Fulminant Emphysematous Hepatitis - A Rare Cause of Septic Shock.

Emphysematous hepatitis is a rare entity characterized by the replacement of hepatic parenchyma by gas, leading to acute liver failure. Often it occurs in patients with diabetes mellitus, liver disease or a recent history of abdominal surgery. We present a case of emphysematous hepatitis in a 74-year-old man with no recognizable risk factors. Despite the early broad-spectrum antimicrobial therapy and supportive care, the condition progressed to a fatal outcome, as seen in other case reports. Early recognition of this condition and rapid and aggressive management may improve patient outcomes. LEARNING POINTS: Emphysematous hepatitis is a rare condition characterized by replacement of hepatic parenchyma by gas.The diagnosis of emphysematous hepatitis requires imaging, preferably a computed tomography scan.Emphysematous hepatitis warrants awareness among clinicians for early diagnosis and rapid and aggressive management.

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study.

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8. Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

[Diabetes Knowledge Test Feasibility in Portugal]. / Fiabilidade da Escala de Conhecimento da Diabetes em Portugal.

INTRODUCTION: Given the rising incidence of type 2 diabetes and taking into account that much of its control depends on the patient's attitude towards his illness, loomed the need to equip health professionals with capable tools to determine the educational needs of their patients, allowing a more personalized intervention to correct habits that could be harmful to the diabetics' health. OBJECTIVE: Verify the Diabetes Knowledge Test reliability in Portugal. Analysis of socio-demographic and pathologic variables' correlation with the number of correct answers in the test. MATERIAL AND METHODS: Application of the translated version of Diabetes Knowledge Test to a convenience sample of a primary care center in Covilhã. RESULTS: In general, the questions obtained a Cronbach's alpha > 0.800. Diabetics with better results in the survey proved to be more compliant, with a positive relationship between knowledge and diabetes' control. However, only 9.2% of diabetics have good knowledge about their disease, and the majority (65.8%) shows an average one. The insulin treated patients show the worst results (77.6% with low knowledge). The variables 'treatment route' and 'complications' show statistical impact on the level of knowledge that diabetics have about their pathology (p values 0.00 and 0.048, respectively). Inhabitants of rural areas, without complications secondary to diabetes and treated orally, proved to be more compliant and to have better knowledge about the disease. DISCUSSION: Contrary to previous studies, variables such as age and educational level showed no relation with the performance in the survey. Inhabitants of the rural area and diabetics treated orally obtained better results than what had been previously advocated. CONCLUSION: It has been proved the moderate to high psychometric reliability of the test, as its value establishing a correlation between diabetes knowledge and control. It is expected that its future application will help identifying the reasons for uncontrolled diabetics, allowing a more individualized intervention by the health professionals.

Introdução: Dada a crescente incidência da diabetes tipo 2 e considerando que parte do seu controlo se deve à atitude do pacienteface à doença, torna-se importante munir os profissionais de saúde com ferramentas capazes de determinar as carências educacionais dos utentes, permitindo uma intervenção mais personalizada na correção de hábitos nocivos. Objetivos: Verificação da fiabilidade da Escala de Conhecimentos da Diabetes em Portugal. Análise e correlação das diferentes variáveis sociodemográficas e patológicas com o número de respostas corretas. Material e Métodos: Aplicação da escala a uma amostra de conveniência de diabéticos tipo 2 do Centro de Saúde da Covilhã.Resultados: Na generalidade, as questões obtiveram um valor de alfa de Cronbach > 0,800. Diabéticos com melhores resultados demonstraram maior controlo, estabelecendo uma relação positiva entre o conhecimento e o controlo da diabetes. Apenas 9,2% dos diabéticos apresentou bom conhecimento sobre a doença, sendo que a maioria (65,8%) demonstrou um conhecimento mediano. Os insulinotratados exibiram os piores resultados (77,6% com baixo conhecimento). As variáveis 'via de tratamento' e 'complicações' demonstraram ter impacto no desempenho obtido no questionário (valores p iguais a 0,00 e 0,048, respetivamente). Os diabéticos rurais, os sem complicações e os não insulinotratados revelaram-se os mais cumpridores e conhecedores. Discussão: Contrariando estudos anteriores, variáveis como a idade e o grau de escolaridade não demonstraram influenciar o conhecimentodo diabético. Habitantes do meio rural e diabéticos tratados oralmente obtiveram melhores resultados do que o que havia sido defendido previamente. Conclusão: Demonstrou-se a fidelidade psicométrica moderada a elevada do teste, assim como uma correlação positiva entre o controloda diabetes e o desempenho no inquérito. Espera-se que a sua futura aplicação possibilite identificar as razões do descontrolo dos diabéticos, permitindo uma atuação mais individualizada pelos profissionais de saúde.