Etiological Spectrum Research Articles

ПРОБЛЕМА АБОРТОВ СВИНОМАТОК

The aim of the study was to establish the spectrum of etiology of abortions in sows. The study was conducted in the format of a systematic review of scientific publications, information and analytical reviews and reports, the objects of which were abortions of sows of various etiologies. Information was searched in databases and scientific publications (ProMED, PMC, NCBI, WAHID, OIE Publications, OIE Working Group Wildlife Diseases, Wildlife Disease Association), the main sources are given in the list of references. The economic efficiency of pig farming is ensured by the high genetic potential of pigs, full-fledged feeding and well-being for infectious, invasive and mass non-communicable diseases. It is believed that 25-30 piglets can be obtained from one sow per year for 2.2-2.8 farrowing and thus increase meat production to 3000 kg per year per sow with a feed consumption of no more than 2.8 kg per 1 kg of weight gain. The level of pig reproduction is one of the criteria for evaluating the effectiveness of pig farming. Abortions of pregnant sows are one of the main causes of economic losses in all countries of the world. Abortion of pigs is considered premature termination of pregnancy with subsequent resorption of the embryo (embryonic mortality, or concealed abortion), maceration, mummification of fetuses detained in the uterus or miscarriages expelled from the uterus (dead fetuses). The etiology of sow abortions is diverse, which significantly complicates the identification of the causes of pathology. Abortions can be infectious, mycotoxic, invasive, non-contagious, alimentary and traumatic in nature. Any infection that causes an increase in body temperature during the implantation of an embryo into the uterine wall can lead to embryonic death. According to many researchers, the causes of sow abortions are determined only in 40-50% of cases. It is believed that such indicators are due to a wide variety of etiological agents that cause abortions, stillbirths and the birth of non-viable piglets. Rapid and accurate laboratory diagnosis is crucial for the fight against abortion.

Etiologic factors and imaging features of cytotoxic lesions of the corps callosum (Cloccs): A series of 5 patients

Cytotoxic Lesions of the Corpus Callosum (CLOCCS) are secondary lesions associated with various etiologies, including trauma, infection, and metabolic disorders. Recognizing these lesions is crucial as they can mimic primary callosal lesions such as ischemia. This retrospective study presents a series of five patients with CLOCCS, evaluating their clinical and radiological characteristics over a one-year period. Imaging, particularly MRI, plays a pivotal role in diagnosis, with diffusion-weighted sequences revealing characteristic features of cytotoxic edema. Clinical context, additional imaging findings, and patient history aid in distinguishing CLOCCS from other pathologies. The study highlights diverse etiologies contributing to CLOCCS, including trauma, infection (e.g., Malaria, COVID-19), and metabolic disorders. Treatment strategies depend on addressing the underlying cause. Understanding the spectrum of etiologies and imaging features of CLOCCS is vital for accurate diagnosis and appropriate management.

Clinical Profile and Etiology of Patients with Pericardial Effusion

Background: Pericardial effusion are one of the common cardiac problems in our part of the world and is associated with high risk of morbidity and mortality if not diagnosed and treated. The aim of this study was to determine etiological spectrum and clinical presentation of moderate to large pericardial effusion.Methods: A descriptive cross-sectional study was conducted from February 2023 to July 2023 at Department of Cardiology, NMC-TH. Fifty patients were included in the study who visited to NMC-TH; OPD, ward and emergency department. Apart from routine investigations, ECG, chest X-ray and echocardiography were performed in all patients. Pericardiocentesis was done in 37 patients (74%). Specific investigations for the suspected etiological diagnosis were done. Results: A total of 50 patients (30 Male, 20 Female) were included in the study with age ranging from 11 to 76 years. The most common clinical presentations were dry cough (86%) followed by shortness of breath (70%) and fever (66%). In this study, the most common etiology of pericardial effusion was tuberculosis (n-22; 44%) followed by malignancy 6(12%), idiopathic 6(12%), and Hypothyroidism 4(8%). Among malignancies, carcinoma of lung was the commonest 3(50%). Tuberculosis was the most common cause in patients presenting with tamponade 8(61.5%) followed by malignancy 2(15.3%).Conclusion: This study shows tuberculosis is the most common cause of pericardial effusion followed by malignancy.

Symptomatic Upper Extremity Peripheral Artery Disease is Associated With Poor Outcomes and a Broad Spectrum of Etiologies

The symptomatic upper extremity peripheral artery disease (sUE-PAD) is poorly studied compared with the lower extremity peripheral artery disease (LE-PAD). We aimed to describe sUE-PAD etiologies and outcomes at 2 years. From an observational survey conducted in two French tertiary hospitals, demographic characteristics, etiology, treatment, and outcomes during follow-up were collected on patients with ICD-10 I74.2 code (arterial thrombosis of the upper limbs). We identified 181 patients (53% male, 55 ± 17 years) with hypothenar hammer syndrome (13.8%), cardioembolism (13.3%), atheroma (12.7%), or connective tissue disease (10.5%). No etiology could be found for 16.0% of them. The amputation rate was 13.3%, and lasting symptoms remained at 21.3%. During follow-up, atrial fibrillation occurred in 1 patient and cancer in 4. At 2 years, 59 patients were lost to follow-up, 110 patients were alive, and 12 patients had died. Age and cancer were associated with death. sUE-PAD is not benign, with 20% impaired upper extremity outcome and 10% overall mortality at 2 years. Less frequent than LE-PAD, sUE-PAD presents different characteristics: more women, younger age, and a broad spectrum of etiologies. sUE-PAD requires thorough etiological assessment and is considered to be associated with a severe overall prognosis.

Demographic Distribution and Etiological Bacterial Spectrum of Patients with Non-Odontogenic Abscesses and Phlegmons of the Head and Neck

The aims of the present study are to prove that in non-odontogenic abscesses and phlegmons in the head and neck region, the main microbiological agents are representatives of the oral resident microflora, as in odontogenic purulent inflammatory diseases in the same area, and to determine and compare the demo¬graphic distribution between the two analyzed etiological groups. It includes and studies 57 patients with non-odontogenic abscesses and phlegmons of the head and neck. In all of them, as a routine procedure, mate¬rial was taken from the surgical wound for microbiological examination and the identification of the isolated bacteria was confirmed by a microbiological analyzer “VITEK” (“BioMérieux”, France). After analyzing the obtained results, the goal was confirmed - the largest part is of the resident microflora (59.5%, n=34) of which 50.75% (n=29) mixed resident microflora and 8.75% (n=5) mono infections, followed by represen¬tatives of Gram-positive bacteria (15.75 %, n=9), Gram-negative ones (5.25%, n=3) and obligate anaerobes (1.75%, n=1). In the studied group of patients with non-odontogenic abscesses, Gram-positive bacteria are 3 times more than Gram-negative. The causative agents of phlegmons of non-odontogenic origin in the maxil¬lofacial region are Gram-negative bacteria and obligate anaerobes in a 1:1 ratio. Unlike patients with odonto¬genic purulent diseases, in which the young population under the age of 44 is most affected, non-odontogenic abscesses and phlegmons most often affect mature individuals between the ages of 45 and 59.

An Osteopathic Approach to Vertigo with Galbreath Technique: A Case Report

Abstract Vertigo is a symptom with a wide range of etiologies as diverse as the patients it affects. The wide spectrum of etiologies can make a diagnosis difficult and therefore delay definitive treatment. The diagnosis is not commonly linked to somatic dysfunctions, however these somatic dysfunctions may be contributing to or causing a problem altogether. This case highlights the importance of investigating for somatic dysfunctions related to a patient’s presentation. A 73-year-old female presented with a history of vertigo and a current feeling of fullness and ringing in her ears. She was found to have significant Eustachian tube dysfunction related to her condition. An osteopathic approach with emphasis on the Galbreath technique was utilized to relieve her ear symptoms and decrease her ongoing episodes of vertigo.

Budd-Chiari syndrome in children: Challenges and outcome

Budd-Chiari syndrome (BCS) is an uncommon disease of the liver, characterised by obstruction of the hepatic venous outflow tract. The etiological spectrum of BCS as well as venous obstruction pattern show wide geographical and demographic variations across the globe. Compared to adults with BCS, children have primary BCS as the predominant etiology, earlier clinical presentation, and hence better treatment outcome. Underlying prothrombotic conditions play a key role in the etiopathogenesis of BCS, though work-up for the same is often unyielding in children. Use of next-generation sequencing in addition to conventional tests for thrombophilia leads to better diagnostic yield. In recent years, advances in radiological endovascular intervention techniques have revolutionized the treatment and outcome of BCS. Various non-invasive markers of fibrosis like liver and splenic stiffness measurement are being increasingly used to assess treatment response. Elastography techniques provide a novel non-invasive tool for measuring liver and splenic stiffness. This article reviews the diagnostic and therapeutic advances and challenges in children with BCS.

OGC P39 The accuracy of Hospital Acquired Pneumonia (HAP) Diagnosis after Oesophagectomy

Abstract Background Oesophagectomy is a high-risk intervention associated with significant rates of morbidity. Pneumonia is a complex spectrum of infective and non-infective aetiology, varying in severity and is common after oesophagectomy. Inconsistent definitions of pulmonary complications pose significant challenges in both the clinical and research setting. The internal Esophageal Consensus Complications Group (ECCG) have adopted the Centre for Disease Control (CDC) criteria for HAP diagnosis to address this. However, other validated diagnostic criteria are also available. This study aimed to better understand the incidence of HAP after oesophagectomy, and the accuracy of four validated diagnostic tools. Methods This was a retrospective review of all consecutive oesophagectomies undertaken at a regional OG centre serving a population of 3.5 million patients between 2014-2022. Datapoints included patient demographics; comorbidities; post-operative course and re-admissions. The timing of pneumonia diagnosis was determined in the post-operative period, alongside observations and Computed Tomography (CT) and Chest X-Ray (CXR) reports. Four diagnostic criteria (Centres for Disease control- CDC, American Thoracic Society - ATS, Utrecht and Clinical Pulmonary Infection Score - CPIS) were applied to determine the incidence of HAP in comparison to patients treated for HAP. Statistical tests were performed in STATA. Results 460 patients were included, 356 (77.40%) were male. 223 (48.5%) were treated for HAP between 2014-2022. 56 (12.2%) met the CDC criteria. Mean days to diagnosis was 5 days (SD +/- 3.72). Diagnostic sensitivity and specificity for HAP was 88.89%, and 50.15% respectively. The ATS criteria were met by 79 patients (17.2%), showing a similar sensitivity (97.53%) and specificity (92.02%) to the CDC criteria. The Utrecht criteria had the lowest specificity (75.20%) for HAP diagnosis. 192 patients had sputum samples; 158 (82.29%) were culture positive. 52 patients were re-intubated, of which 29 (55.8%) were reintubated due to respiratory failure. Conclusions HAP is a complex and nuanced diagnosis with high inter-observer variation. Currently available and validated diagnostic tools result in different rates of HAP diagnosis. These findings highlight the importance of adopting robust approaches to diagnosing HAP to avoid unnecessary treatments and to more accurately determine the effectiveness of protocolised management (such as ERAS) that target HAP. The findings also highlight important implications on outcome reporting in research, particularly with interventions (e.g. minimally invasive and robotic surgery) which aim to reduce the burden of post-operative morbidity. Further widescale studies are required to validate these findings.

The Etiological Bacterial Spectrum of Neck Abscesses of Lymph Node Origin - Gram-Positive and Gram-Negative Bacteria.

According to our medical practice as maxillofacial and oral surgeons, operated patients with purulent infections of the cervical lymph nodes are not many in number. On the other hand, the presence of a purulent infection requires not only the surgical evacuation of the pusbut also the application of antimicrobial preparations. This necessitatesgood knowledge of the spectrum of the bacterial causative agents of the disease, the determination and analysis of which is the purpose of this original article. The bacteria studied in 181 patients with a mean age of 26.25 years, ranging between 29 days and 82 years, who underwent surgery for suppurating cervical lymph nodes, were retrospectively analyzed over a period of eight years. No bacteria were found in 69 of them. In 83 (74.11%) of the remaining 112 studied patients, the isolated microorganisms were of the gram-positive spectrum - Staphylococcus aureus (n=34), gram-positive resident microflora represented by more than one bacterial species (n=21), Staphylococcus hemolyticus (n=10), Staphylococcus epidermidis (n=9) and beta-hemolytic streptococci (n=9). Gram-negative bacteria were 25.89% (n=29) - Klebsiella pneumoniae (n=8), Bartonella henselae (n=7), Klebsiella oxytoca (n=6), Enterobacter cloacae (n=5) and Flavimonas oryzihabitans (n=3). No anaerobic and fungal microorganisms were isolated. Therefore, antimicrobial therapy in these patients should be directed against both gram-positive and gram-negative bacteria, which in our study were represented in a ratio of approximately three to onein favor of gram-positive microorganisms. Otherwise, we create a prerequisite for the formation of phlegmon on the neck, which hides real chances for the lives of patients.

Etiological Spectrum of Cirrhosis in India: A Systematic Review and Meta-analysis

Cirrhosis is a significant cause of morbidity and mortality globally and in India. This systematic review and meta-analysis aimed to ascertain the etiological spectrum and changing trends of cirrhosis in India. We searched electronic databases, including Pubmed/Medline, Scopus, and Embase. We included original studies that reported the etiology of cirrhosis in the Indian population. We included 158 studies (adults: 147, children: 11). The overall pooled estimate of alcohol as a cause of cirrhosis in adults was 43.2% (95% confidence interval (CI) 39.8-46.6%; I2= 97.8%), followed by nonalcoholic fatty liver disease (NAFLD)/cryptogenic in 14.4%, 95% CI (11.7-17.3%; I2= 98.4%), hepatitis B virus (HBV) in 11.5%, 95% CI (9.8-13.3%; I2= 96.6%), and hepatitis C virus (HCV) in 6.2%, 95% CI (4.8-7.8%; I2= 97.2%) of the included patients. The most common cause of cirrhosis in all zones was alcohol-related. Comparison of etiologies over time revealed a reduction in the viral hepatitis-related and an increase in the proportion of alcohol-related and NAFLD/cryptogenic-related cirrhosis. The overall pooled estimates of various etiologies in children were: HBV in 10.7%, 95% CI (4.6-18.7%; I2= 91.0%), NAFLD/Cryptogenic in 22.3%, 95% CI (9.0-39.2%; I2= 96.7%), and HCV in 2.0%, 95% CI (0.0-8.5%; I2= 94.6%). Alcohol is the most common etiology of cirrhosis in adults in India. The proportions of alcohol and NAFLD-related cirrhosis are increasing, and those of viral hepatitis-related cirrhosis are reducing. The results of our meta-analysis will help formulate health policies and the allocation of resources.

Epidemiological effectiveness of domestic influenza vaccines in cases with vaccination against a new coronavirus infection in 2022–2023

The study presents the results of an epidemiological prospective field cohort study on a comparative assessment of the epidemiological effectiveness of domestic inactivated influenza vaccines and vaccines against new coronavirus infection during immunization of adults aged 18 years. Statistically significant differences were found in the incidence of influenza, acute upper respiratory infections, and new coronavirus infection between the vaccinated and unvaccinated groups. The etiologies of cases of acute upper respiratory infections registered in the study participants during the epidemic season of influenza in 2022–2023 were verified. The clinical symptoms of influenza in the vaccinated group were significantly less severe than those in the unvaccinated group. No significant differences were found in the clinical picture of acute upper respiratory infections between the compared groups. Influenza immunoprophylaxis is an urgent problem, which consists of the ability of viruses to change their antigenic structure and avoid immunity, remaining in constant circulation. Thus, the antigenic composition of influenza vaccines must be systematically updated to ensure the formation of effective population immunity. More studies on the etiological spectrum of respiratory pathogens and assessment of the epidemiological effectiveness of vaccination against vaccine-controlled infections in the analyzed groups are needed. Therefore, to assess immunological protection, including the assessment of the epidemiological effectiveness of seasonal vaccines used against influenza and new coronavirus infection, the priority age group includes individuals aged 18–25 years (especially those belonging to organized collectives) and adults with an unfavorable premorbid background. The use of domestic vaccines against influenza and the new coronavirus infection for specific immunoprophylaxis is generally recognized as the most effective sanitary and anti-epidemic (preventive) measure in the morbidity management of several infectious diseases.

Etiological Spectrum, Epidemiological Characteristics in Compensated and Decompensated Cirrhosis at First Presentation

ABSTRACT Context and Aim: Decompensation as a presenting feature is uncommon among cirrhosis-seeking consultations and may indicate the poor outcomes. This study will be assessing the etiology and epidemiological characteristics among compensated and decompensated cirrhosis at first presentation. Settings and Design: A cross-sectional study in a tertiary care hospital in south Kerala, India. Subjects and Methods: Two hundred and nine patients with liver cirrhosis were evaluated for: age at presentation to the hospital, biochemical, virologic, Child–Pugh and Model for end-stage liver disease (MELD), and MELD Sodium (MELD Na) scores. Using cutoff for MELD Na and Child scores A versus B and C, the degree of association in those with or without decompensation was evaluated. Results: The mean (standard deviation) age of participants was 58.24 (±9.9) years. Seventy-seven percent were males. 11.5% were with decompensated cirrhosis (DC). 61.2% had alcoholic liver disease (ALD); 8.1% had hepatitis B; 2.4% hepatitis C virus; 0.5% autoimmune hepatitis; and 27.8% had nonalcoholic steatohepatitis (NASH). In compensated cirrhosis (CC), 60.5% had ALD and 28.1% (n = 52) had NASH, whereas, in those with decompensation, 66.7% had ALD and 25% had NASH. In CC, 54.1% were Child A and the rest B and C compared to DC, wherein 58.3% were with Child B and C and 41.7% in Child A. MELD Score of 9+ was more in DC compared to CC (P = 0.05). Alcoholic hepatitis was observed in 32% of DC. Conclusions: Decompensation was the presenting feature in 11.5%, and alcohol abuse was the major risk factor. Those with DC have higher MELD scores.

Etiological Profile of Dyspepsia in Difficult-to-reach Tribal Population of Himachal Pradesh

Abstract Background: Dyspepsia exhibits a diverse range of underlying causes, with functional dyspepsia (FD) surpassing organic etiologies in prevalence. However, there exists a noticeable absence of prior research delineating the etiological spectrum of dyspepsia among the tribal regions of Himachal Pradesh (HP). The present study was carried out to determine the etiological profile of dyspepsia within this specific population. Materials and Methods: Conducted as a cross-sectional observational study centered around an endoscopy health camp, this investigation took place at the community health center in Kaza – a pivotal administrative hub in the remote Spiti Valley of the Lahaul and Spiti tribal district in HP. The study encompassed consecutive patients above 18 years of age presenting with gastrointestinal complaints. Those predominantly reporting dyspepsia were selected and subsequently underwent thorough endoscopic examination. Data analysis incorporated factors such as age, gender, history of smoking, alcohol consumption, nonsteroidal anti-inflammatory drug usage, and endoscopic findings. Results: Encompassing a total of 187 patients with an average age of 48.5 ± 13.4, the study found that endoscopy yielded normal results in 59.9% of cases (categorized as FD), whereas 40.1% displayed abnormal findings (categorized as organic dyspepsia). Among the latter, the most prevalent organic lesions were peptic ulcer disease (PUD) (62.7%) and erosive esophagitis (22.7%). Furthermore, gastric malignancy was detected in 4% of the cases. Conclusion: The primary organic causes of dyspepsia within the tribal areas of HP appear to be dominated by PUDs, closely followed by erosive esophagitis. Gastric malignancy, although less frequent, was identified in approximately 4% of the dyspeptic cases studied.

S1676 The Etiological Spectrum of Gastric Outlet Obstruction in Children Beyond Infancy and Outcomes of Endoscopic Balloon Dilatation

S1676 The Etiological Spectrum of Gastric Outlet Obstruction in Children Beyond Infancy and Outcomes of Endoscopic Balloon Dilatation

Etiological Bacterial Spectrum of Purulent Inflammation of Cervical Lymph Nodes in Children With Unknown Causes of Lymphadenopathy.

In the management of the non-specific purulent inflammation of the cervical lymph nodes in children, not only surgical treatment to evacuate the available pusbut also antibacterial therapy is mandatory. Knowledge of the spectrum of the bacterial causative agents of this disease is of fundamental importance for it. This retrospective study included 66 patients with purulent inflammation of the cervical lymph nodes with a mean age of 5.79 years, ranging from 29 days to 17 years, who were hospitalized for the period 2015-2022 in the three pediatric clinics at the St. Marina University Multispecialty Hospital for Active Treatment in Varna, Bulgaria, and operated by an oral or maxillofacial surgeon, in which for microbiological examination material from the suppurated lymph node was taken and analyzed first by direct microscopy for gram-positivity and then on a biochemical machine identifier VITEK(bioMérieux, Marcy-l'Étoile, France). In all of them, the patients and their parents did not provide anamnestic data explaining the etiology of their infectious diseases of the cervical lymph nodes. There was no clear cause that would explain the occurrence of cervical lymphadenopathy - skin infections, dental diseases, diseases of the ears and upper and lower respiratory tracts, onco-hematological diseases, and others. During the medical examination by pediatricians and surgeons, no entrances to the infection were found, but only local signs of inflammation (redness, swelling, and pain), increased levels of blood markers of inflammation (leukocytes, neutrophils, erythrocyte sedimentation rate, and C-reactive protein) and there was imaging evidence (ultrasound, magnetic resonance imaging, and computed tomography) of a purulent collection in the lymph nodes and/or in the soft tissues surrounding them. Exudate without microbial growth was found in 22 of the cases. The main causative agents of purulent lymphadenopathy are gram-positive bacteria (n=32, 72,73%) - Staphylococcus aureus (n=16), Staphylococcus haemolyticus (n=8), Beta-hemolytic streptococcus(n=2), and gram-positive mixed resident microflora (n=6). However, in 27.27% (n=12) of all 44 patients described in this article with isolated pathogens, cultures were gram-negative. These are Bartonella henselae (n=4), Klebsiella pneumoniae (n=4), Klebsiella oxytoca (n=2), and Flavimonas oryzihabitans (n=2).

Ukraine: Chronic Kidney Disease in children and adolescents: retrospective and priorities

The present study aimed to assess the prevalence and structure of chronic kidney disease (CKD) in children and adolescents to determine the priorities for the development of pediatric nephrology in Ukraine.
 Methods. Individuals who were born in Ukraine after 1994 and had CKD diagnosed before the age of 18 were investigated. The number of CKD cases was estimated per 100,000 newborns depending on the year of birth, divided into time intervals: 1995-2004 and 2005-2022 years of birth. Both groups were stratified with the generalization of the etiological component. The patients on Kidney Replacement Therapy (KRT) were separated into special clinical group, and the etiological and age spectrum analysis of KRT initiation was performed depends of the year of birth. In addition, cross-sectional analysis of the etiological structure of KRT incidence and prevalence in years 2019 and 2021 was conducted.
 Results. The prevalence of CKD in children and adolescents in Ukraine increased over a long period up to year 2022 (average cases per 100,000 births: 43.5 in years 1995-2004, 37.0 in years 2005-2022:) with an amplification of early stages (CKD1-4: year 2010 - 81.4%, year 2022 - 92.0%) and KRT decrease, respectively (average cases per 100,000 births: 6.5 and 3.3 in the analyzed time intervals). The individuals with primary urological pathology made up a third or more among CKD patients (depending on the year of birth). The etiological and age spectrum differences of KRT were determined in the analyzed time intervals. Depending on the underlying cause of CKD, the age of KRT initiation in born before year 2005 varied from 9 to 16 years, in the following period - from 1 to 9 years.
 The differences from the ESPN Registry were identified in cross-sectional etiological spectrum of CKD with KRT initiation in year 2019 (age up to 15 years old): the higher proportion of patients after Acute Kidney Injury/AKI (16.7%) or with glomerulonephritis/GN (30.0%), and the smaller one of congenital anomalies of kidney and urinary tract/CAKUT (26.6%). The distribution of KRT causes in Ukraine under the age of 18 did not change in years 2019 and 2021 (including polycystic kidney disease/PKD 12.1-11.2%, GN 15.0-16.5%, AKI 12.1-13.1%, CAKUT 32.4-31.0%, respectively), but only for CAKUT and PKD was approximated to ISPN Global Registry data.
 Conclusions. The revealed qualitative changes in the etiological and age structure of morbidity over a long period in Ukraine indicate the CKD pathomorphosis and require updating the clinical managment of patients depends of the economic and organizational potential of the country, the challenges of martial law and the difficulties of the next recovery period.

Preoperative Predictors of Mortality in Patients with Perforation Peritonitis

Abstract Background: Perforation peritonitis is the most common surgical emergency in India. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, management of peritonitis continues to be highly demanding, difficult and complex. The spectrum of etiology of perforation continues to be different from that of western countries and there is paucity of data from India regarding it’s etiology, prognostic indicators, morbidity and mortality patterns. Aims and Objective: Our research sought to show the variety of perforation peritonitis that we encountered at the LLRM Medical College and Hospital Meerut as Despite the fact that perforation peritonitis has implications that contemporary surgeons cannot avoid but by applying preoperative predictors effectively, they can diagnose a patient’s condition and reduce the mortality burden on society. Materials and Methods: Seventy consecutive patients admitted to LLRM MEDICAL COLLEGE MEERUT with perforation peritonitis, of age more than 12 years scheduled for emergency laparotomy were studied prospectively. The parameters studied were age and sex of the patients, history of chronic smoking ,duration of symptoms, SBP, pulse rate, respiratory rate, oxygen saturation on presentation ,delay in initiating surgical intervention, and preoperative biochemical parameters such as hemoglobin and serum creatinine. In-hospital mortality was taken as the outcome. Results: We encountered a mortality of 24.28% in our study. Multiple linear (enter) regression identified the age, duration of symptoms, SBP on presentation, SPO2 on presentation respiratory rate on presentation, serum creatinine levels, and the delay in instituting surgical intervention as independent predictors of mortality. Conclusion: Routine biochemical investigations, delay in presentation and surgical intervention are good predictors of mortality. Recognizing such patients early with risk stratification and providing early goal-directed therapy can improve the outcome.

Etiological Spectrum and Outcome of Acute Kidney Injury in Children: A Tertiary Care Experience

Objective: To determine the aetiologies and outcomes which would help reduce preventable deaths from acute kidney injury.
 Study Design: Prospective longitudinal study.
 Place and Duration of Study: Paediatric Nephrology unit at University of Child Health Sciences, The Children’s Hospital Lahore Pakistan, from Aug 2021 to Jul 2022.
 Methodology: A total of 149 children who fulfilled the selection criteria were included in the study. Kidney Disease: Improving Global Outcomes guidelines were used for defining and staging acute kidney injury. The aetiology for each case of acute kidney injury was determined using standard workup/protocol and classified as pre-renal, renal and post-renal. Outcome parameters were recovery, improvement, death and progression to chronic kidney disease.
 Results: The mean age of children was 61.79±52.26 months, predominantly boys (68.5%). The most common etiological group was renal (73,49%), followed by pre-renal (53,35.6%) and post-renal (23,15.4%). It was observed that the majority of children had stage-3 AKI (63.8%), with kidney replacement therapy (KRT) given in 92(61.7%) cases. Mortality was seen in 30.9%, while recovery, improvement and death occurred in 69(46.3%), 44(29.5%) and 36(24.2%), respectively, at the time of discharge. At three months of follow-up, recovery, progression to chronic kidney disease, and death occurred in 73(49.0%), 20(13.4%) and 10(6.7%) children, respectively.
 Conclusion: Intrinsic renal disease was the most common etiological group occurring primarily in the form of AGN, and sepsis was found to be the most common underlying aetiology. Most patients presented in Stage 3 of acute kidney injury, and recovery was seen in many patients.

Evaluation of pancytopenia based on bone marrow examination in adults in a tertiary care hospital in Islamabad.

Objective: To evaluate etiological spectrum of pancytopenia in adults using bone marrow aspiration biopsy. Study Design: Randomized Prospective study. Setting: Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad. Period: October 2018-October 2020. Material & Methods: Eight hundred bone marrow biopsies were performed out of which 250 patients came with pancytopenia. 135 patients out of these were in adult age group which are included in this study. Results: Out of 250 patients adults were 135 that presented with pancytopenia. Male to female ratio came out to be 1.22:1. The most common disorder that results in pancytopenia came out to be megaloblastic anemia that was 29.6%, after that 26.6% were infection related changes, 10.3% aplasia, 9.6% reactive marrow, 5.9% acute leukemia, 3.7% chronic leukemia and iron deficiency anemia followed by 2.9% myelodysplastic syndromes and hypersplenism, 2.2% multiple myeloma, 1.4% mixed deficiency anemia and 0.74% myelofibrosis. We also analyzed patients on their presenting complaints as well. Most common complaint of presentation was fever (54.8%), (31.85%) with fatigue and malaise, (31.1%) pallor, vomiting and diarrhea (25.9%) followed by bleeding (14.8%). On clinical examination 12% cases presented with hepatomegaly and 16.6% with splenomegaly. Conclusion: Pancytopenia is a common hematological finding in our setup with megaloblastic anemia to be the most common cause of it. Therefore, it’s very important to diagnose it as this is a curable (reversible) deficiency and patients can easily be managed to prevent serious hematological and neurological abnormalities.

Frequency of significant steatosis and compensated advanced chronic liver disease among adults with chronic liver disease.

With changes in the epidemiology and treatment of chronic liver disease (CLD), the impact of various etiologies of liver disease on steatosis and advanced fibrosis are uncertain. A retrospective study was conducted among liver disease patients of various etiologies undergoing transient elastography (TE) over a 9-year duration. Data for 2886 patients were analyzed and had the following demographics: The median age was 60 (IQR: 45-69) years, 51% were males, and ethnicity was predominantly Chinese (52.5%), followed by Malays (34%) and Indians (12.3%). The median CAP score was 272 (IQR: 219-319) dB/m and the median liver stiffness measurement (LSM) score was 6.5 (IQR: 4.9-9.7) kPa. Hepatic steatosis occurred across the spectrum of etiologies of CLD. Among patients with steatosis, the most common etiologies were nonalcoholic fatty liver disease (NAFLD) at 62% and chronic hepatitis B (CHB) at 26.3%. TE findings suggestive of cACLD (10.1-15kPa) and highly suggestive of cACLD (>15kPa) were observed in 11.3% and 12.4% of patients, respectively. NAFLD was found to be the most common etiology for cases with suggestive of cACLD (47.2%) and highly suggestive of cACLD (41.5%). Hepatic steatosis is common in CLD, regardless of etiology. Compared with other etiologies, NAFLD is now the leading cause of cACLD.