Frequency and severity of general surgical emergencies during the COVID-19 pandemic: single-centre experience from a large metropolitan teaching hospital

Introduction The COVID-19 pandemic has put significant stress on healthcare systems globally. This study focuses on emergency general surgery services at a major trauma centre and teaching hospital. We aimed to identify whether the number of patients and the severity of their presentation has significantly changed since the implementation of a national lockdown. Materials and methods This study is a retrospective review of acute referrals (from general practice and accident and emergency) to the emergency general surgery team over a 14-day period before (group 1) and during (group 2) lockdown. Results A total of 151 patients were reviewed by the general surgical team in group 1 and 75 in group 2 (a 50.3% reduction). The number of days with symptoms prior to presentation was significantly shorter in group 1 compared with group 2 (3 vs 4, p = 0.04). There was no significant difference in the National Early Warning Score, white blood cell count, lymphocytes and C-reactive protein on admission between the two groups of patients. There were significantly fewer patients admitted after lockdown compared with pre-lockdown (66% vs 48%, p = 0.01). Length of hospital stay was significantly shorter during lockdown compared with pre-lockdown (5 days vs 4 days, p = 0.04). Conclusion Fewer patients were referred and admitted during lockdown compared with pre-lockdown, and the length of stay was also significantly reduced. There was also a delay in presentation to hospital, although these patients were not more unwell based on the scoring criteria used within this study.

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Comparative study between open and laparoscopic lymphadenectomy (pelvic and para-aortic) in gynecological malignancies

International Surgery Journal ◽

10.18203/2349-2902.isj20181583 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1657

Author(s):

Hytham R. Yassin ◽

Soliman ALShakhs ◽

Mohammed Hamed ◽

Adel Karam ◽

Mohammed Mouneer

Keyword(s):

Comparative Study ◽

Radical Surgery ◽

Safe Procedure ◽

Gynecological Malignancies ◽

Number Of Patients ◽

Significant Difference ◽

Operative Complications ◽

Group 2 ◽

Group 1

Background: Objective of present study was to compare the results of lymphaenectomy (pelvic and para-aortic) between laparoscopy and laparotomy in gynecological malignancies.Methods: Authors analyze the results of 30 patients suffering from gynecological malignancies (Enometrial, Ovarian and cervical) submitted to surgery as apart of treatment. Patients were classified in Two Groups Group (1) included15 patients were submitted to open radical surgery and group (2) included 15 patients Were submitted to laparoscopic radical surgery between May 2016 and October 2017.Results: In present comparative study, there was significant difference regarding intra operative blood loss, operative time and post operative hospital stay (P<0.001) and there was no significant difference regarding intra-operative complications, post-operative complications, total number of lymph node harvested, number of positive lymphnodes (P>0.05).Conclusions: Laparoscopic lymphadenectomy is a technically feasible and safe procedure. Authors recommend further study in large number of patients with longer duration and follow up period for assessment of oncological out-come.

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Efficacy and opioid-sparing effect of interpleural bupivacaine in patients undergoing laparoscopic cholecystectomy: Prospective observational study (Running title: Efficacy of inter-pleural bupivacaine in laparoscopy)

Serbian Journal of Anesthesia and Intensive Therapy ◽

10.5937/sjait2106103a ◽

2021 ◽

Vol 43 (5-6) ◽

pp. 103-110

Author(s):

A.K. Prasath ◽

Senthil Kumar ◽

Mohanhariraj Angamuthammal ◽

Agnes Evangleen

Keyword(s):

Laparoscopic Cholecystectomy ◽

Pain Relief ◽

Study Groups ◽

P Value ◽

Number Of Patients ◽

Significant Difference ◽

Vas Scores ◽

The Difference ◽

Group 2 ◽

Group 1

Introduction: Laparoscopic cholecystectomy is considered minimally invasive, but pain following laparoscopy is moderate to severe, leading to increased morbidity and length of hospital stay. Various medications, including opioids, NSAIDs, and techniques like intraperitoneal local anesthetic infiltration, are used. In this study, we investigated interpleural block with bupivacaine for pain relief following laparoscopic cholecystectomy. Methods: A total of 60 patients were included in the study. 30 patients received 20 ml of 0.5% interpleural bupivacaine (group 1), and 30 patients recieved 20 ml of 0.9% normal saline (group 2). We recorded visual analog score (VAS), vital signs, and postoperative opioid requirements. Tramadol (2 mg/kg) was rescue medication if VAS ≥ 5. Results: Significant difference between study groups was recorded among VAS scores measured at 30 minutes, 1, 2, 6, 10, and 12 hours (p value < 0.05). The difference in VAS scores at 15 minutes and 14 hours between study groups was insignificant (p value > 0.05). The number of patients who received tramadol was 9 (30%) patients in group 1 and 29 (96.7%) patients in group 2. The difference in proportion for tramadol intake at 6 hours was significant among study groups (p-value < 0.05). Conclusion: Interpleural bupivacaine 20 ml of 0.5% used as analgesia reduces post-operative opioid requirement following laparoscopic cholecystectomy. Hence interpleural block can be safely used as a regional technique for pain relief following laparoscopic cholecystectomy.

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The study of cardiotoxicity of hydroxychloroquine and azithromycine combination in hospitalized patients with COVID-19

Sechenov Medical Journal ◽

10.47093/2218-7332.2020.11.2.29-39 ◽

2020 ◽

Vol 11 (2) ◽

pp. 29-39

Author(s):

Yu. N. Belenkov ◽

I. V. Menshikova ◽

I. S. Ilgisonis ◽

Yu. I. Naimann ◽

Yu. V. Pak ◽

...

Keyword(s):

Hospital Mortality ◽

Qt Interval ◽

Ministry Of Health ◽

Cardiovascular Comorbidity ◽

Corrected Qt Interval ◽

Number Of Patients ◽

Increased Risk ◽

Significant Difference ◽

Group 2 ◽

Group 1

Hydroxychloroquine (HCH) is included in guidelines for treatment of novel coronavirus infection (COVID-19). Data on increased risk of cardiovascular complications when using it have been published. Aim. To evaluate the safety and tolerability of HCH and azithromycine (AZM) combination for the treatment of the patients with COVID-19 in recommended by Russian Ministry of Health doses in real practice.Methods. 132 patients (62 men and 70 women of average age 59.2 ± 9.3 years), 59% of whom had cardiovascular comorbidities, were included in prospective сohort study. 112 patients took HCH + AZM (group 1) and 20 patients took other medications without potential cardiotoxicity (group 2). At the admission to the hospital and after 5–7 days of the treatment corrected QT interval was calculated, new rhythm and conduction disorders, other side effects and hospital mortality have been registering. Relative risk (RR) and 95% confidence interval (CI) were calculated. Results. Elongation of corrected QT-interval within the normal range was registered in 22.3% of patients in group 1 and in 15% — in group 2. An increase in the QT length to the upper limit of the norm (480 msec) was observed in 1.8% of patients in group 1. There were no statistically significant differences between the groups in the number of patients with prolonged QT interval (RR = 1.488, 95% CI: 0.496–4.466, р = 0.478). The occurrence of new arrhythmias, conduction disturbances and allergic reactions was not recorded. Tolerability of combination HCH + AZM was satisfactory in the majority of patients. The hospital mortality in group 1 was 1.8%, in group 2 — 5% without statistically significant difference (p = 0.374). Conclusion. A combination of HCL + AZM according to the scheme recommended by the Ministry of Health of the Russian Federation for the treatment of the patients with COVID-19 and cardiovascular comorbidity in inpatient conditions is safe.

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The impact of COVID-19 on primary retinopexy in preventing retinal detachment in a tertiary eye hospital emergency department

European Journal of Ophthalmology ◽

10.1177/1120672121994727 ◽

2021 ◽

pp. 112067212199472

Author(s):

George Moussa ◽

Emma Samia-Aly ◽

Walter Andreatta ◽

Kim Son Lett ◽

Arijit Mitra ◽

...

Keyword(s):

Retinal Detachment ◽

Case Series ◽

Significant Shift ◽

Number Of Patients ◽

Increased Risk ◽

Significant Difference ◽

Male Patients ◽

Group 2 ◽

The Impact ◽

Group 1

Purpose: To review the effect of COVID-19 on rhegmatogenous retinal detachment (RRD) rate following primary retinopexy. Methods: Retrospective consecutive case series of 183 patients attending Birmingham and Midlands Eye Centre undergoing primary retinopexy (cryotherapy and laser) between March 23rd to June 30th in 2019 (Group 1) and 2020 (Group 2). Results: In total we reviewed 183 retinopexies, 122 in Group 1 and 61 in Group 2, a reduction of 50%. In Group 2 compared to Group 1, we showed a significant difference in characteristics of patients having primary retinopexy with an increase in proportion of male patients from 50 (41.0%) to 39 (63.9%) ( p = 0.005), increase in high myopes from 1 (0.8%) to 4 (6.6%) ( p = 0.043), more slit lamp laser retinopexy from 83 (68.0%) to 52 (85.2%) ( p = 0.013) and less cryopexy from 21 (17.2%) to 2 (3.3%) ( p = 0.008). In Group 2, primary retinopexy resulted in significantly more 3-month RRD rate 1 (0.8%) to 5 (8.2%) ( p = 0.016). There were no changes in number of patients requiring further retinopexy ( p = 1.000) Conclusion: This study demonstrates a reduction of primary retinopexy, an increased risk for RRD following primary retinopexy and a significant shift in type of primary retinopexy performed, demographics, operator and change in characteristics of type of retinal break observed during this pandemic. This study contributes to the growing literature of the secondary effects of the COVID-19 pandemic on other aspects of healthcare that is not just limited to the virus itself.

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Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-05879-9 ◽

2020 ◽

Vol 28 (8) ◽

pp. 2578-2585 ◽

Cited By ~ 2

Author(s):

Yoann Bohu ◽

Shahnaz Klouche ◽

Hasan Basri Sezer ◽

Serge Herman ◽

Olivier Grimaud ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Return To Sport ◽

Knee Function ◽

Level Of Evidence ◽

Number Of Patients ◽

Significant Difference ◽

Group 2 ◽

Bone Tunnels ◽

Group 1

Abstract Purpose To compare return to sport and knee function 1 year after anterior cruciate ligament (ACL) reconstruction using autografts with and without vancomycin presoaking. Methods A case–control study based on a retrospective analysis of prospective data included athletes over the age of 16 operated from 2012 to 2018 for ACL reconstruction. There were two groups of patients due to a change in treatment protocols: Group 1 « without vancomycin » before November 2016 and Group 2 « with vancomycin» after this date. In Group 2, the graft was soaked in a vancomycin solution for 10 min and then fixed into the bone tunnels. The primary evaluation criterion was the return to sport 1 year after surgery. The secondary criteria were various knee scores. The number of patients needed to perform a non-inferiority study was calculated. Results 1674 patients fulfilled the selection criteria, 1184 in Group 1 and 490 in Group 2. The series included 1112 men and 562 women, mean age 30 ± 9.7 years, 68 professional athletes, 674 competitive athletes and 932 recreational athletes. While seven patients presented with post-operative septic arthritis in Group 1, this complication was not found in Group 2. No significant difference was identified in the return to running between the two groups 1 year after surgery (75.9% vs. 76.1%, n.s.). Significantly more of the patients in Group 2 returned to their preinjury sport (p = 0.04). Knee function was comparable between the groups. Conclusion Vancomycin-soaked grafts during ACL reconstruction reduce the risk of post-operative infection of the knee without affecting the return to sport or knee function. Level of evidence III. Trial registration https://clinicaltrials.gov/, ClinicalTrials.gov Identifier: NCT02511158

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Is Patient Outcome Affected by the Administration of Intravenous Fluid During Bowel Preparation for Colonic Surgery?

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x202047 ◽

2007 ◽

Vol 89 (5) ◽

pp. 487-489 ◽

Cited By ~ 4

Author(s):

G Sanders ◽

CHC Arthur ◽

KB Hosie ◽

AW Lambert

Keyword(s):

Bowel Preparation ◽

Urine Output ◽

Haemoglobin Concentration ◽

Intravenous Fluid ◽

Colonic Surgery ◽

Number Of Patients ◽

Significant Difference ◽

Calculated Volume ◽

Group 2 ◽

Group 1

INTRODUCTION We have previously shown that Picolax® bowel preparation causes a significant dehydrating effect, which can be minimised by administering a calculated volume of intravenous fluid. The aim of this prospective study was to assess whether peri-operative outcome is affected by administering a calculated volume of intravenous fluid during bowel preparation. PATIENTS AND METHODS Patients having bowel preparation (Picolax®: Ferring Pharmaceuticals Ltd, Middlesex, UK) prior to colonic surgery were prospectively randomised to receive no intravenous fluid (group 1) or calculated intravenous crystalloid based on their body weight (group 2), during preparation. In both groups, transfusion was protocol-driven. Outcome variables measured included intra-operative and postoperative intravenous fluid requirement, hourly recorded urine output for 24 h, number of patients transfused, number of units of blood transfused, time to the passage of flatus, time to having their bowels open, time until tolerating a full diet, complications and length of stay in hospital. RESULTS Thirty-three patients were recruited – group 1 (n = 18) and group 2 (n = 15). There were 24 men and 9 women, median age 69 years (range, 29–86 years). There was no significant difference between the groups with respect to age, sex, weight, ASA grade, preoperative haemoglobin concentration, duration or type of operation. The total number of patients receiving a transfusion (P = 0.026) and the number of units of blood transfused (P = 0.017) was significantly greater in group 1. The number of units of blood transfused intra-operatively was significantly greater in group 1 (P = 0.029). Significantly fewer patients had a urine output <30 ml/h in the first 24-h after operation (P = 0.046) in group 2. There was no difference between groups in other outcomes measures. CONCLUSIONS This study indicates that a calculated volume of intravenous fluid administered during bowel preparation improves patient outcomes with respect to blood transfusion and postoperative oliguria. We advocate calculated intravenous fluid administration in all patients undergoing bowel preparation prior to colonic surgery.

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In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽

10.1024/0301-1526/a000867 ◽

2020 ◽

Vol 49 (4) ◽

pp. 281-284

Author(s):

Atıf Yolgosteren ◽

Gencehan Kumtepe ◽

Melda Payaslioglu ◽

Cuneyt Ozakin

Keyword(s):

Vascular Graft ◽

Graft Infection ◽

Vascular Graft Infection ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Prosthetic Vascular Graft Infection ◽

Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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Tuberculosis of the meninges and central nervous system. Experience of clinical diagnostics in St. Petersburg for 50 years

MedAlliance ◽

10.36422/23076348-2020-8-1-14-24 ◽

2020 ◽

Vol 8 (1) ◽

pp. 14-24

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Medical Errors ◽

Clinical Diagnostics ◽

Lethal Outcome ◽

Significant Difference ◽

Group 2 ◽

Allergic Vasculitis ◽

Tuberculosis Meningitis ◽

Group 1

The clinic and diagnostics of tuberculosis meningitis (TM) in 926 patients treated in St. Petersburg hospitals in 1965–1994 (group 1) and in 1995–2018 (group 2) is presented. The TM clinic is demonstrated to be determined by the form of tuberculosis and its characteristic generalization nature in the presence of repeated waves of bacteremia and allergic vasculitis of greater or lesser severity. There is clinical peculiarity of TM in primary pulmonary tuberculosis and its early large-focal and late miliar generalization, as well as in hematogenous tuberculosis. In patients of the 1st and 2nd groups the TM clinic shows in some respects a noticeable similarity, in others — a significant difference. Despite the typical symptoms, early diagnosis of TM took place in less than 20% of patients. Clinical examples illustrating the unusual development of TM, contrasting with its usual course, are given. A number of objective and subjective factors contributing to the adverse evolution of TM and its lethal outcome are discussed. These include the peculiarity of modern tuberculosis, especially when associated with HIV infection, as well as medical errors associated with ignorance of the pathogenesis of tuberculosis and failure to comply with the minimum examination for tuberculosis.

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Two Adhesive Systems-effect on Adhesion to Tooth Structure

Revista de Chimie ◽

10.37358/rc.19.7.7389 ◽

2019 ◽

Vol 70 (7) ◽

pp. 2608-2613

Author(s):

Larisa Simona Deac ◽

Kamel Earar ◽

Adela Loredana Colceriu Burtea ◽

Alexandra Stefania Berghe ◽

Aurora Antoniac ◽

...

Keyword(s):

Adhesive Systems ◽

Hybrid Layer ◽

Tooth Structure ◽

Selective Etch ◽

Etch And Rinse ◽

Significant Difference ◽

Wisdom Teeth ◽

Group 2 ◽

Self Etch ◽

Group 1

This study evaluates and compares by dye penetration method and SEM photomicrographs the sealing obtained using two different classes of adhesive systems (etch-and-rinse and self-etch with selective etching) with SDR (Dentsply) bulk fill composite. 84 class V cavities were prepared on oral and vestibular face of 42 intact, freshly extracted wisdom teeth. The cavities were randomly divided in two groups and restored: Group 1 with prime &bond one select (Dentsply) and SDR (Dentsply) and Group 2 with prime&bond one Etch&Rinse (Dentsply) and SDR (Dentsply). Prime&bond one Select (Dentsply) is a single component adhesive and can be used in self etch mode, in selective enamel etch mode, or in etch-and-rinse mode. We chosen for this study the selective etch of the enamel mode. Prime&bond one Etch Rinse (Dentsply) is a universal etch-and-rinse one-bottle dental adhesive, designed to be used in two steps. The bulk fill composites are commonly used in modern dentistry due to their properties of low polymerization shrinkage and curing in layer of 4 mm depth, offering the practitioner a fast clinical procedure with good results. The results showed a good sealing at enamel and dentin margins with no statistically significant difference between adhesives, even though the mean of enamel infiltration was smaller for Group1. Furthermore the results show that there were differences between the two groups, for the infiltrations at the enamel, the values of microleakage being arithmetically higher for Group 1, but with no statistically difference between the two groups.SEM images showed for both groups a good adhesion surface with the tooth, but the hybrid layer of the total-etch adhesives is different from the hybrid layer formed by self etch adhesives, in terms of thickness, uniformity. In conclusion both adhesive systems have equivalent sealing qualities and can be successfully used with SDR.

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Reducing Gingivitis Remotely using the iGAM mHealth app (part 2): Prospective Observational Study (Preprint)

10.2196/preprints.24955 ◽

2020 ◽

Author(s):

Guy Tobias ◽

Assaf B Spanier

Keyword(s):

Oral Health ◽

Tooth Loss ◽

Prospective Observational Study ◽

Dental Clinics ◽

Significant Difference ◽

Observational Cohort ◽

Group 2 ◽

And Behavior ◽

Oral Hygiene Habits ◽

Group 1

BACKGROUND Gingivitis is a non-painful, inflammatory condition that can be treated with home remedies. Left untreated gingivitis can lead to tooth loss. Periodic dental examinations are important for early diagnosis and treatment of gum diseases. In order to contain the spread of the corona virus, governments, including in Israel, have restricted movements of their citizens which has caused routine dental checkups to be postponed. OBJECTIVE This study aimed to examine the ability of an mHealth app- iGAM to reduce gingivitis. METHODS A prospective observational cohort study was performed, 160 unpaid participants were divided into 2 equal groups and downloaded the iGAM app. Group 1 photographed their gums weekly for eight weeks. Group 2 photographed their gums at the time of recruitment and 8 weeks later. After photo submission, the participants received the message "It is recommended to read the information contained within the app regarding maintaining oral hygiene habits". A single blinded researcher examined the images and scored them according to the Modified Gingival Index (MGI). RESULTS The average age of group 1 was 26.77 (S.D. ± 7.43), and 28.53 (S.D. ± 10.44) for group 2. The majority were male (74.7% in group 1 vs. 66.7% in group 2), most participants described themselves as "secular", most were "single", non-smokers (74.7% vs. 78.4%) and did not take medications (85.3% vs. 78.4%). 126 subjects completed the study. A statistically significant difference (P <.001) was found in the dependent variable (MGI) in a linearly negative manner. As time passed, the gum condition improved, there were significantly lower gingivitis scores in group 1 (M = 1.16, S.D. ± 1.18) compared to group 2 (M = 2.16, S.D. ± 1.49), after eight weeks. Those with more recent dental visits had a lower MGI (p = .037). No association was found between knowledge and behavior, most participants were familiar with the recommendations for maintaining oral health, yet they only performed some. CONCLUSIONS A dental selfie taken once a week using an mHealth app (iGAM) reduced the signs of gingivitis and promoted oral health. During the current pandemic where social distancing recommendations may be causing people to avoid dental clinics, this app can remotely promote gum health. CLINICALTRIAL The protocol was approved by Hadassah research ethics committee (IRB, 0212-18-HMO)

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