scholarly journals Challenges in the Diagnosis of Leak After Sleeve Gastrectomy: Clinical Presentation, Laboratory, and Radiological Findings

2020 ◽  
Author(s):  
Mohammad Al Zoubi ◽  
Nesreen Khidir ◽  
Moataz Bashah
Keyword(s):  
Abdominal Pain ◽  
Sleeve Gastrectomy ◽  
White Blood Cells ◽  
Delayed Diagnosis ◽  
Contrast Study ◽  
Radiological Findings ◽  
Reactive Protein ◽  
Presenting Symptoms ◽  
Clinical Presentations ◽  
The Mean

Abstract Background The presentation of leak after laparoscopic sleeve gastrectomy (LSG) is variable. A missed or delayed diagnosis can lead to severe consequences. This study presents our experience: the clinical presentations, laboratory, and radiological findings in patients with leak after LSG. Methods A retrospective review of patients who were diagnosed and treated as leak after LSG at our center (January 2012–November 2019). Results Eighty patients developed leak: 68 (85%) after primary LSG, 6 (7.5%) after Re-LSG and 6 (7.5%) after band removal to revisional LSG. Mean age 35.9 ± 10 years. The diagnosis was within 18 ± 14 days after surgery. Five (6.3%) patients were diagnosed during the same admission. Only 29.3% of patients were diagnosed correctly from the first visit to the ER. Most were misdiagnosed as gastritis (49%) and pneumonia (22.6%). Thirty-four patients (45.3%) were diagnosed correctly at the third visit. The most common presenting symptoms were abdominal pain (90%), tachycardia (71.3%), and fever (61.3%). The mean white blood cells (WBCs) count was 14700 ± 5900 (cells/mm3), c-reactive protein (CRP) 270 ± 133 mg/L, lactic acid 1.6 ± 0.85 mmol/L, and albumin 30.3 ± 6.6 g/L. The abdominal CT scans revealed intraabdominal collection in 93.7% of patients, extravasation of contrast in 75%, and pleural effusion in 52.5%. Upper gastrointestinal contrast study (UGIC) showed extravasation of contrast in 77.5% of patients. Conclusion Abdominal pain, tachycardia, or fever after LSG should raise the suspicion of a leak. CT scan of the abdomen and UGIC study detected leaks in 75% and 77.5% consecutively. Only 29.3% of patients were diagnosed correctly as a leak from the first visit to the ER.

Abdominal Tuberculosis in Ahmadi, Kuwait: A Clinico-Pathological Review

1998 ◽  
Vol 28 (3) ◽  
pp. 137-139 ◽  
Author(s):  
Naser UAMA Abdul-Ghaffar ◽  
Ibrahim Tarif Ramadan ◽  
Amin Ali Marafie
Keyword(s):  
Young Adults ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Intestinal Obstruction ◽  
Diagnostic Method ◽  
Abdominal Tuberculosis ◽  
Presenting Symptoms ◽  
Clinical Presentations ◽  
Pathological Review ◽  
Antituberculous Chemotherapy

For studying abdominal tuberculosis (TB) in Ahmadi, files of all patients admitted to our hospital with abdominal TB over 15 years (1981–1996) were reviewed. Nineteen patients are reported here. Young adults were predominant in our study. The non-Arab Asians were the most frequently affected group in relation to their population in Ahmadi, and Kuwaitis were the least frequently affected group. Abdominal pain, sweating, anorexia and fever were the most frequent presenting symptoms. Ascites and intestinal obstruction were the most frequent clinical presentations. Two patients presented with acute appendicitis and one patient had tuberculous pancreatitis. Abdominal lymph nodes, peritoneum, ileum and caecum were the most frequently affected abdominal structures. We found laparoscopy very helpful in the diagnosis of abdominal TB and we recommend it as the diagnostic method of choice. All our patients responded well to antituberculous chemotherapy. It should be kept in mind that abdominal TB still affects the indigenous and expatriate population of Kuwait.

scholarly journals Examining Multisystem Inflammatory Syndrome in Children (MIS-C) Amidst the SARS-CoV-2 Pandemic

2020 ◽  
Vol 3 ◽  
Author(s):  
Matthew Harris ◽  
Dibyadyuti Datta ◽  
Katrina Co ◽  
Samina Bhumbra ◽  
Chandy John
Keyword(s):  
Gastrointestinal Symptoms ◽  
Care Patient ◽  
Common Finding ◽  
Laboratory Findings ◽  
Patient Reports ◽  
Reactive Protein ◽  
Presenting Symptoms ◽  
Literature Searches ◽  
Clinical Presentations ◽  
Inflammatory Syndrome

Background/Objective: Multisystem Inflammatory Syndrome in Children (MIS-C) is a novel and rare pediatric post-infectious complication associated with SARS-CoV-2 infection. First described in April 2020, our scope of understanding is limited but rapidly growing. Our objective was to construct a literature repository containing MIS-C patient data from available publications to serve as a curated collection of literature on the topic. This collection facilitates direct comparison of data from various sources, allowing for informed discussions of MIS-C.    Methods: A database search strategy was developed for locating primary literature on MIS-C available on PubMed, medRxiv, and bioRxiv databases. Literature searches were conducted from June 26, 2020 to July 10, 2020. Search results were tested against several criteria before inclusion in the repository. Intrinsic limitations for each publication were identified during quality review. Data from each source was organized in a standardized format for analysis.   Results: 26 publications met inclusion criteria, 9 (35%) in pre-print status. 742 cases of probable or confirmed MIS-C were reported. Individuals ranged from 7 months to 20 years old and 58% were male. By SARS-CoV-2 PCR testing, 257/707 (36%) were positive while 485/597 (81%) were positive by SARS-CoV-2 serology testing. Common presenting symptoms included fever, one or more gastrointestinal symptoms, and rash. Laboratory testing varied, but elevated C-Reactive Protein was the most common finding (411/689, 60%), followed by elevated D-Dimer (214/470, 46%). Echocardiogram findings included coronary artery dilation in 38/414 (9%) and decreased ejection fraction in 177/330 (54%). Treatments offered included intravenous immunoglobulin (486/742, 65%), followed by steroids (376/742, 51%). 450/577 (78%) required ICU care. Patient outcomes were generally favorable, with 11 (1%) fatalities at the time of publication.  Conclusion/Impact: Our repository of MIS-C literature compiled patient reports to identify common clinical presentations and laboratory findings. Future literature reviews are necessary to elucidate mechanisms associated with MIS-C and establish diagnostic criteria. 

scholarly journals Sex differences in a cohort of COVID-19 Italian patients hospitalized during the first and second pandemic waves.

2021 ◽  
Author(s):  
Virginia Quaresima ◽  
Cristina Scarpazza ◽  
Alessandra Sottini ◽  
Chiara Fiorini ◽  
Simona Signorini ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Death Rate ◽  
White Blood Cells ◽  
Laboratory Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Mean ◽  
Second Wave ◽  
Length Of Hospitalization ◽  
Older Males

Abstract Background: Coronavirus Disease 2019 (COVID-19) severity seems to be influenced by genetic background, sex, age, and presence of specific comorbidities. So far, little attention has been paid to sex-specific variations of demographic, clinical and laboratory features of COVID-19 patients referred to the same hospital in the two consecutive pandemic waves.Methods: Demographic, clinical and laboratory data were collected in 1,000 COVID-19 patients (367 females and 633 males), 500 hospitalized in the first wave and 500 in the second one, at the ASST Spedali Civili of Brescia from March to December 2020. Statistical analyses have been employed to compare data obtained in females and males, taking into account their age, and during the first and second COVID-19 waves. Results: The mean age at the time of hospitalization was similar in females and males but was significantly higher for both in the second wave; the time elapsed from symptoms onset to hospital admission did not differ between sexes in the two waves and no correlation was observed between delayed hospital admission and length of hospitalization. The number of multi-symptomatic males was higher than that of females and patients with a higher number of comorbidities were more frequently admitted to intensive care unit (ICU) and more frequently died. Older males remained in ICU longer than females and showed a longer disease duration, mainly the first wave. The highest levels of white blood cells, neutrophils, C-reactive protein and fibrinogen were significantly higher in males and in the first, and along with higher levels of D-dimer, ferritin, lactate dehydrogenase and procalcitonin which were preferentially documented in patients requiring ICU or died. While the ICU death rate was higher in males, the overall death rate did not differ between the sexes; however, the deceased women were older.Conclusions: These data indicate that once patients were hospitalized, the risk of dying was similar between females and males. Therefore, future studies should aim at understanding the reasons why, for a given number of SARS-CoV-2 infection, less females develop the disease requiring hospitalization.

scholarly journals Clinical outcomes and safety of polymyxin B in the treatment of carbapenem-resistant Gram-negative bacterial infections: a real-world multicenter study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaojuan Zhang ◽  
Shaoyan Qi ◽  
Xiaoguang Duan ◽  
Bing Han ◽  
Shuguang Zhang ◽  
...  
Keyword(s):  
Real World ◽  
Bacterial Infections ◽  
White Blood Cells ◽  
Polymyxin B ◽  
High Morbidity ◽  
Gram Negative ◽  
Reactive Protein ◽  
Carbapenem Resistant ◽  
The Mean ◽  
Univariate Analyses

Abstract Background High morbidity and mortality due to carbapenem-resistant Gram-negative bacilli (CR-GNB) has led to the resurgence of polymyxin B (PMB) use in the last decade. The aim of our multicenter, real-world study was to evaluate the effectiveness and safety of PMB in the treatment of CR-GNB infections. Methods The real-world study included patients treated with intravenous PMB for at least 7 days during the period of October 2018 through June 2019. Associations between these clinical features and 28-day mortality or all-cause hospital mortality were explored through univariate analyses and multivariable logistic regression. Results The study included 100 patients. Many patients presented with combined chronic conditions, septic shock, mechanical ventilation, and the presence of Klebsiella pneumoniae. The mean duration of PMB therapy was 11 days (range 7–38 days). Temperature (38 °C vs 37.1 °C), white blood cells (14.13 × 109/l vs 9.28 × 109/l), C-reactive protein (103.55 ug/l vs 47.60 ug/l), procalcitonin (3.89 ng/ml vs 1.70 ng/ml) and APACHE II levels (17.75 ± 7.69 vs 15.98 ± 7.95) were significantly decreased after PMB treatment. The bacteria eradication rate was 77.65%. The overall mortality at discharge was 15%, and 28-day mortality was 40%. Major adverse reactions occurred in 16 patients. Nephrotoxicity was observed in 7 patients (7%). Conclusions Our results provide positive clinical and safety outcomes for PMB in the treatment of CR-GNB. Timely and appropriate use of PMB may be particularly useful in treating patients with sepsis in CR-GNB infections.

Clinical Presentations of Iranian Confirmed COVID-19 Patients at the Admission Time: A Preliminary Retrospective Study

2021 ◽  
Author(s):  
Alireza Tabibzade ◽  
Mohammad Amin Abbasi ◽  
Sajad Karampoor ◽  
Mohammad Hadi Karbalaie Niya ◽  
Maryam Esghaei ◽  
...  
Keyword(s):  
Survival Rate ◽  
Clinical Symptoms ◽  
White Blood Cells ◽  
Ground Glass Opacity ◽  
Laboratory Assessment ◽  
Beneficial Effects ◽  
Reactive Protein ◽  
Admission Time ◽  
Clinical Presentations ◽  
Study Results

Background and Aims: The current preliminary study aimed to assess the clinical symptoms of the 67 Iranian COVID-19 patients and investigate the possible beneficial effects of the naproxen compared to the standard therapeutic regimen. Materials and Methods: We assessed 67 COVID-19 patients. All COVID-19 cases were confirmed by computed tomography (CT) and real time-polymerase chain reaction tests. We evaluated the clinical symptoms of the patients at the admission time. Also, a group of 28 patients received naproxen besides their standard treatment. Clinical presentations, radiographic features, white blood cells (WBC) in peripheral blood, hemoglobin, platelets, C-reactive protein, erythrocyte sedimentation rate, blood urea nitrogen, lactate dehydrogenase, Albumin, and Creatine Phosphokinase were evaluated. Results: The patients' clinical symptoms show that cough (89.6%) was the most repeated signed at the admission time, followed by fever at 78.7%, fatigue at 70%, and myalgia at least 64.2%. Unilateral slight ground-glass opacity was the most abundant presentation by 64.1% in CT. The laboratory assessment in patients indicates that mean WBC was 6193 ± 3258 (x106/L), and mean lymphocyte was 27.8 ± 12%. The survival rate and the hospitalization days for patients with or without the Naproxen regimen were not statistically significant. Conclusion: The most common clinical symptoms in Iranian patients with COVID-19 at the admission time include cough, fever, fatigue, and myalgia. Based on the current study results, the survival rate and the hospitalization days for patients with or without Naproxen usage were not statistically significant. The laboratory parameters could not show any particular statistically significant differences.

scholarly journals Clinical Outcomes and Safety of Polymyxin B in the Treatment of Carbapenem-resistant Gram-negative Bacterial Infections: a Real-world Multicenter Study

2021 ◽  
Author(s):  
Xiaojuan Zhang ◽  
Shaoyan Qi ◽  
Xiaoguang Duan ◽  
Bing Han ◽  
Shuguang Zhang ◽  
...  
Keyword(s):  
Real World ◽  
Bacterial Infections ◽  
White Blood Cells ◽  
Polymyxin B ◽  
High Morbidity ◽  
Gram Negative ◽  
Reactive Protein ◽  
Carbapenem Resistant ◽  
The Mean ◽  
Univariate Analyses

Abstract Background: High morbidity and mortality due to carbapenem-resistant Gram-negative bacilli (CR-GNB) has led to the resurgence of polymyxin B (PMB) use in the last decade. The aim of our multicenter, real-world study was to evaluate the effectiveness and safety of PMB in the treatment of CR-GNB infections.Methods: The real-world study included patients treated with intravenous PMB for at least 7 days during the period of October 2018 through June 2019. Associations between these variables and 28-day mortality or all-cause hospital mortality were explored through univariate analyses and multivariable logistic regression. Results: The study included 100 patients. Many patients presented with combined chronic conditions, septic shock, mechanical ventilation, and the presence of Klebsiella pneumoniae. The mean duration of PMB therapy was 11 days (range 7–38 days). Temperature (38°C vs 37.1°C), white blood cells (14.13×109/L vs 9.28×109/L), C-reactive protein (103.55 ug/l vs 47.60 ug/l), procalcitonin (3.89 ng/ml vs 1.70 ng/ml) and APACHE Ⅱ levels (17.75 ± 7.69 vs 15.98 ± 7.95) were significantly decreased after PMB treatment. The bacteria eradication rate was 77.65%. The overall mortality at discharge was 15%, and 28-day mortality was 40%. Major adverse reactions occurred in 16 patients. Nephrotoxicity was observed in 7 patients (7%).Conclusions: Our results provide positive clinical and safety outcomes for PMB in the treatment of CR-GNB. Timely and appropriate use of PMB may be particularly useful in treating patients with sepsis in CR-GNB infections.

C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy

2012 ◽  
Vol 27 (3) ◽  
pp. 864-871 ◽  
Author(s):  
Konstantinos Albanopoulos ◽  
Leonidas Alevizos ◽  
Maria Natoudi ◽  
Dimitrios Dardamanis ◽  
Evangelos Menenakos ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Postoperative Complications ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Blood Cells ◽  
White Blood Cells ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Early Predictors

scholarly journals Post-operative procalcitonin and C-reactive protein predict pancreatic fistula after laparoscopic pancreatoduodenectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Ma ◽  
Peiqiang Jiang ◽  
Bai Ji ◽  
Yanqing Song ◽  
Yahui Liu
Keyword(s):  
Pancreatic Fistula ◽  
White Blood Cells ◽  
Area Under The Curve ◽  
Serum Levels ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Laparoscopic Pancreatoduodenectomy ◽  
Auc Value ◽  
The Mean ◽  
Predictive Risk

Abstract Background Clinically relevant pancreatic fistula (CRPF) is a serious complication following laparoscopic pancreaticoduodenectomy (LPD). This study aimed to determine if C-reactive protein (CRP) and procalcitonin (PCT) serum levels could be used as early biomarkers to predict CRPF after LPD. Methods In this retrospective study, we collected peri-operative data of patients who underwent LPD between January 2019 and November 2019. We compared serum levels of white blood cells (WBC), CRP, and PCT on post-operative days (POD) 1, 2, 3, 5, and 7 between the CRPF and non-CRPF groups and analyzed the predictive risk factors for CRPF. Results Among the 186 patients included in this study, 18 patients (9.7%) developed CRPF, including 15 and 3 patients with grade B and C fistulas, respectively. The mean WBC, CRP, and PCT levels were higher on most PODs in the CRPF group compared to the non-CRPF group. Receiver operating characteristic (ROC) analysis indicated that CRP levels on POD 2, 5, and 7 can predict CRPF development after LPD, with the area under the curve (AUC) value reaching the highest level on POD 2 (AUC 0.794). PCT levels on POD 2, 3, 5, and 7 were highly predictive of CRPF after LPD. The highest AUC value was achieved on POD 3 [PCT > 2.10 ng/ml (AUC 0.951; sensitivity 88.2%, specificity 92.9%, P < 0.001)]. Conclusions Both CRP and PCT levels can be used to predict CRPF development after LPD, with PCT having a higher predictive value.

CLINICAL AND PARACLINICAL CHARACTERISTITICS OF ROTAVIRUS DIARRHEA IN CHILDREN LESS THAN 5 YEARS OLD IN PEDIATRIC DEPARTMENT OF BINH DINH GENERAL HOSPITAL

2013 ◽  
pp. 50-56
Author(s):  
Quoc Tinh Nguyen ◽  
Thi Cu Nguyen
Keyword(s):  
General Hospital ◽  
Acute Diarrhea ◽  
White Blood Cells ◽  
Blood Calcium ◽  
Pediatric Department ◽  
Rotavirus A ◽  
Initial Symptoms ◽  
Stool Specimens ◽  
The Mean ◽  
Rotavirus Diarrhea

Background: Diarrhea is a leading cause of morbidity and mortality in children in developing countries. Rotavirus is the most important factor cause of severe diarrhea and mortality in children, especially under 2 years. Objective: To study Clinical and paraclinical characteristitics of rotavirus diarrhea in children less than 5 years old in the Pediatric Department of Binh Dinh General Hospital. Methods: Cross observational study, 417 children from 2 months to 5 years old who were hospitalized for acute diarrhea without blood in stool in Pediatric Department of Binh Dinh general hospital, from 15/3/2012 to 14/3/2013. There were 228 patients with rotavirus - positive stool specimens and 189 patients with rotavirus - negative stool specimens. Tested for rotavirus A classification by agglutination techniques. Results: Percentage of Rotavirus diarrhea in children <5 years was 54.7%. The mean age of rotavirus diarrhea was 14.83 ± 9.08 tháng months. Ages with the highest cases of rotavirus diarrhea are 2 - 12 months: 48.2%. Rotavirrus diarrhea is experienced in every month but, the highest prevalence is experienced in the spring - summer) with 71,5%. Clinical characteristitics of rotavirus diarrhea: Vomit presents in 91,7% of cases. 32.9% of the initial symptoms of the disease is vomiting. Mean number of vomiting episodes per day: 7 ± 3.57 times, significantly higher compared with non-rotavirus acute diarrhea (p <0,01). Mean number of bowel movement per day: 10.61±4.18 times, mean duration of diarrhea: 6.66 ± 2.52 days. Younger children have higher frequency and duration of diarrhea compared to older children. Paraclinical characteristitics of rotavirus diarrhea: the mean number leukocyte: 9.74 ±3.61 (x 109/l). 2.2% with low blood sodium status; 8.8% with reduction in serum potassium concentration. 26.3% with low blood calcium and glucose status. Laboratory characteristics of stool: 8.8% with white blood cells in stool, 41.7% with carbohydrate in stool. Conclusion: Rotavirus accounting for 54.7% of the causes of diarrhea in children. Rotavirus diarrhea is experienced throughout the year but the highest prevalence is in the spring-summer. Prominent symptoms of the disease are vomiting and watery stool. Children <24 months experience higher frequency and duration of diarrhea compared to older age groups. Key words: Diarrhea, Rotavirus.

Sign in / Sign up

Export Citation Format

Share Document