending the indoor and outdoor departments were studied. RESULTS: Out of the 70 cases studied, rheumatic manifestations were seen in 61.42% of cases: arthritis in 54.28% and soft tissue rheumatism in 17.14%. Enthesitis was seen in 2.84% of cases. The incidence of arthritis in lepra reactions was 57.57%. CONCLUSIONS: Musculoskeletal manifestations can occur at any time during the infection. Articular inflammation in leprosy usually occurs in reactive states, particularly erythema nodosum leprosum (ENL). Leprosy can present with arthritis as the first symptom