RESUMO
Introduction Despite significant advances in the field of medicine, sepsis is constantly growing as a major public health concern. The global epidemic of sepsis imposes a significant economic burden on healthcare systems world-over. Furthermore, its high prevalence in society is inevitably paralleled by an excessive mortality rate, with approximately six million deaths reported every year. The primary aim of this study was to evaluate and compare, the management of acutely septic patients against outcomes in a tertiary teaching institution in Pakistan versus a similar one in the United Kingdom. Methods This study was a dual-centred, retrospective comparative analysis comparing all patients admitted through the emergency department at the respective tertiary centres. Patient details were collected and compared across the two sites to evaluate the effect of individual characteristics on prognosis. The outcomes of these presentations were analysed by comparing rates of in-hospital mortality, admission to the ICU or discharge. Results The total number of patients identified as having sepsis was 60 in the Pakistan cohort, and 92 in the Aberdeen cohort. No significant difference was found when comparing genders, and the results of basic observations were largely similar at presentation. Twenty-five per cent (25%) (n=38) of the total study population were deemed to have a poor outcome at 3 days, but 50% of the Pakistan cohort was deemed to have a poor outcome. Conclusion Managing sepsis has developed significantly in recent years, but most of this development was implemented in high-income countries. There was a significant delay in time to resuscitate septic patients in Pakistan, with significantly raised three-day morbidity and mortality. There is a need for further comparative studies of the management of sepsis in Pakistan and other low-income countries to identify the problems and tackle obstacles on every level of the healthcare system.
RESUMO
BACKGROUND: Pilonidal disease (PD) is a debilitating condition characterised by the infection of subcutaneous tissue in the sacrococcygeal area. It is associated with a high risk of recurrence, pain, infection, and purulent discharge. The two main surgical methods of pilonidal sinus disease include excision with primary closure/flap repair or excision of the sinus with healing by secondary intent. Wounds left open to heal by secondary intent remain extremely common due to their association with reduced risk of recurrence, however, it is associated with prolonged healing times. This study aims to determine whether platelet-rich plasma (PRP) reduces healing time in patients post pilonidal sinus surgery with healing by secondary intent compared to simple wound dressings. METHOD: Six databases were searched from their date of origin to May 30, 2022 for randomised control trials using predetermined inclusion and exclusion criteria. Only four papers were selected for review as per the Population, Intervention, Comparison, Outcomes and Study design (PICOS) criteria. Critical appraisal was carried out according to the Scottish Intercollegiate Guidelines Network Methodology Checklist for Randomised Control Trials and was assessed for risk of bias according to the Cochrane Handbook for Systematic Review of Interventions. The pooled effect size was calculated using the fixed-effect model. A homogeneity of pooled effect size for the studies was also found (Cochrane Q test, p-value = 0.97 I-square = 0.0%). RESULT: Four studies (n = 336) were included in this review. Three of the four studies reported a statistically significant reduction in time taken in healing the wound. The mean difference between the intervention (PRP group) and the control group was 13.01 days, (95% CI 12.15-13.86 days, p < 0.00001). All of the included studies also reported a statistically significant reduction in time taken to return to work/activities of daily living in the treatment group compared to the control group (MD 9.68 days, 95% CI 9.16-10.21 days, p < 0.00001). CONCLUSION: This study shows that PRP is effective in reducing healing time and is associated with a significantly shorter period taken to return to work/activities of daily living in patients post pilonidal sinus surgery, which was the primary and secondary outcome investigated in this systematic review, respectively. PRP should routinely be offered to patients undergoing excisional pilonidal sinus surgery for the aforementioned benefits.
