Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low-or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.

Objectives Vulnerable, urban populations with a history of substance use disorders have a high prevalence of hepatitis C virus (HCV). Primary care-based treatment has been proposed to improve access to care. In this study, we present outcomes from our urban, primary care-based HCV treatment program in patients treated with telaprevir or boceprevir in combination with pegylated-interferon and ribavirin (‘‘triple therapy’’). Methods We collected data from 126 consecutive patients with genotype 1 HCV monoinfection seen in our treatment program (2011–2013). Among the 40 who initiated treatment, we analyzed factors associated with achieving a sustained viral response (SVR). Results During the study period, 40 patients initiated triple therapy (32%), 80% with recent or past substance use disorders. Patients initiating treatment were younger than untreated patients (P = 0.002), but otherwise did not differ demographically, or in the severity of their liver fibrosis (P >0.05). An SVR was achieved in 18 patients (45%) and was less likely in patients with recent or past substance use disorders or psychiatric illness (both P <0.01). Conclusions Nearly one third of patients initiated triple therapy with SVR rates comparable to other HCV treatment settings, despite a significant burden of mental illness and substance dependence. Our experience demonstrates that a primary care-based practice can successfully deliver HCV care to a vulnerable population. Additional interventions may be needed to improve outcomes in patients with recent or past substance use disorders or psychiatric illness.

A 36-year-old man with familial adenomatous polyposis secondary to an adenomatous polyposis coli mutation status post proctocolectomy with ileal pouch-anal anastomosis presented with hematochezia. Pouchoscopy revealed a 4-cm indurated mass in the distal ileal pouch just 17 months after a normal pouchoscopy. Histopathology was diagnostic for Burkitt lymphoma, and the patient achieved complete remission with subsequent chemotherapy. Although there are reports of Burkitt lymphoma in patients with ileal pouch-anal anastomosis, to date, this is the first report in a patient with familial adenomatous polyposis. This case highlights the presentation of a rapidly enlarging tumor not commonly seen in the adult gastroenterology population.

Background: Patients who are hospitalized for decompensated cirrhosis often require an abdominal paracentesis. Several studies and various societies have deemed this procedure to carry low risk of complications. However, Hospital Internists are increasingly referring this procedure to Interventional Radiology (IR) to perform. As a result, hospital costs, use of resources, and patient length of stay (LOS) have all risen. The primary aim of this study was to compare the complication rates after paracentesis performed at bedside by Internal Medicine Residents with those performed by Interventional Radiology Attendings. The secondary aim was to compare additional clinical outcomes including time to procedure, bacterial culture yield, and transfusion rates between the two groups. Methods and Findings:A retrospective analysis was conducted of all paracentesis procedures performed on patients admitted to a single large academic tertiary care medical center from July 2017 to April 2018. Data was queried based on procedure notes and orders placed in the electronic medical record. Clinical outcomes were assessed up to 48 hours post index procedure and compared between patients who had bedside and IRguided procedures. 118 paracentesis encounters were included in the final analysis. Complication rates regarding hemorrhage, persistent leakage of fluid, abdominal perforation, and ICU transfer were similar between bedside and IR paracentesis. As for secondary outcomes, a significant different was found with regards to time to procedure. The time from procedure referral to procedure completion was less in the bedside group (5.3 hours ± 6.8 vs. 22.5 hours ± 36.5; p=0.001). However, no statistical differences were found in terms of total hospital LOS, the number of units of red blood cell, platelet or fresh-frozen plasma transfused pre-and post-procedure, bacterial fluid culture yield, and the volume of ascites removed during therapeutic paracentesis. Conclusion:This study suggests that bedside abdominal paracentesis performed by Internal Medicine resident physicians and those performed by Interventional Radiologists have similar complication rates. Other clinical outcomes including volume removed during therapeutic paracentesis and the need for blood product transfusion were also shown to be comparable between the two groups whereas bedside paracentesis was found to be superior in terms of time to procedure. The findings of this study suggest that IR-guided paracentesis should not be favored routinely over bedside paracentesis.