11^th International Congress on Clinical and Medical Case Reports September 14-15, 2020 Vienna, Austria

Biography:

Neringa Musteikaite has completed her medicine from Lithuanian university of Health Sciences and she is pursuing her Pathologist Resident from Lithuanian university of Health Sciences. She is the member of Lithuanian Society of Pathology. She has presented an oral report at the conference organised by Lithuanian Society of Pathology.  

Abstract:

Pancreatic disease can rarely express itself by extra-abdominal pathological processes. The symptomatic triad of pancreatic disease, panniculitis and polyarthritis, also known as PPP syndrome, is characterized by severe chronic episodes and high mortality rate. The pathognomic hallmark of PPP syndrome is fat necrosis in affected tissues. It is essential to identify its indicators due to complicated diagnosis procedure as a result of absent or mild abdominal symptoms. We report a case of 58-year-old male with a history of acute pancreatitis 1 years ago, admitted to University Hospital because of progressing feet joint arthritis, panniculitis, and febrile fever with chills lasting for approximately 2 weeks. Significantly increased levels of plasma lipase and α-amylase with inflammatory changes of blood and ascitic fluid were identified by laboratory testing, although patient did not complain of pancreatitis clinical symptoms. Inflammatory features of joints and surrounding soft tissues were detected during palmar ultrasound. Skin biopsy was not informative. Ascites, excessive oedematous changes in multiple organs were identified, whereas no pancreatic parenchymal changes were observed. Patient did not respond to applied treatment, and he died. Predominate peripancreatic steatonecrosis, superior mesenterial vein necrosis with perforation complicated by extensive steatonecrosis at omentum, liver, colon, local lymph nodes, and subcutaneous tissues were identified during an autopsy. Finally, this condition was named as PPP syndrome. Knowledge of association between panniculitis and polyarthritis with acute pancreatic disease may lead to a prompt diagnosis and management. Histopathological features of skin lesions can be a valuable clue for focusing attention to a pancreatic disease.

 

Biography:

Bishow Bekhyat Karki is currently working as a General Surgeon from University Hospitals of Leicester NHS Trust, UK

 

Abstract:

Background: Correctly performed informed consent acts as a shield against complaints by patients and claims of malpractice against the doctors. Laparoscopic Appendectomy accounts for a significant portion of general surgical workload hence shows a difference in the patient consenting. The purpose of this study is to to compare the variations in consenting practice amongst Foundation Year 2 Doctor (FY2) , Core Surgical Trainees (CT)  and Specialist Registrar(SpR) for Laparoscopic Appendectomy with specific reference to the documentation of significant risks of surgery.

Methodology: A proforma was devised which included information like significant and/or commonly recognised complications of Laparoscopic Appendectomy as well as grade of the consenting medical professional.  The proforma containing 10 standard complications 5 major and 5 minor) was then cross-referenced with the consent forms of 38 patients and the documented risks in each form was noted.

Findings: The result showed a wide variation in the documentation of complications based on the grades of the medical professional. Out of 38 consent forms, 32 (84.21 %) were completed by Junior Grade Doctors out of which 15 by FY2 and 17 by Core Surgical Trainees and 6/38 (15.78 %) by SpR. Of the set standard 10 complications, FY2 documented an average of 4.2, Core Trainees documented 6.2 and ST3+ documented 8.16 complications.

Conclusion and Significance: There is a need of improvement in the documentation of complications especially among Junior Doctor which require proper intervention either by conducting a consenting workshop or using a Procedure specific consent (PSCF) which can significantly improve consenting practice for a standardised list of complications and act as a source of information for the patient and a prompt to discuss the risks.

 

Biography:

Bishow Bekhyat Karki is currently working as a General Surgeon from University Hospitals of Leicester NHS Trust, UK

Abstract:

Background: The United Kingdom now has one of the highest death rates from COVID 19, with over 40,000 deaths (1). It has been posited that the identification of care workers with immunity or increased resistance could be important in developing future strategies.

Methods: This was a retrospectively conducted survey of general surgical staff at a tertiary surgical unit.

Results: We surveyed 215 staff that had undergone antibody testing. Of the: 175/215 who reported contact with COVID-19 positive patients, 6/215 had a positive PCR result and 15/215 reported a positive antibody test. Only 3/6 that had a positive PCR test demonstrated antibodies.

Conclusion: Our “immunity” rate of 7% is extremely low and is concerning especially in respect of the anticipated “herd immunity” which would mitigate many of the issues presently being confronted and it is likely to be many months at least before this makes a realistic contribution. Continued testing for the presence of COVID-19 antibodies will contribute to crucial sero prevalence data that can be used by public health bodies whose advice will necessarily evolve as increasing data sets become available.