Ranjan George Baxla

Bio: Ranjan George Baxla is an academic researcher from Rajendra Institute of Medical Sciences. The author has contributed to research in topics: Acute pancreatitis & Internal hernia. The author has an hindex of 2, co-authored 6 publications receiving 23 citations.

Predicting morbidity and mortality in acute pancreatitis in an Indian population: a comparative study of the BISAP score, Ranson’s score and CT severity index

Abstract: Objective: Our aim was to prospectively evaluate the accuracy of the bedside index for severity in acute pancreatitis (BISAP) score in predicting mortality, as well as intermediate markers of severity, in a tertiary care centre in east central India, which caters mostly for an economically underprivileged population. Methods: A total of 119 consecutive cases with acute pancreatitis were admitted to our institution between November 2012 and October 2014. BISAP scores were calculated for all cases, within 24 hours of presentation. Ranson’s score and computed tomography severity index (CTSI) were also established. The respective abilities of the three scoring systems to predict mortality was evaluated using trend and discrimination analysis. The optimal cut-off score for mortality from the receiver operating characteristics (ROC) curve was used to evaluate the development of persistent organ failure and pancreatic necrosis (PNec). Results: Of the 119 cases, 42 (35.2%) developed organ failure and were classified as severe acute pancreatitis (SAP), 47 (39.5%) developed PNec, and 12 (10.1%) died. The area under the curve (AUC) results for BISAP score in predicting SAP, PNec, and mortality were 0.962, 0.934 and 0.846, respectively. Ranson’s score showed a slightly lower accuracy for predicting SAP (AUC 0.956) and mortality (AUC 0.841). CTSI was the most accurate in predicting PNec, with an AUC of 0.958. The sensitivity and specificity of BISAP score, with a cut-off of � 3 in predicting mortality, were 100% and 69.2%, respectively. Conclusions: The BISAP score represents a simple way of identifying, within 24 hours of presentation, patients at greater risk of dying and the development of intermediate markers of severity. This risk stratification method can be utilized to improve clinical care and facilitate enrolment in clinical trials.

Accuracy of C-reactive Protein, Neutrophil Count, Total Leukocyte Count and Ultrasonography in Diagnosis of Acute Appendicitis

Abstract: Background: The most common cause of acute surgical abdomen is acute appendicitis and most commonly done emergency surgery is appendicectomy. Although a battery of tests and different scoring methods are available for diagnosis of acute appendicitis, it is very diffi cult to do prevent negative explorations for appendicectomy (15-30%). None of the tests has satisfactory sensitivity and specifi city that can be relied upon. Objectives: The aim of the present study was to evaluate role of C-reactive protein (CRP), total leukocyte count, neutrophil count and ultrasonography (USG) of abdomen in diagnosing acute appendicitis and reducing the rates of negative appendicectomies. In addition, emphasis was given to whether combining the investigations in the same patient would improve the diagnostic accuracy. Materials and Methods: A total of 100 clinically diagnosed patients of acute appendicitis, posted for emergency appendicectomy were included in the study in General Surgery Department of Rajendra Institute of Medical Sciences, Ranchi during the period from September 2011 to October 2013. Preoperatively blood tests for CRP, total leukocyte count, differential leukocyte count (DLC) and USG abdomen were done. All patients were subjected to histological examination postoperatively, which was taken as the gold standard. The four investigations results were correlated with histo-pathological examination reports to evaluate their role in diagnosis of acute appendicitis. Results: In the present study, CRP has the highest sensitivity and specifi city (90%, 80%) followed by USG (87.5%, 90%), white blood cells (WBC) count (78.75%, 80%) and neutrophil count (77.5%, 80%). Combining CRP and WBC count increases the sensitivity and specifi city of the tests (96.25%, 80%). Conclusion: CRP contains important diagnostic information and hence should always be included in the diagnostic workup of acute appendicitis. The sensitivity of WBC count and DLC are low individually, but when combined with CRP the sensitivity and specifi city increases. When all four tests are negative acute appendicitis is very unlikely and surgery can be safely deferred in these patients thereby reducing the negative appendicectomy rates.

Filarial scrotal tumor

Abstract: Filariasis caused by the nematode Wuchereria Bancrofti is a public health and socioeconomic problem in tropical and sub-tropical countries. The clinical manifestations depend upon the course of infection in the human host and the worm load. It is a rarity to document filarial worms in histopathology from the testes. We present a giant filarial scrotum of size 30 kg in weight. INTRODUCTION: Lymphatic filariasis is a major health problem in India with a large number of patients tending to be asymptomatic. Genital filariasis in India more commonly presents as a secondary vaginal hydrocele with an associated epididymo-orchitis. CASE REPORT: A 40y/M, from jhalda, farmer by occupation. No history of trauma associated. c/o: Scrotal swelling for 8yrs.patient gave history of progressive increase in the size of swelling from football size to present size. During initial period of disease patient sometimes had rise in body temperature, malaise and tenderness in the swelling but with progression of disease the all symptoms vanished. O/E: swelling is 38into 34cm in size, ovoid in shape, you can get above the swelling. The swelling was non-reducible. Coughing impulse is absent. Skin above the swelling was wrinkled, Penis was buried. Cord was thickened, testis not palpable. Swelling was oval in shape hard in consistency, non-tender, with no rise in local temperature, no translucency; reducibility. USG: suggest Filarial scrotal tumour With the patient in a modified lithotomy position, we excised the lymphedematous mass with a U-shaped incision. The neo-scrotum was made by anterior and posterior flaps. Both testes have been preserved. Reduction scrotoplasty has been done. A romovac drain was put in pouches prepared for the testicles. Postoperative period was uneventful mass was send for histopathological examination. Patient was followed for 6 month for recurrence.

Herniation through lesser sac: a rare type of primary internal hernia causing small intestinal obstruction

Abstract: Primary internal hernia is a rare phenomenon, where there is protrusion of an abdominal organ mostly gut through epiploic foramen. Clinical presentation of internal hernia is non specific.Imaging has been of limited utility in cases of acute intestinal obstruction; moreover ,interpretation of imaging features is operator dependant. Thus internal hernias are usually detected at laparotomy and preoperative diagnosis in an emergency setting is either difficult or most of the time not suspected We describe the case of a 14-year-old male who presented with acute abdominal pain and abdominal distension with no history of trauma .A loop of jejunum was found to enter the lesser sac with multiple peforated jejunal loop 35cm distal to dj junction. .The segment of perforated bowel loop of length 10cm was resected and jejuno-jejunostomy was done.This is a rare type internal hernia into lesser sac.

JEJUNOJEJUNAL INTUSSUSCEPTION IN AN ADULT DUE TO LIPOMA. Lipoma bağlı jejunojejunal intussusepsiyon olgusu.

Abstract: Intussusception is a rare cause of intestinal obstruction in adults Among all types jejuno-jejunal intussussception is very rare We are presenting a case of jejuno-jejunal intussusception in an adult that was treated by resection and anastomosis OZET Intussusepsiyon yetiskinlerde barsak tikanikliginin nadir bir sebebidir Ozellikle jejuno-jejunal tip intussusepsiyon ise cok daha nadir gorulen bir durumdur Burada, jejuno-jejunal intussusepsiyon nedeniyle rezeksiyon ve uc uca anastomoz yaptigimiz bir olguyu sunduk

The early prediction of mortality in acute pancreatitis : a large population-based study. Commentary

Abstract: Background: Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome. Methods: Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17 992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18 256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II. Results: CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN) >25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age >60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 (95% Cl 0.79 to 0.84) versus APACHE II AUC of 0.83 (95% Cl 0.80 to 0.85). Conclusions: A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.

A comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification

Abstract: Objective Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Bedside Index of Severity in Acute Pancreatitis (BISAP), Ranson's score and modified Computed Tomography Severity Index (CTSI) in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India. Methods Fifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study. APACHE II, BISAP and Ranson's score were calculated for all the cases. Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography (CT). Optimal cut-offs for these scoring systems and the area under the curve (AUC) were evaluated based on the receiver operating characteristics (ROC) curve and these scoring systems were compared prospectively. Results Of the 50 cases, 14 were graded as severe acute pancreatitis. Pancreatic necrosis was present in 15 patients, while 14 developed persistent organ failure and 14 needed intensive care unit (ICU) admission. The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis (0.919), pancreatic necrosis (0.993), organ failure (0.893) and ICU admission (0.993). APACHE II was the second most accurate in predicting severe acute pancreatitis (AUC 0.834) and organ failure (0.831). APACHE II had a high sensitivity for predicting pancreatic necrosis (93.33%), organ failure (92.86%) and ICU admission (92.31%), and also had a high negative predictive value for predicting pancreatic necrosis (96.15%), organ failure (96.15%) and ICU admission (95.83%). Conclusion APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral, especially in resource-limited developing countries.

Computed Tomography Severity Index vs. Other Indices in the Prediction of Severity and Mortality in Acute Pancreatitis: A Predictive Accuracy Meta-analysis

Abstract: Background: The management of the moderate and severe forms of acute pancreatitis (AP) with necrosis and multiorgan failure remains a challenge. To predict the severity and mortality of AP multiple clinical, laboratory-, and imaging-based scoring systems are available. Aim: To investigate, if the computed tomography severity index (CTSI) can predict the outcomes of AP better than other scoring systems. Methods: A systematic search was performed in three databases: Pubmed, Embase, and the Cochrane Library. Eligible records provided data from consecutive AP cases and used CTSI or modified CTSI (mCTSI) alone or in combination with other prognostic scores [Ranson, bedside index of severity in acute pancreatitis (BISAP), Acute Physiology, and Chronic Health Examination II (APACHE II), C-reactive protein (CRP)] for the evaluation of severity or mortality of AP. Area under the curves (AUCs) with 95% confidence intervals (CIs) were calculated and aggregated with STATA 14 software using the metandi module. Results: Altogether, 30 studies were included in our meta-analysis, which contained the data of 5,988 AP cases. The pooled AUC for the prediction of mortality was 0.79 (CI 0.73-0.86) for CTSI; 0.87 (CI 0.83-0.90) for BISAP; 0.80 (CI 0.72-0.89) for mCTSI; 0.73 (CI 0.66-0.81) for CRP level; 0.87 (CI 0.81-0.92) for the Ranson score; and 0.91 (CI 0.88-0.93) for the APACHE II score. The APACHE II scoring system had significantly higher predictive value for mortality than CTSI and CRP (p = 0.001 and p < 0.001, respectively), while the predictive value of CTSI was not statistically different from that of BISAP, mCTSI, CRP, or Ranson criteria. The AUC for the prediction of severity of AP were 0.80 (CI 0.76-0.85) for CTSI; 0.79, (CI 0.72-0.86) for BISAP; 0.83 (CI 0.75-0.91) for mCTSI; 0.73 (CI 0.64-0.83) for CRP level; 0.81 (CI 0.75-0.87) for Ranson score and 0.80 (CI 0.77-0.83) for APACHE II score. Regarding severity, all tools performed equally. Conclusion: Though APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of both mortality and AP severity. When the CT scan has been performed, CTSI is an easily calculable and informative tool, which should be used more often in routine clinical practice.

An Artificial Neural Networks Model for Early Predicting In-Hospital Mortality in Acute Pancreatitis in MIMIC-III.

Abstract: Background Early and accurate evaluation of severity and prognosis in acute pancreatitis (AP), especially at the time of admission is very significant This study was aimed to develop an artificial neural networks (ANN) model for early prediction of in-hospital mortality in AP Methods Patients with AP were identified from the Medical Information Mart for Intensive Care-III (MIMIC-III) database Clinical and laboratory data were utilized to perform a predictive model by back propagation ANN approach Results A total of 337 patients with AP were analyzed in the study, and the in-hospital mortality rate was 112% A total of 12 variables that differed between patients in survivor group and nonsurvivor group were applied to construct ANN model Three independent variables were identified as risk factors associated with in-hospital mortality by multivariate logistic regression analysis The predictive performance based on the area under the receiver operating characteristic curve (AUC) was 0769 for ANN model, 0607 for logistic regression, 0652 for Ranson score, and 0401 for SOFA score Conclusion An ANN predictive model for in-hospital mortality in patients with AP in MIMIC-III database was first performed The patients with high risk of fatal outcome can be screened out easily in the early stage of AP by our model