scholarly journals Surgical Versus Conservative Management of Acute Appendicitis During the COVID-19 Pandemic: A Single-Centre Retrospective Study

Cureus ◽  
2021 ◽  
Author(s):  
Andrew Lotfallah ◽  
Amaar Aamery ◽  
George Moussa ◽  
Mangta Manu
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Conservative Management ◽  
Single Centre

scholarly journals Incidence of complicated acute appendicitis: a single-centre retrospective study

2017 ◽  
Vol 33 (4) ◽  
pp. 295-299
Author(s):  
Aneta Piotrowska ◽  
Sławomir Osman ◽  
Przemysław K. Wolak
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Single Centre ◽  
Complicated Acute Appendicitis

scholarly journals 746 COVID-19: Changing the Future of Emergency Epistaxis Management

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Y Devabalan
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Conservative Management ◽  
Demographic Data ◽  
Outpatient Management ◽  
Single Centre ◽  
Airway Emergency ◽  
Haemostatic Agents ◽  
Standard Operating ◽  
Life Threatening

Abstract Introduction Acute epistaxis can be a life-threatening airway emergency. Therefore, the majority of patients in whom conservative management (including cautery) has failed are admitted. However, due to the COVID-19 pandemic, our management has shifted towards a more outpatient centred approach. Method A single centre retrospective study was undertaken of all epistaxis patients managed by the ENT team at our centre over a five-month period from 1st January to 31st May 2020. The first 10 weeks (Pre-COVID-19) were managed using pre-existing guidelines. The following 10 weeks (COVID-19) were managed using the new COVID-19 standard operating procedures which aimed to minimise inpatient admissions. Results 142 patients, with similar demographic data, were seen across the 5-month period. There were significantly more patients aged over 65 presenting in the COVID-19 group (p = 0.04). There was a significantly increased use of local haemostatic agents (Nasopore ® and Surgiflo ®) and decreased use of nasal packing in the COVID-19 group. There were significantly fewer admissions (p < 0.0005) in the COVID-19 group, but similar rates of representation, length of stay and morbidity. Conclusions The COVID-19 pandemic has accelerated the shift towards the use of local haemostatic agents and outpatient management of epistaxis, which is as safe and effective as previously well-established epistaxis management.

scholarly journals 720 Outcomes of Conservative Management of Acute Appendicitis During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Oxenham ◽  
P Jull ◽  
D Karunaratne ◽  
N Laskar ◽  
R Harshen
Keyword(s):  
Acute Appendicitis ◽  
Conservative Management ◽  
Operative Mortality ◽  
Hospital Admissions ◽  
Operative Management ◽  
Single Centre ◽  
Day Range ◽  
Uncomplicated Appendicitis ◽  
Single Centre Study ◽  
Spread Of Infection

Abstract Introduction During the SARS-CoV-2 (COVID-19) pandemic, appendicitis was managed conservatively to reduce peri-operative mortality; spread of infection; and hospital admissions. We describe the outcomes observed from conservative management during the pandemic. Method This prospective single centre study included all patients with clinically acute appendicitis between 31/3/2020 to 31/5/2020. Length of admission and 30-day complications were recorded. This was compared to retrospective data from 31/3/2019 to 31/4/2019. Results Of the 35 patients included between 31/3/2020 to 31/5/2020: 19 patients were managed conservatively with antibiotics; 8 required operative management after trial of antibiotics; and 8 required surgery on admission. Of the initially conservatively managed patients, three suffered complications (Clavien Dindo >1). Length of admission in conservative patients averaged 1.3 days (0-5 day range). In May 2019, 30 patients admitted with clinical appendicitis were all managed with appendicectomy. The average admission was 2.93 days (1-50 day range) with 4 patient complications. There was no difference (P = 0.22) when comparing the length of admissions within the pandemic and non-pandemic cohorts. Conclusions Our study demonstrates no increase in complications or length of admission during the pandemic. We support the recommendation that conservative management of uncomplicated appendicitis is continued during the COVID-19 pandemic.

scholarly journals SP4.1.14 Single centre experience in managing acute appendicitis during COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Valdone Kolaityte ◽  
Ishani Mukhopadhyay ◽  
Daniel Newport ◽  
Imran Aslam
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Patient Outcomes ◽  
Treatment Strategies ◽  
Open Appendicectomy ◽  
Single Centre ◽  
Single Centre Experience ◽  
Significant Difference ◽  
Management Approaches ◽  
The Uk

Abstract Background Given the pressure of COVID pandemic, the UK Intercollegiate guidance encouraged a move towards non-operative or open appendicectomy management of acute appendicitis. The aim of the study was to assess the approaches used to manage acute appendicitis and their outcomes during pandemic peak and after it. Methods This was a single-centre retrospective study, 2-observer data collection. We collected and analysed data on acute appendicitis management approaches (surgical and non-surgical) and patient outcomes were compared during the peak of the pandemic (04-2020 to 06-2020) and post-peak (07-2020 to 09-2020) periods. Results 190 patients - (peak – 88, F:M=1.09, median age – 30.5) and post-peak 102 (F:M=1.12, median age -31)). There were no significant differences for APPY risk score, ASA grade, comorbidities between the groups. There was more diagnostic imaging performed during the peak of the pandemic (peak 71.6%, post-peak – 56.9%) (p = 0.035 X2=4.431). Comparison between managing patients during peak and post-peak showed that approaches were the following: conservative (14.8% vs 14.7%, P = 0.998), laparoscopic appendicectomy (65.3% vs 96.6% P = <0.001), open appendicectomy (34.7% vs 3.4% P = <0.001). There was no significant difference in postoperative complications (Clavien-Dindo II-IIIb), readmission to hospital, or total LoS (median=3 days) between the groups (p > 0.05). Median LoS for patients treated conservatively was 1 day. Only 1 patient developed COVID postoperatively, the mortality was 0%. Conclusions Treatment strategies adapted and modified in COVID peak were effective and safe in managing acute appendicitis. Laparoscopic surgery remained a safe practice even in the peak of COVID pandemic.

scholarly journals Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

scholarly journals Appendiceal Neuroendocrine Tumours - Experience of One Service

2021 ◽  
Author(s):  
Vítor Devezas ◽  
Laura Elisabete Barbosa
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Neuroendocrine Tumours ◽  
Adult Population ◽  
Right Hemicolectomy ◽  
Good Prognosis ◽  
Alive Today

AbstractTumours of the appendix are rare and tend to be diagnosed incidentally, in cases of acute appendicitis. For some authors, appendiceal neuroendocrine tumours (ANETs) are the most frequent neoplasm of the appendix, observed in 0.3% to 0.9% of cases acute appendicitis. The present is a unicentric retrospective study conducted between January 2005 and March 2017. Out of a total of 3,007 surgeries for appendiceal pathologies performed in the adult population at the hospital where the present study was conducted, there were 70 (2.33%) malignant cases, 20 (28.6%) of which were ANETs. The patients had a median age of 44 years (range: 18 to 85 years), and were predominantly women (there were 1.9 times more women than men). In 16 cases (80%), a simple appendicectomy was performed (1 patient was submitted to a right hemicolectomy later). The cases of ANETs had a good prognosis in our series: 85% of the patients are either alive today or were alive after 5 years of follow-up. Despite the fact that ANETs are described as the most frequent tumor of the appendix, this was not confirmed in our series, in which they only represented 28.6% of the cases; adenocarcinoma was the most frequent tumor (65.7%) among our sample.

scholarly journals A single-centre, retrospective study of the incidence of invasive fungal infections during 85 years of autopsy service in Brazil

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kátia Cristina Dantas ◽  
Thais Mauad ◽  
Carmen D. Saldiva de André ◽  
Ana Luiza Bierrenbach ◽  
Paulo Hilário Nascimento Saldiva
Keyword(s):  
Retrospective Study ◽  
Essential Role ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Single Centre ◽  
Historical Trends ◽  
Aids Pandemic ◽  
History Of ◽  
Frequent Infection ◽  
Over Time

AbstractAutopsy continues to play an essential role in monitoring opportunistic fungal infections. However, few studies have analysed the historical trends of fungal infections in autopsies. Here, we analyse available data on fungal infections obtained from autopsy reports during 85 years of autopsies performed by the largest autopsy service in Brazil. All invasive fungal infections presented in autopsy reports between 1930 and 2015 were included. Of the 158,404 autopsy reports analysed, 1096 involved invasive fungal infections. In general, paracoccidioidomycosis (24%) was the most frequent infection, followed by candidiasis (18%), pneumocystosis (11.7%), cryptococcosis (11%), aspergillosis (11%) and histoplasmosis (3.8%). Paracoccidioidomycosis decreased after the 1950s, whereas opportunistic fungal infections increased steadily after the 1980s during the peak of the AIDS pandemic. The lung was the most frequently affected organ (73%). Disseminated infection was present in 64.5% of cases. In 26% of the 513 cases for which clinical charts were available for review, the diagnosis of opportunistic fungal infections was performed only at autopsy. Our unique 85-year history of autopsies showed a transition from endemic to opportunistic fungal infections in São Paulo, Brazil, reflecting increased urbanization, the appearance of novel diseases, such as AIDS in the 1980s, and advances in medical care over time.

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