Abdominal Physical Examination Research Articles

Interventional Intensive Care in Postoperative Period of Gastric Surgical Repair Due to Perforated Peptic Ulcer Disease : A Case Report

Introduction: Perforated peptic ulcer is the most common indication for emergency gastric surgery. good management of postoperative peptic ulcer perforation patients in the ICU will reduce patient mortality rates. Case presentation A 76-year-old male patient presented with a major complaint of pain throughout the abdomen that had worsened since 1 day, the abdominal pain had been felt for 4 days before admission. The patient had a history of painkiller drug consumption routinely for 3 years. The patient’s vital signs were normal, with a qSOFA score 1 and a VAS score 5. Abdominal physical examination showed the abdominal distended, no visible contour and no visible peristaltic, decreased bowel sound, and there is tenderness and rebound tenderness at the whole abdomen Patient was taken up for emergency laparostomy, then the patient underwent diagnostic laparoscopic in an elective setting with intraoperative findings of gastric perforation, then patient continued with the gastric repair. In the postoperative period, the patient was treated in the ICU of Dr. M. Djamil General Hospital. Conclusion: Intensive care management for post-gastric repair surgery patients is generally the same as for other abdominal surgery patients. The intensive care management needs comprehensive treatment, starting from oxygen therapy, monitoring, analgesia, fluid therapy, antibiotic therapy, glycemic control, and nasogastric tube nutrition.

Abdominal physical examinations in early stages benefit critically ill patients without primary gastrointestinal diseases: a retrospective cohort study.

Gastrointestinal (GI) function is critical for patients in intensive care units (ICUs). Whether and how much critically ill patients without GI primary diseases benefit from abdominal physical examinations remains unknown. No evidence from big data supports its possible additive value in outcome prediction. We performed a big data analysis to confirm the value of abdominal physical examinations in ICU patients without GI primary diseases. Patients were selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database and classified into two groups depending on whether they received abdominal palpation and auscultation. The primary outcome was the 28-day mortality. Statistical approaches included Cox regression, propensity score matching, and inverse probability of treatment weighting. Then, the abdominal physical examination group was randomly divided into the training and testing cohorts in an 8:2 ratio. And patients with GI primary diseases were selected as the validation group. Several machine learning algorithms, including Random Forest, Gradient Boosting Decision Tree, Adaboost, Extra Trees, Bagging, and Multi-Layer Perceptron, were used to develop in-hospital mortality predictive models. Abdominal physical examinations were performed in 868 (2.63%) of 33,007 patients without primary GI diseases. A significant benefit in terms of 28-day mortality was observed among the abdominal physical examination group (HR 0.75, 95% CI 0.56-0.99; p = 0.043), and a higher examination frequency was associated with improved outcomes (HR 0.62, 95%CI 0.40-0.98; p = 0.042). Machine learning studies further revealed that abdominal physical examinations were valuable in predicting in-hospital mortality. Considering both model performance and storage space, the Multi-Layer Perceptron model performed the best in predicting mortality (AUC = 0.9548 in the testing set and AUC = 0.9833 in the validation set). Conducting abdominal physical examinations improves outcomes in critically ill patients without GI primary diseases. The results can be used to predict in-hospital mortality using machine learning algorithms.

Polycystic Kidney Disease with Breast Nodules in a Male: A Case Report

Background: Polycystic kidney disease is a multisystem and progressive congenital kidney disorder characterized by kidney enlargement and the growth of cysts in the kidneys and other organs. Autosomal dominant polycystic kidney disease (ADPKD) is the most common type of inherited kidney disorder and is observed in 1/500 – 1/1000 people. The diagnosis is usually made by a positive family history , and the Ravine ultrasonographic criteria assess the age and number of cysts in both kidneys.
 Case presentation: A 37-year-old male was reported with complaints of intermittent hematuria and a painless lump in the right breast for the last 6 years. Patients routinely drink herbal medicine when symptoms appear. Abdominal physical examination revealed renal ballottement. The lump in the right breast is palpable as a lump ± 1 cm from the nipple. No abnormalities in kidney or liver function were found on laboratory examination. Ultrasound was performed, and polycystic kidney disease was obtained in both kidneys and liver, as well as a hypervascular solid nodule in the right breast. The patient was given antibiotics and antifibrinolytics. Healthy lifestyle education is also provided to patients. The patient was then referred for a biopsy of the nodule.
 Conclusion: Autosomal dominant polycystic kidney disease (ADPKD) is a common disease but only a few cases of ADPKD are accompanied by nodules in the breast, so a further approach is needed.

Wilms tumour in a two day old neonate: A rare and challenging case

Wilms tumor or nephroblastoma is the second most common renal tumor occurring in the neonatal age group next to congenital mesoblastic nephroma. The most common age group of presentation of Wilms tumor is between 3 and 4 years of age. Here, we report a case of right-sided Wilms tumor in a 2-day-old neonate. A term-born female baby presented on day 2 of birth with abdominal distension and physical examination revealed a large palpable mass in the right lumbar region crossing the midline. Imaging features were suggestive of a retroperitoneal mass of probable right renal origin. The patient was taken up for right radical nephroureterectomy and Per-operatively, there was anticipated tumor spillage. Post-operative histopathological examination was suggestive of a triphasic Wilms tumor with no anaplasia and favorable histology. The patient was diagnosed with Wilms tumor of the right kidney, COG stage III, SIOP (“International Society of Pediatric Oncology”) intermediate risk loss of heterozygosity testing for 1p and 16q was negative. She was started on chemotherapy with a DDA4 regimen. She completed whole abdominal radiotherapy and tolerated treatment well. The child is disease free and is under regular follow-up. This case of neonatal Wilms tumor was indeed a challenge to the pediatric surgeons and the oncologists but the final results were worth the challenge that was faced.

Comparison of the prognostic value of a comprehensive set of predictors in identifying risk of metabolic-associated fatty liver disease among employed adults

ObjectiveMetabolic-associated fatty liver disease (MAFLD) is of concern in employed adults, while the crucial indicators in predicting MAFLD are understudied in this population. We aimed to investigate and compare the prediction performance of a set of indicators for MAFLD in employed adults.MethodsA cross-sectional study recruiting 7968 employed adults was conducted in southwest China. MAFLD was assessed by abdominal ultrasonography and physical examination. Comprehensive indicators of demographics, anthropometric, lifestyle, psychological, and biochemical indicators were collected by questionnaire or physical examination. All indicators were evaluated for importance in predicting MAFLD by random forest. A prognostic model based on multivariate regression model was constructed to obtain a prognostic index. All indicators and prognostic index were compared to evaluate their prediction performance in predicting MAFLD by the receiver operating characteristic (ROC) curve, calibration plot, and Decision curve analysis (DCA).ResultsTriglyceride Glucose-Body Mass Index (TyG-BMI), BMI, TyG, triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C), and TG ranked the top five important indicators, and TyG-BMI performed the most accurate prediction of MAFLD according to the ROC curve, calibration plot and DCA. The area under the ROC curves (AUCs) of the five indicators were all over 0.7, with TyG-BMI (cut-off value: 218.284, sensitivity: 81.7%, specificity: 78.3%) suggesting the most sensitive and specific indicator. All five indicators showed higher prediction performance and net benefit than the prognostic model.ConclusionThis epidemiological study firstly compared a set of indicators to evaluate their prediction performance in predicting MAFLD risk among employed adults. Intervention targeting powerful predictors can be helpful to reduce the MAFLD risk among employed adults.

OC-053 LONG-TERM FOLLOW-UP OF A SLOWLY RESORBABLE BIOSYNTHETIC MESH IN VHWG GRADE 3 HERNIA REPAIR

Abstract Background Incisional hernia recurrence occurs frequently after initial repair. In potentially contaminated hernia, these numbers can rise up to 50%. Recently, resorbable meshes have been used to prevent infection in complicated incisional hernia and prevent long term mesh complications. Present study focuses on the long term outcomes of a resorbable mesh. Methods Patients included in the priorly conducted Phasix trial with Ventral Hernia Working Group (VHWG) grade 3 hernia were invited for an abdominal CT scan and physical examination. Primary outcome was hernia recurrence, secondary outcomes comprised of abdominal wall configuration, mesh resorption and long term mesh complications. Results Of the 84 patients included in the 2-year follow-up, 56 were available for long term follow-up up to five years. Mean follow-up time was 4.2 years. CT scan was made in 36 (64.3%) of patients. Kaplan-Meier analysis showed a recurrence rate of 16.7% after five years. Four (7.1%) new recurrences were found between 2-year and 4.2 years follow-up of which three by CT scan. In 50% of CT scans, no signs of postoperative distortions of the abdominal wall were observed. No long term mesh complications were reported. Conclusion After long term follow-up, VHWG 3 hernia repair with biosynthetic mesh demonstrated good performance with regard to hernia recurrence. Possibly, tissue reconstruction took place in the first two years after implantation by the use it or lose it principle, which led to sufficient native abdominal wall strength to prevent recurrences after resorption of the mesh.

Opisthorchis Felineus Infection is a Risk Factor for Cholangiocarcinoma in Western Siberia: A Hospital-based Case-control Study.

Cholangiocarcinoma (CCA), a fatal bile duct cancer, has a high incidence in Western Siberia, Russian Federation. In addition, Opisthorchis felineus, a bile duct-dwelling trematode liver fluke is highly endemic. Closely related species have been shown to be cancerogenic agents in Asia. We therefore examined the association between O felineus infection and CCA in Western Siberia. We conducted a hospital-based, individually matched case-control study between January 2017 and August 2020 in Tomsk Oblast and Khanty-Mansiysk Autonomous Okrug, Yugra, Russian Federation. Histologically confirmed CCA patients (cases) were compared with matched age, sex, and place of residence hospital controls. The examination of study participants included the diagnosis of current and past O felineus infection, abdominal ultrasonographical assessment, physical examination, and interview on exposures to potential risk factors. We identified 40 patients with CCA and 160 controls. Exposures to O felineus infection was strongly associated with CCA (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.4-10.8; P = .008). Also, cases reported more often that they were currently or in the past were infected by O felineus compared with controls (OR, 4.03; 95% CI, 1.7-9.5; P = .001). Furthermore, cases reported river fish consumption and fishing habits significantly more often than controls (OR, 5.5; 95% CI, 1.5-19.8; P = .009 and OR, 3.3; 95% CI, 1.4-7.7; P = .005). The study results revealed a strong significantly increased risk for CCA development in O felineus-infected individuals. Elaboration of the guidelines on screening programs for early CCA diagnosis, prevention, and treatment is socially important in endemic regions.

Spontaneous enteroatmospheric fistula in a patient with COVID-19 disease

Coronavirus 2019 (COVID-19) disease patients present with upper respiratory symptoms; however, these patients may show gastrointestinal symptoms on arrival at the hospital. This finding requires an abdominal physical examination and imaging for 33% of patients. Enteroatmospheric fistulas (EAF) may form a connection between the external environment and the gastrointestinal tract and usually presents various difficulties in controlling the disease without surgical intervention. Its management requires a high level of clinical expertise to control and treat the fistula. In this case report, spontaneous EAF and its management are presented in a 65-year-old morbidly obese female patient who spontaneously had EAF during her hospitalization for COVID-19.

The effect of flipped classroom in multiple clinical skills training for clinical interns on Objective Structured Clinical Examinations (OSCE)

ABSTRACT Aims The flipped classroom (FC) is a hybrid approach, combining online learning and face-to-face classroom activities. To comprehensively evaluate the role of the Flipped Classroom (FC) model in clinical skills teaching of medical interns and investigate the acceptance and recognition of FC and Objective Structured Clinical Examinations (OSCE). Methods In the teaching of clinical skills, the students were further grouped into two groups- A and B (A = 37, B = 42), using a computer-based random digital method. group A adopted the traditional classroom (TC) model, and group B adopted the FC model. OSCE was used to assess the clinical skills of the two groups of interns. Two independent sample t-test was used to analyze the difference of participant’s demographic data and OSCE scores between the two different teaching model. We sent FC questionnaires to group A and OSCE questionnaires to groups A and B. Results The score of OSCE in group B was higher than that in group A (P = 0.024), especially in the heart physical examination (P < 0.050), lung physical examination (P < 0.050), and abdominal physical examination (P < 0.050). The result of the FC questionnaires showed that regarding online courses, most students in group B thought watching videos was a good way to prepare for class (97.6%), For offline courses, most medical interns said that it enhanced their learning ability (88.1%), and they could accept this form of teaching (85.7%). As for the form of OSCE questionnaires, most people in group A and B said that they knew more about this form of assessment (81.0%), that it truly reflected the clinical ability (82.3%). Conclusions FC model has shown good results in clinical skills training, while FC and OSCE can be further promoted in future teaching and assessment.

Achieving physical examination competence through optimizing hands-on practice cycles: a prospective cohort comparative study of medical students.

BackgroundDeliberate practice (DP) was proposed for effective clinical skill training, which highlights focused, repetitive practice and feedback as the key points for practice. Although previous studies have investigated the effect of feedback in DP, little is known about the proper repetitive cycles of clinical skills training especially in physical examination (PE) training.MethodsWe drew learning curves and designed a comparative study to find out the optimal number of hands-on practice cycles, an important aspect of DP, in abdominal PE training for medical students. A comparative study was conducted to validate the optimal number of hands-on practice by dividing students into two cohorts including Cohort A (high-frequency hand-on training) and B (low-frequency hand-on training).ResultsThe learning curve study of 16 students exhibited a threshold of four repetitive practices when 81.25% students reached the competence score. A total of 74 students’ final exam scores were collected for analysis. Students in Cohort A (4–5 PEs) scored significantly higher than those in Cohort B (≤3 PEs) (84.41 ± 11.78 vs 76.83 ± 17.51] in the final exam (P = 0.030)).ConclusionHigh-frequency practice can improve students’ competence of abdominal PE skill. We recommend four cycles of hands-on practice for each student in a training course like PE training.

Active extraperitoneal hematoma in the anterior abdominal wall after blunt injury

A 65-year-old male patient had extraperitoneal hematoma of the anterior abdominal wall after blunt trauma. The patient was treated with conservative management because of stable hemodynamics without deterioration of physical examination and laboratory tests; however, computed tomography revealed active bleeding. In abdominal wall hematoma, physical examination, hemodynamic monitoring, and laboratory tests may be the most important factor in determining a therapeutic plan. Repetitive imaging can be obtained and invasive treatment should be considered if these indices suggest hematoma exacerbation. Patients with abdominal trauma who have altered coagulation status should be carefully monitored for abdominal wall hematoma. Detecting abdominal wall hematoma is important because it may be the clue for potential intra-abdominal organ injury or delayed complication.

Could We Use Vital Signs and Lactate Levels Together to Predict the Prognosis in Abdominal Pain?

Objectives: Abdominal pain occupies most of the emergency department admissions. This entity leads to research various markers for the early detection of causes in patients presenting with abdominal pain. There is limited data about collaborations between lactate levels and vital signs at admission in abdominal pain.&#x0D; Materials and Methods: Patients aged 18 years and older, who had presented with abdominal pain to the Emergency Department, in total 102 patients, were included to the study. The patients’ demographics, vital signs, abdominal physical examination findings, diagnosis and outcomes of patients were recorded. The 1 ml venous blood samples were collected by blood gase injectors from the patients and lactate levels were analyzed.&#x0D; Results: Female patients’ percentile was 68,6% and mean age was 39 years old. The systolic blood pressure levels were normal in 45 patients, low in 26% patients and high in 29% patients. The seventy-six of the patients had normal pulse rate and 26 of them were tachycardic. Most common diagnosis was non-specific abdominal pain (37,25%) and the least common was ovarian torsion/intracystic hemorrhage (0,98%) and obstruction due to hernia (0,98%). There was no statistically significant relation between lactate level and pulse rate (p=0,637), systolic blood pressure (p=0,052), diastolic blood pressure (p=0,095), respiratory rate (p=0,527), body temperature (p=0,040) and oxygen saturation (p=0,905). Similarly, no significant association occurred between lactate levels and diagnosis and outcomes.&#x0D; Conclusion: Further studies including more patients groups have to be done in order to attain more reliable data about this topic.

Prenatal and Postnatal Detection of Fetal Structural Defects by Abdominal Ultrasound and Physical Examination in Azadi Teaching Hospital in Kirkuk City

Background: The prevalence of birth defects increased abruptly in recent years especially in Iraq. The etiology may be related to either genetic or environmental factors. Material & Method: In this cross sectional study that is conducted in Azadi Teaching Hospital in Kirkuk city in Sonographic unit & delivery room. A total of 1814 prenatal fetuses and postnatal newborns with their mothers were involved in this study. All the fetuses or newborns were examined for search of different fetal structural defects. The aim of the study: Was to identify the prevalence of fetal structural defects among pregnant women who attending Azadi Teaching Hospital. Results: Neurological defects were the most frequent detected anomaly (58.8%) followed by skeletal defects (15.4%), (10.3%) for hydropsfetalis, (7.7%) for urinary system defects, (7.7%) for cystic hygroma and only (5.1%) for facial defects. The anomaly detection rate by trans-abdominal ultrasound was (1.9%) during 2nd and 3rd trimesters, and postnatal diagnosis by physical examination was (2.5%). Conclusion: The following factors were found to involve in the etiology of fetal structural defects; family history of congenital anomalies, maternal age, multigravidas mothers, taking tonics and supplements during pregnancy, smoking, living in rural areas finally socioeconomic status.

An unusual lesion of the gallbladder mimicking gallbladder carcinoma

A 59-year-old woman was admitted to our department due to repeated right upper abdominal pain for 4 months and abnormal weight loss of 11 kg within half a year. Abdominal physical examination was unremarkable. Blood routine test, liver function test and electrolyte were normal, but CA199 level slightly increased (63.98 KU/L; reference, < 35). Abdominal CT scan showed focal thickening of gallbladder wall with liver involvement of segment V (Fig. 1A) and multiple hypodense nodules adjacent to gallbladder (Fig. 1B).

An 80 years old woman with acute gastric volvulus.

Gastric volvulus is an abnormal rotation of the stomach around itself. It is a life-threatening condition due to the risk of abs ingestis pneumonia or strangulation and gangren7perforation of the stomach. Imaging as X-ray transit of the first digestive tract or Thoracic CT Scan is usually diagnostic. The population affected ranges from pediatric age group to elderly with multiple co-morbidities. The mortality from acute gastric volvulus is now 15%-20%. An 80-year-old Caucasian man was admitted to Emergency Room of our institution for dysphagia, vomiting and epigastric pain. His past medical history was negative for previous gastrointestinal disease or surgery. He referred only dysphagia for solid food and mild retrosternal pain. On physical examination, the patient was in slight distress. Oxygen saturation on pulse oximetry was 85 %, blood pressure (BP) was 90/75 mmHg while supine, heart rate was 100/min, and the temperature was 36 C. On auscultation, he had breath sounds were bilaterally reduced. His abdominal physical examination was unremarkable. The abdomen was soft, non-tender, mildly distended .White blood tests were in normal range. Computed tomography (CT) scan showed the displacement of the stomach above the gastro esophageal junction; the stomach appeared upside-down with the antrum showing huge gastric distension with no free fluid or air. We performed an explorative laparoscopy which confirmed the intra-thoracic rotation of the stomach. We proceed to release it from its adherence from the thorax to the abdomen and complete the operation with a laparoscopic nissen fundoplication. Postoperative recovery was uneventful. Esophagus transit was normal. At the 3-day, the patient was in good clinical condition and he was discharged.

Petersen's space hernia.

Petersen´s Space Hernia was first described in 1900 by Walther Petersen MD. It is an internal hernia, arising after any type of gastrojejunostomy, in particular, after Roux-en-Y anastomosis. A 49-years-old Caucasian woman was admitted to Emergency Room of our institution complaining of epigastric abdominal crampy pain and alimentary vomiting. Her past medical history highlighted Roux-Y Gastric Bypass for morbid obesity and weight loss of 60kg. Her abdominal physical examination revealed Blumberg sign. Vital signs were normal. White blood tests were in normal range. Body temperature was 36.2°C. CT scan demonstrated a “twist” in the mesentery with “whirlpool sign” of the jejunum. The patient was referred to operating theatre. We performed an exploratory laparotomy, disclosing an incarcerated Petersen´s space Hernia of the common limb, with obstruction of the jejunum. The incarcerated bowel was repositioned and there was no irreversible ischemia, no resection being required. The Petersen´s space was closed with a suture. The post-operative period was unremarkable and the patient was discharged at the fourth post-operative day.

Digitizing abdominal palpation with a pressure measurement and positioning device

An abdominal physical examination is one of the most important tools in evaluating patients with acute abdominal pain. We focused on palpation, in which assessment is made according to the patient’s response and force feedback. Since palpation is performed manually by the examiner, the uniformity of force and location is difficult to achieve during examinations. We propose an integrated system to quantify palpation pressure and location. A force sensor continuously collects pressure data, while a camera locates the precise position of contact. The system recorded, displayed average and maximum pressure by creating a pressure/time curve for computer-aided diagnosis. Compared with previous work on pressure sensors of quantifying abdominal palpation, our proposed system is the integrated approach to measure palpation force and track the corresponding position at the same time, for further diagnosis. In addition, we only make use of a sensing device and a general web camera, rather than commercial algometry and infrared cameras used in the previous work. Based on our clinical trials, the statistics of palpation pressure values and the corresponding findings are also reported. We performed abdominal palpation with our system for twenty-three healthy participants, including fourteen males and nine females. We applied two grades of force on the abdomen (light and deep) by four-quadrant and nine-region schemes, record the value of pressure and location. In the four-quadrant scheme, the average pressures of abdominal palpation with light and deep force levels were 0.506(N) and 0.552(N), respectively. In the nine-region scheme, the average pressures were 0.496(N) and 0.577(N), respectively. Two episodes of contact dermal reaction were identified. According to our experiment statistics, there is no significant difference in the force level between the four-quadrant and nine-region scheme. Our results have the potential to be used as a reference guide while designing digital abdominal palpation devices.

Test characteristics of focused assessment with sonography for trauma (FAST), repeated FAST, and clinical exam in prediction of intra-abdominal injury in children with blunt trauma.

In children with blunt abdominal trauma (BAT), focused assessment of sonography in trauma (FAST) has been reported with low sensitivity, on the whole, in the detection of intra-abdominal injuries (IAI). The aim of the present study was to assess test characteristics of FAST using different strategies including repeated FAST (reFAST), and physical exam findings. This retrospective study evaluated BAT pediatric patients with stable hemodynamics who underwent computed tomography (CT). Demographic data, initial physical examination, and results of FAST, reFAST (if done), and CT imaging were recorded. Different strategies of FAST were cross-tabulated with CT as the gold standard and test characteristics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were interpreted. 129 patients with a mean age of 8.6 ± 4.7 were studied and 74% were male. Comparing CT-positive and -negative groups, from the demographic and clinical findings, only positive physical exam (tenderness or ecchymosis) was significantly higher in the CT-positive group (59% vs. 17%; p < 0.01). In a multivariate analysis, positive FAST modality and clinical exam remained independent predictors for a positive CT result (likelihood ratios of 34.6 and 6.4, respectively). Out of the different diagnostic strategies for the prediction of IAI, the best overall performance resulted from the FAST-reFAST-tenderness protocol with sensitivity, specificity, PPV, NPV, and accuracy of 87%, 77%, 70%, 91%, and 81%. For children with blunt abdominal trauma, physical examination plus FAST and reFAST as needed, seems to have reasonable sensitivity, specificity, and accuracy in detecting intra-abdominal injuries and may reduce the need for CT scans.

Ultrasound evaluation of schistosomiasis-related morbidity among the Xakriabá people in the state of Minas Gerais, Brazil.

ObjectiveTo use ultrasound to investigate the morbidity related to schistosomiasis in the Xakriabá indigenous population.Materials and MethodsThis was a field-based census study conducted in the territory of the Xakriabá people. A total of 166 individuals were invited, and 148 (≤ 77 years of age) agreed to participate. Most participants underwent abdominal ultrasound, physical examination, and stool examination. Mann-Whitney U and chi-square tests were used for comparisons. We determined risk by calculating odds ratio (OR) and performed logistic regression analysis.ResultsSchistosoma mansoni eggs were found in 31 (26.7%) of the 116 stool samples examined, 22 (70.9%) of the 31 being from individuals 4-16 years of age. The median count was 144 eggs/g of feces (interquartile range, 264). Of the 105 participants examined with ultrasound, 68 (64.8%) had hepatomegaly (left lobe), 6 (5.7%) had splenomegaly, and 4 (3.8%) had portal hypertension. Egg-positive stool samples were more common in those with an enlarged left lobe (OR = 3.4; 95% confidence interval (CI): 1.1-11.2; p = 0.043). Periportal fibrosis was found in 30 participants (28.6%), of whom 9 (30%) had pattern C, 10 (33.3%) had pattern D, and 11 (36.7%) had pattern Dc. Age was the only independent risk factor for fibrosis (p = 0.007). Fibrosis was up to nine-fold more common in alcohol drinkers than in nondrinkers (OR = 9.28; 95% CI: 2.60-33.06; p < 0.001). Among the 138 participants in whom the clinical form was classified, the chronic hepatic form was identified in 54 (39.1%), of whom 32 (59.2%) were under 30 years of age and one (1.8%) was hepatosplenic.ConclusionSchistosomiasis in the Xakriabá population is characterized by a high frequency of egg-positive stool samples, predominantly in children/adolescents, and by chronic hepatic form in the young, especially among alcohol drinkers.

Determination of factors associated with perforation in patients with geriatric acute appendicitis.

Recognition and management of abdominal emergencies in geriatric patients are more complicated compared to the younger population. We aimed to investigate the demographic characteristics of geriatric patients diagnosed with acute appendicitis and to investigate the factors associated with perforation in the early stages in this study. After obtaining local ethical committee approval, patients 65 years and older who had appendectomy between January 2015 and December 2019 were included the study. Demographic data of the patients, physical examination findings, and laboratory results were analyzed. Patients were divided into two groups based on surgical reports: Perforated and simple appendicitis. During the study period, 72 patients were evaluated. In our study, 48.6% of the patients were male, and the median age was 71.5 years (IQR 25-75, 68-80). Perforated appendicitis was detected in 28% of the patients. We were determined that the vast majority of patients with perforated appendicitis were male; had more frequent chronic kidney disease and post-operative local complications; had increased leukocytes, neutrophils, blood urea nitrogen, creatinine, and total bilirubin; and had reduced albumin; and these differences were statistically significant (all values p<0.05). Multivariate analysis shows increased neutrophil count and male sex was significantly associated with perforated appendicitis (p=0.035 and p=0.01, respectively). Geriatric patients with chronic kidney disease can be at higher risk of perforated appendicitis due to inadequate abdominal physical examination results. In addition, male gender and an elevated neutrophil count are independent predictors of perforation.