Article of interest: Does Atelectasis Cause Fever After Surgery? Putting a Damper on Dogma.

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Crompton JG, Crompton PD, Matzinger P. Does Atelectasis Cause Fever After Surgery? Putting a Damper on Dogma. JAMA Surg. 2019 May 1;154(5):375-376.

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fever after an operationFigure. Damage-Associated Molecular Patterns (DAMPs) and Pathogen-Associated Molecular Patterns (PAMPs)

“The danger model of immunity challenges the premise of our current therapeutic approach in treating noninfectious causes of postoperative fever. The clinical benefit of interventions targeting atelectasis as a cause of postoperative fever, such as incentive spirometry, need to be reassessed. Continue reading →

The utility of biomarkers in inflammatory bowel disease, with a focus on fecal calprotectin

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Petryszyn P, et al. Faecal calprotectin as a diagnostic marker of inflammatory bowel disease in patients with gastrointestinal symptoms: meta-analysis. Eur J Gastroenterol Hepatol. 2019 Nov;31(11):1306-1312.

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“The study aimed to assess efficacy of faecal calprotectin as a diagnostic marker of IBD in patients with symptoms suggestive of such diagnosis. Inclusion criteria comprised experimental and observational studies, adults with gastrointestinal symptoms, calprotectin as index and colonoscopy as reference test, presence of data on/enabling the calculation of diagnostic accuracy parameters. For each study, sensitivity and specificity of faecal calprotectin were analysed as bivariate data. Nineteen studies were identified. The total number of patients was 5032. Calculated pooled sensitivity and specificity were 0.882 [95% confidence interval (CI), 0.827-0.921] and 0.799 (95% CI, 0.693-0.875), respectively. Following faecal calprotectin incorporation in the diagnostic work-up of 100 people with suspected IBD, 18 non-IBD patients will have a colonoscopy performed and one patient with the disease will not be referred for this examination. Faecal calprotectin concentration measurement is a useful screening test to rule out IBD, at the same time reducing the need for colonoscopy by 66.7%.”

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Choosing the appropriate patch repair based on the duodenal perforation size

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Poris S, et al. Routine versus selective upper gastrointestinal contrast series after omental patch repair for gastric or duodenal perforation. Surg Endosc. 2018 Jan; 32(1):400-404.

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“Age greater than 60 years (p-0.0470, CI-0.76-31.54), pulse rate greater than 110/minute (p-0.0217, CI-1.04-34.48), systolic blood pressure less than 90 mm Hg (p-0.0016, CI-2.04-71.9), haemoglobin level less than 10 g/dl (p-0.0009, CI-2.25-135.02), serum albumin less than 2.5 grams/dl (p-0.0145, CI-1.21-38.31), total lymphocyte count less than 1800 cells/mm-3 (p-0.0003, CI-8.9-42.2), size of perforation greater than 5 mm (p-0.0011, CI-1.09-36.13) were identified as risk factors for releak. Serum albumin, hemoglobin and size of perforation were independent risk factors for prediction of releak on multivariate analysis. The anthropometric parameters namely mean triceps skin fold thickness, mean mid arm circumference and mean body mass index were all significantly less in cases as compared to controls. Releak was found to be a significant cause of death in patients with perforated duodenal ulcer. A total of 8 patients died in both the groups. The mortality rate in the releak group was 55.6% (5 out of 9 patients) compared to 2.7% (3 out of 110 patients) in the control group [p-0.0001].”

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Article of interest: Volvulus of the Small Bowel and Colon

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Kapadia MR. Volvulus of the Small Bowel and Colon. Clin Colon Rectal Surg. 2017 Feb; 30(1):40-45.

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“Volvulus of the intestines involves twisting around a fixed point. It may occur anywhere along the gastrointestinal tract where there is a long, mobile intestinal segment with a narrow mesenteric attachment. Volvulus leads to luminal obstruction and can compromise intestinal blood flow. For this reason, it tends to be a surgical emergency which requires prompt attention. Failure to recognize the signs and symptoms of intestinal volvulus may lead to bowel ischemia and perforation.”

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.

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Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 11. doi: 10.1016/S0140-6736(20)30566-3. [Epub ahead of print]

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“191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/L (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.”