PROVIDING EMERGENCY SURGICAL CARE TO PATIENTS IN A COVID-19 PANDEMIC

Among the features of surgical care for patients with COVID-19 are the need for strict compliance with the epidemiological regime, minimizing the number of staff in the operating room, the possible minimization of surgical interventions and reducing their duration. The most important task in these conditions is the safety of personnel. Materials and methods. The results of surgical treatment of 85 pa-tients with acute surgical pathology are presented, and the presence of the virus was confirmed by the results of laboratory tests in 75.3 %. 24.7 % of patients had a clear picture of pneumonia of viral etiology with a high probability. All operations were performed in compliance with the epidemiological regime by pre-trained and instructed per-sonnel in compliance with the rules of asepsis and antiseptics. Discussion of results. There are no fundamental changes in the tac-tics of management of patients with acute surgical pathology. Howev-er, in the presence of the patient, in addition to acute surgical disease, COVID-19 and viral pneumonia of varying severity, it is necessary to take into account the increased risk of both bacterial and thrombo-embolic complications. Conclusions. Given the limitations caused by the spread of COVID-19, emergency surgical care should be provided to all pa-tients in a timely, highquality and complete manner. Any action of the emergency surgical service must be justified by the specific situa-tion, with the absolute priority of public and patient safety.

History and Challenges Ahead for General Surgery Training in East Africa

This review highlights the history of the commencement of training in East Africa. The challenges faced in setting up a recognised training curriculum in General Surgery are outlined. The supply of health professionals with surgical skills is disproportionate to the world burden of surgical disease. The disproportion between the burden of surgical disease and the low numbers of trained personnel is more pronounced in developing low income countries. General surgery is being left in referral hospitals with few staff as surgical subspecialisation is gaining momentum. The provision of essential general surgery management is therefore below par which is the responsibility of the General Surgeon. In order to bridge the discrepancy training of more general surgeons is required. Specialist surgeons should also be trained first as general surgeons as it will give them the ability to respond to a general surgical emergency when practising as specialists and will provide them with a good overall understanding of the needs in general surgery.

Management of acute appendicitis in emergency departments during pandemic times: who are the most affected, children or adults?

COVID-19 was the most important public health problem in the world during the years 2020 - 2021 . Its appearance and rapid global expansion caused an abrupt change in the management of diseases in all medical departments, due to the risk of contagion and death . The outcomes of acute surgical pathologies have been one of the main questions due to organizational modifications in hospitals, in order to control the dynamics of emergency and critical care for COVID-19 patients, leaving aside the approach and control of the surgical disease burden. Fear of infection, long distances, confinement, socioeconomic problems, and institutional restrictions were some of the aspects that most affected the flow of patients with diseases other than COVID-19, leading to delays in care. Appendicitis is the leading cause of acute surgical abdomen worldwide, occurring in approximately 10% of the population. Its age range of presentation is between 5 and 45 years, with male predominance. Considering the variability of the symptomatology, the rapidly progressive deterioration, and the limitations in the access to timely surgical services, its early diagnosis and management are indispensable. The delay in the management of this pathology constitutes an increase in the risk of perforation and peritonitis, which in turn can lead to sepsis and death. Considering the heterogeneity of the behavior of the pandemic among the different continents, and the response of the health systems and the community to this public calamity, it is not known with certainty which age group was the most affected with respect to appendicitis during this period of time.

NEW POSSIBILITIES OF ANTIBIOTIC THERAPY IN THE TREATMENT AND PREVENTION OF I NFECTED ACUTE PANCREATITIS

Summary. Introduction. One of the most difficult problems in surgery today is the treatment of acute pancreatitis, which remains the third most frequent acute surgical disease. The frequency of the latter is growing every year. Despite the achievements of pharmacotherapy and infusion therapy, mortality in acute pancreatitis remains at the level of 15–45 %, and in the development of purulent complications it reaches 70–80 %. The urgency of the problem. The use of antibiotics for complicated pancreatic necrosis is obvious, but antibiotic therapy does not always lead to the desired result. Given this, the attitudes of surgeons to the use of antibiotics do not coincide, especially when it comes to their preventive use. The above determines the urgency of the problem. Purpose of work. To study the possibilities of new ways of supplying antibiotics to the pancreas in its acute inflammation. Materials and methods. We have studied the immediate results of the use of antibiotics in acute pancreatitis in the conditions of their introduction by the lymphotropic route. The examination of patients was performed according to generally accepted methods, including ultrasound at admission and on the 4th day of treatment. Results and discussion. During the first 4 days of treatment, the patient’s condition almost normalized: the pain in the first day was localized in the epigastrium, changing from cutting and «tearing» to dull; weakness, dry mouth disappeared and the temperature returned to normal. The number of leukocytes decreased from (10,5 ± 3,8)×109/l to (6,6 ± 2,4) × 109/l. The leukocyte index of intoxication according to Calf-Calif decreased by (2,63 ± 0,7) cu, ESR – normalized, the amount of blood amylase decreased on average from 500 cu. up to 50 cu. This was due to a decrease in the volume of the pancreas in the head, body, cauda by 6,4 – 3,9 – 7,0 mm, respectively. Conclusions. The lymphotropic route of administration of antibiotics to the inflamed pancreas contributed to its reduction, which was accompanied by an improvement in the indicators of the inflammatory process according to Calf-Caliph, a decrease in the number of leukocytes and ESR, reduced gland volume and elimination of pain and other signs of the disease by the 4th day.

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

Immunocompromised patients are a heterogeneous and diffuse category frequently presenting to the emergency department with acute surgical diseases. Diagnosis and treatment in immunocompromised patients are often complex and must be multidisciplinary. Misdiagnosis of an acute surgical disease may be followed by increased morbidity and mortality. Delayed diagnosis and treatment of surgical disease occur; these patients may seek medical assistance late because their symptoms are often ambiguous. Also, they develop unique surgical problems that do not affect the general population. Management of this population must be multidisciplinary.This paper presents the World Society of Emergency Surgery (WSES), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) joined guidelines about the management of acute abdomen in immunocompromised patients.

Postoperative Follow-Up and Recovery after Abdominal Surgery

Postoperative patient care has several components: - surveillance, − prevention of complications associated with surgical disease or other preexisting comorbidities, − specific postoperative treatment of the surgical disease and its complications. While these distinctions are purely didactic, the postoperative care merges into an active surveillance with a higher level of standardization than it would seem at first glance. Computing, interpreting and integrating signs and symptoms with active search of proofs by lab tests or other paraclinical explorations highly depends on skills and dedication of the entire healthcare team. Those attributes gained through continuous theoretical preparation but validated by current practice bring added value, always in favor of the patients’ best interests. In this chapter, we propose to explore the main clinical and paraclinical means and tools that can improve the outcomes of surgical procedures for a faster and safer recovery. We will also discuss the need for different types of surgical bed drains placement and their management, the use of antibiotics and thrombotic event prophylaxis.