Geographic influence on postoperative complications in children with complicated appendicitis: a single center study

Abstract Background Acute appendicitis is one of the most common abdominal emergencies in children. Complicated appendicitis is much more common in pediatric age group than in adults due to probability of delay in diagnosis or misdiagnosis. Geographic status has an influence on the clinical course of such surgical cases. This prospective comparative study was conducted at the pediatric surgery department in our hospital in Egypt during the period from December 2018 to August 2019, aiming to find the relation between residence of patients and occurrence of post-operative complications among patients in Sharkia Governorate, Egypt. Patients were divided into two groups: rural and urban. Data recorded included demographic data, preoperative assessment, operative findings, postoperative course, postoperative complications, and follow-up. Results Sixty patients were included in the study, 32 of them were from rural areas, and 28 were from urban areas. There was no significant difference between them regarding demographics. Duration of symptoms was significantly longer with rural group (3.7 ± 1.4 vs. 3.07 ± 0.92 days). Length of hospital stay was significantly longer with the rural group (4.7 ± 1.7 vs. 4.7 ± 1.7 days). The rate of wound infection was significantly higher with the rural group (34.37% vs. 10.7%), while other postoperative complications were increased with rural group, but that was not statistically significant. The regularity of follow-up was higher with the urban group. Conclusions Children with complicated appendicitis from rural areas are at higher risk for occurrence of postoperative complications and poor outcome, with less regularity in follow-up. This is because of many obstacles they faced, including difficulties of transportation, insufficient medical services, and low socioeconomic and educational statuses.

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Implication of late diagnosis for survival of patients with colorectal carcinoma

Vojnosanitetski pregled ◽

10.2298/vsp0902135z ◽

2009 ◽

Vol 66 (2) ◽

pp. 135-140

Author(s):

Darko Zdravkovic ◽

Dragoljub Bilanovic ◽

Tomislav Randjelovic ◽

Marija Zdravkovic ◽

Borislav Toskovic

Keyword(s):

Colorectal Cancer ◽

Weight Loss ◽

Abdominal Pain ◽

Potential Role ◽

Duration Of Symptoms ◽

Delay In Diagnosis ◽

Intermittent Abdominal Pain ◽

Significant Difference ◽

Significant Factors

Background/Aim. Colorectal cancer (CRC) is one of the most frequent diseases and early diagnosis has a potential role to improve survival. The aim of this study was to analyze influence of delay in diagnosis on survival in patients with colorectal cancer. Methods. A total of 119 patients with pathohystological diagnosis of CRC were included in the study. They were operated at our Department for Surgery from 2000 to 2002. They were divided into two groups according to the duration of symptoms: early operated patients - EOP (symptoms were presented for 3 months) and late operated patients - LOP (duration of symptoms was more than 3 months). Follow-up period was 5 year. Results. Weight loss, intermittent abdominal pain and anorexia were more frequent in LOP (p < 0.01). Young age, blood in stool, and tumor localized in rectum were dominant characteristics in EOP (p < 0.05). Overall delay in diagnosis was 2.19 ? 0.79 months in EOP and 11.37 ? 5.68 months in LOP. There was highly statistically significant difference between these two groups (p < 0.01). Overall survival was 44.75%. Five years survival was 65.9% in the group of EOP and 26.5% in the group of LOP (?2 = 28.16, p < 0.01) Weight loss was dominant characteristics in the patients who did not survive five years (?2 = 14.26, p < 0.01). A period of 2 months in delay in diagnosis is 'cut-off' value in prediction of death (sensitivity of 75.5% and specificity of 90.3%). Conclusion. A delay in diagnosis and stage of the disease are highly significant factors of patients with CRC survival. In everyday medical practice higher importance should be put on weight loss, intermittent abdominal pain, change in bowel habits, as well as on syderopenic anaemia.

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A hospital-based study on clinical data, demographic data and visual function of keratoconus patients in Central China

Scientific Reports ◽

10.1038/s41598-021-87291-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kaili Yang ◽

Liyan Xu ◽

Qi Fan ◽

Yuwei Gu ◽

Bo Zhang ◽

...

Keyword(s):

Clinical Data ◽

Rural Areas ◽

Visual Function ◽

Urban Areas ◽

Demographic Data ◽

Corneal Thickness ◽

Positive Family History ◽

Education Level ◽

Central China ◽

The Mean

AbstractChina is a populous country but lacks epidemiological data on keratoconus (KC). The present study aimed to investigate the clinical data, demographic data, and visual function (VF) data of KC patients in Central China. A total of 524 KC eyes in 307 KC patients (217 bilateral and 90 unilateral) from Henan Eye Hospital were included in the current study. Demographic and VF data were assessed with questionnaires administered by well-trained staff during face-to-face interviews. Visual acuity value was examined by a qualified optometrist, and the clinical data were measured by professional clinicians. The distributions of sex, residence and education level of KC patients were compared by Chi-square tests, and the ratios of people wearing glasses and rigid gas permeable (RGP) lenses were compared by McNemar tests. General linear models/Chi-squared tests were used to compare the clinical and demographic data according to KC severity. Spearman’s correlation analysis was used to test the associations between the data and KC severity. The mean age at diagnosis was 20.98 ± 6.06 years, and males had a higher ratio of KC than females (P < 0.001). Patients in rural areas had a higher rate of KC than those in urban areas (P = 0.039), and the proportion of KC patients with a higher education level (above high school) was high (P < 0.001). A total of 68.40% of the patients reported eye rubbing and 3.52% had a positive family history. The percentage of people wearing glasses was higher than that of patients wearing RGP lenses (P < 0.001). The total VF score of KC patients was 69.35 ± 15.25. The thinnest corneal thickness (TCT) and stiffness parameter at the first applanation (SP-A1) values were inversely correlated with KC severity (P < 0.05). The mean, steep, and max keratometry (Km, Ks and Kmax) values, the RGP lens use and keratoplasty were positively correlated with KC severity (all P < 0.05). The total VF score of the eye with better VA decreased as the severity increased (r = − 0.21, P = 0.002). The present study comprehensively describes various associated features of KC patients from a tertiary hospital in Central China, providing a reference for understanding the characteristics of KC patients in China.

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An Academic-Community Collaboration to Deliver Medication Therapy Management (MTM) Services to Patients Living in Rural Counties of a Southwestern State in the United States

Journal of Pharmacy Practice ◽

10.1177/08971900211000219 ◽

2021 ◽

pp. 089719002110002

Author(s):

David Rhys Axon ◽

Melissa Johnson ◽

Brittany Abeln ◽

Stephanie Forbes ◽

Elizabeth J. Anderson ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Program Effectiveness ◽

Small Town ◽

The United States ◽

Small Towns ◽

Academic Community ◽

Service Needs ◽

Medication Therapy

Background: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. Objective: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. Methods: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). Results: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. Conclusion: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.

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Impact of adenotonsillectomy on the quality of life of patients operated on at the Hospital de Clínicas, Paraguay

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.v8i4.1650 ◽

2021 ◽

pp. 1-7

Author(s):

Carlos Mena Canata ◽

Rebeca Noemí Ruiz Vallejos

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Rural Areas ◽

Urban Areas ◽

Obstructive Sleep ◽

Significant Difference ◽

Before And After ◽

The Impact

The objective of this study is to determine the impact of adenotonsillectomy on the quality of life of postoperative patients.The study is observational, cross-sectional, and retrospective. The files of all postoperative adenotonsillectomy patients in Otorhinolaryngology Service, Hospital de Clínicas, San Lorenzo Paraguay. The Obstructive sleep apnea – 18 questionnaire (OSA 18) was applied, asking patients about symptoms before and after surgery. An effective sample of 143 postoperative patients was obtained. The average age was 6.05 ± 2.08 years, 55.10% (81) were male and 44.89% (66) were female, 65.30% (96) were from urban areas and 34.69% (51) from the rural areas. The t test was performed for means of two paired samples, comparing the results of the Obstructive sleep apnea – 18 questionnaire surveys before and after surgery which presented a significant difference (p <0.05) with a tendency to improve the quality of life after surgery. It has been shown that there is a significant difference, a considerable improvement in the quality of life of patients after adenotonsillectomy.

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Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

The Journal of Knee Surgery ◽

10.1055/s-0038-1676372 ◽

2019 ◽

Vol 33 (01) ◽

pp. 034-041 ◽

Cited By ~ 1

Author(s):

Theodore S. Wolfson ◽

David Novikov ◽

Kevin K. Chen ◽

Kelvin Y. Kim ◽

Afshin A. Anoushiravani ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Subgroup Analysis ◽

Blood Management ◽

Folate Supplementation ◽

Level Of Evidence ◽

Significant Difference ◽

Total Knee

AbstractDespite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

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Pathogenicity and non-opportunistic character of Blastocystis spp.: a hospital-based survey in Central Cameroon

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10122 ◽

2018 ◽

Vol 12 (05) ◽

pp. 373-379 ◽

Cited By ~ 3

Author(s):

Stéphanie Jupsa-Mbiandou ◽

Samuel Fosso ◽

Edimo Billé ◽

Tito T Mélachio-Tanekou ◽

Gideon Ajeagah-Aghaindum ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Age Groups ◽

Clinical Signs ◽

Hiv Positive ◽

Cross Sectional ◽

Significant Difference ◽

Blastocystis Spp ◽

Stool Samples ◽

Hiv Negative

Introduction: Blastocystis spp. is a protist found in humans. Although usually the most frequent protozoa found in stool samples of both symptomatic and healthy subjects, its pathogenic or rather opportunistic role is yet to be clearly elucidated. To attempt to fill this gap, a cross-sectional study was conducted to compare the frequency of Blastocystis spp. in HIV positive (HIV+) versus HIV negative (HIV-) individuals in four health facilities of the Center Region of Cameroon. Methodology: Stool samples were collected from 283 HIV positive and 245 HIV negative subjects and analyzed using direct diagnostic tests. Results: A total of 46 (8.7%) individuals were found infected with Blastocystis spp., including 6.7% HIV positive and 11.0% HIV negative. This species was more frequent in urban and semi-urban areas than in rural areas, but evenly distributed among genders and age groups as well as among all sectors of activity. The prevalence of Blastocystis spp. (11.3%) was higher in HIV+ patients with a CD4 count ≥ 500 cells / mm3, but no significant difference was found among HIV clinical stages. Likewise prevalence, the mean number of cysts per gram of stool was similar between HIV positive and HIV negative individuals. People infected with Blastocystis spp. showed diverse clinical signs, but only flatulence was significantly more prevalent. The frequencies of these clinical signs were not related to HIV status. Conclusion: No clear relationship links the infection with Blastocystis spp. to HIV, although its presence was associated with digestive disorder, suggesting that this parasite might not be opportunist.

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Changes in Umbilical and Cerebral Blood Flow in Pregnancies Diagnosed with Clinical Chorioamnionitis. Is Chorioamnionitis Predictable?

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.863 ◽

2019 ◽

pp. 1

Author(s):

Berfin Okmen Ozkan ◽

Emre Ekmekci

Keyword(s):

Umbilical Artery ◽

Demographic Data ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Significant Difference ◽

Umbilical Artery Doppler ◽

Doppler Evaluation ◽

Umbilical Arteries

Objective: To evaluate the predictability of clinical chorioamnionitis by Doppler changes in fetal middle cerebral and umbilical arteries, at hospitalized patients due to preterm premature rupture of membranes.Study Design: Patients who were admitted and hospitalized due to preterm premature rupture of membranes between 24 weeks and 33 weeks and 6 days pregnancies are included in the study. Demographic data of patients, gestational age at referring to hospitalization, fetal presentation at admission, delivery time, delivery indications and total follow-up time until delivery of each case were recorded.Results: A total of 108 patients were evaluated retrospectively. The rate of clinical chorioamnionitis was 5.55% (6/108). There was no significant difference between pregnancies terminated with the diagnosis of clinical chorioamnionitis and pregnancies terminated with other indications in terms of the maximum systolic velocity at middle cerebral artery and umbilical artery pulsatility indices.Conclusion: Clinical chorioamnionitis is a serious complication and is more common in patients being followed up after preterm premature rupture of membranes. Although it is crucial to be predicted due to neonatal worse prognosis, it cannot be predicted by middle cerebral and umbilical artery Doppler evaluation.

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Perbedaan Pengetahuan dan Sikap Remaja tentang Infeksi Menular Seksual di SMA/SMK Perkotaan dan Pedesaan

e-CliniC ◽

10.35790/ecl.v9i1.31856 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Erald J. Lanes ◽

Suzanna P. Mongan ◽

John J. E. Wantania

Keyword(s):

High Schools ◽

Sexually Transmitted Infections ◽

Rural Areas ◽

Urban Areas ◽

Cross Sectional ◽

Equal Distribution ◽

Sexually Transmitted ◽

Knowledge And Attitudes ◽

Significant Difference ◽

Premarital Sexual

Abstract: Premarital sexual behavior in adolescence is a high risk factor for sexually transmitted infections. Sexually transmitted infections (STIs) are infections that are generally transmitted through sexual contact. Differences in social, cultural, and economic factors were found to affect the incidence and prevalence of sexually transmitted infections between different groups in a population. These are likely caused by differences in the knowledge and attitudes of adolescents living in urban and rural areas. This study was aimed to obtain the differences in the level of knowledge and attitudes toward STIs of adolescents in urban and rural area schools. This was a descriptive study with a cross-sectional design conducted on 50 adolescents of urban senior high schools and 50 adolescents of rural senior high schools/vocational high schools. Questionnaires were distributed via email by using Google form. The results showed that adolescents living in urban areas had good knowledge about STIs meanwhile adolescents living in rural areas had fair knowledge. The attitudes about STIs of most adolescents living in urban areas and rural areas were good. In conclusion, adolescents living in urban areas had better knowledge about STIs than those living in rural areas, however, there was no significant difference in attitudes about STI between the two regions. Equal distribution of education in Indonesia is needed in urban as well as in rural areas.Keywords: sexually transmitted infections, adolescents, knowledge, attitudes, urban and rural Abstrak: Perilaku seksual pranikah pada usia remaja merupakan faktor risiko tinggi terhadap infeksi menular seksual (IMS). Infeksi menular seksual merupakan infeksi yang umumnya ditularkan melalui hubungan seksual. Perbedaan faktor sosial, kultural maupun ekonomi dapat memengaruhi insiden dan prevalensi IMS antara kelompok yang berbeda dalam suatu populasi. Hal tersebut kemungkinan besar disebabkan oleh adanya perbedaan pengetahuan dan sikap remaja yang tinggal di wilayah perkotaan dan pedesaan. Penelitian ini bertujuan untuk mengetahui perbedaan tingkat pengetahuan dan sikap remaja terhadap IMS di sekolah wilayah perkotaan dan pedesaan. Jenis penelitian ialah deskriptif dengan desain potong lintang dan kuesioner didistribusikan secara daring menggunakan Google Form. Responden ialah 50 remaja di SMA wilayah perkotaan dan 50 remaja di SMA/SMK wilayah pedesaan. Hasil penelitian mendapatkan bahwa pengetahuan remaja tentang IMS pada siswa SMA perkotaan sebagian besar berada dalam kategori baik sedangkan pada siswa SMA/SMK pedesaan sebagian besar berada dalam kategori cukup. Sikap remaja tentang IMS pada siswa SMA/SMK perkotaan dan pedesaan sebagian besar baik. Simpulan penelitian ini ialah remaja perkotaan memiliki pengetahuan yang lebih baik mengenai IMS dibandingkan remaja di pedesaan namun tidak terdapat perbedaan sikap remaja yang bermakna mengenai IMS antara kedua wilayah. Pemerataan pendidikan di Indonesia dibutuhkan di wilayah perkotaan dan pedesaan.Kata kunci: infeksi menular seksual, remaja, pengetahuan, sikap, perkotaan dan pedesaan

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Follow-up of Children With Trait in a Rural Setting

PEDIATRICS ◽

10.1542/peds.83.5.876 ◽

1989 ◽

Vol 83 (5) ◽

pp. 876-877

Author(s):

Herman Harris

Keyword(s):

Sickle Cell ◽

Rural Areas ◽

Urban Areas ◽

Cost Effective ◽

Rural Setting ◽

Urban Centers ◽

Hb S ◽

The Individual ◽

Limited Testing

The Comprehensive Sickle Cell Centers were established in 1972 to test, educate, counsel, and research sickle cell anemia and related hemoglobinopathies. Standards and protocols for testing, education, and research were readily established because similar procedures and methods were already in operation at the institutions where the centers were located. The most difficult and still the most controversial program to provide is counseling. It became evident, early, that there is no universally accepted method for informing carriers of abnormal Hb S about their results. Centers located in large urban areas with a limited testing radius do not face the same problems as centers located in rural areas where the testing radius may cover an entire state or several states. Individual, or one-on-one, counseling of persons with trait results appears to be successful for urban centers where the individual may be called to the center and given information. But, in a rural setting, it is not feasible for the center to ask a person to travel 350 miles to be told he or she has nothing to worry about. And it is not cost-effective to send a caseworker 350 miles to say the same thing. It must, therefore, be concluded that each agency or center must adopt counseling methods that meet its specific needs. Each program must be flexible, imaginative, and creative and must successfully and accurately deliver information about being a carrier for the sickle gene or other hemoglobinopathy and its implication and significance for patients and their future offspring. To do this, we must first look at the problems facing us.

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Comparison of Volar and Dorsal Approach for PIP Arthroplasty

Hand ◽

10.1177/1558944719861718 ◽

2019 ◽

pp. 155894471986171

Author(s):

Geneva V. Tranchida ◽

Scott T. Allen ◽

Susan M. Moen ◽

Lauren O. Erickson ◽

Christina M. Ward

Keyword(s):

Surgical Approach ◽

Revision Surgery ◽

Statistical Difference ◽

Demographic Data ◽

Complication Rates ◽

Hand Therapy ◽

Dorsal Approach ◽

Volar Approach ◽

Significant Difference

Background: No consensus exists about whether a volar approach (VA) or dorsal approach (DA) for proximal interphalangeal (PIP) arthroplasty yields better results. Previously reported range of motion (ROM) and complications vary from study to study. This retrospective review compared the ROM and complication rates of VA and DA approaches to PIP arthroplasty. Methods: The study included 66 adults (88 digits) who underwent PIP arthroplasty from 2000 to 2015, with minimum 30-day follow-up. Demographic data, surgical approach, pre- and post-operative ROM, duration of immobilization, timing and duration of hand therapy (occupational therapy [OT]), and major and minor complications were recorded. We compared mean change in ROM, postoperative ROM, and complication rates, and examined the association of duration of immobilization and time to OT initiation with postoperative ROM. Results: While there was no difference in postoperative ROM between volar and dorsal groups (56° and 54°, respectively, P > .05), there was a greater gain in ROM in the DA group (25° vs 2.7°, P = .017). There was no statistically significant difference in overall incidence of complications (VA: 37.8%, DA: 30.3%; P > .05) or revision surgery (VA: 15.6%, DA: 17.1%; P > .05). There were no differences in duration of immobilization, time to OT initiation, or number of OT sessions between the two groups, and none of these correlated with postoperative ROM. Conclusions: We identified no statistical difference in mean postoperative ROM, incidence of complications or revision surgery between volar and dorsal approaches for PIP arthroplasty.

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