scholarly journals Surgical management of perforated bowel due to typhoid infection. What are the predictive factors for pre-operative diagnosis in the endemic area

2020 ◽  
Vol 11 (1) ◽  
pp. 676-683 ◽  
Author(s):  
Hussain Taher Abbas AL Baaj ◽  
Ali Abdul Hussein Handoz ◽  
Aws Rassul hussain Al-Salih
Keyword(s):  
Wound Infection ◽  
Acute Abdomen ◽  
Wound Dehiscence ◽  
Proper Choice ◽  
Fecal Fistula ◽  
Diffuse Peritonitis ◽  
Mortality And Morbidity ◽  
Limited Surgery ◽  
Chest X Ray ◽  
Almost All

Perforated typhoid fever is a common cause of peritonitis in the endemic areas and associated with high mortality and morbidity if not managed properly. This prospective study included 75 patients with perforated bowel that operated upon in two years( 2017-2018) and other 29 cases of non-perforated typhoid enteritis presented as acute abdomen.  Of 75 cases, 13 (17%) presented as local peritonitis, while 63 (87%) as general peritonitis, which was confirmed by chest X-Ray/ gas under the diaphragm in 80%. 61(81%) patients were males. The age was 15-40 years in 54 (72%) patients. White Blood Cell count [WBC] is low or normal in all cases.  35(46%) patients were presented as an acute abdomen without fever. All patients had at least one perforation in the terminal ileum. There was single perforation in 47(62%) patients. The midline incisions were complicated by dehiscence in 15 (24%) of 54 cases and by wound infection in 35(64%).  Six(8%) cases were complicated by fecal fistula and 3(4%) patients unfortunately died. Wound infection complicated 4 (26%) of 15 cases of gridiron incisions, but no wound dehiscence or incisional hernia. Conclusion: WBC is helpful in the diagnosis of perforated bowel due to typhoid infection. This is important for the proper choice of an incision. Grid iron incision is associated with minimal complications and is preferred to the midline one. Acute diffuse peritonitis indicates perforation in almost all cases, but only one-third of local peritonitis caused by perforation. Early limited surgery and the proper choice of antibiotics according to local microbiologist opinion or culture decreased the mortality to 4%.

scholarly journals A CLINICAL STUDY AND OUTCOME OF PERFORATIVE PERITONITIS IN A RURAL BASED TEACHING HOSPITAL

2020 ◽  
pp. 1-2
Author(s):  
Kaushik Mandal ◽  
Mohan Kumar Das ◽  
Santanu Dutta ◽  
Anirban Bhunia
Keyword(s):  
Wound Infection ◽  
Early Recognition ◽  
Wound Dehiscence ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Post Operative Period ◽  
Surgical Emergencies ◽  
Study Results ◽  
Perforative Peritonitis ◽  
Gastro Intestinal Tract

Background Peritonitis due to perforation of gastro intestinal tract one of the commonest surgical emergencies all over the world and the most common surgical emergency in India. Aims and objectives to evaluate role of clinical assessment and usefulness of basic investigations in diagnosis and follow-up, to evaluate incidence of wound infection, wound dehiscence in post-operative period, to assess mortality upto1 month of post-operative period. Methods All consenting patients above 18 years treated with symptoms and signs of perforative peritonitis in Burdwan Medical College and Hospital from March 2018 to August 2019 were included in this institution based, interventional, prospective, non-randomised, analytical study. Results We found that 40(80.0%) patients had gas under diaphragm in Chest X-ray report. It was found that 9(18.0%) patients had acute appendicitis, 1(2.0%) patient had appendicular perforation and 40(80.0%) patients had perforative peritonitis. We found that 30(60.0%) patients had chest infection. 10(20.0%) patients had wound infection.6 (12.0%) patients had wound dehiscence. Conclusion Early recognition of symptoms and referral is very important in reducing mortality and morbidity.

scholarly journals Diagnosing gastric volvulus in chest X-ray: report of three cases

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Narendra Pandit ◽  
Abhijeet Kumar ◽  
Tek Narayan Yadav ◽  
Qamar Alam Irfan ◽  
Sujan Gautam ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Abdomen ◽  
Gastric Volvulus ◽  
X Ray ◽  
Pain Abdomen ◽  
Life Threatening ◽  
Chest X Ray ◽  
High Index Of Suspicion ◽  
Specific Symptoms ◽  
Prompt Diagnosis

Abstract Gastric volvulus is a rare abnormal rotation of the stomach along its axis. It is a surgical emergency, hence requires prompt diagnosis and treatment to prevent life-threatening gangrenous changes. Hence, a high index of suspicion is required in any patients presenting with an acute abdomen in emergency. The entity can present acutely with pain abdomen and vomiting, or as chronic with non-specific symptoms. Chest X-ray findings to diagnose it may be overlooked in patients with acute abdomen. Here, we report three patients with gastric volvulus, where the diagnosis was based on the chest X-ray findings, confirmed with computed tomography, and managed successfully with surgery.

Updates in Diabetic Wound Healing, Inflammation, and Scarring

2021 ◽  
Author(s):  
Nina Dasari ◽  
Austin Jiang ◽  
Anna Skochdopole ◽  
Jayer Chung ◽  
Edward Reece ◽  
...  
Keyword(s):  
Wound Healing ◽  
Disease Process ◽  
Wound Dehiscence ◽  
Diabetic Patients ◽  
Wound Infections ◽  
Diabetic Wound ◽  
Complex Process ◽  
Diabetic Wound Healing ◽  
Almost All ◽  
Diabetic Wounds

AbstractDiabetic patients can sustain wounds either as a sequelae of their disease process or postoperatively. Wound healing is a complex process that proceeds through phases of inflammation, proliferation, and remodeling. Diabetes results in several pathological changes that impair almost all of these healing processes. Diabetic wounds are often characterized by excessive inflammation and reduced angiogenesis. Due to these changes, diabetic patients are at a higher risk for postoperative wound healing complications. There is significant evidence in the literature that diabetic patients are at a higher risk for increased wound infections, wound dehiscence, and pathological scarring. Factors such as nutritional status and glycemic control also significantly influence diabetic wound outcomes. There are a variety of treatments available for addressing diabetic wounds.

scholarly journals Causes and management of secondary postpartum haemorrhage in a tertiary medical college hospital in Bangladesh

2017 ◽  
Vol 6 (7) ◽  
pp. 2694
Author(s):  
Kamrun Nessa ◽  
Sumia Bari ◽  
Sanjida Khan ◽  
Ferdowsi Sultana ◽  
Tania Akbar
Keyword(s):  
Maternal Morbidity ◽  
Postpartum Haemorrhage ◽  
Mode Of Delivery ◽  
Wound Dehiscence ◽  
College Hospital ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Maternal Mortality And Morbidity ◽  
Postnatal Women ◽  
Low Incidence

Background: Globally postpartum haemorrhage remains a leading cause of maternal death. It affects only 1-2% of postnatal women. This low incidence of secondary PPH and linkage to maternal morbidity rather than mortality was the reason for the little attention among obstetricians, but it is recently gaining importance and interest with the increase morbidity and mortality related to secondary PPH.Methods: A retrospective study was conducted on the diagnosed patients of secondary PPH admitted in Enam Medical College and Hospital, Dhaka, Bangladesh, from January 2015 to December 2016. Among 33 cases of secondary PPH age of the patients, parity, mode of delivery, causes and management were noted from medical records. All data was analyzed by SPSS16.Results: Among 33 patients 14 (42.4%) were primi and 19 (57.6%) were multipara, age between 18 to 38 years, majority admitted 2nd and 3rd week after delivery. Among 33 patients 12% delivered vaginally at home and 30% vaginally at hospital and 58% undergone LUCS. We found 34% retained bits of placenta, 27% uterine wound dehiscence, 24% retained clots and 15% endometritis as causes. Less than 3 units blood needed in 22 (66.7%) patients and 11 (33.3%) needed more than 3 units. About 6 (18%) patients were treated conservatively, MVA were needed in 18 (55%) patients, repair of wound in 4 (12%) and TAH was in 5 (15%).Conclusions: Secondary PPH is increasing may result in significant maternal morbidity as well as mortality. More study needed to identify the risk factors and causes to reduce maternal mortality and morbidity.

scholarly journals 1484. Microbial Etiology of Community-acquired Pneumonia in Immunocompromised Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S743-S744
Author(s):  
Abhishek Deshpande ◽  
Pei-Chun Yu ◽  
Michael Rothberg
Keyword(s):  
Panel Member ◽  
Positive Culture ◽  
Empiric Therapy ◽  
Community Acquired Pneumonia ◽  
Immunocompromised Patients ◽  
Viral Pathogens ◽  
Chest X Ray ◽  
Microbial Etiology ◽  
Almost All ◽  
Immunocompetent Patients

Abstract Background Community-acquired pneumonia (CAP) is a leading cause of infection related mortality. Few studies have specifically evaluated the microbial etiology of CAP in immunocompromised patients. Using a large national inpatient database, we compared the microbial etiology of CAP in immunocompromised patients compared to immunocompetent patients. Methods We included adult patients admitted with pneumonia from 2010-2015 to 176 US hospitals participating in Premier. Patients were identified as having CAP if they had a chest X-ray and were on antimicrobials on the first day. Immunocompromised was defined by the receipt of immunosuppressive medications or ICD-9 codes for neutropenia/ hematological malignancy/ organ transplantation or comorbidities with AIDS. For microbial etiology, patients were included if they had a positive culture or test collected by hospital day 0 through 3. Patients with identical bacteria in blood and urine were excluded. Results A total of 168,159 patients had a diagnosis of CAP with a culture/test performed on first 3 days. A pathogen was detected in 18.8% of patients. Among pathogen positive patients, 4,851 patients were identified as immunocompromised and 26,752 as immunocompetent. Almost all patients (99%) had at least one culture, blood (96%) and respiratory (51%). Among patients who were immunocompromised, the most common bacterial pathogens (compared to immunocompetent patients) were, S. pneumoniae (17.7% vs 19.0%), MRSA (13.1% vs 14.4%), MSSA (12.0% vs 11.8%), P. aeruginosa (12.0% vs 9.9%), E. coli (7.4% vs 6.4%), K. pneumoniae (5.8% vs 4.9%), H. influenzae (5.5% vs 5.5%), M. pneumoniae (3.0% vs 3.0%) and L. pneumophila (0.93% vs 1.2%). Among viral pathogens, while the most common were influenza virus (12.9% vs 14.1%) followed by rhinovirus (1.5% vs 0.89%), immunocompromised patients has a higher prevalence of noninfluennza viruses (3.42% vs 2.43%). Conclusion In a large US inpatient sample, the causative organisms in immunocompromised patients did not differ much from those in immunocompetent patients. CAP pathogens in immunocompromised patients were more likely to involve gram-negative bacilli such as P.aeruginosa and E.coli, than gram-positive cocci. These findings may have implications when deciding on empiric therapy in these patients. Disclosures Abhishek Deshpande, MD, PhD, Ferring Pharmaceuticals (Advisor or Review Panel member)Merck (Consultant)

scholarly journals WOUND INFECTION

2010 ◽  
Vol 17 (01) ◽  
pp. 64-67
Author(s):  
UZMA HUSSAIN ◽  
AFSHAN SAEED ◽  
FARZANA LATIF
Keyword(s):  
Cesarean Section ◽  
Wound Infection ◽  
Wound Dehiscence ◽  
Severe Anaemia ◽  
Medical College ◽  
Emergency Cesarean ◽  
Section Design ◽  
Elective Cesarean ◽  
Wound Discharge ◽  
Very High

Objective: To evaluate the effects of the anaemia in wound infection after cesarean section. Design: Prospective study. Setting:Department of Obstetric-Gynaecology in Sir Ganga Ram Hospital / Fatima Jinnah Medical College Lahore. Period: Sep 2008 to Sep 2009.Patients and Methods: The study comprises of 100 pregnant women with moderate to severe anaemia. Selected cases underwent cesareansection due to different indications. The rate and frequency of wound infection was observed in all these women. Results were analysed andtabulated. Results: 100 cases with moderate to severe anaemia who underwent cesarean section were included. Moderate aneamia wasrecognized in 55% of cases and 19% with severe anaemia. Wound discharge was seen in 44 % of cases and wound dehiscence was foundin 56 % cases. Culture was positive in 41 % patients and majority of these were unbooked. Non elective cesarean delivery was performed in99% of cases. Conclusion: The rate of wound infection was very high in moderate to severely anemic women who underwent non elective/ emergency cesarean section.

scholarly journals Factors Affecting the Perception and Practice of Iranian Nomadic and Semi-Nomadic Pastoralists in Regard to Biosecurity Practices in Sheep and Goat Farms: A Cross-Sectional and Prospective Study

Ruminants ◽  
2022 ◽  
Vol 2 (1) ◽  
pp. 54-73
Author(s):  
Zeinab Hatami ◽  
Richard A. Laven ◽  
Saeid Jafari-Gh. ◽  
Mahdi Moazez-Lesko ◽  
Pegah Soleimani ◽  
...  
Keyword(s):  
Prevention Measures ◽  
Extension Programs ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Factors Affecting ◽  
Nomadic Pastoralists ◽  
Almost All ◽  
Biosecurity Practices ◽  
Umbilical Cords ◽  
Annual Mortality

Preventing the spread of diseases between and within farms (biosecurity) is essential for minimizing animal mortality and morbidity, as well as for reducing the risk of spread of zoonotic diseases. These effects are even greater in countries such as Iran, which have to deal with multiple ongoing epidemics of infectious disease. However, there is currently no published information about biosecurity practices on sheep and goat farms in Iran in published research. The aim of this study was to collect such information and to identify some of the factors affecting biosecurity practices. Data were gathered using a checklist and in-depth interviews with 99 nomadic and semi-nomadic pastoralists. Regression analysis was used to identify the relationships between the collected variables and the biosecurity scores. The results showed that neither within- nor between-farm disease prevention measures were appropriately applied on most farms (median total score of total biosecurity was 37.3/90; Q1 = 29.0 and Q3 = 44.7). Almost all the farmers reported slaughtering animals on farms and nobody properly disposed of the bodies of the dead animals. Additionally, the majority of the participants did not disinfect the umbilical cords of newborns. Of the collected variables, the annual mortality rate was associated with most within-farm biosecurity practices. The increase in annual mortality rates was associated with the regular cleaning of troughs (p = 0.03), preventing feed and water from being contaminated by urine and feces (p = 0.02), providing a clean and dry place for animals to rest (p = 0.05) and disinfecting the navel cord (p = 0.03). The results of this survey suggest that there is a clear need for extension programs to enhance Iranian and sheep and goat farmers’ perceptions and practices regarding biosecurity measures.

scholarly journals Crystalline Penicillin for Community Acquired Pneumonia: Does it still work?

2013 ◽  
Vol 11 (2) ◽  
pp. 36-39 ◽  
Author(s):  
Nirjala Aryal ◽  
Arun Kumar Neopane ◽  
Moon Thapa ◽  
Umesh Kumar Singh ◽  
Keshav Agrawal
Keyword(s):  
Respiratory Rate ◽  
Clinical Features ◽  
Community Acquired Pneumonia ◽  
Response To Treatment ◽  
Haemophilus Influenzae Type ◽  
Streptococcus Pneumonia ◽  
Mortality And Morbidity ◽  
Underdeveloped Countries ◽  
Chest X Ray ◽  
A Prospective Study

Introduction: Pneumonia is the most common cause of mortality and morbidity in children in underdeveloped countries. The common bacterial agents are Streptococcus pneumonia followed by Haemophilus influenzae type b. The only measure to treat bacterial pneumonia is the correct use of antibiotics along with oxygen in moderate to severe cases. The objectives of this study were to see the clinical features of community-acquired pneumonia and to observe the response to treatment with crystalline penicillin in hospitalized children. Methods: This study was a prospective study. The children aged between two months to 59 months with pneumonia were treated with intravenous crystalline penicillin. Response was observed by normalization of respiratory rate and absence of lower chest indrawing. Results: Out of 88 children treated, 79(89.8%) showed improvement in 48 hours. In children who had tachypnoea, 62.9% showed normalization in respiratory rate in the first 24 hours and 37.1 percent in 48 hours of treatment. Similarly, among children with lower chest indrawing; 61.1% showed improvement in 24hours and the remaining in 48hours.  In 24 hours of treatment 17.7% of children became afebrile and 46.8% in 48hours of treatment. Conclusion: The most common clinical features like cough, fever, tachypnoea and lower chest indrawing can be used to diagnose CAP where Chest X- ray is not possible. The response to treatment with Crystalline Penicillin is a very good and, thus, can be used as the first line drug in the treatment of children with CAP.Medical Journal of Shree Birendra Hospital; July-December 2012/vol.11/Issue2/36-39 DOI: http://dx.doi.org/10.3126/mjsbh.v11i2.7908 

scholarly journals Association Between Serum Albumin And The Success Of Fluid Resuscitation In Children Hospitalizen In Cipto Mangunkusumo Hospital Burn Center

2019 ◽  
Vol 5 (2) ◽  
pp. 226-233
Author(s):  
Rismala Dewi ◽  
Karina Kaltha ◽  
Aditya Wardhana ◽  
Piprim B. Yanuarso
Keyword(s):  
Serum Albumin ◽  
Fluid Resuscitation ◽  
Sampling Method ◽  
Burn Injury ◽  
Significant Loss ◽  
Mortality And Morbidity ◽  
Burn Center ◽  
Pediatric Resuscitation ◽  
Almost All ◽  
Burn Patient

Background : Burn injury has a great impact on mortality and morbidity in children. Significant loss of albumin (hypoalbuminemia) in burn patient often leads to serious complications. However, it is still unclear whether serum albumin has a role in the success of fluid resuscitation in children with burn injury. Method : This is a retrospective cohort study based on medical record of children hospitalized with burn injury at Cipto Mangunkusumo Hospital Burn Centre from January 2012-March 2018. The subjects collected with the total sampling method. Result : Most burn injury happen because of scalds, and have grade 2 burn injury with PELOD score<10. Almost all subjects was succesfully resuscitated in the first 24 hour (95,1%). No association was found between the success of fluid resuscitation with either serum albumin [RR 1,175(95%CI 0,3-4,4) p=0,812], or with ureum, creatinin, lactate level, weight and the degree/extent of the burn injury. Conclusion: The success rate of fluid resuscitation in pediatric burn injury was quite high in Cipto Mangunkusumo Hospital Burn Centre. No association was found between serum albumin and the success of fluid resuscitation during the first 24 hour period. Keywords: albumin, burn, pediatric, resuscitation  

Multiple Laparotomies are a Predictor of Fascial Dehiscence in the Setting of Severe Trauma

2005 ◽  
Vol 71 (5) ◽  
pp. 402-405 ◽  
Author(s):  
Mamta Swaroop ◽  
Michael Williams ◽  
Wendy Ricketts Greene ◽  
Jack Sava ◽  
Kenneth Park ◽  
...  
Keyword(s):  
Wound Infection ◽  
Injury Severity ◽  
Damage Control ◽  
Wound Dehiscence ◽  
Severe Trauma ◽  
Outcome Data ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Abdominal Abscess ◽  
Increased Risk

The purpose of this study was to determine the incidence of wound dehiscence after repeat trauma laparotomy. We performed a retrospective analysis of adult trauma patients who underwent laparotomy at an urban level 1 trauma center during the past 5 years. Patients were divided into single (SL) and multiple laparotomy (ML) groups. Demographic, clinical, and outcome data were collected. Data were analyzed using χ2, t testing, and ANOVA. Overall dehiscence rate was 0.7 per cent. Multiple laparotomy patients had damage control, staged management of their injuries, or abdominal compartment syndrome as the reason for reexploration. SL and ML patients had similar age and sex. ML patients had a higher rate of intra-abdominal abscess than SL patients (13.7% vs 1.2% P < 0.0001), but intra-abdominal abscess did not predict wound dehiscence in the ML group ( P = 0.24). This was true in spite of the fact that ML patients had a significantly higher Injury Severity Score (ISS) than SL patients (21.68 vs 14.35, P < 0.0001). Interestingly, wound infection did not predict dehiscence. Patients undergoing repeat laparotomy after trauma are at increased risk for wound dehiscence. This risk appears to be associated with intraabdominal abscess and ISS, but not wound infection. Surgeons should leave the skin open in the setting of repeat trauma laparotomy, which will allow serial assessment of the integrity of the fascial closure.

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