DIPLOMATE OF NATIONAL BOARD, NEW DELHI



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1. |Name of the Candidate and Address | |

| |[in block letters] |DR.KAMALESH.T.N |

| | |POST GRADUATE RESIDENT, |

| | |DEPARTMENT OF GENERAL MEDICINE, |

| | |KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES, |

| | |BANASHANKARI 2ND STAGE, |

| | |BANGALORE – 560004. |

|2. |Name of the Institution | KEMPEGOWDA INSTITUTE OF |

| | |MEDICAL SCIENCES. |

| | | |

| | | |

|3. |Course of study and subject |M.D. GENERAL MEDICINE |

|4. |Date of admission to Course |31-05-2012 |

|5. |TITLE OF THE TOPIC: |

| |THE CLINICAL STUDY OF END STAGE LIVER DISEASE IN CORRELATION WITH MELD SCORE AND MELD Na SCORE |

|6. |BRIEF RESUME OF THE INTENDED WORK: |

| |INTRODUCTION: |

| |It is very important to give a score for all patients who are critically ill. Now-a-days the trend is shifting from the |

| |general scoring system towards disease specific scoring system. MELD score was previously used for predicting the outcome |

| |in patients undergoing elective transjugular intrahepatic portosystemic shunts and in patients undergoing liver |

| |transplantation. |

| |Now-a-days MELD score has been shown to be of much use in predicting outcome in end stage liver disease. |

| |Many studies have shown that hyponatremia is one of the independent predictor of outcome in patients with cirrhosis |

| |especially those with ascitis. A decrease in serum sodium by 1 meq results in 12% reduction in 3months survival. |

| |Hence it was thought that adding serum sodium to MELD score would strengthen the predicting power of MELD score. And this |

| |score is popularly known as MELD-Na score. |

| |Correlating each of the clinical features to these scores gives a meaningful dimension to each clinical feature. And by doing|

| |so we can give a outcome priority to each clinical feature. |

| |MELD score = 0.957 x log(creatinine in mg/dl) + 0.378xlog(bilirubin mg/dl) + 1.120xlog(INR)+0.643. |

| |The score is multiplied by 10 and rounded to the nearest whole number. |

| | |

| |MELD-Na score = MELD+1.59 (135-Na) |

| |3 month mortality prediction by MELD score : |

| |MELD score > 40 : 71.3% mortality |

| |MELD score 30–39 : 52.6% mortality |

| |MELD score 20–29 : 19.6% mortality |

| |MELD score 10–19 : 6.0% mortality |

| |MELD score < 9 : 1.9% mortality |

| |Mortality prediction by MELD Na score: |

| |1. MELD-Na” score of 20 was associated with a 6% (95%CI: 3%–9%) risk of death within 6 months of registration. |

| |2. “MELD-Na” score of 30 was associated with a 16% (95% CI: 9%–22%) risk and |

| |3. “MELD-Na” score of 40 with a 37% (95% CI: 22%–49%) risk. |

| | |

| |According to Medicare guidelines, patients will be considered to be in the terminal stage of liver disease (life expectancy |

| |of six months or less) and eligible for hospice care, if they meet the following criteria (1 and 2 must be present; factors |

| |from 3 will lend supporting documentation): |

| |1. The patient should show both a and b: |

| |a. Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio (INR)> 1.5 |

| |b. Serum albumin ................
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