scholarly journals Hepatic Encephalopathy in Liver Cirrhosis: Precipitating factor and Outcome

2019 ◽  
Vol 17 (1) ◽  
pp. 2-4
Author(s):  
Dipendra Khadka ◽  
Dipendra Khadka ◽  
Anil Shrestha ◽  
S. D. Bassi ◽  
Binus Bhandari
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Hospital Stay ◽  
Early Recognition ◽  
Wide Spectrum ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Precipitating Factors ◽  
Cross Sectional ◽  
Precipitating Factor

Introduction: Hepatic encephalopathy, one of the major decompensating events of liver cirrhosis manifest as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma. The main aim of this study was to determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Methods: A hospital based cross-sectional study carried out in the Department of Medicine, Nepalgunj Medical College, Kohalpur from September 2018 to May 2019. Patients of liver cirrhosis with signs and symptoms of hepatic encephalopathy (HE) were enrolled in the study. Detailed history was taken with patients or patient's visitor regarding precipitating factors. Child Turcotte Pugh (CTP) class was used for assessing liver disease severity and West Haven classification was used for grading of hepatic encephalopathy. Results: Total patients of hepatic encephalopathy studied were 150. Among which, 114 (76%) were male and 36 (24%) were female. Mean age was 45 ± 11years. Common precipitating factors for hepatic encephalopathy identified were constipation 25.3%, Upper gastrointestinal bleed (9.3%), Spontaneous bacterial peritonitis (8%). No identifiable factor was observed in 6.7% cases. Significant relationship was noted with CTP class and grading of Hepatic encephalopathy. Hospital stay was also found longer (≥5 days) among patients having more than one precipitating factor. Conclusions: Early recognition of precipitants and patient education is very crucial in the management of hepatic encephalopathy. Patients having ≥ 2 precipitating factor had longer hospital stay and higher grade of hepatic encephalopathy.

scholarly journals Prevalence of Acute Kidney Injury in Patients with Liver Cirrhosis

2020 ◽  
Vol 58 (228) ◽  
Author(s):  
Pukar Thapa ◽  
Sudhamshu KC ◽  
Achyut Bikram Hamal ◽  
Dilip Sharma ◽  
Sandip Khadka ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Liver Cirrhosis ◽  
Hospital Stay ◽  
Hepatorenal Syndrome ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Tubular Necrosis ◽  
Advanced Liver Cirrhosis ◽  
Life Threatening

Introduction: Acute kidney injury is a common and life-threatening event in patients with liver cirrhosis occurring in approximately 20-50% of hospitalized patients of liver cirrhosis. Pre-renal acute kidney injury, the hepatorenal syndrome type of acute kidney injury and acute tubular necrosis represent the common causes. The aim of this study was to study the profile of acute kidney injury in patients with liver cirrhosis. Methods: Consecutive patients of liver cirrhosis admitted in Liver unit of Bir Hospital were studied to see the presence of acute kidney injury in this hospital based descriptive cross-sectional study. Clinical and laboratory parameters along with various clinical outcome were compared between different groups categorized by the severity of liver disease and renal dysfunction. Results: Out of 302 liver cirrhosis patients, 56 (18.5%) had acute kidney injury among which 23 (46%) were found to have pre-renal acute kidney injury, 15 (30%) with hepatorenal syndrome– acute kidney injury and 12 (24%) with intrinsic renal disease. Patients with higher stages of acute kidney injury had longer duration of hospital stay and hepatorenal syndrome-acute kidney injury was seen in patients with higher grade of ascites and with hyponatremia. Conclusions: Acute kidney injury is a common occurrence in patients with advanced liver cirrhosis with pre-renal acute kidney injury being the commonest cause. Median hospital stay is directly affected by the severity of acute kidney injury and hepatorenal syndrome–acute kidney injury was seen in patients with higher grade of ascites and hyponatremia. Early identification of patients at high risk for acute kidney injury may help to reduce mortality and contain costs.  

scholarly journals HEPATIC ENCEPHALOPATHY

2018 ◽  
Vol 25 (12) ◽  
pp. 1857-1862
Author(s):  
Ashok Kumar Lohano ◽  
Shamsuddin Shaikh ◽  
Nazia Arain
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Serum Sodium Level ◽  
Cross Sectional Study ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Cross Sectional ◽  
Medicine Department ◽  
Grade Ii ◽  
Cirrhotic Patients

Objectives: To determine the prevalence and relation to severity of hyponatremia in liver cirrhotic patients associated with hepatic encephalopathy. Study Design: Cross sectional study. Place and Duration of Study: Medicine Department of Peoples University of Medical and Health Sciences Nawabshah from 26th October 2016 to 25th April 2017. Material and Methods: All patients of either gender with 15 to 70 years associated liver cirrhosis, were included in the study. Diagnosis of liver cirrhosis was confirmed by laboratory and ultrasonographic findings. Exclusion criteria were patients outside of patient range, patients with hepatocellular carcinoma, or anotherco morbid. Sodium levels were measured by 2cc bloodsample by blood from cubital vein preferably. Encephalopathy was evaluated via West Haven classification. All the data were entered into SPSS 20 version and were analyzed by using the same software. Results: A total of 369 patients met the inclusion criteria. Among them were 129 males and 240 females. The overall mean age of study subjects was 57.07±9.23 years. The overall mean duration of hepatic encephalopathy was 2.53±0.733 days. The overall mean serum sodium level for study subjects was 129.59±7.11 mEq/L. Most of the study subjects, 83.5% had HCV, 12.7% patients were HBV positive whereas 3% were positive for HBV as well as HCV. 26 patients had grade 1 encephalopathy, 30 patients had grade II encephalopathies, 258 patients had grade III encephalopathies, and 55 patients had grade IV encephalopathy. In our study, 73.2% study subjects were observed with hyponatremia. Out of 270 study subjects found with hyponatremia, 25.2% had mild hyponatremia, 44.8% had moderate hyponatremia, and 30% had severe hyponatremia. The results showed that there was a significant association of hyponatremia with viral markers (p=0.030), duration of hepatic encephalopathy (p=0.102) and grades of hepatic encephalopathy (p=0.746). Conclusion: We concluded hyponatremia is frequently found in patients with cirrhosis liver. Significant correlation of hyponatremia with the severity of hepatic encephalopathy.

scholarly journals Preparedness of pre-intern medical graduates of three universities in Sri Lanka to diagnose and manage anaphylaxis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chandrani Nirmala Wijekoon ◽  
Indika Wettasinghe ◽  
Dinithi Fernando ◽  
Arosha Sampath Dissanayake ◽  
Malinda Gunawardana ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Early Recognition ◽  
Correct Diagnosis ◽  
Cross Sectional Study ◽  
Intravenous Route ◽  
Cross Sectional ◽  
Diagnosis And Management ◽  
Medical Graduates ◽  
Self Confidence ◽  
Case Diagnosis

Abstract Background Early recognition and the optimal management of anaphylaxis saves lives but studies from different countries have demonstrated gaps in knowledge and practices between healthcare workers. There is a paucity of such data from Sri Lanka. We assessed knowledge, perception and self-confidence in the diagnosis and management of anaphylaxis amongst pre-intern medical graduates who would soon become first-contact doctors attending emergencies. Methods This cross-sectional study included pre-interns who graduated with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees in 2019 from three Sri Lankan universities with differing undergraduate curricula. Using consecutive sampling data were collected within four months of the final-MBBS examinations with a self-administered questionnaire and the answers on case diagnosis and management were used as the basis of outcome scores. Results 385 participants responded (response rate: 91.5%). 16.4% correctly identified all anaphylaxis triggers. Only 7.3% correctly diagnosed all ten case scenarios and 34.5% all seven cases of anaphylaxis. 98.2 and 97.9% correctly identified 1:1000 adrenaline as the first-line treatment and the intramuscular route. 9.9% would preferentially but incorrectly use the intravenous route if access was available. Only 79.2 and 55.6% knew the correct adult and paediatric doses of adrenaline and 50% agreed that follow-up care was needed. The mean scores for case diagnosis and management of anaphylaxis were 7.7/10 ± 1.4 and 16.9/20 ± 1.9, respectively. Multiple linear regression indicated that the final MBBS results classification (class of degree or no class indicated) was a positive predictor of case diagnosis score [class vs no class: B = 0.662 (95% CI 0.347–0.978), p < 0.001] and being a graduate of University 2 [B = 1.568 (95% CI 1.182–1.953), p < 0.001] and passing with a class at final MBBS [B = 0.716 (95% CI 0.319–1.113), p < 0.001] were positive predictors of management score. Self confidence in diagnosing and managing anaphylaxis were rated as 79.7 and 62.1% and there was a positive correlation between knowledge and perception scores and self-confidence (case-diagnosis: rpb = 0.111, p = 0.03; management: rpb = 0.164, p = 0.001). Conclusions Knowledge, perception and self confidence in the diagnosis and management of anaphylaxis was sub optimal amongst pre-interns and we identified areas that need improvement. A higher MBBS qualification classification was a predictor for correct diagnosis and management and confidence in diagnosis and management positively correlated with knowledge and perception scores. Further and enhanced educational and training strategies are needed for this life threatening emergency condition.

scholarly journals Signs and symptoms in Gaucher Disease: priority nursing diagnoses

2018 ◽  
Vol 71 (1) ◽  
pp. 104-110 ◽  
Author(s):  
Márcia Koja Breigeiron ◽  
Vitória da Costa Moraes ◽  
Janice Carneiro Coelho
Keyword(s):  
Gaucher Disease ◽  
Bone Pain ◽  
Genetic Diagnosis ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Physical Mobility ◽  
Risk For Bleeding ◽  
Nursing Diagnoses

ABSTRACT Objective: Identify the signs and symptoms of patients with Gaucher Disease, inferring possible priority nursing diagnoses. Method: Cross-sectional study, developed in a specialized laboratory, between 2013 and 2015. The sample (n = 91) comprised the records of patients with genetic diagnosis for Gaucher Disease. The study respected research norms. Results: Prevalence of female sex (57.1%), age at diagnosis between 0 and 10 years, and origin from the Southeast Region of Brazil were prevalent. Hematologic changes, bone pain, hepatomegaly, splenomegaly, and fatigue were the most recurrent signs and symptoms. The inferred diagnoses for the studied population were: Risk for bleeding; Fatigue; Chronic pain and Acute pain; Impaired physical mobility; Imbalanced nutrition: less than body requirements; and Risk for Developmental Delay. Conclusion: The establishment of Priority Nursing Diagnoses based on signs and symptoms makes it possible to achieve expected outcomes for each individual in the care context.

scholarly journals Pain in emergency units: correlation with risk classification categories

2018 ◽  
Vol 26 (0) ◽  
Author(s):  
Wandressa Letícia Viveiros ◽  
Meiry Fernanda Pinto Okuno ◽  
Cássia Regina Vancini Campanharo ◽  
Maria Carolina Barbosa Teixeira Lopes ◽  
Gabriella Novelli Oliveira ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
Medical Specialty ◽  
Cross Sectional Study ◽  
Risk Classification ◽  
Moderate Intensity ◽  
Ratio Test ◽  
Intense Pain ◽  
Cross Sectional ◽  
Mild Pain

ABSTRACT Objectives: to correlate risk classification categories with the level of pain of patients in an emergency service. Method: cross-sectional study carried out in the Risk Classification of 611 patients. The variables studied were: age, gender, comorbidities, complaint duration, medical specialty, signs and symptoms, outcome, color attributed in the risk classification of and degree of pain. We used Analysis of Variance, a Chi-Square test and a Likelihood Ratio test. Results: the average age was 42.1 years (17.8); 59.9% were women; the green (58.9%) and yellow (22.7%) risk classification prevailed and hypertension (18.3%) was the most common Comorbidity. The most frequent pain intensity was moderate (25.9%). In the red category, patients presented a higher percentage of absence of pain; in the blue, mild pain; and in the green, yellow and orange categories, there was a greater percentage of intense pain (p < 0.0001). Conclusion: among the patients who presented pain, the majority reported moderate intensity. Regarding risk categories, most patients in the red category did not report pain. Those who were classified as green, yellow and orange, reported mostly intense pain. On the other hand, patients in the blue category reported predominantly mild pain.

scholarly journals Mental health and burden in mothers of children with congenital Zika syndrome during COVID-19 pandemic

2021 ◽  
Vol 21 (suppl 2) ◽  
pp. 481-490
Author(s):  
Gabriela Lopes Gama ◽  
Bruna Milena da Silva ◽  
Mariana Balbino da Silva ◽  
Rayssa Vieira Brandão Ferreira ◽  
Jousilene de Sales Tavares ◽  
...  
Keyword(s):  
Mental Health ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Symptoms Of Depression ◽  
Maternal Schooling ◽  
The Social ◽  
Burden Scale ◽  
Congenital Zika Syndrome ◽  
Health Impairments

Abstract Objectives: to evaluate burden, frequency of anxiety and signs and symptoms of depression in mothers of children with congenital Zika syndrome (CZS) during the COVID-19 pandemic and the social isolation period. Methods: this is a cross-sectional study conducted with mothers who care for their children with CZS. The data were collected by an online form with questions regarding mother's socioeconomic conditions and questions related with Zarit burden scale and Beck's inventories on depression and anxiety. Spearman’s correlation tests and multiple regression analyzes were performed to assess factors related to mothers' burden and mental health. Results: 41 mothers were evaluated, 51.2% had mild burden, 39% had minimal anxiety and 73.2% did not have signs and symptoms of depression. Negative correlations were observed between levels of burden and maternal schooling (p=0.01), presence of signs and symptoms of anxiety and receiving financial aid (p<0.04) as well as the presence of signs and symptoms of anxiety and having children with seizures history (p=0.03). Conclusion: despite the risk of their children again being victims of an epidemic virus, mothers who care for their children with CZS did not present serious mental health impairments.

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