The impact of an enhanced recovery after surgery (ERAS) programme in emergency colorectal surgery has not yet been reported. The objective of this study was to evaluate the feasibility and the results of patients included in an ERAS protocol following emergency colon surgery for left colon perforation. For this purpose, patients with a low to moderate risk of mortality, according to a Peritonitis Severity Score (PSS), and treated with an ERAS protocol (ERAS group) after emergency surgery for left colon perforation were compared for a period of 40 months (March 2014-June 2017) with a control group of patients treated with conventional care (CC group) during the 38 months prior to implementation of the new ERAS protocol (January 2011-February 2014). The main endpoint was 90-day postoperative morbidity according to the Clavien-Dindo classification. Secondary endpoints included length of postoperative hospital stay, 90-day readmission rate, protocol compliance and mortality. Fifty patients were included in the study, 29 in the ERAS group and 21 in the CC group. There were no significant differences between the groups in the demographic data or in the operative characteristics. A reduction in the incidence of postoperative complications (20.7% vs. 38%; p > 0.05) and in the postoperative hospital stay (7.7 + /-3.85 vs. 10.9 + /-5.6 days; p = 0.009) were observed in the ERAS group. The 90day readmission rate did not differ significantly between the two groups (2 vs. 1). No 90-day mortality was observed in either group. The ERAS group showed better results than the CC group in protocol compliance. We conclude that ERAS protocols are feasible and help to reduce morbidity and length of hospital stay without adversely affecting the rate of readmission or mortality.

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A stiffer chest wall was observed in patients with IAH. In patients with risk factors for IAH, pressures in these compartments were highly variable.

all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40% of them through heads and faces, and 10% of them through trunks, cervical regions and other organs of the bodies. In the persons who were bitten by animals in the head region, the mean latency period for rabies was 33 days (SD = ±12.2 days), while the mean latency period in the persons who were bitten through hands and feet was 77 days (SD = ±45.8 days). The P value was <0.1. The results of this study showed that there is a significant reciprocal correlation between annual raining level and the frequency rate of animal bites in the province of Kerman (r = 0.5, P < 0.01). Conclusions According to this study, the role of foxes in the epidemiology of human rabies in the province of Kerman, located in the southeast of Iran, seems very important. Since most of the animal bite individuals, during the one-decade survey in this region of Iran, did not seem aware of the risk of exposure to the viral infection of rabies through animal bites, the public education of preventive measurements of rabies seems imperative by the public health authorities as well as vaccination of animals against rabies, especially dogs and cats, as well as mass vaccination of wild animals by means of distribution of oral vaccines in the vast and scattered forests by helicopters belonging to Veterinary Organization Authorities being recommended. Collaboration of intersectional public health relationships of medical science universities of the province of Kerman as well as all related authorities to control rabies prevalence in the regional and interregional provi...

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