Background: One of the most common difficulties in the operation fatality is perforation peritonitis. The goal of this study was to identify risk factors for peptic ulcer disease (PUD) in young patients. Materials and method: In this study, 70 patients were evaluated and clinical examinations and endoscopies were performed at 8 weeks and 6 months. Place and Duration: A population‐based cohort study was conducted at the Gastroenterology department of Sharif Medical College, Lahore for one-year duration from January 2021 to December 2021. Result: Six patients died, and 4 patients were not followed up on, out of a total of 80 patients. There were 62 men and 8 women among the remaining 70 patients. The majority of the patients were between the ages of 35 and 40. After eight weeks, 34 (50%) had no infections on endoscopy, with 34 patients (48.6%) on treatment and 1 (1.4%) not on any therapies. The residual 35 patients (50%) had active ulcers and other positive endoscopic outcomes. Six months after surgery, 56 patients (80%) had no ulcers on endoscopy, with 34 on treatment and 12 without treatment. The rest 14 had some positive endoscopic findings. The study also revealed other factors linked with peptic ulcer perforation and impacting healing in the postoperative phase. Preoperative PUD symptoms, alcohol consumption, comorbidities, chronic drug consumption (NSAIDs/steroids), smoking, postoperative treatment given and H. pylori infection were all variables. Conclusion: All patients with peptic ulcer perforation should receive H2 blockers or proton pump inhibitors as a post - operative therapies, as well as an anti-Helicobacter pylori regimen. Postoperative follow-up should include routine endoscopic examinations of these patients to detect ulcer healing. Keywords: peptic ulcer disease, endoscopies, chronic drug consumption.

Introduction: Delaying broad-spectrum antibiotics beyond 1-2 hours once the septic shock is diagnosed increases patients' risk of death. However, what is the impact of already being on antibiotics when a septic shock is diagnosed? Aim: We compared demographics, clinical characteristics and outcomes in septic shock patients on antibiotics initiated prior to versus after septic shock was diagnosed; whose initial antibiotics were considered appropriate for the offending organism(s); and who died in versus were discharged from the ICU. Methods: Data were prospectively collected on 161 patients ≥ 14-years-old (female: male=1:1; mean age 61.1yrs) admitted to the ICU for septic shock, and followed for ≥30 days, or until hospital discharge or death. Results: Few inter-group differences were identified. Those treated early were more likely to have a nosocomial infection (p=0.03), skin or soft tissue source of their infection (p=0.01), or a diabetes-related limb amputation (p=0.02); but received fewer antibiotics (p=0.01). Those on appropriate antibiotics were more likely to be female (p=0.048), but less likely to have a skin or soft tissue source of infection (p=0.03). Neither starting antibiotics early, nor being on appropriate antibiotics impacted any outcome measure, including survival. Predictors of mortality were ≥1 co-morbid condition (p=0.03), more versus fewer co-morbid conditions (p=0.009), cardiovascular disease at baseline (p=03), requiring dialysis at baseline (p=0.008), and a higher day#1 SOFA score (p<0.001). Conclusions: Our data fail to demonstrate any benefit to being on antibiotics prior to the diagnosis, irrespective of whether the ultimately-identified offending organism is sensitive or resistant.

Background & Objectives: It is generally believed that significant delay in administering antibiotics in severely septic patients and those with septic shock increases mortality. However, most studies were retrospective and/or of questionable design. Moreover, the starting times from which delays were measured varied and often seemed somewhat amorphous. We assessed the duration of time between antibiotics being ordered and first administered among patients with newly diagnosed septic shock in a Saudi intensive care unit (ICU), and its effects on 30-day mortality and the rate of major complications. We also sought to identify any time threshold at which the mortality rate clearly increased. Methodology: Data were prospectively collected on 96 patients ≥14-years-old (male/ female = 49%; mean age 62.1 y) admitted to our ICU and followed for ≥30 days, or until hospital discharge or death. The time between ordering and administering the first dose of antibiotics after diagnosis of septic shock was recorded and its impact upon survival and major complications analyzed. Results: Fifty of 96 patients died within the ICU. Unexpectedly, mortality rate declined steadily between < one min (60%) and 5 h delay (44%), but rose sharply beyond five hours (p < 0.001). Time delay did not significantly influence the rate of any major complication other than death. Conclusions: Our results call into question recent conclusions that delays administering antibiotics beyond one to two hours result in significantly increased mortality. Further prospective, large scale studies are necessary to clarify this issue. Citation: Algethamy HM, Arab AA, Morish A, Meriky LH, Numan MS, Alotaibi AF. Does the time between ordering and administering the first dose of antibiotic influence outcomes in septic shock patients? Anaesth pain & intensive care 2019;23(3):--