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.

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.

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.

Neural therapy approach in a hospitalized patient with acute stress disorder. case report

ABSTRACT Introduction: Acute stress disorder is a picture of rapid onset that follows a traumatic event. It is characterized by dissociative, intrusive, avoidance and activation symptoms that affect the quality of life of the patient. To date, there is no evidence of a relationship between altered organ function and this disorder, and there is no literature on its treatment with neural therapy on an inpatient basis. Case presentation: 53-year-old woman, who developed symptoms compatible with acute stress disorder after the resection of an intra-abdominal mass diagnosed as lymphoma. The patient was assessed by the neural therapy department, which applied procaine into specific skin zones -determined by the clinical history and physical examination-, with improvement of dissociated symptoms. Discussion: The neural therapy approach allowed identifying the relationship between the dissociative symptoms of the patient and the associated alteration in organ function, as well as applying a therapy that led to the resolution of the symptoms. Conclusions: The neural therapy approach allows for a comprehensive perspective and treatment of the patient, taking into account the close functional relationship between mind-emotions-body. This type of treatment also offers therapeutic strategies to hospitals, which can accompany the treatment established by other health specialists.

RESUMEN Introducción. El trastorno por estrés agudo es un cuadro de rápida instauración que se da luego de un evento traumático y se caracteriza por síntomas disociativos, intrusivos, de evitación y de activación que afectan la calidad de vida del paciente. A la fecha, no se ha evidenciado una relación causal orgánica de este trastorno y tampoco existe literatura sobre su intervención mediante terapia neural intrahospitalaria. Presentación del caso. Paciente femenino de 53 años quien desarrolló síntomas compatibles con un trastorno por estrés agudo posterior a la resección de una masa abdominal secundaria a un linfoma. La mujer fue valorada por el servicio de medicina neuralterapéutica, que intervino con procaína en sitios específicos de la piel -determinados por anamnesis y examen físico- con posterior mejoría de los síntomas disociativos. Discusión. El enfoque neuralterapeútico permitió, por un lado, identificar un vínculo entre los síntomas disociativos de la paciente y la alteración orgánica asociada, y, por el otro, hacer una intervención con la que se logró la resolución de tales síntomas. Conclusiones. La medicina neuralterapéutica ofrece estrategias de intervención a nivel hospitalario que pueden ir concomitantes al tratamiento instaurado por otras profesiones en el área de la salud ya que permite tener una perspectiva integral del paciente al considerar la estrecha relación funcional entre mente, emociones y cuerpo.

Effect of intraoperative application of dexmedetomidine on acute post-traumatic stress disorder in female patients / 中华麻醉学杂志

Objective To evaluate the effect of intraoperative application of dexmedetomidine on acute post-traumatic stress disorder (PTSD) in female patients with lower limb fracture.Methods Ninety female patients with lower limb fractures caused by traffic accident,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 20-35 yr,weighing 40-72 kg,scheduled for elective internal fixation,were divided into 3 groups (n =30 each) using a random number table:control group (group C),low-dose dexmedetomidine group (group D1) and high-dose dexmedetomidine group (group D2).Ropivacaine (0.75％) 10-15 ml was injected into the epidural space,and operation was started after pain disappeared at the plane T8-10.Two percent lidocaine 5-10 ml was intermittently injected to maintain the anesthetic plane at T10.After successful epidural anesthesia,dexmedetomidine 0.5 and 1.0 μg/kg were intravenously infused over 30 min in D1 and D2 groups,respectively,while the equal volume of normal saline was given in group C.Patient-controlled epidural analgesia was performed with 0.15％ ropivacaine after operation and lasted until 48 h postoperatively,maintaining visual analogue scale score ≤ 3 (baseline).Morphine 3 mg was intravenously injected for rescue analgesia when visual analogue scale score＞3.The requirement for rescue analgesia within 48 h after operation was recorded.Acute Stress Disorder Scale (ASDS),Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were assessed at 1 h before operation and on 1,3 and 7 days after operation.The patients were followed up for 3 months by telephone,and the PTSD Checklist-Civilian Version score was evaluated.The occurrence of acute PTSD (PTSD Checklist-Civilian Version score ＞ 38) was recorded.Results Compared with group C,the ASDS,SAS and SDS scores were significantly decreased on 1,3 and 7 days after operation,and the incidence of acute PTSD was decreased in D1 and D2 groups (P＜0.05).Compared with group D1,the ASDS scores were significantly decreased on 1,3 and 7 days after operation,and the incidence of acute PTSD was decreased (P＜0.05),and no significant change was found in SAS or SDS scores at each time point in group D2 (P＞ 0.05).There was no significant difference in the requirement for rescue analgesia between the three groups (P＞0.05).Conclusion Intraoperative application of dexmedetomidine can reduce the occurrence of acute PTSD and it is dose-related in female patients.

Síndrome del corazón roto y estrés agudo / A propósito de un caso

Resumen Introducción: El estrés se ha asociado con un síndrome de insuficiencia cardiaca aguda, con morbilidad y mortalidad importantes. Metodología: Reporte de caso y revisión no sistemática de la literatura relevante. Presentación del caso: Mujer de 65 arios con antecedente de trastorno de ansiedad generalizada no tratado que, tras la muerte violenta de un hijo, sufría dolor opresivo en el precordio, el cuello y la extremidad superior izquierda que duraba más de 30 min; la sospecha clínica inicial fue síndrome coronario agudo. Revisión de la literatura: La miocardiopatía de tako-tsubo se caracteriza por disfunción ventricular izquierda, reversible en la mayoría de los casos, y alteraciones del movimiento de la pared ventricular sin anormalidades coronarias, asociado a altas concentraciones plasmáticas de catecolaminas, que en la mayoría de los casos coinciden con un estresor agudo de tipo físico o emocional. Conclusiones: La miocardiopatía de tako-tsubo es un diagnóstico diferencial que los médicos que atienden a pacientes con sospecha de síndrome coronario deben considerar, especialmente ante mujeres posmenopáusicas con antecedentes de comorbilidades psiquiátricas como el trastorno de ansiedad generalizada.

Abstract Introduction: Stress has been associated with an acute heart failure syndrome of important morbidity and mortality. Methods: Case report and non-systematic review of the relevant literature. Case presentation: A 65-year-old woman with a history of an untreated generalized anxiety disorder, whom after the violent death of her son presented with oppressive chest pain irradiated to neck and left superior extremity, lasting for more than 30 minutes, initial clinical suspect suggests acute coronary syndrome. Literature review: Tako-tsubo cardiomyopathy is characterized by a reversible left ventricular dysfunction and wall movement abnormalities, without any compromise of the coronary arteries, associated to high plasma levels of catecholamines which in most cases correlates with an acute stress of emotional or physical type. Conclusions: Tako-tsubo cardiomyopathy has to be considered by physicians among the differential diagnosis when facing patient with suspected acute coronary syndrome, especially in postmenopausal women with a history of psychiatric comorbidities such as a generalized anxiety disorder.

Acute stress response after critical burn / 中华烧伤杂志

The stress response is a preexisting and adaptive behavioral mode of all living beings, which may bring deleterious consequences of dysfunction or failure of tissue and organ. This article aims to elaborate theories of stress response, summarize the manifestation and mechanism of acute stress response in critically burned patients, and help to improve clinical curative efficacy and prognosis of these patients by physiological, psychological and pharmacological methods.

The relationship between traumatic event exposure rate and major depressive disorder prevalence in community population in Tianjin / 天津医药

Objective To investigate the prevalence of traumatic event exposure and its relationship with major depressive disorder (MDD) in community population in Tianjin. Methods A multi-stage cluster random sampling method was used for the general health questionnaire (GHQ-12) in the population aged above 18 in 15538 families of 18 counties in Tianjin city. Among the 11748 subjects who completed the survey, they were divided into the high-risk group (100%), medium risk group (40%) and low risk group (10%) according to the risk level of mental disorders. Finally, 4438 residents were interviewed with the diagnostic and statistical manual of mental disorders Fourth Edition (DSM-Ⅳ) axisⅠdiagnostic clinical interview version (SCID-Ⅰ/P). The prevalence of respondents exposed to traumatic events and MDD was calculated. Logistic regression analysis was applied to obtain the risk factors of MDD. Results A total of 469 people experienced traumatic events in 4438 subjects, and the adjusted total exposure rate was 10.3%. Seventy-six people suffered from MDD in 469 cases with traumatic events, and the adjusted total exposure rate was 6.7%. The prevalence of MDD was 3.3% in people with no traumatic events. Logistic regression analysis showed that female (OR=1.77,95%CI:1.27-2.46), widowed/divorced and experienced a traumatic event (OR=2.21,95%CI:1.46-3.34) were the risk factors of MDD. Conclusion The total exposure rate of traumatic events is 10.3% in community residents in Tianjin, and the prevalence of MDD is related with the traumatic event exposure. It is suggested that the whole society should mobilize and participate extensively, and pay more attention to the psychological health problems of high risk population.

Clinical treatment analysis of 60 cases with no midline shift-severe craniocerebral trauma accompanied with post-traumatic acute diffuse brain swelling / 中国基层医药

Objective To investigate the clinical efficacy and treatment method for no midline shift-severe craniocerebral trauma accompanied with post-traumatic acute diffuse brain swelling (PADBS).Methods 60 PADBS patients were randomly divided into conservative treatment group and operation group,30 patients in each group.The operation group was treated with intracranial pressure monitoring by implantation of the probe and decompressive craniectomy,while the conservative treatment group received conservative treatment.The postoperative recovery was observed.Results The GCS scores of operation group postoperative 7d and 15d were (11.21 ± 2.24) and (12.88 ±2.31),which were obviously higher than (7.47 ± 1.51) and (8.19 ± 1.28) of the conservative treatment group (t =2.215,2.321,all P ＜ 0.05).Postoperative long-term follow-up results indicated that,according to GOS score,63.3％ patients in the operation group recovered well,which was significantly higher than 26.7％ in the conservative treatment group.While the percent of patients with coma or dead was 6.7％ and 10.0％ in the operation group,which were significantly lower than the conservative treatment group (x2 =15.721,4.172,3.84,all P ＜ 0.05).Conclusion In general,PADBS could not be cured easliy,the operation methods of using intracranial pressure monitoring and decompressive craniectomy based on conservative treatment could help to evaluate the trauma objectivly,detect the changes of disease earlier,treat in time and assess the prognosis accurately,all which would reduce the mortality.

Psychometric Properties of the Korean Version of Stanford Acute Stress Reaction Questionnaire

The present study aimed to examine the psychometric properties of the Korean version of Stanford Acute Stress Reaction Questionnaire (SASRQ). A Korean version of the SASRQ was produced through forward translation, reconciliation, and back translation. A total of 100 healthy, non-clinical participants were selected through screening and clinical interview, and they each were given a set of questionnaires including SASRQ. Psychometric properties of SASRQ were then examined through statistical analyses. Full-scale and subscales of SASRQ yielded excellent internal consistency (Cronbach's alpha=0.98 and 0.78-0.95, respectively). Test-retest reliability at 2-week intervals was satisfactory, with coefficient r ranging between 0.47 and 0.71. Convergent validity was also demonstrated by strong correlations between SASRQ and other trauma-related questionnaires. Correlation with Social Desirability Scale, however, was not found to be significant; thus evidenced divergent validity. The Korean version of SASRQ appears to be a reliable and valid measurement tool for assessing symptoms of acute stress disorder. Including clinical samples for comparison with controls would be necessary in future studies.

Serum levels of brain-derived neurotrophic factor in acute and posttraumatic stress disorder: a case report study / Nível sérico do fator neurotrófico derivado do cérebro no transtorno de estresse agudo e no transtorno de estresse pós-traumático: relato de casos

OBJECTIVE: The aim of this study was to evaluate brain-derived neurotrophic factor levels in two patients, one with posttraumatic stress disorder and one with acute stress disorder, before and after treatment, and to compare those levels to those of healthy controls. METHOD: Brain-derived neurotrophic factor level, Davidson Trauma Scale, Beck Depression Inventory, Global Assessment of Functioning, and Clinical Global Impression were assessed before and after 6 weeks of treatment. RESULTS: Brain-derived neurotrophic factor levels were higher in patients than in matched controls before treatment. After 6 weeks, there was a reduction in symptoms and an improvement in functioning in both cases. At the same time, brain-derived neurotrophic factor levels decreased after treatment, even in case 2, treated with psychotherapy only. CONCLUSIONS: These results suggest that serum levels of brain-derived neurotrophic factor, as opposed to what has been described in mood disorders, are increased in posttraumatic stress disorder as well as in acute stress disorder.

OBJETIVO: O objetivo do estudo foi avaliar os níveis séricos do fator neurotrófico derivado do cérebro em um paciente com transtorno de estresse pós-traumático e em um paciente com transtorno de estresse agudo antes e após o tratamento, comparando esses níveis aos de controles saudáveis. MÉTODO: Os níveis do fator neurotrófico derivado do cérebro, a Escala Davidson de Trauma, o Inventário de Depressão de Beck, a Avaliação do Funcionamento Global e a Impressão Clínica Global foram medidos antes e após seis semanas de tratamento. RESULTADOS: Os níveis de fator neurotrófico derivado do cérebro foram maiores nos pacientes, quando comparados aos controles, antes do tratamento. Depois de seis semanas houve redução dos sintomas e melhora do funcionamento nos dois casos. Ao mesmo tempo, houve redução dos níveis de fator neurotrófico derivado do cérebro, mesmo no caso 2, tratado exclusivamente com psicoterapia. CONCLUSÕES: Esses resultados sugerem que o fator neurotrófico derivado do cérebro está aumentado tanto no transtorno de estresse pós-traumático quanto no transtorno de estresse agudo, de forma oposta às alterações até então descritas nos transtornos do humor.

Effects of cannabinoid 1 receptor on regulation of visceral sensitivity in rats with acute restraint stress / 中华消化杂志

Objective To investigate the effects of cannabinoid 1 receptor (CB1R) on regulating visceral sensitivity in rats with acute partial restraint stress. Methods Thirty Sprague-Dawley rats were divided into blank control (sham stress), acute stress and CB1R groups with 10 each. The frequency of discharge of electromyogram (EMG) was recorded at the 1st, 2nd, 5th and 8th day to evaluate the visceral sensitivity to colorectal distension (CRD) in rats. The expression of the CB1R mRNA was determined by means of RT-PCR at day 8. Results There was no significant difference in baseline discharge frequency among three groups at the 1st day. But the discharge frequencies corresponding to CRD at 40,60,80 mm Hg at the 2nd day were significantly lower in CB1R group [(22.37±1.49)/min, (42.24±3.03)/min and (69.09±5.54)/min, respectively] than in acute stress group [(39.71±1.84)/min, (84.45±8.85)/min and (112.56±11.66)/min, respectively, P<0.05)]. The discharge frequencies corresponding to CRD at 40, 60,80 mm Hg in acute stress group [(104.12±6.77)/min, (158.07±18.68)/min, (193.58±25.69)/min,respectively] showed a significant elevation at the 5th day in comparison with blank control group[(36.33±5.42)/min, (74.07±8.25)/min, (102.94±7.95)/min, respectively, P<0.05] or CB1R group [(74.66±6.44)/min,(140.10±4.68)/min and (160.39±5.60)/min,respectively, P<0.05]. However, at the 8th day after stress, there was no significant difference in discharge frequency among three groups. The expressions of CB1R mRNA in ileocecal junction, proximal colonic and distal colonic tissues were significantly higher in acute stress group (2.53±0.52, 2.29±0.42, 2.54±0.29 respectively) than in blank control group(0.56±0.15, 0. 73±0.12, 0.82±0.09, respectively, P<0.05). There was no effect of CB1R agonist on CB1R mRNA expression in rats. Conclusion The visceral sensitivity in rats induced by stress can trigger the accommodation of endogenous cannabinoid system that plays an important role in modulation of visceral sensitivity.

Therapy of patients with tentorial herniation due to post-traumatic acute diffuse brain swelling around operations / 中国医师杂志

Objective To summarize and discuss the therapy of patients with tentorial herniation due to post-traumatic acute diffuse brain swelling around operations to improve the therapeutic efficacy.Methods A retrospective study was accomplished on 70 patients with tentorial herniation due to post-traumatic acute diffuse brain swellin around operations.Results According to Glasgow outcome scale,44 of 70 cases got favorable outcome,including 37 cases good recovery and 7 cases moderate deficit.The 26 of 70 cases got unfavorable outcome,including 6 cases severe deficit,5 cases persistent vegetable status and 15 cases dead.Conclusions This comprehensive therapy improves the efficacy of patients with tentorial herniation due to post-traumatic acute diffuse brain swelling around operations,which is worth spreading and applying.