scholarly journals Role of serial lactate measurement to predict 28-day mortality in patients undergoing emergency laparotomy for perforation peritonitis: prospective observational study

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
S. P. Jobin ◽  
Souvik Maitra ◽  
Dalim Kumar Baidya ◽  
Rajeshwari Subramaniam ◽  
Ganga Prasad ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Apache Ii Score ◽  
Emergency Laparotomy ◽  
Clinical Trial Registry ◽  
Arterial Lactate ◽  
Mannheim Peritonitis Index ◽  
Institutional Ethics ◽  
Lactate Measurement ◽  
Perforation Peritonitis

Abstract Background Serial lactate measurement is found to predict mortality in septic shock. Majority of patients with perforation peritonitis for emergency laparotomy are in sepsis and mortality rate is substantial. However, lactate dynamics has not been studied in this patient population. Methods After institutional ethics clearance and informed written consent, 113 patients with suspected or proven perforation peritonitis presenting for emergency laparotomy were recruited in this prospective observational trial. Baseline Mannheim peritonitis index (MPI), SOFA and APACHE II score were calculated. Lactate values were obtained at baseline, immediate and 24-h postoperative period. Primary outcome was 28-day mortality. Results Mortality was 15.04% at 28 days. Age, SOFA, qSOFA, APACHE, preoperative lactate, MPI and site of perforation were significantly different between survivors and non-survivors. Arterial lactate values at preoperative (cut off 2.75 mmol/L), immediate postoperative (cut off 2.8 mmol/L) and 24 h-postoperative period (cut off 2.45 mmol/L) independently predicted mortality at day 28. Combination of MPI and 24-h lactate value was best predictor of mortality with AUC 0.99. Conclusion Preoperative, immediate postoperative and 24-h postoperative lactate value independently predict 28-day mortality in perforation peritonitis patients undergoing emergency laparotomy. Combination of MPI and 24-h lactate value is the most accurate predictor of mortality. Trial registration Clinical Trial Registry of India - CTRI/2018/01/011103

The role of matrix metalloproteinase 9 and its inhibitors in scarring processes following surgery for primary open-angle glaucoma

2019 ◽  
pp. 72-80
Author(s):  
Е.В. Маркелова ◽  
О.В. Овчинникова ◽  
А.С. Хохлова ◽  
Л.П. Догадова ◽  
А.В. Костюшко ◽  
...  
Keyword(s):  
Matrix Metalloproteinase ◽  
Postoperative Period ◽  
Open Angle Glaucoma ◽  
Matrix Metalloproteinase 9 ◽  
Tissue Inhibitors Of Metalloproteinases ◽  
Open Angle ◽  
Tissue Inhibitors ◽  
Surgery Outcome ◽  
Metalloproteinase 9

Оперативное вмешательство - один из основных методов лечения глаукомы. Однако развитие избыточного рубцевания созданных путей оттока определяет результат хирургического лечения в отдаленные сроки. Процессы рубцевания на данный момент недостаточно изучены. Цель исследования - оценка роли матриксной металлопротеиназы-9, ее ингибиторов в процессах рубцевания у больных с первичной открытоугольной глаукомой после оперативного лечения. Методика. Для выявления возможных маркеров избыточного рубцевания методом твердофазного иммуноферментного анализа определяли содержание матриксных металлопротеиназ-9, тканевых ингибиторов металлопротеиназ 2 и -3 в слезной жидкости у 37 пациентов с активной стадией первичной остроугольной глаукомы в динамике послеоперационного периода. Средний возраст пациентов составил 52,8 лет. В зависимости от исхода оперативного вмешательства все пациенты были разделены на 2 группы - с благоприятным исходом (без избыточного рубцевания) и с неблагоприятным исходом (с избыточным рубцеванием) на месте сформированных дополнительных путей оттока внутриглазной жидкости в послеоперационном периоде. Группа контроля включала 20 человек в возрасте от 50 до 66 лет без сопутствующей офтальмологической и соматической патологии в стадии обострения. Результаты. В динамике показано изменение концентрации матриксной металлопротеиназы-9 и ее ингибиторов в послеоперационном периоде. Анализ данных свидетельствует об обратной зависимости уровня матриксной металлопротеиназы-9 и тканевых ингибиторов металлопротеиназы 2 и 3 типов с исходом операции - чем выше концентрация металлопротеиназы-9 и ниже концентрация тканевых ингибиторов металлопротеиназ 2, -3 в слезной жидкости, тем выше вероятность неблагоприятного исхода в виде рубцевания сформированных дополнительных путей оттока внутриглазной жидкости в послеоперационном периоде. Заключение. Мониторинг уровня металлопротеиназ и их тканевых ингибиторов после проведения хирургического лечения пациентов с первичной открытоугольной глаукомой позволяет прогнозировать раннее рубцевание, дает возможность разработки новых методов лечения как в раннем, так и в позднем послеоперационном периоде. Surgery is one of the major treatments for glaucoma; however excessive scarring of created outflow patways affects the long-term outcome. At the present time, scarring processes are not sufficiently studied. Aim. To evaluate the role of matrix metalloproteinase 9 and its inhibitors in scarring after surgical treatment of open-angle glaucoma. Methods. Concentrations of matrix metalloproteinase 9 and tissue inhibitors of metalloproteinases 2 and 3 were measured in tear fluid of 37 patients (mean age, 52.8) with active primary open-angle glaucoma in dynamics during the postoperative period to identify possible markers of excessive scarring. Based on the surgery outcome, all patients were divided into two groups, with a favorable outcome (without excessive scarring) and an unfavorable outcome (with excessive scarring) in the created additional outflow pathways for the intraocular fluid in the postoperative period. The control group included 20 subjects aged 50-66 without eye disease or somatic disease at exacerbation stage. Results. Analysis of changes in concentrations of matrix metalloproteinase 9 and its inhibitors in the postoperative period showed their inverse relationship with the surgery outcome. The higher was the metalloproteinase 9 level and the lower the level of tissue inhibitors of metalloproteinases 2 and 3 the higher was the probability of unfavorable outcome evident as excessive scarring of the formed additional pathways for tear fluid outflow in the postoperative period. Conclusion. Postoperative monitoring of metalloproteinases and their tissue inhibitors allows to predict early scarring and to develop new treatments both in early and late postoperative periods.

scholarly journals Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

2019 ◽  
Vol 103 (11-12) ◽  
pp. 578-584
Author(s):  
Fatih Ciftci ◽  
Fazilet Erözgen
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Postoperative Period ◽  
Perforated Peptic Ulcer ◽  
Apache Ii ◽  
Morbidity And Mortality ◽  
Apache Ii Score ◽  
Peptic Ulcers ◽  
Presentation Time ◽  
Independent Risk Factors

Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI (P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.

Decrease in proven ventriculitis by reducing the frequency of cerebrospinal fluid sampling from extraventricular drains

2011 ◽  
Vol 115 (5) ◽  
pp. 1040-1046 ◽  
Author(s):  
Teresa A. Williams ◽  
Gavin D. Leslie ◽  
Geoffrey J. Dobb ◽  
Brigit Roberts ◽  
Peter Vernon van Heerden
Keyword(s):  
Head Injuries ◽  
Tertiary Hospital ◽  
Sampling Frequency ◽  
Apache Ii Score ◽  
Optimum Frequency ◽  
Clinical Indicators ◽  
Historical Comparison ◽  
Institutional Ethics ◽  
Daily Sampling ◽  
Definition Of

Object Ventriculitis associated with extraventricular drains (EVD) increases rates of morbidity and mortality as well as costs. Surveillance samples of CSF are taken routinely from EVD, but there is no consensus on the optimum frequency of sampling. The goal of this study was to assess whether the incidence of ventriculitis changed when CSF sampling frequency was reduced once every 3 days. Methods After receiving institutional ethics committee approval for their project, the authors compared a prospective sample of EVD-treated patients (admitted 2008–2009) and a historical comparison group (admitted 2005–2007) at two tertiary hospital ICUs. A broad definition of ventriculitis included suspected ventriculitis (that is, treated with antibiotics for ventriculitis) and proven ventriculitis (positive CSF culture). Adult ICU patients with no preexisting neurological infection were enrolled in the study. After staff was provided with an education package, sampling of CSF was changed from daily to once every 3 days. All other management of the EVD remained unchanged. More frequent sampling was permitted if clinically indicated during the third daily sampling phase. Results Two hundred seven patients were recruited during the daily sampling phase and 176 patients when sampling was reduced to once every 3 days. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was lower for the daily sampling group than for the every-3rd-day group (18.6 vs 20.3, respectively; p < 0.01), but there was no difference in mean age (47 and 45 years, respectively; p = 0.14), male or female sex (61% and 59%, respectively; p = 0.68), or median EVD duration in the ICU (4.9 and 5.8 days, respectively; p = 0.14). Most patients were admitted with subarachnoid hemorrhage (42% in the daily group and 33% in the every-3rd-day group) or traumatic head injuries (29% and 36%, respectively). The incidence of ventriculitis decreased from 17% to 11% overall and for proven ventriculitis from 10% to 3% once sampling frequency was reduced. Sampling of CSF once every 3 days was independently associated with ventriculitis (OR 0.44, 95% CI 0.22–0.88, p = 0.02). Conclusions Reducing the frequency of CSF sampling to once every 3 days was associated with a significant decrease in the incidence of ventriculitis. The authors suggest that CSF sampling should therefore be performed once every 3 days in the absence of clinical indicators of ventriculitis. Reducing frequency of CSF sampling from EVDs decreased proven ventriculitis.

Thoracoabdominal impalement injury during pregnancy

2021 ◽  
Vol 14 (8) ◽  
pp. e244463
Author(s):  
Charisse Anne F Aquino ◽  
Maria Jesusa B Banal-Silao
Keyword(s):  
Multidisciplinary Team ◽  
Major Trauma ◽  
Trauma Centre ◽  
Emergency Laparotomy ◽  
Penetrating Abdominal Trauma ◽  
Penetrating Wound ◽  
Primigravid Woman ◽  
Thick Steel ◽  
Trauma In Pregnancy

Trauma has emerged as the leading cause of death during pregnancy. Penetrating abdominal trauma in pregnancy requires a rigorous clinical evaluation to establish a complete assessment of obstetric and non-obstetric lesions. In the case of major trauma, treatment is essentially carried out in a trauma centre with a multidisciplinary team to improve maternal and fetal prognosis. This is a case of a 20-year-old primigravid woman, 33 weeks and 4 days age of gestation, who was admitted for impaled foreign body. She was brought to the emergency department for a penetrating wound of the chest and abdomen after being accidentally impaled by a metre-long, inch-thick steel rod. Emergency laparotomy, caesarean section and thoracotomy were performed. The aim of this report is to discuss the assessment, management and role of the multidisciplinary team in the management of a pregnant trauma patient.

scholarly journals Institutional Ethics Committee Regulations and Current Updates in India

2017 ◽  
Vol 18 (8) ◽  
pp. 738-741
Author(s):  
Amit V Mahuli ◽  
Simpy A Mahuli
Keyword(s):  
Ethics Committees ◽  
Ethics Committee ◽  
Trial Registry ◽  
Clinical Trial Registry ◽  
Multiple Factors ◽  
Research Guidelines ◽  
Institutional Ethics ◽  
Controller General ◽  
Human Participants ◽  
Indian Scenario

ABSTRACT Aim The aim of the review is to provide current updates on regulations for ethics committees and researchers in India. Background Ethical dilemmas in research since time immemorial have been a major concern for researchers worldwide. The question “what makes clinical research ethical” is significant and difficult to answer as multiple factors are involved. Review results The research involving human participants in clinical trials should follow the required rules, regulations, and guidelines in one's own country. It is a dynamic process, and updates have to be learned by researcher and committee members. The review highlights the ethical regulation from the Drug Controller General of India, Clinical Trial Registry of India, and Indian Council of Medical Research guidelines. Conclusion In this article, the updates on Indian scenario of the Ethical Committee and guidelines are compiled. Clinical significance The review comes handy for clinical researchers and ethics committee members in academic institutions to check on the current updates and keep abreast with the knowledge on regulations of ethics in India. How to cite this article Mahuli AV, Mahuli SA, Patil S, Bhandi S. Institutional Ethics Committee Regulations and Current Updates in India. J Contemp Dent Pract 2017;18(8):738-741.

scholarly journals Perforation Peritonitis at High Altitude

2018 ◽  
Vol 56 (210) ◽  
pp. 625-628 ◽  
Author(s):  
Bhawana Amatya ◽  
Paleswan Joshi Lakhey ◽  
Prativa Pandey
Keyword(s):  
High Altitude ◽  
Distal Gastrectomy ◽  
Acute Mountain Sickness ◽  
Emergency Laparotomy ◽  
Delay In Diagnosis ◽  
First Case ◽  
Life Threatening ◽  
Perforation Peritonitis ◽  
Proper Diagnosis ◽  
Mountain Sickness

Trekkers going to high altitude can suffer from several ailments both during and after their treks. Gastro-intestinal symptoms including nausea, vomiting, and abdominal pain are common in high altitude areas of Nepal due to acute mountain sickness or due to a gastro-intestinal illness. Occasionally, complications of common conditions manifest at high altitude and delay in diagnosis could be catastrophic for the patient presenting with these symptoms. We present two rare cases of duodenal and gastric perforations in trekkers who were evacuated from the Everest trekking region. Both of them had to undergo emergency laparotomy and repair of the perforation using modified Graham’s patch in the first case and distal gastrectomy that included the perforated site, followed by two-layer end-to-side gastrojejunostomy and two-layer side-to-side jejunostomy in the second case. Perforation peritonitis at high-altitude, though rare, can be life threatening. Timely evacuation from high altitude, proper diagnosis and prompt treatment are essential

scholarly journals Role of interleukin-18 and plasma B-type natriuretic peptide in predicting requirement of kidney replacement therapy and/or mortality in individuals with acute heart disorders

2019 ◽  
Vol 8 (4) ◽  
pp. 292-300
Author(s):  
Aida Hamzić-Mehmedbašić ◽  
Damir Rebić ◽  
Amina Valjevac ◽  
Hajrunisa Čubro ◽  
Azra Durak Nalbantić ◽  
...  
Keyword(s):  
Heart Failure ◽  
Replacement Therapy ◽  
Natriuretic Peptide ◽  
Left Ventricular ◽  
Apache Ii Score ◽  
Interleukin 18 ◽  
Cutoff Value ◽  
Coronary Syndrome ◽  
Heart Disorders

Introduction: Although many predictive tools have already been developed, efforts are still proceeding to identify a reliable biomarker to predict the prognosis of the patients with acute heart disorders. Objectives: The aim was to evaluate the role of renal injury biomarkers (serum cystatin C, serum and urine interleukin-18, IL-18) and heart failure biomarkers (plasma B-type natriuretic peptide, BNP) in the prediction of the postdischarge requirement of renal replacement therapy (RRT) and/or 6-month mortality in patients with acute heart disorders. Patients and Methods: In patients diagnosed with acute heart disorders (acute heart failure [AHF] and/or acute coronary syndrome [ACS]) and admitted to the intensive care units, baseline clinical parameters, renal and cardiac biomarkers were determined. Patients were followed up for 6 months. The composite outcome was the postdischarge requirement of RRT and/or 6-month mortality. Results: Of 120 patients, 5.8% continued RRT after discharge. The 6-month mortality was 20%. Cox logistic regression analysis showed that urine IL-18 (P=0.021), plasma BNP (P=0.046), Acute Physiology and Chronic Health Evaluation (APACHE) II score (P=0.002), and left ventricular diastolic dysfunction (P=0.045) were independent predictors of the postdischarge requirement of RRT and/or 6-month mortality. For predicting RRT and/or 6-month mortality, using urine IL-18 cutoff value of 29.1 pg/mL showed 66.7% sensitivity and 67.7% specificity (area under the curve, AUC 0.70, P=0.003), while using plasma BNP cutoff value of 881.6 pg/mL showed 66.7% sensitivity and 70.8% specificity (AUC 0.76, P<0.001). Conclusion: Urine IL-18 and plasma BNP are independently predictive for the postdischarge requirement of RRT and/or 6-month mortality in patients with acute heart disorders.

scholarly journals Hemorrhagic Shock as a Sequela of Splenic Rupture in a Patient with Infectious Mononucleosis: Focus on the Potential Role of Salicylates

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Konstantinos Bouliaris ◽  
Dimos Karangelis ◽  
Marios Daskalopoulos ◽  
Konstantinos Spanos ◽  
Michael Fanariotis ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Infectious Mononucleosis ◽  
Potential Role ◽  
Splenic Rupture ◽  
Emergency Laparotomy ◽  
Hemorrhagic Complication ◽  
Spontaneous Splenic Rupture ◽  
Predisposing Factor ◽  
Life Threatening

Despite the fact that the vast majority of splenic ruptures are traumatic, infectious mononucleosis has been incriminated as a major predisposing factor that affects the integrity of the spleen, thus causing atraumatic ruptures and life-threatening hemorrhages. Herein we present a case of a 23-year-old Caucasian male who underwent an emergency laparotomy for acute abdomen and hemorrhagic shock, caused by spontaneous splenic rupture secondary to infectious mononucleosis. The potential role of salicylates in the development of a hemorrhagic complication in a patient with infectious mononucleosis is discussed.

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