Acute Lymphangitis 30-Year-Old Male Patient. Case Report

La linfangitis es un proceso inflamatorio en los linfáticos que generalmente ocurre después de la inoculación de microorganismos a través de un defecto de la piel o como complicación de una infección más distal. La linfangitis aguda se presenta como una enfermedad cutánea generalizada con eritema y fiebre, que puede ir acompañada de manifestaciones sistémicas como fiebre. Los microorganismos más comunes son el estreptococo betahemolítico y el estafilococo aureus. El diagnóstico correcto se basa en la historia y el examen físico. También se deben considerar los estudios de laboratorio y microbiológicos como posible punto de entrada para el inicio de un tratamiento adecuado, que inicialmente se basará en una terapia antibiótica empírica, que requiere terapia parenteral y hospitalización. Se reporta paciente masculino de 30 años que presenta desde hace 1 semana una lesión cutánea eritematosa y lineal en abdomen, pruriginosa, sin fiebre ni otra sintomatología acompañante.Lymphangitis is an inflammatory process in the lymphatics that generally occurs after inoculation of microorganisms through a skin defect or as a complication of a more distal infection. Acute lymphangitis presents as a generalized skin disease with erythema and fever, which may be accompanied by systemic manifestations such as fever. The most common microorganisms are beta-hemolytic streptococcus and staphylococcus aureus. The correct diagnosis is based on history and physical examination. Laboratory and microbiological studies should also be considered as a possible entry point for the initiation of adequate treatment, which will initially be based on empirical antibiotic therapy, requiring parenteral therapy and hospitalization. A 30-year-old male patient is reported who has had an itchy, erythematous, linear skin lesion on the abdomen for 1 week, without fever or other accompanying symptoms

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2