Evaluation of the Potential Association of Platelet Levels, Mean Platelet Volume and Platelet Distribution Width with Acute Appendicitis

BACKGROUND: The occurrence and early management of acute appendicitis among children are especially important due to the difficult diagnosis and nonspecific symptoms of the disease. Diagnosis of appendicitis in children is very difficult due to similarity of its symptoms to other diseases, and also its self-limiting nature Platelet indexes such as mean platelet volume (MPV) and platelet distribution width (PDW) have been suggested as a biomarker of inflammation. AIM: Therefore, we examined the association of MPV and PDW with acute appendicitis in children. METHODS: This cross-sectional study was conducted on 464 patients with suspected acute appendicitis under the age of 18 years referred to the specialised hospitals of the ten studied provinces between October 2014 and October 2015. All data obtained regarding patient's lab tests, i.e. platelet count, MPV and PDW and also radiological studies and surgical reports were gathered in datasheets and analysed to evaluate the potential association of platelet levels, mean platelet volume (MPV) and platelet distribution width (PDW) with acute appendicitis RESULTS: Our results showed that the MPV was significantly higher in acute appendicitis in comparison to perforated appendicitis as well as acute gangrenous appendicitis. PDW was significantly higher in acute appendicitis in comparison to perforated appendicitis and acute gangrenous appendicitis. The current project indicated that PDW < 10.05 had a sensitivity of 35% and specificity of 75%, platelet count < 229500 had a sensitivity of 24% and specificity of 75% and MPV < 8.95 had a sensitivity of 70% and specificity of 71%. CONCLUSION: Our study suggested that platelet indexes such as MPV and PDW could significantly correlate with acute appendicitis in pediatric patients. Hence, we believe that both MPV and PDW could use as a simple and low-cost lab test for diagnosing acute appendicitis. Also, this study revealed that the MPV lower than 8.95 could be a novel index for diagnosing acute appendicitis with sensitivity of 70% and specificity of 71%

Comparison of Honey versus Polylactide Anti-Adhesion Barrier on Peritoneal Adhesion and Healing of Colon Anastomosis in Rabbits

BACKGROUND: Postoperative adhesion is still a consequence of intra-abdominal surgeries, which results in bowel obstruction and abdominopelvic pain. Bowel anastomosis as a common abdominal surgery has the incidence of leakage in up to 30% of patients that increase morbidity and mortality. Due to similar pathways of adhesion formation and wound healing, it is important to find a way to reduce adhesions and anastomosis leakage. AIM: This study was designed to compare antiadhesive as well as anastomosis healing improvement effect of honey and polylactide anti-adhesive barrier film. METHODS: Forty-five rabbits divided into three groups of honey, adhesion barrier film, and control group in an animal study. Under a similar condition, rabbits underwent resection and anastomosis of cecum under general anaesthesia. In the first group, honey was used at the anastomosis site, in the second one polylactide adhesion barrier film utilised, and the third one was the control group. Adhesion, as well as anastomosis leakage, was assessed after 21 days. Data were analysed using the Statistical Package for Social Scientists (SPSS) for Windows version 25. RESULTS: Three groups of 15 rabbits were studied. The results showed that mean peritoneal adhesion score (PAS) was lower in the honey group (1.67) in comparison to the adhesion barrier film group (3.40) and the control group (6.33). CONCLUSION: Bio-absorbable polylactide barrier has an anti-adhesion effect but is not suitable for intestinal anastomosis in rabbits. Further studies needed to evaluate these effects on human beings

Successful management of multiple small bowel perforations due to polyarteritis nodosa

Classic Polyarteritis nodosa (PAN)) is a medium-sized vessel vasculitis that usually occurs in middle-aged men. One of the dramatic manifestations of PAN that requires surgical intervention is multiple small bowel perforations. Many studies have reported a high rate of mortality in PAN due to acute abdominal complications. We report here the case of multiple small bowel perforations in a 22-year-old man, who presented with an acute abdomen, and eventually, PAN was diagnosed. In our case, PAN led to multiple small bowel perforations and diffuse patchy necrosis. All perforations were primarily repaired and corticosteroids were prescribed. Using corticosteroid in patients with abdominal sepsis is injurious; however, laparostomy is the method we suggest, to achieve the purpose, including prevention of a short bowel and infection control. Our patient was discharged, well, after 48 days of hospitalization and referred to a rheumatologist

Patency and outcomes of tunneled hemodialysis catheter via femoral versus jugular vein access

The design of a suitable catheter to achieve a permanent, economical, and efficient vascular pathway for hemodialysis has been always accompanied by difficult and potential complications. Various strategies have been adopted to minimize the use of tunneled catheters that are used for dialysis. Regarding this, the present study aimed to assess the success, patency, as well as early and late complications of cuffed femoral and jugular hemodialysis catheters. This case–control study was performed on 145 hemodialysis patients who were candidates for the insertion of tunneled hemodialysis catheters at Rasoul-e-Akram Hospital in Tehran, Iran, during 2015–2016. The data were collected retrospectively by reviewing the patients' medical records. The participants were divided into two groups of femoral and jugular accesses, based on the type of catheter they had. To determine the procedure-related outcomes, they were assessed 1 week, 1 month, and 6 months after catheterization. According to the results, the mean times of catheter efficacy (patency) were 4.43 ± 3.11 and 5.65 ± 4.57 months in the femoral and jugular access groups, respectively, showing no significant difference between the two groups (P = 0.095). Furthermore, the femoral and jugular access groups had the infection prevalence of 23.2% and 16.2%, thrombosis prevalence of 28.6% and 20.9%, and mortality rates of 3.5% and 1.4%, respectively. According to the multivariable linear regression model, the history of catheterization could predict reduced catheter patency. In addition, catheter-related infection could be predicted among females based on the multivariate logistic regression analysis. As the findings indicated, femoral and jugular hemodialysis catheter insertions showed no significant difference in terms of the mean patency, complications (e.g., infection and thrombosis), and mortality rate