BACKGROUND AND OBJECTIVES Typhoid ileal perforation is a common problem seen in tropical countries. Over the years, advances in the treatment of typhoid fever has decreased the incidence of typhoid ileal perforation. This study is conducted to throw a light on prognostic factors in the surgical outcome of typhoid ileal perforations. METHODOLOGY Fifty consecutive patients clinically diagnosed as having typhoid ileal perforation was taken for the study over a period of 18 months from November 2011 to May 2013. Pre-operative patients were investigated for the air under the diaphragm using upright chest X-ray and erect abdomen X-rays. Blood culture and Widal tests were done to diagnose the patients that they were suffering from typhoid fever. Patients with general peritonitis due to other causes excluded from the study. RESULTS Out of 50 patients, there were 40 (80%) males and 10 (20%) females, thus the male:female ratio was 4:1. Their ages ranged from 16-58 years. There were 32 patients presented early and 18 patients presented lately. The patients presented to the hospital with spectrum of symptoms. All the patients had pain abdomen to present with, out of which 29 patients had fever, 33 had dehydration and 16 had shock on presentation. In these 50 patients, 33 patients had single perforations and 17 had multiple perforations. The single perforation was treated with simple closure and resection anastomosis was done in cases of multiple perforations. The patients were observed for complications of surgery. The mean hospital stay was 13.28 days. We lost 6 cases. There were 19 cases of wound infection, 12 cases of wound dehiscence, 7 cases of enterocutaneous fistula, 4 cases of respiratory tract infections. The blood culture was positive in 4 cases and the culture yielded Salmonella typhi. The Widal test was positive in 44 cases. There were 13 cases of abdominal fluid culture positive. All yielded the growth of E. coli. CONCLUSION Typhoid ileal perforation is one of the most common surgical emergency encountered by the general surgeon. Widal test is still useful in the diagnosis of typhoid fever in our country. The number of perforations and the peritoneal contamination and the delay in getting medical facility-surgery, shock at the time of presentation at hospital are directly proportional to the morbidity and mortality. Availing early medical facility, which is a modifiable risk factor. If timely early medical attention is sought, majority of morbidity and mortality can be tackled.
BACKGROUND: Organophosphorus (OP) poisoning is a major public health problem in developing world. OP pesticides inhibit carboxylic esterase enzymes including plasma cholinesterase (PChE). Clinical manifestations following OP poisoning can be associated with the extent of decrease of PChE. This study was designed to investigate the relevance of diastolic function of the heart, severity of diastolic dysfunction and the reversibility of dysfunction in organophosphorus compound poisoning patients in relation to plasma cholinesterase (PChE) levels with the treatment. MATERIALS AND METHODS: 76 patients admitted with organophosphorus compound poisoning were evaluated for diastolic dysfunction by echocardiography. Clinical features and the nature of compound involved were recorded. Severity of diastolic dysfunction was assessed. Cholinesterase levels were assessed. Initially there was worsening of diastolic function. As the treatment progressed, there was improvement in the pattern of diastolic dysfunction with the corresponding improvement in cholinesterase level and clinical improvement. This was a cross-sectional study which was conducted from 1st January 2014 to February 2015. RESULTS: In total, mean age of patients were 31.2 (range: 19-46) years. Majority of patients were females (68.4%), and agricultural workers (75%). Main clinical findings at the time of admission were congested conjunctiva (83%), pin point pupil (89%), lacrimation (78%), vomiting (69%), non-reactive pupil (85%), respiratory distress (65%) and abdominal pain (45%). Mean (SD) PChE at 6 hours post-exposure was 3242.6 IU/L. At presentation, cyanosis, muscle weakness, convulsion, respiratory distress and fasciculation were related to cases with >75%reduction of PChE, while, constricted and nonreactive pupil, lacrimation and congested conjunctivae were related to cases with 50-75% reduction and abdominal pain, dryness of conjunctiva, vomiting and diarrhea were related to <50% reduction. 11.8% of patients had normal diastolic function. 88.1% patients were found to have diastolic dysfunction. 15.7% had grade I diastolic dysfunction which persisted in same level throughout treatment. In 72.3 % patients there was gradual worsening of diastolic function. With the treatment there was gradual improvement in diastolic function from grade III to grade I. At the end of 5 days, 19.7% patients had complete reversal of dysfunction. 68.4% patients had persistent mild dysfunction even at the time of discharge. CONCLUSIONS: Patchy myocardial involvement as a result of direct cardiac toxicity could be one of the factors responsible for cardiac complications. Continuous cardiac monitoring should be undertaken to detect dynamic cardiac changes. These findings can assist health professionals to better evaluate patients' prognosis and improve their treatment plan. KEYWORDS: Organophosphorus compound, Diastolic dysfunction, Plasma cholinesterase (PChE). The replacement of an oxygen atom in the organophosphorus structure by sulfur leads to the formation of organo...
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