scholarly journals 746 COVID-19: Changing the Future of Emergency Epistaxis Management

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Y Devabalan
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Conservative Management ◽  
Demographic Data ◽  
Outpatient Management ◽  
Single Centre ◽  
Airway Emergency ◽  
Haemostatic Agents ◽  
Standard Operating ◽  
Life Threatening

Abstract Introduction Acute epistaxis can be a life-threatening airway emergency. Therefore, the majority of patients in whom conservative management (including cautery) has failed are admitted. However, due to the COVID-19 pandemic, our management has shifted towards a more outpatient centred approach. Method A single centre retrospective study was undertaken of all epistaxis patients managed by the ENT team at our centre over a five-month period from 1st January to 31st May 2020. The first 10 weeks (Pre-COVID-19) were managed using pre-existing guidelines. The following 10 weeks (COVID-19) were managed using the new COVID-19 standard operating procedures which aimed to minimise inpatient admissions. Results 142 patients, with similar demographic data, were seen across the 5-month period. There were significantly more patients aged over 65 presenting in the COVID-19 group (p = 0.04). There was a significantly increased use of local haemostatic agents (Nasopore ® and Surgiflo ®) and decreased use of nasal packing in the COVID-19 group. There were significantly fewer admissions (p < 0.0005) in the COVID-19 group, but similar rates of representation, length of stay and morbidity. Conclusions The COVID-19 pandemic has accelerated the shift towards the use of local haemostatic agents and outpatient management of epistaxis, which is as safe and effective as previously well-established epistaxis management.

scholarly journals Characteristics, Comorbidities, and Outcomes Among Patients Admitted With COVID-19 in Sheikh Khalifa Medical City: A Retrospective Study

2021 ◽  
Author(s):  
Moustafa Abdelwahab ◽  
Lara Al Qadi ◽  
Mohammad Al Jawabreh ◽  
Hanan Sulaiman ◽  
Mariam Al Blooki
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Length Of Stay ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Case Series ◽  
Minimum Length ◽  
Diabetic Patients ◽  
Upper Respiratory Tract ◽  
Medical City

Abstract Background: Many studies were published to describe the clinical characteristics of COVID-19, however there is still lack of knowledge and it’s time to take stock of the war against coronavirus disease 2019 (COVID-19) pandemic before we hit another million in a matter of days. Simply Identifying COVID-19 features will help in mapping the disease and guiding pandemic management. A retrospective review, retrospective study was initiated in SKMC to describe the demographic data, clinical characteristics, and outcomes of COVID-19 cases who were hospitalized during that period.Methods: Confirmed positive COVID-19 sample patients from April 1st 2020 to May 31st 2020 in Sheikh Khalifa Medical City. Clinical characteristics, Demographic data, incubation periods, laboratory findings, and patient outcomes data retrieved from 336 cases in the electronic medical chart (SALAMTAK).Results: The median age was 44 years and 83.9% (n = 282) of the patients were men. The patients with diabetes mellitus being the most common risk factor (25.0%), followed by hypertension (22.9%) and Age ≥60 were (13.4%). Total 36 patients (10.7%) were asymptomatic. The most common symptoms were upper respiratory tract symptoms, manifested as dry cough (70.2%), and followed by fever (54.2%), shortness of breath (43.5%), headache (25.9%) and sore throat (25.3%). Less common symptoms were diarrhea (16.7%) chest pain (14.6%). The maximum length of stay is 32 days. The minimum length of stay in [ICU/HDU] was 1 day and the maximum was 21 days.Conclusion: In this retrospective study, fever and cough were common symptoms. Special attention should be given to patients with risk factors especially patients with one risk factor such as diabetic patients, patients with hypertension and older patients over 60 years as they are the most highly prevalent in this case series. Disease was affecting males and D-dimer was significantly elevated in deceased patients.

scholarly journals Characteristics, Comorbidities, and Outcomes among Patients admitted with COVID-19 in Sheikh Khalifa Medical City: A Retrospective Study

2021 ◽  
Author(s):  
Lara Al Qadi ◽  
Moustafa Abdelwahab ◽  
Mohammad Al Jawabreh ◽  
Hanan Sulaiman ◽  
Mariam Al Blooki
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Length Of Stay ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Case Series ◽  
Minimum Length ◽  
Diabetic Patients ◽  
Upper Respiratory Tract ◽  
Medical City

Abstract Background: Many studies were published to describe the clinical characteristics of COVID-19, however there is still lack of knowledge and it’s time to take stock of the war against coronavirus disease 2019 (COVID-19) pandemic before we hit another million in a matter of days. Simply Identifying COVID-19 features will help in mapping the disease and guiding pandemic management. A retrospective review, retrospective study was initiated in SKMC to describe the demographic data, clinical characteristics, and outcomes of COVID-19 cases who were hospitalized during that period. Methods: Confirmed positive COVID-19 sample patients from April 1st 2020 to May 31st 2020 in Sheikh Khalifa Medical City. Clinical characteristics, Demographic data, incubation periods, laboratory findings, and patient outcomes data retrieved from 336 cases in the electronic medical chart (SALAMTAK). Results: The median age was 44 years and 83.9% (n = 282) of the patients were men. The patients with diabetes mellitus being the most common risk factor (25.0%), followed by hypertension (22.9%) and Age ≥60 were (13.4%). Total 36 patients (10.7%) were asymptomatic. The most common symptoms were upper respiratory tract symptoms, manifested as dry cough (70.2%), and followed by fever (54.2%), shortness of breath (43.5%), headache (25.9%) and sore throat (25.3%). Less common symptoms were diarrhea (16.7%) chest pain (14.6%). The maximum length of stay is 32 days. The minimum length of stay in [ICU/HDU] was 1 day and the maximum was 21 days. Conclusion: In this retrospective study, fever and cough were common symptoms. Special attention should be given to patients with risk factors especially patients with one risk factor such as diabetic patients, patients with hypertension and older patients over 60 years as they are the most highly prevalent in this case series. Disease was affecting males and D-dimer was significantly elevated in deceased patients.

scholarly journals EP.WE.93An Overview of the Effect of COVID-19 on the General Surgical Take: Before, During and After the First UK National Lockdown

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rachel Heard ◽  
Maja Kopczynska ◽  
Michal Woyton ◽  
Elizabeth Allen ◽  
Madeline Garcia ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Conservative Management ◽  
Demographic Data ◽  
Surgical Pathology ◽  
Large Decrease ◽  
Very Elderly ◽  
Data Treatment ◽  
National Guidance ◽  
New Challenges ◽  
Surgical Conditions

Abstract Aims Emergency general surgical (EGS) services have faced new challenges during the coronavirus pandemic. This study compared all EGS presentations before, during and after the first UK national lockdown between March and May 2020. Methods All EGS patients presenting to our centre in four separate weeks were included. These weeks represented ‘pre-lockdown’, ‘early lockdown’, ‘established lockdown’ and ‘post lockdown’ groups. Demographic data, treatment, admission and outcomes were collected for all patients and compared between groups. Results 178 patients accounted for 214 EGS attendances over four weeks. Attendances decreased from 74 pre-lockdown, to 43 in early lockdown, 32 in late lockdown and rose to 65 in the post lockdown group. Significantly more patients received repeat outpatient reviews in the lockdown groups (p = 0.002). Length of stay was significantly reduced in established lockdown (0.5 days vs. 2 days pre-lockdown, p = 0.042). There was a trend towards conservative management of surgical pathology in the lockdown groups (65% vs 47% pre and post-lockdown, p = 0.10). No very elderly or frail EGS patients presented during the lockdown study period. There was no evidence of delay to presentation. Conclusions The COVID-19 pandemic and UK Coronavirus lockdown resulted in a large decrease in EGS admissions and alteration in characteristics of these admissions. New national guidance during the pandemic advocated ambulatory and conservative management of surgical conditions where possible and is reflected in our cohort. These changes reverted almost back to pre-lockdown state the week following the easing of the first UK national lockdown.

653 Resourceful Surgical Planning for Coverage of Large Burns: Optimizing Cultured Epithelial Autografts (CEAs) Outcomes by Combining with a Modified MEEK Procedure

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S184-S184
Author(s):  
Beretta C Coffman ◽  
Shawn P Fagan ◽  
Bounthavy Homsombath ◽  
Kevin Lack ◽  
Zaheed Hassan
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Surgical Planning ◽  
Demographic Data ◽  
The Other ◽  
Study Analysis ◽  
Total Group ◽  
Additional Surgery ◽  
Cultured Epithelial Autografts ◽  
Age Range

Abstract Introduction We previously reported a modified MEEK technique providing reliable skin transfer using a specific adhesive called, “The Rule of Sevens”.¹ This innovative approach is now part of our practice and we have experienced good outcomes as a result. With that technique perfected, we have also begun incorporating this method as part of the surgical plan for coverage of large TBSA burns with CEAs. This study is a report of our initial experiences utilizing a combination of our modified MEEK procedure and CEA grafting for larger TBSA burns. Methods This retrospective study was granted exemption by IntegReview IRB. Demographic data was reviewed. In some cases, incomplete documentation related to percentage take was noted. To account for this limitation, we agreed with other investigators in the literature and applied the “clinically relevant” assessment to this study analysis. This approach assumed that take and final coverage were successful when re-grafting was not required by the time of discharge or death.² Results Nineteen (19) patients total were treated with MEEK/CEA from April 2016 – February 2020. One patient was an outlier, acquiring infection, requiring additional surgery to close the wound, and did not meet criteria to evaluate. There were 4 females (25%) and 14 males (74%), age range 9–71, Mean 37, Median 34, Mode N/A. TBSA was 30–92%, Mean 62 Median 60, Mode 55. Length of stay was 20–188 days, Mean 89, Mode 136. This is approximately 1.5 days’ stay, per percent of burn in this group of patients with larger burns. MEEK meshing ratio was documented on 16 patients, range from 6:1 - 9:1 ratio. Five patients had a 6:1 ratio, 11 patients had 9:1 meshing ratio used. There were 6 deaths in the total group of 18 evaluable patients (33%). Of these, all had MEEK performed initially, however; 3 did not live long enough to have CEA placed. One patient died before initial takedown of CEA could be performed. The other two died during treatment, both had documentation supporting 70% and 90% take, respectively. To determine overall take, we determined whether any of the surviving patients treated needed further grafting. None of the 12 remaining patients required further grafting. This met our criteria of successful take and gave us a 100% success rate. There were 9 patients with documentation clearly stating a percent take rate. In this group, the documented percent take range was 60–97%, Mean 84%, Median 85% and Mode 96%,80%. Again, none of these patients required additional surgery. Conclusions A modified MEEK technique in providing coverage of larger burns with CEA has offered our center better options of expansion thus perfecting the technique of transfer. Most importantly, the MEEK/CEA has resulted in excellent outcomes with a documented mean take rate of 84%.

scholarly journals Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

Effect of Undertriage on the Outcomes of Cancer Patients with Febrile Neutropenia, Sepsis, and Septic Shock

2021 ◽  
pp. 105477382199968
Author(s):  
Anas Alsharawneh
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Emergency Setting ◽  
Extended Length ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Timely Treatment

Sepsis and neutropenia are considered the primary life-threatening complications of cancer treatment and are the leading cause of hospitalization and death. The objective was to study whether patients with neutropenia, sepsis, and septic shock were identified appropriately at triage and receive timely treatment within the emergency setting. Also, we investigated the effect of undertriage on key treatment outcomes. We conducted a retrospective analysis of all accessible records of admitted adult cancer patients with febrile neutropenia, sepsis, and septic shock. Our results identified that the majority of patients were inappropriately triaged to less urgent triage categories. Patients’ undertriage significantly prolonged multiple emergency timeliness indicators and extended length of stay within the emergency department and hospital. These effects suggest that triage implementation must be objective, consistent, and accurate because of the several influences of the assigned triage scoring on treatment and health outcomes.

scholarly journals Long-term outcomes after penile prosthesis placement for the Management of Erectile Dysfunction: a single-Centre experience

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Valentine Frydman ◽  
Ugo Pinar ◽  
Maher Abdessater ◽  
William Akakpo ◽  
Pietro Grande ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Erectile Dysfunction ◽  
Penile Prosthesis ◽  
Perioperative Outcomes ◽  
Single Centre ◽  
Satisfactory Outcome ◽  
Single Centre Experience ◽  
Life Threatening ◽  
Few Data

Abstract Background Penile prothesis (PP) is the gold-standard treatment of drug-refractory erectile dysfunction (ED). While postoperative outcomes have been widely described in the literature, there are few data about patient satisfaction and intraoperative events. We aimed to assess long-term patient satisfaction and perioperative outcomes after PP implantation in a single-centre cohort of unselected patients using validated scales. Results A total of 130 patients received a PP (median age: 62.5 years [IQR: 58–69]; median International Index of Erectile Function (IEEF-5) score: 6 [IQR: 5–7]). Median follow-up was 6.3 years [IQR: 4–9.4]. Thirty-two (24.6%) patients underwent surgical revision, of which 20 were PP removals (15.4%). Global PP survival rate was 84.6% and previous PP placement was a risk factor for PP removal (p = 0.02). There were six (4.6%) non-life-threatening intraoperative events including two which resulted in non-placement of a PP (1.5%). EAUiaic grade was 0 for 124 procedures (95.4%), 1 for four procedures (3.1%) and 2 for two procedures (1.5%). Of patients who still had their PP at the end of the study, 91 (80.5%) expressed satisfaction. Conclusions PP implantation is a last-resort treatment for ED with a satisfactory outcome. PPs are well accepted by patients.

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