scholarly journals Evaluation of role of granulocyte macrophage colony stimulating factor (GM-CSF) in treatment of patients with perforation peritonitis: a prospective study

2018 ◽  
Vol 5 (5) ◽  
pp. 1902
Author(s):  
Tapan Singh Chauhan ◽  
Chisel Bhatia ◽  
Satish Dalal ◽  
Nityasha Nara ◽  
Tulit Chhabra
Keyword(s):  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Neutropenic Patient ◽  
Septic Complications ◽  
Systemic Complications ◽  
Anticancer Chemotherapy ◽  
Gm Csf ◽  
Group A ◽  
Group B

Background: GM-CSF has been demonstrated to be effective in reducing the incidence of infection in patients who receive myelosuppressive anticancer chemotherapy or patients who are neutropenic and agranulocytic. We study the role of GM-CSF in non-neutropenic patients with Systemic Inflammatory Response Syndrome (SIRS), infections and sepsis with impaired neutrophil function to access the current rationale for administering GM-CSF in addition to standard antibiotic therapy to critically ill patientsMethods: All patients undergoing surgery for peritonitis due to gastrointestinal perforations were included in this study and were divided into two groups alternatively to avoid any bias i.e. Group A 1, 3, 5 etc. and Group B 2, 4, 6 etc. Group A - all patients received GM-CSF along with standard antibiotics. Group B patients received antibiotics only. Course of patient in immediate postoperative period, time to improvement, duration of hospital stay, antibiotic therapy, rate of complications were compared.Results: Patients in group A had a lower duration of antibiotic therapy and hospital stay. Patients in group A took less time to show clinical improvement compared to patients in Group B. Group A also had a much lower rate of infectious and systemic complications compared to group B. Conclusions: Results of the present study show that GM-CSF is an important molecule when used as adjunct to antibiotics in cases of abdominal sepsis. Use of this growth factor is associated with less incidence of septic complications and morbidity, a shorter duration of antibiotic therapy and hospital stay without significantly compromising the cost. The results of present study help in identifying its role in non-neutropenic patient groups who are most likely to benefit from its administration.

scholarly journals Early Enteral Nutrition in Neonates Following Abdominal Surgery

2018 ◽  
Vol 7 (2) ◽  
pp. 21 ◽  
Author(s):  
G. Raghavendra Prasad ◽  
J. V. Subba Rao ◽  
Amtul Aziz ◽  
T. M. Rashmi ◽  
Saniya Ahmed
Keyword(s):  
Enteral Nutrition ◽  
Hospital Stay ◽  
Abdominal Pressure ◽  
Early Enteral Nutrition ◽  
Necrosis Factor Alpha ◽  
Septic Complications ◽  
Tnf Α ◽  
Gut Mucosa ◽  
Group A ◽  
Group B

Introduction: Nil per oral (NPO)/nil by mouth has been the most commonly practiced convention in post-operative period. Misplaced fear of aspiration led to routine prescription of “NPO.” Starvation leads to atrophy of the gut mucosa leading to decreased barrier effect of gut mucosa. This starvation-induced gut mucosal injury increases septic complications and mortality. The study aims at establishing the feasibility and effect of early enteral nutrition (EEN) in neonates following abdominal surgeries.Materials and Methods: A total of 260 cases formed the cohort of prospective cohort study, 79 in EEN - Group “A” and 181 in NPO - Group “B.” Effect of EEN was evaluated with regard to outcome, hospital stay, surgical site infections (SSI), stress markers such as C-reactive protein (CRP), procalcitonin, tumor necrosis factor alpha (TNF α), and neonatal-predisposition, insult/injury, response, organ failure (Neo-PIRO) scores, intra-abdominal pressure (IAP) grade, tolerance of feeds, and time to first stool. Chi-square was the statistical method used. Epi info version 7 was the software used.Results: Group B had higher mortality (20.09%) than Group A (P < 0.05). 33.7 in Group B developed SSI, of which 90% were deep and intracavitary (P < 0.05). Hospital stay was less in Group A (P < 0.05). CRP and Neo-PIRO scores were less in Group A compared to Group B (P < 0.05). TNF-α expression and IAP scores were not statistically significant (P > 0.05). Procalcitonin levels were higher in Group B. Feeds were better tolerated in Group A. First stool appeared earlier in Group A than B. There was no difference in anastomotic leak in both the groups.Conclusion: EEN in neonates following abdominal surgeries is feasible, well tolerated reduces the hospital stay and mortality, and reduces SSIs, and early gut motility could be established.

scholarly journals ROLE OF OCTREOTIDE ON OUTCOME OF PATIENTS WITH ACUTE PANCREATITIS

1969 ◽  
Vol 5 (1) ◽  
pp. 639-643
Author(s):  
AJMAL KHAN ◽  
SAMIULLAH ◽  
MANZOOR ALI ◽  
SAIFUREHMAN
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Pain Control ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
P Values ◽  
Group A ◽  
Group B

BACKGROUND: acute pancreatitis is a multisystem disease carrying broad spectrum of clinicalpresentation and complications. The objective of this study was to determine the positive role ofoctreotide in the out come of patients suffering from acute pancreatitis.OBJECTIVE: The objective of this study was to assess the role of octreotide in patients having acutepancreatitis.PATIENTS AND METHODS: This is a descriptive, comparative, prospective study. The study wasconducted in the department of surgery Saidu Group of Teaching hospital Saidu Sharif Swat fromJanuary 2011 to June 2014. Total of seventy consecutive patients having acute pancreatitis wasrandomized in a prospective trail for the treatment, at tertiary care hospital in Malakand division SwatKPK Pakistan. The data of patients were recorded on a purposely prepared proforma for this study. Thediagnosis of patients was established on basis of biochemical (serum amylase, WCC, C-reactive protein)and radiological (USG, CT- scan) investigations. The patients were divided into two groups, A and B.Group A, had received octreotide along with fluids, omeprazole, analgesic. Group B received fluids,omeprazole, analgesic without octreotide. Ages of the Group A and B were matched (±5 years). Datawas analyzed using SPSS version 16 employing chi-square test (X" test). A p-value below 0.05 wasconsidered statistically significant.RESULTS: In this prospective, comparative study two groups, each of 35 consecutive patients wereselected. The mean age in Group A was 37 ±12.41 years and in Group B 40±10.32 years (p DO.364).There were 12 males and 23 females in group A, while 14 males and 21 females in group B. Both thegroups were comparable. All the patients in octreotide group A and non-octreotide group B weresurvived. No major complications were noted in either group. As far as mean hospital stay was 7 ±2.10days in group A, while it was 9±3.14 days in group B (p<0.032). All the P- values for the criteria ofstudy were calculated. P-values were significant when we consider pain control and hospital stay intwo groups.CONCLUSION: In our study we found that octreotide was more effective in the final outcome ofpatients with acute pancreatitis. There is clear cut beneficial effect of octreotide on hospital stay andreduced need of analgesics in patients having acute pancreatitis.KEYWORDS: Acute Pancreatitis, Octreotide, Hospital Stay, pain control.

scholarly journals NEAR TOTAL THYROIDECTOMY;

2018 ◽  
Vol 21 (02) ◽  
pp. 382-385
Author(s):  
Ghulam Yasin ◽  
Muhammad Rizwan Anwar ◽  
Waseem Sadiq Awan ◽  
Zaffar Iqbal Gondal ◽  
Ghulam Mustafa Araien
Keyword(s):  
Hospital Stay ◽  
Total Thyroidectomy ◽  
Length Of Hospital Stay ◽  
Benign Diseases ◽  
Patient Morbidity ◽  
Drain Group ◽  
Group A ◽  
Group B ◽  
Method Group

Objective: To evaluate the role of surgical drains in near total thyroidectomy.Study Design: It was a Randomized clinical trial conducted at department of surgery, DHQteaching Hospital, Dera Ghazi Khan from Jun 2012 to May 2013. Patients and Methods: Patientswere randomized into two groups by lottery method. Group A were those in which drains wereplaced and Group B patient were operated and no drains were placed. Inclusion criteria includedall patients presenting for near total thyroidectomy for benign diseases. Those with massivegoiters or nodules larger than 6 cm were excluded. 40patients were enrolled in the study.Complications, length of hospital stay, and overall cost were evaluated. Results: In the Group B(no drain group), there was 03 days mean hospital stay with no increase in postoperativecomplications like swelling. While Group A (drain group) mean hospital stay was 06 days.Conclusions: Thyroid surgery without the use of a drain decreases the length of hospital stay,with no increase in patient morbidity. The overall cost is significantly reduced.

scholarly journals A STUDY ON ROLE OF OCTREOTIDE ON OUTCOME OF PATIENTS WITH ACUTE PANCREATITIS

2020 ◽  
pp. 22-24
Author(s):  
Vishal Lodha ◽  
Rajesh Sonsale ◽  
Sandip Jadhav
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Care Hospital ◽  
Group A ◽  
Group B ◽  
Control Study

Introduction: Mild pancreatitis is a self limiting disease, while morbidity and mortality is considerably high in cases of severe necrotizing pancreatitis. Octreotide reduces secretion, release and activation of exocrine hormones; there is collection of pancreatic hormones in duct which in return causes irreversible destruction of the exocrine and endocrine pancreatic parenchyma leading to mal-digestion and diabetes. There are lot of controversies in the treatment of acute pancreatitis, so through this study we tried to evaluate whether there is a beneficial role of octreotide or not. Materials and Method: This case control study was done on patients admitted for the treatment of acute pancreatitis at a tertiary care hospital in Central India. This is retrospective study. The data of inpatient records were taken from the medical records department (MRD) of the hospital. The diagnosis of patients was established on basis of biochemical and radiological investigations. The patients were divided into two groups; cases and control, cases had received octreotide along with fluids (group A) controls received fluids without octreotide (group B). Symptomatic treatment was given in both the groups. Ages of the cases and controls were matched (±3 years). The statistical analysis of data was done and results were obtained. Results: In this retrospective case control study the records of fifty two patients were selected. The mean age in Group A was 35 ±16.45 years and in Group B 40±17.51 years in Group B (tA/B1.061; p ˂0.294). There were 22 males and 4 females in group A, while 20 males and 6 females in group B. Both the groups were comparable. All the patients in octreotide group survived while there were three deaths in control group. As far as mean hospital stay is was 10 days ± 7.10 in group A while it was 7 days ±3.65 in group B. All the p values for the criteria of study are non-significant. But when we talk about percentage, 11.53% patient died in control group. Conclusion: In our study we found that octreotide does not affect the final outcome of patients with acute pancreatitis. There is no effect on hospital stay and reduced need of analgesics in patients with acute pancreatitis. Keywords: Acute Pancreatitis; Octreotide; Hospital Stay; Mortality

scholarly journals Role of Pigtail Catheter Drainage in the Management of Liver Abscess – A Retrospective Analysis

2021 ◽  
Author(s):  
Saurabh Kumar ◽  
Kamlesh Ahari ◽  
Naresh Kumar Midha ◽  
Deepak Kumar ◽  
Maya Gopalakrishnan ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Liver Abscess ◽  
Health Concern ◽  
Western India ◽  
Pigtail Catheter ◽  
Catheter Drainage ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Introduction – Liver abscess (especially amoebic) is an important health concern in tropical countries. Effective management of liver abscess included appropriate antibiotics and drainage of abscess cavity. Percutaneous abscess drainage by pigtail catherization is now gaining popularity. We analysed the role of pigtail catheter drainage in the treatment of liver abscess.Method and Material – This was a retrospective analytical study conducted in a tertiary care center in western India. Data of total 64 patients admitted with diagnosis of liver abscess were analyzed. To find the effectiveness of treatment data were analyzed in three groups based on treatment strategies, Group A (Conservative treatment), Group B (Percutaneous needle aspiration) and Group C (Pigtail catheter drainage).Results – A total of 64 patients of liver abscess were analyzed. There was male predominance (93.75%). Mean abscess volume in Group C (307.9 ± 212.8 ml) was significantly higher when compared to Group A (130.8 ± 72.9 ml, p = 0.03) and Group B (177.2 ± 129.5; p = 0.024). Duration of hospital stay and residual abscess volume at the time of discharge did not show statistically significant difference between treatment groups. Pigtail catheterization of abscess with volume >150ml shortened the hospital stay, whereas it prolonged the hospital stay in patients with abscess volume <150ml.Conclusion - Percutaneous pigtail catherization would be an operative decision for management of liver abscess. We concluded that use of pigtail catherization of patients with abscess volume > 150ml improved the clinical outcome.

scholarly journals Role of intraperitoneal instillation of bupivacaine after laparoscopic cholecystectomy for post-operative pain management: a randomized controlled trial

2020 ◽  
Vol 7 (10) ◽  
pp. 3239
Author(s):  
Pramatha Nath Datta ◽  
Arijit Roy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Management ◽  
Hospital Stay ◽  
Rating Scale ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Rescue Analgesia ◽  
Group A ◽  
Group B

Background: Intra peritoneal (IP) local anaesthesia (LA) is a simple, cheap and safest method of providing post-operative (post-op) analgesia after laparoscopic cholecystectomy (LC). In this research, the role of intraperitoneal (IP) instillation of bupivacaine on post-op pain was studied. Post-op pain at 6, 12 and 24 hours was assessed using numeric rating scale. The degree of ambulation postoperatively at 6 and 24 hours and the requirement of analgesics was taken into account. The length of hospital stay was also a factor.Methods: A total of 76 patients during January 2018 to December 2018, undergoing LC, fitting the inclusion criteria were included randomly and divided in to two groups, bupivacaine group (B) and control group (A) based on a pre-generated random number sequence by the principal investigator. The surgical outcome was compared based on multiple parameters and the primary outcome measures were the post-op pain and analgesic requirement.Results: Degree of ambulation at 6 hours was significantly better in group B, compared to group A (p=0.008). The requirement of first dose of rescue analgesia was found to be within 6 hours (post-op) in 34 patients of group A (89.47%) as compared to 13 patients of group B (34.21%), was found to be statistically significant (p<0.001). There was statistically significant (p=0.002) difference with respect to length of hospital stay between the two groups.Conclusions: In our study we found that IP bupivacaine (0.5%) is an effective, economical, safe method of post-op pain management with better post-op recovery. 

Tissue Ki67 proliferative index expression and pathological changes in hemodialysis arteriovenous fistulae: Preliminary single-center results

2021 ◽  
pp. 112972982110154
Author(s):  
Raffaella Mauro ◽  
Cristina Rocchi ◽  
Francesco Vasuri ◽  
Alessia Pini ◽  
Anna Laura Croci Chiocchini ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Hot Spot ◽  
Wall Thickening ◽  
Proliferating Cells ◽  
Ki 67 ◽  
Group A ◽  
The Mean ◽  
Set Up ◽  
Group B

Background: Arteriovenous fistula (AVF) for hemodialysis integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes. Aim of this study is to determine the role of Ki67, a well-established proliferative marker, related to AVF, and its relationship with time-dependent histological morphologic changes. Materials and methods: All patients were enrolled in 1 year and stratified in two groups: (A) pre-dialysis patients submitted to first AVF and (B) patients submitted to revision of AVF. Morphological changes: neo-angiogenesis (NAG), myointimal thickening (MIT), inflammatory infiltrate (IT), and aneurysmatic fistula degeneration (AD). The time of AVF creation was recorded. A biopsy of native vein in Group A and of arterialized vein in Group B was submitted to histological and immunohistochemical (IHC) analysis. IHC for Ki67 was automatically performed in all specimens. Ki67 immunoreactivity was assessed as the mean number of positive cells on several high-power fields, counted in the hot spots. Results: A total of 138 patients were enrolled, 69 (50.0%) Group A and 69 (50.0%) Group B. No NAG or MIT were found in Group A. Seven (10.1%) Group A veins showed a mild MIT. Analyzing the Group B, a moderate-to-severe MIT was present in 35 (50.7%), IT in 19 (27.5%), NAG in 37 (53.6%); AD was present in 10 (14.5%). All AVF of Group B with the exception of one (1.4%) showed a positivity for Ki67, with a mean of 12.31 ± 13.79 positive cells/hot spot (range 0–65). Ki67-immunoreactive cells had a subendothelial localization in 23 (33.3%) cases, a myointimal localization in SMC in 35 (50.7%) cases. The number of positive cells was significantly correlated with subendothelial localization of Ki67 ( p = 0.001) and with NA ( p = 0.001). Conclusions: Native veins do not contain cycling cells. In contrast, vascular cell proliferation starts immediately after AVF creation and persists independently of the time the fistula is set up. The amount of proliferating cells is significantly associated with MIT and subendothelial localization of Ki67-immunoreactive cells, thus suggesting a role of Ki-67 index in predicting AVF failure.

scholarly journals Adolescents and primary herpetic gingivostomatitis: an Italian overview

2021 ◽  
Author(s):  
Elena Bardellini ◽  
Francesca Amadori ◽  
Federica Veneri ◽  
Giulio Conti ◽  
Alberto Paderno ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Antibiotic Therapy ◽  
Medical Records ◽  
Bacterial Infections ◽  
Group A ◽  
Acid Gel ◽  
Herpetic Gingivostomatitis ◽  
Group B ◽  
Italian Adolescents ◽  
Hyaluronic Acid Gel

Abstract Aim The aim of this study was to investigate the therapies administered to Italian adolescents with primary herpetic gingivostomatitis (PHGS) Methods The medical records of 74 adolescents with PHSG were reviewed. The following data were recorded: age, gender, day of onset, type of treatment, lesions’ severity, pain scoring, eating, and drinking ability. The oral examination was performed at the first evaluation (T0) and after one week (T1). Results All patients showed up at the first visit at least 48 h after the onset of symptoms. No patient was prescribed an antiviral therapy. An antibiotic therapy was prescribed in order to prevent secondary bacterial infections. Fifteen patients had been treated with non alcoholic chlorhexidine rinses (group A), 29 patients with non alcoholic chlorhexidine rinses plus hyaluronic acid gel (group B); 30 patients with non alcoholic chlorhexidine rinses plus Mucosyte® (group C). A significant improvement of the pain scoring and lesions’ severity was noted in group C. Conclusion In Italian adolescents, PHGS is diagnosed at least 48 h after onset and the antibiotic therapy is widely prescribed in order to prevent overinfections. Among topical therapies, an association of verbascoside and sodium hyaluronhate seems to favour a faster healing.

scholarly journals High Basal Maximal Standardized Uptake Value (SUVmax) in Follicular Lymphoma Identifies Patients with a Low Risk of Long-Term Relapse

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2876
Author(s):  
Giovanni Manfredi Assanto ◽  
Giulia Ciotti ◽  
Mattia Brescini ◽  
Maria Lucia De Luca ◽  
Giorgia Annechini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Follicular Lymphoma ◽  
Standardized Uptake Value ◽  
Metabolic Tumor Volume ◽  
Late Relapse ◽  
Prognostic Role ◽  
Pet Ct ◽  
Group A ◽  
Group B

Background: Despite that the unfavorable prognostic role of a high Total Metabolic Tumor Volume (TMTV) in Follicular Lymphoma has been demonstrated, the role of SUVmax alone at baseline PET/CT could have a different prognostic role. Patients and Methods: We performed a retrospective observational monocentric cohort study. All patients affected by FL who underwent a basal PET/CT were included. Two subgroups were identified and compared in terms of PFS and OS: (A) Basal SUVmax ≤ 6; and (B) Basal SUVmax > 6. Results: Ninety-four patients were included, 34 in group A (36.2%) and 60 in group B (63.8%). The PFS at two years was comparable in the two groups (97%). The five-year PFS was 73.5% for group A and 95% for group B (p 0.005). The five-year PFS in the whole cohort was 87.5%. A clear advantage was confirmed in group A in the absence of other risk factors. Patients with SUVmax ≤ 6 and no risk factors showed a 5-year PFS of 73% against 83% for patients with SUVmax > 6 and at least two risk factors. Conclusion: A high FDG uptake favorably correlated with PFS. A low basal SUVmax reflected a higher rate of late relapse requiring a prolonged follow-up. The basal SUVmax is an approachable parameter with prognostic implications.

scholarly journals Clinical significance of late diastolic tissue doppler parameters after onset of STEMI: from the view point of the timing of the echocardipography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Iwahashi ◽  
J Kirigaya ◽  
M Horii ◽  
T Abe ◽  
E Akiyama ◽  
...  
Keyword(s):  
Tissue Doppler ◽  
Atrial Function ◽  
Diastolic Velocity ◽  
Long Time ◽  
Group A ◽  
St Elevation ◽  
Group B ◽  
First Time

Abstract Background The early transmitral flow velocity (E) divided by the early diastolic velocity of the mitral valve annulus (e') is referred to as the “E/e' ratio,” is useful even for ST elevation acute myocardial infarction (STEMI). However, the role of late diastolic velocity (a') which reveals the atrial function for STEMI is still unclear. Objectives We evaluated the clinical usefulness of tissue Doppler including atrial function for a first-time STEMI by long time follow up. Furthermore, we evaluated the meaning of each parameters by performing immediately after PCI or 2 weeks later. Methods We treated consecutive 571 first-time STEMI patients by immediate PCI within 12 hours after onset, and we examined 270 patients at immediately after PCI (GroupA, 65 years, 250 male) and 301 patients at 2 weeks after onset (GroupB, 64 years, 243 male). We examined trans mitral flow and TDI, then defined E/e' as LV filling pressure and A/a' as left atrial function. We followed them for a long time (&gt;5 years). The primary end point (PE) was cardiac death or re-admission for heart failure (HF). Results We followed the patients in Group A for 10 years, Group B for 5 years. PE occurred in 64 patients in GroupA during 10 years, and 45 patients in GroupB during 5 years. We analyzed the univariate and multivariate Cox hazard analyses and we compared e' and a', E/e' and A/a' (Table). In GroupA, a' and A/a' were the independent predictors, on the other hand neither a' nor A/a' were the predictors in GroupB. E/e' was an independent predictor both in GroupA and B. Conclusion TDI parameters have different meanings by the timing of echocardiography after onset of a first-time STEMI. These results demonstrated that atrial dysfunction immediately after onset of STEMI suggests the poor prognosis after STEMI. Cox Hazard Proportional Analysis Funding Acknowledgement Type of funding source: None

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