Comparison of a Novel Score "NOD-ACLF" to Other Established Prognostic Scores for Prediction of Mortality in APASL-ACLF Patients: A Cohort Study from a Tertiary Care Center of North India.

Background: Commonly used prognostic scores for acute on-chronic liver failure (ACLF) have complex calculations. We tried to compare the simple counting of numbers and types of organ dysfunction to these scores, to predict mortality in ACLF patients. Methods: In this prospective cohort study, ACLF patients diagnosed on the basis of Asia Pacific Association for Study of the Liver (APASL) definition were included. Severity scores were calculated. Prognostic factors for outcome were analysed. A new score, the Number of Organ Dysfunctions in Acute-on-Chronic Liver Failure (NOD-ACLF) score was developed. Results: Among 80 ACLF patients, 74 (92.5%) were male, and 6 were female (7.5%). The mean age was 41.0±10.7 (18-70) years. Profile of acute insult was; alcohol 48 (60%), sepsis 30 (37.5%), variceal bleeding 22 (27.5%), viral 8 (10%), and drug-induced 3 (3.8%). Profiles of chronic insults were alcohol 61 (76.3%), viral 20 (25%), autoimmune 3 (3.8%), and non-alcoholic steatohepatitis 2 (2.5%). Thirty-eight (47.5%) were discharged, and 42 (52.5%) expired. The mean number of organ dysfunction (NOD-ACLF score) was ->4.5, simple organ failure count (SOFC) score was >2.5, APASL ACLF Research Consortium score was >11.5, Model for End-Stage Liver Disease-Lactate (MELD-LA) score was >21.5, and presence of cardiovascular and respiratory dysfunctions were significantly associated with mortality. NOD-ACLF and SOFC scores had the highest area under the receiver operating characteristic to predict mortality among all these. Conclusion: The NOD-ACLF score is easy to calculate bedside and is a good predictor of mortality in ACLF patients performing similar or better to other scores.

Comparison of Objectively Assessed Versus Patient-Reported Clarity of Last Rectal Effluent for the Prediction of Quality of Bowel Preparation for Colonoscopy: A Prospective, Case-Control Study.

INTRODUCTION: Colonoscopy is a crucial procedure for various clinical purposes, including screening for colorectal cancer. Adequate bowel preparation is essential for its success. Poor bowel preparation can lead to bad outcomes. An objective assessment of bowel preparation quality is typically only possible after the colonoscope is inserted. This study aimed to objectively correlate the clarity of last rectal effluent, directly collected in a transparent container, with the quality of bowel preparation, and compare it with patient-reported descriptions. METHODS: This prospective, single-centre, case-control study obtained ethical clearance and included patients aged >18 years undergoing colonoscopies. Cases included patients who collected the last rectal effluent and took photographs, while controls relied on verbal descriptions. Data collected included demographics, clinical information, bowel preparation quality, and lastly, stool clarity. A statistical analysis was performed to identify correlations and associations. RESULTS: Of the 70 included patients, 45 were male. The mean age was 35.8 ± 14.3 years. Cases had a higher mean age (37.8 ± 14.6). A higher number of cases had comorbidities (11, 68.8%). Photographic recording of the last rectal effluent was not associated with the adequacy of bowel preparation. Thin yellow fluid was the most common last-rectal effluent clarity (33, 47.1%). Thin, clear fluid was significantly associated with adequate bowel preparation. CONCLUSION: Objective assessment of last rectal effluent clarity correlates with the quality of bowel preparation. This can improve the quality of bowel preparation for colonoscopies and potentially reduce the need for repeat procedures, contributing to better patient outcomes and cost savings in healthcare systems.

Dengue Encephalitis Versus Japanese Encephalitis in Cases of Dengue Fever With Altered Sensorium: A Diagnostic Dilemma.

Dengue and Japanese encephalitis (JE) are diseases that often conquer the top headlines in the leading newspapers during epidemics. Although recovery is the rule in most dengue cases, some unfortunately land up with multiple organ dysfunction syndromes, get critical, and even succumb to death. The main risk here is bleeding due to thrombocytopenia and platelet dysfunction. On the other hand, JE often presents with acute encephalitis syndrome (AES). We report a confirmed case of dengue (NS1 reactive, IgM dengue positive) by enzyme-linked immunosorbent assay (ELISA) who developed sudden onset altered sensorium. Non-contrast computed tomography (NCCT) head was done, which showed an infarct in the right gangliocapsular region with normal-sized ventricles. The patient had deteriorated in the past four days, which warranted a repeat NCCT head, revealing dilated ventricles and hemorrhagic transformation in the old infarct with surrounding edema. CSF viral markers were suggestive of IgM anti-JE virus positive. An MRI brain was planned but could not be done due to the deteriorating condition of the patient. Unfortunately, the patient landed up with multiple organ dysfunction syndrome and succumbed to death.

Type 2 Diabetes Mellitus in a Young Female Later Diagnosed as​​​​ Pancreatogenic Diabetes: The Dilemma in Classifying Diabetes Mellitus.

Diabetes mellitus type 3c (DM3c) is a diabetes caused by pancreatic pathology. It occurs due to the destruction of the endocrine islet cells. Diabetes diagnosed at the age of 20-30 years share a common dilemma in segregating between the type of diabetes the patient has, as its management varies depending on the type of diabetes the patient is harboring. However, insulin remains the treatment of choice in later decades as the pancreatic reserves of beta cells exhaust, although it takes decades to happen. We report a case of a woman who was diagnosed with diabetes mellitus at the age of 26, was on oral hypoglycemic agents (OHA), and was shifted to insulin therapy as she became non-responsive to OHA in a short span of six years, which was alarming. The patient presented to us with the chief complaints of recurrent abdominal pain that aggravated on taking meals and was associated with multiple episodes of vomiting for two months. Blood gas analysis on admission had no evidence of metabolic acidosis, urine ketones were negative, and a random blood sugar test (RBS:202) excluded the possibility of diabetic ketoacidosis. Serum amylase and serum lipase were within normal limits. Contrast-enhanced computed tomography (CECT) of the abdomen was suggestive of the atrophic pancreas with the non-dilated main pancreatic duct. Magnetic resonance cholangiopancreatography (MRCP) was done to rule out the congenital anomalies of the pancreas responsible for chronic pancreatitis, which showed no structural abnormalities. During our clinical workup, we postulated that the diabetes she was diagnosed with at the age of 26 was DM3c, i.e., pancreatogenic diabetes. The rapid shift of patients from OHA to subcutaneous insulin in a short span must be alarming to the physician managing diabetes and needs extensive workup to look upon the etiology of the same.