scholarly journals P122 The Diagnosis and Management of Appendicitis During the COVID-19 Pandemic: The Pennine Acute Trust Experience

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Daniel Idama ◽  
George Aldersley ◽  
Meghan Connolly ◽  
Alexander O'Connor ◽  
Daniel Idama
Keyword(s):  
White Cell Count ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Symptom Duration ◽  
C Reactive Protein ◽  
Diagnosis And Management ◽  
Reactive Protein ◽  
Significant Difference ◽  
Computed Topography ◽  
Acute Trust

Abstract Introduction Appendicitis management has evolved recently with more reliance on Computed Topography (CT) and laparoscopic surgery being commonplace. In this project we looked at how the Coronavirus pandemic (COVID-19) had impacted the diagnosis, management and outcomes of patients with appendicitis in our unit. Method A retrospective review of patients diagnosed with appendicitis from 1st March – 30th April in 2019 and 2020. Data was collected on diagnosis, management and outcomes. Results In 2020, 91 patients were identified (mean 33, range 6-85, F:M 1:1.4). In 2019, 107 patients were identified (mean 32, range 7-69, M:F 1:1.1). There was no significant difference in patients’ symptom duration (p = 0.21), White Cell Count (p = 0.20) or C-Reactive Protein (p = 0.10). More CTs were performed in 2020 (56/91, 61.5%) than in 2019 (40/107, 37.4%). Less patients underwent appendicectomy in 2020 (75/91, 82.4%) than in 2019 (104/107, 97.2%). Open appendicectomies were performed in 64% (48/75) of those operated in 2020 compared with 12.2% (13/104) in 2019. There was no difference in hospital length of stay or re-admissions rates. Conclusion The diagnosis and management of appendicitis changed considerably at our trust during COVID-19 with more reliance on CT diagnosis and less use of laparoscopy. Despite this, outcomes remained unchanged.

scholarly journals 341 The Diagnosis and Management of Appendicitis During the COVID-19 Pandemic: The Pennine Acute Trust Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
D Idama ◽  
G Aldersley ◽  
M Connolly ◽  
A O'Connor
Keyword(s):  
White Cell Count ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Symptom Duration ◽  
C Reactive Protein ◽  
Diagnosis And Management ◽  
Reactive Protein ◽  
Significant Difference ◽  
Computed Topography ◽  
Acute Trust

Abstract Introduction Appendicitis management has evolved recently with more reliance on Computed Topography (CT) and laparoscopic surgery being commonplace. In this project we looked at how the Coronavirus pandemic (COVID-19) had impacted the diagnosis, management and outcomes of patients with appendicitis in our unit. Method A retrospective review of patients diagnosed with appendicitis from 1st March – 30th April in 2019 and 2020. Data was collected on diagnosis, management and outcomes. Results In 2020, 91 patients were identified (mean 33, range 6-85, F:M 1:1.4). In 2019, 107 patients were identified (mean 32, range 7-69, M:F 1:1.1). There was no significant difference in patients’ symptom duration (p = 0.21), White Cell Count (p = 0.20) or C-Reactive Protein (p = 0.10). More CTs were performed in 2020 (56/91, 61.5%) than in 2019 (40/107, 37.4%). Less patients underwent appendicectomy in 2020 (75/91, 82.4%) than in 2019 (104/107, 97.2%). Open appendicectomies were performed in 64% (48/75) of those operated in 2020 compared with 12.2% (13/104) in 2019. There was no difference in hospital length of stay or re-admissions rates. Conclusions The diagnosis and management of appendicitis changed considerably at our trust during COVID-19 with more reliance on CT diagnosis and less use of laparoscopy. Despite this, outcomes remained unchanged.

scholarly journals Effects of statins on clinical outcomes in hospitalized patients with community-acquired pneumonia

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093858
Author(s):  
Rony M. Zeenny ◽  
Hanine Mansour ◽  
Wissam K Kabbara ◽  
Nibal Chamoun ◽  
Myriam Audi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Hospital Length ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Comorbid Conditions ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Significant Difference ◽  
Chronic Use

Objective We evaluated the effect of chronic use of statins based on C-reactive protein (CRP) levels and hospital length of stay (LOS) in patients admitted with community-acquired pneumonia (CAP). Methods We conducted a retrospective study over 12 months at a teaching hospital in Lebanon comparing patients with CAP taking chronic statins with patients not taking statins. Included patients with CAP were older than age 18 years and had two CRP level measures during hospitalization. CURB-65 criteria were used to assess the severity of pneumonia. A decrease in CRP levels on days 1 and 3, LOS, and normalization of fever were used to assess the response to antibiotics. Results Sixty-one patients were taking statins and 90 patients were not taking statins. Patients on statins had significantly more comorbid conditions; both groups had comparable CURB-65 scores. In both groups, no statistically significant difference was seen for the decrease in CRP level on days 1 and 3 and LOS. No difference in days to normalization of fever was detected in either group. Conclusion No association was found between the chronic use of statins and CRP levels, LOS, or days to fever normalization in patients with CAP.

scholarly journals Hemoadsorption for management of Patients on Veno-venous ECMO Support for Severe COVID-19 Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Travis Geraci ◽  
Zachary Kon ◽  
Nader Moazami ◽  
Stephanie Chang ◽  
Julius Carillo ◽  
...  
Keyword(s):  
Clinical Effect ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
C Reactive Protein ◽  
Ecmo Circuit ◽  
Reactive Protein ◽  
Small Series ◽  
Cytokine Levels ◽  
Median Hospital ◽  
Vv Ecmo

Background and aim of the study: Patients with severe coronavirus disease 2019 (COVID-19) develop a profound cytokine-mediated pro-inflammatory response. This study reports outcomes in 10 patients with COVID-19 supported on veno-venous extracorporeal membrane oxygenation (VV-ECMO) who were selected for the emergency use of a hemoadsorption column integrated in the ECMO circuit. Materials and Methods: Pre and post treatment, clinical data and inflammatory markers were assessed to determine the safety and feasibility of using this system, and to evaluate the clinical effect. Results: During hemoadsorption, median levels of interleukin (IL)-2R, IL-6, and IL-10 decreased by 54%, 86%, and 64% respectively. Reductions in other markers were observed for LDH (-49%), ferritin (-46%), D-dimer (-7%), C-reactive protein (-55%), procalcitonin (-76%) and lactate (-44%). Vasoactive-inotrope scores decreased significantly over the treatment interval (-80%). The median hospital length of stay was 53 days (36-85) and at 90-days post cannulation, survival was 90% which was similar to a group of patients without the use of hemoadsorption. Conclusions: Addition of hemoadsorption to VV-ECMO in patients with severe COVID-19 is feasible and reduces measured cytokine levels. However, in this small series, the precise impact on the overall clinical course and survival benefit still remains unknown.

scholarly journals Importance of respiratory syncytial virus as a predictor of hospital length of stay in bronchiolitis

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 110
Author(s):  
Jefferson Antonio Buendia ◽  
Diana Guerrero Patino
Keyword(s):  
Hospital Stay ◽  
Negative Binomial ◽  
Length Of Hospital Stay ◽  
Negative Binomial Regression ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Negative Binomial Regression Model ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Syncytial Virus

IIntroduction : Bronchiolitis is the leading cause of hospitalization in children. Estimate potentially preventable variables that impact the length of hospital stay are a priority to reduce the costs associated with this disease. This study aims to identify clinical variables associated with length of hospital stay of bronchiolitis in children in a tropical middle-income country Methods: We conducted a retrospective cohort study in 417 infants with bronchiolitis in tertiary centers in Colombia. All medical records of all patients admitted throughto the emergency department were reviewed. To identify factors independently associated we use negative binomial regression model, to estimate incidence rate ratios (IRR) and adjust for potential confounding variables Results : The median of the length of hospital stay was 3.68 days, with a range of 0.774 days to 29 days, 138 (33.117%) of patients have a hospital stay of 5 or more days. After modeling and controlling for potential confounders age <6 months, comorbidities (CHD or neurological), BPD,  chest indrawing, Detection of RSV isolation, and C-reactive protein were independent predictors of LOS Conclusions : Our results show that in infants with bronchiolitis, Detection of RSV isolation, age <6 months, comorbidities (CHD or neurological), BPD,  chest indrawing, and C-reactive protein were independent predictors of LOS. As a potentially modifiable risk factor, efforts to reduce the probability of RSV infection can reduce the high medical cost associates with prolonged LOS in bronchiolitis.

scholarly journals Importance of Respiratory Syncytial Virus as a Predictor of Hospital Length of Stay in Bronchiolitis

2020 ◽  
Author(s):  
jefferson buendia ◽  
Diana Guerrero ◽  
Carlos Rodriguez Martinez
Keyword(s):  
Hospital Stay ◽  
Negative Binomial ◽  
Length Of Hospital Stay ◽  
Negative Binomial Regression ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Negative Binomial Regression Model ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Syncytial Virus

Abstract BackgroundBronchiolitis is the leading cause of hospitalization in children. Estimate potentially preventable variables that impact the length of hospital stay are a priority to reduce the costs associated with this disease.ObjectiveThis study aims to identify clinical variables associated with length of hospital stay of bronchiolitis in children in a tropical middle-income countryMethodsWe conducted a retrospective cohort study in 417 infants with bronchiolitis in tertiary centers in Colombia. All medical records of all patients admitted to the emergency department were reviewed. To identify factors independently associated we use negative binomial regression model, to estimate incidence rate ratios (IRR) and adjust for potential confounding variablesResultsThe median of the length of hospital stay was 3.68 days, with a range of 0.74 days to 29 days, 138 (33.17%) of patients have a hospital stay of 5 or more days. After modeling and controlling for potential confounders age < 6 months, comorbidities (CHD or neurological), BPD, chest indrawing, RSV isolation, and C-reactive protein were independent predictors of LOSConclusionsOur results show that in infants with bronchiolitis, RSV isolation, age < 6 months, comorbidities (CHD or neurological), BPD, chest indrawing, and C-reactive protein were independent predictors of LOS. As a potentially modifiable risk factor, efforts to reduce the probability of RSV infection can reduce the hight medical cost associates with prolonged LOS in bronchiolitis.

scholarly journals Importance of respiratory syncytial virus as a predictor of hospital length of stay in bronchiolitis

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 110
Author(s):  
Jefferson Antonio Buendia ◽  
Diana Guerrero Patino
Keyword(s):  
Hospital Stay ◽  
Negative Binomial ◽  
Length Of Hospital Stay ◽  
Negative Binomial Regression ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Negative Binomial Regression Model ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Syncytial Virus

Introduction: Bronchiolitis is the leading cause of hospitalization in children. Estimate potentially preventable variables that impact the length of hospital stay are a priority to reduce the costs associated with this disease. This study aims to identify clinical variables associated with length of hospital stay of bronchiolitis in children in a tropical middle-income country Methods: We conducted a retrospective cohort study in 417 infants with bronchiolitis in tertiary centers in Colombia. All medical records of all patients admitted to the emergency department were reviewed. To identify factors independently associated we use negative binomial regression model, to estimate incidence rate ratios (IRR) and adjust for potential confounding variables Results: The median of the length of hospital stay was 3.68 days, with a range of 0.74 days to 29 days, 138 (33.17%) of patients have a hospital stay of 5 or more days. After modeling and controlling for potential confounders age <6 months, comorbidities (CHD or neurological), BPD,  chest indrawing, RSV isolation, and C-reactive protein were independent predictors of LOS Conclusions: Our results show that in infants with bronchiolitis, RSV isolation, age <6 months, comorbidities (CHD or neurological), BPD,  chest indrawing, and C-reactive protein were independent predictors of LOS. As a potentially modifiable risk factor, efforts to reduce the probability of RSV infection can reduce the high medical cost associates with prolonged LOS in bronchiolitis.

scholarly journals The use of biochemical markers in complicated and uncomplicated acute diverticulitis

2018 ◽  
Author(s):  
Dulitha Kumarasinghe ◽  
Assad Zahid ◽  
Greg O'Grady ◽  
Timothy Leow ◽  
Tabrez Sheriff ◽  
...  
Keyword(s):  
Cell Count ◽  
Acute Diverticulitis ◽  
White Cell Count ◽  
Complicated Diverticulitis ◽  
White Cell ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Uncomplicated Diverticulitis ◽  
Significant Difference ◽  
Post Hoc

Abstract BACKGROUND: Diverticulosis is extremely common in western society. A recent study has shown that outpatient, non-antibiotic management of acute uncomplicated diverticulitis may be a feasible and safe option. However the ability to identify these patients is still difficult. This study explores the ability of white cell count, C-reactive protein and bilirubin in differentiating patients with complicated and uncomplicated diverticulitis as well as progression to surgical intervention. METHODS: This is a retrospective study of patients admitted with acute diverticulitis over a 5-year period (2009-2014) at a single institution in Australia. Patients were classified into three groups; uncomplicated diverticulitis, complicated diverticulitis without surgery and complicated diverticulitis with surgery. ANOVA and Bonferroni's post-hoc analyses were used to compare markers across the groups. RESULTS: A total of 541 patients met the inclusion criteria for this study. One-way ANOVA showed a significant difference in white cell count (p&lt;0.0001), C-reactive protein (p&lt;0.0001) and bilirubin (p=0.0006) between all three groups. Post-hoc analyses showed a significant difference in white cell count, C-reactive protein and bilirubin when comparing uncomplicated diverticulitis against complicated diverticulitis without surgery (p&lt;0.05) and complicated diverticulitis with surgery (p&lt;0.05). White cell count also showed a significant difference when comparing complicated diverticulitis without surgery and complicated diverticulitis with surgery (p&lt;0.05). CONCLUSIONS: White cell count, C-reactive protein and bilirubin can distinguish between uncomplicated and complicated diverticulitis.

scholarly journals Evaluation of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and C-Reactive Protein in Tension-Type Headache Patients

2021 ◽  
Author(s):  
Hasan Hüseyin Özdemir ◽  
Ahmet Dönder
Keyword(s):  
Systemic Inflammation ◽  
Tension Type Headache ◽  
Neutrophil To Lymphocyte Ratio ◽  
Control Group ◽  
C Reactive Protein ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Significant Difference ◽  
Type Headache

Abstract Objectives A tension headache is the most common type of headache, and its causes are multifactorial. A relationship has been shown between migraine headaches and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP). In this study, we investigated the NLR, PLR, and serum CRP levels in frequent episodic tension-type headache (FETTH) and chronic tension-type headache (CTTH) patients. Materials and Methods This retrospective study included 64 patients with FETTH, 80 patients with CTTH, and 60 healthy controls who were followed up in the neurology clinic. Hematological parameters were compared between the patient and control groups. Results In CTTH patients, platelets, NLR, PLR, and CRP values were statistically higher than in FETTH patients and patients in the control group. In FETTH patients, the PLR value was higher than in patients in the control group, but there was no statistically significant difference in NLR and CRP values between FETTH patients and patients in the control group. Also, there was no correlation between these values and age and gender. Conclusion Increase platelet count might have an effect on tension-type headache pathophysiology. Systemic inflammation parameters were shown to be significantly higher in CTTH patients. More comprehensive studies are needed to evaluate the effect of systemic inflammation on the chronicity of tension headaches.

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