Evaluation of Acute Appendicitis Cases During the Covid-19 Pandemic Period: A Retrospective Study

<p>Aim:</p><p>The Covid-19 pandemic has imposed an increased burden on healthcare resources, leading to changes in emergency department admissions and clinical presentations. This study aims to assess potential changes in the management of acute appendicitis patients in surgical practice before and during the Covid-19 pandemic.</p><p>Methods:</p><p>Demographic data, surgical procedures, length of hospital stay, preoperative laboratory results, radiological evaluations, intraoperative findings, drainage usage, pathological results, and postoperative complication rates of patients undergoing surgery for acute appendicitis before the Covid-19 pandemic (September 11, 2018 - March 11, 2020) and during the pandemic (March 11, 2020 - September 11, 2021) were retrospectively evaluated.</p><p>Results:</p><p>During the Covid-19 pandemic, it was found that the age and length of hospital stay of total appendicitis cases significantly decreased compared to the period before the Covid-19 pandemic (p=0.002 and p=0.040). While the rates of open appendectomy were higher before the Covid-19 pandemic (%79.9 vs. %60.7), it was observed that the rates of laparoscopic appendectomy were higher during the Covid-19 pandemic compared to before (p<0.001). Similarly, while the rates of perforated appendicitis were higher before the pandemic (%20.3 vs. %16.8), the rates of acute appendicitis were higher during the pandemic compared to before (%82.2 vs. %77.8), with the difference being statistically close to significance (p=0.078).</p><p>Conclusion:</p><p>This study demonstrates that there was no decrease in hospital admissions for acute appendicitis cases during the Covid-19 pandemic, and there was no increase in post-appendectomy complication rates. The preference for laparoscopic appendectomy may have contributed to shorter patient hospitalization. Furthermore, changes in radiological evaluation preferences were observed during the pandemic period.</p><p> </p><p> </p&gt

Intestinal involvement in Wegener's granulomatosis

Wegener's granulomatosis is a necrotizing vasculitis that may affect any viscera. Gastrointestinal involvement is rather uncommon. We present a case of Wegener's granulomatosis with multiple small bowel ulcers and a single ileal perforation. Histological examination of the surgically resected specimen demonstrated evidence for necrotizing vasculitis. Gross and histological features of the gastrointestinal disease in Wegener's granulomatosis are discussed

Comparison of Intraabdominal and Trocar Site Local Anaesthetic Infiltration on Postoperative Analgesia After Laparoscopic Cholecystectomy

Objective: This study aimed to compare the efficacy of local anaesthetic infiltration to trocar wounds and intraperitoneally on postoperative pain as a part of a multimodal analgesia method after laparoscopic cholecystectomies

CT-guided tractography is a safe and complementary diagnostic tool in the management of penetrating abdominal trauma

Summary: Background/Objective: Despite extensive published research, the surgical approach to penetrating abdominal trauma patients is still under debate. Computed tomography-guided tractography (CTT) is an imaging modality in which water soluble iodinated contrast medium is administered into the site of the injury in the CT unit. The aim of this study was to determine the diagnostic accuracy of the CTT. Methods: A retrospective evaluation was made of patients admitted to the Emergency Department with penetrating abdominal trauma and who underwent CTT. Contrast enhanced abdominal CT and CTT reports, surgical findings and clinical results were examined. Results: Evaluation was made of a total of 101 patients comprising 89 males (88.1%) and 12 females (11.9%). CTT was determined to have 92.8% sensitivity, 93.6% specificity, 97% positive predictive value, and 85.5% negative predictive value. In 27 patients (26.7%) where the CTT indicated passage through the peritoneum, no parenchymal organ injury was present. Only one patient (2.9%) without peritoneal penetration on CTT had organ injury at exploration. No procedure-related morbidities developed. Conclusion: CTT is a safe imaging modality for the evaluation of hemodynamically stable patients. Compared to other imaging modalities, there is clearer demonstration of whether or not the peritoneum is intact. However penetration on CTT does not exactly correlate with organ injury. Keywords: Computed tomography guided tractography, Penetrating abdominal trauma, Therapeutic trauma laparotomy, Negative laparotom

New Findings on Autoimmune Etiology of Idiopathic Granulomatous Mastitis: Serum IL-17, IL-22 and IL-23 Levels of Patients

Background Idiopathic Granulomatous Mastitis (IGM) is a benign chronic inflammatory breast disease that mimics breast cancer, and the etiopathogenesis has not yet been fully evaluated. Autoimmunity has received the most focus as a possible etiology. Our aim in this prospective clinical study was to investigate the possible association between the cytokines, interleukin IL-17, IL-22, IL-23 and IGM. Materials and Methods The current study was conducted in 26 women with histopathologically diagnosed IGM, and 15 control women of reproductive age having no breast disease history. Blood samples were collected, and serum concentrations of IL-17, IL-22, and IL-23 were determined. Results In the analysis of variables, the patients with IGM and the control group had statistically significant differences between serum IL-22 titers (p = 0.0378) and IL-23 titers (p = 0.0469. No statistically significant difference was found between IGM patients and the control group in serum IL-17 titers (p = 0.9724). Conclusion The results of the current study, especially pertaining to serum IL-22 and IL-23 levels, support the etiopathogenesis of IGM in favor of the autoinflammatory thesis. Nevertheless, this thesis should be supported by a large case number and prospective clinical studies

Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV mortality prediction score (IMPRES)

KUCUK, Ahmet Oguzhan/0000-0002-6993-0519; Kirakli, Cenk/0000-0001-6013-7330; KUCUK, Mehtap PEHLIVANLAR/0000-0003-2247-4074; Aksoy, Iskender/0000-0002-4426-3342WOS: 000504051300010PubMed: 31655511Background/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results: The following cut-off scores were used to indicate mortality risk: 8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total 1M PRES scores of greater than 8 (P < 0.001). Conclusion: The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data