Background: Acute pancreatitis (AP) is an inflammatory condition usually caused by alcohol or gallstones. Our goal was to prospectively compare the diagnostic efficacy of the Acute Physiology & Chronic Health Evaluation (APACHE) II, the Bedside Index of Severity in Acute Pancreatitis (BISAP), the Ranson's score & the Modified Glasgow Score (MGS) in determining the severity & outcome of Acute pancreatitis in a tertiary care facility in central India. Methods: Between December 2020 & December 2022, this prospective observational study was done in rural area of Wardha district. 110 subjects were included, and the diagnosis of acute pancreatitis was done using Atlanta criteria. APACHE II, MGS, Ranson score on admission, Ranson score 48 hours after admission & BISAP were used to evaluate each subject. The reciever operating curve was used to measure the specificity, sensitivity, NPV, PPV, diagnostic accuracy, area under the curve (AUC) & these scoring methods were then prospectively compared. Results: When a cut-off based on the literature was used, the APACHE II score could accurately diagnose severe cases of AP (n=110) in 69 patients, BISAP in 68 patients, MGS in 49, Ranson score on admission in 48 patients & after 48 hours in 48 patients. This study showed that Ranson score 48 hours after admission had a AUC (0.991), Ranson score at admission (AUC 0.989) & Modified Glasgow Scale (AUC 0.6486) had fair accuracy as compared to APACHE II (AUC 0.974) & BISAP (AUC 0.896) for determining the level of severity among AP patients based on ROC curves. Conclusion: To predict the severity of AP, the Ranson score after 48 hours showed the highest NPV, PPV, sensitivity, specificity, and diagnostic accuracy of all the scoring methods tested. The BISAP score had the highest specificity, sensitivity, PPV& NPV for determining the outcome of AP.

Hepatic encephalopathy is the most common neurologic complication of liver cirrhosis, whereas acquired hepatocerebral degeneration (AHD) is an underappreciated neurologic manifestation. Parkinsonism, ataxia, and neuropsychiatric symptoms are its defining characteristics. In individuals with chronic parenchymal liver disease with portosystemic shunting, it is an underrecognized etiology of psychomotor retardation. It has been hypothesized that the etiology of AHD is due to manganese buildup in the basal ganglia. This case report details a hepatocerebral degeneration (AHD) case in a patient with chronic parenchymal liver disease who improved after taking a dopamine agonist.

A 65-year-old man presented to the emergency medicine department with altered sensorium, a high-grade fever, and shock. On routine workup, he was diagnosed with acute respiratory distress syndrome with sepsis. Later, it was found that the patient had undetectable serum thyroid stimulating hormone and high triiodothyronine (T3) levels, which were diagnosed as a thyroid storm. This highlights the fact that a thyroid storm can present in any way and should be considered when determining the cause of septic shock that is not responding to standard treatment. A rare endocrine emergency, thyroid storm is a life-threatening endocrinological emergency with a considerable death rate of between 10% and 30% and multi-organ failure. It happens in thyrotoxic patients and manifests as the decompensation of several organs brought on by extreme stress. In addition to shock, the patient also had altered sensory perception, a cough, a fever, palpitations, and a sore throat. The patient was initially diagnosed with septic shock and was later treated with oral carbimazole, higher antibiotics, inotropes, and propranolol.

Peripheral vascular disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral vascular disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.