Comparing the first and second waves of COVID-19 in a tertiary university hospital in Barcelona

Background: Hospitals have constituted the limiting resource of the healthcare systems for the management of the COVID-19 pandemic. As the pandemic progressed, knowledge of the disease improved, and healthcare systems were expected to be more adapted to provide a more efficient response. The objective of this research was to compare the flow of COVID-19 patients in emergency rooms and hospital wards, between the pandemic's first and second waves at the University Hospital of Vall d’Hebron (Barcelona, Spain), and to compare the profiles, severity and mortality of COVID-19 patients between the two waves. Methods: A retrospective observational analysis of COVID-19 patients attending the hospital from February 24 to April 26, 2020 (first wave) and from July 24, 2020, to May 18, 2021 (second wave) was carried out. We analysed the data of the electronic medical records on patient demographics, comorbidity, severity, and mortality. Results: The daily number of COVID-19 patients entering the emergency rooms (ER) dropped by 65% during the second wave compared to the first wave. During the second wave, patients entering the ER were significantly younger (61 against 63 years old p<0.001) and less severely affected (39% against 48% with a triage level of resuscitation or emergency; p<0.001). ER mortality declined during the second wave (1% against 2%; p<0.000). The daily number of hospitalised COVID-19 patients dropped by 75% during the second wave. Those hospitalised during the second wave were more severely affected (20% against 10%; p<0.001) and were referred to the intensive care unit (ICU) more frequently (21% against 15%; p<0.001). Inpatient mortality showed no significant difference between the two waves. Conclusions: Changes in the flow, severity and mortality of COVID-19 patients entering this tertiary hospital during the two waves may reflect a better adaptation of the health care system and the improvement of knowledge on the disease.

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Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

International Journal of Emergency Medicine ◽

10.1186/s12245-020-00319-4 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

German Devia Jaramillo ◽

Norberto Navarrete Aldana ◽

Zaira Rojas Ortiz

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Cardiac Activity ◽

Pulseless Electrical Activity ◽

Cardiac Arrest Patient ◽

University Hospital ◽

Bedside Ultrasound ◽

Emergency Rooms ◽

Significant Difference ◽

The University

Abstract Background The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound. Objective This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms. Materials and methods This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient. Results Of a total of 108 patients, the median of the age was 71 years, 65.8% were male subjects, and the most frequent cause for cardiac arrest was the cardiogenic shock (32.4%). ROSC was observed in 41 cases (37.9%) and survival at discharge was 18 cases (16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC. Conclusion There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

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Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

10.21203/rs.3.rs-28052/v1 ◽

2020 ◽

Author(s):

German Alberto Devia ◽

Norberto Navarrete ◽

Zaira Melina Rojas Ortiz

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Cardiac Activity ◽

Pulseless Electrical Activity ◽

University Hospital ◽

Bedside Ultrasound ◽

Emergency Rooms ◽

Significant Difference ◽

Ultrasound Assessment ◽

The University

Abstract Background The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound.Objective This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients, and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms.Materials and Methods This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor, Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient.Results Of a total of 108 patients the median of the age was 71 years, 65.8% were male subjects, the most frequent cause for cardiac arrest was the cardiogenic shock(32.4%). ROSC was observed in 41 cases(37.9%) and survival at discharge was 18 cases(16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC.Conclusion There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

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Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

10.21203/rs.3.rs-28052/v2 ◽

2020 ◽

Author(s):

German Alberto Devia ◽

Norberto Navarrete ◽

Zaira Melina Rojas Ortiz

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Cardiac Activity ◽

Pulseless Electrical Activity ◽

Cardiac Arrest Patient ◽

University Hospital ◽

Bedside Ultrasound ◽

Emergency Rooms ◽

Significant Difference ◽

The University

Abstract Background: The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound. Objective: This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients, and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms. Materials and Methods: This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor, Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient. Results: Of a total of 108 patients the median of the age was 71 years, 65.8% were male subjects, the most frequent cause for cardiac arrest was the cardiogenic shock(32.4%). ROSC was observed in 41 cases(37.9%) and survival at discharge was 18 cases(16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC. Conclusion: There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

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Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-0950-9892 ◽

2019 ◽

Vol 128 (10) ◽

pp. 693-698

Author(s):

Sabine Dillenberger ◽

Detlef K. Bartsch ◽

Elisabeth Maurer ◽

Peter Herbert Kann

Keyword(s):

Primary Hyperparathyroidism ◽

Multiple Endocrine Neoplasia ◽

University Hospital ◽

Primary Surgery ◽

Endocrine Neoplasia ◽

Single Centre Experience ◽

Significant Difference ◽

History Of ◽

The University

Abstract Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

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Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Neurological Sciences ◽

10.1007/s10072-020-04775-x ◽

2020 ◽

Author(s):

Nishita Padmanabhan ◽

Indira Natarajan ◽

Rachel Gunston ◽

Marko Raseta ◽

Christine Roffe

Keyword(s):

National Institutes Of Health ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Stroke Treatment ◽

Patient Demographics ◽

The United Kingdom ◽

Significant Difference ◽

Ischaemic Attack ◽

Provision Of Care

Abstract Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

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Seasonal variability in the incidence of carcinomatous meningitis

Journal of Neurosurgery ◽

10.3171/2014.11.jns14174 ◽

2015 ◽

Vol 122 (3) ◽

pp. 543-546 ◽

Cited By ~ 1

Author(s):

Angelos Koutras ◽

Minas Sakellakis ◽

Thomas Makatsoris ◽

Charalabia Psachoulia ◽

Maria Kardari ◽

...

Keyword(s):

Seasonal Variability ◽

Warm Season ◽

Cold Climate ◽

University Hospital ◽

Carcinomatous Meningitis ◽

Warm Climate ◽

Significant Difference ◽

The University ◽

Official Data ◽

Median Interval

OBJECT The aim of the study was to investigate whether there are seasonal differences in the occurrence of carcinomatous meningitis (CM), with a greater prevalence of the disease in months with higher temperatures. METHODS The authors searched the records of all patients with a diagnosis of CM from 1998 until 2013 at the University Hospital of Patras, Greece. The date of hospitalization was extracted for each patient. The cases were divided into 2 categories depending on the time of CM diagnosis. Based on the official data regarding the annual temperature distribution in this region, the authors divided the patients into 2 groups. The first group consisted of cases diagnosed with CM from October 15 to April 15 (cold climate and shorter daytime duration), whereas the second group comprised patients diagnosed between April 15 and October 15 (warm climate and longer daytime duration). RESULTS Overall, 44 confirmed cases of CM were found. The most common type of malignancy associated with the development of CM was breast cancer (27 patients), while the second most common tumor was lung carcinoma (11 patients). The median interval between the time of initial cancer diagnosis and CM was 4.5 years. Thirty-one patients were diagnosed with CM during the period between April 15 and October 15, while the remaining 13 patients developed CM between October 15 and April 15, a significant difference (p = 0.01). CONCLUSIONS Significantly more patients developed CM during the warm season of the year. To the authors' knowledge, this is the first study to provide evidence for the potential seasonal variability in CM incidence. However, these results should be validated prospectively in larger cohorts.

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[Availability and use of emergency services in Tunisia:main results of a comprihensive national survey]

Eastern Mediterranean Health Journal ◽

10.26719/2001.7.4-5.805 ◽

2001 ◽

Vol 7 (4-5) ◽

pp. 805-811

Author(s):

M. K. Chahed ◽

N. Somrani ◽

H. Achour

Keyword(s):

Emergency Service ◽

Emergency Services ◽

Health Workers ◽

University Hospital ◽

Emergency Rooms ◽

Hospital Emergency ◽

Public Emergency ◽

Use Of Emergency Services ◽

The University

In order to assess hospital emergency rooms, a comprehensive national epidemiological investigation was conducted in all 155 public emergency structures in Tunisia. Here we present the main results of the levels of availability and use of emergency services. Coverage of the population by services is adequate [one emergency service per 60, 000 people]. Emergency wards admit about 2, 500, 000 patients every year [a quarter of the population of the country]. The university hospital emergency services are the most heavily used [150 patients per day on average]. Emergency services are sought for medical [60%], surgical [18%], paediatric [14%] and gynaecological reasons [5%]. It would be useful to assess the quality of care delivered and the satisfaction of citizens and health workers.

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Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score

10.1101/2020.05.09.20096834 ◽

2020 ◽

Author(s):

Ian Levenfus ◽

Enrico Ullmann ◽

Edouard Battegay ◽

Macé M. Schuurmans

Keyword(s):

Time Frame ◽

University Hospital ◽

Emergency Setting ◽

Clinical Experiences ◽

Emergency Rooms ◽

Laboratory Findings ◽

Student’S T ◽

The University ◽

Post Hoc ◽

Short Time

Clinical prediction scores support the assessment of patients in the emergency setting to determine the need for further diagnostic and therapeutic steps. During the current COVID-19 pandemic, physicians in emergency rooms (ER) of many hospitals have a considerably higher patient load and need to decide within a short time frame whom to hospitalize. Based on our clinical experiences in dealing with COVID-19 patients at the University Hospital Zurich, we created a triage score with the acronym AIFELL consisting of clinical, radiological and laboratory findings. The score was then evaluated in a retrospective analysis of 122 consecutive patients with suspected COVID-19 from March until mid-April 2020. Descriptive statistics, Student's t-test, ANOVA and Scheffe's post hoc analysis confirmed the diagnostic power of the score. The results suggest that the AIFELL score has potential as a triage tool in the ER setting intended to select probable COVID-19 cases for hospitalization in spontaneously presenting or referred patients with acute respiratory symptoms.

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Intra-abdominal hypertension in the ICU – a prospective epidemiological study

Medicine and Pharmacy Reports ◽

10.15386/cjmed-455 ◽

2015 ◽

Vol 88 (2) ◽

pp. 188-195 ◽

Cited By ~ 3

Author(s):

Georgi M. Arabadzhiev ◽

Valentina G. Tzaneva ◽

Katya G. Peeva

Keyword(s):

Elective Surgery ◽

Treatment Options ◽

Point Of View ◽

University Hospital ◽

Abdominal Pressure ◽

Medical Patients ◽

Invasive Treatment ◽

Abdominal Hypertension ◽

Significant Difference ◽

The University

The aim of this prospective study is to examine the frequency and the severity of intra-abdominal hypertension in a mixed ICU of the University hospital.Methods: A closed system for intravesical intermittent measurement of IAP was constructed.Results: The frequency and the severity of IAH were examined in the period from June 2009 to December 2012 in 240 ICU patients divided into 3 groups (patients submitted to elective surgery, emergency surgery, and medical patients) in the University Hospital. In the elective surgery group there was 12.5% IAH, while in the emergency group IAH was 43.75%, and in the medical patients it was 42.5%. There was no statistical significant difference in the frequency of IAH among the mixed population of patients we examined and those studied by other authors with the same type of population.Conclusions. The standardized measurement of intra-abdominal pressure is fundamental for defining intra-abdominal hypertension and abdominal compartment syndrome. The measurement of intra-abdominal pressure should be a part of the basic monitoring of patients at risk of intra-abdominal hypertension. Our point of view is that before there are indications for a surgical decompression, less invasive treatment options should be optimized.

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Influence of Gender in Selecting Fixed and Removable Prosthesis

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl3.2925 ◽

2020 ◽

Vol 11 (SPL3) ◽

pp. 268-272

Author(s):

Abigail Ranasinghe ◽

Keerthi Sasanka ◽

Raghu Sandhya

Keyword(s):

Tooth Loss ◽

University Hospital ◽

Negative Effects ◽

Chi Square ◽

Fixed Partial Denture ◽

Masticatory Efficiency ◽

Significant Difference ◽

Removable Prosthesis ◽

Chi Square Test ◽

The University

Tooth loss is a common dental problem. Impairment of oral functions and masticatory efficiency is a result of tooth loss. The negative effects of tooth loss can be managed by the fixed and removable prosthesis. This study was conducted to determine the influence of gender in selecting prosthesis. This study was a retrospective observational study conducted in a university hospital in Chennai. Data collection was done with the help of the electronic dental record of the university- Dental information archiving software (DIAS). It records all patients data from initial visit to last visit chronologically. This was followed by Excel tabulation. Data was analysed using SPSS Software. The association of study variables was calculated using the Chi-Square test. Within the limits of the study, female patients were willing for replacement of teeth than male patients (55%). There was a significant difference in choosing the type of prosthetic treatment. It was seen that fixed partial denture was chosen over removable prosthesis (59.8%).

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