Kirkeby Simpson (polandstamp84)

Neonatal gastric perforation (NGP) is a rare, perplexing, life-threatening entity affecting neonates. We share our experience of operating upon cases of NGP s and highlight important points observed which may aid in further improving care of neonates, diagnosed with this entity. A retrospective analysis of all consecutive patients with NGP operated by the author, at various centers between January 2015 and December 2018, was carried out. We analyzed different variables for these and reached logical conclusions. Between January 2015 and December 2018, we treated ten patients with gastric perforation. All the neonates were preterm, except one. Mean birth weight in our series was 1745 g (range 1300-2400 g). Deterioration in activity, worsening of sepsis, metabolic acidosis, increased ventilator requirements, and abdominal distension were prominent clinical features identified in all patients. Selleckchem Thiomyristoyl All patients subsequently had massive pneumoperitoneum before surgery. Six patients had perforation along the greater curvature, two had perforation at the posterior wall, and two had near total gastric necrosis. We had four mortalities out of ten patients operated. NGP is associated with high mortality, especially in premature and low birth weight neonates. Severity of contributing factors in a premature predisposed neonate determines the severity of gastric necrosis, which in turn is an important prognostic factor. Certain preoperative signs can be useful and can aid in initiating preventive measures to curtail severity of the pathology. NGP is associated with high mortality, especially in premature and low birth weight neonates. Severity of contributing factors in a premature predisposed neonate determines the severity of gastric necrosis, which in turn is an important prognostic factor. Certain preoperative signs can be useful and can aid in initiating preventive measures to curtail severity of the pathology.From a local outbreak to a global pandemic, the severe acute respiratory syndrome-coronavirus-2 infection has spread across 210 borders to infect 2.5 million humans. There is an organized disruption in the routine hospital functioning to divert the available resources for effective crisis management; most of the departments have been split to carve out a "COVID task force." The recommended indications for treatment of various medical conditions, medical procedures, and protocols have regressed on the evolutionary timeline. Newer recommendations are being released and updated regularly based on emerging evidence and experts' opinions. In view of exponential spread of the virus through routes already identified or those still elusive, the shedding of the virus during the incubation period, and lack of scientific evidence, the questions of "laparoscopy" or "no laparoscopy" assume importance. Herein, the evidence in literature pertaining to patient safety, efficient and effective utilization of hospital resources, and safety of health-care workers (HCWs) during the pandemic have been reviewed from the perspective of laparoscopy. The pathobiology of the virus including its survival properties and the different modes of transmission has been highlighted, and the relative risk to the HCWs between open and laparoscopic surgery dwelt upon. The recommendations from various international bodies have been discussed. Notwithstanding the absence of concrete evidence to exclude the possibility of bioaerosol-based transmission of the disease to the operating room staff, there is a multitude of other concerns which are addressed by avoiding the use of the laparoscope in the current scenario. Moreover, the absence of evidence is not evidence of absence; considering the high contagion and a long latent period associated with this virus, the onus is upon each individual surgeon to decide if one needs evidence of bioaerosol-based transmission or evidence in favor of safety before taki