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Mithany RH, Shaikh A, Scott C, Abdalla M, Graham M, Gerogiannis IN. Can Salmonella typhi Cause Acute Appendicitis? Cureus 2024; 16:e53213. [PMID: 38425622 PMCID: PMC10902744 DOI: 10.7759/cureus.53213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Salmonella typhi, commonly known for causing typhoid fever, is recognized as a bacterium responsible for a wide range of gastrointestinal and systemic infections. While its systemic manifestations have been well-documented, its association with localized gastrointestinal complications, such as appendicitis, remains relatively rare and less explored. This case report presents a compelling clinical case of a 55-year-old patient who presented with symptoms of gastrointestinal distress and was diagnosed with S. typhi-induced appendicitis. The patient's history, clinical presentation, laboratory investigations, radiological findings, management, and outcomes are thoroughly discussed. The report also touches upon the broader context of appendicitis etiology and highlights the significance of prompt diagnosis and intervention in cases of Salmonella-induced appendicitis.
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Affiliation(s)
- Reda H Mithany
- Laparoscopic Colorectal Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
| | - Amarah Shaikh
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
| | - Catherine Scott
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
| | - Mazin Abdalla
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
| | - Matthew Graham
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
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Jones RP. Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System. Int J Environ Res Public Health 2023; 20:7171. [PMID: 38131722 PMCID: PMC11080941 DOI: 10.3390/ijerph20247171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Based upon 30-years of research by the author, a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 people is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem, a new approach to bed modeling has been developed that plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with a higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence of overutilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, and surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.
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The SMML, van Amstel P, Noordzij SM, Bakx R, Bijlsma TS, Derikx JPM, van Heurn LWE, van der Kuip M, Gorter RR. Trends in Simple and Complex Appendicitis in Children and the Potential Correlation to Common Viral Pathogens-A Retrospective Cohort Study between 2010 and 2019 in The Netherlands. Children (Basel) 2023; 10:1912. [PMID: 38136114 PMCID: PMC10741496 DOI: 10.3390/children10121912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
The aim of this study was to evaluate the annual, seasonal and monthly trends in children with simple and complex appendicitis and their correlation to common viral pathogens in the Netherlands. A consecutive multicenter retrospective cohort study was performed between 2010 and 2019 including children (<18 years) surgically treated for appendicitis. The primary outcome was the distribution of children with simple and complex appendicitis per year, season and month. Relevant seasonal variation was defined as ≥5%. The secondary outcome was a positive correlation of the number of patients with simple and complex appendicitis to common viral pathogens (data anonymously provided by the Dutch Working Group on Clinical Virology from the Dutch Society for Clinical Microbiology (NVMM)). In total, 896 patients were included: N = 524 (58%) patients with simple and N = 372 (42%) with complex appendicitis. Of the children aged 0-5 years, 81% had complex appendicitis, versus 38% in 6-18 years (p < 0.001). An overall decline was demonstrated for both simple and complex appendicitis between 2010 and 2019. No seasonal variation was found for simple appendicitis. For complex appendicitis, the highest number of patients was found in spring, and lowest in summer (N = 372, spring 28.2 ± 5.1% versus summer 21.0 ± 5.8%, p = 0.011), but the variance was regarded as not relevant (<5% from baseline). A positive correlation was found between complex appendicitis with Adenovirus 40.41 (R = 0.356, 95%CI 0.045-0.604, p = 0.026) and simple appendicitis with Adenovirus NON 40.41 (R = 0.332, 95%CI 0.019-0.586, p = 0.039), but these correlations did not remain significant after a Bonferroni correction (p < 0.003). In conclusion, we found no relevant seasonal variation for simple or complex appendicitis, nor positive correlation with common viral pathogens.
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Affiliation(s)
- Sarah-May M. L. The
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.-M.M.L.T.); (P.v.A.); (S.M.N.); (R.B.); (J.P.M.D.); (L.W.E.v.H.)
- Amsterdam Reproduction and Development Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Paul van Amstel
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.-M.M.L.T.); (P.v.A.); (S.M.N.); (R.B.); (J.P.M.D.); (L.W.E.v.H.)
- Amsterdam Reproduction and Development Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Sophie M. Noordzij
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.-M.M.L.T.); (P.v.A.); (S.M.N.); (R.B.); (J.P.M.D.); (L.W.E.v.H.)
- Department of Surgery, Northwest Hospital, 1815 JD Alkmaar, The Netherlands;
| | - Roel Bakx
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.-M.M.L.T.); (P.v.A.); (S.M.N.); (R.B.); (J.P.M.D.); (L.W.E.v.H.)
- Amsterdam Reproduction and Development Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Taco. S. Bijlsma
- Department of Surgery, Northwest Hospital, 1815 JD Alkmaar, The Netherlands;
| | - Joep. P. M. Derikx
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.-M.M.L.T.); (P.v.A.); (S.M.N.); (R.B.); (J.P.M.D.); (L.W.E.v.H.)
- Amsterdam Reproduction and Development Research Institute, 1081 HV Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, 1081 HV Amsterdam, The Netherlands
| | - L. W. Ernest van Heurn
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.-M.M.L.T.); (P.v.A.); (S.M.N.); (R.B.); (J.P.M.D.); (L.W.E.v.H.)
- Amsterdam Reproduction and Development Research Institute, 1081 HV Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Martijn van der Kuip
- Department of Pediatric Infectious Diseases and Immunology, Emma Children’s Hospital, Amsterdam UMC, Amsterdam Infection & Immunity Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Ramon R. Gorter
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.-M.M.L.T.); (P.v.A.); (S.M.N.); (R.B.); (J.P.M.D.); (L.W.E.v.H.)
- Amsterdam Reproduction and Development Research Institute, 1081 HV Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, 1081 HV Amsterdam, The Netherlands
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Arredondo Montero J, Torres López A, Hurtado Ilzarbe G, Antona G, Ros Briones R, López-Andrés N, Martín-Calvo N. Flow cytometric characterization of cecal appendix lymphocyte subpopulations in children: a pilot study. Pediatr Surg Int 2023; 39:274. [PMID: 37736768 PMCID: PMC10516785 DOI: 10.1007/s00383-023-05558-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Scientific literature regarding the characterization of lymphocyte subpopulations of the cecal appendix is sparse, with few precedents limited to immunohistochemical techniques. METHODS We conducted a prospective pilot study to characterize lymphocyte subpopulations of the cecal appendix in children. Participants were divided into three groups: (1) patients without histological acute appendiceal inflammation, (2) patients with histological uncomplicated acute appendicitis, and (3) patients with histological complicated acute appendicitis (gangrenous, perforated). A fresh sample of the base of the appendix was taken from all patients and a flow cytometric study was performed. Quantitative variables were compared using Kruskal-Wallis test and Mann-Whitney U test. RESULTS This study included 57 patients divided into Group 1 (n = 5), Group 2 (n = 37), and Group 3 (n = 15). Median values (IQR) of the percentage of B-lymphocytes were 67.8 [66.8-68.1] in group 1, 61.15 [53.74-66.4] in group 2, and 52.1 [33-62.02] in group 3 (p = 0.02). Median values (IQR) of the percentage of NK-lymphocytes were 0.26 [0.2-0.3] in group 1, 0.55 [0.37-0.66] in group 2, and 0.84 [0.35-1.45] in group 3 (p = 0.008). Median values (IQR) of the percentage of T-lymphocytes were 31.9 [31.7-33.1] in group 1, 37.68 [32.15-45.69] in group 2, and 46.9 [37.03-67] in group 3 (p = 0.02). Pair comparisons of groups 2 and 3 also showed significant differences in the percentage of B lymphocytes (p = 0.03) and NK-lymphocytes (p = 0.02). CONCLUSIONS Significant differences in lymphocyte subpopulations were identified according to the histologic grade of the cecal appendix. More specifically, a lower percentage of B-lymphocytes and a higher percentage of T- and NK-lymphocytes were observed in cases of acute appendicitis. These findings must be confirmed and their etiopathogenic, diagnostic, and prognostic implications elucidated in future studies with larger sample sizes.
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Affiliation(s)
- Javier Arredondo Montero
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
- Preventive Medicine and Public Health Department, School of Medicine, University of Navarra, Pamplona, Navarra, Spain.
| | - Andrea Torres López
- Hematology and Haemotherapy Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | | | - Giuseppa Antona
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Raquel Ros Briones
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Natalia López-Andrés
- Cardiovascular Translational Research, NavarraBiomed (Miguel Servet Foundation), Hospital Universitario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
| | - Nerea Martín-Calvo
- Preventive Medicine and Public Health Department, School of Medicine, University of Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Health Institute Carlos III, Madrid, Spain
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