scholarly journals Evaluation of Mannheim’s Peritonitis Index in Prediction of Mortality in Patients with Non-traumatic Hollow Viscus Perforation Peritonitis

2021 ◽  
Vol 19 (1) ◽  
pp. 179-184
Author(s):  
Vikal Chandra Shakya ◽  
Anang Pangeni ◽  
Saurav Karki ◽  
Lokesh Raj Sharma
Keyword(s):  
Univariate Analysis ◽  
Individual Risk ◽  
P Value ◽  
Diffuse Peritonitis ◽  
Hollow Viscus ◽  
Predictive Values ◽  
Mortality And Morbidity ◽  
Prediction Of Mortality ◽  
Perforation Peritonitis ◽  
Hollow Viscus Perforation

Background: Hollow viscus perforation peritonitis is one of the commonest surgical emergencies with high mortality and morbidity. The objective of this study was to evaluate the effectiveness of Mannheim’s peritonitis index in prediction of mortality in these patients.Methods: This is a retrospective, observational cohort study in these patients managed in a single-center from January 1, 2013 to December 30, 2019. Total index scores were plotted in the receiver operating characteristic curves to find out the cut-off point. Sensitivity, specificity, relative risk, positive and negative predictive values were calculated. The individual risk factors were analyzed for mortality as well.Results: Case records of 395 cases of non-traumatic hollow viscus perforation peritonitis were available, there were 33 mortalities (8.2%), mean score was 22.96 (+7.6) points (range 10-43 points). The sensitivity and specificity with score cut-off of 25 came to be 75.8% and 56.35%; positive and negative predictive value being 13.7% and 96.2%. Risk of patients for mortality with scores >25 was 3.62 times those with scores <25 for mortality. Mortality rate was 2.4% with scores <21, 8.9% with 21–29 and 20.9% with >29 respectively (p-value <0.05). Univariate analysis showed age >50 years, presence of organ dysfunction, diffuse peritonitis, non-colonic origin and character of exudates were significant factors; multivariate analysis showed only organ failure as significant.Conclusions: Mannheim peritonitis index is very useful in stratification of severity of the disease and prediction of mortality in patients with peritonitis, and should be included in management of all these patients.Keywords: Mannheim’s peritonitis index; perforation peritonitis

scholarly journals Evaluation of Mannheim peritonitis index to predict outcome of patients with hollow viscus perforation

2020 ◽  
Vol 7 (5) ◽  
pp. 1385
Author(s):  
Jotdeep Singh Bamrah ◽  
Gopal Swaroop Bhargava ◽  
Manu Kohli
Keyword(s):  
Scoring System ◽  
P Value ◽  
Predictive Capacity ◽  
Chi Square ◽  
Hollow Viscus ◽  
Mannheim Peritonitis Index ◽  
Mortality And Morbidity ◽  
Generalized Peritonitis ◽  
Perforation Peritonitis ◽  
Hollow Viscus Perforation

Background: Acute generalized peritonitis from gastrointestinal hollow viscus perforation is a potentially life-threatening condition. Mannheim peritonitis index (MPI) is a specific scoring system that facilitates early identification of patients with severe peritonitis for aggressive surgical approach and improved outcomes.Methods: A prospective observational study in 60 patients attending surgical emergency unit with perforation peritonitis was conducted to analyse the predictive capacity of MPI. MPI score was categorized into 3 groups: <21, 21 to 29 and >29. Data was compared for predicting mortality and morbidity. P value, chi square test and 95% CI were used as statistical tools.Results: Two thirds of 60 patients studied were younger than 50 years of age. Prognosis was poorer in patients above 50 years with age. 80% presented after 24 hours. Ileal perforation was the commonest etiology. Morbidity and mortality were worst in patients with MPI score >29.Conclusions: Mannheim peritonitis index is disease specific, easy to apply and effective scoring system predicting the outcome in perforation peritonitis, with increasing MPI score being directly proportional to higher mortality and morbidity of the patient.

scholarly journals Comparative study between POMPP score versus Boey score to predict morbidity and mortality in peptic perforation peritonitis

2021 ◽  
Vol 8 (2) ◽  
pp. 543
Author(s):  
Bhanu Prakash K. R. ◽  
Subhas Patil ◽  
Manasa Mohan
Keyword(s):  
Peptic Ulcer ◽  
Morbidity And Mortality ◽  
High Rate ◽  
P Value ◽  
Peptic Ulcer Perforation ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Ulcer Disease ◽  
Ulcer Perforation ◽  
Perforation Peritonitis

Background: Peptic ulcer disease (PUD) results from an imbalance between stomach acid-pepsin and mucosal defense barriers. It affects 4 million people worldwide annually. Peptic ulcer perforation is one of the most common surgical emergencies and is associated with a high rate of morbidity and mortality. This is due to presence of various risk factors among the population like H. pylori infection, long term NSAID use, alcohol ingestion, smoking and steroid use. Peptic ulcer perforation peritonitis usually requires an emergency surgical intervention and hence the need for this study, to compare POMPP and Boey scores as predictors of morbidity and mortality in patients with peptic perforation peritonitis.Methods: This prospective observational study was conducted in the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020. All patients above 18 years with features of hollow viscus perforation with per-operative finding of perforated peptic ulcer were included in the study. Patients with histopathology suggestive of malignancy were excluded.Results: A total of 65 patients were included in the study. On analysis of the data by Chi-square test, P value of both POMPP and Boey scores was found to be <0.05 which is statistically significant. The most important predictive factors of mortality and morbidity were duration of perforation >24 hours, age >65 years and pre-operative shock.Conclusions: Both scoring systems are easy to use and can assist in accurate and early identification of high-risk patients and are important in predicting mortality and morbidity in patients with peptic ulcer perforation.

EFFICACY OF MANNHEIM PERITONITIS INDEX IN PREDICTION OF MORTALITY AND MORBIDITY IN PATIENTS WITH SECONDARY PERITONITIS

2021 ◽  
pp. 66-68
Author(s):  
Mayank Mangwani ◽  
Subhash Chander Sharma ◽  
Alok Vardhan Mathur
Keyword(s):  
Organ Failure ◽  
Scoring System ◽  
Secondary Peritonitis ◽  
Hollow Viscus ◽  
Irreversible Damage ◽  
Mannheim Peritonitis Index ◽  
Generalized Peritonitis ◽  
Prediction Of Mortality ◽  
Perforation Peritonitis ◽  
Hollow Viscus Perforation

Background: Acute generalized peritonitis following hollow viscus perforation is a potentially life threatening condition leading to a cascade of infective processes, sepsis, disseminated intravascular coagulation, multi organ failure and death in the presence of irreversible damage to the vital organs. Grading the severity of acute peritonitis can contribute in better management of patients with perforation peritonitis. The Mannheim Peritonitis Index (MPI) scoring system takes into account various characteristics like age of the patient, gender, duration of peritonitis, organ failure, Malignancy, colonic sepsis, extent of spread and character of the peritoneal uid. The Objective of this study was to determine the Prognostic value of MPI in patients with Secondary Peritonitis. Methods: In this study conducted at SMI Hospital, Dehradun, Over a period of 1 year, all patients presenting with features of Peritonitis due to hollow viscus perforation were included. MPI score of all the patients were calculated and categorized into three groups; less than 21, 21-29 and more than 29. Mortality of patients from each group was calculated and predictive value of each factor was determined. Results:Total 150 patients were included in this study. There were total 21 mortalities. For patients with a score <21, the mortality rate was 0%; for score 21–29, it was 4.3%; and for score >27, it was 67.9% (P < 0.001). Age> 50 years, presence of organ failure, malignancy, presentation after 24 hours, generalized peritonitis and Fecal exudate were associated with higher mortality rates. Conclusions: MPI is a simple and useful scoring system to determine the prognosis and complications in patients with perforation peritonitis.

scholarly journals Cas/Medevac in field area: An experience and lessons drawn

2019 ◽  
Vol 63 ◽  
pp. 33-38
Author(s):  
Murtaza ◽  
P Biswal
Keyword(s):  
United Nations ◽  
Medical Care ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Medical Establishment ◽  
Level Ii ◽  
Incremental Information ◽  
Standard Operating ◽  
Field Area ◽  
Hollow Viscus Perforation

Introduction: Success of Cas/Medevac missions depends on effective coordination between all agencies involved. The focus by medical authorities on the treatment and medical care at time leads to avoidable procedural complexity. Certain lessons are drawn from the United Nations (UNs) field areas for Cas/Medevac missions/laid down procedures and recommendations made for streamlining our own procedures. Materials and Methods: The data pertaining to Cas/Medevac details from IFH Level-II Malakal (UN Mission in South Sudan [UNMISS]) for January 2017 - February 2018 were collected and analyzed. Standard operating procedures (SOPs) followed in the UN field areas for Cas/Medevac missions were also studied and analyzed. Results and Discussion: A total of 19 cases were air evacuated from IFH Level-II UNMISS to higher medical establishments and 11 cases from periphery to IFH Level-II in 1 year plus period. Aeromedical issues involved are discussed here with emphasis on Medevac of patient with suspicion of hollow viscus perforation/pancreatitis. Procedures and documentation followed in the UN Medevac missions are discussed and suggestions made for improving Cas/ Medevac procedures in field areas. A sample of Cas/Medevac incremental information form is also suggested. Conclusion: Timely evacuation of a casualty to an appropriate medical establishment can reduce mortality and morbidity significantly. Experience of Cas/Medevac missions in the UN field area is presented in this paper along with analysis and discussion on SOPs followed in the UN mission areas. Suggestions are made to refine and streamline our own Cas/Medevac procedures in field areas and theaters of conflict.

scholarly journals Surgical management and perioperative complications of peritonitis secondary to hollow viscus perforation in a tertiary care centre

2021 ◽  
Vol 8 (11) ◽  
pp. 3359
Author(s):  
Lokesh M. G. ◽  
S. Chandrashekar ◽  
Arundathi Raikar ◽  
Abhishek S. S.
Keyword(s):  
Perioperative Complications ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Threatening Condition ◽  
Hollow Viscus Perforation

Background: High mortality and morbidity is associated with peritonitis secondary to hollow viscus perforation, proving it a most common life threatening condition which needs emergency surgical care. Hence a proper evaluation was needed regarding appropriate management to have a better outcome, which was a challenge to operating surgeon.Methods: A serial study of 96 cases of peritonitis secondary to hollow viscus perforation was conducted at tertiary care centre, department of general surgery, Mysore medical college and research institute, Mysore, Karnataka from the period of August 2020 to July 2021. Data related to aetiology, surgical intervention and its peri-operative complications were noted. Appropriate statistical analyses were done to draw the inference.Results: Out of 96 cases studied, 74 were male, 22 were female with mean age of 45.53 years. Most common cause of peritonitis was GU perforation, followed by idiopathic, infective, malignancy, appendicular perforation and Trauma.Conclusions: Hollow viscus perforation being most common surgical emergencies, surgical outcomes and its related complications depends on age, general condition, site, co-morbidities and aetiologies.

Predicting the pathologic complete regression with hematologic markers during neoadjuvant chemoradiotherapy in the locally advanced rectal cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 583-583
Author(s):  
Jae-Sung Kim ◽  
Joo Ho Lee ◽  
Changhoon Song
Keyword(s):  
Rectal Cancer ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
P Value ◽  
Complete Regression ◽  
Operating Characteristics ◽  
Predictive Values

583 Background: The present study aimed to evaluate the hematologic markers for predicting the pathologic complete regression during and after neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer. Methods: Total 297 patients with rectal cancer underwent neoadjuvant CRT followed by surgical resection and performed complete blood counts (CBC) serially during and after CRT. The timepoints of CBC were before CRT (pre-), three weeks after the day of starting CRT (intra-), and four weeks after CRT (post-). We calculated the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR) using the serial CBC test. The ratio of change in PLR (cPLR), NLR (cNLR), and dNLR (cdNLR) was calculated as the change of value/pre-value. Chi-square and T-test for univariate analysis and multivariate logistic regression were performed to identify the significant predictor for pCR. Receiver operating characteristics (ROC) analysis was used to compare the predictive values. Results: The overall rate of pCR was 15.9%. The Pre-Hb, pre-NLR, intra-PLR, intra-NLR, intra-cPLR, intra-cNLR, post-WBC, post-Hb, and post-cPLR were significantly different between patients with pCR and no pCR. In the multivariate logstic regression, pre-Hb (OR 1.456 p-value .026), intra-cPLR (OR 4.949, p-value < .001), post-WBC (OR 0.664, p-value .008), and post-PLR (OR 1.011 p-value .001) were significant predictors for pCR. In the comparison of ROCs, intra-cPLR was the most accurate predictor for pCR among the hematologic variables (AUC = 0.74, p ≤ .001). Conclusions: Change of PLR during neoadjuvant CRT is the clinically applicable and significant predictor for pCR with high negative predictive value in the patients with LRC.

Impact of Immune response-associated gene polymorphisms on tumor response in rectal cancer patients treated with capecitabine +/- oxaliplatine and radiation in the ACCORD-12/PRODIGE-2 phase III trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15151-e15151
Author(s):  
Valerie Boige ◽  
Caroline Mollevi ◽  
Nathalie Chaput ◽  
Sophie Gourgou ◽  
David Azria ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Tumor Response ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Phase Iii ◽  
P Value ◽  
Neoadjuvant Radiotherapy ◽  
Predictive Values ◽  
Phase Iii Trial

e15151 Background: We examined whether 133 germline polymorphisms (SNPs) in 15 candidate genes (CSF1R, IL8RA, TLR4, IL10, IL10RA, CTLA4, IL2, IL2RA, TGF b1, ICOS, IL13, IL13RA2, IFNgR, IL15 and IL15RA) would predict clinical outcome in the ACCORD-12 phase III trial which randomly compared neoadjuvant radiotherapy (RT) plus capecitabine (CAP45) with dose-intensified RT plus capecitabine and oxaliplatin (CAPOX50) in T3-4 Nx M0 resectable rectal cancer. Methods: A candidate-gene association study was conducted in 316 patients (n = 161 in the CAPOX50 and n = 155 in the CAP45 arm). The primary end-point was tumor response according to the Dworak score in each arm. Logistic regressions were used to assess univariate/multivariate associations. The Storey and Tibshirani method based on the control of false discovery rate was used ( q-value < 0.10 (adjusted p-value) considered as true discovery). Multivariate models adjusted on treatment arm and T stage were performed to determine prognostic and predictive values of SNPs for tumor response. Results: In univariate analysis, two SNPs in IL2RA (rs11256456: OR = 5.1 [2.38; 11] and rs706781: OR = 4.2 [1.98 ; 8.74]) were significantly associated with the Dworak score in the CAP45 arm, and one in IL2RA the CAPOX50 arm (rs2104286: OR = 0.11 [0.01 ; 0.90]. All were confirmed in the multivariate analysis. A significant haplotypic effect was observed in the CAP-45 arm (p = 0.0001). Interaction was significant for IL2RA rs11256456 ( p= 0.03) and rs706781 ( p= 0.002) and no significant for IL2RA rs2104286 ( p= 0.722), suggesting a predictive deleterious effect the first two ones for response to oxaliplatin-based chemoRT, and a prognostic effect of the third one for response to chemoRT (+/- oxaliplatin). None of the three IL2RA SNPs were correlated with survival in the multivariate analysis. Conclusions: This pharmacogenetic analysis shows that SNPs in IL2RA have a significant association with response to chemoRT with capecitabine in patients with locally advanced rectal cancer. Their predictive effect may identify patients in whom oxaliplatin addition to chemoRT is deleterious.

scholarly journals Occupational risk factors for shoulder chronic tendinous pathology in the Spanish automotive manufacturing sector: a case-control study.

2020 ◽  
Author(s):  
BEATRIZ RODRIGUEZ DIEZ-CABALLERO ◽  
Joaquin Alfonso-Beltran ◽  
Iker J. Bautista ◽  
Carlos Barrios Pitarque
Keyword(s):  
Risk Factors ◽  
Psychosocial Factors ◽  
Manufacturing Sector ◽  
Univariate Analysis ◽  
Individual Risk ◽  
Predictive Values ◽  
Occupational Risk Factors ◽  
Automotive Manufacturing ◽  
Multiple Variables ◽  
Load Handling

Abstract Introduction: Musculoskeletal Diseases (MSDs) are among the most prevalent health problems encountered in the workforce in Europe. Multiple risk factors contribute to their onset. In the present study, different individual risk factors for chronic tendinous pathology affecting the shoulder were analysed in a sample of workers from the automotive manufacturing sector. Methods: An observational retrospective study was conducted with 73 cases of officially recognised and compensated occupational diseases and 94 aleatory cases of healthy workers from the same car assembly company. The experimental group comprised individuals with tendinous chronic pathology of the rotator cuff. Multiple variables that identified the risks present in the job were assessed along with participants clinical evaluation. Furthermore, two standardised guidelines for risk factors assessment were also used: the Spanish National Institute of Social Security (INSS) and the American Occupational Information Network (O*Net). Both descriptive statistical analysis and Odds ratios calculations considering the occupational disease as a dependent variable were performed. Results: Using univariate analysis, the use of hand tools, exposure to mechanical pressure in the upper limbs and awkward postures were the most prevalent risk factors. Pressure on the palm of the hand and the hand tool impacting the hand were also important risk factors. Some psychosocial factors such as lack of autonomy and mental workload were also associated shoulder tendinous diseases. In the logistic regression model, age, load handling, and awkward postures were the core risk factors responsible for most of the tendinous chronic injuries of the shoulder in this sample of car assembly workers.Conclusions: Both ergonomic and psychosocial factors were present and increased the risk of developing occupational chronic tendinopathies at the shoulder in this sample of workers. Aging, load handling, and awkward postures showed the strongest predictive values. Greater knowledge of how risk factors interact would facilitate the design of better preventive workplace strategies.

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