Search

Introduction: Determining which patients who meet systemic inflammatory response syndrome (SIRS) criteria have bacterial sepsis is a difficult challenge for emergency physicians. We sought to determine whether the neutrophil-to-lymphocyte ratio (NLR) could be used to exclude bacterial sepsis in adult patients who meet ≥2 SIRS criteria and are being evaluated for sepsis. Methods: Consenting adult patients meeting ≥2 SIRS criteria and undergoing evaluation for sepsis were enrolled. We recorded patient age, gender, vital signs, and laboratory results. We then later reviewed health records for culture results, end organ dysfunction, survival to discharge, and final diagnoses.Patients were classified as having sepsis if they met ≥2 SIRS criteria and were ultimately diagnosed with a bacterial source. We analyzed data using descriptive statistics and sensitivity and specificity analyses. A receiver operating characteristic curve (ROC) was created to determine test characteristics. Results: A total of 231 patients had complete datasets. Patients’ median age was 69 (interquartile range [IQR] 54–81), and 49.6% were male. There were 154 patients (66.7%) ultimately diagnosed with sepsis with an identified bacterial source, while 77 patients with ≥2 SIRS criteria had non-infectious reasons for their presentations (33.3%). Septic patients had a median NLR 12.36 (IQR [interquartile range] 7.29–21.69), compared to those without sepsis (median NLR 5.62, IQR 3.89–9.11, P < 0.001). The NLR value of 3 applied as a cutoff for sepsis had a sensitivity of 96.8 (95% confidence interval [CI] 92.2–98.8), and a specificity of 18.2 (95% CI 10.6–29.0). The ROC for NLR had an area under the curve of 0.74. Conclusion: The neutrophil-to-lymphocyte ratio is a sensitive tool to help determine which patients with abnormal SIRS screens have bacterial sepsis.

La sepsis desencadena una reacción en cadena en el organismo debido a una infección produciendo una respuesta incontrolada que puede acabar en fallo multiorgánico y la muerte. Para facilitar los diagnósticos se han creado diferentes sistemas para detectar de forma temprana diferentes patologías, se trata de escalas conocidas como Early Warning Scores (EWS) o escalas de alerta temprana. El objetivo de este trabajo es conocer la eficacia diagnóstica de las EWS utilizadas en pacientes con sepsis en servicios de urgencias y emergencias con posibilidad de ingreso en UCI. Se realizó una revisión sistemática y metaanálisis. La base de datos utilizada fue PubMed, seleccionando finalmente 10 artículos. Debido a la gran variedad de escalas diagnósticas, nos centramos en qSOFA, NEWS/NEWS2 y SIRS, y como resultado el ingreso en UCI. Para realizar el me-taanálisis se utilizaron fórmulas matemáticas para obtener los datos reales de pacientes afectados. Se empleó el test de Deek para conocer la existencia de riesgo de sesgo de publicación. Para conocer la evidencia de la calidad de los artículos se utilizó la herramienta QUADAS-2. Un total de 344.724 pacientes fueron estudiados, de los cuales 33.502 fueron ingresos en UCI. La sensibilidad para qSOFA, NEWS/NEWS2 y SIRS fue de 0.31, 0.51 y 0.69 y la especificidad 0.92, 0.91 y 0.44 respectivamente. Presentaron un AUROC de qSOFA=0.73, NEWS/NEWS2=0.79 y SIRS=0.58, encontrando que NEWS/NEWS2 fue la que mejor resultados obtuvo. Las tres escalas analizadas muestran efectividad para el ingreso en UCI de pacientes con sepsis, obteniendo que NEWS/NEWS2 tuvo los mejores resultados a pesar de no ser una escala creada específicamente para la detección del paciente con sepsis., Grado en Enfermería

Bakgrund: Sepsis är ett tillstånd som årligen drabbar ca 50.000 personer i Sverige. Tillståndet har en hög dödlighet och de som överlever sepsis riskerar långtidskomplikationer efter tillfrisknande. Vanliga symtom vid sepsis är andfåddhet, kräkningar, smärta, feber, frossa och påverkat mental status. Dock kan sepsis vara svårt att identifiera då symtomen ibland är diffusa. Tidig behandling med antibiotika räddar liv. Screeningverktyg som används inom ambulanssjukvården i Region Halland för att identifiera sepsis är qSOFA (Quick Sequential Organ Failure Assessment) och SIRS (Systemic Inflammatory Response Syndrome). Syfte: Syftet med studien var att undersöka patientkarakteristiska, dödlighet och slutdiagnos hos patienter som triagerats med ESS 44/47 (misstänkt infektion) och ESS 53 (ospecifika symtom) av ambulanspersonal samt patienter som har en positiv qSOFA eller SIRS. Syftet var även att undersöka förekomsten av patienter där ambulanspersonal haft infektionsmisstanke (ESS 44/47) men inte förvarnat (orange, gul eller grön prioritet) in till sjukhus trots positiv qSOFA. Metod: Studien är en kvantitativ retrospektiv journalgranskningsstudie. Den inkluderade populationen var ambulansuppdrag inom Region Halland mellan 2019 och 2022 som triagerats med ESSkoderna 44, 47 och 53. 4860 ambulansuppdrag inkluderades i studien. Resultat: 63% i gruppen ESS 44/47 och 30% i ESS 53 fick en infektionsdiagnos på akutmottagningarna. Ur hela populationen lades 83% in på sjukhus och 15% avled inom 30 dagar. Högsta dödligheten identifierades bland qSOFA positiva (36%) vilket var signifikant högre än dödligheten bland de med positiv SIRS. Slutsats: Majoriteten av populationen läggs in på sjukhus, vilket speglar vårdbehovet. Dödligheten är hög vilket ställer höga krav på den prehospitala vården. Vid sepsis är tid till behandling det som räddar liv, något som prehospital sjukvårdspersonal kan vara med och påverka.

Bakgrund: Sepsis är ett tillstånd som årligen drabbar ca 50.000 personer i Sverige. Tillståndet har en hög dödlighet och de som överlever sepsis riskerar långtidskomplikationer efter tillfrisknande. Vanliga symtom vid sepsis är andfåddhet, kräkningar, smärta, feber, frossa och påverkat mental status. Dock kan sepsis vara svårt att identifiera då symtomen ibland är diffusa. Tidig behandling med antibiotika räddar liv. Screeningverktyg som används inom ambulanssjukvården i Region Halland för att identifiera sepsis är qSOFA (Quick Sequential Organ Failure Assessment) och SIRS (Systemic Inflammatory Response Syndrome). Syfte: Syftet med studien var att undersöka patientkarakteristiska, dödlighet och slutdiagnos hos patienter som triagerats med ESS 44/47 (misstänkt infektion) och ESS 53 (ospecifika symtom) av ambulanspersonal samt patienter som har en positiv qSOFA eller SIRS. Syftet var även att undersöka förekomsten av patienter där ambulanspersonal haft infektionsmisstanke (ESS 44/47) men inte förvarnat (orange, gul eller grön prioritet) in till sjukhus trots positiv qSOFA. Metod: Studien är en kvantitativ retrospektiv journalgranskningsstudie. Den inkluderade populationen var ambulansuppdrag inom Region Halland mellan 2019 och 2022 som triagerats med ESSkoderna 44, 47 och 53. 4860 ambulansuppdrag inkluderades i studien. Resultat: 63% i gruppen ESS 44/47 och 30% i ESS 53 fick en infektionsdiagnos på akutmottagningarna. Ur hela populationen lades 83% in på sjukhus och 15% avled inom 30 dagar. Högsta dödligheten identifierades bland qSOFA positiva (36%) vilket var signifikant högre än dödligheten bland de med positiv SIRS. Slutsats: Majoriteten av populationen läggs in på sjukhus, vilket speglar vårdbehovet. Dödligheten är hög vilket ställer höga krav på den prehospitala vården. Vid sepsis är tid till behandling det som räddar liv, något som prehospital sjukvårdspersonal kan vara med och påverka.

Background: The risk of mortality should be assessed in all patients admitted to the Paediatric Intensive Care Unit (PICU). Procalcitonin (PCT) is a valuable biomarker in the diagnosis of sepsis in the PICU. Its use as a prognostic marker has been widely investigated with conflicting results. This study was done to assess the association between PCT and outcomes in the PICU in our setting thereby investigating its prognostic capabilities. Objectives: The primary objectives were to determine the admission PCT, the PCT between 48 – 72 hours of admission, and the PCT change within this time frame, of patients admitted to the PICU at two tertiary hospitals within the Bloemfontein academic complex as well as their primary (PICU mortality) and secondary (length of PICU stay, number of ventilatory days) outcomes. The secondary objectives were to compare these PCT trends with the primary and secondary outcomes. Methods: The study was a retrospective analytical cross-sectional medical record review of patients, between 1 to 60 months of age, who were admitted to the PICU within the Bloemfontein academic hospital complex from 01 January 2017 to 31 December 2018. Admission PCT and trends within 72 hours of admission were compared to the participant outcomes (PICU mortality, length of PICU stay and number of ventilator days). Data was obtained from the participants electronic and paper medical records and the National Health Laboratory Services database. De-identified data was submitted for analysis by the Department of Biostatistics, University of Free State. Results: 381 participants were included in the study. 55 participants died. 220 required mechanical ventilation. The median length of PICU stay was 6 days. Non-survivors had a higher median admission PCT (13.94ng/ml, IQR 1.0 – 100.0) than survivors (1.45ng/ml, IQR 0.36 – 13.08) (p<0.0001, 95% CI 1.28 – 15.12). Non-survivors had a higher median PCT at 48-72(12.79ng/ml, IQR 2.08 – 100.00) hours than survivors (1.31ng/ml, IQ

Objective: To evaluate the prediction of mortality using the qSOFA scale and other clinical indicators in patients with sepsis, in the intensive care unit in a health institution of the public network of the City of Barranquilla, between July 2020 and February 2021. Methods: An analytical, longitudinal, prospective study was conducted. With the information obtained, the database was performed in Excel, and then, an univariate and multivariate analysis to describe the best predictor of mortality in sepsis. Results: Of 101 cases, 82% (n=83) had septic shock, the most common presentation in males with 61% (n=64), with a greater frequency of socioeconomic stratum 1, most of them were sepsis acquired in community 81% (n=85), with a Charlson comorbidity index of 3.4 ± 3.0. Serial measurements of lactate and CRP had no statistically significant relationship with mortality. The value of q-SOFA presented a statistically significant association with mortality (p < 0.05), high q-SOFA values have twice the risk of death (OR = 2.16; 95% CI = 1.08 – 4.33). Sensitivity of 68.6% and specificity of 48.4%, PPV of 76% and VPN of 34.37% Conclusion: The qSOFA score was found to be the best predictor of mortality in sepsis compared to SIRS, SOFA, PCR and Lactate., Objetivo: Evaluar la predicción de mortalidad mediante la escala qSOFA y otros indicadores clínicos en pacientes con sepsis, en el servicio de terapia intensiva en una institución de salud de la red pública de la Ciudad de Barranquilla, entre Julio de 2020 a febrero de 2021. Métodos: Se realizó un estudio analítico, longitudinal, prospectivo. Con la información obtenida, se realizó la base de datos en Excel, y un análisis univariado y multivariado para describir el mejor predictor de mortalidad en sepsis. Resultados De 101 casos, el 82% (n=83) tenían shock séptico, mayor presentación en el sexo masculino con 61% (n=64), con mayor frecuencia de estrato socioeconómico 1, la mayoría fueron sepsis adquirida en comunidad 81% (n=85), con un índice de comorbilidad de Charlson de 3,4 ± 3,0. Las mediciones seriadas del lactato y de la PCR, no tuvieron relación estadísticamente significativa con mortalidad. El valor de q-SOFA presentó una asociación estadísticamente significativa con la mortalidad (p < 0,05), valores de q-SOFA elevados tienen el doble de riesgo de muerte (OR = 2,16; IC 95% = 1,08 – 4,33). Sensibilidad de 68,6% y especificidad de 48,4%, VPP de 76% y VPN de 34,37%. Conclusión: La escala qSOFA se encontró como el mejor predictor de mortalidad en sepsis comparado con SIRS, SOFA, PCR y Lactato.

Pediatric sepsis continues to be one of the main causes of mortality in low and middle-income countries, its early recognition in emergencies requires the use of criteria that allow us to predict the severity of the patient. Objective : our study aims to compare the SIRS criteria and qSOFA regarding its discriminatory capacity in mortality in children with sepsis. Methods: a prospective multicenter study was carried out in emergency services enrolling children with suspected sepsis subsequently admitted to the PICU, in which the scores in qSOFA and SIRS were evaluated comparing them with the results at hospital discharge. Results: 64 patients were enrolled, admitted in emergency in Sepsis (19%), Septic Shock (20.6%) and with Multiple Organ Dysfunction (60.4%) stage, with a mortality respectively of 9.5% and 14.3% and 76.2%; germ could be rescued in 33.9% of the cases; Evaluating the SIRS criteria, we see that the absence of them is associated with lower mortality (p = 0.044; OR 0.618: 95% CI 0.502-0.761); otherwise, 2 or more qSOFA criteria are associated with higher mortality (p = 0.047 ; OR 3.52: 95% CI 1.090-11.371). Conclusion: both criteria used to define sepsis in pediatrics demonstrated their usefulness, the use of the qSOFA score given its close relationship with mortality can be used to anticipate life-threatening organ alterations., La sepsis pediátrica continúa siendo una causa importante de mortalidad en países de bajos y medianos ingresos, su reconocimiento temprano en emergencias requiere del uso de criterios que nos permitan predecir anticipadamente la gravedad del paciente. Objetivo: nuestro estudio pretende comparar los criterios de SIRS y qSOFA en cuanto a su capacidad discriminatoria en mortalidad en sepsis pediátrica. Métodos: realizamos un estudio multicéntrico, prospectivo en servicios de emergencias incluyendo niños con sospecha de sepsis subsecuentemente ingresados a UTIP, en los cuales se evaluaron los puntajes en SIRS y qSOFA comparándolos con los resultados al egreso. Resultados: se enrolaron 64 pacientes, admitidos en estadios de Sepsis (19%), Shock Séptico (20,6%) y con Disfunción Multiorgánica (60,4%), con una mortalidad respectivamente de 9,5%, 14,3% y 76,2%; en 33,9% de los casos se pudo rescatar algún germen. Evaluando los criterios SIRS vemos que la ausencia de ellos se asocia con mayor sobrevivencia (p=0,044; OR 0,618: IC95% 0,502-0,761), Por otro lado, 2 o más criterios qSOFA se asocia con mayor mortalidad (p=0,047; OR 3,52: IC95% 1,090-11,371). Conclusión: ambos criterios utilizados para definir sepsis en pediatría demostraron su utilidad, el uso del score qSOFA dada a su estrecha relación con la mortalidad puede emplearse para anticipar alteraciones orgánicas potencialmente mortales.

The discovery of inflammasomes has enriched our knowledge in the pathogenesis of multiple inflammatory diseases. The NLR pyrin domain-containing protein 3 (NLRP3) has emerged as the most versatile and well-characterized inflammasome, consisting of an intracellular multi-protein complex that acts as a central driver of inflammation. Its activation depends on a tightly regulated two-step process, which includes a wide variety of unrelated stimuli. It is therefore not surprising that the specific regulatory mechanisms of NLRP3 inflammasome activation remain unclear. Inflammasome-mediated inflammation has become increasingly important in acute pancreatitis, an inflammatory disorder of the pancreas that is one of the fatal diseases of the gastrointestinal tract. This review presents an update on the progress of research into the contribution of the NLRP3 inflammasome to acute pancreatic injury, examining the mechanisms of NLRP3 activation by multiple signaling events, the downstream interleukin 1 family of cytokines involved and the current state of the literature on NLRP3 inflammasome-specific inhibitors.

Background Paradoxical reaction after the initiation of tuberculosis treatment is defined as increased inflammation following effective antimycobacterial treatment. This is a phenomenon that can severely complicate a patient's recovery, potentially leading to further morbidity and residual deficits. Paradoxical reaction remains poorly understood regarding its pathophysiology and management. Only a limited number of reports look critically at the available therapeutic options, with evidence of the efficacy of prednisolone therapy being primarily limited to extrapulmonary PR only. Case We describe two HIV negative patients who were admitted to our department with pulmonary tuberculosis, presenting with inflammatory patterns attributable to PR and their response to adjunctive steroid therapy. Discussion and Conclusions The presented cases further highlight the need for immunological studies and randomized trials for corticosteroid therapy are needed to better understand this phenomenon as well as provide an evidence-base for anti-inflammatory treatment. Furthermore, by means of this case series, we are also able to highlight the potential variability in the symptomatology of the lesser known PR phenomenon, in which we observed a hypotensive shock-like syndrome not previously described in literature.

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Bakgrund: Sepsis erfordrar att tidiga behandlingsåtgärder initieras, annars riskerar patienten utstå svåra komplikationer som i värsta fall kan leda till döden. Då sjukdomstillståndet uttrycks genom diffusa symtom kan denna tidiga initiering av behandlingsåtgärder vara svår, vilket ställer höga krav på vårdpersonalens kunskap. Syfte: Att kartlägga vårdpersonalens kunskaper gällande definition, identifiering och hantering av sepsis i ett tidigt skede inom akutsjukvården. Metod: Litteraturstudie baserad på nio kvantitativa artiklar. Databassökningar genomfördes i CINAHL, PubMed, Scopus och Web of science. Artiklarna är kvalitetsgranskade och analyserade med Fribergs analysmodell och sammanställd i text samt i tabeller. Resultat: Kunskapsbrister redovisas. Professionerna med högre utbildningsnivå redovisar högre kunskapsnivåer. Lägst kunskapsnivåer redovisas gällande minskad kroppstemperatur, vätskeinfusion, vasopressorer och mätning av laktat- och leukocyter. Konklusion: Genom kontinuerlig och uppdaterad utbildning, implementering av evidensbaserade riktlinjer och ett bra teamarbete kan minska mortaliteten. Senges teori om lärande organisationer visar på vikten av teamarbetet. Vidare forskning bör fokusera på hur kunskapsnivåerna kan förbättras då resultatet redovisar kunskapsbrist hos vårdpersonal., Background: Sepsis requires that early treatment measures are initiated, otherwise the patient risks enduring severe complications which in the worst case can lead to death. As the disease state is expressed through diffuse symptoms, this early initiation of treatment measures can be difficult, which places high demands on the care staff’s knowledge. Aim: To map the care staff’s knowledge regarding definition, identification and management of sepsis at an early stage in emergency care. Method: Literature study based on nine quantitative articles. Database searches were performed in CINAHL, PubMed, Scopus and Web of science. The articles are quality reviewed and analyzed with Friberg's analysis model and compiled in text and tables. Results: Knowledge gaps are reported. The professions with a higher level of education report higher levels of knowledge. The lowest levels of knowledge are reported regarding reduced body temperature, fluid infusion, vasopressors and measurement of lactate and leukocytes. Conclusion: Through continuous and updated training, implementation of evidence-based guidelines and good teamwork can reduce mortality. Seng's theory of learning organizations shows the importance of teamwork. Further research should focus on how the levels of knowledge can be improved as the results report a lack of knowledge among care staff.

Bakgrund: Sepsis erfordrar att tidiga behandlingsåtgärder initieras, annars riskerar patienten utstå svåra komplikationer som i värsta fall kan leda till döden. Då sjukdomstillståndet uttrycks genom diffusa symtom kan denna tidiga initiering av behandlingsåtgärder vara svår, vilket ställer höga krav på vårdpersonalens kunskap. Syfte: Att kartlägga vårdpersonalens kunskaper gällande definition, identifiering och hantering av sepsis i ett tidigt skede inom akutsjukvården. Metod: Litteraturstudie baserad på nio kvantitativa artiklar. Databassökningar genomfördes i CINAHL, PubMed, Scopus och Web of science. Artiklarna är kvalitetsgranskade och analyserade med Fribergs analysmodell och sammanställd i text samt i tabeller. Resultat: Kunskapsbrister redovisas. Professionerna med högre utbildningsnivå redovisar högre kunskapsnivåer. Lägst kunskapsnivåer redovisas gällande minskad kroppstemperatur, vätskeinfusion, vasopressorer och mätning av laktat- och leukocyter. Konklusion: Genom kontinuerlig och uppdaterad utbildning, implementering av evidensbaserade riktlinjer och ett bra teamarbete kan minska mortaliteten. Senges teori om lärande organisationer visar på vikten av teamarbetet. Vidare forskning bör fokusera på hur kunskapsnivåerna kan förbättras då resultatet redovisar kunskapsbrist hos vårdpersonal., Background: Sepsis requires that early treatment measures are initiated, otherwise the patient risks enduring severe complications which in the worst case can lead to death. As the disease state is expressed through diffuse symptoms, this early initiation of treatment measures can be difficult, which places high demands on the care staff’s knowledge. Aim: To map the care staff’s knowledge regarding definition, identification and management of sepsis at an early stage in emergency care. Method: Literature study based on nine quantitative articles. Database searches were performed in CINAHL, PubMed, Scopus and Web of science. The articles are quality reviewed and analyzed with Friberg's analysis model and compiled in text and tables. Results: Knowledge gaps are reported. The professions with a higher level of education report higher levels of knowledge. The lowest levels of knowledge are reported regarding reduced body temperature, fluid infusion, vasopressors and measurement of lactate and leukocytes. Conclusion: Through continuous and updated training, implementation of evidence-based guidelines and good teamwork can reduce mortality. Seng's theory of learning organizations shows the importance of teamwork. Further research should focus on how the levels of knowledge can be improved as the results report a lack of knowledge among care staff.

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

Secondary peritonitis (PS) results from direct contamination of the peritoneum by effusion of the digestive tract or urogenital tract or associated solid organs. Appendicitis is considered the main and most common cause of this pathology. The objec- tive pursued when developing this research is based on generating a contribution of current content that, in general, serves to strengthen and expand knowledge about laparotomy in case of secondary peritonitis, and in turn, as a contribution to health professionals in the face of the constant need to update regarding the medico-scientific contents of interest, without prejudice to the learning that any person interested in this subject can acquire with this same material. The research meth- odology is based on a bibliographic design and a review method. The results, presented as evidence, refer to the opinions and criteria that some experts have expressed through their own studies, which refer especially to laparotomy treatment of secondary peritonitis, and other general aspects associated with the complication. In conclusion, according to the data sources used in this study, it is possible to dare to infer that, although there are, more and more, studies that support the special indication of laparotomy as a therapeutic modality of PS, it turns out that it does not It is the only way for its effective treatment, given that, even with clear advances in antimicrobial therapy and in supportive care in intensive care units (ICU), as well as in the technique and implementation of new surgical materials; This type of invasive intervention still reports high risks that are associated with high morbidity and mortality rates, a situation that, by the way, is still equally supported by sufficient evidence and that maintains its real feasibility in discussion for the majority of patients diagnosed with PS., La peritonitis secundaria (PS) resulta de la contaminación directa del peritoneo por derrame del tubo digestivo o del aparato urogenital o los órganos sólidos asociados. La apendicitis se considera la causa principal y más común de esta patología. El objetivo que se persigue al desarrollar la presente investigación se basa en generar un aporte de contenido vigente que, en general, sirva para el fortalecimiento y ampliación de los conocimientos en torno a la laparotomía en caso de peritonitis secundaria, y a su vez, como contribución a los profesionales de la salud ante la constante necesidad de ac- tualización respecto a los contenidos medicocientíficos de interés, sin menoscabo del aprendizaje que pueda adquirir con este mismo material cualquier persona interesada en la presente temática. La metodología investigativa se fundamenta en un diseño bibliográfico y un método de revisión. Los resultados, presentados como evidencia, refieren las opiniones y criterios que algunos los expertos han expresado mediante sus propios estudios, que aluden especialmente al tratamiento por laparotomía de la peritonitis secundaria, y otros aspectos generales asociados a la complicación. En conclusión, de acuerdo a las fuentes de datos utilizadas en este estudio, es posible atreverse a inferir que, si bien existen, cada vez más, estudios que sostienen la especial indicación de la laparotomía como modalidad terapéutica de la PS, resulta ser que no es la única vía para su tratamiento efectivo, dado que, aun evidenciándose claros avances en la terapia antimicrobiana y en los cuidados de sostenimiento en las unidades de cuidados intensivos (UCI), así como también en la técnica e im- plementación de nuevos materiales quirúrgicos; este tipo de intervención invasiva todavía reporta elevados riesgos que se asocian a altas de tasa de morbilidad y mortalidad, situación que por cierto aún se encuentra igualmente sustentada con evidencia suficiente y que mantiene en discusión su factibilidad real

The discovery of inflammasomes has enriched our knowledge in the pathogenesis of multiple inflammatory diseases. The NLR pyrin domain-containing protein 3 (NLRP3) has emerged as the most versatile and well-characterized inflammasome, consisting of an intracellular multi-protein complex that acts as a central driver of inflammation. Its activation depends on a tightly regulated two-step process, which includes a wide variety of unrelated stimuli. It is therefore not surprising that the specific regulatory mechanisms of NLRP3 inflammasome activation remain unclear. Inflammasome-mediated inflammation has become increasingly important in acute pancreatitis, an inflammatory disorder of the pancreas that is one of the fatal diseases of the gastrointestinal tract. This review presents an update on the progress of research into the contribution of the NLRP3 inflammasome to acute pancreatic injury, examining the mechanisms of NLRP3 activation by multiple signaling events, the downstream interleukin 1 family of cytokines involved and the current state of the literature on NLRP3 inflammasome-specific inhibitors.

The normal physiologic changes of pregnancy complicate evaluation for sepsis and subsequent management. Previous sepsis studies have specifically excluded pregnant patients. This narrative review evaluates the presentation, scoring systems for risk stratification, diagnosis, and management of sepsis in pregnancy. Sepsis is potentially fatal, but literature for the evaluation and treatment of this condition in pregnancy is scarce. While the definition and considerations of sepsis have changed with large, randomized controlled trials, pregnancy has consistently been among the exclusion criteria. The two pregnancy-specific sepsis scoring systems, the modified obstetric early warning scoring system (MOEWS) and Sepsis in Obstetrics Score (SOS), present a number of limitations for application in the emergency department (ED) setting. Methods of generation and subsequently limited validation leave significant gaps in identification of septic pregnant patients. Management requires consideration of a variety of sources in the septic pregnant patient. The underlying physiologic nature of pregnancy also highlights the need to individualize resuscitation and critical care efforts in this unique patient population. Pregnant septic patients require specific considerations and treatment goals to provide optimal care for this particular population. Guidelines and scoring systems currently exist, but further studies are required.

The normal physiologic changes of pregnancy complicate evaluation for sepsis and subsequent management. Previous sepsis studies have specifically excluded pregnant patients. This narrative review evaluates the presentation, scoring systems for risk stratification, diagnosis, and management of sepsis in pregnancy. Sepsis is potentially fatal, but literature for the evaluation and treatment of this condition in pregnancy is scarce. While the definition and considerations of sepsis have changed with large, randomized controlled trials, pregnancy has consistently been among the exclusion criteria. The two pregnancy-specific sepsis scoring systems, the modified obstetric early warning scoring system (MOEWS) and Sepsis in Obstetrics Score (SOS), present a number of limitations for application in the emergency department (ED) setting. Methods of generation and subsequently limited validation leave significant gaps in identification of septic pregnant patients. Management requires consideration of a variety of sources in the septic pregnant patient. The underlying physiologic nature of pregnancy also highlights the need to individualize resuscitation and critical care efforts in this unique patient population. Pregnant septic patients require specific considerations and treatment goals to provide optimal care for this particular population. Guidelines and scoring systems currently exist, but further studies are required.

To measure plasma N-terminal fragments of pro-B-type natriuretic peptides (NT-proBNP) and cardiac troponin T (cTnT) concentration in hospitalized dogs and relate these markers to underlying conditions and evaluate their potential as prognostic markers in dogs with systemic inflammatory response syndrome (SIRS)., info:eu-repo/semantics/published

Background: Recent attempts to translate Sepsis-3 criteria to children have been restricted to PICU patients and did not target children in emergency departments (ED). We assessed the prognostic accuracy of the age-adjusted quick Sequential Organ Failure Assessment score (qSOFA) and compared the performance to SIRS and the quick Pediatric Logistic Organ Dysfunction-2 score (qPELOD-2). We studied whether the addition of lactate (qSOFA-L) would increase prognostic accuracy. Methods: Non-academic, single-center, retrospective study in children visiting the ED and admitted with suspected bacterial infection between March 2013 and January 2018. We defined suspected bacterial infection as initiation of antibiotic therapy within 24 h after ED entry. Age-adjusted qSOFA, SIRS, qPELOD-2, and qSOFA-L scores were compared by area under the receiver operating characteristics curve (AUROC) analysis. Primary outcome measure was PICU transfer and/or mortality and secondary outcome was prolonged hospital length of stay. Results: We included 864 ED visits [474 (55%) male; median age 2.5 years; IQR 9 months-6 years], of which 18 were transferred to a PICU and 6 ended in death [composite outcome PICU transfer and/or mortality; 23 admissions (2.7%)]. 179 (22.2%) admissions resulted in prolonged hospital length of stay. PICU transfer and/or death was present in 22.5% of visits with qSOFA≥2 (n = 40) compared to 2.0% of visits with qSOFA < 2 (n = 444) (p < 0.01). qSOFA tends to be the best predictor of PICU transfer and/or mortality (AUROC 0.72 (95% CI, 0.57-0.86) compared to SIRS [0.64 (95% CI, 0.53-0.74), p = 0.23] and qPELOD-2 [0.60 (95% CI, 0.45-0.76), p = 0.03)]. Prolonged hospital length of stay was poorly predicted by qSOFA (AUROC 0.53, 95% CI 0.46-0.59), SIRS (0.49, 95% CI 0.44-0.54), and qPELOD-2 (0.51, 95%CI 0.45-0.57). qSOFA-L resulted in an AUROC of 0.67 (95%CI, 0.50-0.84) for PICU transfer and/ormortality and an AUROC of 0.56 (95% CI, 0.46-0.67) for prolonged hospital length o

Spreading processes are ubiquitous in nature and societies, e.g. spreading of diseases and computer virus, propagation of messages, and activation of neurons. Computer viruses cause an enormous economic loss. Moreover, many illnesses/diseases still causing a serious threat to public health. For example, the outbreaks of circulating influenza strains cause millions of illness and deaths worldwide every year. Pronounced outbreaks of flu usually occur during winter. This recognized timing allows public health agencies to organize their flu-related mitigation and response activities to prepare for the winter flu season. Although the general wintertime peak of influenza incidence in temperate regions can be easily forecast, the specific intensity, duration, and time of individual local outbreaks are quite changeable. Even after an outbreak has begun, it is still difficult to predict the future characteristics of the epidemic curve. If the diseases/viruses outbreak characteristics could be reliably predicted, the public health response will be better coordinated.The goal is to develop a fast and accurate epidemic model to estimate, fit and forecast the spreading of an epidemic on a defined network. The aim is to conduct a study over viruses spreading phenomena both theoretically and numerically, then create a general model/algorithm that can be easily applied to different diseases and computer viruses. In this master thesis, we propose a new approach which can be used on real illness/viruses data (such as influenza) to estimate and forecast the epidemic more accurately. The approach is to use a model-inference system combining the network science, susceptible-infected-recovered-susceptible (SIRS) model, statistical filtering techniques and gradient descent. We are able to fit and estimate with a relatively low error compared to other algorithms. Moreover, we forecast the out-breaker with a high accuracy, four weeks before the true out-breaker on synthetic epidemic data. T, Electrical Engineering | Telecommunications and Sensing Systems

BackgroundThe original equine sepsis score provided a method of identifying foals with sepsis. New variables associated with sepsis have been evaluated, but the sepsis score has not been updated.ObjectivesTo evaluate the sensitivity and specificity of 2 updated sepsis scores and the systemic inflammatory response syndrome (SIRS) criteria in regard to detecting sepsis in foals.AnimalsTwo-hundred and seventy-three ill foals and 25 healthy control foals.MethodsHistorical, physical examination, and clinicopathologic findings were used to calculate the original sepsis score and 2 updated sepsis scores. SIRS criteria were also evaluated. Sepsis scores and positive SIRS scores were statistically compared to foals with sepsis.ResultsOne-hundred and twenty-six foals were septic and 147 sick-nonseptic. The original and updated sepsis scores were significantly higher in septic foals as compared to sick-nonseptic and healthy foals. The sensitivity and specificity of the updated sepsis scores to predict sepsis were not significantly better than those of the original sepsis score. One-hundred and twenty-seven of 273 (46.5%) foals met the original SIRS criteria and 88/273 (32%) foals met the equine neonatal SIRS criteria. The original SIRS criteria had similar sensitivity and specificity for predicting sepsis as did the 3 sepsis scores in our study.Conclusions and clinical importanceThe updated sepsis scores did not provide improved ability in predicting sepsis. Fulfilling the original SIRS criteria provided similar sensitivity and specificity in predicting sepsis as the modified sepsis score and might serve as a diagnostic aid in identifying foals at risk for sepsis.

Caesarean section is the delivery through a surgical incision in the abdomen and uterus with various risks, such as Surgical Site Infection (SSI) which either occurs rapidly (24-48 hours postoperatively) or delayed. To reduce the risk of various post-cesarean section infections, prophylactic antibiotics are given. The administration of prophylactic antibiotics with recommended regimens, such as in developed countries as in the United States and Europe, with first generation of cephalosporins has not been applied in Dr. Iskak Hospital, Tulungagung. This hospital still used other types of antibiotics, such as cefotaxime or ceftriaxone. In addition, for several reasons, prophylactic antibiotics were continued with other antibiotics to reduce the risk of delayed infection. This study was designed to analyze the effectiveness of prophylactic antibiotics as recommended in cesarean section. This was a prospective observational study with consecutive sampling type, examined 41 mothers with cesarean section at the Department of Obstretics and Gynecology, Dr. Iskak Hospital, Tulungagung, Indonesia. This study was conducted from May to July, 2017. The results of the study showed that the effectiveness of prophylactic antibiotic use was 98% based on the clinical parameters and maternal laboratory outcome, which showed that SIRS was in normal category. Whereas, there was one mother (2%) who had SSI on day 10 postoperatively.

Spreading processes are ubiquitous in nature and societies, e.g. spreading of diseases and computer virus, propagation of messages, and activation of neurons. Computer viruses cause an enormous economic loss. Moreover, many illnesses/diseases still causing a serious threat to public health. For example, the outbreaks of circulating influenza strains cause millions of illness and deaths worldwide every year. Pronounced outbreaks of flu usually occur during winter. This recognized timing allows public health agencies to organize their flu-related mitigation and response activities to prepare for the winter flu season. Although the general wintertime peak of influenza incidence in temperate regions can be easily forecast, the specific intensity, duration, and time of individual local outbreaks are quite changeable. Even after an outbreak has begun, it is still difficult to predict the future characteristics of the epidemic curve. If the diseases/viruses outbreak characteristics could be reliably predicted, the public health response will be better coordinated.The goal is to develop a fast and accurate epidemic model to estimate, fit and forecast the spreading of an epidemic on a defined network. The aim is to conduct a study over viruses spreading phenomena both theoretically and numerically, then create a general model/algorithm that can be easily applied to different diseases and computer viruses. In this master thesis, we propose a new approach which can be used on real illness/viruses data (such as influenza) to estimate and forecast the epidemic more accurately. The approach is to use a model-inference system combining the network science, susceptible-infected-recovered-susceptible (SIRS) model, statistical filtering techniques and gradient descent. We are able to fit and estimate with a relatively low error compared to other algorithms. Moreover, we forecast the out-breaker with a high accuracy, four weeks before the true out-breaker on synthetic epidemic data. T, Electrical Engineering | Telecommunications and Sensing Systems

Caesarean section is the delivery through a surgical incision in the abdomen and uterus with various risks, such as Surgical Site Infection (SSI) which either occurs rapidly (24-48 hours postoperatively) or delayed. To reduce the risk of various post-cesarean section infections, prophylactic antibiotics are given. The administration of prophylactic antibiotics with recommended regimens, such as in developed countries as in the United States and Europe, with first generation of cephalosporins has not been applied in Dr. Iskak Hospital, Tulungagung. This hospital still used other types of antibiotics, such as cefotaxime or ceftriaxone. In addition, for several reasons, prophylactic antibiotics were continued with other antibiotics to reduce the risk of delayed infection. This study was designed to analyze the effectiveness of prophylactic antibiotics as recommended in cesarean section. This was a prospective observational study with consecutive sampling type, examined 41 mothers with cesarean section at the Department of Obstretics and Gynecology, Dr. Iskak Hospital, Tulungagung, Indonesia. This study was conducted from May to July, 2017. The results of the study showed that the effectiveness of prophylactic antibiotic use was 98% based on the clinical parameters and maternal laboratory outcome, which showed that SIRS was in normal category. Whereas, there was one mother (2%) who had SSI on day 10 postoperatively.

Acute Zika virus (ZIKV) infection is usually mild and self-limiting. Earlier, we reported three cases of fatal acute ZIKV infection in patients without typical signs of ZIKV, but rather with criteria of systemic inflammation response syndrome (SIRS). To follow up these observations, we prospectively included patients at the emergency room with temperature instability and suspected to have acute ZIKV infection, SIRS, or both. A total of 102 patients were included of whom N = 21 (21%) were suspected of acute ZIKV infection, N = 56 (55%) of acute ZIKV infection with SIRS criteria, and N = 25 (24%) of SIRS alone. ZIKV-PCR was positive in N = 21 (20%) patients. Eight (38%) ZIKV-positive patients needed admission to the hospital of whom four (50%) presented with SIRS alone. One ZIKV-positive patient had vascular co-morbidity and died following shock and severe coagulopathy. We confirm the hypothesis that acute ZIKV infection can present atypical and severely with systemic inflammation and have lethal course particularly amongst patients with significant prior disease.

Background A proposed revision of sepsis definitions has abandoned the systemic inflammatory response syndrome (SIRS), defined organ dysfunction as an increase in total Sequential Organ Function Assessment (SOFA) score of ≥ 2, and conceived “qSOFA” (quick SOFA) as a bedside indicator of organ dysfunction. We aimed to (1) determine the prognostic impact of SIRS, (2) compare the diagnostic accuracy of SIRS and qSOFA for organ dysfunction, and (3) compare standard (Sepsis-2) and revised (Sepsis-3) definitions for organ dysfunction in ED patients with infection. Methods Consecutive ED patients admitted with presumed infection were prospectively enrolled over 3 years. Sufficient observational data were collected to calculate SIRS, qSOFA, SOFA, comorbidity, and mortality. Results We enrolled 8,871 patients, with SIRS present in 4,176 (47.1%). SIRS was associated with increased risk of organ dysfunction (relative risk [RR] 3.5) and mortality in patients without organ dysfunction (OR 3.2). SIRS and qSOFA showed similar discrimination for organ dysfunction (area under the receiver operating characteristic curve, 0.72 vs 0.73). qSOFA was specific but poorly sensitive for organ dysfunction (96.1% and 29.7%, respectively). Mortality for patients with organ dysfunction was similar for Sepsis-2 and Sepsis-3 (12.5% and 11.4%, respectively), although 29% of patients with Sepsis-3 organ dysfunction did not meet Sepsis-2 criteria. Increasing numbers of Sepsis-2 organ system dysfunctions were associated with greater mortality. Conclusions SIRS was associated with organ dysfunction and mortality, and abandoning the concept appears premature. A qSOFA score ≥ 2 showed high specificity, but poor sensitivity may limit utility as a bedside screening method. Although mortality for organ dysfunction was comparable between Sepsis-2 and Sepsis-3, more prognostic and clinical information is conveyed using Sepsis-2 regarding numbe

Aims of this study were to investigate the changes in inflammatory regulation as shown by proinflammatory cytokines (IL-6) and anti-inflammatory cytokines (IL-10) from patients with systemic inflammatory responses syndrome (SIRS) that affect pain intensity changes with the marked increase of critical-care pain observation tools (CPOT) and decreased of the pain pressure threshold (PPT). A cross-sectional analysis to compare the values of IL-6, IL-10, PPT, and CPOT of SIRS patients and patients without SIRS. Of the 46 patients who were the subjects of the study, there were 21 SIRS patients and 25 patients non-SIRS.