Objective: Appendicitis is a common surgical emergency among children. The coronavirus pandemic affected the system of hospitals more than any other field, and great amount of people were concerned about visiting the hospitals for any reason. In this study, it was aimed to evaluate the profile of appendicitis by emphasizing perforated and acute appendicitis in the pandemic period and to compare the rates with previous three years. Material and Methods: Charts of the children who underwent laparoscopic appendectomy due to appendicitis between March 11-September 30 between 2017-2020 were retrospectively analyzed in terms of demographic data, duration of symptoms, duration between hospital admission and surgery, radiologic imaging and perioperative outcomes. Results: This study includes 467 children who underwent laparoscopic appendectomy. There were 97 procedures in 2020, 111 in 2019, 146 in 2018 and 113 in 2017. Multiple comparison tests revealed that age did not show difference; but onset of symptoms in admission (p= 0.004), hospitalization time before surgery (p< 0.001), total hospitalization time (< 0.001) showed statistically significant difference between years. Pairwise comparisons showed that these parameters were increased in 2020 compared to other years. Perforated appendicitis rate was significantly increased in 2020 when compared to previous years. Conclusion: Although there is no direct relation between appendicitis and COVID-19 infection in the current knowledge, perforated appendicitis was found to be increased in children during the COVID pandemic. Reason of the higher rate of perforated appendicitis may be multifactorial; however, the pandemic appears to have a role in increased morbidity in children with appendicitis indirectly due to delay of hospital admissions.
Неінвазивна вентиляція легень (НВЛ) є методом респіраторної підтримки на основі застосування різних допоміжних режимів вентиляції с використанням в якості основного інтерфейсу маски, яка може бути легко накладена і так же легко від›єднана від дихальних шляхів пацієнта. Ключовим фактором досягнення успіху при НВЛ є правильна селекція пацієнтів. Важливо підкреслити, що для НВЛ необхідний строгий відбір хворих, головними критеріями є збереження свідомості і згода хворого, а також стабільна гемодинаміка.При використанні НВЛ значно менше ускладнень, ніж при традиційній штучній вентиляції легенів (ШВЛ). Масочна вентиляція дозволяє знизити до мінімуму число інфекційних і «механічних» ускладнень. Нозокоміальна пневмонія відноситься до частих ускладнень ШВЛ і є найважливішим чинником, що визначає результат лікування хворого. При НВЛ не відбувається прямого контакту з трахеєю (інтубаційна трубка, аспіраційний катетер), пацієнт може сам звільнити дихальні шляхи від мокротиння після зняття маски. На відміну від ШВЛ, при НВЛ голосові зв›язки зберігають свою природну рухливість, що знижує ризик розвитку аспірації -провідного фактора ризику розвитку вентиляційної пневмонії.У статті представлений досвід авторів щодо використання НВЛ у відділенні реанімації хірургічної клініки Азербайджанського медичного університету, який свідчить про високу ефективність та безпечність цього методу респіраторної підтримки у хворих на тяжкі пневмонії, асоційованими з COVID-19. В якості ілюстрації наведено опис клінічного випадку.
Objectives: Management of non-palpable testes is still one of the controversial topics of pediatric surgery. Laparoscopic exploration has been characterized as a gold standard in the diagnosis and management of undescended testes in recent years. In this study, we aimed to share our experience of diagnostic laparoscopy in non-palpable testes.Materials and Methods: Seventy-three patients with non-palpable testes diagnosis, who were treated in the clinic between June 2006 and December 2017, were included in the study. Diagnostic laparoscopy was applied to all patients. According to findings determined during diagnostic laparoscopy, the next step of non-palpable testes management was planned. Age at presentation, affected side, operative techniques and results were recorded. Results:The age of the children ranged from 6 to 197 months. The median age of patients was 46.7 months. The mean period of clinical follow-up was 19 months, ranging from 1 to 96 months. Laterality of non-palpable testes was determined through physical examination and confirmed via diagnostic laparoscopy. Sixty-six patients had unilateral non-palpable testes: Twenty-five testicular units were right-sided and 41 testicular units were left-sided. Other seven patients had bilateral non-palpable intra-abdominal testes. Conclusion:Despite controversies and different advised techniques in the management of non-palpable testes, laparoscopy remains to be important. Laparoscopic assistance in the management of non-palpable testes not only leads to determination of localization and decision of next step procedure, but also helps to avoid unnecessary surgical attempts.
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