ABSTRACT
Purpose@#The European Organization for Research and Treatment of Cancer quality of life (QOL) questionnaires (QLQ-C30, QLQ-OG25, and QLQ-STO22) are widely used for the assessment of gastric cancer patients. This study aimed to use these questionnaires to evaluate QOL in postgastrectomy patients. @*Methods@#We prospectively evaluated 106 patients with distal gastrectomy (DG), 57 with pylorus-preserving gastrectomy (PPG), and 117 with total gastrectomy (TG). Body weight and QOL questionnaires were evaluated preoperatively and postoperatively (at 3 weeks, and 3, 6, and 12 months). @*Results@#TG patients had significantly more weight loss than DG/PPG patients. Compared with DG, patients after PPG had less dyspnea (P = 0.008) and trouble with coughing (P = 0.049), but more severe symptoms of insomnia (P = 0.037) and reflux (P = 0.030) at postoperative 12 months. Compared with DG/PPG, TG was associated with worse body image, dysphagia, eating, and taste in both OG25 and STO22. Moreover, OG25 revealed worse QOL in the TG group with respect to odynophagia, eating with others, choked when swallowing, trouble talking, and weight loss. The QOL of patients who received chemotherapy was worse than those in the chemo-free group in both physical functioning and symptoms such as nausea/vomiting, appetite loss, and trouble with taste; however, these side effects would soon disappear after finishing chemotherapy. @*Conclusion@#PPG was similar to DG in terms of postoperative QOL and maintaining body weight, while TG was always inferior to both DG and PPG. Adjuvant chemotherapy can affect both body weight and QOL despite being reversible.
ABSTRACT
The objective of the review was to investigate the scientific production and evaluate the effectiveness of epinephrine in the treatment of cardiac arrest in terms of survival and neurological status. PubMed, Embase, and Google Scholar databases were searched up till November 2017 for published studies in English language and human subjects discussing early epinephrine administration in patients with cardiac arrest in case of shockable rhythm in emergency medicine. Prehospital epinephrine management may increase short-term survival [ROSC] yet does not improve survival to release, or neurologic results after out-of-hospital cardiac arrest OHCA. Although there is no clear proof of long-lasting advantages complying with the use of epinephrine in OHCA, there is insufficient evidence to sustain altering present guidelines which recommend its management [1 mg every 3-5 min] throughout resuscitation. As a result, there is a need for additional clinical trials to analyze whether lower dosages or alternative regimes of epinephrine administration. Furthermore, one of the most important aspects of care in cardiac arrest is basic life support [BLS] measures, consisting of adequate compressions and early defibrillation
ABSTRACT
This review article aims to summarize the major causes of thrombocytopenia and characterize the main general symptoms of thrombocytopenia. As well we summarize the diagnosis and treatment methods. We conducted the search using electronic biomedical databases such as; Medline, and Embase, for studies published up to September 2017 in the English language concerning the thrombocytopenia in general. Thrombocytopenia can either be primary or secondary, in that it could go along with a broad spectrum of syndromes and diseases and may be triggered by different systems. Trigger investigation and recognition might be important and sometimes life-saving as in TTP, heparin-induced thrombocytopenia, acute leukemia or perhaps severe ITP. Taking a detailed history and a thorough physical examination can give clues concerning possible underlying illness and clinical treatments. Cautious evaluation of the peripheral blood smear is necessary. When the differential diagnosis is problematic, sometimes a short trial of therapy could help to clarify the reason. For instance, it might be difficult to differentiate inherited thrombocytopenia [without a family history] from immune thrombocytopenia [ITP]; in this example, intravenous immunoglobulin infusion will likely have no effect in inherited thrombocytopenia, however, will generally be useful in ITP
ABSTRACT
Background: in our present review, the main goal was to determine the factors that influence the time of CT in diagnosis of SAH in emergency department, since the ED physicians are the first who are approaches to the patients, awareness and attitude of those physicians are very important for the benefit of SAH patients
Methods: we conducted a comprehensive search using following databases; PUBMED, EMBASE, SCOPUS of studies that involving data on the roles and time of CT in diagnosis of subarachnoid hemorrhage [SAH] in ED patients with acute headache, published in English language up to 2017
Conclusion: CT within 6 hours might be considered enough to rule out SAH in the following circumstances: a neurologically regular patient, a thunderclap headache presentation, a clear time of beginning, and a modern-day CT scan carried out within 6 hours of beginning read by a going to radiologist. Time from headache beginning to imaging is reasonably associated with favorable imaging for SAH. Postpone to health center presentation represent the biggest portion of time to imaging, especially those without SAH. These findings recommend restricted opportunity to minimize lumbar puncture rates merely by accelerating in-hospital processes when imaging hold-ups are under 2 hours, as diagnostic yield of imaging decreases beyond the 6-hour imaging window from headache beginning
ABSTRACT
Mesenteric ischemia is relatively a rare disorder seen in the emergency department [ED]. Due to the effect of hypobaric hypoxia and higher liability for thrombosis encountered in high altitude areas, acute occlusive mesenteric ischemia [AOMI] would represent an actual challenge in Taif and related districts. Another risk factor is that about twenty-five percent of Saudis are victims of diabetes due to the changes in lifestyle and diet leading to increasing levels of obesity. Vague nonspecific clinical findings and limitations of diagnostic studies in addition to cultural and social factors, may lead to late presentation making the diagnosis a significant challenge and in turn higher morbidity and mortality are expected. In this study, we review type of AOMI, pattern of presentation, laboratory, radiological, Intraoperative findings and results of treatment in 36 patients who were admitted to King Abdul Aziz Specialist Hospital and King Faisal Hospital, Al Taif, Saudi Arabia from January 2009 to January 2012. 36 patients with final diagnosis of AOMI were included in this retrospective study by means of review of their files and medical records. The disease was more common in men than women [23 male and 13 females]. The mean age of patients was 54 years. The mean time of presentation was 2.4 days after occurrence of symptoms. Abdominal pain was the most common symptom of patients followed by nausea, vomiting, constipation and bloody diarrhea. On physical examination; tachycardia was prevalent, Oliguria was seen in approximately 69.4% of patients, 11.1% of patients were in shock status. All patients had abdominal tenderness and 61.1% of patients had marked peritoneal signs [rebound tenderness with guarding or/and rigidity]. Twenty one/36 [58.3%] patients were diabetics, 17/36 patients [47.2%] were hypertensive and 8/36 patients [22.2%] with associated cardiac disorders. In laboratory tests, Leukocytosis was present in all patients. Secondary polycythemia was seen in 38.9% of patients. D-Dimer level was high in all patients. In 61.1% of patients, exploratory laparotomies were done based on clinical, laboratory, abdominal ultrasound and plain x-ray findings without performing CT angiography due to presentation with marked peritoneal signs. In all patients gangrenous lesions were detected during surgery and resection of these parts was done. Gangrene and in turn resection, was extensive in 14/36 patients [38.9%] and they developed short bowel syndrome. There were 22/36 patients [61.1%] with superior or/and inferior mesenteric vein thrombosis, 10/36 patients [27.8%] with superior mesenteric artery thrombosis, in one of them there is associated focal thrombosis of aorta and renal arteries and 4/36 patients [11.1%] with superior mesenteric artery embolism. All patients received postoperative anticoagulant therapy. Patients with short bowel syndrome were prepared to receive total parental nutrition [TPN] for life. Intra-operative deaths were 3/36 [8.3%].There were 5/36 deaths [13.9%] accruing within one month after surgery and all died secondary to sepsis and its sequalae with total deaths of 8/36 patients [22.2%]. Acute occlusive mesenteric ischemia [AOMI] especially of venous type will represent a challenging problem in Taif and related districts. The surgeon must pay intensive attention to patients presented by unexplained central abdominal pain and he has to be with high index of suspicion especially if it meets with the classic teaching of "pain out of proportion to physical findings ". Early diagnosis, aggressive approach to early resuscitation of the patients, correction of metabolic and hemodynamic derangements, and performing laparotomy as soon as these derangements were corrected would decrease morbidity and mortality. In some patients it is necessary to perform second look operation for re-evaluation of the viability of the intestine