Spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastro-duodenoscopy at a Tertiary Hospital in Ibadan, south west, Nigeria

Introduction: Dyspepsia is a symptom complex with varied underlying etiologies. The underlying etiology determines the precise treatment and prognosis though Helicobacter pylori infection plays a central role. The aim of this study was to describe the spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastroduodenoscopy at the University College Hospital, Ibadan.Methods: A retrospective analysis of computerized database patients with dyspepsia who underwent oesophago-gastro–duodenoscopy from 2015 to 2019.Results: A total of 1,373 procedures were done and dyspepsia was the indication in 736 (53.2%) comprising 317 (43.1%) male and 405 (55%) female (P< .001). The age ranged from 18 to 100 with a mean of 50 ± 15 years. The age group 40–59 years had the highest representation (P = .00). The esophageal mucosa was normal in 592 (80.4%) while 45 (6.1%) and 36 (4.9%) patients had esophagitis and esophageal candidiasis, respectively. In the stomach, 230 (31%) patients had normal mucosa while 433 (57.5%) and 40 (5.4%) patients had gastritis and gastric ulcers, respectively. Antrum was the most commonly involved site by the gastritis and ulcers in 236 (55.8%) and 24 (60%) patients, respectively. The mean age of those with non-ulcer dyspepsia was 49.8 ± 15 while that of those with organic dyspepsia was 55.7 ± 13.7 years (P= .01). Furthermore, there was a significant correlation between the age group and organic dyspepsia (P = .00). The first part of the duodenum was normal in 594 (80.7%) while bulbar duodenitis was seen in 106 (14.4%).Conclusion: In our practice, OGD in patients with dyspepsia is either normal or yielded few abnormalities. The most common abnormalities were gastritis, duodenitis, esophagitis and gastric ulcers. Gastritis and ulcers were antral predominant and gastric ulcers were more common than duodenal ulcers. There was a significant relationship between increasing age and organic dyspepsia

Tumor necrosis factor-alpha and interleukin-1 alpha as predictors of survival in peritonitis: A pilot study

Context: Peritonitis induces an inflammatory response characterized by the elevation of various cytokine levels. Included in this cascade of cytokines are tumor necrosis factor‑alpha (TNF‑α) and interleukin‑1 alpha (IL‑1α). The outcome of patient care may be associated with the pattern of elaboration of these cytokines.Aim: The aim of this study was to describe the pattern of cytokine response (TNF‑α and IL‑1α) in the course of peritonitis and evaluate them as predictors of mortality in peritonitis.Setting and Design: This was a prospective study conducted in the Division of Gastrointestinal Surgery, University College Hospital, Ibadan.Methods: Consenting patients with clinical diagnosis of generalized peritonitis over a 6‑month period (July to December 2015) were recruited. The serum samples of these patients were obtained at presentation, immediately after surgery, and 24 h and 48 h after surgery with a follow‑up period of 30 days.Results: Twenty‑six samples out of thirty could be analyzed. Serum TNF‑α and IL‑1α levels were both elevated at presentation in all patients. However, the patterns of change after intervention varied between the survivors and nonsurvivors.Conclusion: Peritonitis triggers a simultaneous increase in serum levels of TNFα and IL‑1α. Lower serum level of TNF‑α is associated with survival, while on the contrary, higher level of IL‑1α is associated with survival.Keywords: Cytokines, outcome, peritoniti

Tumor necrosis factor-alpha and interleukin-1 alpha as predictors of survival in peritonitis: A pilot study

Context: Peritonitis induces an inflammatory response characterized by the elevation of various cytokine levels. Included in this cascade of cytokines are tumor necrosis factor-alpha (TNF-α) and interleukin-1 alpha (IL-1α). The outcome of patient care may be associated with the pattern of elaboration of these cytokines. Aim: The aim of this study was to describe the pattern of cytokine response (TNF-α and IL-1α) in the course of peritonitis and evaluate them as predictors of mortality in peritonitis. Setting and Design: This was a prospective study conducted in the Division of Gastrointestinal Surgery, University College Hospital, Ibadan. Methods: Consenting patients with clinical diagnosis of generalized peritonitis over a 6-month period (July to December 2015) were recruited. The serum samples of these patients were obtained at presentation, immediately after surgery, and 24 h and 48 h after surgery with a follow-up period of 30 days. Results: Twenty-six samples out of thirty could be analyzed. Serum TNF-α and IL-1α levels were both elevated at presentation in all patients. However, the patterns of change after intervention varied between the survivors and nonsurvivors. Conclusion: Peritonitis triggers a simultaneous increase in serum levels of TNFα and IL-1α. Lower serum level of TNF-α is associated with survival, while on the contrary, higher level of IL-1α is associated with survival

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population