EP.WE.433Assessment of the temporary Surgical ED Study and Audit

Abstract Aims To ascertain the effectiveness of the newly formed surgical ED during Covid-19 outbreak in terms of: Methods/Study design Retrospective cohort of 992 patients were identified and included from the period of the 5th April to 5th May 2020 Inclusion criteria: All patients attended and triaged in the new surgical emergency department. Exclusion criteria: Patients who were not triaged. Results The temporary surgical emergency department was successful in accommodating all surgical patients categorized 2, 3 and 4 with category 4 being the highest number at 45%. Hospital services were successfully accessed in 771(77.72%) during patients stay in ED including Bloods and imaging with X-ray as the most service used at 42.33%. 221(22.27%) patients didn’t require any investigations and were discharged after review by the surgical doctor within the 4-hour window. Conclusion Presence of a dedicated surgical emergency during the covid period was essential to separate medical patients from non-medical patients. Having a decision maker on the front line right after triage has reduced the overall number of admissions, number of emergency breeches and unnecessary investigations. Having a dedicated space with dedicated team could make a huge impact on the service in terms of time, effort and money spent.

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Comparison between primary repair and exteriorization in cases of Typhoid perforation

Annals of King Edward Medical University ◽

10.21649/akemu.v11i3.1004 ◽

2016 ◽

Vol 11 (3) ◽

Cited By ~ 1

Author(s):

Asaad Akbar Khan ◽

Intesarur Rashid Khan ◽

Umer Najeeb ◽

Asim Jameel Sheikh

Keyword(s):

Abdominal Pain ◽

Comparative Study ◽

Clinical Finding ◽

Primary Repair ◽

Inclusion Criteria ◽

Widal Test ◽

Exclusion Criteria ◽

Bowel Sounds ◽

X Ray ◽

History Of

Objectives: This comparative study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of typhoid perforation Materials and methods: :80 patients were selected out of which 48 were males and 32 were females. Inclusion criteria: Consisted of a history of fever abdominal pain, constipation, sharp shooting pain superimposed over the colicky abdominal pain clinical finding included tense tender abdomen and absent bowel sounds, investigations including gas under diaphragm in abdominal x-ray and positive widal test. Exclusion criteria: Consisted of negative Widal test even if there was gas under diaphragm, per op findings suggestive of tuberculosis or histopathology reports suggestive of tuberculosis or any pathology other than typhoid. Primary repair was done in patients who presented within 36 hrs of experiencing sharp shooting pain and per op findings of minimal contamination. Exteriorization in the form of loop or double barrel ileostomy was done in other cases.

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Accuracy of lung ultrasound and chest X-rays in diagnosing acute pulmonary oedema in patients presenting with acute dyspnoea in emergency department

Journal of the Pakistan Medical Association ◽

10.47391/jpma.03-453 ◽

2021 ◽

Vol 71 (10) ◽

pp. 2423-2425

Author(s):

Sanniya Khan Ghauri ◽

Khawaja Junaid Mustafa ◽

Arslaan Javaeed ◽

Abdus Salam Khan

Keyword(s):

Emergency Department ◽

Lung Ultrasound ◽

Acute Pulmonary Oedema ◽

X Rays ◽

Acute Dyspnea ◽

Inclusion Criteria ◽

Predictive Values ◽

X Ray ◽

Acute Dyspnoea ◽

Chest X Ray

To determine the diagnostic accuracy of lung ultrasound and chest X-ray in diagnosing Acute Pulmonary Edema (APE) in patients presenting with acute dyspnea in emergency department. This study was conducted at the emergency department of Shifa International Hospital, Islamabad from 31st July 2018 to 31st January 2019. A total of 225 patients presenting with dyspnoea and satisfying inclusion criteria were assessed by clinical examination, lung USG and chest X-ray. The results of chest X-ray and lung USG were compared with clinical diagnosis. The current study revealed sensitivity of chest X-ray and LUS ( 60.16% versus 91.05%), specificity (66.67% versus 91.18%), positive predictive value (68.52% versus 92.56%) and the negative predictive values (58.12% versus 89.42%) respectively. Present study revealed that the LUS has better accuracy than chest X-ray for diagnosis of APE. Continuou...

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Immediate results of pneumonectomy in the complex treatment of patients with destructive pulmonary tuberculosis

MedAlliance ◽

10.36422/23076348-2020-8-3-54-65 ◽

2020 ◽

Vol 8 (3) ◽

pp. 54-65

Keyword(s):

Postoperative Complications ◽

Pulmonary Tuberculosis ◽

Drug Sensitivity ◽

Early Postoperative Period ◽

P Value ◽

Comprehensive Treatment ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

X Ray ◽

Surgical Methods

Introduction. Currently, surgical methods in the compre-hensive treatment of patients with pulmonary tuberculosis remain in demand all over the world. Among them, pneu-monectomy is performed in 10.3–21.8% of cases and is of-ten accompanied by various postoperative complications.Objective. Study of the immediate results of pneu-monectomy in the comprehensive treatment of patients with destructive pulmonary tuberculosis.Material and methods. A continuous retrospective study was carried out in 2012 through 2017. Inclusion criteria: pa-tients between 18 and 75 years; diagnosis verified by cul-ture technique; total destructive lesion of one of the lungs; chemotherapy for at least 6 months, taking into account the data on MTB drug sensitivity. Exclusion criteria: pre-sence of a destructive lesion in the contralateral lung. 129 patients were enrolled into the study. Patients’ sex, age, duration of the disease, complications of pulmonary tuber-culosis before surgery, MTB drug sensitivity, bacterial shed-ding, X-ray changes, respiratory function, lung perfusion, comorbidity and degree of activity of a specific process were studied, as well as the characteristics of surgical inter-ventions, intraoperative and postoperative complications. Postoperative complications were assessed in accordance with TM&M classification. Differences between groups were determined using the χ2 test. A p value less than 0.05 was considered to be statistically significant.Results. Complications in the early postoperative period developed in 52 (40.4%) patients; 26 (20.2%) patients had minor complications, 26 (20.2%) major ones. In postope-rative period 1 (0.8%) patient died. Postoperative compli-cations were eliminated in 125 (96.9%) patients. Among bacillary patients, bacterial shredding ceased in 80 (91%). Satisfactory immediate result was achieved in 120 (93%) patients, unsatisfactory, in 9 (7%). In the group of patients with major postoperative complications there were sig-nificantly more patients with a disease duration of more than 36 months, as well as those with HCV infection and MDR/XDR MTB (p<0.05).Conclusion. Pneumonectomy is a highly effective opera-tion in the comprehensive treatment of patients with uni-lateral destructive pulmonary tuberculosis

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Adverse Effects of Natural Products: A Brief Pre-Systematic Review

Current Nutraceuticals ◽

10.2174/2665978601999200702163914 ◽

2020 ◽

Vol 01 ◽

Author(s):

Carla Pires ◽

Ana Fernandes

Keyword(s):

Systematic Review ◽

Adverse Event ◽

Natural Products ◽

Adverse Events ◽

In Vitro Study ◽

Google Scholar ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Meta Analyses

Background: Natural products are commonly used for treating health problems. These products may be associated with adverse events, which are defined as "noxious and unintended response to a medicinal product" by the European Medicine Agency. Objectives: To identify studies describing at least one adverse event (or with potential to promote an adverse event) related to the use of natural products, as well as to describe the involved product(s) and adverse event(s). Methods: A pre-systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Keywords: "natural product(s)" and ["adverse drug reaction(s)" or "adverse effect(s)"]. Screened databases: PubMed, SciELO, DOAJ and Google Scholar. Inclusion criteria: papers describing at least one adverse event associated with the use of natural products and published between 2017 and 2019. Exclusion criteria: Repeated studies, reviews and papers written in other languages than English, Portuguese, French or Spanish. Results: 104 studies were identified (20 PubMed; 0 SciELO; 2 DOAJ; 82 Google Scholar), but only 10 were selected (4 PubMed and 6 Google Scholar): 1 in-vitro study; 2 non-clinical studies, 1 study reporting in-vitro and clinical data and 5 studies were cases reports. Globally, 997 reports of adverse drug reactions with natural products were identified, mainly non-severe cases. Conclusion: Since a limited number of studies was found, we conclude that adverse events due to natural products may be underreported, or natural products may have a good safety profile. This review contributes for assuring the safety of natural products consumers, by evaluating the knowledge/information on the potential adverse events and interactions of these products.

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The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

Lipids in Health and Disease ◽

10.1186/s12944-021-01488-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Robert J. Sanchez ◽

Wenzhen Ge ◽

Wenhui Wei ◽

Manish P. Ponda ◽

Robert S. Rosenson

Keyword(s):

Acute Pancreatitis ◽

Medical Records ◽

Adult Population ◽

Baseline Period ◽

Prior History ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Recurrent Acute Pancreatitis ◽

History Of ◽

Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

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Applicability of the VOYAGER trial criteria: a cohort study on patients in the nationwide Danish Vascular Registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2390 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Soegaard ◽

P.B Nielsen ◽

F Skjoeth ◽

T.B Larsen ◽

N Eldrup

Keyword(s):

Myocardial Infarction ◽

Lower Extremity ◽

Major Adverse Cardiovascular Events ◽

Funding Source ◽

Inclusion Criteria ◽

Private Company ◽

Exclusion Criteria ◽

Dual Pathway ◽

Event Rates ◽

Lower Extremity Revascularization

Abstract Introduction Peripheral artery disease (PAD) carries a high risk of debilitating stroke, myocardial infarction, and death. The VOYAGER PAD trial investigates whether rivaroxaban 2.5 mg plus aspirin vs aspirin alone leads to a reduction in major adverse cardiovascular events (MACE) in patients with symptomatic PAD undergoing revascularization. However, it is unclear whether patients enrolled in VOYAGER PAD reflect those undergoing lower extremity revascularization in daily clinical practice. Purpose To describe the proportion of patients eligible for the VOYAGER PAD trial within the nationwide Danish Vascular Registry (DVR), the reasons for ineligibility, and rates of cardiovascular outcomes in VOYAGER-eligible and VOYAGER-ineligible patients. Methods We identified and characterized all patients from 2000–2016 undergoing open surgical or endovascular revascularization for symptomatic PAD in the DVR and applied the VOYAGER inclusion and exclusion criteria. We computed one-year rates per 100 person-years of VOYAGER PAD trial endpoints of MACE, myocardial infarction, ischemic stroke, major amputation, major bleeding, cardiovascular (CV) death, and all cause death. Results In the DVR, 32,911 patients underwent lower extremity revascularization for symptomatic PAD and were evaluated for eligibility. Among these, 32.2% had at least one exclusion criteria and an additional 40.6% without exclusion criteria did not fulfil inclusion criteria. The “VOYAGER-eligible” population therefore comprised 27.2% of the identified patients (Figure 1A). Main reasons for exclusion were atrial fibrillation (30.7%), poorly regulated hypertension (19.6%), PCI or ACS within 12 months before (16.0%), treatment with strong inhibitors or inducers of cytochrome P450 (9.2%), active cancer (8.8%), and severe renal failure (8.3%). Main reasons for non-inclusion were aorto-iliac procedures (79.0%), non-successful revascularization (13.1%), and age<50 years (7.1%). Compared with “VOYAGER-eligible” patients, event rates were slightly lower among patients in the DVR not fulfilling inclusion criteria and markedly higher for “VOYAGER excluded” patients (Figure 1B). Conclusion In this nationwide cohort of symptomatic PAD patients undergoing lower extremity revascularization, 27.2% full filled the inclusion and exclusion criteria for dual pathway therapy in the VOYAGER PAD trial. Non-inclusion predominantly related to aorto-iliac procedures and were associated with lower event rates. Future studies are needed to clarify if these patients could also benefit from dual pathway therapy. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG, Berlin, Germany

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Single-bone versus both-bone plating of unstable paediatric both-bone forearm fractures. A randomized controlled clinical trial

International Orthopaedics ◽

10.1007/s00264-021-05097-z ◽

2021 ◽

Author(s):

Mohamed Khaled ◽

Amr A. Fadle ◽

Ahmed Khalil Attia ◽

Andrew Sami ◽

Abdelkhalek Hafez ◽

...

Keyword(s):

Clinical Trial ◽

Operative Time ◽

Forearm Fractures ◽

Inclusion Criteria ◽

Fracture Union ◽

Exclusion Criteria ◽

Bone Fixation ◽

Fixation Group ◽

Significant Difference ◽

Single Bone

Abstract Purpose This clinical trial compares the functional and radiological outcomes of single-bone fixation to both-bone fixation of unstable paediatric both-bone forearm fractures. Methods This individually randomized two-group parallel clinical trial was performed following the Consolidated Standards of Reporting Trials (CONSORT) statement at a single academic tertiary medical centre with an established paediatric orthopaedics unit. All children aged between nine and 15 years who presented to the emergency department at Assiut university with unstable diaphyseal, both-bone forearm fractures requiring surgical intervention between November 1, 2018, and February 28, 2020, were screened for eligibility against the inclusion and exclusion criteria. Inclusion criteria were diaphyseal unstable fractures defined as shaft fractures between the distal and proximal metaphyses with an angulation of > 10°, and/or malrotation of > 30°, and/or displacement > 10 mm after attempted closed reduction. Exclusion criteria included open fractures, Galeazzi fractures, Monteggia fractures, radial head fractures, and associated neurovascular injuries. Patients who met the inclusion criteria were randomized to either the single-bone fixation group (intervention) or the both-bone fixation group (control). Primary outcomes were forearm range of motion and fracture union, while secondary outcomes were forearm function (price criteria), radius re-angulation, wrist and elbow range of motion, and surgical time Results A total of 50 children were included. Out of these 50 children, 25 were randomized to either arm of the study. All children in either group received the treatment assigned by randomization. Fifty (100%) children were available for final follow-up at six months post-operatively. The mean age of single-bone and both-bone fixation groups was 11.48 ± 1.93 and 13 ± 1.75 years, respectively, with a statistically significant difference (p = 0.006). There were no statistically significant differences in gender, laterality, affection of the dominant hand, or mode of trauma between single-bone and both-bone fixation groups. All patients in both groups achieved fracture union. There mean radius re-angulation of the single-bone fixation groups was 5.36 ± 4.39 (0–20) degrees, while there was no radius re-angulation in the both-bone fixation group, with a statistically significant difference (p < 0.001). The time to union in the single-bone group was 6.28 ± 1.51 weeks, while the time to union in the both-bone fixation group was 6.64 ± 1.75 weeks, with no statistically significant difference (p = 0.44). There were no infections or refractures in either group. In the single-bone fixation group, 24 (96%) patients have regained their full forearm ROM (loss of ROM < 15°), while only one (4%) patient lost between 15 and 30° of ROM. In the both-bone fixation group, 23 (92%) patients have regained their full forearm ROM (loss of ROM < 15°), while only two (8%) patients lost between 15 and 30° of ROM. There was no statistically significant difference between groups in loss of forearm ROM (p = 0.55). All patients in both groups regained full ROM of their elbow and wrist joints. On price grading, 24 (96%) and 23 (92%) patients who underwent single bone fixation and both-bone fixation scored excellent, respectively. Only one (4%) patient in the single-bone fixation group and two (8%) patients in the both-bone fixation group scored good, with no statistically significant difference in price score between groups (p = 0.49). The majority of the patients from both groups had no pain on the numerical pain scale; 22 (88%) patients in the single-bone fixation group and 21 (84%) patients in the both-bone fixation groups, with no statistically significant difference between groups (p = 0.38). The single-bone fixation group had a significantly shorter mean operative time in comparison to both-bones plating (43.60 ± 6.21 vs. 88.60 ± 10.56 (min); p < 0.001). Conclusion Single-bone ulna open reduction and plate fixation and casting are safe and had a significantly shorter operative time than both-bone fixation. However, single-bone ORIF had a higher risk radius re-angulation, alas clinically acceptable. Both groups had equally excellent functional outcomes, forearm ROM, and union rates with no complications or refractures. Long-term studies are required.

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Prognosis in patients with prior myocardial infarction and PEGASUS-TIMI 54 criteria in the CLARIFY registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1431 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Biscaglia ◽

G Campo ◽

K Fox ◽

J.C Tardif ◽

M Tendera ◽

...

Keyword(s):

High Risk ◽

Major Bleeding ◽

Artery Bypass ◽

Real Life ◽

Prolonged Treatment ◽

Funding Source ◽

Inclusion Criteria ◽

Private Company ◽

Exclusion Criteria ◽

Coronary Syndrome

Abstract Background/Introduction The PEGASUS-TIMI 54 trial showed that prolonged treatment with ticagrelor reduces the cumulative occurrence of ischemic adverse events. CLARIFY is the biggest real life registry on chronic coronary syndrome. Purpose - To evaluate the percentage of patients eligible for long-term ticagrelor therapy in the CLARIFY registry. – To compare the outcome of this subgroup of patients with those with PEGASUS exclusion criteria or without PEGASUS inclusion criteria. Methods Within the CLARIFY population, we selected post MI patients and we excluded those with missing info (post MI evaluable population). Then, we divided patients into 3 groups: excluded (meeting PEGASUS exclusion criteria, namely use of P2Y12 receptor antagonists or chronic oral anticoagulant, any stroke, coronary-artery bypass grafting in the past 5 years); eligible (meeting PEGASUS high-risk inclusion criteria, namely age≥65 years; diabetes; multivessel disease; creatinine clearance <60 ml/min) and ineligible (not meeting PEGASUS high-risk inclusion criteria). We therefore compared the ischemic (CV death, MI and stroke) and bleeding (major bleeding) outcome of the 3 groups adjusting for age, sex, smoking and geographical region. Results Among the 11811 post-MI evaluable patients, 4706 (39.8%) were included in the eligible group, 5715 (48.4%) in the excluded group, and 1390 in the ineligible group (11.8%). Both the ischemic and bleeding endpoints were significantly different among the 3 groups with the excluded patients with the worst and ineligible patients with the best outcome (see table). The same trend was shown for CV death, while the occurrence of MI was not significantly different among the 3 groups. In the eligible group, the ratio between ischemic and bleeding events was 6:1, whereas between CV death and major bleeding was 3.5:1. Conclusions Around 40% of CLARIFY post-MI patients could benefit from prolonged ticagrelor therapy. In this group of patients, ischemic risk seems to be higher than the bleeding one. Ischemic & bleeding risk in the 3 groups Funding Acknowledgement Type of funding source: Private company. Main funding source(s): CLARIFY registry was funded by Servier

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Exoskeletons for all: The interplay between exoskeletons, inclusion, gender, and intersectionality

Paladyn Journal of Behavioral Robotics ◽

10.1515/pjbr-2020-0036 ◽

2020 ◽

Vol 11 (1) ◽

pp. 217-227 ◽

Cited By ~ 1

Author(s):

Roger Andre Søraa ◽

Eduard Fosch-Villaronga

Keyword(s):

New Technology ◽

Health Condition ◽

End Users ◽

Target Market ◽

Inclusion Criteria ◽

Wearable Robot ◽

Exclusion Criteria ◽

Intersectionality Theory ◽

Design Choice ◽

The One

AbstractIn this article, we investigate the relation between gender and exoskeleton development through the lens of intersectionality theory. Exoskeleton users come in a wide variety of shapes, sizes, and genders. However, it is often the case that wearable robot engineers do not develop such devices primarily on the premise that the product should fit as many end users as possible. Instead, designers tend to use the one-size-fits-all approach – a design choice that seems legitimate from the return of an investment viewpoint but that may not do as much justice to end users. Intended users of exoskeletons have a series of user criteria, including height, weight, and health condition, in the case of rehabilitation. By having rigid inclusion criteria for whom the intended user of the technology can be, the exclusion criteria will grow in parallel. The implications and deep-rootedness of gender and diversity considerations in practices and structural systems have been largely disregarded. Mechanical and robot technology were historically seen as part of a distinct male sphere, and the criteria used today to develop new technology may reflect the biases that existed in another time that should no longer be valid. To make this technology available for all, we suggest some tools to designers and manufacturers to help them think beyond their target market and be more inclusive.

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