Neonatal and maternal factors associated with hepatic dysfunction after birth asphyxia

Background: Liver cell injury commonly occurs after perinatal asphyxia. This study aimed to identify the neonatal and maternal factors related to hepatic dysfunction associated with birth asphyxia. Methods: A case control study was carried out in Basra comprising 43 asphyxiated newborns, and 57 healthy full terms enrolled as control. Serum levels of liver enzymes [alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP)] were measured and compared between the study and control groups. Levels beyond +2SD above the mean of control considered high. Statistical analysis was done using SPSS program version 20. Chi-Square test and ANOVA were used where appropriate, P-value <0.05 was considered as significant. Elevated levels of enzymes were studied in relation to selected neonatal and maternal variables. Results: Higher levels of liver enzymes were found related to gestational age > 40 weeks, newborn’s body weight > 4 Kg, mother’s age>35 years, parity > 4 children and maternal medical disease. The results were statistically significant (P<0.05). However, no statistical differences were detected regarding newborn’s gender and growth status, maternal education and mode of delivery. Conclusion: The study highlights the relationship between maternal and neonatal risk factors and perinatal asphyxia associated with hepatic dysfunction.

THE CLINICAL PROFILE OF DENGUE PATIENTS IN CHILDREN

Background: To study the clinical profile of dengue in children Methods: The hospital based study was conducted on patients presenting to paediatric hospital, who fulfilled inclusion and exclusion criteria. Results: Based on the symptoms, the most common symptoms noticed were fever 94.00% followed by myalgia 85.00% decreased appetite 83%, retroorbital pain in 84.0% and vomiting 81.00% Conclusion: It concluded that common symptoms observed were fever, myalgia, decreased appetite and headache The common complications presented were hepatic dysfunction and shock with no mortality indicating the presence of less virulent organisms.. Keywords: Dengue, Complication, Shock

Clinico-pathological changes in COVID-19 patients

Background: Novel Corona virus is associated with the respiratory disorder. Corona virus cases disease ranging from a common cold like illness severe acute respiratory syndrome. Biochemical parameters become altered in the patients, and this has been correlated with the severity of the disease. The present study was undertaken to analyse the effect of novel corona virus infection in organs other than lungs.Methods: The study is a retrospective studycarried out in RMCH and RC, Kanpur from July 2020 to June 2021. Haematological, biochemical and inflammatory biomarker study was conducted in 336 COVID-19 patients.Results: Out of 336 COVID-19 patients the maximum number of patients belonged to the age group of 61-70 years. There were 75% symptomatic and 25% asymptomatic cases of confirmed COVID-19. Sore throat was the most common presentation followed by cough and dyspnoea. Other manifestations include fever, myalgia, loss of taste, loss of smell and running nose. Serum CRP and PCT concentration were observed in more severe cases 22.2% and 17% respectively. Haematological findings include decrease in total RBC count (58.33%). Symptomatic COVID-19 patients have thrombocytopenia (30.95%), lymphopenia (25%), leucocytosis (11.90%) and leucopenia 8.33%. Hepatic dysfunction and renal dysfunction was observed in 71.42% and 14.28% symptomatic cases respectively.Conclusions: We concluded that novel corona virus is not only affecting respiratory system but also other vital organs. On the basis of haematological and biochemical findings we can predict the severity of COVID-19 infection which could be helpful for management of the disease.

Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection

Background: This study was aimed to investigate the incidence, risk factors, and outcomes of patients with postoperative hepatic dysfunction (PHD) after frozen elephant trunk (FET) for type A aortic dissection (TAAD).Method: A retrospective study was performed with 492 patients who underwent FET for TAAD between 2015 and 2019. Independent risk factors for PHD were determined by multivariate mixed-effect logistic analysis with surgeon-specific factor as a random effect.Results: The incidence of PHD was 25.4% (n = 125) in our cohort. Patients with PHD presented higher early mortality (10.4 vs. 1.1%, p &lt; 0.001), rates of acute kidney injury (42.4 vs. 12.8%, p &lt; 0.001), and newly required dialysis (23.2 vs. 3.0%, p &lt; 0.001) compared with those without PHD. Moreover, with the median follow-up period of 41.3 months, the survival curve was worse in patients with PHD compared with no PHD group (log-rank p &lt; 0.001), whereas it was similar after excluding patients who died within 30 days (log-rank p = 0.761). Multivariable analyses suggested that PHD was predicted by preoperative aspartate transferase [odds ratio (OR), 1.057; 95% confidence intervals (CI), 1.036–1.079; p &lt; 0.001], celiac trunk malperfusion (OR, 3.121; 95% CI, 1.008–9.662; p = 0.048), and cardiopulmonary bypass time (OR, 1.014; 95% CI, 1.005–1.023; p = 0.003). Retrograde perfusion (OR, 0.474; 95% CI, 0.268–0.837; p = 0.010) was associated with a reduced risk of PHD. Celiac trunk malperfusion was an independent predictor for PHD but not associated with early mortality and midterm survival.Conclusions: PHD was associated with increased early mortality and morbidity, but not with late death in midterm survival. PHD was predicted by preoperative aspartate transferase, celiac trunk malperfusion, and cardiopulmonary bypass (CPB) time, and retrograde perfusion was associated with a reduced risk of PHD.

Prevalence, Causes and Management of Obstruction of Common Bile Duct: Review Article

Gallstones cause biliary obstruction in about 5 out of 1000 people, whereas 10 to 15% of the adult population in the United States will have gallstones at some point in their lives. Gall stones, also known as cholelithiasis, are the precursor of choledocholithiasis, which occurs when gall stones pass through the cystic duct and lodge in the common hepatic ducts, causing an obstruction. Routine labs and some specialized labs are used in the diagnosis of biliary blockage. Severe complications can happen if left unchecked such as damaging the hepatic dysfunction, renal failure, nutritional deficiencies, bleeding problems, and infections. Treatment depends on the causing effect of bile duct obstruction. Sphincterotomy with lithotripsy, choledochotomy, choledochoduodenostomy, choledochojejunostomy, or cholecystectomy are the most used for large gall stones treatment. This review looks at the prevalence, etiology and management of the disease.