scholarly journals Epidemiology and Management of Peritonitis at a Rural Hospital in Zambia

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Sergiy Karachentsev
Keyword(s):  
Peptic Ulcer ◽  
Acute Appendicitis ◽  
Organ Failure ◽  
Perforated Peptic Ulcer ◽  
Rural Hospital ◽  
Level Of Care ◽  
Significant Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The World

Background: Peritonitis is a common surgical emergency with varying etiologies encountered the world over. It is associated with significant morbidity and mortality despite intensive research and advances in management. Methods: Records of 119 patients operated on for peritonitis at a rural surgical hospital in Zambia over a 10-year period were retrospectively reviewed. Results: Common sources of peritonitis were perforated peptic ulcer, acute appendicitis, pelvic inflammatory disease, and perforated terminal ileum. Postoperative period became complicated in 42 patients (32.3%). Fourteen patients (11.8%) died postoperatively; the highest level of mortality was in patients with perforated peptic ulcer (26%). Organ failure was found in 29 patients (24.4%) and was associated with increased risk of death. Conclusions: Individual approach with identifying signs of organ failure is essential to determine the patient’s prognosis and decide on the level of care. Patients without organ dysfunction can be successfully managed in a rural surgical hospital. Keywords: Peritonitis, Epidemiology, Morbidity, Mortality, Rural hospital, Zambia

scholarly journals Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study

2019 ◽  
Vol 44 (3) ◽  
pp. 869-875
Author(s):  
H. Boyd-Carson ◽  
◽  
B. Doleman ◽  
D. Cromwell ◽  
S. Lockwood ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Cohort Study ◽  
Perforated Peptic Ulcer ◽  
Source Control ◽  
Risk Of Death ◽  
Increased Risk

A COMPARATIVE OBSERVATIONAL STUDY OF PROGNOSTIC FACTOR SCORES TO PREDICT MORBIDITY AND MORTALITY IN PATIENTS OF PERFORATED PEPTIC ULCER

2021 ◽  
pp. 4-8
Author(s):  
Ananay Vishvakarma ◽  
Subhasish Roychowdhury ◽  
Anil Kumar Saha
Keyword(s):  
Peptic Ulcer ◽  
High Risk ◽  
Prognostic Factor ◽  
Sofa Score ◽  
Adverse Outcome ◽  
Perforated Peptic Ulcer ◽  
Morbidity And Mortality ◽  
Factor Scores ◽  
Increased Risk ◽  
Risk Patients

Background: Perforation is one of the common complication of peptic ulcer disease which is associated with signicant morbidity and mortality. It is a disease which needs emergent surgical intervention. Accurate and early identication of high-risk patients with Perforated Peptic Ulcer is important for risk stratication. Here, we calculate the three prognostic factor scores, (i) The Boey Score, (ii) The Peptic ulcer perforation (PULP) score, and (iii) The quick sequential organ failure assessment (q-SOFA) score, preoperatively to predict postoperative outcome. Aims & Objective: The aim of the study is to identify patients with an increased risk of adverse outcome, so that we can target the level of perioperative monitoring and treatment in high-risk patients. Also, to determine and compare the ability of three prognostic factor scores to predict morbidity and mortality in patients of Perforated Peptic Ulcer. Methods: Aprospective comparative observational study was conducted comprising of 92 patients with conrmed perforated peptic ulcer (PPU) attending the emergency ward of Department of General Surgery between February 2019 to July 2020. After conrmation of diagnosis, risk stratication according to the three prognostic factor scores (Boey score, PULP score, and q-SOFA score) was done. Acomparison was made between each score through calculation of positive predictive value (PPV) and negative predictive value (NPV). We used receiver operating characteristics (ROC) curve in my study to estimate the predictive ability of each scoring system. Results: The study include 92 patients. Female 41.3% and Male 58.7%. The mean age was 45.38 years. The most common site of PPU was the rst part of duodenum - D1 (64.1%). The most common operative procedure done was the Grahm's patch repair. The morbidity rate was 28.3%. Overall mortality rate was 10.9%. The AUROC for morbidity prediction was 0.791 for Boey score, 0.918 for PULP score, and 0.61 for q-SOFAscore. The AUROC for mortality prediction was 0.829 for Boey score, 0.865 for PULPscore, and 0.602 for q-SOFAscore. Conclusion:Boey score and PULP score helps in accurate and early identication of PPU patients with an increased risk of adverse outcome. q-SOFA score cannot signicantly predict morbidity and mortality in PPU patients. Overall, PULP score performs best but Boey score is crude and simple to calculate and is used to assess the patient rapidly

scholarly journals COVID-19 and the Heart

2020 ◽  
pp. 1-5 ◽  
Author(s):  
Chaitanya Rojulpote ◽  
Karthik Gonuguntla ◽  
Shivaraj Patil ◽  
Abhijit Bhattaru ◽  
Paco Bravo
Keyword(s):  
Cardiovascular System ◽  
The Novel ◽  
Health Crisis ◽  
Risk Of Death ◽  
Increased Risk ◽  
The World ◽  
Significant Burden ◽  
Coronary Syndromes ◽  
Novel Virus ◽  
Underlying Mechanisms

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes coronavirus disease 2019 (COVID-19) has resulted in a global health crisis. Prior to the arrival of this viral pandemic, the world was already plagued with a significant burden of cardiovascular disease. With the introduction of the novel virus, the world now faces a double jeapordy. Early reports have suggested an increased risk of death in individuals with underlying cardio-metabolic disorders. The exact effects of COVID-19 on the cardiovascular system are not well determined, however lessons from prior viral epidemics suggest that such infections can trigger acute coronary syndromes, arrhythmias and heart failure via direct and indirect mechanisms. In this article, we aimed to discuss the effects and potential underlying mechanisms of COVID -19 as well as potential implications of treatments targeted against this virus on the cardiovascular system.

scholarly journals HIV and Patient Monitoring in Malawi

2018 ◽  
Author(s):  
Brian Williams
Keyword(s):  
Patient Monitoring ◽  
Current System ◽  
Best Interest ◽  
Data Set ◽  
Cd4 Cell Count ◽  
Risk Of Death ◽  
Current State ◽  
Increased Risk ◽  
The World ◽  
World Ranking

Malawi has developed an excellent, nation-wide system for monitoring people infected with HIV and keeping track of key epidemic markers. Their success lies in two things: the focus on simplicity and the use of data collection not only to track the epidemic and identify problems but also to give regular feedback and support to every clinic in the country. This achievement is the more remarkable given that Malawi is one of the poorest countries in the world, ranking 190 out of 194 countries by GDP, but has one of the most severe epidemics of HIV in the world, ranking 9th out of 168 countries by HIV prevalence. We first discuss the current state and likely future epidemic trends in Malawi: unless we know where we are and where we are going we cannot decide what to do or how to do it to in order to achieve a better outcome. We then discuss the history and development of Malawi’s patient monitoring system, as reported in their Integrated HIV Program Reports,ix which have been published quarterly since the beginning of 2004. We consider the current state of patient monitoring and support as reflected in the most recent report for the third quarter (Q3) of 2016 and comment on some of the questions that this raises. Finally, we consider ways in which the current system could be improved by strengthening Malawi’s analytical capacity and making better use of this unique data set. The focus here is on HIV in adultsv because if ART is initiated early in all adults living with HIV this should include testing all pregnant women for HIV and starting them on treatment immediately. However, PMTCT is especially important and care must be given to reducing MTCT and identifying the long-term child survivors of mother-to-child transmission and this demands a complementary assessment. There is an ongoing debate about the relative merits of treatment and prevention in reducing transmission and it should be made clear that the primary reason for starting people on treatment early is that it is in the best interest of the individual patient to start treatment as soon as possible after becoming infected. Allowing a person’s immune system to deteriorate to any degree is not consistent with the clinician’s commitment to ‘first do no harm’ and even those with the highest CD4+ cell count are at a substantially increased risk of death. What matters, therefore, is to get as many people as possible onto ART, ensure that they remain virally suppressed, and consider prevention in this context.

scholarly journals Valentino's syndrome a perforated peptic ulcer mimicking acute appendicitis

2012 ◽  
Vol 2012 (jun28 1) ◽  
pp. bcr0320126015-bcr0320126015 ◽  
Author(s):  
S. I. Wijegoonewardene ◽  
J. Stein ◽  
D. Cooke ◽  
A. Tien
Keyword(s):  
Peptic Ulcer ◽  
Acute Appendicitis ◽  
Perforated Peptic Ulcer

scholarly journals Emerging statistics on the Epidemiology of COVID-19: Making prevention in pregnancy less grievous than the disease

2020 ◽  
Vol 3 (1) ◽  
pp. 27-36
Author(s):  
John Imaralu
Keyword(s):  
Pregnant Women ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Mortality Rates ◽  
Sub Saharan Africa ◽  
Main Body ◽  
Risk Of Death ◽  
Increased Risk ◽  
The World ◽  
Sub Saharan

Background: Pregnant women are a vulnerable group to the COVID-19 infection; although it is expected that adaptive changes of pregnancy put them at increased risk of adverse outcome from any respiratory tract infection, interventions for the COVID-19 may put them in more danger. Nigeria is one of the leading countries with very poor maternal mortality indices and many other sub-Saharan African nations are in the same boat. Contingency plans need to be put in place to prevent precipitous deterioration in mortality rates occasioned by the dreaded SARS- Cov-2 pandemic. This mini-review of literature and WHO global statistics is aimed to determine the trends in COVID-19 transmission and mortality rates to provide evidence-based information that may enable governments to tailor their interventions to the peculiar needs, of sub-Saharan African populations. Main body: Emerging epidemiological trends on transmission and mortality within Africa and the worst affected regions of the world suggests better outcomes of this infection in sub-Saharan Africa, than in other regions of the world. Also, present data allude to similar outcomes between pregnant and non-pregnant women. The present containment measures of isolation and quarantine, including city-wide lockdowns, may put pregnant women at higher risk of death from other causes rather than COVID-19. The danger posed, is the limitation of access to emergency obstetric care services when pregnant women develop non-COVID-19 complications of pregnancy. Conclusion: The COVID-19 pandemic has lower local transmission rates and fatality in Africa, the region where the virus arrived last. While special efforts should be geared at shielding the elderly and infirm from contracting the infection, preventive measures in pregnant women must allow for access to emergency obstetric care to forestall iatrogenic adverse maternal outcomes.

scholarly journals Incidence of malignancy in gastric/antral perforation

2019 ◽  
Vol 6 (9) ◽  
pp. 3347 ◽  
Author(s):  
Sumit Bhaskar ◽  
Priyanka Kumari ◽  
Sweta . ◽  
Dipendra K. Sinha
Keyword(s):  
Gastric Cancer ◽  
Emergency Department ◽  
Peptic Ulcer ◽  
Gastric Perforation ◽  
Histopathological Examination ◽  
Significant Morbidity ◽  
Ulcer Disease ◽  
The World ◽  
Biopsy Report ◽  
Acute Perforation

Background: Gastrointestinal perforation is one of the most commonly encountered cases in emergency department. Acute perforation of the stomach and duodenum causes significant morbidity and mortality. These perforations occur more commonly as a complication of peptic ulcer disease but in a few cases gastric cancer also present as gastric/antral perforation. Previously it was reported that approximately 10-16% of all gastric are caused by malignancy/gastric cancer. To study the incidence of malignancy in gastric perforation in present time, a study was carried out at our institute including all cases of gastric/antral perforations that presented to emergency department over a period of two years.Methods: Cases of gastric/antral perforation that presented to our emergency were included in study. Biopsy from the margin of perforation was taken and sent for histopathological examination. Results obtained were further analysed with respect to total no. of cases, age, sex, personal habits and histopathological type.Results: Out of total 60 cases that were included in study, biopsy report of 5 cases came to positive of malignancy.Conclusions: The incidence of malignancy in gastric/antral perforation was found to be 8% in our study which shows a decline in this region as compared to incidence in the world.

scholarly journals Síndrome de Valentino: una causa no común de abdomen agudo. Reporte de un caso

2020 ◽  
Vol 12 (3) ◽  
pp. 231-235
Author(s):  
Jaime Lenin Veintimilla Hurtado ◽  
Ana Belén Rivas Ullaguari ◽  
Alonso Xavier Quito Becerra ◽  
Viviana Gisela Patiño Cuenca ◽  
Yessica Gabriela Castillo Andrade
Keyword(s):  
Peptic Ulcer ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Case Reports ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Perforated Peptic Ulcer ◽  
Exploratory Laparotomy ◽  
Peptic Ulcer Perforation ◽  
Successful Recovery

BACKGROUND: Valentino’s syndrome is secondary to a perforated peptic ulcer, which could be located in the stomach or the duodenum, patients present with clinical features that suggest acute appendicitis, with localized peritonitis. There are few case reports about this syndrome worldwide and no one submitted in Ecuador. It is essential to transmit this clinical case for the knowledge of the medical- scientific community. CASE REPORT: A 63-year-old male patient came to the emergency department with abdominal pain, located in the right iliac fossa, that began 12 hours ago, associated to peritoneal irritation signs and hemodynamic decompensation; suggestive of peritonitis. An exploratory laparotomy was performed. EVOLUTION: During exploratory laparotomy, no inflammatory changes were identified in the appendix. After abdominal cavity exploration, a perforated gastric ulcer was found. Primary raffia was stitched in two planes, incidental appendectomy and lavage of the abdominal cavity were performed. The patient had a successful recovery; and was discharged after 7 days at hospitalization. CONCLUSION: The perforation of a peptic ulcer can generate right iliac fossa pain, simulating acute appendicitis due to its clinical similarity. The medical team should consider Valentino’s Syndrome as an important differential diagnosis during the evaluation of a patient that arrives to the emergency room with abdominal pain, suggestive of appendicitis. KEYWORDS: ABDOMINAL PAIN, ILIUM, APPENDICITIS, PEPTIC ULCER PERFORATION, ABDOMEN ACU-TE, PERITONITIS

scholarly journals The outcome of surgery for perforated peptic ulcer in modern times

2018 ◽  
Vol 5 (5) ◽  
pp. 1702
Author(s):  
Ruchir Vats ◽  
Babar Rehmani ◽  
Saurabh Agrawal
Keyword(s):  
Peptic Ulcer ◽  
Statistical Tests ◽  
Operative Procedure ◽  
Perforated Peptic Ulcer ◽  
General Surgeon ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Student’S T ◽  
Operative Findings

Background: A laparotomy for peritonitis due to perforated peptic ulcer is one of the commonest emergency operations done by a general surgeon and is still associated with a marked mortality and morbidity. The aim was to assess the current mortality and morbidity in patients operated for perforated peptic ulcer and to identify the factors associated with increased mortality in these patients.Methods: All adult patients operated for perforated peptic ulcer over a period of one year were included in this prospective observational study. The demographics, clinical presentation, pre-operative laboratory parameters, operative findings, operation done, and the outcomes were noted in pre-designed proforma. Mortality and morbidity was assessed and factors relating to increased mortality were determined using standard statistical tests of significance such as Chi square test and the student’s t test.Results: 55 patients underwent laparotomy for perforated peptic ulcer (23 gastric and 32 duodenal perforations). There were 53 males and only 2 females in the group. Their mean age was 44 years. The mortality was 16% (9/55) and morbidity was 25% (14/55). Complications were encountered in 14 patients, most commonly surgical site infection in 13% cases, entero-cutaneous fistula occurred in 3 patients and one of them expired despite re-exploration due to persistent sepsis. The other two patients survived, and fistula healed spontaneously. The operative procedure done was Graham’s patch or it’s modification. Only 2 patients had antrectomy with Billroth II reconstruction.Conclusions: Despite the advances in management of critically ill patients, the mortality (16%) and morbidity (25%) for this common surgical emergency remains high and is unchanged over the last half century. Presence of comorbidities and low serum albumin are associated with an increased risk of adverse outcome.

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