Role of early enteral feeding in mild and moderate acute pancreatitis

Background: Timing of enteral feeding in acute pancreatitis was always a matter of controversy. Increasing evidence suggests that early enteral feeding reduces systemic and local complications of pancreatitis and thereby hospital stay. Hence the study has been undertaken to determine the feasibility, advantages and disadvantages of early enteral feeding in mild and moderate acute pancreatitis. Methods: Patients admitted with symptoms and signs suggestive of mild and moderate acute pancreatitis who were started on early enteral feeding (within 48 hours of admission) were included in study. Blood investigation results are used to classify patients accordingly to mild and moderate acute pancreatitis based on Ransons’s score. Patients were followed up and categorized based on development of complications, length of hospital stay.Results: Majority of the patients who were started on early enteral feeding showed significant decrease in complications and hospital stay. Study also suggested that age is a significant risk in development of complications. Gender is not significant in the development of complications.Conclusions: There is significant decrease in rate of systemic complication, local infective and non-infective complications, length of hospital stay among acute pancreatitis patients who were started on early enteral feeding (within 48 hours).

Vascular Changes and Hypoxia in Periodontal Disease as a Link to Systemic Complications

The hypoxic microenvironment caused by oral pathogens is the most important cause of the disruption of dynamic hemostasis between the oral microbiome and the immune system. Periodontal infection exacerbates the inflammatory response with increased hypoxia and causes vascular changes. The chronicity of inflammation becomes systemic as a link between oral and systemic diseases. The vascular network plays a central role in controlling infection and regulating the immune response. In this review, we focus on the local and systemic vascular network change mechanisms of periodontal inflammation and the pathological processes of inflammatory diseases. Understanding how the vascular network influences the pathology of periodontal diseases and the systemic complication associated with this pathology is essential for the discovery of both local and systemic proactive control mechanisms.

Estimating the Risk of Deep Brain Stimulation in the Modern Era: 2008 to 2020

BACKGROUND Deep brain stimulation (DBS) was first approved by the United States Food and Drug Administration in 1997. Although the fundamentals of DBS remain the same, hardware, software, and imaging have evolved significantly. OBJECTIVE To test our hypothesis that the aggregate complication rate in the medical literature in the past 12 years would be lower than what is often cited based on early experience with DBS surgery. METHODS PubMed, PsycINFO, and EMBASE were queried for studies from 2008 to 2020 that included patients treated with DBS from 2007 to 2019. This yielded 34 articles that evaluated all complications of DBS surgery, totaling 2249 patients. RESULTS The overall complication rate in this study was 16.7% per patient. There was found to be a systemic complication rate of 0.89%, intracranial complication rate of 2.7%, neurological complication rate of 4.6%, hardware complication rate of 2.2%, and surgical site complication rate of 3.4%. The infection and erosion rate was 3.0%. CONCLUSION This review suggests that surgical complication rates have decreased since the first decade after DBS was first FDA approved. Understanding how to minimize complications from the inception of a technique should receive more attention.

Reallocation of Carotid Surgery Activity with the Support of Telemedicine in a COVID-Free Clinic during COVID-19 Pandemic

The aim of this study is to report the reallocation of carotid surgery activity with the support of telemedicine in a COVID-free clinic during COVID-19 pandemic. Patients with symptomatic carotid stenosis or asymptomatic vulnerable plaques were reallocated to a COVID-free private clinic which began to cooperate with the National Health System during the emergency. Quick training of staff nurses was performed. Surgeons moved to the COVID-19 free clinic. Remote cerebral monitoring was performed with the support of telemedicine. Twenty-four patients underwent standard carotid endarterectomy with eversion technique. Five patients (20.8%) had recently symptomatic stenosis, and the remaining 19 patients (79.2%) had a risky asymptomatic carotid stenosis. No technical issue with remote cerebral monitoring was detected. In the early postoperative period, no neurological/systemic complication was observed. Three patients under dual antiplatelet therapy (12.5%) had neck hematoma. All patients were discharged the day after surgery. In our preliminary experience, reallocation in a COVID-free clinic allowed us to maintain a functioning carotid surgery activity during COVID-19 pandemic. A multidisciplinary approach and support of telemedicine were crucial. Training of unskilled nurse staff was necessary.

Case Report: Capillary Leak Syndrome With Kidney Transplant Failure Following Autologous Mesenchymal Stem Cell Therapy

Mesenchymal stem cells (MSCs) have attracted great interest in the field of kidney transplantation due to their immunomodulatory and reparative properties. In registered clinical trials, MSCs have been used before, at the time of, or early after transplantation and have been reported to be well-tolerated with no serious safety concerns. No results are available on the use of MSCs in the late post-transplant period. Here, we present a case report of a severe systemic complication mimicking capillary leak syndrome with ultimate kidney transplant failure after autologous transplantation of MSCs used as rescue treatment of late antibody-mediated kidney allograft rejection.

RECOVERY COMPLICATION IN COVID - 19 SURVIVORSHIP: A NEW CHALLENGE

The growing population of COVID-19 survivors in second wave represents a clear challenge to clinicians and researchers to look beyond the search for a cure and to address the multifaceted needs of those living with and beyond diagnosis. Common complications that disrupt the psychosocial, physical aspects of life and multi systemic complication for adult. COVID-19 survivors after primary treatment include: fatigue, neurological, cardiovascular, hepatic impairment,ocular,dermatological manifestation,Oral manifestation,acute pancreatitis,musculoskeletal,renal and reproductory system complications. Psychosocial interventions,particularly group-based interventions,physical activity programs, continuous monitoring and prompt treatment have shown great promise in improving these outcomes.Future research will identify even bettertargeted, more efficacious, and more cost effective medication and vaccination policy to counter COVID-19 outcomes. Healthcare providers must realize that they serve as vital gatekeepers to services that will help optimize outcomes. Addressing these issues in the post-treatment period represents the new challenge to supportive care.

Raktamokshana - A Systemic Review

Raktamokshana is the important para surgical method of bloodletting incorporated by Acharya Sushruta in the basic plan of detoxification therapy. Though the broad utility of this therapy is extensively elaborated in Ancient Text of Ayurveda, it has limited use in the clinical practices of Panchakarma that may occur due to apprehension about the procedure to develop any surgical or systemic complication; lack of skill for practical demonstration or knowledge regarding its efficacy. The meta-analysis of various techniques of the Raktamokshana, is primarily planned to study their effectiveness & safety for managing multiple disorders. On an extensive review of the literature regarding this topic, 16 studies are conducted with 469 participants at different places or states from India. A narrative synthesis of all included studies & their critical analysis was demonstrated concisely using tables. It was found that only two modes of Raktamokshana, i.e., Siravedha & Jaoukavacharana, which are widely used in practice for different skin and musculoskeletal disorders, while only two trials study the modified Shringa method. No clinical study was carried out to demonstrate the effect of other methods of Raktamokshana or modifications in various clinical entities. The efficacy of three modes of Raktamokshana, i.e., Siravedha, Jalouka & Shringa, can be justified based on the basic principles of Ayurveda & physiological actions. This study demands to conduct scientific multi-centric research studies with a large sample size in the future to embark on these conclusions & to enhance their acceptance globally.

Cerebellar talcosis following posterior reversible encephalopathy syndrome in an intravenous methamphetamine abuser

Background: Intravenous (IV) methamphetamine abuse is associated with a variety of short- and long-term effects on the nervous system, some of which have yet to be fully elucidated. One known systemic complication that has not been described in nervous system tissues is the deposition of substrate crystals contained in injectable drugs. Case Description: An unusual case is presented of a 35-year-old active IV methamphetamine abuser with posterior reversible encephalopathy syndrome (PRES) who subsequently developed multifocal bilateral cerebellar enhancing lesions and leptomeningeal enhancement due to biopsy-proven crystalline deposits. Conclusion: Although large crystalline substances will not normally penetrate the blood–brain barrier (BBB), during a state of BBB compromise such as with PRES, talc deposition may occur in the central nervous system.

Mid-term lifetime survivals of octogenarians following primary and revision total knee arthroplasties were satisfactory: a retrospective single center study in contemporary period

Background As life expectancy increases, the number of octogenarians requiring primary and revision total knee arthroplasty (TKA) is increasing. Recently, primary TKA has become a common treatment option in octogenarians. However, surgeons may still be hesitant about performing revision TKA on octogenarians because of concern about risk and cost benefit. The purpose of this study was to investigate clinical outcomes, postoperative complications, and mid-term lifetime survival in octogenarians after primary and revision TKA. Materials and methods We retrospectively reviewed 231 primary TKAs and 41 revision TKAs performed on octogenarians between 2000 and 2016. The mean age of patients undergoing primary TKA was 81.9 years and that of patients undergoing revision TKA was 82.3 years (p = 0.310). The age-adjusted Charlson comorbidity index was higher in revision TKA (4.4 vs. 4.8, p = 0.003). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. The incidence of postoperative complications (TKA-related, specific or systemic) and lifetime survival rate (endpoint death determined by telephone or mail communication with patient or family) were investigated. Results The WOMAC and ROM improved significantly after primary and revision TKA, although postoperative results were worse in the revision group (33.1 vs. 47.2; 128.9° vs. 113.6°; p < 0.001, respectively). There were no cases of aseptic or septic component failure in either group. One case of periprosthetic fracture was observed in the revision group (0% vs. 2.4%, p = 0.151), and three cases of deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE) (one case of DVT and two cases of PTE) were observed in the primary group (1.3% vs. 0%, p = 1.000). The most common systemic complication in both groups was delirium (7.4% vs. 14.6%, p = 0.131). There were no differences between the two groups in the other systemic complication rates. The 5-year and 10-year lifetime survival rates were 87.2% and 62.9%, respectively, in primary TKA and 82.1% and 42.2%, respectively, in revision TKA (p = 0.017). Conclusions Both primary and revision TKA are viable options for octogenarians, based on the satisfactory clinical outcomes, TKA-related complication rates, and mid-term lifetime survival. Delirium needs to be managed appropriately as the most common systemic complication in both primary and revision TKA in octogenarians. Level of evidence IV

TO STUDY THE DIFFERENT CLINICAL PRESENTATION OF MALARIA

Method: This study was done at Department Of Medicine. All patients admitted with malaria in tertiary care Centre during the study period August 2017 to July 2018 were taken for the study after considering the inclusion and exclusion criteria. Our study is a clinical, prospective, observational and open study. Result: Fever occurred in all patients, and it was intermittent in 72.5% of the cases, continuous in 17.5% of the cases and remittent in the remaining 10%. Intermittent fever is the commonest. All 100% patients had chills and rigors. Most of the Patients (65%) had presented with acute illness of 2- 10 days duration of fever. Bifrontal dull aching to throbbing headache associated with fever was presenting clinical symptoms in 92% of patients. Most of the patients complained of generalized weakness, malaise and myalgia. Cerebral manifestation is seen in 10% of patients. Spleenomegaly was predominant in 64% of patients and 40% patient had hepatomegaly. Patient with mixed infection had more propensity to develop systemic complication. Conclusion: Malaria is an age-old disease of mankind, caused by protozoal plasmodium and transmitted by anopheles mosquito. It is prevalent throughout most tropical countries. Both species are commonly presented with symptoms of intermittent Fever, chills, Bi-frontal headache, vomiting and commonly clinical feature is splenomegaly. Severe complication like anemia, thrombocytopenia jaundice, acute renal failure and sometimes life threatening cerebral malaria are need to address promptly to avoid adverse outcome. Keywords: Clinical, Malaria, WHO & Presentation.