Complicated Appendicitis: A Surgical Controversy Concerning Risk Factors, Diagnostic Algorithm and Therapeutic Management

By surgeon’s perspective, complicated appendicitis is defined as perforated appendicitis, periappendicular abscess, gangrenous appendicitis or peritonitis, noted on radiological studies upon hospital admission, operative reports or pathology results of the surgical specimen. Despite that this clinical condition is truly common in everyday surgical routine, its causes and risk factors are still unclear. Some parameters have been associated with complicated appendicitis, like older age, type 2 diabetes, symptoms for longer duration, appendicoliths/fecaliths, delays in surgery after onset of symptoms and after admission. Furthermore, currently, there is no standard diagnostic algorithm for complicated appendicitis. To be specific, radiological findings lack sensitivity, intraoperative assessment may overestimate it while, histopathological examination is regarded as more specific diagnostic method. In addition, the optimal treatment for complicated appendicitis remains controversial between an immediate surgical operation (laparotomy/laparoscopy) or a trial of nonoperative management. Hereby, by reviewing the current literature, we would aim to clarify the risk factors and the diagnostic procedure of complicated appendicitis as well as to compare the operative management with the conservative one according to the type of complicated appendicitis, the success rate and the postoperative complications.

Occupational Burn Injuries in Finland 2011-2015

IntroductionThis study comprises all hospitalized work related burn injuries in one country during 2011-2015. The purpose was to describe demographics, causes and risk factors of occupational burn injuries with special focus on the outcome of return to work. Material and methodsThis is a retrospective study on two data sources of which Finnish Workers’ Compensation Center´s (FWCC) register includes all work-related burn cases at a given time. Additional data has been obtained from those patients, who were referred to the National Burn Centre (NBC) during the same time according to the Emergency Management of Severe Burns (EMSB) criteria. We compare demographics, injury mechanisms and general burn data of these two patient groups. ResultsBased on FWCC register, in 2011-2015 occurred 11623 work related burn cases of whom 54% were men. During the study period NBC admitted 26 patients fulfilling EMSB criteria. The most severe patients treated in NBC had injuries affecting multiple body parts. In FWCC data hand was most injured body part. Kitchen/bakery work was the most common profession in FWCC register but in NBC material industrial and transport professions dominated. In FWCC register patients had lower mean age (37 years vs. 43 years). Most severe injuries occurred among older patients: in NBC data those with total body surface area 40% or over had mean age 53 years. Majority of patients returned to work. ConclusionSafety at work in Finland is good and the vast majority of work-related burn injuries are minor. Young adults working in kitchen and bakery work are susceptible to minor burn injuries whereas, unexpectedly, elderly men working in transports and industry sustain most severe burn accidents. Retirement after work related injury becomes very expensive for all parties and this data can be used in preventing those cases as well as the minor accidents.

Unplanned Surgery After Transcatheter Closure of Ventricular Septal Defect in Children: Causes and Risk Factors

Objectives: To evaluate the causes and risk factors of unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children.Methods: A total of 773 patients with VSD who had the devices transcatheter released between January 2013 and December 2018 in our institution were retrospectively reviewed. Univariate and multivariate analyses were used to identify the risk factors for unplanned surgery.Results: Twenty four patients (3.1%) underwent unplanned surgery after transcatheter closure of VSD. The most common cause for unplanned surgery was new-onset or worsening aortic regurgitation (14/24; 58.3%), followed by occluder migration (4/24; 16.7%), complete atrioventricular block (2/24; 8.3%), severe hemolysis (2/24; 8.3%), residual shunt (1/24; 4.2%), and occluder edge near the tricuspid valve chordae (1/24; 4.2%). Logistic regression analysis revealed that primary aortic valve prolapse (OR: 5.507, 95%CI: 1.673–18.123, P = 0.005); intracristal VSD (OR: 8.731, 95%CI: 2.274–33.527, P = 0.002); eccentric occluder (OR: 4.191, 95%CI: 1.233–14.246, P = 0.022); larger occluder size (OR: 1.645, 95%CI: 1.331–2.033, P < 0.001); and pulmonary artery systolic pressure ≥45 mmHg (OR: 4.003, 95%CI: 1.073–14.941, P = 0.039) were risk factors for unplanned surgery.Conclusions: New-onset or worsening aortic regurgitation was the primary cause for unplanned surgery after transcatheter closure of VSD in children. Primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, pulmonary artery systolic pressure ≥45 mmHg could increase the risk of unplanned surgery.

Causes and Risk Factor of Post-Traumatic Stress Disorder in Adult Asylum Seekers and Refugees

Objectives: To assess the causes and risk factors of post-traumatic stress disorder (PTSD) in adult asylum seekers and refugees. To explore whether the causes and risk factors of PTSD between male and female adult refugees/asylum seekers are different. Study design: Systematic review of current literature. Data Sources: PubMed, Web of Science, Scopus and Google Scholar up until February 2019. Method: A structured, systematic search was conducted of the relevant databases. Papers were excluded if they failed to meet the inclusion and exclusion criteria. Afterwards, a qualitative assessment was performed on the selected papers. Results: 12 Studies were included for the final analysis. All papers were either case studies/reports or cross-sectional studies. Traumatic events experienced by refugees/asylum seekers are the most frequently reported pre-migration causes of PTSD development, while acculturative stress is the most common post-migration stressor. There were mixed reports regarding the causes of PTSD between both genders of refugees/asylum seekers. Conclusions: This review’s findings have potential clinical application in terms of helping clinicians to risk stratify refugees/asylum seekers for PTSD development and thus aid in embarking on earlier intervention measures. However, more rigorous research similar to this study is needed for it to be implemented into clinical practice.

Depression and tobacco smoking (analytical review). Part 2

In the pathogenesis of depressive disorders and the consequent suicidal behavior, an important role belongs to the neurochemical processes and structures of the central nervous system. An analytical study of Russian and foreign literature was carried out to obtain information about the relationship between neurochemical factors in the development of depressive disorders and to elucidate the causes and risk factors of suicidal behavior due to depression and an unhealthy habit common among young people, i.e. tobacco smoking. A systematic search of scientific publications on the neurobiological aspects of the research into the causes and risk factors of depressive spectrum disorders was carried out. The analysis of the results of relevant neurobiological studies in the field of etiology and formation of depressive disorders with suicidal behavior contributes to the development of effective means of prevention and treatment of depressive spectrum disorders.

Epidemiological Principles

This chapter reviews the basic epidemiological concepts and principles that are relevant for all primary health care workers. It describes patterns of disease frequency in populations and quantifies diseases, disability, and deaths with the use of health indicators. It measures causes and risk factors that influence disease frequency and the use of epidemiology in improving the effectiveness of health interventions in health services and public health programmes. Epidemiology is also essential for local health planning, management, and evaluation of these services at the district level.

Depression and tobacco smoking (analytical review). Part 1

In the pathogenesis of depressive disorders and the consequent suicidal behavior, an important role belongs to the neurochemical processes and structures of the central nervous system. An analytical study of Russian and foreign literature was carried out to obtain information about the relationship between neurochemical factors in the development of depressive disorders and to elucidate the causes and risk factors of suicidal behavior due to depression and an unhealthy habit common among young people, i.e. tobacco smoking. A systematic search of scientific publications on the neurobiological aspects of the research into the causes and risk factors of depressive spectrum disorders was carried out. The analysis of the results of relevant neurobiological studies in the field of etiology and formation of depressive disorders with suicidal behavior contributes to the development of effective means of prevention and treatment of depressive spectrum disorders.

Prevalence and Pathophysiology of Pediatric Urolithiasis - A Review

Urolithiasis is a condition in which hard deposits made of salts and minerals are accumulated inside the kidneys. A lot of studies demonstrated adult urolithiasis but studies on pediatric urolithiasis is still scarce. Studies had shown that pediatric urolithiasis prevalence is progressively increasing worldwide. The main cause for this increase is not totally clear but has been associated to changes in climate, nutritional habits and other environmental factors. Pediatric urolithiasis is distinctive and different from adult urolithiasis concerning prevalence, etiology and clinical presentation. Over the time while the condition was evolving, the main cause has changed from predominantly infectious to metabolic in nature. Pediatric urolithiasis should not be underestimated as it is associated with morbidity mainly since it possesses a striking feature which is ability to recur. Metabolic risk factors are more communal in pediatric urolithiasis than in adults. The common type of calculi in children is comprised of either calcium oxalate or calcium phosphate mainly and is often associated with a metabolic abnormality. Informed as metabolic abnormalities, Idiopathic hypercalciuria and hypocitraturia are the most frequently reported. A good understanding of the causes and risk factors of pediatric urolithiasis will provide better strategies and techniques for calculi treatment and prevention in children.

Exudative otitis media in children: the main causes. Part I

Otitis media, including exudative otitis, is one of the most common childhood diseases. Almost asymptomatic course in children of early and preschool age leads to undiagnosed hearing loss. In such cases the minimal auditory deficit significantly affects the auditory-speech development and the formation of higher cortical functions in children. It is pediatricians who are the first to deal with the manifestations of exudative otitis media. Consequently, their knowledge and understanding of the disease, including the most common causes and risk factors, is important. The first part of the literature review considers the theories of the exudative otitis media formation, the role of viral and bacterial flora in the development of the disease, the effect of obstruction of the auditory tube against the background of nasopharyngeal neoplasms, craniofacial anomalies (including chromosomal aberrations), allergic diseases, rhinosinusitis and adenoiditis.

Dairy cattle lameness prevalence, causes and risk factors in selected farms of southern Ethiopia

A cross-sectional study was conducted from October 2018 to December 2019 to estimate the prevalence of lameness in dairy cows, to assess the causes and associated risk factors in southern Ethiopia. A total of 2009 dairy cows were visually and clinically examined, and the overall prevalence of lameness was found to be 14. 1% (95% CI=12.7-15.7). The prevalence of lameness was significantly (P< 0.05) higher in Arsi Negelle, Yirgalem, and Wolaita Sodo than in Wondo Genet and Hawassa. The prevalence of lameness was also associated with the stages of pregnancy and parity (P < 0.05). Generally, the prevalence of lameness in dairy cows was increasing with the increase in parity and stage of pregnancy. The main abnormalities observed in this study were hooves overgrowth (6%), lesions between hooves (4%), lesions on legs (2.2%), trauma (0.6%), arthritis (0.5%), and a sole ulcer (0.3%). Most of these abnormalities were mainly due to faulty management. Hence, based on this finding it is recommended that hoof management and trimming are very essential components of lameness control. Furthermore, early detection and treatment of lame cows; training of the owners on hoof management; and improvement of the housing are helpful to keep lameness at a lower level.