Pub Date : 2024-05-01DOI: 10.1097/gh9.0000000000000451
Rajab A. Alzahrani
The most common malignant lesion in the nasopharynx is the nasopharyngeal carcinoma (NPC), commonly presents with painless upper cervical lymphadenopathy secondary to nodal metastasis and the undifferentiated type is the most common diagnosis. Compared with other types of cancers, NPC is uncommon, albeit with a high difference in geographical distribution where the worldwide cases account for only 0.6% of all annually diagnosed cancers diagnosed, however, in Saudi Arabia the overall incidence among all age groups is 0.1–0.13 per 10 000. Other rare types of malignancies are also seen at the nasopharynx and due to the nonspecific clinical and imaging characteristics; the preoperative diagnosis may be difficult. This study retrospectively assessed the nasopharyngeal tumors diagnosed in a referral hospital in Al-Baha regions, Saudi Arabia during 10 years period that came with unusual presentations at the level of clinical, radiological, or pathological features to raise the awareness of healthcare provides by these entities. Twenty patients were included and revealed unusual (atypical) clinical presentation in 50% of case including a case presented with respiratory symptoms as a first presentation where multiple lung foci were seen and proved to be a metastatic NPC. Histopathological diagnoses were challenging for 40% of the cases revealing unusual malignant types. In summary, however, the nasopharyngeal malignancy is a rare entity, accurate diagnosis may be missed in clinical or even in the pathology examination. Surgeons and pathologists should be aware of the unusual presentation to provide early and more accurate diagnosis for such serous tumors.
{"title":"Nasopharyngeal tumors with unusual presentations: a retrospective analysis from Saudi Arabia","authors":"Rajab A. Alzahrani","doi":"10.1097/gh9.0000000000000451","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000451","url":null,"abstract":"The most common malignant lesion in the nasopharynx is the nasopharyngeal carcinoma (NPC), commonly presents with painless upper cervical lymphadenopathy secondary to nodal metastasis and the undifferentiated type is the most common diagnosis. Compared with other types of cancers, NPC is uncommon, albeit with a high difference in geographical distribution where the worldwide cases account for only 0.6% of all annually diagnosed cancers diagnosed, however, in Saudi Arabia the overall incidence among all age groups is 0.1–0.13 per 10 000. Other rare types of malignancies are also seen at the nasopharynx and due to the nonspecific clinical and imaging characteristics; the preoperative diagnosis may be difficult. This study retrospectively assessed the nasopharyngeal tumors diagnosed in a referral hospital in Al-Baha regions, Saudi Arabia during 10 years period that came with unusual presentations at the level of clinical, radiological, or pathological features to raise the awareness of healthcare provides by these entities. Twenty patients were included and revealed unusual (atypical) clinical presentation in 50% of case including a case presented with respiratory symptoms as a first presentation where multiple lung foci were seen and proved to be a metastatic NPC. Histopathological diagnoses were challenging for 40% of the cases revealing unusual malignant types. In summary, however, the nasopharyngeal malignancy is a rare entity, accurate diagnosis may be missed in clinical or even in the pathology examination. Surgeons and pathologists should be aware of the unusual presentation to provide early and more accurate diagnosis for such serous tumors.","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/gh9.0000000000000412
H. Khan, Khulud Qamar, Yumna Salman, Amaima Shakir, M. S. Butt, Z. H. Tharwani, Abdullah Malikzai
Anemia is a multivariate and highly prevalent health concern among the worldwide population. However, owing to the socioeconomic conditions of Pakistan and physiological changes that take place during pregnancy, an exceptionally high percentage of pregnant Pakistani females suffer from anemia with the most common cause being iron deficiency. Unsurprisingly, many complications for both mother and child have been recorded in association with this issue, such as postpartum hemorrhage, low birthweight, stunted development, and still birth. Given the situation, it is imperative to strengthen operational measures while introducing more effective strategies to improve health status among pregnant women.
{"title":"Exploring the relationship between anemia in pregnancy and infant mortality: a narrative review","authors":"H. Khan, Khulud Qamar, Yumna Salman, Amaima Shakir, M. S. Butt, Z. H. Tharwani, Abdullah Malikzai","doi":"10.1097/gh9.0000000000000412","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000412","url":null,"abstract":"Anemia is a multivariate and highly prevalent health concern among the worldwide population. However, owing to the socioeconomic conditions of Pakistan and physiological changes that take place during pregnancy, an exceptionally high percentage of pregnant Pakistani females suffer from anemia with the most common cause being iron deficiency. Unsurprisingly, many complications for both mother and child have been recorded in association with this issue, such as postpartum hemorrhage, low birthweight, stunted development, and still birth. Given the situation, it is imperative to strengthen operational measures while introducing more effective strategies to improve health status among pregnant women.","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/gh9.0000000000000446
Shahzaib Ahmad, Saeed Ahmad, Muhammad H. Bin Khawar, Muhammad H. Khan, Abdul Latif
{"title":"Beyond anesthesia: exploring the underlying causes of the fungal meningitis outbreak in the US","authors":"Shahzaib Ahmad, Saeed Ahmad, Muhammad H. Bin Khawar, Muhammad H. Khan, Abdul Latif","doi":"10.1097/gh9.0000000000000446","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000446","url":null,"abstract":"","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141033059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/gh9.0000000000000449
Abdullahi Said Hashi, Abdirahim Ali Nur Adam, Isak Mohamed
In 2019, there were over 73 000 estimated tetanus cases globally, including more than 27 000 cases of neonatal tetanus, and the worldwide deaths caused by tetanus were almost 34 684. The mortality rate of tetanus is greater than 50% in countries without ICUs and 10% in developed countries, mostly attributed to autonomic dysfunction. Countries with the greatest rates of post-neonatal tetanus mortality (greater than five fatalities per 100 000 people) were Somalia, South Sudan, and Kenya. A 66-year-old unvaccinated male patient came to our hospital emergency department with generalized rigidity, neck stiffness, lockjaw, and an altered level of consciousness for 5 days. His symptoms started with stiffness in his neck and back 4 days before. The patient was diagnosed with tetanus, as he was unimmunized, had a recent injury, and presented clinical findings. The authors started treatment by administering intramuscular human tetanus immunoglobulin and metronidazole. He was admitted to the ICU and placed in an isolation room with minimal auditory and visual stimuli. Following 2 weeks after admission his blood pressure began to fall, and his pulse rate started to fluctuate with alternating tachycardia and bradycardia. After 1 month in the ICU, he was discharged from the ICU and transferred to the ward. A catch-up immunization regimen was established. Tetanus is a rare condition in the Western world, primarily due to widespread vaccination programs from infancy to adulthood. There are crucial barriers that still exist to overcoming this disease in our country, including a lack of reliable immunization programs. In tetanus, the increase in survival is associated with the use of intensive care facilities for the management of tetanus, besides expanding the knowledge of the disease, which is a challenge for developing countries. It is essential to have enough immunization at an early stage of trauma since severe autonomic dysfunction linked to tetanus might be lethal.
{"title":"Delayed presentation and management approach of autonomic dysfunction associated with severe tetanus","authors":"Abdullahi Said Hashi, Abdirahim Ali Nur Adam, Isak Mohamed","doi":"10.1097/gh9.0000000000000449","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000449","url":null,"abstract":"\u0000 \u0000 In 2019, there were over 73 000 estimated tetanus cases globally, including more than 27 000 cases of neonatal tetanus, and the worldwide deaths caused by tetanus were almost 34 684. The mortality rate of tetanus is greater than 50% in countries without ICUs and 10% in developed countries, mostly attributed to autonomic dysfunction. Countries with the greatest rates of post-neonatal tetanus mortality (greater than five fatalities per 100 000 people) were Somalia, South Sudan, and Kenya.\u0000 \u0000 \u0000 \u0000 A 66-year-old unvaccinated male patient came to our hospital emergency department with generalized rigidity, neck stiffness, lockjaw, and an altered level of consciousness for 5 days. His symptoms started with stiffness in his neck and back 4 days before. The patient was diagnosed with tetanus, as he was unimmunized, had a recent injury, and presented clinical findings. The authors started treatment by administering intramuscular human tetanus immunoglobulin and metronidazole. He was admitted to the ICU and placed in an isolation room with minimal auditory and visual stimuli. Following 2 weeks after admission his blood pressure began to fall, and his pulse rate started to fluctuate with alternating tachycardia and bradycardia. After 1 month in the ICU, he was discharged from the ICU and transferred to the ward. A catch-up immunization regimen was established.\u0000 \u0000 \u0000 \u0000 Tetanus is a rare condition in the Western world, primarily due to widespread vaccination programs from infancy to adulthood. There are crucial barriers that still exist to overcoming this disease in our country, including a lack of reliable immunization programs. In tetanus, the increase in survival is associated with the use of intensive care facilities for the management of tetanus, besides expanding the knowledge of the disease, which is a challenge for developing countries.\u0000 \u0000 \u0000 \u0000 It is essential to have enough immunization at an early stage of trauma since severe autonomic dysfunction linked to tetanus might be lethal.\u0000","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141040658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/gh9.0000000000000442
H. A. Obaid hassnah, Ghina Haidar, Maysoun Kudsi, Arwa Azmeh
Rheumatoid arthritis (RA) is a systemic immune disease. The authors aimed to report the characteristics of ocular manifestations in patients with RA. Demographic and clinical characteristics were collected including: age, sex, and BMI. Disease data included the duration, the present main complaint, including the number of painful and swollen joints, duration of morning stiffness, and the patient’s self-evaluation form had also been applied and registered. Eye symptom including pain, dryness, redness, photophobia, discharge, and blurred vision was asked and registered, in addition to full medical history, treatment, and evaluation of clinical disease activity index. Rheumatologic examination included: the number of tender and swollen joints in patients was done. All study subjects underwent complete ophthalmological examination in the following manner: visual acuity assessment by Snellen’s chart, evaluation of pupil diameter and reflexes as well as eyeball movements, tear film evaluation by using Schirmer’s test, intraocular pressure measurement, slit-lamp evaluation of the anterior segment with concentration on ocular surface assessment, followed by installation of topical mydriatic/cycloplegic eyedrops for posterior eye segment exam and fundoscopy. Laboratory tests included rheumatic factor, anti cytoplasmic citrulinted peptide, C-reactive protein, and erythrocyte sedimentation rate were performed and analyzed. Mean age of study group was 41.5±10 years,78.59% of which were females. Ocular manifestations were present in 31.14%. Dry eye was diagnosed in (36.71%), among which burning sensation was found in (35.15%), and photophopia in (27.34%). The most frequent ocular manifestation was episcleritis (66.40%), while scleritis was diagnosed in (22.65%), and keratoconjuctivitis was present in (7.04%). The most common manifestations of ocular involvement in our RA patients was episcleritis, dry eye, and scleritis. Positive serum rheumatoid factor and anticitrulinated peptide antibody significantly increased the risk of having ocular manifestations, especially dry eyes, and the ocular manifestations prevalence was higher among male patients, long disease duration and treatment with biologics and disease-modifying antirheumatic drugs. Ocular symptoms are relatively frequent manifestation of RA. Regular ophthalmological examinations are essential among patients with RA.
类风湿性关节炎（RA）是一种全身性免疫疾病。作者旨在报告 RA 患者眼部表现的特征。 收集的人口统计学和临床特征包括：年龄、性别和体重指数。疾病数据包括病程、目前的主诉（包括关节疼痛和肿胀的次数）、晨僵持续时间，还应用并登记了患者的自我评估表。此外，还询问并登记了患者的眼部症状，包括疼痛、干涩、发红、畏光、分泌物和视力模糊，以及完整的病史、治疗情况和临床疾病活动指数评估。风湿病学检查包括：患者关节触痛和肿胀的数量。所有研究对象都接受了完整的眼科检查，包括：用斯奈伦视力表评估视力，评估瞳孔直径和反射以及眼球运动，用施尔默试验评估泪膜，测量眼压，用裂隙灯评估前段，重点是眼表评估，然后在后眼段检查和眼底镜检查中使用局部迷迭香/环麻痹眼药水。实验室检查包括风湿因子、抗胞浆枸橼酸肽、C 反应蛋白和红细胞沉降率，并进行分析。 研究组的平均年龄为（41.5±10）岁，其中 78.59% 为女性。31.14%的患者有眼部表现。36.71%的患者被诊断为干眼症，其中35.15%的患者有灼热感，27.34%的患者有视力障碍。最常见的眼部表现是上巩膜炎（66.40%），诊断出巩膜炎的有（22.65%），出现角膜炎的有（7.04%）。 在我们的 RA 患者中，最常见的眼部受累表现是上睑板腺炎、干眼症和巩膜炎。血清类风湿因子和抗桔皮肽抗体阳性会显著增加出现眼部表现，尤其是干眼症的风险，而男性患者、病程长以及接受生物制剂和改善病情抗风湿药物治疗的患者出现眼部表现的几率更高。 眼部症状是 RA 比较常见的表现。定期进行眼科检查对 RA 患者至关重要。
{"title":"Eye involvement in patients with rheumatoid arthritis: a cross-sectional study","authors":"H. A. Obaid hassnah, Ghina Haidar, Maysoun Kudsi, Arwa Azmeh","doi":"10.1097/gh9.0000000000000442","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000442","url":null,"abstract":"\u0000 \u0000 Rheumatoid arthritis (RA) is a systemic immune disease. The authors aimed to report the characteristics of ocular manifestations in patients with RA.\u0000 \u0000 \u0000 \u0000 Demographic and clinical characteristics were collected including: age, sex, and BMI. Disease data included the duration, the present main complaint, including the number of painful and swollen joints, duration of morning stiffness, and the patient’s self-evaluation form had also been applied and registered. Eye symptom including pain, dryness, redness, photophobia, discharge, and blurred vision was asked and registered, in addition to full medical history, treatment, and evaluation of clinical disease activity index. Rheumatologic examination included: the number of tender and swollen joints in patients was done. All study subjects underwent complete ophthalmological examination in the following manner: visual acuity assessment by Snellen’s chart, evaluation of pupil diameter and reflexes as well as eyeball movements, tear film evaluation by using Schirmer’s test, intraocular pressure measurement, slit-lamp evaluation of the anterior segment with concentration on ocular surface assessment, followed by installation of topical mydriatic/cycloplegic eyedrops for posterior eye segment exam and fundoscopy. Laboratory tests included rheumatic factor, anti cytoplasmic citrulinted peptide, C-reactive protein, and erythrocyte sedimentation rate were performed and analyzed.\u0000 \u0000 \u0000 \u0000 Mean age of study group was 41.5±10 years,78.59% of which were females. Ocular manifestations were present in 31.14%. Dry eye was diagnosed in (36.71%), among which burning sensation was found in (35.15%), and photophopia in (27.34%). The most frequent ocular manifestation was episcleritis (66.40%), while scleritis was diagnosed in (22.65%), and keratoconjuctivitis was present in (7.04%).\u0000 \u0000 \u0000 \u0000 The most common manifestations of ocular involvement in our RA patients was episcleritis, dry eye, and scleritis.\u0000 Positive serum rheumatoid factor and anticitrulinated peptide antibody significantly increased the risk of having ocular manifestations, especially dry eyes, and the ocular manifestations prevalence was higher among male patients, long disease duration and treatment with biologics and disease-modifying antirheumatic drugs.\u0000 \u0000 \u0000 \u0000 Ocular symptoms are relatively frequent manifestation of RA. Regular ophthalmological examinations are essential among patients with RA.\u0000","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141051167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/gh9.0000000000000452
Kritika Bhattarai, Ashish Acharya, Kamal Gyawali
Gout is an inflammatory disease caused by the deposition of monosodium urate monohydrate crystals around the synovial joints, affecting the first metatarsophalangeal joints followed by ankle and knees. It is found to be more prevalent among men and older women. Tophi tends to develop if the acute phase of the disease is not controlled. In contrast, our patient had an unusual presentation of multiple tophi affecting several joints accompanied by deformities. Here, the authors present a case of a 63 years old male with chronic multiarticular tophaceous gout with a history of more than 30 years. He presented with multiple joint deformities and prior surgical history of excision of tophi. Laboratory reports revealed elevated serum uric acid, and X-ray showed joint deformities with tophi. However, the parameters of renal function test were normal. Surgical excision of the tophi was done. Gout is one of the most common inflammatory arthritis, which if untreated can progress to tophi formation. The diagnosis can be made clinically and by several investigations including serum uric acid estimation and aspiration of the joint to reveal monosodium urate monohydrate crystals. A long standing case of multiarticular tophi causing joint deformities does require surgical intervention. Early treatment and diagnosis of hyperuricemia prevent the progression to gouty arthritis and tophi formation. Long history of multiple tophaceous gout is an unusual presentation, which we intend to present here as a novel case report. Nevertheless, such cases require surgical interventions.
{"title":"Chronic multiarticular tophaceous gout with abnormally large tophi, case of surgical intervention: a case report from Nepal","authors":"Kritika Bhattarai, Ashish Acharya, Kamal Gyawali","doi":"10.1097/gh9.0000000000000452","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000452","url":null,"abstract":"\u0000 \u0000 Gout is an inflammatory disease caused by the deposition of monosodium urate monohydrate crystals around the synovial joints, affecting the first metatarsophalangeal joints followed by ankle and knees. It is found to be more prevalent among men and older women. Tophi tends to develop if the acute phase of the disease is not controlled. In contrast, our patient had an unusual presentation of multiple tophi affecting several joints accompanied by deformities.\u0000 \u0000 \u0000 \u0000 Here, the authors present a case of a 63 years old male with chronic multiarticular tophaceous gout with a history of more than 30 years. He presented with multiple joint deformities and prior surgical history of excision of tophi. Laboratory reports revealed elevated serum uric acid, and X-ray showed joint deformities with tophi. However, the parameters of renal function test were normal. Surgical excision of the tophi was done.\u0000 \u0000 \u0000 \u0000 Gout is one of the most common inflammatory arthritis, which if untreated can progress to tophi formation. The diagnosis can be made clinically and by several investigations including serum uric acid estimation and aspiration of the joint to reveal monosodium urate monohydrate crystals. A long standing case of multiarticular tophi causing joint deformities does require surgical intervention.\u0000 \u0000 \u0000 \u0000 Early treatment and diagnosis of hyperuricemia prevent the progression to gouty arthritis and tophi formation. Long history of multiple tophaceous gout is an unusual presentation, which we intend to present here as a novel case report. Nevertheless, such cases require surgical interventions.\u0000","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141048547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/gh9.0000000000000206
Kehinde Alare, Joshua Opanike, Temidayo Adebayo, O. Owonikoko
Patients with atrial fibrillation (AF) are at an increased risk of developing ischemic thromboembolic stroke, which can increase the burden of such co-morbid states. Inflammation has been found to promote the formation of thrombus, which can serve as a source of an embolus that can be dislodged to the cerebral vessels causing ischemic stroke. It is important to assess the risk of stroke in patients with AF which led to the formation of the CHA2 DS2-VASc score which clinically predicts the risk of stroke in patients with AF. This article suggests the use of C-reactive protein as a better tool in the risk assessment of stroke in patients with AF.
心房颤动（房颤）患者发生缺血性血栓栓塞性中风的风险增加，这可能会加重此类并发症的负担。研究发现，炎症可促进血栓形成，而血栓可成为栓子的来源，栓子可脱落至脑血管导致缺血性中风。评估心房颤动患者的中风风险非常重要，因此形成了 CHA2 DS2-VASc 评分，该评分可在临床上预测心房颤动患者的中风风险。本文建议使用 C 反应蛋白作为评估房颤患者中风风险的更好工具。
{"title":"Stroke risk assessment utility of C-reactive protein in patients with atrial fibrillation","authors":"Kehinde Alare, Joshua Opanike, Temidayo Adebayo, O. Owonikoko","doi":"10.1097/gh9.0000000000000206","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000206","url":null,"abstract":"Patients with atrial fibrillation (AF) are at an increased risk of developing ischemic thromboembolic stroke, which can increase the burden of such co-morbid states. Inflammation has been found to promote the formation of thrombus, which can serve as a source of an embolus that can be dislodged to the cerebral vessels causing ischemic stroke. It is important to assess the risk of stroke in patients with AF which led to the formation of the CHA2 DS2-VASc score which clinically predicts the risk of stroke in patients with AF. This article suggests the use of C-reactive protein as a better tool in the risk assessment of stroke in patients with AF.","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/gh9.0000000000000450
Y. Limbu, S. Regmee, S. D. Adhikari, Aakash Mishra, R. Ghimire, D. Maharjan, Suman Shrestha, P. B. Thapa
The Whipple’s procedure or pancreatoduodenectomy (PD), is recognized for its technical intricacy in surgical practice. This study aims to categorize PD into four types based on procedural complexity and anticipated postoperative outcomes, intending to integrate this classification into the progressive training of surgical fellows. In this retrospective cohort study, 242 PDs, performed by a single unit across multiple centers from January 2016 to December 2022, were categorized into four types based on technical complexity and extent of surgical intervention. These types were: Type 1 (dilated duct, firm pancreas), Type 2 (as Type 1 + vascular reconstruction), Type 3 (nondilated duct, soft pancreas), and Type 4 (as Type 3 + vascular reconstruction). The study assessed patient characteristics, surgical parameters, and perioperative morbidity and mortality, comparing the outcomes of the four PD types. Type 1 PD was predominant (65.2%), with the lowest 30-day mortality (2.53%). Conversely, Type 4 PD, though least performed (3.3%), exhibited the highest mortality (25%) and major complications (25%). Statistically significant differences were noted in the incidence of clinically relevant-postoperative pancreatic fistula, delayed gastric emptying, and wound complications among the PD types, with overall surgical morbidity being higher in Types 3 and 4. In conclusion, our data compellingly links morbidity, such as postoperative pancreatic fistula, with the technical challenges of the procedure, even though not all mortality can be attributed solely to surgical factors. The implementation of this system offers a structured approach to surgical training, paving the way for trainees to adeptly navigate and proficiently perform this complex surgical technique.
{"title":"Grading the Whipple’s procedure: a strategy for structured skill advancement in surgical training","authors":"Y. Limbu, S. Regmee, S. D. Adhikari, Aakash Mishra, R. Ghimire, D. Maharjan, Suman Shrestha, P. B. Thapa","doi":"10.1097/gh9.0000000000000450","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000450","url":null,"abstract":"\u0000 \u0000 The Whipple’s procedure or pancreatoduodenectomy (PD), is recognized for its technical intricacy in surgical practice. This study aims to categorize PD into four types based on procedural complexity and anticipated postoperative outcomes, intending to integrate this classification into the progressive training of surgical fellows.\u0000 \u0000 \u0000 \u0000 In this retrospective cohort study, 242 PDs, performed by a single unit across multiple centers from January 2016 to December 2022, were categorized into four types based on technical complexity and extent of surgical intervention. These types were: Type 1 (dilated duct, firm pancreas), Type 2 (as Type 1 + vascular reconstruction), Type 3 (nondilated duct, soft pancreas), and Type 4 (as Type 3 + vascular reconstruction). The study assessed patient characteristics, surgical parameters, and perioperative morbidity and mortality, comparing the outcomes of the four PD types.\u0000 \u0000 \u0000 \u0000 Type 1 PD was predominant (65.2%), with the lowest 30-day mortality (2.53%). Conversely, Type 4 PD, though least performed (3.3%), exhibited the highest mortality (25%) and major complications (25%). Statistically significant differences were noted in the incidence of clinically relevant-postoperative pancreatic fistula, delayed gastric emptying, and wound complications among the PD types, with overall surgical morbidity being higher in Types 3 and 4.\u0000 \u0000 \u0000 \u0000 In conclusion, our data compellingly links morbidity, such as postoperative pancreatic fistula, with the technical challenges of the procedure, even though not all mortality can be attributed solely to surgical factors. The implementation of this system offers a structured approach to surgical training, paving the way for trainees to adeptly navigate and proficiently perform this complex surgical technique.\u0000","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141040384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1097/gh9.0000000000000313
Abdelmuniem Ahmed
{"title":"Antibiotic resistance in Sudan: urgent action required","authors":"Abdelmuniem Ahmed","doi":"10.1097/gh9.0000000000000313","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000313","url":null,"abstract":"","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140664465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1097/gh9.0000000000000288
A. Aborode, A. F. Obianuju, L. Lawal, Nasir Abdulrasheed, T. Y. Olatunji, A. S. Auwal, A. Olorukooba, F. A. Ahmed
{"title":"Outbreak of meningitis in Nigeria: a silent fight","authors":"A. Aborode, A. F. Obianuju, L. Lawal, Nasir Abdulrasheed, T. Y. Olatunji, A. S. Auwal, A. Olorukooba, F. A. Ahmed","doi":"10.1097/gh9.0000000000000288","DOIUrl":"https://doi.org/10.1097/gh9.0000000000000288","url":null,"abstract":"","PeriodicalId":506642,"journal":{"name":"International Journal of Surgery: Global Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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