Abstract 3012: Impact of Thromboaspiration during Primary PCI on Microvascular Damage and Infarct Size: Acute and Long term ce-MRI Evaluation.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Gennaro Sardella ◽  
Massimo Mancone ◽  
Raffaele Scardala ◽  
Leonardo De Luca ◽  
Chiara Bucciarelli Ducci ◽  
...  
Keyword(s):  
Infarct Size ◽  
Primary Pci ◽  
Microvascular Damage ◽  
St Segment ◽  
Group 2 ◽  
Procedural Outcomes ◽  
The Impact ◽  
Mri Evaluation ◽  
Group 1

Background: In patients with ST-elevatrion myocardial infarction (STEMI), impairment of microcirculatory function is a negative independent predictor of myocardial function recovery. Compared with conventional stenting, thrombectomy during primary percutaneous coronary intervention (PCI) seems to improve the parameters of myocardial tissue perfusion. We sought to evaluate the impact of thromboaspiration on procedural outcomes and microascualr damage and infarct size by contrast enhanced-MRI (ce-MRI) as compared to conventional primary PCI. Methods:We randomized 75 patients (mean age 64.3±10.2, 55 male) referred to our Hospital with a STEMI (<9 hours from symptoms onset) and an occlusive thrombus at basal angiography, to thromboaspiration with a manual device (Export ®-Medtronic (n=38) (group 1)) and standard PCI (n=37) (group 2). 3 days after procedure and 3 months later a ce-MRI was performed to assess the microvascular damage (as hypoenhancement (HO)) and infarct size (as hyperenhancement(HR)) in the 2 groups. The primary end points were the angiographic result in terms of the TIMI ≥ II flow , MBG ≥ 2 and ST-segment resolution (STr)≥ 70% post-stenting and the microvascular damage (grams/g) and infarct size (grams/g) evaluated by ce-MRI. Results: No differences on baseline, clinical and angiographic preprocedural findings were observed between the two groups. After trombectomy, a TIMI II flow was present in in 38.6 vs 19.6% (p=0.054) and TIMI III was 30.7 vs 72.5% (for group 1 and 2, respectively, p<0.001). Postprocedural MBG ≥2 was 70,3% vs 28,7% (p<0.001) and 90′ ST-segment resolution was 80% vs 37.5% (for group 1 and 2, respectively, p<0.001). Ce-MRI showed an HO of 4.04±5.87g at 3 days vs 0.12±0.4g at 3 months (p= 0.04) in group 1, and 3.7±5.04 vs 2.7±2.3 (3 d and 3 m. respectively)(p=ns) in group 2. At 3 days HR was 17.39±15.6g vs 11.01±8.07g at 3 months in group 1 (p=0.04) and 14.02±7.5g vs 13.6±12.7g ( 3 d. and 3 m. respectively) (p=ns) in group 2. Conclusion:Compared with conventional stenting, a pretreatment with thrombectomy during primary PCI, improves epicardial flow and procedural outcomes. The long term ce-MRI evaluation suggests a reduction in microvascular damage and infarct size compared with the acute evaluation in the thrombectomy group.

Abstract 102: Acute Mechanical Unloading of the Left Ventricle Promotes Cardioprotective Signaling and Limits Myocardial Infarct Size

2014 ◽  
Vol 115 (suppl_1) ◽  
Author(s):  
Navin K Kapur ◽  
Vikram Paruchuri ◽  
Xiaoying Qiao ◽  
Kevin Morine ◽  
Wajih Syed ◽  
...  
Keyword(s):  
Infarct Size ◽  
Myocardial Infarct ◽  
Ischemia Reperfusion ◽  
Left Ventricular ◽  
Myocardial Infarct Size ◽  
Stroke Work ◽  
Coronary Reperfusion ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Management of an acute myocardial infarction (AMI) focuses on restoring oxygen supply to limit myocardial damage, however ischemia-reperfusion injury (IRI) remains a major determinant of mortality in AMI. No studies have targeted initially reducing left ventricular stroke work (LVSW) to limit IRI in AMI. The Impella CP axial-flow pump reduces LVSW. We tested the hypothesis that first reducing myocardial work and delaying coronary reperfusion reduces infarct size by activating cardioprotective signaling pathways. Methods: AMI was induced by occlusion of the left anterior descending artery (LAD) via angioplasty for 90 minutes in 50kg male Yorkshire swine (n=5/group). In Group 1, the LAD was reperfused for 120 minutes. In Group 2, after 90 minutes of ischemia the Impella CP device was activated and the LAD left occluded for an additional 60 minutes (150 minutes of LAD occlusion total), followed by 120 minutes of reperfusion. The Impella CP was active throughout reperfusion. Western blot analysis quantified myocardial kinase activity. Results: Compared to Group 1, Group 2 had a reduced LVSW, LV end-diastolic volume and end-diastolic pressure after reperfusion [Fig A]. Group 2 showed increased myocardial phosphorylation of cardioprotective kinases: AKT, ERK, GSK3β and STAT-3 [Fig B]. Compared to Group 1, the percent myocardial infarct size normalized to the area at risk (AAR) was reduced in Group 2 (73+13% vs 42+15%, p=0.02). Conclusion: We report the potential benefit of primarily unloading the heart and delaying coronary reperfusion to salvage myocardium in AMI. This is the first report to examine the impact of the Impella CP on cardioprotective signaling in the heart.

scholarly journals Impact of Renal Function on Long-Term Clinical Outcomes in Patients With Coronary Chronic Total Occlusions: Results From an Observational Single-Center Cohort Study During the Last 12 Years

2020 ◽  
Vol 7 ◽  
Author(s):  
Lei Guo ◽  
Huaiyu Ding ◽  
Haichen Lv ◽  
Xiaoyan Zhang ◽  
Lei Zhong ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Insufficiency ◽  
Clinical Outcomes ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The number of coronary chronic total occlusion (CTO) patients with renal insufficiency is huge, and limited data are available on the impact of renal insufficiency on long-term clinical outcomes in CTO patients. We aimed to investigate clinical outcomes of CTO percutaneous coronary intervention (PCI) vs. medical therapy (MT) in CTO patients according to baseline renal function.Methods: In the study population of 2,497, 1,220 patients underwent CTO PCI and 1,277 patients received MT. Patients were divided into four groups based on renal function: group 1 [estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m2], group 2 (60 ≤ eGFR &lt;90 ml/min/1.73 m2), group 3 (30 ≤ eGFR &lt;60 ml/min/1.73 m2), and group 4 (eGFR &lt;30 ml/min/1.73 m2). Major adverse cardiac event (MACE) was the primary end point.Results: Median follow-up was 2.6 years. With the decline in renal function, MACE (p &lt; 0.001) and cardiac death (p &lt; 0.001) were increased. In group 1 and group 2, MACE occurred less frequently in patients with CTO PCI, as compared to patients in the MT group (15.6% vs. 22.8%, p &lt; 0.001; 15.6% vs. 26.5%, p &lt; 0.001; respectively). However, there was no significant difference in terms of MACE between CTO PCI and MT in group 3 (21.1% vs. 28.7%, p = 0.211) and group 4 (28.6% vs. 50.0%, p = 0.289). MACE was significantly reduced for patients who received successful CTO PCI compared to patients with MT (16.7% vs. 22.8%, p = 0.006; 16.3% vs. 26.5%, p = 0.003, respectively) in group 1 and group 2. eGFR &lt; 30 ml/min/1.73 m2, age, male gender, diabetes mellitus, heart failure, multivessel disease, and MT were identified as independent predictors for MACE in patients with CTOs.Conclusions: Renal impairment is associated with MACE in patients with CTOs. For treatment of CTO, compared with MT alone, CTO PCI may reduce the risk of MACE in patients without chronic kidney disease (CKD). However, reduced MACE from CTO PCI among patients with CKD was not observed. Similar beneficial effects were observed in patients without CKD who underwent successful CTO procedures.

ST Depression, No ST Change, or ST Elevation in Inferior Derivations: Which Has the Worst Outcomes in Acute Anterior Myocardial Infarction?

Cardiology ◽  
2017 ◽  
Vol 139 (1) ◽  
pp. 53-61
Author(s):  
Mert İlker Hayıroğlu ◽  
Ahmet Okan Uzun ◽  
Ceyhan Türkkan ◽  
Muhammed Keskin ◽  
Edibe Betül Börklü ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Death ◽  
Anterior Myocardial Infarction ◽  
St Depression ◽  
St Segment ◽  
St Elevation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: The combination of electrical phenomena and remote myocardial ischemia is the pathophysiological mechanism of ST segment changes in inferior leads in acute anterior myocardial infarction (MI). We investigated the prognostic value of ST segment changes in inferior derivations in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PCI). Methods: In this prospective single-center analysis, we evaluated the prognostic impact of ST segment changes in inferior derivations on 354 patients with acute anterior MI. Patients were divided into the following 3 groups according to admission ST segment changes in inferior derivations: ST depression (group 1), no ST change (group 2), and ST elevation (group 3). Results: In-hospital multivariate analysis revealed notably high rates of in-hospital death for patients in group 3 compared to patients in group 2 (OR 2.5; 95% CI 1.6-7.6, p < 0.001). Group 1 and group 2 had similar in-hospital and long-term mortality rates. After adjusting for confounding baseline variables, group 3 had higher rates of 18-month mortality (HR 3.3; 95% CI 1.5-8.2, p < 0.001). Conclusion: In patients with a first acute anterior MI treated with primary PCI, ST elevation in inferior leads had significantly worse short-term and long-term outcomes compared to no ST change or ST segment depression.

scholarly journals THE IMPACT OF VETOM 20.76 BASED ON PREDATORY FUNGUS ARTHROBOTRYS OLIGOSPORA ON THE LEUCOCYTES IN THE GEESE BLOOD

2019 ◽  
pp. 103-108
Author(s):  
N. S. Iakovleva ◽  
G. A. Nozdrin ◽  
M. S. Iakovleva ◽  
S. N. Tishkov ◽  
A. I. Shevchenko
Keyword(s):  
Live Weight ◽  
Control Group ◽  
Group 2 ◽  
The Impact ◽  
Higher Doses ◽  
Leukocyte Concentration ◽  
Experimental Group ◽  
Different Doses ◽  
Group 1

The paper demonstrates the results on the effect of new specimen Vetom 20.76 on concentration of leukocytes in the blood of geese on the basis of the predatory fungus Artusbotus oligospora. In order to achieve the goal of the experiment, one control group and six experimental groups were arranged on the principle of paired analogues. Each group contained 10 geese aged 1 month. The geese from the experimental groups received Vetom 20.76 in different doses in the morning with water once a day: the geese of the 1st experimental group - dose of 0.5 ppm/kg of live weight during 15 days; 2nd experimental group - 1 ppm/kg of live weight during 15 days; 3rd experimental group - 2 ppm/kg of live weight during 15 days, 4th experimental group - 0.5 ppm/kg live weight during 30 days, 5th experimental group - 1 ppm/kg live weight during 30 days and 6th - 2 ppm/kg live weight during 30 days. The geese of control group didn’t receive the specimen. The concentration of leukocytes in the blood of experimental geese increases in the period of specimen application as well as in the period of its aftereffect. If Vetom 20.76 is prescribed for 15 days, the effect of leukopoiesis stimulation finishes on the 30th day. If the specimen is applied during 30 days, the leukocytes in the blood continue to increase up to the 60th day. This long-term application of Vetom 20.76 dosed 0.5ppm/kg increases leucocytes within the physiological norm. Application of higher doses (1 and 2 ppm/kg) the leukocyte concentration conforms to the physiological norm

scholarly journals Post-COVID-19 transient hypogonadism and erectile dysfunction

2021 ◽  
Vol 14 (3) ◽  
pp. 112-118
Author(s):  
F.R. Asfandiyarov ◽  
◽  
V.A. Kruglov ◽  
S.V. Vybornov ◽  
K.S. Seidov ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Testosterone Level ◽  
Erectile Function ◽  
Hormone Replacement ◽  
Severe Illness ◽  
Hormonal Profile ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Introduction. The SARS-CoV-2 virus pandemic is one of the biggest public health challenges in the modern era. Currently, along with the continuing high incidence rate, the immediate and long-term consequences of COVID-19 are predictably becoming increasingly important. The impact of the COVID-19 on andrological health and erectile function has been studied insufficiently. The aim of this study was to assess the impact of COVID-19 infection on erectile function. Material and methods. From May 2020 to April 2021 44 men after COVID-19 pneumonia were consulted for decrease in libido, erectile function and the quality of sexual intercourse in three Astrakhan medical centers. The examination of patients included standard general clinical methods, hormonal profile studying (testosterone, luteinizing homone, prolactin) and number of standardized questionnaires. Results. No changes in the levels of luteinizing hormone and prolactin were observed. Total testosterone levels ranged from 8.0 to 14.8 nmol / L. According the testosterone level patients were divided into two groups. In group 1 patients testosterone level was 12.0 nmol/L and more, in group 2 patients – less than 12 nmol/L. In patients of the group 1 erectile dysfunction was regarded as one of the manifestations of asthenic syndrome and was relatively easily corrected by the administration of PDE-5 inhibitors and antiasthenic therapy. Patients of the group 2 had more severe complaints, «worse» scores on questionnaire scales and more significant asthenic syndrome. Discussion. The possible mechanisms of androgen deficiency and hormonal profile changes in those patients may be a direct damaging of gonadal cells by virus and nonspecific suppression of the hypothalamic-pituitary system caused by a severe illness. In some cases, testosterone preparations were prescribed to those patients to achieve a therapeutic effect. Conclusions. COVID infection may have a negative impact on erectile function. The main causes of this are decrease of testosterone level, endothelial dysfunction, and long-term asthenization. Those changes may be reversible by rehabilitation and drug correction. One should not rush to begin hormone replacement therapy. It makes sense to start treatment with antiasthenic drugs, and add testosterone preparations in the absence of an effect only. This study addresses only some aspects of the COVID-19 influence on the men's health. In the context of the ongoing pandemic and the inevitable increase in the number of ill patients, further comprehensive studies are needed to clarify all the details and organize adequate andrological care for these patients.

Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

2020 ◽  
Vol 104 (11-12) ◽  
pp. 975-981
Author(s):  
Alexander Tamalunas ◽  
Yannic Volz ◽  
Boris Alexander Schlenker ◽  
Alexander Buchner ◽  
Alexander Kretschmer ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Oldest Old ◽  
Complication Rates ◽  
Age Group ◽  
Patient Cohort ◽  
Group 2 ◽  
The Impact ◽  
Group 1

<b><i>Purpose:</i></b> With a median age at diagnosis of 73 years, bladder cancer has the highest median age of all cancers. Age alone seems to be an independent risk factor for developing the disease with peak age advancing into the range of 85 years. As demographic changes will lead to an ever more aging population in western countries, incidence of advanced age malignancies will rise. We, therefore, analyzed a contemporary radical cystectomy (RC) series at a single high-volume center on patients undergoing RC for urothelial carcinoma of the bladder (UCB). We aim to evaluate the feasibility of RC in the oldest-old patient cohort by assessing perioperative complications and long-term outcome. <b><i>Materials and Methods:</i></b> We retrospectively analyzed data of 1,278 consecutive patients who underwent RC for UCB at our tertiary referral center between 2004 and 2019. A total of 408 patients were aged 75–97 years at the time of RC and were further divided into 2 groups: 75–84 years of age (group 1) and ≥85 years of age (group 2). Median follow-up was 23 months. Outcome was analyzed using the χ<sup>2</sup> test, Mann-Whitney U test, Kaplan-Meier method, and log-rank test. <b><i>Results:</i></b> Perioperative Clavien-Dindo grade ≥III complications were seen in 25.1% (92/366) of group 1 patients and 35.7% (15/42) of group 2 patients (<i>p</i> = 0.073). Thirty- and 90-day mortality was 3.3 and 8.7% in group 1 and 4.8 and 14.3% in group 2 (<i>p</i> = 0.617 and <i>p</i> = 0.242, respectively). Three-year overall survival was 54.6% in group 1 and 31.3% in group 2 (<i>p</i> = 0.03). Three-year cancer-specific survival was 64.8% in group 1 and 38.8% in group 2 (<i>p</i> = 0.037). Recurrence-free survival was 105 months in group 1 and 12 months in group 2 (<i>p</i> = 0.039). <b><i>Conclusion:</i></b>In light of increasing life expectancy in western nations, we sought to evaluate the impact of age in a large series of elderly patients undergoing RC for UCB. We found that RC offers acceptable perioperative complication rates in the oldest-old patient cohort (≥85 years). Therefore, RC for UCB can be offered as a viable treatment option even in the oldest patients.

Cocaine/Polydrug Use in Pregnancy: Two-Year Follow-up

PEDIATRICS ◽  
1992 ◽  
Vol 89 (2) ◽  
pp. 284-289 ◽  
Author(s):  
Ira J. Chasnoff ◽  
Dan R. Griffith ◽  
Catherine Freier ◽  
James Murray
Keyword(s):  
Head Circumference ◽  
Head Size ◽  
Developmental Outcome ◽  
Long Term Outcome ◽  
Developmental Index ◽  
Group 2 ◽  
The Impact ◽  
Group 1

The impact of cocaine on pregnancy and neonatal outcome has been well documented over the past few years, but little information regarding long-term outcome of the passively exposed infants has been available. In the present study, the 2-year growth and developmental outcome for three groups of infants is presented: group 1 infants exposed to cocaine and usually marijuana and/or alcohol (n = 106), group 2 infants exposed to marijuana and/or alcohol but no cocaine (n = 45), and group 3 infants exposed to no drugs during pregnancy. All three groups were similar in racial and demographic characteristics and received prenatal care through a comprehensive drug treatment and follow-up program for addicted pregnant women and their infants. The group 1 infants demonstrated significant decreases in birth weight, length, and head circumference, but by a year of age had caught up in mean length and weight compared with control infants. The group 2 infants exhibited only decreased head circumference at birth. Head size in the two drug-exposed groups remained significantly smaller than in control infants through 2 years of age. On the Bayley Scales of Infant Development, mean developmental scores of the two groups of drug-exposed infants did not vary significantly from the control group, although an increased proportion of group 1 and 2 infants scored greater than two standard deviations below the standardized mean score on both the Mental Developmental Index and the Psychomotor Developmental Index compared with the control infants. Cocaine exposure was found to be the single best predictor of head circumference. Across all infants in the study, a significant correlation between small head size and developmental scores was found. The present study demonstrates that intrauterine drug exposure may place infants at risk for developmental outcome and that head growth after birth may be an important biological marker in predicting long-term development in children exposed in utero to cocaine and other drugs.

scholarly journals General anaesthesia during radiofrequency ablation of atrial fibrillation is associated with improved procedural characteristics but with similar long-term outcomes: a single center study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Traykov ◽  
D Marchov ◽  
M Marinov ◽  
D Boychev ◽  
V Gelev
Keyword(s):  
Atrial Fibrillation ◽  
Conscious Sedation ◽  
Complication Rates ◽  
Single Center ◽  
Lower Radiation Dose ◽  
Procedural Time ◽  
Group 2 ◽  
Procedural Outcomes ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Introduction General anaesthesia (GA) or conscious sedation can be used during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) based on physician’s and patient’s preference. Increasing number of centers include GA in their institutional protocols for RFCA of AF.  Purpose The current study aims to compare real-world data on procedural characteristics, complication rate and procedural outcomes in patients undergoing RFCA of AF under GA or sedation at a single center. Methods A total of 167 patients (116 males, age 57.53 ± 9.78 years) with paroxysmal or persistent AF undergoing RFCA were studied retrospectively. Patients underwent RFCA under GA (108 patients, Group 1) provided by the anaesthesia team at our institution or under conscious sedation (59 patients, Group 2) guided by the operator using bolus doses of midazolam and fentanyl. We compared procedural time, fluoroscopy time, dose-area product (DAP), number of lesions and cumulative RF time between the two groups. We also analysed the complication rates and the long-term outcome in the two groups. Results are presented as mean ± SD or median (25th – 75th percentile). Results   Groups 1 and 2 were comparable in terms of baseline clinical characteristics. Group 1 patients demonstrated significantly shorter procedural time as compared to Group 2: 149.52 ± 41.31 min vs. 208.23 ± 77.10 min, P &lt; 0.0005. Fluoroscopy time was also shorter in Group 1 24 (20-31.75) min compared to 36 (22.5-46.5) min in Group 2, P &lt; 0.0001. This corresponded to lower radiation dose expressed by DAP which was also significantly lower in Group 1 patients: 3230 (1660-6793.2) cGy/cm2 vs. 13880 (4215-21324) cGy/cm2 for Group 2, P &lt; 0.0001. Administration of GA during the procedure was associated with lower number of RF applications: 52.49 ± 19.36 in Group 1 vs. 68.33 ± 30.74 in Group 2, P = 0.0001. This corresponded with the lower cumulative RF time noted in the patients from Group 1: 2499.2 ± 824.17 sec vs. 3220 ± 1357.26 sec in Group 2, P &lt; 0.0001. Procedural complications occurred in 5 patients from Group 1 (4.6%) and in 8 patients (13.6%) in Group 2, P = 0.066. There was a single case of atrioesophageal fistula in a patient from Group 1. After a median follow-up of 20 (8-41) months 75% of the patients from both Group 1 and Group 2 were arrhythmia-free following 1.5 ± 0.68 procedures (P = 1.0).  Conclusion Performing RFCA of AF under GA is associated with shorter procedural time, lower radiation dose and with the need for less energy application. This does not result in significantly lower complication rates. Long-term procedural outcomes do not seem to be affected by the use of GA.

CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Statistical Significance ◽  
Treatment Procedure ◽  
Fetal Survival ◽  
Ex Utero Intrapartum Treatment ◽  
Life Threatening ◽  
Group 2 ◽  
Cd34 Immunostain ◽  
The Impact ◽  
Diaphragmatic Hernias ◽  
Group 1

AbstractShort CommunicationsEXIT (ex-utero intrapartum treatment) procedure is a fetal survival-increasing modification of cesarean section. Previously we found an increase incidence of fetal vascular malperfusion (FVM) in placentas from EXIT procedures which indicates the underlying stasis of fetal blood flow in such cases. This retrospective analysis analyzes the impact of the recently introduced CD34 immunostain for the FVM diagnosis in placentas from EXIT procedures.Objectives and MethodsA total of 105 placentas from EXIT procedures (48 to airway, 43 to ECMO and 14 to resection) were studied. In 73 older cases, the placental histological diagnosis of segmental FVM was made on H&E stained placental sections only (segmental villous avascularity) (Group 1), while in 32 most recent cases, the CD34 component of a double E-cadherin/CD34 immunostain slides was also routinely used to detect the early FVM (endothelial fragmentation, villous hypovascularity) (Group 2). 23 clinical and 47 independent placental phenotypes were compared by χ2 or ANOVA, where appropriate.ResultsThere was no statistical significance between the groups in rates of segmental villous avascularity (29 vs. 34%), but performing CD34 immunostain resulted in adding and/or upgrading 12 more cases of segmental FVM in Group 2, thus increasing the sensitivity of placental examination for FVM by 37%. There were no other statistically significantly differences in clinical (except for congenital diaphragmatic hernias statistically significantly more common in Group 2, 34 vs 56%, p=0.03) and placental phenotypes, proving the otherwise comparability of the groups.ConclusionsThe use of CD34 immunostain increases the sensitivity of placental examination for FVM by 1/3, which may improve the neonatal management by revealing the increased likelihood of the potentially life-threatening neonatal complications.

scholarly journals The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Francesco A. Ciarleglio ◽  
Marta Rigoni ◽  
Liliana Mereu ◽  
Cai Tommaso ◽  
Alessandro Carrara ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Transfusion ◽  
Emergency Surgery ◽  
Surgical Care ◽  
Close Correlation ◽  
Negative Effects ◽  
Group 2 ◽  
Retrospective Comparative Study ◽  
The Impact ◽  
Group 1

Abstract Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89–11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01–63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11). Conclusions This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a “filter effect” induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.

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