Modified Computed Tomography Severity Index for Evaluation of Acute Pancreatitis and its Correlation with Clinical Outcome: A Tertiary Care Hospital Based Observational Study

BACKGROUND

Acute Pancreatitis is a very common condition leading to the emergency visits in both developed and developing countries. Computed Tomography plays a pivotal role in the diagnosis and subsequent management of pancreatitis. The modified CT severity index includes a simplified assessment of pancreatic inflammation and necrosis as well as an assessment of extra pancreatic complications.

AIM

To study role of modified computed tomography severity index in evaluation of acute pancreatitis and its correlation with clinical outcome.

MATERIALS AND METHODS

This was a hospital based prospective correlative study done on patients of all age groups referred to the Department of Radio diagnosis from the various indoor and outdoor departments of the hospital, with clinical/Laboratory/ultrasonography findings suggestive of acute pancreatitis. The severity of pancreatitis was scored using Modified CT severity index & CT severity index and classified into mild, moderate and severe categories. Total of 50 patients of acute pancreatitis presenting to the emergency department of our hospital were included in the study. Clinical outcome parameters for correlation collected from respective referral departments included, the length of hospital stay (in days), need for surgical intervention, need for percutaneous intervention (aspiration and drainage), evidence of infection in any organ system (combination of a fever > 100°F and elevated WBC >15,000/ mm(3)), evidence of organ failure (PaO2 < 60 mm Hg or need of ventilation, systolic BP of < 90 mm Hg, serum creatinine of >300μmoles/L or urine output of < 500 ml / 24 h) and death.

RESULTS

The age of the patients in the study group was in the range of 17 to 80 years. Maximum patients were in the age group 40-50 years (42.0%). The mean age was 42.32 years. Out of 50 cases, 33 (66%) were male and 17 (34%) were females with a male to female ratio of 2:1. Cholelithiasis was found to be most common aetiological factor for acute pancreatitis in 40% cases. Alcoholic pancreatitis was seen in 36% of cases. Together cholelithiasis and alcoholism accounted for 76% of cases. Pleural effusion was the most common extra-pancreatic complication, 28 patients (56%), followed by ascites. Majority of patients were categorized as severe pancreatitis (44%). 38% patients were grouped into moderate pancreatitis and 18% were categorized in mild pancreatitis. The outcome parameters in terms of length of hospital stay, need of intervention, development of infection, and development of organ failure were more in patients with higher modified CT severity index.

CONCLUSION

In conclusion CECT was found to be an excellent imaging modality for diagnosis, establishing the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In this study, it had a stronger statistical correlation with the clinical outcome, be it the length of hospital stay, development of infection, occurrence of organ failure and overall mortality. It could also predict the need for interventional procedures.

Screening for Hearing Impairment in High Risk Neonates: A Hospital Based Study

BACKGROUND

Hearing loss very early in life can have multiple deleterious effects on the new born most commonly being related to attainment of speech and language. Also, it can affect social, emotional and academic achievement of the child.Early identification of hearing impairment has been shown to improve prognosis and hence screening programs have been widely and strongly advocated.

AIMS AND OBJECTIVES

To estimate the incidence of neonatal hearing loss in high risk neonates admitted in tertiary level teaching hospital and to determine the risk factors predictive of hearing impairment in them.

MATERIALS AND METHODS

It was a prospective study over a period of one year. We screened high risk neonates for hearing impairment admitted to NICU using Brain stem Auditory Evoked Response (BAER).The morphology of the response and wave and interwave latencies was examined in respect to age-appropriate forms. Follow up BAER after one month was performed in cases where initial BAER was abnormal. Babies who tested abnormal on the follow-up were referred for detailed audiology diagnostic work up.

RESULTS

A total of 200 cases comprising 118 males (59%) and 82 females (41%) were enrolled. On initial BAER testing, 18 (15.25%) males and 14 (17%) female neonates had hearing loss. Whereas 7 males (70%) and 3 females (30%) had hearing loss out of the total 10 hearing loss cases in the Follow up-BAER testing. Two out of the 6 neonates with birth weight <1500g had hearing loss in the follow up of BAER testing. Use of ototoxic medications, hyperbilirubinemia requiring exchange transfusion, perinatal asphyxia and bacterial meningitis were the major risk factors occurring in 45%, 30% and 26% and 10%. Five neonates had unilateral hearing loss and the rest five (5%) had bilateral impairment.Meningitis was the significant independent clinical risk factors for predicting hearing impairment in high risk neonates.The risk of BAER increased cumulatively with BAER abnormality rate of 4.2%, 22.2% and 33.3% with one two and three risk factors respectively.

CONCLUSION

The overall incidence of hearing loss in initial BERA testing was 16%, in males it was 15.25% in males and in 17% in females,only 62.5% of neonates had a persistent abnormal BAER, with male gender a significant risk factor for this. The incidence of hearing loss increased with number of risk factors. The study highlights that although universal hearing screening programs are warranted; most newborns with a detected hearing loss can be identified based on the risk factors. Thus, a targeted approach for hearing screening may be more feasible in resource limited settings.

Morbidity and Mortality Pattern in Late Preterm Infants at a Tertiary Care Hospital in Jammu & Kashmir, Northern India

INTRODUCTION

The morbidity and mortality pattern in late preterm infants is higher than term infants (gestational age ≥ 37weeks). The main reason behind that is the relative physiologic and metabolic immaturity, though there is no significant difference in the weight or the size of the two groups.

AIM

The present study was undertaken to study the incidence, early neonatal morbidity and mortality (within first 7 days of life) in late preterm infants (34 - 36 6/7 weeks).

MATERIALS AND METHODS

It was a hospital based prospective study conducted from April 2012 to March 2013. The study was conducted in the Department of Paediatrics and Neonatology at G.B. Pant General Hospital and Department of Gynaecology and Obstetrics L.D hospital and G.B. pant general hospital, (associated hospitals of Government Medical College, Srinagar).

RESULTS

A total of 4100 neonates were included in the study. Incidence of late preterm neonates was 11.58 %. Three hundred sixty five (76.8%) of late preterm and 965 (28.3%) of term infants had at least one of the predefined neonatal conditions. Late preterm infants were at significantly higher risk for overall morbidity due to any cause (p<0.0001), respiratory morbidity (p<0.0001), mechanical ventilation (p=0.0002), jaundice (p<0.0001), hypoglycaemia (p<0.0001), and sepsis (p<0.0001) Perinatal asphyxia (p= 0.186). Early neonatal mortality in late preterm neonates was 2.5% or 25/1000 live births.

CONCLUSION

Compared with term infants, late preterm infants are at high risk for overall morbidity, respiratory morbidity, and need of mechanical ventilation, jaundice, hypoglycaemia & sepsis. They also have a higher mortality as compared to term neonates.

Procalcitonin and C-reactive protein as early diagnostic markers of sepsis or septic shock in children who presented with fever to the pediatric emergency department at a tertiary hospital, in Riyadh, Saudi Arabia

BACKGROUND

Sepsis is a leading cause of morbidity and mortality in children, requiring early recognition for timely intervention. Traditional biomarkers like C-reactive protein (CRP) are widely used but have limitations in specificity and early detection. Procalcitonin (PCT) has emerged as a promising alternative for differentiating bacterial infections from viral illnesses. This study aims to evaluate the diagnostic performance of PCT and CRP in identifying sepsis among febrile pediatric patients presenting to the emergency department (ED).

METHODS

We conducted a retrospective, observational study at a tertiary hospital from January 2022 to January 2024. A total of 208 children aged 1 month to 14 years with fever (≥ 38 °C) were included. Patients were categorized into sepsis (n = 84) and non-sepsis (n = 124) groups based on clinical assessment and blood culture results. Biomarker levels, patient demographics, clinical outcomes, and disposition were analyzed.

RESULTS

Elevated PCT and CRP levels were significantly associated with sepsis. PCT demonstrated earlier elevation compared to CRP, correlating with higher rates of PICU admission (34.7% vs. 11.1%, p < 0.001). Blood culture positivity was a strong predictor of severe sepsis (OR: 9.369, p < 0.0003). Logistic regression identified high-grade fever, chronic disease, and viral co-infections as additional risk factors.

CONCLUSION

PCT is a superior early biomarker for detecting invasive bacterial infections compared to CRP. Incorporating PCT in sepsis protocols can improve early diagnosis, guiding prompt and appropriate management in pediatric ED settings.