Surgical manifestations and management of gastrointestinal and hepato-pancreato-biliary ascariasis: an observational study

Background: Ascaris lumbricoides is the largest intestinal nematode parasite of humans. This study describes different presentations and management patterns of gastrointestinal and hepato-pancreato-biliary ascariasis presenting to a tertiary centre of North-eastern India.Methods: This was a prospective observational study aimed to study the presentations and management patterns of Ascaris related surgical diseases including intestinal obstruction, pancreatitis and cholangitis in a tertiary centre of Northeast India. All consenting cases of gastrointestinal and hepato-pancreato- biliary ascariasis admitted in our hospital were included.Results: Ninty patients with Ascaris sequeale were included, which included biliary ascariasis without cholangitis: 36, pancreatitis: 30, cholangitis: 18 and sub-acute intestinal obstruction: 6. Ultrasound was the most useful diagnostic investigation followed by stool examination and endoscopy. Hepato-pancreato-biliary ascariasis was managed conservatively and the progress monitored with sonography. The surgical management choledocho-duodenostomy was done for three patients having biliary ascariasis with unresolving obstructive jaundice and recurrent cholangitis on conservative management and 6 patients underwent therapeutic endoscopic worm removal. There were no deaths. No patient needed ICU care.Conclusions: Sonography can be helpful in diagnosing the presence of worms, its complications and in evaluating response to treatment. Hepato-pancreato-biliary ascariasis can be managed conservatively for majority of the patients.

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Is nurse-led telephone follow-up for post-operative obstructive sleep apnoea patients effective? A prospective observational study at a paediatric tertiary centre

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2019.109766 ◽

2020 ◽

Vol 129 ◽

pp. 109766 ◽

Cited By ~ 3

Author(s):

Hussein Walijee ◽

Salil Sood ◽

Anne Markey ◽

Madhankumar Krishnan ◽

Anita Lee ◽

...

Keyword(s):

Observational Study ◽

Obstructive Sleep Apnoea ◽

Prospective Observational Study ◽

Sleep Apnoea ◽

Tertiary Centre ◽

Obstructive Sleep

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Renal Resistive Index in Patients with Septic Shock: Changes in the Renal Resistive Index as a Parameter of Tissue Perfusion in the Assessment of Response to Treatment during Resuscitation of Patients with Septic Shock; a Prospective Observational Study

10.21203/rs.3.rs-223523/v1 ◽

2021 ◽

Author(s):

Hamed Aminiahidashti ◽

Mohammad Sazgar ◽

Fatemeh Jahanian ◽

Soroush Niksalehi ◽

Iraj Golikhatir

Keyword(s):

Septic Shock ◽

Observational Study ◽

Prospective Observational Study ◽

Resistive Index ◽

Tissue Perfusion ◽

Response To Treatment ◽

Renal Resistive Index ◽

P Value ◽

Volume Assessment ◽

Treatment Onset

Abstract BackgroundSeptic shock, a complication characterized by altered tissue perfusion, is associated with high mortality if left untreated. Renal resistive index (RRI) reflects changes in intrarenal perfusion. Therefore, the present study aimed at investigating changes in RRI during resuscitation of patients with septic shock and evaluating its relationship with other micro- and macrociculatory perfusion parameters.MethodsThe present prospective observational study was performed on all patients referring to the emergency department intensive care unit (ED-ICU) diagnosed with septic shock from July 2018 to September 2019. Demographic characteristics of the study subjects were recorded and their hemodynamic, paraclinical, and RRI values were measured at three time points of on arrival, and 30 and 120 minutes and six hours after admission, by ultrasound.ResultsA total of 109 subjects entered data analysis; their mean age was 67.62 ± 14.67 years, of which 65 (59.1) were male. The RRI values were 0.71 ± 0.27, on arrival, at 30 and 0.70 ± 0.1 on 60 minutes, at six hours after treatment onset, respectively, showing that RRI values decreased during the study, which was statistically significant (P-value= 0.00). ConclusionA decrease in RRI value during resuscitation is associated with an increase in MAP in patients with septic shock. Accordingly, RRI can be used as an indicator of microcirculatory perfusion in the treatment process and volume assessment of patients with septic shock.

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Clinical study of adhesion obstruction at a tertiary care hospital: a prospective observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20211298 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1201

Author(s):

Iqbal Saleem Mir ◽

Younis Bashir ◽

Yaser Hussain Wani ◽

Younis Dar ◽

Shiwani Thakur ◽

...

Keyword(s):

Observational Study ◽

Intestinal Obstruction ◽

Surgical Procedure ◽

Prospective Observational Study ◽

Tertiary Care ◽

Abdominal Distension ◽

Acute Intestinal Obstruction ◽

Predisposing Factors ◽

Clinical Feature ◽

Care Hospital

Background: Adhesion obstruction is one of the most common presentations of acute abdomen and an important cause of general surgical consultation. This study aimed to analyse demographic features, clinical features, predisposing factors, and management of this surgical problem.Methods: The present study was a prospective observational study and was conducted in the Department of General Surgery of SMHS hospital entitling 267 patients who were diagnosed and treated over 5 years from May 2014 to April 2019.Results: The most common age group diagnosed with acute intestinal obstruction was between 31 to 40 years, with the incidence more in males (65.5%) as compared to females (34.4%). The most common clinical feature was abdominal pain (98.1%) followed by vomiting (93.6%), constipation (86.1%) abdominal distension (82.3%). Postoperative adhesions (40.07%) followed by obstructed hernias (23.3%) and malignancies (14.6%) were the most common predisposing factors. Ischemia was the most common complication in 11.2% of patients followed by necrosis at 6.7% and perforation at 2.9%. Adhesiolysis was the most common surgical procedure performed 43.8% followed by anatomical repair 21.7% and resection and end to end anastomosis 15.3%, enterotomy 10.86%, and Hartman’s procedure 8.2%.Conclusions: Adhesive intestinal obstruction is an important surgical emergency. Post-operative adhesions remain the most common cause of acute intestinal obstruction, with patients most commonly presenting with pain abdomen, all necessary steps must be taken to lessen the chances of adhesions after any surgical procedure.

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Relationships between sites of abdominal pain and the organs involved: a prospective observational study

BMJ Open ◽

10.1136/bmjopen-2019-034446 ◽

2020 ◽

Vol 10 (6) ◽

pp. e034446 ◽

Cited By ~ 2

Author(s):

Shun Yamashita ◽

Masaki Tago ◽

Naoko E Katsuki ◽

Tomoyo M Nishi ◽

Shu-ichi Yamashita

Keyword(s):

Abdominal Pain ◽

Urinary Tract ◽

Observational Study ◽

Biliary Tract ◽

Prospective Observational Study ◽

General Medicine ◽

University Hospital ◽

Likelihood Ratios ◽

Left Flank ◽

Tertiary Centre

ObjectivesAbdominal pain is one of the most frequent chief complaints in primary care settings. The aim of the present study was to determine the positive likelihood ratios (PLRs) and negative likelihood ratios (NLRs) of the relationships between the sites of abdominal pain and the organs involved.DesignProspective observational study.SettingA single tertiary centre, a university hospital in Japan.ParticipantsA total of 2591 new outpatients visited the Department of General Medicine at a university hospital from April 2017 to March 2018. Of these, 326 patients aged ≥20 years with abdominal pain were enrolled.ResultsSites of abdominal pain were classified into 11 categories including nine different abdominal sections, ‘generalised abdomen’ and ‘site-indeterminate’. The PLRs between ‘right subcostal’ and ‘liver and biliary tract’; between ‘right subcostal’ and ‘musculoskeletal’ ; between ‘epigastric’ and ‘oesophagus, stomach and duodenum’; between ‘right or left flank’ and ‘urinary tract’; between ‘left flank’ and ‘dermatological’; and between ‘mid-lower’ and ‘intestinal’ ranged from 2.17 to 4.14. The PLRs between ‘epigastric’ and ‘urinary tract’; between ‘mid-lower’ and ‘liver and biliary tract’; between ‘periumbilical’ and ‘urinary tract’; and between ‘generalised abdomen’ and ‘oesophagus, stomach and duodenum’ were low, ranging from 0.17 to 0.25. The NLR ranged from 0.5 to 1.5, excluding the relationship between ‘left flank’ and ‘dermatological’.ConclusionThe presence of pain at right subcostal, epigastric, right or left flank and mid-lower sites might be useful for identifying the organs involved. Additionally, the presence of pain at mid-lower, epigastric, periumbilical and generalised abdominal sites might be helpful for denying the involvement of some organs. Some sites of abdominal pain can be indicative of the organs involved.Trial registration numberUMIN000037686

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