1069 Diverticular Disease: An Audit of Adherence to NICE Guidelines

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Lesi ◽  
M R Iqbal ◽  
L Khan
Keyword(s):  
Diverticular Disease ◽  
Complicated Diverticulitis ◽  
University Hospital ◽  
Full Blood Count ◽  
C Reactive Protein ◽  
Nice Guidelines ◽  
Reactive Protein ◽  
Presenting Symptoms ◽  
Uncomplicated Diverticulitis ◽  
Retrospective Audit

Abstract Introduction Diverticular disease is a common surgical problem ranging from diverticulosis to uncomplicated diverticulitis to complicated diverticulitis. The NICE Guidelines for diverticular disease recommended that antibiotics should only be given in patients who are systemically unwell, background of immunosuppression or have complicated diverticulitis. We aimed to access the compliance to these guidelines with regards to the use of antibiotics at our local institute. Method This was a retrospective audit reviewing the management of patients with Computed Tomography Scan findings of uncomplicated acute diverticulitis (Hinchey Ia) at the surgical emergency unit at Basildon University Hospital between August 2018 and May 2020. Data obtained included demographic data, presenting symptoms (fever, abdominal pain), haematological investigations (full blood count and c-reactive protein) and use of intravenous/oral antibiotics. Results Twenty patients were included, the M:F ratio was 1:1.9, the age range was between 36-80 years. 13 patients (65%) had left iliac fossa pain as part of their presenting symptom while only three (15%) had pyrexia. Seventeen patients(85%) had NEWS score between 0-1 with 60% of the patients presenting with elevated white blood cell count and 75% with c-reactive protein >5. All our patients were prescribed antibiotics. Conclusions There was no discrimination in the use of antibiotics/admission for uncomplicated diverticulitis as all patients had antibiotics and as such there is need for increased awareness about the guidelines among the surgical team and adherence to the protocol to prevent indiscriminate use of antibiotics.

scholarly journals The use of biochemical markers in complicated and uncomplicated acute diverticulitis

2018 ◽  
Author(s):  
Dulitha Kumarasinghe ◽  
Assad Zahid ◽  
Greg O'Grady ◽  
Timothy Leow ◽  
Tabrez Sheriff ◽  
...  
Keyword(s):  
Cell Count ◽  
Acute Diverticulitis ◽  
White Cell Count ◽  
Complicated Diverticulitis ◽  
White Cell ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Uncomplicated Diverticulitis ◽  
Significant Difference ◽  
Post Hoc

Abstract BACKGROUND: Diverticulosis is extremely common in western society. A recent study has shown that outpatient, non-antibiotic management of acute uncomplicated diverticulitis may be a feasible and safe option. However the ability to identify these patients is still difficult. This study explores the ability of white cell count, C-reactive protein and bilirubin in differentiating patients with complicated and uncomplicated diverticulitis as well as progression to surgical intervention. METHODS: This is a retrospective study of patients admitted with acute diverticulitis over a 5-year period (2009-2014) at a single institution in Australia. Patients were classified into three groups; uncomplicated diverticulitis, complicated diverticulitis without surgery and complicated diverticulitis with surgery. ANOVA and Bonferroni's post-hoc analyses were used to compare markers across the groups. RESULTS: A total of 541 patients met the inclusion criteria for this study. One-way ANOVA showed a significant difference in white cell count (p<0.0001), C-reactive protein (p<0.0001) and bilirubin (p=0.0006) between all three groups. Post-hoc analyses showed a significant difference in white cell count, C-reactive protein and bilirubin when comparing uncomplicated diverticulitis against complicated diverticulitis without surgery (p<0.05) and complicated diverticulitis with surgery (p<0.05). White cell count also showed a significant difference when comparing complicated diverticulitis without surgery and complicated diverticulitis with surgery (p<0.05). CONCLUSIONS: White cell count, C-reactive protein and bilirubin can distinguish between uncomplicated and complicated diverticulitis.

scholarly journals Interleukin-6 and C-Reactive Protein Are Overexpressed in the Liver of Perinatal Deaths Diagnosed with Fetal Inflammatory Response Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Lívia Helena M. Pereira ◽  
Juliana R. Machado ◽  
Janaínna G. P. Olegário ◽  
Laura P. Rocha ◽  
Marcos V. Silva ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Acute Stress ◽  
University Hospital ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Ascending Infection ◽  
Term Births ◽  
Liver Fragments ◽  
Fetal Inflammatory Response

Anatomopathologic studies have failed to define the fetal inflammatory response syndrome (FIRS) as a cause of fetal death. Here, liver fragments of perinatal autopsies were collected at a university hospital from 1990 to 2009 and classified according to the cause of death, perinatal stress, and gestational age (GA) of the fetus. IL-6, TNF-α, and C-reactive protein (CRP) expression were immunostained, respectively, with primary antibody. Cases with congenital malformation, ascending infection, and perinatal anoxia showed increased IL-6, CRP, and TNF-α, respectively. Prematures presented higher expression of IL-6 whereas term births showed higher expression of CRP. Cases classified as acute stress presented higher expression of IL-6 and TNF-αand cases with chronic stress presented higher expression of CRP. GA correlated negatively with IL-6 and positively with CRP and TNF-α. Body weight correlated negatively with IL-6 and positively with CRP and TNF-α. Despite the diagnosis of FIRS being clinical and based on serum parameters, the findings in the current study allow the inference of FIRS diagnosis in the autopsied infants, based on anin situliver analysis of these markers.

scholarly journals Evaluation correlates C-reactive protein with advanced stage Hodgkin's lymphoma and response to treatment in a tertiary university hospital in Brazil

2015 ◽  
Vol 37 (4) ◽  
pp. 242-246 ◽  
Author(s):  
Talita Máira Bueno da Silveira da Rocha ◽  
Ana Luiza Pereira Miranda Silva ◽  
Sérgio Costa Fortier ◽  
Carlos Sérgio Chiattone
Keyword(s):  
Hodgkin’S Lymphoma ◽  
University Hospital ◽  
Hodgkin's Lymphoma ◽  
Response To Treatment ◽  
Advanced Stage ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals Papel de la proteína C reactiva y la velocidad de sedimentación globular en la predicción de colecistectomía laparoscópica dificultosa: su aplicación en un programa de residencia universitario

2020 ◽  
Vol 112 (2) ◽  
pp. 171-177
Author(s):  
Matías H. Loccisano ◽  
◽  
Martín Drago ◽  
Hernán Todeschini ◽  
Luis E. Sarotto
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Residency Program ◽  
Surgical Planning ◽  
Analytical Study ◽  
University Hospital ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Symptomatic Cholelithiasis ◽  
Technical Issues ◽  
Difficult Cholecystectomy

Background: laparoscopic cholecystectomy is one of the most common procedures performed in general surgery. The anatomical differences of the gallbladder and the presence of factors related to inflammation can cause technical issues during surgery. Objective: the aim of the present study was to determine the value of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as predictors of difficult cholecystectomy and to evaluate their application during presurgical planning within a university residency program. Material and methods: we conducted a retrospective and analytical study in a tertiary university hospital. A total of 104 adult patients undergoing laparoscopic cholecystectomy due to symptomatic cholelithiasis between January and July 2019 were included. The patients were categorized into two groups: difficult cholecystectomy and non-difficult cholecystectomy. Results: there were statistically significant differences in ESR and CRP values between both groups (p < 0.001). Sensitivity of ESR was 100%, specificity was 45%, with a PPV of 40% and NPV of 100%. Sen- sitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Both parameters were elevated in 14 of 16 difficult cholecystectomies and in 2 of 44 non-difficult cholecystectomies. Sensitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Conclusion: measuring ESR and CRP has proved to be a reliable method to predict difficult chole- cystectomies due to symptomatic cholelithiasis. This could be applied for surgical planning within a university residency program.

scholarly journals High Specific C-Reactive Protein in Prediction of the Early Outcome of Primary Intra Cerebral Hemorrhage

2021 ◽  
pp. 54-61
Author(s):  
Khaled Eltoukhy ◽  
Mohamed Gomaa ◽  
Yasmin Ibrahim ◽  
Mohamed Saad
Keyword(s):  
Cerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Multivariable Analysis ◽  
University Hospital ◽  
Control Group ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Test Kit ◽  
Hs Crp ◽  
Ct Brain

Background: Primary intra cerebral hemorrhage (ICH) has high rate of disability and death. Many factors was supposed to be predictors of the outcome. The significance of measuring C-reactive protein (CRP) levels to predict the outcome is uncertain, and data have been controversial. The objective of our clinical study was to determine the relationship of hs-CRP levels with bad outcome. The authors tested if (independent of confounding factors) hs-CRP levels was elevated on admission (< 24 hours after ictus). Fifty patients with acute spontaneous hemorrhagic stroke, within 24 hours of onset confirmed by CT brain were admitted at neurology department, Mansoura University Hospital from June 2017 to September 2018. Age and sex cross-matched 50 healthy persons were studied as control group. Patient and control groups were subjected to full history, general and neurological examination, GCS on admission, National Institute of Health Stroke Scale (NIHSS) on admission, ICH score and Canadian scale on admission and after 30 days, Venous Blood samples were taken within 24 hours of onset and tested for routine laboratory investigations (liver function, serum creatinine, CBC and blood glucose) and High Sensitive C-Reactive Protein level using Enzyme Immunoassay Test Kit. Computed tomography (CT) brain was repeated 72 hours later. Multivariable regression analyses were used to evaluate associations of hs-CRP concentration and ICH outcome. Kaplan–Meier analysis was used for survival. Results: This study revealed that Hs-CRP is significantly higher in patient group (9.3 mg/l) when compared to control group (0.68 mg/dl) with p value < 0,001. There was statistically significant correlation between NIHSS and hs-CRP levels but there was no statistically significant correlation between hs-CRP levels and stroke outcome. Conclusion: Taking these covariates into multivariable analysis revealed that there is correlation between hs-CRP and hemorrhagic stroke but it cannot be used as a predictor of its outcome.

scholarly journals Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

2021 ◽  
Author(s):  
Sufana Alsaif ◽  
Ailín C Rogers ◽  
Priscilla Pua ◽  
Paul T Casey ◽  
Geoff G Aherne ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Inflammatory Markers ◽  
Postoperative Morbidity ◽  
Colorectal Neoplasia ◽  
Full Blood Count ◽  
C Reactive Protein ◽  
Elective Colorectal Surgery ◽  
Reactive Protein ◽  
Grade 3

Abstract Background: Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim: The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods: This retrospective study catalogues 218 patients undergoing elective, potentially-curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results: Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6 and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC=0.871), and values above 17.5 mg/L predicted severe complications (AUC=0.934). Conclusions: Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

scholarly journals TYPE 2 DIABETES MELLITUS;

2014 ◽  
Vol 21 (06) ◽  
pp. 1174-1177
Author(s):  
Mukhtiar Hussain Jaffery ◽  
Nisar Ahmed Shah ◽  
Muhammad Sajid Abbas Jaffri ◽  
Athar Hussain Memon ◽  
Syed Zulfiquar Ali Shah
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Urban Areas ◽  
University Hospital ◽  
Diabetic Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Mean

Objective: To determine the frequency of raised C-reactive protein (CRP) in patients with type 2 diabetes mellitus. Patients and methods: This cross sectional descriptive study of six months study was conducted at Liaquat University Hospital Hyderabad from March 2013 to August 2013. All diabetic patients of ≥35 years age of either gender for >01 year duration visited at OPD were evaluated for C-reactive protein and their glycemic status by hemoglobin A1c. The data was analyzed in SPSS and the frequency and percentage was calculated. Results: During six month study period, total 100 diabetic patients were evaluated for C-reactive protein. Majority of patients were from urban areas 75/100 (75%). The mean ±SD for age of patients with diabetes mellitus was 51.63±7.82. The mean age ±SD of patient with raised CRP was 53±7.21. The mean ±SD for HbA1c in patients with raised CRP is 9.55±1.73. The mean random blood sugar level in patients with raised CRP was 247.42 ± 6.62. The majority of subjects from 50-69 years of age group with female predominance (p = 0.01) while the CRP was raised in 70(70%) patients in relation to age (p=0.02) and gender (p=0.01) respectively. Both HbA1c and CRP was raised in 64.9% (p = 0.04) in patients with type 2 diabetes mellitus. The mean ±SD of CRP was 5.8±1.21 while for male and female individuals with raised CRP was 3.52±1.22 and 5.7±1.63 respectively. Conclusions: The raised CRP was observed in patients with type 2 diabetes mellitus

scholarly journals C – REACTIVE PROTEIN

2015 ◽  
Vol 22 (02) ◽  
pp. 256-262
Author(s):  
Ahmed Hussain ◽  
Shahnawaz Abro ◽  
Ashfaque Ahmed Bhurgiri ◽  
Raheel Imtiaz Memon ◽  
Syed Zulfiquar Ali Shah
Keyword(s):  
Acute Appendicitis ◽  
University Hospital ◽  
Radiographic Imaging ◽  
C Reactive Protein ◽  
Diagnostic Laboratory ◽  
Cross Sectional ◽  
Male And Female ◽  
Reactive Protein ◽  
Laboratory Investigations ◽  
The Mean

Acute appendicitis is the most common abdominal surgical emergency despiteadvances in radiographic imaging and diagnostic laboratory investigations; the diagnosis ofacute appendicitis remains challenge. Objectives: To evaluate the C-reactive protein in patientswith acute appendicitis. Patients and methods: This cross sectional descriptive study of sixmonths study was conducted at Liaquat University Hospital Hyderabad. All the patients withacute appendicitis were admitted in the ward and were further evaluated for C-reactive protein.The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Results:One hundred subjects with acute appendicitis were recruited and studies. The mean age ±SD ofthe patients was 27.83±07.52 in overall population while it was 29.73±06.64 and 25.84±04.92in male and female subjects with acute appendicitis. The CRP was raised in 60% patients. Thedistribution of age in relation to gender and CRP was statisitically significant (p= 0.01 and<0.01) whereas the CRP was also observed as statistically significant in context to genderand histopathology (p= 0.02 and 0.03) respectively. The mean ±SD of CRP was 7.53±1.52in overall population while it was 6.84±1.64 and 8.65±1.53 in male and female patients withraised CRP. Conclusions: The CRP was elevated in patients with acute appendicitis.

Elevated C-reative protein (CRP) as a surgical indication for appendicitis

2021 ◽  
Vol 16 (4) ◽  
pp. 190-193
Author(s):  
Shahida Khatoon ◽  
Mujeeb ur Rehman ◽  
Sohail Ahmed Memon
Keyword(s):  
White Blood Cells ◽  
Signs And Symptoms ◽  
University Hospital ◽  
P Value ◽  
C Reactive Protein ◽  
Diagnostic Laboratory ◽  
Histopathological Findings ◽  
Reactive Protein ◽  
Non Invasive

Objective: Role of C-reactive protein value in the diagnosis of appendicitis by correlating with severity of appendicitis on histopathological findings. Methodology: This descriptive study was conducted at the department of general surgery Unit-IV, Liaquat University Hospital Hyderabad from March 2016 to February 2017. All cases above 12 years of age with severe appendicitis based on presenting signs and symptoms were included. The patient underwent routine laboratory investigations including abdominal plain x-ray in an erect position and ultrasound abdomen. The blood sample was taken from each patient for C-reactive protein and was send to Hospital diagnostic laboratory. During surgery, a specimen of each patient was sent to a diagnostic laboratory for histopathology. All the data were record on Performa. Results: A total of 305 patients were studied; their mean age was 35.7+9.7 years. Males were found in the majority (73%). 75.41% of patients had leukocytosis. C-reactive protein was raised among 26.22% of patients. On histopathological findings, 04.91% of patients had a normal appendix, while 69.83% had gross inflammation of the appendix, 19.67% patients had gangrenous appendix, and 05.57% patients had perforation and peritonitis. Elevated C reactive protein (CRP) and leukocytosis were significantly associated with the severity of appendicitis, p value 0.001. Conclusion: C-reactive protein is a non-invasive and reliable indicator for surgical treatment of appendicitis. C-reactive protein and white blood cells (WBCs) were significantly associated with the severity of appendicitis.

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