DSpace Community:

Comparison of zinc levels in liver cirrhosis and evaluating the severity using child pugh score

2022-01-01T00:00:00Z

Title: Comparison of zinc levels in liver cirrhosis and evaluating the severity using child pugh score Authors: Vidyadhari Kakumanu Abstract: Background and Objectives: “Liver cirrhosis represents the final common pathway for chronic liver diseases, characterized by extensive fibrosis and hepatocyte dysfunction. Zinc, an essential micronutrient with critical roles in protein synthesis, enzymatic reactions, and antioxidant defense, has been implicated in liver pathophysiology. However, the relationship between zinc deficiency and cirrhosis severity remains incompletely characterized in the Indian population. This study aimed to evaluate serum zinc levels in patients with liver cirrhosis and correlate them with disease severity as measured by the Child-Pugh classification.” Methods: “This hospital-based cross-sectional study was conducted among 85 patients with cirrhosis of liver attending the outpatient and inpatient departments of BLDE University's Shri BM Patil Medical College Hospital. Detailed clinical evaluation, biochemical investigations including serum zinc levels, and Child-Pugh scoring were performed. Zinc deficiency was defined as serum levels below 51 μg/dL. Statistical analysis included descriptive statistics, chi-square tests, and ANOVA to assess relationships between variables.” Results: The study cohort comprised predominantly middle-aged males (95.3%), with alcoholic etiology (89.4%) being the leading cause of cirrhosis. Advanced disease was common, with 67.1% of patients categorized as Child-Pugh Class C. Zinc deficiency was observed in 97.6% of patients, with mean zinc levels showing a significant progressive decrease from Child-Pugh Class A (50.4±4.31 μg/dL) to Class B (42.32±4.86 μg/dL) to Class C (37.02±3.68 μg/dL) (p<0.001). There was a perfect parallelism between zinc and albumin deficiency (both 97.6%). The mortality rate during the study period was 15.3%. Conclusion: This study demonstrates an extraordinarily high prevalence of zinc deficiency in liver cirrhosis with a significant inverse correlation with disease severity. The progressive decline in zinc levels with worsening Child-Pugh scores suggests that zinc deficiency may be both a marker of advanced disease and potentially a contributor to disease progression. These findings support the incorporation of zinc assessment into the routine evaluation of cirrhotic patients and suggest that zinc supplementation could be considered as an adjunctive therapy, particularly in advanced disease.

Clinical profile of acute kidney injury in intensive care unit patients

2022-01-01T00:00:00Z

Title: Clinical profile of acute kidney injury in intensive care unit patients Authors: Vaitla Chandrakanth Abstract: INTRODUCTION • Patients in the intensive care unit (ICU) frequently experience acute kidney injury (AKI), which is a clinical problem that predicts a poor result on its own. • AKI is one among the leading causes of ICU admissions and common contributor to in hospital morbidity and mortality rates. • AKI is linked to prolonged hospital stays, which raises the cost of treatment. • AKI may be treatable with early detection and treatment, but a higher rate of morbidity and mortality may result from a delayed diagnosis. AIM • Analysis of the clinical spectrum of AKI patients in ICU. • Study the cause and risk factors of AKI. • Analysis of final outcome of patients with AKI. MATERIALS AND METHODS The study was conducted at B.L.D. E (DEEMED TO BE UNIVERSITY), Shri B.M. Patil Medical College, Hospital & Research Centre, Vijayapura. All patients above 18 years of age, admitted in ICU diagnosed with Acute Kidney Injury using KDIGO criteria or developed Acute Kidney Injury after admission to ICU were taken for study. Chronic Kidney Disease patients were not included in the study. All patients were classified according to KDIGO criteria and the outcome was analyzed. RESULTS • In our study most of the cases were over the 50 years of age. • In our study sepsis was the most common etiology, second most common being Acute Gastroenteritis. Other Etiologies include hepatorenal syndrome, cardiorenal syndrome, CVA, snake bite, post operative cases and poisoning and others. • 64.10% patients were managed conservatively, 35.90 % required hemodialysis. • Out of 78 patients, 50 patients survived. Mortality was seen in 28 patients. CONCLUSION The most frequent cause of AKI in ICU patients is sepsis. It also has a high death rate. In each case of sepsis, preventing the development of multi-organ failure is crucial. Dialysis was used to treat our patients cautiously and when necessary. Common causes of increased mortality include multi-organ dysfunction, lung and other infections, delayed diagnosis and treatment, and the frequent occurrence of comorbidities. Although there was a correlation between AKI and hospital outcomes, the prognosis of AKI severity is more affected by organ failure.

Serum uric acid levels in patients with chronic nonspecific musculoskeletal pain

2022-01-01T00:00:00Z

Title: Serum uric acid levels in patients with chronic nonspecific musculoskeletal pain Authors: Tumarada V A M k Raja Abstract: Background: Chronic nonspecific musculoskeletal pain (CNMP) represents a significant global health challenge affecting approximately 20-30% of the adult population. Despite its prevalence, the underlying pathophysiological mechanisms remain poorly understood. Recent evidence suggests potential roles for metabolic factors in pain generation and perpetuation. By contrasting cases with healthy controls and assessing related demographic and clinical factors, this study sought to determine the link between serum uric acid levels and CNMP. Methods: A case-control study was conducted with 30 patients diagnosed with CNMP (pain lasting ≥4 weeks without identifiable structural or inflammatory cause) and 30 age-matched healthy controls. Comprehensive demographic data, clinical characteristics, and lifestyle factors were assessed. Laboratory investigations included complete blood count, erythrocyte sedimentation rate, fasting blood sugar, renal function tests, rheumatoid factor, anti-streptolysin O titer, and serum uric acid levels. Statistical analysis was performed using appropriate tests, with p<0.05 considered significant. Results: The case and control groups showed similar age distribution, with most participants in the 21-40 years bracket (46.7% vs. 53.3%). All participants had normal BMI (18.5-24.9 kg/m2). Significantly, 60% of CNMP patients exhibited hyperuricemia (men >7 mg/dl, women >6 mg/dl) compared to none in the control group (p<0.001). Serum creatinine levels were higher in cases compared to controls (0.8±0.1 vs. 0.67±0. mg/dl, p<0.001) while remaining within normal clinical ranges. Most CNMP patients (83.3%) reported pain duration of 4 weeks, with 96.7% describing moderate intensity. Nearly all cases (96.7%) were negative for rheumatoid factor, and all were negative for anti-streptolysin O titer. No significant differences were observed in hematological parameters, dietary patterns, smoking, or alcohol consumption between groups. Conclusion: This study demonstrates a significant association between elevated serum uric acid levels and CNMP, with 60% of patients exhibiting hyperuricemia compared to none in the control group. This finding suggests that uric acid may play a role in the pathophysiology of CNMP through pro-inflammatory effects, oxidative stress induction, or microvascular dysfunction. Serum uric acid could serve as a potential biomarker and therapeutic target in CNMP, supporting a more integrated approach to chronic pain management that considers biochemical factors alongside biomechanical and psychosocial dimensions. Further research is warranted to establish causality and optimize therapeutic approaches targeting uric acid metabolism in CNMP patients.

Correlation of serum potassium and plasma cholinesterase in assessing the severity of acute organophosphate poisoning

2022-01-01T00:00:00Z

Title: Correlation of serum potassium and plasma cholinesterase in assessing the severity of acute organophosphate poisoning Authors: Eswara Sai Sontineni Abstract: Introduction: Organophosphate (OP) compounds are widely used as pesticides, particularly in agricultural regions, and constitute a significant cause of poisoning worldwide. The toxicity primarily results from inhibition of acetylcholinesterase enzyme, leading to accumulation of acetylcholine at synapses and manifesting as a characteristic cholinergic toxidrome. While plasma cholinesterase levels have been traditionally used to confirm exposure and assess severity, their correlation with clinical outcomes is not always consistent. Recent studies have suggested alterations in serum electrolytes, particularly potassium, as potential markers of poisoning severity. This study aimed to correlate serum potassium and plasma cholinesterase levels with the clinical severity of acute organophosphate poisoning. Methods: This prospective study was conducted at Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, from May 2023 to December 2024. A total of 83 patients with acute organophosphate poisoning were included. Detailed clinical assessment, including Glasgow Coma Scale (GCS) scoring and pupillary examination, was performed at admission. Serum potassium and plasma cholinesterase levels were measured at admission and after 24 hours. Patients were classified as having severe or non-severe poisoning based on clinical parameters and requirement for mechanical ventilation. Statistical analysis was performed to assess the correlation between biochemical markers and poisoning severity. Results: The majority of patients (67.5%) were between 20-40 years of age, with a slight male predominance (51.8%). Common clinical features included vomiting (74.7%), muscle weakness (62.6%), and bronchospasm (30.1%). Severe poisoning was observed in 37.3% of patients, with 26.5% requiring mechanical ventilation. Patients with severe poisoning had significantly lower serum potassium levels both initially (3.32±0.59 vs 4.08±0.47 mEq/L, p<0.001) and at 24 hours (3.6±0.55 vs 4±0.34 mEq/L, p=0.001) compared to non-severe cases. Similarly, plasma cholinesterase levels were significantly lower in severe cases, both initially (1465.4±2336.2 vs 3455.4±2785.4, p=0.001) and at 24 hours (1633.5±2620.9 vs 3550.9±2794.6, p=0.01). A significant positive correlation was observed between serum potassium and acetylcholinesterase levels in both severe (r=0.675, p=0.001) and non-severe (r=0.582, p=0.003) poisoning cases. Patients requiring mechanical ventilation had markedly lower initial potassium levels (3.12±0.48 mEq/L vs. 3.97±0.54 mEq/L, p<0.001). There was a strong association between mortality and low serum potassium, with non-survivors having dramatically lower potassium levels (2.86±0.44 mEq/L) compared to survivors (3.94±0.51 mEq/L, p<0.001). Similarly, patients who died had profoundly reduced initial acetylcholinesterase levels (452.8±198.6) compared to those who were discharged (3212.9±2824.8, p<0.001). Severe poisoning was also associated with lower GCS scores (p<0.001) and smaller pupil sizes (1.48±0.67 vs 2.37±0.74 mm, p<0.001). Conclusion: Serum potassium levels show a significant correlation with the severity of acute organophosphate poisoning, comparable to the established marker plasma cholinesterase. The combination of these biochemical parameters with clinical indicators like GCS scores and pupillary changes provides a comprehensive approach to severity assessment. Serum potassium measurement can serve as a simple, cost- effective, and readily available tool for early risk stratification, particularly in resource- limited settings.