Control de daños en las emergencias abdominales no traumáticas: causas, indicaciones, factores de riesgo y resultados / Damage control in non-traumatic abdominal emergencies: causes, indications, risk factors and results

RESUMEN Antecedentes : la estrategia de control de daños (ECD) es muy utilizada para el tratamiento de las emergencias abdominales no traumáticas. Objetivo : describir las causas y condiciones fisiopatológicas del empleo de la ECD, determinar la mortalidad según la etiología, criterios de aplicación y factores de riesgo asociados, y comparar la mortalidad observada con la esperada en una serie consecutiva. Material y métodos : se realizó un estudio observacional y retrospectivo, sobre 118 pacientes tratados con ECD, portadores de peritonitis secundarias y hemorragias abdominales graves, con síndrome compartimental abdominal, sepsis abdominal o sistémica o ambas, hipotensión y parámetros de acidosis metabólica asociados. Se analizaron varios factores de riesgo y se comparó la mortalidad observada versus la esperada (APACHE II). Resultados : 112 pacientes presentaron peritonitis generalizada y 6, sangrados intraabdominales graves. La mortalidad fue mayor en la isquemia intestinal grave (p = 0,002). Estuvo relacionada con mayor número de criterios fisiopatológicos de aplicación y con algunos factores de riesgo: glóbulos blancos (GB) ≥ 10 000 ×mm3, hemoglobina (HB) ≤ 9 g/%, creatininemia ≥ 1,3 mg/%, pH ≤ 7,25, ácido láctico ≥ 2,5 mmol/L, diabetes, puntuación (score) ASA ≥ 4, ≥ 4 operaciones y ausencia de cierre parietal inicial. La mortalidad global observada fue 43,1% y la esperada ‒según APACHE II‒ fue del 53%. Conclusiones : la mortalidad fue significativamente mayor en la isquemia intestinal grave y con la presencia de algunos de los factores de riesgo evaluados. Estuvo asociada al número de criterios de aplicación. La mortalidad observada fue menor que la esperada, aunque no significativa.

ABSTRACT Background : Damage control strategy (DCS) is usually used for the treatment of non-traumatic abdominal emergencies. Objective : The aim of the present study was to describe the main causes and pathophysiologic conditions to perform this strategy, the criteria applied and the associated factors and to compare the observed mortality with the expected mortality in the series. Material and methods : We conducted an observational and retrospective study of 118 patients treated with DSC, with secondary peritonitis and severe abdominal bleeding, abdominal compartment syndrome, abdominal or systemic sepsis or both, hypotension and parameters of metabolic acidosis. Several risk factors were analyzed and it was compared observed versus expected mortality (APACHE II). Results : 112 patients presented generalized peritonitis and 6 had severe intra-abdominal bleeding. Mortality was greater in severe mesenteric ischemia (p = 0.002) and was associated with the number of pathophysiologic criteria used for implementation and with white blood cell (WBC) count ≥ 10 000 x mm3, hemoglobin (Hb) ≤ 9 g/dL, creatinine level ≥ 1.3 mg/dL, pH ≤ 7.25, lactic acid ≥ 2.5 mmol/L, diabetes, ASA score ≥ 4, ≥ 4 operations and open abdomen. The overall observed mortality and expected mortality according to the APACHE II score were 43.1% and 53%, respectively. Conclusions : Mortality was significantly greater in patients with severe mesenteric ischemia, presence of some of the risk factors evaluated and was associated with the number of criteria used for implementation. The observed mortality was non-significantly lower than expected.

A Clinical Study and Management of Non Traumatic Acute Abdomen

Background: The acute abdomen is a condi?on that demands urgent a?en?on and treatment, ranging from trivial to life threatening condi?ons. The aim of this study was to know in detail the epidemiology and outcome in nontrauma?c acute abdomen. Methods: An ins?tu?on based, cross-sec?onal study was conducted from December 2019 to April 2020, at Department of General Surgery Govt. Medical College Kota Rajasthan. The study included 100 cases of non-trauma?c abdomen. Results: Non- trauma?c acute abdominal pain was more common in 2ndto 6thdecade of life. The males to female ra?o is 2.85:1. Hollow viscus perfora?on (30%) forms the commonest cause of acute abdomen followed by acute appendici?s, Sub acute intes?nal obstruc?on, renal/ureteric colic, cholelithiasis, pancrea??s, non-specific pain abdomen, OBG related pathology, liver abscess, Meckel’s diver?culi?s and splenic abscess in 24%, 23%, 8%, 4%, 3%, 3%, 2%, 1%, 1% and 1% respec?vely. Sixteen pa?ents managed conserva?vely. Most common surgical procedures done were exploratory laparotomy with needful for hollow viscus perfora?on and open/laparoscopic appendicectomy for acute appendici?s. Conclusions: Proper history taking, clinical examina?on with suppor?ve imaging findings are most important to narrow the differen?al diagnosis and for immediate interven?on to limit morbidity and mortality.

Evidence-based practice of pre-examination and triage management for patients with non-traumatic acute abdomen / 中国实用护理杂志

Objective:To apply the best evidence of pre-examination and triage management of patients with non-traumatic acute abdomen to clinical practice and evaluate its effects.Methods:Using convenience sampling method, 15 nurses and 237 patients with non-traumatic acute abdomen admitted in the emergency department of Shanxi Provincial People ′s Hospital from January to May 2021 were selected as the research objects, 114 cases as the baseline review group and 123 cases as the after-effect evaluation group. Following the clinical evidence practice application of JBI Evidence-Based Nursing Center Systematic standard procedures, using self before-after control study to compare the knowledge and behavior of triage nurses before and after evidence application, and compliance with each review index; using a non-contemporaneous controlled trial to compare the changes of pre-examination and triage time and triage accuracy between two groups. Results:After the application of evidence, the score of the triage nurses on the pre-examination and triage of non-traumatic acute abdomen increased from 98.00±6.56 in the after-effect evaluation group to 114.20±3.88 in the base-line review group, and the difference was statistically significant ( t=8.62, P<0.05); after the application of evidence, the compliance with indicators 1-9,12,13,15-17 was significantly improved and the difference was significant ( χ2 values were 11.46-123.06, all P <0.05). After the application of evidence, the compliance rate of those indicators <80% increased to more than 80% except indicator 6, the accuracy of patient triage rose from 84.21%(96/114) to 93.50%(115/123) with a statistically significant difference ( χ2=5.22, P<0.05); after the application of the evidence, the triage time was 2.00(1.00,4.00) min, shorter than 3.00(2.00,4.63) min in the base-line review group, and the difference was statistically significant ( Z=-3.18, P<0.05). Conclusions:The application of the best evidence of pre-examination and triage for non-traumatic acute abdomen can improve the nursing practice of non-traumatic acute abdomen triage, improve the accuracy of non-traumatic acute abdomen triage, and shorten the triage time.

Research Status and Prospects of Non-Traumatic Fat Embolism in Forensic Medicine / 法医学杂志

In the practice of forensic pathology, fat embolism is one of the common causes of death, which can be divided into two categories: traumatic and non-traumatic. Non-traumatic fat embolism refers to the blockage of small blood vessels by fat droplets in the circulatory blood flow caused by non-traumatic factors such as underlying diseases, stress, poisoning and lipid metabolism disorders. At present, it is believed that the production of non-traumatic fat embolism is related to the disturbance of lipid metabolism, C-reactive protein-related cascade reaction, the agglutination of chylomicron and very low-density lipoprotein. The forensic identification of the cause of death of non-traumatic fat embolism is mainly based on the case, systematic autopsy, HE staining and fat staining, but it is often missed or misdiagnosed by forensic examiners because of its unknown risk factors, hidden onset, the difficulty of HE staining observation and irregular implementation of fat staining. In view of the lack of attention to non-traumatic fat embolism in forensic identification, this paper reviews the concepts, pathophysiological mechanism, research progress, existing problems and countermeasures of non-traumatic fat embolism, providing reference for forensic scholars.

Application of low dose S-ketamine in analgesia of elderly patients with non-traumatic acute abdomen in emergency / 中华急诊医学杂志

Objective:To investigate the efficacy and safety of low dose S-ketamine in analgesia of elderly patients with non-traumatic acute abdomen (NTAA) in emergency department.Methods:This was a randomized controlled trail. From January to August 2021, elderly patients with NTAA in the Emergency Department of the No. 904 Hospital of the Joint Logistic Support Force were selected. Analgesia was administered intravenously with 0.3 mg/kg S-ketamine or 0.1 mg/kg morphine injection for 15 min. Visual analogue score (VAS), respiratory rate, heart rate, non-invasive blood pressure and pulse oxygen saturation were recorded at 15 min, 30 min, 60 min and 90 min. The mini-mental state examination (MMSE) scores were recorded at 90 min after injection. The incidence of salvage analgesia, incidence of adverse reactions and diagnostic accuracy after analgesia were recorded in the two groups. VAS scores and vital signs were compared between the two groups by two-way repeated measures analysis of variance, and multiple comparisons between and within groups were performed.Results:A total of 137 elderly patients with NTAA were selected and randomly divided into two groups: S-ketamine group (SK group, 68 cases) and morphine group (M group, 69 cases). After the exclusion of patients with abscission, 39 cases were included in the SK group and 45 cases in the M group. VAS score of the SK group was significantly lower than that of the M group in 15 min after administration [(3.1±1.8) vs. (4.8±2.2)], and the difference was statistically significant ( P=0.013). There were no significant differences in vital signs and MMSE score between the two groups or within the group at each time point after medication (all P>0.05). However, the incidence of dizziness in the SK group was significantly higher than that in the M group (61.54% vs. 31.11%, P=0.005). Conclusions:Intravenous administration of low dose S-ketamine is not considered to be more effective than morphine in alleviating acute abdominal pain in elderly patients with NTAA. S-ketamine provides not only satisfactory analgesia but also short recovery time and high controllability. S-ketamine is one of the recommended analgesic alternatives of NTAA for elderly patients in emergency.

Estudo e prevalência de bexiga neurogênica em pessoas com lesão medular traumática e não traumática no Brasil / Study and prevalence of neurogenic bladder in users with traumatic and non-traumatic spinal cord injury in Brazil

A bexiga neurogênica, frequentemente associada à lesão medular de causa traumática e não traumática, é uma disfunção vesical decorrente de alterações no sistema nervoso. Este estudo investigou e analisou a bexiga neurogênica, sua prevalência e manejo em pessoas com diagnóstico de lesão medular traumática (LMT) e não traumática (LMNT) em uma rede de hospitais de reabilitação. Tratou-se de um estudo quantitativo, transversal, exploratório, descritivo e analítico. Para responder à questão central do estudo, foi selecionada uma amostra com 954 participantes, probabilística, aleatória estratificada, das seis unidades da rede participantes do estudo, com dados coletados diretamente dos prontuários eletrônicos. A prevalência de bexiga neurogênica foi de 94,65% (n=903), 67% tinham diagnóstico de lesão medular traumática e 33% de lesão medular não traumática, 69,32% eram homens e 30,68%, mulheres, com média de idade de 46,12 anos (DP=13,26). O cateterismo vesical intermitente foi a principal forma de esvaziamento (66,11%), e a maioria realizava o autocateterismo intermitente (74,04%). A micção voluntária foi associada ao tipo de lesão, sendo mais prevalente entre os participantes com LMNT (p≤0,001, Teste Qui-quadrado). Para investigação urológica, 93,36% realizaram exames de ultrassonografia renal e vias urinárias e 87,82%, estudo urodinâmico. A irregularidade da parede vesical (p≤0,029, teste Qui-quadrado de Pearson), o espessamento vesical (p ≤ 0,001, teste Qui-quadrado de Pearson) e a hiperatividade detrusora (p≤0,009, teste Qui-quadrado de Pearson) também apresentaram diferença estatística de acordo com o tipo de lesão, mais prevalentes nos participantes com LMT. Assim como a dilatação pielocalicinal, mais prevalente nos participantes com LMNT (p≤0,025, teste Qui-quadrado de Pearson). Os participantes com LMT apresentaram maior pressão detrusora média, 38,73cmH2O vs. 30,17cmH2O do que os com LMNT (p ≤ 0,001, teste de Mann- Whitney). Sabe-se que a bexiga neurogênica de pessoas com lesão medular traumática tende a apresentar maior número de complicações e maior risco para o trato urinário superior, principalmente quando há relação com a presença de pressão elevada, baixa complacência e capacidade vesical reduzida. Este estudo evidenciou diferenças importantes entre o perfil de pessoas com lesão medular traumática e não traumática, mostrando a necessidade do manejo personalizado de acordo com a causa da lesão medular.

Neurogenic bladder is a dysfunction that results from changes in the nervous system, and is frequently associated with traumatic and non-traumatic spinal cord injuries. This study investigated and analyzed the neurogenic bladder, its prevalence and management in people diagnosed with traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI) in a network of rehabilitation hospitals. This is a quantitative, transversal, exploratory, descriptive and analytical study. A probabilistic, stratified random sample, composed of 954 participants, was used to answer the research question. Participants were selected from six of the hospital-network units and data were directly retrieved from electronic medical records. The prevalence of neurogenic bladder was 94.65% (n = 903), where 67% had a diagnosis of traumatic spinal cord injury and 33% non-traumatic spinal cord injury, 69.32% were male and 30.68% female, with a mean age of 46.12 years (SD = 13.26). The main draining method was intermittent bladder catheterization (66.11%), in most cases performed as intermittent self-catheterization (74.04%). Voluntary urination was associated with the type of injury, being more prevalent among participants with non-traumatic spinal cord injury (NTSCI) (p≤0.001, Chi- Square Test). For urological investigation, 93.36% of the participants were submitted to a renal and urinary-tract ultrasound scan and 87.82% to urodynamics. Bladder wall irregularity (p≤0.029, Pearson's chi-square test) and thickening (p ≤ 0.001, Pearson's chi-square test), and detrusor hyperactivity (p≤0.009, Pearson's chi-square test) also presented a statistical difference according to the type of injury, with a higher prevalence in participants with traumatic spinal cord injury (TSCI). That was also the case of pyelocaliceal dilation, which was more prevalent in participants with NTSCI (p≤0.025, Pearson's Chi-square test). Participants with TSCI showed a mean detrusor pressure of 38.73 cmH2O, higher than the value of 30.17 cmH2O recorded for those with NTSCI (p ≤ 0.001, Mann-Whitney test). It is known that a neurogenic bladder in people with traumatic spinal cord injury tends to have a greater number of complications and greater risk for the upper urinary tract, especially when there is a relationship with the presence of high pressure, low compliance and reduced bladder capacity. This study unveiled important differences in the profiles of people with traumatic and non-traumatic spinal cord injury, highlighting the need for treatment to be tailored according to the cause of the spinal cord injury.

Role of osteogenic signaling pathway in non-traumatic femoral head necrosis / 中国组织工程研究

BACKGROUND: In recent years, the incidence of non-traumatic femoral head necrosis has increased gradually. It has the characteristics of insidious onset, rapid development of disease and high disability rate, bringing a great burden to patients, their families and society. Confirming its pathogenesis is of great significance for the early effective treatment of non-traumatic femoral head necrosis. OBJECTIVE: To review the relevant literature worldwide and to summarize the research progress of osteogenic signaling pathways in the pathogenesis of non-traumatic femoral head necrosis. METHODS: PubMed, Embase, Medline, CNKI, VIP and WanFang databases were retrieved with the keywords of “non-traumatic osteonecrosis of femoral head, osteogenesis, signaling pathways, pathogenesis, Wnt/β-catenin, PPARy, TGF-β/Smad, PI3K/AKT, MAPK, Notch” in English and Chinese, respectively. The articles concerning mechanism and application of osteogenic signaling pathways associated with avascular necrosis of the femoral head were included. RESULTS AND CONCLUSION: Recently, the role of osteogenic signaling pathways in non-traumatic femoral head necrosis has received increasing attentions. The abnormal differentiation of bone marrow mesenchymal stem cells in the development of non-traumatic femoral head necrosis has also become an issue of concern. Abnormal differentiation of bone marrow mesenchymal stem cells, inhibition of osteogenic differentiation, increased bone destruction, and imbalance of bone metabolism may be the main cause of non-traumatic femoral head necrosis, and Wnt/β-catenin, PPARy, TGF-β/Smad, PI3K/AKT, MAPK, Notch and other osteogenic signaling pathways may be a viable approach to intervention for non-traumatic femoral head necrosis. Although a large number of in vitro and animal studies have confirmed that osteogenic signaling pathway may have the potential to regulate bone marrow mesenchymal stem cell differentiation and reverse femoral head necrosis, its specific mechanism of action remains unclear and little is reported on its clinical applications. Therefore, exploring the mechanism of signaling pathways and accelerating its clinical use are the directions of the future research.

A Prospective Study of the Demographic Pattern and Site of Perforation of Non-traumatic Hollow Viscus Perforation Peritonitis in Vindhya Region

Background: Perforation peritonitis is a commonly encountered surgical emergency and it is defined as inflammation of theserosal membrane that lines the abdominal cavity and the visceral organs. The aim of this study is to analyze the demographicpattern and site of perforation of non-traumatic hollow viscus perforation peritonitis in Vindhya region.Materials and Methods: A total of 209 cases were studied with hollow viscus perforation peritonitis admitted in the surgicalwards in Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa (MP), India, in the period fromJune 1, 2018, to May 31, 2019. All necessary investigations were carried out. X-ray, Ultrasonography abdomen, and bloodinvestigations were done. The patient underwent emergency exploratory laparotomy and a careful record of pre-operative andpost-operative findings was made and was carefully filled in the pro forma. All the patients were advised to attend the surgicaloutpatient department for follow-up.Results: Of 10,887 patients admitted to Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa(MP), India, from June 1, 2018, to May 31, 2019, in which non-traumatic hollow viscus perforation peritonitis was diagnosedin 209 patients (1.9%), among which most of the patients were male (177) and rest were female (32). Most of the patientsbelonged to the low-socio-economic status of 21–40 years of the age group. From this study, the duodenum was found to bethe most common site of perforation, followed by stomach.Conclusion: Patients were admitted in the Department of Surgery, Shyam Shah Medical College and Sanjay Gandhi HospitalRewa, the Vindhya region in the Madhya Pradesh, patients diagnosed as a case of non-traumatic hollow viscus perforationperitonitis were included in the study. The majority of the patients of the perforation peritonitis belonged to 21–40 years ofage group. 41–60 years of age group was the second most common age group of patients who presented with perforationperitonitis with a male-to-female ratio of 5.5:1. The most common site of perforation was duodenum followed by gastric andappendicular and the least common site of perforation was colon.

Application of bisphosphonates in avascular necrosis of the femoral head / 中国组织工程研究

BACKGROUND: Animal experiments have shown that bisphosphonates exhibit a preventive effect on femoral head collapse. However, clinical application of bisphosphonates remains disputed. Systematic administration of bisphosphonates has many adverse reactions. There is an increasing number of studies on local application of bisphosphonates. OBJECTIVE: To review the research progress of bisphosphonates in the treatment of avascular necrosis of the femoral head. METHODS: The first authors (GJC and MJH) searched PubMed and CNKI databases to retrieve papers regarding bisphosphonate treatment of osteonecrosis of the femoral head using the search terms “osteonecrosis of the femoral head, bisphosphonates, systemic therapy, topical therapy, osteogenesis, bone destruction, bone remodeling” in English and Chinese. Sixty-two eligible papers were included in the final analysis. RESULTS AND CONCLUSION: It remains disputed whether bisphosphonates inhibit or activate osteoblasts. Current studies have shown that low concentration of bisphosphonates can promote the proliferation of osteoblasts, while high concentration of bisphosphonates can inhibit the proliferation of osteoblasts. Long term systematic application of bisphosphonates can induce mandibular osteonecrosis and other side effects. Topical application of bisphosphonates for treatment of avascular necrosis of the femoral head is still in the experimental stage. The optimal bisphosphonate concentration and the duration of efficacy in the treatment of avascular necrosis of the femoral head have not been determined. These should be clarified by in-depth high-quality experiments prior to clinical application.

Susceptibility genes related to non-traumatic femoral head necrosis: Improving detection accuracy and developing new treatment strategy / 中国组织工程研究

BACKGROUND: Although the mechanism of femoral head necrosis has a series of explanations such as glucocorticoids, ethanol, decompression sickness, sickle cell anemia, and genetic susceptibility, the specific pathogenesis is still unclear. OBJECTIVE: To highlight the genetics of non-traumatic femoral head necrosis by combining recent genetic studies, thus providing new treatments for the repair and reconstruction of femoral head. METHODS: A computer-based online retrieval of CNKI, WanFang, PubMed and Web of Science databases was performed to search the related articles published from January 2000 to April 2019. The keywords were “non-traumatic femoral head necrosis, susceptibility genes, pathogenesis” in Chinese and English, respectively. According to the inclusion and exclusion criteria, the irrelevant and repetitive articles were excluded, and finally 49 eligible articles were included for analysis. RESULTS AND CONCLUSION: Non-traumatic femoral head necrosis is an extremely complex disease whose pathogenesis is caused by a combination of factors rather than a single genetic gene. COL2A1 genetic mutation is the high susceptibility gene to non-traumatic femoral head necrosis. High-coagulation and low-fibrinolytic state-related loci in the blood, interleukin-related gene loci in immune system and lipid-related loci become more and more important in inducing non-traumatic femoral head necrosis. With the deep understanding of human genetic technology, the accuracy of detecting susceptible genes will be continuously improved, which is conducive to the prevention, diagnosis and precise individualized treatment of non-traumatic femoral head necrosis.

Three-dimensional printed navigation template assisted core decompression and bone grafting for treatment of ARCO stage II non-traumatic femoral head necrosis / 中国组织工程研究

BACKGROUND: Core decompression and bone grafting is the main postoperative method in the treatment of ARCO stage II non-invasive necrosis of the femoral head, but there are risks of inaccurate location, incomplete or excessive removal of necrotic bone. OBJECTIVE: To observe the accuracy and safety of three-dimensional(3 D) printed navigation template assisted core decompression and bone grafting in the treatment of ARCO stage II non-traumatic femoral head necrosis. METHODS: Eighty patients(96 hips) of ARCO stage II non-traumatic femoral head necrosis were enrolled from January to November 2017 in Honghui Hospital Affiliated to Xi’an Jiaotong University. The patients were randomly divided into two groups. In the 3 D group, 40 cases(48 hips) received 3 D printed navigation template assisted core decompression and bone grafting. In the control group, 40 cases(48 hips) received core decompression and bone grafting(no navigation template). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The operation time, intraoperative fluoroscopy, and intraoperative blood loss were recorded, and X-ray examination results at 3, 6, 12, and 24 months after operation were observed. The femoral head survival rate, hip Harris score, and pain visual analogue scale score were evaluated. The efficacy was compared. RESULTS AND CONCLUSION:(1) Compared with the control group, the operation time was shortened from(132.57±14.86) minutes to(82.63±10.31) minutes; the number of intraoperative fluoroscopy was reduced from(16.80±2.15) times to(4.93±1.36) times; blood loss was reduced from(143.23±17.98) mL to(75.64± 16.23) mL in the 3 D group. Operation time, number of fluoroscopy, and blood loss were superior in the 3 D group than in the control group(P < 0.05).(2) The 24-month follow-up of imaging showed that only 2 cases of the femoral head collapsed in the 3 D group, but the hip joint function was acceptable. There was no artificial hip arthroplasty and the femoral head survival rate was 96%. In the control group, femoral head collapsed in 9 cases. Four of them had total hip arthroplasty due to limited hip joint activity, and the femoral head survival rate was 81%. The survival rate of the femoral head in the 3 D group was higher than that in the control group(P=0.024).(3) Compared with the control group, Harris score and visual analogue scale score were improved in the 3 D group(P < 0.05).(4) Applying 3 D printed navigation template to core decompression and bone grafting for ARCO stage II non-traumatic femoral head necrosis can reduce the operation time, intraoperative fluoroscopy and blood loss, and improve the accuracy and safety of intraoperative positioning.

Fatal Non-traumatic Fat Embolism

@#Non-traumatic fat embolism (NTFE) is infrequently encountered in the clinical setting. The incidence of clinically detected fat embolism is less than 1%. It is diagnosed based on the evidence of fat emboli occluding the vessel lumen in a patient with no prior history of trauma. We report a case of NTFE in a lady who developed breathlessness and collapsed following home vaginal delivery. Post-mortem examination revealed extensive fat emboli in the pulmonary vessels. We elucidate the clinical challenges in diagnosing fat embolism (FE) in a patient without history of trauma.

Correlation of risk factors with Glasgow coma scale to predict the severity and outcome of children with non-traumatic coma

Background: Non-traumatic coma is the problem of pediatric group, accounts 10-15% in hospital admissions. Assessment of the severity of coma is useful to speculate the survival. The aim was to assess outcome in pediatric non-traumatic coma with role of Glasgow coma scale and modified Glasgow coma scale.Methods: Total of 80 cases of non-traumatic coma between 1 month to 12 years, coma severity was assessed by using Glasgow coma scale. A score of less than 8 and more than 8 were used for analysis of outcome.Results: The maximum number of patents with non-traumatic coma were in the age group of 1 month-5 years, 40 children (50%). On neurological examination 42 (52.5%) children has GCS score of >8, 38 cases (47.5%) has GCS <8, 20 children had meningeal signs, 7 children had cranial nerve deficit (7th nerve), 9 children had decebrate posture. Out of 80 cases, 8 cases expired (10%), 4 cases were discharged against medical advice (4%), 68 cases were improved and discharged (85%), among these, 8 cases were discharged with complication (11.7%). Overall mortality was (10%) (8/80), males outnumbered females in frequency with ratio of 1.28:1. CNS infection accounted for almost about 66%.Conclusions: Children with GCS and MGCS scores of less than 8 have poor prognosis and a very high probability of death. Those with GCS score of more than 8 have good prognosis. Identification of these cases at the outset can help prepare the treating physician to plan critical care referral and to give a preliminary assessment of outcome to the family.

Clinical Profile, Etiology and Outcome of Non Traumatic Coma in a Tertiary Care Centre

Introduction: Non Traumatic Coma is a very common presentation in emergency department. This study aimed at studying the various etiologies and factors determining outcome in these patients. Material and methods: This prospective observational cohort study was conducted in Goa Medical College and Hospital, over a period of six months on 100 patients of non traumatic coma. Outcome was recorded as either complete recovery, partial recovery with some disability or Death. Various factors affecting outcome were studied. Results: Among 100 cases of non traumatic coma studied, cerebrovascular accidents (33%) and metabolic causes (37%) constitute the major causes. Among cerebrovascular accidents, mortality among those with intracranial bleed was higher (66.6%) than that among cerebral infarct (46%). Metabolic, infective etiologies and drug overdose had better outcome. Patients with low GCS, abnormal respiratory pattern, and papilledema had worse outcome. Conclusion: Mortality was highest among patients with cerebrovascular accident. Patients with metabolic, infective and drug overdose had relatively better outcome. Other factors indicating poor outcome include low GCS, absent oculocephalic reflex, abnormal respiratory pattern and presence of papilledema

Role of Magnetic Resonance Imaging in Evaluation of Low Back Pain of Non-Traumatic Causes

Low back pain (LBP) is a commonly encountered complaint in clinical practice with a significant economic burden to the society. The objective of study was to evaluate the changes seen on MRI in patients with low back pain due to various non-traumatic causes and to distinguish various causes of low back pain with level of spinal involvement. Methods: This descriptive observational study was carried from October 2015 to October 2017 in 106 patients with low back pain who underwent MRI of the lower spine at Department of Radio-Diagnosis, Chalmeda AnandRao institute of Medical sciences. Patients who met the inclusion/exclusion criteria were included in the study. Results: More than 40% of patients (n=43; 40.57%) were in the age group of 41 to 60 years (Figure 24). There were 29 patients in the age group of 21 to 40 years (27.36%), followed by age group of > 60 years (n =21; 19.8%) and least patients were in the age group of <20 years (n =13; 12.26%. Conclusions: We concluded that 106 patients, degenerative changes were the commonest cause for low back pain followed by infective and neoplastic etiologies. The ability of MRI to detect morphological abnormalities, extent of lesion and nerve root compression all help in complete evaluation of low back pain.

Retrospective study analyzing the data on non-traumatic abdominal emergency surgeries done tertiary care hospital, Chennai

Background: Abdominal pain is one among the common reason to visit the casualty. Appendicitis remains the commonest cause in it. An accurate diagnosis is needed for the essential treatment. Materials and methods: All patients admitted in emergency surgical ward as acute abdomen and underwent emergency surgeries during a period of November 2015 to January 2016 (3 months) in our Stanley Hospital were studied. Patients with history of trauma were excluded from the study. Patients managed conservatively were also excluded from the study. A total of 268 cases underwent emergency abdominal surgery were studied. The age, sex, type of surgery done, etc. details were collected from the emergency registers and other records available. The results were tabulated for age and sex incidence according to different surgeries done. Results: A total of 178 cases of acute appendicitis were operated. The majority of cases were in the age group of 10-30 years. 2 patients having appendicular mass were operated and 6 appendicular abscess patients were operated and drained. Most of the patients were operated by open appendectomy and few numbers of patients operated via laparoscopy technique. A total of 32 cases of intestinal perforation were studied. Out of 32 during the study 2 case of gastric perforation and 2 cases of ileal perforation were reported. Total number of cases operated was 20 with inguinal hernia accounting for 15 cases and umbilical hernia 2 and epigastric hernia 2 cases, 1 case of incisional hernia. 3 cases (10%) of large bowel obstruction observed and were due to gangrenous bowel, sigmoid.

Correlation of serum Ghrelin levels with disease severity in patients with non-traumatic osteonecrosis of femoral head:A preliminary study / 实用医学杂志

Objective The scope of this study was aimed to explore the relationship between serum Ghrelin levels and disease severity in non-traumatic ONFH patients. Methods 84 non-traumatic ONFH patients and 84 healthy controls were enrolled for this study in our hospital. The radiographic progression was determined by FICAT grading system. The clinical severity was evaluated by visual analogue scale(VAS),Harris hip scores(HSS). The serum APN concentrations were examined by enzyme-linked immunosorbent assay(ELISA).Serum adiponectin and IL-33 levels were also examined. The relationship between serum Ghrelin levels and radiographic severity,clinical severity and biochemical indices were investigated. Results Serum Ghrelin levels were significantly lower in ONFH patients than in healthy controls. Serum Ghrelin levels were negatively correlated with FICAT grading system. In addition,Serum Ghrelin levels were also negatively related to VAS scores and positively associated with HSS scores ,Last ,Serum Ghrelin levels were positively with adiponectin levels and negatively correlated with IL-33 levels. Conclusion Serum Ghrelin levels in non-traumatic ONFH patients were negatively associated with the disease severity. Decreased serum Ghrelin levels may reflect disease severity of non-traumatic ONFH.

Role of Radiology in Evaluation of Non-Traumatic Acute Abdomen

Acute abdominal pain may be caused by a myriad of diagnoses, including acute appendicitis, diverticulitis, and cholecystitis. Imaging plays an important role in the treatment management of patients because clinical evaluation results can be inaccurate. Performing computed tomography (CT) is most important because it facilitates an accurate and reproducible diagnosis in urgent conditions. Also, CT findings have been demonstrated to have a marked effect on the management of acute abdominal pain. The cost-effectiveness of CT in the setting of acute appendicitis was studied, and CT proved to be cost-effective. CT can therefore be considered the primary technique for the diagnosis of acute abdominal pain, except in patients clinically suspected of having acute cholecystitis. In these patients, ultrasonography (US) is the primary imaging technique of choice. When costs and ionizing radiation exposure are primary concerns, a possible strategy is to perform US as the initial technique in all patients with acute abdominal pain, with CT performed in all cases of non-diagnostic US. The use of conventional radiography has been surpassed; this examination has only a possible role in the setting of bowel obstruction. However, CT is more accurate and more informative in this setting as well. In cases of bowel perforation, CT is the most sensitive technique for depicting free intraperitoneal air and is valuable for determining the cause of the perforation. Imaging is less useful in cases of bowel ischemia, although some CT signs are highly specific. Magnetic resonance (MR) imaging is a promising alternative to CT in the evaluation of acute abdominal pain and does not involve the use of ionizing radiation exposure. However, data on the use of MR imaging for this indication are still sparse. In this study, 76 patients with clinical manifestation of gastrointestinal conditions those were referred to radiology department of Dhiraj general hospital during time period of August 2015 to August 2016 were included. There were 44 male patients (57.9%) and 32 (42.1%) female patients. In our study spectrum of conditions included were: most common condition was Shah H, Parikh C, Raychaudhuri C. Role of Radiology in Evaluation of Non-Traumatic Acute Abdomen. IAIM, 2017; 4(3): 1-9. Page 2 Acute cholecystitis (15.8%), followed by pancreatitis and acute appendicitis (14.4%), Intestinal obstruction (13.1%), acute diverticulitis and malignancy (9.2%), inflammatory conditions (7.7%), Herniation, Midgut volvulus with malrotation, Necrotising Enterocolitis, Hepato-biliary Disorders, Perforated Viscus, acute peritonitis (1.3%).

Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain / 世界急诊医学杂志（英文）

BACKGROUND:Musculoskeletal complaints, especially non-traumatic neck and back pain, are routinely encountered in the emergency department (ED) and lead to ED overcrowding, a burgeoning wait time for physiotherapy and outpatient orthopedic reviews. The study aimed to evaluate the impact of early physiotherapy evaluation and treatment (EPET) vs. standard care (SC) on clinical outcomes for patients presenting to the ED with non-traumatic neck and back pain. METHODS:A retrospective observational study of 125 patients who presented to the ED with non-traumatic neck and back pain with/without peripheral symptoms from July 2010 to February 2011. Neck Disability Index (NDI), Modified Oswestry Low Back Pain Disability Questionnaire (MODI) and 11-point Numeric Pain Rating Scale were used as outcome measures and compared between groups at a mean of 34 days from their initial ED visit. RESULTS:We identified a total of 125 patients. EPET group comprised 62 patients (mean age, 45 years; men, 63％) and SC group comprised 63 patients (mean age, 45 years; men, 43％). The EPET and SC groups received physiotherapy at a median of 4 and 34 days respectively from their first ED visit. EPET patients had significantly lower levels of disability (9.0％ vs. 33.4％, Welch t-test, P<0.001) and pain (median value, 1 vs. 4 points, Mann-Whitney U-test, P<0.001) compared with SC patients. CONCLUSION:Early access to physiotherapy in ED was associated with reduced pain and disability levels. EPET protocol can potentially decrease the demand on outpatient orthopedic services, thereby freeing up available resources to treat patients who are more likely to benefit from it.

Development of non-traumatic-pain acupuncture-moxibustion apparatus and its industrialization / 中国针灸

In order to alleviate the discomforts induced by the invasive manipulation of acupuncture, improve the acceptability of acupuncture-moxibustion therapy and promote the application of it in healthcare, the research team developed the non-traumatic-pain acupuncture-moxibustion apparatus for disease treatment and prevention as well as healthcare, such as crude herbal moxibustion plus cupping device (cupping device), the healthcare cloth for warming the governor vessel (healthcare cloth) and the governor vessel intelligent diagnosis apparatus (diagnosis apparatus). Cupping device was developed through the integration of crude herb extract for moxibustion and silica gel, which is used specially on the governor vessel, Jiaji (EX-B2) and the bladder meridian of food-for chronic disorders and healthcare. The healthcare cloth was prepared with hi-tech thermal material and on the basis ofnourishment of the governor vessel, acting on warming, benefitingand promotingcirculation. It is applicable for the people of 7 body constitutions, such as neutral constitution,deficiency constitution anddeficiency constitution to regulate the body constitution. The diagnosis apparatus integrates the functions of diagnosis and treatment as well as data analysis, implying the future of "internet+" medical development of TCM. The industrialization of non-traumatic-pain acupuncture-moxibustion apparatus should be guided under the national policy and use fully the advantage of internet so as to maintain and promote the people's health through the industry-university-research cooperation.