scholarly journals Perspective on the true incidence of bowel perforations occurring with extreme lateral lumbar interbody fusions. How should they be treated?

2021 ◽  
Vol 12 ◽  
pp. 576
Author(s):  
Nancy E. Epstein
Keyword(s):  
General Surgery ◽  
Interbody Fusion ◽  
Bowel Perforation ◽  
Mortality Rates ◽  
High Morbidity ◽  
Lumbar Surgery ◽  
Multiple Series ◽  
True Incidence ◽  
Timely Fashion ◽  
Overall Mortality

Background: What is the risk of bowel perforation (BP) with open or minimally invasive (MI) extreme lateral lumbar interbody fusion (XLIF)? What is the truth? Further, if peritoneal symptoms/signs arise following XLIF/MI XLIF, it is critical to obtain an emergent consultation with general surgery who can diagnose and treat a potential BP. Literature Review: In multiple series, the frequency of BP ranged markedly from 0.03% (i.e. 1 of 2998 patients), to 0.08% (11/13,004), to 0.5%, to 8.3% (1 in 12 patients), up to 12.5% (1 in 8 patients). BPs attributed to different causes carry high mortality rates varying from 11.1% to 23%. For the 11 (0.08%) BP occurring out of 13,004 patients undergoing XLIF in one series, there was one (9.09%) death due to uncontrolled sepsis. In another series, where 31 BP were identified for multiple lumbar surgical procedures identified through PubMed (1960–2016), including 10 (32.2%) for lateral lumbar surgery including XLIF, the overall mortality rate was 12.9% (4/31). Conclusion: The incidence of BPs occurring following XLIF/MI XLIF procedures ranged from 0.03% to 12.5% in various reports. What is the true incidence of these errors? Certainly, it is more critical that when spine surgeons’ patients develop acute peritoneal symptoms/signs following these procedures, they immediately consult general surgery to both diagnose, and treat potential BP in a timely fashion to avoid the high morbidity (87.1%) and mortality rates (12.9%) attributed to these perforations.

scholarly journals Avian influenza A(H5N1) – current situation

2009 ◽  
Vol 14 (18) ◽  
Author(s):  
A Melidou
Keyword(s):  
Influenza Virus ◽  
Influenza A ◽  
Mortality Rates ◽  
High Morbidity ◽  
Pacific Region ◽  
H5n1 Influenza Virus ◽  
Highly Pathogenic ◽  
H5n1 Influenza ◽  
The Pacific ◽  
Overall Mortality

The A(H5N1) influenza virus has re-emerged in 2003 in Asia, Africa, the Pacific Region as well as Europe and since then has become endemic in some countries. The virus is usually highly pathogenic and is associated with high morbidity and overall mortality rates that reach 61%.

Emergent Right Hemicolectomies

2005 ◽  
Vol 71 (8) ◽  
pp. 653-657 ◽  
Author(s):  
Amy D. Wyrzykowski ◽  
David V. Feliciano ◽  
Timothy A. George ◽  
Lorraine N. Tremblay ◽  
Grace S. Rozycki ◽  
...  
Keyword(s):  
Damage Control ◽  
Primary Anastomosis ◽  
Bowel Perforation ◽  
Demographic Data ◽  
Wound Dehiscence ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Trauma Patients ◽  
Abdominal Abscess

Emergent right hemicolectomies have historically been associated with surprisingly high morbidity and mortality rates. A retrospective review of emergent right hemicolectomies over a 7-year period was performed to assess current morbidity and mortality. Emergent right hemicolectomy was defined as a procedure performed for an acute abdomen with no formal preoperative cleansing of the colon. Demographic data, diagnostic evaluation, length of stay and outcomes were evaluated. Over the study period, 122 emergent right hemicolectomies were performed on both general surgery and trauma patients. The average patient was 52.9 ± 18.5 years old, and the majority of patients (66.4%) were male. The indications for the procedures performed were bowel perforation (51), hemorrhage (25), cancer (16), benign obstruction (14), phlegmon (8), ischemia (6), or other (2). Resection with primary anastomosis was performed in 98 patients, 16 had an end ileostomy, and 8 underwent damage control procedures in which gastrointestinal continuity was not reestablished at the time of the original operation. Postoperative complications developed in 48 patients (39.3%). The majority of the complications (83.3%) were related to infection including intra-abdominal abscess (21 patients), sepsis (16), and wound infection (5). Other complications included anastomotic leak (5), wound dehiscence (3), stoma-related (3) and postoperative bowel obstruction (2). The patients who developed complications did not differ from those who had an uneventful postoperative course in terms of age, indication for procedure, or presence of intra-abdominal abscess or gross contamination at the time of the original procedure. The overall mortality rate was 13 per cent. Patients who died were older than those who lived (63 ± 19 vs 52 ± 18; P = 0.03) and were significantly more likely to have evidence of shock on presentation ( P = 0.0013). Emergent right hemicolectomies continue to be associated with high morbidity and mortality rates. The most common complications are related to infection. Age and manifestations of shock at the time of admission are strong predictors of mortality.

scholarly journals Cardiac complications during the active phase of COVID-19: review of the current evidence

2021 ◽  
Author(s):  
Mohammad Said Ramadan ◽  
◽  
Lorenzo Bertolino ◽  
Tommaso Marrazzo ◽  
Maria Teresa Florio ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Myocardial Damage ◽  
Active Phase ◽  
Mortality Rates ◽  
Major Effect ◽  
Current Evidence ◽  
Cardiac Complications ◽  
Published Data ◽  
Improving Patient Care ◽  
Overall Mortality

AbstractGrowing reports since the beginning of the pandemic and till date describe increased rates of cardiac complications (CC) in the active phase of coronavirus disease 2019 (COVID-19). CC commonly observed include myocarditis/myocardial injury, arrhythmias and heart failure, with an incidence reaching about a quarter of hospitalized patients in some reports. The increased incidence of CC raise questions about the possible heightened susceptibility of patients with cardiac disease to develop severe COVID-19, and whether the virus itself is involved in the pathogenesis of CC. The wide array of CC seems to stem from multiple mechanisms, including the ability of the virus to directly enter cardiomyocytes, and to indirectly damage the heart through systemic hyperinflammatory and hypercoagulable states, endothelial injury of the coronary arteries and hypoxemia. The induced CC seem to dramatically impact the prognosis of COVID-19, with some studies suggesting over 50% mortality rates with myocardial damage, up from ~ 5% overall mortality of COVID-19 alone. Thus, it is particularly important to investigate the relation between COVID-19 and heart disease, given the major effect on morbidity and mortality, aiming at early detection and improving patient care and outcomes. In this article, we review the growing body of published data on the topic to provide the reader with a comprehensive and robust description of the available evidence and its implication for clinical practice.

scholarly journals Prognostic factors for mortality in invasive pneumococcal disease in adult: a system review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hao Chen ◽  
Hiromi Matsumoto ◽  
Nobuyuki Horita ◽  
Yu Hara ◽  
Nobuaki Kobayashi ◽  
...  
Keyword(s):  
Invasive Pneumococcal Disease ◽  
Odds Ratio ◽  
Pneumococcal Disease ◽  
Web Of Science ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Solid Organ ◽  
Factors Associated ◽  
System Review ◽  
Overall Mortality

AbstractRisk factors associated with mortality in invasive pneumococcal disease remain unclear. The present work is a meta-analysis of studies that enrolled only patients with invasive pneumococcal disease and reported on mortality. Potentially eligible reports were identified from PubMed, CHAHL, and Web of Science, comprising 26 reports in total. Overall mortality for invasive pneumococcal disease was reported as 20.8% (95% confidence interval (CI) 17.5–24%). Factors associated with mortality were age (odds ratio (OR) 3.04, 95% CI 2.5–3.68), nursing home (OR 1.62, 95% CI 1.13–2.32), nosocomial infection (OR 2.10, 95% CI 1.52–2.89), septic shock (OR 13.35, 95% CI 4.54–39.31), underlying chronic diseases (OR 2.34, 95% CI 1.78–3.09), solid organ tumor (OR 5.34, 95% CI 2.07–13.74), immunosuppressed status (OR 1.67, 95% CI 1.31–2.14), and alcohol abuse (OR 3.14, 95% CI 2.13–4.64). Mortality rates with invasive pneumococcal disease remained high, and these findings may help clinicians provide appropriate initial treatment for this disease.

The Obesity Paradox in Emergency General Surgery Patients

2021 ◽  
pp. 000313482096852
Author(s):  
Sean R. Maloney ◽  
Caroline E. Reinke ◽  
Abdelrahman A. Nimeri ◽  
Sullivan A. Ayuso ◽  
A. Britton Christmas ◽  
...  
Keyword(s):  
General Surgery ◽  
Multivariable Analysis ◽  
Operative Management ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Emergency General Surgery ◽  
Common Procedure ◽  
Increased Risk ◽  
Social Security Death Index ◽  
The Impact

Operative management of emergency general surgery (EGS) diagnoses involves a range of procedures which can carry high morbidity and mortality. Little is known about the impact of obesity on patient outcomes. The aim of this study was to examine the association between body mass index (BMI) >30 kg/m2 and mortality for EGS patients. We hypothesized that obese patients would have increased mortality rates. A regional integrated health system EGS registry derived from The American Association for the Surgery of Trauma EGS ICD-9 codes was analyzed from January 2013 to October 2015. Patients were stratified into BMI categories based on WHO classifications. The primary outcome was 30-day mortality. Longer-term mortality with linkage to the Social Security Death Index was also examined. Univariate and multivariable analyses were performed. A total of 60 604 encounters were identified and 7183 (11.9%) underwent operative intervention. Patient characteristics include 53% women, mean age 58.2 ± 18.7 years, 64.2% >BMI 30 kg/m2, 30.2% with chronic obstructive pulmonary disease, 19% with congestive heart failure, and 31.1% with diabetes. The most common procedure was laparoscopic cholecystectomy (36.4%). Overall, 90-day mortality was 10.9%. In multivariable analysis, all classes of obesity were protective against mortality compared to normal BMI. Underweight patients had increased risk of inpatient (OR = 1.9, CI = 1.7-2.3), 30-day (OR = 1.9, CI = 1.7-2.1), 90-day (OR = 1.8, CI 1.6-2.0), 1-year (OR = 1.8, CI = 1.7-2.0), and 3-year mortality (OR = 1.7, CI = 1.6-1.9). When stratified by BMI, underweight EGS patients have the highest odds of death. Paradoxically, obesity appears protective against death, even when controlling for potentially confounding factors. Increased rates of nonoperative management in the obese population may impact these findings.

scholarly journals Review: Research Toward Safer Resection of the Cirrhotic Liver

HPB Surgery ◽  
2000 ◽  
Vol 11 (5) ◽  
pp. 285-297 ◽  
Author(s):  
M. A. J. Moser ◽  
N. M. Kneteman ◽  
G. Y. Minuk
Keyword(s):  
Surgical Technique ◽  
Liver Function ◽  
Mortality Rates ◽  
Cirrhotic Liver ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Hepatic Surgery ◽  
Postoperative Course ◽  
Cirrhotic Patients ◽  
Surgery Resection

Despite recent advances in hepatic surgery, resection of the cirrhotic liver continues to be fraught with high morbidity and mortality rates. As a result, for many patients requiring resection of HCC the postoperative course is complicated and the probability of cure is diminished by coexisting cirrhosis. In this review, we discuss the characteristics of the cirrhotic liver which make it poorly tolerant of resection and the most common complications that follow such surgery. The main purpose of this paper is to review recent attempts to identify interventions that might be beneficial to cirrhotic patients undergoing resection. These interventions include assessment of liver reserve, advances in surgical technique, and improvement in liver function and regeneration.

scholarly journals ANTI-CANDIDA ALBICANS ACTIVITY OF THE ASSOCIATION OF CITRONELAL WITH ANFOTERICIN B OR WITH CETOCONAZOLE

2019 ◽  
Vol 16 (31) ◽  
pp. 250-257
Author(s):  
Patrícia Duarte Costa SILVA ◽  
Brenda Lavínia Calixto dos SANTOS ◽  
Gustavo Lima SOARES ◽  
Wylly Araújo de OLIVEIRA
Keyword(s):  
Candida Albicans ◽  
Antifungal Activity ◽  
Amphotericin B ◽  
Inhibitory Concentration ◽  
Fungal Infections ◽  
Pathogenic Fungi ◽  
Mortality Rates ◽  
New Drugs ◽  
High Morbidity ◽  
Isolated Species

Fungal infections caused by species of the genus Candida are responsible for high morbidity and mortality rates, mainly affecting immunocompromised individuals. Among fungi, Candida albicans is the most frequently isolated species of clinical specimens. A problem associated with increased resistance of pathogenic fungi to the agents used in the therapeutic regimen and the limited number of drugs to cure these infections. As a result, the search for new drugs with antifungal activity has become increasingly important. The aim of this study is to study the antifungal activity of citronellal alone and in combination with amphotericin B or ketoconazole. The Minimal Inhibitory Concentration of citronellal, amphotericin B and ketoconazole against strains of Candida albicans were evaluated by the microdilution technique, and the Minimum Fungicide Concentration of citronellal against the same strains was also performed. Through the checkerboard methodology the effect of the combination of citronelal with amphotericin B or with ketoconazole was determined. This study showed that the association of citronellal with ketoconazole was shown to be an additive against one of the strains of C. albicans and indifferent to another strain. While the combined activity of citronellal and amphotericin B demonstrated an indifferent effect on the strains tested.

scholarly journals The Covid-19 Epidemic, China Containment Contexts, and Risk Mitigation, Public Health Lessons Learned, is it Feasible for Europe & Us

2020 ◽  
pp. 1-2
Author(s):  
Hamid Yahya Hussain ◽  
Keyword(s):  
Public Health ◽  
Health System ◽  
Risk Mitigation ◽  
Mortality Rates ◽  
Lessons Learned ◽  
High Morbidity ◽  
Wuhan City ◽  
City Population ◽  
Short Time ◽  
Complete Collapse

Despite the high morbidity and mortality rates of COVID-19 infection china witnessed during the first two months of 2020, and compared to the short time of the epidemic among Wuhan city population in Hubei territory, the response of the health system to the disaster in this country was significantly effective, despite what seemed clear in the early days that the virus was fierce to the point of conquering the capabilities of the country, and it is so explosive, we all had the feeling that China was on the verge of complete collapse within few weeks.

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